My costly lesson in leasing equipment.
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Contract Services↗
Biomedical subjects
C C Patterson
Publications and source records attributed to C C Patterson.
Follow-up study of clinical and immunological findings in patients presenting with acute parvovirus B19 infection.
This study was undertaken to examine the natural history of parvovirus B19 infection in persons without a known immune defect in terms of both clinical symptoms and immune responsiveness to the virus. Fifty-three patients with acute B19 infection (positive for serum anti-B19 IgM) were studied; symptoms at acute infection were rash and arthralgia (n = 26), rash (n = 7), arthralgia (n = 16), aplastic crisis (n = 3), and intrauterine fetal death (n = 1). Patients were followed for 26-85 months (mean 57 months) and reassessed for persistent symptoms, anti-B19 antibodies, and antibodies to the unique region of B19 VP1. There were 23 cases of arthralgia persisting for longer than 1 year after acute infection. One of these patients, a 48-year-old woman at follow-up, had had persistent arthralgia for 4 years following acute B19 infection, had rheumatoid factor at a titre of 1920 IU/ml detected at follow-up, and had been independently diagnosed as having rheumatoid arthritis at the time of follow-up. All 53 patients were positive for serum anti-B19 IgG compared to 45 of 53 age- and sex-matched control patients, a significant difference (two-tailed P value = 0.008). All test patients at follow-up and control patients were negative for serum anti-B19 IgM and antibodies to the unique region of B19 VP1. Serum from acute infection from 33 of 53 test patients was tested for antibodies to the unique region of VP1, and 16 of these were positive. The presence of this antibody did not correlate with subsequent duration of symptoms but did correlate with a short interval between symptom onset and blood sampling. The unique region of B19 VP1 is known to be crucial for a successful humoral response to the virus, and it seems that the antigenic role played by this region is important only during the acute phase of B19 infection.
Acute Disease↗
Epidemiology of childhood IDDM in Northern Ireland 1989-1994: low incidence in areas with highest population density and most household crowding. Northern Ireland Diabetes Study Group.
During the period 1989-1994, 462 cases of insulin-dependent diabetes mellitus were registered among children from Northern Ireland aged under 15 years. The estimated completeness of the register was 98.8% (95% confidence interval (CI) 97.7%, 99.9%). A standardised rate of 19.6 (95% CI 17.8, 21.4) per 100 000 person years was obtained, placing Northern Ireland near the top of the range of published incidence in the United Kingdom, with a rate close to that reported for Scotland. In an analysis based on 217 postcode sectors, areas with a high population density and the most material deprivation were observed to have the lowest incidence rates. After inclusion of population density in a Poisson regression analysis, the component of deprivation which was found to be most significant was household crowding. Relative to children living in areas of low population density, there was a reduced risk for children in medium (relative incidence 0.85 (95% confidence limits CI 0.67, 1.09)) and high (0.62 (95% CI 0.48,0.80)) population density areas. Similarly, relative to children living in areas with low levels of household crowding, there was a reduced risk for children in medium (relative incidence 0.73 (95% CI 0.58,0.93)) and high (0.67 (95% CI 0.53, 0.83)) levels of household crowding. Tests for space-time clustering at diagnosis and at birth were negative. A possible explanation for the differences in incidence rate observed in this study is that exposure to infections very early in childhood is a protective factor. Later infections may act as either initiators or promoters of diabetes, but the absence of space-time clustering suggests that no single specific infectious agent is responsible.
Adolescent↗
Cutaneous neoplasia following PUVA therapy for psoriasis.
