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Biomedical subjects

C C Patterson

Publications and source records attributed to C C Patterson.

At least 127 records · Page 7Linked to original sources
PubMed1990

Validation of two methods of long-term epidemiological follow-up.

Two methods of long-term epidemiological follow-up were compared by using each to study the survival of 1622 myocardial infarction patients registered by the Belfast MONICA Project. Length of follow-up ranged between 3 and 5 years during which time 277 deaths were recorded. A computer-based method for linking MONICA Project registration records with the Registrar General's death certification data identified 273 of the 277 deaths. Follow-up supplied by the Northern Ireland Central Services Agency through the flagging of patients in their master patient index identified 271 deaths; four of the six deaths which were missed occurred before computerisation of the index was complete. The study illustrates the value of computer-based linkage with death certification data and of flagging in the Central Services Agency master patient index.

Computer Communication Networks↗
PubMed1989

Short term outcome in babies refused perinatal intensive care.

OBJECTIVE: To compare the mortality in babies refused admission to a regional perinatal centre with that in babies accepted for intensive care in the centre. DESIGN: Retrospective study with group comparison. SETTING: Based at the Royal Maternity Hospital, Belfast, with follow up of patients in all obstetric units in Northern Ireland. PATIENTS: Requests for transfer of 675 babies to the regional perinatal centre (prenatally and postnatally) were made from hospitals in Northern Ireland between January 1984 and December 1986. In all, 343 babies were refused admission to the centre, and complete data were available for 332 of them. These babies were either admitted to other neonatal intensive care units (261 babies) or remained in hospitals with only special care cots (71 babies). MAIN OUTCOME MEASURE: Short term mortality. RESULTS: Seventy of the 332 babies refused admission to the centre died compared with 51 of the 333 who were admitted. Multivariate analysis based on a logistic model showed a non-significant increase in mortality among babies treated in other intensive care units compared with babies treated in the centre (relative odds 1.2; 95% confidence interval 0.7 to 1.9). The increase in mortality in babies who remained in a special care baby unit, however, was significant (3.5; 1.7 to 7.0). This increase was particularly significant in babies born at less than or equal to 32 weeks' gestation and who weighed less than 1500 g (8.4; 2.5 to 28.1). CONCLUSIONS: The results of the study confirm the benefits of neonatal intensive care and its particular value in improving survival in babies of low birth weight. As the babies were refused admission to the regional perinatal centre because intensive care cots were not available this deficiency should be corrected.

Gestational Age↗
PubMed1989

Coronary risk factor prevalence in a high incidence area: results from the Belfast MONICA Project.

Northern Ireland remains at the top of the world mortality league for ischaemic heart disease. The Province is providing a centre for the World Health Organisation's MONICA Project. Registration of coronary heart disease events began in 1983 and the first of three population surveys took place in 1983-4. A total of 2,361 men and women aged 25-64 years was screened. Subjects were shorter and heavier than their fellow citizens in Great Britain. The estimated mean cholesterol levels in the 25-64-year-old population (5.80 mmol/l in males and 5.85 mmol/l in females) were similar to those reported from Great Britain. Although mean systolic blood pressures were lower, mild diastolic hypertension was considerably more common; cigarette smoking levels were similar. The results were consistent with those expected for an area with a high coronary heart disease mortality, with more than 80% of subjects being at increased risk in terms of the three major factors (cigarette smoking, hypertension and raised cholesterol). Public concern about coronary heart disease has grown and recently the Department of Health and Social Services (NI) has launched a 10-year prevention programme which will primarily employ a population approach.

Adult↗
PubMed1988

Factors influencing total cholesterol and high-density lipoprotein cholesterol concentrations in a population at high coronary risk.

