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R J Prescott

Publications and source records attributed to R J Prescott.

At least 145 records · Page 8Linked to original sources
PubMed1991

A numerical prognostic index for clinical use in identification of poor-risk patients with Hodgkin's disease at diagnosis. Scotland and Newcastle Lymphoma Group (SNLG) Therapy Working Party.

The aim of this study was to assess the feasibility of using objective data obtained at diagnosis of Hodgkin's disease to predict those patients who were likely to die of progressive disease within 4 years of diagnosis. 92 consecutive patients from one centre (Newcastle upon Tyne) were used to construct a numerical index based on disease stage (Ann Arbor), age, haemoglobin and absolute lymphocyte count. Weight was assigned according to a predictive value in univariate and multivariate analyses based on survival. The index produced was then validated on a separate patient set (455) from other centres within the Scotland and Newcastle Lymphoma Group (SNLG) on whom the same prospective information was available. The index produced provided a useful separation of those patients destined to die of disease. Of 101 patients with index higher than 0.5, 62 (61.4%) were dead at 4 years, whereas with index lower than 0.5, 61 (18%) of 336 patients were dead at 4 years. The index includes Ann Arbor stage but possesses additional practical prognostic value which allows identification of patients with early stage destined to die of disease. Of 149 patients with stage IA and IIA disease 15 patients had index higher than 0.5, and 10 (60%) have died, whereas the remaining patients had survival of 90% and 85% respectively. This numerical index is applicable to all patients at diagnosis and in the SNLG population gives better predictive survival at 4 years than stage alone, and provides a basis for selecting patients for more aggressive therapy.

Adolescent↗
PubMed1991

Inter-relations between relapses, drug regimens and compliance with treatment in tuberculosis.

The inter-relationships between relapse, treatment regimen and compliance in 1009 patients treated for tuberculosis between 1978 and 1987 are reported. Multiple linear logistic regression using relapse as the dependent variable was used because of the complex relationships between treatment, compliance, age and calendar year of treatment. Compliance (P less than 0.0001) was the major determinant of relapse, but age (P = 0.047) was also significantly associated. Relapse was not related to sex, site of disease, ethnic group or the presence of multiple disease sites. Although the regimen given, the total duration of treatment and treatment with or without pyrazinamide were not statistically associated with relapse, pyrazinamide containing regimens were associated with better compliance. Compliance was best in those aged 60 years and over and worst in those aged 15-29 years. Some of the non-compliance leading to relapse was only uncovered by close Health Visitor surveillance and not by the physician supervising treatment, emphasizing the important role of field staff in patient follow-up.

Adolescent↗
PubMed1991

Epidermal growth factor receptors in intracranial and breast tumours: their clinical significance.

A method to determine the binding of epidermal growth factor (EGF) to the particulate fraction of the cell has been established and evaluated using rat liver, human placenta, and tumours of human breast and brain. Little EGF receptor (EGFR) activity was detected in normal or benign tumour tissues except for meningioma (positive in 95% samples), but EGFR were present in 43% of 131 breast tumours and 75% of 55 primary cerebral tumours. Despite the strong inverse correlation between EGFR activity and oestrogen receptors in breast tumours and a tendency for high levels of EGFR activity to be associated with glioblastoma multiforme, analysis showed that EGFR was of little prognostic significance in patients with tumours of either breast or brain.

Adolescent↗
PubMed1991

A critical analysis of prognostic factors for survival in intermediate and high grade non-Hodgkin's lymphoma. Scotland and Newcastle Lymphoma Group Therapy Working Party.

