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Biomedical subjects

J B Howell

Publications and source records attributed to J B Howell.

At least 19 recordsLinked to original sources
PubMed1991

Respiratory symptoms among elderly people in the New Forest area as assessed by postal questionnaire.

This study was carried out to estimate the prevalence of respiratory symptoms among people aged 65 years and older and assess the value of a postal survey in obtaining this information. A questionnaire was sent to 2011 subjects (957 men) drawn by age-stratified random sampling from the age-sex registers of four New Forest group practices (1:3.3 sample). A total of 1803 replied, a 96.2% response after excluding 136 who had died or moved from the area. The accuracy of replies was verified for 355 (20%) randomly selected subjects. Forty per cent had no respiratory symptoms. Exertional breathlessness was common (38%), increasing in prevalence with age but not with smoking history, and was the only symptom reported by 10% of subjects. Only 14.2% were current smokers; more of the subjects aged 85 years and over were lifelong non-smokers. Two hundred and ninety-six (16.4%) had chronic bronchitis, which was more common among smokers; 151 (8.4%) gave a history of asthma, of whom half (76) had active asthma, which was slightly less common among the very elderly subjects. Only 489 (27.1%) of subjects had seen their doctors with chest symptoms during the preceding 2 years.

Age Factors↗
PubMed1989

Cutaneous defects of focal dermal hypoplasia: an ectomesodermal dysplasia syndrome.

The 5 major cutaneous defects of development found in focal dermal hypoplasia, an ectomesodermal dysplasia syndrome, are: aplasia cutis congenita, multiform atrophy-like areas, striate, papillomatous, and lipomatous lesions of skin. Subepidermal lipomatosis, present in some lesions, has been reported to be due to absence of dermis or a striking underdevelopment of connective tissue with replacement by adipose tissue from herniation of subcutaneous fat through multiple areas of hypoplasia. We believe this theory to be a major error in interpretation of the microscopic findings. We have had the unique experience of studying 2 patients periodically for 27-30 years and 2 additional patients for a shorter time. Biopsy specimens were removed at intervals for analysis from the same or similar lesions (43 specimens) from these 4 individuals. Our evidence strongly supports the concept that the cutaneous defects of development involving fat cells represent heterotopic fat i.e. a fat nevus resulting from dysplasia, not hypoplasia followed by herniation of subcutaneous fat.

Adipose Tissue↗
PubMed1989

Prevalence of respiratory symptoms among 7 and 11 year old schoolchildren and association with asthma.

A new self administered questionnaire completed by parents was used to study the prevalences of wheeze, shortness of breath, and cough in 2503 Southampton schoolchildren aged 7 and 11 together with exacerbating factors and background information including treatment and diagnosis. The questionnaire had a response rate of 84% and was found to be highly repeatable with respect to current symptoms. The overall prevalences of wheeze and shortness of breath in the current year (1986) were 12.1% and 8.5% respectively. Social class, home ownership, parental smoking, and presence of a family pet were unrelated to symptom prevalence. According to the parents the overall diagnosis rate for asthma was 9.5%. In common with other studies, however, we found considerable evidence for undertreatment. The symptoms of wheeze and nocturnal and morning breathlessness occurred more commonly in boys, but this sex ratio decreased with increasing age. The prevalences of wheeze and shortness of breath were similar in the two age groups. In contrast, there were only small differences between the sexes with respect to cough whereas, among children without wheeze or shortness of breath, there was a fall in the prevalence of cough from 18.9% at 7 years to 8.7% at 11 years. When controlling for the other respiratory symptoms, wheeze was the only symptom significantly related to parental asthma. The fall in the prevalence of cough between the two age groups is unlikely to be related to changes in asthma prevalence and, when not associated with wheeze, may be an indicator of separate pathology.

Age Factors↗
PubMed1989

Prevalence of atopy and range of bronchial response to methacholine in 7 and 11 year old schoolchildren.

A sample of 397 from 2503 children aged 7 and 11 years, who took part in an earlier questionnaire study of respiratory symptoms in Southampton, was chosen for methacholine bronchial provocation and allergen skin testing. Results were obtained from 330 (84%). A good level of repeatability was achieved for bronchial provocation testing giving a 95% confidence interval equivalent to 1.74 doubling concentrations. The main problem encountered with methacholine was its bitter taste in high concentrations. The proportion of children, in whom the dose of methacholine which produced a fall of 20% in the forced expiratory volume in one second (PD20 methacholine) was less than or equal to 6.4 mumol, fell from 29.1% at 7 years to 16.5% at 11 years. The prevalence of atopy increased from 26% at 7 years to 31.6% at 11 years. A highly significant association was found between bronchial responsiveness to methacholine and atopy, which was independent of symptoms or age group.

Bronchi↗
PubMed1989

Associations between respiratory symptoms, bronchial response to methacholine, and atopy in two age groups of schoolchildren.

