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Biomedical subjects

A McNulty

Publications and source records attributed to A McNulty.

At least 19 recordsLinked to original sources
PubMed2001

Characteristics of homosexually-active men with gonorrhoea during an epidemic in Sydney, Australia.

Our objective was to investigate an epidemic of gonorrhoea among homosexually-active men in Sydney. Demographic and behavioural data on all homosexually-active men diagnosed with gonorrhoea (any site) at the Sydney Sexual Health Centre (SSHC) from 1992 through 1998 were reviewed. The men diagnosed with anal gonorrhoea were then compared with all homosexually-active men who tested negative for anal gonorrhoea or who were not tested for anal gonorrhoea at the SSHC between 1996 and 1998. Data on HIV status and country of birth of men diagnosed with anal gonorrhoea during 1998 at the Taylor Square Private Clinic were also reviewed. Over the period 1992 to 1998, homosexually-active men diagnosed with gonorrhoea at SSHC tended to become older at the time of diagnosis (median age 26.5 years in 1992 up to 31.0 years in 1998), indicating a cohort effect in the clinic population due to service reductions. When compared with men who tested negative for anal gonorrhoea at SSHC between 1996 and 1998, those with anal gonorrhoea were more likely to have anogenital symptoms (adjusted odds ratio [OR] 2.3), to have had a past history of gonorrhoea (OR 3.1), to present as a contact of gonorrhoea (OR 8.6), to have used condoms less consistently (OR 2.3), to be HIV positive or of unknown HIV status (OR 3.2), and to have been born in an English-speaking country other than Australia (OR 2.9). The last feature was not observed at the private clinic. In conclusion, the gonorrhoea epidemic was linked to public health service reductions, though it seems unlikely to be the only factor. Homosexually-active men with anal gonorrhoea had well established behavioural risk factors while men with concurrent HIV infection were over-represented. Given the role of gonorrhoea in promoting the spread of HIV infection, a National Sexual Health Strategy--closely linked to the National HIV/AIDS Strategy--is due.

Adolescent↗
PubMed1997

Incidence of HIV infection in a cohort of homosexually active men.

The purpose of this study was to estimate the incidence of human immunodeficiency virus (HIV) in a cohort of homosexually active men in Sydney. In 1984-85 the Sydney AIDS Prospective Study enrolled homosexually active men, who were followed by six-monthly visits, although regular contact with most participants ceased in the early 1990s. In 1993-94 a major effort was made to establish the HIV status of all participants who had attended more than once. Of the 1075 men enrolled, 528 (49 per cent) were negative at enrollment and had at least one further documented HIV test. The annual incidence rate of HIV infection was highest in the early years of the study, 1984 (9.6 per cent) and 1986 (5.0 per cent), and remained low from 1987 (1.9 per cent) to 1994 (0.0 per cent). The incidence of HIV infection was higher among men aged under 34 years at enrollment and men who reported more than four sexual partners in the six months before enrollment, but these associations disappeared by 1987. The decrease in HIV incidence is consistent with findings from other cohorts followed for this length of time.

Adolescent↗
PubMed1997

Herpes zoster and the stage and prognosis of HIV-1 infection.

OBJECTIVES: To examine the incidence of herpes zoster in HIV-1 infection. To assess the prognostic significance of the occurrence of herpes zoster and progression to AIDS or death DESIGN AND METHODS: 146 homosexually active men with known times of HIV-1 seroconversion were identified through the Sydney AIDS Prospective Study and the clinic records of a private medical practice with large caseload of HIV infected homosexual men. Medical records were reviewed for a history of herpes zoster, CD4+ lymphocyte counts, and HIV-1 disease status. Cox's proportional hazards model was used to determine whether herpes zoster predicted progression to AIDS or death. RESULTS: After a mean follow up of 54 months, 30 men (20%) had an episode of herpes zoster and three of these men had one recurrence. The overall incidence of herpes zoster was 44.4 episodes per 1000 person years (95% CI 30.0-63.5). Herpes zoster was not found to be a marker of deteriorating immune functions as measured by CD4+ lymphocyte counts. CD4+ counts did not differ significantly between those with and without zoster at 1 year (551 v 572.10(6)/1, p = 0.79), 2 years (451 v 557, p = 0.11), and 3 years (424 v 481, p = 0.50) following HIV-1 seroconversion. There was no statistically significant difference in progression to AIDS (RR = 1.89, 95% CI 0.80-4.46, p = 0.15) or death (RR = 0.90, 95% CI 0.31-2.65, p = 0.85) from HIV-1 sero-conversion in those who did and those who did not develop herpes zoster. CONCLUSION: The incidence of herpes zoster was consistent with the findings of other studies. There was no association between the occurrence of herpes zoster and progression of HIV-1 disease.

