PubMed Health⌕ Search

Biomedical subjects

C Gillis

Publications and source records attributed to C Gillis.

At least 19 recordsLinked to original sources
PubMed2006

The natural history of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the USA, and it remains one of the few diseases that continues to increase its numbers. The development and progression of COPD can vary dramatically between individuals. A low level of lung function remains the cornerstone of COPD diagnosis and is a key predictor of prognosis. Lung function, however, is not the only factor in determining morbidity and mortality related to COPD, with factors such as body mass index, exercise capability and comorbid disease being important predictors of poor outcomes. Exacerbations of COPD are additional important indicators of both quality of life and outcomes in COPD patients. Definitions of exacerbations can vary, ranging from an increase in symptoms to COPD-related hospitalisations and death. COPD exacerbations are more common in patients with lower levels of lung function and may lead to more rapid declines in lung function. Better understanding of the natural history of COPD may lead to better definitions of specific COPD phenotypes, better interventions and improved outcomes.

Cardiovascular Diseases↗
PubMed2004

Why does specialist treatment of breast cancer improve survival? The role of surgical management.

Evidence that the survival of women with breast cancer treated by specialist surgeons is better than that by nonspecialists is limited. Previous reports have not identified the cause of this survival advantage. Our aim was to determine if the survival difference was due to case-mix, adjuvant treatment or the treatment provided by specialist surgeons. The case-records and pathology reports of 2776 women were reviewed. This represented 95% of all those diagnosed with breast cancer between 1/1/1986 and 31/12/1991 in a defined geographical area. Case-mix, surgery, pathology and adjuvant therapies of the 2148 women treated with curative intent were analysed. A standard of adequate surgical management was defined and confirmed as a valid predictor by examining rates of local recurrence, independent of all other prognostic factors. Against this standard, we compared the adequacy of surgical management, local recurrence rates and the survival outcomes of specialists and nonspecialists over an 8-year follow-up period. The inter-relationship between adequacy of surgical management, locoregional recurrence and survival was examined. While the case-mix and prescription of adjuvant therapies were comparable between specialist and nonspecialist surgeons, the efficacy and outcome of local treatment differed widely. Breast cancer patients treated in specialist compared to nonspecialist units had half the risk of inadequate treatment of the breast (24 vs 47%, P<0.001), a five-fold lower risk of inadequate axillary staging (8 vs 40%, P<0.001) and nine times lower risk of inadequate definitive axillary treatment (4 vs 38%, P<0.001). Local recurrence rates were 57% lower (13 vs 23% at eight years, P<0.001) and the risk of death from breast cancer was 20% lower for women treated in specialist units, after allowing for case-mix and adjuvant therapies. Adequacy of surgical management correlated with locoregional recurrence, which in turn correlated with the risk of death. The surgical management in specialised breast units is more often adequate, local and regional recurrence rates are lower, and survival is correspondingly better. We conclude that adequate surgical management of breast cancer is fundamental to improving the outcome from breast cancer irrespective of where it is delivered.

Adult↗
PubMed2003

Specialisation and breast cancer survival in the screening era.

It is recommended that specialist surgeons treat all breast cancer, although the limited evidence to support this is based on treatment patterns prior to the introduction of screening. Whether a specialist survival advantage exists in the post-screening era is uncertain, as referral and treatment patterns may have changed, in addition to the effect of screening on the natural history of breast cancer. Our aim was to determine the impact of screening on the caseload and case-mix of specialist surgeons, to determine if the survival advantage associated with specialist care is maintained with longer follow-up and persists after the introduction of screening. Using the West of Scotland Cancer Registry, all 7197 women treated for breast cancer in a 15-year time period (1980-1994) in a geographically defined cohort were followed up for an average of 9 years, and pathological stage and socioeconomic status were linked with mortality data. We show that the caseload of specialists has increased substantially (from 11 to 59% of the total workload) and that smaller cancers have been selectively referred. However, even after allowing for pathological stage, socioeconomic status and method of detection, specialist treatment was associated with a significantly lower risk of dying (prescreening: relative risk of dying=0.83, 95% CI=0.75-0.92; post-screening: relative risk of dying=0.89, 95% CI=0.78-1.00). We conclude that this survival benefit is most consistent with effective surgical management rather than selective referral, the influx of screen-detected cancers or adjuvant therapies.

