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Biomedical subjects

R J Prescott

Publications and source records attributed to R J Prescott.

At least 109 records · Page 6Linked to original sources
PubMed1994

The Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up.

The Edinburgh Randomised Trial of Breast Cancer Screening recruited 44,288 women aged 45-64 years into the initial cohort of the trial during 1978-81, and 10 years of follow-up is now complete. A total of 22,944 women were randomised into the study group and were offered screening for 7 years; the remaining women formed the control group. After 10 years, breast cancer mortality is 14-21% lower in the study group than in the controls depending on the precise definition of the end point. These differences are not statistically significant; for breast cancer as the underlying cause of death the relative risk is 0.82 (95% confidence interval 0.61-1.11). Rates of locally advanced and metastatic cancer were substantially lower in the study group, but screening has failed to achieve marked reductions in rates of small node-positive cancers. Those women who accepted the final invitation to screening have been monitored over the 3 year period prior to their first screen under the UK service screening programme. Interval cases, expressed as a proportion of the control incidence, increased from 12% in the first year to 67% in the third year. The reduction in breast cancer mortality for older women (aged at least 50 years) is the same as that for the total study group for this duration of follow-up. For analyses of breast cancer mortality in younger women updates recruited to the trial from 1982 to 1985 (10,383 women with 6-8 years' follow-up) have been included. The reduction in breast cancer mortality for women aged 45-49 years at entry was 22% (relative risk = 0.78, 95% confidence interval = 0.46-1.31).

Breast Neoplasms↗
PubMed1994

Cutaneous epithelioid angiosarcoma: a clinicopathological study of four cases.

Four cases of cutaneous epithelioid angiosarcoma are described together with the potential diagnostic trap of mistaking these tumours for poorly differentiated carcinoma or malignant melanoma. The immunophenotypic profile using four endothelial markers showed positive staining in all cases for factor VIII related antigen in a predominantly paranuclear dot-like fashion and for CD31 (JC70); in three cases for CD34 (QB-END/10) and in two cases with UEA-1. All four cases were cytokeratin (CAM 5.2 and AE1/AE3) negative in contrast to the positive staining reported at non-cutaneous sites. Aberrant S-100 protein expression was seen in one case. In two cases subsequent recurrences showed better differentiation than the original tumour. Electronmicroscopy confirmed the absence of non-endothelial lines of differentiation but failed to reveal Weibel-Palade bodies.

Aged↗
PubMed1994

A population-based, controlled study of the relation between HIV infection and cervical neoplasia.

OBJECTIVE: To study a geographically defined population of women exposed to a drug-related risk for human immunodeficiency virus (HIV), together with carefully matched neighbourhood controls, in order to examine (1) the proportion of different groups having cervical cytopathology screening; (2) the association between HIV infection and cervical intraepithelial neoplasia; (3) the independent effect of CD4+ lymphocyte count and duration of HIV infection; and (4) the correspondence between cervical cytopathology and colposcopically directed biopsy. DESIGN: A population-based study. SUBJECTS: All women domiciled in Lothians with the following characteristics: between 1983 and 1987 they had a history of injection drug use or a seropositive partner with a history of injection drug use; they had a pregnancy after that exposure where their serostatus was known. In addition, neighbourhood controls were identified by computer matching for the following criteria--post-code sector, housing deprivation score, age, parity, pregnancy outcome, ethnic group, year of pregnancy, smoking. MAIN OUTCOME MEASURES: Search was carried out for the cervical smear nearest in time to the index pregnancy end date, providing serostatus was known at that time. All identified smears were assessed by a cytopathologist without knowledge of clinical information, study group or serostatus. RESULTS: Of 376 women, appropriate cervical smears were identified for 336. The proportions screened in the different groups were similar. There were more abnormal smears in the seropositive group than in the drug-related seronegative (P < 0.01) or the neighbourhood control groups (P < 0.001). HIV-infected women with abnormal smears had lower CD4+ lymphocyte counts (P < 0.0005). There was a reasonable correspondence between cytopathological classification and histological grading, and this was of similar strength in cases and controls (weighted kappa 0.72, 0.74). CONCLUSIONS: There is a definite relation between HIV infection and cervical intraepithelial neoplasia. This is related to immune depletion but whether this is the sole mechanism for the association is unclear.

Adult↗
PubMed1994

Lack of association between maternal phosphoglucomutase-1 phenotype and fetal macrosomia in diabetic pregnancy.

