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Biomedical subjects

I M Murray-Lyon

Publications and source records attributed to I M Murray-Lyon.

At least 55 records · Page 3Linked to original sources
PubMed1990

Diminished response to recombinant hepatitis B vaccine in homosexual men with HIV antibody: an indicator of poor prognosis.

Three doses of a recombinant DNA HBV vaccine (MSD) were given to healthy male homosexuals. Seventy-eight out of 104 (77.6%) participants had detectable antibody (anti-HBs) two months after the third dose. Seroconversion occurred in only 9 out of 27 subjects (33.3%) who were anti-HIV positive compared with 69 out of 77 (89.6%) who were negative (chi 2 = 30.8; P less than .001). Fifteen of the 18 anti-HIV positive who did not mount an antibody response to the hepatitis B vaccine (anti-HBs) later progressed to persistent generalised lymphadenopathy syndrome (5), AIDS-related complex (5), and AIDS (5). Only one of the nine anti-HIV positive anti-HBs responders developed PGL (chi 2 = 10.14; P less than .005). Our results show that anti-HIV positive homosexuals are poor responders to the recombinant hepatitis B vaccine and anti-HIV positive non-responders are more likely to develop clinically apparent HIV infection.

Follow-Up Studies↗
PubMed1990

Preventing alcohol related birth damage: a review.

Since 1974 numerous clinical studies have made it clear that heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units daily) can result in a child being born with a specific combination of physical and mental disabilities known as the Fetal Alcohol Syndrome. More moderate levels of intake (as little as 10 g of 1 unit daily) are associated with other fetal problems known as Fetal Alcohol Effects. The most common of these is growth retardation. Reduction of alcohol consumption is beneficial to pregnancy outcome. However, despite this great clinical and research interest within the field there has been comparatively little attention paid to researching possible preventative strategies and appropriate policy development. This paper first describes the size of the problem posed by drinking in pregnancy in the U.S.A. and the U.K., detailing the contrasting policy response on either side of the Atlantic. It examines the difficulties of formulating appropriate advice and then assesses the available research reports on preventative measures. The strategies described include general publicity and counselling for pregnant women. In addition, attention has been paid to the problems of dissemination by emphasising professional education. One major shortcoming is that most of these studies appear to have been carried out with little reference to existing knowledge on health education and promotion, or educational work in the antenatal or alcohol fields. In addition, little attention appears to have been paid to the characteristics of the groups at whom intervention might be targeted or the underlying social or psychological factors which maintain drinking in these groups. The second part of this paper, therefore, attempts to suggest appropriate avenues for developing preventative strategies by presenting a wide-ranging review with special reference to British experience. Particular attention is given to the issues of form and content of appropriate messages, targeting of risk populations, the venue for intervention, and media and the actual mechanisms involved in implementing the programme. We conclude that women should be advised to limit their alcohol consumption to no more than one unit a day when they are either pregnant or planning a pregnancy. We recommend that pregnant women should be asked about their alcohol and given appropriate advice during routine antenatal clinic visits. We suggest that the form of advice should be designed with the characteristics of the risk population in mind.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcoholism↗
PubMed1990

Is pregnancy a time of changing drinking and smoking patterns for fathers as well as mothers? An initial investigation.

This paper describes changing smoking and drinking patterns before and during pregnancy in 313 expectant couples. Fathers were more likely to drink and smoke more heavily than mothers throughout. Before pregnancy in only 42% of couples were both partners safe drinkers and non-smokers. This increased to 50% during pregnancy. Most mothers reduced alcohol consumption during pregnancy and although about half of the fathers also changed their drinking patterns, only about a fifth decreased their consumption. Levels of paternal and maternal drinking in pregnancy were positively associated with pre-pregnancy levels. Rates and levels of both maternal and paternal smoking declined in pregnancy. There was a positive association between partners of both the prevalence and level of drinking and smoking between partners. There was some indication that mothers were more likely to reduce smoking and drinking if their partner joined them in doing so. Risk drinking in couples was more common in those who were older and of higher social status, but smoking was more common among the younger couples of lower social status.

Adult↗
PubMed1990

Ethnic differences in the consequences of alcohol misuse.

The drinking habits of Asian and indigenous patients receiving in-patient care for alcoholism in West London were studied. Although both racial groups reported similar levels of current alcohol intake, the Asian developed problems and presented for in-patient detoxification with a shorter mean duration of drinking than the indigenous subjects. Values for mean corpuscular volume (MCV) and gamma glutamyl transpeptidase (GGT) were higher in the Asians, suggesting the Asians were at greater risk of alcohol-related physical damage.

Adult↗
PubMed1989

Randomised controlled trial of interferon alfa (lymphoblastoid interferon) in chronic non-A non-B hepatitis.

