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Biomedical subjects

G M Stirrat

Publications and source records attributed to G M Stirrat.

At least 19 recordsLinked to original sources
PubMed1992

Management of severe pre-eclampsia and eclampsia by UK consultants.

OBJECTIVE: To determine the current management of severe pre-eclampsia and eclampsia in the United Kingdom. DESIGN: One-page postal survey to all (1007) UK consultant obstetricians with questions about use of antihypertensive and anticonvulsant drugs in severe pre-eclampsia and eclampsia, other management strategies, definition of factors determining severity, protocol development and regional review. RESULTS: 688 replies (69.6% response rate). The antihypertensive drugs used were mainly oral labetalol (35%), oral methyl dopa (23%) and parenteral hydralazine (29%); diuretics were not used. Diazepam was the preferred drug in eclampsia. Very few consultants used magnesium sulphate (2%). Anticonvulsants were also prescribed by 85% of consultants to prevent fits; the drugs then preferred were diazepam (41%), phenytoin (30%) and chlormethiazole (24%). Two-thirds of consultants felt there was a need for trials to study the effectiveness of antihypertensive and anticonvulsant drugs. In a woman with proteinuric hypertension, 15% of consultants did not regard the development of headache as indicating severe pre-eclampsia. Consistent management practices were not associated with agreement about protocols. Regional review does not appear to have occurred. CONCLUSION: Antihypertensive and anticonvulsant therapies are widely used but trials are considered necessary. Improvements in the management of women with severe pre-eclampsia or eclampsia might occur if UK obstetricians sought more collective opinion and undertook regional audit of protocols.

Anticonvulsants↗
PubMed1992

The challenge of evaluating surgical procedures.

All new interventions and procedures must be properly assessed in comparison to the currently accepted method(s). It is unethical not to do so. The optimum method is by Randomised Controlled Trial (RCT). This is ideally suited to the testing of drugs because the trial can usually be double blind and placebo controlled. RCTs are less commonly used for the evaluation of new surgical techniques. There are valid and invalid reasons for this and these are discussed.

Clinical Trials as Topic↗
PubMed1991

Changes in anal canal sensation after childbirth.

Obstetic trauma predisposes to faecal incontinence. Anal canal sensation is impaired in incontinent patients. To assess the effect of childbirth on anal canal sensation anal mucosal electrosensitivity was measured in 122 primiparous patients in the immediate postnatal period and in 74 at 6 months postpartum. There were 35 normal vaginal deliveries, 36 forceps deliveries, 20 ventouse extractions, ten vaginal breech deliveries and 21 caesarean sections. Sensation was impaired in the lower, mid and upper anal canal immediately after delivery in those patients who had a normal vaginal delivery or a forceps delivery when compared with controls or with those delivered by caesarean section. Women who had ventouse deliveries had impaired sensation immediately after delivery in the mid anal canal compared with controls and those undergoing caesarean section. By 6 months there were no differences between any group. Patients who sustained a division of the external anal sphincter at delivery had impaired sensation which persisted in the upper anal canal at 6 months.

Anal Canal↗
PubMed1991

Assessment and management of hypertensive disorders in pregnancy by health professionals in the Avon district.

A questionnaire based survey was carried out in the Avon health districts to investigate the assessment and management of hypertensive disorders in the third trimester of pregnancy by health professionals. A total of 673 responses were analysed from 310 general practitioners, 48 hospital doctors, 214 hospital midwives, 81 community midwives and 120 student midwives. The study revealed a wide variation in the criteria used for the diagnosis of a hypertensive disorder in pregnancy and some outmoded recommendations for management. The importance of continuing education is stressed, in order to ensure that current research and the consensus of expert opinion is being relayed to the personnel involved in antenatal care.

Female↗
PubMed1990

Recurrent miscarriage. II: Clinical associations, causes, and management.

Firm evidence on the causes of recurrent miscarriage is scant. The true rate is probably artificially heightened by a reproductive compensation effect. The commonest direct cause is probably repeated sporadic chromosome abnormalities, which occur consecutively merely by chance. Congenital and acquired anatomical defects of the uterine fundus and cervix, parental chromosomal rearrangements, gene mutations, antibodies to cardiolipin, and luteal phase defects each make a small contribution. Other causes, such as polycystic ovaries and immune rejection, may play some part but the evidence is not clear. Psychological stress, subclinical infections, thyroid disorders, and diabetes mellitus are probably not relevant. Reassurance and clear statements about prognosis are important and psychological support must be offered throughout investigation and subsequent pregnancy. Much more rigorous scientific studies from which clearer conclusions can be drawn are vital for better understanding of this important clinical problem.

Abortion, Habitual↗
PubMed1990

Recurrent miscarriage.

On epidemiological evidence, the definition of recurrent miscarriage should be three or more consecutive pregnancy losses. Data should be collected to 28 weeks' gestation but analysis up to 20-22 weeks' or 500 g fetal weight should also be possible. General practitioners and gynaecologists should do what they feel is suitable for couples whose history does not meet these criteria but a diagnosis of recurrent miscarriage should not be made. Women meeting the definition can be subdivided into primary and secondary groups, respectively consisting of those who have lost all previous pregnancies and those who have had one successful pregnancy followed by consecutive losses.