Age Distribution↗
PubMed2000

Primary and secondary care management of women with early breast cancer from affluent and deprived areas: retrospective review of hospital and general practice records.

OBJECTIVES: To investigate whether poorer survival of breast cancer among deprived women compared with affluent women is related to their NHS care. DESIGN: Retrospective review of hospital and general practice case records. SETTING: Greater Glasgow Health Board area. SUBJECTS: Women diagnosed with breast cancer in 1992-3 who lived in the most affluent (deprivation categories 1 and 2) and the most deprived areas (deprivation categories 6 and 7) of Glasgow (Carstairs and Morris deprivation index). MAIN OUTCOME MEASURES: Breast cancer treatment, time from general practice consultation to clinic visit and surgery, and details of hospital admissions and follow up in primary and secondary care. RESULTS: The access to care and surgical and oncological treatment of women from affluent and deprived areas were similar. Admissions to hospital for problems not related to breast cancer were more common in those living in deprived areas (number admitted once or more: 51 (24%) v 13 (10%), P=0.001). Consultation patterns in general practice by the second year after diagnosis showed women in deprived areas consulting more frequently than women in affluent areas (median (interquartile range) number of consultations (5 (2-10) v 7 (4-13), P=0.01). CONCLUSION: Women living in affluent areas did not receive better NHS care for breast cancer than women in deprived areas. However, women from deprived areas seem to have greater comorbidity, and poorer outcomes from breast cancer among these women is probably due to factors which result in deprived communities having poorer health outcomes rather than to management of their breast cancer.

Adult↗
PubMed2000

MRI in multiple sclerosis of the spinal cord: evaluation of fast short-tan inversion-recovery and spin-echo sequences.

We compared the sensitivity of T2-weighted spin-echo (FSE) and fast short-tau inversion-recovery (fSTIR) sequences in detection of multiple sclerosis of the spinal cord in 100 consecutive patients with clinically confirmed multiple sclerosis (MS); 86 patients underwent also brain MRI. In all, 310 focal lesions were detected on fSTIR and 212 on T2-weighted FSE, spinal cord lesions were seen better on fSTIR images, with a higher contrast between the lesion and the normal spinal cord. In 24 patients in whom cord plaques were shown with both sequences, the cranial study was normal or inconclusive. Assessment of spinal plaques can be particularly important when MRI of the brain is inconclusive, and in there situations fSTIR can be helpful.

Adult↗
PubMed2000

Socio-economic deprivation and stage of disease at presentation in women with breast cancer.

BACKGROUND: This study describes and compares the pathological prognostic factors and surgeon assessment of stage of breast cancer of women living in affluent and deprived areas to assess whether clinical stage at presentation may explain the known poorer survival outcomes for deprived women. PATIENTS AND METHODS: A population-based review of the case records of 417 women with breast cancer was carried out. RESULTS: No difference in pathological criteria was found between the 88% of women living in affluent and deprived areas for whom such data were available. Clinical assessment of the remaining 50 cases showed that women living in deprived areas were more likely to present with locally advanced or metastatic disease. CONCLUSION: The poorer survival of women from deprived areas with breast cancer may be explained by more deprived women presenting with advanced cancers.

Breast Neoplasms↗
PubMed2000

Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality.

