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Biomedical subjects

D Oakes

Publications and source records attributed to D Oakes.

At least 55 records · Page 3Linked to original sources
PubMed1988

Long-term palliation with the classic Blalock-Taussig shunt.

Eighty-five patients received a classic Blalock-Taussig shunt between 1973 and 1986. Their age range was 1 day to 9.3 years and their median age was 4 months. Forty-one percent (35/85) were less than 1 month of age. The basic operative technique was unchanged throughout the time period. The subclavian artery opposite the side of the arch was used in 89% (79/88) of the patients. All anastomoses were done with monofilament suture and there was a tendency toward smaller suture material (7-0) in the latter years. All anastomoses except one were done with an interrupted suture technique. The operative mortality rate was 4.7% (4/85) and was not statistically related to age, diagnosis, or year of operation. Palliation was considered to be satisfactory until either a second shunt or a premature corrective operation were necessary. Seven patients required a second shunt and three, a premature corrective operation. The mean time between the initial shunt and the second procedure, either a second shunt or a corrective operation, was 2.9 years and 2.4 years, respectively. Twenty-five patients have had an elective corrective operation and the mean interval to that procedure was 3.9 years. Two years after the operation, 97% of patients older than 1 month of age at operation remain in well-palliated condition, as do 87% of those less than 1 month of age. At 4 years, 87% of those older than 1 month and 54% of those less than 1 month of age continue to be in well-palliated condition. The classic Blalock-Taussig shunt provides excellent palliation at a low operative mortality for virtually all patients for a minimum of 2 years. It will provide adequate pulmonary blood flow for most patients for an extended period of time beyond 2 years.

Anastomosis, Surgical↗
PubMed1986

Hepatocellular adenoma and nodular regenerative hyperplasia of the liver in a young man.

A 26-year-old man had a massive intraabdominal hemorrhage from a hepatocellular adenoma (HCA). The tumor arose within a liver that demonstrated generalized nodular regenerative hyperplasia. The patient had no factors predisposing to either HCA or nodular regenerative hyperplasia (NRH) of the liver. Although rare, HCA should be included in the differential diagnosis of spontaneous intraperitoneal hemorrhage even in young men. The coexistence of HCA and NRH of the liver in this patient may indicate a common pathogenesis.

Adult↗
PubMed1986

An approximate likelihood procedure for censored data.

An approximate likelihood procedure is suggested for the estimation of the parameters of the density of a single homogeneous sample subject to right censoring. Two examples are given involving the gamma distribution. The method is typically consistent and although it is always inefficient, the efficiency loss is second-order in the degree of censoring when this is small. The relation of the techniques to the results of Reid (1981, Annals of Statistics 9, 78-92) on influence functions for censored data, to the EM algorithm, and to the nonparametric regression techniques of Miller (1976, Biometrika 63, 449-464) and Buckley and James (1979, Biometrika 66, 429-436) are indicated. Simple estimates of standard error are obtained.

Animals↗
PubMed1985

Pleural calcification in northwest Greece.

Mass miniature radiography in 1969 detected a high prevalence of pleural calcification in three villages in northwest Greece. In 1980 a survey of a 15% sample of the population over the age of 10 was carried out with a 80% response rate. Full-size radiographs, ventilatory capacity measurements, and a detailed questionnaire on respiratory symptoms, type of work, and residence were used. Independent classification of the 408 films by two readers using the ILO/UC scheme showed very few small opacities but a very high prevalence of pleural calcification first evident in young adults and rising to 70% in the elderly. The overall prevalence was 34.7% in men and 21.5% in women. A comparison with the 1969 survey showed a progression rate of 5% per annum. In neither sex was there a significant relation of pleural calcification to smoking, ventilatory capacity, nor type of work, though those classified as field croppers had a slightly higher prevalence. There was no obvious evidence of increased lung cancer or mesothelioma in the villages. The agent responsible for this apparently benign condition was not identified.

Adolescent↗
PubMed1985

Hepatorenal syndrome managed with hemodialysis, then reversed by peritoneovenous shunting.

A patient with acute decompensated chronic liver disease developed acute tubular necrosis after an episode of hypotension. Renal failure was managed by hemodialysis for 11 weeks during which period hepatic function improved. Despite persistently severe oliguria, tubular function recovered as judged by a fall in urine sodium content and a rise in specific gravity, suggesting the development of the hepato-renal syndrome. Therefore, a peritoneovenous shunt was inserted. This was followed by a prompt diuresis; further dialysis was not required. This case suggests potential roles for hemodialysis and peritoneovenous shunting in patients with advanced, but potentially reversible hepatic and renal failure and draws attention to the need for formal evaluation of such a possibility.

