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Biomedical subjects

M Turner-Warwick

Publications and source records attributed to M Turner-Warwick.

At least 109 records · Page 6Linked to original sources
PubMed1981

A standardized filter paper technique for assessing nasal secretory activity.

A simple filter paper technique for estimating nasal secretory activity (NSA) was studied in 179 healthy adults. The technique was reproducible and NSA correlated independently with age and race (P less than 0.001 in each case) but not with sex or smoking habits. Subjects with a past history of atopic disease (asthma, rhinitis or eczema) produced significantly more nasal secretion than those without such a history (P less than 0.03). Among the former there was no significant difference in quantity of secretion recovered between those with and those without a past history of rhinitis. Increased NSA appears to be a marker of the atopic state and its measurement could be of value in the management of patients with allergic nasal disorders.

Adolescent↗
PubMed1981

Bronchoalveolar macrophages in sarcoidosis and cryptogenic fibrosing alveolitis.

Previous reports suggest that blood monocytes and tissue epithelioid cells in patients with sarcoidosis are "activated', but few studies have been undertaken on human alveolar macrophages. In the present study, bronchoalveolar lavage samples have been obtained from eighteen patients with sarcoidosis and these have been compared with twenty controls and twenty-nine patients with non-granulomatous chronic inflammatory interstitial lung disease (cryptogenic fibrosing alveolitis). Assessment of the functional state of the macrophages was made by measurements of C3b receptor sites on the cell membrane, intra and extracellular lysosomal enzyme (beta-D-glucosamidase) and the degree of spreading of macrophages on glass. C3b receptor sites and intracellular levels of lysosomal enzyme were significantly reduced in sarcoidosis compared to controls; levels of extracellular enzyme in the lavage supernatant fluid and macrophage spreading were similar to controls. These features suggest that alveolar macrophages from patients with sarcoidosis are not "activated'. By contrast, in cryptogenic fibrosing alveolitis, macrophages show a greater extracellular:intracellular ratio of lysosomal enzyme and more spreading, suggestive of "activation'.

Adult↗
PubMed1981

Autoantibodies in cystic fibrosis.

Autoantibodies to smooth muscle were found more frequently (21%) in the sera of patients with cystic fibrosis than in age- and sex-matched controls. This appears to be associated with liver involvement. There was no increase in the frequency of occurrence of antibodies to 'reticulin' or cell nuclei in the sera of patients with cystic fibrosis.

Adolescent↗
PubMed1981

Raised enzyme markers of chronic inflammation in asymptomatic farmers' lung.

Subclinical inflammatory activity may be one of the factors which influences the variable natural history of farmers' lung. Serum lysozyme (LYS) and angiotensin converting enzyme (ACE) have been measured in 52 farmers with a previous history of farmers' lung and in 51 healthy control farmers. The group with farmers' lung assessed during the winter, although having had no recent acute symptoms, had significantly higher levels of LYS and ACE compared to both healthy control farmers seen in winter and farmers' lung subjects seen in summer. There was a mild but significant negative correlation between LYS and farm size in the farmers' lung subjects assessed in winter. The results suggest that active inflammation may be present in subjects with farmers' lung in the absence of acute symptoms during the season when dust exposure occurs as the result of feeding cattle.

Adolescent↗
PubMed1981

Association of HLA B8 with spontaneous resolution in sarcoidosis.

HLA may influence the natural history of some diseases. HLA frequencies have been compared in 164 healthy control subjects, 50 patients with sarcoid lung fibrosis, and 37 patients with sarcoidosis that resolved spontaneously. B8 was increased significantly in the resolved group compared to both healthy control subjects (p less than 0.001) and the fibrotic group (p less than 0.01). The results support the findings of other investigators, and are consistent with the hypothesis that inherited host factors, perhaps related to immune response, influence the clinical expression of sarcoidosis.

Adult↗
PubMed1981

Recurrent chest infections, ciliary abnormalities and partial complement deficiency in a Jordanian family.

Four girls born to second cousin parents developed chronic chest infection and bronchiectasis in infancy. Three were studied in detail: they all had the same HLA haplotype, all showed random orientation of cilia or compound cilia in the respiratory tract, and all had low levels of the C1 and C2 components of the complement system. Although the cause of the respiratory disease in this family remains unclear, it is suggested that the low C1 levels may have contributed to the disease in two of the children while the low C2 levels were artefacts and the ciliary abnormalities were secondary to chronic chest infection.

Bronchiectasis↗
PubMed1981

Immunohistochemical study of collagen types in human foetal lung and fibrotic lung disease.