OBJECTIVE: To determine the effect of low dose interferon alfa (human lymphoblastoid interferon) on aminotransferase activities in chronic non-A non-B hepatitis. DESIGN: Prospective randomised controlled parallel group study of active treatment versus no treatment carried out over 16 weeks and preceded by baseline measurements at weeks 8 and 4 and time zero. SETTING: HEPATOLOGY outpatient clinics in secondary referral centres. PATIENTS: Fourteen adults with histologically proved chronic hepatitis and persistently raised aminotransferase activities for six months or more. INTERVENTIONS: Seven patients randomised to receive interferon alfa 5 megaunits (MU) daily for one week, reducing to 5 MU thrice weekly for seven weeks, then 3 MU thrice weekly for eight weeks. Controls not treated. END POINT: Control of hepatic enzyme activity in chronic non-A non-B hepatitis. MEASUREMENTS AND MAIN RESULTS: Serum aspartate aminotransferase activity remained raised in controls (mean increase in study period 23.4 U/l) but fell rapidly to normal in the treated group (mean decrease 106.4 U/l). In four cases values were normal by eight weeks and in five cases by 16 weeks. Only minor side effects were recorded (fever, myalgia), which became less common as treatment progressed. CONCLUSIONS: Continuous low dose interferon alfa reduces aspartate aminotransferase activity to normal in most patients with chronic non-A non-B hepatitis and may prevent progression to cirrhosis.

Adult↗
PubMed1989

Drinking and smoking patterns amongst women attending an antenatal clinic--I. Before pregnancy.

This paper provides basic epidemiological data on smoking and drinking patterns before pregnancy amongst 1117 pregnant women attending a London antenatal clinic. Similar data are already available from North America and surveys have been done in Scotland but there is a dearth of information from England and Wales. In the early stages of pregnancy, prior to recognition, heavy alcohol consumption (in excess of 56 units of alcohol per week) is associated with the Foetal Alcohol Syndrome. More moderate levels of intake (as little as 10 units of alcohol per week) have been associated with Foetal Alcohol Effects such as growth retardation. In our sample 19% of the mothers were drinking more than 10 units of alcohol per week. Six per cent were consuming more than the 14 units of alcohol currently recommended by three of the medical Royal Colleges as 'safe' for non-pregnant women. Average weekly alcohol consumption was related to both the usual frequency and amount drunk, but also to binge drinking, beverage choice and combination, and reasons for drinking. In general, drinking was frequent and light. Those women who drank more per week tended to drink more frequently than those in the lower weekly consumption bands. Fourteen per cent of the sample admitted to binge drinking (more than 14 units of alcohol in a single sitting). Wine was the most popular beverage type. The range of beverages consumed was wider in the higher alcohol consumption bands. Those in the lower bands were more likely to drink only one beverage type. Social reasons for drinking were of far greater importance than reasons which emphasised the effects of drinking. However, heavy drinkers were unlikely to drink solely for social reasons. Seventy-seven per cent of the mothers were non-smokers, but the incidence of smoking increased in the higher alcohol consumption bands. The demographic characteristics of the smokers were in marked contrast to those of the heavier drinkers. Smokers tended to be younger, of lower social status and multiparous, whereas the heavier drinkers were more likely to be older, of higher social status and primiparous. This finding is of fundamental importance to those interested in planning screening or intervention programmes.

Adult↗
PubMed1989

Drinking and smoking patterns amongst women attending an antenatal clinic--II. During pregnancy.

This paper describes smoking and drinking patterns during pregnancy amongst a cohort of 2266 women who enrolled at a London antenatal clinic 1982-1983. Only 12% of mothers were non-drinkers before pregnancy, but 44% abstained in the first trimester, 38% in the second and 50% in the third. Before pregnancy 20% of mothers were drinking more than the recommended 10 units of alcohol per week. This dropped to 6% during pregnancy. Mean consumption at each of the three stages of pregnancy was highest amongst those mothers who were the heaviest drinkers before pregnancy. The heaviest pre-pregnancy drinkers were also the least likely to abstain at any point in pregnancy. Of those mothers who were drinking less than 10 units of alcohol per week before pregnancy, 3% increased during pregnancy. Wine was the most popular beverage choice but heavier drinkers were more likely to drink beers and spirits in addition. Before pregnancy 29% of mothers smoked. This dropped to 23% in pregnancy. Consumption levels fell amongst those who continued smoking. The heaviest pre-pregnancy smokers were the most likely to reduce but the least likely to stop. Smoking was positively associated with the level of both pre-pregnancy and pregnancy drinking. The most commonly cited reasons for changes in drinking and smoking habits in pregnancy were concern for the child, concern for self or concern for both. Feeling sick or ill was a more commonly stated reason for reduction of drinking than smoking. Social pressures were important in reducing smoking, but the mass media were quoted as a more important influence in reducing drinking. Mothers who drank more than 10 units of alcohol per week during pregnancy were more likely to be older, of higher social status and primiparous. In contrast those who smoked in pregnancy were more likely to be younger, of lower social status and multiparous. This has important implications for planning antenatal health education.

Adolescent↗
PubMed1989

Alcohol, smoking and pregnancy: some observations on ethnic minorities in the United Kingdom.

