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Biomedical subjects

J Gunn

Publications and source records attributed to J Gunn.

At least 73 records · Page 4Linked to original sources
PubMed1998

Does an early postnatal check-up improve maternal health: results from a randomised trial in Australian general practice.

OBJECTIVES: To investigate whether a visit to a general practitioner one week after discharge results in less depression, increased breastfeeding rates, improved patient wellbeing, fewer physical problems and greater satisfaction with general practice care than the traditional six week postnatal check-up. DESIGN: A randomised controlled trial. SETTING: Rural and metropolitan Victoria, Australia. Population Women giving birth at one rural and one metropolitan hospital between February and December 1995 inclusive. METHODS: All women received a letter and appointment date to see a general practitioner for a check-up: the intervention group for one week after hospital discharge, the control group for six weeks after birth. A mail-out survey was conducted at three and six months after birth, including Edinburgh Postnatal Depression Scale and Short Form 36. RESULTS: 1017/1407 (72.3%) women giving birth at participating hospitals were eligible for the trial: 683 (67.2%) gave informed consent. The average response rate to postal follow up at three and six months was 67.5%. No significant differences were found between the groups in: Edinburgh Postnatal Depression and Short Form 36 scores; number of problems; breastfeeding rates; or satisfaction with general practitioner care. Women in the intervention group were less likely to attend for their check-up (76.4% vs 88.4%; P = 0.001), more likely to discuss labour and birth at their check-up (OR= 1.77, 95% CI 1.17-2.68), less likely to have a vaginal examination (OR = 0.51; 95%, CI 0.34-0.77) or pap smear (OR = 0.34; 95% CI = 0.22-0.52) at their check; more likely to report difficulties with low milk supply (OR= 1.72; 95% CI = 1.12-2.66) and adjusting to the demands of a new baby (OR = 1.76; 95% CI 1.13 2.74), more likely to talk to a general practitioner about their baby (68.2% vs 58.0%; P=0.02) and less likely to consult a hospital doctor about their baby (7.3% vs 14.0%, P = 0.02). CONCLUSIONS: To make clinically important improvements in maternal health more is required than early postnatal review.

Breast Feeding↗
PubMed1998

Intravascular stents: a new technique for tissue processing for histology, immunohistochemistry, and transmission electron microscopy.

BACKGROUND: Study of the vascular response to stent implantation has been hampered by difficulties in sectioning metal and tissue without distortion of the tissue stent interface. The metal is often removed before histochemical processing, causing a loss of arterial architecture. Histological and immunohistochemical sections should be 5 microns with an intact tissue stent interface. OBJECTIVES: To identify the most suitable cutting and grinding equipment, embedding resin, and slides for producing thin sections of stented arteries with the stent wires in situ for histological, immunohistochemical, and transmission electron microscopic (TEM) analyses. METHODS: 20 balloon stainless steel stents were implanted in the coronary arteries of 10 pigs. Twenty eight days later the stented arterial segments were excised, formalin fixed, embedded in five different resins (Epon 812, LR white, T9100, T8100, and JB4), and sectioned with two different high speed saws and a grinder for histological, immunohistochemical, and TEM analyses. Five stented human arteries were obtained at necropsy and processed using the best of the reported methods. RESULTS: The Isomet precision saw and grinder/polisher unit reliably produced 5 microns sections with most embedding resins; minimum section thickness with the horizontal saw was 400 microns. Resin T8100, a glycol methacrylate, enabled satisfactory sectioning, grinding, and histological (toluidine blue, haematoxylin and eosin, and trichromatic and polychromatic stains) and immunohistochemical analyses (alpha smooth muscle actin, von Willebrand factor, vimentin, proliferating cell nuclear antigen, and CD68 (mac 387)). T9100 and T8100 embedded stented sections were suitable for ultrastructural examination with TEM. Stented human arterial sections showed preserved arterial architecture with the struts in situ. CONCLUSION: This study identified the optimal methods for embedding, sawing, grinding, and slide mounting of stented arteries to achieve 5 microns sections with an intact tissue metal interface, excellent surface qualities, histological and immunohistochemical staining properties, and suitability for TEM examination. The technique is applicable to experimental and clinical specimens.

Animals↗
PubMed1998

The six week postnatal check up. Should we forget it?

In order to deal with the uncertainty that is inherent. In general practice, many of us use accepted dogmas that we may have been taught as students, and which become incorporated into everyday practice in an unquestioning manner. How do some of these fare when held up to the light of current best practice and evidence based medicine? Some will hold true, others will go the way of many accepted best practices of the past; they fade into the annals of medicine as we move on to newer methods and techniques. This new series explores some of our current accepted practices or sacred cows.