To determine the risk of cutaneous neoplasia following photochemotherapy (PUVA), we reviewed patients with psoriasis treated at our unit between 1979 and 1991. Two hundred and forty-five patients were assessed, with a median duration of follow-up of 9.5 years. Fifty-nine per cent were male, and 41% female. The median number of exposures was 59, and the median total dose was 133 J/cm2 for the group as a whole. Non-melanoma skin cancers (NMSC) occurred in six individuals (2.4%). Basal cell carcinoma occurred in all six and one individual also developed four squamous cell carcinomas and Bowen's disease of the penis. No cases of malignant melanoma were recorded. Patients who developed NMSC received a median number of 225 exposures and a median cumulative dose of 654 J/cm2. Compared with a control study population in West Glamorgan, Wales, there was a 1.4 (95% confidence limits (CL) 0.5 and 3.1) times increased risk of NMSC. A statistically significant increased incidence of NMSC was found for patients who had received 100 or more exposures, and 250 or more J/cm2, with risks of 3.7 (95% CL 1.0 and 9.5), and 4.0 (95% CL 1.1 and 10), respectively. A PUVA dose of < 250 J/cm2 or < 100 exposures conferred a minimal increase in risk of NMSC in our study population.
Adult↗
Simple measure of insulin resistance.
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Blood Glucose↗
Pilot study of an orthodontic treatment need learning package for general dental practitioners.
This pilot study evaluated an Index of Orthodontic Treatment Need Learning Package which was developed for use by general dental practitioners. Fifty-seven dentists participated in a randomised controlled trial which involved assessing the need for orthodontic treatment among two representative samples of 16 study casts. All the dentists assessed the first set of study casts without any aids or assistance. During the assessment of the second set of study casts one group of dentists used an IOTN Learning Package in the form of a poster, another group used an IOTN Learning Package in the form of a booklet, and the remaining group acted as a control and did not use any Learning Package. The results reveal that compared with the control dentists, the dentists using the IOTN poster and the IOTN booklet had, respectively, 1.8 and 2.6 fewer errors when assessing aesthetic need and 2.0 and 2.1 fewer errors when assessing dental health need.
Female↗
High incidence of congenital dislocation of the hip in Northern Ireland.
To determine the incidence of congenital hip dislocation (CDH) a retrospective study was carried out of cases occurring in a defined population using multiple information sources. Of 138,600 children born in the period 1983-1987, a total of 243 were diagnosed with CDH, defined as those requiring splintage or surgery whose treatment extended beyond 6 months of age. Incidence and estimates of relative risks for pre-disposing factors were determined. The rate was 1.75 cases per 1000 livebirths. Major risk factors were female gender and breech presentation. The proportions of cases identified before 1, 3 and 6 months of age were 8, 14 and 35%, respectively. Despite using a restrictive definition, we have obtained an incidence rate among the highest reported in any United Kingdom population. Early detection is widely accepted as desirable, but neonatal screening has proved ineffective.
Female↗
Paediatric consultation patterns in general practice and the accident and emergency department.
The age, sex, source of referral and diagnosis of children brought to a paediatric accident and emergency department by their parents were compared to those consulting their general practitioner. A simultaneous, prospective review of these consultations was carried out over a six-week period in an inner-city paediatric teaching hospital and a group practice in a socially deprived urban area. 730 children less than 13 years of age who presented for a new consultation were seen. 629 (86%) presented initially to the general practitioner, who dealt with all but 25 (4.0%) without onward referral to the accident and emergency department. 127 consultations took place at the accident and emergency department, of which 104 (82%) were parental referrals. There was no sex difference in children seen by the general practitioner. There was a decreasing trend with increasing age in the proportion of children who consulted the general practitioner, perhaps due to the higher frequency of injury in the older children. Over three quarters (77%) of injured children were brought directly to the accident and emergency department, compared with only 4% of children without injuries (p < 0.001). Of 22 children with injuries who presented to the general practitioner, only 4 (18%) required onward referral. General practitioners met the great majority of the paediatric workload generated by the practice. Audit between primary and secondary care gives a more reliable picture than data from only one source. Injured children are more likely to be taken to the accident and emergency department. Further study of the severity of injury in children is required to determine if there is potential to reduce parental referrals to accident and emergency departments.
Child↗
Autres pays, autres coeurs? Dietary patterns, risk factors and ischaemic heart disease in Belfast and Toulouse.