Acute Kidney Injury↗
PubMed1985

Pulmonary function of London firemen.

In a longitudinal study of a sample of firemen in London 1006 firemen were interviewed and examined in 1976 and 895 were seen a second time 12 months later. On each occasion a Medical Research Council respiratory questionnaire was administered and forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured. The average levels of FEV1, FVC, and FEV1/FVC in both years compared favourably with conventional predicted values. Separate multiple regression analysis for the two years indicated that the FEV1 and FVC fell more rapidly in those aged over 40, and that cigarette smoking had a strong harmful effect on these measures of function. Only among men with over 20 years' service was there possibly any evidence (not statistically significant) of an effect from duration of employment. The comparatively large fall in FEV1 and FVC from 1976 to 1977 was due mainly to instrumental variation. The prevalence of respiratory symptoms was higher in smokers than non-smokers and increased with the number of cigarettes smoked.

Adolescent↗
PubMed1985

Mortality of welders and other craftsmen at a shipyard in NE England.

Personnel records of over 1000 welders and electricians but only 235 caulkers and 557 platers employed at a shipyard in NE England between 1940 and 1968 were obtained and the mortality followed up to December 1982. The observed number of deaths (13 from mesothelial tumours, nine among the electricians) were compared with the number to be expected in the Newcastle connurbation. Welders and caulkers were most exposed to welding fumes, electricians to asbestos. The study was limited by the lack of accurate job exposure details, and there was no record of smoking habits, but welders and caulkers showed a higher standardised mortality ratio for all causes, lung cancer, ischaemic heart disease, pneumonia, and accidents than platers and electricians.

Air Pollutants, Occupational↗
PubMed1984

Mortality study of British pathologists 1974-80.

Membership lists of the Royal College of Pathologists from 1974 to 1980 were used to establish a population of 2307 men and 413 women. During the period of study 126 of these pathologists died and death certificates were obtained for 121. The standardised mortality ratios (SMR) for all causes in men were 56 and in women 99. Deaths from accidents, poisoning, violence, and especially suicide, were noted to be in excess of that expected from the general population but similar to that for medical practitioners. Drug overdose was the cause of each suicide. Excess deaths from lymphatic and haemopoietic neoplasms noted in a previous study were not present but an excess of brain tumours was found. Including 1981 data thus far collected, deaths from brain tumour were apparently in excess (observed 6, expected less than 2.0, p less than 0.02). Possible aetiological hypotheses include previous exposure to organic solvents or tuberculosis infection. In view of the pathologists' exposure to formaldehyde it is interesting to note that no nasal or nasal sinus tumours were reported and the SMR for lung cancer was 41.

Brain Neoplasms↗
PubMed1982

Absences attributed to respiratory diseases in welders.

Certified sickness rates of 36 male welders were examined for the period 1970-9. They were compared with 36 male controls from the same petrochemical plant, matched for age, smoking habits, duration of employment, and social class. Indices of severity (average annual duration), duration (average length of spell), and frequency (inception rate of spells and inception rate per worker) were calculated. Absences for all diseases were similar, but absences attributed to respiratory diseases were slightly higher in welders in severity, duration, and frequency. The proportion of days lost attributed to respiratory diseases was 2.3 times higher in welders compared with controls. This was due to a large increase in absences attributed to lower respiratory tract diseases, the ratio of welders to controls being more than four to one for both severity and inception rate of spells. The comparison between welders and controls in smokers and non-smokers confirms other studies which show that smokers tend to be more affected by welding fumes than non-smokers.

Absenteeism↗
PubMed1982

A concordance test for independence in the presence of censoring.

An extension of the definition of Kendall's coefficient of concordance is proposed for testing independence in bivariate censored survival times. The test statistic counts the number of known concordances minus the number of known discordances. The variance of the statistic is calculated for an random-censorship model which, however, does not require independence of the components of the censoring distribution. Two examples are given.

Cell Survival↗
PubMed1982

Effects of approximation in exposure assessments on estimates of exposure- response relationships.

