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Biomedical subjects

A Francis

Publications and source records attributed to A Francis.

At least 19 recordsLinked to original sources
PubMed2003

Premenstrual symptomatology, locus of control, anxiety and depression in women with normal menstrual cycles.

The present study was designed to investigate the relationships between premenstrual symptomatology, locus of control, anxiety, and depression in women with normal menstrual cycles. Sixty-nine female participants completed a survey, comprised of the Menstrual Distress Questionnaire (MDQ; Moos, 1968), Levenson's (1981) locus of control scales, the Depression Anxiety Stress Scale (DASS; Lovibond and Lovibond, 1995), and a questionnaire constructed by the researchers based on the DSM-IV criteria for Premenstrual Dysphoric Disorder (PMDD). Both overall and specific subtypes of premenstrual symptomatology were found to correlate with external locus of control, anxiety, and depression. In addition, locus of control was found to moderate the relationship between premenstrual symptomatology, anxiety and depression. Finally, women who were in the premenstrual phase when completing the questionnaire scored significantly lower on the internal scale than those in either the follicular or early luteal phases. It was concluded that an external locus of control may be associated with a susceptibility to depression or anxiety when certain premenstrual or postmenstrual changes are experienced.

Adult↗
PubMed2002

Breast papilloma: mammogram, ultrasound and MRI appearances.

Breast papilloma are difficult to diagnose by triple assessment. Their symptoms, clinical signs and radiological appearances are differing widely. In this paper, we report the symptoms and clinical signs of 35 patients with proven breast papilloma and consider the relative merits of mammography, ultrasound scans and magnetic resonance imaging in their assessment.

Journal Article↗
PubMed2001

Mice with a homozygous gene trap vector insertion in mgcRacGAP die during pre-implantation development.

In a phenotypic screen in mice using a gene trap approach in embryonic stem cells, we have identified a recessive loss-of-function mutation in the mgcRacGAP gene. Maternal protein is present in the oocyte, and mgcRacGAP gene transcription starts at the four-cell stage and persists throughout mouse pre-implantation development. Total mgcRacGAP deficiency results in pre-implantation lethality. Such E3.5 embryos display a dramatic reduction in cell number, but undergo compaction and form a blastocoel. At E3.0-3.5, binucleated blastomeres in which the nuclei are partially interconnected are frequently observed, suggesting that mgcRacGAP is required for normal mitosis and cytokinesis in the pre-implantation embryo. All homozygous mutant blastocysts fail to grow out on fibronectin-coated substrates, but a fraction of them can still induce decidual swelling in vivo. The mgcRacGAP mRNA expression pattern in post-implantation embryos and adult mouse brain suggests a role in neuronal cells. Our results indicate that mgcRacGAP is essential for the earliest stages of mouse embryogenesis, and add evidence that CYK-4-like proteins also play a role in microtubule-dependent steps in the cytokinesis of vertebrate cells. In addition, the severe phenotype of null embryos indicates that mgcRacGAP is functionally non-redundant and cannot be substituted by other GAPs during early cleavage of the mammalian embryo.

Animals↗
PubMed2001

Anterior cruciate ligament rupture: reconstruction surgery and rehabilitation. A nation-wide survey of current practice.

A database of the current practice of anterior cruciate ligament (ACL) reconstruction surgery in Great Britain was collated from a postal survey. This survey revealed that clear trends are emerging in the United Kingdom (UK) with regard to ACL reconstruction surgery (such as the type of graft used and timing of surgery) and rehabilitation. Certain issues, however, remain controversial, including bracing and knee range of movement. Clinical outcome measures are consistently used to judge operative success, but few specialists use defined objective measurements such as the IKDC scoring system.

Anterior Cruciate Ligament↗
PubMed2001

The diagnosis of invasive lobular breast carcinoma. Does MRI have a role?

Invasive lobular breast carcinoma accounts for approximately 15% of all breast cancers and is difficult to detect using conventional breast imaging techniques. We report a comparison between clinical, ultrasound scan (USS), mammographic and magnetic resonance imaging (MRI) of 22 patients with invasive lobular breast carcinomas. Actual tumour size was ascertained by histopathology. MRI detected 21 of the 22 invasive lobular cancers whilst mammography and USS detected 16 and 20 respectively. 19 tumours were clinically palpable. MRI was more accurate at assessing tumour size than USS and clinical examination, both of which underestimated tumour size.