Highly purified type-specific anti-collagen antibodies (prepared in animals to types I, II, III, and IV bovine collagen) were used in an indirect immunofluorescence method for the study of human lung collagen. The tissue localisation of each collagen type, and the apparent type I:III collagen ratio was assessed in normal foetal and adult lung and in fibrotic lung lesions. In the latter, the relationship of the findings to the natural history of the lesion was considered. This method was compared with routine connective tissue stains. The following observations were made. (1) Foetal lung in the canalicular phase of development proved a useful substrate for validating and standardizing the procedure. (2) Collagen fluorescence was more sensitive than connective tissue stains in detecting collagen in foetal tissues and sites of early fibrosis. (3) On the basis of collagen-type fluorescence, two distinctive patterns of fibrosis were recognised. Areas of mature collagen surrounding vessels and bronchi and in established scar tissue, for example in asbestotic pleural plaques, were virtually exclusively type I collagen. By contrast, areas of early active fibrosis like sarcoid nodules and organising pneumonia, which usually contained variable numbers of fibroblasts and chronic inflammatory cells, were characterised by an increased proportion of type III collagen and a greater intensity of both types I and III collagen fluorescence. The possible significance of this change in type III:I collagen ratio is discussed. Determination of the stage of fibrotic lesions by this method might have applications in the prediction of disease progression, and influence management of some conditions.

Adult↗
PubMed1981

Cryptogenic fibrosing alveolitis. Relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis.

A minority of patients with cryptogenic fibrosing alveolitis (idiopathic pulmonary fibrosis) respond to treatment with corticosteroids. The purpose of this study was to identify factors other than histologic features that relate to responsiveness and prognosis. An analysis of 120 patients on whom data were prospectively collected is reported. The relationships between pulmonary function measurements, differential cell counts on bronchoalveolar lavage fluid, physiologic response to treatment, and survival are discussed. Patients responding to treatment with corticosteroids or immunosuppressive drugs had more severe initial impairment of the FVC (p less than 0.0001) and a more recent onset of disease (p less than 0.001). Lavage cell counts showed that increased proportions of lymphocytes were associated with responsiveness to corticosteroids and good prognosis (p less than 0.001), whereas increased eosinophils or increased neutrophils without increased lymphocytes were associated with failure to respond (p less than 0.025), and increased eosinophils were associated with a greater likelihood or progressive deterioration (p less than 0.05). Life table comparisons of survival in different groups showed improved survival in patients responding to treatment (p less than 0.05). Among nonresponders, those with more severe impairment of the FVC had shorter survival (p less than 0.05). We concluded that physiologic and bronchoalveolar lavage data allow predictions of responsiveness to treatment and prognosis that are of practical value to clinicians.

Adult↗
PubMed1981

An outbreak of Nocardia asteroides infection in a renal transplant unit.

An outbreak of Nocardia asteroides infection occurred in the nephro-urological intensive care unit, St. Peter's Group of Hospitals, London in 1979. In is suggested that the outbreak has been due to patient-to-patient transmission. Five months before the outbreak. N. asteroides was first isolated from nephrostomy urine from an asymptomatic patient who had undergone several urological operations. Subsequently six of the seven patients admitted for renal transplant over a three month period developed proven infections. The first transplant patient had an abdominal abscess and the other five had only pulmonary disease with obvious radiological lesions. Bacteriological diagnosis was made in three patients by examination of sputum and in the other three from bronchoscopic specimen, pleural fluid and pus from an abscess respectively. Five of the six renal transplant patients were treated with amoxycillin and erythromycin. Clinical and radiological improvement was observed and no patient died as a result of the infection. In the intensive care unit air and dust samplings were positive for N. Asteroides. The unit was closed and fumigated with formaldehyde and when the air sampling continued to be negative the unit was then re-opened.

Adult↗
PubMed1981

Chronic bronchial suppuration and inflammatory bowel disease.

Seven patients with severe, unexplained chronic bronchial suppuration and inflammatory bowel disease are reported. In three, rapidly progressive bronchiectasis developed within one year of procto-colectomy, in two it developed in association with an exacerbation of colitis and in the other two a milder, limited colitis post-dated the start of the lung disease. The high incidence of arthropathy and skin rashes suggests a systemic disease, and personal and family histories of auto-immune conditions were common. Antinuclear antibodies were detected in six and smooth muscle antibodies in five of the seven patients and there was no evidence of liver disease. Evidence of circulating immune complexes was found in two patients. In the four patients who received corticosteroid therapy there was an impressive improvement in cough, sputum volume and dyspnoea, especially when taking high doses. Because of the time relationships of the bowel and lung symptoms, we suggest that these disorders may be related.

Adrenal Cortex Hormones↗
PubMed1981

Evidence of increased histamine levels of lung lavage fluids from patients with cryptogenic fibrosing alveolitis.