AIDS-Related Opportunistic Infections↗
PubMed1996

Lack of consistency between five definitions of nonprogression in cohorts of HIV-infected seroconverters.

OBJECTIVE: To identify appropriate criteria for characterizing HIV-infected nonprogressors. DESIGN: Five definitions were compared as follows: (1) last CD4 count > 500 x 10(6)/l; (2) two most recent CD4 counts > 500 x 10(6)/l; (3) calculated CD4 count based on linear regression > 500 x 10(6)/l; (4) CD4 slope > or = 0 with no antiretroviral use; (5) all CD4 counts > 500 x 10(6)/l, decline in CD4 slope < 5 cells per year, no antiretroviral use. PARTICIPANTS: Five prospective cohorts of homosexual men with documented dates of HIV-1 seroconversion. MAIN OUTCOME MEASURES: Proportions of nonprogressors were calculated 7, 8, 9 and 10 years following seroconversion (n = 285). Definitions were evaluated with respect to consistency over time and across sites. Subjects lacking CD4 counts within 3 years preceding end of follow-up were excluded. RESULTS: Across sites, proportions of nonprogressors ranged from 1% (definition 5) to 17.5% (definition 1) 10 years after seroconversion. Definitions based on absolute CD4 counts (definitions 1-3) had higher proportions and were less consistent than those based on stable slopes (definitions 4 and 5). For each definition, proportions decreased as follow-up increased, but were most stable for definition 4 (3%). Site differences decreased as follow-up increased, but remained nearly threefold for definitions 1-3. None of the definitions classified the same subjects as nonprogressors at any timepoint. CONCLUSIONS: Observations regarding nonprogression are highly dependent on the definition and the duration of follow-up. Our findings highlight methodological challenges which will need to be overcome in natural history studies of nonprogression.

CD4-Positive T-Lymphocytes↗
PubMed1994

Fertility considerations in nerve-sparing retroperitoneal lymph-node dissection.

Nerve-sparing retroperitoneal lymph-node dissection (RPLND) maintains the patient's ability to ejaculate postoperatively. However, since testicular cancer patients sometimes have diminished spermatogenesis, questions have been raised as to the advisability of nerve preservation relative to ultimate fertility. Fertility status was assessed in clinical stage A patients by two methods. These included standard semen analysis and a post-RPLND survey. The results show that approximately 75% of non-seminomatous testicular cancer patients who present in clinical stage A have fertility potential as based on semen analysis. Additionally, of those patients responding to the post-RPLND survey who had attempted pregnancy following RPLND, 76% reported attainment of pregnancy. Nerve-sparing RPLND maintains fertility potential in clinical stage I patients; furthermore, this fertility potential appears to be worth preserving as many patients will be capable of impregnating their partners.

Ejaculation↗
PubMed1994

The fertility of patients with clinical stage I testis cancer managed by nerve sparing retroperitoneal lymph node dissection.

Nerve sparing retroperitoneal lymph node dissection reliably preserves emission and ejaculation in patients with clinical stage I nonseminoma. The fertility of 51 patients who underwent nerve sparing retroperitoneal lymph node dissection was assessed by 3 different methods: standard semen analysis, analysis of chromatin content by deoxyribonucleic acid histogram and assessment of ultimate fertility status by a questionnaire. Approximately 75% of these patients have semen analyses generally considered to be in the normal range. Virtually all patients who underwent deoxyribonucleic acid histogram analysis had histograms similar to controls. A retrospective analysis of fertility was performed in 201 patients who had previously undergone nerve sparing retroperitoneal lymph node dissection. Of these patients who attempted pregnancy after nerve sparing retroperitoneal lymph node dissection 76% have been successful. Approximately 75% of patients who present with clinical stage I nonseminoma are potentially fertile. Nerve sparing retroperitoneal lymph node dissection is capable of preserving this potential in allowing these patients to father children.

Female↗
PubMed1993

Urethral discharge in men.

Urethral discharge in men is usually associated with sexually transmitted disease. The authors present an overview of likely organisms involved, their clinical course and most appropriate treatment.

Humans↗
PubMed1991

Detection of antisperm-antibodies in patients with primary testicular cancer.

Serum antisperm-antibodies have been noted to develop as a result of various types of testicular pathology and injury. Their presence sometimes correlates with impaired fertility. We examined 52 patients with non-seminomatous low-stage testicular cancer for the presence of serum antisperm-antibodies to determine whether or not auto-immunity is a factor in the depressed fertility known to exist in these patients. Twenty-one per cent were discovered to have serum antisperm-antibodies using an immunofluorescent technique.

