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Biomedical subjects

P Hurley

Publications and source records attributed to P Hurley.

At least 19 recordsLinked to original sources

Unilateral hydronephrosis resulting from intraluminal obstruction of the ureter by adenosquamous endometrioid carcinoma arising from disseminated endometriosis.

A case of adenosquamous carcinoma arising in the background of disseminated pelvic endometriosis presented as unilateral hydronephrosis and a polypoid intraluminal ureteral mass. This is the first case of a malignancy arising in endometriosis presenting as an obstructive ureteral mass. The patient had a history of total hysterectomy and bilateral salpingo-oophorectomy 5 years earlier because of an endometriotic cyst, and had since been under unopposed estrogen replacement therapy. An analysis of the case and related literature is presented. Possible pathogenic mechanisms are discussed.

Carcinoma, Adenosquamous↗

Measuring outcomes in children's rehabilitation: a decision protocol.

OBJECTIVE: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation. DESIGN: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge and use of clinical outcome measures. SETTING: A children's rehabilitation center in a city of 50,000. PARTICIPANTS: All service providers in the children's rehabilitation center. Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. INTERVENTION: Using a conceptual framework based on the International Classification of Impairment, Disability, and Handicap (ICIDH), an outcome measurement decision-making protocol was developed. The decision-making protocol was computerized in an educational software program with an attached database of critically appraised measures. Participants learned about outcome measures through the program and selected outcome measures that met their specifications. The computer software was tested for feasibility in the children's rehabilitation center for 6 months. OUTCOME MEASURES: Knowledge and use of clinical outcome measures were determined before and after the feasibility testing using a survey of all service providers currently at the centre and audits of 30 randomly selected rehabilitation records (at pretest, posttest, and follow-up). RESULTS: Service providers indicated that the outcomes software was easy to follow and believed that the use of the ICIDH framework helped them in making decisions about selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing what measures were available. Use of outcome measures as identified through the audit did not change. CONCLUSIONS: The "All About Outcomes" software is clinically useful. Further research should evaluate whether using the software affects the use of outcome measures in clinical practice.

Child↗

Screening methods for thyroid hormone disruptors.

The U.S. Congress has passed legislation requiring the EPA to implement screening tests for identifying endocrine-disrupting chemicals. A series of workshops was sponsored by the EPA, the Chemical Manufacturers Association, and the World Wildlife Fund; one workshop focused on screens for chemicals that alter thyroid hormone function and homeostasis. Participants at this meeting identified and examined methods to detect alterations in thyroid hormone synthesis, transport, and catabolism. In addition, some methods to detect chemicals that bind to the thyroid hormone receptors acting as either agonists or antagonists were also identified. Screening methods used in mammals as well as other vertebrate classes were examined. There was a general consensus that all known chemicals which interfere with thyroid hormone function and homeostasis act by either inhibiting synthesis, altering serum transport proteins, or by increasing catabolism of thyroid hormones. There are no direct data to support the assertion that certain environmental chemicals bind and activate the thyroid hormone receptors; further research is indicated. In light of this, screening methods should reflect known mechanisms of action. Most methods examined, albeit useful for mechanistic studies, were thought to be too specific and therefore would not be applicable for broad-based screening. Determination of serum thyroid hormone concentrations following chemical exposure in rodents was thought to be a reasonable initial screen. Concurrent histologic evaluation of the thyroid would strengthen this screen. Similar methods in teleosts may be useful as screens, but would require indicators of tissue production of thyroid hormones. The use of tadpole metamorphosis as a screen may also be useful; however, this method requires validation and standardization prior to use as a broad-based screen.

Animals↗

Risk behavior and correlates of risk for HIV infection in the Dallas County Household HIV survey.

OBJECTIVES: The Dallas County study of a proposed national household seroprevalence survey was designed to assess the feasibility of conducting a national survey and to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis B virus infection for Dallas County. Risk behavior data were collected and correlated with HIV infection. METHODS: Participants in this survey represented a probability sample of the county. A self-administered questionnaire on demographic characteristics and HIV risk behavior was completed and a blood sample was obtained. RESULTS: Of the 1724 adults eligible for the survey, 1446 completed the questionnaire and 1374 provided a blood sample. The prevalence estimates were 0.4% for HIV and 7.3% for hepatitis B virus. A strong relationship was observed between HIV and hepatitis B status and risk behavior. CONCLUSIONS: In this study population, receptive anal intercourse and increasing numbers of male partners had the strongest correlation with the prevalence of HIV and hepatitis B virus infection in men. The high level of risk reporting for individuals positive for HIV or hepatitis B suggests that survey participants who engage in risk behaviors were willing to report those behaviors.