The WHO MONICA project monitors trends and determinants in cardiovascular disease to relate classical risk factor changes to trends in incidence rates. The Belfast and Toulouse MONICA centres have also collaborated in dietary studies. Both centres have validated incidence and attack rates for ischaemic heart disease using coronary event registration. These data confirm that the disease in middle-aged men is between three and four times as common in Belfast as in Toulouse. Risk factor surveys show some differences between the centres, but the overall risks assessed by two multiple logistic function scoring systems were identical. A weighed dietary survey revealed no important difference in macronutrient intake, although carbohydrate and saturated fat intake in Belfast was significantly higher. Protein, dietary cholesterol and polyunsaturated fat, particularly linoleic acid intake, was significantly higher in Toulouse, as was consumption of wine, cheese, fruit and vegetables, but not potatoes. The Northern Irish diet is typically Northern European, but although the diet in Toulouse has some features of the Mediterranean diet, it is not appreciably different from that in Belfast in terms of total fat intake. Major differences are present for several food items, and in general these differences add support to the antioxidant hypothesis.
Antioxidants↗
Randomised trial of methods of extubation in acute and chronic respiratory distress.
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Acute Disease↗
A case-control investigation of perinatal risk factors for childhood IDDM in Northern Ireland and Scotland.
OBJECTIVE: To identify perinatal risk factors for childhood insulin-dependent diabetes mellitus (IDDM) and determine if they differ between early-onset and late-onset disease. RESEARCH DESIGN AND METHODS: We selected 258 diabetic children in Northern Ireland and 271 diabetic children in Scotland from population-based registers. For each diabetic child, five matched control subjects were drawn from the same population. All perinatal data were recorded routinely at birth. Odds ratios (ORs) were estimated for parental age, social class, breast-feeding, deprivation measures, and other perinatal variables. RESULTS: Scottish data indicated an increased risk among children born to older mothers (OR = 2.43, 95% confidence interval [CI] 1.49-3.97 for mothers > or = 35 years of age relative to those < 25 years of age). Northern Ireland data showed no such effect. Only Northern Ireland data showed an excess risk in children of professional or managerial families (OR = 1.51, 95% CI 1.11-2.04). A small but nonsignificant reduction in risk among breast-fed children was observed only after adjustment for social class (OR = 0.76, 95% CI 0.54-1.07). Deprivation measures were associated with reductions in risk. Children delivered by cesarean section were at increased risk in both Northern Ireland (OR = 1.66, 95% CI 1.10-2.50) and Scottish (OR = 1.70, 95% CI 1.12-2.59) data. In Northern Ireland data only, children of first pregnancies were at increased risk (OR = 1.41, 95% CI 1.03-1.93). Both data sets indicated that a first pregnancy was a more important risk factor for early-onset disease than for late-onset disease. CONCLUSIONS: Many reported risk factors are weak and show inconsistencies between studies. They may be secondary to more direct, as-yet-undiscovered risk factors. Although irrelevant in the majority of cases, the increased risk associated with delivery by cesarean section deserves further study.
Adult↗
Jass' classification revisited.
BACKGROUND: In 1986, Jass and colleagues claimed to have improved on Dukes' classification of prognosis for carcinoma of the colon and rectum. To have clinical relevance, such results should be reproducible and confirmed by other institutions. STUDY DESIGN: Retrospective clinicopathologic study of 312 carcinomas of the colon and rectum to determine whether or not Jass' classification is superior to that of Dukes' as assessed by their relative reproducibility and prognostic significance. RESULTS: Dukes' classification had excellent intraobserver and interobserver reproducibility (kappa values of 0.86 and 0.93, respectively). In contrast, the reproducibility of variables assessed by Jass showed only slight to fair agreement (lymphocytic infiltration: intraobserver and interobserver kappa values of 0.08 and 0.05, respectively, growth pattern: intraobserver and interobserver kappa values of 0.37 and 0.41, respectively). Dukes' stage and patient age were the most important prognostic variables on multivariate regression analysis. Tumor differentiation, nuclear polarity, tubule configuration, and lymphocytic infiltration remained significantly related to survival in the presence of Dukes' stage and age. The model which best predicted prognosis was a combination of Dukes' stage, patient age and tumor differentiation. Further addition of the variables assessed by Jass to this model did not significantly improve the prediction of prognosis. CONCLUSIONS: Dukes' classification is of greater prognostic value and more reproducible than the components of Jass' classification. The continued use of Dukes' classification is, therefore, warranted for prognostic and therapeutic decisions in patients with carcinoma of the colon and rectum.
