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Biomedical subjects

A J Fox

Publications and source records attributed to A J Fox.

At least 181 records · Page 10Linked to original sources
PubMed1989

Parental age and motor neuron disease.

A case-control approach was used to study the relationship between parental age and motor neuron disease (MND) in a nationally representative sample of men. [The method, involving a search for parents' records in the NHS Central Register, is new and may be of interest in other conditions where parental age is thought to play a part.] The parents of men who died of MND in 1979 were not older than the parents of sex, age and regionally standardised controls who died in the same year.

Adult↗
PubMed1989

Regrowth of aneurysm sacs from residual neck following aneurysm clipping.

It is recognized that incomplete treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. For this reason, patients treated at the authors' institution in whom a large portion of the aneurysm neck or sac remained after application of a clip or ligature have been subjected to reoperation. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of aneurysms recurring from a narrow residual neck after clipping have been reported, and a few instances of recurrent aneurysm have been described after apparently complete occlusion of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm occlusion and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons.

Adolescent↗
PubMed1989

Longitudinal studies based on vital registration records.

We describe here the increased use of routine vital event and census records to construct national follow-up and longitudinal studies. The strengths and weaknesses of these studies are discussed and examples given of their use in research into relationships between employment and mortality and socio-economic differences in mortality.

Demography↗
PubMed1988

Longitudinal insights into the ageing population.

In several countries the fraction of the population who are very old is increasing dramatically. Interest in this phenomenon in part reflects concern about the burdens this section of the community will place on younger people. Views of the elderly are generally based on cross-sectional data on generations who 'aged' in quite different circumstances to those who will be old in 20 or 40 years time. This paper describes recent findings relevant to the changing experiences of older men and women during the 1970s and early 1980s from the Office of Population Censuses and Surveys Longitudinal Study. This is a new source which enables researchers to study the sociodemographic histories of a representative sample of the population of England and Wales. The period after retirement from formal employment is one which sees men and women experience more changes to their domestic circumstances than is commonly appreciated. Many of these changes are related to earlier socioeconomic circumstances which also influence people's abilities to cope with change and their need for support.

Aged↗
PubMed1988

Indications for treatment and classification of 132 carotid-cavernous fistulas.

Classification of carotid-cavernous fistulas (CCFs) into the four types described by Barrow allows the surgeon to choose the optimal therapy for each patient. Type A patients have fast flow fistulas that are manifest by a direct connection between the internal carotid arterial siphon and the cavernous sinus through a single tear in the arterial wall. The best therapy is obliteration of the connection by a detachable balloon. Ninety-two of 95 traumatic CCFs were treated in this fashion. Direct surgical exposure of the cervical or cavernous internal carotid artery (ICA) was necessary in the remaining 3 patients, who had undergone unsuccessful surgical trapping. Three ruptured cavernous aneurysms and 2 spontaneous CCFs also had Type A connections. Other carotid-cavernous fistulas are slow flow, spontaneous dural arteriovenous malformations (AVMs) that have been classified into B, C, and D types on the basis of arterial supply. Occlusion of the ICA is not a logical choice in the treatment of dural AVMs that occur in the elderly, are relatively benign, and are often bilateral. Type B are rare and are fed by meningeal branches of the ICA only. We have not seen this type of dural fistula in our series. Type C are supplied by feeders from the external carotid only and can almost always be obliterated successfully by embolizing the external carotid artery (ECA) branches. There are 4 Type C cases in this series of 37 spontaneous CCFs. All occurred in patients less than 30 years of age and were shunts between the middle meningeal artery and the cavernous sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Unemployment and mortality: comparison of the 1971 and 1981 longitudinal study census samples.

Mortality in the period 1981-3 among men in the Office of Population Censuses and Surveys longitudinal study who were seeking work in 1981 was examined to investigate whether the finding of a high mortality rate among a comparable group of men who were followed up from the 1971 Census was repeated despite appreciable changes in the size and structure of the labour force over the intervening years. The pattern of mortality shortly after both censuses suggests that sick unemployed men were not categorised as seeking work, and it is concluded that for both samples the mortality of those who were reported to be seeking work was raised for reasons other than initial poor health. Other findings from the two censuses are also broadly similar. If confirmed after longer follow up this will add considerably to the evidence of the adverse health consequences of unemployment.

