Measuring peak expiratory flow (PEF) variation has been suggested as a indicator of asthma disease severity and also of nonspecific bronchial hyperreactivity. To test these assumptions, we examined the relationships between PEF variation, methacholine reactivity, symptom scores, and medication requirements in 74 children with tightly controlled allergic asthma. The level of mean diurnal variation (MDV) for the group was 7.1%, which is generally regarded as normal. We found statistically significant correlations between MDV and both methacholine reactivity (r = 0.43, p = 0.0001) and symptom scores (r = 0.28, p = 0.016). These asthma variables were analyzed longitudinally in 33 children who were followed up at 6-month intervals for at least 36 months. Visit-to-visit changes in MDV were generally not reflective of changes in other variables. However, group levels of MDV gradually decreased over time, especially in children with initial MDV of more than 8%. This reduction in group MDV coincided with similar reductions in group medication requirements and methacholine reactivity. We conclude that children with moderately severe asthma that is tightly controlled may have normal levels of PEF variation. The correlation between PEF variation and other asthma variables is statistically significant but too weak to be useful in the treatment of individual patients. In contrast, measurement of MDV may be a useful indicator of disease severity in group studies of asthma.

A group of ambulatory asthmatic children was studied with serum and salivary theophylline levels following a prescribed dose of a hydroalcoholic solution of theophylline to determine compliance. The gas chromatographic procedure used was both selective and sensitive for theophylline without the necessity of withholding coffee, tea, chocolate, or cocoa. In the first group of patients, only 11% achieved therapeutic levels, 65% had less than therapeutic levels, and 23% had no measurable drug in saliva. With more directive and supervised drug administration in a second group of patients, 42% achieved therapeutic levels, 51% were below therapeutic levels, and only 6% had no measurable drug. Monitoring patients with salivary theophylline levels proved an effective way of improving compliance and also alerted physicians to noncompliance as a possible explanation of "treatment failure". Salivary specimens are readily obtained and noninvasive so that the technique is readily adaptable for use in the office of clinic setting.

This office technic makes possible the identification of group A beta hemolytic streptococci within eight to 24 hours. De signed by men in private practice for fast, accurate results, this method has been used in 700 successive throat cultures from patients seen in the authors' office.

Three groups of premature infantswere compared as to their daily caloric intake, weight gain, and length of hospital stay.1.Group A fed the usual 120 to 130calories per kilo of body weight per day after 10 to 14 days of age showed the smallest weight gain and longest period of hospitalization.2.Group B fed on a semidemand schedule after the second week of life showed a greater daily weight gain and required a correspondingly shorter period of hospitalization.3.Group C fed on a demand scheduleafter the second day of life showed the greatest average daily weight gain and the shortest period of hospitalization.

Summary 1. Another case of galactosemia, in a 2 1/2 month old infant, has been reportedand the literature reviewed. 2. Our case had the features common to all the other cases—namely, failure to gain weight and develop properly, melituria, and albuminuria. In addition, our patient showed cataracts, which have been described in 50 per cent of the other cases. The reducing substance was identified as galactose. By the removal of lactose from the diet, there was subsidence of all the pathologic signs and symptoms except for the enlarged liver. 2. Carbohydrate studies were done, and results similar to those of previousworkers were reached; these were a normal glucose tolerance curve, a high galactose tolerance curve, and antagonistic effects of glucose and galactose upon one another. 3. Theories of the mechanism of galactosemia have been reviewed.