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Biomedical subjects

D Hill

Publications and source records attributed to D Hill.

At least 109 records · Page 6Linked to original sources
PubMed1998

Human placenta and fetal membranes contain peptide YY1-36 and peptide YY3-36.

Extracts of human term amniotic, placental, and chorion/decidua tissue contained, respectively, 4.36 +/- 2.79 (pmol/g wet wt; mean +/- S.E.M.: n = 5). 2.78 +/- 0.5 (n = 5) and 0.68 +/- 0.68 (n = 5) peptide YY (PYY)-like immunoreactivity. Using a specific PYY antiserum, gel filtration chromatography and reverse-phase high performance liquid chromatography (HLPC), amniotic, placental and fetal intestinal tissue extracts were demonstrated to contain PYY-like immunoreactivity consisting of equal amounts of PYY1-36 and PYY3-36. The presence of pancreatic polypeptide was not detected in any of the extracts. Positive immunohistochemical staining for PYY was seen in extravillous trophoblasts in the decidual septa and fetal membranes, the syncytiotrophoblast and cytotrophoblasts, amniotic epithelial cells and in maternal decidual stromal cells. Positive staining for PYY was found at the earliest date examined (9.5 weeks) and remained present throughout pregnancy to term. PYY1-36 and PYY3-36 may play important roles in human pregnancy, acting via endocrine or paracrine mechanisms.

Amnion↗
PubMed1997

Chronic expression of murine flt3 ligand in mice results in increased circulating white blood cell levels and abnormal cellular infiltrates associated with splenic fibrosis.

The effect of chronic expression of flt3 ligand (FL) on in vivo hematopoiesis was studied. Retroviral vector-mediated gene transfer was used in a mouse model of bone marrow transplantation to enforce expression of mouse FL cDNA in hematopoietic tissues. As early as 2 weeks posttransplantation, peripheral blood white blood cell counts in FL-overexpressing recipients were significantly elevated compared with controls. With the exception of eosinophils, all nucleated cell lineages studied were similarly affected in these animals. Experimental animals also exhibited severe anemia and progressive loss of marrow-derived erythropoiesis. All of the FL-overexpressing animals, but none of the controls, died between 10 and 13 weeks posttransplantation. Upon histological examination, severe splenomegaly was noted, with progressive fibrosis and infiltration by abnormal lymphoreticular cells. Abnormal cell infiltration also occurred in other organ systems, including bone marrow and liver. In situ immunocytochemistry on liver sections showed that the cellular infiltrate was CD3+/NLDC145+/CD11c+, but B220- and F4/80-, suggestive of a mixed infiltrate of dendritic cells and activated T lymphocytes. Infiltration of splenic blood vessel perivascular spaces resulted in vascular compression and eventual occlusion, leading to splenic necrosis consistent with infarction. These results show that FL can affect both myeloid and lymphoid cell lineages in vivo and further demonstrate the potential toxicity of in vivo treatment with FL.

Animals↗
PubMed1997

Osteoprotegerin: a novel secreted protein involved in the regulation of bone density.

A novel secreted glycoprotein that regulates bone resorption has been identified. The protein, termed Osteoprotegerin (OPG), is a novel member of the TNF receptor superfamily. In vivo, hepatic expression of OPG in transgenic mice results in a profound yet nonlethal osteopetrosis, coincident with a decrease in later stages of osteoclast differentiation. These same effects are observed upon administration of recombinant OPG into normal mice. In vitro, osteoclast differentiation from precursor cells is blocked in a dose-dependent manner by recombinant OPG. Furthermore, OPG blocks ovariectomy-associated bone loss in rats. These data show that OPG can act as a soluble factor in the regulation of bone mass and imply a utility for OPG in the treatment of osteoporosis associated with increased osteoclast activity.

Amino Acid Sequence↗
PubMed1997

Competency-based learning in traumatology.

