Clinical medical officers in a child health service.
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Biomedical subjects
Publications and source records attributed to P M Lambert.
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Previous reports on radiation myelopathy of the thoracic spinal cord have attempted to predict tolerance doses as a function of overall treatment time and number of fractions by extrapolation of data from collected myelopathy cases having markedly heterogeneous treatment parameters. A review of long term survivors receiving radical radiotherapy with conventional fractionation for lung and esophageal cancer was undertaken to determine if the proposed tolerance levels were consistent with clinical results in a series of patients constituting the group at risk for developing myelopathy. Spinal cord doses were determined in 58 patients who survived greater than or equal to 18 months following radiotherapy. All patients were treated with megavoltage equipment at dose rates of 200 rads/day continuously (53 patients) or 250 rads/day using split course (5 patients). Tumor doses ranged from 4500 rads to 7000 rads. Seventeen patients (29%) received less than 5000 rads to the thoracic cord, 6 patients (10%) received 5000 rads, and 35 patients (61%) received greater than 5000 rads. There were two patients who developed myelopathy. Review of our data, the clinical data of others and recent experimental results suggest that the slope of tolerance curves for thoracic spinal cord commonly utilized to express time-dose-fractionation relationships may be inappropriate. It is suggested that cord tolerance to well fractionated radiation has been previously underestimated.
The power of four cardiorespiratory symptoms to predict subsequent mortality has been analysed in data derived from a random sample of the population of Great Britain recruited in 1965 and followed for 12.4 years. The associations of respiratory symptoms with all causes of death (except stroke) and of cardiovascular symptoms with death from coronary heart disease were strong. The trends of these two associations over the 12.4 years of the follow-up differed substantially: the relative death rates associated with respiratory symptoms remained throughout at about the same level, while those associated with cardiovascular symptoms declined after four years. The excess premature deaths associated with presence of one or more symptoms at entry represented about a quarter of the observed deaths of men and one tenth of those of women.
Carcinomas of the gallbladder and extrahepatic bile ducts carry a dismal prognosis. Due to the proximity of a number of vital structures and their early invasion, these tumors are rarely resectable. Long-term survival or cure is an exception. Results of treatment in 11 patients are reported. In 4 patients, radiotherapy was given as an adjuvant to surgery; in 5 patients the aim was palliation, while 2 patients received potentially curative doses of radiation. Good palliation has been achieved. Long-term, disease-free survival has been observed in some radically treated patients. The results suggest that radiotherapy may contribute to cure not only when used as a surgical adjuvant but also as the sole treatment modality in unresectable but still localized carcinomas of the bile ducts.
Unpublished data from the Hospital In-patient Enquiry in England, Wales, and Scotland between 1958 and 1972 show that the frequency of admissions to hospital for peptic ulcer, particularly gastric ulcer, has fallen. This seems more likely to have been due to a true fall in the incidence of ulcer than to changes in treatment. Some three times as many people are admitted to hospital with duodenal ulcer in the north as in the south, but the frequency of admissions for gastric ulcer seems to vary little. The reasons for these differences are not understood.
The in vitro retentive strength of 24 test bridges was studied. The bridges were maxillary canine to central incisor spans, and an acrylic pontic replaced the lateral incisors. The pontic was retained by a resin polymerized with ultraviolet light. The mean forces necessary to dislodge the pontic bonded to natural teeth in the three-unit bridges were determined to be 41.5 lb for a force applied toward the incisal edge and 55.8 lb for a force applied toward the gingival ridge. A promising clinical application of this technique is suggested.
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Early neonatal mortality in England and Wales in the second quarter of 1970 after a major influenza epidemic was slightly but significantly higher than in the corresponding quarter of the previous year. An increase was also noted in the first quarter of 1970. Analysis of infant mortality and an index of influenza prevalence over the past quarter-century indicates that similar increases occurred in relation to four of the other five major influenza epidemics during the period, the exception being the "Asian 'flu" epidemic of the autumn of 1957. It is suggested that the increased mortality in 1970 was the consequence of an increase in the prematurity rate, but we have no evidence to indicate whether the effect is specifically due to the virus or is nonspecific in nature.
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A pilot scheme was set up in Hampshire in January 1970, in which a local health authority doctor was "attached" to a group of general practitioners to carry out developmental assessment on infants and young children. Older pre-school children are also seen when necessary, and in all cases possible future educational requirements are considered. Such a scheme reduces duplication of work, increases mutual understanding between general practitioners and local health authority doctors, and helps to make full use of the limited resources of medical manpower.
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Some patients require hemimandibulectomy who are poor candidates for reconstructive surgery or who do not want to subject themselves to multiple surgical episodes. With the use of an articulated external skeletal fixation appliance, near-normal esthetics and function can be achieved in these patients without bone grafting. A report of one such case is presented.
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Cigarette smoking and 5-year survivorship of 20,017 British and 10,016 Norwegian migrants to the United States were compared with 17,696 British and 26,155 Norwegian nonmigrants. The highest mortality ratios for 5-year age-adjusted death rates observed were of cigarette smokers to nonsmokers, ranging from 1.40 to 1.60 for men and from 1.18 to 1.36 for women. Mortality ratios of nonmigrants to migrants ranged from 1.07 to 1.19 for men and from 1.22 to 1.36 for women. Mortality ratios for British to Norwegian groups ranged from 1.13 to 1.27. Some differences in mortality ratios for cardiovascular diseases contrasted with mortality ratios for noncardiovascular diseases were noted. The most important of these differences was the apparent lack of any consistent difference between nonmigrants and migrants in their 5-year cardiovascular mortality rates, although there were consistent differences for noncardiovascular diseases.