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Biomedical subjects

M G Chapman

Publications and source records attributed to M G Chapman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Bone mass in hirsute women with androgen excess.

The spinal and femoral bone mass of 32 hirsute women with oligomenorrhoea and androgen excess was measured using dual photon absorptiometry and compared with the bone mass of 32 control women with regular menstrual cycles. Despite significantly lower oestradiol levels in the hirsute population there was no significant difference in the bone mass. Furthermore there was no significant difference in bone mass in five hirsute women with undetectable levels of oestradiol. It is concluded that androgen excess can maintain normal bone mass in the face of low or undetectable oestradiol levels.

Absorptiometry, Photon↗
PubMed1989

Evidence of redistribution of cardiac output in asymmetrical growth retardation.

Thirty-one fetuses with growth retardation were studied by Doppler estimation of the cardiac output from each side of the fetal heart. Asymmetrical growth retardation was diagnosed in 16 fetuses by a head to abdominal circumference ratio above the 95th centile. In the 15 fetuses with symmetrical growth retardation, the distribution of cardiac output was normal. The mean and maximum velocity of blood flow in the pulmonary artery and aorta were similar to values in normal fetuses, and there was a greater calculated output from the right heart than from the left. The right heart flow expressed as a percentage of the combined cardiac output was not statistically significantly different from that in normal fetuses. In contrast, all 16 fetuses with asymmetrical growth retardation had a higher mean and maximum velocity in the aorta than in the pulmonary artery. The calculated volume flow from each side of the heart showed a greater output from the left than the right heart in 15. The right heart flow expressed as a percentage of the combined cardiac output was statistically different from the value in normal fetuses. These findings are consistent with theories of the redistribution of fetal blood flow, where cerebral blood flow is preferentially 'spared'.

Cardiac Output↗
PubMed1989

Serum concentrations of alkaline phosphatase isoenzymes and osteocalcin in normal pregnancy.

We measured serum alkaline phosphatase isoenzymes and osteocalcin levels in 40 healthy women at 4-week intervals throughout uncomplicated pregnancies and 6 weeks after delivery in 17 women. Serum bone alkaline phosphatase was significantly higher in the third trimester than in early pregnancy (P less than 0.001), and this elevation was still apparent at the end of the puerperium, suggesting increased bone turnover. Serum osteocalcin was not detected (less than 0.2 micrograms/L) after the first trimester in the majority of women, and it reappeared within 48 h after delivery. The disappearance of osteocalcin after the first trimester and its rapid reappearance after delivery suggest placental clearance of this peptide. We conclude that serum osteocalcin measurements cannot be used as a marker of bone metabolism during pregnancy.

Adult↗
PubMed1988

Occult infiltrating placenta previa percreta: an unusual case highlighting the management problems in a young patient.

Placenta previa in association with placenta accreta has been recorded on average in 1 in 500 pregnancies; its association with placenta percreta is a much rarer condition. We report an unusual case of placenta previa which presented as a severe form of occult parasitic infiltration, invading the internal iliac vessels. This was followed by life-threatening complications, despite preventative measures. Use of a prediction index to suspect placenta previa is mentioned.

Adult↗
PubMed1988

Two fetal antigens (FA-1 and FA-2) and endometrial proteins (PP12 and PP14) isolated from amniotic fluid; preliminary observations in fetal and maternal tissues.

Rabbit antihuman antibodies were derived by the injection of fractions of second trimester amniotic fluid known to contain proteins of endometrial/decidual origin. Using standard separation and absorption procedures, two antibody preparations were generated which demonstrated specificities against two and three proteins, respectively, in line immunoelectrophoresis and crossed immunoelectrophoresis. Analysis against proteins of fetal, maternal, endometrial and placental origin revealed that the bispecific antiserum reacted only with placental protein 14 (PP14; also known as progestagen-dependent endometrial protein, PEP) and one other hitherto undescribed antigen referred to as Fetal Antigen 1 (FA-1) molecular mass 60 kDa; electrophoretic mobility: slow; alpha 1-alpha 2; fast, albumin. The trispecific antiserum demonstrated specifities against placental protein 12 (PP12), alpha-fetoprotein (AFP) and another previously undescribed antigen referred to as Fetal Antigen 2 (FA-2) molecular mass 35 and 140 kDa; electrophoretic mobility: albumin. Following purification, monospecific antisera against each of these proteins (with the exception of AFP) were derived in new rabbits. Maternal and fetal blood, amniotic fluid and aqueous extracts from endometrial/decidual and placental tissues were analysed in rocket immunoelectrophoresis using these antisera to examine the distribution in these tissues. The analyses demonstrated a pattern of distribution typical for proteins of endometrial/decidual origin in these compartments in the case of PP12 and PP14, but suggested that the primary source of origin of FA-1 and FA-2 may be the fetus.

Amniotic Fluid↗
PubMed1988

Suppression of in vitro lymphocyte reactivity to phytohemagglutinin by placental protein 14.

