Vitamins, neural tube defects, and ethics committees.
Explore the source record for details and available documents.
Ethics, Medical↗
Biomedical subjects
S M Gore
Publications and source records attributed to S M Gore.
Long-term survival of patients with breast cancer: a study of the curability of the disease.
A retrospective analysis was made of 3878 cases of breast carcinoma first seen in Edinburgh from 1954 to 1964. During this time there was a policy to treat breast cancer by simple mastectomy and x-ray therapy, and over 90% of cases classified as international stages I and II were so treated. The mortality in these women was compared with that in an equivalent normal population using Scottish national age-specific death rates. For every year of follow-up within 20 years of initial treatment there was an excess mortality from all causes. There was an overall excess mortality of 58% among patients with breast cancer 15-20 years after initial treatment, and 20 times more deaths occurred in this period from breast cancer than in a normal population. For patients disease-free after 15 years there was still a 28% excess mortality from all causes. Factors known to be of major prognostic significance for five-year survivorship had less influence than might have been expected when the ratio of observed to expected deaths was considered for longer periods of follow-up. The effect of clinical staging (I, II, or III), though initially marked, largely disappeared by the 10th year of follow-up, and after allowing for age there was no evidence beyond 10 years of an effect on survival of the original stage of the disease. Similarly, the effect of tumour size on survival disappeared after 10 years. Women who were premenopausal at presentation still had a significant excess of deaths in the fourth quinquennium of follow-up. In the menopausal and postmenopausal groups combined there was still a small non-significant excess of deaths from all causes after 15 years but this almost disappeared when patients who had already relapsed were excluded. In terms of overall mortality only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.
Adult↗
Atenolol versus adrenaline eye drops and an evaluation of these two combined.
In a 1-day, 1-dose, double-masked, randomised trial, with each of 12 patients acting as his/her own control, atenolol drops 4% (a selective beta1-adrenergic blocker) produced a significantly greater fall in ocular tension measured by applanation than did adrenaline drops 1% (P is less than 0.01 Wilcoxon matched pairs signed ranks test). The mean differences, which favoured atenolol, between the falls in pressure produced by these 2 drugs at 1.5 hours, 3.5 hours, 5.5 hours, and 7 hours after instillation of the drops was 2.1, 4.6, 4.0, and 3.6 mmHg, respectively. Long-term studies would be required before any conclusion was justified about the relative merits of these 2 drugs in the treatment of glaucoma. There was no significant difference between the ocular hypotensive effects of atenolol-then-adrenaline and adrenaline-then-atenolol. It was disappointing that the expected adjuvant effect of atenolol's preceding adrenaline was not found-rather the reverse. Atenolol alone, however, was significantly better than atenolol-then-adrenaline (P is less than 0.02 Wilcoxon matched pairs signed ranks test), and there was also some indication that it was superior to adrenaline-then-atenolol. The response to adrenaline did not differ markedly from the response to the combination in either order.
Atenolol↗
Double blind trial of clonidine in the treatment of migraine in a general practice.
The value of clonidine (;Dixarit') for the prophylaxis of migraine has been assessed by a double blind cross-over trial. A dose of up to 0.15 mg daily was used. No effect on the frequency of the headaches could be detected over and above the 60 per cent reduction observed with a placebo. Severity, assessed subjectively by the patient, when it varied between placebo and clonidine, was less with clonidine (p<0.01). There was also some evidence that headaches lasting more than 12 hours were less common during treatment with the drug.
Adolescent↗
Misuse of statistical methods: critical assessment of articles in BMJ from January to March 1976.
Sixty-two reports that appeared as Papers and Originals (excluding short reports) in 13 consecutive issues of the British Medical journal included statistical analysis. Thirty-two had statistical errors of one kind or another; in 18 fairly serious faults were discovered. The summaries of five reports made some claim that was unsupportable on re-examination of the data. Medical investigators should consult with people who have a real understanding of statistical methods throughout their projects.
Periodicals as Topic↗
Reproducibility of measurements of oestrogen-receptor concentration in breast cancer.
The reproducibility of measurements of oestrogen-receptor activity has been examined in multiple specimens from a rabbit uterus, a rat mammary tumour and human breast tumours. The relationship between receptor concentration and tumour histology has also been investigated in 11 large primary tumours. In the animal tissues, receptor measurements were relatively reproducible (coefficient of variance: wet wt. basis 16-17%, protein basis 16-21%) but in human breast tumours receptor activity varied considerably (c.v.: wet wt. basis, 22-125%; protein basis, 28-72%). In addition to these variations in receptor activity within tumours, there was a difference between tumours, as demonstrated by an analysis of variance (P less than 0.01). In the 11 primary breast cancers selected for study, the level of receptor activity was related to menopausal status and the tumour content of the specimen. We conclude that the receptor activity detected varies within a tumour and depends upon the tumour content of the biopsy specimen. Predictions based on precise quantitation of receptor concentrations may therefore necessitate replicate tumour sampling and correction for the fraction of non-tumour tissue in each sample.
