151
|
Bates D. A Colour Atlas of Stroke: Cerebrovascular Disease and its Management. Journal of Neurology, Neurosurgery and Psychiatry 1987. [DOI: 10.1136/jnnp.50.9.1249-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
152
|
Bates D. Syringobulbia: A Contribution to the Pathophysiology of the Brainstem. Journal of Neurology, Neurosurgery and Psychiatry 1987. [DOI: 10.1136/jnnp.50.8.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
153
|
Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke 1987; 18:700-7. [PMID: 3496690 DOI: 10.1161/01.str.18.4.700] [Citation(s) in RCA: 342] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As part of a prospective study of the neurologic and neuropsychological complications of coronary artery bypass graft surgery, 312 patients were compared with a control group of 50 patients undergoing major surgery for peripheral vascular disease. The purpose of comparing the 2 groups was to determine to what extent neurologic complications after heart surgery can be attributed to cardiopulmonary bypass. The 2 groups were similar with respect to age, preoperative neurologic and intellectual status, anesthetic methods, duration of operation, perioperative complications, and time spent in the intensive therapy unit. Certain potential risk factors for cerebrovascular disease were more common in the control than the coronary bypass patients. The important difference between the 2 groups was that only the latter group underwent cardiopulmonary bypass. In this group 191 of 312 (61%) and 235 of 298 (79%), respectively, developed early neurologic and neuropsychological complications. By the time of hospital discharge 17% had neurologic disability and 38% had significant neuropsychological symptoms. In the control group 9 of 50 (18%) developed neurologic complications resulting largely from trauma to lower limb sensory nerves. Two patients developed primitive reflexes. Fifteen of 48 (31%) showed neuropsychological impairment on 1 or 2 subtest scores. Moderate or severe intellectual dysfunction was not seen in the control patients in contrast to the 24% thus affected in the coronary bypass group. The difference in frequency and severity of central nervous system complications between the 2 groups is likely to reflect cerebral injury resulting from cardiopulmonary bypass.
Collapse
|
154
|
Shaw PJ, Bates D, Cartlidge NE, Heaviside D, French JM, Julian DG, Shaw DA. Neuro-ophthalmological complications of coronary artery bypass graft surgery. Acta Neurol Scand 1987; 76:1-7. [PMID: 3498286 DOI: 10.1111/j.1600-0404.1987.tb03535.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In a prospective study of neurological complications of coronary bypass surgery, detailed pre- and post-operative bedside ophthalmological evaluation was undertaken in 312 patients. Post-operative neuro-ophthalmological complications developed in 80/312 (25.6%) patients and included: areas of retinal infarction (17.3%); retinal emboli (2.6%); visual field defects (2.6%); reduction of visual acuity (4.5%) and Horner's syndrome (1.3%). Neuro-ophthalmological complications were not observed in a control group of 50 patients undergoing major peripheral vascular surgery. Ten of 75 patients reviewed at 6 months still had detectable neuro-ophthalmological abnormalities, but functional disability occurred only in those with persistent visual field defects. Multivariate analysis revealed that extra-coronary vascular disease, severe and prolonged duration of heart disease prior to operation, and large drop in haemoglobin level during surgery may predispose to neuro-ophthalmological complications.
Collapse
|
155
|
Ince PG, Shaw PJ, Fawcett PR, Bates D. Demyelinating neuropathy due to primary IgM kappa B cell lymphoma of peripheral nerve. Neurology 1987; 37:1231-5. [PMID: 3037440 DOI: 10.1212/wnl.37.7.1231] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 53-year-old man presented with a painful, demyelinating sensorimotor peripheral neuropathy with lymphomatous infiltration on sural nerve biopsy, but no evidence of systemic lymphoma. The neuropathy responded to cytotoxic therapy. Seven years later he developed generalized lymphadenopathy due to B cell lymphoplasmacytoid lymphoma, with a subpopulation of cells expressing a monoclonal pattern of IgM kappa. The lymphomatous infiltrate in the original nerve biopsy showed similar monoclonal IgM kappa reactivity. The mechanism of demyelination of the peripheral nerves may be similar to that described in patients with IgM kappa monoclonal gammopathies.
