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Biomedical subjects

R Greenwood

Publications and source records attributed to R Greenwood.

At least 19 recordsLinked to original sources
PubMed1992

Childhood cancer, intramuscular vitamin K, and pethidine given during labour.

OBJECTIVE: To assess unexpected associations between childhood cancer and pethidine given in labour and the neonatal administration of vitamin K that had emerged in a study performed in the 1970 national birth cohort. DESIGN AND SETTING: 195 children with cancer diagnosed in 1971-March 1991 and born in the two major Bristol maternity hospitals in 1965-87 were compared with 558 controls identified from the delivery books for the use of pethidine during labour and administration of vitamin K. MAIN OUTCOME MEASURES: Odds ratios for cancer in the presence of administration of pethidine or of intramuscular vitamin K. Both logistic regression and Mantel-Haenszel techniques were used for statistical analyses. RESULTS: Children of mothers given pethidine in labour were not at increased risk of cancer (odds ratio 1.05, 95% confidence interval 0.7 to 1.5) after allowing for year and hospital of delivery, but there was a significant association (p = 0.002) with intramuscular vitamin K (odds ratio 1.97, 95% confidence interval 1.3 to 3.0) when compared with oral vitamin K or no vitamin K. There was no significantly increased risk for children who had been given oral vitamin K when compared with no vitamin K (odds ratio 1.15, 95% confidence interval 0.5 to 2.7). These results could not be accounted for by other factors associated with administration of intramuscular vitamin K, such as type of delivery or admission to a special care baby unit. CONCLUSIONS: The only two studies so far to have examined the relation between childhood cancer and intramuscular vitamin K have shown similar results, and the relation is biologically plausible. The prophylactic benefits against haemorrhagic disease are unlikely to exceed the potential adverse effects from intramuscular vitamin K. Since oral vitamin K has major benefits but no obvious adverse effects this could be the prophylaxis of choice.

Administration, Oral↗
PubMed1992

Neurology and rehabilitation in the United Kingdom: a view.

The relationship between neurology and rehabilitation medicine is discussed. The question "Does rehabilitation work?" is not useful. Rather, it should be asked when and how specific rehabilitation techniques should be applied? A satisfactory solution to these questions will not be found without informed neurological involvement. It is argued that the management of most neurological diseases would be improved if neurologists were more familiar with the principles of rehabilitation medicine. Two possible avenues for future development would be the appointment of neurologists with a specific commitment to rehabilitation, and the establishment of academic centres for restorative neurology.

Activities of Daily Living↗
PubMed1992

Lung function abnormalities in repaired oesophageal atresia and tracheo-oesophageal fistula.

BACKGROUND: Respiratory complications are common after neonatal repair of oesophageal atresia and tracheo-oesophageal fistula. The prevalence of lung function abnormalities and the relation between gastrointestinal complications and lung function has not been studied in a large number of patients. METHODS: Lung volumes and flow-volume loops were measured in 155 patients without spinal curvature aged 6-37 years who had undergone surgery for oesophageal atresia and tracheo-oesophageal fistula. RESULTS: Sixty four of the 155 patients had evidence of mild lower airways disease, with values for FEV1 more than two standardised scores below the predicted value in 39 (25%) and above 2 standardised scores for the residual volume (RV)/total lung capacity (TLC) ratio in 64 (41%). Restrictive lung disease (TLC more than 2 standardised scores below predicted) was present in 28 (18%). Severe lung function abnormalities were present in under 10% of the 155. Half the subjects had some evidence of extra-thoracic tracheal obstruction, with a high ratio of expiratory to inspiratory flow for peak flow in 76 (50%) and at 50% of vital capacity in 59 (38%). Patients with radiological gastro-oesophageal reflux in early childhood had more airways obstruction and smaller lung volumes. Patients with current gastrointestinal symptoms were similar in their lung function to symptom free patients. CONCLUSIONS: Minor lung function abnormalities are common in patients after repair of oesophageal atresia. Early diagnosis and management of gastro-oesophageal reflux may help to minimise these lung function abnormalities.

Adolescent↗
PubMed1991

Aluminium sulphate in water in north Cornwall and outcome of pregnancy.

OBJECTIVE: To determine whether the excess aluminum sulphate accidentally added to the local water supply in north Cornwall in July 1988 had an adverse effect on the outcome of pregnancies. DESIGN: Outcomes of all singleton pregnancies in the affected area at the time of the incident (n = 92) were compared with those in two control groups: pregnancies in this area completed before the incident (n = 68) and pregnancies in a neighbouring area (n = 193). SUBJECTS: Mothers in the three groups, among whom there were 13 miscarriages, five terminations of pregnancy, and 336 live births. MAIN OUTCOME MEASURES: Fetal and perinatal loss, birth weight, gestation, obstetric complications, neonatal condition, and congenital defects. RESULTS: Among 88 pregnancies in women exposed to excess aluminum sulphate there was no excess of perinatal deaths (n = 0), low birthweight (n = 3), preterm delivery (n = 4), or severe congenital malformations (n = 0). There was, however, an increased rate of talipes in exposed fetuses (four cases, one control; p = 0.01). CONCLUSIONS: Because of small numbers it is not possible to say that high doses of aluminum sulphate are safe in pregnancy, but there is no evidence from this study of major problems apparent at birth.

Abnormalities, Drug-Induced↗
PubMed1991

Comparison of prevalence of depression in mothers of twins and mothers of singletons.

