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Biomedical subjects

M Fulton

Publications and source records attributed to M Fulton.

At least 19 recordsLinked to original sources

Primary bony and cartilaginous sarcomas of chest wall: results of therapy.

Primary bony and cartilaginous sarcomas of the chest wall are uncommon, and data concerning treatment and results are sparse. To assess the results of therapy, we reviewed our 40-year experience. Records of 38 patients with osteosarcoma and 88 with chondrosarcoma arising in chest wall admitted to Memorial Sloan-Kettering Cancer Center from 1949 to 1989 were reviewed. The 88 patients with chondrosarcoma ranged in age from 5 to 86 years (median age, 49 years); the male/female ratio was 1.3:1. Presenting complaint was mass, pain, or both in 93%. Primary therapy was resection (n = 84), radiation therapy (n = 3), or chemotherapy (n = 1). Overall 5-year survival was 64%. Significant adverse prognostic factors included metastases at initial presentation (n = 9), metastases at any time during the course of disease (n = 23), age greater than 50 years (n = 42), incomplete or no resection (n = 13), and local recurrence (n = 24). Sex, grade, and tumor size were not prognostic factors. The 38 patients with osteosarcoma ranged in age from 11 to 78 years (median age, 42 years); the male/female ratio was 1.5:1. Presenting complaint was mass, pain, or both in 95%. Primary therapy included resection (n = 31; alone in 13, with radiation therapy in 3, with chemotherapy in 15), radiation therapy (n = 3), radiation therapy and chemotherapy (n = 2), chemotherapy (n = 1), or no treatment (n = 1). Overall 5-year survival was 15%. Significant adverse prognostic factors included presence of synchronous metastases (n = 13) and metastases at any time during the course of disease (n = 26).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Effects of hysterectomy on bowel and bladder function.

A case control study compared the bowel habit of 91 post-hysterectomy women with paired controls from the same family doctor practice. More cases had an abnormal bowel frequency, a firmer stool consistency and assessed themselves as having abnormal bowel function, predominantly constipation after hysterectomy, than controls. Significantly more cases than controls had consulted a doctor because of constipation but there was no significant difference in laxative usage. There was a significant short-term association between decreased bowel frequency and increased urinary frequency after hysterectomy. This became highly significant in those patients who developed chronic symptoms. Oophorectomy, unilateral or bilateral, did not significantly affect bowel habit other than to intensify the change in stool consistency. The hypothesis is discussed that the post-hysterectomy effects on bowel and bladder function may have a common aetiology in a degree of autonomic denervation of both viscera.

Adult

Quantitative assessment of full range-of-motion isometric lumbar extension strength.

The purpose of this study was to evaluate the reliability and variability of repeated measurements of isometric (IM) lumbar extension (LB EXT) strength made at different joint angles. Fifty-six men (age, 29.4 +/- 10.7 years) and 80 women (age, 24.3 +/- 9.1 years) completed IM LB EXT strength tests on 3 separate days (D1, D2, and D3). On D1 and D2, subjects completed two tests (T1 and T2) separated by a 20- to 30-minute rest interval. For each test, IM LB EXT strength was measured at 72, 60, 48, 36, 24, 12, and 0 degrees of lumbar extension. Mean IM strength values, within-day reliability coefficients, and test variability over the seven angles improved from D1 to D2 (D1: mean, 160.0 to 304.1 N.m, r = 0.78 to 0.96, SEE = 37.6 to 46.9 N.m; D2: mean, 176.3 to 329.1 N.m, r = 0.94 to 0.98, SEE = 29.0 to 34.4 N.m). Mean strength values leveled off by D3 (174.5 to 317.0 N.m). The most reliable test results showed that the IM LB EXT strength curves were linear and descending from flexion to extension and ranged from 235.8 +/- 85.2 to 464.9 +/- 150.7 N.m for men (extension to flexion) and from 134.6 +/- 53.2 to 237.3 +/- 71.9 N.m for women. Lumbar extension strength was clearly greatest in full flexion, which is in contrast to previously reported results. One practice test was required to attain the most accurate and reliable results. These data indicate that repeated measures of IM LB EXT strength are highly reliable and can be used for the quantification of IM LB EXT strength through a range of motion.

