Biomedical subjects
Publications and source records attributed to C C Evans.
We report three elderly patients who presented with increasing dyspnoea on exertion and radiological evidence of basal bullous emphysema. On further investigation they were found to have alpha-1-antitrypsin deficiency. We emphasize that alpha-1-antitrypsin deficiency can present much later than is usually the case especially if the patient is a life-long non-smoker.
This paper reports 10 year follow up data on four patients who underwent mechanical dilatation of multiple bronchial stenoses (sarcoidosis two cases, berylliosis one case, idiopathic stenoses one case). Two patients enjoyed symptomatic and physiological improvement during the nine years before they presented with a recurrence of stenosis. The other two had recurrences sooner, and improved only slightly after they had started prednisolone treatment.
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One member of each pair of twin lambs from 37 five-and six-year-old Scottish blackface ewes, grazing reseeded pasture suspected of causing a molybdenum-sulphur induced copper deficiency in sheep, was given an injection of 12.5 mg copper calcium edetate at about eight weeks of age. Plasma copper concentrations of these lambs were maintained in the normal range by further injections of copper as required (treatment group). The remaining member of each twin pair received no copper therapy (control group). The control lambs and all ewes showed marked hypocupraemia throughout lactation, whereas the plasma copper concentrations of the treatment lambs, and also of single lambs with continuous access to unimproved hill grazings, remained normal. The live-weight gain of the treatment lambs was significantly greater than that of the control lambs, the difference in mean live-weights after 12 weeks being 2.5 kg. All lambs showed some degree of osteoporosis; this was most severe in the control lambs which had less dense bones and were also more susceptible to bone fractures and to disease. Differences between treatment and control lambs were also observed in haematological parameters and in fleece characteristics.
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HLA antigens were determined in 37 patients with asbestosis and 37 matched controls with equivalent asbestos exposure but no pulmonary fibrosis. All had worked in the same textile factory. No significant differences in the prevalence of antigens were found between the two groups or between either group and controls who had not been exposed to asbestos. When the data were combined with findings from other pilot studies the previously suggested association between asbestosis and HLA-B27 was not confirmed. Subjects who were positive for HLA-B12 tended also to have advanced radiographic fibrosis. Asbestos workers without pulmonary fibrosis had an unexpectedly high frequency of HLA-BW5, which might indicate that this antigen protects against the development of pulmonary fibrosis.
The lung volumes of 12 female and eight male patients with acromegaly, chosen because of the absence of associated cardiorespiratory disease, were determined physiologically and radiographically. Enlarged lung volumes were found in half the males but in none of the females, due allowance being made for the presence of a significant thoracic kyphosis. Upper airway narrowing was suggested by an increase in the expiratory-inspiratory flow rate ratio in six patients, four of whom were male, and acromegaly of the larynx was confirmed in the three subjects who consented to laryngoscopy. Upper airway obstruction is more likely to account for respiratory death in acromegaly than disordered pulmonary function in enlarged acromegalic lungs. Neither of these respiratory findings could be correlated with the fasting level of growth hormone but there was a suggestion that they were more likely to occur when the duration of the disorder was longer.
Eighteen patients who satisfied stringent criteria for the diagnosis of Buerger's disease, healthy controls, and patients with atherosclerosis were tested for various HLA antigens. The incidence of HLA-A9 and HLA-B5 was significantly greater among those with Buerger's disease. This finding supports the concept that Buerger's disease is a distinct clinicopathological condition.
Postoperative analgesic requirements of a series of 45 patients who underwent orthognathic surgery are presented. Of the first 25 patients treated before a minimal analgesic protocol was begun, 21 received narcotic medication for relief of discomfort. In the second group of 20 patients, five received mild analgesics and one received a narcotic. A combination of factors such as paresthesia, immobilization, premedication, steroids, and residual effects of general anesthetic agents probably contributed to the relative lack of severe pain after orthognathic surgery.
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