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Biomedical subjects

J Britton

Publications and source records attributed to J Britton.

At least 127 records · Page 7Linked to original sources
PubMed1996

Pancreaticopleural fistula: a rare complication of chronic pancreatitis.

Pancreaticopleural fistula is an uncommon sequelae of pancreatitis. The condition is often elusive, as respiratory rather than abdominal symptoms usually predominate and the fistula can be difficult to demonstrate radiologically. Confirmation is by demonstrating a high amylase content in the pleural aspirate relative to the serum. About half the fistulae will close with conservative treatment but persistent or recurrent effusions, often associated with stenosis or disruption of the main pancreatic duct, are an indication for surgery. The long-term outcome is good in 80-95% of cases. We report five patients with pleural effusion of pancreatic origin due to pancreaticopleural fistula.

Adult↗
PubMed1996

Study of the aetiology of wheezing illness at age 16 in two national British birth cohorts.

BACKGROUND: Data from two national British birth cohorts were used to measure the increase in prevalence of wheezing illness at age 16 between 1974 and 1986, and to investigate the role of several potential risk factors in the increase. METHODS: The occurrence of self-reported asthma or wheezy bronchitis within the past year, and the frequency of attacks of wheezing illness at age 16, were compared in 11,262 and 9266 children born in one week of 1958 and 1970, respectively. The effects of several putative risk factors for asthma--including birth weight, maternal age, birth order, breast feeding, maternal smoking in pregnancy, child's personal smoking, and father's social class--on the change in occurrence of wheezing illness at age 16 were assessed by multiple logistic regression. RESULTS: The annual period prevalence of asthma or wheezy bronchitis at age 16 increased from 3.8% in 1974 to 6.5% in 1986 (prevalence ratio (PR) = 1.71, 95% CI 1.52 to 1.93). The proportion of children experiencing attacks more than once a week increased from 0.2% to 0.7% (PR = 3.77, 95% CI 2.28 to 6.23). The prevalence of self-reported eczema and hayfever within the past year doubled between 1974 and 1986, suggesting that the increase in asthma was part of a general increase in the prevalence of atopic disease. However, in the complete dataset, after adjustment for the effects of the risk factors studied, the prevalence odds ratio for asthma or wheezy bronchitis in 1986 compared with 1974 was virtually unchanged from the unadjusted value at 1.77 (95% CI 1.46 to 2.15). CONCLUSION: The prevalence of wheezing illness in British teenagers increased by approximately 70% between 1974 and 1986. This increase appears to have occurred in the context of a general increase in atopic disease and was largely unexplained by changes in the distribution of maternal age, birth order, birth weight, infant feeding, maternal smoking, active smoking by the child, or father's social class.

Adolescent↗
PubMed1996

Mortality rates from cryptogenic fibrosing alveolitis in seven countries.

BACKGROUND: Registered mortality from cryptogenic fibrosing alveolitis (CFA) in England and Wales has increased substantially since the specific International Classification of Diseases code for CFA was introduced in 1979. However, since a significant proportion of deaths from CFA are misclassified as post inflammatory fibrosis (PIF), it is possible that the observed rise in CFA mortality is due to diagnostic transfer from this code. To investigate this, and to assess mortality trends in other countries, annual CFA and PIF mortality data from England and Wales, USA, Australia, Scotland, Canada, New Zealand, and Germany were analysed. METHODS: Crude annual mortality rates were calculated and rates standardised by Poisson regression to allow assessment of changes over time and comparison between countries, sexes, and age groups. The relative trends in mortality from CFA and PIF were assessed by calculating the annual ratio of CFA to PIF deaths. RESULTS: Men were more likely than women to die from both CFA and PIF in all countries. The highest standardised CFA mortality rate occurred in England and Wales, and the lowest in Germany. Since 1979 mortality from CFA has increased in England and Wales, Australia, Scotland and Canada, but there was no trend in CFA mortality in New Zealand or Germany. In the USA mortality from CFA was low and has fallen. Mortality from PIF increased in all countries except New Zealand and Germany, and the highest PIF mortality, together with the greatest increase over time, was seen in the USA. Changes over time in the annual ratio of CFA to PIF deaths in all countries were small, implying that diagnostic transfer is not a major cause of the increasing CFA mortality. CONCLUSIONS: Mortality from CFA continues to increase in England and Wales and in many other countries. Diagnostic transfer from PIF does not appear to be a major cause of this.

Adolescent↗
PubMed1996

The effect of lifestyle on wheeze, atopy, and bronchial hyperreactivity in Asian and white children.