OBJECTIVE: To assess the reports that maternal phosphoglucomutase-1 (PGM1) phenotype is highly related to macrosomia in diabetic pregnancy. This could be either a direct metabolic phenomenon, or the PGM1 locus could be a marker for a tightly linked gene involved in the maternal control of fetal growth. DESIGN: A comparative biochemical genetic study. SETTING: A large diabetic pregnancy clinic. SUBJECTS: One hundred and fifty-two women who had diabetes during pregnancy, 136 being insulin dependent before pregnancy. Two hundred and thirty-six women without pre-existing medical or pregnancy complications who functioned as a control group. MEASURES: PGM1 phenotype was assessed by conventional electrophoresis and subgroups were examined using iso-electric focusing. OUTCOME: Standardised birthweight was corrected for sex, maternal parity and gestation confirmed in every case by early pregnancy ultrasound. Maternal diabetes control was assessed by glycosylated haemoglobin. RESULTS: No differences were found in the observed phenotype frequencies for diabetics and control pregnant women. No association between PGM1 phenotype and macrosomia in diabetic pregnancy was found. PGM1 did not make a significant contribution to birthweight, standardised birthweight, length or ponderal index of the baby as assessed by multiple regression. CONCLUSIONS: Our study of a larger number of insulin dependent diabetics in Scotland makes the claim that macrosomia in diabetic pregnancy is associated with PGM1 phenotype unlikely to be of general significance.

Analysis of Variance↗
PubMed1994

Gastrointestinal tract aspergilloma: possible cause of malabsorption.

A 62 year old man with chronic lymphocytic leukaemia presented with malabsorption, the cause of which could not be found during life. Necropsy examination showed aspergillosis, limited to the stomach, where tumour-like masses were seen, the oesophagus, and lungs. This case illustrates the problems of diagnosing fungal infections in life and the importance of clinicopathological correlation at necropsy.

Aspergillosis↗
PubMed1994

Histopathological features of failed prosthetic Leeds-Keio anterior cruciate ligaments.

Artificial ligaments such as the Leeds-Keio ligament are inserted into knee joints to treat cruciate ligament trauma. Three cases of prosthetic ligament failure are reported, showing foreign body granulomatous inflammation around implanted fibres, together with abundant fibre particles within giant cells. It is suggested that intra-operative fibre fragmentation can produce a sufficient quantity of dendritic particles to elicit a granulomatous reaction, which can ultimately lead to ligament instability and failure.

Adult↗
PubMed1994

Systemic argyria.

A 74 year old man presented with signs and symptoms of mild cardiac failure. His face and chest were severely discoloured, which was thought to be due to cyanosis. He deteriorated and died of bronchopneumonia. At post mortem examination multiple organs, including the skin, showed silver pigment deposition; he also had a gastric malignant neuroendocrine tumour. He gave no history of contact with silver compounds. Systemic argyria caused by chronic ingestion of silver compounds is a rare condition which, apart from its cosmetic effects, is thought to be relatively harmless; it is not thought to be carcinogenic. This condition can pose diagnostic problems for both clinicians and pathologists.

Adenoma↗
PubMed1994

Use of flutter VRP1 in the management of patients with steroid-dependent asthma.

We have assessed a new positive expiratory pressure device, the Flutter VRP1, in 20 patients with moderately severe asthma. Patients were studied for an initial 1-week 'run-in' period, followed by 2 weeks of the flutter device in one of which the ball-bearing was removed from the bowl. Peak expiratory flow rates, salbutamol inhaler requirements and visual analogue scores were recorded daily. Ease of sputum expectoration showed a significant improvement after 6 days of the flutter device, but there were no differences in objective measurements of lung function nor in salbutamol use. The device may be a useful adjunct to asthma therapy.

Adult↗
PubMed1994

Use of a 7-day diary for urinary symptom recording.

A cohort of 254 men, aged 40-79 years, was followed up at 1 year in a community-based survey of benign prostatic hyperplasia. Immediately after completing a questionnaire about the occurrence of 12 urinary symptoms over the previous month, the men were invited to keep a prospective diary asking about the same symptoms over 7 consecutive days in order to assess the amount of day-to-day variation in symptoms and to examine to what extent the findings reflected those of the retrospective questionnaire. The majority of men reported minor degrees of daily fluctuations in symptoms. Only modest correlations existed between the diary mean and maximum score for each symptom and the corresponding retrospective questionnaire score. Where repeated assessments of urinary symptom status are considered necessary a prospective diary may be more appropriate than a retrospective questionnaire.

Adult↗
PubMed1994

Sex differences in susceptibility to etiologic factors for peripheral atherosclerosis. Importance of plasma fibrinogen and blood viscosity.

