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Biomedical subjects

P Gillett

Publications and source records attributed to P Gillett.

18 recordsLinked to original sources
PubMed2004

Antisepsis for abdominal hysterectomy: a randomised controlled trial of povidone-iodine gel.

OBJECTIVE: To assess whether infectious morbidity after total abdominal hysterectomy is decreased by the addition of 20 cc povidone-iodine gel at the vaginal apex after the usual vaginal preparation with povidone-iodine solution. STUDY DESIGN: Randomised controlled trial. SETTING: Fifteen secondary and tertiary hospitals in Canada. SAMPLE: A total of 1570 women undergoing planned total abdominal hysterectomy. METHODS: Computer-generated randomisation using a centralised telephone service was stratified by study centre with variable block size. In the operating room, a swab for bacterial vaginosis was taken before vaginal antisepsis. Study group remained concealed until the standard surgical preparation in the operating room was complete. Then povidone-iodine gel 20 cc was placed at the vaginal apex in the intervention group only. Participants were followed for one month post-operative. MAIN OUTCOME MEASURES: The primary outcome was post-operative infectious morbidity during the 30 days after surgery, defined as: febrile morbidity with hospital stay greater than five days or antibiotic treatment, or infection requiring readmission to hospital or additional visit. Other outcomes included abdominal wound infection, pelvic abscess and other pelvic infections. RESULTS: Post-operative infectious morbidity within 30 days occurred in 128/780 (16%) women receiving povidone-iodine gel preparation and 142/790 (18%) women not receiving gel (RR 0.9, 95% CI 0.7 to 1.1). Pelvic abscess was diagnosed in 0 patients in the gel group and in seven patients in the control group (P < 0.01). No significant difference was found in pelvic cellulitis (eight in each group) or abdominal wound infection (51 in the gel group and 58 in the control group, P= 0.5). CONCLUSION: Povidone-iodine vaginal gel antisepsis led to a 9% relative decrease in overall infectious morbidity after abdominal hysterectomy, which was not statistically significant. Povidone-iodine vaginal gel decreased the risk of pelvic abscess after total abdominal hysterectomy.

Abscess↗
PubMed2001

Expectant treatment of ectopic pregnancies: clinical and sonographic predictors.

OBJECTIVE: We identified the potential clinical and sonographic predictors of the spontaneous resolution of ectopic pregnancies. SUBJECTS AND METHODS: We performed a prospective study of 78 consecutive patients with a transvaginal sonographic diagnosis of ectopic pregnancy who had either two consecutive quantitative measurements of their beta subunit of human chorionic gonadotropin (beta-hCG) more than 24 hrs apart or an embryo with a heart beat. We evaluated the patient's age, time from the last menstrual period, beta-hCG level, size of ectopic pregnancy, presence of a gestational sac or embryonic elements, vascularity on color Doppler sonography, peak systolic velocity, and resistive index of ectopic pregnancy at the time of presentation as potential independent predictors of the final outcome. Logistic regression was performed to identify the independent predictors. RESULTS: Forty-six patients had declining beta-hCG levels, and 32 ectopic pregnancies showed an embryo with a heart beat or had steady or rising beta-hCG levels. Univariate analysis indicated that a longer time from the last menstrual period (older ectopic pregnancies), lower beta-hCG levels, and the absence of gestational sac are statistically more significantly seen in ectopic pregnancies with declining beta-hCG levels (p < 0.05). Resistive index of ectopic pregnancy reached borderline significance (p = 0.05). In a multiple logistic model, the same variables were independent predictors of outcome (p < 0.05). Resistive index was also a predictor (p = 0.09). CONCLUSION: Longer times from the last menstrual period, lower beta-hCG levels, absence of gestational sacs, and higher resistive indexes of ectopic pregnancy at the time of presentation appear to be independent predictors of the spontaneous resolution of ectopic pregnancy.

Adult↗
PubMed2000

Forms facilitating primary care documentation.

Documentation is a time-consuming but vital component of patient care. As health care providers function under increasing time constraints, well-designed forms can help simplify and improve the documentation process. Patient record forms can help clinicians identify essential points of the history and physical examination and can provide anticipatory guidance. One classification system frequently used by primary care providers is the evaluation and management (E/M) code system. E/M codes are a subset of the Current Procedural Terminology codes developed by the American Medical Association to standardize the terminology used to describe medical and surgical services. This article presents one documentation system that primary care providers may find effective in their documentation efforts.