Collapse
|
156
|
Simons-Morton BG, Brink S, Bates D. Effectiveness and cost effectiveness of persuasive communications and incentives in increasing safety belt use. HEALTH EDUCATION QUARTERLY 1987; 14:167-79. [PMID: 3110105 DOI: 10.1177/109019818701400204] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Safety Belt Connection Project was a worksite health promotion project conducted at a medical school and hospital complex to test the effectiveness and cost effectiveness of four treatment conditions (TCs): TC1, Persuasive Communications (PCs) alone; TC2, PCs plus overt monitoring; TC3, PCs plus incentives; and TC4, PCs plus incentives and prompts. Parking lots were randomized to treatment condition. A community traffic intersection served as a comparison group. Trained observers recorded safety belt use rates (SBURs) of subjects (front seat occupants) over a two-week period at baseline and after a four-week period of intervention. Results were analyzed by chi-square comparisons of pre-treatment and post-treatment SBURs. At baseline, significant differences in SBURs between treatment groups were observed. Significant pre-to-post differences were found for TC3 and TC4: the SBUR in TC3 went from 18.3% - 38.4% (p less than 0.001) and the SBUR in TC4 went from 16.9% - 44.8% (p less than 0.001). Both TC3 and TC4 were effective, but TC4 cost 2.6 times more per person influenced to wear their safety belt.
Collapse
|
157
|
Gray CS, Taylor R, French JM, Alberti KG, Venables GS, James OF, Shaw DA, Cartlidge NE, Bates D. The prognostic value of stress hyperglycaemia and previously unrecognized diabetes in acute stroke. Diabet Med 1987; 4:237-40. [PMID: 2956026 DOI: 10.1111/j.1464-5491.1987.tb00870.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a prospective study of 86 patients with acute stroke, blood glucose and HbA1 were estimated within 72 h of onset. The prevalence of previously diagnosed diabetes mellitus was 8% whereas 28% could be assumed to have had unrecognized hyperglycaemia preceeding the acute event as identified by a stable HbA1 raised more than two SD above the mean reference value. Complete functional recovery of the limbs within 4 weeks of the stroke was confined to those patients with a normal admission blood glucose. None of the patients with a raised admission blood glucose regained full functional recovery within 4 weeks. Cumulative mortality at 4 weeks was significantly raised in patients with an elevated blood glucose value irrespective of their HbA1 values (p less than 0.05). The prevalence of unrecognized hyperglycaemia as a risk factor for acute stroke is greater than previously reported in the UK and admission blood glucose concentration is of greatest importance in predicting early mortality and morbidity.
Collapse
|
158
|
Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. Long-term intellectual dysfunction following coronary artery bypass graft surgery: a six month follow-up study. THE QUARTERLY JOURNAL OF MEDICINE 1987; 62:259-68. [PMID: 3498965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As part of a prospective study of neurological and neuropsychological complications of coronary bypass surgery, 259 patients underwent psychometric assessment before operation and at seven days and six months after operation using a battery of 10 standard tests of intellectual function. This report describes the natural history of intellectual dysfunction soon after surgery and the incidence and functional impact of late neuropsychological impairment. The mean neuropsychological scores for the whole group remained unchanged or improved compared with levels before operation for the majority of the 10 tests. Analysis of the test scores for individuals showed that 147 of 259 (57 per cent) patients showed deterioration on at least one test score at six months. The degree of impairment was usually mild. One hundred and thirty of the 147 patients showed mild cognitive dysfunction (score deterioration on one or two tests) and only 17 patients had moderate or severe impairment (score deterioration on three or more tests). Detectable neuropsychological deterioration at six months often did not matter to the patient in functional terms. Seventy-one per cent of these patients had no significant symptoms; 27 per cent had minor symptoms and only 2 per cent were seriously disabled. Of the patients unemployed at six months, in only one case was intellectual impairment the factor preventing return to work. A search for possible predisposing factors for long-term intellectual dysfunction was made using a multivariate analysis of 91 variables for each patient. Cardiac failure before surgery and global impairment of left ventricular function were the only factors showing significant correlation.
Collapse
|
159
|
Qizilbash N, Bates D. Incidence of motor neurone disease in the northern region. J Epidemiol Community Health 1987; 41:18-20. [PMID: 3668454 PMCID: PMC1052569 DOI: 10.1136/jech.41.1.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The incidence of motor neurone disease in the Northern Region was studied for the year 1981 by means of hospital activity analysis records and questionnaire. The crude incidence rate was 2.2 per 100,000. This was not significantly different from the rate determined by using death certification. The age standardised incidence ratio for the region was 163 using the 1976 population and deaths from motor neurone disease in England and Wales as the reference. The female to male ratio was 1:1.8 and the average age of diagnosis was 63 years. No meaningful intraregional variation was observed. Thus mortality appears to reflect incidence fairly accurately.
