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S M Gore

Publications and source records attributed to S M Gore.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Analysis of the frequency of anti-HLA hyperimmunization in patients with kidney transplantation].

Highly sensitized patients tend to accumulate on renal transplant waiting lists. A long period of time is often needed for the identification of a compatible graft possessing the rare HLA antigens against which these patients are not immunized. The aim of this study was to identify factors which could explain the fact that the percentage of highly sensitized patients on the Swiss waiting list is one of the highest in Europe. Although no definite conclusion is possible, it seems that this phenomenon is not related to the fact that many of these patients have received mismatched grafts. It seems rather to result from the relatively high rate of transplantations for non-sensitized versus highly sensitized patients in comparison to what is encountered in other countries. The fact that this probably represents only a relative increase in hypersensitized patients is confirmed by the stability of the absolute number of these patients on the waiting list during recent years.

Europe↗
PubMed1990

Early diet in preterm babies and developmental status at 18 months.

424 preterm infants were randomly assigned a standard "term" formula or a nutrient-enriched "preterm" formula as sole diets (trial A) or as supplements to mother's own expressed milk (trial B) for a median of 4 weeks postnatally. 18 months post term, blind evaluation of 377 survivors showed that those previously fed preterm rather than term formula had major developmental advantages, more so in motor than mental function; the advantages, in both mental and motor scores, were especially striking in small-for-gestational-age infants and in males. For motor development index in trial A, this advantage was 15 points; in infants born small for gestation, it was 23 points (nearly 1.5 SD). Moderate developmental impairment (developmental index less than 85), notably motor impairment, was considerably more common in the group fed term formula. Infants fed preterm formula also had a small benefit in social maturity quotient. Thus, a short period of early dietary manipulation in preterm infants had major consequences for later development, which suggests that the first weeks may be critical for nutrition.

Age Factors↗
PubMed1990

Unrelated donor marrow transplantation between 1977 and 1987 at four centers in the United Kingdom.

Retrospectively we analyzed the histocompatibility data and clinical results of bone marrow transplantation in 51 patients who received marrow from unrelated donors (UD) from 1977 to 1987 at one of four UK BMT centers. We compared the results with those obtained in 51 transplants carried out at the same centers using HLA-identical (ID) sibling donors. Of the UD/recipient pairs 32 (63%) were serologically identical for HLA A, B, and DR antigens, and 37% showed varying degrees of mismatch. UD-BMT primary diagnoses were: severe aplastic anemia or Fanconi's anemia (n = 17), acute leukemia (n = 11), chronic myeloid leukemia (n = 21), and other conditions (n = 2). T cell depletion of the graft was associated with a significant improvement in survival in both UD and ID-BMT. Graft failure was more common in recipients of UD than of ID transplants (13 [25%] vs. 5 [10%] P = 0.05) but there was no significant difference in the frequency of acute or chronic graft-versus-host disease. Actuarial survival was superior for recipients of ID transplants (UD vs. ID: 49% vs. 78%, respectively, at 3 months; 32% vs. 63% at one year). Reduced survival for recipients of UD-BMT was confirmed in case control regression analysis (relative risk 3.0, P = 0.01). Nevertheless in patients whose only alternative is a partially mismatched family donor we think that UD-BMT is justified.

Bone Marrow Transplantation↗
PubMed1990

Corneal arcus: some morphology and applied pathophysiology.

The frequency and density of corneal arcus in 101 patients (101 eyes), 54 males and 47 females, were greatest in the 12 o'clock sector of the peripheral cornea. Sectors below 12, nasally and temporally, were approximately symmetrically affected. Both properties decreased progressively and significantly at the 11 and 1 o'clock sectors, then 10/2, then 9/3; 8/4 and 7/5 differed insignificantly from each other but were significantly less affected than 9/3, and more affected than 6 o'clock. Breadth and density were significantly positively correlated. The greater vascularity and higher temperature at the upper limbus might explain this pattern. The morphology of arcus is concluded to indicate the site of a peripheral corneal filter which prevents ingress of large light-scattering particles with the centripetal flow of tissue fluid. Filtration of immune complexes at the same site may initiate tissue destruction, hence some peripheral corneal ulcerations.

Adult↗
PubMed1990

Renal transplant rejection. Transient immunodominance of HLA mismatches.

Many studies have shown long-term benefits of HLA matching in kidney transplantation. By examining rates of graft loss within consecutive posttransplant intervals, using data from the UK Transplant Service, we show that the long-term benefits of HLA matching are due to reduction of the graft failure rate within five months of transplantation. After 5-months, HLA-A,B,DR matching appears to have little impact on graft loss. We suggest that graft losses after 5 months may be attributable to non-HLA targets.

Graft Rejection↗
PubMed1989

Organ donation from intensive care units in England.

