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Biomedical subjects

W C Smith

Publications and source records attributed to W C Smith.

At least 145 records · Page 8Linked to original sources
PubMed1990

Orbital complications of sickle cell disease.

Swelling and pain of the peri-orbital tissues in patients with sickle cell disease has been described. This has most often been ascribed to orbital apex syndrome, but there are recent reports in the literature of frontal bone infarctions compounding this syndrome. We will present a case report of a child with sickle cell disease with bilateral orbital abscesses and frontal bone infarctions. The literature pertaining to the diagnosis and treatment of the orbital complications of sickle cell disease is reviewed. We stress that intravenous antibiotics are not adequate therapy for orbital abscesses and that these must be drained surgically.

Abscess↗
PubMed1990

Cardiovascular disease in Edinburgh and north Glasgow--a tale of two cities.

Scotland has one of the highest mortality rates from coronary heart disease for both men and women. However within Scotland there are major geographical differences in the mortality rates, exemplified by the differences between the two largest Scottish cities. Glasgow on the west has a much higher mortality rate for cardiovascular diseases than Edinburgh in the east. During 1986 coronary risk factor population surveys were conducted simultaneously in Edinburgh and North Glasgow as part of the WHO MONICA study. These surveys employed standardized methods and the central quality control of the WHO project. Measures of coronary heart disease morbidity were higher in North Glasgow, except for electrocardiographic evidence of ischaemia, consistent with the mortality rates. The major coronary risk factors were uniformly higher in North Glasgow than in Edinburgh, except for serum lipids which were not significantly different. The risk factors, except the lipids, showed a gradient by socioeconomic status, so that when the risk factors levels were standardized for housing tenure the significant differences between the cities largely disappeared, and the serum cholesterol levels in women become significantly higher in Edinburgh because of their slight negative relationship with social status. This study shows that the socioeconomic differences between Edinburgh and North Glasgow largely explain the coronary risk factor differences between the cities. The socioeconomic differences in coronary disease and its major risk factors require further investigation and may be more fundamentally important than the geographical differences in the patterns of coronary heart disease.

Adult↗
PubMed1990

Plasma fibrinogen and coronary risk factors: the Scottish Heart Health Study.

Plasma fibrinogen was measured in a sample of 8824 men and women aged 40-59 years participating in the Scottish Heart Health Study, and related to cardiovascular risk factors. Women had higher fibrinogen levels than men. In both sexes, multivariate analysis showed that fibrinogen was positively associated with age, smoking, total cholesterol and body mass index and negatively associated with alcohol consumption. Among women, early menopause and systolic blood pressure were also associated with fibrinogen levels. Univariate analyses showed weak positive associations with fish consumption for both sexes although only male white fish consumption entered the final model. Women with a history of contraceptive pill usage had significantly lower fibrinogen levels. The relationship between fibrinogen and physical activity was complex, and could largely be explained by smoking. These findings support the hypothesis that raised fibrinogen is one mechanism by which several major risk factors may promote coronary heart disease. However, known risk factors explained, at most, 10% of the total variance in fibrinogen levels among the general population.

Adult↗
PubMed1990

Cholesterol as a risk factor for coronary heart disease.

The intense current interest in lipids as causal risk factors in coronary heart disease has encouraged a unifactorial, one-dimensional approach to coronary risk based on fixed total serum cholesterol or low density lipoprotein (LDL) cholesterol cut-points. Epidemiological evidence shows that coronary heart disease risk is multifactorial; the risk associated with a given lipid value is modulated overwhelmingly by the level or presence of other factors. While populations with high lipid values may be characterized as being at high risk, individual risk cannot be determined by isolated lipid measurements. To characterize individuals as at high or low risk by considering lipid values alone results in serious misclassification. Cut-points derived from middle-aged American men create anomalies when applied to different age and sex groups and to different populations. Clinical management of risk factors in individuals should involve the negotiation of a flexible and multi-dimensional individual regime, comprising all modifiable factors.