Collapse
|
160
|
Shaw PJ, Smith NM, Ince PG, Bates D. Chronic periphlebitis retinae in multiple sclerosis. A histopathological study. J Neurol Sci 1987; 77:147-52. [PMID: 3819765 DOI: 10.1016/0022-510x(87)90117-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Retinal periphlebitis in multiple sclerosis is of particular interest in relation to our understanding of the pathogenesis of the demyelinating central nervous system plaques. Previous studies have largely been clinical, and there is little detailed histopathological information relating to this condition. We present the first detailed report in the neurological literature on the histological findings in chronic periphlebitis retinae associated with multiple sclerosis. The most significant abnormalities of the affected retinal veins were the presence of thick laminated collagen in the wall, associated with a scanty infiltration of plasma cells.
Collapse
|
161
|
Bates D. Practical problems in the organisation of clinical trials in multiple sclerosis. Neuroepidemiology 1987; 6:6-16. [PMID: 3627345 DOI: 10.1159/000110096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The problems of organising clinical trials in MS include the general aspects relating to clinical trials in any discipline but extend also to specific problems arising in the assessment of a relapsing remitting condition. These factors relating to the clinical characteristics of the disease, the diagnosis, the selection of patients and the methods of clinical and laboratory assessment are described and discussed. Suggestions are made for the use of internationally accepted diagnostic criteria for MS and a review is made of the other recognised problems in this field.
Collapse
|
162
|
Shaw PJ, Bates D, Cartlidge NEF, Heaviside D, French JM, Julian DG, Shaw DA. Neurological complications of coronary artery bypass surgery: Authors' reply. West J Med 1986. [DOI: 10.1136/bmj.293.6547.625-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
163
|
|
164
|
Shaw PJ, Bates D, Cartlidge NE, Heaviside D, French JM, Julian DG, Shaw DA. Neurological complications of coronary artery bypass graft surgery: six month follow-up study. BRITISH MEDICAL JOURNAL 1986; 293:165-7. [PMID: 3015318 PMCID: PMC1340906 DOI: 10.1136/bmj.293.6540.165] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As part of a major prospective study of the neurological complications of coronary artery bypass graft surgery patients were reviewed over six months to determine the clinical course and functional impact of early postoperative complications. One hundred and ninety one out of 312 (61%) patients had developed early postoperative disorders. At six months 165 of the 191 patients with early neurological complications were reviewed. Of the 165, 85 still had detectable neurological signs, but these were often minor and of little functional importance. Only 10 patients had neurological disability at six months, and this was major in only four patients, all of whom had suffered major perioperative stroke. No patient with non-disabling neurological complications in hospital became functionally impaired on returning home. Neurological disorders are not a major cause of failure to return to work by six months after coronary artery bypass surgery. Of 139 patients who were of working age and had not returned to work by six months, only four were prevented by neurological injury related to surgery. The long term prognosis for early neurological disorders after coronary artery bypass surgery is usually favourable, except in those patients who have sustained major perioperative stroke.
Collapse
|
165
|
Bates D. Hyperbaric oxygen therapy in multiple sclerosis. Br J Hosp Med (Lond) 1986; 35:365. [PMID: 3521780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
166
|
Duggan-Keen M, Roberts DF, Bates D. Cell-mediated immunological status in multiple sclerosis patients. Acta Neurol Scand 1986; 73:408-14. [PMID: 3727917 DOI: 10.1111/j.1600-0404.1986.tb03297.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In vitro lymphocyte proliferation in response to allogeneic pooled cells, mitogens (PHA, Con A and PWM), and PPD was measured in 67 patients with clinically definite MS and in 67 age and sex-matched controls. Overall, dose-response curves in the two groups were similar, but response to PHA and PWM was significantly greater among patients, and a greater percentage of patients failed to respond to peak and suboptimal PPD concentrations. There was a reduced response to allogeneic pooled cells in Dw2 positive controls, and, in both patients and controls, a tendency towards a higher PPD response in Dw2 positive males. The results suggest that there is some alteration of balance of immune regulation in MS, which is slightly affected by Dw2 status.
