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Biomedical subjects

M Charlton

Publications and source records attributed to M Charlton.

49 records · Page 3Linked to original sources
PubMed1993

Cancer in young people in the north of England, 1968-85: analysis by census wards.

OBJECTIVE: To determine whether the seeming excess of childhood leukaemia and lymphoma identified in Seascale, Cumbria, UK, remains unusual when put into a wider context. DESIGN: Analysis of cancer incidence by geographical area. SETTING: The north of England including the Northern and North Western Regional Health Authority regions and the Southport and South Sefton districts of the Mersey Regional Health Authority. SUBJECTS: Altogether 6686 cases of malignant disease in people under 25 years old. MEASUREMENTS AND MAIN RESULTS: Cases of cancer diagnosed before their 25th birthday between January 1968 and December 1985 identified from three regional cancer registries were allocated to a census ward on the basis of 'usual place of residence'. Population data were derived from the 1971 and 1981 censuses, and the cancer incidence was calculated for each ward. Of the 6686 cases, there were 1035 cases of acute lymphoblastic leukaemia and 361 of non-Hodgkins lymphoma. Wards were ranked by cancer incidence and Poisson probability, using different population bases. Seascale ward is the most highly ranked ward for acute lymphoblastic leukaemia for the time periods 1968-85 or 1968-76. It is not the most highly ranked for non-Hodgkins lymphoma. However, combining acute lymphoblastic leukaemia and non-Hodgkins lymphoma incidence gives an even more extreme position for Seascale. The most extreme Poisson probability for any of the analyses was that for brain tumours in the electoral ward of Ashton St Michael, Tameside (p = 0.000009). CONCLUSION: The incidence of acute lymphoblastic leukaemia and non-Hodgkins lymphoma in the Seascale ward remains high when put into a wider context. For other cancers there are wards with even more extreme Poisson probability values.

Adolescent↗
PubMed1993

General practice in New Zealand.

General practice in New Zealand has evolved into a 'user pays' system and although operating within a national health service, it has many interesting differences from general practice in the United Kingdom. Emphasis is placed on biculturalism in health care. Income is derived through a fee for service, which includes a proportion from patients dependent on their means tested reimbursement from the government for provision of general medical services. Consultations are fewer in number and longer in duration. New Zealand society has considerable awareness in the area of medical ethics and there is a medical insurance scheme which covers ill health as a result of accidents. Great advances have been made in provision for out of hours work. New Zealand has its own royal college of general practitioners, membership examination and scheme for vocational training. This paper, based on the authors' personal experience of 12 months' study leave in New Zealand in 1991-92, examines these important areas of difference and reflects on the health reforms that are currently taking place in New Zealand.

Delivery of Health Care↗
PubMed1992

Endoscopic therapy for bile duct stones in a geriatric population.

During the 5 year period to May 1988, 137 consecutive patients (age range, 65-102 years; median 84 years) with a diagnosis of choledocholithiasis, were referred to The Middlesex Hospital Geriatric Department. Endoscopic sphincterotomy was successful in 96.2% of cases and immediate biliary drainage was achieved in all but one of these patients. Stones were cleared endoscopically in 73.3% and surgically in 4.7% of cases. Long-term stenting was employed in 14.3% of patients. The 30 day mortality after endoscopic or surgical treatment was 4.7% (six deaths), although death was probably unrelated to therapy in half the cases. Deaths were due to procedural cardiorespiratory arrest (1), pancreatitis (1), pneumonia (2) and cerebrovascular accident (2). Endoscopic treatment is effective even in a high-risk geriatric population. After sphincterotomy patients with intact gall bladders should be managed expectantly.

Aged↗
PubMed1989

Factors influencing mortality and morbidity following oesophageal resection.

Operative mortality and morbidity following oesophageal resection has fallen in recent years. We have attempted to identify the factors responsible for this improvement by reviewing the results of surgery at this hospital over the last 6 years. Two hundred and two oesophageal resections were performed between January 1981 and June 1987 for carcinoma. Of these, 21 patients (10.4%) died before leaving hospital. Fourteen patients died of multisystem failure, 1 died of pure respiratory failure and 2 died of renal failure. Two died of surgical causes (other than anastomotic leak), 1 died of pulmonary embolus and 1 from a cerebro-vascular accident. No patient died of purely cardiac causes. The most significant risk factors in those dying (Chi-square test) were: postoperative respiratory failure, defined as reventilation after initial successful extubation, (P less than or equal to 0.001), reoperation as an emergency in the early postoperative period (P less than or equal to 0.001), anastomotic leak (P less than or equal to 0.01) and age over 70 (P less than or equal to 0.005). Less significant risk factors were chyle leak and histologically undifferentiated tumour. Of the 181 survivors, 103 left hospital with no complications of any kind. The mean stay in hospital for survivors was 15 days. Respiratory infection occurred in 22% of patients, prolonged gastric stasis in 8%, wound infection in 5% and empyema in 1%. As long as high risk groups are accepted for radical surgery, operation will carry a significant mortality in those groups. In others, we believe that perioperative monitoring and early aggressive treatment of complications can further reduce mortality and morbidity.

Adenocarcinoma↗
PubMed1989

Nasopharyngeal EEG recording in psychiatric patients.

Because psychiatric patients with underlying CNS pathology in the temporal lobe areas may not respond well to traditional medications, the detection of electroencephalogram (EEG) abnormalities in patients with behavior dysfunction can be valuable to the evaluation process. As EEGs recorded with nasopharyngeal electrodes can monitor dysrhythmic discharges in the basomedial aspects of the temporal lobe that are not visible with the routine wake scalp EEG, the authors tried to determine whether the nasopharyngeal lead EEGs are more effective than the scalp EEGs in detecting spike and spike-and-wave discharges. The EEGs of 648 psychiatric inpatients and outpatients, which were recorded over an 18-month period from January 1985 to June 1986, were retrospectively studied, and the results showed that the nasopharyngeal lead recordings revealed a greater percentage of epileptiform abnormalities.

Ambulatory Care↗
PubMed1978

Huntington's disease: treatment with muscimol, a GABA-mimetic drug.

Muscimol, a gamma-aminobutyric acid (GABA) analogue that exerts potent and specific agonist effects on GABA receptors, was administered orally to 10 patients with Huntington's disease. In this double-blind study, muscimol treatment did not result in improvement in these patients' motor or cognitive functions. However, muscimol administration did ameliorate chorea in the most severely hyperkinetic patient, and it was associated with the appearance of dystonic features, electroencephalographic changes, and behavioral alterations in some patients. These latter observations support a functional relationship between GABA-ergic activity and the genesis of both systonia and EEG abnormalities in humans. The therapeutic failure of muscimol indicates that the GABA disturbances in Huntington's disease does not alone account for the clinical features of this disorder.

Activities of Daily Living↗