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Biomedical subjects

D J Hunter

Publications and source records attributed to D J Hunter.

At least 307 records · Page 17Linked to original sources
PubMed1985

A platelet function defect in preeclampsia.

A prospective study was performed on 26 preeclamptic patients and 17 pregnant control subjects relating the platelet count to in vivo platelet function as assessed by the bleeding time and in vitro platelet function as assessed by collagen-stimulated thromboxane B2 biosynthesis. The results of these tests were normal in all control subjects. Nine of the 26 preeclamptic patients (34%) showed thrombocytopenia, and five of these patients had a prolonged bleeding time. Four of the 16 nonthrombocytopenic patients also had a prolonged bleeding time. Eleven patients had impaired thromboxane B2 biosynthesis, and seven of these had a prolonged bleeding time. In all patients, the bleeding time returned to normal, and in most the platelet count returned to normal within five days or after delivery. A significant proportion of patients with preeclampsia develop an acquired defect of platelet function that could contribute to bleeding.

Bleeding Time↗
PubMed1984

Variations in urinary levels of free 6 beta-hydroxycortisol, cortisol, and estrogens in late pregnancy.

The urinary excretion of 6 beta-hydroxycortisol (6 beta-OHF), free cortisol, and estriol was studied at 4-hourly intervals in 9 subjects between the 36th and 38th week of pregnancy. The ratio of 6 beta-OHF to creatinine showed a significant diurnal rhythm with a 40% fall from a peak at 06.00-10.00 h to a trough at 22.00-02.00 h. There was a significant positive correlation between the excretion of 6 beta-OHF and free cortisol. Estrogen excretion showed no diurnal variation. No increase was observed in the 6 beta-OHF:creatinine ratio in early morning urine samples from 5 subjects followed daily prior to the onset of spontaneous labour at term. Normal nonpregnant females were also found to excrete significant quantities of 6 beta-OHF. These findings suggest that the clinical significance of 6 beta-OHF levels measured in a single void sample of urine has to be reassessed in the face of such a marked diurnal variation.

Circadian Rhythm↗
PubMed1983

Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?

The perinatal mortality rate among very low-birth weight infants has been decreased by 20% during the last 4 years of the 1973 to 1980 period here reported. The concurrent increase in the cesarean section rate from 11.9% to 49.1% during the same time frames has been assumed to be responsible for the improved outcome. The changes were most marked in the extremely low-birth weight group (less than 1,000 gm). The survival rates and cesarean section rates were examined among infants of similar birth weight and gestational age in the vertex presentation, in the same time frames. A similar or greater reduction in mortality rate (from 85% to 45%) was noted in the very low-birth weight vertex infants, whereas the cesarean section rate remained minimally and not significantly increased (14.2% to 22.2%). The interpretation of this finding is by no means clear but must include the hypothesis that the increased cesarean section rate may be incidental and in no way related to the improved outcome. The most statistically significant determinants of outcome remain birth weight and gestational age strata, with no significant difference in outcomes when the extremely low-birth weight group is analyzed separately from the entire very low-birth weight group. As yet unidentified perinatal care practices, other than cesarean section, may be more likely to affect outcome in this high-risk group.

Birth Weight↗
PubMed1983

The outcome of prolonged labor as defined by partography and the use of oxytocin: a descriptive study.

A descriptive study of 300 consecutive spontaneous labors in primigravid patients whose pregnancies were of 37 or more weeks' gestation with a singleton fetus in the vertex presentation, showed a cesarean section rate of 13%, a forceps delivery rate of 49%, and a spontaneous delivery rate of 38%. Oxytocin was used in 17% and epidural analgesia was used in 75% of the patients. The median rate for cervical dilatation for those women with spontaneous deliveries was 2 cm/hr (interquartile range = 1.5 to 3.3 cm/hr) and for those delivered with forceps, 1.2 cm/hr (interquartile range = 0.9 to 1.8 cm/hr). When labor was prolonged by 4 hours or more, the cesarean section rate rose to 34%. Oxytocin was used in only 41% of these patients. Of 23 women delivered by cesarean section for dystocia/disproportion, only nine received oxytocin. From the low incidence of low Apgar scores in all labor groups from this series, there would not appear to be a fetal advantage to earlier intervention. Although the suggestion from this study is that oxytocin administration when labor is prolonged by 4 hours will reduce the need for cesarean section, the true value of such an intervention can be tested only by a randomized controlled trial.

