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Biomedical subjects

D Barlow

Publications and source records attributed to D Barlow.

At least 55 records · Page 3Linked to original sources
PubMed1997

Is routine diagnostic laparoscopy for infertility still justified? A pilot study assessing the use of hysterosalpingo-contrast sonography and magnetic resonance imaging.

We assessed the value of hysterosalpingo-contrast sonography (HyCoSy) and magnetic resonance imaging (MRI) as alternatives to laparoscopy and dye insufflation with or without hysteroscopy in the investigation of infertility. A total of 19 women had all three procedures, in addition, one became pregnant after HyCoSy alone. The findings were: uterine fibroids (n = 5), minimal-mild endometriosis (n = 4) and moderate-severe endometriosis (n = 3) including one case of bilateral endometriomas, endometrial polyp (n = 1), polycystic ovaries (n = 2), bilateral dermoid cysts (n = 1), haemorrhagic corpus luteal cyst (n = 1) and minimal adhesions (n = 3). At laparoscopy, 31/37 tubes were patent and there was 84% concordance with the tubal patency findings at HyCoSy. The uterine fibroids and ovarian cysts were detected using transvaginal scanning; the endometrial polyp and a congenital uterine anomaly were identified using HyCoSy. These findings were detected using MRI, but in addition the technique distinguished the dermoid cysts from the endometriomas, identified the two other cases of moderate-severe endometriosis, fibroids <2 cm (n = 2) and adenomyosis (n = 5), and interpreted the haemorrhagic corpus luteum as an endometrioma. Our data suggest that women with normal HyCoSy and MRI findings have a normal pelvis and may not need routine surgical investigation.

Adult↗
PubMed1997

Assortative sexual mixing in a heterosexual clinic population--a limiting factor in HIV spread?

OBJECTIVE: To assess the degree of sexual mixing in a sexually transmitted disease clinic population stratified by country of birth. DESIGN: Prospective linked HIV serosurvey incorporating demographic and sexual risk data gathered by a doctor-administered questionnaire. SETTING: The Department of Genitourinary Medicine at St Thomas' Hospital, London, UK. SUBJECTS: Fifteen thousand eight hundred and seventy-eight heterosexuals who attended between April 1992 and February 1995. MAIN OUTCOME MEASURE: The degree of assortative (like-with-like) mixing, after stratification of the population by country of birth, of index patients, their parents and their sexual partners. RESULTS: Sexual mixing in this population of sexually transmitted disease clinic attenders is highly assortative when the CoB of parents (family origin) of index patients is taken into account. CONCLUSION: Our findings help to explain the low spread of heterosexual HIV infection in the UK to date, and may help future projections, and health targeting of those at risk. This model can be applied to other mixed population.

Ambulatory Care Facilities↗
PubMed1997

Heterosexual gonorrhoea at St Thomas'--I: Patient characteristics and implications for targeted STD and HIV prevention strategies.

This paper compares the socio-demographic characteristics of patients with gonorrhoea with a control group of other attendees to an inner-London genitourinary medicine (GUM) clinic. Between 16 May and 21 December 1994 inclusive there were 312 culture-confirmed heterosexually-acquired cases of Neisseria gonorrheae treated in our clinic: 192 (61.54%) men and 120 (38.46%) women. There were significant differences between the population of cases and controls. Both male (z = -5.36, P < 0.001) and female (z = -6.6, P < 0.001) cases were younger than controls. Cases were more likely to be black African-Caribbean than were controls and these differences were more marked in men (chi 2 = 47.85, P < 0.001). Cases were also more likely to reside in south London postal districts than were controls (chi 2 = 24.98, P < 0.001). The implications of these findings for targeted health interventions are discussed and we suggest avenues for further work.

Adolescent↗
PubMed1997

Heterosexual gonorrhoea at St Thomas'--II: Sexual behaviour and sources of infection.

This paper examines sexual behaviour in heterosexuals presenting to an inner-London genitourinary medicine (GUM) clinic with gonorrhoea. When comparing patients' documented sexual histories, there were notable differences between cases and a control group, especially in men. Male cases were more likely to have had both multiple sexual partners (chi 2 = 18.5, P < 0.001) and concurrent sexual relationships (chi 2 = 15.2, P < 0.001) in the 30 days preceding presentation. Unlike cases, male controls were more likely to have used a condom at last intercourse with a 'casual' partner (chi 2 = 17.5, P < 0.001). In an examination of the sources of infection in cases, women were far more likely to have been recipients of gonorrhoea than they were to transmit the infection. The source of their infection was most usually a regular sexual partner. In men, 'casual' and 'regular' partners and 'one night stands' were all important sources of infection. Our hypothesis that case patients would have met the sources of their infection in particular venues was not supported by the results of an original questionnaire survey.

