Biomedical subjects
Publications and source records attributed to R F Harrison.
Therapeutic radiation for malignant conditions is known to cause sarcomatous change in an irradiated field after a latent period; equally this change may occur following radiotherapy to benign conditions which may result in a more difficult management problem later. Radiotherapy to benign conditions should be reserved for use after failure of conventional surgery or other interventional techniques.
The first year's activity of a fully out-patient based, self financing, in vitro fertilisation service is reported. 98 couples had superovulation regimes tailored to need. 138 cycles were started. 109 retrievals were attempted using the vaginal ultrasound probe under Fentanyl and Midazolam sedation. In 106, oocytes were successfully retrieved (average seven per patient). In 80, embryos were transferred (average three). 13 patients achieved clinical pregnancies giving an overall pregnancy rate of 9.4% per cycle, 12% per oocyte retrieval, 16.5% per embryo transfer and 13% per patient who embarked on the programme. One pregnancy was ectopic, two aborted, and 10 are ongoing; this includes seven singleton foetuses and three sets of twins. All pregnant patients were referred back to their unit of origin for antenatal care and delivery.
Tissue from 15 livers with primary sclerosing cholangitis, obtained at transplantation, was examined histologically with respect to: small and medium sized bile duct lesions; large bile duct lesions; fibrosis/cirrhosis; and parenchymal changes. Lesions affecting small and medium-sized bile ducts were quantified by determining the percentage of 20 portal tracts involved. The two characteristic bile duct lesions of primary sclerosing cholangitis, periductal fibrosis and fibro-obliterative scars, were largely confined to medium-sized portal areas. Although present in each case, the number of such lesions varied considerably. Loss of bile ducts was the most conspicuous feature in small portal tracts where the diagnostic duct lesions of primary sclerosing cholangitis were rarely observed. Inflammation, ulceration and cholangiectases of large intrahepatic ducts were common, and appear to be useful additional diagnostic features.
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Since 1986 in vitro fertilisation and allied techniques have formed a part of the fertility service at St. James's Hospital. By June 1988 using routine methodology, IVF or GIFT has been attempted at least once in 94 women with a further 17 having one repeat procedure and 4 two repeat procedures performed. Although embryos were cultured from 54% of oocytes in which fertilisation was attempted, no pregnancies were achieved during that period with IVF. Ten pregnancies had occurred during a GIFT cycle (9 at first attempt, 16%) 60% of these are on-going. Also continuing were pregnancies where ovulation induction was abandoned on day 8 (1) and where conception occurred spontaneously whilst on the waiting list for the procedure (8) and in untreated cycles following the procedure (4) (16%). Seventy percent of patients who failed the first time expressed a wish to try again.
In an initial exploratory study, proneness to atopy was measured by specific allergen history, allergen skin testing and plasma IgE in couples with unexplained infertility and in a comparison group of couples who had recently had a child. At least one of the assessments was positive in 29 out of 47 infertile couples and in 52 out of 103 controls, but only five of the infertile group and two of the fertile group had all three assessments positive. Raised IgE levels occurred significantly more often in the infertile couples than in the comparison group.
To determine whether portal lymphadenopathy in primary biliary cirrhosis is caused by deposition of lipofuscin pigment in sinus histiocytes and to compare primary biliary cirrhosis with other liver diseases a retrospective study on a consecutive series of 169 livers obtained at transplantation was carried out. There were grouped into eight diagnostic categories: primary biliary cirrhosis (n = 51), primary sclerosing cholangitis (n = 10), extrahepatic biliary atresia (n = 6), chronic rejection (n = 9), cirrhosis (other causes) (n = 38), primary liver neoplasia (n = 21), acute liver disease (n = 20), and retransplantation (other) (n = 14). Lymph nodes were present in 66 specimens. Fifty of these contained granules of lipofuscin pigment. The highest incidence of lymph node enlargement and the largest amounts of pigment were present in cases of primary biliary cirrhosis. A similar pattern of lymph node enlargement was also commonly observed in other chronic cholestatic conditions (primary sclerosing cholangitis, biliary atresia, chronic rejection). Much less pigment was seen in nodes draining livers with non-cholestatic cirrhosis or primary tumours. Nodes were not found in acute liver disease. It is concluded that portal lymphadenopathy associated with lipofuscin is a common finding in various chronic cholestatic liver diseases. The pathogenesis of this lesion is uncertain. Most cases are asymptomatic with enlarged nodes which may be detected only at laperotomy or necropsy and may be wrongly attributed to neoplastic disease. Diagnostically, the finding of large amounts of lipofuscin in enlarged portal lymph nodes is a good indicator of underlying chronic cholestatic liver disease.
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Using couples with unexplained infertility as clinical models, a sub-group of approximately one-third separate out with high stress profile scores and intermittent mild elevations of prolactin 'spikers'. Pregnancy rates in such women when treated with a combination of clomiphene citrate and bromocriptine are found to be significantly more successful than placebo.
The authors review the frequency of reporting and severity of perineal pain in the post-partum period after episiotomy. The usage and efficacy of available analgesia is discussed.
Aerosol formulations of lignocaine (5%) and cinchocaine (2%) were compared with a water-only placebo spray in a single-dose study in 76 primiparous patients complaining of moderate or severe post-episiotomy pain. In comparison with a water-only placebo, both local anaesthetic formulations gave significant relief when administered to the perineal wound but the lignocaine spray proved to be the more effective. The only side-effect reported was slight stinging occurring immediately after administration of the lignocaine spray in 2 cases. Serum concentrations of local anaesthetic post-administration were negligible. An interesting finding was that breast-feeding patients responded less well to this form of analgesia than patients in whom lactation had been suppressed with frusemide.
A comparison of pain relief after a single perineal application of alcoholic and aqueous formulations of lignocaine (5%) spray with an aqueous formulation of cinchocaine (2%) spray was made in 72 primiparous patients complaining of moderate or severe post-episiotomy pain. All three formulations were similar in efficacy, the aqueous lignocaine preparation appearing slightly more effective than the others.
The analgesic effectiveness of aqueous and alcoholic formulations of lignocaine (5%) spray was compared with that of mefenamic acid (500 mg) or placebo in a double-blind study in 103 primiparous patients complaining of moderate or severe perineal pain associated with episiotomy. The results, assessed after a single dose, showed that the aqueous lignocaine formulation provided a level of pain relief superior to that obtained with the alcoholic formulation or placebo, and similar to that obtained with mefenamic acid.
Analgesic effect, labor outcome, safety and consumer satisfaction were compared in 170 primigravid women; 50 using TENS initially for pain relief, 20 using entonox, 50 pethidine + promazine and 50 lumbar epidural. 88% choosing epidural related it fully effective. 90% using entonox, 96% using TENS and 54% given pethidine + promazine found partial relief. 82% of patients given TENS and 80% given pethidine + promazine required additional analgesia. This was also needed by one of the 20 patients choosing entonox. Women using entonox alone had the shortest labors and women using lumbar epidural, the longest. Operative delivery was significantly more common in women receiving lumbar epidural. No significant inter-group differences were noted in cord pH or Apgar scores. Parturients and midwives both gave high consumer satisfaction ratings to all methods--except for pethidine + promazine, whose use must therefore be questioned. The analgesic efficacy of lumbar epidural outweighs any possible side effects. Entonox appears suited to those able to cope with the earlier part of labor, drug-free. Realization of the potential of TENS requires the design of machines specifically to cope with the quality of the pain of labor.
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Explore the source record for details and available documents.