OBJECTIVES: Height is inversely associated with cardiovascular disease mortality risk and has shown variable associations with cancer incidence and mortality. The interpretation of findings from previous studies has been constrained by data limitations. Associations between height and specific causes of death were investigated in a large general population cohort of men and women from the West of Scotland. DESIGN: Prospective observational study. SETTING: Renfrew and Paisley, in the West of Scotland. SUBJECTS: 7052 men and 8354 women aged 45-64 were recruited into a study in Renfrew and Paisley, in the West of Scotland, between 1972 and 1976. Detailed assessments of cardiovascular disease risk factors, morbidity and socioeconomic circumstances were made at baseline. MAIN OUTCOME MEASURES: Deaths during 20 years of follow up classified into specific causes. RESULTS: Over the follow up period 3347 men and 2638 women died. Height is inversely associated with all cause, coronary heart disease, stroke, and respiratory disease mortality among men and women. Adjustment for socioeconomic position and cardiovascular risk factors had little influence on these associations. Height is strongly associated with forced expiratory volume in one second (FEV1) and adjustment for FEV1 considerably attenuated the association between height and cardiorespiratory mortality. Smoking related cancer mortality is not associated with height. The risk of deaths from cancer unrelated to smoking tended to increase with height, particularly for haematopoietic, colorectal and prostate cancers. Stomach cancer mortality was inversely associated with height. Adjustment for socioeconomic position had little influence on these associations. CONCLUSION: Height serves partly as an indicator of socioeconomic circumstances and nutritional status in childhood and this may underlie the inverse associations between height and adulthood cardiorespiratory mortality. Much of the association between height and cardiorespiratory mortality was accounted for by lung function, which is also partly determined by exposures acting in childhood. The inverse association between height and stomach cancer mortality probably reflects Helicobacter pylori infection in childhood resulting in--or being associated with--shorter height. The positive associations between height and several cancers unrelated to smoking could reflect the influence of calorie intake during childhood on the risk of these cancers.

Body Height↗
PubMed2000

[Aspects of FLAIR sequences, 3D-CISS and diffusion-weight MR imaging of intracranial epidermoid cysts].

We propose to assess the usefulness of diffusion-weighted MR Imaging (DWI), fluid-attenuated inversion recovery (FLAIR) and constructive interference in steady state (CISS) sequences in depicting epidermoid cysts (EC). FLAIR, CISS and DWI were obtained in 7 patients among 22. All patients were studied with T1 and T2 sequences. On Spin Echo images, EC demonstrate signal similar to LCS, which may lead to difficult differentiation between EC and arachnoid cyst (AC), specially for inexperienced radiologists. EC appear with a heterogeneous signal on T1 images (32%), irregular limits (91%) and with extension through foramen of Pacchioni in 18% of cases. On FLAIR sequence, the tumors were heterogeneous, different from void signal of CSF in 86% of cases. On CISS sequence, the tumors appear heterogeneous, hyperintense but less than LCS and with irregular limits in all cases. Some more, CISS images allowed to appreciate exact tumor extension and their relations with nerves and vessels. On DWI images, signal is hyperintense in all cases. Our study exhibited the great usefulness of DWI, CISS and FLAIR sequences in diagnosis of EC and in differentiating EC from AC.

Brain Diseases↗
PubMed2000

[Contribution of 3D CISS MRI for pre- and post-therapeutic monitoring of obstructive hydrocephalus].

This report describes the use of the recent three-dimensional Fourier transform constructing imaging in the steady state (CISS) MR sequence in the management of obstructive hydrocephalus. It is a gradient-echo imaging technique with high resolution which remains sensitive to flow. It enables locating the obstruction and determining the upstream impact. It provides anatomical information about third ventricle (V3) morphology and relationships useful before ventriculostomy. Twenty patients with obstructive hydrocephalus at the level of cerebral aqueduct or posterior V3 underwent sagittal 3DFT-CISS acquisition, supplemented by frontal, axial and coronal reformations in the cerebral aqueduct axis. 9 patients were examined after ventriculostomy with the same protocol. CISS-3DFT allows good visualization of the cerebral aqueduct and diagnosis of the underlying cause of obstruction (malformation, tumor), sometimes better than classical sequences. In case of complete obstruction, the flow-related signal void is usually absent in the cerebral aqueduct or V3. The position of V3 floor and its relationship with the tip of basilar artery are well analyzed. The dilatation of the anterior V3 recesses is a better sign of activity of hydrocephalus - and then of therapeutical indication - than classical transependymal resorption signs which are not always present in chronic longstanding adult hydrocephalus. Of the 9 ventriculostomy patients seven had linear flow-related signal void through V3 floor, from anterior V3 to basal cisterns on the postoperative MR study. This flow void confirms patent ventriculostomy.

