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Biomedical subjects

M Turner-Warwick

Publications and source records attributed to M Turner-Warwick.

At least 19 recordsLinked to original sources
PubMed1979

Radiographic progression of asbestosis: preliminary report.

In a collaborative study with the Pneumoconiosis Medical Panel, 232 asbestos workers were seen between 1967 and 1975. During this time, 50 of the 232 (21.5%) workers dies, 33 (13.8%) from respiratory disease probably related to asbestos exposure [10 (4.3%) pleural mesothelioma, three (1.3%) peritoneal mesothelioma, 10 (4.3%) asbestosis, 10 (4.3%) carcinoma of the lung]. Of the 182 survirors, 119 were recalled for other studies, and follow-up data were obtained as additional information at the same time, over a 1--7 year period. Paired radiographs were read, and 21 patients (17.6%) had worsened. As expected, the frequency of progression increased with a longer follow-up time, so that about one third of the subjects displayed progression after a minimum follow-up of 6 years. Ten of 73 patients (13.6%) had progressed in 3 years or less and may be defined as rapid progressors. No particular clinical feature distinguished clearly between progressors and nonprogressors, but there was a trend toward a greater frequency and higher titer of ANA among the progressors in this group. There was also a higher frequency of progression in those who were initially classified radiographically as 1/1 of 1/2 than in those with other initial radiographic appearances. This pilot study is now forming the basis for a larger, longer-term comprehensive survey.

Antibodies, Antinuclear↗
PubMed1979

Aspergillus fumigatus and lung disease.

The range of clinical presentations of lung diseases associated with Aspergillus spp. is great. The conditions are very frequently misdiagnosed but errors should be avoided if the possibility of a fungal cause is considered and simple immunological tests undertaken. Often no more than skin-prick tests and serum precipitins need to be done. In many cases, fungus is not isolated from the sputum and negative results do not exclude the possibility of A. fumigatus as the causal agent. Treatment often results in marked clinical improvement and there is evidence that suppression of recurrent episodes of bronchopulmonary aspergillosis prevents progressive lung damage.

Alveolitis, Extrinsic Allergic↗
PubMed1979

Value of measuring serum angiotensin I converting enzyme and serum lysozyme in the management of sarcoidosis.

Serum angiotensin I converting enzyme (ACE) and lysozyme have been measured in 23 controls, 115 patients with sarcoidosis, and 64 with other chest diseases. Both enzymes were significantly raised in sarcoidosis. ACE was raised above the normal range in 21 of 72 (29%) patients with definite sarcoidosis and in 17 of 38 (45%) of those who were untreated and seen within one year of presentation. The rise discriminated usefully between those with stable and progressive disease (5% and 62% respectively). Lysozyme was raised in 50 of 72 (69%) patients with sarcoidosis but also in 11 of 54 (20%) patients with other chest diseases. Discrimination between stable and progressive disease was useful only if very high levels were considered. Five patients had serial measurements after treatment with oral steroids and showed a progressive fall in levals of both enzymes, but patients with other diseases also showed a significant fall within the normal range when so treated. Measurement of these enzymes may help in the management of some cases of sarcoidosis, but results require critical interpretation.

Adult↗
PubMed1979

Factors influencing the prevalence of asthma among first degree relatives of extrinsic and intrinsic asthmatics.

The prevalence of asthma, hay fever, and eczema was examined in first degree relatives of extrinsic (atopic) and intrinsic (non-atopic) asthmatics attending the asthma clinics of the Brompton Hospital and the Doncaster Royal Infirmary. In both the Doncaster and Brompton populations the prevalence of asthma, hay fever, and eczema was significantly higher among relatives of extrinsic than among relatives of intrinsic asthmatics. Furthermore, the prevalence of these traits tended to be higher among siblings of extrinsic probands with one or both parents affected than among siblings of probands with neither parent affected. Most importantly, the prevalence of asthma among first degree relatives was positively correlated with the prevalence of hay fever or eczema or both among relatives and with the degree of atopy in the probands. These findings are consistent with the results of previous investigations in which the expression of asthma was shown to depend on a genetic predisposition to the trait as well as exposure to environmental provoking agents. We further suggest that the presence of atopy in genetically predisposed individuals increases the risk of developing asthma.

Adolescent↗
PubMed1979

Histocompatibility antigens in asthma: population and family studies.

