Search

A cohort study of 1425 persons with Down's syndrome (DS), and of their parents (447 mothers, 435 fathers) and siblings (1176), was set up to investigate death rates from various causes and cancer incidence patterns. In individuals with DS the all-cause death rate was six times that of the national population (SMR = 622: 95% CI 559-693), the excess being attributable to many different causes. These included: leukaemia (SMR = 1304: 95% CI 651-2334); diabetes mellitus (SMR = 982: 95% CI 267-2515); Alzheimer's disease (SMR = 22028: 95% CI 7137-51326); epilepsy (SMR = 1727: 95% CI 744-3403); and congenital anomalies (SMR = 4987: 95% CI 4175-5955). The overall survival showed marked improvements for successive birth cohorts, particularly at young ages. For mothers and fathers of persons with DS, all-cause death rates were 20% lower than national rates and there were no significant excesses from any specific cause. For siblings, all-cause death rates were similar to national rates; the only condition with a significantly raised mortality ratio was colo-rectal cancer (SMR = 793: 95% CI 216-2031), but this may well be a chance finding.

Mortality and cancer incidence were assessed in a cohort of 1373 patients with numerical sex chromosome abnormalities diagnosed at three cytogenetics centres in Britain during 1959-90, and were compared with expectations from national rates. Four hundred patients with Turner's syndrome were followed, of whom 62 died, with a relative risk (RR) of death of 4.16 (95% confidence interval (CI) 3.22-5.39). Turner's syndrome patients had greatly raised risks of death from diseases of the nervous, cardiovascular, respiratory, digestive and genitourinary systems. One hundred and sixty three deaths occurred among 646 patients with Klinefelter's syndrome with a 47,XXY constitution, giving an RR of 1.63 (1.40-1.91). Mortality in these patients was significantly raised from diabetes and diseases of the cardiovascular, respiratory and digestive systems. There was also significantly increased mortality for patients with X polysomy (RR = 2.11 (1.43-3.02)) and Y polysomy (RR = 1.90 (1.20-2.85)), the former with significantly increased mortality from cardiovascular disease and the latter from respiratory disease. The only significantly raised risks of cancer incidence or mortality in the cohort were for lung cancer and breast cancer in patients with Klinefelter's syndrome with a 47,XXY constitution, and non-Hodgkin's lymphoma in men with more than three sex chromosomes.

The UK National Case-Control Study was carried out to investigate the relationship between oral contraceptive use and breast cancer risk. This study investigates whether general practitioner notes could be used as the sole data source for epidemiological studies of young women and what the effect would be on non-response and recall bias.

Human papillomaviruses (HPVs) play an important part in the development of cervical cancer, but the role of other infectious agents, such as herpes simplex virus (HSV), is not clear. We assayed serum samples collected from 219 women with cervical cancer and from 387 controls for antibody to infectious agents. HPV 16-E7 and/or HPV 18-E7 antibodies were significantly related to cervical cancer risk (RR 1·9, 95% Cl 1·2-3·2). Antibodies to HSV types 1 and 2, Chlamydia trachomatis, and to multiple infectious agents were associated with cervical cancer when seroprevalence rates in all cases and controls were compared, but when HPV-seropositive cases and controls were compared these associations were weaker and non-significant. This finding suggests that past infections with sexually transmitted infections other than HPV may be surrogate markers of exposure to HPV, and of no separate aetiological significance.

To test the hypothesis that high levels of endogenous oestrogens increase the risk for developing breast cancer, concentrations of oestrone, oestradiol and oestriol were measured in 24 h urine samples from 1000 women participants in a prospective study of breast cancer on the island of Guernsey. Sixty-nine subjects were diagnosed with breast cancer subsequent to urine collection. Among women who were premenopausal at the time of urine collection, cases excreted less oestrogen than controls; the odds ratios (95% CI) for breast cancer in the middle and upper thirds of the distribution of oestrogen excretion, in comparison with the lower third (reference group, assigned odds ratio = 1.0), were 0.5(0.2-1.2) and 0.4(0.2-1.1) respectively for oestrone, 0.8(0.4-1.8 and 0.4(0.2-1.1) for oestradiol, 0.7(0.3-1.6) and 0.7(0.3-1.6) for oestriol and 0.9(0.4-2.0) and 0.5(0.2-1.3) for total oestrogens. Among women who were post-menopausal at the time of urine collection, the trend was in the opposite direction, with an increase in risk associated with increased oestrogen excretion; the odds ratios were 0.9(0.3-2.2) and 1.1(0.5-2.8) for oestrone, 0.8(0.3-2.3) and 1.9(0.8-4.6) for oestradiol, 1.5(0.6-3.9) and 1.8(0.7-4.6) for oestriol and 0.9(0.4-2.6) and 1.9(0.7-4.7) for total oestrogens. The trends of increasing risk with increasing oestrogen excretion among post-menopausal women were statistically significant for oestradiol (P = 0.022) and for total oestrogens (P = 0.016). We conclude that high levels of endogenous oestrogens in post-menopausal women are associated with increased breast cancer risk, but that the relationship of oestrogens in premenopausal women with risk is unclear.

