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Biomedical subjects

A J Fox

Publications and source records attributed to A J Fox.

At least 253 records · Page 14Linked to original sources

A study of the mortality of Cornish tin miners.

Increased mortality from cancer of the lung has been found in several studies of miners exposed to high levels of radioactivity in underground air. In view of their exposure to raised levels of radiation, we have studied the mortality of a group of men recorded as Cornish tin miners in 1939. Using occupational description, a crude classification of exposure was derived for these miners. The meaningfulness of this classification was supported by differences in mortality from silicosis and silicotuberculosis. A twofold excess of cancer of the lung was found for underground miners, while for other categories mortality from this cause was less than expected. This supports the findings of previous studies on exposure to radon and its daughters. An excess of cancer of the stomach was also observed among underground miners.

Adult↗

Mortality of wives of men dying with cancer of the penis.

711 women were identified who in 1939 were married to men who died with cancer of the penis in England and Wales during the period 1964 to 1973. The records of women were traced through the National Health Service Central Register and, by January 1975, 378 (53%) were found to have died. Expected numbers of deaths from all causes, all cancers and from some specific cancers were calculated assuming the women to have the same mortality rates as the general population of England and Wales. The total number of deaths (378) was close to the number expected (366-8) but there was a slight excess of deaths from cancer (89 against 76.5 expected). Of the individual sites examined only cancer of the cervix showed a statistically significant excess (11 deaths against 3.9 expected, P = 0.002). This finding is similar to those reported in two other studies of the wives of men with cancer of the penis. On the basis of these studies it is suggested that some cases of cancer of the cervix and cancer of the penis may have a common aetiology. Other epidemiological characteristics of the two diseases do not show a marked similarity.

Adult↗

Relationships between psychological measurements and cerebral organic changes in Alzheimer's disease.

Twenty-two patients were carefully defined as having progressive dementia without other known cause and not complicated by clinical or laboratory evidence of multiinfarct dementia. Their degree of dementia measured by the ESD correlated highly with EEG disturbance (r=-0.79). The LPRS correlated 0.73 with ventricular enlargement. Although the EEG and CT scan only correlated significantly with each other in advanced cases, a combined index of EEG and CT Scan change, (Physical Measures Index) achieved a correlation of 0.93 with a combined index of psychological change (Psychological Measures Index). The results indicate the possiblity of using physical and psychological measures to monitor quantitative change in Alzheimer's Disease, the EEG contributing more initially and the CT scan more in the most advanced cases.

Alzheimer Disease↗

Intrathecal metrizamide enhancement of the optic nerve sheath.

The subarachnoid space continues into the orbit as part of the optic nerve sheath. This space varies in size but is usually tiny. Occasionally, prominent (one case in our experience) enhancement of the optic nerve as part of metrizamide computed tomography (CT) cisternography is seen on transverse and coronal scans presumably because of a patulous optic subarachnoid space. In five cases, we have appreciated minimal enhancement of optic nerves with metrizamide only by close comparison of CT numbers with base-line scans. One of these patients had a tiny meningioma removed successfully from the optic sheath, with return to normal vision of a previously blind eye.

Adult↗

Successful embolization of a fistula between the ascending pharyngeal artery and internal jugular vein.

The case of a fistula between the ascending pharyngeal artery and internal jugular vein in a patient with a high jugular bulb is presented. The lesion was missed by selective internal and external carotid angiography due to technical reasons, but was well demonstrated by common carotid and subsequent superselective ascending pharyngeal angiography. A single Gelfoam embolus soaked in Pantopaque obliterated the lesion.

Arteriovenous Fistula↗

Angiography of the external carotid to internal carotid anastomosis.

The EC/IC bypass is being performed more and more, and angiography is essential as part of the postoperative evaluation. This review of 41 patients points out the need for selective external carotid angiography in those cases where intracranial vessels fill spontaneously at the same time as the shunt. However, 8 of 11 cases showed the superficial temporal artery to be larger on the selective external carotid angiogram than in the common carotid study done during the same session. In two cases undergoing staged occlusive procedures as treatment for giant aneurysm, the external carotid artery leading to an EC/IC was occluded as an angiographic complication without neurologic sequelae.

Adult↗

Occupational mortality: work or way of life?

For more than 100 years the Registrar General has reviewed mortality in depth in a series of supplements relating extra information provided by decennial censuses to deaths in a period before and after the census. The volume describing occupationl mortiality in 1970--72 was recently published (Registrar General, 1978). Here we consider in more detail one of the questions raised by occupational mortality studies: how much does mortality of an occupation group reflect work environment and how much way of life? We first describe the traditional method of distinguishing these direct and indirect influences (that is, the comparison of the mortality of men following an occupation with that of their wives) and then introduce an alternative which we call 'social class standardisation'.

Adolescent↗

Mortality experience of workers exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain.

