Biomedical subjects
Publications and source records attributed to A Britton.
Many new hip prostheses are now available for use in total hip replacement. The majority remain untested relative to standard prostheses; however, many new prostheses are substantially more costly. We examine how much more effective new prostheses must be, in terms of reducing the need for revision operations, in order to justify this increased cost.
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Research into the effect of alcohol on cardiovascular disease has indicated protective effects from moderate consumption. These observations, made in industrialized countries, have influenced policies on alcohol in countries where the situation may be quite different--specifically, where consumption is substantially higher or patterns of drinking are different. In central and eastern Europe and the former Soviet Union, a growing body of epidemiological research indicates a positive rather than negative association between alcohol consumption and cardiovascular deaths, especially sudden cardiac deaths. By means of a systematic review of published work, we examine whether there is a physiological basis for the observed association between alcohol and heart disease seen in eastern Europe, focusing on the effects of high levels of consumption and of irregular or binge drinking. In binge drinkers, cardioprotective changes in high-density lipoproteins are not seen, and adverse changes in low-density lipoproteins are acquired. Irregular drinking is associated with an increased risk of thrombosis, occurring after cessation of drinking. It predisposes both to histological changes in the myocardium and conducting system and to a reduction in the threshold for ventricular fibrillation. Measures of frequency as well as quantity of consumption should be included in epidemiological studies. Taken with the epidemiological evidence emerging from eastern Europe, these observations have important implications for estimates of the burden of disease attributable to alcohol.
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An ongoing study was made of 804 primary Stanmore total hip prostheses implanted in 839 patients between 1973 and 1991. The earliest surviving implants were brought back for radiologic and clinical review in 1995 at an average of 17 years after surgery. The remainder of the patients still living were sent a questionnaire to assess their current status. Survivorship was 95% at 10 years, 85% at 15 years, and 73% at 20 years. The average Merle d'Aubigné-Postel score was excellent up until 14 years. Patient satisfaction remained high until 22 years. Overall, 10% of the prostheses had failed. The results of this study suggest that the Stanmore prosthesis is capable of producing satisfactory long-term results that compare favorably with those of other cemented prostheses.
The dramatic increase in the volume of research based information means that effective policy makers must be able to conduct and interpret literature reviews. This article sets out the steps that should be followed in doing so. They are: explicitly defining the question; locating relevant literature; assessing the quality of studies and deciding whether they should be included; synthesizing and re-analyzing the results; and presenting them in a clear and concise manner. The article identifies the leading sources of information, including electronic databases and useful Internet addresses and describes briefly how each stage should be conducted, highlighting the strengths and weaknesses of different approaches and the ways in which bias may be introduced.
OBJECTIVE: To assess the relation between tap water lead and maternal blood lead concentrations and assess the exposure of infants to lead in tap water in a water supply area subjected to maximal water treatment to reduce plumbosolvency. DESIGN: Postal questionnaire survey and collection of kettle water from a representative sample of mothers; blood and further water samples were collected in a random sample of households and households with raised water lead concentrations. SETTING: Loch Katrine water supply area, Glasgow. SUBJECTS: 1812 mothers with a live infant born between October 1991 and September 1992. Blood lead concentrations were measured in 342 mothers. MAIN OUTCOME MEASURES: Mean geometric blood lead concentrations and the prevalence of raised tap water lead concentration. RESULTS: 17% of households had water lead concentration of 10 micrograms/l (48.3 nmol/l) or more in 1993 compared with 49% of households in 1981. Tap water lead remained the main correlate or raised maternal blood lead concentrations and accounted for 62% and 76% of cases of maternal blood lead concentrations above 5 and 10 micrograms/dl (0.24 and 0.48 mumol/l) respectively. The geometric mean maternal blood lead concentration was 3.65 micrograms/dl (0.18 mumol/l) in a random sample of mothers and 3.16 micrograms/dl (0.15 mumol/l) in mothers whose tap water lead concentrations were consistently below 2 micrograms/l (9.7 nmol/l). No mother in the study had a blood lead concentration above 25 micrograms/dl (1.21 mumol/l). An estimated 13% of infants were exposed via bottle feeds to tap water lead concentrations exceeding the World Health Organisation's guideline of 10 micrograms/l (48.3 nmol/l). CONCLUSIONS: Tap water lead and maternal blood led concentrations in the Loch Katrine water supply area have fallen substantially since the early 1980s. Maternal blood lead concentrations are well within limits currently considered safe for human health. Tap water lead is still a public health problem in relation to the lead exposure of bottle fed infants.
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Thyroids from 213 adult herring gulls of both sexes were collected during incubation from nine colonies in the Great Lakes basin of eastern North America between 1974 and 1983, and from a single colony in the Bay of Fundy from 1977 to 1982. Qualitative and quantitative histological assessment revealed that the majority of the gulls from the Great Lakes basin suffered from goiter. These thyroids had a greater mass than those from the Bay of Fundy, and were microfollicular and frequently hyperplastic. The histopathology was similar to that previously observed in Pacific salmon from the Great Lakes. These findings are consistent wit a forage fish-borne goitrogenic etiology other than, or in addition to, iodine deficiency. Temporal and spatial differences in the severity of thyroid dysfunction are consistent with the hypothesis that polyhalogenated hydrocarbons are responsible for the goiter development and thyrotoxic effects observed in herring gulls from the Great Lakes area.
In a patient with a spontaneous inhibitor detected against factor V, the initial pattern of laboratory results suggested a possible nonspecific (lupuslike) inhibitor, a finding that did not agree with the clinical history. Further evaluation led to the identification of the specific inhibitor. The patient was then treated successfully with platelets and immunosuppression. This case highlights the nonspecific nature of many of the procedures utilized to evaluate patients with circulating anticoagulants and underscores the need for a careful integration of clinical and laboratory data to diagnose and manage these patients properly.
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