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Biomedical subjects

R R West

Publications and source records attributed to R R West.

At least 19 recordsLinked to original sources
PubMed1992

A case control study of factors associated with macroscopic breast cysts.

Women who have a breast cyst aspirated are at increased risk of developing breast cancer. We present an age-matched case control study comparing the reproductive characteristics of 352 women who had a breast cyst aspirated with a control group of 352 contemporaneous clinically normal women. Women with breast cysts were more likely to be nulliparous [odds ratio (OR) = 2.28, 95% confidence interval (CI) = 1.34-3.88] or have a late age at first live birth (chi 2 trend = 5.6, P less than 0.025), and a late menopause (chi 2 trend = 4.3, P less than 0.05). They were less likely to have ever used the oral contraceptive pill (OR = 0.38, 95% CI = 0.26-0.55) or to have used the pill for a short duration (chi 2 trend = 16.8, P less than 0.001), and were less likely to have had a hysterectomy (OR = 0.58, 95% CI = 0.36-0.93). They were more likely to wear a small bra (chi 2 trend = 18.6, P less than 0.001) and bra cup (chi 2 trend = 5.6, P less than 0.025). Nulliparity, late age at first live birth and late menopause are factors common to breast cancer risk.

Adult↗
PubMed1992

Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome.

Over a 5-year period from 1985 to 1989, 2760 patients underwent open heart surgery at the University Hospital of Wales. Of these, 44 (1.6%, 35 men, mean age 61 years) developed median sternotomy dehiscence 2-40 (median 9) days after surgery. Infection was an associated factor in 18 patients (41%) and Staphylococcus aureus the predominant isolate in seven of those. Thirty-seven patients underwent rewiring of the sternotomy wound and seven patients underwent debridement, removal of wires and delayed closure. In those undergoing rewiring, sternal stability was maintained in 34 patients (92%). There were seven deaths (16%), of which two were considered to be wound-related. Median hospital stay of survivors was 34 (range 16-84) days. Comparison with 88 matched controls by univariate analysis showed preoperative chronic obstructive airways disease, reduced FEV1/FVC ratio (both P < 0.001) and smoking (P < 0.05) were all more common in the dehiscence group. In addition, reoperation for bleeding (P < 0.05), prolonged bypass time, postoperative ventilation period and length of stay in the intensive care unit (all P < 0.001) were more common in the study group.

Cardiac Surgical Procedures↗
PubMed1992

Smoking: its influence on survival and cause of death.

Smoking is strongly associated with age-specific death rates for a number of diseases. Increased age-specific death rates for a disease may imply either more deaths from the disease with increased absolute lifetime risk, or earlier deaths, without increased absolute lifetime risk. The British doctor smoking data are re-analysed using lifetable methods for survival, cumulative mortality and the disease-specific cumulative mortality. The most significant effect of smoking is on survival: life shortening amounts to three years for light smokers, five for moderate smokers, and eight for heavy smokers, compared with those who never smoked. Smoking increases the absolute number of deaths from some causes, including lung cancer; for other causes, including ischaemic heart disease, it brings forward death without increasing the absolute number of deaths. The smoking associations with more or earlier death have implications for research into the mechanisms of disease causation, for health promotion, for rational health-care planning, and for social policy.

Adult↗
PubMed1992

Reproductive factors associated with mastalgia.

Mastalgia has been classified as an aberration of the normal, rather than a disease. We present an age-matched, case-control study which compares the reproductive factors of patients with severe cyclical and noncyclical mastalgia with control groups of women who presented to a breast clinic but in whom no clinical abnormality was found and who did not later develop breast disease. There were few statistically significant differences in reproductive factors between the cases and controls, which lends some support to the concept that mastalgia can be considered to be an aberration of the normal.

