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Biomedical subjects

M Turner-Warwick

Publications and source records attributed to M Turner-Warwick.

At least 73 records · Page 4Linked to original sources
PubMed1984

Circulating beta-adrenoceptor blocking factors in asthma.

The hypothesis that a generalized defect in beta-adrenoceptor function characterized asthma and atopy has been proposed by Szentivanyi. Such a defect may be intrinsic to the beta-adrenoceptor mechanism or could be attributed to circulating factors which interfere with the binding of catecholamines to beta-adrenoceptors. This study shows that sera from a proportion of the asthmatic population studied contain beta-adrenoceptor blocking activity and that the degree of inhibition correlates with some of the clinical indices of asthma.

Adrenal Cortex Hormones↗
PubMed1984

Persisting airflow limitation in asthmatics receiving routine self-adjusted medication.

Sixty-two patients with moderate asthma adjusted their routine medication (bronchodilator aerosol 59/62, beclomethasone dipropionate 55/62) to control their symptoms to their own and their doctor's satisfaction. They recorded peak expiratory flow (PEF) 3 times daily over about 8 months. PEF and spirometry were performed before and after aerosolised salbutamol on hospital attendances at monthly intervals. The subjects were classified as having Persistent Airflow Limitation (PAL) if every measurement, including that following a bronchodilator, persistently failed to reach a value of at least the predicted minus 2 SD. PAL was present in 7/62 by using FEV1 and in 27/62 using PEF. PAL was related to patient's age (p less than 0.02) and to duration of asthma (p less than 0.02). Flow-volume curves (available in 46/62 patients) correlated closely with PEF recorded at home on the same morning. Maximum expiratory flows at 50% and 25% of FVC were significantly lower in patients with PAL (assessed by PEF) than in those without PAL, suggesting more severe small airways dysfunction in those with PAL.

Adult↗
PubMed1984

Malignant mesothelioma of the pleura: clinical aspects and symptomatic treatment.

A series of 140 patients with malignant pleural mesothelioma is reported. Clinical presentation was delayed in cases without a large effusion, but there was extensive tumour at presentation, shown by thoracoscopy, thoracotomy or computed tomography, in all patients investigated. Thoracoscopy was a useful diagnostic alternative to thoracotomy. With progression of disease, mesothelial extension was more important than distant metastases, which were usually too small and sparse to produce symptoms. Skin deposits of tumour in sites of previous invasive procedures did not cause pain or other clinical problems, and we consider that diagnostic and therapeutic procedures should not be withheld to avoid them. In the management of recurrent pleural effusions, intrapleural bleomycin, preceded by aspiration and followed by suction, was a useful alternative to surgery. Pneumothorax, spontaneous or iatrogenic, required decortication. Adequate pain relief was difficult; radiotherapy and nerve blocking procedures were not effective and opiates were often necessary.

Adult↗
PubMed1984

Inhaled lactose-free sodium cromoglycate powder in the treatment of recurrent asthma.

Sodium cromoglycate is widely used in many countries as a first-line drug in the prevention of bronchial asthma, but in others, particularly the United States, there are doubts about its role. It has been suggested that the lactose, which was used as a carrier substance in the earlier preparation, might have contributed to the apparent efficacy of the drug. In view of this a double-blind controlled trial comparing inhaled lactose-free sodium cromoglycate powder (C) with placebo (P) has been undertaken in patients with chronic asthma not adequately controlled by bronchodilators. Thirty adult patients (15 C, 15 P) with demonstrable reversibility of their airflow obstruction of at least 20% and who were not taking corticosteroids or sodium cromoglycate were admitted to the study. The C patients had, on average, more severe asthma in the 4-week pretrial assessment period and were taking more bronchodilators. After 12 weeks on trial therapy the results for the C group were significantly better than for the P group in terms of changes in symptom scores, the amount of inhaled bronchodilator used and morning and evening peak flow rates. There was already evidence of greater improvement in the C group by 4 weeks. These results indicate that in this group of atopic patients with frequent asthma symptoms despite bronchodilator therapy, inhaled lactose-free sodium cromoglycate powder provided improved control of asthma symptoms.

Adolescent↗
PubMed1984

Digital vasculitis in patients with cryptogenic fibrosing alveolitis.