Colonic Neoplasms↗
Colorectal carcinoma: importance of clinical and pathological factors in survival.
A series of clinicopathological variables was assessed on 312 patients undergoing surgical resection for primary colorectal cancer. Although the presence of venous invasion was related to mortality (P = 0.02), classifying invasion into involvement of thick-walled or thin-walled veins did not produce a variable of prognostic value. Intestinal obstruction (P = 0.04) and the macroscopic appearance of the tumour (P = 0.04) were related to mortality from colorectal cancer, but not from all causes of death. Duke's stage, increasing patient age and poorly differentiated tumours were the variables which were individually most significantly related to poor prognosis (P < 0.001 for each analysis). Cox's regression analysis identified these three variables as independent predictors of outcome in colorectal cancer. This study confirms that Duke's stage, patient age and tumour differentiation are still the most important clinicopathological variables in colorectal cancer.
Adult↗
Reduction in the risk of bronchopulmonary dysplasia from 1980-1990: results of a multivariate logistic regression analysis.
A retrospective analysis (1980-1990) of normally formed low birthweight (< 2500 g) infants surviving to at least 28 days following intermittent positive pressure ventilation (IPPV) for longer than 12 h was performed. Bronchopulmonary dysplasia (BPD) was defined as oxygen dependency at 28 days with characteristic radiographic findings. Logistic regression analysis of risk factors, before and after the initiation of IPPV was performed on 412 infants. Decreasing birth weight (BW) and gestational age (GA) were associated with an increased risk of BPD. When controlled for these variables, predictive factors prior to IPPV were gender, age at IPPV, respiratory diagnosis, and year of birth. Following IPPV, duration of peak inspiratory pressure > 25 cm H2O, duration of fraction of inspired oxygen (FiO2) > 0.60 (DO2), maximum peak inspiratory pressure (MPIP), maximum FiO2, patent ductus arteriosus, bacteraemia and either pneumothorax or pulmonary interstitial emphysema were associated with an increased risk of BPD. Adjusting for BW and GA, there was a significant reduction in BPD risk from 1980-1990 (relative odds of 0.88 for each year compared to the previous year). This trend could be largely accounted for by decreases in MPIP and DO2 during the study period. Surfactant treatment was not independently associated with a significant change in the risk of BPD. Based on this analysis, we developed a scoring system for predicting the risk of BPD in the neonatal period which we evaluated in a random sample of infants. This predicted infants at risk of BPD with a sensitivity of 65% and a specificity of 88%.(ABSTRACT TRUNCATED AT 250 WORDS)
Birth Weight↗
Morphometric analysis of colorectal cancer.
Thirteen nuclear and cellular morphometric variables were measured in 312 cases of colorectal adenocarcinoma. All variables, except nuclear shape factors, differed significantly (P < 0.001) between normal colorectal and tumor tissue. In adenocarcinomas, epithelial nuclei in well-differentiated mucosa tended to be elliptic, while those in poorly differentiated mucosa were more spheric. Increasing values of maximum nuclear and elliptic diameter were associated with progression from none to simple tubule configuration (P < 0.001), none to easily discerned nuclear polarity (P < 0.001), and expanding growth pattern (P < 0.001). Univariate survival analysis revealed that none of the morphometric variables was significantly related to patient survival. Multivariate regression analysis showed that no morphometric variable could add significantly to a model containing the variables of patient age, Dukes stage, and tumor differentiation. Morphometry may be useful in distinguishing malignant from normal tissue and degrees of differentiation, but it is of little prognostic value in colorectal adenocarcinoma.
Adenocarcinoma↗
Multicentre randomised trial comparing high and low dose surfactant regimens for the treatment of respiratory distress syndrome (the Curosurf 4 trial).
