Biomedical subjects
Publications and source records attributed to A D Howie.
In two patients who had recently undergone major abdominal operations and were later suspected of having pulmonary emboli, pulmonary angiography showed no evidence of embolism, but in both cases one of the hemidiaphragms was clearly outlined by contrast material. It is suggested that subdiaphragmatic inflammation was responsible for this unusual appearance.
With the early diagnosis of cystic fibrosis and the better management of these patients in childhood increasing numbers are surviving to adult life. The main problem requiring continuous medical care in the older cystic fibrosis patient is persisting and often progressive chest disease. For this reason the cystic fibrosis clinic for adolescents and young adults was started in the Western Infirmary in 1975. This paper presents our observations on 13 patients who had attended between 1975 and 1977. Eleven patients are alive and well and have shown no evidence of deterioration over this period. Ten are at school or in regular employment. With optimum medical supervision it is possible to give young adults with cystic fibrosis a worthwhile existence.
Pulmonary function was monitored at regular intervals throughout pregnancy in three patients with bronchiectasis. They tolerated pregnancy well, and the underlying lung disease did not appear to have any adverse effect on the outcome of the pregnancy.
The incidence, severity and time-course of dyspnoea were assessed in 62 women on eight occasions throughout a normal pregnancy. Fifteen per cent of subjects noticed an increase in dyspnoea in the first trimester compared with the nonpregnant state and in almost half of them dyspnoea was experienced before 19 weeks gestation; 76% complained of this symptom by 31 weeks gestation. After this time, few subjects noticed any increase in their symptoms.
Several series have suggested that pulmonary function abnormalities are common in systemic lupus erythematosus. However, only isolated studies have attempted to relate these abnormalities to immunological aspects of the diseases. In the present study respiratory symptoms, pulmonary function tests, and immunological data were reviewed in 22 patients with systemic lupus erythematosus. Seventeen subjects had either clinical evidence or abnormalities of lung function suggestive of pulmonary involvement. A restrictive ventilatory defect or reduction in pulmonary diffusing capacity for carbon monoxide was demonstrated in 14 of the patients only 4 of whom were dyspnoeic. There was no correlation between pulmonary involvement, co-existent renal lupus, and immunological abnormality.
Potassium deficiency is an important complication in the treatment of heart disease. However, there is a serious dichotomy in the literature. Severe potassium depletion has been reported in this condition when exchangeable potassium was measured whereas normal levels or marginal depletion were found in measurements of total body potassium. To clarify this situation, simultaneous measurements of total body potassium by whole-body counting, and of exchangeable potassium by isotope dilution using 43K, were made in 10 male subjects with established airways obstruction. Sequential determinations showed that exchangeable potassium increased up to 68 hours after administration, and values obtained at only 24 hours would have been a substantial underestimate. In this group of subjects neither total body nor exchangeable potassium at 48 hours was significantly different from the expected normal value.
Specific airways conductance and forced expiratory volume in one second were measured monthly from the first trimester until term in 30 subjects in the course of a normal pregnancy. Measurements were also made in the postpartum period. There was no significant change in these measurements either throughout pregnancy or compared with postpartum values. Our results suggested that the function of the larger pulmonary airways was not altered in pregnancy.
Transient airways obstruction associated with reduction in the transfer factor (diffusing capacity) of the lungs is reported in a patient with a clinical syndrome in keeping with extrinsic allergic alveolitis after exposure to Ramin dust (Gonystylus bancanus). The alterations in pulmonary function were consistently demonstrated on testing the patient in his working environment and were reproduced in the laboratory after inhalational challenge. The importance of the temporal relationship of changes in pulmonary function to contact with suspected allergenic material is emphasized.
Total body potassium was measured in 12 patients with cor pulmonale, by determination of potassium-40, a naturally occurring radioisotope. In all subjects the observed value of total body potassium showed no significant depletion when compared with that predicted from height and age. All previous studies in similar groups of patients have been confined to the estimation of exchangeable potassium by the technique of isotope dilution. Results using the latter technique have shown gross potassium depletion. It is suggested that the apparent disparity between total body potassium and exchangeable potassium could be explained by the requirement for a longer equilibration period when using isotope dilution techniques in patients who are in chronic hypoxaemic state.
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