PubMed Health⌕ Search

Biomedical subjects

W R North

Publications and source records attributed to W R North.

At least 19 recordsLinked to original sources
PubMed1990

'Close shave' in anterior resection.

Of 192 anterior resections for rectal cancer performed over 10 years by one author (R.J.H.), 169 (88 per cent) included total mesorectal excision and all included lavage of the clamped distal rectum. Of this series, 152 (79 per cent) were classed as curative, 110 with a resection margin greater than 1 cm and 42 with a resection margin less than or equal to 1 cm. The group with a greater than 1 cm margin had a significantly lower Dukes' A to B ratio than the group with a margin less than or equal to 1 cm, although the proportion with Dukes' C lesions was similar in both groups (chi 2 = 6.712; P = 0.035). There were no local recurrences in the latter group (95 per cent confidence interval (CI) is 0-5.9 per cent) while there were four (3.6 per cent) in the former group (95 per cent CI is 0.8-7.4 per cent). There were no significant differences in recurrence rates, local and distant, between the two groups (Fisher's exact test, P = 0.2). Reduction of resection margin, provided total mesorectal excision and washout is properly performed, does not increase local recurrence or compromise survival.

Aged↗
PubMed1990

Selection of patients with breast cancer for routine follow-up bone scans.

Routine radionuclide bone scans have not been considered cost-effective for the routine follow-up after treatment of primary breast cancer. However subgroups of patients exist in whom early relapse in the skeleton is likely and this study examines again the role of the bone scan in routine follow-up. Serial radionuclide bone scans were performed every 6 months during the first 2 years of follow-up of 560 patients with breast cancer. Tumor characteristics which predict early relapse in bone were identified and the scan conversion rate from negative to positive determined for each prognostic group. A total of 199 (28%) of patients have relapsed, 50 (9%) with first recurrence in bone within two years of diagnosis. All were identified on the bone scan with a median lead time of 4 months over radiological evidence of bone involvement. The overall scan conversion rate was 2.8%. This was significantly higher in poor prognosis patients with T4 tumours (6.3%), more than four involved axillary lymph nodes (6.1%) and inoperable tumours (6.5%), than in good prognosis patients with T1 tumours (1.1%), negative axillary lymph node involvement (1.2%) or well-differentiated ductal grade tumours (1.1%). We do not recommend routine bone scans in the follow-up of all patients with breast cancer. In patients with a good prognosis after primary treatment they cannot be considered cost-effective. However, in those with features which predict early recurrence in the skeleton the frequency of scan conversion is sufficient to justify serial bone scanning during the first two years of follow-up.

Adult↗
PubMed1989

Stress and relapse of breast cancer.

To elucidate the association between stressful life events and the development of cancer the influence of life stress on relapse in operable breast cancer was examined in matched pairs of women in a case-control study. Adverse life events and difficulties occurring during the postoperative disease free interval were recorded in 50 women who had developed their first recurrence of operable breast cancer and during equivalent follow up times in 50 women with operable breast cancer in remission. The cases and controls were matched for the main physical and pathological factors known to be prognostic in breast cancer and sociodemographic variables that influence the frequency of life events and difficulties. Severely threatening life events and difficulties were significantly associated with the first recurrence of breast cancer. The relative risk of relapse associated with severe life events was 5.67 (95% confidence interval 1.57 to 37.20), and the relative risk associated with severe difficulties was 4.75 (1.58 to 19.20). Life events and difficulties not rated as severe were not related to relapse. Experiencing a non-severe life event was associated with a relative risk of 2.0 (0.62 to 7.47), and experiencing a non-severe difficulty was associated with a relative risk of 1.13 (0.38 to 3.35). These results suggest a prognostic association between severe life stressors and recurrence of breast cancer, but a larger prospective study is needed for confirmation.

Adult↗
PubMed1988

Prednisolone improves the response to primary endocrine treatment for advanced breast cancer.

Two hundred and twenty patients with progressive advanced breast cancer were given primary endocrine treatment (PET) according to menstrual status. Pre-menopausal patients received ovarian irradiation (O) and post-menopausal tamoxifen 10 mg bd (T). Patients were randomised to receive either no additional treatment or prednisolone 5 mg bd (P). Similar results were observed in each menstrual subgroup. In 194 evaluable patients, the response to PET + P was 49% and to PET alone 30% (P less than 0.01). P increased the median duration of response from 9 to 14 months (P less than 0.002) and the median time to disease progression from 5 to 9 months (P less than 0.001). Response to P after O or T alone occurred in only 2/62 (3%). Median survival in patients randomised to receive P at the outset of PET was prolonged by 4 months (P less than 0.05). The addition of P significantly improves the response to O or T in the treatment of advanced breast cancer.

Adult↗
PubMed1988

Assessment of trace metal intake and status in a Gujerati pregnant Asian population and their influence on the outcome of pregnancy.

