Biomedical subjects
Publications and source records attributed to C P Warren.
Two cases of hypersensitivity pneumonitis in grain workers are described. Both cases had evidence of sensitization to the gram-negative bacteria Erwinia herbicola as judged by skin tests, detection of serum precipitins, and inhalation challenge. E. herbicola is frequently found in the microflora of grains.
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Allergy to one of the most common Canadian storage mites. Lepidoglyphus destructor, was demonstrated in a grain worker by immediate skin testing and inhalation challenge. The frequency of sensitization to this mite was found to be 12% in 100 asthmatics by skin testing. In 4% of these asthmatics sensitization to another storage mite, Acarus siro, was found, all of whom were also sensitized to L. destructor and the house dust mite, Dermatophagoides farinae. There was a significantly higher proportion of asthmatics sensitive to the storage mites and to fungi who had a history of exposure to grain compared to those who did not.
Results of skin testing to common allergens, total serum IgE levels, and the responses to a respiratory questionnaire were obtained for 1768 individuals participating in a survey of a rural population. The geometric mean total IgE levels in a group of subjects without skin-test reactions and with no histories of asthma or hay fever was 14.8 U/ml for men and 11.9 U/ml for women. When individuals were classified according to skin reactivity and smoking history there was a significant difference in IgE levels among nonsmokers, exsmokers, and smokers, with smokers having the highest levels. The percentage of subjects with elevated total IgE levels was higher in smokers than in nonsmokers regardless of skin reactivity to common allergens. Among smokers there was no relationship between intensity and duration of smoking and IgE levels. Among exsmokers IgE levels tended to be lower in those who had stopped smoking earlier.
We compared a 2-week course of 32 mg/d methylprednisolone with placebo in a double-blind crossover trial in 46 well-characterized patients with stable chronic obstructive pulmonary disease. Placebo and steroid trials were separated by 2 weeks when no tablets were given. Response was assessed by measuring forced expiratory volume in 1 second (FEV1.0). Placebo responses were normally distributed (mean, 0.8% change in FEV1.0; range, -30% to 33%). Six patients showed a greater than 50% increase of FEV1.0 in response to steroid; a seventh showed a 36% increase and an eighth, a 29% increase. Because of these patients the group as a whole showed a significantly greater FEV1.0 after steroid than after placebo. The eight steroid responders did not differ from nonresponders in age, sex, smoking history, or duration and intensity of symptoms including wheeze. Baseline lung function and eosinophilia of blood or sputum did not differ between the two groups. Patients who responded to steroids also responded to inhaled beta agonists: Acute bronchodilator response averaged 25% in steroid responders and 13% in nonresponders, a difference that was statistically significant although there was overlap between the two groups.
A group of 76 cattle farmers from southern Manitoba answered the National Heart, Lung, and Blood Institute questionnaire on respiratory symptoms and supplementary questions on farming and farming-related syndromes. Lung function was tested, serum was examined for precipitating antibodies, and skin testing with common allergens was performed. Analysis of the men's answers revealed a high prevalence of chronic respiratory symptoms among the farmers in all categories of smoking history, and the presence of these symptoms was significantly associated with a history of symptoms related to handling mouldy hay or grain; 51% of the men had chronic symptoms and 55% had symptoms related to crop handling. In seven farmers (9%) the symptoms related to crop handling suggested an attack of farmer's lung. One other farmer, with a history of illness after handling mouldy hay, had a reduced total lung capacity, and in 18 the ratio of the forced expiratory volume in the first second to the forced vital capacity was lower than predicted. Precipitating antibodies against Thermoactinomyces were absent in all farmers, but two farmers had antibodies against Aspergillus ruber. Immediate hypersensitivity was found in 16 (21%) of the farmers; sensitivity to Dermatophagoides farinae was commonest.
Of a random sample of farmers in two crop districts of Manitoba mailed a respiratory questionnaire in 1976, 833 (82% of those currently farming in the area) replied. More than half were grain farmers and nearly half had never smoked cigarettes. The prevalence of chronic cough and phlegm production, wheezing and exertional dyspnea was positively related to the amount of smoking but was also higher than expected in nonsmokers. Acute dyspnea, sometimes of delayed onset and accompanied by fever, was most commonly related to handling old grain and was reported by 44% of the farmers. Current smokers were more susceptible than nonsmokers to this type of dyspnea. Farmers with history of acute dyspnea while handling grain were more likely to wear masks, but the overall rate of mask wearing, even among those at highest risk, was low.
