Biomedical subjects
H S Cuckle
Publications and source records attributed to H S Cuckle.
Recurrence risk of neural tube defects following a miscarriage.
Data from 280 sibships in three published series were used to see if the increased risk of neural tube defect (NTD) associated with having had a miscarriage in the immediately preceding pregnancy was also found in women with a previous affected pregnancy. A statistically significant relative risk of 4.0 (2-tail P = 0.0111, Fisher exact test) was found among such women, and this could not be accounted for by the effect of parity or of a history of miscarriage in general. The finding may be useful when counselling patients.
The influence of diabetes mellitus upon peripheral vascular disease.
The treatment of 332 consecutive patients referred to a peripheral vascular unit with rest pain, ulceration or gangrene of the lower limb has been studied. Ninety-seven (20 per cent) of the patients had diabetes mellitus. Although diabetes was related to adverse limb salvage and patient survival rates, this could be accounted for by the influence of initial presenting clinical features and treatment upon survival time. The influence of these factors upon survival time was still strong even when the data were stratified for diabetric status. Thus, an extensive amputation carries the worse prognosis, with a less extensive amputation intermediate between an extensive amputation and any other form of therapy. Patients with both rest pain and ulceration or gangrene have a poor prognosis when assessed by either limb salvage or mortality. The majority of the patients with less extensive amputations are diabetic. This is related to the high incidence of localized ulceration among those in the diabetic group. In diabetics, a less extensive amputation, if clinically indicated, is worthwhile because of the low incidence of a subsequent extensive amputation after a less extensive amputation and the better survival rate for those patients with less extensive amputations as compared with those with extensive amputations.
[The components of tobacco smoke: does there exist a less toxic cigarette?].
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A simple method for amniotic fluid gel-acetylcholinesterase determination, suitable for routine use in the antenatal diagnosis of open neural tube defects.
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Maternal serum alpha-fetoprotein and low birth weight in relation to gestational age.
To determine when in the first and second trimester a raised serum alpha-fetoprotein (AFP) level best predicts low birth weight a case-control study was performed on 157 singleton low birth-weight (less than or equal to 2.5 kg) and 314 singleton control pregnancies (birth weight greater than 2.5 kg). The association between raised maternal serum AFP and low birth weight was confirmed, but there was no special time in pregnancy before 29 weeks gestation when a raised AFP level predicted low birth weight materially better than at any other time.
Evidence against oral contraceptives as a cause of neural-tube defects.
Information on oral contraceptive (OC) use, collected at the first antenatal visit, was abstracted from the medical notes in respect of 107 index pregnancies resulting in the delivery of an infant with a neural-tube defect (NTD) and 214 unaffected controls. The relative risk of having an NTD infant for women who had at any time used OCs was 0.82 (95% confidence interval 0.52, 1.32) compared with that in women who had never used OCs. For women who stopped OC use less than 3 months before becoming pregnant or who continued in early pregnancy, the relative risk was 1.18 (95% confidence interval 0.70, 1.98) compared with women who had used OCs at any other time. An analysis restricted to those women who had at any time used OCs did not suggest an association between NTD risk and the interval between stopping OC use and becoming pregnant. None of our analyses therefore provided any evidence that OCs cause NTDs and if a risk exists it can only be small.
Nomogram for estimating an individual's risk of having a fetus with open spina bifida.
A nomogram indicating the risk of having a fetus with open spina bifida in relation to a particular maternal serum and amniotic fluid alpha-fetoprotein (AFP) level is described. The nomogram is designed for counselling patients with borderline amniotic fluid AFP results, who on average are only marginally at risk of having a fetus with open spina bifida. The use of the nomogram will refine the estimate of risk for a particular woman by combining the estimate derived from the amniotic fluid AFP level with that derived from the maternal serum AFP level. Details are also given for further refining the estimate risk by using information from an amniotic fluid gel acetylcholinesterase determination.
False positive gel-acetylcholinesterase results in blood-stained amniotic fluids.
The effect of blood contamination on the gel-acetylcholinesterase (AChE) test used in the diagnosis of fetal open neural-tube defects was studied with amniotic fluid samples artificially contaminated with fetal or maternal blood in concentrations covering a range exceeding that usually found in clinical practice. Amniotic fluid samples contaminated with maternal blood gave negative gel-AChE results at all concentrations. Contamination with fetal blood yielded positive results if the erythrocyte concentration was greater than about 60 x 10(6) cells/ml. Thus contamination of amniotic fluid with blood is only likely to cause false positive gel-AChE results if this critical concentration is exceeded. Such samples will occur only rarely in clinical practice but when they do the diagnosis should be made with caution.
Alpha fetoprotein screening and diagnosis of fetal open neural tube defects: the need for quality control.
A workshop, held in May, 1978, at the National Institute of Child Health and Human Development, considered the quality control of reagents and assays for measuring alpha fetoprotein (AFP) in maternal serum and amniotic fluid for the antenatal screening and diagnosis of open neural tube defects. The recommendations, published in detail elsewhere and summarized in this article, were based on what was known to be readily achievable and on estimates of the effect of assay performance on screening and diagnostic sensitivity and specificity. Main points considered included: (1) choice of units for AFP measurement and interpretation, (2) need for National AFP Reference Preparations and the need for a scientific panel to assess the adequacy of these reference materials, (3) information needed from reagent manufacturers, (4) criteria for assay performance, (5) biological sources of reagents, (6) need for laboratory and epidemiologic monitoring, and (7) need for a minimum assay workload.
Raised maternal serum alpha-fetoprotein levels in subsequent pregnancies.
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Coffee and cancer of the pancreas.
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Raised maternal serum AFP, oligohydramnios and poor fetal outcome.
Six women who had an ultrasound scan examination in early pregnancy on account of a high serum alpha-fetoprotein level were noted to have little or no amniotic fluid. This paper gives details of the six pregnancies, two of which were extrauterine; only one of the six infants survived.
Maternal serum alpha-fetoprotein and diabetes mellitus.
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Should ultrasound be used to estimate gestational age in the screening and antenatal diagnosis of open neural tube defects?
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Early antenatal diagnosis of exomphalos.
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Cut-off levels in AFP screening.
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Relation between maternal serum and amniotic fluid AFP.
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