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Biomedical subjects

C C Patterson

Publications and source records attributed to C C Patterson.

At least 37 records · Page 2Linked to original sources
PubMed1993

Multicentre randomised trial comparing high and low dose surfactant regimens for the treatment of respiratory distress syndrome (the Curosurf 4 trial).

A randomised trial was conducted in 82 centres using the porcine surfactant extract, Curosurf, to compare two regimens of multiple doses to treat infants with respiratory distress syndrome and arterial to alveolar oxygen tension ratio < 0.22. Infants were randomly allocated to a low dosage group (100 mg/kg initially, with two further doses at 12 and 24 hours to a maximum cumulative total of 300 mg/kg; n = 1069) or a high dosage group (200 mg/kg initially with up to four further doses of 100 mg/kg to a maximum cumulative total of 600 mg/kg; n = 1099). There was no difference between those allocated low and high dosage in the rates of death or oxygen dependency at 28 days (51.1% v 50.8%; difference -0.3%, 95% confidence interval (CI) -4.6% to 3.9%), death before discharge (25.0% v 23.5%; difference -1.5%, 95% CI -5.1% to 2.2%), and death or oxygen dependency at the expected date of delivery (32.2% v 31.0%; difference -1.2%, 95% CI -5.2% to 2.7%). For 14 predefined secondary measures of clinical outcome there were no significant differences between the groups but the comparison of duration of supplemental oxygen > 40% did attain significance; 48.4% of babies in the low dose group needed > 40% oxygen after three days compared with 42.6% of those in the high dose group. The total amount of surfactant administered in the low dose regimen (mean 242 mg phospholipid/kg) was probably enough to replace the entire pulmonary surfactant pool. Adopting the low dose regimen would lead to considerable cost savings, with no clinically significant loss in efficacy.

Biological Products↗
PubMed1993

DNA densitometry of colorectal cancer.

DNA analysis was assessed by densitometry for 281 cases of colorectal adenocarcinoma. Detection of aneuploidy in a single case rose from 65% if one, to 92.5% when three or more sections, were analysed. Although aneuploid tumours had significantly larger nuclear areas than near diploid tumours (p = 0.009), densitometric measurements showed no association with clinicopathological variables. DNA content determined by densitometry was compared with that from flow cytometry on 465 tissue sections from 241 cases. Aneuploidy assessed by flow cytometry was significantly associated with that determined by densitometry (p < 0.01 for all comparisons), ploidy state being similar in 381 sections (82%, kappa = 0.63, p < 0.001), and 187 cases (77.6%, kappa = 0.57, p < 0.001). Univariate survival analysis showed that DNA densitometric variables had no significant association with survival in (a) all cases, (b) cases without lymph node metastases, or (c) cases without distant metastases. Multivariate regression analysis of densitometric and clinicopathological variables identified Dukes's stage, patient age, and tumour differentiation as the combination of variables most closely related to survival. Densitometric measurement of DNA content could not significantly improve on the prognostic model containing these three variables. It is concluded that, although the assessment of DNA content by densitometry is comparable with that of flow cytometry, conventional histological variables remain the best predictors of prognosis in colorectal cancer.

Adenocarcinoma↗
PubMed1993

Sleep related hypoxaemia in hypertensive and normotensive men.

BACKGROUND: An association between hypertension and obstructive sleep apnoea (OSA) has been found by some researchers but remains controversial. Since such an association would have important implications for the investigation and management of hypertension, the rate of nocturnal hypoxaemic episodes has been compared in hypertensive and normotensive men. METHODS: The study was carried out in the community in Belfast and its environs. Thirty four men with mild to moderate hypertension aged 40-64 years were identified from general practice and a hypertension clinic. Normotensive men, matched for age and body mass index, were selected from a community survey. Subjects answered a sleep questionnaire and underwent overnight pulse oximetry at home. Computer analysis of the results gave the number and magnitude of dips in oxygen saturation (SaO2 dips, 4% or greater). RESULTS: The median number of SaO2 dips/hour for hypertensives was 2.0, and for normotensives was 0.8. Lowest SaO2 and mean SaO2 levels were significantly lower in the hypertensive group. Only one subject had a rate of SaO2 dips/hour greater than five and symptoms suggestive of OSA. CONCLUSIONS: Both hypertensive and normotensive men had relatively few episodes of nocturnal hypoxaemia. The small increase in the rate of SaO2 dips in hypertensive subjects has not yet been fully explained. These results imply that OSA is not common in hypertensive subjects and is unlikely to be an important cause of hypertension.