Dietary assessments and biochemical indices including plasma zinc and copper were determined in pregnant vegetarian and non-vegetarian Gujerati women in India at 28 weeks gestation, and the results were contrasted with those of a comparable group of Gujerati pregnant women living in Harrow. Even though the dietary intake of energy, protein and zinc was significantly lower in the Indian vegetarian Gujerati group when compared to the equivalent group in Harrow, the birthweights of the babies delivered at term were similar. The intake of zinc in the diet of the Gujerati Indian vegetarian and non-vegetarian groups was only one quarter of the US recommended intake during pregnancy and was approximately one half in the Harrow Indian groups. Even so, the plasma concentrations of zinc were similar in all dietary groups in either India or Harrow. The albumin content in the plasma of both the Gujerati Indian vegetarian and non-vegetarian was significantly reduced when compared to the equivalent Harrow dietary groups. The plasma concentrations of both calcium and sodium were significantly correlated with the albumin concentration but not with the plasma content of zinc. Copper levels were elevated to the normal range in both dietary groups of the Gujerati and were similar to the concentrations found in the Harrow groups.

Birth Weight↗
PubMed1987

Diets of Asian pregnant women in Harrow: iron and vitamins.

In a study of the Asian pregnancy, the dietary intakes of 813 Asians and 54 Europeans living in Harrow were compared. Results of calculation of intakes of iron and vitamins are presented in this paper. The key findings were that vitamins D and B12 intakes were markedly lower amongst the Asians, particularly the Hindu vegetarians. Asians had lower intakes of other vitamins but these levels are unlikely to lead to deficiency and therefore not relevant in clinical terms. The Hindu vegetarians can be regarded as a fairly homogenous group with differences occurring within the group only in vitamin B12 intake. From the nutritional data it appears unnecessary to advocate any change in the Gujarati diet other than supplementation with vitamin D.

Asia↗
PubMed1986

Randomised trial of community-based centre versus conventional hospital management in treatment of alcoholism.

151 problem drinkers (105 men and 46 women) were recruited from the general medical and psychiatric services of a district general hospital and were allocated randomly to a community-based day centre (ACCEPT) or standard hospital inpatient and outpatient services. 115 patients (79%) were followed up at 12 months. The group as a whole showed improvement in all outcome indices at the 3-month follow-up, and this was maintained at 6 and 12 months. Patients assigned to ACCEPT services claimed to have reduced their alcohol intake (55%) more than their hospital counterparts (37%), and this was confirmed by their informants. Patients referred from the psychiatric services reduced their alcohol intake more than those from general medical services. It is concluded that treatment at a community day centre is at least as cost effective as hospital treatment of alcohol abuse.

Adolescent↗
PubMed1986

Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study.

The Northwick Park Heart Study (NPHS) has investigated the thrombotic component of ischaemic heart disease (IHD) by the inclusion of measures of haemostatic function. Among 1511 white men aged between 40 and 64 at the time of recruitment, 109 subsequently experienced first major events of IHD. High levels of factor VII coagulant activity and of plasma fibrinogen were associated with increased risk, especially for events occurring within 5 years of recruitment. These associations seemed to be stronger than for cholesterol, elevations of one standard deviation in factor VII activity, fibrinogen, and cholesterol being associated with increases in the risk of an episode of IHD within 5 years of 62%, 84%, and 43% respectively. Multiple regression analyses indicated independent associations between each of the clotting factor measures and IHD but not between the blood cholesterol level and IHD incidence. The risk of IHD in those with high fibrinogen levels was greater in younger than in older men. Much of the association between smoking and IHD may be mediated through the plasma fibrinogen level. The biochemical disturbance leading to IHD may lie at least as much in the coagulation system as in the metabolism of cholesterol.

Adult↗
PubMed1985

Zinc and copper in Asian pregnancies--is there evidence for a nutritional deficiency?

In 92 Hindu Asians, 59% of them vegetarian, and 51 Europeans longitudinal measurements were made during pregnancy of the zinc and copper concentrations in plasma and hair together with urinary zinc excretion, as indices of their zinc and copper status. Maternal diets were assessed once at booking. Zinc intakes ranged from 3.1 to 16.9 mg/day, with average intakes least in vegetarian Hindus and most in Europeans. Average copper intakes ranged between 1.48 and 1.80 mg/day and were similar in the three patient groups. Both ethnic groups showed the pregnancy-associated fall in the plasma concentration of zinc and rise in that of copper but throughout the study Hindus had statistically significant lower levels of zinc and higher levels of copper than Europeans. Urinary zinc excretion was not only significantly lower throughout the study in Hindus than in Europeans but the increase in excretion which occurred after 20 weeks gestation was smaller. There were no ethnic differences in the zinc content of hair. Urinary zinc excretion correlated with both plasma zinc levels and dietary zinc. Mean birthweight in the Hindus was 2912 g and 34% of infants were below the 10th centile, using the Aberdeen standards, compared with 6% of the European babies (mean birthweight 3349 g). No association was found between crude or adjusted birthweight and any of the measures of zinc or copper status in either ethnic group. The Hindus had an apparently lower average zinc status than the Europeans, but there was no evidence that this had acted as a nutritional constraint and was the cause of their slower rate of intrauterine growth.

