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Biomedical subjects

A Templeton

Publications and source records attributed to A Templeton.

At least 73 records · Page 4Linked to original sources
PubMed1998

A longitudinal study of maternal serum inhibin-A, inhibin-B, activin-A, activin-AB, pro-alphaC and follistatin during pregnancy.

Maternal serum concentrations of inhibin-A, inhibin-B, activin-A, activin-AB, pro-alphaC-related inhibin forms, total follistatin, steroids and gonadotrophins were measured longitudinally in six normal singleton pregnancies. Maternal venous blood was collected randomly during a spontaneous follicular phase prior to donor insemination, at 5, 7, 9, 11, 16, 20, 24, 28, 32 and 36 weeks after the first missed menses and in the early puerperium. Steroid and gonadotrophin profiles conformed to previous reports. While at week 5 of gestation inhibin-A, activin-A and follistatin concentrations were similar to those at the follicular phase, all three increased progressively (P < 0.001) to maximal concentrations in week 36: approximately 48-fold (3740 +/- 1349 ng inhibin-A/ml), approximately 22-fold (6109 +/- 1443 ng activin-A/ml) and approximately 10-fold (3563 +/- 418 ng follistatin/ml) higher. Pro-alphaC concentrations reached a maximum in weeks 5 (approximately 5-fold, P < 0.001) and 36 (1027 +/- 174 pg/ml, P < 0.01). Inhibin-B (71 +/- 23 pg/ml prior to pregnancy) was undetectable (<12 pg/ml) between week 5-16 of gestation but increased slightly in the third trimester (26 +/- 7 pg/ml in week 36). Activin-AB was undetectable throughout pregnancy. Post-partum concentrations of inhibin-A (41 +/- 12 ng/ml), inhibin-B (<12 pg/ml), activin-A (950 +/- 149 pg/ml), pro-alphaC (128 +/- 22 pg/ml) and follistatin (990 +/- 79 ng/ml) were substantially lower than at week 36 of gestation. The activin-A:follistatin ratio increased from 0.5 in week 5 to 1.8 in week 36, suggesting that more free activin-A is available in the maternal circulation during late pregnancy.

Activins↗
PubMed1998

Misoprostol for all?

Explore the source record for details and available documents.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Fertility and pregnancy in inflammatory bowel disease.

OBJECTIVE: A retrospective study of women with inflammatory bowel disease, aged 16-45 years during the 20-year period 1967-1986, was carried out in North East Scotland. METHOD: Five-hundred and three women were identified: 15 patients had died from unrelated causes and 22 had emigrated, but 409 of the remaining 466 patients (88%) replied to the study questionnaire. RESULTS: Women with ulcerative colitis and Crohn's disease had normal fertility when compared with the general population of north east Scotland. However, unresolved infertility problems were more frequent in women who had undergone surgery for inflammatory bowel disease compared with those who had not (12% vs. 5% for Crohn's disease; 25% vs. 7% for ulcerative colitis). Disease relapse rates did not increase in pregnancy. CONCLUSIONS: Overall, at conception women with active disease were as likely to have a normal full-term pregnancy as those in remission. However, spontaneous abortion occurred in five (36%) pregnancies of women who had undergone previous surgery for Crohn's disease and had evidence of recurrent disease. Three of these pregnancies were associated with active disease.

Abortion, Spontaneous↗
PubMed1997

How effective is patient-controlled analgesia? A randomized comparison of two protocols for pain relief during oocyte recovery.