Collapse
|
167
|
Woo E, Nightingale S, Dick DJ, Walls TJ, French JM, Bates D. A study of histocompatibility antigens in patients with motor neuron disease in the northern region of England. J Neurol Neurosurg Psychiatry 1986; 49:435-7. [PMID: 3457897 PMCID: PMC1028772 DOI: 10.1136/jnnp.49.4.435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Histocompatibility antigen (HLA A, B and DR) serotyping was performed on 65 patients with motor neuron disease in the northern region of England and compared to a large control population from the Newcastle upon Tyne area. Thirty two patients had amyotrophic lateral sclerosis, 17 had progressive bulbar palsy and 16 had progressive muscular atrophy. Ten patients had a more slowly progressive course. No significant HLA associations were observed in the motor neuron disease patients. Subdivision of the patients by the clinical course of their disease did not reveal any significant associations. Forty six motor neuron disease patients from the Newcastle upon Tyne area had a reduced frequency of HLA DR4 compared to the local control population. The relevance of histocompatibility antigens to the pathogenesis of motor neuron disease is discussed.
Collapse
|
168
|
Duffell SJ, Sharp MW, Bates D. Financial loss resulting from BVD-MD virus infection in a dairy herd. Vet Rec 1986; 118:38-9. [PMID: 3946068 DOI: 10.1136/vr.118.2.38] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
169
|
Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. Early intellectual dysfunction following coronary bypass surgery. THE QUARTERLY JOURNAL OF MEDICINE 1986; 58:59-68. [PMID: 3486433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As part of a major prospective study of neurological and psychological complications of coronary artery bypass graft surgery, involving 312 patients, detailed psychometric testing was carried out before and after operation on 298 patients using a battery of 10 standard tests of intellectual function. This report is concerned with the early neuropsychological dysfunction detectable one week after operation. Two hundred and thirty-five patients (79 per cent of the cohort) showed impairment in some aspect of cognitive function at the seventh day after operation. Only 63 patients (21 per cent) showed no deterioration from levels before operation in any of the 10 test scores. One hundred and twenty-three of the patients whose scores deteriorated had no symptoms while in hospital. Eighty-nine patients complained of cognitive impairment, and 23 patients were considered to be overtly disabled by their intellectual dysfunction, during the period soon after operation. There is therefore a high incidence of early cerebral dysfunction detectable by psychometric testing following coronary artery bypass graft surgery. Often this was not of sufficient severity to cause serious concern to the patients or to interfere with their everyday activities in the hospital environment.
Collapse
|
170
|
Shaw PJ, Bates D, Cartlidge NE, Heaviside D, Julian DG, Shaw DA. Early neurological complications of coronary artery bypass surgery. BMJ : BRITISH MEDICAL JOURNAL 1985; 291:1384-7. [PMID: 2998539 PMCID: PMC1419012 DOI: 10.1136/bmj.291.6506.1384] [Citation(s) in RCA: 282] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological morbidity was rare. Neurological disorders resulted in death in only one patient (0.3%) and severe disability in only four (1.3%). Forty eight patients were mildly disabled during the early postoperative period, and the remaining 138 with neurological signs had no serious functional disability. The postoperative neurological disorders detected included one death from cerebral hypoxic damage. Prolonged depression of conscious level was observed in 10 patients (3%) and definite stroke in 15 (5%); 78 (25%) developed ophthalmological abnormalities and 123 (39%) primitive reflexes; postoperative psychosis was observed in four (1%); and 37 (12%) developed disorders of the peripheral nervous system. The incidence of serious neurological problems such as fatal cerebral damage, stroke, and brachial plexopathy is in accordance with experience elsewhere. Lesser abnormalities, whose detection required detailed neurological examination, were much commoner than expected from previous reports.
Collapse
|
171
|
Gray CS, French JM, Alberti KGMM, Bates D. Diabetes mellitus and early mortality from stroke. BMJ : BRITISH MEDICAL JOURNAL 1985. [DOI: 10.1136/bmj.291.6505.1349-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
172
|
Bates D. Predicting recovery from medical coma. Br J Hosp Med (Lond) 1985; 33:276-80. [PMID: 4005478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Advances in resuscitation create the risk that patients may be saved with a brain so damaged that they can never recover cognition. It is imperative that those who provide intensive care facilities determine the prognosis of such patients at a relatively early stage. This review suggests ways in which such predictions may be derived for patients in medical coma.
