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Biomedical subjects

J Britton

Publications and source records attributed to J Britton.

At least 163 records · Page 9Linked to original sources
PubMed1990

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.

Adolescent↗
PubMed1990

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.

Adult↗
PubMed1990

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.

Adolescent↗
PubMed1989

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.

Child↗
PubMed1989

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.

Adult↗
PubMed1988

MRI and hydrocephalus in childhood.

In six young patients presenting with raised intracranial pressure during the period of a year, CT revealed the presence of hydrocephalus, but not the cause. Magnetic Resonance Imaging not only showed the site and nature of the obstructing lesion, but also detected additional clinically silent spinal cord tumors in five of the patients. The place of MRI in the diagnosis of diseases involving the region of the cranio-cervical junction and in the elucidation of "unexplained hydrocephalus" is considered.

Child↗
PubMed1988

Seasonal variation in bronchial reactivity in a community population.

Morbidity and mortality from asthma is increased during the grass-pollen season and during the autumn months in the United Kingdom. It is not apparent why this seasonal variation occurs nor whether the variation in morbidity and mortality is associated with variation in bronchial reactivity. We have measured bronchial reactivity on four occasions during 12 months in 60 subjects selected from a community population in the south of England. All subjects had had a histamine challenge test and skin tests to common antigens as part of a survey of asthma prevalence in March 1984. Further measurements of the provocative dose causing a 20% fall in FEV1 (PD20) were made at the peak of the grass-pollen season in June, at the end of September, and in the following March, and current symptoms of respiratory tract infection (RTI) were assessed on all four occasions. Geometric mean PD20 demonstrated significant seasonal variation between 1.38, 0.82, 0.92, and 1.20 mumol in March, June, September, and March, respectively (p less than 0.02). Relative to March 1984, PD20 was significantly decreased in June and September (p less than 0.005 and p less than 0.02, respectively) but not in March 1985 (p = 0.39). Within subjects atopy was significantly related to decrease in PD20 in September (p less than 0.05) and in March 1985 (p less than 0.025) but not in June (p = 0.40). Change in PD20 between occasions was unrelated to RTI symptoms, age, or smoking status, but it was related to change in baseline FEV1/FVC (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Dose related effects of salbutamol and ipratropium bromide on airway calibre and reactivity in subjects with asthma.

The relationship between change in airway calibre and change in airway reactivity after administration of bronchodilator drugs has been investigated by comparing the effect of increasing doses of inhaled salbutamol and ipratropium bromide on the forced expiratory volume in one second (FEV1), specific airways conductance (sGaw), and the dose of histamine causing a 20% fall in FEV1 (PD20) in six subjects with mild asthma. On each of 10 occasions measurements were made of baseline FEV1, sGaw, and PD20 after 15 minutes' rest, and followed one hour later, when the FEV1 had returned to baseline, by a single nebulised dose of salbutamol (placebo, 5, 30, 200 and 1000 micrograms) or ipratropium (placebo, 5, 30, 200 and 1000 micrograms) given in random order. Measurements of FEV1, sGaw, and PD20 were repeated 15 minutes after salbutamol and 40 minutes after ipratropium. Salbutamol and ipratropium caused a similar dose related increase in FEV1 and sGaw, with a mean increase after the highest doses of 0.76 and 0.69 litres for FEV1 and 1.15 and 0.96 s-1 kPa-1 for sGaw. Salbutamol also caused a dose related increase in PD20 to a maximum of 2.87 (95% confidence interval 2.18-3.55) doubling doses of histamine after the 1000 micrograms dose, but ipratropium bromide caused no significant change in PD20 (maximum increase 0.24 doubling doses, 95% confidence interval -0.73 to 1.22). Thus bronchodilatation after salbutamol was associated with a significantly greater change in airway reactivity than a similar amount of bronchodilatation after ipratropium bromide. This study shows that the relation between change in airway reactivity and bronchodilatation is different for two drugs with different mechanisms of action, suggesting that change in airway calibre is not a major determinant of change in airway reactivity with bronchodilator drugs.