Adult

Blood-lead levels and children's behaviour--results from the Edinburgh Lead Study.

The effect of blood-lead on children's behaviour was investigated in a sub-sample of 501 boys and girls aged 6-9 years from 18 primary schools within a defined area of central Edinburgh. Behaviour ratings of the children were made by teachers and parents using the Rutter behaviour scales. An extensive home interview with a parent was also carried out. Multiple regression analyses showed a significant relationship between log blood-lead and teachers' ratings on the total Rutter score and the aggressive/anti-social and hyperactive sub-scores, but not the neurotic sub-score when 30 possible confounding variables were taken into account. There was a dose-response relationship between blood-lead and behaviour ratings, with no evidence of a threshold.

Aggression

Linoleic acid and coronary heart disease.

Low tissue concentrations of the essential fatty acid, linoleic acid, occur in communities with high rates of coronary disease and in patients with angina and myocardial infarction. This relationship is independent of lipids and blood pressure, but in smokers linoleic acid is particularly low because they eat less linoleic acid-containing foods.

Coronary Disease

Factors influencing lead concentrations in shed deciduous teeth.

Data collected for the Edinburgh Lead Study have been used to investigate lead concentrations in children's naturally shed deciduous teeth. A within-child multiple-regression analysis has shown that the upper jaw has a higher concentration of lead than the lower, and that there is a gradient of decreasing concentration from the front to the back of the mouth. Even after the effects of jaw and tooth type have been allowed for, the concentration is still found to be negatively correlated with the weight of the tooth and with the age at which the tooth was shed. No statistically significant effects could be attributed to caries, fillings, or the incomplete resorption of roots. A single-valued index of tooth lead has been derived for each child, taking into account the fact that children gave different types of teeth.

Age Factors

Alcohol consumption and nutrient intake in middle-aged Scottish men.

The relation between alcohol consumption and dietary intake was examined in 164 middle-aged Scottish men taking part in a study of risk factors for coronary heart disease (CHD). A 7-d weighed dietary record was used to assess alcohol and nutrient intake. The mean daily intake of alcohol was 26 g (SD 31 g). Energy derived from alcohol tended to replace energy derived from other nutrients and increasing intake of alcohol was associated with a decrease in the amounts of carbohydrate, total fat, and saturated and monounsaturated fatty acids in the diet. Those with a low alcohol intake (0.1-9 g alcohol/d) had a higher intake of total fiber, cereal fiber, polyunsaturated fatty acids, and linoleic acid and a smaller proportion smoked cigarettes. The differences are small but may contribute to the lower mortality from CHD reported by other studies in those with a low alcohol intake.

Alcohol Drinking

Cigarette smoking, social class and nutrient intake: relevance to coronary heart disease.

The association of cigarette smoking habits and social class with nutrient intake was investigated in 162 men aged 45-54 using a 7-d weighed dietary record. Cigarette smokers had a significantly lower intake of fibre and polyunsaturated fatty acids and a lower P:S ratio than non-smokers. Fibre intake was lower in men in the manual compared to the non-manual group but smoking was a more powerful influence than social class. The differences in nutrient intake were accompanied by differences in the consumption of polyunsaturated margarines and cereal-containing foods. These results should be considered in the explanation of the increased incidence of coronary heart disease in smokers.

Anthropometry

Influence of blood lead on the ability and attainment of children in Edinburgh.

The effect of blood-lead on children's ability and attainment was investigated in a sample of 855 boys and girls aged 6-9 years from eighteen primary schools within a defined area of central Edinburgh. The geometric mean blood-lead value was 10.4 micrograms/dl. In a stratified subsample, 501 children completed individual tests of cognitive ability and educational attainment from the British Ability Scales (BAS). An extensive home interview with a parent was also done. Multiple regression analyses showed a significant negative relation between log blood-lead and BAS combined score, number skills, and word reading when thirty-three possible confounding variables were taken into account. There was a dose-response relation between blood-lead and test scores, with no evidence of a threshold. The size of the effect was small compared with that of other factors. Lead at low levels of exposure probably has a small harmful effect on the performance of children in ability and attainment tests.