Australia↗
PubMed1998

Involvement of Victorian general practitioners in obstetric and postnatal care.

OBJECTIVE: To assess the current nature and extent of general practice (obstetric) involvement and the effect of gender on the provision of maternity care in Victoria. METHOD: A postal survey to a community derived sample of 1104 Victorian general practitioners (with oversampling of female GPs) in August 1994 with hierarchical data analysis techniques used to account for the clustered (divisional) nature of the sampling frame. RESULTS: A 70% response rate was achieved (715 out of an eligible sample of 1022). Three hundred and sixty-two (45.6%) GPs were providing shared care, 127 (17.7%) intrapartum care and 656 (92%) were involved in seeing women for their routine 6 week postnatal checkup. Male and female GPs were equally qualified and as likely to be vocationally registered (90% vs 92%). Female GPs were less likely than male GPs (11% vs 25%) to be involved in intrapartum care (OR = 0.4, 95% CI = 0.3-.06). Female GPs were more likely than male GPs (50% vs 41%) to be involved in shared care (OR = 1.4, 95% CI = 1.01-2.0), and postnatal care (OR = 3.7, 95% CI = 2.5-5.4). Provincial city (population > 15,000) GPs were more likely to provide shared care than other GPs. Fifty-two per cent of GPs providing shared care held a Diploma of Obstetrics. After accounting for the gender differences associated with practice location, rural GPs were more likely to provide intrapartum care (OR = 10.6, 95% CI = 3.5-32.4). CONCLUSION: General practitioners play an important role in all facets of maternity care. Female and male GPs differ in their type of obstetric practice. If GPs are to maintain an intrapartum role, prompt action is required to increase the number of GPs involved in intrapartum care. The training requirements for shared care should be reviewed and a more suitable postnatal care curriculum should be developed.

Adult↗
PubMed1998

Changing patterns of treatment for chronic anal fissure.

To assess changing patterns of treatment for chronic anal fissure, a retrospective analysis of treatment for chronic anal fissure within one hospital between January 1990 and December 1996 was undertaken. A total of 221 patients received treatment for a chronic anal fissure in this period, of whom 209 had a surgical procedure. Manual dilatation of the anus was performed in 21 patients (10%) and has not been performed since 1995. Lateral internal sphincterotomy was performed in 183 patients (88%) and continues to be the mainstay of treatment. Five female patients (2%) were identified as having a sphincter defect by anal manometry combined with endoanal ultrasound and were treated by an anal advancement flap. From 1996 onwards, 15 patients (7%) were treated by topical glyceryl trinitrate (GTN) paste as the first line of treatment. Of these patients, nine have experienced healing of their fissure, and three have had relief of pain without healing of the fissure. Three have gone on to have a lateral internal sphincterotomy. Lateral internal sphincterotomy remains the primary form of treatment for chronic anal fissure. GTN cream has increasingly been offered as preliminary treatment over the last 12 months. Perioperative use of endoanal ultrasound allowed identification of patients who may be at high risk of postoperative incontinence from a sphincterotomy. An anal advancement flap has been used as an alternative surgical approach for these patients.

Adolescent↗
PubMed1998

The role of the general practitioner in postnatal care: a survey from Australian general practice.

BACKGROUND: Despite the practice of routine postnatal check-ups, many women experience problems in the months after childbirth. General practitioners (GPs) are involved in routine postnatal care, yet little research has been undertaken to explore this role. AIM: To report the views of Australian GPs as to what physical examination and discussion should take place at the routine six week postnatal check-up and to determine the influence of gender on the approach to the check-up. METHOD: Postal survey of 1104 Australian GPs, yielding an eligible sample of 1022. RESULTS: A total of 715/1022 (70%) usable surveys returned. Over 65% of GPs recommend routine examination of the abdomen, blood pressure, perineum, vagina, pelvic floor, and breasts at the six week check-up. Fewer than a half the sample believed that physical problems (urine and bowel symptoms, back problems), sexual issues, relationship and parenting issues should be routinely discussed. After controlling for age, practice location, obstetric practice, and qualifications, the sex of the GP remains an important factor influencing the GP's approach to postnatal care. Female GPs are three times more likely to believe that maternal feelings should be discussed routinely and about twice as likely to believe that infant sleeping/behaviour, maternal sleeping/diet/tiredness, coping with other children, relationship with partner, and household work should form part of the routine discussion with all recent mothers. CONCLUSIONS: Sex of practitioner and older age (60 years or more) are the two most important influences on a GP's approach to postnatal care. This study indicates a need for GPs to shift their focus from routine examination to indicated examination to allow more time to discuss common postnatal problems.

