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PubMedDate not supplied

Immunohistochemical study of mammary and extramammary Paget's disease.

Immunophenotypes of mammary (MPD) and extramammary Paget's disease (EPD) are still not well understood. Thirty-four formalin-fixed paraffin-embedded tissue sections from 33 patients with 6 MPD and 28 EPD were studied immunohistochemically with the use of polyclonal c-erbB-2 and pS2 antisera, and monoclonal nm23, B6.2, GCDFP-15, and p53 antibodies. Cases of MPD expressed a high incidence of c-erbB-2 and nm23 compared with those of EPD (100% vs. 29%; p < 0.01, and 83% vs. 29%; p < 0.05, respectively). Although high expression of B6.2 (> 83%) and moderate expression of GCDFP-15 (33-39%), pS2 (33-46%) and p53 (39-50%) were seen, the positivity was not significantly different between MPD and EPD. These findings indicate that MPD and EPD share immunohistochemical features but partially differ in their patterns of antigen expression.

Antigens, Neoplasm↗
PubMed1996

Effects of parathyroidectomy and calcium supplementation on the pressor response to angiotensin II in conscious rats.

OBJECTIVE: We evaluated the effect of parathyroidectomy (PTx) and of calcium supplementation on the pressor response to angiotensin II (Ang II) in conscious rats. STUDY DESIGN: PTx and sham surgery were performed on 10-week-old male Wistar rats. The mean arterial pressure (MAP), heart rate, and the effective pressor dose of Ang II (EPD) which defined as the dose of Ang II required to elicit a rise of 20 mmHg in MAP, were evaluated in PTx and sham operated rats. Intracellular free calcium in platelets was assessed with the fluorescent dye, fura-2 acetoxymethyl ester. In addition, after administering a dose of supplemental calcium chloride, a 10, 20, or 40 mg/rat, we determined the changes in the MAP, EPD, and serum calcium level. RESULTS: The EPD in the PTx rats was significantly lower than the sham operated rats. The serum concentration of calcium in PTx was also significantly lower than the sham operated rats. A statistically significant negative relationship was observed between the EPD and intracellular free calcium in PTx rats. Following administration of 20 mg of calcium chloride (7.4 mg of elemental calcium) to the PTx rats, the EPD returned to the level seen in sham operated rats. CONCLUSION: Results suggest that a depletion of parathyroid hormone is associated with the pressor response to Ang II, and is involved in the regulation of intracellular free calcium.

Angiotensin II↗
PubMed1998

Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women.

UNLABELLED: Postnatal depression occurs in 10-15% of women. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report scale designed specifically as a screening instrument for the postnatal period. It was initially validated for use in the UK, but has subsequently been validated for other communities. It has not been validated for an African community. OBJECTIVE: To determine whether the EPDS is a valid screening scale for depression in a Johannesburg community cohort. PARTICIPANTS AND SETTING: 103 women attending the postnatal clinic at Coronation Hospital, Johannesburg, South Africa. METHOD: The EPDS was validated against the Diagnostic and Statistical Manual (DSM-IV) criteria for depression. It was administered verbally to participants and translated into one of six South African languages where necessary. RESULTS: A threshold of 11/12 on the EPDS identified 100% of women with major depression and 70.6% of women with minor depression. For major and minor depression combined, sensitivity was 80%, specificity 76.6%, positive predictive value 52.6% and negative predictive value 92.2%. CONCLUSION: The EPDS, administered verbally, is a valid screening instrument in this urban South African community.

Cohort Studies↗
PubMed1999

Understanding lower urinary tract function in women soon after bladder neck surgery. Continence Program for Women Research Group.

