Survey of Infantile Gastroenteritis-Ironside et al. MBRDICALmJOURNAL deaths occurred immediately after admission, the fourth was from a non-infective cause, and the fifth followed prolonged. non-specific gastroenteritis. So it is suggested that antibiotics are of real value in treating associated infection but play little part in the severe case or in the control or spread of infection.Even in the developed countries gastroenteritis is still one of the commonest diseases of infancy, with a hospital mortality rate of over 1%. It is therefore remarkable that the aetiology is unknown in most cases, that the chemical pathology of the disease is still imperfectly understood, and that there is little agreement on the optimum treatment.We wish to thank Dr. S British Medical Journal, 1970, 3, 24-26 Summary: A case is reported in which severe thrombocytopenia occurred during administration and readministration of rifampicin. The patient's erythrocytes gave a positive direct antiglobulin test due to complement on the red cell surface; in the serum, complement-fixing antibodies were detected which were directed against the drug.Immunological studies showed antibodies, of both IgG and IgM type, capable of fixing complement to both normal and the patient's platelets, but only in the presence of rifampicin. In addition the IgM type of antibody (but not the IgG) was capable of fixing complement to normal red celis; again only in the presence of the drug.

history of chest problems although he smoked A family exhibiting spontaneous pneumo-20 cigarettes per day. Radiography of the chest thorax in a father and three offspring (two confirmed pneumothorax. He was treated with sons and one daughter) is described. The a chest drain and complete resolution occurred mode of inheritance is apparently auto-with no further episodes. His brother III.5 who somal dominant with two episodes of male was a non-smoker with no previous respiratory to male transmission in one family. The problems presented at the age of 21 to his age of onset varied by up to 13 years within general practitioner with acute shortness of the family. Isolated autosomal dominant breath. This resolved within 24 hours without pneumothorax appears to be a distinct intervention. Two months later he had a further clinical entity.episode of shortness of breath and a left sided (Thorax 1998;53:151-152) pneumothorax was diagnosed and confirmed by radiography. A chest drain was inserted and We describe a family with three affected maining unaffected siblings revealed no differ- Case report A 54 year old man was hired to work in a foundry in 1993. He had a 30 pack year history of smoking and no personal history of asthma Abstract or atopy. His job consisted of making cores The case history is described of a worker which involved frequent exposures to MDI. In who presented with a history suggestive March 1996 an accidental spill of a large volof reactive airways dysfunction syndrome ume of solvent containing MDI occurred in which occurred after an acute high level his work area. He was off duty during the spill inhalation of diphenylmethane diiso-and returned to work 48 hours later. There cyanate. Further exposure at work, at a was a strong and irritant smell in the plant and time when concentrations of isocyanates within one hour he experienced headache, sore Department of Chest were no longer "irritant", suggested oc-throat, cough, and chest tightness. Other workMedicine, cupational asthma; this diagnosis was con-ers in this area reported the same symptoms that

We have investigated the value of cardiopulmonary exercise testing in the pre-operative assessment to patients for abdominal aortic aneurysm repair. Thirty-six patients were entered into the study. All had a pre-operative clinical assessment and investigations including chest radiograph, electrocardiograph, spirometry and echocardiogram with measurement of left ventricular ejection fraction. Each patient performed a symptom limited treadmill exercise test using a STEEP protocol with on-line measurement of respiratory gas exchange. Patients were followed up for 12 months post-operatively by review of casenotes. Thirty out of 36 patients had surgical repair of abdominal aortic aneurysm. There was 1 death in the perioperative period and 2 deaths in the following 12 months. Seven other patients suffered post-operative complications. There were no significant differences in left ventricular ejection fraction, spirometry and peak achieved oxygen consumption (PVO2) between those patients who died or who had post-operative complications and those who had not. However, PVO2 < 20 ml/min/kg was found in 70 per cent of patients who had complications compared with 50 per cent of those who had not. Also 4 patients considered medically unfit for surgery all had PVO2 < 20 ml/min/kg. Cardiopulmonary exercise testing with measurement of PVO2 may be helpful in identifying patients more at risk of post-operative complications but should not be used in isolation without through clinical assessment.

