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Biomedical subjects

A W Goolden

Publications and source records attributed to A W Goolden.

At least 37 records · Page 2Linked to original sources
PubMed1982

Carbon monoxide diffusing capacity in polycythaemia rubra vera.

The diffusing capacity of the lung, or transfer factor, for carbon monoxide (TLCO) was measured in 12 patients with polycythaemia rubra vera. This was significantly raised (mean 152% predicted, SEM +/- 14%) and remained so even after correction to a standard haemoglobin concentration of 14 . 6 g/dl (mean 139% predicted, SEM +/- 13%). Serial measurements of TLCO on two patients after treatment of polycythaemia rubra vera showed a greater fall in relation to haemoglobin concentration than would have been predicted on theoretical grounds if the increases in TLCO had been due entirely to the increased haemoglobin concentration. The pulmonary capillary blood volume (estimated from TLCO) also fell in these two patients after treatment. There was a strong correlation between TLCO and the technetium-99m-labelled red cell volume for the seven men (r = 0 . 92; p less than 0 . 01) and five women (r = 0 . 99; p less than 0 . 001) when studies were performed on the same day. In patients with polycythaemia rubra vera who have no evidence of coexistent pulmonary disease the pulmonary capillary bed appears to share in the expansion of the body blood volume. The single-breath TLCO test may act as a convenient and simple monitor for the response of the disease to treatment.

Adult↗
PubMed1981

Buffy coat autografts for patients with chronic granulocytic leukaemia in transformation.

We have treated 20 patients with chronic granulocytic leukaemia (CGL) in transformation with cytotoxic drugs or with cytotoxic drugs and whole-body irradiation followed by transfusion of autologous blood cells collected at diagnosis and stored in liquid nitrogen. The mean number of nucleated cells autografted was 25.1 X 10(8)/kg (range: 12.5-40.1). Full myeloid engraftment occurred in 18 patients; it was partial in one patient and unassessable in another. The median survival for the 20 patients post-graft was 14 weeks. Two patients are alive, one now in recurrent transformation, and one in second chronic phase that has lasted 52 weeks. For the 18 patients who died the mean survival was 24 weeks (range: 2-125). Two patients with predominantly myelosclerotic transformation showed evidence of engraftment. One patient successfully autografted developed features consistent with graft-versus-host disease which proved fatal. We conclude that autografting may offer substantial palliation for some but not all patients with CGL in transformation.

Blood Cells↗
PubMed1981

Splenic irradiation in B-prolymphocytic leukaemia.

Twelve patients with B-cell prolymphocytic leukaemia (PLL) were treated with splenic irradiation at a weekly dose of 100 cGy to a maximum total dose of 1000 cGy. There was no morbidity associated with this treatment. SEven patients responded. Three achieved a good response and four a partial response. Two of the patients who had a partial response have subsequently died of unrelated causes. Four of the five patients who failed to respond have died as a result of their disease. When more than 25% of the prolymphocytes formed rosettes with mouse red blood cells (MRBC) the patients appeared to respond better to splenic irradiation. There was no correlation between response and the initial white cell count or the size of the spleen.

Aged↗
PubMed1979

Autonomous erythropoietin induced erythrocytosis.

Erythrocytosis in a young Sinhalese man is described. The patient was known to have had a raised Hb and PCV for at least 10 years. Subsequent investigations failed to support the diagnosis of polycythaemia vera or to reveal a cause for secondary polycythaemia. Blood erythropoietin values were raised, but no cause for inappropriate secretion could be identified. Although there was no evidence of erythrocytosis in the family, the findings in this patient appear to be those of a condition which has been called familial polycythaemia. The spleen was unusually large and was associated with hypersplenism and thrombocytopenia. Problems of diagnosis and management are described. Phlebotomy appears to be the treatment of choice, with a regimen of regular venesection for the control of symptoms due to hyperviscosity and vascular occlusion.

Adult↗
PubMed1978

Polycythaemia vera-transformation to myelofibrosis and subsequent reversal.

A woman aged 67 who developed polycythaemia vera 21 years ago has been seen regularly since the diagnosis was first made. She was treated initially with pyrimethamine and then for 10 years by repeated venesections. After a 4 year period when her myeloproliferative disease was considered to be transitional a complete transformation to myelofibrosis occurred. She was treated by splenic irradiation and later with alkylating agents in an attempt to give her symptomatic relief from massive splenomegaly. Repeated and massive haemorrhage from gastro-oesophageal varices was treated initially by percutaneous transhepatic sclerosis of the gastro-oesophageal collateral vessels. A subsequent dacron mesocaval jump graft operation was successful in preventing further haematemesis and melaena. During the last year transformation back to polycythaemia vera has occurred. The evolution of her myeloproliferative disease has been fully documented by detailed blood counting, bone marrow aspirates and trephine biopsies, blood volume studies and other radioisotope investigations including the quantitation of functional erythropoietic tissue with 52Fe.

Aged↗
PubMed1974

Thyroid function in patients treated with radioactive iodine for thyrotoxicosis.

A series of 105 patients treated at least two years earlier with radioactive iodine for thyrotoxicosis have been surveyed. Eighty-five patients (81%) were euthyroid clinically and on the basis of routine thyroid function tests. Of the euthyroid patients 46 (54%) had normal thyroid-stimulating hormone (TSH) levels and 39 (46%) had raised TSH levels. There was no difference in serum triiodothyronine levels between these two groups but the serum protein bound iodine and serum thyroxine, though still well within the normal range, were significantly lower in the group with raised TSH levels. The serum cholesterol was also significantly higher in this latter group.Most of the euthyroid patients were seen again a year later. None had become hypothyroid and neither those with normal nor those with raised TSH levels showed any evidence of a decline in the level of serum thyroxine.It is concluded that raised serum TSH levels in patients treated with iodine-131 are not necessarily indicative of hypothyroidism. There is no indication that patients who have this abnormality become overtly hypothyroid over a 12-month follow up.

Carbimazole↗
PubMed1971

Use of 99 Tc m for the routine assessment of thyroid function.

(99)Tc(m)-pertechnetate is concentrated in the thyroid in the same way as iodide but it does not become organically bound. The uptake of (99)Tc(m) is a measure of the thyroid trap, and this measurement is satisfactory as a routine test in the diagnosis of thyrotoxicosis. The reproducibility of the method is such that suppression tests can be carried out when necessary even when uptake is within the normal range of 0.4-3%. (99)Tc(m) gives a low radiation dose to the thyroid and has certain other advantages over radioactive isotopes of iodine for early thyroid uptake measurements. It is particularly suitable when serial tests of thyroid function are required during treatment with an antithyroid drug.

Blood Proteins↗