Cardiovascular risk factors in men, such as cigarette smoking, hypercholesterolemia, and hypertension, also increase risk in women, but the relative susceptibility to risk factors between the sexes is not established. Our aim was to investigate a wide range of possible etiologic factors in a single population study and identify those that were more strongly related to peripheral atherosclerosis in men or women. We studied personal factors (age and social class), lifestyle factors (smoking, exercise, alcohol intake, and dietary nutrients), and intermediary factors (obesity, diabetes, serum lipids, coagulation, and rheological factors). In the Edinburgh Artery Study in 1988 we measured cardiovascular risk factors in a random population sample of 1592 men and women aged 55 to 74 years. The ankle-brachial pressure index (ABPI), which is inversely related to the degree of peripheral atherosclerosis, was assessed in each subject. Lifetime cigarette smoking was correlated with a lower ABPI equally in men and women (r = -.27, P < .001). Dietary nutrients and alcohol intake were not related differently between the sexes with ABPI. However, recall of strenuous and moderate leisure time exercise during the age range of 35 to 45 years was related more strongly to a higher ABPI in men than in women (P < .05). Plasma fibrinogen, plasma viscosity, and blood viscosity were the only intermediary factors that had stronger univariate correlations with lower ABPI in men than in women. On multivariate analysis, the sex differences persisted for plasma fibrinogen (P < .05) and blood viscosity (P < .001); high-density lipoprotein cholesterol was related to ABPI in men only (sex difference, P < .1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Macrophage prostaglandin E2 and oxidative responses to endotoxin during immunosuppression associated with anaesthesia and transfusion.

The widespread use of blood transfusion in major surgical procedures has led to concern about the immunosuppressive effect of transfusion on patients with underlying malignancy. Transfusion may also suppress the host response to infection. The cellular mechanisms of transfusion-associated immunosuppression may involve macrophage prostaglandin E2 (PGE2) in modulating the host response to cancer and infection. We previously observed that the transfusion of blood increased PGE2 production by unstimulated macrophages. To investigate this PGE2 associated immunosuppression, we studied the effect of transfusion of rats using a physiological stimulus of macrophage PGE2 production, bacterial endotoxin. In the same macrophages, we analysed intracellular oxidative activity. Both allogeneic and syngeneic blood transfusion were associated with increased PGE2 release by macrophages. This stimulation of PGE2 increased with duration of storage of blood. A similar effect of serum indicated that a humoral factor was involved. Endotoxin (50 ng/ml-500 micrograms/ml) stimulated PGE2 production in all transfused subjects. The lowest endotoxin concentration gave proportionately the greatest stimulation. Oxidative activity was down-regulated in macrophages of transfused rats, supporting an immunosuppressive role of PGE2 within the macrophage. An effect of surgery on the oxidative response was also detected.

Anesthesia↗
PubMed1993

Six months versus nine months chemotherapy for tuberculosis of lymph nodes: final results.

Of 199 patients treated for peripheral lymph node tuberculosis, 157 completed treatment as planned. Fifty received E2H9R9, 56 Z2 H9R9 and 51 Z2H6R6 regimens (E = Ethambutol; H = Isoniazid; R = Rifampicin; Z = pyrazinamide: numbers denote duration of therapy in months). In follow-up from 9 to 30 months, there were no significant differences between the regimens in enlargement of existing nodes, development of new glands or sinuses, in the need for new operative procedures, or in the percentage with measurable nodes at 30 months. Nine patients were felt to have had a clinical relapse (4 E2H9R9; 2 Z2H9R9; 3 Z2H6R6) although this was not confirmed bacteriologically in the five cases where material was sent for culture. These differences were not statistically different. The 6 month Z2H6R6 regimen performs just as well as the 9 month regimens Z2H9R9 and E2H9R9 in patients with fully sensitive organisms, and has the additional benefits of convenience and reduced cost.

Adolescent↗
PubMed1993

Diet as a risk factor for peripheral arterial disease in the general population: the Edinburgh Artery Study.

The Edinburgh Artery Study included a cross-sectional survey of 1592 men and women (aged 55-74 y). One aim was to examine relationships between an indicator of peripheral arterial disease, the ankle brachial pressure index (ABPI), and dietary factors. Nutrient intake was derived from a food-frequency questionnaire. Higher frequency of consumption of fiber-containing foods was associated with greater mean ABPI in males and higher consumption of meat and meat products were significantly associated with low mean ABPI in males and females. In a multiple linear regression with ABPI as outcome and energy-adjusted nutrients as predictors, cereal fiber (P = 0.02) and alcohol (P = 0.04) were positively associated with the ABPI in males but not in females. Dietary vitamin E(alpha-tocopherol) intake was positively associated with ABPI (P = 0.04) independently of smoking and other nutrients. Dietary vitamin C intake was significantly related to ABPI (P = 0.006) only among those who had ever smoked.