Administration, Inhalation↗
PubMed1988

Is the carbon monoxide transfer factor diminished in the presence of diabetic retinopathy in patients with insulin-dependent diabetes mellitus?

Impaired carbon monoxide gas transfer has been demonstrated in patients with insulin-dependent diabetes mellitus (IDDM), but no relationship has been documented between impairment of gas transfer and the presence of other clinical evidence of diabetic microangiopathy. This study set out to determine whether carbon monoxide gas transfer was related to the presence of microangiopathy by measuring the carbon monoxide transfer coefficient (KCO) in twenty patients with IDDM complicated by retinopathy, and in twenty patients without retinopathy. The patients were reasonably matched for age (mean 47 yrs in the retinopathy group, 41 yrs in the non-retinopathy group) but those with retinopathy had a longer mean duration of diabetes (23 yrs vs 13 yrs). Carbon monoxide transfer coefficient was normal in both groups, with no significant difference between them. Values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were lower than predicted in the retinopathy group (92 (SEM 3.6%) and 91 (SEM 4.0%) respectively, p less than 0.05) but were not significantly different from those in the non-retinopathy group. This study demonstrates normal lung function in IDDM, with no relationship between impairment of gas transfer and the presence of microangiopathy elsewhere.

Adult↗
PubMed1988

Early postoperative endoscopic sphincterotomy for retained biliary stones.

Endoscopic sphincterotomy was attempted on 18 patients with retained biliary stones. Endoscopy was performed within 2 weeks of the operation in 13 patients and within 3 weeks in 5 patients. A T-tube was present in 14 patients and 6 patients had multiple stones. Sphincterotomy and complete duct clearance was achieved in 17 patients (94%) and a complication (haemorrhage) occurred in one patient (6%).

Adult↗
PubMed1986

Real-time sonographic display of caudal spinal anomalies.

Real-time computerized ultrasonography with 3.5 and 5.0 MHz sector and linear array transducers (Acuson) depicts spinal anatomy and pathology more clearly than was possible with previous ultrasonic equipment. Split screen (dual image) techniques display increased lengths of spine in a single image. Articulated arm, B-mode sonography remains useful for older patients in whom the pathology lies far from the transducer and in a few post-operative patients in whom dense scar frustrates real-time examination. Sonography is a very useful screening tool for subcutaneous pathology, meningoceles and lipomas, but, thus far, has failed to demonstrate consistently the presence of hydromyelia, intracanalicular (epi)dermoid tumors and dermal sinus stalks ascending toward conus medullaris.

Child↗
PubMed1986

Histamine challenge testing: comparison of three methods.

Non-specific bronchial reactivity is related to the severity of clinical asthma. Histamine challenge testing is increasingly used in association with questionnaires in epidemiological studies of the prevalence and morbidity of asthma in the community. The histamine challenge method described by Cockcroft et al is widely used and well standardised but it has disadvantages for epidemiological studies, being relatively slow and dependent on a supply of pressurised air. In this study we have assessed two simpler methods, one described by Yan et al and one by Mortagy, and compared these with the Cockcroft method. Twenty four adults with asthma were tested with each method in set order in a balanced design, and retested with each method in the same order. The Mortagy and Yan methods recorded PC20 or PD20 values on both occasions in all 24 subjects, but the Cockcroft method only 16 subjects. Repeatability, assessed as the 95% range for a single measurement, did not differ significantly, being +/- 1.94, 2.11, and 2.40 doubling concentrations for the Mortagy, Yan, and Cockcroft methods respectively. The Mortagy and Yan methods required less cumbersome equipment and took under 15 minutes to complete, compared with up to 45 minutes for the Cockcroft technique. The similar repeatability of all three methods in these subjects suggests that the two faster techniques are viable alternatives. The technical problems of standardising the Mortagy method lead us to conclude that, of the three methods compared, the Yan technique offers the greatest advantages for epidemiological studies.

Adolescent↗