Crude human decidual extracts containing up to 26.6 mg/l of placental protein 14 (PP14) and purified PP14 were assessed for their effects on the in vitro lymphocyte reactivity to phytohemagglutinin (PHA). Both decidual extract and purified PP14 suppressed the mitogenic response to PHA with the suppression being dose-dependent over the range of PP14 concentrations investigated (0-26.6 mg/l). On the specific reduction of the PP14 content by a monoclonal anti-PP14 immunoadsorbant the suppression was reduced. The suppressive activity of PP14 was related to the degree of proliferation of the stimulated lymphocytes. These results suggest that PP14, which is present at peak levels in the first trimester of pregnancy and constitutes up to 10% of the soluble protein content of decidual tissue, may be an immunomodulator important for the survival of the implanting embryo and maintenance of early pregnancy.

Decidua↗
PubMed1988

Doppler assessment of the cardiac and uteroplacental circulations in normal and complicated pregnancies.

Blood flow velocity waveforms were recorded in four sites in the fetal circulation in a series of 271 normal and 71 complicated pregnancies. The sites were the umbilical artery, the uterine artery branches in the placental bed, and distal to the two arterial valves in the heart. The blood flow through the arterial valves was added to estimate combined cardiac output. Normal ranges for values in all sites were established in our own series, and were similar to other published results. Abnormality of the waveform in the umbilical artery proved the most useful predictor of perinatal morbidity. Reversal of the normal pattern of increasing diastolic flow in the umbilical artery with advancing gestation was an important prognostic finding in the pregnancies studied serially. The combined cardiac output did not fall until late in the course of fetal compromise, and low values were seen only with an abnormal umbilical artery tracing.

Blood Flow Velocity↗
PubMed1988

N-terminal sequence analysis of human placental protein 14, purified in high yield from decidual cytosol.

Human placental protein 14 (PP14) has been purified in high yield from first trimester decidual cytosol. High-performance liquid chromatography on anion exchange, gel filtration and reverse-phase chromatography were used. The protein obtained is approximately 97% pure with an overall recovery of about 50% from the original tissue extract. The first 24 amino acids of the N-terminal were found to be Met-Asp-Ile-Pro-Gln-Thr-Lys-Gln-Asp-Leu-Glu-Leu-Pro-Lys-Leu-Ala-Gly-Thr-Glu-His - Glu-Met-Ala-Met. PP14 has been characterized in this study to be a dimeric glycoprotein of Mr 60,000, with homologous subunits having an Mr of 28,000.

Amino Acid Sequence↗
PubMed1988

Detection of abnormal cervical smears. A comparative study.

The inefficiency of the Ayres Spatula in detecting abnormality in cervical cytology has been demonstrated recently in a number of trials. In a randomized single-blind trial we have compared the Multispatula with the Ayres Spatula in a group of 158 women who previously had abnormal smears and had been referred to colposcopy clinics in the Lewisham and North Southwark Health Authority of London. The quality of the smears, as assessed by the presence or absence of endocervical cells, revealed that the Multispatula (87.3% pick-up) produced significantly better smears (p less than 0.005) compared with the Ayres Spatula (54.4% pick-up). In 149 smears collected with the Multispatula, atypia was confirmed. However, in only 129 smears taken with the Ayres Spatula were abnormal smears detected (p decreases less than 0.005). We concluded that the Multispatula produces a better quality smear which results in a decreased false negative rate in comparison with the Ayres Spatula.

Clinical Trials as Topic↗
PubMed1987

Identification of placental protein 14 as an immunosuppressive factor in human reproduction.

Extracts of human decidual tissue obtained in the first trimester of pregnancy showed potent suppressive activity in mixed lymphocyte cultures. These extracts contained substantial amounts of the decidual protein PP14. Purified PP14 also exhibited in vitro immunosuppressive activity, and such activity in decidual extract and purified PP14 preparations was removed by treatment with a monoclonal anti-PP14 antibody-based immunoadsorbent. PP14 was present in seminal plasma, which also exhibited immunosuppressive activity that could be reduced, but not removed, by the immunoadsorbent. PP14 may be an important immunomodulator in the human reproductive system.

Animals↗
PubMed1987

Doppler assessment of umbilical artery blood flow for the prediction of outcome in fetal cardiac abnormality.

In a series of 244 pregnancies referred for fetal echocardiography, the umbilical artery waveform was also studied by pulsed Doppler ultrasound. In 152 normal pregnancies diastolic flow in the umbilical artery was always detectable after 20 weeks gestation. In 4 of 58 normal patients examined before 20 weeks, diastolic flow was absent in some part of the recording. In 34 fetuses with congenital heart disease detected at between 18 and 37 weeks gestation, 10 were found consistently to have associated absent diastolic flow. Five of these fetuses died in utero between 5 and 21 days after the recording; three were aborted and the remaining two died in the neonatal period at 4 and 7 days after the examination. Fetal congenital heart disease with normal umbilical blood flow also had a poor prognosis in general, but the adverse outcome was much less immediate than in fetuses with absent diastolic flow. No correlation was found between the type of congenital heart disease and the characteristics of the umbilical artery waveform. Absent diastolic flow in the umbilical artery indicates a poor short-term prognosis for fetuses with congenital heart disease, particularly after 20 weeks, when fetal death is predictable.