Endotoxin produced by a culture of Enterobacter agglomerans isolated from cotton dust was inhaled by 12 normal subjects. No significant airway constriction was obtained in doses equivalent to those experienced in a workshift in a dusty mill. There was a statistically significant difference between this result and the bronchoconstriction that had occurred after flax dust inhalation in the same subjects. It is suggested that Enterobacter agglomerans endotoxin is not the causative agent of the acute bronchoconstriction that follows inhalation of textile dust.Neal et al reported that inhalation of a sterile filtrate of a culture of Aerobacter cloacae by a volunteer resulted in fever, dyspnoea, and coughing.' Pernis et al administered the endotoxin of Escherichia coli to three subjects and the endotoxin of Salmonella abortus equi to two of these subjects in doses of 15, 30, and 60 ug.2 Coughing, slight dyspnoea, and slight reduction in forced expiratory volume in one second (FEV,) were reported along with fever, malaise, and a skin reaction. Cavagna et al found that two out of eight normal subjects inhaling 80 pg of E coli endotoxin showed a fall in FEV, of more than 10%.3 Van der Zwan et al found a 14% fall in FEV, in subjects with bronchial hyperreactivity after inhaling 4mg endotoxin from Haemophilis influenza.4These experiments suggested that the bacterial endotoxin content of textile dusts may be the causative agent of the bronchoconstriction that is the response of normal subjects to these dusts. The effects were, however, not easily comparable with the equivalent dose of endotoxin in textile dusts. A further uncertainty is the evidence that endotoxins from different bacteria have differing biological activities.5 7We have reported the ventilatory responses of a panel of 12 normal subjects to flax dust when we found a 30% reduction in this response after steam Accepted 26 November 1985 treatment which also reduced the endotoxin content by 50%.8 It is therefore of interest to compare the response of this panel of subjects with the direct inhalation of the appropriate endotoxin in the equivalent dose. Cotton and other organic dusts commonly contain Enterobacter agglomerans9 and this has also been found in flax dust (B Buick, personal communication). We have challenged our panel of normal subjects with the endotoxin produced by this organism, isolated and purified by the technique of Helander et al,6 and given in a dose guided by Limulus assay of the endotoxin content of flax dust. Methods SUBJECTSThe same panel of 12 normal subjects who participated in the flax dust trial8 were studied. One subject was a smoker but did not smoke on trial days. The subjects gave informed consent and the experiments had the approval of the ethical committee. ENDOTOXINThe endotoxin was prepared in Helsinki by Helander et al.6 The organism Ent agglomerans was isolated and cultured from the cotton dust and the lipopolysaccharide extract prepared from the culture. The endotoxin was dissolved in 2 ml of saline and inhaled b...

Ciprofloxacin and amoxycillin were compared in the treatment of respiratory infections (pneumonia, acute bronchitis, exacerbation of chronic lung disease) in a study of 48 patients randomly assigned to ten days treatment with standard doses of either drug. Forty-eight patients were evaluated, 26 in the ciprofloxacin group and 22 in the amoxycillin group. The response to therapy was judged by clinical and bacteriological criteria. Ciprofloxacin was as effective as amoxycillin with a successful outcome in 81% and 82% of cases respectively. A specific bacterial cause was determined in just over half the cases (28 patients) and eradication rates were higher for ciprofloxacin than for amoxycillin, 87% and 64% respectively. In particular, amoxycillin was unsuccessful in two patients infected with Branhamella catarrhalis. Both regimens were safe and produced little, if any, adverse effect (one possible episode in each treatment group). Ciprofloxacin was found to be as effective in bacterial respiratory tract infections as amoxycillin.