Collapse
|
173
|
Barnes MP, Bates D, Cartlidge NE, French JM, Shaw DA. Hyperbaric oxygen and multiple sclerosis: short-term results of a placebo-controlled, double-blind trial. Lancet 1985; 1:297-300. [PMID: 2857361 DOI: 10.1016/s0140-6736(85)91079-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a study of 120 patients with chronic multiple sclerosis the effects of treatment with 100% oxygen at 2 atmospheres absolute for 90 min daily for a total of 20 exposures were compared with those of normal air at normal pressure for a similar length of time within the same compression chamber. No patient in either group showed any improvement on the Kurtzke disability status scale. 12 of 51 patients in the hyperbaric-oxygen group and 3 of 47 control patients improved on the Kurtzke functional systems scale on the subjective bowel/bladder parameter only. Such a degree of improvement can also be achieved with medication for urinary symptoms, but none of the patients in this study received such medication. The short-term results of this trial do not support the claims made for hyperbaric oxygen in the management of multiple sclerosis.
Collapse
|
174
|
Abstract
A 63-year-old man developed delayed cerebral radiation necrosis following radiotherapy to a nasopharyngeal carcinoma. Complete resolution of his neurological deficit resulted from corticosteroid therapy alone. Serial CT scans showed the disappearance of the patients' mass lesion. The literature on cerebral necrosis following radiotherapy of extracranial neoplasms is reviewed with particular emphasis on management.
Collapse
|
175
|
Pfeffer RI, Kurosaki TT, Chance JM, Filos S, Bates D. Use of the mental function index in older adults. Reliability, validity, and measurement of change over time. Am J Epidemiol 1984; 120:922-35. [PMID: 6507430 DOI: 10.1093/oxfordjournals.aje.a113963] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The Mental Function Index is a weighted combination of scores on three brief tests. The Index was developed to aid in the discrimination of elderly persons with early cases of senile dementia from nondemented elderly individuals. In a previous report (Am J Epidemiol 1981;114:515-27), the authors described preliminary results with the Index in 195 elderly persons in a southern California retirement community. The present study seeks to assess whether similar results can be achieved in samples other than that from which the discriminant function defining the Index was derived. Seven separate studies were done on a total of 210 persons, comprising subjects recruited from a teaching hospital which serves a predominantly lower to lower-middle class population, referrals from the same physicians as in the earlier study, and (for the reliability sample) persons from the upper-middle class community which was the major referral source. It was found that scores on the brief measures correlate 0.86 with those on the three Halstead-Reitan subtests most sensitive to brain damage and to aging. The Index provides a graded measure of disease severity comparable to global neurologic assessment (r = -0.84) and level of social function (r = 0.76). Entry Index is a crude predictor of cognitive status in older adults after several years. Changes in the Index over time parallel those in independent measures of change. The results suggest that the Index will be useful for assessment of disease severity and of longitudinal change, as well as for diagnostic screening, in population studies of senile dementia.
Collapse
|
176
|
Dworkin RH, Bates D, Millar JH, Paty DW. Linoleic acid and multiple sclerosis: a reanalysis of three double-blind trials. Neurology 1984; 34:1441-5. [PMID: 6387534 DOI: 10.1212/wnl.34.11.1441] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Data from three double-blind trials of linoleic acid in the treatment of multiple sclerosis (MS) were reanalyzed to examine whether inconsistency in the results was due to a relationship between patient characteristics and treatment response. The combined data consisted of neurologic assessments over 2 1/2-year trials for 87 treated patients and 85 control patients. Treated patients with minimal or no disability at entry had a smaller increase in disability than did controls (p less than 0.05). In addition, treatment reduced the severity and duration of relapses at all levels of disability and duration of illness at entry to the trials.
Collapse
|
177
|
Shaw DA, Venables GS, Cartlidge NE, Bates D, Dickinson PH. Carotid endarterectomy in patients with transient cerebral ischaemia. J Neurol Sci 1984; 64:45-53. [PMID: 6376714 DOI: 10.1016/0022-510x(84)90054-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A randomised controlled trial of endarterectomy in patients with carotid artery disease showed that operation significantly reduced the frequency of transient ischaemic attacks (TIA) in the relevant vascular territory. Because of the high post-operative morbidity in the surgical group, the trial was abandoned before conclusions could be drawn as to the influence of endarterectomy on long-term survival or on the incidence of subsequent strokes.