BACKGROUND: A multidisciplinary, competency-based trauma teaching program was introduced for final year medical students (n = 67) at Royal Prince Alfred Hospital (RPAH) in 1994 to complement the surgical clerkship. METHODS: The method involved small groups rotating through a series of teaching stations each structured to address a predetermined competency. Four 3-hour sessions were held on the subject areas of resuscitation, plastic, orthopedic, and neurotrauma. Performance in the trauma section of a summative Objective Structured Clinical Examination (OSCE), 6 months after the teaching, was compared with that of a control group (n = 127) from other campuses where trauma was taught by a series of discipline-based lectures. Three trauma OSCE stations were designed to test psychomotor skills while five addressed aspects of the cognitive domain. Checklists were used to ensure standardization of scoring in a range of questions asked for skills tested at each station. RESULTS: The marks of the RPAH students (mean 78% +/- SD 9%) were significantly higher (P < 0.0005) than the controls (mean 70% +/- SD 9%) in the 8 trauma questions. There was no significant difference (P = 0.8) in marks obtained by the study group (mean 61% +/- SD 8%) and controls (mean 63% +/- SD 7%) in 22 questions sampling a wide spectrum of nontrauma subject areas. The study group performed significantly better in one of the three skills stations and three of the five problem-solving stations when compared with the control group. CONCLUSION: The innovation has the potential to fulfill a need for an integrated trauma program in the undergraduate core curriculum.

Australia↗
PubMed1997

Evaluation and impact of promotion of a cancer helpline to cancer patients through their specialists.

Four hundred and sixty four cancer patients attending their first outpatient consultation (96% of those eligible) were given a pamphlet promoting a cancer helpline by their participating specialist. Calls to the helpline during and six weeks following the study period were made relating to 4% (95% CI: 2.1%-5.6%) of patients or family members receiving the pamphlet. Whilst this response is small, the willingness of cancer specialists to distribute the pamphlet identifies them as a valuable channel for linking patients with complementary services.

Advertising↗
PubMed1997

The effect of intravenous ketorolac given intraoperatively versus postoperatively on outcome from gynecologic abdominal surgery.

STUDY OBJECTIVES: To examine the effect of timing of an intravenous (i.v.) dose (intraoperative vs. postoperative) of ketorolac tromethamine on pain scores and overall outcome after total abdominal hysterectomy (TAH) and myomectomy. DESIGN: Prospective, randomized, placebo-controlled study. PATIENTS: 248 ASA physical status I and II adult female patients scheduled for elective hysterectomy or myomectomy. INTERVENTIONS: General anesthesia was administered that consisted of thiopental sodium for induction, enflurane or isoflurane in nitrous oxide-oxygen for maintenance, and small doses of fentanyl and midazolam. Patients were randomized into three groups to receive toradol/placebo on a dosing schedule of dose 1 given one-half hour prior to expected end of surgery, dose 2 given on awakening in the postanesthesia care unit, and doses 3, 4, and 5 given at 6, 12, and 18 hours, respectively, after dose 2; Group 1 patients received placebo (saline) for dose 1, ketorolac 60 mg i.v. for dose 2, and ketorolac 30 mg i.v. for doses 3, 4, and 5. Group 2 patients received ketorolac 60 mg i.v. for dose 1, placebo for dose 2, and ketorolac 30 mg i.v. for doses 3, 4, and 5. Group 3 patients received placebo for all doses. All patients were given i.v. morphine PCA postoperatively, and morphine usages, visual analog pain intensity (VAS) scores, as well as adverse events and median times to recovery milestones were recorded. MEASUREMENTS AND MAIN RESULTS: VAS scores (mean) before dose 2 were significantly lower in Group 2 than Group 1, as were at-rest evaluations at 15 minutes and one hour. Group 2 patients also had decreased morphine requirements as compared to placebo. Both ketorolac groups (Groups 1 and 2) had significantly higher values for patient and observer overall ratings, case of nursing care, and tolerability as compared to placebo (Group 3). There were no significant differences among groups in adverse events or median times to recovery milestones. CONCLUSIONS: Although it is possible to demonstrate an improvement in early postoperative pain scores with intraoperative ketorolac and better overall ratings of ketorolac both intraoperatively and postoperatively as compared with placebo, the lack of clinically significant differences in analgesic efficacy in the two active study groups indicates the need for a careful consideration by the clinician of the risks versus benefits involved in the administration of antiplatelet medication in the perioperative period.

Adult↗
PubMed1997

Public perceptions of drugs causing most deaths in Australia 1986-93.

