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1.  Importance of district of residence and known primary site for bowel cancer survival: analysis of data from Wessex Cancer Registry. 
STUDY OBJECTIVE--The aim was to compare survival with colon and rectal cancer across the 10 districts of Wessex taking into account the age and sex of the individual. DESIGN--The study was based on registrations on the Wessex Cancer Registry between 1979 and 1984 with colon and rectal cancer. Survival up to 31 December 1986 was examined using a Cox regression model; individuals surviving to the end of the follow up period were treated as censored in the analysis. Survival was examined in the first fortnight, the first month, and the first six months after registration separately. PARTICIPANTS--The data comprised 6239 residents of the Wessex Region who had been diagnosed with colon cancer and 3203 residents diagnosed with rectal cancer. For 140 cases survival data or age were missing and these cases were excluded. MEASUREMENTS AND MAIN RESULTS--Results are presented in the format of a league table giving the order of districts from lowest to highest survival rates. No significant differences in survival are found between districts in relation to rectal cancer. We find that one or two districts have consistently high or low survival rates with colon cancer in various periods of follow up, but cannot differentiate between the districts in the centre of the list. Site unspecified is considered as an explanatory variable; it is more predictive than district, and it approaches the importance of age in explaining survival with colon cancer. CONCLUSIONS--There are significant differences in survival with colon cancer between districts; however data on stage at registration are not available and we are unable to say whether the differences in survival are due to differences in stage at diagnosis or differences in survival with similar stage at diagnosis. We found that cases where the site of the cancer within the colon was not recorded on the register have significantly lower survival, and we suggest that site unspecified may be related to stage at diagnosis.
PMCID: PMC1059565  PMID: 1645084
3.  Relative risks of low birthweight in Scotland 1980-2. 
Routinely collected data for 187,000 Scottish singleton livebirths in 1980-2 were used to relate the risk of birthweight below 2500 g, 2000 g, 1500 g, and 1000 g to sex of infant and nine maternal factors. Maternal height was a major predictor of birthweight below 2500g but was less important in predicting birthweight in the lower intervals. A history of prenatal death and spontaneous abortion was important for all four intervals and was associated with most extreme risks for birthweight below 1000 g. The analysis confirms that the patterns of risk of birthweight below 2500g and 2000 g associated with social class, marital status, and maternal age and height found among the women of the 1958 cohort of British births are still applicable in the early 1980s.
PMCID: PMC1052598  PMID: 3498784
4.  Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study 
BMJ : British Medical Journal  2000;320(7239):906-908.
Objective
To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people.
Design
Observational study.
Setting
General practice with four centres in Poole, Dorset.
Participants
155 elderly patients aged 70 to 84 years.
Main outcome measures
Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography.
Results
The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%.
Conclusions
Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to “rule in” the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early.
PMCID: PMC27331  PMID: 10741999
5.  Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey 
BMJ : British Medical Journal  1999;318(7180):368-372.
Objective
To assess the prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function.
Design
Cross sectional survey.
Setting
Four centre general practice in Poole, Dorset.
Subjects
817 elderly patients aged 70-84 years.
Main outcomes
Echocardiographic assessment of left ventricular systolic function including measurement of ejection fraction by biplane summation method where possible, clinical symptoms, and signs of left ventricular dysfunction.
Results
The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was considerably more prevalent than moderate (1.6%) or severe dysfunction (0.7%). Measurement of ejection fraction was possible in 82% of patients (n=667): in patients categorised as having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed.
Conclusions
Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown.