The aim of this work was to correlate anatomic and urodynamic measures with function following bladder neck surgery. Eighty-seven women who underwent bladder neck surgery at two tertiary academic medical centers in the southeastern U.S. were studied in this prospective outcomes analysis. Preoperative and 6-week and 6-month postoperative status was assessed with urodynamic testing, physical examination, and condition-specific quality of life instruments. Correlations of dynamic urethral obstruction (quantified by pressure transmission ratio, PTR, determinations) and urethral support (quantified by urethral axis measurements) with functional status were determined. At 6 weeks, 50% of the subjects with inadequate dynamic obstruction (PTR < 90%) had genuine stress incontinence (GSI) compared to 5% of those with PTR >/= 90% (P = .00002). Of those with excessive obstruction (PTR > 110%), 32% had detrusor instability (DI) and 47% had emptying phase dysfunction (EPD) compared to 6% and 24%, respectively, of those with PTR </= 110% (P = .006 and P = .04). At 6 months, subjects with excessive obstruction were more likely to have EPD than other subjects (75% vs. 27%, P = .001). Those with optimal dynamic obstruction (PTR >/= 90% but </= 110%) were more likely to have normal function (no GSI, no DI, and no EPD) than those with higher or lower PTRs (59% vs. 34%, P = .04). Urethral axis measurements did not correlate with functional status at either follow-up session. The magnitude of dynamic urethral obstruction is related to function after bladder neck surgery. Excessive obstruction is associated with DI and EPD, inadequate obstruction with GSI, and optimal obstruction with normal function. Neurourol. Urodynam. 18:629-637, 1999.

Adult↗
PubMed2005

Risk factors for depression in the first postnatal year: a Turkish study.

BACKGROUND: The aim of the study was to identify risk factors for depression and to estimate its prevalence in postnatal mothers. METHODS: This cross-sectional and multi-centre study was carried out on 1,350 Turkish women in their first postnatal year. Measures included a structured questionnaire and the Turkish version of the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Of the women, 31.1% had a score of 13 or higher on the EPDS. The mean score and standard deviation was 9.8+/-5.7. In the multivariate analysis, EPDS scores were significantly associated with economic status, access to support from family members and close friends, emotional distress at the pregnancy, whether the pregnancy was planned, health problems during pregnancy, the perceived standard of baby care after delivery, and mental disorder before and during pregnancy. CONCLUSION: The prevalence of EPDS-based depression among Turkish women in postnatal the period was high, and was associated with several social, economic and demographical factors.

Cross-Sectional Studies↗
PubMedDate not supplied

Early postnatal dexamethasone diminishes transforming growth factor alpha localization within the ileal muscularis propria of newborn mice and extremely low-birth-weight infants.

Focal small bowel perforation (FSBP) occurs most commonly in the ileum of extremely low-birth-weight (ELBW) infants. Early postnatal dexamethasone (EPD) administration results in an increased risk for FSBP in this patient population, but the mechanism by which this occurs is unknown. Infants with FSBP have healthy mucosa but thinned smooth muscle, suggesting a mechanism involving the muscularis propria for these perforations. One explanation for these findings would be that dexamethasone alters the tissue availability of pertinent growth factors to the smooth muscle. To explore this possibility, we administered dexamethasone or saline by intraperitoneal injection to newborn mice for 3 days (dosed at 1 microg/g of body weight/day) to simulate EPD protocols. The animals were sacrificed after 72 h of treatment and their ileums harvested and prepared for microscopy. Immunolocalization was performed for three related growth factors (epidermal growth factor [EGF], heparin-binding EGF [h-EGF], and transforming growth factor alpha [TGF-alpha]) and their common receptor. We found TGF-alpha to be abundant and discretely localized in the muscularis propria in control animals but to be diminished in dexamethasone-treated animals. EGF-receptor immunostaining was also decreased with dexamethasone but there was minimal to no detection of EGF or h-EGF in either treatment condition. Surgical and autopsy specimens of the ileum were obtained from seven ELBW infants who either received EPD or not. These tissues were used for immunolocalization of the same growth factors and similar distributions for TGF-alpha were observed in several of these cases. These findings are consistent with an autocrine role for TGF-alpha in ileal smooth muscle proliferation and suggest a mechanism by which EPD might mediate smooth muscle thinning.

Animals↗
PubMed1981

Angiotensin-II sensitivity and prostaglandin-synthetase inhibition in pregnancy.

Angiotensin-II sensitivity was measured with a standardized test in 8 healthy nonpregnant females and in 14 healthy primigravid women. In the primigravid women the effective pressor dose (EPD), i.e. the minimal dose of angiotensin-II (A-II) necessary for a rise in diastolic blood pressure of 20 mm Hg, was 17.1 +/- 5.7. This is significantly higher than the EPD in the control group (5.2 +/- 1.2). The pregnant patients were also tested 75 min after a 50 mg indomethacine suppository, which produced a decrease of the EPD of 9.5 +/- 3.0, a fall of 44%. None of the 7 patients tested between 28 and 32 wk of gestation developed pregnancy-induced hypertension. They all had a normal EPD. It may be concluded that (1) A-II sensitivity is decreased in pregnancy, and (2) vascular reactivity in pregnancy is at least in part mediated by prostaglandins.