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The relations between postoperative pulmonary complications and physiotherapy were studied in 194 patients who underwent cholecystectomy for cholelithiasis. Radiologically confirmed pulmonary disorders such as atelectasis and pneumonia developed in 42 patients. These complications occurred in the older patients in the group who had spent a longer time in hospital before operation and whose anesthesia had lasted longer. Patients receiving physiotherapy had substantially fewer pulmonary disorders.
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The processing and reprocessing of repatriated remains of military personnel in the U.S. Army Central Identification Laboratory, Thailand, were a complex set of laboratory and administrative procedures. These procedures had been standardized and systematized to comply with the requirements of the case papers generated for each set of remains examined. Supplementary osteological data, obtained during laboratory examination but not requested by the standard forms, revealed additional information that suggested that the history of the remains was somewhat different from the accounts reported in the accompanying records or in the accounts related by the former inmates of the prison camps in North Vietnam.
The lung function of 14 patients with extrinsic allergic alveolitis caused by exposure to mouldy hay (farmer's lung) or to birds (bird fancier's lung) was studied one week and four to six weeks after the last exposure to antigen. These data, together with lung mechanics measured four weeks after antigen exposure, were compared with measurements in 34 healthy non-smoking control subjects. Shortly after exposure to antigen there were reduction in lung volumes, increased elastic recoil (reduced compliance), and varied effects on expiratory flow and reduced gas transfer. With time, lung volumes and gas transfer improved, but expiratory flow often remained decreased. The data on lung mechanics showed that reduced compliance was often found, but this increased recoil did not always produce high airflow indicating increased upstream airways resistance. Patients with a longer duration of the illness tended to have increased compliance (reduced recoil) and low airflow. These results show that the described pathological changes of airway involvement, fibrosis, and emphysema in allergic alveolitis are manifest in the lung function of patients with the disease.
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Lung diseases in farmers attributable to their occupation include (a) farmer's lung, caused by exposure to mouldy hay, (b) the asthma caused by exposure to grain dust and (c) silo-filler's disease. Their prevalence in Canada is unknown. Farmer's lung results from inhalation of mould spores in hay; the mechanism is immunologic. The exact cause and mechanism of grain dust asthma are unknown but may be immunologic. Silo-filler's disease is caused by the toxic effects of inhaled nitrogen dioxide.
Six patients with extrinsic allergic alveolitis had weak immediate and strong late reactions of intracutaneous injection of bird serum. Biopsy of the late reaction revealed vasculitis and immunoglobulin and complement deposition in one. The antibody responsible for the immediate hypersensitivity could be transferred in serum. It was short lasting (4 hr) and resistant to heat and 2-mercaptoethanol. No evidence of an immediate reaction in the lungs could be detected following inhalation challenge as judged by examination of spirometry, flow volume loops and single breath nitrogen washout curves.
The smoking habits of 18 patients with extrinsic allergic alveolitis, 22 with cryptogenic fibrosing alveolitis, and 75 patients with sarcoidosis were compared with the smoking habits of the normal population of the Prairie Region for 1973. The patients were diagnosed at the same two hospitals over the four-year period November 1971--75 and were of comparable age. Non-smoking was significantly associated with allergic alveolitis in men and the three cases in women were all non-smokers. For the other two diseases, smoking habits were similar to those of the local population.
Immunological studies of forty-three patients with cystic fibrosis showed that positive prick tests to at least one common allergen were obtained in 70%, to multiple allergens in 28% and to A. fumigatus in 50%. Specific IgE antibodies against these allergens were found in the appropriate subjects. In spite of this evidence of type 1, IgE, sensitization none of the patients had a history of infantile eczema. Intracutaneous tests with A. fumigatus extract gave types 1 and 3 reactions in sixteen patients (37%), only seven of whom were among the sixteen (37%) who gave positive precipitin tests. Raised levels of total serum IgG and IgA were found as compared with healthy controls and asthmatic subjects. No differences were found in total serum IgM and IgD levels. The high incidence of allergy to A. fumigatus in cystic fibrosis is confirmed.
Using a solid-phase radioimmunoassay, serum IgE level was determined in 46 normal subjects, 53 patients with bronchial asthma, 44 patients with chronic bronchitis and / or emphysema, and 19 patients with restrictive lung disease. Sputum IgE was measured simultaneously in 51 of the subjects. The range of serum IgE concentration in the normal subjects was wide. It varied between 15 and 750 ng/ml with a mean of 135 ng. Asthmatic patients had significantly higher levels of serum IgE with a mean of 579 ng/ml, but only 30% fell outside the normal 95% confidence limits. Patients with chronic bronchitis, emphysema and restrictive lung diseases had normal IgE levels. There was a significant correlation between serum and sputum IgE levels.