Achievement

Children's blood lead and exposure to lead in household dust and water--a basis for an environmental standard for lead in dust.

Good quantitative evidence on the role of lead in household dust as a source of exposure to children has been lacking. A study of 495 children in Edinburgh, Scotland shows a significant relationship between lead in dust vacuumed from the floors of the children's homes and their blood lead levels. A multiple regression analysis incorporating drinking water and household dust estimates that a 1,000 micrograms g-1 increase in dust lead concentration would increase blood lead by 1.9 micrograms dl-1, for a child with the median population blood lead of 10.1 micrograms dl-1. Dust lead concentration is a more useful predictor of blood lead than lead loading. The sanding or blow-lamp stripping of old paint is found to be an important source of the higher household dust lead concentrations. Finally, the dust lead-blood lead relationship is used to derive a standard for lead in house dust, as no such standard exists for this exposure route.

Child

Cross-sectional thigh components: computerized tomographic assessment.

The purpose of this study was to examine the efficacy of the Picker Synerview Fourth Generation CT Scanner in assessing cross-sectional areas of muscle, bone, and subcutaneous fat of the thigh. A secondary purpose was to resolve individual muscle bellies using the CT scanner and to determine the effects of body composition in isolating those muscles. Both limbs of one cadaver were used to compare actual cross-sectional areas with the CT images. Each limb was dissected and photographed. Accuracy of repeated measurements was assessed using human volunteers. Absolute and percent error between the CT measurements and the measurements of the cross-sectional areas differed most at the bone. No differences were found between repeat scans. CT images and photographic measurements of individual muscles were generally quite similar, as assessed by absolute and percent error. The gracilis and sartorious were reasonably well defined in those individuals with more than 8% body fat. The results are discussed in terms of possible applications of the CT scanner in sports medicine research.

Adipose Tissue

A comparison of the nutrient intake of some Scotsmen with dietary recommendations.

During 1980 and 1982, 164 men aged 45-54 in North Edinburgh and West Fife participated in a 7-day individual weighed dietary survey. The mean energy intake was 11.2 MJ (2700 kcal), 38.1 per cent of which came from fat and 6.7 per cent from alcohol. The P:S ratio was 0.30 and the mean daily fibre intake 19.8 g. Saturated fatty acids accounted for 16.3 per cent of the energy and polyunsaturated fatty acid for 4.6 per cent. Oleic acid was the principal dietary fatty acid accounting for 32.4 per cent of fatty acids. The major polyunsaturated fatty acid was linoleic acid and contributed 3.5 per cent of energy. Cereal and cereal products were the principal source (30.8 per cent) of linoleic acid. Though this study was conducted prior to the publication of recent dietary recommendations, a small proportion of the men were achieving some of them but few would have met the recommendations in full.

Animals

Adipose tissue and platelet fatty acids and coronary heart disease in Scottish men.

The relation between coronary heart disease (CHD) and fatty acid composition of adipose tissue and platelets was examined in a random sample of 448 middle-aged Scottish men. The linoleic acid (18:2n6) content in adipose tissue of 28 men with previously unidentified CHD was significantly lower than that in the rest of the group. Platelet linoleic and other fatty acids were not significantly different in men with new CHD. Fatty acid content of adipose tissue reflects long-term dietary intake, and a 7-day weighed dietary record in a random sub-sample of 164 men confirmed that intake of linoleic acid in 10 of the 28 new CHD cases was significantly lower than in the healthy men. In a multiple logistic analysis adipose tissue linoleic acid, age, high density lipoprotein cholesterol, and weight/height index each made an independent contribution to the explanation of new CHD. When all fatty acids were included in a second regression analysis, low concentrations of dihomo-gamma-linolenic (20:3n6) acid in adipose tissue showed a more significant relation with new CHD than did linoleic acid.

Adipose Tissue

The management of hypertension--a survey of opinions among general practitioners.

