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Biomedical subjects

P Hugh-Jones

Publications and source records attributed to P Hugh-Jones.

At least 19 recordsLinked to original sources

Chronic cardiac toxicity after inhalation of 1,1,1-trichloroethane.

Two patients showed evidence of chronic cardiac toxicity after repeated exposure to 1,1,1-trichloroethane. In both cases there was circumstantial evidence of a deterioration after routine anaesthetic use of the related compound halothane. An adolescent boy who sniffed trichloroethane presented with multiple ventricular arrhythmias during tonsillectomy. Follow up showed mild chronic left ventricular impairment. A 54 year old man had repeated industrial exposure to trichloroethane and deteriorated from mild stable cardiac failure to end stage cardiac failure after halothane anaesthesia for herniorrhaphy. Chronic cardiac toxicity is a previously unreported feature of this type of solvent exposure. Related compounds such as halothane may have a toxic interaction after exposure to trichloroethane.

Adolescent

Laser photodynamic therapy for inoperable bronchogenic squamous carcinoma.

Fifteen consecutive patients with advanced squamous bronchogenic carcinoma, most of whom had had radiotherapy, were given palliative photodynamic therapy, using either haematoporphyrin derivative or dihaematoporphyrin ether to light sensitize their tumour. All tumours responded to treatment by subsequent light at 630 nm and in the 12 patients where adequate tumour illumination was achieved there was complete clearing of the bronchus in three and partial (more than 50 per cent clearing) in the remaining nine, with relief of haemoptysis and/or breathing obstruction. One patient with recurrent tumour in a pneumonectomy stump after radiotherapy has remained disease-free for over two years since photodynamic therapy. The main complications were temporary skin light sensitization reaction in three, infection after reaeration of lung tissue in two, and transient but severe worsening of breathing obstruction in two.

Aged

Long term changes in lung function after surgical treatment of bullous emphysema in smokers and ex-smokers.

Eleven patients who had received surgical treatment for bullous emphysema had regular assessment of lung function for a minimum of four years (mean 8.8, range 4-20 years). For each patient we estimated the annual rate of change in FEV1 and "relaxed" vital capacity (before and after bronchodilator aerosol) and in carbon monoxide transfer factor (TLCO), transfer coefficient (KCO), and arterial carbon dioxide and oxygen tensions (Paco2 and Pao2). Among the 11 who had undergone operation, all lung function variables declined at a faster rate in those who continued to smoke than in ex-smokers, the difference in rate being significant (p less than 0.05) for FEV1 (before bronchodilator), TLCO and KCO. In ex-smokers the rate of change in most lung function indices was not significantly different from zero--that is, no change; in smokers all lung function indices except Paco2 declined at a rate significantly greater than zero. These findings suggest that long term results of surgical treatment for bullous emphysema are likely to be greatly improved if patients abandon smoking.

Adult

Dead space and tidal volume of the giraffe compared with some other mammals.

The ventilation, tidal volume and anatomical dead-space were measured in a living giraffe and compared with similar measurements in a camel, red deer, llama and man. The giraffe had a resting tidal volume of about 3.3 litres with a dead-space/tidal-volume ratio of 0.34. The giraffe breathes slowly, apparently because of the unusually small diameter of its trachea relative to its length, compared with known measurement in other mammals.

Animals

Tetracosactrin for the management of asthmatic patients after long-term corticosteroids.

Thirty-five of 41 asthmatic patients, who had been taking oral corticosteroids regularly for between one and 12 years, recovered their adrenal function after courses of depot tetracosactrin, even those with apparently complete adrenal suppression. They all showed benefit by transfer to depot tetracosactrin, though steroid withdrawal symptoms could be troublesome. Skin pigmentation in three, and two severe reactions to tetracosactrin were encountered. We believe that it is advisable to give depot tetracosactrin when converting severe asthmatics to the use of beclomethasone dipropionate aerosols who have previously been treated by long-term steroids with consequent adrenal suppression.

Adolescent

Emphysema.

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Pulmonary Emphysema

Deaths from asthma.

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Adrenal Cortex Hormones

Distinction between infection and rejection in lung transplantation.

In distinguishing between infection and rejection after human lung transplantation clinical and radiological features were unhelpful, and even confusing. However, incipient rejection could be predicted and distinguished from infection by monitoring alterations in lymphocyte activity by the rosette inhibition test. Earlier prediction seems possible by detecting circulating lung-binding antibody. The ability to detect changes in the immunological status of a patient, even before clinical deterioration, has fundamental implications for the management of patients after transplantation.

Antigen-Antibody Reactions

Lung transplantation in a patient with fibrosing alveolitis.

The transplantation of the right lung into a man aged 40 who was suffering from cryptogenic fibrosing alveolitis is described. Before transplantation he had been dependent on oxygen, even at rest, for 24 hours a day for almost two years. The donor was a boy of 16 years who had had a fatal cerebral haemorrhage. The transplanted lung functioned perfectly from the time of operation until the patient's sudden death two months later from an overwhelming haemoptysis apparently from a small peribronchial abscess rupturing into the pulmonary artery. By the third postoperative week the patient had been able to walk unaided and without distress outdoors. The problem of differentiating infection from incipient rejection is discussed. We conclude that clinically successful lung transplantation can be achieved, but only if the problems of lung function, infection, and immunosuppression can all be overcome.

Adult

Pulmonary emphysema and alpha 1-antitrypsin deficiency.

Of 72 patients with radiological evidence of pulmonary emphysema, emphysema occurred either alone or in association with bronchitis in 61, and 8 of these (13%) were found to have alpha(1)-antitrypsin deficiency. The main features of this condition are: exertional dyspnoea of relatively early onset (generally between 30 and 45 years of age), severely impaired FEV(1) and T(L)CO, and radiological emphysema predominantly affecting the lower zones of the lungs. It is probable that any patient with all the above abnormalities has alpha(1)-antitrypsin deficiency. There is evidence to suggest that cigarette smoking may hasten the onset of this type of emphysema.

Adult