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Biomedical subjects

S W Banham

Publications and source records attributed to S W Banham.

At least 55 records · Page 3Linked to original sources

Relationships between avian exposure, humoral immune response, and pigeon breeders' disease among Scottish pigeon fanciers.

In a large scale clinical survey of Scottish pigeon fanciers, 277 people completed a detailed questionnaire and provided a venous blood sample. There were 29 (10.4%) who fulfilled the clinical criteria for pigeon breeders' disease used in the study and 84 (30.3%) who showed a significant serum IgG antibody response to pigeon gammaglobulin (4 micrograms/ml) and were considered to have been sensitised. Increasing exposure was associated with a progressive tendency towards sensitisation, but the intensity of the antibody response was related to the presence of symptoms and not the degree of exposure. Thirteen out of 15 subjects in the survey with a serum concentration of antipigeon IgG greater than 60 micrograms/ml fulfilled the clinical criteria for pigeon breeders' disease, and those affected within 10 years of starting the hobby had the highest mean antibody response. Accurate quantitation of antibody response is therefore helpful in the investigation of pigeon breeders' disease. The radioimmunoassay provides a quantitative method for determining antibody response that can be used in the routine screening of pigeon fanciers and in serial monitoring of their response.

Adult↗

Short duration combination chemotherapy in the treatment of small cell lung cancer.

Ninety five patients (57 with limited disease and 38 with extensive disease) with previously untreated small cell lung cancer were entered into a study of short duration combination chemotherapy with intravenous cyclophosphamide (750 mg/m2) on day 1, adriamycin (40 mg/m2) on day 1, and etoposide VP-16 (100 mg/m2) on days 1, 2, and 3, with the addition on day 10 of methotrexate 50 mg/m2 with folinic acid rescue and vincristine 2 mg. The treatment was repeated on day 22 and only three courses were given. No maintenance chemotherapy was given, though patients with a complete response received radiotherapy (30-40 Gy (3000-4000 rads] to the primary site in most cases. Forty nine patients (86%) with limited disease achieved a response, with 26 (46%) complete remissions. Twenty five patients (66%) with extensive disease had a response, but only eight (21%) had a complete response. Actuarial survival analysis for the whole patient population showed a median survival of 13 months for patients with limited disease and seven months for those with extensive disease. The median survival was 14 months for those patients with limited disease who achieved a complete response, but only 10 months for non-responders. Myelosuppression was the major expression of toxicity. There were three deaths related to treatment and seven patients had febrile episodes during neutropenia that required antibiotics. Mucositis, which was usually mild, occurred in 49% of patients. The primary site was the main site of initial relapse in 56% of the patients who relapsed. Among patients with limited disease who achieved a complete response, relapses at the primary site were less common in those who received radiotherapy (five out of 12) than in those who did not (all eight). The results indicate that this short duration chemotherapy in small cell lung cancer gives response rates and the potential for long term survival similar to those obtained in other series while allowing patients the maximum time free from treatment.

Antineoplastic Combined Chemotherapy Protocols↗

Mediastinal imaging in lung cancer.

Sixty-six patients with lung cancer underwent mediastinal staging with gallium scanning, CT scanning and mediastinal exploration at mediastinoscopy and/or thoracotomy. Histological findings at time of mediastinal exploration were correlated with the results of the non-invasive staging scans. Gallium scanning had an accuracy of 78.8 per cent and CT scanning had an accuracy of 77.3 per cent. There was no evidence of increased test accuracy by performing both scans in the same individual. Either scanning technique may be utilised as a simple non-invasive mediastinal staging procedure, and where negative it is appropriate to proceed directly to thoracotomy.

Gallium Radioisotopes↗

High-dose cyclophosphamide and VP 16 as late dosage intensification therapy for small cell carcinoma of lung.

This study investigated the use of late dose intensification therapy (LDIT) with cyclophosphamide (180 mg/kg) and VP 16 (1 g/m2) plus autologous bone marrow rescue in 22 patients with small cell lung cancer (SCLC). These patients were selected from a group of 95 patients who received three courses of a five-drug induction regimen comprising cyclophosphamide (750-1000 mg/m2), adriamycin (40 mg/m2), VP 16 (100 mg/m2) for 3 days, methotrexate (50 mg/m2) and vincristine (2 mg) (CAVMO). There were 16 patients with limited disease, 8 of whom were in complete remission (CR) and 8 in partial remission (PR) after the induction therapy. The other 6 patients had extensive disease; 3 of these achieved CR and 3 PR after induction therapy. Of the 11 patients in PR, 5 responded to LDIT; 3 had a further PR, and 2 CR. Subsequent to LDIT radiotherapy 4000 cGy was given to the primary site in 10 of the 22 patients. Since the start of the study, 19 of the 22 patients have relapsed and died (median survival 11 months), while 3 remain alive and in remission at 11, 11, and 24 months. Comparison of the survival of patients receiving LDIT with that of an equivalent group (with respect to staging and response to induction chemotherapy) of patients who received induction chemotherapy alone showed no significant difference. In this study, LDIT following conventional induction therapy in patients with chemosensitive tumours did not improve survival.