Humans↗
PubMed1993

The role of flow cytometry in carcinoma of the colon and rectum.

Flow cytometry was performed upon 312 patients with adenocarcinoma of the colon and rectum, satisfactory results being obtained with 275 (108 diploid, 130 aneuploid and 37 tetraploid). The proportion of nondiploid instances increased from 28 percent if one, to 80 percent when six specimens were assessed per patient. Reproducibility of the technique showed substantial agreement in the assessment of deoxyribonucleic acid ploidy (Kappa value equals 0.74). Increasing values of cells in the diving (G2/M) phase of the cell cycle were associated with little lymphocytic tumor infiltration (p = 0.0002) and extensive tumor fibrosis (p = 0.003). Univariate survival analysis revealed that, although diploid tumors tended to have a better prognosis than nondiploid tumors (p = 0.06), no flow cytometric variable was significantly related to survival. Flow cytometry similarly was not of prognostic value in instances without lymph node metastases or without distant metastases. Multivariate regression analysis of flow cytometric and clinicopathologic variables identified Dukes' stage, patient age and tumor differentiation as the combination of variables most closely related to survival. No flow cytometric variable could significantly improve on the prognostic model containing these three variables. It is concluded that conventional histologic variables remain the best predictors of prognosis in carcinoma of the colon and rectum.

Adenocarcinoma↗
PubMed1992

Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE Study.

EURODIAB ACE is a collaborative European study that was set up to assess incidence of childhood insulin-dependent diabetes mellitus (IDDM) in Europe, test the proposal of a south-north gradient, and to gather information to determine the causes and pathogenesis of the disease. Here, the basic epidemiological results are reported. Newly diagnosed cases of IDDM in children aged up to 15 years were identified prospectively in twenty-four geographically well-defined study regions in Europe and Israel (a total of 16.8 million children) during 1989 and 1990. 3060 cases were identified with estimated ascertainment rates exceeding 90% in all study regions. Age-standardised and sex-standardised incidence rates varied widely, ranging from 4.6 (northern Greece) to 42.9 (two regions in Finland) cases per 100,000 per year. Rates in southern Europe were generally higher than previously assumed, and there was an unexpectedly high incidence in Sardinia, which had the second highest rate (30.2 cases per 100,000 per year) recorded in Europe. Eastern European regions had generally low rates. The collaborative network now established provides a framework for further studies to examine the complex interaction between genetic and environmental factors in the cause and pathogenesis of IDDM.

Adolescent↗
PubMed1992

Serum copper and zinc in random samples of the population of Northern Ireland.

Serum copper and zinc concentrations (mumol/L) were measured in nonfasting subjects aged 25-64 y participating in two independent population surveys in Northern Ireland. In 1983-84, copper in 1144 males was 17.2 +/- 3.1 (mean +/- SD) and zinc was 12.1 +/- 1.7 (SD). Copper in 1055 females, neither pregnant nor taking estrogens or progestogens, was 19.0 +/- 3.9 and zinc was 11.6 +/- 1.4. In 1986-87 copper in 1142 males was 17.9 +/- 3.3 and zinc was 13.2 +/- 2.1. Copper in 1034 females was 20.1 +/- 3.9 and zinc was 12.7 +/- 2.0. Zinc but not copper concentrations decreased from early morning to late afternoon; both were unaffected by reported postprandial time. There was a positive relationship between copper and age for both sexes but zinc showed only a slight upward trend with age. A positive relationship between copper and the aggregation of classical risk factors for coronary heart disease was demonstrated.

Adult↗
PubMed1992

Synergistic interaction between midazolam and propofol.