Adult↗

A microtitre plate method for measuring biopterin with cryopreserved Crithidia fasciculata.

The assay of biopterin derivatives in dried blood spots is used by us in initial screening for inherited defects in tetrahydrobiopterin synthesis. The previously described method (1) required aseptic technique and microbiological facilities. The modification detailed here has the advantages of antibiotic cover, which overcomes these needs and microtitre plate technology allowing the incubation time to be halved with precision and accuracy retained. Data reduction facilities may be applied.

Adult↗

Alpha thalassaemia hydrops fetalis in the UK: the importance of screening pregnant women of Chinese, other South East Asian and Mediterranean extraction for alpha thalassaemia trait.

OBJECTIVE: Alpha zero (alpha 0 or alpha-1) thalassaemia is an important genetic risk for women originating from Hong Kong, Singapore, Vietnam, Thailand, the Philippines or South China. Cypriots are also at risk. Carriers of alpha zero thalassaemia trait can be detected by routine haemoglobinopathy screening. When a couple are both carriers, in each pregnancy there is a 25% risk that the fetus will have alpha thalassaemia hydrops fetalis; this is fatal for the fetus and carries serious obstetric and psychological risks for the mother. Most informed couples at risk request prenatal diagnosis and selective abortion. This study investigates the effectiveness of screening, counselling and prenatal diagnosis for alpha thalassaemia hydrops fetalis in the UK. DESIGN: Retrospective analysis of the notes. SUBJECTS: 18 couples attending University College Hospital London for prenatal diagnosis of alpha thalassaemia hydrops fetalis since 1982. RESULTS: The study shows underdiagnosis of both alpha zero thalassaemia trait and alpha thalassaemia hydrops fetalis leading to avoidable stillbirths and complications in pregnancy. CONCLUSION: We recommend early screening for alpha zero thalassaemia trait for all women of Southeast Asian or eastern Mediterranean origin and the offer of prenatal diagnosis when indicated. The diagnosis of alpha thalassaemia hydrops fetalis should be considered in women of the relevant ethnic origin who have a stillbirth, neonatal death, abnormal ultrasound findings at fetal anomaly scanning (especially a large placenta), or who develop pre-eclampsia.

Abortion, Spontaneous↗

Ethics, social forces, and politics in AIDS-related research: experience in planning and implementing a household HIV seroprevalence survey.

A controversial proposal for a survey of HIV infection in a probability sample of U.S. household residents as part of the government's surveillance of the AIDS epidemic provided a number of challenges to survey science. These were compounded by ethical concerns and social sensitivities surrounding the topic. Questions about the ability of a voluntary survey to produce an accurate national estimate of infection demanded rigorous study. In 1987, the Centers for Disease Control began planning field tests of a survey to obtain blood samples and information about respondents' sexual behavior and drug use. The authors were part of the team deployed by the National Center for Health Statistics that, with the contractor staff from Research Triangle Institute, conducted studies in Pittsburgh and Dallas, but only after much was learned about developing processes and procedures for dealing both with broad community concerns and with the interests of those gravely touched by the epidemic.

Advisory Committees↗

Fetal blood sampling and pregnancy loss in relation to indication.