Journal Article↗
PubMed2001

Primary intraosseous carcinoma of the jaw: pooled analysis of world literature and report of two new cases.

Primary intraosseous carcinoma (PIOC) is a rare malignant neoplasm of the jaw. These tumours are believed to arise from the odontogenic epithelium and hence are also referred to as odontogenic carcinoma. A detailed search was made for squamous cell PIOC of the jaw in English literature using Medline Cancer CD. The data obtained were transferred onto dBase software. Two detailed case reports of patients treated at Regional Cancer Centre, Trivandrum during 1996 and 1997 were also included. A pooled analysis was carried out. Survival analysis was carried out using Kaplan-Meier method and log-rank statistics were used for comparing survival. A total of 35 cases were analysed, of which 33 were from published literature. The mean age of the patients at the time of diagnosis was 52.3 years with male to female ratio being 2.5:1. Posterior mandible was the predominant site. The median follow-up time was 28 months. Overall survival at 5 years was 37.8% (95% CI; 14.8-61.0) while the corresponding disease free survival was 29.8% (95% CI; 9.2-54.1). Primary intraosseous carcinoma is a rare tumour of jawbones, characterized by progressive swelling of the jaw, pain and loosening of tooth. The tumour is locally aggressive and metastasizes to regional nodes. The overall and disease free survival is poor with almost 50% patients failing loco-regionally within the first 2 years of follow-up.

Adult↗
PubMed2001

ECT for prolonged catatonia.

OBJECTIVE AND BACKGROUND: Electroconvulsive therapy (ECT) is highly effective for acute catatonia but its use in prolonged catatonia is not well established. We report three cases of prolonged catatonia with medical complications or comorbidities treated by ECT. METHOD: Case reports. RESULTS: A 24 year-old woman developed fever and autonomic instability after parenteral neuroleptics. Catatonia and autonomic signs persisted for 14 weeks. After minimal improvement from lorazepam, 15 bilateral ECTs led to resolution. A 26-year-old woman with a history of lupus erythematosus, complicated by lupus cerebritis with lesions in the cortex and basal ganglia and a communicating hydrocephalus, was catatonic for 9 weeks. Lorazepam produced marginal improvement. A series of 14 bilateral ECTs led to improved mobility, speech, and interaction, but the response was less robust than Case 1. A 40-year-old man with mental retardation and intermittent psychosis developed severe neuroleptic malignant syndrome and remained catatonic for 4 months. After lorazepam produced minimal improvement, his catatonia resolved with 20 bilateral ECTs. CONCLUSIONS: ECT may improve prolonged catatonia with complex medical comorbidities, but may require many treatment sessions. Gross cerebral pathology may predict a less robust response. As for acute catatonia, ECT may resolve prolonged catatonia after benzodiazepines have failed.

Adult↗
PubMed2001

Emergence of catatonia during ECT.

Emergence of catatonia during electroconvulsive therapy (ECT) is unexpected, as catatonia responds well to ECT. We report four cases with onset of catatonia during ECT. Four inpatients with affective disorders (three without prior catatonia) developed catatonia by Bush-Francis criteria during a course of ECT. All four patients had been taking benzodiazepines, which were stopped 5-15 days before ECT. Two became catatonic after ECT no. 4, one after ECT no. 1, and one after ECT no. 10. The episodes of catatonia resolved promptly with the resumption of benzodiazepines. Two patients completed a course of ECT, whereas two received neuroleptics and/or antidepressants without further ECT. All showed improvements in their affective and psychotic symptoms. The cases illustrate the appearance of catatonia during a course of ECT and suggest recent cessation of benzodiazepines as a risk factor. Benzodiazepines relieve the catatonia, and ECT may be continued.

Adult↗
PubMed2001

Perinatal outcome in SGA births defined by customised versus population-based birthweight standards.

