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Biomedical subjects

M E Crowther

Publications and source records attributed to M E Crowther.

At least 19 recordsLinked to original sources
PubMed1995

Communication following a stillbirth or neonatal death: room for improvement.

OBJECTIVE: To assess the extent of knowledge which mothers had about a previous stillbirth or neonatal death, their satisfaction with the information and advice given them, and their degree of anxiety during a subsequent pregnancy. DESIGN: Personal interview. SETTING: Antenatal clinic of a British military hospital in Germany. SUBJECTS: Forty-eight caucasian, pregnant women, 28 of whom had had a previous stillbirth (Group A) and 20 a neonatal death (Group B). RESULTS: Over half (25/48) the women had a poor or confused knowledge of the events surrounding the death, only 29% were satisfied with the information they had received, and nearly 40% became pregnant within six months of the death despite medical advice against conceiving soon after such an event. The mothers of stillborn babies were significantly less likely to know the birthweight than the mothers of babies who died after birth (60% vs 95%), and 40% had not given the baby a name. Over a third of the mothers were admitted to hospital because of anxiety about the current pregnancy. CONCLUSIONS: Dissatisfaction with the quality of information given by hospital staff, rapid conception despite medical advice to the contrary, and anxiety in a subsequent pregnancy were common after a previous stillbirth or neonatal death. A poor or confused knowledge about the baby's death was more likely if the death had been intrauterine and unexplained, or associated with maceration, a lethal abnormality, an emergency delivery resulting in stillbirth, or a preventable cause.

Abortion, Spontaneous↗
PubMed1995

Perinatal death: worse obstetric and neonatal outcome in a subsequent pregnancy.

A retrospective case-control study was undertaken of women with a history of a previous stillbirth or neonatal death, who subsequently delivered in BMH Rinteln. Their obstetric and neonatal outcome was compared to that of a control group of women of similar age and parity and its relationship to specific socio-economic factors assessed. Index patients had a worse obstetric and neonatal outcome. They were statistically significantly more likely to be admitted to hospital during their pregnancy (46% vs 26%), to have medical complications (58% vs 34%), to be delivered prematurely (16% vs 8%), and by Caesarean section (22% vs 9%). Their babies were more likely to have complications (28.8% vs 20.4%), to be of low birth weight (14% vs 7%), require intubation (11% vs 5%) and be admitted to the Special Care Baby Unit (SCBU) (13% vs 7%). Apart from small stature, no differences in socio-economic factors between the two groups could be identified. Index patients were four times more likely than controls to have their pregnancy terminated prematurely as a result of complications (6.7% vs 1.6%), but there was also a high level of obstetric intervention in the absence of clear medical indications. Although perinatal mortality was not statistically increased, the results were suspicious and it is concluded that these women should continue to be considered a high-risk group.

Adult↗
PubMed1993

Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery.

OBJECTIVE: To assess the prevalence and severity of psychosexual dysfunction in women treated for cancer of the cervix and vulva by radical vulvectomy, Wertheim's hysterectomy and pelvic exenteration; and to identify the risk factors for sexual morbidity and ways in which it might be reduced. DESIGN: Retrospective study of patients by questionnaire and semistructured interview, 6 months to 5 years following surgery. SETTING: Gynaecology-Oncology Unit of a general hospital. PATIENTS: 105 English speaking women with gynaecological cancer. RESULTS: 90% of the women in relationships had been sexually active prior to surgery. Of this group, 24% had no sexual difficulties post-operatively; 66% of the latter still had problems more than 6 months later, and 15% of the latter never resumed intercourse (excluding those with a colpectomy). 82% of those aged less than 50 years who had had radiotherapy suffered sexual dysfunction. Lack of desire was the commonest problem, and half the women felt that their sexual relationship had deteriorated, yet only 16% felt that their marriage had worsened. Younger women were more likely to attribute personal and marital distress to their sexual problems. More information on sexual matters would have been liked by 28% of the women. CONCLUSIONS: Sexual dysfunction is common following radical pelvic surgery and tends to remain a chronic problem. As well as organic causes there is a strong psychogenic element brought about by loss of fertility, disfigurement, depression and anxiety about one's desirability as a sexual partner. The presence of a stable relationship before the diagnosis of cancer helps women cope better, and young single women are a very vulnerable group. Patients want more information on sexual matters and the provision of sexual counselling may improve outcome in the future.

Adult↗
PubMed1992

Psychosocial adjustment following major gynaecological surgery for carcinoma of the cervix and vulva.