Serum total cholesterol and high-density lipoprotein (HDL) cholesterol concentrations were measured in 1122 men and 1147 women aged between 25 and 64 years during the first Belfast MONICA survey, and the results subjected to multiple regression analysis. In both men and women, total cholesterol increased with age. Although HDL-cholesterol showed little variation with age, the values were considerably higher in women than men. Total cholesterol increased with body mass index while HDL-cholesterol decreased, and these findings persisted after adjustment for age. Regular exercise was associated with higher HDL-cholesterol values, even after adjustment for age and body mass index. Among men and women who abstained from alcohol, lower values of HDL-cholesterol were observed. In both sexes, cigarette smoking was associated with significant increases in total cholesterol values and decreases in HDL-cholesterol values, though some of these findings became apparent only after adjustment for other relevant factors. Perhaps surprisingly, a measure of health knowledge showed no association with blood lipid concentrations.

Adult↗
PubMed1988

Diclofenac sodium for post-tonsillectomy pain in children.

Diclofenac sodium was assessed as an analgesic for postoperative pain following paediatric tonsillectomy in a randomised double blind trial. In a comparison made with both a pethidine and a control group diclofenac was shown to be an effective analgesic. No significant difference in analgesic efficacy was demonstrated between the two drugs, although patients who received diclofenac tended to be less drowsy postoperatively than those who received pethidine. There were no significant differences between the two drugs in respect of time to awaken from anaesthesia or incidence of postoperative vomiting.

Anesthesia Recovery Period↗
PubMed1988

Prediction of outcome shortly after delivery for the very low birthweight (less than or equal to 1500 g) infant.

Obstetric and perinatal data for 387 very low birthweight infants (less than or equal to 1500 g) who were admitted to a neonatal intensive care unit were used to derive and test a multivariate statistical model for predicting shortly after birth the risk of death before hospital discharge. Using the gestational age, the Apgar score at 5 minutes and the presence or absence of respiratory distress, the model correctly predicted outcome for 94% of survivors but for only 53% of deaths. The model successfully identified a subgroup with a low (less than 1 in 20) predicted risk of death. This subgroup comprised over one-third of the infants but included 47% of the survivors and only 5% of the deaths. The probabilities derived from the model are tabulated and may help paediatricians in maternity units without neonatal intensive care facilities to decide which very low birthweight infants to transfer for additional care.

Delivery, Obstetric↗
PubMed1988

Geographical variation in the incidence of diabetes mellitus in Scottish children during the period 1977-1983.

Routinely collected Scottish hospital discharge data were used to identify newly diagnosed cases of diabetes mellitus under the age of 19 years. In the period 1977-83 there were 2183 cases, an average annual incidence of 21.0 per 100,000 per annum. This rate is one of the highest reported and represents a continuation of the increase in incidence which occurred during the period 1968-76. Statistically significant geographical variation in incidence was observed with the higher incidence in the least densely populated areas. Seasonal variation in the month of first admission was evident in all except the under-five age group with peaks occurring in winter. An estimated 60% of newly diagnosed cases were readmitted within 5 years and the pattern of readmission was found to differ little between males and females or between age groups.

Adolescent↗
PubMed1987

Lead in ancient human bones and its relevance to historical developments of social problems with lead.

Concentrations of metabolic lead in buried ancient bones are obscured by replacement of calcium in apatite by excessive amounts of soil moisture Pb. Concentrations of metabolic barium in bones are affected in a similar way. Added soil Pb and Ba, expressed as log(Pb/Ca) versus log(Ba/Ca) among various bones at a given burial site, are positively covariant, with about 5-fold more soil Pb added for each unit of added soil Ba. The typical natural metabolic Ba/Ca ratio in contemporary people can be measured unambiguously because it as unaffected by industrial pollution. It applies to ancient people because it has not changed historically. The intercept of the covariance curve for buried bones of a given ancient population at the known metabolic Ba/Ca ratio indexes the corresponding metabolic Pb/Ca ratio in bones of that population. Lead levels which prevailed in Romans appear to have been similar to those in contemporary people, which are approximately 1000-fold above natural levels in humans determined by this method in ancient Peruvians. This indicates that studies of natural biochemical reactions in cells free of industrial Pb should be made, because most present biochemical knowledge is founded on data obtained from systems polluted with Pb 1000 to 100000-fold above natural levels. The 5000 year history of smelting Pb by humans indicates that a system of education fostered by genetically common lower brain center functions operated on hundreds of successive generations in a context of cultural changes invoked by feedback from developments in engineering technologies to give rise to the difference between present typical and prehistoric natural levels of Pb in humans. Archaeological and anthropological studies of early developments in writing, music and metallurgy by ancient Peruvians and Persian peoples should be combined with PET-scan studies of their descendants to discover if, as preliminary archaeological data suggest, the two ancient populations differed on a genetic basis in higher brain functions, yet are indistinguishable as metallurgical engineers. This would demonstrate that higher centers of the human brain did not exercise guiding control, through hundreds of generations, over those developments of engineering technologies which resulted in the extreme pollution of the earth's biosphere with poisonous Pb.

