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Editor—There are still few pulmonary rehabilitation programmes in Britain.1 A recent meta-analysis of randomised trials strongly supports respiratory rehabilitation for patients with chronic obstructive pulmonary disease.2 The results of further trials looking at the comparative effectiveness of hospital and home …

Exchangeable sodium and potassium, total body water, and sulphate space were measured in 42 patients with severe valvular heart disease who were free of oedema. Compared with normal subjects of the same height, no increase in exchangeable sodium was found but a mean potassium depletion of 27% was shown. This depletion was not related to diuretic therapy, and no relationship between the degree of depletion and postoperative arrhythmias was found. It is concluded that the major cause of the low exchangeable potassium is the reduction in cell mass that occurs in chronic heart disease, and that there is no significant fall in the intracellular potassium concentration.

The effects of lymphography on ventilatory function and gas transfer factor were studied in nine patients. Serial measurements made up to one month showed no change in the forced expiratory volume in one second or vital capacity. A small but reversible fall in transfer factor was found. The greatest reduction was at 24 or 48 hours. It was concluded that patients with normal lungs are unlikely to encounter difficulties but that patients with severe lung disease require careful assessment before lymphography.

A study of the effect of additional oral potassium on the low body potassium of seven patients with severe valvular heart disease showed that the potassium supplements were retained. After one month's treatment the exchangeable potassium was significantly increased, but the predicted value was not reached in any of the patients. There was no significant change in plasma potassium. These results suggest that it is of benefit to increase the dose of oral potassium for at least one month preoperatively in patients undergoing cardiac surgery.