PubMed Health⌕ Search

Biomedical subjects

P Prior

Publications and source records attributed to P Prior.

At least 73 records · Page 4Linked to original sources
PubMed1985

Cancer and rheumatoid arthritis: epidemiologic considerations.

Statistical methods used to investigate the epidemiology of cancer in rheumatoid arthritis are reviewed and their relative merits discussed. A cohort analysis of cancer morbidity was carried out on a consecutive series of 489 patients with rheumatoid arthritis seen at the Queen Elizabeth Medical Centre, Birmingham, United Kingdom between 1964 and 1978 and followed to December 31, 1983. Forty-two cancers were observed in the series in comparison with 31.13 expected (p less than 0.05) on the basis of cancer morbidity rates for the West Midlands region. The excess was due to the high relative risk of cancers of lymphatic and hematopoietic tissues (observed = 11, expected = 1.27, relative risk = 8.7, p less than 0.001). The effects of confounding factors, including duration of rheumatoid arthritis and hospital selection on the level and pattern of risk over time were examined. When two cases diagnosed soon after first attendance at hospital were excluded, lymphomas (ICD 200, 201, 8th Revision) showed a pattern of increasing relative risk with time from five years after first attendance. The increasing risk appears to be unrelated to the use of immunosuppressive or cytotoxic drugs.

Antineoplastic Agents↗
PubMed1984

Cause of death in rheumatoid arthritis.

A series of 489 consecutive patients with definite or classical rheumatoid arthritis was followed for a mean of 11.2 years. Cohort-analysis of the series showed a three-fold increase in mortality overall in comparison with age- and sex-specific rates in the general population. In patients first seen in hospital early in the course of the disease (less than 5 years from onset), the excess of deaths from circulatory, respiratory and musculoskeletal disorders was highly significant. Malignant disease and digestive system disorders accounted for a small excess of borderline significance. Patients who were referred later (greater than 5 years from onset) experienced, in addition, a highly significant excess of deaths from infections and disorders of the digestive and genito-urinary system but not from malignant neoplasms.

Adult↗
PubMed1984

Cancer morbidity in rheumatoid arthritis.

A consecutive series of 489 patients with rheumatoid arthritis seen at the centre was studied to determine their cancer morbidity. Overall the 36 cancers diagnosed in the series between 1964 and 1981 were not significantly in excess of the expected number, but there was a highly significant excess of tumours of the reticuloendothelial system. The excess was mainly due to 6 observed cases of lymphoma. We conclude that there is a highly significant association between rheumatoid arthritis and the subsequent development of lymphoproliferative malignancy in this series.

Adult↗
PubMed1984

Lymphoproliferative malignancy in rheumatoid arthritis: a study of 20 cases.

A series of 20 patients with definite or classical rheumatoid arthritis who subsequently developed a lymphoproliferative malignancy are described. The mean time between the onset of the 2 diseases was 13.2 years. A wide range of types of non-Hodgkin's lymphoma and Hodgkin's disease were found; there were no unusual histological features in the lymphomas. Although many of the patients had had gold, penicillamine, and other second-line drugs, none of them had received cytotoxic drugs, and there was no evidence that therapy was a cause of their malignancies. The likely cause of the association is a predisposition to both diseases.

Adult↗
PubMed1984

Survival of patients with colorectal cancer complicating ulcerative colitis.

The crude five year survival of patients with colorectal cancer complicating ulcerative colitis in a large series of patients under long term review has, for the first time, been compared with the survival of patients with colorectal cancer in the general population (West Midlands region) from which the colitic patients were drawn. Thirty five cases of colorectal cancer were diagnosed in 676 patients with ulcerative colitis between 1944 and 1976. An actuarial five year survival curve was computed for the colitic and non-colitic patients with colorectal cancer. In ulcerative colitis patients with cancer the five year survival was 33.5% (range 16.9-50.1%) compared with 32.6% (28.2-37.0%) in the non-colitic cancer patients drawn from the relevant general population. Overall the prognosis is much better than earlier reports suggest. It is perhaps disappointing that in a closely monitored group the outcome is only as good as that in the general population. Surveillance programmes should improve the outcome in those patients with ulcerative colitis who accept the need for regular review.

Adult↗
PubMed1984

Ulcerative colitis: why is the mortality from cardiovascular disease reduced?