Adult↗
PubMed1990

An evaluation with piglets of bovine milk, hydrolyzed bovine milk, and isolated soybean proteins included in infant milk formulas. I. Effect on organ development, digestive enzyme activities, and amino acid digestibility.

A study, using the piglet as a model for the human infant, was undertaken to determine the effect of the protein source of a milk formula on organ development, the activity of digestive enzymes, and the absorption of amino acids as measured at the terminal ileum and over the entire digestive tract. Three isocaloric liquid milk formulas containing equal amounts of either intact bovine milk, hydrolyzed bovine milk, or isolated soybean protein as the sole source of this nutrient and with equal levels of fat and carbohydrate were each given to six 14-day-old piglets over a 19-day period in a manner that mimicked human infant feeding practice. Following a 6-day metabolism study, the piglets were killed, their organs removed, and samples of digesta collected. The protein source of the milk-based formula did not affect (p greater than 0.05) the weight/unit body weight of the small intestine, large intestine, liver, or pancreas, but the relative weight of the kidneys was lower (p less than 0.05) for animals fed the intact bovine milk-based formula and that of the stomach was higher (p less than 0.01) for piglets receiving the isolated soybean formula. The activities of pepsin, intestinal trypsin and chymotrypsin and pancreatic chymotrypsin were not influenced (p greater than 0.05) by protein source, but piglets receiving the bovine milk-based formula had a lower level of activity (p less than 0.01) for pancreatic trypsin. The apparent ileal and fecal absorption of nitrogen was similar for the three milk-based formulas, the overall mean ileal absorption of nitrogen (+/- SE) being 89.0% (+/- 1.44). Excluding cystine, where ileal absorption was relatively lower (p less than 0.05) with the isolated soybean formula (86.7%) compared with the intact bovine milk (91.5%), protein source had little effect on the apparent absorption of essential amino acids. It was concluded that the replacement of intact cow's milk protein in human infant formulas by either hydrolyzed cow's milk or isolated soybean protein is unlikely to cause any major disturbance in the digestive process.

Amino Acids↗
PubMed1990

Alcohol consumption and unemployment among men: the Scottish Heart Health Study.

There is growing concern about the relationship between health-related behaviour and employment status. Data from the Scottish Heart Health Study included information on the self-reported drinking habits of 4170 full-time employed and 479 unemployed men. This enabled the patterns of alcohol consumption in the unemployed to be compared to those of the full-time workers. There were appreciable differences in both frequency and quantity of reported alcohol consumption between the two groups and a higher percentage of the unemployed reported being non-drinkers. Nevertheless, the unemployed drinkers drank more alcohol than those in employment, even after standardization for both age and social class (27.9 units vs 20.7 units per week). Binge drinking was common in both groups, but the proportion was higher among the unemployed (58.8% of the unemployed reported drinking more than eight units in any day in the previous week compared to 33.5% among the full-time workers). In an attempt to validate these findings and to assess the possible health consequences of heavy drinking, serum gamma-glutamyltransferase levels were analysed. Overall, the unemployed were found to have higher levels, this finding being largely influenced by the excess of heavy drinkers. The reasons behind these differences in drinking behaviour between the employed and unemployed need to be identified before any cause and effect hypotheses can be generated, and counselling given where needed.

Adult↗
PubMed1990

Geographical clustering of risk factors and lifestyle for coronary heart disease in the Scottish Heart Health Study.

A large cross sectional study, the Scottish Heart Health Study, of 10,359 men and women from 22 districts of Scotland was undertaken to try to explain the geographical variation of coronary heart disease mortality. Analysis by district showed that of the classic risk factors only cigarette smoking was strongly associated with heart disease mortality among both men and women. Mean diastolic blood pressure was weakly associated with rates among men and high density lipoprotein cholesterol showed a strong negative association among women. Total cholesterol showed a weak negative association with heart disease mortality, but, because the serum concentrations of cholesterol were uniformly high in all districts, a strong association with mortality would not be expected. In both men and women many dietary factors showed moderate or strong associations with mortality from coronary heart disease in a district--of these a low consumption of vitamin C was most notable. Other factors associated with heart disease included alcohol consumption and serum triglycerides among men, and obesity, physical activity, and serum triglycerides among women. Many factors associated with heart disease showed strong intercorrelations. Clustering of risk factors (including smoking, alcohol, and diet among men, and smoking, diet, and obesity among women) was associated with much of the regional variation in heart disease mortality in Scotland.