OBJECTIVE: To determine whether customised birthweight standard improves the definition of small for gestational age and its association with adverse pregnancy outcomes such as stillbirth, neonatal death, or low Apgar score. DESIGN: Population based cohort study. POPULATION: Births in Sweden between 1992-95 (n = 326,377). METHODS: Risks of stillbirth, neonatal death, and Apgar score under four at five minutes were calculated for the lowest 10% birthweights according to population-based and customised standards, and were compared with the data from the group with birthweights over this limit. Population attributable risks for stillbirth using various birthweight centile cutoffs were calculated for the two standards. OUTCOME MEASURES: Odds ratios and 95% confidence intervals for stillbirth, neonatal death and Apgar score under four at five minutes, and population attributable risks for stillbirth at different birthweight centiles. RESULTS: Risks of stillbirth, neonatal death, and Apgar score under four at five minutes and population attributable risks of stillbirth were consistently higher if 'small for gestational age' was classified by a customised rather than by the population-based birthweight standard. Compared with infants who were not small for gestational age by both standards, the odds ratio for stillbirth was 6.1 (95% CI 5.0-7.5) for small for gestational age by customised standard only, whereas it was 1.2 (95 % CI 0.8-1.9) for small for gestational age by population standard only. CONCLUSIONS: Compared with the population-based birthweight standard, a customised birthweight standard increases identification of fetuses at risk of stillbirth, neonatal death and Apgar score under 4 at 5 minutes, probably due to improved identification of fetal growth restriction.

Adult↗
PubMed2000

Customized fetal weight limits for antenatal detection of fetal growth restriction.

OBJECTIVE: To define cut-off limits for individually adjustable fetal weight standards for the detection of intrauterine growth restriction. DESIGN: Retrospective study, with the outcome measures small-for-gestational age (SGA) birth weight, operative delivery for fetal distress, umbilical artery pH < 7.15, and admission to the neonatal intensive care unit. SUBJECTS AND METHODS: Two hundred and fifteen women considered to be at increased risk of uteroplacental insufficiency were recruited to a study of serial ultrasound scans. Fetal weights were derived using standard formulae and, retrospectively, weight percentiles were calculated after individual adjustment for maternal height, weight in early pregnancy, ethnic group, parity and fetal sex. INTRODUCTION: One or more antenatal scans indicative of fetal weight below the 10th customized percentile were predictive for a SGA neonate at birth (P < 0.001), operative delivery for fetal distress (P < 0.01) and admission to neonatal intensive care (P < 0.01) but not for a low umbilical artery pH (P = 0.6). Receiver-operator curves showed the optimal customized fetal weight percentile limit for predicting an SGA neonate to be the 18th percentile (sensitivity 83%, specificity 79%, positive predictive value 63% and negative predictive value 92%). For the prediction of operative delivery for fetal distress and admission to neonatal intensive care, the optional customized cut-off value was the 8th percentile. CONCLUSIONS: The assessment of fetal weight using ultrasound and an individually-adjusted standard is predictive of growth restriction and perinatal events associated with hypoxia or diminished reserve. The optimal cut-off value for predicting operative delivery for fetal distress or admission to the neonatal intensive care unit suggests that the 10th customized percentile is a good limit for clinical use.

Adult↗
PubMed2000

Intraoperative axillary lymph node assessment in breast cancer.

Bedside assessment of axillary lymph node metastases in breast cancer is notoriously inaccurate. The aim of this study was to assess the accuracy of the clinical assessment of the presence of axillary node metastases in patients with breast cancer, both at the bedside and intraoperatively. Intraoperative assessment was significantly more accurate than bedside assessment, having an accuracy of 86%, compared with 66% of bedside clinical assessment. As axillary lymph node involvement is an important prognostic factor in breast cancer, this technique which has a high specificity and far higher sensitivity than bedside clinical assessment and may have a valuable role to play in planning management.

Journal Article↗
PubMed2000

Residual catatonic state following neuroleptic malignant syndrome.

Neuroleptic malignant syndrome (NMS) is usually a self-limited disorder, with most cases resolving within 2 weeks after antipsychotic drug discontinuation. However, the course of NMS may not always be short-lived. In this report, the authors describe five patients who developed a residual catatonic state that persisted after acute hyperthermic symptoms of NMS had subsided and compare them with 27 similar cases in the literature. Two of our patients recovered gradually with supportive treatment. Three patients were treated with electroconvulsive therapy (ECT). Of these, two showed a positive response, although one died later of intercurrent pneumonia. A third patient did not respond to ECT, but recovered gradually thereafter. Although dopamine agonists or benzodiazepines have been advocated for the treatment of residual symptoms in previous case reports, ECT was the treatment most often associated with a rapid response and no mortality, even in patients refractory to pharmacotherapy. In conclusion, catatonic and parkinsonian symptoms of NMS may persist as a residual state lasting for weeks to months after more fulminant acute symptoms abate. These residual symptoms may be more likely to develop in patients with pre-existing structural brain disorders. Although patients may improve gradually with supportive care or pharmacotherapy, ECT can often be highly effective in treating the residual catatonic state that follows NMS.