Female↗
PubMed1997

Homopolymeric tract heteroplasmy in mtDNA from tissues and single oocytes: support for a genetic bottleneck.

While mtDNA polymorphisms at single base positions are common, the overwhelming majority of the mitochondrial genomes within a single individual are usually identical. When there is a point-mutation difference between a mother and her offspring, there may be a complete switching of mtDNA type within a single generation. It is generally assumed that there is a genetic bottleneck whereby a single or small number of founder mtDNA(s) populate the organism, but it is not known at which stages the restriction/amplification of mtDNA subtype(s) occur, and this uncertainty impedes antenatal diagnosis for mtDNA disorders. Length polymorphisms in homopolymeric tracts have been demonstrated in the large noncoding region of mtDNA. We have developed a new method, T-PCR (trimmed PCR), to quantitate heteroplasmy for two of these tracts (D310 and D16189). D310 variation is sufficient to indicate clonal origins of tissues and single oocytes. Tissues from normal individuals often possessed more than one length variant (heteroplasmy). However, there was no difference in the pattern of the length variants between somatic tissues in any control individual when bulk samples were taken. Oocytes from normal women undergoing in vitro fertilization were frequently heteroplasmic for length variants, and in two cases the modal length of the D310 tract differed in individual oocytes from the same woman. These data suggest that a restriction/amplification event, which we attribute to clonal expansion of founder mtDNA(s), has occurred by the time oocytes are mature, although further segregation may occur at a later stage. In contrast to controls, the length distribution of the D310 tract varied between tissues in a patient with heteroplasmic mtDNA rearrangements, suggesting that these mutants influence segregation. These findings have important implications for the genetic counselling of patients with pathogenic mtDNA mutations.

Animals↗
PubMed1996

Hormone replacement therapy in a risk-benefit perspective.

The relative cost-effectiveness of different treatment strategies for hormone replacement therapy (HRT) was assessed within the framework of a computer model. Where data were lacking, it was necessary to make assumptions about the effects of HRT, particularly in relation to combined oestrogen-progestogen therapy and cardiovascular disease; however, sensitivity analyses were performed to assess the impact of changing these assumptions on the cost-effectiveness equation. It appears that net expenditure by the NHS will depend critically on the direct costs of treatment, rather than on any indirect costs incurred or saved as a result of side-effects. In terms of mortality, a reduction in cardiovascular disease risk would have greatest impact and would overshadow any small increase in breast cancer risk which may be associated with long-term use. If the cardioprotective effect of oestrogen is real, our results suggest that long-term prophylactic treatment of hysterectomised women would be relatively cost-effective. Treatment of symptomatic menopausal women for any period of time appears to offer very good value for money. The lack of data relating to combined oestrogen-progestogen therapy and cardioprotection, and the major importance of the latter in the equation of benefits and risks, make it more difficult to draw conclusions about the cost-effectiveness of treating non-hysterectomised asymptomatic women for prophylactic reasons.

Aged↗
PubMed1996

Contrast sonography for uterine cavity assessment: a comparison of conventional two-dimensional with three-dimensional transvaginal ultrasound; a pilot study.

OBJECTIVE: To compare conventional two- (2-D) and three-dimensional (3-D) scanning of the uterine cavity with and without saline contrast medium. DESIGN: Observational pilot study. SETTING: University-based fertility service. PATIENT(S): Ten IVF patients requiring uterine cavity assessment. INTERVENTION(S): Two-dimensional and 3-D transvaginal scans before and after injection of saline into the uterine cavity. MAIN OUTCOME MEASURE(S): Number and type of uterine cavity abnormalities detected by each technique. RESULT(S): The 2-D scanning suggested cavity abnormalities in 4 of 10 women (fibroids, 3; hyperechoeic thick endometrium, 1). The 3-D scanning confirmed these and revealed one additional abnormality suggestive of a uterine septum. The 2-D scanning with saline injection diagnosed abnormalities in 5 of 10 (uterine septum, 1; fibroids, 3; endometrial polyp, 1). The 3-D contrast scanning with saline did not add any further information to 2-D contrast scanning with saline. CONCLUSION(S): In this pilot study, 3-D scanning to assess the uterine cavity appeared to offer no advantages over conventional 2-D contrast sonography.

Female↗
PubMed1996

A comparison of patient tolerance of hysterosalpingo-contrast sonography (HyCoSy) with Echovist-200 and X-ray hysterosalpingography for outpatient investigation of infertile women.

The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 +/- 5.2 and 9.5 +/- 4.8 min and 9.4 +/- 5.2 and 11.5 +/- 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2 h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy 14/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 85%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time.

