Search PubMed⌕ Search

Biomedical subjects

P Winter

Publications and source records attributed to P Winter.

At least 73 records · Page 4Linked to original sources
PubMed1995

Contrasting geographical distribution of mortality from pneumoconiosis and chronic bronchitis and emphysema in British coal miners.

To explore whether the characteristics of coal mine dust that predispose to chronic airways obstruction are the same as those associated with pneumoconiosis, mortality from the two disease was compared in coal miners in 22 counties of England and Wales during 1979-80 and 1982-90. The proportional mortality ratios (PMRs) for coal workers' pneumoconiosis varied from 135 (95% confidence interval (95% CI) 16-488) in Leicestershire to 3825 (95% CI 1538-7881) in South Glamorgan. The PMRs for chronic bronchitis and emphysema were consistently higher than those in other occupations, but showed much less geographical variation and did not correlate geographically with those for pneumoconiosis. These findings indicate that the pathogenetic mechanisms by which coal mine dust causes chronic bronchitis and emphysema depend on different features of the dust from those producing pneumoconiosis. Also, they suggest that current social security regulations in Britain, which require evidence of pneumoconiosis as a condition of compensation for chronic bronchitis and emphysema in coal miners, may discriminate unfairly against claimants from some regions.

Adult↗
PubMed1995

When is the indication of percutaneous chemolysis justified?

Persistent residual stone fragments after extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL) as well as pyelo- and nephrolithotomy represent a great problem in the treatment of stones. The choice of therapy for patients with insufficient renal drainage, poor renal function, and a high anesthetic risk also remains quite difficult. Between 1991 and 1993, 5 patients underwent percutaneous antegrading chemolysis with 'Suby G' solution. Two patients, presenting struvite and apatite stones, were free of stones afterwards. In 1 patient, where stone size could be observed. In 2 other brushite component, a large decrease in stone size could be observed. In 2 other cases, with stones mainly consisting of whewellite and weddelite, chemolysis proved ineffective. Evaluating our own clinical experience and relevant medical literature, the present study goes on to prove that the indication of percutaneous chemolysis in risk patients as described above is dependent on stone analysis, and must be regarded as an effective adjuvant treatment.

Adult↗
PubMed1995

Maximal displacement of the ureter by a liposarcoma.

We describe a patient with displacement of both ureters to the right side caused by a liposarcoma. The left ureter was displaced beyond the right ureter. The risk of intraoperative trauma to the ureter could be minimized by preoperative placement of ureteral stents.

Humans↗
PubMed1994

Lobar pneumonia: an occupational disease in welders.

We have used data from three analyses of occupational mortality for England and Wales to investigate a suspected hazard of pneumonia in welders. Mortality from the disease was consistently raised in welders aged 15-64, with standardised mortality ratios of 184 (95% CI 150-224) in 1959-63 and 157 (121-200) in 1970-72. Analysis of data for 1979-80 and 1982-90 showed that the increased risk is attributable mainly to an excess of pneumococcal and unspecified lobar pneumonia (proportional mortality ratio 255, 95% CI 192-332). No excess occurred in men above retirement age (65). A possible explanation of these findings is that welding fume reversibly increases the susceptibility of the lung to pneumonic infection. The observation of a similar mortality pattern in moulders and coremakers points to the metallic component of the fume as a possible culprit, but ozone or oxides of nitrogen could also be implicated. There are grounds for lobar pneumonia to be considered an occupational disease in welders.

Adolescent↗
PubMed1993

Cortisone image and emotional support by key figures in patients with bronchial asthma. An empirical study.

In a subgroup of patients with bronchial asthma, irrational fears of steroid medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone often underlies non-compliant illness behaviour. In the present study, cortisone image and the relationship with a key figure was investigated in 62 patients with bronchial asthma, all of whom had participated in a structured asthma treatment and teaching programme (ATTP). The data show that (1) perceiving cortisone as threatening predicts poor adherence to ATTP guidelines how to manage severe attacks, and (2) patients having a supportive relationship with their key figure are less likely to experience threatening aspects of cortisone.

Acute Disease↗
PubMed1993

Scanning electron microscopy of 2,8-dihydroxyadenine crystals and stones.