Drug use is a major cause of preventable mortality and morbidity in Australia. Tobacco is by far the largest cause of drug-related deaths. This paper reports changes in public awareness of the relative morbidity risks of different drugs between 1986 and 1993, a period of considerable activity for drug education and control. Broadly representative samples of Australians were surveyed in the two years using the same methods. Results indicate a significant increase in identification of tobacco as the largest cause of death, from a list of six drugs, although only a minority of respondents were correct in 1993. Alcohol was the second most identified drug, consistent with it being responsible for most drug deaths not attributable to tobacco. These results are discussed in the context of other studies. It is concluded that while improvement in knowledge has occurred, it is unlikely to be sufficiently strong to motivate action.

Journal Article↗
PubMed1997

Paclitaxel as a radiosensitizer combined with fractionated stereotactic radiotherapy in the treatment of recurrent medulloblastoma.

This report describes the treatment of a 39-year-old man with recurrent medulloblastoma previously treated with extensive chemotherapy and radiation therapy. A novel treatment technique combining paclitaxel (275 mg IV bolus) and fractionated stereotactic radiotherapy (30 Gy in six fractions over 3 weeks) was given to palliate the patient's significant neurologic symptoms. The patient experienced a significant improvement both radiographically and in the quality of his life at follow-up 5 months after completion of treatment. No toxicity has been observed. The treatment of medulloblastoma with paclitaxel and fractionated stereotactic radiotherapy, either alone or in combination, merits further investigation.

Adult↗
PubMed1997

Public health approaches to skin cancer control.

Approaches in both the primary prevention and early detection areas to control the incidence and mortality of skin cancer have been examined in terms of a model for skin cancer control. Population-based approaches are thought to be appropriate in public health terms because it is possible for individuals to reduce their exposure to sunburn (and subsequently, their risk of skin cancer), by individual sun protection behavioural change. A number of preventative intervention studies have identified specific methods for achieving such change. The success of Australian efforts in changing behaviours and reducing sunburn is also described, along with the need to equip doctors and patients with the knowledge and skills required for the early detection of skin cancer. Approaches that promote screening with acceptable sensitivity along with reasonable specificity are important when considering the costs and effectiveness of population-based programmes.

Attitude to Health↗
PubMed1997

Bleeding associated with vaginal hysterectomy.

The increased use of blood transfusion, ultrasound evidence of postsurgical haematoma, the frequency of postoperative febrile morbidity of unknown cause and reports of these complications in large series which contain both abdominal and vaginal hysterectomy over the last 25 years, suggests that bleeding may be more common after vaginal hysterectomy. We performed laparoscopy routinely after vaginal hysterectomy in 50 patients. The frequency of bleeding was 48%, consistent with other studies ranging from 30 to 98%. Arterial bleeding from a branch of the uterine or vaginal artery occurred in 20%. The frequency of bleeding was not related to uterine size, ranging from normal to that equivalent in size to that of a pregnancy of 18 weeks' gestation. The most common site of bleeding was the vaginal vault. Liberal definitions of haemorrhage, possible emphasis in speed in performing hysterectomy, and difficulty in visualizing and ligating major and minor blood vessels, may have contributed to the increased frequency of bleeding reported after vaginal hysterectomy. Haemostasis is more easily obtained at laparoscopic surgery because of magnification, close inspection, routine use of suction irrigation and bipolar electrocoagulation. Routine laparoscopy at the completion of vaginal hysterectomy is recommended. New and improved methods of vessel closure are also required. Attitudes to haemorrhage during hysterectomy require change to further reduce the use of blood transfusion.

Blood Loss, Surgical↗
PubMed1997

Predictors of returning for second round screening at a population based mammographic screening programme in Melbourne, Australia.

OBJECTIVE: To examine factors associated with returning for second round mammography screening. SETTING: This was a population based mammographic screening programme in Melbourne, Australia. DESIGN: A cohort design was used whereby 668 women were interviewed before the screening programme began and attendance for both first and second round screening was ascertained from programme records. The cohort sample was drawn from two regions of a defined area (close to and distant from the screening centre). MAIN RESULTS: Of the 315 women who attended for first round screening, 75% from the proximal sample and 70% from the distal sample returned for second round screening. Attendance at the second round was predicted by the following: the method of recruitment for first round screening, with women who required a letter of invitation and a reminder being less likely to reattend than those who initially attended in response to a community campaign (OR = 0.34; CI 0.19, 0.61); mammographic history before the initial screen, with women who reported previous diagnostic mammography being more likely to reattend than those who did not (OR = 2.97; CI 1.01, 8.9); stated intention of attending for the initial screen, with those with weakest intention of attending for their first round being less likely to attend for second round (OR = 0.44; CI 0.23, 0.85); and increasing scores on a scale that measured preventive orientation to health (OR = 1.24; CI 1.02, 1.50). CONCLUSION: Our findings corroborate other findings of reduced long term attendance for screening from people who are "reluctant participants" initially.