Collapse
|
178
|
Abstract
The frequencies of lymphocytes of different types in the blood of 96 multiple sclerosis patients in different phases of the disease were examined by rosetting, in relation to the HLA antigens present. In the total series of patients, there is a significant deficit of A2, and this is also suggested in the active and progressive cases, but there is no evidence of association of particular HLA haplotypes with the different phases of the disease. There was little variation among the patient categories in the frequency of T cells of different types, but patients in relapse showed a higher proportion of cells showing surface IgG. In general, there is little association of cell surface markers with HLA type, but when B8 is present there appear to be fewer E and EAC rosettes in patients in exacerbation, fewer E and IgG surface markers in remission, and more of the IgG markers in progression.
Collapse
|
179
|
Crawford DC, Nightingale S, Bates D, Tomlinson BE. Spinal cord compression by extramedullary haematopoiesis in myelofibrosis. Postgrad Med J 1984; 60:62-3. [PMID: 6694952 PMCID: PMC2417733 DOI: 10.1136/pgmj.60.699.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 50-year-old man with a 20-year history of myelofibrosis developed mild impairment of dorsal column sensation and ataxia of gait. A myelogram and subsequent peroperative biopsy demonstrated spinal cord compression due to extramedullary haematopoiesis. There was an excellent clinical response to surgery and radiotherapy. The characteristic clinical features and the pathogenesis of this unusual complication of myelofibrosis and extramedullary haematopoiesis are discussed.
Collapse
|
180
|
Bates D. Why practitioners must be good writers. THE PUBLIC RELATIONS JOURNAL 1983; 39:6-7. [PMID: 10261274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
181
|
Bates D. Predicting recovery from coma. Br J Hosp Med (Lond) 1983; 29:276, 279-82. [PMID: 6871516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
182
|
Bates D. 11 signal trends in not-for-profit public relations. THE PUBLIC RELATIONS JOURNAL 1982; 38:22-3. [PMID: 10258081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
183
|
Nightingale S, Venables GS, Bates D. Polymyalgia rheumatica with diffuse cerebral disease responding rapidly to steroid therapy. J Neurol Neurosurg Psychiatry 1982; 45:841-3. [PMID: 7131021 PMCID: PMC491571 DOI: 10.1136/jnnp.45.9.841] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 58-year-old woman presented with the classical features of polymyalgia rheumatica. She also had a global dementia; CT scan and EEG showed diffuse cerebral disease. After steroid treatment, the polymyalgia rheumatica and dementia rapidly resolved and the CT scan and EEG became normal. The inter-relationships of the giant cell arteritides are discussed in the light of this report of the association of polymyalgia rheumatica and steroid-responsive diffuse cerebral disease.
Collapse
|
184
|
Nightingale S, Bates D, Heath PD, Barron SL. Wernicke's encephalopathy in hyperemesis gravidarum. Postgrad Med J 1982; 58:558-9. [PMID: 7145795 PMCID: PMC2426443 DOI: 10.1136/pgmj.58.683.558] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 20-year-old woman developed severe persistent vomiting early in pregnancy. In three months she lost 18 kg of body weight and showed the biochemical features of mild hepatic failure. Four days after starting intravenous dextrose and insulin, she developed short-term memory loss, confusion, ataxia, dysarthria, mild left upper motor neurone facial weakness and upbeat nystagmus. Thiamine was given and no further deterioration occurred. The vomiting persisted until intra-uterine fetal death. Thereafter, her medical, neurological and psychological problems gradually improved. The association of hyperemesis gravidarum, intravenous calorie load and Wernicke's encephalopathy is discussed.
Collapse
|
185
|
|
186
|
Bates D, Retief DH, Jamison HC, Denys FR. Effects of acid etch parameters on enamel topography and composite resin--enamel bond strength. Pediatr Dent 1982; 4:106-10. [PMID: 6752904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
187
|
Roberts DF, Bates D. The genetic contribution to multiple sclerosis. Evidence from North-East England. J Neurol Sci 1982; 54:287-93. [PMID: 7097301 DOI: 10.1016/0022-510x(82)90189-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A study of 206 patients with multiple sclerosis in the north-east of England and their families shows no evidence of monogenic involvement in the disorder. Much more likely is a multifactorial etiology in which the genetic component is polygenic. On this model the heritability is calculated at 52.1% or 40.9% if age variation in incidence is allowed for. The genetic component is present but no more then moderate in extent.
