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Biomedical subjects

M Walker

Publications and source records attributed to M Walker.

At least 253 records · Page 14Linked to original sources
PubMed1997

Effect of fresh fruit consumption on lung function and wheeze in children.

BACKGROUND: Fresh fruit consumption and vitamin C intake have been associated with improved lung function in adults. Whether this is due to enhancement of lung growth, to a reduction in lung function decline, or to protection against bronchospasm is unclear. METHODS: In a cross-sectional school based survey of 2650 children aged 8-11 from 10 towns in England and Wales the main outcome measure was forced expiratory volume in one second (FEV1) standardised for body size and sex. Exposure was assessed by a food frequency questionnaire to parents and by measurement of plasma levels of vitamin C in a subsample of 278 children. RESULTS: FEV1 was positively associated with frequency of fresh fruit consumption. After adjustment for possible confounding variables including social class and passive smoking, those who never ate any fresh fruit had an estimated FEV1 some 79 ml (4.3%) lower than those who ate these items more than once a day (95% CI 22 to 136 ml). The association between FEV1 and fruit consumption was stronger in subjects with wheeze than in non-wheezers (p = 0.020 for difference in trend), though wheeze itself was not related to fresh fruit consumption. Frequency of consumption of salads and of green vegetables were both associated with FEV1 but the relationships were weaker than for fresh fruit. Plasma vitamin C levels were unrelated to FEV1 (r = -0.01, p = 0.92) or to wheeze and were only weakly related to fresh fruit consumption (r = 0.13, p = 0.055). CONCLUSIONS: Fresh fruit consumption appears to have a beneficial effect on lung function in children. Further work is needed to confirm whether the effect is restricted to subjects who wheeze and to identify the specific nutrient involved.

Ascorbic Acid↗
PubMed1997

Nuclear DNA content of fine needle aspirates of invasive ductal carcinomas of the breast.

Patients with aggressive breast cancers benefit from chemotherapy prior to surgery. If the biology of the breast cancers were better characterised pre-operatively, more patients at risk could be offered chemotherapy. We have assessed nuclear DNA content of fine needle aspirates (FNA) of 103 invasive ductal breast cancers and compared this to tumour size, node status and histological grade. Median follow-up was 18 months so no prognostic studies were made. Diploid and non-diploid tumours were distributed equally in node negative and positive patients. However non-diploidy status increased in line with known prognostic markers of tumour size and histological grade. This suggests that ploidy might contribute to the pre-operative assessment of prognosis. We conclude that nuclear DNA of breast cancer FNAs may be of value in the pre-operative biological assessment of breast cancer patients.

Adult↗
PubMed1997

Do labor medications affect breastfeeding?

Do labor medications affect breastfeeding? Few studies examine breastfeeding as an outcome of labor medication. While parents may be told that labor medications and epidurals have no effect on newborns, the literature reports significant neurobehavioral effects of these medications on the newborn and the mother-infant relationship.

Analgesia, Epidural↗
PubMed1997

Breastfeeding the sleepy baby.

Sleepy babies can be a source of frustration to both mothers and health care providers during the early days of breastfeeding. This paper looks at some reasons for excessive sleepiness and offers suggestions for helping sleepy babies to breastfeed using the baby as a guide.

Age Factors↗
PubMed1997

Zidovudine monotherapy versus zidovudine plus zalcitabine combination therapy in HIV-positive persons with CD4 cell counts 300-500 cells/mm3: a double-blind controlled trial. The M50003 Study Group Coordinating and Writing Committee.