Adult↗
PubMed1985

Diet during pregnancy in an Asian community in Britain--energy, protein, zinc, copper, fibre and calcium.

Dietary intake of 813 pregnant Harrow Asians of mainly Gujarati descent was compared with the intake of 54 pregnant Europeans living in the same area. The diet of the Europeans had more protein and zinc but less fibre and fat that that of the Harrow Asians. The average rate of weight gain and the energy intakes were similar in both groups. Hindu non-vegetarians and Muslim non-vegetarians differed somewhat, because the Hindus, who are more recent converts to meat-eating, have diets with a lactovegetarian basis to which small amounts of meat have been added. Among the Hindu vegetarians, those who ate eggs and cheese had higher protein and zinc intakes, but otherwise Hindu vegetarians can be regarded as a fairly homogeneous group. Although the protein and zinc intakes of the Asians, particularly the vegetarians, were lower than those of the Europeans, there was no evidence of adverse consequences to the mother and fetus.

Adult↗
PubMed1985

The relationship between daily ethanol consumption, haematological and hepatic indices of toxicity and severity of alcohol dependence in problem drinkers presenting at a district general hospital.

Daily ethanol consumption, routine laboratory tests and severity of alcohol dependence were investigated in a sample of 127 problem-drinkers, presenting at a district general hospital. Ethanol consumption correlated significantly with severity of dependence, but not with laboratory tests of haematological and hepatic toxicity.

Adolescent↗
PubMed1984

Haemostasis in normal pregnancy.

A study has been undertaken in 72 women to provide systematic information on the changes that occur in a wide range of haemostatic variables during and after pregnancy. Factors VII, VIII:C, VIIIR:Ag, X, fibrinogen and alpha 1-antitrypsin, rose markedly throughout pregnancy. Factors II and V and alpha 2 macroglobulin all rose early on but then decreased steadily. Antithrombin III:C and Ag fell slightly. There was a marked decrease in fibrinolytic activity from 11-15 weeks onwards. Levels of fibrin degradation products rose from 21-25 weeks onwards. The rise in coagulation factors that occurs could be due to increased synthesis or increased activation by thrombin, or to both. The findings are consistent with a mild degree of local intravascular coagulation from early on in pregnancy in some women.

Antigens↗
PubMed1984

Factors affecting birthweights in Hindus, Moslems and Europeans.

The birthweights of 664 Hindu and 132 Moslem babies were compared with those of 486 European babies born at the same hospital. The mean birthweight of the Europeans was 3362 g, compared with 3146 g for the Moslems and 2960 g for the Hindus. The Asian women were smaller than the European and tended to have a shorter length of gestation. Forty-four per cent of the Asians and 46% of the European mothers were of social classes I and II; 28% of the Europeans and 2% of the Asians smoked. There were no significant differences between Asians and Europeans in the effects of maternal size, parity, gestational age and fetal sex on birthweight. After adjustment for these variables and for cigarette smoking there was no significant difference in birthweight between the Moslems and the Europeans, but the mean birthweight of the Hindus was about 190 g lighter than that of the Europeans. Hindus from East Africa had lighter babies than those from India.

Asia↗
PubMed1983

Haemostatic variables and the outcome of myocardial infarction.

In a study of 272 patients with myocardial infarction (MI) the 68 who died within 1 year had significantly higher levels of factor VIIIR:Ag, factor VIII:C, fibrinogen, alpha 1 antitrypsin and alpha 2 macroglobulin than those who survived. The mean white cell count (WCC) and peak creatine kinase (CK) were also significantly higher in those who died compared with the survivors. There was considerable intercorrelation between many of the haemostatic variables, WCC and CK as well as between many of the clinical predictors of outcome and the laboratory variables. The differences in haemostatic variables between those who died and those who survived may merely reflect the size of the infarct; alternatively, the haemostatic system may influence prognosis following an MI.

Antigens↗
PubMed1982

Common units for clotting factors assayed against different standards.

There are no generally accepted units for clotting factors except factor VIII. Results are usually expressed as percentages of the standards used in the assays and standards vary in their potency. Over a six year period, factors V, VII and VIII were measured in over 3000 participants in the Northwick Park Heart Study. Six different standards had to be used. For comparative purposes, all results were expressed in terms of the first standard (71/11). This paper describes how appropriate conversion values were derived. Three different methods were compared. One consisted of the assay of each standard against its replacement. Another was based on the use of a reference plasma spanning the use of two successive standards. The third was a population-based, or epidemiological method using the data from all the participants in the study. This method is based on the assumption that results would be the same in comparable groups of study participants. In order to ensure comparability, personal characteristics which affect clotting factor levels, such as age and degree of obesity, were taken into account. The three methods gave similar results but the population method was, in general, the most satisfactory for factor VIII as well as factors V and VII, and has been adopted for routine use.

Adolescent↗