Ambulatory Care↗
PubMed1996

Peritoneal fluid cytokines and the relationship with endometriosis and pain.

It is generally accepted that the current scoring system for endometriosis has little correlation with clinical symptoms such as pain, and therefore we may deduce that either endometriosis does not cause pain, or that the current scoring system does not indicate the biological activity of the disease. Pain may occur because the presence of endometriosis produces an intraperitoneal inflammatory response, and several studies have shown that the cytokine content of peritoneal fluid differs between women with and without endometriosis. We studied the relationship between tumour necrosis factor alpha (TNF alpha), platelet-derived growth factor (PDGF), interleukin (IL)-6, IL-4 and TNF (alpha and beta) activity in peritoneal fluid and the clinical history of pain and infertility. TNF alpha concentrations were increased in peritoneal fluid of women with endometriosis and of infertile women; PDGF concentrations were increased in peritoneal fluid of parous women; IL-6 was increased in peritoneal fluid of women with adhesions; IL-4 was absent from peritoneal fluid. PDGF and IL-6 concentrations were cycle related, with the highest amounts in the menstrual and proliferative phases respectively. We failed to demonstrate any association between concentrations of cytokines in vitro and pain symptoms or severity of endometriosis.

Adult↗
PubMed1996

Comparative efficacy and safety of single oral doses of sparfloxacin versus ciprofloxacin in the treatment of acute gonococcal urethritis in men.

A double-blind, randomised, international multicentre study was conducted to compare the efficacy and safety of sparfloxacin 200 mg versus ciprofloxacin 250 mg as single oral-dose treatment for acute gonorrhoea in men. A total of 238 patients were included and 191 were evaluable for primary efficacy (eradication of Neisseria gonorrhoeae). At follow-up, 99% (96/97) of the sparfloxacin-treated patients were culture-negative compared with 98% (92/94) in the ciprofloxacin group. Three of the four patients who harboured gonococci at follow-up admitted to having had unprotected sexual intercourse after treatment and were probably reinfections. The rate of post-gonococcal urethritis was 26% in both groups, although Chlamydia trachomatis was isolated in only 4% of patients at inclusion. Both drugs were well tolerated. Single oral doses of sparfloxacin 200 mg and ciprofloxacin 250 mg are equally effective in the treatment of acute gonorrhoea in men.

Acute Disease↗
PubMed1996

A comparative study of two different regimens of sparfloxacin versus doxycycline in the treatment of non-gonococcal urethritis in men.

A multicentre, double-blind, randomised study comparing the efficacy and safety of oral sparfloxacin (200 mg on day 1 followed by 100 mg daily for 2 or 6 additional days) with doxycycline (200 mg once daily for 7 days) in the treatment of non-gonococcal urethritis in men was conducted. The overall success rates for the three treatment groups were statistically equivalent both at the end of treatment and at the follow-up visits. For chlamydial urethritis, the rates of relapse or possible reinfection were similar in the 7-day sparfloxacin and doxycycline groups. For ureaplasmal urethritis and urethritis of unknown aetiology, the rates of relapse or possible reinfection were lower in the 7-day sparfloxacin group than in the other two treatment groups. Sparfloxacin was well tolerated. A 7-day sparfloxacin regimen appears to be a useful alternative to doxycycline for the treatment of non-gonococcal urethritis in men.

Adolescent↗
PubMed1996

Nurses performing embryo transfer: successful outcome of in-vitro fertilization.

This prospective study demonstrates the feasibility and outcome of embryo transfer performed by nursing staff with medical cover available. Of 771 patients who had embryo transfer, 679 (88%) had their embryo transfer performed by a nurse. In 92 cases (12%) a doctor performed the embryo transfer, either as the first operator, or having been brought in to assist the nurse who experienced difficulty. The pregnancies per transfer for nurse transfer was 246/679 (36%) and where a doctor performed the transfer 20/68 (29%). These data show a high comparable success rate when a nurse performed the embryo transfer, and a low incidence of direct medical involvement.

Embryo Transfer↗
PubMed1996

Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK.

We investigated the length of time between the onset of pain symptoms and the surgical diagnosis of endometriosis in women from the UK and the USA. A total of 218 women with surgically confirmed disease, recruited through endometriosis self-help groups, completed a postal questionnaire. The mean +/- SD delay in diagnosis for women from the USA was 11.73 +/- 9.05 years, significantly higher than the equivalent delay of 7.96 +/- 7.92 years for women from the UK (P < 0.01). The stage of disease did not effect the length of time between the onset of symptoms and diagnosis. Therefore there is considerable delay in the diagnosis of endometriosis for women from both the UK and the USA. Efforts to reduce this delay are required to minimize the suffering of women with this disease.

Adult↗