OBJECTIVE: To assess the safety and clinical and immunological activity of zalcitabine/zidovudine combination therapy compared with zidovudine monotherapy in persons with no or limited antiretroviral experience and CD4 counts of 300-500 cells/mm3. DESIGN AND SETTING: A double-blind controlled multi-centre study conducted in specialist human immunodeficiency virus (HIV) care centres in Spain, Portugal and Australia. Participants were randomized at study entry to zidovudine (200 mg three times daily) plus zalcitabine (0.75 mg three times daily) or matched placebo. The primary end point was the proportion of patients with CD4 above baseline value at 24 months. The secondary end points were time to AIDS/death, quality of life (by MOS-30) and safety. RESULTS: The study was terminated prematurely following the results of the Delta and ACTG 175 studies. Two-hundred and fifty-six patients entered the protocol of whom all but 15 were treatment naive. One hundred and twenty-seven patients commenced zidovudine and 129 commenced a combination of zidovudine/zalcitabine. The median duration of follow-up was 634 days with a median time on blinded therapy of 500 days. Using the last available CD4 count data, 32.4% randomized to zidovudine and 65.1% randomized to zidovudine/zalcitabine remained above baseline at study close (P < 0.001). No significant differences were observed in the time taken for CD4 count to return to baseline. Over 104 weeks, median CD4 counts rose in the combination group from 399 to 509 cells/mm3 whereas those randomized to zidovudine fell from 410 to 374 cells/mm3. Only 12 AIDS events and two deaths (both accidental) occurred during the study with no differences between groups. No differences in quality of life were observed. Adverse events were the cause of treatment discontinuation in 8.6% of patients with no differences between treatment arms. A further 8.2% of patients were lost to follow-up. At least one adverse event (all severities, all relationships) was experienced by 80.3% of patients randomized to zidovudine and 79.8% of patients on combination. Peripheral neuropathy (all grades) was reported in 10.1% of patients randomized to the combination and 3. 1% in the zidovudine arm (P = 0.026). Oral ulcers were reported in 7.8% and 4.7% of combination and zidovudine monotherapy arms, respectively. Neutropenia was more common in the zidovudine group (22%) than the combination group (14%). CONCLUSIONS: Combination of zidovudine/zalcitabine as initial therapy maintains CD4 count above commencement levels in a significantly greater proportion of patients than zidovudine monotherapy. In persons with CD4 counts > or = 300 cells/mm3 inclusion of zalcitabine with zidovudine does not increase the incidence of adverse events or adversely affect quality of life.

Adult↗
PubMed1997

Quantitative measurement of estrogen and progesterone receptors in breast lumps using image cytometry.

OBJECTIVE: To evaluate image cytometry for detecting estrogen (ER) and progesterone receptors (PR) in breast lumps quantitatively. STUDY DESIGN: Fifty consecutive breast lumps were analyzed for ER and PR using the avidin-biotin complex on tissue sections. RESULTS: Mean ER-positive nuclear area percentage (PA%) for 25 invasive ductal carcinomas was 47.81% and for PR was 57.83%. Mean ER PA% was 40.78% and PR 58.91% for seven invasive lobular carcinomas. There were two papillary carcinomas and one in situ ductal carcinoma. Fourteen of 15 benign breast lumps were benign breast lesions. Mean ER PA% was 65.95% and PR 73.43% for 10 fibroadenomas and for 4 fibrocystic lesions was 51.57% and 44.13%, respectively. CONCLUSION: Quantitative detection of ER and PR can be achieved by image cytometry. We aim in the future to assess this method in prognostic studies and the preoperative cytology of breast cancers.

Adult↗
PubMed1997

Subcutaneous recombinant hirudin (HBW 023) versus intravenous sodium heparin in treatment of established acute deep vein thrombosis of the legs: a multicentre prospective dose-ranging randomized trial. International Multicentre Hirudin Study Group.

The aim of this multicentre, prospective, randomised, dose-ranging study was to compare the safety and efficacy of subcutaneous recombinant hirudin (HBW 023) against intravenous sodium heparin in acute lower limb deep venous thrombosis (DVT). Patients were randomized to treatment with either HBW 023 or heparin for 5 +/- 1 days. HBW 023 was given according to body-weight in three dose groups. Thromboembolic disease was assessed by phlebography and ventilation/perfusion (V/Q) scanning on Day 1 and Day 5 +/- 1. One hundred and fifty-five patients were enrolled, of these 121 were evaluable for efficacy analysis. Significantly fewer patients on HBW 023 developed new V/Q abnormalities during the treatment period, (p = 0.006). There was no difference between the groups in thrombus extension or regression, major bleeding complications or serious adverse events. There were significantly fewer findings of new V/Q mismatch after treatment with HBW 023, and anticoagulant control was superior in these patients.