Antineoplastic Combined Chemotherapy Protocols↗

Effect of cigarette smoking on the antibody response to inhaled antigens and the prevalence of extrinsic allergic alveolitis among pigeon breeders.

There was a reduced prevalence of symptoms of Extrinsic Allergic Alveolitis (EAA) among the cigarette smokers in a survey of 102 volunteer pigeon breeders. These smokers had a significantly lower antibody response against the inhaled antigens associated with the disease; only one of twenty-three smokers (4.3%), but thirty-nine of sixty-five non-smokers (55.4%) had elevated serum IgG antibody levels, despite similar degrees of avian exposure in each group. The appearance of antibody in six of fourteen ex-smokers (42.9%) suggested that the apparent inhibitory effect of smoking on the antibody response was reversible. The smoking group had lower total serum IgG and IgA, higher serum IgD, and their total IgM and IgE levels were similar to the nonsmokers.

Alveolitis, Extrinsic Allergic↗

Vindesine and cisplatin combination chemotherapy compared with vindesine as a single agent in the management of non-small cell lung cancer: a randomized study.

One hundred and five patients with inoperable non-small cell lung cancer were included in a randomized trial comparing the activity of vindesine as a single agent with the combination of vindesine and cisplatin. All patients were previously untreated and the majority (70%) had squamous carcinoma. The overall partial response rates in 88 evaluable patients were 7% for vindesine alone and 33% for the combined regime. There were no complete responders in either arm. The median survival of patients treated with vindesine and cisplatin was 11 months, compared with 4 months in those treated with vindesine alone (P = 0.008). Patients showing a partial or complete response to vindesine and cisplatin survived a median duration of 13 months, compared with 7 months for non-responders (P = 0.03). This survival benefit associated with the combination was particularly apparent for patients with ECOG performance status 0 or 1 (median survival greater than 18 months and 13 months respectively), locoregional disease (median survival 14 months) and squamous cell histology (median survival 13 months). Myelo-suppression was greater with the combination but was not a major treatment problem. Neurotoxicity, which was frequently dose-limiting, was of similar severity in both treatment groups. The results indicate that the combination of vindesine and cisplatin is superior to vindesine alone for remission induction in non-small cell lung cancer and confers a significant survival advantage compared with vindesine alone in patients with favourable prognostic factors.

Adenocarcinoma↗

Alteration in the low frequency lung sounds in respiratory disorders associated with crackles.

Lung sounds were recorded in three groups of 5 subjects, 2 conditions associated with pulmonary crackling (asbestosis and pulmonary oedema), and in normal non-smoking males. A technique was used which permitted extraction and analysis of the low-frequency sounds. Differences were evident in the 5-50 Hz range of the frequency spectra which allowed separation of all 3 groups. A prominent feature was the close similarity of the low-frequency sounds within the asbestos group when plotted on a scattergram. The findings suggest that alteration in low-frequency breath sound occurs in parenchymal lung disease and that its potential merits further investigation.

Asbestosis↗

Antibody measurement in extrinsic allergic alveolitis.

Serum IgG antibody against purified avian antigens was quantified by radioimmunoassay in 507 active pigeon fanciers, of whom 110 had documented Pigeon Breeders Disease (PBD). The incidence of PBD increased from 3.7% in the antibody-negative group to 78% of those with IgG antibody greater than 30 micrograms/ml. The highest levels of antibody tended to occur in subjects with relatively short avian exposure, and a significant correlation between decreasing antibody levels and increasing years of avian contact was demonstrated, which was unrelated to age or smoking history. The antibody -positive subjects had lower daily hours of avian contact and this group which contained most of the PBD subjects demonstrated some self-regulation of antigen exposure.

Age Factors↗

Haematological reconstitution following high dose and supralethal chemo-radiotherapy using stored, non-cryopreserved autologous bone marrow.