Abstracting and Indexing↗
PubMed2000

Pediatric gastrointestinal mucosal biopsy. Special considerations in children.

In most disorders of the gastrointestinal mucosa that occur in children and adults, the mucosal manifestations are the same. This article focuses on disorders and approaches to gastrointestinal procedures and mucosal biopsy that are of a particularly or peculiarly pediatric nature. This article discusses, in detail, the issues pertaining to endoscopy and other techniques of mucosal biopsy in children. Some approaches and techniques are considerably different than those in adults.

Adult↗
PubMed1998

Clinical nurse specialist prescriptive authority and the legislative process.

Despite certification and graduate education, clinical nurse specialists are denied prescriptive authority in many states. Restrictions on their scope of practice and prescriptive authority are barriers to potential contributions to the health care delivery system. The article describes the experience of the New Mexico Council of Clinical Nurse Specialists in the process of obtaining prescriptive authority. It discusses council formation, lobbying activities, the legislative process, and ways to become politically involved. Clinical nurse specialists are encouraged to become politically active and work through their state nurses association to change restrictive policies.

Drug Prescriptions↗
PubMed1997

Breast abscess due to Corynebacterium striatum.

Corynebacterium striatum, a normal constituent of the skin flora, is rarely pathogenic. Previous reports of infection are few, and are mainly confined to immunosuppressed patients or those with indwelling prosthetic devices. We report a case in which the organism caused a recurrent breast abscess in a woman with normal immune function. The only previous reports of Corynebacterium striatum mastitis have been in cows.

Abscess↗
PubMed1996

Role of endovaginal sonography in the diagnosis and management of ectopic pregnancy.

Although diagnostic laparoscopy is still considered the standard reference in the diagnosis of ectopic pregnancy (EP), use of high-resolution endovaginal sonography, in conjunction with qualitative serum assays of the beta subunit of human chorionic gonadotropin (beta-hCG), allows detection of earlier and smaller EPs. The most common endovaginal sonographic finding of EP (89%-100% of cases) is an extraovarian, round or elongated, solid tubal mass. A tubal ring (an extrauterine saclike structure) is the second most common finding (40%-68% of cases). Pelvic fluid may be present, but it is a nonspecific finding. An EP may have a pseudosac, which can be distinguished sonographically from the true gestational sac of an intrauterine pregnancy. Color Doppler techniques can complement endovaginal sonographic findings, but they should be performed only after a thorough real-time evaluation of the adnexal region. Current therapeutic options for EP include expectant management (ie, close follow-up), medical treatment (usually injections of methotrexate), and surgery. Accurate diagnosis with endovaginal sonography is the prerequisite to nonsurgical management, since surgery is the logical treatment if laparoscopy is used for diagnosis.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1996

Vertical transmission of hepatitis C virus infection.

Since the virus responsible for non-A, non-B hepatitis was cloned in 1989, much has been learnt about the epidemiology, diagnosis and clinical spectrum of hepatitis C virus (HCV) infection. As the routes of transmission are elucidated, specific groups of children as well as adults are known to be at particular risk of infection. The women most at risk of HCV infection are those with a history of injecting drug use. Mother-to-child transmission has been documented, although the exact risk has not been quantified, and the factors influencing the risk remain to be evaluated. This article reviews current knowledge on vertical transmission of HCV, and provides some guidelines on the management of infants born to women infected with the virus.

Adult↗
PubMed1993

Effect of maternal serum on viability and function of early human placental explants.