We gave either midazolam or propofol for induction of anaesthesia to 140 ASA I or II female patients (18-60 yr). ED50 values were obtained by probit analysis for three clinical end-points: loss of response to command; loss of eyelash reflex; failure to respond to application of an anaesthetic face mask delivering 1% isoflurane. Propofol ED50 values (95% confidence intervals) were 1.25 (0.99-1.48) mg kg-1, 1.61 (1.29-1.94) mg kg-1 and 1.51 (1.20-1.82) mg kg-1, respectively. ED50 values for midazolam were 0.26 (0.20-0.37) mg kg-1, 0.29 (0.23-0.47) mg kg-1 and 0.25 (0.20-0.32) mg kg-1, respectively. An additional 92 similar patients received one of nine dose combinations of midazolam and propofol for induction of anaesthesia, propofol being administered 2 min after midazolam. Success of induction was based on the clinical end-point of loss of response to command. Administration of 25% of the ED50 of midazolam followed by 50% of the ED50 of propofol resulted in loss of response to command in 50% of patients, while 50% of the ED50 of midazolam, followed by 25% of the ED50 of propofol had the same effect. A probit regression model specifying a synergistic interaction between midazolam and propofol fitted the data significantly better than a model specifying no interaction.

Adolescent↗
PubMed1992

Urban/rural and deprivational differences in incidence and clustering of childhood diabetes in Scotland.

Scottish hospital discharges were monitored during the period 1977-1983 for new cases of diabetes in children aged 18 years or under. An estimated ascertainment rate of 94% was obtained by validation against an independent register of cases. The postcode sector at the time of admission was available for 2125 (97%) of the 2183 cases, and was used as the basis for a small-area analysis of urban/rural and socioeconomic differences in incidence and to test for clustering. Incidence rates standardized for age and sex showed important differences between the 16 Scottish postcode areas. At the sector level, the standardized rate was 20% lower in urban sectors compared to rural sectors, but this could be explained by area to area differences and by socioeconomic effects within areas. In contrast, significant socioeconomic differences in incidence were evident within areas which could not be explained by urban/rural effects, the children in deprived sectors having 80% of the risk of those in other sectors. Rates were particularly low among children in deprived urban sectors. Nevertheless, significant variations in incidence remained between the 16 areas which could not be explained by either urban/rural or socioeconomic differences, indicating the existence of other important factors. Tests for clustering of cases both within postcodes sectors and across adjacent postcode sectors were also performed. Although clusters could be identified, they were no more common than would be expected by chance. Tests for space-time clustering were also negative.

Adolescent↗
PubMed1991

Poor prognosis for malignant melanoma in Northern Ireland: a multivariate analysis.

All cases of cutaneous malignant melanoma, CMM, diagnosed in Northern Ireland between 1974-1978 were reviewed, classified and followed up until the end of 1984. The overall 5 year survival is 54%, among the worst reported in recent literature. Multivariate analysis of these cases confirms some previous findings from other studies, but also reveals features not apparent in univariate analysis. Prognosis worsens with increasing thickness and the presence of ulceration. Likewise histopathological type has an independent effect on survival, ALM having the worst prognosis. Tumour profile emerges as a significant feature affecting prognosis, flat lesions having the poorest outlook, given their thickness. Survival is worse with increasing age. Anatomical site is less important than suggested by previous univariate analysis. Sex has little influence on prognosis when adjusted for the other variables. Cell type and pigmentation are of no prognostic value. Several features including diagnostic delay contribute to the poor overall survival for CMM in Northern Ireland. Educational intervention is essential if this trend is to be reversed.

Female↗
PubMed1991

A sibling-controlled study of intelligence and academic performance following Reye syndrome.

The authors compared the intellectual, cognitive and academic abilities of 22 survivors of Reye syndrome attending normal schools with the sibling nearest in age as control. The British Ability Scales, visual and verbal IQ, short-term memory scales and attainment tests were administered to all children. Reye syndrome children as a group differed significantly from the controls only on the basic number skills test. However, children with severe encephalopathy and those whose illness occurred in infancy had significant deficits on many of the tests. 18 children recovered without requiring 'additional educational provision'; the mean IQ of the 22 Reye syndrome children was 101. Nonetheless, these children's poor performance on the basic number skills test has important implications for teachers, and careful monitoring of future educational performance is essential.