Adolescent↗
PubMed1992

Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome.

Food intolerance seems to be an important cause of the hyperkinetic syndrome, but restricted diets are expensive, socially disruptive, and often nutritionally inadequate. Enzyme-potentiated desensitisation (EPD) may overcome some of these difficulties. EPD was tested in a double-blind placebo-controlled trial among 40 children with food-induced hyperkinetic behaviour disorder. A total of 185 children with established hyperkinetic syndrome underwent oligoantigenic dietary treatment for four weeks. 116 whose behaviour responded had provoking foods identified by sequential reintroduction. Foods that reproducibly provoked overactivity were avoided. 40 patients who were then invited to take part in the hyposensitisation trial were randomly assigned to treated and control groups. Treated patients received three doses of EPD (beta-glucuronidase and small quantities of food antigens) intradermally at two-monthly intervals. Controls received buffer only. Thereafter, patients were allowed to eat known provoking foods. Of 20 patients who received active treatment, 16 became tolerant towards provoking foods compared with 4 of 20 who received placebo (p less than 0.001). Our results show that EPD permits children with food-induced hyperkinetic syndrome to eat foods that had previously been identified as responsible for their symptoms. These results also support the notion that food allergy is a possible mechanism of the hyperkinetic syndrome.

Adolescent↗
PubMed1995

Use of the Edinburgh Postnatal Depression Scale in a southern, rural population in the United States.

1. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for the incidence of postpartum depression in women receiving their pre- and post-partal care at a southern, rural health department maternity clinic. 2. One hundred eighty-one women completed the EPDS during their postpartum visit. Scores on the EPDS ranged from 0 to 27. Thirty-six of the 181 subjects (19.9%) had scores of 12 or more, the threshold identified by Cox, et al. (1987) as indicating women likely to be experiencing postpartum depression. 3. Results support use of the EPDS as a screening tool for postpartum depression in this population.

Depressive Disorder↗
PubMedDate not supplied

Changes in maternal depressive symptoms across the postpartum year at well child care visits.

OBJECTIVE: To describe the incidence, continuation, and resolution of symptoms during the postpartum year in urban women experiencing high depressive symptom levels at one or more well child care visits. METHODS: As part of a prior study of postpartum depressive symptoms, demographic data and the Edinburgh Postnatal Depression Scale (EPDS) were systematically collected from pediatric records of a clinic that routinely screens mothers with the EPDS at each first-year well child care visit. To explore the course of depressive symptoms throughout the postpartum year in this pilot study, we included only data from the records that had at least one EPDS > or = 10 (N = 100), a score indicating a high likelihood for clinically significant depressive symptoms. RESULTS: Among 49 women who completed the EPDS at least once before 3 months and between 3 and 11 months postpartum, 33% had high symptom levels throughout the year, 41% improved after the first 3 months, and 26% developed high symptom levels after the first 3 months. CONCLUSIONS: Postpartum depressive symptoms persist in many women throughout the postpartum year. Routine screening throughout the year might better identify both a subgroup of women who develop new symptoms during the year, as well as the women whose symptoms persist.

Adult↗
PubMed2005

Comparison of the safety and efficacy of emboli prevention devices versus platelet glycoprotein IIb/IIIa inhibition during carotid stenting.

Distal embolization is the main potential risk of carotid stenting, and techniques to minimize this risk are evolving. Between July 1998 and March 2002, 305 consecutive patients who underwent elective or urgent percutaneous carotid intervention at The Cleveland Clinic were prospectively followed. During this period, the clinical practice of carotid stenting evolved from the routine use of glycoprotein IIb/IIIa inhibitors (GPIs) to routine emboli-prevention device (EPD) placement. A total of 199 patients received adjunctive GPIs (91% abciximab), and 106 patients underwent the procedure with an EPD (85% filter design, 15% occlusive balloon). At 30 days, the composite end point of neurologic death, nonfatal stroke, and major bleeding, including intracranial hemorrhage, was significantly lower among patients treated with EPDs compared with those treated with GPIs (0% vs 5.1%, p = 0.02). EPDs may provide an overall safer and more effective means of neuroprotection during carotid stenting than GPIs.

