Three cheers for reform.
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Biomedical subjects
Publications and source records attributed to R Lilford.
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Transabdominal chorionic villus sampling, carried out with a fine-bore needle and cannula under ultrasound guidance, was as successful as transcervical aspiration but avoided the risks of bacterial contamination associated with the latter technique. The transabdominal procedure can be carried out under local anaesthesia, and multiple samples can be obtained, if necessary, through a single cannula.
Aspiration biopsy of trophoblastic villi was performed on 56 patients immediately preceding suction termination of pregnancy, using a malleable metal cannula and ultrasound guidance. Villi were obtained from 47 patients (84%), with sampling success rising to 93% after experience. Immediate complications were noted in 14% of patients and correlated with placental positions situated furthest from the cervical canal. Karyotyping from cultured and/or direct preparations was attempted on the villus samples and was successful in 42. Clarity of the karyotypes obtained from direct preparations in this series was not found to be adequate for diagnostic purposes. A number of practical suggestions which facilitate chorion villus sampling are described.
We have carried out a longitudinal study of human polyomavirus infection in 71 pregnant women and correlated the virological findings with changes in the defence system in the same patients. As reactivation of human polyomaviruses generally occurred late in the second trimester it was possible to distinguish between the immunological changes which preceded the onset of reactivation and those which were secondary to the infection. Evidence of reactivation was detected in 26 women; all had high or rising antibody titres against BK or JC virus, but only five of these developed viruria. A positive correlation was observed between a high monocyte count in early pregnancy and subsequent virus reactivation. The virus excretors had significantly lower neutrophil counts than the women who had no evidence of virus reactivation. In contrast, women with serological evidence of virus activity but no viruria has significantly higher neutrophil counts than the non-activators. They also had stronger lymphocyte responses to PHA than the virus excretors. Virus activators were found to have a significant lymphopenia in the third trimester compared to the non-activators. High antibody levels did not appear to inhibit virus excretion. These findings suggest that monocytosis may predispose to reactivation of human polyomaviruses in pregnancy. On the other hand, ability to contain the virus once it has been activated, was associated with neutrophilia, and relatively vigorous in vitro reactivity of lymphocytes to PHA. Persistent lymphopenia was probably secondary to virus reactivation. The model on which this study is based could be adapted to investigate the causes of reactivation of other viruses. It may also help to identify risk factors in patients who are particularly susceptible to infection with opportunistic viruses.
A 47-year-old multiparous woman presented with endometriosis, true urinary incontinence, and the mucosal and skin lesions of pyoderma gangrenosum. The subsequent investigations, treatment and course are discussed, as well as the possible causal interrelationship between the above three conditions.
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