Eighteen patients with small cell carcinoma of the lung received high dose cyclophosphamide (180-200 mg/kg) intensification following five pulses of 'CHOP' chemotherapy (cyclophosphamide 750 mg/m2 i.v., adriamycin 50 mg/m2 i.v., vincristine 1.4 mg/m2 i.v., prednisolone 40 mg orally for 5 d). They received infusions of autologous bone marrow which had been stored at 4 degrees C for 34 h. Pancytopenia was predictable in onset and its duration acceptable. Recovery of neutrophils to greater than 1.0 x 10(9)/l was achieved in 17.5 +/-0.9 d (mean +/- SEM) and platelets to greater than 100 x 10(9)/l in 17.5 +/- 0.8 d. Four patients with acute myeloid leukaemia in complete remission received intensification with the supralethal combination of cyclophosphamide and total body irradiation followed by infusion of autologous marrow which had been stored at 4 degrees C for 54 h. Haematological reconstitution in these patients was acceptable but slower (greater than 1.0 x 10(9)/l neutrophils between days 26 and 40; greater than 20 x 10(9)/l platelets between days 23 and 77). Except in one case, normal peripheral counts were attained in all patients. It is concluded that bone marrow stored at 4 degrees C for up to 54 h is a simple and practical source of viable stem cells which have the capacity for acceptable haematological reconstitution.

Antineoplastic Combined Chemotherapy Protocols↗

Seasonal variation of antibody levels among pigeon fanciers.

IgG antibody against avian antigens was measured by quantitative radioimmunoassay in serum samples obtained regularly from twenty pigeon fanciers over a 1-year period. A seasonal variation was seen in nine antibody-positive subjects; eight of whom had symptoms of pigeon breeder's disease (PBD), and a clear peak of antibody production occurred during late summer, corresponding with the period of maximum avian contact in the sporting season. All subjects with insignificant specific IgG levels were asymptomatic and displayed minimal changes throughout the year despite a similar exposure pattern to antigen for all individuals. Raised total IgG was a feature of six symptomatic subjects, two of whom had raised total IgA. Three of these six subjects had maximum hypergamma-globulinaemia coinciding with peak specific-antibody levels, but in general the total immunoglobulin levels tended to remain high throughout the year with only marginal fluctuations. The total immunoglobulin levels in the other individuals were within normal limits and displayed no remarkable changes during the year. The subjects with pigeon breeder's disease had a more active immune responsiveness to avian contact, and the association of the highest levels with periods of maximal contact with antigen may have an important bearing on the dynamic nature of this condition.

Adult↗

Skin testing and extrinsic allergic alveolitis.

Skin testing with six common allergens, tuberculin and a sterile avian antigen preparation from pigeon serum was performed on 102 pigeon fanciers. The incidence of positive prick tests to common allergens was no different for subjects with extrinsic allergic alveolitis. EAA, caused by avian exposure than the whole group. Positive immediate weal and flare reactions following skin prick testing with avian antigen occurred in 22 subjects and was closely correlated with atopy. However, when the same antigen was administered intradermally, 69 subjects developed an immediate (15 min) weal and flare reaction which did not correlate with atopy, instead, the weal diameter correlated significantly with the serum IgG antibody titre against pigeon serum gamma-globulin antigen, and furthermore, the higher grades of reaction were highly selective for subjects with EAA. Ten subjects, all with strong early intradermal skin reactions, developed a late (4-6 h) skin reaction; this was again highly selective for EAA. The subjects with cutaneous anergy to tuberculin had markedly higher IgG antibody titres to avian antigens, and these included the majority of the subjects with alveolitis.

Allergens↗

Antibody against a pigeon bloom-extract: a further antigen in pigeon fanciers' lung.

Pigeon bloom, a waxy powder which coats the feathers of racing pigeons, has been investigated as a potential antigen in pigeon fanciers' lung. Precipitins to a soluble bloom-extract were demonstrated in fifty-nine of ninety-seven people studied at two Scottish-pigeon shows, whilst precipitins to pigeon serum were found in thirty-seven. A radioimmunoassay was developed to allow an estimation of the intensity of antibody response to this antigen in nineteen pigeon fanciers being investigated for pigeon fanciers' lung. The mean antibody level to bloom extract was significantly higher (P less than 0.05) in those with acute symptoms compared to those with less severe symptoms. Pigeon bloom is a highly antigenic material and provides an alternative to pigeon droppings as a source for the inhalant antigens regularly encountered by those keeping pigeons.

Alveolitis, Extrinsic Allergic↗