Between 1979 and 1987 the Scotland and Newcastle Lymphoma Group registered 972 adults with Working Formulation high or intermediate grade non-Hodgkin's lymphoma. Clinical, pathological and investigational data were recorded prospectively on a computer database allowing analysis for prognostic factors. We have derived prognostically important characteristics and have tested prospectively the validity of the prognostic index on a geographically distinct sub-set of patients from the Edinburgh/Borders clinics. Multivariate analysis showed the following factors to be important in declining order of power; advancing age, worsening performance status, CNS/liver involvement, abnormal white cell count, 'B' symptoms and advancing clinical stage. Patient individual scores allowed them to be aggregated into one of three distinct prognostic groupings separated by arbitrary cut-points into a Best Group (39%) where the median survival exceeds 5 years (53% alive at 5 years), an Intermediate Group (30%) with median survival of 21 months (21% alive at 5 years), and a Worst Group (31%) whose median survival is 7 months (8% alive at 5 years). Similar prognostic group separations occurred when analysis was confined to: patients younger than 70 years; patients treated with initial chemotherapy; patients treated with initial radiotherapy; patients within any of the major pathological sub-groups.

Adult↗
PubMed1991

Skewflap versus long posterior flap in below-knee amputations: multicenter trial.

A multicenter trial of alternative techniques for below-knee amputation is described in which surgeons in 11 centers randomized 191 patients with end-stage occlusive vascular disease to two different methods of stump construction. The skewflap technique was performed in 98 and the long posterior flap was performed in 93. The two groups were well matched in respect to age, sex, smoking, diabetes, and indications for amputation. Early outcome was compared in terms of 30-day mortality rate: skew 11 (11%) deaths versus long posterior flap 16 (17%); the state of the wound at 1 week (primary healing 60% in both groups); the need for surgical revision at the same level 7 (7%) versus 7 (8%), and revision to a higher level 10 (10%) versus 7 (8%). Follow-up information at 6 months was available from records or by mailed questionnaire in 188 (98%) at 6 months, 20 died during that interval. It showed that a prosthetic limb was fitted to 64 (84%) of skew flaps and 50 (77%) of long posterior flaps. Walking, alone or with support, was achieved in 59 (78%) and 46 (71%), respectively. None of these differences reached statistical significance. It is concluded that the skew flap is just as effective as the long posterior flap and is an excellent option for below-knee amputation.

Aged↗
PubMed1991

Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population.

Intermittent claudication has been studied in cardiovascular surveys but limited information is available on asymptomatic peripheral arterial disease. The purpose of this paper is to describe the prevalence of both asymptomatic and symptomatic disease and relation to ischaemic heart disease in the Edinburgh Artery Study. A cross-sectional survey was conducted on an age-stratified sample of men and women aged 55 to 74 years selected from age-sex registers in ten general practices in the city. Arterial disease was assessed in 1592 participants by means of the WHO questionnaire on intermittent claudication and measurement of the ankle brachial systolic pressure index (ABPI) and change in ankle systolic pressure during reactive hyperaemia. The prevalence of intermittent claudication was 4.5% (95% confidence interval (CI): 3.5%-5.5%). Major asymptomatic disease causing a significant impairment of blood flow occurred in 8.0% (95% CI: 6.6%-9.4%). A further 16.6% (95% CI: 14.6%-18.5%) had criteria considered abnormal in clinical practice: 9.0% had ABPI less than 0.9 and 7.6% had reactive hyperaemia pressure reduction greater than 20%. Intermittent claudication was equally common in both sexes. The ABPI and reactive hyperaemia results suggested a slight preponderance of asymptomatic disease in males and were consistent with an increasing prevalence with age and lower social class. Mean ABPI was higher in normal men than women, and was lower in the left leg than the right suggesting a unilateral predisposition to disease. Subjects with major asymptomatic disease had more evidence of ischaemic heart disease than in the normal population (relative risk (RR) 1.6; 95% CI: 1.3-1.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

The identification of discrete prognostic groups in low grade non-Hodgkin's lymphoma. The Scotland and Newcastle Lymphoma Group Therapy Working Party.

