Biomedical subjects
R M Seal
Publications and source records attributed to R M Seal.
Pedunculated capillary haemangioma of the bronchus.
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Primary lymphoproliferative conditions of lung.
The clinical, laboratory, and pathological features of six primary lymphoproliferative conditions of the lung are described. These comprise two patients with malignant lymphomas, one with pseudolymphoma, one with lymphoid interstitial pneumonia (LIP), one with lymphomatoid granulomatosis, and one with plasma cell granuloma. We recommend that the term 'premalignant lymphoma' be used for pseudolymphoma since the condition, although tending to remain localised, has a malignant potential. A combination of dyspnoea, cough, and pyrexia were the presenting features in our cases of premalignant and malignant lymphoma although they may often be discovered accidentally by chest radiography. The patient with LIP presented with the usual symptoms of dyspnoea and cough. The initial manifestations of the patient with lymphomatoid granulomatosis were skin radh and peripheral neuropathy nine months before the pulmonary symptoms, a not unusual occurrence. Plasma cell granuloma is often asymptomatic but our patient presented with cough, chest pain, haemoptysis. Premalignant lymphoma tends to pursue a benign course although exceptionally it may become disseminated. Malignant lymphoma may remain localised for many years but a significant proportion metastasise. Lymphomatoid granulomatosis and LIP have a varied course but both may terminate in malignant lymphoma. Plasma cell granuloma is always benign. The interrelationships of these conditions and their differential diagnosis are discussed.
Pulmonary responses to particulate materials capable of activating the alternative pathway of complement.
The cellular sequence of events evoked by the intratracheal injection of both respirable mouldy hay dust and zymosan in unsensitized rats and rabbits was markedly similar and contained many features seen in lung biopsies from farmer's lung cases. It is considered that a combination of ability to activate the alternative pathway of complement and the particulate nature of mouldy hay dust and zymosan produced the pulmonary response seen and as such, considerable insight has been gained into mechanisms by which unsensitized individuals respond to dust inhalation. It is suggested that alternative pathway activation may produce an attack of farmer's lung in the absence of precipitins or other forms of hypersensitivity to the dust or its components and that cases designated as 'pulmonary mycotoxicosis' are more rationally explained by this mechanism.
Hypersensitivity pneumonitis after exposure to isocyanates.
Four patients exposed to isocyanate vapour developed dyspnoea associated with restriction and reduced gas transfer as well as moderate airways obstruction on lung function testing. In one patient bilateral radiographic shadowing was present and an open lung biopsy was performed. The microscopic appearances ranged from acute inflammation to end-stage fibrosis but the centribular accentuation of disease and the presence of areas resembling bronchopulmonary aspergillosis suggested that the process was a hypersensitivity response to inhaled allergen. Challenge tests with albumin and toluene diisocyanate-albumin were carried out in sensitized and control rabbits. The sensitized animals developed extensive lung damage of the type associated with an Arthus reaction. It is suggested that patients exposed to isocyanates may occasionally develop a hypersensitivity pneumonitis rather than the more usual asthmatic syndrome.
Aspergillus prosthetic valve endocarditis.
The clinical, laboratory, and histopathological features of seven cases of Aspergillus fumigatus prosthetic valve endocarditis are presented. The exact nature of the lesion, a combination of infective fungal endocarditis and thrombosis on the prosthetic valve, is discussed and the difficulties in clinical diagnosis are emphasized. Helpful indications were sudden unexplained heart failure with the appearance of new murmurs, and emboli to large or medium-sized systemic arteries. Fever and anaemia were inconstant, and in no case was blood culture or precipitin investigation helpful. Spore contamination of operating theatre air was the likely source of infection, and measures taken to overcome this and other predisposing factors are discussed. Since medical diagnosis is usually late and the few reported cures in this condition have included replacement of the prosthesis, early surgical intervention combined with antifungal chemotherapy is advised.
Lymphosarcoma in Crohn's disease: report of a case.
In a patient who had a family history of ulcerative colitis and colonic carcinoma, a jejunal lymphosarcoma developed four years after resection for Crohn's disease of the small intestine. It is suggested that the association of lymphosarcoma with Crohn's disease is more than a chance association.