Breast↗
PubMed1991

A model for microtubule-associated protein 4 structure. Domains defined by comparisons of human, mouse, and bovine sequences.

cDNAs encoding human and mouse microtubule-associated protein 4 (MAP 4) were isolated. MAP 4 is encoded by a single gene. Multiple MAP 4 mRNAs are transcribed that are differentially expressed among mouse tissues. Open reading frames for the human and mouse MAP 4 clones indicate three distinct regions consisting of related sequences with different motifs. Approximately 30% of the protein is tandem related repeats of approximately 14 amino acids. Another region contains clusters of serine and proline. Four 18-mer repeats characteristic of the microtubule-binding domains of MAP 2 and tau are located at the carboxyl-terminal portion of MAP 4. Amino acid sequence analysis revealed that human and mouse MAP 4 are homologs of the bovine 190-kDa MAP/MAP U (Aizawa, H., Emori, Y., Murofushi, H., Kawasakai, H., Sakai, H., and Suzuki, K. (1990) J. Biol. Chem. 265, 13849-13855). Mouse and human MAP 4 and the bovine 190-kDa MAP are approximately 75% similar, indicating that these proteins are all members of the same class. Domains with extremely high conservation (greater than or equal to 88%) are: 1) the extreme amino terminus; 2) a proline-rich region between the KDM and S,P domains; 3) the microtubule-binding domain; and 4) the extreme carboxyl terminus.

Amino Acid Sequence↗
PubMed1991

Is there an increased risk of breast cancer in women who have had a breast cyst aspirated?

A consecutive series of 644 women who presented with breast nodularity between 1976 and 1982 have been followed up to determine their rate of subsequent breast cancer. Fifteen women have developed breast cancer, 14 of these were among 352 women with an aspirated cyst (relative risk 4.4). Women with multiple cysts had the highest risk and women with breast nodularity had no excess risk. Review of histology specimens from those women who had undergone biopsy showed an excess of florid epithelial hyperplasia in women who subsequently developed breast cancer and women with multiple aspirated cysts were more likely to have florid epithelial hyperplasia. Multiple cysts are clinical markers of histological breast proliferation and women who have had multiple breast cysts aspirated have an increased risk of breast cancer and should be advised to practice regular self examination.

Adult↗
PubMed1991

Specificity of association in analysis of mortality and inference on causality.

Specificity of association between putative risk factor and disease under study is important to inference on causality. Nevertheless many studies investigate mortality of a single disease without comparison with a control. Age-standardized proportional mortality ratios make single disease studies into case-control studies and thus demonstrate whether or not associations are disease specific. Comparison of disease-specific with all-cause mortality experiences of whole populations classified by exposure, clearly distinguishes between exposures associated with more death and with earlier/younger death, thereby overcoming an important limitation of the familiar standardized mortality ratio (SMR). Smoking is associated with more death from lung cancer (lifetime cause-specific proportions, never 1%, light 6%, moderate 8% and heavy 12%) and with earlier/younger death from ischaemic heart disease (never 35%, light 34%, moderate 32% and heavy 29%).

Adult↗
PubMed1991

Leukaemia mortality among relatives of cystic fibrosis patients.

A total of 219 families of patients with cystic fibrosis living in Wales were studied for the occurrence of other diseases and for cause of death, and the findings in relation to leukaemia are reported. There were eight deaths due to leukaemia, five of the myeloid type, in first and second degree relatives; this is significantly more than the expected on the basis of national age specific mortality rates. In comparison, mortality among siblings, parents, aunts and uncles, and grandparents from all causes was within the expected. Screening the five patients with myeloid leukaemia for the delta F508 mutation showed that four were carriers of this mutation. It is concluded that carriers of the delta F508 mutation may have an increased risk of developing acute myeloid leukaemia. This could happen through the direct effect of the cystic fibrosis gene itself, or through its influence on another gene, such as the met oncogene, or gene(s) involved in granulocyte function on the long arm of chromosome 7.

Adult↗
PubMed1989

Post-infarction ventricular septal defect: the importance of right ventricular coronary perfusion in determining surgical outcome.