A prognostic model was developed by examination of the prospectively recorded presentation characteristics of patients presenting with low grade non-Hodgkin's lymphomas (LGL). A geographically distinct group (Edinburgh and Borders) was excluded in order to test the validity of the model based on the rest of the Scotland and Newcastle Lymphoma Group (SNLG) population. Between 1979 and 1987 506 patients presented with low grade lymphoma according to Working Formulation definition within one of each of the three main pathology categories. The median available follow-up was 47 months. In a multivariate analysis performance status, age, stage, gender and haemoglobin all contributed separately. 25% of all patients had relatively good prognosis with a median survival not reached and 84% alive at 5 years. Conversely for the worst prognostic group of 25% of patients the median survival is 18 months with only 26% surviving at 5 years. Finally for the intermediate group of 50% of all patients, median survival is 69 months with 58% alive at 5 years. These striking prognostic separations are shown also to be valid in sub-group analysis. Thus young patients within any pathology subgroup have been identified with bad prognostic lymphoma for whom novel strategies in therapy should be devised.

Aged↗
PubMed1991

Predictable and unpredictable hazards of erythropoietic protoporphyria.

A female patient with a long history of erythropoietic protoporphyria developed progressive rapid derangement of hepatic function requiring urgent orthotopic liver transplantation. In the immediate post-operative period the patient developed unusual and serious complications, including a generalized axonal neuropathy, intestinal ulceration and a large second-degree phototoxic burn of the abdominal wall. Recovery was achieved only after prolonged intensive hospital care and rehabilitation. Attention is drawn to the need for protecting such patients from phototoxic injury during prolonged surgery and the importance of rapid transfer to a specialized unit at the earliest sign of hepatic failure.

Adult↗
PubMed1991

Infection in exacerbations of asthma: views of different groups of practitioners.

A questionnaire designed to elucidate views on the frequency of infection in asthma and its management was circulated to general practitioners, general physicians, paediatricians and respiratory physicians in the north of England. On the whole, general practitioners agreed with the general physicians and paediatricians with respiratory physicians. The generalists, and to a lesser extent the specialists, tended to overestimate the risk of bacterial infection, which was perceived to be a particular risk following viral infection in intrinsic asthma. This resulted in more frequent prescription of antibiotics than is justified by the published evidence. There was a tendency for frequent prescribers of antibiotics to withhold corticosteroids. If prescribing habits are to be altered, education will have to be directed at those responsible for acute admissions to hospital as well as at general practitioners.

Acute Disease↗
PubMed1991

Acute and chronic effects of once-daily isosorbide-5-mononitrate on the exercise capacity of patients with angina pectoris treated with a beta-blocking drug.

Forty-four patients with stable effort angina pectoris were included in a double-blind, randomised, placebo-controlled, parallel group study to compare the effect of two slow-release forms of isosorbide-5-mononitrate ('Ismo-Retard' 40 mg and 'Imdur' 60 mg) on exercise capacity when given as an adjunctive treatment to beta adrenoreceptor blocking therapy. In a symptom-limited exercise test performed three hours after the first dose, Ismo-retard increased the total duration of exercise by 92 seconds (confidence interval (CI) 5.1-116.9) p less than 0.006, and the time of onset to anginal pain by 117 seconds (CI 27.8, 156.1) p less than 0.004. A similar improvement in total duration of exercise (by 87 seconds) was noted three hours following 15 consecutive once-daily doses (CI 16.8-128) p less than 0.02, and in the time of onset to anginal pain by 101 seconds (CI 19.8-139.6) p less than 0.01. For Imdur the corresponding results were 53 seconds (CI 12.7-56.3), 84 seconds (CI 15.4-103.7), p less than .02, 54 seconds (CI 1.4-78.4) and 85 seconds (CI 6.9-120.5) respectively. These results would suggest that both active treatments were effective anti-anginal agents.

Adrenergic beta-Antagonists↗
PubMed1990

The effects of indomethacin on gastroduodenal morphology and mucosal pH gradient in the healthy human stomach.