Aged↗
PubMed1993

Successful application of a previously derived prognostic index in the analysis of a randomised trial of 281 patients with high grade non-Hodgkin's lymphoma (HIGNHL).

BACKGROUND: The selection of patients for experimental therapies for high grade non-Hodgkin's lymphoma (NHL) is now recognised to be very influential in affecting results. We showed previously that simple clinical indices could be used to create an index of risk of death in a series of 972 patients. We wished to test this prognostic index in a subsequent randomised treatment trial of CHOP-based chemotherapy. PATIENTS AND METHODS: 281 patients with high grade NHL randomised between two chemotherapy designs were followed up from 1-6 years and survival analysed to develop a Cox model which was then compared against the previously described prognostic index. RESULTS: The previous index based on age, sex, performance status, stage and symptoms was similar to the data-derived model. Three year survivals for the best (109), intermediate (93) and worst (79) cohorts were 69%, 50% and 24% respectively, similar to the survivals in the previous series. CONCLUSIONS: CHOP-based chemotherapy is probably adequate for around 40% of cases of high grade NHL. The prospective test of a prognostic index shows that we can be confident about selecting poor-risk patients for trials of novel therapies, including dose intensification.

Aged↗
PubMed1993

Throat pain and pharyngeal packing: a controlled randomized double-blind comparison between gauze and tampons.

In order to determine whether patients having pharyngeal packing experience more or less post-operative throat pain when tampons were used, 80 patients were randomized into two groups to receive either gauze or tampon pharyngeal packing. A third control group of 40 patients were intubated but did not have any throat packs. Post-operative throat pain was subjectively rated at both 6 hours and at 24 hours by an independent observer. Thirty-eight per cent of patients had moderate or severe throat pain in the gauze group, whilst in the tampon and control groups these amounted to only 15% and 1% respectively. A significantly higher proportion of patients also had a moderate or severe sore throat at 24 hours in the former group. Intubation alone resulted in a sore throat post-operatively in 50% of patients, but 85% of those had a mild sore throat only. No differences in pain ratings in any group could be shown between men or women or between age groupings. Endotracheal intubation often causes post-operative throat pain which is exacerbated by the use of pharyngeal packing. The results presented suggest that tampons are a safe, effective alternative to gauze and result in less severe post-operative throat pain.

Double-Blind Method↗
PubMed1993

Fetal growth, gestation length and phosphoglucomutase-1 phenotype.

This study investigates reports that phosphoglucomutase-1 (PGM1) phenotype is associated with fetal growth and gestation length. A total of 350 women were studied, 234 having uncomplicated pregnancies and 114 with a baby weighing greater than 90th centile, corrected for parity, gestation and fetal sex. All women had gestation confirmed by early ultrasound. Conventional cellulose acetate electrophoresis was used to distinguish the three common PGM1 phenotypes and polyacrylamide gel isoelectric focusing to distinguish the ten PGM1 subtypes. Neither PGM1 phenotype nor subtype were found to be associated with gestation length or standardised birth weight. Logistic regression, where maternal age, parity, fetal sex, maternal weight, gestation and smoking were introduced as explanatory variables in addition to PGM1 phenotype testing against the dependent variables birth weight, standardised birth weight and gestation length, did not show differences related to PGM1 phenotype. Two possible reasons for the discrepancy with previously published data are discussed. We conclude that the study provides no support for the belief that PGM1 phenotype is related to fetal growth or gestation length and that the original observations could have arisen as a result of statistical artefact due to multiple testing.

Biomarkers↗
PubMed1993

Pilot study and randomised trial of mitozantrone and ifosfamide for relapsed non-Hodgkin's lymphoma. Scotland and Newcastle Lymphoma group (SNLG) Working Party on Therapy.

This report compares a pilot study followed by a trial of the combination of mitozantrone and ifosfamide for relapsed lymphoma. In the pilot study (15 patients) toxicity and activity of the combination was tested on a variety of relapsed non-Hodgkin's lymphoma. In the trial (19 patients) the therapy was confined to patients with high and intermediate grade non-Hodgkin's lymphoma in which the combination was compared against single agent mitozantrone. The median survival of patients on the pilot and trial was very poor at around six months, but some individuals survived for several years from both groups. The main toxicities of treatment were, predictably, nausea and vomiting and bone marrow suppression on the combination, and bone marrow suppression alone on the single agent mitozantrone. There was no obvious disadvantage of the single agent treatment when compared with the combination, but this statement has to be interpreted with caution given the high death rate amongst all patients and the very small numbers who entered the randomised trial.

Adult↗