Adolescent↗
PubMed1999

Spinal ligament pathology.

Young elite athletes, particularly horses used for jumping, are at a relatively high risk for injury to the ligaments associated with the axial skeleton. Extreme back flexion appears to be a contributing factor to ligament damage. Back pain due to injury of the ligaments of the axial skeleton has often been considered to be secondary to lower limb injury, to the extent that a separate definitive diagnosis, treatment, and prognosis were unnecessary. Diagnostic imaging, ultrasound in particular, has demonstrated ligamentous damage that can be the limiting factor in return to previous athletic use. A high index of suspicion for back ligament damage during clinical examination for hind limb lameness will lead to improved diagnosis and therapy.

Animals↗
PubMed1998

Education and occupational social class: which is the more important indicator of mortality risk?

STUDY OBJECTIVES: In the UK, studies of socioeconomic differentials in mortality have generally relied upon occupational social class as the index of socioeconomic position, while in the US, measures based upon education have been widely used. These two measures have different characteristics; for example, social class can change throughout adult life, while education is unlikely to alter after early adulthood. Therefore different interpretations can be given to the mortality differentials that are seen. The objective of this analysis is to demonstrate the profile of mortality differentials, and the factors underlying these differentials, which are associated with the two socioeconomic measures. DESIGN: Prospective observational study. SETTING: 27 work places in the west of Scotland. PARTICIPANTS: 5749 men aged 35-64 who completed questionnaires and were examined between 1970 and 1973. FINDINGS: At baseline, similar gradients between socioeconomic position and blood pressure, height, lung function, and smoking behaviour were seen, regardless of whether the education or social class measure was used. Manual social class and early termination of full time education were associated with higher blood pressure, shorter height, poorer lung function, and a higher prevalence of smoking. Within education strata, the graded association between smoking and social class remains strong, whereas within social class groups the relation between education and smoking is attenuated. Over 21 years of follow up, 1639 of the men died. Mortality from all causes and from three broad cause of death groups (cardiovascular disease, malignant disease, and other causes) showed similar associations with social class and education. For all cause of death groups, men in manual social classes and men who terminated full time education at an early age had higher death rates. Cardiovascular disease was the cause of death group most strongly associated with education, while the non-cardiovascular non-cancer category was the cause of death group most strongly associated with adulthood social class. The graded association between social class and all cause mortality remains strong and significant within education strata, whereas within social class strata the relation between education and mortality is less clear. CONCLUSIONS: As a single indicator of socioeconomic position occupational social class in adulthood is a better discriminator of socioeconomic differentials in mortality and smoking behaviour than is education. This argues against interpretations that see cultural--rather than material--resources as being the key determinants of socioeconomic differentials in health. The stronger association of education with death from cardiovascular causes than with other causes of death may reflect the function of education as an index of socioeconomic circumstances in early life, which appear to have a particular influence on the risk of cardiovascular disease.

Adult↗
PubMed1997

Lifetime socioeconomic position and mortality: prospective observational study.