There is increasing evidence linking Western culture to increasing prevalence of asthma. We have measured the prevalence of symptoms of asthma, bronchial hyperreactivity, and atopy in a sample of white and Asian inner city schoolchildren aged 8-11 yr in the U.K. and assessed the influence of certain aspects of western culture on these variables. Bronchial reactivity was measured by methacholine challenge, atopy by allergen skin prick tests, and symptoms of asthma and aspects of lifestyle by questionnaire. Degree of Westernization was assessed from dietary habit categorized as exclusively Asian, mostly Asian, mixed, or exclusively English. The questionnaire was completed by 92% of children. The 308 white and 539 Asian children were of similar age (mean 9.3 yr versus 9.4 yr) with slightly more girls in the Asian group (52.6% versus 47.4%). The white children reported more wheeze within the past year (14.2% versus 8.8%, p = 0.01) but less were atopic (29.5% versus 38.4%, p = 0.01) with no significant difference in the prevalence of hyperreactivity (31.5% versus 29.6%, p = 0.57). Most Asians (97%) included Asian food in their diet; 35% ate a mostly Asian diet, 45% ate a mixed English and Asian diet, and 17% ate an exclusively Asian diet. After controlling for confounding factors whites were at higher risk of hyperreactivity and lower risk of atopy, and the risk of hyperreactivity and to a lesser extent atopy among Asian children was related to diet in a dose response fashion. The relative odds for hyperreactivity with an exclusively Asian, mostly Asian, or a mixed diet relative to an English diet were 0.31 (95% CI 0.15 to 0.62), 0.88 (0.56 to 1.37), and 0.99 (0.65 to 1.49), and for atopy were 1.22 (0.72 to 2.06), 1.47 (0.99 to 2.19), and 1.78 (1.23 to 2.58). These results suggest that diet or other closely related factors associated with Westernization are involved in the etiology of atopy and hyperreactivity.

Asian People↗
PubMed1995

Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results.

OBJECTIVE: To establish the safety, short term outcome, and theatre costs of transabdominal laparoscopic repair of inguinal hernia performed as day surgery. DESIGN: Randomised controlled trial. The control operation was the two layer modified Maloney darn. SETTING: Teaching hospital and district general hospital. SUBJECTS: 125 men randomised to laparoscopic or open repair of inguinal hernia. OUTCOME MEASURES: Morbidity, postoperative pain and use of analgesics, quality of life, and theatre costs. Outcome was assessed by questionnaires administered to patients daily for 10 days and at six weeks postoperatively and by outpatient review at six weeks. Return to normal activity was assessed by questionnaire at three months. RESULTS: One vascular complication (2%) occurred in the group that had open repair. Seven complications (12%) including vessel injury and early recurrence arose in the group that had laparoscopic repair (difference in complication rate 10% (95% confidence interval 4% to 18%; P = 0.02). Pain scores and quality of life assessed by the short form 36 showed a significant benefit to the group that had laparoscopic repair in the early postoperative period. Return to normal activity was not significantly different between the two groups. Total theatre costs were higher in the group that had laparoscopic repair (mean cost for laparoscopic repair 850 pounds (622 pounds to 1078 pounds); mean cost for open repair 268 pounds (245 pounds to 292 pounds)). CONCLUSIONS: Because of the greater complication rate and higher theatre costs for laparoscopic repair and the patient outcome preferences expressed, the results of larger trials of clinical and cost effectiveness using recurrence as the primary outcome measure should be known before laparoscopic herniorrhaphy is widely adopted.

Adult↗
PubMed1995

Septic arthritis in a lumbar facet joint: a rare cause of an epidural abscess.

A 10-year-old boy presented with a 7-day history of back pain and pyrexia. MRI showed an epidural abscess arising from septic arthritis in a lumbar facet joint. Whilst septic arthritis in a large joint is relatively common in children, epidural abscess is rare. This case illustrates how infection in a synovial joint may extend into the extradural space and might be the route of infection in more cases than has previously been recognised.

Abscess↗
PubMed1995

Relationship between balance system function and agoraphobic avoidance.

There is a striking similarity between the situations avoided by people with agoraphobia and the environments which provoke disorientation in people with organic balance disorders. This study investigated the possibility that agoraphobia might be linked to balance system dysfunction by comparing the results of balance system tests in 36 people with symptoms of panic and agoraphobia and 20 normal controls. A traditional battery of audiovestibular tests was supplemented with moving platform posturography, which assesses the postural instability induced by disorienting perceptual conditions. Subjects also completed questionnaire measures of somatic symptoms of dizziness and anxiety, agoraphobic cognitions, avoidance behaviour and state anxiety. Over 60% of the Ss with symptoms of panic and agoraphobia were destabilised by the disorienting perceptual conditions, compared with just 10% of the normal controls. Postural instability was strongly related to reported agoraphobic avoidance (r = 0.63, P < 0.01), even after controlling for symptoms, anxiety and agoraphobic cognitions. In our discussion we consider alternative interpretations of these findings, future directions for research, and implications for therapy.