Adult↗
PubMed1997

The effects of a duplication in the ovine growth hormone (GH) gene on GH expression in the pituitaries of ram lambs from lean and fat-selected sheep lines.

Growth hormone (GH) gene expression was investigated in pituitaries of 14- to 15-month-old ram lambs from flocks selected for high (fat) or low (lean) back fat depth, which were also homozygous for a single GH gene allele, heterozygous or homozygous for a duplication in the GH gene. The pituitaries of lean sheep of all three GH genotypes were significantly heavier than those of fat sheep, but there were no pituitary weight differences between GH genotypes. No significant lean-fat selection line- or GH genotype-specific differences were measured in pituitary GH concentration. However there was a significant increase (P < 0.01) in the total pituitary content of GH in lean compared with fat animals and a significant interaction between GH genotype and lean-fat selection line (P < 0.05) was noted for GH content. No significant differences were measured in the relative concentration of GH mRNA, suggesting that the ratio of GH mRNA per mg total cellular RNA remained constant across lean-fat selection line and GH genotype. We conclude that the pituitary glands of Coopworth sheep selected for low backfat depth (lean) are bigger and have an increased GH content, but appear to contain similar concentrations of GH mRNA and immunoreactive GH as the pituitaries of fat sheep. The presence of the GH gene duplication in sheep has little measurable effect on the expression and storage of GH in the pituitary.

Alleles↗
PubMed1997

Co-localisation of insulin-like growth factor II and the proliferation marker MIB1 in hepatocellular carcinoma cells.

AIM: To assess the effect of insulin-like growth factor II (IGF-II) on proliferation of hepatocellular carcinoma (HCC) cells. METHODS: Expression of IGF-II mRNA and protein was detected in 10 archival HCC specimens using in situ hybridisation and immunohistochemistry, respectively. Expression of the Ki-67 antigen, a proliferation marker, was determined immunohistochemically on the same sections. RESULTS: Increased expression of IGF-II mRNA and protein was detected in five of the 10 HCCs in cells located at the periphery of tumour nests. The pattern of localisation of IGF-II was almost identical with that of Ki-67 antigen. CONCLUSIONS: Most of the Ki-67 antigen positive cells co-expressed IGF-II, suggesting that IGF-II may act as an autocrine or paracrine growth factor, and may play an important role in the development of HCC.

Carcinoma, Hepatocellular↗
PubMed1997

The effect of oligonucleotides to c-myb on vascular smooth muscle cell proliferation and neointima formation after porcine coronary angioplasty.

Proto-oncogenes, including c-myb, are expressed early after vascular injury. The application of antisense oligodeoxynucleotides (AS-ODNs) against these genes inhibits cell proliferation and neointima formation in small animals and in peripheral arteries. The aim of this study was to investigate the specificity of action of AS-ODN-c-myb in vitro and to assess its effect, when delivered locally, on neointima formation after percutaneous transluminal coronary angioplasty (PTCA) in porcine coronary arteries. AS-ODN-c-myb inhibited the proliferation of vascular smooth muscle cells (VSMCs) in vitro in a dose-dependent manner. There was a corresponding reduction in steady state levels of c-myb mRNA and protein. Expression of another early gene, c-fos, was unaffected. S1 nuclease analysis demonstrated intact full-length AS-ODN-c-myb retrieved from VSMCs in culture after 12 hours. A range of ODNs, related and unrelated to c-myb, with and without a GGGG sequence, inhibited VSMC proliferation. Phosphorothioated AS-ODN-c-myb was 30 times less potent than unphosphorothioated AS-ODN-c-myb. PTCA induced porcine coronary artery neointima formation. c-myb mRNA was maximally induced 18 hours after injury. Unmodified AS-ODN-c-myb, sense-ODN-c-myb, saline, or nothing was delivered immediately after balloon dilatation via a double-skinned porous balloon (Transport, SciMed). Fluorescence-labeled AS-ODN-c-myb was deposited throughout the vessel wall. Mean maximum intima/media cross-sectional area 4 weeks after PTCA was reduced with AS-ODN-c-myb by 79% compared with saline (P < .05), 82% compared with sense-ODN-c-myb, and 63% compared with nothing (P < .10). Conclusions are as follows: (1) c-myb is expressed in VSMCs after vascular injury. (2) AS-ODN-c-myb is retained intact in VSMCs, reducing their proliferation in vitro in dose-dependent fashion, with reduction in c-myb mRNA and protein, whereas sense-ODN-c-myb is not. (3) A range of ODNs can reduce VSMC proliferation by a non-sequence-specific mechanism. (4) Phosphorothioate protection of antisense molecules may reduce their efficacy. (5) Local delivery of unmodified AS-ODN-c-myb via the Transport catheter reduces neointima formation after porcine PTCA. (6) Local delivery of fluid may exacerbate neointimal thickening.