Adult↗
PubMed2000

Early pregnancy predictors of preterm birth: the role of a prolonged menstruation-conception interval.

OBJECTIVE: To study early pregnancy characteristics as possible risk factors associated with preterm birth. DESIGN: Retrospective analysis of prospectively collected maternity data. POPULATION: 21,069 singleton deliveries with record of a specified last menstrual period and a midtrimester dating scan. SETTING: Catchment area of tertiary centre serving a general maternity population. METHODS: Univariate and multivariate analysis. Variables included: maternal age; height; weight at first visit; parity; ethnic group; cigarette smoking and alcohol consumption recorded in early pregnancy; history of abortion; history of preterm birth; and discrepancy between menstrual dates and ultrasound dates. MAIN OUTCOME MEASURES: Adjusted odds ratios for factors associated with preterm birth, stratified according to parity (nulliparae vs multiparae) and gestational age (early preterm, 24-33 weeks; late preterm, 34-36 weeks; all preterm, < 37 weeks). Population attributable risk (aetiologic fraction) of the significant variables for preterm birth. RESULTS: The overall preterm (< 37 weeks) delivery rate according to scan dates was 7 x 0%. Preterm birth was associated with young (< 20 years), short (< or = 155 cm) and underweight (< or = 52 kg) mothers, non-Europeans, cigarette smokers, previous abortion or previous preterm delivery, and a prolonged menstruation-conception interval. Preterm births which followed the spontaneous onset of labour (72%) had results which were similar to the overall group, while there were too few iatrogenic preterm deliveries for separate analysis. Logistic regression showed that associations varied in different parity and gestational age groups. For nulliparae, smoking was not associated with preterm birth, but it was strongly associated with multiparous women (adjusted OR 1 x 8, 95% CI 1 x 6-2 x 1). A past history of premature delivery had the highest risk for birth before 34 weeks in the index pregnancy (adjusted OR 5 x 1, 95% CI 3 x 4-7 x 6). A discrepancy between menstrual and scan dates of greater than +7 days, suggestive of a prolonged interval between last menstruation and conception, was present in 23 x 3% of all pregnancies, and was associated with an increased risk of preterm delivery in all gestational age categories for nulliparae (adjusted OR 1 x 5, 95% CI 1 x 3-1 x 8) and multiparae (adjusted OR 1 x 9, 95% CI 1 x 6-2 x 2). Because of its high prevalence, this variable constituted a relatively high population-attributable risk for premature birth for both nulliparae (10 x 7%) and multiparae (16 x 6%). CONCLUSIONS: A discrepancy of more than +7 days between menstrual and scan dates, indicating a prolonged interval between last menstruation and conception, is a significant predictor of preterm birth. This effect is independent of other factors such as maternal age, height, weight and smoking which are also associated with prematurity. In a maternity population with ultrasound scan dates and recorded last menstrual period, this variable can be easily calculated and used as a marker for increased surveillance.

Analysis of Variance↗
PubMed1999

Over a decade of experience with a yeast recombinant hepatitis B vaccine.

Experience with the yeast recombinant hepatitis B vaccine Engerix-B now exceeds 10 years. We reviewed published studies on this vaccine. These show the vaccine to be safe, causing mostly only minor local symptoms and to be highly immunogenic both in monitored clinical trials and under field conditions. Engerix-B consistently elicits high geometric mean antibody titres and a high protective efficacy has been established in three groups at high-risk of hepatitis B infection, homosexual men, institutionalised mentally handicapped subjects and neonates of chronic carrier mothers. The profile of the recombinant hepatitis B vaccine in certain high-risk groups and immuno compromised people is discussed. Finally we present updated post marketing surveillance data based on 496 million distributed doses of vaccine.

Adolescent↗
PubMed1999

Neuregulins and ErbB receptors in cultured neonatal astrocytes.

