Acute angle closure glaucoma associated with nebulised ipratropium bromide and salbutamol.

For most patients with multiple myeloma treatment is palliative and comprises combined melphalan and prednisolone. Despite several clinical trials the evidence on more intensive combinations is conflicting. Nevertheless, in younger patients the results of trials of high dose chemotherapy with bone marrow trans-plantation seem promising. Cytotoxic drugs have no established role in the palliative treatment of cancers of the thyroid, kidney, and prostate. The lipid soluble nitrosoureas have been used for treating gliomas, but evidence that they improve quality of life or survival is unconvincing. Conclusions Systemic cytotoxic treatment has been remarkably successful in curing a few uncommon disseminated tumours, notably testicular cancer, acute lympho-blastic leukaemia, and Hodgkin's disease. This has encouraged the widespread use of chemotherapy for other more common cancers, but progress has been slow despite the enormous clinical research effort worldwide. We have therefore cautioned against the uncritical use of chemotherapy and stressed the importance of giving it selectively and only with adequate supportive care. The guidelines suggested in this paper should encourage the more effective use of chemotherapy in the palliation of advanced cancer and be useful as predetermined standards for medical audit; commissioners of health care may also find them useful when deciding how best to deploy available resources. They should be considered as complementary to innovative clinical research directed towards finding more active and less toxic treatments for disseminated cancer. Response of patients in phase II studies of chemotherapy in ovarian cancer: implications for patient treatment and the design of phase II trials. Nebulised ipratropium bromide and salbutamol have become standard drugs for managing acute exacer-bation of chronic obstructive airways disease. We report five cases of patients who presented with acute angle closure glaucoma provoked by the combined administration of these drugs. Case reports All five patients had been admitted by general physicians with a diagnosis of acute exacerbation of chronic obstructive airway disease and had been started on combined nebulised ipratropium and salbutamol six times a day. Each patient was referred to the ophthalmic department after a sudden reduction in visual acuity and severe ocular pain and periorbital headache on the affected side(s). Three patients also had nausea and vomiting. All patients had congested conjunctivae, hazy corneas, shallow anterior chambers, and fixed mid-dilated pupils in the affected eyes. Angle closure glaucoma was bilateral in three patients (table). The patient in case 3 gave a history suggestive of abortive attacks of acute angle closure …