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Biomedical subjects

D R Aickin

Publications and source records attributed to D R Aickin.

At least 19 recordsLinked to original sources

Female genital schistosomiasis.

Schistosoma haemtobium infection in travelers from endemic areas is usually asymptomatic, or presents with hematuria. Uncommon manifestations include neurological syndromes, genital dysaesthesias and watery or blood stained semen. This organism also causes disease within all structures of the female genital tract because of communications between pelvic venous complexes, and can occur long after return home. Schistosomiasis may not be suspected, resulting in delays in diagnosis and treatment. We present two cases which illustrate the diverse nature of this condition.

Adult↗

Pre-ovulatory oxytocin administration promotes the onset of the luteinizing hormone surge in human females.

Luteinizing hormone (LH) secretion during the ovulatory cycle is believed to be predominantly regulated by gonadotrophin-releasing hormone. Investigations in animals have strongly suggested that oxytocin also participates in LH control and the physiological events controlling LH surge initiation. In the human female, however, there has been no evidence supporting oxytocin's involvement in the processes leading to ovulation. In this study the effect of a preovulatory infusion of oxytocin on the onset of the LH surge was investigated in women aged 20-35 years who had natural ovulatory menstrual cycles of lengths between 25-35 days. Vaginal ultrasound scanning monitored follicular growth during the late follicular phase. When a follicle > 14 mm in diameter was observed each woman was randomized into one of two groups. One group (n = 8) received an oxytocin infusion of 256 mIU/min for 2 h, the other group (n = 8) received normal saline. The women who were administered oxytocin at this late follicular stage had an earlier onset of the LH surge than those who had received saline (P < 0.01). The results indicate that oxytocin promotes the onset of the LH surge in humans.

Adult↗

Maternal mortality in New Zealand.

New Zealand's maternal mortality rate in the triennium 1986-8 was reviewed in comparison with the rates from Australia and the United Kingdom during 1985-7. The New Zealand rate of 9.6 obstetric deaths/100,000 total births was higher than that for the United Kingdom (6.2) and Australia (4.4). Six of 16 deaths in New Zealand during the triennium were caused by sepsis, including five cases of puerperal infection with group A beta-haemolytic streptococci. Careful analysis of maternal deaths in New Zealand remains an important priority to provide audit of the performance of maternity services.

Australia↗

Second trimester maternal serum alpha-fetoprotein as an indicator of fetal risk.

Serum alpha-fetoprotein levels were raised to 2.0 or more times the median for gestation in 30 of 507 singleton pregnancies after excluding pregnancies complicated by fetal neural tube defects. The serum alpha-fetoprotein levels were significantly more often elevated in pregnancies complicated by prematurity, fetal heart rate abnormalities, delivery of a small for dates infant, a perinatal death and admission of the baby to the neonatal unit. While the predictive value of an elevated serum alpha-fetoprotein was 76% for abnormal outcomes in general it ranged between only 16% and 46% for specific abnormalities. The usefulness of this assay relates only to its ability to predict an abnormal outcome when performed during the second trimester.

Apgar Score↗

Salivary estriol concentrations during normal pregnancies, and a comparison with plasma estriol.

Saliva would have advantages over plasma or urine for monitoring estriol during pregnancy. Specimen collection, after stimulation of flow by citric acid, is non-invasive and simple. We measured concentrations of unconjugated estriol in saliva and compared them with those in plasma in normal pregnancies, and found a good correlation (r = 0.79). In addition, trends of concentrations in saliva and plasma were statistically compared and found to be highly correlated. The variation among individuals in the saliva/plasma concentration ratio suggested that some inter-individual factor(s) may affect this relationship. The normal reference interval for unconjugated estriol concentration in saliva from 20 weeks of gestation to term was established.

Estriol↗

Clinical usefulness of estriol assay for predicting "light-for-dates" infants.

A method was developed for determining clinical usefulness of a test for predicting "light-for-dates" infants before birth. The method was applied in a prospective study of assay of maternal estriol at 35-36 weeks of gestation as a means of identifying such infants. With the tenth centile for estriol values as the cutoff, low estriol values identified less than a third of all light-for-dates infants, and less than a third of pregnancies with low estriol values were associated with births of light-for-dates infants. Our reanalysis of data from three other published studies, using the same method of assessment, gave similar results. When laboratory tests are expected to provide clinically relevant information, we urge that data should be appropriately collected, analyzed, and reported, so clinical usefulness can be evaluated.

Estriol↗

Amenorrhoea.

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Adolescent↗

Antenatal biochemical screening to predict low birthweight infants.

Urine and plasma oestriol, plasma progesterone, human placental lactogen, beta 1-glycoprotein and serum cystyl aminopeptidase were measured at intervals during 608 pregnancies. The predictive accuracy of low values for identification of pregnancies with low birthweight outcomes was assessed for each test at various gestations. Data were analysed to obtain 10th-90th centile values for each test from 28 weeks to delivery. Groups with values under different centile levels were compared: those under the lower centiles had higher proportions but smaller absolute numbers of low birthweight infants than those under higher centiles. No test was superior to the others at all centiles and gestations. Biochemical screening of pregnant populations to identify high-risk groups for intensive fetal monitoring has limited potential. If screening is used, the definition of high-risk groups is best achieved by practical rather than statistical criteria. If monitoring facilities are available and well accepted by patients then higher centile 'cut-offs' to define fetal risk may be used than when they are not. Combining any pair of tests with values below the 10th centile did not reduce false positive and negative predictions any more than could be achieved by movement of centiles up or down for a single test.

Cystinyl Aminopeptidase↗

Fetal respiratory movements observed by ultrasound during abnormal pregnancies.

Observations of fetal respiratory movements were carried out during 35 pregnancies with complications likely to indicate increased fetal risk. Fetal breathing was demonstrated in 25 of 35 patients studied, and in 29 of 47 separate examinations. Of 17 patients delivering after 36 weeks gestation in whom observations were made with two weeks of delivery, three did not demonstrate fetal breathing. Infants born from these pregnancies were severely growth retarded in two instances and light for dates in the other. Although absent fetal breathing is likely to detect increased fetal hazard near term, the time and expense needed for accurate recording of fetal breathing will restrict application of the technique in the meantime.

Female↗