Collapse
|
188
|
Nightingale S, Bates D, Bateman DE, Hudgson P, Ellis DA, Gibson GJ. Enigmatic dyspnoea: an unusual presentation of motor-neurone disease. Lancet 1982; 1:933-5. [PMID: 6122772 DOI: 10.1016/s0140-6736(82)91934-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
189
|
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Bates D, Detels R, Filos S, Butzke C. A survey diagnostic tool for senile dementia. Am J Epidemiol 1981; 114:515-27. [PMID: 7304582 DOI: 10.1093/oxfordjournals.aje.a113217] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
To validate a senile dementia survey diagnostic tool, 195 individuals aged 61-91 and referred by their physicians as normal or mildly demented were examined. The etiologic diagnosis used as criterion was the consensus of two experienced neurologists, assisted by clinical and laboratory data from referring physicians and by neuropsychologic evaluation of questionably affected persons. Agreement between the neurologists was high, as indicated by a weighted Kappa coefficient of 0.97 (95% confidence interval (Cl) (0.94, 1.00)). Agreement between the instrument and criterion diagnosis was also excellent (kappa w = 0.93; 95% Cl (0.88, 0.98)). Used alone as a screening diagnostic tool, the cognitive function portion of the instrument was much more sensitive (0.929) than previously used brief tests and was acceptably specific (0.800). Because normals complete this cognitive test in 15-20 minutes, it should be a major advance in population-based studies of senile dementia and normal aging.
Collapse
|
190
|
McLachlan SM, Nicholson LV, Venables G, Mastalgia FL, Bates D, Smith BR, Hall R. Acetylcholine receptor antibody synthesis in lymphocyte cultures. JOURNAL OF CLINICAL & LABORATORY IMMUNOLOGY 1981; 5:137-42. [PMID: 7241564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The synthesis of immunoglobulin and acetylcholine receptor antibody by lymphocytes extracted from the peripheral blood and thymus of patients with myasthenia gravis was investigated using the Marbrook culture system. Small amounts of immunoglobulin were synthesised by thymic lymphocytes cultured in medium without mitogen for 14 days and acetylcholine receptor antibody activity was detectable in cultures from 3 out of 5 patients with thymic hyperplasia. Addition of Pokeweed mitogen to the cultures increased both IgG and acetylcholine receptor antibody synthesis and under these conditions receptor antibody activity was detectable in all 5 thymic lymphocyte cultures studied. Peripheral blood lymphocytes also produced small amounts of IgG when cultured in the absence of mitogen but acetylcholine receptor antibody levels were undetectable. In the presence of Pokeweed mitogen, however, peripheral blood lymphocytes synthesised increased amounts of IgG and acetylcholine receptor antibody activity was detectable in cultures of lymphocytes from 3 out of 4 patients. The amount of acetylcholine receptor antibody per microgram IgG, the specific activity, was greater in cultures of thymic lymphocytes than the specific activity of IgG in serum, suggesting that the hyperplastic thymus may be a major site of acetylcholine receptor antibody synthesis. Therefore it should be possible to use the culture system described to investigate the processes involved in the breakdown of self-tolerance in myasthenia gravis.
Collapse
|
191
|
|
192
|
Levy DE, Bates D, Caronna JJ, Cartlidge NE, Knill-Jones RP, Lapinski RH, Singer BH, Shaw DA, Plum F. Prognosis in nontraumatic coma. Ann Intern Med 1981; 94:293-301. [PMID: 7224376 DOI: 10.7326/0003-4819-94-3-293] [Citation(s) in RCA: 215] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We conducted serial neurologic examinations on 500 patients in nontraumatic coma to identify factors predicting recovery. Overall, 81 patients (16%) led an independent life at some point within the first year; the remainder either died without recovery from coma (61%), never improved beyond the vegetative state (12%), or regained consciousness but remained dependent on others for daily activities (11%). Functional recovery did not depend on age but was to some degree related to the cause of coma (subarachnoid hemorrhage and other cerebrovascular disease having the worst recovery; hypoxia-ischemia, intermediate; and hepatic and miscellaneous causes, best) and especially to early clinical signs of brain dysfunction. Even within hours of the onset of coma, only one of 120 patients lacking two of corneal, pupillary, and oculovestibular responses ever regained independent function. The study identifies clinical features of comatose patients that appear within the first week and that are important for predicting recovery and designing future therapeutic trials.
