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Biomedical subjects

L Chappell

Publications and source records attributed to L Chappell.

8 recordsLinked to original sources
PubMed2006

High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation.

OBJECTIVES: Increased perinatal mortality in monoamniotic twin pregnancies is attributed to cord accidents in utero and at delivery. We evaluated the following parameters in monoamniotic pregnancies: (1) the incidence of cord entanglement; (2) the effect of sulindac on amniotic fluid volume and stability of fetal lie; and (3) the perinatal outcome with our current management paradigm. METHODS: This is a retrospective review of monoamniotic pregnancies of >or=20 weeks' gestation managed with serial ultrasound surveillance, medical amnioreduction and elective Cesarean delivery at 32 weeks' gestation. Mean amniotic fluid index (AFI) and change in AFI in monoamniotic pregnancies managed with oral sulindac was compared with 40 gestation-matched monochorionic-diamniotic controls. RESULTS: Among 44 monoamniotic pregnancies, 20 with two live structurally normal twins at 20 weeks' gestation satisfied the inclusion criteria. All fetuses survived to 28 days postnatally despite early prenatal cord entanglement in all but one case. Whereas AFI remained stable throughout gestation in the controls, the AFI fell in those patients on sulindac from a mean value of 21.0 cm (95% CI, 18.5-23.6 cm) at 20 weeks to a mean of 12.4 cm (95% CI, 10.1-14.6 cm) at 32 weeks (ANOVA P across gestation = 0.001) but mainly remained within normal limits. Fetal lie was stabilized in 11/20 cases in the monoamniotic group compared with 13/40 in the control group (P < 0.0001). CONCLUSIONS: Cord entanglement appears unpreventable, as it typically occurs in early pregnancy. Sulindac therapy reduces AFI, leads to more stable fetal lie, and may prevent intrauterine death by diminishing the risk of constricting cords that are already entangled. Perinatal survival in monoamniotic pregnancies managed by a regime of sulindac from 20 weeks' gestation, close ultrasound surveillance and elective abdominal delivery at 32 weeks' gestation seems empirically higher than that in the literature.

Amniocentesis↗
PubMed1999

Lack of consistency in research papers over the definition of pre-eclampsia.

The most common definition of pre-eclampsia involves hypertension and proteinuria. This has changed little in over a hundred years despite advances in understanding the underlying pathological process. However, a number of variations in definition exist, and this paper demonstrates a lack of consistency in research articles in defining pre-eclampsia. A quarter of papers omit description, and many authors choose their own interpretation of the standard classification. Editors and reviewers should ensure that papers include a clear description of the definition used and an adequate description of the population studied to allow meaningful interpretation of research findings.

Female↗
PubMed1988

Phylogeny of Onchocerca volvulus and related species deduced from rRNA sequence comparisons.

A rapid, direct method for determining the partial nucleotide sequence of large subunit ribosomal RNA was adapted and applied to a group of helminth parasites. Small samples of total, unfractionated cellular RNA isolated from each organism were analysed and the nucleotide sequences of equivalent portions of the large subunit ribosomal RNA compared. The data obtained were used to construct a phylogenetic tree showing the evolutionary relationships within this group of organisms.

Animals↗
PubMed1986

Phylogeny of helminths determined by rRNA sequence comparison.

The nucleotide sequence of the 5' ends of the 28S-like rRNA molecules of five species of helminths was determined directly, using a variation on the dideoxynucleotide chain-termination method which requires only 10 micrograms of total cellular RNA for analysis. Nucleotide sequence comparisons over 208 bases allowed the phylogeny of these organisms to be determined. The data show that the rRNA sequence of Nematospiroides dubius, a nematode, is as divergent from that of two platyhelminths, Hymenolepis diminuta and Schistosoma mansoni, as it is from the rRNA sequence of the two nematodes Onchocerca gibsoni and Brugia pahangi. The latter two appear to be very closely related, whereas the two platyhelminths are more distant from each other. The study demonstrates the usefulness and generality of rRNA sequencing for the systematic phylogenetic classification of parasitic organisms whose tissues are only available in relatively small amounts.

Animals↗
PubMed1983

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Attitude to Death↗