Twelve patients are described with features of cryptogenic fibrosing alveolitis (CFA) with associated florid digital vasculitis (DV). Nine patients had features of various 'connective tissue disorders' involving systems other than the lung, but three had no such features. The immunological features of these patients with DV have been compared with a group of 17 patients who had CFA alone ('lone CFA') and in whom the same range of special laboratory tests were being undertaken concurrently. The group with DV had a higher erythrocyte sedimentation rate and a higher serum IgM, but the most interesting immunological distinction was an increased prevalence of antinuclear antibodies with a nucleolar staining pattern. In addition, the group with DV also had a greater prevalence of single stranded DNA antibodies and of smooth muscle autoantibodies. Circulating immune complexes were not detected more frequently in the group with vasculitis. Ten of the 12 patients were initially treated with corticosteroids and neither the vasculitis nor the lungs improved. In eight the incapacitating DV responded to immunosuppressants (four) or penicillamine (four). In three of these eight patients the lungs also improved.

Adult↗
PubMed1983

Histocompatibility antigens in coal miners with pneumoconiosis.

Twenty-five histocompatibility antigens have been measured in 100 coal miners with pneumoconiosis attending a pneumoconiosis medical panel and the results compared with a panel of 200 normal volunteers not exposed to dust. Chest radiographs were read independently by three readers according to the ILO U/C classification. On a combined score, 40 men were thought to have simple pneumoconiosis and 60 men complicated pneumoconiosis. The number of antigens tested and associations between antigens caused difficulties in assessing the statistical significance of differences in prevalence of antigens between groups of men. Using stringent criteria for statistical significance, no significant differences were found in antigen prevalences between miners and controls, or miners with simple or complicated pneumoconiosis. When a less stringent statistical approach was applied, three antigens appeared to have abnormal prevalences in these 100 miners by comparison with the normal volunteers. More detailed examination of these antigen prevalences in relation to radiographic category of pneumoconiosis did not provide any supportive evidence that these slight associations were of statistical or clinical significance. Reports on histocompatibility antigens in miners with pneumoconiosis are reviewed briefly and the results compared. There is no good evidence that any of the histocompatibility antigens so far tested are associated with a clinically important altered risk of simple or complicated pneumoconiosis when dust is inhaled.

Aged↗
PubMed1983

The significance of antinuclear and DNA antibodies in cryptogenic fibrosing alveolitis.

The roles of antinuclear and DNA antibodies in the pathogenesis of cryptogenic fibrosing alveolitis were investigated in 53 patients. Twenty-two patients who had antinuclear antibodies detected in their serum had a significantly higher proportion of women, a higher prevalence of Raynaud phenomenon and digital vasculitis, and higher erythrocyte sedimentation rates, paralleled by raised serum globulin and IgG levels, than patients with no antinuclear antibodies detected. Serum antibodies to double-strand DNA (DS-DNA), assayed by a Farr binding technique, were significantly raised in 25% of patients with cryptogenic fibrosing alveolitis. Serum binding of single-strand DNA (SS-DNA) was greatly increased in all the patients with cryptogenic fibrosing alveolitis, achieving levels similar to those found in systemic lupus erythematosus. Serum DS-DNA binding correlated with IgA levels but not with disease activity. Thus, unlike in systemic lupus erythematosus, antibodies to DS-DNA and SS-DNA with their capacity to form immune complexes are unlikely to be of major importance in the pathogenesis of cryptogenic fibrosing alveolitis.

Adolescent↗
PubMed1983

Effect of naloxone on circadian rhythms in lung function.

To determine whether the endogenous opioid peptides play a part in the pathogenesis of asthmatic morning dipping, six patients with chronic asthma with a reproducible peak flow pattern of morning dipping were investigated in a double blind, randomised, crossover study of naloxone versus placebo. Naloxone was given as a loading dose of 8 mg followed by a continuous infusion of 5.6 mg/h from midnight until 10 am on two consecutive nights. Naloxone had no significant effect on PEFR, FEV1, or FVC at 6 am. There was, however, an improvement over placebo values in all these indices between the hours of 8 am and 8 pm on the day after the first naloxone infusion in all six patients. This effect was not observed after the second naloxone infusion.

Adolescent↗
PubMed1983

Cryptogenic fibrosing alveolitis: prediction of fibrogenic activity from immunohistochemical studies of collagen types in lung biopsy specimens.

Collagen immunofluorescence studies were performed on biopsy specimens from 25 patients with cryptogenic fibrosing alveolitis. We studied the relationship of these results to the clinical, radiological, and physiological assessments of disease activity during six-month periods before and after the lung biopsy; to the appearances on routine histological examination; to the inflammatory cell proportions in bronchoalveolar lavage fluid; and to the response to treatment. Positive associations were observed between the presence of type III collagen and disease activity before (p less than 0.015) and after (p less than 0.02) lung biopsy. These were independent of clinical and routine histological features. The type-III-positive group also contained nine of the 11 responding to treatment. None of the type-III-positive patients had a quiescent or stable course. In contrast, most patients with no type-III-collagen fluorescence had a stable course over the time of this study and did not improve on treatment. It is suggested that collagen typing may be an additional useful method of assessing potentially reversible disease in cryptogenic fibrosing alveolitis.