Neuregulins (NRGs) are a family of growth factors involved in signaling between neurons and glial cells of the peripheral and central nervous system. NRGs are synthesized and secreted by a number of cell types including Schwann cells, neurons, and oligodendrocytes. NRG transduction signals are mediated by the erbB family of receptor tyrosine kinases. These NRGs may be important for paracrine or autocrine signaling during development, injury, and the normal functioning of the central nervous system. In this study, we characterize the NRGs and erbB receptors expressed by cultured neonatal rat astrocytes. Using immunoblotting protocols with pan-specific antibodies, we identified eleven NRG molecular weight isoforms from approximately 16 kDa to 105 kDa in cultured neonatal rat astrocytes. Immunocyotchemistry with isoform-specific antibodies revealed the expression of both major isoform families (NRGalpha, NRGbeta). Additionally, astrocyte-conditioned media contained two molecular weight isoforms of NRGs. We detected mRNA expression of NRGalpha and NRGbeta in astrocytes by amplifying mRNA transcripts with reverse transcription polymerase chain reaction. Furthermore, we confirm that cultured astrocytes express all four erbB receptors as detected by immunocytochemical and immunoblotting techniques. These data indicate that astrocytes contain and secrete NRGs.

Animals↗
PubMed1999

Fetal growth rate and adverse perinatal events.

OBJECTIVE: To study fetal weight gain and its association with adverse perinatal events in a serially scanned high-risk population. SUBJECTS AND METHODS: A total of 200 pregnant women considered at increased risk of uteroplacental insufficiency had a total of 1140 scans in the third trimester, with a median of six scans in each pregnancy. The average fetal growth rate was retrospectively calculated for the last 6 weeks to birth, and expressed as daily weight gain in grams per day. Adverse pregnancy outcome was defined as operative delivery for fetal distress, acidotic umbilical artery pH (< 7.15), or admission to the neonatal intensive care unit (NICU). RESULTS: Fetuses with normal outcome in this high-risk pregnancy population had an average antenatal growth rate of 24.2 g/day. Compared to pregnancies with normal outcome, the growth rate was slower in those that required operative delivery for fetal distress (20.9 g/day, p < 0.05) and those that required admission to the NICU (20.3 g/day, p < 0.05). The growth rate in pregnancies resulting in acidotic umbilical artery pH also seemed lower, but this did not reach statistical significance. CONCLUSIONS: Impaired fetal weight gain prior to birth is associated with adverse perinatal events suggestive of growth failure.

Body Weight↗
PubMed1999

Controlled trial of fundal height measurement plotted on customised antenatal growth charts.

OBJECTIVE: The purpose of this study was to evaluate the effect of a policy of standard antenatal care which included plotting fundal height measurements on customised antenatal charts in the community. DESIGN: Prospective, non-randomised, controlled, population-based study. POPULATION: Two defined and separate referral areas from community to teaching hospital, with similar delivery rates and socioeconomic characteristics. A total of 1272 consecutively booked women with singleton pregnancies and dating ultrasound scans before 22 weeks of gestation. INTERVENTION: In the study area customised fundal height charts were issued to each mother at the routine hospital booking scan, on which regular fundal height measurements were to be plotted by community midwives. The charts adjusted limits according to maternal characteristics including height, weight, parity and ethnic group. Usual management in the control area included fundal height assessment by abdominal palpation and recording on a standard co-operation card. OUTCOME MEASURES: Antenatal detection of small and large for gestational age babies; number of antenatal investigations for fetal growth in each group. RESULTS: The study group had a significantly higher antenatal detection rate of small for gestational age babies (48% vs 29%, odds ratio 2.2, 95% confidence interval 1.1-4.5) and large for gestational age babies (46% vs 24%, OR 2.6, CI 1.3-5.5). There was no increase in the study group in the overall number of scans per pregnancy done in the ultrasound department (1.2 vs 1.3, P = 0.14), but a slight decrease in repeat (two or more) third trimester scans (OR 0.8, CI 0.6-1.0, P = 0.08). Women in the study group had significantly fewer referrals for investigation in a pregnancy assessment centre (OR 0.7, CI 0.5-0.9; P = 0.01) and fewer admissions to the antenatal ward (OR 0.6, CI 0.4-0.7, P < 0.001). There were no differences in perinatal outcome. CONCLUSIONS: Serial measurement of fundal height plotted on customised charts leads to increased antenatal detection of small and large babies. This is accompanied by fewer investigations, which is likely to represent increased confidence in the community to recognise normal fetal growth. With adjustments for physiological variables, fundal height measurements appear to be a cost effective screening method which can result in substantial improvements in the antenatal assessment of fetal growth.

Adult↗