OBJECTIVE: To determine whether the apparent additional and exceptional stresses associated with bearing and parenting twins affect the emotional wellbeing of mothers. SETTING: Great Britain, 1970-5. DESIGN: Cohort study of 13,135 children born between 4 April and 11 April 1970. Mothers of all children, both singletons and twins, were interviewed by health visitors (providing demographic data) and completed a self report measure of emotional well-being (the Rutter malaise inventory) when the child was 5 years of age. The malaise scores of mothers of twins were compared with those of all mothers of singletons and then with those of mothers categorised by the age spacing of their children (only one child, widely spaced, or closely spaced), taking account of maternal age, social class, and whether the study child had a disability, by using logistic regression. SUBJECTS: 139 mothers of twins--122 pairs of twins and 17 twins whose cotwin had died--and 12,573 controls, who were mothers of singletons. RESULTS: A significantly higher proportion of mothers of twins at 5 years had malaise scores indicative of depression than mothers of singletons at the same age. Mothers who had borne twins, one of whom had subsequently died, had the highest malaise scores and were three times more likely than mothers of singletons to experience depression. Both mothers of twin pairs and mothers of singletons closely spaced in age were at significantly higher risk of experiencing depression than mothers of children widely spaced in age or mothers of only one child (p less than 0.0001). Odds ratios indicated that the risk of depression in mothers of twins was higher than that in mothers of closely spaced singletons. CONCLUSION: Mothers of twins are more likely to experience depression. This suggests a relation between the additional and exceptional stresses that twins present and the mother's emotional wellbeing.

Adult↗
PubMed1991

The pathogenesis of the Lesch-Nyhan syndrome: ATP use is positively related to hypoxanthine supply to hypoxanthine guanine phosphoribosyltransferase.

In order to explain features of severe hypoxanthine guanine phosphoribosyltransferase (HPRT) deficiency, the Lesch-Nyhan syndrome, a continuous supply of substrate, hypoxanthine, for the enzyme must be generated. This supply must be increased in association with increased ATP turnover. We have shown that ATP turnover continuously supplies hypoxanthine for recycling by the enzyme HPRT and that this supply increases curvilinearly with increasing ATP turnover. The effects of increasing exercise on ATP turnover were examined using a Latin square experimental design. The outputs of hypoxanthine, xanthine, urate and creatinine were measured. The data were then examined statistically.

Adenosine Triphosphate↗
PubMed1991

Management of adipsia by a behavioural modification technique.

Adipsia combined with diabetes insipidus after hypothalamic damage may produce major difficulties in clinical management. If there is an associated memory impairment it may be impossible to teach self-regulation of fluid balance, necessitating long-term hospital supervision. The successful use of a behaviour modification technique to achieve independent drinking and allow discharge from hospital into the community is described in a patient with adipsia, diabetes insipidus and memory impairment resulting from the removal of a craniopharyngioma.

Adult↗
PubMed1977

Monosynaptic reflexes in falling man.

We have examined peripheral proprioceptive input during fall in man. The first 80 ms of unexpected free fall, both in a parachute harness and while seated, has been studied using the monosynaptic Hoffman (H) and Achilles tendon (T) reflexes. Facilitation of the H reflex begins about 30 to 40 ms after release, representing the onset of motor neurone facilitation before the electromyographic activity which begins about 80 ms after release. Earlier facilitation of the T reflex may represent spindle excitation due to change in muscle shape as suggested by Matthews and Whiteside (1960), but the T reflex inhibition described by these authors after 50 ms of seated fall is probably a purely mechanical phenomenon.

Achilles Tendon↗
PubMed1976

Landing from an unexpected fall and a voluntary step.

The electromyographic (EMG) response of soleus to a sudden fall has previously been shown to consist of two peaks of activity, the first a response to release, and the second in relation to landing (Greenwood and Hopkins, 1976). We have now examined activity in soleus during falls at various reduced accelerations. The amplitude of the first peak is proportional to acceleration and is not present during falls at accelerations of less than about 2-0 ms-2. The timing of the second peak is related to the timing of landing whether the duration of the fall depends upon the height or upon the acceleration of the fall. Its timing depends upon knowledge of the height of the fall, rather than to ongoing visual information, and upon labyrinthine function. EMG activity in soleus was also examined during voluntary downward steps which could be unexpectedly increased in height. The moment of landing is preceded by an increase of EMG activity and is followed by a number of peaks of activity. These peaks were not seen after the moment of expected landing during unexpectedly lengthened steps and thus probably represent reflex activity due to the mechanical event of landing.

Acceleration↗
PubMed1976

Muscle responses during sudden falls in man.

1. E.m.g. activity in soleus during an unexpected fall is found to be more complex than that described by Melvill Jones & Watt (1971b). After a silent period of about 80 msec an initial peak of activity lasts until about 100 msec after release. In falls from sufficient heights a second peak of activity occurs before landing. 2. The initial peak of activity is found in muscles throughout the body and is absent during falls in which the subject releases himself. It is suggested that this initial peak is a startle response to release and on landing during the initial peak any deceleration due to tension in the leg muscles is in part coincidental. 3. The second peak of activity is found in muscles of the lower limbs. Its timing is related to the timing of landing. It is suggested that this is the activity concerned in thhe voluntary control of landing. 4. No initial peak of activity could be recorded in two patients with absent labyrinthine function.

Acceleration↗
PubMed1976

Clinical observations on treatment of alkylmercury poisoning in hospital patients.

Twenty-six patients suffering from methylmercury poisoning were treated by different therapeutic regimes. Seven received penicillamine or N-acetyl-d-L-penicillamine, 10 were treated with dimercaprol sulfonate and 9, who could not be treated, were given a placebo and were used as controls. Penicillamine, N-acetyl-d-L-penicillamine, and dimercaprol sulfonate reduced the blood level of mercury and increased its urinary excretion. No appreciable clinical improvement was noticed among the severe or very severe cases, while mild or moderate cases improved clinically irrespective of the treatment given.

Adolescent↗