Mortality from a post-infarction ventricular septal defect (VSD) can be reduced by surgery, selection for which would be helped by knowledge of factors affecting the postoperative prognosis. We reviewed our 9-year experience (1978-1987) of 40 surgically treated patients, comparing preoperative characteristics in those who died postoperatively (n = 15, 37%) and those who survived (n = 25, 63%), all still alive. Sex, age, infarct size as assessed by peak serum creatine kinase values, left ventricular end-diastolic pressure and pulmonary/systemic flow ratio (2.9 +/- 0.2 vs 3.1 +/- 0.3) were similar. Survivors had a lower incidence of inferior infarct than those who died (6, 24% vs 9, 60%, P less than 0.05), a lower incidence of cardiogenic shock (7, 28% vs 10, 67%, P less than 0.05), less elevation of right ventricular end-diastolic pressure (10.1 +/- 0.9 vs 14.7 +/- 1.0 mm Hg, P less than 0.01) and less impairment of right ventricular coronary supply as determined by a coronary angiography-derived myocardial score (0.9 +/- 0.3 vs 4.7 +/- 0.7, P less than 0.001). The data suggest that right ventricular coronary perfusion influences prognosis. The proposed angiographic score may help to identify preoperatively those patients most likely to benefit from surgery.

Cardiac Catheterization↗
PubMed1989

Coronary artery bypass surgery: current practice in the United Kingdom.

A survey of current clinical practice was carried out among the 84 consultant cardiac surgeons currently performing coronary artery bypass surgery in the United Kingdom. The 80 surgeons who returned the questionnaire performed an estimated total of 17,100 coronary artery bypass graft operations in 1987, a mean case load of 214 operations each. Sixty two of the 80 surgeons regarded the internal mammary artery as the graft conduit of choice, and seven preferred the saphenous vein. The internal mammary artery was used in 73% of bypass grafts to the left anterior descending coronary artery but in only 4% of grafts to the circumflex and right coronary systems. Contraindications to the use of the internal mammary artery included advanced age of the patient (51 surgeons), insufficient flow through the internal mammary artery (49), and endarterectomy (35). Seventy four of the 80 surgeons considered intraoperative damage to the saphenous vein to be a possible cause of vein graft failure, but there was no agreement about how it should be reduced. All surgeons advocated pharmacological measures to enhance graft patency. Dipyridamole and aspirin constituted the most popular regimen (58 surgeons), though only 28 started dipyridamole preoperatively. Warfarin was prescribed postoperatively on occasion by 22 surgeons, but 14 of these used it only after endarterectomy.

Aged↗
PubMed1989

An epidemiological survey of primary tumours of the brain and spinal cord in South East Wales.

This survey is founded on 526 patients who presented with a primary tumour of the brain, spinal cord or their coverings over a seven year period. The patients resided in one of the three counties comprising South East Wales, which has a population of about 1.3 million. Each tumour type is classified according to age, sex and area of residence of the patient. Age and sex adjusted annual incidence rates were calculated for each tumour type. All types of glioma have a higher incidence in males, while meningiomas are twice as common in females. Gliomas are the most commonly occurring tumour with an average annual incidence of 3.6 per 100,000 and a peak incidence for malignant astrocytomas of 7.6 in the 55 to 64 year age group. The low grade astrocytoma is the most common tumour of childhood. Oligodendrogliomas occur most commonly in adults between the ages of 35 and 44 years. In this survey there is an unexplained relatively high incidence of oligodendrogliomas. The majority of primary tumours arose in the brain, but there were 24 tumours of the spinal cord, nerve sheath and meninges. Comment is made on the presence and possible aetiological significance of chemical industries within South East Wales.

Adolescent↗
PubMed1989

Myelodysplasia, chemical exposure, and other environmental factors.

This paper describes a case-control study of the occupational and environmental exposures of patients with myelodysplasia. The methodology, first described in Canada for solid tumors, estimates lifetime exposures to a number of potential toxic hazards or carcinogens. This pilot study confirms that the methodology, with the use of questionnaires and interviews, can estimate exposures to specific chemicals and shows some significant associations with myelodysplasia, including exposure to petrol or diesel compounds.

Air Pollutants↗