Adult↗
PubMed1990

Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study.

Data from 10,359 men and women aged 40-59 years from 22 districts in the Scottish Heart Health Study were used to describe the prevalence rates of coronary heart disease in Scotland in 1984-1986 and their relation to the geographical variation in mortality in these districts. Prevalence was measured by previous history, Rose chest pain questionnaire, and the Minnesota code of a 12 lead resting electrocardiogram. The prevalence of coronary heart disease in Scotland was high compared with studies from other countries that used the same standardised methods. A history of angina was more common in men (5.5%) than in women (3.9%), though in response to the Rose questionnaire 8.5% of women and 6.3% of men reported chest pain. A history of myocardial infarction was three times more common in men than women, as was a Q/QS pattern on the electrocardiogram. There were significant correlations between the different measures of coronary prevalence. District measures of angina correlated well with mortality from coronary heart disease, and these correlations tended to be stronger in women than in men. There was no significant correlation between mortality from coronary heart disease and measures of myocardial infarction. The study provides data on the prevalence of coronary heart disease in men and women that are valuable for the planning of cardiological services.

Adult↗
PubMed1990

Hypophysectomy eliminates and growth hormone (GH) maintains the midpregnancy elevation in GH receptor and serum binding protein in the mouse.

[125I]Iodomouse GH [( 125I]iodo-mGH) binding to samples of serum and hepatic microsomal membranes was measured in hypophysectomized pregnant, sham-operated pregnant, intact pregnant, and intact adult virgin mice. Surgeries were carried out on day 11 of pregnancy, and the animals were killed on day 14. The binding of mGH to both serum and hepatic microsomal membranes of intact virgin mice was much lower than to those of intact pregnant mice. In hypophysectomized mice, the mGH-binding capacity of both serum and hepatic microsomes decreased to values similar to those of nonpregnant mice. No significant differences were observed between intact and sham-operated pregnant animals in the maternal serum mGH concentration, the serum GH-binding protein concentration, or the hepatic GH receptor concentration. GH receptor and binding protein-encoding mRNAs were also higher in intact and sham-operated pregnant mice than in virgin and hypophysectomized mice. Hypophysectomized mice were treated with 200 micrograms/day bovine GH, administered by osmotic minipump; after 3 days of treatment, a significant elevation of hepatic GH receptor and serum GH-binding protein levels was observed. These results demonstrate an up-regulation of hepatic GH receptors and serum GH-binding protein by GH during pregnancy in the mouse.

Animals↗
PubMed1990

Diagnosis of early embryonic demise by endovaginal sonography.

To determine the embryonic size at which cardiac activity is always seen in a normal early pregnancy, 398 endovaginal sonograms were evaluated in which the gestational sac contained a yolk sac and/or embryo of less than or equal to 12 mm in crown-rump length (CRL). In the 99 sonograms in which there was a yolk sac but no identifiable embryo, cardiac activity was absent in 75; 58 of these pregnancies progressed normally. Of the 299 sonograms where there was an identifiable embryo with CRL less than or equal to 12 mm, cardiac activity was absent in 31; 29 of these were proven to be failed pregnancies. In two cases the pregnancy progressed normally; the CRL was 2 mm in one case and 4 mm in the other. We conclude that once an embryo is seen by endovaginal sonography, the absence of cardiac activity usually indicates embryonic demise. However, when cardiac activity is absent, one should refrain from definitively diagnosing embryonic demise, based on a single sonogram, if the CRL is less than 5 mm.

