Biomedical subjects
J Britton
Publications and source records attributed to J Britton.
Airway hyperresponsiveness and the clinical diagnosis of asthma: histamine or history?
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Pollution and respiratory morbidity: how much do we accept?
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Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study.
OBJECTIVE: To determine whether an intervention programme based on existing school and community resources can reduce school absence and improve participation in games lessons and sport in children with unrecognised or undertreated asthma. DESIGN: Parallel group controlled intervention study. SETTING: 102 primary schools in Nottingham: 49 were randomised to receive the intervention and 53 to be control schools. SUBJECTS: All children aged 5 to 10 years with parent reported absence from school because of wheezing in the previous year and taking no treatment or beta agonists only. INTERVENTIONS: Children with asthma were referred to their general practitioner for assessment of symptoms and treatment. Teachers were given education on asthma by the school nurse in 44 of the 49 intervention schools. MAIN OUTCOME MEASURES: Changes in school absence and missed games and swimming lessons because of wheezing, and schools' policy towards management of asthma in school. RESULTS: Of 17,432 children screened, 451 met the entry criteria--228 in intervention schools and 223 in control schools. 152 (67%) children in intervention schools visited their general practitioner, of whom 39 (26%) were given a new diagnosis of asthma and 58 (38%) had treatment for asthma increased or changed. Over the next academic year mean (SE) parent reported school absence due to wheezing fell significantly, but to a similar extent, in both intervention and control schools (0.82 (0.11) and 1.09 (0.21) weeks respectively). There was little change in school recorded absence or participation in games lessons and swimming lessons in either group. At the end of the study intervention schools were more likely to have improved aspects of management of asthma in school. CONCLUSION: The intervention resulted in a majority of children being assessed by their general practitioner and improved teachers' understanding and management of asthma, but it did not result in any appreciable reduction in morbidity.
The developing gastrointestinal tract and milk-borne epidermal growth factor.
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Intradiploic meningiomas. A radiological study of two cases confirmed histologically.
Approximately 1% of meningiomas arise in extradural sites. Intradiploic meningiomas form only a very small proportion of this number. They tend to occur in young patients. The CT and MRI appearances, although unusual, may be characteristic of the condition. We present two cases and describe the CT and MR appearance; the latter has not previously been described.
Ocular toxicity of ethambutol.
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Neurosarcoidosis--demonstration of meningeal disease by gadolinium enhanced magnetic resonance imaging.
Arriving at a firm diagnosis of neurosarcoidosis continues to pose serious problems, particularly when evidence of granulomatous disease outside the nervous system is lacking. The commonest mode of presentation of neurosarcoidosis is with cranial nerve palsies. Two cases of presumed neurosarcoidosis with cranial nerve palsies showed clear evidence of focal meningeal disease on gadolinium-DTPA enhanced MRI brain scans. Although not specific for sarcoidosis, this technique may be very useful in aiding the diagnosis in suspected cases.
Milk-borne epidermal growth factor (EGF) and its processing in developing gastrointestinal tract.
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What causes cryptogenic fibrosing alveolitis? A case-control study of environmental exposure to dust.
OBJECTIVE: To investigate the role of occupational and domestic exposure to dust in the aetiology of cryptogenic fibrosing alveolitis. DESIGN: Matched case-control study. SUBJECTS: 40 Patients with cryptogenic fibrosing alveolitis and 106 community controls matched for age and sex who responded to a questionnaire. MAIN OUTCOME MEASURE: Responses to self administered questionnaire asking about lifetime exposure to dust, animals, and smoke at home and at work. RESULTS: The patients with cryptogenic fibrosing alveolitis were more likely to report occupational exposure to metal dust (matched odds ratio 10.97 (95% confidence interval 2.30 to 52.4), p less than 0.001) or wood dust (2.94 (0.87 to 9.90), p = 0.08), to have worked with cattle (10.89 (1.24 to 96.0), p = 0.01), and to have lived in a house heated by a wood fire (12.55 (1.04 to 114), p = 0.009). A history of smoking and social class based on occupation were not significantly related to disease state. CONCLUSION: Environmental exposure to dust may be an important factor in the aetiology of cryptogenic fibrosing alveolitis.
Rising mortality from cryptogenic fibrosing alveolitis.
OBJECTIVE: To determine the pattern of mortality ascribed to cryptogenic fibrosing alveolitis and to identify factors that might be important in the aetiology of the disease; and to assess the validity of death certification of the disease. DESIGN: A retrospective examination of mortality ascribed to cryptogenic fibrosing alveolitis in England and Wales between 1979 and 1988 with analysis, by multiple logistic regression, of independent effects of age, sex, region of residence, and social class as indicated by occupation on data for 1979-87; also a retrospective review of hospital records of patients certified as having died of cryptogenic fibrosing alveolitis in Nottingham and of the certified cause of death of patients known to have had the disease. MAIN OUTCOME MEASURES: Time trends in mortality nationally; effects on mortality of age, sex, and region of residence; validity of death certification in Nottingham. RESULTS: The annual number of deaths ascribed to cryptogenic fibrosing alveolitis doubled from 336 in 1979 to 702 in 1988, the increase occurring mainly at ages over 65. Mortality standardised for age for both sexes likewise increased steadily over the period. Deaths due to cryptogenic fibrosing alveolitis were commoner in men (odds ratio 2.24, 95% confidence interval 2.11 to 2.33) and increased substantially with age, being 7.84 (7.24 to 8.49) times higher in subjects aged much greater than 75 than those aged 45-64. Odds ratios of death due to cryptogenic fibrosing alveolitis adjusted for age and sex were increased in the traditionally industrialised central areas of England and Wales (p less than 0.02, maximum odds ratio between regions 1.25), but no significant increase in odds of death was found for manual occupations. Of 23 people whose deaths were registered in Nottingham as having been due to cryptogenic fibrosing alveolitis, 19 were ascertained from clinical records to have had the disease. Only 17 of 45 patients known to have had cryptogenic fibrosing alveolitis in life were recorded as having died from the disease. CONCLUSIONS: The diagnostic accuracy of death certification of cryptogenic fibrosing alveolitis is high, but the number of deaths recorded as being due to the disease may underestimate the number of patients dying with the disease by up to half. Mortality due to the disease is increasing, and the male predominance and regional differences in mortality suggest that environmental factors are important in its aetiology.
Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma.
The effects of two pranayama yoga breathing exercises on airway reactivity, airway calibre, symptom scores, and medication use in patients with mild asthma were assessed in a randomised, double-blind, placebo-controlled, crossover trial. After baseline assessment over 1 week, 18 patients with mild asthma practised slow deep breathing for 15 min twice a day for two consecutive 2-week periods. During the active period, subjects were asked to breathe through a Pink City lung (PCL) exerciser--a device which imposes slowing of breathing and a 1:2 inspiration:expiration duration ratio equivalent to pranayama breathing methods; during the control period, subjects breathed through a matched placebo device. Mean forced expiratory volume in 1 s (FEV1), peak expiratory flow rate, symptom score, and inhaler use over the last 3 days of each treatment period were assessed in comparison with the baseline assessment period; all improved more with the PCL exerciser than with the placebo device, but the differences were not significant. There was a statistically significant increase in the dose of histamine needed to provoke a 20% reduction in FEV1 (PD20) during pranayama breathing but not with the placebo device. The usefulness of controlled ventilation exercises in the control of asthma should be further investigated.
Endocrine disorders following treatment of childhood brain tumours.
We have studied the long-term endocrine effects of treatment on 144 children treated for brain tumours. All received cranial irradiation, 86 also received spinal irradiation and 34 chemotherapy. Almost all patients (140 of 144) had evidence of growth hormone insufficiency. Treatment with growth hormone was effective in maintaining normal growth but could not restore a deficit incurred by delay in instituting treatment. The effect of spinal irradiation on spinal growth was not corrected by growth hormone. As spinal growth makes the major contribution to the pubertal growth spurt and limb length the major contribution to childhood growth, treatment with GH will have maximal effect on leg length if instituted before the onset of puberty. Primary thyroid dysfunction was found in 11 of 47 children (23%) treated with craniospinal irradiation but in none treated with cranial irradiation alone. The incidence rose to 69% of 29 children treated with spinal irradiation and chemotherapy and to 50% of four children treated with cranial irradiation and chemotherapy. This effect of chemotherapy has not previously been reported and was detected by us through measurement of serum TSH concentration. Primary thyroid dysfunction requires treatment with thyroxine to prevent increasing the risk of secondary thyroid tumours. Seven of 20 girls (35%) treated with spinal irradiation had primary ovarian dysfunction as determined by raised gonadotrophin levels. Chemotherapy increased this, but not significantly. Three of 15 boys (20%) treated with chemotherapy had primary testicular dysfunction. Gonadotrophin deficiency occurred in seven boys. Four of 90 children had deficiency of cortisol secretion in response to hypoglycaemia. These results confirm the requirement for long-term follow-up of children treated for brain tumours from the endocrine point of view. Anticipation of hormone deficiencies and replacement treatment can improve the quality of life of survivors.
Change in use of asthma as a diagnostic label for wheezing illness in schoolchildren.
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Bronchial provocation testing.
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Closed spinal dysraphism: analysis of clinical, radiological, and surgical findings in 104 consecutive patients.
We reviewed 104 consecutive cases of closed dysraphism in patients seen at one institution between December 1984 and June 1987. All patients had myelographic studies, and 43 had associated CT examinations. Clinical and surgical findings (64 patients) were correlated with myelographic information. Twenty-three patients (22%) with clinical or plain film findings compatible with dysraphism had normal-appearing cords on conventional myelography, movement between supine and prone positions, and no lesions in the spinal canal. Cerebellar tonsillar ectopia (majority of tonsils between foramen magnum and C1) was found in 17 patients (16%). Six patients (6%) exhibited varying degrees of hydromyelia. In the supine position, CT-myelography of meningoceles, meningomyeloceles, or lipomeningomyeloceles may limit demonstration of the neural placode and nerve roots because of compression of the CSF-containing sac. In the decubitus position, CT scans improved demonstration of neural tissue-CSF space relationships. CT scans were useful in demonstrating anomalous paraspinal bones, diastematomyelia spurs, and spinal and sacral bone deficiency. Axial CT-myelography of intradural lipomas showed apparent neural tissue extension into the lipomas.
Endoscopic sphincterotomy for bile duct stones: an institutional review of 272 patients.
The results of the first 283 endoscopic sphincterotomies (ES) attempted in Oxford for bile duct stones are described. Endoscopic sphincterotomy was achieved in 272 patients (96%) and complete duct clearance was achieved in 88% of these patients; an overall success rate of 85%. Complications occurred in 26 patients (10%), five of whom required an emergency laparotomy. Eight patients died within 30 days of ES but only two deaths were attributed directly to the procedure. Although the sphincterotomies were performed by several endoscopists in varying stages of training, the results are similar to those from other large reports. In the last year of the study (1987), 58 patients were referred from within the Oxfordshire District which suggests an annual demand for ES for bile duct stones of 11 patients per 100,000 of population.