Morphometric studies on the pathology of chronic airways obstruction

Scott, Kenneth W. M (1977) Morphometric studies on the pathology of chronic airways obstruction. MD thesis, University of Glasgow.

Abstract

The work submitted in this thesis consists of seven individual and inter-related studies, all of which are concerned with aspects of the pathology of chronic airways obstruction. This is a disease complex made up of pulmonary emphysema, chronic bronchitis and bronchiolitis. In all the studies quantitation of the extent and severity of the disease processes was carried out. In the first study the incidence of pulmonary emphysema was established in a series of 50 autopsies on men, performed in a general hospital in Glasgow. Emphysema was present in more than trace amounts in 32 lungs (64%). Centrilobular emphysema was the commonest variety found, being the only or predominant type present in 17 lungs (34%), panlobular emphysema was the only or predominant type in 5 lungs (10%) and in 15 lungs (30%) significant amounts of both centrilobular and panlobular emphysema were present. These results were compared to the published incidences of emphysema in other British industrial centres. Secondly the incidence of bronchial mucous gland hypertrophy, consistent with chronic bronchitis, was ascertained in 359 consecutive autopsies performed in the same Glasgow hospital. Hypertrophy of the bronchial mucous glands was measured by two techniques which showed good correlation. Using the Reid Index 31 per cent of bronchi showed mucous gland hypertrophy in the chronic bronchitis range as compared to 33 per cent by a point counting technique. Changes of this degree were commoner in men than women, but were not related to age or smoking habits. The mean Reid Index was significantly greater in smokers (0.46 +/- 0.11) than non-smokers (0.41+/- 0.09) and there was a significant relationship between the presence of a chronic productive cough during life and the size of the bronchial mucous glands at autopsy. The third paper involved a comparison of the changes in the lungs and heart of patients dying from chronic airways obstruction and those with non-fatal chest disease. A series of 50 autopsies was performed in Sheffield, to determine the size of the right ventricle, the amount, type and distribution of emphysema, the size of the bronchial mucous glands and the proportion of the lung occupied by the lumen of small airways of less than 2 mm. in diameter. Eighteen patients died as a result of chronic airways obstruction, 17 had symptoms of chest disease but died from some unrelated cause and 15 had no symptoms related to the respiratory system. A positive correlation was found between the total amount of emphysema, the amount of panlobular emphysema, the reduction in small airways lumen and both the clinical severity of disease and the weight of the right ventricle. No relationship was found between clinical severity and the amount of centrilobular emphysema or the bronchial mucous gland size. The fourth project was concerned with the changes in the pulmonary arterioles in the same 50 cases. The number of thick-walled peripheral lung vessels (defined as vessels less than 100 u in diameter, which had two distinct elastic laminae) was calculated in all the cases. The mean number of these vessels was found to be significantly greater both in the fatal disease group, as compared to both other groups, and in cases with right ventricular hypertrophy as compared to those with normal hearts. Significant correlations were found between the number of thick-walled vessels and the right ventricular weight, the total amount of emphysema, the amounts of centrilobular and panlobular emphysema and the proportion of the lung occupied by the lumen of small airways. The fifth study involved the examination of small airway changes in chronic airways obstruction by a radiographic method. (Abstract shortened by ProQuest.).

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Additional Information: Adviser: G H Roberts
• Keywords: Medicine, Pathology
• Date of Award: 1977
• Depositing User: Enlighten Team
• Unique ID: glathesis:1977-72647
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 11 Jun 2019 11:06
• Last Modified: 11 Jun 2019 11:06
• URI: https://theses.gla.ac.uk/id/eprint/72647