Abciximab↗
PubMed2006

Salvage treatment for childhood ependymoma after surgery only: Pitfalls of omitting "at once" adjuvant treatment.

PURPOSE: To discuss the results obtained by giving adjuvant treatment for childhood ependymoma (EPD) at relapse after complete surgery only. METHODS AND MATERIALS: Between 1993 and 2002, 63 children older than 3 years old entered the first Italian Association for Pediatric Hematology and Oncology protocol for EPD (group A), and another 14 patients were referred after relapsing after more tumor excisions only (group B). Prognostic factors were homogeneously matched in the two groups. We report on the outcome of group B. RESULTS: Mean time to first local progression in group B had been 14 months. Tumors originated in the posterior fossa (PF) in 10 children and were supratentorial (ST) in 4; 11 had first been completely excised (NED) and 3 had residual disease (ED). Diagnoses were classic EPD in 9 patients, anaplastic in 5. Eight children were referred NED and 6 ED after two or more operations, 5 had cranial nerve palsy, 1 had recurrent meningitis, and 2 had persistent hydrocephalus. All received radiotherapy (RT) to tumor bed and 5 also had pre-RT chemotherapy. Six of 14 patients (6/10 with PF tumors) had a further relapse a mean 6 months after the last surgery; 4 of 6 died: progression-free survival and overall survival at 4 years after referral were 54.4% and 77%, respectively. Considering only PF tumors and setting time 0 as at the last surgery for group B, progression-free survival and overall survival were 32% and 50% for group B and 52% (p < 0.20)/70% (p < 0.29) for the 46 patients in group A with PF tumors. Local control was 32% in group B and 70.5% in group A (p = 0.02). CONCLUSIONS: Relapsers after surgery only, especially if with PF-EPD, do worse than those treated after first diagnosis; subsequent surgery for tumor relapse has severe neurologic sequelae.

Adolescent↗
PubMed2005

Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome.

OBJECTIVES: The purpose of this research was to define the predictors of the "slow-reflow" phenomenon during carotid artery intervention with filter-type embolic protection devices (EPDs) and to determine its prognostic significance. BACKGROUND: During carotid artery intervention using filter-type EPDs, we have observed cases in which there is angiographic evidence of a significant reduction in antegrade flow in the internal carotid artery proximal to the filter device, termed "slow-flow." The predictors of this phenomenon and its prognostic significance are unknown. METHODS: Using a single-center prospective carotid intervention registry, patients with slow-flow were compared to patients with normal flow during carotid intervention with respect to clinical, procedural, and lesion characteristics, and the 30-day incidence of death and stroke. RESULTS: A total of 414 patients underwent 453 carotid artery interventions using EPDs. Slow-flow occurred in 42 patients (10.1%) undergoing 42 carotid interventions (9.3%), and most commonly occurred after post-stent balloon dilatation (71.4%). Multivariate logistic regression analysis identified the following predictors of slow-flow: recent history (<6 months) of stroke or transient ischemic attack (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.4 to 5.6, p = 0.004), increased stent diameter (OR 1.4, 95% CI 1.02 to 1.94, p = 0.044), and increased patient age (OR 1.05, 95% CI 1.01 to 1.09, p = 0.025). Among patients with slow-flow, the 30-day incidence of stroke or death was 9.5% compared to 2.9% in patients with normal flow (chi-square = 4.73, p = 0.03). This difference was driven by the disparity in the 30-day incidence of stroke (9.5% vs. 1.7%). CONCLUSIONS: Slow-flow during carotid intervention with EPDs is a frequent event that is associated with an excess risk of periprocedural stroke. The association of the phenomenon with clinically symptomatic carotid lesions and use of larger stent diameters suggests that embolization of vulnerable plaque elements may play a pathogenic role.

Aged↗
PubMed2006

An exploration of the relationship between postnatal distress and maternal role attainment, breast feeding problems and breast feeding cessation in Australia.