In this study we report a significant increase in histamine in lung lavage fluids from a group of 33 patients with lone cryptogenic fibrosing alveolitis (lone CFA), and from a group of 13 patients having CFA in association with other connective tissue disorders, when compared with findings for 13 smoking patient controls without peripheral lung disease (P less than 0.001, P less than 0.05 respectively). The increases were independent of smoking or treatment. Significant correlations were obtained between the raised histamine levels in CFA and increased levels of albumin and increased counts of neutrophils and eosinophils in the lavage fluids, and with more pronounced fibrosis in CFA lung biopsies.. Thus histamine is associated with features of inflammation relating to progressive or more severe disease. No significant increase in histamine was observed in a group of 22 patients with sarcoidosis, although 21 had evidence of disease involving the lung parenchyma. There were, however, significantly higher levels in the patients with X-ray evidence of upper lobe contraction, suggestive of "fibrosis" (P less than 0.025). The levels also showed a correlation with increasing counts of lavage neutrophils (P less than 0.005), a feature also associated with X-ray evidence of contraction in this group. Mast cells were readily identified in biopsies from 12 CFA patients suggesting that these cells may provide one possible source of histamine in CFA lungs. These observations raise the question whether histamine, and/or possibly other substances derived from mast cells, plays any role in amplifying inflammation associated with pulmonary fibrosis.

Adult↗
PubMed1981

Pulmonary disorders associated with Sjögren's syndrome.

Pulmonary disease is recognized to occur as a complication of Sjögren's syndrome and we have studied 17 patients, the majority middle-aged women, with this association. Eight had sicca syndrome alone and nine had Sjören's syndrome in association with a connective tissue disease. Various pulmonary disorders were found: 10 had diseases mainly affecting pulmonary parenchyma (recurrent pneumonia, granulomatous infiltration, pseudolymphoma and fibrosing alveolitis) and six had disorders of the airways (bronchitis, bronchiectasis and asthma). One patient presented with a mediastinal immunoblastic lymphoma. To test the hypothesis that physical factors such as the retention of viscid mucus may play a part in the development of lung disease in Sjögren's syndrome, we have measured mucociliary clearance in patients with Sjögren's syndrome using 99Tc-labelled polystyrene particles. The mucociliary clearance rate was found to be normal from central airways and the whole lung clearance rate was significantly increased in Sjögren's syndrome compared with normal controls. The latter was attributed to the failure of penetrance of the radioaerosol into the periphery of the lung consistent with obstruction of small airways in Sjögren's syndrome. The patients with Sjögen's syndrome and lung disease were characterized by a number of immunological markers irrespective of the presence or type of associated connective tissue disorder. The commonest found were speckled antinuclear antibody by indirect immunofluorescence, antibodies to the acidic nuclear antigen B by counterimmunoelectrophoresis, increased serum DNA binding, increased levels of circulating immunoglubulins, rheumatoid factor in high titre and circulating soluble immune complexes as detected by Clq binding assay.

Adult↗
PubMed1980

Clinical practice with regard to management of the adult asthmatic with cromoglycate.

An open clinical long-term trial of cromoglycate (DSCG) involving 80 asthmatics over a period of more than one year showed significant effectiveness of DSCG compared with placebo. It was possible to improve the quality of life for asthmatics and reduce the oral steroids; it was also noted that the patients undergoing DSCG treatment needed less bronchodilator than the placebo group. The strict prescription of 4 inhalations per day was not ordered. Instead, half of the patients in the trial inhaled as regularly as possible and the other half when they felt that it was necessary. The results obtained were as good as those following a strict prescription. In general, extrinsic allergic asthma reacted better to DSCG than intrinsic asthma. What is recommendable above all is to prescribe DSCG prophylactically in pollen asthma during the critical months. Expected allergenic contact or exercise, which usually leads to onset of asthma, are also optimal indications for prophylactic use of DSCG. Failures of DSCG have been unjustly publicized, e.g. when asthma suddenly worsens. With the introduction of beclomethasone the standards of well-being of asthma patients have risen, producing the unjust impression that DSCG therapy helps less dramatically than ten years ago. Too often the well-established specific desensitization is regarded as sufficient in the treatment of asthma.

Adult↗
PubMed1980

Skin tests with tuberculin (PPD) Candida albicans and Trichophyton spp. in cryptogenic fibrosing alveolitis and asbestos related lung disease.

Delayed skin hypersensitivity responses were elicited in patients with cryptogenic fibrosing alveolitis (CFA) (twenty-eight), asbestosis (eight), mesothelioma (eight) and a "control" group, having miscellaneous lung diseases not normally believed to be associated with T cell deficiency (twenty). Three antigens, Candida albicans, trichophyton and purified protein derivative (PPD) in a range of doses were used. There was no evidence of impaired cellular immunity in CFA or in mesothelioma, indeed there was a significantly increased frequency of reactions to PPD in both of these conditions (P less than 0.05 and P less than 0.01 respectively). There was, however, a trend of decreased responsiveness in the group with asbestosis. The dosage regimen used rarely gave completely negative results (only one of thirty-two completed tests), and may provide a basis for a simple and standard regimen for screening patients suspected of having defective T cell responses.

Adolescent↗