One-hundred and five women had undergone major gynaecological surgery for carcinoma of the cervix and vulva were interviewed retrospectively to elicit post-operative psychosocial and psychosexual problems. This interview took place between 6 months and 5 yr after surgery. Responses to the Hospital Anxiety and Depression Scale indicated that 20% of the women were 'probable' cases of anxiety and 21% were 'definite' cases. On the depression scale, 18% were 'doubtful' cases and 14% were 'definite' cases. Scores on the scales were not associated with age of the woman, the type of operation or the time period between being interviewed and the operation. Two-thirds of the women who were sexually active prior to the operation indicated ongoing sexual problems when interviewed and the presence of these problems was found to be significantly associated with the woman's level of anxiety.

Adaptation, Psychological↗
PubMed1991

Unicornuate uterus.

True unicornuate uterus is a rare anomaly which is often associated with renal tract anomalies, and may predispose to infertility and pregnancy complications. Three additional cases are reported here. One of the women had associated bony and cardiac anomalies, although there was no good evidence that these were part of a syndrome. The diagnosis in each case was made incidentally during the surgical investigation of abdominal pain, which in one case was caused by an ectopic pregnancy, itself a rare occurrence with unicornuate uterus.

Abdominal Pain↗
PubMed1990

A retrospective study of all low birth-weight preterm babies born in BMH Rinteln between 1980-1989.

A retrospective study was undertaken of all preterm babies born in BMH Rinteln between 1980-88 weighing less than 2500g. The total proportion of low birth weight babies was 7% and 58% of these were preterm (454 babies). Sixty per cent of women presented after the spontaneous rupture of membranes or in established labour. Conservative management of ruptured membranes, whilst not leading to life-threatening sepsis, did not significantly prolong pregnancy. Sixteen percent of the babies were very low birth weight (under 1500g). Delivery of these infants by Caesarean section when presenting by the breech improved survival, although this was not statistically significant. Thirty percent of all babies were delivered by Caesarean section before 36 weeks, reflecting obstetric emergencies in the mother which predisposed to preterm delivery. Neonatal survival depended on both gestational maturity and birth weight and was not significantly better in babies who were low birth weight for gestational age. These infants however represented 75% of the still-births and congenital abnormalities. Sixty percent of the mothers smoked and 50% had other identifiable risk factors for preterm delivery; 20% of the multiparous patients had previously experienced a perinatal death, preterm delivery or had a baby with intra-uterine growth retardation. It is suggested that preterm delivery is a significant problem in an Army population despite full employment, adequate housing and comprehensive medical care. Attempts to stop labour are unlikely to be successful. Effort should be made antenatally to identify those women who may be at risk of "idiopathic" preterm labour, as patient education programmes have been shown to decrease the incidence.

Adult↗
PubMed1989

Therapeutic considerations in the use of intraperitoneal radiolabelled monoclonal antibodies in ovarian carcinoma.

Eleven patients with ovarian cancer have been treated with a radiolabelled monoclonal antibody directed against human milk fat globule membrane (HMFG2). All patients had Stage III disease and had previously undergone debulking surgery followed by chemotherapy. Although 16 patients have been referred, 5 could not be treated. This paper discusses the criteria for patient selection and treatment, and describes the technical difficulties of this form of therapy and the complications sustained following the intraperitoneal instillation of up to 150 mCi iodine-131 labelled HMFG2. Significant complications included two ileo-cutaneous fistulae and peritonitis in one patient which prevented treatment from being given.

Adult↗
PubMed1988

Verrucous carcinoma of the female genital tract: a review.

The 102 cases of verrucous carcinoma of the female genital tract reported in the world literature have been reviewed. The difficulties in diagnosis of this tumor are discussed; correct diagnosis is heavily dependent on close collaboration between clinician and pathologist, and the provision to the latter of a sufficiently large biopsy specimen. Effective management requires surgical resection, which may at times need to be radical. Radiotherapy and chemotherapy are of doubtful value.

Carcinoma, Papillary↗
PubMed1987

Localization of radioiodine conjugated to the monoclonal antibody HMFG2 in human ovarian carcinoma: assessment of intravenous and intraperitoneal routes of administration.