One hundred and twenty-two patients with intrinsic asthma, extrinsic atopic asthma, or asthma with allergic bronchopulmonary aspergillosis were tissue typed for the HLA A, B, and C loci. No associations were found with any of the clinical groups, or with serum total IgE concentrations. Sixty-eight members of 10 families where more than one member was affected by asthma were studied. The segregation of haplotypes in siblings of the propositi who were or were not affected by asthma did not differ from the predicted segregation, and there were no differences when atopy or serum total IgE were considered. No biologically important association between HLA and asthma has been shown.

Adolescent↗
PubMed1979

Small cell carcinoma: combined approach to treatment.

Fifty-six patients with untreated small cell carcinoma of the bronchus were treated with three courses of chemotherapy (cyclophosphamide, vincristine, and procarbazine and methotrexate) and assessed for response. Thirty-one patients (55.4%) were classified as responders; they were given a course of radiotherapy and were then randomly allocated to continued cyclical chemotherapy or not further chemotherapy until relapse. Non-responders to chemotherapy were treated with radiotherapy or palliatively. The median survival was 10.5 months in responders and 6 months in non-responders (P less than 0.01). The one-year survival in responders was 42%. There was no statistical difference in survival between patients treated with continued chemotherapy and those treated at relapse. Sixty-nine per cent of patients experienced no side effects from chemotherapy. Three indicators of non-response to chemotherapy were identified--exercise tolerance at diagnosis, macroscopic liver metastases, and inappropriate ADH secretion.

Adult↗
PubMed1979

Circulating immune complexes in patients with cryptogenic fibrosing alveolitis.

Increased Clq binding levels have been obtained in serum from twenty-one (50%) of forty-two patients with cryptogenic fibrosing alveolitis (CFA) suggesting the presence of circulating immune complexes. There was a low frequency of positive results using a number of other tests for circulating immune complexes. The increased Clq binding levels were observed in six (35%) out of seventeen patients with lone lung involvement and in fifteen (60%) out of twenty-five patients with extrapulmonary connective tissue disorders. There was an especially close correlation between arthritis and elevated Clq binding. A strong correlation between Clq binding levels and levels of circulating rheumatoid factor (RF) and IgG, and enhancement in macrophage radiobioassay tests using RF-containing sera, suggested that RF might be involved in the circulating immune complexes in these patients. DNAase pre-treatment of sera did not influence the findings, and there was no correlation between Clq binding and levels of immunofluorescent ANA, C-reactive protein levels, or platelet counts. A weak correlation between Clq binding and erythrocyte sedimentation rates, and slightly lower binding levels in treated than untreated patients with 'lone' CFA suggested that binding levels may give some indication of disease activity and may in some instances be influenced by treatment.

Adult↗
PubMed1979

The role of histocompatibility (HLA) antigens in asbestosis.

Histocompatibility antigens on the A, B and C loci have been studied in 172 asbestos workers, 92 of whom had radiographic evidence of asbestosis and 80 of whom had normal radiographs. Within each population, 77 were selected who matched for age, sex, duration from first exposure, duration of exposure and approximate heaviness of exposure. Results were also compared with 174 normal unexposed volunteers. No differences of statistical significance were found in the frequency of histocompatibility antigens tested when the matched or the total population of asbestos workers with and without asbestosis were compared. There was, however, a consistent trend of increase in B27 amongst those with asbestosis (11%) and this reached conventional significance (P < 0.05) when the 92 asbestotics were compared with the whole group having normal radiographs (asbestos workers 5.0% and volunteers 5.2%). Amongst the group having asbestosis, those with HLA-B27 had a significantly shorter exposure to the dust (13.5 years) compared with those without asbestosis (22.3 years), although the mean radiographic profusion score for the two categories was similar. No statistical differences could be found when B5, B8 and B12 were analysed in a similar way, but there was a trend suggesting that B5 was less frequent amongst a small group of cases showing radiographic progression over a three-year follow-up, compatible with the suggestion that this antigen might be linked with with some protective effect.

Asbestos↗
PubMed1978

Lymphocyte responses to phytohaemagglutinin in patients with asbestosis and pleural mesothelioma.