Data on respiratory symptoms were obtained on 2503 schoolchildren aged 7 and 11 in Southampton by means of a self administered parental questionnaire. Children were classified into seven symptom groups from which 330 were tested for bronchial responsiveness to less than or equal to 6.4 mumol methacholine and skin tested for the presence of atopy. The symptoms of wheeze, cough, and shortness of breath were all significantly associated both with each other and bronchial responsiveness to methacholine but only wheeze was associated with atopy. The association of wheeze with both bronchial responsiveness to methacholine and atopy remained highly significant when controlling for the symptoms of cough and shortness of breath. Neither cough nor shortness of breath, however, were significantly related to bronchial responsiveness to methacholine when controlling for the symptom of wheeze. This study therefore calls into question the epidemiological relevance of these two symptoms as diagnostic features of asthma, particularly in the absence of wheeze, although they may be useful indicators of morbidity. Wheeze was not related to bronchial responsiveness to methacholine in the absence of atopy or to atopy in the absence of bronchial responsiveness to methacholine but was strongly related to the combination of the two phenomena. The presence of these three characteristics could therefore indicate a discrete disease entity. The decrease in the prevalence of cough between 7 and 11 years appeared to be mirrored by a similar decrease in the prevalence of wheeze when the symptom was not associated with the combination of bronchial responsiveness to methacholine and atopy. On the basis of these findings and those of others we suggest that the latter group may represent children with a separate disease entity(ies) or with residual symptoms secondary to acute viral or other infections of the lower respiratory tract.

Asthma↗
PubMed1986

Respiratory symptoms and bronchial reactivity: identification of a syndrome and its relation to asthma.

Two postal questionnaire surveys were carried out among the adult population of Southampton aimed at clarifying the diagnostic criteria for asthma (study 1) and at testing the validity of symptoms so identified as diagnostic of bronchial hyper-reactivity (study 2). The questionnaires asked about respiratory symptoms and included three questions thought likely to disclose increased bronchial reactivity. Laboratory measurements on subsamples of respondents included spirometry and bronchial challenge with increasing doses of histamine till a concentration was reached provoking a fall of more than 20% (PC greater than 20) in forced expiratory volume in one second. In the first study no normal subject (that is, one who did not report shortness of breath or wheezing on the questionnaire) had a PC greater than 20 below 0.5 g/l. Of 51 subjects who reported shortness of breath or wheezing, or both, nine had a cluster of abnormalities consisting of one or more symptoms of bronchial irritability, nocturnal dyspnoea, and prolonged morning tightness together with PC greater than 20 values of 0.5 g/l or less. These symptoms in conjunction with a low PC greater than 20 were termed the bronchial irritability syndrome. In the second study bronchial challenge confirmed the close association of these symptoms with bronchial hyper-reactivity, all other subjects being less reactive to histamine. Only 27% of subjects with symptoms of the bronchial irritability syndrome had been diagnosed as asthmatic by their general practitioners. The bronchial irritability syndrome is a definable entity for epidemiological study and patient care.

Adult↗
PubMed1986

Cutaneous keratocysts of nevoid basal cell carcinoma syndrome.

Four cysts were removed from two unrelated patients with nevoid basal cell carcinoma syndrome. Multiple sections from each cyst were studied. Two cysts showed histologic features similar to keratocysts that occur in the jaws of patients with this syndrome. The cysts were lined by a festooned epithelium consisting of two to five layers of squamous cells that formed keratin without the presence of a granular cell layer. One cyst contained some lanugo hair and a small bud of follicular epithelium. This cyst was therefore similar to cutaneous steatocysts but did not have an identifiable sebaceous component. The second cyst was devoid of hair and adnexal structures and was indistinguishable from a jaw keratocyst. Two other cysts were typical epidermoid (infundibular) cysts. Although speculative, it is likely that some cutaneous cysts in patients with nevoid basal cell carcinoma syndrome are identical to jaw keratocysts and may be another cutaneous marker for this disease complex.

Adult↗
PubMed1986

Spotting sinister spots. A challenge to dermatologists to examine every new patient at increased risk for signs of early melanoma.

Preventing death from malignant melanoma is the most pressing issue in preventive dermatology in the United States because the mortality rate has increased markedly. Dermatologists, as the physicians best suited by training to identify early malignant melanoma, need to take the lead in developing a national project of educating physicians, patients, and the public to recognize the clinical features of early malignant melanoma and to appreciate that prompt excision results in a high rate of cure. The immediate challenge is to commit ourselves to examining every new patient and to conducting periodic "skin scans" of every patient at increased risk for melanoma. Just as the Papanicolaou screening test has markedly reduced cervical cancer mortality rates, commitment to early identification and excision of melanomas can mean a comparable triumph for preventive dermatology and will help us meet the challenge of our Australian colleagues to make melanoma a word, not a death sentence.

Adult↗
PubMed1985

A useless raffle.

A mailed questionnaire was sent to 2712 subjects asking about respiratory symptoms, and a raffle for three prizes of 50 pounds, 30 pounds, and 20 pounds was organised. The response rate in the 1762 who were told about the raffle was no higher than for 950 subjects who served as controls.

Awards and Prizes↗