Animals↗
Comparison of ocular hypotensive effects of acetazolamide and atenolol.
The ocular hypotensive effect of single oral doses of (a) atenolol (50 mg), (b) acetazolamide (500 mg), (c) atenolol (50 mg) and acetazolamide (500 mg) in combination, and (d) vehicle (inert tablets) were compared in 8 patients with glaucoma. In this single-dose, double-masked trial the combination was observed as most effective in reducing ocular tension. Both the combination and atenolol performed markedly better than vehicle. That acetazolamide did not reduce ocular tension significantly more than vehicle is probably explained by relatively low initial ocular tensions. There was no evidence of interaction between atenolol and acetazolamide in this study. Acetazolamide probably remains the first-choice oral medication for glaucoma. It is cautiously suggested that beta-blocking drugs may have a future therapeutic role, but longer-term studies on larger numbers will be required to establish this.
Acetazolamide↗
Atenolol eye drops in glaucoma: a double-masked, controlled study.
Guttae atenolol 4% (Tenormin), a pure beta1-blocking (i.e., cardioselective) drug, produced a median overall fall of 5-6 mmHg (range 3-2 to 13-2 mmHg) in the first tonometrised eyes of 7 patients with open-angle glaucoma or ocular hypertension and 1 with closed-angle glaucoma (off any treatment for the whole of the day preceding each test day) after allowance for an 'effect' of guttae saline 0-9%, in a double-masked, cross-over trial. By a Wilcoxon matched pairs rank test this was significant at the P less than 0-05 level. The median overall fall of 3-5 mmHg (range 0-8 to 10-8 mmHg) in the second-tonometrised eyes of 7 patients (1 of the 8 contributed only 1 eye) was also significant (P less than 0-05). In 2 patients who had been treated with guttae atenolol 4% daily 3 X for 1 and 2 months there is evidence that, on replacing the atenolol 4% with saline 0-9%, a rise of pressure of around 3 mmHg occurred 2 and 3 and 5 days later, i.e., the drug still retained its effectivity (slightly reduced) after 1 and 2 months.
Atenolol↗
Atenolol eye drops.
Explore the source record for details and available documents.
Adrenergic beta-Antagonists↗
Observer variation in the clinical assessment of stroke.
Clinical assessments have to be used in epidemiological studies in the absence of more objective means of establishing diagnosis or recording events in the natural history of disease. This requires the standardization of definition, technique and interpretation as a means of reducing observer variability in clinical examination. The methods used to reduce the observer variation in the clinical assessment of stroke patients are described and results are presented which demonstrate the degree to which this was achieved.
Cerebrovascular Disorders↗
Long term survival analysis: the curability of breast cancer.
Methods of survival analysis for long-term follow-up studies are illustrated by a study of mortality in 3878 breast cancer patients in Edinburgh followed for up to 20 years. The problems of life tables, advantages of hazard plots and difficulties in statistical modelling are demonstrated by studying the relationship between survival and both clinical stage and initial menopausal status at diagnosis. To assess the 'curability' of breast cancer, mortality by year of follow-up is compared with expected mortality using Scottish age-specific death rates. Techniques for analysing such relative survival data include age-corrected life tables, ratio of observed to expected deaths and excess death rates. Finally, an additive hazard model is developed to incorporate covariates in the analysis of relative survival and curability.
Actuarial Analysis↗
Outpatient medical care of injection drug use related HIV.
By the end of March 1990 470 HIV positive patients, 77% injection drug use (IDU) related, had attended the outpatient department of the Regional Infectious Disease Unit with a cumulative loss to follow-up of only 20%. Coincident with the prescribing of oral methadone and a specific all-day IDU-related HIV medical clinic the total number of appointments increased from 28/month in May 1986 to 300/month in May 1989 (P less than 0.001) and the number of defaulted appointments decreased from a maximum of 60% (17/28) to 16% (48/294, P less than 0.001) in these months. There was a significant initial increase in the number of defaulted appointments for the infectious disease (ID) clinics from 11% (77/726) to 16% (124/797, P less than 0.01) which returned to previous levels once a specific IDU-related HIV clinic was established. There was also a significant decline in the number of new patients referred which was greater for the urinary tract infection clinics (108 to 56 per 6 months, P less than 0.0001) than for the ID clinics (119 to 88 per 6 months, P less than 0.05).
Adolescent↗