In order to clarify current opinion on aspects of the management of hypertension, a postal questionnaire was sent to all 420 general practitioners in the Lothian Health Board Area. Three hundred and nine doctors (74 per cent) replied.A high proportion were willing to undertake the investigation and follow-up of most hypertensive patients in general practice but there were conflicting opinions on the use of Phase 4 and Phase 5 in the measurement of blood pressure, the number and type of investigations which were appropriate, the level of diastolic blood pressure at which treatment should begin, and the level to which the diastolic blood pressure should be reduced with treatment.

Aged

The management of hypertension--a study of records in general practice.

We investigated the management of a group of 322 hypertensive patients by 71 general practitioners in the Lothian Health Board Area by a survey of the general practitioners' records. Eighty-five per cent of patients were diagnosed by the general practitioner and 57 per cent were cared for entirely by him. Two thirds of the patients were women. Hospital referral was more common in men and in patients with high initial blood pressures. One third of patients had only one blood pressure recorded before treatment. The result of treatment as measured by the latest diastolic blood pressure was similar for patients treated by the general practitioner and those referred to hospital, being 100 mm Hg or less in 77 per cent of patients.

Adult

Regional variations in mortality from ischaemic heart and cerebrovascular disease in Britain.

In middle-aged men and women, mortality from ischaemic heart disease and cerebrovascular disease is highest in the north and west of Britain. The worst region is West Central Scotland. Statistical analysis using a linear logistic model shows that the differences between the regions are significant and the yearly fluctuation in numbers of deaths contributes little to the overall variation.

Adult

Palmerston North mice, a new animal model of systemic lupus erythematosus.

This report describes a previously unrecognized animal model of SLE, the PN mouse. Although outbred PN mice were studied originally as models of polyarteritis nodosa, their inbred descendants have autoimmune disease which closely resembles SLE. In the current study, positive indirect immunofluorescence tests for ANA appeared when the mice were 5 months old, and 80% of mice were ANA-positive at 10 months of age. Anti-DNA were detected in sera from newborn mice and from 53% of mice under 2 months of age. Seventy-six percent of PN mice developed anti-DNA at the age of 10 months. Glomerular deposits of IgG, IgM, IgA, and complement appeared at 2 to 4 weeks of age, and examination of renal tissue by electron microscopy showed basement membrane thickening and dense intramembranous deposits. Neoplasms arose in 14% of PN mice. Female mice died earlier than male mice, and the most common causes of death were glomerulonephritis and arteritis. It was concluded that the serologic and histologic characteristics of disease in PN mice resembled SLE.

Animals

Phonocardiographic and echocardiographic features of Lillehei-Kaster mitral prosthesis.

Fifteen patients were studied with phonocardiography (phono) and echocardiography (echo) three to 13 months after mitral valve replacement with Lillehei-Kaster mitral valve prostheses. Echo measurements in all patients included prosthesis excursion (DE), opening velocity (OV), closing velocity (CV), and Q-to-mitral prosthesis closure (Q-MPC). In five patients, further, echo measurements included isometric contraction period (ICP), left ventricular ejection time (LVET), and time to completion of aortic valve opening (TCAO). Phono measurements in all patients included pre-ejection period (PEP), LVET, and PEP/LVET. Further phono measurements in the same five patients in whom further echo measurements were performed included Q to first heart sound (Q-S1), ICP, and isometric relaxation period (IRP). Phono and echo measurements were done sequentially. The echo results showed widespread values for DE, OV and CV with no correlation between clinical state, size of prosthesis, or postoperation duration. There was a positive correlation between CV and OV, r + 0.65. Q-MPC by echo averaged 72 msec, which is longer than reported values for Q-to-mitral valve closure in normal people. Similarly, ICP by echo was shorter than ICP by phono in every patient. Of the phono measurements IRP was shortest (45 msec) in one patient in congestive heart failure with a possible prosthesis malfunction. We conclude that echo- and phonocardiography are useful tools in evaluating mitral prosthesis function, but because normal values are widespread, individual measurements may be useful for followup in the same individual. Precise measurement of subdivisions of systolic intervals are now possible with these techniques.

Adult