Adolescent↗
PubMed1987

Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis).

As part of a prospective clinicopathologic study, a cohort of 105 "normal" elderly volunteers was investigated with computed tomographic scans, psychometric testing (Extended Scale for Dementia [ESD]) and neurologic examination. Computed tomographic scans were evaluated for the presence or absence of white matter lucencies, termed leuko-araiosis. These are defined as patchy or diffuse areas of decreased attenuation involving only white matter and with no change in adjacent ventricles or sulci. The nine controls with leuko-araiosis had lower scores on the ESD than the 96 controls without leuko-araiosis (mean ESD with leuko-araiosis, 227.1 +/- 14; without leuko-araiosis, 237.1 +/- 8), and the difference remains significant even after adjusting for the possible confounding effects of age, sex, education, and infarct detected on computed tomography. Significant differences were also found comparing subjects with leuko-araiosis and those without in respect to abnormal gait, limb power, plantar response, and the rooting and palmomental reflexes. Leuko-araiosis may represent a marker for early dementia. The pathophysiology of this finding remains uncertain. Our results suggest that white matter abnormalities play a role in the development of intellectual impairment in the elderly.

Aged↗
PubMed1987

Cognitive and neurologic findings in demented patients with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis).

A series of patients referred to the University of Western Ontario, London, Dementia Study for investigation of possible dementia underwent computed tomographic scans, psychometric testing (Extended Scale for Dementia [ESD]), and neurologic examination. Thirty-nine of the 113 patients studied (ischemic score, less than or equal to 4) were found to have leuko-araiosis, which we have defined as patchy or diffuse lucencies in the white matter. Patients with leuko-araiosis had significantly lower mean scores on the ESD, 109.7 +/- 61.2, compared with mean scores of 148.5 +/- 78.0 in those without. However, only a trend toward lower scores on the ESD was observed when age, sex, education, and infarct were taken into account in the analysis of covariance. Leuko-araiosis was found to be associated with increasing age, hypertension, abnormalities of power in the limbs, and extensor-plantar responses in this sample of patients. In patients with Alzheimer's disease (AD) alone, diagnosed clinically, 29 out of 91 demonstrated leuko-araiosis on computed tomography, but scores on the ESD in this group overall were not significantly different when those with and without leuko-araiosis were compared. In less advanced cases, however, a highly significant trend was evident for leuko-araiosis to be associated with increased dementia in AD. The results are consistent with the hypothesis that leuko-araiosis is associated with dementia in AD, and that this is either most marked or most easily identifiable before the dementia becomes very severe.

Aged↗
PubMed1987

Comparison of dot-blot DNA hybridisation and immediate early nuclear antigen production in cell culture for the rapid detection of human cytomegalovirus in urine.

The sensitivity and specificity of four modes of two assays, immediate early nuclear antigen detection in cell culture (IENAD) at 24 and 48 h post-infection (p.i.) by immunofluorescence using a murine monoclonal antibody, and dot-blot DNA hybridisation with overnight or prolonged autoradiography using the 32P-labelled HindIII J fragment of human cytomegalovirus (HCMV) DNA as probe, were compared for the rapid detection of HCMV in urine. The sensitivity of IENAD was enhanced by low-speed centrifugation at the time of inoculation. DNA hybridisation with overnight autoradiography was significantly less sensitive than IENAD at 24 h p.i. (P less than 0.001), and even with prolonged autoradiography the hybridisation assay was slower and significantly less sensitive than IENAD at 48 h p.i. (P less than 0.02). The specificity of the two assays was virtually 100%. The sensitivity of DNA hybridisation was thus clearly inferior to that of IENAD.

Antigens, Surface↗
PubMed1987

Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms.

