Biomedical subjects
Publications and source records attributed to P Cullinan.
Random ciliary orientation has recently been proposed as a variant of primary ciliary dyskinesia. We report a 12 year old boy with all the features of primary ciliary dyskinesia and absent nasal mucociliary clearance in whom repeated biopsies of the nasal epithelium showed normal ciliary beat frequency. The only abnormality discovered was disorientation of the central microtubules of his cilia.
Occupational asthma in two women employed in the manufacture of condoms is reported. The spores of Lycopodium clavatum, used as a rubber dusting agent, were identified as the causative agent.
Fibrosing alveolitis, a condition characterized by a poor prognosis and a limited response to treatment, is readily identified by thin-section computed tomography (CT). Fibrotic and inflammatory histologic results, obtained at open lung biopsy, both have characteristic CT patterns. To evaluate whether CT could predict prognosis and response to therapy, we examined the CT appearances of 76 patients with lone cryptogenic fibrosing alveolitis and 66 patients with fibrosing alveolitis associated with systemic sclerosis. CT abnormalities were categorized as predominantly a ground-glass pattern (Grade 1), mixed (Grade 2), or predominantly a reticular pattern (Grade 3). In cryptogenic fibrosing alveolitis, 4-yr survival was highest in association with CT Grade 1 and higher with CT Grade 2 than with CT Grade 3, independent of the extent of abnormal lung on CT, duration of dyspnea, or severity of depression of DLCO or FVC, p < 0.001. A response to therapy in previously untreated cryptogenic fibrosing alveolitis was seen most frequently with CT Grade 1 and more frequently with CT Grade 2 than with CT Grade 3, p < 0.025. In systemic sclerosis, CT appearances were not predictive of 4-yr survival; a response to therapy was seen more frequently with CT Grade 2 (three of seven patients) than with CT Grade 3 (zero of six patients). These data have shown that CT appearances are of prognostic value in fibrosing alveolitis and that they are likely to play an increasing role in disease-staging in this condition.
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In order to measure the prevalence of chronic respiratory symptoms in the population and to identify subjects for a case-referent study of aetiologic factors, 10,000 persons registered with general practices in south east England were surveyed. Responses to an initial postal questionnaire were validated by telephone interview; clinical interviews and simple spirometry were subsequently carried out on a sample of persons aged 5-54 years, reporting persistent sputum production. Results indicated that the postal questionnaire was an effective and sensitive method of surveying respiratory symptoms in the population. Comparison with earlier surveys suggests that the prevalence of chronic cough and sputum in Great Britain has fallen in males but not in females. Of those adults reporting persistent sputum production, high proportions reported associated symptoms of wheezing (54%), breathlessness (45%) or upper respiratory tract symptoms (54%). Thirty percent recalled a serious respiratory infection in childhood and 52% were current cigarette smokers although 34% reported that they had never been regular smokers. Overall there was little evidence of serious airflow obstruction in this group.
For a study of fatality in pulmonary tuberculosis in England and Wales, a sample (n = 1222) of patients notified in 1983 as having tuberculosis confined to the lungs was selected and their mortality up to the time of finishing chemotherapy calculated. During that time 158 patients died, a case fatality of 12.9%. Stratification by age and radiographic extent of disease confirmed these as important predictors of death. Comparison with a referent population showed that the all cause mortality among people with pulmonary tuberculosis was 10 times greater than that of the age and sex matched general population. This ratio fell with increasing age and with extent of disease. Coefficients derived from a logistic regression analysis allowed probability of death during chemotherapy of patients with pulmonary tuberculosis to be estimated.
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BACKGROUND: The extent and nature of long term health sequelae among survivors of the Bhopal gas disaster are not known. In 1994 an International Medical Commission was set up with the aim of assessing respiratory, neurological and other health effects attributable to gas exposure. METHODS: An epidemiological survey of a representative sample of gas-exposed inhabitants of Bhopal was conducted in January 1994; for reference, a group of unexposed persons in the same city were surveyed. Questionnaires regarding health and exposure were administered to 474 persons, and a random sample (n=76) were subjected to respiratory and neurological testing. Responses to the questionnaire and the results of clinical testing were analysed according to a measure of individual gas exposure. RESULTS: A large number of subjects reported general health problems (exposed v. unexposed; 94% v. 52%) and episodes of fever (7.5/year v. 2.5/year); adverse outcome of pregnancy (e.g. still-births, 9% v. 4%) and respiratory symptoms (81% v. 38%), with a strong gradient by exposure category. This was not accounted for by differences in smoking, and was consistent with the results of spirometric testing. Neurological and psychiatric symptoms were reported more frequently by subjects in high exposure categories and the results of neurological examination and testing tended to confirm this finding. Ophthalmic symptoms demonstrated a similar pattern. Although a number of other symptoms were reported (with the possible exception of gastrointestinal disease), there was no clear evidence of other organ system damage attributable to gas exposure. CONCLUSION: The gradient of reported symptoms and clinical test results with estimates of exposure among these survivors of the gas leak suggests that a proportion of their current respiratory and neurological disease was due to gas exposure.