Abortion, Habitual↗
PubMed1990

Fetal Doppler shift waveforms in intrauterine growth retardation: laplace transform analysis technique.

An approach to the analysis of fetal blood flow velocity/time waveforms is described using a Doppler shift flowmeter. The waveform shape is described in terms of its Laplace transform. Variations in the value of the dominant coefficient in the Laplace transform in the descending thoracic aorta appear to distinguish growth retarded from normally grown fetuses early in pregnancy. Growth retardation was defined by an index of size specifically aimed at detecting the disproportionately grown fetus. Simpler methods of waveform shape description fail to detect the growth retarded fetus early in the second trimester.

Aorta, Abdominal↗
PubMed1988

Expression of class I and II major histocompatibility complex antigens in Wilms' tumour and normal developing human kidney.

The Wilms' tumour is a solid childhood tumour of the kidney, consisting of blastema, tubules and mesenchyme. Embryonic tumours, such as Wilms', may arise as a result of a developmental disturbance in differentiation. The expression of class I and II major histocompatibility complex (MHC) antigens was investigated on 6 Wilms' tumours and related to that in the developing human kidney in this immunohistological study, using a panel of monoclonal antibodies. The Wilms' tumour blastemal cells were class I MHC antigen negative, but differentiated structures were positive. Class II MHC antigens were not observed in Wilms' tumours. In the developing human kidney class I MHC antigen expression was observed on glomeruli from 8 weeks and on tubules from 13 weeks gestational age. Class II MHC antigen expression was observed on glomeruli from 11 weeks and on tubules from 13 weeks gestation. These results suggest that the blastemal cells within the Wilms' tumour may reflect an early stage of development with respect to the expression of MHC antigens.

Adult↗
PubMed1985

An immunohistological study of HLA antigen expression by gestational choriocarcinoma.

Two cases of gestational choriocarcinoma have been examined for the expression of HLA and trophoblast antigens using the indirect immunoperoxidase technique on frozen tissue sections. Approximately 40-70% of tumour cells express MHC Class I antigen as detected by a panel of antibodies to monomorphic, or framework, MHC Class I antigenic determinants. Evidence in one case suggests that most of these cells may not express the paternal, polymorphic HLA antigenic determinants but that a small subpopulation do carry the fully antigenically active molecule. These latter may give rise to patient anti-paternal HLA antibodies. Class II (HLA DR or DC) antigens are expressed by none, or very few, tumour cells.

Choriocarcinoma↗
PubMed1979

Amniotic-fluid acetylcholinesterase as a possible diagnostic test for neural-tube defects in early pregnancy.

Raised levels (greater than or equal to 4.5 munits/ml) of acetylcholinesterase (AChE) activity in amniotic fluid at 14--23 weeks of pregnancy were significantly associated with open fetal neural-tube defects. Out of 72 pregnancies correctly classified by the amniotic-fluid alpha-fetoprotein (A.F.P.) test, 2 of 56 without neural-tube defects and all 16 with open neural-tube defects (8 with anencephaly and 8awith open spina bifida) had raised levels of AChE. Out of 5 pregnancies misclassified by the A.F.P. test (4 without neural-tube defects and 1 with open spina bifida), only 1 was misclassified by the AChE test--namely, one of those without a neural-tube defect. Thus, only 3 of the 77 pregnancies tested were misclassified by the quantitative AChE test. A qualitative test for an isoenzyme of AChE found in cerebrospinal fluid correctly classified these 3 pregnancies. These findings suggest that the analysis of AChE in amniotic fluid may be a useful test in the diagnosis of open neural-tube defects.

Acetylcholinesterase↗
PubMed1979

Antenatal screening in Oxford for fetal neural tube defects.

Between May 1975 and the end of 1977, 6443 antenatal patients were screened mainly between 16 and 22 weeks of pregnancy for neural tube defects (NTDs) at the John Radcliffe Hospital, Oxford, by maternal serum alpha-fetoprotein (AFP) measurement; a take-up of 72 per cent. Seventeen out of 18 (94 per cent) patients with open NTD pregnancies (9 out of 9 with anencephaly and 8 out of 9 with open spina bifida) had positive screening tests, and all except one were offered and accepted a termination of pregnancy. Two hundred and forty-five (3.8 per cent) patients with unaffected pregnancies also had positive screening tests, although only 1.4 per cent had an amniocentesis. Following ultrasonography, about 50 per cent of patients with unaffected pregnancies with positive screening tests were not offered an amniocentesis because they had a multiple pregnancy or their gestational age had been underestimated. The odds of having a fetus with an NTD among the women who had an amniocentesis was about 1 to 6 (1 to 11 for open spina bifida alone). Two apparently normal pregnancies were terminated. A survey of the acceptability of the screening programme among a consecutive sample of 73 patients who knew that they had a positive screening test revealed that all except one had no objection to screening in general, and 68 (93 per cent) wanted to be tested again in a future pregnancy. The approximate direct cost of the programme was 2 pounds to 3 pounds per patient screened, or about 1000 pounds per NTD detected (about 2200 pounds per open spina bifida detected).

Amniocentesis↗