Barium↗
PubMed1987

The role of intraluminal tension and pH in the development of necrotizing enterocolitis: an animal model.

Presented is an in vivo animal model of necrotizing enterocolitis (NEC) in which we used an isolated loop of rabbit colon. Changes in mucosal perfusion and macroscopic and microscopic appearances were studied after exposure of the mucosa to different intraluminal tensions and pHs. Mucosal perfusion was reduced with increasing intraluminal tension and decreasing pH. Histologic changes consistent with NEC were identified after five hours when the mucosa had been exposed to both increased intraluminal tension and decreased pH. Factors affecting intraluminal tension and pH could influence the development of NEC in the neonate.

Animals↗
PubMed1987

Haemodynamic effects of vecuronium, pancuronium and atracurium in patients with coronary artery disease.

Thirty patients with ischaemic heart disease scheduled for coronary artery bypass grafting were randomly allocated to three equal groups. Following morphine, hyoscine and pentobarbitone premedication, anaesthesia was induced with diazepam 0.3 mg kg-1. Five minutes later neuromuscular blockade was induced with pancuronium 0.1 mg kg-1, vecuronium 0.1 mg-1 or atracurium 0.5 mg kg-1, followed after 6 min by fentanyl 25 micrograms kg-1. Pancuronium and atracurium caused significant increases in heart rate, while vecuronium induced little change. Systemic vascular resistance decreased significantly from 1515 dyn s cm-5 to 1200 dyn s cm-5 following atracurium. Cardiac index was increased transiently in the atracurium group, but a more sustained increase was observed following pancuronium. Nine patients in the atracurium group showed skin flushing and one developed skin weals.

Atracurium↗
PubMed1987

Classification of normal colorectal mucosa and adenocarcinoma by morphometry.

Semi-automatic image analysis was used to make a morphometrical assessment of 15 nuclear and cellular variables in normal (n = 20) and malignant (n = 30) colorectal epithelium. Principal components analysis on the matrix of correlations between variables identified four main sources of variation within the dataset. These were, in decreasing order of importance: (1) nuclear size, nuclear cytoplasmic ratio and nuclear position within the cell; (2) the variability of nuclear size; (3) nuclear elongation and polarity; (4) nuclear shape and its variation. Discriminant analysis was conducted between histologically normal mucosa (n = 10) and adenocarcinoma in ulcerative colitis (n = 20). Using stepwise variable selection, the mean nuclear cytoplasmic ratio (normal, mean 20.4 (s.d. +/- 2.0); tumour, mean 39.7 (s.d. +/- 7.0)) and the coefficient of variation of nucleus to cell apex distance (normal, mean 19.2 (s.d. +/- 7.5); tumour, mean 47.8 (s.d. +/- 9.1)) were chosen as discriminating features. They were used to derive a discriminant function which gave perfect discrimination between the two groups. Scatter plots of these two variables confirmed complete separation of normal mucosa from adenocarcinoma and provided a simple method of applying the discriminant function. Discriminatory performance did not deteriorate when the function was applied to further normals (n = 10) and adenocarcinoma (n = 10). This study highlights the descriptive differences between normal and malignant colorectal epithelium and shows that case allocation may be made to these two lesion categories using a morphometrically-derived classification rule.