OBJECTIVES: To explore the relationships between maternal distress, breast feeding cessation, breast feeding problems and breast feeding maternal role attainment. DESIGN: Longitudinal cohort study. SETTING: Three urban hospitals within Sydney, Australia. PARTICIPANTS: 449 women were invited to participate in the study, with an 81% response rate. MEASUREMENT: Self-report questionnaires were used to collect the data in pregnancy (28-36 weeks) and 2 weeks and 3 months after birth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postnatal distress, and the Maternal Role Attainment subscale (MRA) of the Maternal Breast Feeding Evaluation Scale (MBFES) was used to measure breast feeding maternal role attainment. FINDINGS: Women with high MRA were less likely to stop breast feeding (even when they had breast feeding problems) than women with low MRA. Antenatal EPDS and anxiety scores were not related to breast feeding cessation or breast feeding problems when analysed alone. As hypothesised, the relationship between breast feeding cessation and postnatal distress (EPDS scores) varied according to MRA level. Women who were categorised as high MRA and no longer breast feeding had higher EPDS scores and were more likely to be categorised as distressed (36%) than women who had low MRA (<12%) or women who had high MRA and continued to breast feed (7%). IMPLICATIONS: There is a complex relationship between maternal identity, stopping breast feeding earlier than desired, and psychological distress. Women with strong beliefs about the importance of breast feeding to their maternal role may benefit from psychological assessment and support should they decide to stop breast feeding earlier.

Adult↗
PubMed2006

Validation of the Thai Edinburgh Postnatal Depression Scale for screening postpartum depression.

This study aimed to validate and determine an appropriate cut-off score on the Thai Edinburgh Postnatal Depression Scale (EPDS) as a screen for postpartum depression. A prospective cohort of postpartum women at 6-8 weeks were tested using the EPDS and clinically interviewed by psychiatrists to establish a DSM-IV diagnosis of major or minor depressions in a university hospital in Southern Thailand. Of 351 postpartum women interviewed, 38 postpartum women met the criteria for depressive disorders, major depression in four women (1%) and minor depressive disorder in 34 women (10%). The area under the curve was 0.84 (95% confidence interval 0.76-0.91). Using an EPDS cut-off sum score of 6/7, major and/or minor depression was detected with a sensitivity of 74%, specificity of 74%, positive predictive value of 26% and negative predictive value of 95%. When the cut-off score was higher, the sensitivity was lower but the specificity was higher. The Thai version of the EPDS is a valid self-report instrument and is useful in Thailand where no other screening instrument for postpartum depression is available.

Adult↗
PubMed2000

An international study exploring levels of postpartum depressive symptomatology.

OBJECTIVE: Differences in postpartum depressive symptomatology (PPDS) among an international sample of 892 women from nine countries representing five continents were explored. METHOD: Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) were used to assess PPDS among a convenience sample that completed the two questionnaires twice, yielding a total of four sets of scores per subject. Women sampled were primiparae with no obstetrical complications, and had a healthy baby. Depression history and therapy were ruled out as exclusion criteria. RESULTS: Mean scores for EPDS and BDI varied across sites at both time points (P value<.001). European and Australian women had the lowest levels of PPDS, USA women fell at the midpoint, and women from Asia and South America had the highest depressive symptom scores. The moderate concordance between the EPDS and BDI suggested that the measures have complementary uses for screening and assessment. CONCLUSION: Utility of EPDS and BDI for yielding profiles of postpartum women's depressive symptomatology was demonstrated. Further research to validate depressive symptom measures with diverse international populations is indicated.

Adult↗
PubMed1997

Eccrine sweat gland carcinoma of the scrotum with associated extramammary Paget's disease.

Sweat gland carcinomas are rare tumors which have not previously been reported as arising from the scrotum. We present the first known case of primary eccrine sweat gland carcinoma of the scrotum in association with extramammary Paget's disease (EPD) and review the presentation and management of these tumors. Sweat gland carcinomas frequently coexist with EPD and this association provides insight into the histogenesis of EPD, which is presently unknown. Sweat gland carcinoma should be included in the differential diagnosis of cutaneous scrotal tumors and carefully ruled out pathologically if the diagnosis of EPD alone is made.

Adenocarcinoma↗
PubMed2002

Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial.

BACKGROUND: Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs. METHODS: We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects. FINDINGS: 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ. INTERPRETATION: Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.

Adult↗