Fetal bovine serum (FBS) is frequently used to supplement chemically defined media such as Ham's F10 when studying placental explant cultures. However in vitro production of hormones is usually declining by the 2nd or 3rd day and is short-lived (7 to 10 days). In this study we explored the use of human maternal serum (HMS) from early gestation as the medium supplement to Ham's F10. Early placental hormone production was compared using two concentrations of FBS and HMS. On Day 3 of incubation, progesterone production in 10% HMS was 12-fold increased over that in 10% FBS, estradiol production was increased 10-fold, and beta hCG production more than 3-fold. When the serum concentrations were increased to 40%, the results in all cases were similar to those at 10%. Preliminary characterization studies revealed that the stimulatory activity of HMS is heat-labile, neither extractable into organic solvent (diethyl ether) nor dialyzable, suggesting that it is protein in nature. In a long-term incubation, compared with FBS (7 days), HMS permitted survival of culture up to 30 days, judged both histologically and biochemically. We conclude that HMS provides substance(s), probably protein in nature, not present in FBS or non-pregnant human serum, which are important for human placental viability and function in vivo.

Blood Physiological Phenomena↗
PubMed1992

Ovarian cysts in postmenopausal women: preliminary results with transvaginal alcohol sclerosis. Work in progress.

Seven patients with a recurrent ovarian cyst after transvaginal needle aspiration underwent alcohol sclerosis of the cyst. The cysts had the appearance of simple cysts at ultrasound (US). Sclerosis, an outpatient procedure, was performed with a transvaginal approach under continuous endovaginal US guidance. After aspiration of the cyst contents, approximately two-thirds of the aspirated fluid was replaced with 100% alcohol that was left in place for 20 minutes and then aspirated. No complication was observed. Four cysts had not recurred at follow-up examinations performed 2, 5, 7, and 12 months, respectively, after sclerosis. One patient underwent surgery because mucinous material was found on analysis of the specimen, which was proved to be a benign cystadenoma. The two other cysts recurred, and one patient underwent surgery. Alcohol sclerosis of ovarian cysts may have a role in the treatment of postmenopausal women with ovarian cysts with a low risk of malignancy.

Aged↗
PubMed1992

Transvaginal US-guided aspiration of ovarian cysts and solid pelvic masses.

Sixty-eight transvaginal ultrasound (US)-guided aspirations or biopsies were performed in 61 patients, of whom 48 had ovarian cysts and 13 had solid pelvic masses. In one patient with an ovarian cyst, aspiration revealed malignancy. Thirty-six of the 48 cysts were drained transvaginally in 23 premenopausal and 13 postmenopausal women, with recurrence rates of 48% and 80%, respectively. In seven cases a cyst was aspirated twice. In the 13 patients with solid pelvic lesions, 11 lesions proved to be malignant, with positive biopsy results in nine (sensitivity, 82%). Two benign lesions were correctly identified. No major complication was observed. The authors conclude that the transvaginal route offers simple access to pelvic lesions in pre- and postmenopausal patients. For women with a solid pelvic lesion, transvaginal aspiration biopsy with endovaginal US guidance is a safe and effective alternative to surgery, especially for patients with previously diagnosed malignant disease.

Adult↗
PubMed1985

The nuclear location signal.

A short sequence of predominantly basic amino acids Pro-Pro-Lys-Lys-Lys-Arg-Lys-Val from SV40 Large T is responsible for the normal nuclear location of the protein. Alteration of Lys-128 to each of six different residues other than Arg renders Large T cytoplasmic, whereas single amino acid changes in the surrounding region impair but do not prevent nuclear accumulation. When transposed to the amino terminus of cytoplasmic Large T species, or Escherichia coli beta-galactosidase or of chicken muscle pyruvate kinase, the sequence around Lys-128 of Large T is able to direct the recipient protein to the nucleus. This demonstrates that these amino acids can be sufficient for nuclear location and can act as a nuclear location signal. A computer search of over 2500 proteins reveals that some other nuclear proteins (for example, BK virus Large T, SV40 VP2 and adenovirus 72kDa DNA binding protein) contain very similar basic tracts, but so too do some presumed non-nuclear proteins (for example, poliovirus VP3). We suggest that the related sequence acts as the nuclear location signal in the other nuclear proteins but that the sequence does not function in all cases, perhaps because it is not accessible. A similar, but shorter or less basic sequence, was detected in a number of other nuclear proteins, for example, polyoma virus Large T, SV40 VP1 and several histones. However, such sequences were also found in many other proteins. Perhaps the shorter basic sequences can also act as nuclear location signals, but to be functional they need to be exposed (for example, at the amino terminus of the protein as in SV40 VP1) or to be present in multiple copies.