The lack of purine salvage enzyme, adenine phosphoribosyltransferase (APRT), leads to 2,8-dihydroxyadenine stone formation and/or crystalluria because it is insoluble in urine. Urolithiasis composed of 2,8-dihydroxyadenine is not only formed in a complete defect of APRT, but also in a partial deficiency of this enzyme. The defect is inherited as an autosomal recessive trait, the homozygous state is associated with high urinary levels of 2,8-dihydroxyadenine and with crystalluria, calculus formation, and potential nephrotoxicity. Determination of the APRT activity will facilitate quantification of the enzyme deficiency and elucidation of the hereditary history. 2,8-dihydroxyadenine excretion in the 24-hour urine and its circadian rhythm were determined using a new method of high performance liquid chromatography determination. By means of a standard case presentation, we illustrate the analysis of urinary sediments and calculi as well as the scanning electron microscopic images of this kind of stone.

Adenine↗
PubMed1993

[Causes of mortality in a swine breeding establishment].

Preweaning losses: During the period from September 1991 to August 1992, from 18021 piglets born alive 3417 died until weaning. Major causes of death were crushing by the sow, low birth weight, starvation, splay-leg disease and enteritis. Of these animals 51.6% died during the first three days of life. Mortality decreased during the preweaning period. Litters with more than 11 pigs had elevated death rates of piglets. Mortality was higher during the cold season (except January). Postweaning losses: During the postweaning period 6.4% of the weaned piglets were lost. Of these piglets 4.1% died and the remaining 2.3% were sold due to umbilical hernia. Diseases of the gastrointestinal tract were the main cause of death. Losses of gilts: During the one-year surveillance period 373 gilts were lost. Most of 18 deceased animals died from bleeding due to gastric ulcers and from purulent bronchopneumonia. 314 (91.1%) of the remaining 355 gilts were sold, the residual 9.9% of the animals were slaughtered mainly because of diseases of the musculoskeletal system. Losses of sows: In the breeding herd of 950 to 1035 animals, 35 sows died and 492 were culled in the course of one year. Most deaths resulted from cardiac failure and splenic torsion. Urogenital and locomotor diseases were the main reason for culling. The sows removed from the herd had produced an average of 3.6 litters, but 52.8% had produced no more than 3 litters. Losses of boars: During the survey 10 boars were slaughtered.

Animals↗
PubMed1993

[Cortisone level and emotional support by key figures in patients with bronchial asthma].

In a subgroup of patients with bronchial asthma, irrational fears of cortisone medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone, often underlies noncompliant illness behaviour. In the present study, cortisone image and subjectively experienced emotional support by a key figure was investigated in 62 patients, all of whom had participated in the Düsseldorf Asthma treatment and teaching programme (ATTP). The data show that patients having a supportive relationship with their key figures are less likely to experience threatening aspects of cortisone. The findings are discussed in light of psychoanalytic object relations theory.

Adaptation, Psychological↗
PubMed1992

Center differences and cross-national invariance in help-seeking for panic disorder. A report from the cross-national collaborative panic study.

Help-seeking behaviour for treatment of panic disorder was investigated in the sample of the Cross-National Collaborative Panic Study Second Phase. A total of 1168 patients were entered into this trial in 14 countries. Although there were significant center differences in prior treatment and utilization of health services there were also similarities. Treatment had been provided mainly by general practitioners. Drug treatment consisted mostly of prescription of classical tranquilizers and had a longer duration than treatment by psychotherapy. Patients with agoraphobic avoidance, past major depression and longer duration of illness used medical and psychiatric treatment facilities more intensely. Older and more severely disabled subjects were more frequently treated by medical health care providers and were more likely to receive psychotropic drugs. The results indicate that general practitioners carry an important load in the treatment of panic disorders but may need more information about recent development in pharmacotherapy for this condition.

Adult↗
PubMed1992

Differentiation between major and minor depression.

Though the concept of Major Depression was generated by clinicians using depressed inpatients as models, a polydiagnostic study in 600 psychiatric inpatients with heterogenous psychological disturbances revealed that all six competing operational definitions of Major Depression (including DSM-III-R and ICD-10) were too restrictive to serve as a general concept of depression. Another polydiagnostic study in 500 primary care outpatients showed that more than two-thirds of all non-chronic depressed cases were below the severity threshold of Major Depression: these patients are classified as Depression Not Otherwise Specified (NOS) by DSM-III-R. Loosening of the over-restrictive time criteria would broaden the concept of Major Depression so as to meet the requirements of a general concept of depression, while the definition of Minor Depression below the threshold of Major Depression would add to a reduction of cases of NOS Depression by more than 80%. For the evaluation of antidepressant drugs in outpatient samples, we propose that patients with these modified definitions of Major and Minor Depression be included, provided they meet a minimum severity criterion of 13 or more points on the Hamilton Depression Scale; four-fifths of the modified Major Depression group and one-third of the Minor Depression group do in fact meet this criterion.