Identification particulars were obtained for over 7000 men who were at some time between 1940 and 1974 exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride. Approximately 99% of these men have been traced and their mortality experience studied. The overall standardised mortality ratio, 75-4, shows a significant reduction compared with the national rates. Four cases of liver cancer were found. Two of these have been confirmed by a panel of liver pathologists as angiosarcoma and two as not angiosarcoma. There is no evidence to support the hypothesis that cancers other than those of the liver are associated with exposure to vinyl chloride monomer. The two cases of angiosarcoma were found in men who had been exposed to high concentrations of the monomer although the second man died only eight years after first exposure. The industry in Great Britain has expanded considerably since the second world war with over 50% of men having entered with the last decade. Conclusions drawn about the effect of vinyl chloride monomer on the mortality experience of men in this industry must consequently be tempered by the reservation that the full impact may not yet be in evidence.

Chemical Industry↗

Bladder cancer in rubber workers. Do screening and doctors' awareness distort the statistics?

The use of recognised carcinogens in the rubber industry before 1950 led to the introduction of screening progammes offering urinary cytology to workers who had been exposed. Publicity given to the introduction of these programmes and to individual claims for compensation have increased medical practitioners' awareness of a relationship between work and the industry and the subsequent development of bladder cancer. In this study 27 rubber workers and 88 controls registered in 1966 and 1967 with bladder cancer have been followed. A comparison of their death-rates and of the relative frequency of bladder cancer recorded on the death certificates should indicate whether cytological screening or doctors' awareness might explain a recent rise in the bladder-cancer death-rate in this industry. Since the proportions of rubber workers and controls who died before 1976 were similar (74% and 73% respectively) and bladder cancer was mentioned with similar frequence on their death certificates (80% and 83% respectively) neither screening nor doctor's awareness would appear to have an important influence.

Adenocarcinoma↗

Low mortality rates in industrial cohort studies due to selection for work and survival in the industry.

Occupational groups are often described as being relatively healthy because their mortality rates are lower than those of the national average. Although correct this confuses the issue for those who are interested in assessing the effects of exposure to a particular chemical. In a further analysis of data collected in a study of all men ever exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain, three factors have been shown to contribute to the low mortality rates that were observed. The three factors: the selection of a healthy population for employment, the survival in the industry of the healthier men, and the length of time that this population has been pursued, have been quantified. The mortality experience within five years of entering this industry was shown to be as low as 37% of that expected; for circulatory disease and respiratory disease it was as low as 21%. There was a progressive increase in standardized mortality ratio with the length of time since entry so that the effect had almost disappeared 15 years after entry. To avoid confounding the selection effect with the survival effect the latter was measured by separating men who survived 15 years after entering the industry according to whether or not they were still in the industry after this period. Those who had left experienced an overall standardized mortality ratio some 50% higher than those still in the industry. This effect, although consistent in the age groups between 25 and 74 years and for all cause groups studied, was greatest in those aged between 25 and 44 years and for lung cancer and respiratory disease.

Adult↗

A survey of occupational cancer in the rubber and cablemaking industries: analysis of deaths occurring in 1972-74.

The records of 40 867 men employed for at least one year in the rubber and cablemaking industries have now been observed for eight years. This analysis compares the mortality pattern for 1972-74 with that previously reported for 1968-71. It indicates a significant excess of deaths due to cancer of the bladder throughout the industry including men who had not been exposed to acknowledged bladder carcinogens. This excess is in deaths occurring in 1973 and 1974 in the 45-64 and 65 years plus age groups. The two sectors of the industry where this excess is significant are footwear and footwear supplies except adhesives, and the tyre sector. The excess of all cancers taken together previously noted throughout the study population for 1968-71 is confirmed for 1972-74 as is the excess for lung cancers. The greater excess in the tyre sector is also confirmed, particularly in those men in the 55-64 year age group and those who entered the industry between 1950 and 1960. While men employed in 1967 on moulding, press, autoclave, and pan curing, and workers in finished goods, stores, packaging, and despatch continue to have more lung cancer deaths than expected for 1972-74, the excess is no longer statistically significant. An excess of cancer of the stomach which was overlooked in 1968-71 is not confirmed in 1972-74 but is nevertheless high when the total period of study 1968-74 is considered. The limitations of the study are discussed with particular reference to extrapolating the results to the whole industry. We conclude that there is a higher rate of lung cancer in the tyre sector of the industry and that immediate investigations are required to test the hypothesis concerning the recent excess of bladder cancers. Attention should now be paid to the control of exposures to all potential hazards in the industry.

Environmental Exposure↗

The effect of angiography on the electrophysiological state of the spinal cord. A study in control and traumatized cats.

The tonic vibration reflex (TVR) and evoked cerebral potential (ECP) were used to evaluate the effects of aortic injections of Renografin- 76, saline, and a mixture of sodium and sucrose on the spinal cord in 7 control cats and 12 which were recovering from trauma. Results showed that Renografin-76 produced different toxic effects in control and traumatized spinal cords as measured by the TVR. The disappearance of either ECP or TVR following the Renografin injection in 4 cases exemplifies the enhanced risk of injecting angiographic materials into traumatized spinal cords during recovery. The TVR shows promise as an electrophsiological criterion of minimal toxic effects of angiographic contrast agents on the spinal cord.

Angiography↗