To define further the injury and the mechanisms of mucosal injury induced by indomethacin, the effect of 28-day continuous administration of oral indomethacin on gastroduodenal morphology, gastric histology, and the protective mucus-bicarbonate barrier overlying gastroduodenal mucosa in humans was studied. In the studies, indomethacin caused acute gastroduodenal damage in 100% of cases, with maximal damage at 24 hours of administration. With continued intake this damage resolves, although a minority (two study subjects) progressed to discrete ulceration. Why these two subjects failed to adapt is unknown. Biopsy specimens taken during the studies showed no significant changes in inflammatory or regenerative features, and thus failed to shed any light on this process of adaptation to damage. Mucosal pH gradient studies showed a significant increase in juxtamucosal pH at the time of maximal damage (24 hours); this is thought to represent passive diffusion of alkali from damaged mucosa. In conclusion, mucosal adaptation to acute damage by indomethacin occurs in humans. The mechanisms through which the mucosa adapts in this intriguing way remain unknown.

Adaptation, Physiological↗
PubMed1990

The effect of established and gestational diabetes on pregnancy outcome.

OBJECTIVE: To study the prevalence and type of glucose intolerance in pregnancy and the effect of different types on perinatal mortality and fetal size. DESIGN: A prospective case-control study with data collected by patient interview and examination of all available records during a 16-months period between 1984 and 1986. SETTING: A large maternity hospital in Kuwait where diabetes in pregnancy is common. SUBJECTS: The cases were a consecutive sample of 731 women, delivered during the study period, recorded in the labour ward register as being diabetic or having abnormal glucose tolerance, the control group was formed from the next woman in the register (provided she was not known to be diabetic). MAIN OUTCOME MEASURES: Type of diabetes followed the WHO classification, with subdivision depending on level of fasting plasma glucose. Type of perinatal death was examined in detail and birthweight centile calculated. RESULTS: Of the 731 cases, 22% were established diabetics, most were treated with oral hypoglycaemic drugs before pregnancy and insulin during pregnancy. Of those discovered during pregnancy, 43% were classified as gestational diabetes and the remainder as impaired glucose tolerance. Overall, 50% of cases were treated with insulin. Established diabetics had a perinatal mortality rate nearly four times greater than non diabetics (RR, 3.7, 95% CI 2.6 to 6.4) and for gestational diabetics RR was 2.0 95% CI 1.2 to 3.7). Unexplained deaths were particularly common, both in established diabetics (RR, 18.4, 95% CI 3.9 to 85.7) and in gestational diabetics (RR, 13.4, 95% (CI 2.9 to 61.6). Cases with impaired glucose tolerance had no stillbirths and had a lower perinatal loss than the controls, though this was not statistically significant. Heavier babies were seen in all case groups compared with controls, though the impaired glucose tolerance group had lower birthweights than the other two case groups. CONCLUSIONS: Type 2 diabetes was found to be common, most cases being diagnosed in pregnancy. Under the conditions found in Kuwait, diabetes, in the sense of a raised fasting glucose, is accompanied by a high rate of perinatal loss from unexplained stillbirth. This applies whether the condition was present before pregnancy or was discovered during pregnancy. Fetal macrosomia was also common in both situations. Impaired glucose tolerance, where fasting levels remain normal, does not appear to increase fetal loss, but may be associated with fetal macrosomia. As these women age they are likely to develop overt diabetes in the non-pregnant state, and subsequently to develop serious complications of this disease. Improving glycaemic control, both during preg

Adult↗
PubMed1990

Irradiation-induced penile angiosarcoma.

We report a case of angiosarcoma of the glans penis in a 77 year old male Caucasian. The tumour developed 18 years after a course of radiotherapy for a penile ulcer which was an intra-epidermal squamous carcinoma. The differential diagnosis and the concept of radiotherapy-induced angiosarcomas are discussed.

Aged↗