Embryo, Mammalian↗
PubMed1990

Smoking and housing status in Scottish MONICA: examples of a modified case-control analysis.

Data from the Scottish MONICA Project in North Glasgow has been used to compare the characteristics of coronary heart disease cases with those of a sample of men and women drawn from the general population. A case-control methodology was used, with cases taken from the MONICA register of acute myocardial infarction events for 1985 and 1986, and controls from the MONICA population survey conducted in 1986. Information on smoking levels and on housing status is available for both cases and controls, and this information has been used to provide examples of possible analyses. Relative risks were estimated for smoking, and it was found that current smokers had 3.8 times the level of risk of never-smokers in men and 3.1 times in women. Some evidence for a dose-response relationship was found, with heavy smokers being at higher risk. A comparison of cases and controls by housing status revealed that both men and women in public housing are at higher risk than home owners, but that some of this increased risk is related to the higher smoking levels of council housing tenants. These analyses can be extended to other factors provided information is available on both coronary cases and survey subjects.

Adult↗
PubMed1990

A quantitative study of the relationship between systemic and histological parameters of immunity in individual leprosy patients.

A group of 52 untreated leprosy patients were examined to determine the relationship between local and systemic immunological parameters across the clinico-pathological spectrum. The Ridley-Jopling classification, bacterial index (BI), and granuloma fraction (GF) were assessed in biopsies from 40 cases. The densities of apoptoses, mitoses, and plasma cells were also measured. Systemic immunity to mycobacteria was assessed by skin tests with leprosin A and PPD, and by measurement of the serum antibody responses to Mycobacterium leprae, M. tuberculosis, and M. scrofulaceum. The serum responses to phenolic glycolipid-I (PGL-I) of M. leprae was assessed using a glycoconjugate which mimics an immunodominant epitope. The serum antibody levels and skin test results showed the expected inverse relationship. The BI within lesions showed an inverse correlation with the skin test results, but none of the other histological parameters studied showed a significant relationship with the other measurements of systemic immunity. Our findings suggest that the inverse relationship between delayed-type hypersensitivity and humoral immunity in leprosy patients, which is strong in groups of patients across the leprosy spectrum, is less strong in individual patients than is often thought. The lack of correlation of many histological and systemic parameters suggests that local factors modulate systemic immunity in the pathogenesis of leprosy lesions.

Adolescent↗
PubMed1989

How-often-that-high graphs of serum cholesterol. Findings from the Scottish Heart Health and Scottish MONICA studies.

The Scottish Heart Health and Scottish MONICA studies included measurements of serum total cholesterol in 10,450 representative men and women aged 25-64 years recruited across Scotland in 1984-86. The results were typical of Britain as a whole. A new graph, called the HOTH graph ("how often that high?"), shows the percentage of the population with serum total cholesterol at or above any given value. Median (equal to mean) cholesterol levels in men were 5.5, 6.0, 6.3, and 6.2 mmol/l in successive 10-year age groups 25-64, whilst equivalent values in women were 5.2, 5.5, 6.4, and 7.2 mmol/l. By comparison with other countries these are high, but the percentage of the population above specific cutpoints is disproportionate, varying considerably by age and sex. Application of imported cholesterol management algorithms, based on global cut-points, would lead to an overwhelming caseload of patients needing intensive lipid investigation and management, dominated by older women, and incurring great costs. 35% of the population 25-64 years old would be at or above 6.5 mmol/l and 11% at or above 7.8 mmol/l. A population diet and multiple-risk-factor strategy would be more feasible and rational than a one-dimensional cholesterol cut-point approach.

Adult↗
PubMed1989

Development of coronary prevention strategies by health authorities in the United Kingdom.