Angioplasty, Balloon↗
PubMed1996

Point prevalence of mental disorder in unconvicted male prisoners in England and Wales.

OBJECTIVES: To determine prevalence of mental disorder among male unconvicted prisoners and to assess the treatment needs of this population. DESIGN: Semi-structured interview and case note review of randomly selected cross section of male remand population. Non-attenders were replaced by the next name on prison roll. SETTING: Three young offenders' institutions and 13 adult men's prisons. SUBJECTS: 750 prisoners, representing 9.4% cross sectional sample of male unconvicted population. MAIN OUTCOME MEASURES: Prevalence of ICD-10 diagnoses of mental disorder, and associated treatment needs. RESULTS: Psychiatric disorder was diagnosed in 469 (63%) inmates. The main diagnoses were: substance misuse, 285 (38%); neurotic illness, 192 (26%); personality disorder, 84 (11%); psychosis, 36 (5%); other and uncertain, 36 (0.5%). Subjects could have more than one diagnosis. The average refusal rate was 18%. In total 414 inmates (55%) were judged to have an immediate treatment need: transfer to an NHS bed, 64 (9%); treatment by prison health care services, 131 (17%); motivational interviewing for substance misuse, 115 (15%); and therapeutic community placement, 104 (14%). CONCLUSIONS: Mental disorder was common among male unconvicted prisoners. Psychosis was present at four or five times the level found in the general population. Extrapolation of our results suggests that remand population as a whole probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 prisoners with serious mental illness.

Adult↗
PubMed1996

Visits to medical practitioners in the first 6 months of life.

OBJECTIVE: To assess the use of medical practitioners' services by mothers and their babies in the 6 months following childbirth. METHODOLOGY: Aggregated Medicare data detailing medical practitioner services provided to a random sample of 650 Victorian babies born between 1 March and 31 May 1993 and their mothers were obtained from the Health Insurance Commission. This provided data on services provided between March and December of 1993 to the selected cohort. Services provided by the public hospital system to mothers and babies are not included. RESULTS: Mothers and babies in the sample used 6404 medical practitioner services in the 6 months following birth; 57% of services were to babies, 43% to mothers. Of the 6404 medical practitioner services 5042(79%) were provided by general practitioners (GP), 804(12%) by paediatricians, 319(5%) by obstetricians and 239(4%) by 'other' specialists. The mean number of visits to a GP by mothers was 3.5 and by babies was 4.2 in the 6 months following birth. General practitioners were more likely to be vocationally registered and there were differences in the item numbers charged between those who were vocationally registered and those who were not. The length of GP consultation differed significantly between mothers' and babies' visits. CONCLUSIONS: A previously undocumented level of postnatal use of medical practitioner services is presented. It suggests a significant level of postnatal maternal and infant morbidity that requires further study.

Family Practice↗
PubMed1996

Detection of micrometastases in colorectal cancer patients by K19 and K20 reverse-transcription polymerase chain reaction.

Tumor stage in bowel and breast cancer is the chief determinant of prognosis and the need for adjuvant therapy. The intermediate filament protein keratin 19 (K19) is expressed by epithelia and corresponding malignancies. Recently, the detection of K19 gene expression by RT-PCR has been reported as a sensitive tool for detecting occult metastasis to the lymph nodes and bone marrow of patients with primary epithelial tumors. Doubt has arisen, however, about the tissue specificity of K19 gene expression. In this study, we report a comparison of RT-PCR for K19 with another keratin, K20, in the lymph nodes and bone marrow of 15 patients with colorectal cancer, eight control patients who underwent bowel resection for benign disease, and four other control patients. K19 and K20 gene expression was detected in 84 and 26 of 109 lymph nodes and in 6 and 0 of 15 bone marrow aspirates, respectively, from colorectal cancer patients. K19 gene expression was also detected in 34 of 40 lymph nodes and in 5 of 12 bone marrow aspirates from control patients, whereas K20 gene expression was undetectable in any control sample. In conclusion, K19 RT-PCR lacks specificity as a marker of occult lymph node and bone marrow metastasis. In contrast, K20 RT-PCR was specific and should be evaluated further in future studies.

Colorectal Neoplasms↗