OBJECTIVE: To audit all deaths in intensive care units (excepting coronary care only and neonatal intensive care units) in England to assess potential for organ procurement. DESIGN: An audit in which 14 regional health authorities and London special health authorities each designated a regional liaison officer to identify intensive care units and liaise with Department of Health and the Medical Research Council's biostatistics unit in distribution, return, and checking of audit forms. Audit took place from 1 January to 31 March 1989 and will continue to 31 December 1990. SETTING: 278 Intensive care units in England. PARTICIPANTS: Colleagues in intensive care units (doctors, nurses, coordinators, and others), who completed serially numbered audit forms for all patients who died in intensive care. RESULTS: The estimated number of deaths in intensive care units was 3085, and validated audit forms were received for 2853 deaths (92%). Brain stem death was a possible diagnosis in only 407 (14%) patients (about 1700 cases a year) and was confirmed in 282 (10%) patients (an estimated 1200 cases a year). Half the patients (95% confidence interval 45% to 57%) in whom brain stem death was confirmed became actual donors of solid organs. Tests for brain stem death were not performed in 106 (26%) of 407 patients with brain stem death as a possible diagnosis, and general medical contraindication to organ donation was recorded for 48 (17%) of 282 patients who fulfilled brain stem death criteria before cessation of heart beat. The criteria were fulfilled before cessation of heart beat and in the absence of any general medical contraindication to organ donation in 234 patients, 8% of those dying in intensive care (an estimated 1000 cases a year). Consent for organ donation was given in 152 (70%) of 218 cases (64% to 76%) when the possibility of organ donation was suggested to relatives. In only 14 out of 232 families (6%; 3% to 9%) was there no discussion of organ donation with relatives. Corneal suitability was recorded as "not known" in a high proportion (1271; 45%) of all deaths and intensive care units reported only 123 corneal donors (4% of all audited deaths). CONCLUSION: When brain stem death is a possible diagnosis tests should always be carried out for confirmation. Early referral to the transplant team or coordinator should occur in all cases of brain stem death to check contraindications to organ donation. There should be increased use of asystolic kidney donation, and patients should be routinely assessed for suitability for corneal donation. Finally, more publicity and education are necessary to promote consent.

Aged↗
PubMed1989

Predictions of the AIDS epidemic in the U.K.: the use of the back projection method.

Back projection methods are used to predict the yearly number of new AIDS diagnoses and the number of new HIV infections, to the end of 1992. The AIDS, but not the HIV, predictions are insensitive to the choice of incubation period distribution. A wide range of predictions is consistent with the AIDS diagnoses in years up to 1987, but limited ancillary information on the relative rates of new HIV infection in 1984 to 1987 can be used to narrow this range. The range of prediction based on AIDS reports to the end of 1988 is lower and narrower than the range based on reports to the end of 1987. The number of new AIDS cases in 1992 appears likely to fall in the range 1000-3000.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Premenopausal breast cancer patients treated with conservative surgery, radiotherapy and adjuvant chemotherapy have a low risk of local failure.

The use of adjuvant chemotherapy in premenopausal breast cancer patients with positive nodes is now routine, but the optimal local treatment of these patients is uncertain. To determine the effect of adjuvant chemotherapy on the likelihood of local recurrence as the first site of failure in premenopausal patients treated with conservative surgery (CS) and radiotherapy (RT), we examined the outcome of 74 patients treated with CS, RT, and adjuvant chemotherapy and compared it to the outcome in 192 patients treated with CS and RT alone. Adjuvant chemotherapy consisted of four or more cycles of either a doxorubicin-containing regimen or cyclophosphamide, methotrexate, and 5-fluorouracil. All patients were less than 50 years old, had UICC-AJCC Stage I or II breast cancer treated between 1968 and 1981, had gross excision of the primary tumor, and had a total radiation dose to the primary tumor bed of greater than or equal to 6000 cGy. Factors predicting for local recurrence, such as extensive intraductal carcinoma and age less than 35, were equivalent in the two groups. Women treated with adjuvant chemotherapy had significantly worse T- and N-stages than women treated with conservative surgery and radiotherapy alone: 61% versus 36% had T2 tumors (p = 0.0003), 34% versus 6% had clinically positive nodes (p less than 0.0001), and 97% versus 4% had pathologically positive nodes (p less than 0.0001). Despite the poorer prognosis of patients treated with adjuvant chemotherapy, within 5 years of diagnosis, 4% of patients who received adjuvant chemotherapy had their initial relapse in the breast and 24% had initial failure elsewhere, compared with 15% local failure first and 14% failure elsewhere first for those treated without chemotherapy (p = 0.01). We conclude that premenopausal patients with positive nodes treated with combined modality therapy (conservative surgery, radiation therapy, and adjuvant chemotherapy) have a low risk of local recurrence as a first site of failure. These results suggest a possible interaction between radiation therapy and chemotherapy in their effects on local tumor control.

Adult↗
PubMed1989

Early diet in preterm babies and developmental status in infancy.