The localization of i.p. injected, radioiodine conjugated monoclonal antibody HMFG2 was studied in 18 patients with ovarian carcinoma. Patients were injected i.p. at time points up to 168 h before laparotomy, at which time tumor, ascites, normal tissue, and blood samples were removed and the contained radioactivity measured. In the first 10 patients, localization was compared with that of a simultaneously injected irrelevant (nonspecific) antibody (UJ13A) of the same immunoglobulin class and, in the subsequent 8 patients, with HMFG2 administered i.v. After i.p. injection, HMFG2-radioiodine was found in concentrations of 0.0001-0.0030% of the injected amount per gram in solid tumor, 0.0363-0.02560%/g in ascites, 0.0003-0.0017%/g in blood, and 0.001-0.0012%/g in normal tissue. Tumor:normal tissue ratios of 0.9-10.0 and tumor:blood ratios of 0.3-4.0 were seen up to 168 h after injection. Localization of the HMFG2 conjugate was consistently greater than that of the irrelevant antibody. For solid tumor, the i.v. route of administration resulted in consistently higher absolute levels of HMFG2 conjugate uptake but tumor:blood and tumor:normal tissue ratios were similar. On the other hand the i.p. route of administration offered consistent advantages of 4- to 71-fold over the i.v. route when HMFG2 conjugate localization on ascites cells was examined. Ascites:normal tissue and ascites:blood ratios of up to 512 and 448, respectively, were achieved. After i.p. injection, radioiodine was cleared from the body exponentially with a half-life of 50 h. Maximum circulating blood levels of 8.6 +/- 2.0% injected activity were seen at 48 h and these then decreased with a t 1/2 value of 38 h. Over 80% of injected activity was cleared in the urine as nonprotein bound iodine by 168 h.

Antibodies, Monoclonal↗
PubMed1986

Surgical procedures for ovarian cancer.

The management of 191 patients with ovarian cancer is presented. A significant proportion of these patients were initially seen (16%) or operated on (7%) by a general surgeon. The current surgical approach to this disease should be aggressive, and in 23% of these patients a non-gynaecological surgical procedure was required. Although chemotherapy is the main form of treatment following surgery, its chances of success are influenced by the amount of tumour left after surgery. The picture is not uniformly hopeless, and of 34 patients who subsequently underwent laparotomy to check the effectiveness of chemotherapy, 10 (29%) had no evidence of disease. Palliative surgery also has an important place in the management of this disease to provide comfort from disabling symptoms, and in some cases it may prolong life.

Adolescent↗
PubMed1982

Sequential studies of circulating immune complexes in gynecological malignancies.

Immune complexes have been assayed sequentially in seventeen patients with gynecological malignancies, using a polyethylene glycol precipitation assay and a Clq solid phase assay. The PEG assay demonstrated a good correlation between PEG assay levels and the course of disease in nine out of eleven patients with ovarian adenocarcinoma and all four patients with endometrial carcinoma. Three of the patients with ovarian cancer were not treated with aggressive surgery and exhibited equivocal signs of progressive disease during subsequent follow-up. There was no clear relationship between immune complex levels and the clinical condition in two of these patients. The ClqSP assay result did not correlate with disease progression and, in several instances, progressive disease was associated with a fall in ClqSP values. In a further series, twelve out of twenty patients with ovarian cancer who were initially in remission from disease but subsequently relapsed demonstrated elevated levels of PEG immune complexes between one and three months before clinical detection of recurrence whereas patients who stayed in remission maintained normal levels of PEG immune complexes. These data suggest that the PEG assay may be of clinical value in the monitoring of ovarian cancer patients with minimal residual disease following surgery.

Adenocarcinoma↗
PubMed1981

E-rosette forming cells and cell mediated immunity in ovarian cancer.

Parameters of cell mediated immunity were examined in 50 women with ovarian cancer, and included E-Rosette formation lymphocyte number, and lymphocyte blastogenesis to PPD. Alterations in these parameters were also determined following surgery and during chemotherapy. Relapse patients demonstrated significantly decreased numbers of "active" and "total" E-Rosette forming cells, as well as a significantly decreased spontaneous incorporation of 125Iododeoxyuridine into unstimulated lymphocytes; PPD responses and total lymphocyte counts were not significantly different from the control group. Analysis of T-cell subpopulations in relapse patients suggested that these cells were suppressed in the unseparated lymphocyte state. Chemotherapy led to an expected decrease in lymphocytes but an unexpected increase in the numbers of E-Rosette forming cells initially. It was postulated that serum factors accounted for the decreased values of these cells in relapse patients rather than a true depletion.

Erythrocytes↗
PubMed1979

Trophoblastic proteins in ovarian carcinoma.

Trophoblast-"specific" proteins in the plasma of 37 patients with primary epithelial carcinoma of the ovary were measured. Circulating pregnancy-specific beta1-glycoprotein (SP1) was detected in 5 subjects, human chorionic gonadotrophin (hCG) was found in 2 subjects, and human placental lactogen (hPL) was detected in 8 subjects.

Chorionic Gonadotropin↗