A recent mortality study of patients with ulcerative colitis showed significant deficits in deaths from cardiovascular disease and from respiratory disease in males. The reasons for the observed deficits have been examined by studying the risk factors in a consecutive series of 103 patients with ulcerative colitis using matched controls. The patients and controls were assessed for age, sex, social class, alcohol and tobacco consumption. Height, weight and blood pressure were recorded and fasting blood samples were taken for serum lipid estimation. Patients with ulcerative colitis had significantly lower systolic and diastolic blood pressures and the changes were particularly marked in patients with extensive colitis and after panproctocolectomy. After matching for age, sex and social class the patients with ulcerative colitis smoked significantly less than controls. Serum lipid measurements were similar in both groups. The lower blood pressure may be related to sodium and water depletion particularly in ileostomy patients and those with extensive colitis.

Adult↗
PubMed1984

Determining disease activity in inflammatory bowel disease.

To provide a stronger relationship between clinical assessment of disease activity and laboratory measurements, we studied hemoglobin concentrations, sedimentation rates, and the serum levels of albumin and of seromucoids in 86 patients; first when seriously ill with either ulcerative colitis or Crohn's disease, and then again when they were well. Only albumin and seromucoids were separated clearly in the two states: hemoglobin and sedimentation rates showed significant overlap. Paired correlation tests between 10 laboratory variables in 149 patients with Crohn's disease of varying severity revealed a highly significant correlation between seromucoids and albumin (r = 0.71). Both variables correlated with six others, but at lower levels. Processing the correlation matrix by factor analysis suggested that the serum levels of albumin and seromucoid are indicators of the same effect--disease activity. A simple index using only hemoglobin, albumin, and seromucoid values, was derived from this analysis, positive values indicating health and negative ill health. Serum levels of albumin and seromucoids provide the essential data to determine disease activity at routine follow-up of inflammatory bowel disease or to indicate the success or failure of therapeutic regimens, overriding any arbitrary clinical assessment.

Adult↗
PubMed1982

Cancer morbidity in ulcerative colitis.

Cancer morbidity at all sites has been studied in a series of 676 patients with ulcerative colitis under long-term review, of whom more than two-thirds had extensive disease, and the level and pattern of risk over time examined. Age-, sex-, and site-specific incidence rates were used to compute the number of cancers that might have been expected to occur. A highly significant excess of cancers was observed overall but the excess was due entirely to cancers of the digestive system. In women there was no excess or deficit of cancers outside the digestive system. In men there was a small deficit of cancers of the respiratory system. An overall 11-fold excess colorectal cancer risk was found in the series compared with that in a relevant general population after patient-years at risk had been corrected for surgical resection and patients with colorectal cancer at their first referral had been corrected for surgical resection and patients with colorectal cancer at their first referral had been excluded. When these data were expressed in an actuarial form the cumulative probability of developing colorectal cancer in the series was 8% (3.5-13%) at 25 years, after the diagnosis of ulcerative colitis had been established. The relative risk of developing colorectal cancer was highest in those patients developing colitis before the age of 30 years, and the relative risk fell as the age at diagnosis of their colitis increased. The pattern of risk of colorectal cancer over time suggests that there is an association between cancer and colitis in susceptible individuals and that the level of risk is related to age at onset of colitis.

Adult↗
PubMed1982

Mortality in ulcerative colitis.

The pattern of mortality has been examined in a series of 676 patients with ulcerative colitis under long-term review to identify excesses or deficits in mortality for all causes of death in relation to the general population. The mortality risk for the whole series was 1.7 times that of the general population (p less than 0.001). Most of the excess mortality could be attributed to diseases of the digestive system. There was a heavy burden of mortality during the first year afer diagnosis and the first year after radical surgery. The significance of the excess of cancer deaths was due to the inclusion of patients who were diagnosed with cancer at first referral. In man there was a deficit of circulatory system deaths particularly those with early onset ulcerative colitis treated by panproctocolectomy after 40 yr of age. Mortality from all other causes including breast cancer showed no significant difference from that expected in the general population.

Adult↗
PubMed1981

Multiple primary cancers of the breast and ovary.

Multiple primary cancer of the breast and ovary were investigated as part of a survey being undertaken at the Birmingham and West Midlands Regional Cancer Registry. Population-based data relating to 17,756 registrations for breast and 3470 for ovarian cancer between 1950 and 1964 were analysed. On the basis of person-years at risk and incidence rates for the Region (1960-1962), an increased risk of a second primary tumour in the ovary was observed in patients diagnosed with a first primary in the breast before 45 years of age (O = 8; E = 1.83; P less than 0.001). No excess was found in patients diagnosed after 45 years of age (O = 15; E = 17.06). In patients with an index tumour of the ovary, the observed number of second primary tumours of the breast was not significantly different from the expected number (O = 19; E = 12.95). Complementary analysis (a combined assessment for the 2 sites) showed that the development of a first primary at either site before 45 years of age carried a 2.8-fold risk of a second primary tumour at the other site (O = 9; E = 3.21; P less than 0.01). After 45 years of age no increased risk was found (O = 32; E = 28.63). Over all ages a 1.3-fold risk was observed (O = 42; E = 31.54; P less than 0.05). No evidence of subfertility was found in the 9 patients in the high-risk premenopausal group who developed the 2 tumours. The results are more consistent with an aetiology of early exposure to an external carcinogen than with one of abnormal hormone production.