Depression↗
PubMed1991

Identification of minor affective disorders and implications for psychopharmacotherapy.

Five hundred general practice patients with functional complaints were studied with the Polydiagnostic Interview (PODI) to see whether DSM-IIIR criteria were able to specify affective disorders satisfactorily. Almost one third of the patients received the diagnosis of depression not otherwise specified (NOS). When Research Diagnostic Criteria were applied to these patients more than 70% received specific diagnoses. A modification of DSM-IIIR algorithms enabled us to further specify diagnoses in subjects with depression NOS. On the 17-item Hamilton Depression Scale many of these patients reached scores of 13 or more which is severe enough to justify a therapy trial with antidepressants.

Adjustment Disorders↗
PubMed1991

Identification of CpG islands in a physical map encompassing the Friedreich's ataxia locus.

The Friedreich's ataxia locus has been previously assigned to chromosome 9q 13-21.1 by the demonstration of tight linkage to two anonymous DNA markers. MCT112 (Z greater than 80, theta = 0) and DR47 (Z greater than 50, theta = 0). The absence of recombination between these three loci has prevented the resolution of gene/probe order in this region, impeding strategies for gene isolation. We report physical mapping over a 4-Mb genomic interval, linking the markers MCT112 and DR47 on a common 460-kb NotI fragment and identifying 11 CpG islands in the 1.7-Mb interval most likely to contain the Friedreich's ataxia locus. Four of these islands were detected only by analysis of three YAC clones spanning a 700-kb interval including the MCT112/DR47 cluster. Without clear evidence of the precise location of the disease locus from recombination events, each of these regions must be considered as specifying a potential "candidate" sequence for the mutated gene.

Chromosome Mapping↗
PubMed1991

Mortality and incidence of cancer at four factories making phenoxy herbicides.

To assess the possible carcinogenicity of phenoxy herbicides and related chlorophenols and dioxins, the International Agency for Research on Cancer is coordinating an international collaborative study of workers exposed to these compounds in their production or use. Four British cohorts of chemical manufacturers which have been recruited to the survey are described. They comprise a total of 2239 men employed during 1963-85. These subjects were traced to 31 December 1987 through the National Health Service Central Register and the National Insurance Index, and their mortality compared with that in the national population. Two deaths were from non-Hodgkin's lymphoma with 0.87 expected. Both deaths occurred more than 10 years after first exposure to phenoxy compounds. One further non-Hodgkin's lymphoma was registered in a living subject with probable exposure to phenoxy compounds. No cases of soft tissue sarcoma or Hodgkin's disease were recorded. A nonsignificant excess of lung cancer (19 deaths observed, 14.2 expected) is probably attributable to chance or a confounding effect of smoking. In one cohort only there was increased mortality from circulatory disease (34 deaths observed, 20.4 expected). A nested case-control study did not point to any occupational cause for this excess, but further evaluation will be needed during continued follow up.

Cardiovascular Diseases↗
PubMed1991

Arytenoid subluxation: diagnosis and treatment.

Both arytenoid subluxation and recurrent laryngeal nerve paralysis (RLNP) may result from injury to the larynx, and they may be difficult to distinguish clinically. A patient with arytenoid subluxation who was initially believed to have RLNP was treated with medialization laryngoplasty 1 year after the injury. Preoperative magnetic resonance imaging and computed tomography effectively demonstrated the cricoarytenoid subluxation, which was confirmed by intraoperative electromyography (EMG) showing normal electrical activity in the thyroarytenoid muscle. Photographs from preoperative fiberoptic laryngoscopy are presented to identify the appearance of arytenoid subluxation. Computed tomographic findings and photographs from laryngoscopy of two patients with RLNP documented by intraoperative EMG evaluation are presented to help distinguish the clinical appearance of this disorder from arytenoid subluxation. An integrated approach to the diagnosis and treatment of arytenoid subluxation is presented.

Adult↗
PubMed1990

On the necessity of adrenal extirpation combined with radical nephrectomy.

Adrenal metastasis of renal cell carcinoma usually is an autopsy finding and seldom a clinical diagnosis. The incidence of ipsilateral suprarenal gland involvement also can be identified by histological examination of the organ with radical nephrectomy. The necessity of adrenalectomy performed in combination with nephrectomy is discussed. After a retrospective examination of our patients we discovered 8 adrenal metastases among 138 radical nephrectomies. Five patients who also had metastases in the lymph nodes (stages pN1 to pN2) died after an average of 26.4 months. Three patients without lymph node involvement are free of tumor. In these cases routine adrenalectomy must be regarded as a possible curative treatment.

Adrenal Gland Neoplasms↗