OBJECTIVE: To assess the relation between the indication for fetal blood sampling and pregnancy loss following the procedure. DESIGN: Retrospective study. SETTING: The tertiary referral Fetal Medicine Units at Guy's and University College Hospitals, London. SUBJECTS: Women undergoing diagnostic fetal blood sampling in four groups: (1) 94 having prenatal diagnosis with normal ultrasound findings; (2) 94 with a structural fetal abnormality; (3) 30 having fetal assessment and (4) 35 with non-immune hydrops. INTERVENTIONS: Freehand ultrasound guided fetal blood sampling from umbilical cord, intrahepatic vein or fetal heart. MAIN OUTCOME MEASURES: Pregnancy losses were divided into those within 2 weeks and those 2 weeks after the procedure, obstetric accidents and neonatal deaths. RESULTS: The 253 patients had fetal blood sampled on 268 occasions. Fifty-one pregnancies were terminated. Overall, 51 of the remaining 202 desired continuing pregnancies were lost, of which 19 (9%) were lost within 2 weeks of the procedure. After exclusion of the pregnancies that were terminated, the procedure-related losses within 2 weeks of sampling were 1 in 76 (1%), 5 in 76 (7%), 4 in 29 (14%) and 9 in 36 (25%) in groups 1, 2, 3 and 4 respectively. CONCLUSIONS: The risk of fetal blood sampling is increased in abnormal pregnancies, reflecting the underlying pathology and this must be taken into account when counselling patients before the procedure.

Abortion, Spontaneous↗

Detection of human pancreatic pro-phospholipase A2 activation using an immunoassay for the free activation peptide DSGISPR.

There are several forms of the enzyme phospholipase A2 (PLA2) in human tissues. In the pancreas the enzyme is produced as a zymogen, pro-phospholipase A2 (pro-PLA2). The active form is generated upon proteolytic cleavage of the N-terminal prophospholipase A2 activation peptide (PLAP), with the sequence Asp-Ser-Gly-Ile-Ser-Pro-Arg (DSGISPR). Antisera specific for free PLAP were produced by immunization with the synthetic peptide, N-terminally conjugated to bovine thyroglobin. Affinity purified antibodies were used to develop a radioimmunoassay with a detection limit of 5 nmol/L. Competitive inhibition studies with amino-terminally truncated sequences showed that, at least, the C-terminal pentapeptide (GISPR) was required for significant inhibition. Anti-PLAP antibodies did not react with native human pancreatic homogenate (a source of pro-PLA2). A large immunoreactive signal was generated upon trypsinization, which coeluted with synthetic PLAP when chromatographed on Sephadex-G25. Likewise, Sephadex-G50 chromatograph fractions of the untrypsinized homogenate reacted with the antibodies only after trypsinization. The immunoreactive signal appeared at a molecular weight of 14,500 which corresponds to the reported molecular weight of pancreatic pro-PLA2. This demonstrates that the assay is specific for the free peptide and reports pro-PLA2 activation. PLAP assay may therefore contribute to the study of the role of the PLA2 activation event in disease states such as pancreatitis.

Amino Acid Sequence↗

Trypsinogen activation peptides assay in the early prediction of severity of acute pancreatitis.

Trypsinogen activation can be quantified by measurement of released activation peptides (TAP assay). TAP assay in urine was performed on admission for 55 patients with acute pancreatitis. TAP concentration correlated with subsequent disease severity in 87%, whereas C-reactive protein concentration, and multifactorial scoring at 48 h, were correct in 55% and 84%. Sensitivity and specificity for TAP assay were 80% and 90%, for C-reactive protein 53% and 55%, and for multifactorial scoring at 48 h, 60% and 93%. Urine TAP assay distinguishes acute pancreatitis without trypsinogen activation from acute pancreatitis with trypsinogen activation, and helps to identify patients who will progress to the severe acute disease. Use of the assay should allow early intensive treatment of those who need it.

Acute Disease↗

Unusual remission of Pneumocystis carinii pneumonia in a patient with the acquired immune deficiency syndrome.

Pneumocystis carinii is a well-recognized cause of pneumonia in patients with immune deficiency, and when untreated, mortality approaches 100 percent. Although rare cases suggesting spontaneous recovery (usually accompanied by resolving immune deficiency) have been reported, spontaneous resolution of P. carinii pneumonia in patients with the acquired immune deficiency syndrome (AIDS) has not been described. A patient with AIDS in whom Pneumocystis pneumonia developed and remitted without appropriate therapy is described. This case suggests that the immunologic defects of AIDS are not fixed and that fluctuations in the degree of immunocompetence may allow for clinical recovery from opportunistic infections associated with AIDS even without appropriate therapy.

Acquired Immunodeficiency Syndrome↗