Adult↗
PubMed1997

Aspirin use in middle-aged men with cardiovascular disease: are opportunities being missed?

BACKGROUND: Since the 1980s, clinical trial evidence has supported aspirin use in the secondary prevention of cardiovascular disease (CVD). AIM: To explore aspirin use among British men with known CVD in a population-based study. METHOD: Longitudinal study (British Regional Heart Study), in which subjects have been followed up for cardiovascular morbidity and mortality since 1978-1980. Aspirin use was assessed by questionnaires to study participants in November 1992 (Q92); cardiovascular diagnoses are based on general practice notifications to October 1992. A total of 5751 men aged 52-73 years (87% of survivors) completed questions on aspirin use. RESULTS: Overall, 547 men (9.5%) were taking aspirin daily, of whom 321 (59%) had documented CVD. Among men with pre-existing disease, 153 out of 345 (44%) men with myocardial infarction, 42 out of 109 (39%) with stroke, and 75 out of 247 (29%) with angina were taking aspirin daily. Among men with angina (54% versus 26%) or myocardial infarction (59% versus 42%), those who had undergone coronary artery bypass surgery (CABG) or angioplasty were more likely to be receiving aspirin. Higher rates of aspirin use were also found in those whose last major event occurred after January 1990 (47% versus 34%). There was no association between aspirin use and social class or region of residence. CONCLUSION: Despite strong evidence of its effectiveness, many patients with established CVD were not receiving aspirin. Daily aspirin treatment was less likely in men with less recent major CVD events and in those who had not received invasive treatment.

Aged↗
PubMed1997

Bowel obstruction in a pregnant patient with ileal pouch-anal anastomosis.

Bowel obstruction is a rare but serious complication of pregnancy for both the mother and the developing fetus. This report describes the case of 17-year-old girl with ileal pouch-anal anastomosis (IPAA). She presented at 36 weeks' gestation with a complete small-bowel obstruction. Because conservative management was unsuccessful, labour was induced to relieve the obstruction or simplify surgery. Soon after spontaneous vaginal delivery she began to pass copious amounts of flatus and stool. The bowel obstruction resolved within hours. This report illustrates how IPAA alters the anatomy of the gastrointestinal tract, placing the ileal pouch at risk from compressive obstruction by the gravid uterus. Induction of labour in a near-term fetus is a reasonable initial method of management in such women.

Adenomatous Polyposis Coli↗
PubMed1996

Influence of fathers' social class on cardiovascular disease in middle-aged men.

BACKGROUND: The independent effect of early life circumstances on adult cardiovascular risk is still unresolved. We assessed the associations of father's social class with cardiovascular risk factors and with risk of ischaemic heart disease and stroke in adult life. METHODS: We did a longitudinal study of cardiovascular disease in 5934 men aged 40-59 years at enrollment. A cross-sectional measurement survey was done between 1978 and 1980 and a follow-up questionnaire was completed in 1992. The main endpoints were non-fatal myocardial infarction and stroke based on general practitioners' reports obtained between screening and 1992 and on recall of physician-diagnosed ischaemic heart disease in the 1992 questionnaire. FINDINGS: Father's social class was strongly associated with social class in adulthood (fathers' occupation was manual for 41.3% of professionals [I] vs 89.1% for unskilled manual workers [V]) and was significantly related to height (non-manual vs manual 175.4 cm [SE 0.2] vs 172.9 cm [0.1], p < 0.0001) and obesity (213 [14.1%] vs 804 [20.1%], p < 0.0001) irrespective of adult social class; no association was found with blood glucose (log, 1.69 [0.005] vs 1.70 [0.003], p = 0.22) or cholesterol (6.34 [0.03] vs 6.29 mmol/L [0.02], p = 0.16. Men whose fathers' social class was manual had significantly higher rates of non-fatal myocardial infarction (342/4006 vs 92/1510) and self-reported physician-diagnosed ischaemic heart disease (686/4006 vs 192/1510) than men whose fathers' social class was non-manual, even after adjustment for adult social class and other established risk factors (relative odds 1.3 [95% Cl 1.0-1.7], p < 0.05 and 1.3 [1.1-1.6], p < 0.01, respectively). The influence of father's social class on non-fatal myocardial infarction and ischaemic heart disease was only seen in men whose adult social class was non-manual. No association was seen between father's social class and non-fatal stroke. INTERPRETATION: Father's social class is strongly associated with adult social class. The higher risk of non-fatal myocardial infarction and self-reported physician-diagnosed ischaemic heart disease seen in men whose father's social class was manual suggests that socioeconomic status early in life has some persisting influence on ischaemic heart disease risk in adult life.