Although the conventional method of pain relief during outpatient oocyte recovery involves physician-administered drugs, patient-controlled analgesia (PCA) offers an alternative technique with the potential to give women more control over peroperative analgesia. We conducted a prospective randomized study to compare the effect of fentanyl administered either through a PCA delivery system or by a physician. Thirty-nine women were randomized to PCA during egg collection while 42 were allocated to receive intermittent doses administered by a physician. Pain was evaluated by means of a 100 mm linear analogue scale. The mean (SD) pain score in the PCA group was 38.5 (19.8) while in the other group it was 46.1 (21.3) (P = 0.1). In the PCA group, 64% of women felt very satisfied with their analgesia as compared with 57% in the non-PCA group (P = 0.6). Among the PCA users, 39% of demands were successful. Significantly more fentanyl (97.5 microg) was used in the PCA group than in the other group (84.6 microg) (P = 0.03). Though intraoperative PCA with fentanyl is an effective alternative to physician-administered techniques, many women still feel the need for more analgesia during the procedure.

Adult↗
PubMed1997

Endometrial assessment procedures: an audit of current practice in Scotland.

The objective was to determine, in relation to endometrial assessment procedures, the extent to which the current practice of gynaecologists in Scotland (as assessed both by questionnaire survey of clinicians and review of hospital records) accords with recommendations in recent evidence-based guidelines. All 132 consultant gynaecologists in Scotland were surveyed and 123 (93%) responded. In addition, the case records of 1199 consecutive women undergoing endometrial assessment procedures in 12 representative hospitals were reviewed. Over two thirds of consultants agreed that endometrial assessment procedures are seldom indicated in women aged under 40 years and over 80% agreed that when such procedures are indicated, outpatient endometrial biopsy represents the method of choice. However, the review of case records showed that 23% of the women who underwent endometrial assessment were aged under 40 years and only 44% of the procedures undertaken were out-patient endometrial biopsies. We conclude that some Scottish women may be undergoing endometrial assessment procedures unnecessarily and that, in some centres, traditional dilatation and curettage is being replaced by hysteroscopy under general anaesthetic in theatre although there is no evidence that this procedure provides more clinically useful information than out-patient endometrial biopsy.

Adult↗
PubMed1997

Immediate colposcopy or cytological surveillance for women with mild dyskaryosis: a cost effectiveness analysis.

BACKGROUND: The aim of the study was to compare the cost effectiveness of immediate diagnosis and treatment of mild dyskaryosis compared with the usual policy of cytological surveillance. METHODS: A cost effectiveness analysis was carried out alongside a randomized clinical trial. RESULTS: Immediate diagnosis and treatment increased total costs by 50 per cent from 54.42 pounds per treated woman [95 per cent confidence interval (CI) 48.85 pounds-59.98 pounds] in the surveillance group to 82.02 pounds per woman in the immediate diagnosis and treatment group with an incremental cost of 27.60 pounds (95 per cent CI 22.04 pounds-33.17 pounds). However, the number of cases of CIN III detected increased by 69 per cent for the policy of immediate diagnosis and treatment. This led to an average cost effectiveness ration of 180.18 pounds for the immediate diagnosis and treatment group and 199.94 pounds per case of CIN III detected for the surveillance group, with a marginal cost effectiveness ratio of 148.22 pounds (95 per cent CI 94.01 pounds-309.33 pounds) for the immediate diagnosis and treatment group. CONCLUSION: Immediate diagnosis and treatment increases the total cost of managing mildly dyskaryotic smears but this increased cost is offset by a sharp increase in the number of cases of CIN III detected.

Colposcopy↗
PubMed1997

Gastric inlet patch containing submucosally infiltrating adenocarcinoma.

We describe a patient with an unusual segment of ectopic gastric mucosa in the proximal esophagus. The gastric heterotopia was circumferential and unusually long at 7 cm. It contained benign rugal-type folds, a stricture at the mid-portion of the gastric inlet patch was lined by normal antral-type gastric mucosa but harbored submucosally infiltrating adenocarcinoma. There was no evidence of Helicobacter pylori infection by biopsy or serologic screening. Malignancy, including submucosally infiltrating adenocarcinoma, should be considered in patients with strictures involving ectopic gastric mucosa in the proximal esophagus.

Adenocarcinoma↗
PubMed1996

Factors that affect outcome of in-vitro fertilisation treatment.

