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Biomedical subjects

I Sutherland

Publications and source records attributed to I Sutherland.

At least 73 records · Page 4Linked to original sources
PubMed1977

Prevention of Fatal Postoperative pulmonary embolism by low doses of heparin. Reappraisal of results of international multicentre trial.

The results of a multicentre trial, designed to assess the efficacy of low-dose heparin in preventing fatal postoperative pulmonary embolism, were published in July 1975. In view of inconsistencies which have now become apparent in the data from one of the twenty-eight centres which took part in the trial, the results of the trial have been re-examined, excluding the data from this centre. Of 4031 patients remaining after exclusion of these data, 2033 were in the control group and 1998 in the heparin group. 170 (4-2%) patients died during the postoperative period, 94 in the control group and 76 in the heparin group; 70-2% of deaths in the control group and 65-7% in the heparin group had necropsy examination. 15 patients in the control group and none in the heparin group were found at necropsy to have died due to acute massive fatal pulmonary embolism (P less than 0-001). Exclusion of data from the one centre did not alter already published significant differences in the total incidence of deep-vein thrombosis, nor in the frequency of operative and post-operative bleeding complications observed in the control group and the heparin group.

Clinical Trials as Topic↗
PubMed1976

Validation and standardization of Kveim test suspensions prepared from two human sarcoid spleens.

Single lots of a Chase-Siltzbach type I Kveim test material from each of two sarcoid spleens and designated lot 5 of spleen K12 and lot 1 of spleen K13 have been validated alongside a single lot (lot 10) of a 'standard' suspension provided by Dr L. E. Siltzbach and prepared identically from the spleen of patient J (SPLEEN J) in New York. Additionally, a half-dilution of lot 5, K12, was included in this comparison. The reactivity of each suspension was assessed among patients with active and inactive sarcoidosis. The selectivity of each suspension for sarcoidosis was assessed similarly by comparison with results in patients with active and quiescent pulmonary parenchymal tuberculosis and in healthy subjects. All patients were closely matched and two Kveim tests were made in each subject according to a prearranged statistical design. The reactivity of the K12, K12 1/2 dilution, and K13 suspensions among patients with active and inactive sarcoidosis was closely similar to that with the 'standard' S10 suspension and in accordance with the expected proportions of reactions in patients at different stages of sarcoidosis. The K12, K13, and 'standard' S10 suspensions yielded a negligible proportion of positive reactions among patients with active and quiescent pulmonary tuberculosis and among healthy subjects: thus, as judged by these tests each suspension showed a high degree of selectivity for sarcoidosis. The results of this validation study are discussed in relation to the results of other studies in which lots 5 and 14 of K12 and early and late batches of a suspension prepared from another sarcoid spleen at the Commonwealth Serum Laboratories designated CSL and provided by Dr T.H. Hurley in Melbourne were employed. Using lot 5 of K12 positive reactions were found in an appreciable proportion of patients with Crohn's disease, ulcerative colitis, and tuberculous lymphadenitis. A closely similar rate of positive reactions was encountered among patients with Crohn's disease following tests with batch 0025 of CSL suspension and with another lot (lot 14) derived from spleen K12. A close concordance of results was obtained with lot 5(K12) and with batch 0042 CSL among patients with ulcerative colitis, but at a lower rate of reactivity. We conclude that positive reactions also occur in some diseases other than sarcoidosis and consider that the difficulties in determining the criteria for an acceptable test suspension become increasingly apparent as additional Kveim tests are made with one particular lot and with seqential lots of material from a 'validated' tissue source.

Adult↗
PubMed1976

Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli.

This review describes recent epidemiological studies, based upon the risk of infection with tubercle bacilli. In the Netherlands the risk of infection has been decreasing steeply and exponentially for many years, but in some developing countries there was little secular trend in the absence of intensive control measures. Variations in the risk of infection with age are being examined. A comprehensive statistical analysis has shown that the major risk of development of tuberculosis is following a recent primary infection; the risk is smaller following reinfection of a previously infected subject, and is very small indeed, in the absence of reinfection, if the primary infection took place more than 5 years previously.

Adolescent↗
PubMed1975

First results of a randomized clinical trial of fast neutrons compared with X or gamma rays in treatment of advanced tumours of the head and neck. Report to the Medical Research Council.

Results of the first randomized clinical trial to compare the effects of fast neutrons and those of x or gamma rays (photons) in treating patients with advanced tumours of the head and neck are reported. In 37 out of 52 patients treated with neutrons and 16 out of 50 treated with photons the local tumour completely regressed; the tumour later recurred in nine of the 16 photon patients but in none of the 37 neutron patients. The advantages to the neutron-treated patients were seen in tumours of well and poorly differentiated histology and in each site. Complications after treatment did not differ significantly between the groups. Despite these substantial differences in local control of the tumour there were no significant differences in mortality between the series. A detailed study of the effective doses and the response of tumours and normal tissue in each series indicated that the improved results from neutron therapy were due to differences in the biological quality of the beam and not to the rather higher average effective dose in the neutron series. To assess the long-term effects of neutron treatment patients in earlier stages of disease and with smaller tumours should be included in the next phase of the trial.

