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Biomedical subjects

M Hepburn

Publications and source records attributed to M Hepburn.

At least 19 recordsLinked to original sources
PubMed1998

Poor response rate to a continuous schedule of Amifostine therapy for 'low/intermediate risk' myelodysplastic patients.

Ineffective haemopoiesis leading to cytopenia presents the major clinical management problem for patients with myelodysplasia (MDS). Preliminary studies have demonstrated that the synthetic aminothiol Amifostine stimulates multilineage haemopoiesis both in vitro and in vivo in patients with MDS. We have treated 12 patients with an uninterrupted 8-week schedule of thrice-weekly intravenous Amifostine with a starting dose of 300 mg/m2 escalating to 450 mg/m2 in non-responders. No patients satisfied response criteria on study but two patients showed minor responses. We conclude that therapeutic response to Amifostine in MDS may be schedule dependent.

Amifostine↗
PubMed1993

Is HIV infection associated with an increase in the prevalence of cervical neoplasia?

OBJECTIVE: To test the hypotheses: (1) that HIV infection predisposes to cervical intraepithelial neoplasia (CIN); (2) that this CIN is a result of HIV related immunosuppression; and (3) that this CIN is a result of immunosuppression causing increased expression of the potentially oncogenic viruses, human papilloma virus (HPV), Epstein Barr virus (EBV) and herpes simplex virus (HSV). DESIGN: A matched cross sectional study. SETTING: The Department of Gynaecological Oncology, The Samaritan Hospital, London; the Department of Genitourinary Medicine, St Mary's Hospital, London; and the Family Planning Clinic, Claremont Terrace, Glasgow. SUBJECTS: Fifty HIV seropositive women enrolled from the Genitourinary Medicine Department and the Drug Dependency Unit at St Mary's Hospital, London, and the Unit of Infectious Diseases at Ruchill Hospital, Glasgow. Forty-three HIV seronegative controls enrolled from the Department of Genitourinary Medicine at St Mary's Hospital, matched against 43 of the seropositive women for age, age at first intercourse, lifetime number of sexual partners, and smoking habit. MAIN OUTCOME MEASURES: Associations between CIN, as detected by cytology and histology, and HIV infection. Association was also sought between CIN and immunosuppression, as measured clinically by T4 cell number, beta-2-microglobulin and p24 antigen. Associations of these with: (1) HPV, as detected by Southern blot testing and the polymerase chain reaction; (2) EBV, as detected by Southern blot testing; and (3) HSV, as detected by tissue culture of endocervical swabs, was also studied. RESULTS: There was no significant difference in the prevalence of CIN or oncogenic viruses between HIV seropositive and seronegative women in the absence of immunosuppression. If the HIV infected women showed signs of immunosuppression, the prevalence of CIN was increased. No association was shown between detection of HPV, EBV and HSV and immunosuppression or CIN. CONCLUSION: HIV infection may only be associated with an increased risk of CIN when immunosuppression is present.

Adult↗
PubMed1991

Persistence of murine myeloid leukaemic cells in long-term bone marrow cultures.

Patterns of growth in long-term bone marrow culture were compared for a number of murine myeloid leukaemias. A leukaemic pattern of haematopoiesis was maintained in culture for a period of at least 15 weeks for one of the lines. However in the other five murine myeloid leukaemic lines studies, the leukaemic cells appeared not to survive in culture and normal haematopoiesis was established. Transplantation of cells from these established cultures at weeks 7 or 11 into syngeneic recipients revealed that leukaemic cells were present. Thus leukaemic cells seem to persist in long-term bone marrow cultures even in morphologically normal cultures.

Animals↗
PubMed1990

Social problems.

It has long been established that social deprivation adversely affects health, including that of the pregnant woman and her baby; it is therefore justifiable to use medical resources in the treatment of social problems. Antenatal inpatient care was originally seen as potentially beneficial for women without major medical problems, but such a philosophy is not reflected in current practice. Current antenatal outpatient services do not address the needs of women with social problems who, viewing such services as hostile, may fail to attend. Special services such as help with drugs problems or HIV counselling or screening may be rejected from fear of prejudice and consequent repercussions. Such prejudice often arises because staff do not fully understand the issues involved. Antenatal care for women with social problems should consider women in the context of their families and social environment and should be provided by a small number of familiar staff forming part of an integrated multidisciplinary team in close and regular contact. Antenatal admission, if it is the woman's wish, should be viewed as justified in the management of social problems; conversely, women should not be pressurized into admission or made to feel guilty if unable to comply. Outpatient antenatal services should be conveniently sited in the community close to other relevant services and should be flexible, not only in terms of organization and format, but also in the roles of the participants. They should be comprehensive, but with special services in addition to, not instead of, routine care, and provided by a team of appropriately trained staff. In the provision of antenatal care for women with social needs, no single format will be universally applicable or desirable, and the precise design and content of the service should be variable according to local requirements and should take account of the women's wishes as well as their needs. Ultimately it will only be if the women perceive the service as being in their interests and as meeting their needs that they will use it; only if they choose to use it, will it have any chance of success.