Few data from randomised prospective studies address whether early diet influences later neurodevelopment in man. As part of a larger multicentre trial, 502 low birthweight infants were assigned randomly, for a median of 30 days, to receive a preterm formula or unfortified donor breast milk as sole diets or as supplements to their mothers' expressed milk. Surviving infants were assessed at nine months after their expected date of delivery without knowledge of their feeding regimen. The mean developmental quotient was 0.25 standard deviations lower in those fed donor breast milk rather than preterm formula. In infants fed their mother's expressed milk, however, the disadvantage of receiving banked milk compared with preterm formula as a supplement, was greater when the supplement was over half the total intake, and approached five points, representing 0.5 standard deviations for developmental quotient. Infants fed donor breast milk were at particular disadvantage following fetal growth retardation, with developmental quotients 5.3 points lower. We suggest that the diet used for low birthweight babies over a brief, but perhaps critical, postnatal period has developmental consequences that persist into infancy; infants who are small for gestational age are especially vulnerable to suboptimal postnatal nutrition.

Child Development↗
PubMed1989

Topical dexamethasone lowers rabbit ocular tension, as does topical mifepristone (RU 486), a peripheral blocker of dexamethasone and progesterone.

The variability of the response of the rabbit eye to topical 1% dexamethasone has been shown in two groups of 20 young albino rabbits each (total 40) tested in succession. The pressure anomalously fell significantly (but by only 1 mm Hg) in both groups in the first 4 weeks of administration, but not in subsequent weeks. Mifepristone (RU 486), a peripheral antagonist of dexamethasone and progesterone, reduced the pressure significantly, again by only 1 mm Hg, in the first group of 20 rabbits, not the second. Accordingly, no conclusion was possible on the originating question: does pre-treatment with mifepristone prevent the dexamethasone-induced rise in rabbit intra-ocular pressure?

Administration, Topical↗
PubMed1989

A preliminary analysis of late renal allograft failure.

1. New initiatives are required to investigate late allograft failure and its causes. 2. In the UK from 1978 to 1988 major reductions in graft loss rates occurred during the posttransplant epoch from 16-365 days but beyond 1-year failure rates show no overall changes. 3. Cyclosporine has its greatest impact during the interval from 16-365 days posttransplant and there is no evidence from these data of its impact in reducing graft losses beyond 1 year, but switching to other drugs was not taken into account. 4. The relative risk of graft loss associated with beneficial HLA matching apparently dwindles and is negligible beyond 1 year. 5. Major risk factors affecting late kidney allograft failure have yet to be modeled and evaluated.

Cyclosporins↗
PubMed1988

Is dialysis hypotension caused by an abnormality of venous tone?

The role of peripheral vascular tone in the development of hypotension induced by dialysis was investigated in eight patients undergoing haemodialysis with acetate or bicarbonate buffered fluid. Each patient had two sessions of dialysis with acetate fluid and two with bicarbonate fluid in the order acetate, bicarbonate, bicarbonate, acetate or bicarbonate, acetate, acetate, bicarbonate. Mean arterial blood pressure fell at a mean rate of 3.9 mm Hg/hour during dialysis with acetate fluid and 1.4 mm Hg/hour during dialysis with bicarbonate fluid. The rate of fall was significantly greater during dialysis with acetate fluid compared with bicarbonate fluid. Heart rate increased by a mean rate of 2.6 beats/min/hour during dialysis with both acetate and bicarbonate fluid. Vascular resistance in the forearm increased at a rate of 3.6 units/hour during dialysis with acetate fluid and 4.5 units/hour during dialysis with bicarbonate fluid, but the venous bed of the forearm dilated. The index of venous tone rose at a mean rate of 0.23 ml/dl [corrected] over 40 mm Hg/hour during dialysis with acetate fluid and 0.20 ml/dl over 40 mm Hg/hour during dialysis with bicarbonate fluid. Inappropriate peripheral venodilatation may be important in the development of hypotension induced by dialysis.

Blood Pressure↗
PubMed1988

Osteosclerotic myeloma variants.

We describe three patients with sclerotic multiple myeloma. One patient had diffuse bone sclerosis, one had mixed sclerotic and lytic lesions, and the third had POEMS syndrome. The radiological, clinical, and etiological features of sclerotic myeloma variants are discussed.

Adult↗
PubMed1988

Integrated reporting of quality and length of life--a statistician's perspective.

The reporting of trials has been dominated by a concentration on single measures of response, such as survival or extent of side-effects, perhaps selected as giving an impressive P value for treatment comparisons. Relevant questions about trade-offs are seldom answered or even envisaged in the trial design. Cardiovascular trials should provide evidence on quality of life after myocardial infarction or during antihypertensive therapy. Examples from oncology are used to illustrate how the robustness of treatment recommendation can be explored through a grid of quality adjustments, ranging from complete intolerance of side-effects to absolute acceptance of them. Treatment recommendations may need to be specific to patients unless they are independent of the system of quality adjustment used.

Aged↗