Adult↗
PubMed1995

Dose-response relationship and time-course of the effect of inhaled magnesium sulphate on airflow in normal and asthmatic subjects.

1. Magnesium is a dietary cation with a wide range of actions of potential relevance to asthma. 2. To determine the dose-response relationship and time-course of the effect of inhaled magnesium sulphate on the airway, we have studied the effect of 0, 90, 135, 180 and 360 mg of magnesium sulphate given by nebulizer on specific airways conductance (sGaw) in 20 normal subjects, and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), flow at 25% forced vital capacity (Vmax25) and peak expiratory flow (PEF) in 19 asthmatic subjects. 3. On five occasions after baseline measurements of airway calibre, one of the five doses of magnesium sulphate in 3 ml normal saline was administered by nebulizer in a randomized, double-blind design. Measurements of sGaw or FEV1, FVC, Vmax25 and PEF were made at 5 and 10 min after nebulization and at 10 min intervals thereafter up to 90 min. 4. There was no significant difference in the mean area under the curve (AUC) for change from baseline in sGaw or maximum increase from baseline between doses in normal subjects. 5. In asthmatic subjects there was no significant difference in the mean AUC for change from baseline in FEV1, FVC or Vmax25 when compared between doses by analysis of variance. There was a difference in the mean AUC for change from baseline in PEF between doses (ANOVA P for all groups 0.052) but this can be explained by a detrimental effect of the maximum dose of magnesium sulphate. 6. It would appear that inhaled magnesium does not act as a bronchodilator in normal or asthmatic subjects.

Administration, Inhalation↗
PubMed1995

Lumbosacral skin markers and identification of occult spinal dysraphism in neonates.

Some skin lesions over the spine are known to be associated with occult spinal dysraphism, but the significance of common skin lesions, such as sacral pits and dimples, is uncertain. In this prospective study, 95 neonates (1.9% of 4989 live births) were referred with possible markers of occult spinal dysraphism. Seven of 94 babies examined had abnormalities demonstrated by spinal ultrasound, compared with 5 of 105 controls. In 2 of 94 and 3 of 105 of these, the conus medullaris was located at L3 but no other abnormalities were found. Of the 75 babies with a sacral dimple or pit alone, none had an abnormality, suggesting that these skin lesions do not indicate a high risk of occult spinal dysraphism.

Biomarkers↗
PubMed1995

Prospective study of risk factors for early and persistent wheezing in childhood.

The object of this study was to determine the relative importance of low birth weight, preterm birth, low maternal age, household size, exposure to maternal smoking, personal smoking at 16 yrs of age, early termination of breastfeeding and socioeconomic status in the aetiology of wheezing illness in the first 5 yrs of life, and on the persistence of this illness at 16 yrs of age. In 15,712 children born in Britain during one week of April 1970, the occurrence of wheezing by 5 yrs of age, and of wheezing in the past year at 16 yrs of age within this group were analysed in multivariate logistic regression against each potential risk factor. The independent determinants of wheezing by 5 yrs of age were male sex, maternal smoking during pregnancy (odds ratio (OR) for 15+ cigarettes.day-1 = 1.39; 95% confidence interval (95% CI) 1.22-1.58) and low birthweight (OR for birthweight < 2.5 kg = 1.26; 95% Cl 1.07-1.50). Of children who had wheezed by 5 yrs of age, 15% reported wheezing in the past 12 months at 16 yrs of age. The persistence of symptoms at 16 yrs of age was independently related to low maternal age (OR for 20 vs 40 yrs of age = 1.96; 95% CI 1.08-3.45) and to high social status (OR for most vs least advantaged = 1.95; 95% CI 1.13-3.38). We conclude that low birth weight and maternal smoking in pregnancy are independent risk factors for early childhood wheezing, but in 85% of children with early wheezing it resolves by 16 yrs of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Effects of anxiety arousal and mental stress on the vestibulo-ocular reflex.

