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Biomedical subjects

R W Wilmott

Publications and source records attributed to R W Wilmott.

13 recordsLinked to original sources
PubMed1992

Chronic graft-versus-host disease and pulmonary function.

Pulmonary complications are a major cause of morbidity and mortality in bone marrow transplant recipients. Earlier series, consisting mainly of adults, have shown evidence of obstructive changes of pulmonary functions in association with chronic graft-versus-host disease (CGVHD). We longitudinally evaluated spirometry in 46 patients who received bone marrow transplants as children or as young adults to determine whether they had similar abnormalities. Group mean FEV1/FVC, and percent predicted FVC, FEV1, and FEF25-75 values did not demonstrate obstructive changes in association with CGVHD in this patient population. Our findings suggest that younger patients with CGVHD, as a group, may fare better than older bone marrow transplant recipients with CGVHD. However, due to small sample sizes, it cannot be conclusively stated that the pulmonary function parameters analyzed do not differ in the two patient groups.

Adolescent↗
PubMed1991

Predicted values for lung diffusing capacity in healthy children.

Lung diffusing capacity was measured in 92 healthy Caucasian children (52 boys and 40 girls), ranging in age from 6 to 17 years, using the single breath carbon monoxide technique (DLCO). Multiple regression equations were developed to predict the DLCO value. Standing height, gender, weight, and age were significant factors in the prediction of DLCO. Sitting height was not a significant covariate when standing height was in the model, but it could replace standing height in the equation. Equations are presented for the calculation of predicted DLCO in children based on standing or sitting height, age, sex, and weight.

Adolescent↗
PubMed1990

Increased levels of interleukin-1 in bronchoalveolar washings from children with bacterial pulmonary infections.

To investigate its role in pulmonary infections, concentrations of interleukin-1 were measured in 22 bronchoalveolar lavage fluid (BALF) samples from 19 children with cystic fibrosis (CF), and in 13 disease controls by enzyme-linked immunosorbent assay (ELISA) for IL-1 beta and the D10.G4.1 proliferation assay for IL-1 activity. Significantly higher levels of IL-1 beta and IL-1 activity were found in BALF from patients with bacterial pulmonary infections than in those without such infection. There was no significant difference between the levels in patients with CF and pulmonary infections and those in children with bacterial infections complicating other diseases. High performance liquid chromatography showed that most of the IL-1 beta was associated with a molecular weight peak of 17 to 18 kD. Pulmonary inflammation reflected by the number of polymorphonuclear leukocytes (PMN) in the sample correlated significantly with the IL-1 concentration.

Bacterial Infections↗
PubMed1987

A chronic lung disorder following abdominal pregnancy.

Abdominal pregnancy is a rare condition that is associated with a high infant mortality, as well as orthopedic and pulmonary deformations. This article describes the clinical and radiological courses of two infants born after abdominal pregnancies. Evidence of pulmonary hypoplasia secondary to fetal compression was present. The morbidity and mortality for infants born of abdominal pregnancies may depend on the extent of pulmonary involvement, which may relate to the length of fetal compression.

Chronic Disease↗
PubMed1987

Interleukin-1 activity from human cord blood monocytes.

Cord blood monocyte synthesis of IL-1 was investigated by using a thymocyte proliferation assay. Monocytes from 27 infants ranging in gestation from 31 to 41 weeks (mean 38.9, SE 0.54) with birthweights from 1.20 to 4.31 kg (mean 3.24, SE 0.13) were isolated from cord blood; 2 x 10(5) cells/ml were plated in 15 mm wells and stimulated with 10 micrograms/ml LPS (E. coli). Control cultures contained medium alone. Supernatants were harvested after 24 hr and tested in a C3H/HeJ mouse thymocyte proliferation assay. The mean response for 27 cord monocyte samples at 24 hr was 14,142 cpm (SE 1,499), not significantly different than that for cells obtained from eight normal adult volunteers (15,137 cpm, SE 3,535). Vaginally delivered infants with perinatal complications such as amnionitis, fetal distress, or early sepsis had significantly increased unstimulated activity (5,139 vs 1,331 cpm) compared to samples from normal infants, whereas stimulated activity was not significantly different (16,219 vs 12,261 cpm). Thus, the IL-1 response to lipopolysaccharide is intact in newborn human monocytes and there is evidence of an increased unstimulated activity following neonatal complications.

Cells, Cultured↗
PubMed1986

Large-airway collapse due to acquired tracheobronchomalacia in infancy.