This paper describes drinking and smoking patterns before and during pregnancy in 363 women from ethnic minorities living in West London. Drinking and smoking were less common and levels of consumption were lower amongst women of Afro-Caribbean, Asian or Oriental origin than amongst Europeans. However, 75% of the Afro-Caribbeans, 56% of the Orientals and 47% of the Asians did drink alcohol before pregnancy. Twenty-one per cent of the Europeans, 5% of the Afro-Caribbeans, 3% of the Orientals drank more than 100 g alcohol per week (the level at which fetal harm may result). Drinking and smoking decreased in pregnancy in all ethnic groups, but 31% of Afro-Caribbeans, 29% of Orientals and 18% of Asians continued drinking. It is important to take alcohol and smoking histories from all pregnant women whatever their racial origin as part of good antenatal care.

Alcohol Drinking↗
PubMed1989

Screening for alcohol related problems in the antenatal clinic; an assessment of different methods.

This paper assesses different methods of asking about alcohol consumption in the antenatal clinic. Reliable screening methods are essential if appropriate intervention is to be accurately targeted. Women attending antenatal clinic for the first time were questioned about their alcohol consumption in the period immediately before confirmation of pregnancy. Quantity-frequency questions, a question about bingeing and the Cage Questions were asked as part of the routine clinical history by the interviewing doctor. In addition, the women were given a further self-completed questionnaire which contained more detailed questions about the usual quantity and frequency of drinking beers, wines and spirits, the Cage Questions again and the Brief Michigan Alcoholism Screening Test (BMAST). Asking simple quantity-frequency questions coupled with a question about bingeing during the clinical history was shown to be a quick and efficient method of estimating alcohol intake. Self-administered questionnaires were shown to be unnecessary and although the Cage Questions performed better than the BMAST, these alcoholism screening tests were found to be unreliable in this population in which drinking was generally at a low level.

Alcohol Drinking↗
PubMed1988

An evaluation of Dacron prostheses in the relief of jaundice due to malignant obstruction.

In 26 patients, relief of obstructive jaundice due to malignancy has been effected by inserting a Dacron biliary-enteric prosthesis. All cases were considered unsuitable for conventional biliary bypass procedures. The hospital mortality was 27% and mean survival of those patients discharged was 8 months. Insertion of a Dacron prosthesis may prove an alternative to percutaneous biliary stenting in selected patients with neoplastic biliary obstruction.

Adenocarcinoma↗
PubMed1987

Suramin treatment for chronic active hepatitis B--toxic and ineffective.

Suramin has recently been shown to inhibit the activity of the duck hepatitis B virus DNA polymerase (DHBV DNAp) in vitro. However, we found no demonstrable in vivo suppression of human hepatitis B virus DNA polymerase (HBV DNAp) activity in three male patients with severe chronic active hepatitis. Suramin treatment resulted in prolongation of the prothrombin time in all cases and a rise in bilirubin in two and it may have led to haemorrhage from oesophageal varices in one patient and to hepatic encephalopathy in another. Its use in chronic hepatitis is not recommended.

Esophageal and Gastric Varices↗
PubMed1987

Randomised controlled trial of lymphoblastoid interferon for chronic active hepatitis B.

Thirty male patients (27 homosexual) with biopsy proven chronic active hepatitis B were randomised to receive lymphoblastoid interferon (Wellferon) or no treatment. All patients were HBeAg positive and had continuing viral replication. Patients receiving treatment were given a single daily intramuscular injection of interferon for 28 days at a starting dose of 2.5 MU/m2 increasing to a maximum of 7.5 MU/m2/day. Transient side effects of malaise and influenza like symptoms occurred in all patients and resolved rapidly after treatment. Hepatitis B viral replication was suppressed during interferon treatment in all patients but the effect was limited to the period of therapy. After one year there was no appreciable difference in viral markers between the two groups of patients and this treatment schedule appears less effective than the thrice weekly, three month regimes recently reported from other centres.

Adult↗
PubMed1987

Drinkwatchers--description of subjects and evaluation of laboratory markers of heavy drinking.

Clinical examination and measurement of MCV and GGT were carried out on 124 self-referred 'healthy' Drinkwatchers, all of whom had consumed at least 80 g alcohol/day for more than 2 years. The majority (66.1%) were in social classes II and III. Sixty-three subjects (54.1%) had a raised MCV, GGT or hepatomegaly. A raised MCV was significantly more likely to occur in men. Forty-five subjects (36.3%) had an enlarged liver of whom 17 had a normal MCV and GGT. This study shows that MCV and GGT are poor screening tests for excessive alcohol consumption in 'healthy' subjects but, if used at all, MCV appears to be more sensitive in women and GGT in men. Neither test is an adequate substitute for a careful history and full clinical examination.

Adult↗
PubMed1986

Strategy for lymph node biopsy in homosexual men suspected of having LAV/HTLV-III related disease.

Since January 1985 we have changed our policy regarding lymph node biopsy in male homosexuals presenting with lymphadenopathy. Before that date all such patients underwent biopsy if there was no apparent cause. We no longer perform biopsy in male homosexuals presenting with uncomplicated persistent generalized lymphadenopathy (enlargement to more than 1 cm of lymph nodes in more than one extra-inguinal site for more than 3 months with no apparent cause) provided that the patient is positive for the antibody to lymphadenopathy associated virus/human T-lymphotropic virus type III. Such a policy should reduce the need for open biopsy procedures in this group of patients.

Adult↗