The United Kingdom has one of the highest coronary heart disease mortality rates in the world. However, over the last decade there has been a growing impetus in coronary prevention. In 1988 the Faculty of Community Medicine carried out a survey of all health authorities in the UK to assess the progress and problems with coronary prevention. This survey received a 92 per cent response rate and shows some interesting findings. The picture at present reveals a growing momentum in the last couple of years with half the health authorities at present claiming to have a programme. The main hindrances reported are lack of funding rather than lack of interest. The development and difficulties with nutrition and smoking policies, and with blood pressure screening are also described. The regional pattern of development of these programmes and policies is complex. Many authorities favour a general health promotion approach rather than a negative, disease oriented one; this conflict in approach requires further debate.

Coronary Disease↗
PubMed1989

Unemployment, socioenvironmental factors, and coronary heart disease in Scotland.

Scotland, which has one of the highest death rates in the world from coronary heart disease, also has considerable regional variation in mortality from this cause. The relation between standardised mortality ratios for coronary deaths (1979-83) for 56 local government districts and a range of socioeconomic factors from the 1981 Census as well as climatic factors and water hardness were investigated. Strong associations were seen with several measures of social disadvantage, the strongest being with percentage of male unemployment. A fitted multiple regression model with mortality from coronary heart disease in men found independent effects of two social variables (percentage male unemployment and percentage social class III-V) and one climatic factor (rainfall). The model explained much (73%) of the geographical variation in mortality from coronary heart disease, but part of the geographical pattern, in particular some of the east-west gradient in mortality, remained unexplained by it. Explanations for the geographical variation and the association with economic factors are currently being sought in terms of individual risk factors in a large screening study, the Scottish Heart Health Study.

Adult↗
PubMed1989

Concomitants of excess coronary deaths--major risk factor and lifestyle findings from 10,359 men and women in the Scottish Heart Health Study.

The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10,359 men and women aged 40-59 years, in 22 districts of Scotland. The study was conducted during 1984-86, when Scotland had the highest national coronary heart disease mortality reported by the World Health Organisation. A self-completed questionnaire, complemented by a 40 minute visit to a survey clinic, staffed by nurses, enabled the classical major risk factors and some more newly described ones to be measured. The study emphasised quality control and representativeness, and incorporated a World Health Organisation protocol for measurement of key items to allow comparisons in place and time, and therefore also to provide a definitive baseline against which interventions can be assessed. This paper describes the overall findings. Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, lower than in British studies of the 1960s and 1970s. Mean body mass index levels, 26.1 Kg/m2 in men and 25.7 Kg/m2 in women, were not high by international standards. However, mean serum cholesterol levels were 6.4 mmol/l in men and 6.6 mmol/l in women--as high as those in previous British studies and high by international standards. Levels of high density lipoprotein cholesterol, non-fasting triglycerides and fibrinogen are also reported. Physical activity both at work and in leisure time was low.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Coronary risk factor and lifestyle variation across Scotland: results from the Scottish Heart Health Study.

Between 1984 and 1986 the Scottish Heart Health Study recorded coronary risk factors and lifestyle in 10,359 men and women aged 40-59 years across 22 districts of Scotland--districts whose standardised mortality ratio for coronary heart disease in men varied from 61 in Eastwood to 136 in Monklands. This paper presents the results by district. Cigarette smoking levels showed the greatest variation, from 29% to 52% in men and 24% to 51% in women. Blood pressure means varied but were not high (129-138mmHg systolic in men, 126-137mmHg in women, 81-88mmHg diastolic in men and 77-84mmHg in women). Mean serum cholesterol values were high and varied little by district in men, (6.1 to 6.5mmol/l), although there was more variation in women (6.3 to 7.0mmol/l). Body mass index (25.3 to 26.6kg/m2 in men and 24.8 to 26.3kg/m2 in women) also varied little. Distribution of other lipids, fibrinogen, exercise levels and fruit and vegetable consumption is also described. When district mean levels of major coronary risk factors are entered into predictive formulae, cigarette smoking and blood pressure could explain part of the regional variation in mortality, but much remains unaccounted for. Nonetheless, these levels provide data for local preventive initiatives. While the overall pattern and interaction of the factors will repay further study, the high levels of serum cholesterol in all districts, and the level and variation in cigarette smoking, are a challenge for action.

Adult↗