Adolescent↗
PubMed1981

The incidence of bilateral breast cancer: II. A proposed model for the analysis of coincidental tumours.

A statistical model has been proposed in an attempt to integrate coincidental (or synchronous) diagnoses of multiple primary cancers into a general method of analysis. In the context of population-based surveys, such diagnoses form an integral part of the pattern of incidence within the population. Because of clinical surveillance, the diagnosis of subsequent tumours may be advanced in time in comparison with a first primary diagnosis. The model has been used to predict the altered pattern of diagnosis in order to adjust the value of expected numbers. Data from a previously reported survey of bilateral breast cancer have been used to illustrate the model. Analysis in terms of the model showed a 2.6-fold increase in risk for a second primary tumour in the contralateral breast in a series of nearly 22,000 breast-cancer patients. The corresponding risks for 3 main age-ranges (at the time of diagnosis of the first primary) were 5.3 (age 15-44), 3.3 (45-49) and 1.5 (60+). In addition, a maximal risk of 5.0-fold was observed in the series as a whole during the third year after the diagnosis of the first primary.

Adolescent↗
PubMed1981

Multiple primary cancers of breast and cervix uteri: an epidemiological approach to analysis.

Index sites of breast and cervix uteri were selected from populationbased data held at the West Midlands and Birmingham Regional Cancer Registry, and the expected numbers of second primary cancers in cervix and breast were computed (sequence analyses). In the breast series (17,756 patients) a small deficit of cervical tumours was observed (O = 16, E = 2·119, O/E = 0·76, P > 0·05), while in the cervix series (4817 patients) a small excess of breast tumours was found (O = 29, E = 23·38, O/E = 1·24, P > 0·05) over a period of 15 years.A theoretical statement of the combined risk of the 2 tumours occurring in the same individual of a general population was developed and was compared with the practical approach of summing the sequence analyses (complementary analysis). Complementary analysis indicated that there was no excess of women with the 2 primary tumours (O = 45, E = 44·57, O/E = 1·01) and that cancers of the breast and cervix uteri are not aetiologically related.

Adolescent↗
PubMed1981

Brain damage after cardiopulmonary by-pass: correlations between neurophysiological and neuropathological findings.

Ischaemic lesions along cerebral arterial boundary zones were present in nine patients dying after cardiopulmonary by-pass. Their intra-operative cerebral function monitor recordings had shown at least 7 min major depression, its severity correlating with degrees of neurological deficit after operation and EEG abnormality and extent of infarction. In contrast eleven patients with normal or minimally abnormal cerebral function monitor recordings had macroscopically normal brains.

Adult↗
PubMed1981

Mortality in Crohn's disease.

A series of 513 patients with Crohn's disease, who were followed for 1 to more than 35 yr by one unit, experienced a twofold increased risk of dying compared with a matched group drawn from the general population (102 observed; 51.8 expected; p < 0.001). The overall risk was similar for men and women and was greatest in the younger patients within a few years of diagnosis. The relative risk of dying decreased as the age at diagnosis of their Crohn's disease increased and also fell as the period of time from diagnosis increased. There was a small but significant excess of death from tumors of the digestive organs (9 observed; 4 expected; p < 0.05). There was also a significant excess of deaths from suicide in women (3 observed; 0.4 expected; p < 0.01). The major burden of mortality lay in causes directly attributable to Crohn's disease or to associated complications within the digestive system (46 observed; 1.41 expected; p < 0.001).

Adolescent↗
PubMed1980

Malignancy in Crohn's disease.

Cancer morbidity has been evaluated in a series of 513 patients with Crohn's disease under long-term review between 1944-76. In comparison with morbidity rates for cancer in the West Midlands Region (the geographical area from which these patients were drawn) the 31 tumours that occurred represented a relative risk of 1.7 (P less than 0.01) of cancer at all sites. For tumours at sites within the digestive system the relative risk was 3.3 (P less than 0.001). A significant excess of tumours was found in both the upper (P less than 0.01) and lower (P less than 0.001) gastrointestinal tract. There was no excess of tumours at any site outside the digestive system.

Adolescent↗