Clinical Trials as Topic↗
PubMed1975

The risk of tuberculous infection in Sweden.

Large sections of the population of Sweden were tuberculin tested during the 1940s prior to BCG-vaccination. This material has been used to estimate the risk of tuberculous infection and its trends with calendar year and age. An analysis of the results of approximately 200,000 tuberculin tests in military recruits and schoolchildren was made, using the method developed in the Tuberculosis Surveillance Research Unit. The risk of infection was estimated to be 2-8 per cent at age 10 in 1935, the rate decreasing by 9-0 per cent annually. There was also a substantial increase in the risk with each year of age, amounting to 8-6 per cent for each year of age. Separate analyses of the risk of infection and its trend with time for each of the individual 24 counties and the city of Stockholm, showed considerable variations in the level of the risk between the different areas. These are related to variations in tuberculosis in cattle in a further report. In seven areas information was available from earlier surveys in schoolchildren or recruits, using the same method of testing. In these areas separate estimates of the calendar trend of the risk of infection and the age trend have been made. The decrease in the risk with calendar year and the increase with age seem to apply in each of these counties, as in the whole of Sweden. The reliability of the findings was tested by comparing the estimated risk of infection for the whole of Sweden and the tuberculous meningitis mortality rate in children aged 0-4 years between 1925 and 1935. There was a similar trend in the risk and in the mortality rate. Between 1935 and 1940 the decline in the tuberculous meningitis mortality rate became steeper, and amounted to about 11-5 per cent annually between 1935 and 1945. Special measures for the protection of uninfected but exposed children became increasingly common during the 1920s and 1930s, and these were supplemented with BCG-vaccination at a later date. From July 1939 all milk sold for human consumption had to be pasteurised. It is suggested that all these factors may have contributed to the more rapid decrease in the tuberculous meningitis mortality in young children after about 1938.

Adolescent↗
PubMed1975

Studies of tuberculosis in man in relation to infection in cattle.

A study has been made in Sweden to investigate whether the risk of tuberculous infection and its trend with time in man in different areas were related to varying prevalences of tuberculous infection in cattle. It was found that the level of the infection risk in man was related to the prevalence of tuberculous infection in cattle, varying from 3-4 per cent in 1935 at age 15 in counties with less than 2 per cent infected cattle to 5-8 per cent in counties with 20 per cent infected cattle or more. However, the downward trend to the risk of infection with time was not to found be associated with the prevalence of tuberculous infection in cattle. The correlation between the risk of infection in man and the prevalence of infection in cattle in the 24 Swedish counties was positive and highly significant (+0-79). The relationship between cattle tuberculosis and tuberculosis in man was further studied by correlating infection in cattle with tuberculosis mortality and morbidity in man. The correlation with mortality was negative and highly significant (-0-77), i.e. counties with little cattle tuberculosis had a high tuberculosis mortality in man, and vice versa. There were similar large negative correlations with measures of tuberculosis incidence. When variations between the counties in relevant environmental factors, namely capital, urbanization and overcrowding, were taken into account, a strong positive association remains between the prevalence of infected cattle and the risk of tuberculous infection in man, but the associations with tuberculous mortality and morbidity, though they remain negative, become weaker. It is suggested that the probable explanation of these findings is the long-term protection against adult infection with human tubercle bacilli conferred by bovine infection in childhood.

Adolescent↗
PubMed1975

Antibody to herpes-like virus in sarcoidosis.

Anti-hepes-like virus antibody titers in samples of serum drawn from 70 consecutive patients at the time of diagnosis of sarcoidosis were compared with those found in control subjects without sarcoidosis or granulomatous disease, matched for age, sex, and race. Antibody was detected in all 70 sarcoid and control sera; in general, titers were higher for the sarcoid patient than for the matched control subject, but the difference in the geometric mean titer was only 0.5 of a twofold dilution step. Only 21 (30 per cent) of the sarcoid and 8 (11 per cent) of the control sera had titers greater than or equal to 1:600. The difference in the geometric mean titer between patient and control subject did not vary significantly with sex, race, or type of sarcoidosis. A second sample of serum was drawn from 45 of the 70 sarcoid patients after an interval varying from 18 to 60 months. Among these 45 patients the titers were virtually unchanged: 39 (87 per cent) had the same titer on the second occasion, 4 were higher by one dilution, and 2 were lower by one dilution. There was no correlation between the titer of the initial sample of serum and the progression, regression, or attainment of inactivity of the sarcoidosis. From this study we conclude that the elevated anti-herpes-like virus antibody titer found in patients with sarcoidosis are most likely to be related to the ability of these patients to show enhanced humoral antibody responses.

Antibodies, Viral↗