Achievement↗
PubMed1991

Prognosis in familial non-polyposis colorectal cancer.

Familial cases of non-polyposis colorectal cancer have attracted much interest but little is known of their natural history. Using a population based study we have determined whether a positive family history of bowel cancer is an independent prognostic factor. All patients under 55 years with histologically confirmed colorectal cancer in Northern Ireland during the period 1976-8 were studied. The family history was validated in 95% of all nonpolyposis cases (n = 205). Medical history or cause of death were verified for 98% of 1811 first degree relatives. The strength of the family history was assessed using a score that compares the mortality from bowel cancer in the family against the average population mortality, taking account of family size and age structure. The family history score was not predictive of survival neither in univariate analysis or in a Cox's proportional hazards multivariate analysis controlling for age, sex, stage, site, and duration of symptoms. In conclusion, a positive family history does not independently influence prognosis in patients with bowel cancer.

Cause of Death↗
PubMed1991

Histologic characteristics and outcome of familial non-polyposis colorectal carcinoma.

Familial cases of non-polyposis colorectal cancer have recently attracted much interest. Little is known about the characteristic histology or natural history of disease in such cases. Our aim was to determine, through a population-based study, whether mucin-secreting tumours were associated with a positive family history and whether 'familiality' was an independent prognostic variable. All patients under 55 years of age with histologically verified colorectal cancer in Northern Ireland during 1976-78 were studied. The family history was validated in 95% of all non-polyposis cases (n = 205), and the proband's histologic specimen reviewed in over 99%. Mucin-secreting tumours were significantly associated with a positive family history, but familiality was not found predictive of survival in a multivariate analysis controlling for age, sex, stage, site, symptom duration, differentiation, and histologic type.

Adenocarcinoma, Mucinous↗
PubMed1991

Geographical variations and recent trends in cancer mortality in Northern Ireland (1979-88).

Cancer mortality in the 35-74 year age-range for selected sites during the period 1979-88 was investigated for the 26 district council areas of Northern Ireland. Trends in rates during the period were also studied and compared with trends in an earlier period, and with trends reported from the rest of the United Kingdom. Statistically significant differences between the age-standardised death rates in the 26 areas were observed for stomach cancer (women only), pancreatic cancer (women only), lung cancer (men and women) and for all cancers (men and women). Some evidence of spatial aggregation of rates was apparent for ovarian cancer even though rates in the 26 areas did not differ significantly. The patterns are illustrated with maps and some difficulties of interpretation are discussed. Mortality rates for oesophageal cancer increased during the period in both sexes while rates for stomach cancer decreased. Colon cancer rates increased significantly only in men, while an increase in lung cancer rates was confined to women. The mortality from all cancers increased significantly during the period by 0.8% per annum in men and 0.9% per annum in women. These trends were found to be broadly comparable with those reported elsewhere in the United Kingdom.

Adult↗
PubMed1990

On the use of a logistic risk score in predicting risk of coronary heart disease.

Many studies over the last 20 years have used logistic regression to model the relationship between the risk of developing coronary heart disease (CHD) and the levels of risk factors such as high blood pressure, high serum cholesterol, and cigarette smoking. Subsequently, several investigators have proposed the use of some of the published estimated logistic risk functions to predict risk in new populations. Because of great variation in definition of event, duration of follow-up, population characteristics, definition of risk variables, and selection of other variables in the logistic functions, direct use of such established functions would generally not have validity for the prediction of absolute risk levels. A review of fifteen of these studies indicates on the one hand generally similar results in direction and order of magnitude of effects of the major risk factors, confirming the importance of these risk factors of CHD. On the other hand the reviews indicate sufficient variation to suggest that extrapolation to new populations even to predict relative risk is not justified.

Age Factors↗