Information on exposure in cohort studies of occupational groups is often very incomplete. If assessments of exposure level are attempted, they are inevitably subject to random error. Even when unbiased, such measurement error can give rise to bias in an estimate of an exposure-response relationship. Since practical techniques exist to account for this effect only in certain situations where response may be measured on a continuous scale, a technique suitable for mortality studies needs developing. In the present report a procedure is described for reducing the bias due to random error in the estimated exposure-response relationship from a cohort mortality study. This procedure is based on a mechanism for adjusting exposure assessments, taking into account the distribution of exposures, and the independently estimated distribution of measurement errors. The initial bias and its reduction through analysis is shown for some simulated data sets. The results of applying this technique to a cohort mortality study of asbestos workers are presented.

Asbestos↗
PubMed1982

Restricted cohort study designs.

Practical constraints may limit both cohort selection and the degree of follow-up in longitudinal studies of occupational mortality. For example, it may be possible to study only those men employed on a certain date or to trace (through pension fund records) only men employed at or close to normal retirement age or to follow men only for a very limited period after they have left employment. In an examination of the effects of such restrictions, advantage was taken of the availability of detailed work histories and the full follow-up of a large birth cohort of chrysotile asbestos workers. Age-matched case-referent analyses were performed under each type of restriction. All three analyses revealed the clear exposure-response relationship between cumulative dust exposure and lung cancer that was found in the full analysis. Most other findings were also not inconsistent with the earlier results. Such restricted cohort studies, with case-referent approaches to analysis can be justified in logic. The findings provide some empirical support for these methodological variants and suggest that they may be useful when complete follow-up of an entire birth cohort is not feasible.

Adult↗
PubMed1981

Virus warts in meat handlers.

An epidemiological study has been made of virus warts on the hands of all workers in a large meat processing factory. The meat handled is pork and beef. A total of 1141 employees were examined, 687 of whom were constantly handling meat. The plant outline and the work of the 144 workers in the butchery section are described in detail. The prevalence of warts in meat handlers was 33.6-70.4% in different sections. The prevalence in non-meat handlers varied from 18.2% to 44.4%. Half of the employees with warts were unaware of them, particularly in regard to plane warts.

Adult↗
PubMed1981

The health and health care of doctors.

A postal survey of 1,500 doctors who had qualified between 1935 and 1959 and were in active practice in Great Britian elicited 988 replies (a 66 per cent response rate). Nine hundred and thirty-two of the replies were suitable for analysis. There were few differences between hospital doctors and general practitioners in reported medical histories: respiratory tuberculosis had occurred more often among hospital doctors; other respiratory diseases were slightly more common among general practitioners, as were diseases of the digestive tract.The view held by some members of the profession that doctors receive poor medical care was not confirmed. There is, however, cause for disquiet at the possible consequences of self-treatment and the financial implications of illness.

Adult↗
PubMed1980

Perforation of an adenocarcinoma of the small bowel affected by regional enteritis.

This report is of a patient with long-term small bowel regional enteritis who presented with a perforation of an adenocarcinoma involving a diseased portion of ileum. Adenocarcinoma of the small bowel is rare. The incidence of small bowel adenocarcinoma may be higher in patients with regional enteritis, but a definite relationship cannot be established on the basis of data presently available. Small bowel adenocarcinoma in regional enteritis usually presents with obstructive symptoms.

Adenocarcinoma↗
PubMed1971

Factors influencing the uptake of [ 125 I]polyvinyl pyrrolidone by the intestine of the young rat.

1. The uptake of orally administered [(125)I]polyvinyl pyrrolidone (PVP) of mean mol. wt. 160,000 (K. 60) by the small intestine of young rats was determined 4 hr after feeding by measurement of the radioactivity remaining in the wall after flushing out the intestinal contents.2. PVP uptake was proportional to the administered dose of PVP for doses of 1 mg and below. At higher doses, uptake was no longer in linear proportion, suggesting a degree of saturation of uptake.3. Litters were reared in one of three environmental temperatures: 13, 20 and 30 degrees C, and were tested to determine the age at which PVP uptake ceased (;closure'). The results were evaluated statistically (see Appendix).4. There was no significant difference between the time of closure in animals reared at 20 and 30 degrees C, but, relative to these groups, closure was significantly delayed, by approximately 48 hr, in animals reared at 13 degrees C.5. Once closure had begun, there were no significant differences in the rate of decline in PVP uptake with age between animals reared at different environmental temperatures.6. Separation of the young rats from their mother both before and after the test-feed of PVP caused a considerable reduction in PVP uptake. Provided that the body temperature of the young rats was maintained, the main factor contributing to the reduction in PVP uptake appeared to be the absence of milk, rather than separation from the mother.

Animals↗