Amino Acid Sequence↗
PubMed1984

An antibody to a synthetic peptide recognizes polyomavirus middle-T antigen and reveals multiple in vitro tyrosine phosphorylation sites.

Antibodies were raised against three synthetic peptides corresponding to sequences surrounding tyrosine 315, a putative in vitro phosphorylation site in polyomavirus middle-T antigen. Only one of the peptides (called C and corresponding to residues 311 to 330) elicited antibodies that recognized middle-T efficiently. Middle-T present in immunoprecipitates formed with purified anti-C serum still accepted phosphate on tyrosine in an in vitro kinase reaction. This implies that tyrosines other than 315 and 322 that lie within the antibody binding region are phosphorylated under these conditions. This conclusion was supported by the altered partial V8 proteolysis fingerprint of the labeled middle-T. Two-dimensional tryptic fingerprint analysis of 32P-labeled middle-T showed that several tryptic peptides identified as including tyrosine 315 and 322 were missing from middle-T labeled in anti-C immunoprecipitates compared with middle-T labeled in immunoprecipitates made by using anti-tumor cell serum. However, one major labeled peptide remained. This peptide was also present in fingerprints of 32P-labeled middle-T coded by M45, dl23, pAS131, and dl1013, but a peptide with altered mobility was present in dl8 middle-T. This identified the peptide as including tyrosine 250. We deduce from these data that (i) the presence of the antibody against peptide C inhibits phosphorylation of tyrosines 315 and 322; (ii) middle-T labeled in the kinase reaction after immunoprecipitation with anti-C serum is phosphorylated on tyrosine 250; and (iii) when anti-tumor cell serum is used in the in vitro kinase reaction, middle-T is phosphorylated at multiple sites, including residues 250, 315, and 322.

Amino Acids↗
PubMed1982

An antibody to a synthetic peptide that recognises SV40 small-t antigen.

A peptide Tyr.Arg.Asp.Leu.Lys.Leu corresponding to the carboxy-terminal six amino acids of small-t antigen predicted from the DNA sequence of SV40 was synthesised, coupled to bovine serum albumin and to ovalbumin and used to raise antibody in rabbits. The sera obtained immunoprecipitated [125I]peptide. It also recognised SV40 small-t that was synthesised in vitro from SV40 mRNA or extracted from SV40 infected monkey cells. The immunoprecipitation of small-t was inhibited by added peptide. To demonstrate that the determinant was present at the carboxy-terminal end of the molecule, truncated versions of small-t coded for by 0.54-0.59 deletion mutants were tested. dl 890 small-t, which contains an in-phase deletion removing nine amino acids but leaving the carboxy-terminal sequences intact, was recognised by the antipeptide serum. By contrast dl 885 small-t, which has an out-of-phase deletion leading to an altered carboxy terminus coded in an alternative reading frame, was not recognised. The data confirm the location and specificity of the determinant recognised on small-t by the antipeptide serum.

Animals↗
PubMedDate not supplied

Repeat abortion: is it a problem?

As the number of Canadian women who have had induced abortions increases with each succeeding year, the number at risk--and the actual incidence--of repeat abortion also increases. Some researchers have argued that women who have more than one induced abortion are less well adjusted, others that they are less willing to use contraceptives, perhaps because of anxiety about sexuality. Still others have suggested that repeat abortion is unrelated to the psychology or attitudes of individual women, but rather is an inevitable result of imperfect contraceptives, imperfect contraceptive practice and the availability of legal abortion for the termination of unwanted pregnancies. A group of 580 women seeking abortions were interviewed at the Montreal General Hospital and given a number of psychological tests. About one in five of these women were having repeat abortions. The women having repeat abortions were older, less likely to be married and more tolerant of legal abortion than were women having their first abortions. They also had intercourse more frequently than the first-abortion patients. Women obtaining a repeat abortion were slightly more likely to have been using contraceptives at the time they became pregnant, but they did not differ from first-abortion patients in the types of methods that they used. On no other social or demographic characteristics, measures of psychological adjustment or attitudes about sexuality were there any important differences between the groups. A more complex statistical analysis reveals that the two most important factors differentiating first-abortion and repeat-abortion patients are age and coital frequency--both of which are variables that reflect added exposure to the risk of unintended pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