A proportionate study was carried out of the causes of death of the 759 Vegetarian Society members whose deaths were recorded in Society records and whose death certificates could be traced. Compared to the general population, a lower proportion of deaths from respiratory diseases and from lung cancer was noted particularly in long-standing members, consistent with the evidence that vegetarians smoke less than the average. The proportion of deaths from colorectal cancer was slightly lower than in the general population but there was no reduction in the proportions of deaths from other diseases that have been linked with meat or fat consumption, such as cardiovascular diseases and breast cancer. The proportions of deaths from stomach cancer and from accidents and violence were greater than expected. The significance of the findings is discussed and also the possible limitations of the proportionate method of analysis in relation to studies of vegetarians.

Cigarette smoking is associated with a reduction in the risk for endometrial cancer in post-menopausal women and it has been suggested that this is because smoking has an anti-oestrogenic effect. To investigate this, concentrations of oestrone, oestradiol and oestriol were measured in 24 h urine samples from 167 premenopausal women (53 smokers, 114 non-smokers) and 200 post-menopausal women (54 smokers, 146 non-smokers). Among premenopausal women there were no significant differences in oestrogen excretion between smokers and non-smokers. Among post-menopausal women, geometric mean excretion rates for oestrone and oestradiol did not differ significantly between groups, but oestriol excretion was 19% lower (95% confidence interval -34% to -1%) in smokers than in non-smokers. This may partly explain the reduced risk for endometrial cancer among post-menopausal smokers.

Age-standardised mortality rates for breast cancer were examined for 20 countries in Europe, North America, Australia and New Zealand from 1950 to 1992 and age-birth cohort and age-period of death models were fitted to the data. Breast cancer mortality rates generally increased in the earlier decades, but more recently rates have levelled off or begun to decline in most countries. Only in 4 of the 20 countries studied, Belgium, Hungary, Poland and Spain, was there no evidence of a decline or leveling off or mortality in recent birth cohorts or in recent years. In the other countries the decline in mortality appeared to be in part due to birth cohort effects and in part due to period effects. The birth cohort effects were suggestive of a decline in breast cancer rates among women born after about 1920 and were evident in many countries especially Canada, The Netherlands, The United Kingdom and the United States. The decline in mortality in women born after 1920 appeared to be in part related to a reduction in childlessness and a reduction in age at first birth in those generations. As well as the birth cohort effects, there was some evidence of a recent overall decline in mortality rates in several countries, e.g. Austria, FRG, Greece and the UK, and this may be due to an increase in survival resulting from improved management and treatment of women with breast cancer.

The distribution of mortality from 11 causes of death (lymphoid leukaemia, other leukaemia, leukaemia of all types, Hodgkin's disease, other lymphomas, all lymphomas, multiple myeloma, lung cancer, other malignancies, all malignancies and all other causes) has been examined in three age groups throughout England and Wales over the period 1969-78. The reorganisation of local authority administration in 1974 meant that the smallest areas that could be examined were 400 county districts or (in some cases) approximate county districts formed by aggregating pre-1974 local authority areas. The variation in the numbers of deaths observed about the numbers expected was assessed using log-linear models to estimate the effect on the relative risk in each district associated with social class, rural status, population size, health authority region and proximity to one of 15 nuclear installations. Trends in risk with increasing proximity to an installation (as judged by the proportion of the population resident within 10 miles) were examined after adjustment for the other four variables. The results showed that in districts near to an installation there were significant excess mortalities in persons under 25 years of age from leukaemia (RR = 1.15, P = 0.01) and especially from lymphoid leukaemia (RR 1.21, P = 0.01) and from Hodgkin's disease (RR 1.24, P = 0.05) and a significant deficiency of mortality from lymphoid leukaemia in persons aged 25-64 years. No significant trends were observed with an increasing proportion of the population near to the installations and the greatest excess mortality from lymphoid leukaemia in young persons was observed in the districts with the intermediate proportion of the population (10.0-65.9%) near an installation.