BACKGROUND: The effectiveness of in-vitro fertilisation (IVF) treatment depends both on the overall success rate in the treating clinic and on the characteristics of the couple seeking treatment. Since 1991, the Human Fertilisation and Embryology Authority (HFEA) has been collecting information on all IVF cycles carried out in the UK. This database has been analysed to identify the factors that affect the outcome of treatment. METHODS: All IVF treatment cycles and outcomes registered between August, 1991, and April, 1994, were identified (52507). Cycles that involved gamete or embryo donation, frozen embryo transfer, or micromanipulation and unstimulated cycles were excluded. Thus, 36961 cycles (70% of those registered) were included in the analysis. The main outcome measure was liverbirth rate per cycle started. The relation between age and outcome was investigated by fitting of different fractional polynomials of age with logistic regression models. All other factors were analysed by logistic regression with age included in the model. FINDINGS: The overall livebirth rate per cycle of treatment was 13.9%. The highest livebirth rates were in the age-group 25-30 years; younger women had lower rates and there was a sharp decline in older women. At all ages over 30, use of donor eggs was associated with a significantly higher livebirth rate than use of the woman's own eggs, but there was also a downward trend in success rate with age (p = 0.04). After adjustment for age, there was a significant decrease in livebirth rate with increasing duration of infertility from 1 to 12 years (p < 0.001). The medical indication for treatment had no significant effect on the outcome. Previous pregnancy and livebirth significantly increased treatment success. The possibility of success decreased with each IVF treatment cycle. INTERPRETATION: We were able to identify by logistic regression the factors that significantly affect the outcome of IVF treatment, and to measure the magnitude of that effect. These factors should be taken into account in assessment of IVF results. After allowance for background clinic success rates, these factors can be used to predict outcome in individual cases.

Adult↗
PubMed1996

Sequence heterogeneity of Nef transcripts in HIV-1-infected subjects at different stages of disease.

Nef transcripts were analyzed from peripheral blood mononuclear cells of 10 HIV-1-infected subjects with 9-822 CD4+ lymphocytes/cu mm, including 4 individuals with a probable common source infection. There was no relationship between the phylogenetic position of the various nef sequences and the disease state of the person from whom they were derived. The nef open reading frame was disrupted in all three clones from only 1 subject. Functional analyses of a representative clone from each of the remaining 9 subjects showed that all nef alleles were capable of CD4 cell surface down-regulation, but only three nef alleles suppressed the induction of IL-2 transcription.

Amino Acid Sequence↗
PubMed1996

A population based survey of women's experience of the menopause.

OBJECTIVES: To describe the prevalence of, and degree of distress caused by, 15 symptoms commonly attributed to the menopause among a random sample of women aged 45 to 54, selected from the total population of a geographically defined area. DESIGN: Postal questionnaire survey. SETTING: Grampian Health Board area. PARTICIPANTS: Eight thousand women, aged 45 to 54, randomly selected from the Grampian Community Health Index. MAIN OUTCOME MEASURES: Self-reported symptoms, including depression, and use of hormone replacement therapy (HRT) among women of differing menopausal status. RESULTS: The response rate was 78%; 57% of respondents had experienced one or more of the 15 symptoms listed, but only 22% had found such symptoms a problem. Women's experience of classic vasomotor and atrophic symptoms varied according to menopausal status but experience of general somatic and psychological symptoms did not. Users of HRT and women whose menopause was iatrogenic found more symptoms a problem. CONCLUSIONS: Symptoms attributed to the menopause are common among women in the age group studied but often are not perceived as a problem. Among nonusers of HRT, only vasomotor and atrophic symptoms vary with menopausal status. Other somatic and psychological symptoms experienced by middle-aged women cannot be regarded as part of the same "menopausal syndrome'.

Anxiety↗
PubMed1996

Emergency contraception: a survey of women's knowledge and attitudes.