Adult↗
PubMed1996

Heart failure in a macaw with atherosclerosis of the aorta and brachiocephalic arteries.

A female severe macaw (Ara severa) that was at least 11 years old was evaluated for sudden onset of exercise intolerance and dyspnea. Radiography revealed a large heart silhouette, an increase in prominence of the brachiocephalic arteries, and a diffuse increase in opacity of the lungs. Lateral nonselective angiography revealed dilatation of both chambers of the right side of the heart and incomplete emptying of the right atrium. Alterations in the shape and position of the left-side heart chambers and reduction in blood flow through the brachiocephalic arteries and aorta were identified. Despite treatment, the bird died suddenly 2.5 months after the first episode of dyspnea. At necropsy, severe atherosclerosis of the aorta and brachiocephalic arteries, dilatation of all heart chambers, pulmonary edema, and severe hepatic centrolobular atrophy and fibrosis were identified. Correlation between the angiography and necropsy findings suggested that angiography could be an important diagnostic tool for the detection of cardiovascular disease in birds.

Angiography↗
PubMed1996

Life expectancy in men who have never smoked and those who have smoked continuously: 15 year follow up of large cohort of middle aged British men.

OBJECTIVE: To estimate the life expectancy in a representative sample of men who have never smoked and of those who have smoked all their adult lives. DESIGN: 15 year follow up of a large representative cohort of British men in the British regional heart study and use of national mortality statistics for 1992. SUBJECTS: 7735 middle aged British men aged 40-59 at the time of screening (between 1978 and 1980). MAIN OUTCOME MEASURES: Mortality from all causes and from smoking related causes. RESULTS: 1624 men had never smoked at the time of screening and did not take up smoking during the study. 127 of them died during follow up. 3151 men began smoking before they were 30 and were still smoking at the time of screening. Of these, 751 had stopped smoking five years after screening; they were excluded from the analysis five years after the date they had stopped. 560 of the lifelong smokers died during follow up. When study estimates were combined with those from national mortality statistics for men aged 20-40, only an estimated 42% (95% confidence interval 36% to 50%) of lifelong smokers alive at the age of 20 would be alive at 73, compared with 78% (74% to 82%) of lifelong non-smokers. CONCLUSION: These estimates present the effects of smoking on mortality in a way that is easily communicated to patients and the general public in health promotion initiatives.

Adult↗
PubMed1996

Trinucleotide repeats at the FRAXF locus: frequency and distribution in the general population.

FRAXF, the third X-chromosomal fragile site to be cloned, has been shown to harbour a polymorphic compound triplet array: (GCCGTC)n (GCC)n. Expansion and methylation of the GCC-repeat and the neighbouring CpG-rich region result in chromosomal fragility. DNAs from 500 anonymous consecutive newborn males were examined to determine the incidence of various repeat numbers. The range of repeats was from 10-38, with the most common alleles having 14 (52.7%), 12 (16.6%), 21 (9.0%), and 22 (5.2%) triplets. Based on the distribution of repeat numbers, we suggest that the 21-repeat allele resulted from hairpin formation involving 7 GCC-repeats in a 14-repeat allele, accompanied by polymerase slippage. Examination of dinucleotide repeats near the FRAXF repeat will be important in testing this hypothesis. Since the clinical phenotype, if any, of FRAXF is unknown, this database will also be valuable for comparisons with repeat numbers in individuals from special populations.

Chromosome Fragile Sites↗