Hematuria is always an alarming symptom and its cause must be carefully sought by the conscientious physician. If there are repeated short spells of bleeding a malignant lesion somewhere in the urinary tract should be suspected. When the bleeding is associated with dysuria and occurs in the earlier part of life, a tuberculous infection would be a more probable cause; if bleeding is accompanied by severe colic, the presence of calculus is suggested. When hematuria is painless and of long duration, disappearing for weeks at a time, the possibility that it is of the so-called idiopathic or essential type must be considered.In order to make this diagnosis, cystoscopic examination is necessary, at which, all other causes of bleeding being excluded, a diagnosis of essential hematuria is reached by the process of elimination. Some urologists are of the opinion that such a diagnosis serves as a cloak for ignorance of

A perusal of the literature or of statistics relative to malignancy of the bladder inevitably leaves the reviewer with three major impressions: (1) the lack of a uniformity in the classification of tumors of the bladder; (2) the variety of methods employed in their treatment, and (3) the depressingly poor results obtained.Improvement in classification is essential before the value of any method of treatment can be determined. It is obvious that no deductions of value are possible so long as various investigators report their cases under entirely different classifications. Not until a uniform nomenclature has been adopted can the best type of treatment be selected and the final results from such treatment improve.The present confusion with regard to classification is best appreciated after a review of some of the recent reports on malignancy of the bladder. Kidd 1 refers to simple papillomas, inflammatory papillomas, true papillomas, simple primary

The anatomic structure and innervation of the urinary tract lends itself so readily to the application of regional anesthesia that the history of anesthesia in urology becomes necessarily the history of the development of regional anesthesia. In fact, some of the various forms of regional anesthesia were first employed in the treatment of urologic diseases.As in the case of ether, so with regional anesthetics the discovery of its anesthetic properties occurred many years before they were applied in medicine because those making the discovery did not appreciate the importance of it.In prehistoric times the natives of Peru were cognizant of the anesthetic qualities in coca leaves; they were chewed and the saliva was allowed to run into the incision while the famous trephine operations were being performed.Schezer obtained some of these when on his scientific voyage around the world in the Austrian frigate Novar, and observed that

There is a remarkable difference of opinion among neurologists, internists and epidemiologists, with regard to the identity of Landry's paralysis: some contending that the acute ascending or rare descending type of paralysis originally described by Landry is simply a form of poliomyelitis, whereas others contend that Landry's paralysis is an independent symptom complex, not due to the specific virus of poliomyelitis, but due to some unknown form of toxin, bacterial, metabolic or chemic in nature, which seems to have a special affinity for the peripheral motor neurons. With this view, I am inclined to agree, having had the opportunity to

The possibility that renal tuberculosis, once it has reached the point at which diagnosis is beyond question, ever heals has received considerable discussion during the last fifteen years. In 1920 Chute1 reviewed three cases that occurred in his practice; he considered that there were indications in occasional cases that tuberculous processes of the kidney healed. He pointed out how such a belief is necessary if one is to accept the hypothesis of the hematogenous route of the infection. He says:I believe we must assume that tubercle bacilli are brought in approximately equal numbers to both kidneys, that small cortical tuberculous infections are common and that far from going on to complete destruction of every kidney that is infected they are probably promptly stamped out in the greater majority of instances. The generous blood supply of the kidney allows it to overcome perhaps the greater number of infections while

The earliest attempts to correct urinary obstruction, the result of prostatic hypertrophy by major surgical means, consisted in the transvesical resection of that portion of the hypertrophied gland projecting into the bladder. When only this portion of the gland was causing the obstruction the results were good, but as in most cases of intravesical hypertrophy intra-urethral hypertrophy is associated, the symptoms were frequently not relieved because the intra-urethral obstruction remained.For this reason the idea developed that partial removal of the prostate gland was not sufficient, and that to accomplish relief the entire organ had to be removed in addition to the portion that was causing the obstruction. This dictum was generally accepted, although it seemed strange to certain observers that a gland weighing from 20 to 30 Gm. had to be completely removed simply because a small part had begun to obstruct so accessible a channel as the prostatic

Tumors involving the white matter of the parietal lobe are not common, and relatively rare are those of an infiltrating type that involve by direct pressure or actual destruction the sensory or motor neurons of the corona radiata or internal capsule.The case of tumor herein recorded, therefore, is interesting because its location and growth was such that it gradually involved by pressure and in-growth the fibers of the foot of the corona radiata and those of the posterior part of the dorsal limb of the right internal capsule. It implicated in a most selective manner the thalamocortical sensory path

The so-called false or acquired diverticula of the small intestine have been of very little interest to clinicians because of their supposed rare occurrence and also because it was thought that they rarely or never give rise to any clinical symptoms.The following case with multiple mesenteric diverticula of the small intestine shows that, apparently, even in these heretofore considered benign diverticula inflammatory changes may occur which may give rise to clinical symptoms and even endanger the life of the individual. In this case, apparently, one of the diverticula became inflamed and a diverticulitis occurred, causing a partial obliteration of the diverticulum. As the diverticulum extended between the folds of the mesentery, the later became inflamed, thickened and puckered, thus causing an angular bending of the intestine and obstructing its lumen. The local peritonitis arising as the result of this gave rise to the formation of adhesions between the mesentery