Of 68 patients with unclippable aneurysms treated by proximal artery occlusion with detachable balloons, permanent occlusion was achieved in 65; of these patients, 37 had carotid artery aneurysms below the origin of the ophthalmic artery, 21 had aneurysms arising from the supraclinoid portion of the carotid artery, six had basilar trunk aneurysms, and one had a distal vertebral aneurysm. Examination for treatment selection included assessment of the circle of Willis by compression angiography and xenon blood flow studies, with the ultimate evaluation being test occlusion under systemic heparinization with the balloon temporarily placed in the desired position. Of 67 patients who underwent a formal occlusion test, eight with carotid artery aneurysms did not initially tolerate the occlusion test, and ischemic signs disappeared instantaneously with deflation and removal of the balloon. During test occlusion, two additional patients had ischemic events that proved to be embolic; these reversed immediately upon balloon deflation. Of the 65 patients in whom permanent occlusion was effected by detachable balloon, there were nine instances of delayed cerebral events. One of these was a seizure leading to respiratory arrest and resuscitation 3 days following occlusion in a patient who had presented with seizures. The other eight cases were delayed ischemic events; seven were completely reversed and one patient had residual weakness in one leg (1.5% permanent morbidity). Extracranial-intracranial bypass procedures were performed in 25 of the 65 cases. All aneurysms of the carotid artery below the level of the ophthalmic artery presented angiographic proof of complete thrombosis. Ten of 21 aneurysms arising from the supraclinoid portion of the carotid artery were completely thrombosed by proximal occlusion alone, without additional trapping procedures. Similarly, in three of six basilar trunk aneurysms, proximal occlusion alone initiated complete aneurysm thrombosis without trapping. The conclusion is that proximal balloon occlusion for unclippable cerebral aneurysms is a convenient, safe, and effective way of producing arterial occlusion in these cases.

Carotid Artery Diseases↗
PubMed1987

Giant intracranial varices secondary to high-flow arteriovenous fistulae.

An intracranial varix is rare and has been associated mostly with vein of Galen fistulae or arteriovenous (AV) malformations. The authors present eight cases of intracranial, pial or subpial AV fistulae with concomitant giant varices. Six were supratentorial and two were infratentorial. Only one case involved the vein of Galen. In six cases successful surgical and/or endovascular occlusion of the intracranial AV fistula was obtained, and one case was treated conservatively. Staging of surgery and postoperative hypotension were considered to be important in avoiding edema and hemorrhage following obliteration of a large AV shunt. One patient died from delayed postoperative intracerebral bleeding.

Adolescent↗
PubMed1987

Socio-demographic mortality differentials: new longitudinal perspectives.

Recently collected data deriving from Census and vital registration records for one per cent of the population of England and Wales followed prospectively is being used to shed light on issues which have been of central interest to epidemiologists for more than a century. This paper outlines the strengths and weaknesses of this new longitudinal approach.

England↗
PubMed1986

Cardiac and arterial lesions in carotid transient ischemic attacks.

Two hundred fifty consecutive patients with carotid transient ischemic attacks (TIAs) and no previous stroke were assessed with cerebral angiography (95%), two-dimensional echocardiography (86%), electrocardiography (100%), and Holter monitoring (99 selected patients). Angiography disclosed a lesion appropriate to the TIAs in 84%. Lesions also occurred in the asymptomatic carotid artery, but stenosis of more than 75% of the lumen diameter and ulcers were significantly more frequent on the symptomatic side. Twenty-three percent of the patients had a potential source of emboli from the heart, usually in the context of symptomatic heart disease. Among the 205 patients who underwent full angiographic and cardiac investigations, 6% had an isolated potential cardiac source of emboli and 19% had a potential cardiac source of emboli associated with appropriate carotid disease. The search for a potential cardiac source of emboli is strongly indicated in patients with carotid TIAs and known heart disease. In the patients with no history of heart disease, the yield of this search is low, but our results suggest that at least 14 of such patients have an undetected potential cardiac source of emboli. Cardiac and arterial lesions commonly coexist in carotid TIAs.

Adult↗