OBJECTIVES: To assess the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes. DESIGN: Prospective observational study with 21 years of follow up. Social class was determined as manual or non-manual at three stages of participants' lives: from the social class of their father's job, the social class of their first job, and the social class of their job at the time of screening. A cumulative social class indicator was constructed, ranging from non-manual social class at all three stages of life to manual social class at all three stages. SETTING: 27 workplaces in the west of Scotland. PARTICIPANTS: 5766 men aged 35-64 at the time of examination. MAIN OUTCOME MEASURES: Prevalence and level of risk factors for cardiovascular disease; morbidity; and mortality from broad causes of death. RESULTS: From non-manual social class locations at all three life stages to manual at all stages there were strong positive trends for blood pressure, body mass index, current cigarette smoking, angina, and bronchitis. Inverse trends were seen for height, cholesterol concentration, lung function, and being an ex-smoker. 1580 men died during follow up. Age adjusted relative death rates in comparison with the men of non-manual social class locations at all three stages of life were 1.29 (95% confidence interval 1.08 to 1.56) in men of two non-manual and one manual social class; 1.45 (1.21 to 1.73) in men of two manual and one non-manual social class; and 1.71 (1.46 to 2.01) in men of manual social class at all three stages. Mortality from cardiovascular disease showed a similar graded association with cumulative social class. Mortality from cancer was mainly raised among men of manual social class at all three stages. Adjustment for a wide range of risk factors caused little attenuation in the association of cumulative social class with mortality from all causes and from cardiovascular disease; greater attenuation was seen in the association with mortality from non-cardiovascular, non-cancer disease. Fathers having a manual [corrected] occupation was strongly associated with mortality from cardiovascular disease: relative rate 1.41 (1.15 to 1.72). Participants' social class at the time of screening was more strongly associated than the other social class indicators with mortality from cancer and from non-cardiovascular, non-cancer causes. CONCLUSIONS: Socioeconomic factors acting over the lifetime affect health and risk of premature death. The relative importance of influences at different stages varies for the cause of death. Studies with data on socioeconomic circumstances at only one stage of life are inadequate for fully elucidating the contribution of socioeconomic factors to health and mortality risk.

Adult↗
PubMed1997

In vitro endothelialisation of arteriovenous loop grafts for haemodialysis.

OBJECTIVES: To evaluate the feasibility in a pilot study of in vitro endothelialisation of PTFE grafts used as interposition arteriovenous fistulas in uraemic patients. METHODS: Autologous saphenous vein endothelial cells were harvested and cultured on PTFE grafts in seven patients undergoing maintenance haemodialysis. The patients had several previous failures of vascular access sites. The patients were followed with duplex ultrasound, clinical examination and in one case an explanted graft was examined. RESULTS: At the end of follow-up four of the seven patients had patent grafts. One patient occluded the graft immediately postoperatively and another after 3.5 months. The former patient received a second endothelialised graft. In two further patients revision of the outflow was performed. In two patients a functioning graft was excised, in one case because of bleeding of a venous aneurysm and in one case because of suspected infection. The former which was excised 5 weeks postoperatively revealed that 85% of the surface was covered by endothelial cells. CONCLUSIONS: This pilot study shows that in vitro endothelialisation of PTFE grafts used for haemodialysis is possible in uraemic patients. In this highly problematic patient group the results are promising with endothelial cell coverage after 5 weeks of implantation.

Aged↗
PubMed1997

Effect of maturation and aging on the histomorphometric and biochemical characteristics of equine superficial digital flexor tendon.

OBJECTIVE: To assess tendon morphology and non-reducible crosslink concentration, and associations of these findings with horse age and previously reported mechanical and ultrasonographic findings. SAMPLE POPULATION: Superficial digital flexor tendon samples were obtained from 23 horses aged 2 to 23 years. The tendons had undergone ultrasonography and were submitted to biomechanical testing in the physiologic range prior to sample acquisition. PROCEDURE: Samples were sectioned in a transverse plane; then dorsal, palmar, central, lateral, and medial regions were evaluated for fascicle cross-sectional area (CSA), septal width, and vessel density (the product of vessel numbers and vessel CSA per field). Contiguous samples were analyzed for collagen crosslinking. RESULTS: Central fascicles were significantly larger than fascicles in other tendon regions. Fascicle CSA decreased significantly with increasing age. Because total tendon CSA is unrelated to increasing age, fascicle numbers appeared to increase with increasing age. Regional or age effects on septal width were not found. There was no age or regional effect on vessel numbers, density, or fractional area. Fascicle CSA was positively correlated with total tendon CSA; fascicle CSA was negatively correlated with elastic modulus. Hydroxypiridinium concentration tended to increase with increasing horse age; this effect was associated with a positive correlation between hydroxypiridinium values and elastic modulus. CONCLUSIONS: Equine superficial digital flexor tendon undergoes an increase in structural organization and an increase in nonreducible crosslinks with maturation and aging. These changes are associated with an increase in elastic modulus.