A randomised trial was conducted in 82 centres using the porcine surfactant extract, Curosurf, to compare two regimens of multiple doses to treat infants with respiratory distress syndrome and arterial to alveolar oxygen tension ratio < 0.22. Infants were randomly allocated to a low dosage group (100 mg/kg initially, with two further doses at 12 and 24 hours to a maximum cumulative total of 300 mg/kg; n = 1069) or a high dosage group (200 mg/kg initially with up to four further doses of 100 mg/kg to a maximum cumulative total of 600 mg/kg; n = 1099). There was no difference between those allocated low and high dosage in the rates of death or oxygen dependency at 28 days (51.1% v 50.8%; difference -0.3%, 95% confidence interval (CI) -4.6% to 3.9%), death before discharge (25.0% v 23.5%; difference -1.5%, 95% CI -5.1% to 2.2%), and death or oxygen dependency at the expected date of delivery (32.2% v 31.0%; difference -1.2%, 95% CI -5.2% to 2.7%). For 14 predefined secondary measures of clinical outcome there were no significant differences between the groups but the comparison of duration of supplemental oxygen > 40% did attain significance; 48.4% of babies in the low dose group needed > 40% oxygen after three days compared with 42.6% of those in the high dose group. The total amount of surfactant administered in the low dose regimen (mean 242 mg phospholipid/kg) was probably enough to replace the entire pulmonary surfactant pool. Adopting the low dose regimen would lead to considerable cost savings, with no clinically significant loss in efficacy.
Biological Products↗
DNA densitometry of colorectal cancer.
DNA analysis was assessed by densitometry for 281 cases of colorectal adenocarcinoma. Detection of aneuploidy in a single case rose from 65% if one, to 92.5% when three or more sections, were analysed. Although aneuploid tumours had significantly larger nuclear areas than near diploid tumours (p = 0.009), densitometric measurements showed no association with clinicopathological variables. DNA content determined by densitometry was compared with that from flow cytometry on 465 tissue sections from 241 cases. Aneuploidy assessed by flow cytometry was significantly associated with that determined by densitometry (p < 0.01 for all comparisons), ploidy state being similar in 381 sections (82%, kappa = 0.63, p < 0.001), and 187 cases (77.6%, kappa = 0.57, p < 0.001). Univariate survival analysis showed that DNA densitometric variables had no significant association with survival in (a) all cases, (b) cases without lymph node metastases, or (c) cases without distant metastases. Multivariate regression analysis of densitometric and clinicopathological variables identified Dukes's stage, patient age, and tumour differentiation as the combination of variables most closely related to survival. Densitometric measurement of DNA content could not significantly improve on the prognostic model containing these three variables. It is concluded that, although the assessment of DNA content by densitometry is comparable with that of flow cytometry, conventional histological variables remain the best predictors of prognosis in colorectal cancer.
Adenocarcinoma↗
Sleep related hypoxaemia in hypertensive and normotensive men.
BACKGROUND: An association between hypertension and obstructive sleep apnoea (OSA) has been found by some researchers but remains controversial. Since such an association would have important implications for the investigation and management of hypertension, the rate of nocturnal hypoxaemic episodes has been compared in hypertensive and normotensive men. METHODS: The study was carried out in the community in Belfast and its environs. Thirty four men with mild to moderate hypertension aged 40-64 years were identified from general practice and a hypertension clinic. Normotensive men, matched for age and body mass index, were selected from a community survey. Subjects answered a sleep questionnaire and underwent overnight pulse oximetry at home. Computer analysis of the results gave the number and magnitude of dips in oxygen saturation (SaO2 dips, 4% or greater). RESULTS: The median number of SaO2 dips/hour for hypertensives was 2.0, and for normotensives was 0.8. Lowest SaO2 and mean SaO2 levels were significantly lower in the hypertensive group. Only one subject had a rate of SaO2 dips/hour greater than five and symptoms suggestive of OSA. CONCLUSIONS: Both hypertensive and normotensive men had relatively few episodes of nocturnal hypoxaemia. The small increase in the rate of SaO2 dips in hypertensive subjects has not yet been fully explained. These results imply that OSA is not common in hypertensive subjects and is unlikely to be an important cause of hypertension.
Humans↗