Seven infants with wheezing and cyanotic spells were diagnosed as having tracheobronchomalacia by bronchoscopy or fluoroscopy. These studies demonstrated narrowing of the central airways by 75% or more on exhalation. Five patients were premature infants who had been ventilated for hyaline membrane disease. The mean time from onset of symptoms to diagnosis was six months. Determination of the optimal positive end-expiratory pressure (PEEP) during fluoroscopy facilitated subsequent management. Six of the seven patients required PEEP of 8 to 18 cm H2O for at least three months, and five of the seven still require mechanical ventilation. All patients improved, with decreased cyanotic spells and a reduced requirement for ventilatory support. Tracheostomy without PEEP did not appear to be helpful. Tracheobronchomalacia may be more frequent than usually appreciated; the treatment of choice appears to be long-term PEEP.

Airway Obstruction↗
PubMed1986

Pulmonary function abnormalities in homozygous beta-thalassemia.

Pulmonary function tests were performed on 19 patients with homozygous beta-thalassemia ranging in age from 10 to 29 years. These included patients who had and had not received transfusions. None of the 19 subjects had completely normal pulmonary function. Residual volume (in 16 of 19 patients), ratio of residual volume to total lung capacity (12 of 19), and airway resistance (16 of 19) were abnormally increased; maximum expiratory flow (15 of 19) and peak flow (10 of 19) were abnormally reduced. Single-breath carbon monoxide diffusion was normal in 16 of 19. These results indicate that mild to moderate small airway obstruction and hyperinflation are common in thalassemia and that patient age, transfusion history, and iron accumulation are not important factors in the genesis of these pulmonary abnormalities.

Adolescent↗
PubMed1986

Serial evaluation of lymphocyte function in bone marrow-grafted patients.

Deficiencies in both cellular and humoral immunity follow human bone marrow transplantation, predisposing recipients to life-threatening infections. Peripheral blood mononuclear cells (cells of donor marrow origin) from nine patients were collected serially at 3-month intervals during the first year post transplant and evaluated for proliferation and lymphokine (gamma interferon and interleukin-2) production in vitro. Cultures of patient cells or those of normal adult volunteers were stimulated by phytohemagglutinin (PHA) in vitro, and lymphocyte blastogenesis was assayed by tritiated thymidine uptake on day 2. PHA blastogenesis for peripheral blood mononuclear cell cultures from patients post bone marrow transplant achieved normal levels 3-6 months post transplant. Supernatants produced by cells from marrow recipients (less than 12 months post transplant) had lower-than-normal IFN-gamma activity and decreased IL-2 activity. Two patients with acute graft-vs-host disease (GVHD) had persistently depressed PHA blastogenesis, IFN-gamma production, and IL-2 production at 12 months post transplant.

Bone Marrow Transplantation↗
PubMed1985

Cystic fibrosis survival rates. The influences of allergy and Pseudomonas aeruginosa.

Allergy and chronic Pseudomonas aeruginosa (PA) infection are two factors that possibly affect the clinical severity of cystic fibrosis pulmonary disease, although the role of allergy is controversial. We have examined the effects of these factors on actuarial survival rates in 117 children with cystic fibrosis who were skin tested in 1974 and classified as allergic (A+) or nonallergic (A-) by their reactions to 12 prick tests with common environmental allergens. Patients were also classified according to whether or not they had chronic pulmonary infection with PA in 1974 (PA-positive or PA-negative). Survival rates in A+ patients were not significantly different from those in the A- group (percent survival to age 16 years, 67% vs 80%), whereas the PA+ group had significantly worse survival rates than the PA- group (percent survival to age 16 years, 53% vs 84%). There was no significant interaction between allergic skin reactions and either age at onset of chronic PA infection or subsequent duration of survival.

Adolescent↗
PubMedDate not supplied

Pulmonary hemosiderosis.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMedDate not supplied

The relationship between atopy and cystic fibrosis.

The incidence and clinical significance of allergy in cystic fibrosis have been discussed. There is little evidence that the high prevalence of positive allergy skin tests in CF is a clinical manifestation of a hypersensitivity lung disease complicating the primary pulmonary disorder, except in the special case of allergic bronchopulmonary aspergillosis. The lung disease of CF appears to be caused by excessive bronchial secretions and recurrent infection that are the result of abnormal ion transport across the apical membrane of the respiratory epithelial cell. There are two important questions concerning the allergic reactions: Are they clinically significant, and, why do they occur? The former question is partly resolved by the data presented, although well-controlled studies of intervention would help to resolve it further. The cause of these reactions, which occur particularly in relationship to the mold Aspergillus fumigatus, is unknown but the author is inclined to the view that they are the result of recurrent infection that induces heightened immunologic reactivity to inhaled allergens. The significance of AF may be simply that this mold has a "predilection for diseased airways" or may be more complex; for example, owing to abnormal ion composition in respiratory secretions, abnormal lectin expression by CF respiratory epithelial cells, or selective filtration by the airways based on particle size.

Cystic Fibrosis↗