Biomedical subjects

D A Emanuel

Publications and source records attributed to D A Emanuel.

10 recordsLinked to original sources

PubMed1979

Characterization of precipitin response to Micropolyspora faeni in farmer's lung disease by quantitative immunoelectrophoresis.

Sera from 12 patients with farmer's lung disease (FLD) drawn during an acute episode and displaying precipitins to Micropolyspora faeni were analyzed by crossed immunoelectrophoresis with an intermediate gel combined with a rabbit reference precipitate system. Forty-six precipitin arcs were identified in the reference system, and FLD sera reacted with 36 of these antigens. The FLD sera displayed significantly more precipitates and higher precipitin scores when compared with sera from 16 precipitin-positive subjectw who did not have FLD. However, there was overlap between the 2 groups, and neither measurement distinguished the 2 persons who became ill after challenge from one person who did not. Three disease specific antigens were identified that may have special relevance for pathogenesis of disease. Ten exposure-relevant antigens were also identified. We propose that these antigens be important components of a standardized M. faeni antigen preparation.

Chronic Disease↗

PubMed1979

What is the probability that coronary artery surgery prolongs life?

Two-hundred and nine male patients who had coronary artery surgery from 1972 to 1974 at the Marshfield Clinic (MC) were compared with Veterans Administration (VA) coronary patients to determine the probability of coronary surgery prolonging life. The survival data includes operative and late cardiac and noncardiac deaths. Including the MC operative mortality rates but considering late noncardiac deaths withdrawn as alive at the time of death, the MC cumulative 5-year surgical survival rate is 93%. This is identical to predicted 93% 5-year survival rate for any man of 54.5 years, the average age of MC patients living in this geographic locale in 1973. Annual attrition rates, including the noncardiac deaths, are 1.4% for any man 1.5% per year for MC patients, based on MC 5-year survival data. It is probable that coronary surgery prolongs life by sharply reducing late cardiac deaths.

Coronary Artery Bypass↗

PubMed1979

The limited utility of fibrinogen I 125 leg scanning.

Using venography as the reference procedure, this study examined the utility of fibrinogen I 125 scanning for the detection or demonstration of deep venous thrombosis. The results demonstrate the inability of leg scanning to detect accurately the presence or absence of thrombi in the deep venous system. Most striking was the lack of sensitivity of this procedure in areas where the propensity for embolization is greatest. Sensitivity is extremely low in the anatomic areas where leg scanning demonstrates reasonable specificity. The results are nearly identical in the extremity not operated upon. The validity of all prior studies relying heavily or exclusively on 125I leg scans to determine the presence or absence of thrombi must be critically reassessed.

Fibrinogen↗

PubMed1978

Farmer's lung disease among farmers with precipitating antibodies to the thermophilic actinomycetes: a clinical and immunologic study.

Farmers were evaluated for the presence of farmer's lung disease by serologic methods and by clinical histories. From a large farming population screened serologically, 40 of 92 farmers with precipitating antibodies to the thermophilic actinomycetes consented to be evaluated for clinical evidence of farmer's lung disease. Each subject completed a standardized questionnaire which was reviewd by a trained observer. On the basis of the questionnaire and an indepth clinical history, the subjects were grouped into those farmers who had a history of farmer's lung disease (38%), those with no history (50%), or a doubtful group (12%). When these groups were compared for radiologic changes, pulmonary function abnormalities, and immune function, no differences were discernible. None of the parameters tested were useful in predicting which farmer would develop clinical farmer's lung disease. The parameters tested did not provide reliable criteria for differentiating those patients who present without acute symptoms but relate a history of recurrent pulmonary illnesses associated with moldy forage.

Actinomycetales↗

PubMed1978

Case report.

Explore the source record for details and available documents.

Adolescent↗

PubMed1976

Precipitating antibodies in a midwest dairy farming population toward the antigens associated with farmer's lung disease.

A survey of the frequency of precipitins to the antigens of the thermophilic actinomycetes and Aspergillus species was conducted on serum samples from 1,045 farmers obtained at a 3-day exposition on modern farm equipment and farming practices in central Wisconsin. Each farmer filled out a questionnaire including socioeconomic information, lung disease history, exposure history, and smoking history. Precipitins were detected by the double-diffusion method. The antigen panel included eight thermophilic actinomycetes species and a mixture of Aspergillus species. Precipitins were found in the sera of 93 famers (8.9%). The distribution of positive precipitins was: Micropolyspora faeni 63 (67.7%), Thermoactinomyces vulgaris 7 (7.5%), Thermomonospora viridis 2 (2.2%), M. faeni + T. viridis 16 (17.2%), M. faeni + T. vulgaris 1 (1.1%), Aspergillus species 4 (4.3%). Of all the parameters tested for in the questionnaire, those with positive serology differed significantly from the whole population only in that a higher proportion of the positives reported exposure to silo gas and illness after uncapping silos. Comparison of the size of the farm and the number of dairy cows in the state of Wisconsin with the population samples indicated that the sample population was skewed toward those with larger farms and larger dairy herds. This study confirms that a significant proportion of the farm population in Wisconsin does have precipitins to the microorganisms associated with farmer's lung disease. Follow-up studies to establish the relationship between the positive precipitin reactions to the presence of clinical disease are now under way.