Aging↗
PubMed1996

Benefits from specialised cancer care.

The Expert Advisory Group's recommendations to establish cancer centres, cancer units, and a network involving primary care for the treatment of cancer patients in the UK is based on the view that specialisation in cancer care will improve outcomes. Evidence to support the various aspects of specialisation (eg, training, caseload, and the formation of multidisciplinary teams) is strongest for breast cancer, ovarian cancer, and some haematological malignant diseases. There is evidence to support the view that some specialised care can be successfully delivered by a network of district hospitals and main general or teaching hospitals and does not always require referral to cancer centres.

Cancer Care Facilities↗
PubMed1996

Secretion of prostacyclin, tissue plasminogen activator and its inhibitor by cultured adult human endothelial cells grown on different matrices.

OBJECTIVES: The aim of this study was to investigate the secretion of prostacyclin (PGI2), tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI- 1) produced by human great saphenous vein endothelial cells (HSVECs) in vitro when seeded to confluency on different matrices. METHODS: The matrices compared were: uncoated plastic, gelatin, collagen type-I gel, fibronectin, fibrin glue, de-endothelialized porcine aorta and ePTFE vascular grafts pre-coated with collagen type-I or human serum. RESULTS: There were no significant differences between basal production of PGI2 on the different matrices. The HSVECs responded with a significant increase in PGI2 secretion after stimulation with thrombin on all matrices, including the ePTFE grafts. A statistically significant higher secretion of tPA secretion was found in supernatants from cells cultured on collagen type-I gel. Interestingly, tPA secretion was lower by cells seeded on both collagen type-I and serum precoated ePTFE as compared to collagen type-1 gel. PAI-1 secretion however was significantly higher on collagen type-1 gel, gelatin, fibrin glue and porcine aorta but not on pre-coated ePTFE grafts. CONCLUSIONS: The findings emphasise the important effect of the matrix on endothelial secretion of PGI2, tPA and PAI-1. Differences in patency after implantation of in vitro endothelialized grafts, may be due to cellular function depending on the types of graft and matrix chosen.

Adult↗
PubMed1995

Reduction of monocyte adhesion to xenogenic tissue by endothelialization: an adhesion molecule and time-dependent mechanism.

Great interest has been shown for the seeding of autologous endothelial cells on prosthetic materials. We investigated the inflammatory and immunogenic properties of xenogeneic tissue before and after seeding with cultured human great saphenous vein endothelial cells in vitro. Adhesion of monocytes to xenogeneic tissue with or without endothelium and the endothelial cell expression of E-selectin, intercellular adhesion molecule 1, vascular adhesion molecule 1, and major histocompatibility complex class II antigens were investigated 1, 3, and 7 days after seeding. Both monocyte adhesion and endothelial adhesion molecule expression were relatively high 1 day after seeding and were significantly lowered after 3 to 7 days. There was no difference between monocyte adhesion and adhesion molecule expression on viable or nonviable xenogeneic tissue. Monocyte adhesion and adhesion molecule expression increased after interleukin-1 beta or interferon-gamma stimulation of the endothelial cells. The results suggest that human endothelial cells exhibit an early proinflammatory and immunogenic activity immediately after seeding. Three and 7 days after seeding, the endothelialized surface is less adhesive for monocytes as compared with nonendothelialized tissue. These findings have implications when cultured or intraoperatively recruited endothelial cells are used clinically.

Animals↗