Quantitative impairment of lymphocyte responses to phytohaemagglutinin (PHA) has been demonstrated in six (21%) out of twenty-eight patients with asbestos-associated pulmonary fibrosis, in comparison with a group of unexposed normal controls. The impairment tended to occur in patients with fairly severe fibrosis, comparatively short duration of exposure to asbestos dust and with increases in serum immunoglobulin levels. One patient with asbestosis and an associated bronchial carcinoma also had depressed lymphocyte responses to PHA. These findings suggest a relationship between defective T-lymphocyte function and the fibrotic response in asbestosis. Whether it is also linked with the development of lung cancer, occurring either before or at a pre-clinical stage of tumour growth, and is of value in identifying patients especially at risk should now be explored in longitudinal studies. However, eight out of ten patients with asbestos-associated pleural mesothelioma and without lung fibrosis showed no evidence of impaired cellular immunity, either by in vitro testing with PHA or by vivo delayed hypersensitivity skin testing, indicating that impaired T-lymphocyte function is unlikely to be a common finding in all types of asbestos-associated malignancy.

Adult↗
PubMed1977

alpha 1-antitrypsin phenotypes in fibrosing alveolitis and rheumatoid arthritis.

alpha 1-antitrypsin (alpha 1-A.T.) phenotypes were determined in 55 patients with rheumatoid arthritis (R.A.), 33 patients with R.A. and either obstructive airways disease or recurrent chest infections, 49 patients with fibrosing alveolitis (F.A.), 22 patients with R.A. and F.A., and 200 healthy controls. A highly significant increase in the frequency of MZ phenotype was found among patients with F.A., both with and without R.A. Patients with R.A. alone had a normal distribution of phenotypes. Inherited modification of immune function may predispose to F.A. Alternatively, lowered levels of alpha 1-A.T. associated with non-M phenotypes may predispose to tissue damage with subsequent fibrosis.

Alleles↗
PubMed1977

Immune reactions in pulmonary fibrosis.

Two groups of fibrosing lung disorders have been studied, namely connective tissue disorders and fibrogenic inorganic dust diseases. Antinuclear factors (ANA) are frequently raised in both, but to varying extents and having markedly different characteristics when analysed in detail. The evidence for immune complex deposition in the lung in human disease is summarized and the relationship between ANA and the radiographic extent of fibrogenic inorganic dust disease is described. The evidence of lymphocyte responsiveness is incomplete, but holds interesting potential. Preliminary studies of histocompatibility antigens are summarized and warrant further investigation.

Animals↗
PubMed1977

A case of pulmonary veno-occlusive disease respondong to treatment with azathioprine.

Histological features of a lung biopsy specimen from a 46-year-old woman showed all the characteristics described in veno-occlusive disease. The clinical features, however, were distinctive in that in addition to the lung involvement there was alopecia, digital vasculitic ulcers, Raynaud's phenomenon, polyarthritis, and muscle weakness. Treatment with azathioprine resulted in a progressive improvement in her condition. It is suggested that pulmonary small vein occlusion may occur as a pattern of tissue response in more than one situation and that is sometimes more amenable to therapy than has been previously reported.

Alopecia↗
PubMed1977

Studies in chronic allergic bronchopulmonary aspergillosis. 4. Comparison with a group of asthmatics.

A comparison is made of lung function tests and radiographic findings in 20 asthmatic patients with allergic bronchopulmonary aspergillosis paired in terms of sex, age, and duration of asthma with 20 other asthmatics in whom the diagnosis of aspergillosis was excluded in order to see if the aspergillosis causes more lung damage. One hundred per cent of the patients with aspergillosis and 75% of the patients with asthma alone showed a significantly reduced forced expiratory volume in one second (FEV1) before bronchodilator. All the patients in the two groups had a significantly reduced maximal expiratory flow at 50% vital capacity breathing air (V50air) but the severity of the reduction was statistically greater in the aspergillosis group. Reversibility in FEV1 of 15% and more was found in 50% of patients with asthma alone as against 31% of patients with aspergillosis. The degree of reversibility of FEV1 was also statistically greater in patients with asthma alone. Improvement of less than 20% of V50 after helium-oxygen breathing was found in 33% of the patients with asthma alone and in 75% of the patients with aspergillosis. Patients with aspergillosis also showed significantly (0-001 less than P less than 0-01) more reduced gas transfer factor. Radiological features of overinflation were as common in the two groups. Tubular and ring shadows were found in 95% and 60% respectively of patients with aspergillosis as against 45% and 15% of patients with asthma alone.

Adult↗