OBJECTIVES: To assess women's knowledge and attitudes in relation to emergency contraception and to identify ways in which these might be improved. DESIGN: Postal survey: questionnaire seeking level of knowledge of emergency contraception, and attitudes to use, publicity and availability. POPULATION: A stratified random sample of 2000 Grampian women aged 18 to 47. Women were identified through the Community Health Index. RESULTS: Most women (94%) were aware of emergency contraception and identified an appropriate source. Fewer (39%) knew the correct timing for its use. These figures were generally higher among younger, single women. The popular media represented the commonest source of information, and GPs and Family Planning Clinics were cited rarely. Increased advertising was considered desirable by 71% (mainly older women); only 36% (mainly younger, single women) considered over-the-counter availability desirable. Reasons for these responses and factors influencing them were explored. CONCLUSIONS: Knowledge of emergency contraception is greatest among those most likely to use it, but deficient mainly in relation to the correct timing for its use and to intrauterine methods. Publicity should concentrate on the timing of its use. The popular media are an important publicity vehicle, but health professionals appear to be under-used. Many women hold opinions on advertising and over-the-counter availability of emergency contraception which will have to be considered if deregulation proceeds.

Adolescent↗
PubMed1996

A randomised comparison of oral and vaginal misoprostol for cervical priming before suction termination of pregnancy.

OBJECTIVE: To assess the effectiveness and acceptability of oral misoprostol, self-administered 12 h before surgery, as a cervical priming agent prior to day case suction termination of pregnancy. DESIGN: Randomised trial comparing oral misoprostol with the local standard regimen of vaginal misoprostol. SUBJECTS: Sixty consecutive women scheduled for day case suction termination in one gynaecology unit. INTERVENTIONS: Cervical priming with misoprostol 400 mg orally, 12 h prior to surgery or 800 mg vaginally, two to four hours prior to surgery. MAIN OUTCOME MEASURES: Basal cervical dilatation, cumulative force required to dilate the cervix to 9 mm, operative blood loss and side effects (nausea, vomiting, diarrhoea, abdominal pain and vaginal bleeding). RESULTS: There were no significant differences between the oral and vaginal treatment groups in relation to basal dilatation, cumulative force to achieve 9 mm dilatation or gastrointestinal side effects. However, those in the oral group experienced more severe pain and heavier pre-operative bleeding. Two patients in the oral group experienced incomplete abortion at home after taking misoprostol and a further patient required early admission because of heavy bleeding. CONCLUSIONS: Because of the unpredictability of action of oral misoprostol, with incomplete abortion or heavy bleeding occurring prior to admission in three patients, we cannot recommend the dosage schedule evaluated here for routine clinical use.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

The costs of treating miscarriage: a comparison of medical and surgical management.

OBJECTIVES: To estimate and compare the costs of surgical and medical treatment of miscarriage to the National Health Service. DESIGN: A patient-centred, partially randomised trial. SETTING: A teaching hospital in Scotland. PARTICIPANTS: Four hundred and thirty-seven women with a proven first trimester miscarriage. MAIN OUTCOME MEASURES: The cost per patient of surgical and medical management of miscarriage plus the extra cost per patient of introducing medical management of miscarriage under three different scenarios are calculated. RESULTS: The average cost of surgical treatment was Pounds 397 compared with Pounds 347 for medical treatment. Sensitivity analysis showed that the extra cost of introducing the medical management of miscarriage ranged from a cost saving of Pounds 71 per patient to an additional cost of Pounds 47 per patient. CONCLUSIONS: Our analysis showed that it may be possible to generate cost savings by introducing medical methods in the management of early miscarriage. However, the savings assume that costs associated with theatre use can be fully realised.

Abortion, Induced↗
PubMed1996

A comparison of 600 and 200 mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol.