Antigens, Bacterial↗

PubMed1976

The frequency of precipitins to trichloroacetic acid-extractable antigens from thermophilic actinomycetes in farmer's lung patients and asymptomatic farmers.

The hypothesis that the trichloroacetic acid (TCA)-extractable antigen fractions prepared from Micropolyspora faeni cells and other thermophilic actinomycetes are better diagnostic immunodiffusion reagents for the detection of farmer's lung disease than the crude extracellular antigen concentrates has been tested. The frequency of serum precipitins to the TCA-extractable antigens has been compared in symptomatic farmer's lung patients and in healthy farmers having positive precipitin tests to the crude antigen concentrates of the analogous thermophilic actinomycetes. Sixty-eight per cent of the symptomatic group were found to have precipitins to the M. faeni TCA-extractable antigens compared with only 22 per cent of the asymptomatic group. With regard to the other thermophilic actinomycetes tested, no significant differences in frequencies of precipitins to TCA-extractable antigens between the symptomatic and asymptomatic groups were found. However, the total number of patients available for testing with each of these antigens was small. Sufficient chemical characterization of the TCA-extractable antigens was carried out to show that they were chemically similar to the TCA-extractable antigens prepared by other workers.

Antigens, Bacterial↗

PubMed1976

Antibodies of different immunoglobulin classes against antigens causing farmer's lung.

A solid phase radioimmunoassay technique was used to demonstrate antibodies of various immunoglobulin classes in sera against farmer's lung antigens. IgG, IgA, and IgM antibody activity in normal patients and in patients with farmer's lung were detected against Micropolyspora faeni. Only the IgG and IgA antibody activity was different in farmers and in control subjects. An asymptomatic subject could not be differentiated from symptomatic farmers by IgG antibody activity. No IgE antibody activity was detected. The radioimmunoassay technique can be used to show antibody activity against carbohydrate antigens and as a method of evaluation of antigens by inhibition analysis. Certain types of hypersensitivity lung disease can be discriminated by in vitro analysis of serum antibody of various immunoglobulin classes. This is apparent for IgE and possibly true for IgM.

Adult↗

PubMed1976

Open pulmonary biopsy. Nineteen-year experience with 416 consecutive operations.

Four hundred and sixteen open pulmonary biopsies through limited thoracotomies are reported. Tissue sufficient for diagnosis was obtained in all cases. Case selection, operative technique, spectrum of diagnoses, complications, and comparisons with other techniques are defined. Diagnoses by category were as follows: occupational, 105 patients (25 percent); neoplastic disease, 80 patients (19 percent); specific histologic diagnosis, (ie, sarcoidosis), 70 patients (17 percent); specific infection, 23 patients (6 percent); vascular diagnosis, 16 patients (4 percent); and nonspecific pulmonary disease, 122 patients (29 percent). Pneumothorax, minor in most cases, was the most common complication. It occurred in 97 (23 percent) of the patients, but only 24 (6 percent) required the placement of a chest tube. Pleural effusion occurred in 106 patients (25 percent) and was minor. Hemothorax occurred in two (0.5 percent) and superficial wound infection in three (0.7 percent). Overall mortality was 4.5 percent (19 patients). Only two deaths (0.4 percent) were related to the procedure. Open pulmonary biopsy remains our diagnostic method of choice in diffuse lung disease of undetermined etiology.

Adolescent↗

PubMed1975

Pulmonary mycotoxicosis.

Mycotoxicosis is a term used to define a toxic reaction due to the ingestion of toxins produced by fungi. Oral ingestion, however, may not be the sole means of exposure. We have recently observed ten patients who had inhaled massive amounts of fungi, which resulted in an apparent toxic pulmonary reaction. Immunologic studies showed no sensitivity to various fungal antigen preparations and histologic study of the lung showed a multi-focal acute process, with primary involvement of the terminal bronchioles containing large numbers of various spores. Cultures from lung biopsy material revealed at least five fungal organisms. A one to ten year followup indicates that avoidance of massive reexposure to fungal dust is the key to the prevention of recurrent pulmonary mycotoxicosis.

Adolescent↗