Diastole↗
PubMed1986

The use of a birthroom: a randomized controlled trial comparing delivery with that in the labour ward.

A randomized controlled trial of two environments for delivery was conducted at Queen Charlotte's Maternity Hospital. A total of 253 parous women expecting to have a labour ward delivery were invited to participate in the trial but only 148 agreed. These women were randomly allocated to be delivered either with standard labour ward management (n = 72) or in the birthroom--a small bedroom decorated in a homely manner, without facilities for epidural analgesia or electronic fetal monitoring (n = 76). Eleven women in the birthroom group and 10 in the labour ward group withdrew from the trial before labour and four were transferred from the birthroom to the labour ward when in labour. A questionnaire sent in the postnatal period to the women who completed the trial was returned by 80%. In the birthroom group there was significantly (i) decreased admission-to-delivery interval (ii) less analgesia (iii) more freedom of movement (iv) less suturing (v) increased rooming-in. No difference was found in the assessment of difficulty of labour nor in the method of subsequent infant feeding.

Clinical Trials as Topic↗
PubMed1986

Aetiology of non-immune hydrops: the value of echocardiography.

Forty-eight pregnancies, five of them multiple, were referred for fetal cardiac assessment following the detection of non-immune hydrops fetalis; there were 52 hydropic fetuses in total. A cardiovascular aetiology was found in 21 of these 52 (40%); structural heart disease was present in 13, tachyarrhythmia in the remaining eight. The accurate delineation of these causes was possible using fetal echocardiography, and enabled rational management to be instituted. This included termination of pregnancy, pharmacological control of arrhythmias and appropriate timing of delivery.

Echocardiography↗
PubMed1986

Aetiological factors in placenta praevia--a case controlled study.

The obstetric and gynaecological histories of 80 women with proven placenta praevia have been reviewed together with case controls matched for age and parity. There was a significant relation between placenta praevia and previous caesarean section (P less than 0.05), dilatation and curettage (P less than 0.01), spontaneous abortion (P less than 0.05) and evacuation of retained products of conception (P less than 0.05). Repeated uterine instrumentation was associated with increased risk of placenta praevia (P less than 0.001). We were unable to show any influence of previous termination of pregnancy. These findings are consistent with the hypothesis that endometrial/myometrium damage is a significant aetiological factor in low placental implantation.

Abortion, Induced↗
PubMed1986

Spironolactone in the treatment of hirsutism.

Spironolactone (100 mg) for 25 days in each menstrual cycle was assessed over 6 months for treatment of hirsutism in 35 patients. Five patients withdrew due to either nausea or polymenorrhea. the latter problem was encountered in 16 patients. Of the 30 remaining patients, 17 had a significant reduction in hair growth as assessed by Ferriman and Gallwey hair scores (p less than 0.05). The only significant change in endocrine parameters was a reduction in serum testosterone (p less than 0.05). Treatment with spironolactone alone was inferior to our previous experience with the cyproterone acetate--estrogen combination.

Female↗
PubMed1986

Measurement of the pregnancy-associated proteins, placental protein 14 and pregnancy-associated plasma protein A in human seminal plasma.

The pregnancy-associated and placental proteins PP14 and PAPP-A have been measured in human seminal plasma from normal men. PP14 was a significant protein constituent in most seminal plasma samples; sometimes comprising over 2.5% of the total protein content. The concentration of PP14 in seminal plasma from men with oligospermia was in the reference range of this protein derived from values measured in normal men. However, about 14% of samples from vasectomized subjects contained concentrations of PP14 less than normal. It was found that the concentration of PAPP-A in seminal plasma from vasectomized men and men with oligospermia also fell within the reference range for this protein. However, the concentration of PAPP-A in seminal plasma was significantly higher in those subjects whose sperm motility was above 60% than in those with a lower percentage motility, suggesting a possible role of this protein in sperm function.

Glycodelin↗
PubMed1985

Early low-lying placentae--ultrasonic assessment, progress and outcome.

A prospective study was carried out using 100 patients with 64 appropriately matched controls, to follow the course of low-lying placentae, diagnosed before 20 wk gestation. 94% of these placentae had moved out of the lower segment by the 32nd wk, while only 2% of the total required a caesarean section for placenta praevia. No evidence of intrauterine growth retardation or increased incidence of preeclampsia was found. In the light of this and other studies, a routine ultrasound re-check of placental position subsequent to 32 wk is deemed unnecessary unless clinically indicated, saving unnecessary maternal anxiety and over-exposure to ultrasound. Since the posterior low-lying placentae are those more likely to remain praevia, it is they that require follow-up scans.

Adolescent↗