Key messagesLeft ventricular dysfunction detected by echocardiography is common in elderly peopleMen are much more likely to be affected than womenThe accuracy of clinical diagnosis is very limited in this age groupMany patients who would benefit from treatment remain undetected
PMCID: PMC27725  PMID: 9933201
6.  Prognostic indicators in a range of astrocytic tumours: an immunohistochemical study with Ki-67 and p53 antibodies. 
The treatment and prognosis of patients with cerebral astrocytic tumours are currently guided by histopathological classification. This study evaluates immunohistochemistry using Ki-67, an antibody to a nuclear protein expressed in proliferating cells, and DO-7, an antibody to the product of the tumour suppressor gene p53, as prognostic indicators for these tumours. Immunohistochemistry with Ki-67 has been correlated with the behaviour of many different tumours, but its value as a prognostic indicator in astrocytic tumours is diminished by the conflicting results of previous studies. Immunohistochemistry with antibodies to the p53 protein has been used as a prognostic indicator in melanomas and some carcinomas, but the relation between prognosis and accumulation of this protein in astrocytic tumours has not been clarified. We have tested the hypothesis that survival is correlated with Ki-67 immunolabelling indices (LIs) and patterns of p53 immunolabelling in the cerebral astrocytic tumours of a large cohort of patients (n = 123) for whom clinical indices were well documented. Astrocytic tumours were divided into three histological types: fibrillary astrocytoma (n = 24), anaplastic astrocytoma (n = 31), and glioblastoma (n = 68). Histological type and patient age were independent predictors of survival. Median Ki-67 LIs differed significantly (P < 0.0001) between the types of astrocytic tumour, and tumours with a Ki-67 LI < 2% had a significantly (P < 0.0001) better prognosis. Ki-67 LI as a continuous variable carried a significant (P = 0.0043) unadjusted hazard to survival which was lost when adjusted for other variables, notably histological type. By contrast, no relation was found between survival and three categories of p53 labeling (p53-negative, p53 LI < 40%, and p53 LI > 60%). The results indicate that, whereas Ki-67 immunohistochemistry predicts survival in patients with astrocytic tumours, conventional histological appraisal remains the best guide to prognosis, and immunohistochemistry for p53 has no value in the assessment of these tumours.
Images
PMCID: PMC486079  PMID: 7561922
8.  Role of right ventricular endomyocardial biopsy in infants and children with suspected or possible myocarditis. 
British Heart Journal  1994;72(4):360-363.
OBJECTIVES--To assess the diagnostic yield, sampling errors, risks, and therapeutic implications of right ventricular endomyocardial biopsy in children with suspected or possible myocarditis. DESIGN--Retrospective study. SETTING--Tertiary referral centre for paediatric cardiology, cardiac surgery, heart transplantation, and mechanical circulatory support. PATIENTS AND METHODS--Review of clinical and histological findings among 63 consecutive children with possible myocarditis undergoing right ventricular endomyocardial biopsy. Review of cardiac histology at subsequent necropsy or after explantation at time of transplantation. RESULTS--From January 1980 to December 1992, 76 biopsies were performed in 63 children (2 weeks to 18 years of age). In 41 cases, the biopsy was performed for evaluation of dilated cardiomyopathy. The median interval from onset of symptoms was one month. Eight children (20%; all with a history of less than six weeks duration) had biopsy proved myocarditis. Five of the eight children made a full recovery, including four who presented in cardiogenic shock. By contrast, only three of 33 children without evidence of myocarditis showed recovery of ventricular function. The whole heart was available for histological examination in 23 patients. Myocarditis was confirmed in one patient, and no evidence of myocarditis was found in the remaining 22 (all with negative biopsies). One procedure related death occurred in a 2 week old infant with dilated cardiomyopathy. In 22 cases, biopsy was performed for the evaluation of arrhythmia. Only one biopsy showed myocarditis. CONCLUSIONS--The diagnostic yield of a biopsy is low in children with arrhythmias. In children presenting with profound ventricular dysfunction, a diagnosis of acute myocarditis may avoid premature consideration of transplantation as this group has an important potential for full recovery. In less critically ill patients and in those with a longer duration of symptoms the justification for biopsy is not as clear and the procedure is not without risk.
PMCID: PMC1025547  PMID: 7833195

Results 1-8 (8)