M. J. Kendall

GLUTEN SUBFRACTIONS IN CŒLIAC DISEASE

Abstract Gluten, which contains the substance toxic to patients with cœliac disease, has been broken down into twelve subfractions by ion-exchange chromatography. Toxicity testing using an oral-xylose technique was used to demonstrate that the toxin or toxins are present in only one of these subfractions.

Therapeutic advances: leukotriene antagonists for the treatment of asthma

Asthma is the most common respiratory disease encountered in clinical practice, affecting both children and adults. It is an important cause of respiratory morbidity and mortality. Recent therapeutic developments have shown that leukotrienes are the most potent and important inflammatory mediators in the pathology of both acute and chronic asthma. They cause increased bronchoconstriction, mucous secretion, and vascular permeability. Studies using compounds that block leukotrienes (receptor antagonists – montelukast and zafirlukast and 5‐lipoxygenase inhibitors – zileuton) have demonstrated improved asthma control in patients aged 12 years and older. In this article we assess the therapeutic importance of these new compounds.

Recovery from chronic fatigue syndrome associated with changes in neuroendocrine function.

Quality standards have been established in two key areas of pathology directly relevant to standards for the provision of emergency medical services. First, there is a national scheme for accreditation of laboratory services--Clinical Pathology Accreditation (UK) Ltd (CPA)--which has been in formal operation since 1992 and currently covers about 80% of all UK laboratories. Secondly, guidelines have been issued by the Joint Working Group on Quality Assurance (JWGQA) on the support to any point-of-care (near patient) testing facilities. Point-of-care testing (POCT) is increasingly popular in emergency areas, where the availability of faster test results is expected to expedite diagnosis and treatment. When laboratory services are not accredited or POCT equipment and its usage are outside laboratory supervision, there should be concerns that quality standards for pathology service support of the emergency services are not being met.

CARDIOVASCULAR AND METABOLIC EFFECTS OF TERBUTALINE

Terbutaline is a selective beta 2 agonist used predominantly in the treatment of asthma. Since beta‐mediated responses increase heart rate, dilate peripheral arteries, modify carbohydrate metabolism and the uptake of electrolytes into cells, the administration of terbutaline might be expected to produce widespread effects. In this study the intravenous administration of 0.5 mg terbutaline over 60 min has been shown to produce marked changes without upsetting the volunteers. Heart rate, systolic blood pressure and plasma glucose all increase; diastolic pressure and serum potassium decrease. The data suggests that the terbutaline infusion may be a useful tool for the investigator. The results also quantitate some of the side effects which may result from the intravenous administration of a therapeutic dose of terbutaline given to asthmatics or to pregnant women to reduce uterine activity and delay childbirth.

ORAL GLUCOSE IN REDUCTION OF JEJUNOSTOMY EFFLUENT

Abstract A 65-year-old man had a jejunostomy and colectomy for ulcerative colitis complicated by infarction of the ileum. Oral glucose therapy, as used in cholera, reduced intestinal fluid losses by 1000 ml. per 24 hours.

Therapeutic advances: protease inhibitors for the treatment of HIV-1 infection.

Background: Anti‐retroviral treatment of human immunodeficiency virus (HIV) infection is undergoing great changes, brought about by a better understanding of the disease pathology. One of the most recent advances has been the introduction of the protease inhibitors, reversible inhibitors of HIV aspartic protease. Published data on the clinical efficacy of these drugs are limited, but preliminary results suggest that, in combination with one or more nucleoside analogues, they represent an important advance in the treatment of patients with advanced HIV infection. The adverse effects and potential for drug interactions, together with the additional cost associated with prescribing these drugs, mean that careful selection and supervision of these patients is imperative.

Therapeutic advances: riluzole for the treatment of motor neurone disease

Amyotrophic laterial sclerosis is a fatal neurogenerative disorder, for which only symptomatic treatment was previously available. Riluzole was recently launched in the U. S. A. and Europe. This is the first drug to produce a modest increase in survival (≅ 3 months) in patients with this disease. Unfortunately, treatment causes a number of side‐effects of which asthenia is particularly troublesome. Between 10 and 20 per cent of patients can be expected to withdraw from treatment due to these adverse effects. Data on the real time survival advantage and quality of life that can be expected whilst on treatment are needed to identify the place of riluzole in the management of this distressing disease.

5-NUCLEOTIDASE IN THE SERUM AND SYNOVIAL FLUID OF PATIENTS WITH RHEUMATOID DISEASE

Abstract Increased serum 5-nucleotidase, usually indicative of liver disease, occurred in 30% of 66 rheumatoid patients. The same enzyme was found in the synovial fluid of 58% of 24 patients with rheumatoid arthritis, but in much higher concentration than in the serum. Estimation of serum 5-nucleotidase in synovial fluid is of diagnostic value, as it is low in non-inflammatory forms of arthritis.

Therapeutic advances: donepezil for the treatment of Alzheimer's disease.

Until recently, few drugs have been available for the treatment of Alzheimers disease. The first such drug to be launched in the U.K. was the acetylcholinesterase inhibitor, donepezil. The limited published data on donepezil shows only modest cognitive benefit in patients with Alzheimers disease. The cost of diagnosis and drug treatment, the distressing nature of the disease and the limited evidence available, pose difficult decisions for the introduction of new drugs and the management of this condition.

Growth hormone treatment for growth hormone deficient adults

Growth hormone (GH) deficiency in adults is now recognized as a clinical syndrome with characteristic signs and symptoms. Numerous trials with daily subcutaneous biosynthetic human growth hormone (hGH) have been conducted in this patient group. Generally, improvements in insulin‐like growth factor levels, decreases in total fat mass and increases in lean body mass are recorded with no overall effect on total body weight. Variable effects on serum cholesterol, bone mineral density and quality of life have also been reported.