Although the subjective reports of patients suggest that anxiety may aggravate vertigo and imbalance, there has been little research into how anxiety might directly affect balance system functioning. We conducted two studies to examine the effect of anxiety and arousal on the vestibulo-ocular reflex (VOR). In the first study, pre-lest fear ratings were obtained from 20 normal subjects and 36 anxious subjects immediately prior to rotation and caloric testing. Fear ratings were significantly correlated with the maximum slow-phase velocity (SPV) of nystagmus induced by caloric testing. In the second study, we assessed the VOR response to rotation of 36 normal subjects under 3 task conditions: a) minimal alerting (counting backwards during rotation), b) physical arousal (induced by exertion prior to rotation); c) mental arousal (induced by performance of stressful mental tasks during rotation). Both the physical and mental tasks induced a significant increase in heart rate compared with the alerting condition. The maximum SPV of the nystagmus induced by rotation was significantly greater during performance of the mental task than in the other two conditions. These combined results indicate that anxiety may influence the gain of the VOR.

Adolescent↗
PubMed1994

Dietary magnesium, lung function, wheezing, and airway hyperreactivity in a random adult population sample.

Magnesium is involved in a wide range of biological activities, including some that may protect against the development of asthma and chronic airflow obstruction. We tested the hypothesis that high dietary magnesium intake is associated with better lung function, and a reduced risk of airway hyper-reactivity and wheezing in a random sample of adults. In 2633 adults aged 18-70 sampled from the electoral register of an administrative area of Nottingham, UK, we measured dietary magnesium intake by semiquantitative food-frequency questionnaire, lung function as the 1-sec forced expiratory volume (FEV1), and atopy as the mean skin-prick test response to three common environmental allergens. We measured airway reactivity to methacholine in 2415 individuals, defining hyper-reactivity as a 20% fall in FEV1 after a cumulative dose of 12.25 mumol or less. Mean (SD) daily intake of magnesium was 380 (114) mg/day. After adjusting for age, sex, and height, and for the effects of atopy and smoking, a 100 mg/day higher magnesium intake was associated with a 27.7 (95% CI, 11.9-43.5) mL higher FEV1, and a reduction in the relative odds of hyper-reactivity by a ratio of 0.82 (0.72-0.93). The same incremental difference in magnesium intake was also associated with a reduction in the odds of self-reported wheeze within the past 12 months, adjusted for age, sex, smoking, atopy, and kilojoule intake, by a ratio of 0.85 (0.76-0.95). Dietary magnesium intake is independently related to lung function and the occurrence of airway hyper-reactivity and self-reported wheezing in the general population. Low magnesium intake may therefore be involved in the aetiology of asthma and chronic obstructive airways disease.

Adult↗
PubMed1994

Atopy as a risk factor for cryptogenic fibrosing alveolitis.

In a case-control study of occupational and environmental causes of cryptogenic fibrosing alveolitis we recently observed a higher prevalence of self-reported symptoms of wheeze, rhinitis or conjunctivitis in cases than in controls. To determine objectively whether this was due to a higher prevalence of atopy amongst cases of CFA, we have measured skin sensitivity to common allergens (D. Pteronyssinus, grass pollen, and cat fur), eosinophil counts and total Immunoglobulin E (IgE) in venous blood in the 22 surviving CFA cases from that study who were willing to provide a blood sample, and in one matched control per case. At least one positive skin test was recorded in 13 cases and six controls, the matched odds of one or more positive test being significantly increased in cases by a ratio of 8.0 (95% confidence interval 1.01-64, P = 0.05). Geometric mean eosinophil counts and IgE levels were also increased amongst cases by factors of 1.6 (95% CI 0.96-2.6) and 1.9 (0.9-3.8) respectively, although these differences were not significant. Differences in skin sensitivity, eosinophil counts, and IgE levels all tended to be more obvious in the 13 case control pairs in which the case was not taking steroids or other immunosuppressive treatment. We conclude that cases of CFA showed increased skin sensitivity to common allergens, and had evidence of increased IgE and eosinophilia in peripheral blood. These findings suggest that atopy may be an important determinant of susceptibility to CFA.

Aged↗
PubMed1994

Osteomyelitis of the skull base: the role of high resolution CT in diagnosis.

Osteomyelitis of the skull base (involving the temporal, occipital or sphenoid bones) is an uncommon condition occurring in elderly diabetic patients which was almost always fatal in the pre-antibiotic era. Despite the advent of effective antibiotics against the usual causative organism, Pseudomonas aeruginosa, the mortality remains high and is related to delay in diagnosis and inappropriate treatment. We report three cases of osteomyelitis of the skull base, in order to illustrate the difficulties encountered in diagnosis and management. The CT scan appearances, which would appear to be typical for the disease, are described and the pathogenesis of skull base osteomyelitis is discussed.

Aged↗