Community Health Services↗
PubMed1987

Transplantation and morphological studies of primary and passaged murine radiation-induced myeloid leukaemias.

Myeloid leukaemia can be induced reproducibly in CBA/H male mice following X-irradiation. After serial passage of the leukaemic cells into syngeneic recipients, they grow faster and require fewer cells for a take. Transplantation of primary leukaemias requires high cell doses unlike passaged lines derived from them. Passaging at low cell doses retains their primary-like growth and morphological properties. It would seem that these low cell dose passages may be a more useful model which can be used for investigating the biology and therapeutic responses of myeloid leukaemia than routinely passaged cell lines.

Animals↗
PubMed1986

An audit of the detection and management of small-for-gestational age babies.

The detection and management of small-for-gestational age babies (SGA) was assessed in a case record review of 1302 randomly selected pregnancies. Of the 129 babies with birthweights below the 10th centile for gestational age, 34 (26%) were identified antenatally. For every two correctly identified SGA babies there were three false positive predictions. In-patient monitoring and early elective delivery occurred both in the correctly identified pregnancies (24%) and in the false positives (12%). The management of suspected pregnancies bore no apparent relation to test results and appeared arbitrary. Mortality and morbidity, as measured by nursery admission for greater than 48 h and retention in the nursery after the mother's discharge, were higher in SGA babies than in the hospital population as a whole. The number of ill babies was small, however, reflecting the heterogeneous aetiology of small size for gestational age. Moreover, antenatal detection had little influence on these measures of outcome. It is concluded that tests for detection of SGA babies remain imprecise in practice, gestational weight alone correlates poorly with fetal well-being, and the need remains for sensitive tests to detect babies with genuine morbidity.

Birth Weight↗
PubMed1984

Merits of an individualized approach to fetal movement counting compared with fixed-time and fixed-number methods.

The most commonly employed methods for maternal counting of fetal movements take no account of variation in the level of activity between fetuses. This may result in false alarms or prolonged counting in pregnancies in which perceived movements are infrequent. A new counting method is described in which an individualized hourly rate of perceived movements is first calculated for each patient; then, the time taken to feel this number is recorded each day for the remainder of the pregnancy. The new system is associated with a substantially lower false alarm rate than a system of counting for an hour and continuing for a second hour if the level is low. In comparison with the Cardiff 'count-to-10' method, the amount of time spent counting each day was more uniform and was halved overall. Although this system is more complicated to initiate these clear advantages suggest that it should be subjected to large-scale feasibility trials.

Female↗
PubMed1982

Antenatal detection of growth retardation: actual practice in a large maternity hospital.

A retrospective analysis of the antenatal management of 226 cases of growth retardation was carried out. One-hundred-and-fourteen cases (50%) were not suspected antenatally. Of the 112 suspected cases, 107 were subjected to further tests of fetal well-being. Eighty-one (72%) of the 112 received no further action or surveillance because of erroneously reassuring results or no further tests. Thirty-one women were either admitted antenatally (15) or delivered early (16). The low rate of initial suspicion combined with the disappointing results of the further tests emphasizes the need for more accurate screening procedures for growth-retarded babies.

Birth Weight↗
PubMed1982

An audit of caesarean section in a maternity district.

A prospective study of the clinical indications for caesarean sections performed in a large specialist maternity hospital was carried out during the first 3 months of 1981; similar information was collected retrospectively for 1976 and 1971. Demographic changes in the obstetric population were considered. The district section rate increased from 4.4-13% in the last decade. The three most important clinical indications contributing to the rise of caesarean section in primiparae were cephalopelvic disproportion, slow progress and breech presentation. The rate of sections began to fall during the audit and has continued to decrease in the months since. Although it is rather early to draw conclusions, this trend may reflect the critical attention focused on section policy during the period of the study.

Adult↗