Adolescent↗
PubMed1983

Reducing inequalities in health: political and organisational implications for the British National Health Service.

Tackling health inequalities with any hope of success requires an understanding and appreciation of a number of issues concerning the nature and operation of services. Focussing on the British experience, the paper considers notions of need and demand insofar as these have a bearing on health inequalities. Need and demand are not finite, absolute states but are relative notions which are affected by users' attitudes and knowledge and by providers' preferences and interests. Drawing upon recent work, the paper argues that the existence of the National Health Service (NHS) has not fundamentally altered the nature of health inequalities in Britain. Those living in the North of the country generally enjoy poorer health than those living in the South. Inequalities between socio-economic groups are also much in evidence. The paper considers possible policy implications and comes out in favour of process change rather than major structural change of the kind witnessed in recent years in Britain where the NHS has undergone two major upheavals within a decade. This disruption has had the effect of diverting attention away from important policy issues at all levels of service planning and provision.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Policy↗
PubMed1982

Trial of labor after previous cesarean section: prognostic indicators of outcome.

A cross-sectional analytic survey of 92 patients permitted to attempt vaginal delivery after previous lower segment cesarean section ("trial of scar") is reported. Variables which may predict mode of delivery were assessed. Fifty patients (54.3%) were delivered vaginally; 42 patients (45.7%) had repeat cesarean sections in labor. There were three cases of scar dehiscence (3.2%). There were no maternal or fetal mortality. When the cervix was less than 3 cm dilated at initial examination in labor, 10 of 37 patients (27%) were delivered vaginally, compared to 38 of 55 patients (69%) who were delivered vaginally when the cervix was greater than 3 cm dilated. Assessment of cervical dilatation on admission in labor proved to be the most significant prognostic factor at the onset of labor, with regard to successful vaginal delivery in a patient with a lower segment cesarean section scar.

Cervix Uteri↗
PubMed1980

Management of a massive ovarian cyst.

The management of a patient with an ovarian cyst weighing 71.1 kg is described. Preoperative paracentesis did not improve the condition of the patient and should be avoided. Supine hypotension from vena caval occlusion, technically difficult surgery, massive blood replacement, prolonged postoperative ventilatory failure, and persistent bowel distention provided a challenge to the multidisciplinary teams required to manage the largest ovarian tumor reported in 16 years.

Female↗
PubMed1979

Changes in coagulation factors in postmenopausal women on ethinyl oestradiol.

Coagulation factors II, VII, X, VII + X complex and anti-thrombin III were measured in 10 postmenopausal women before, during and after a four-month course of 20 microgram daily of ethinyl oestradiol, taken three weeks in four. Factors VII, X and VII + X complex rose significantly during treatment but only factor X levels were significantly elevated at the end of the four-month treatment period. There was no change in factor II or anti-thrombin III levels. These effects on coagulation factors during ethinyl oestradiol therapy are, in general, similar to those found during treatment with conjugated equine oestrogens and oestradiol valerate in a previous study from the same laboratory. It seems likely that equipotent doses of ethinyl oestradiol and 'natural' oestrogens have similar effects on these coagulation factors.

Antithrombin III↗
PubMed1977

Plasma levels of estrogen, luteinizing hormone, and follicle stimulating hormone following castration and estradiol implant.

Plasma levels of luteinizing hormone, follicle stimulating hormone, and estrogen were studied serially in 20 patients before and after hysterectomy and bilateral salpingo-oophorectomy. Ten patients received an implant of estradiol-17 beta (100 mg) at the time of operation. Ten patients who did not receive an implant acted as controls. Patients recorded the severity of vasomotor symptoms before and after hysterectomy. In those patients who did not receive an implant, plasma estrogen levels fell from a mean preoperative level of 18.1 +/- 10.4 ng/100 ml to 8.7 +/- 1.4 ng/100 ml by 24 hours after oophorectomy and they remained in this range for the 6 months of the study. No significant change in the plasma estrogen level was noted after oophorectomy in those patients who received an implant. The implant prevented the rise in gonadotropin levels and the appearance of vasomotor symptoms seen in those patients who underwent oophorectomy without an implant. Insertion of an implant into oophorectomized patients caused the plasma estrogen level to return to premenopausal levels within 2 weeks and the gonadotropin levels to premenopausal values within 6 weeks. Hot flashes were alleviated within 2 to 6 days. The usefulness of this type of therapy in preventing the appearance of vasomotor symptoms at the time of oophorectomy in premenopausal patients is confirmed.

Adult↗