Adult↗
PubMed1983

Bromocriptine in severe adult asthma--a negative report.

A pilot study had suggested that bromocriptine (a dopamine agonist) might be of benefit in severe asthma, particularly in patients with marked diurnal variation in peak flow. Two studies are reported: (1) a longterm double-blind, controlled trial comparing bromocriptine (B) with placebo (P) in patients with severe asthma and, (2) a withdrawal study in patients who had received known bromocriptine, with apparent benefit, for at least one year. Of 27 patients (16B, 11P) admitted to the double-blind trial only eight (4B, 4P) completed 52 weeks on the trial drug as nine (6B, 3P) had been withdrawn for side-effects, eight (4B, 4P) for failure and two (2B) for both reasons. The results, based on changes in steroid dosage and other medication, daily symptom scores and PEF values, suggest that bromocriptine has little effect in asthma. In addition side-effects were frequent and troublesome. In the withdrawal study, ten patients who had been taking bromocriptine for a year or more were switched to an indistinguishable placebo if their asthma was considered to be stable. The results, of this second study, support the conclusion of the double-blind study, that bromocriptine has little beneficial effect in asthma.

Adult↗
PubMed1983

Slow release theophylline in patients with airways obstruction with particular reference to the effects of food upon serum levels.

Eighteen patients with airways obstruction were given slow release theophylline and were then investigated to determine the influence of a standard meal upon the serum levels achieved over the ensuing 12-hour period. After food the peak to trough differences were decreased and the serum levels were significantly lower over the first 6 hours. In this study, the patients were given 10 mg/kg/day of slow release theophylline and none subsequently was found to have toxic levels, therefore this was considered to be a reasonable dose with which to initiate therapy in adults with uncomplicated airflow limitation. However even under the strictly controlled conditions of the study there were wide variations between individuals in the blood levels achieved and serum monitoring is necessary to use theophylline in an optimal fashion.

Adult↗
PubMed1983

Red cell folate levels, food antibodies and reticulin antibodies in farmer's lung--is there an association with coeliac disease?

Indirect evidence of enteropathy has been sought in a group of 57 subjects with farmer's lung (FL) by clinical questionnaire, estimation of red cell folate levels, the presence of precipitating antibodies to various food antigens and detection of reticulin antibodies. One subject was found who had villous atrophy and responded clinically to gluten withdrawal. There were two subjects with low red cell folate levels and multiple food antibodies, and one subject with reticulin antibodies and multiple food antibodies. Enteropathy is infrequent in subjects diagnosed clinically as having farmer's lung but seems to be more common than would be expected by chance. The mechanism has yet to be elucidated.

Adolescent↗
PubMed1983

Ultrastructural changes in bronchoalveolar lavage cells in sarcoidosis and comparison with the tissue granuloma.

The authors undertook this study to determine whether there were any morphologic changes in bronchoalveolar lavage lymphocytes and macrophages in sarcoidosis and, in particular, to determine whether changes described previously in the mononuclear phagocytes of sarcoid granulomas were also evident in such cells obtained by lavage. Lavage cells from 28 sarcoidosis patients were studied by transmission electron microscopy and compared with lavage cells from 17 control subjects and with lung tissue granulomas from 5 sarcoidosis patients. Interactions between mononuclear phagocytes, especially subplasmalemmal linear densities, and between these cells and lymphocytes were observed in both the tissue granulomas and lavage specimens from sarcoidosis patients. Subplasmalemmal linear densities were never observed in control lavage specimens. Fully developed epitheloid cells were not identified in lavage specimens, but differences were nevertheless found between the lavage cells from sarcoidosis patients and control subjects: in particular, alveolar macrophages in sarcoidosis were larger and showed better developed pseudopodia, more marked polarity, less nuclear heterochromatin, and lysosomes that were larger and more numerous but less electron-dense than normal. Lymphocytes were also enlarged and contained more lysosomes. It is concluded that although there are only a few similarities between the cells of the granuloma and those obtained by bronchoalveolar lavage in sarcoidosis, there are noticeable differences between the lavage cells of sarcoidosis patients and control subjects. In sarcoidosis, a variable proportion (10-70%) of the lavage cells show morphologic features of "activation."

Adult↗