Adenocarcinoma↗
PubMed1986

Does cholecystectomy predispose to colorectal cancer? A case control study.

A case-control study of 598 patients with colorectal cancer (296 men, 302 women) admitted from January 1974 to October 1983 was undertaken. Patients were matched for age and sex, with controls admitted for unrelated conditions. All information was obtained from the hospital records. In men, there was no evidence of an increased risk of colonic cancer after cholecystectomy relative to men without cholecystectomy. There was some evidence of an increased risk in women (relative risk = 1.7; 95 percent confidence interval, 1.0 to 3.1) and this was highest when the tumor was in the right colon (P less than 0.005). This study confirms previous observations that cholecystectomy leads to an increased risk of right-sided colonic tumors in women but not in men. The apparent difference between the sexes may be explained by the low rate of cholecystectomy in the men examined.

Cholecystectomy↗
PubMed1986

Sensitivity to propofol in the elderly.

Two studies were carried out on 609 fit, unpremedicated patients to assess the influence of patient age on the response to the rapidly-acting hindered phenol, propofol, which is being evaluated for induction of anaesthesia. In the first study, 1.25 mg/kg was injected over 20 seconds followed by 10-mg increments every 15 seconds until loss of verbal contact. This showed a great individual variation in response to the drug. A reduction in the 'induction' dose was found in elderly patients, which became marked around 60 years. In the second (340), doses ranging from 1.5-3.0 mg/kg in patients under 60 years and 1.25-2.25 mg/kg in those over 60 years were injected as a bolus over 20 seconds. Doses of 2.25-2.5 mg/kg were required to induce anaesthesia in patients under 60 years, whilst 1.5-1.75 mg/kg was adequate in those over 60 years. Side effects were more marked with the rapid injection and doses in excess of 1.75 mg/kg caused significant hypotension and apnoea in the elderly. These studies reveal marked sensitivity to propofol in the elderly with respect to both induction dose and acute toxicity.

Adult↗
PubMed1986

Prognostic factors in malignant melanoma of the choroid: a retrospective survey of cases occurring in Northern Ireland between 1965 and 1980.

In Northern Ireland between 1965 and February 1980 one hundred eyes were enucleated following diagnosis of malignant melanoma of the choroid. The pathology of 87 cases was available for re-examination. Data on those patients still alive were examined together with the post-mortem reports of those deceased. A mathematical model was constructed to assess tumour volume more accurately. Survival was analysed using univariate and multivariate methods. Actuarial survival curves were constructed and two multivariate regression models were used--the proportional hazards model and the log-logistic model. In addition person years at risk analysis was used to compare survival with the Northern Ireland population. When the data were examined univariately, the location of the tumour, cell type, degree of invasion and the parameters of size (height, diameter and volume) were all significant prognostic indicators. When multivariate analysis was employed, the degree of invasion did not contribute significantly to the model, this being accommodated by tumour size. Cell type was also shown to be of less importance in the multivariate models. The various prognostic indicators together with the person years at risk analysis are discussed.

Adolescent↗
PubMed1985

Changes in liver function tests after propofol ('Diprivan').

Changes in three recognized liver function tests are reported following the use of propofol in 30 fit, unpremedicated women in whom propofol was used as the main anaesthetic agent. Doses of 140 to 330 mg were given, together with nitrous oxide and oxygen. All patients were undergoing minor gynaecological operations and all conformed to Grade 1 physical status of American Society of Anesthesiologists Classification. In none of these patients was there hypoxia or hypercarbia at any time during or following anaesthesia and none of the patients received any other drugs until completion of the study. No significant changes in liver enzymes (aspartate transaminase and alanine transaminase) or in serum alkaline phosphatase were detected.

Adult↗