Aged↗
PubMed1997

Behavioural dynamics of a clinical trial of sunscreens for reducing solar keratoses in Victoria, Australia.

OBJECTIVE: To determine whether the behaviour of participants based on perception of treatment group in a randomised trial contributed to clinical outcome. DESIGN: A double blind randomised controlled trial of the effect of daily application of SPF 17 broad spectrum sunscreen cream (or placebo) on solar keratoses. SETTING: A rural city in Victoria, Australia. Residents aged 40 years or over were invited by letter to attend for a skin cancer screening check. Of these, 588 people with between one and 30 solar keratoses enrolled in the trial and 431 completed the trial, which extended over a six month period that included summer. Participants' perceptions of their treatment allocation, adherence with the treatment regimen, adoption of other sun protection behaviours, side effects, and perceptions of change in condition were measured at two monthly intervals. RESULTS: There were no significant differences between those who completed the study and those that did not for sex, age, treatment group, skin type, number of solar keratoses or correct perception of treatment group. Thirty per cent of those completing the study correctly guessed their treatment allocation, and people were just as likely to be right as to be wrong when they stated their opinion about their treatment allocation (z = 1.04; p = 0.15). Study group, skin type, amount of time spent outdoors, presence of side effects, perceptions of change in skin condition did not significantly predict correct perception of treatment allocation. Multivariate analysis of variance indicated that adoption of other sun protection and adherence with cream use were not significantly affected by actual treatment allocation, correct perception of treatment allocation nor by their interaction. Poisson regression analysis showed a significantly lower difference ratio of solar keratoses in the sunscreen group compared with the placebo base cream group (OR 0.55; CI = 0.46, 0.64), and for women compared with men (OR = 0.76; CI = 0.63, 0.93) but no independent effect of any of the indices of other sun protection or adherence. CONCLUSIONS: A sufficient level of commitment to study procedures was achieved, so that trial participants did not adopt other behaviours that affected treatment outcomes. It is recommended that the potential threat to validity posed by the behaviour of participants be recognised at an early stage in planning of clinical trials, so that strategies to deal with this can be integrated into study protocols.

Adult↗
PubMed1997

Initial impact of the new Australian tobacco health warnings on knowledge and beliefs.

BACKGROUND: New health warnings and contents labelling on tobacco products were introduced in Australia in 1995. OBJECTIVE: To assess awareness of the new warnings at a time when a mix of packs with old and new warnings were being sold and on changes in relevant knowledge and attitudes from shortly before the implementation of the new warnings. DESIGN AND SUBJECTS: Approximately 500 smokers and 500 non-smokers were surveyed in December 1994, before implementation of the new warnings. Similar numbers were also surveyed in May 1995, part-way through implementation. Respondents were selected by random-digit dialling of telephone numbers in Australia. Smokers were oversampled. In addition, 243 smokers from the initial survey were re-surveyed in May 1995. MAIN OUTCOME MEASURES: Awareness of change to health warnings, knowledge of health warnings and tobacco smoke constituents, beliefs about the health effects of smoking, and perceived impact of the warnings. RESULTS: There was high awareness of the new warnings, particularly among smokers, with the increased size of the new warnings being the most salient feature. More than a third of smokers reported being affected by the warnings, with reductions in consumption and talking about warnings being the most common effects. Among smokers, there was an increase in knowledge about the main constituents of tobacco smoke. The number of types of health effects mentioned also increased as did the number of warnings correctly recalled. Overall beliefs about the six warning statements became stronger. Few changes were found for non-smokers. The knowledge and recall effects were replicated in the re-contact subsample, but the belief changes were not. CONCLUSIONS: These results suggest the new health warnings are resulting in better informed smokers and thus suggest that informative health warnings can play an important role in better informing consumers.

Adolescent↗