Collapse
|
193
|
|
194
|
Bates D. : Dispute and Settlement in Rural Turkey: An Ethnography of Law . June Starr. AMERICAN ANTHROPOLOGIST 1980. [DOI: 10.1525/aa.1980.82.3.02a00950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
195
|
Bates D. Are ethics of industry appropriate to medical care? HOSPITAL TRUSTEE 1979; 3:11-4. [PMID: 10244526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
196
|
Bates D, Fawcett PR, Shaw DA, Weightman D. Polyunsaturated fatty acids in multiple sclerosis. BRITISH MEDICAL JOURNAL 1979; 1:683. [PMID: 435724 PMCID: PMC1598244 DOI: 10.1136/bmj.1.6164.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
197
|
Bates D, Fawcett PR, Shaw DA, Weightman D. Polyunsaturated fatty acids in treatment of acute remitting multiple sclerosis. BRITISH MEDICAL JOURNAL 1978; 2:1390-1. [PMID: 363236 PMCID: PMC1608620 DOI: 10.1136/bmj.2.6149.1390] [Citation(s) in RCA: 76] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
One hundred and sixteen patients with acute remitting multiple sclerosis (MS) took part in a double-blind controlled trial of treatment with polyunsaturated fatty acids and were randomly allocated to one of four groups. Two groups received linoleic acid, one alone as a spread and one with gamma-linolenic acid in capsules (Naudicelle); and two control groups received oleic acid, one as a spread and one in capsules. Rates of clinical deterioration and frequencies of attacks were not significantly different between treated and control groups. Exacerbations were shorter and less severe in patients receiving a high dose of linoleic acid than in controls, but those receiving a lower dose--that is, Naudicelle--showed no such difference. Thus supplementing the diet with 20 g linoleic acid marginally affected the duration and severity of relapses of MS but had no effect on overall disability. The dose of Naudicelle used provided insufficient supplementation.
Collapse
|
198
|
Abstract
A patient with subclinical hypothyroidism who presented with true myotonia is described. There was no evidence that either he or members of his family had dystrophia myotonica or myotonia congenita. Treatment with thyroxine resolved his symptoms completely.
Collapse
|
199
|
Landon MJ, Bates D, Kirkley M, Venables G. Effect of anticonvulsant drugs on urinary excretion of gamma-glutamyl transferase in women. Ann Clin Biochem 1978; 15:313-5. [PMID: 32829 DOI: 10.1177/000456327801500174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Excretion of gamma-glutamyl transferase was found to be significantly higher in a group of epileptic patients on long-term anticonvulsant therapy than in normal subjects. The losses, which may reflect renal enzyme induction, were unrelated to drug dose or duration of therapy and were significantly lower than those found in normal healthy pregnant women at term.
Collapse
|
200
|
Yeo PP, Bates D, Howe JG, Ratcliffe WA, Schardt CW, Heath A, Evered DC. Anticonvulsants and thyroid function. BRITISH MEDICAL JOURNAL 1978; 1:1581-3. [PMID: 656820 PMCID: PMC1605396 DOI: 10.1136/bmj.1.6127.1581] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Serum total and free thyroid hormone concentrations were estimated in 42 patients with epilepsy taking anticonvulsants (phenytoin, phenobarbitone, and carbamazepine either singly or in combination). There was a significant reduction in total thyroxine (TT4), free thyroxine (FT4), and free triiodothyronine (FT3) in the treated group compared with controls. Free hormone concentrations were lower than total hormone concentrations, suggesting that increased clearance of thyroid hormones occurs in patients receiving anticonvulsants. Detailed analysis indicated that phenytoin had a significant depressant effect on TT4, FT4, FT3, and reverse T3 (rT3). Phenobarbitone and carbamazepine had no significant main effects, but there were significant interactions between phenytoin and carbamazepine for TT4 and FT4. phenobarbitone and carbamazepine for FT3, and phenytoin and phenobarbitone for rT3.
Collapse
|