OBJECTIVE: To compare the use of 600 and 200 mg mifepristone prior to second trimester termination of pregnancy with the prostaglandin misoprostol. DESIGN: A randomised study. SETTING: A Scottish teaching hospital. PARTICIPANTS: Seventy women undergoing legal induced abortion between 13 and 20 weeks of gestation. INTERVENTION: Administration of either 600 or 200 mg mifepristone 36 to 48 hours prior to prostaglandin. MAIN OUTCOME MEASURE: Induction-abortion interval. RESULTS: The geometric mean induction abortion interval was 6.9 (95% CI 5.8-8.4) h and 6.9 (95% CI 5.8-8.2) h in the 600 and 200 mg groups, respectively (no significant difference). The median dose of misoprostol was 1600 micrograms (three doses) in each group. Analgesic requirements and prostaglandin-related side effects were similar between groups. Overall, 11.4% of women required surgical evacuation of the uterus as a result of retained placenta. CONCLUSIONS: The dose of mifepristone used in second trimester abortion can be reduced from 600 to 200 mg.

Abortifacient Agents, Steroidal↗
PubMed1996

Selective transmission of human immunodeficiency virus type 1 variants to SCID mice reconstituted with human peripheral blood monoclonal cells.

The relative infectiousness of laboratory and primary human immunodeficiency virus type 1 (HIV-1) variants was evaluated in in vitro cell cultures of peripheral blood mononuclear cells or MT-2 cells and in Hu-PBL-SCID mice. HIV(MN) and syncytium-inducing primary isolates were preferentially transmitted to cells in tissue culture. HIV(Ba-L) and non-syncytium-inducing (NSI) primary isolates were more infectious in Hu-PBL-SCID mice. Phylogenetic analysis of env sequences derived from the primary isolates, from the cell cultures, and from five Hu-PBL-SCID mice was performed by using methods designed for resolving differences among closely related sequence pairs. This analysis demonstrated preferential transmission of an evolutionarily related subset of NSI variants to Hu-PBL-SCID mice. The pattern of selective transmission of a restricted range of NSI variants that is observed in the clinical setting is maintained in Hu-PBL-SCID mice and not in tissue culture systems. The Hu-PBL-SCID mouse model system, when used with appropriate phylogenetic analysis methodologies, will be useful for identifying and characterizing the more infectious HIV-1 variants that should be targeted for vaccine development.

Amino Acid Sequence↗
PubMed1996

Role of progesterone and nonsteroidal ovarian factors in regulating gonadotropin-releasing hormone self-priming in vitro.

We investigated the effects of gonadotropin surge-attenuating factor (GnSAF), inhibin, and follistatin on GnRH self-priming and its augmentation by progesterone. Two GnRH challenges, 60 min apart, were administered to rat pituitary monolayers after 90-min exposure to medium alone (control), progesterone, GnSAF, inhibin, or follistatin. Inhibin-stripped follicular fluid from superovulated women was used as a source of GnSAF bioactivity. Under control conditions, the greater response to the second GnRH challenge (peak 2, 9.2 +/- 2.1; peak 1, 4.4 +/- 0.9 ng LH/mL; P < 0.01) demonstrated GnRH self-priming. None of the treatments significantly altered the first LH peak. Progesterone markedly increased GnRH self-priming (peak 2, 12.6 +/- 2.5 ng LH/mL; P < 0.01). However, GnSAF and RU486 significantly reduced GnRH self-priming (peak 2, 4.6 +/- 0.9 and 5.6 +/- 1.6 ng LH/mL, respectively; P < 0.01). The augmentation of self-priming induced by progesterone was completely abolished by coincubation with either GnSAF or RU486 (peak 2, 7.5 +/- 1.6 and 4.3 +/- 0.9 ng LH/mL, respectively; P < 0.01). Neither inhibin nor follistatin had any effect on GnRH self-priming or its augmentation by progesterone. The actions of RU486 in the presence and absence of progesterone demonstrate a nonprogestagenic effect of RU486 on the gonadotropes. In conclusion, the suppression of GnRH self-priming, with or without progesterone augmentation, supports the hypothesis that GnSAF acts by maintaining the pituitary in an unprimed state of reduced responsiveness to GnRH.

Animals↗