Autoantibodies↗
PubMed1990

Unstable angina or non-Q wave infarction despite long-term aspirin: response to thrombolytic therapy with implications on mechanisms.

The pathophysiology and optimal therapy of patients who develop unstable angina in spite of long-term aspirin intake ("aspirin failure") have not been well defined. As part of a prospective study of thrombolytic therapy, 19 consecutive patients were identified who were admitted with unstable angina despite long-term aspirin therapy, and they were compared with 12 patients with unstable angina without previous aspirin use. Both groups received urokinase (3.0 million units over 30 minutes intravenously), maximal antianginal therapy, and intravenous heparin. Fibrinolytic system effects were characterized with serial measurements of fibrinogen, d-dimer, and fibrinogen degradation products (FDPs) at baseline and over the 24 hours following therapy. In comparison with those without previous aspirin use, the aspirin failure patients demonstrated greater d-dimer production after treatment at all points, the values becoming highly significant at 24 hours (1337 +/- 671 versus 709 +/- 620 ng/dl, p less than 0.02), as well as significantly greater FDPs at all points in the first 24 hours after treatment. Post-treatment arteriography (at 24 to 72 hours) indicated more extensive coronary artery disease in the aspirin failure patients (2.56 +/- 8.3 versus 1.63 +/- 1.06 vessels with greater than 50% stenosis, p less than 0.01) and more severe stenoses of the culprit artery (92.7 +/- 22.9% versus 77.3 +/- 36.9% diameter reduction, p = 0.09). By 7 days, both groups had equally low rates of new ischemic events or infarction (3 of 12 for no aspirin versus 4 of 19 for aspirin failure patients). Despite more extensive underlying coronary disease, unstable angina after long-term aspirin therapy appears to respond equally well to thrombolytic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Superiority of warfarin over aspirin long term after thrombolytic therapy for acute myocardial infarction.

Results of recent clinical trials have unequivocally established the value of intravenous thrombolytic therapy in enhancing survival after acute myocardial infarction. However, the optimum long-term antithrombolytic strategy for prevention of recurrent cardiac complications after thrombolysis is unknown at the current time. To determine whether aspirin or warfarin best prevents postdischarge recurrent cardiac events (unstable angina, reinfarction, pulmonary edema, or/and death), we analyzed the long-term course of 203 patients at our institution who received intravenous thrombolytic therapy (streptokinase, tissue plasminogen activator, or urokinase) for acute myocardial infarction. Of these, 129 (64%) survived to hospital discharge without revascularization--92 patients (71%) received aspirin (325 mg/day). whereas 37 (29%) received warfarin. The choice of drug was made by the treating physician. By a mean of 2.5 years of follow-up, 34 of 92 patients receiving aspirin (37%) versus 6 or 37 receiving warfarin (16%) (p less than or equal to 0.02) had unstable angina, reinfarction, pulmonary edema, and/or death. No life-threatening hemorrhage occurred in either group. Warfarin appears to be superior to aspirin long term in patients with postlysis myocardial infarction for the prevention of recurrent cardiac complications.

Aspirin↗
PubMed1989

Urokinase plus heparin versus aspirin in unstable angina and non-Q-wave myocardial infarction.

The pivotal role of thrombosis in unstable angina and non-Q-wave myocardial infarction has been established recently. To assess the value and safety of thrombolytic therapy compared to conventional antithrombotic therapy (aspirin) in arresting progression in this setting to recurrent ischemic end-points, 25 patients presenting with unstable angina and an electrocardiogram showing subendocardial ischemia were randomized to receive either aspirin 325 mg daily, or urokinase 3 x 10(6) U intravenously, over 30 minutes followed by heparin. Incidence of endpoints (intractable ischemia requiring mechanical intervention, new myocardial infarction or death) was determined over 7 days. Coronary arteriography was performed at 24 to 72 hours to determine extent of coronary artery disease and morphologic severity of the culprit lesion, graded by a semiquantitative scoring system ranging from 4+ (definite thrombosis) to 0 (chronic lesion). In the first 24 hours, 7 of 13 aspirin versus 1 of 12 urokinase patients exhibited ischemia progression (p less than 0.05). By 7 days, progression to a primary ischemic endpoint occurred in 8 of 13 aspirin patients (3 myocardial infarctions and 5 intractable ischemias) versus 3 of 12 urokinase patients (2 intractable ischemias and 1 death) (p = 0.18). The apparent benefit of urokinase followed by heparin compared to conventional aspirin therapy in arresting early progression of unstable angina or non-Q-wave myocardial infarction was not associated with enhanced culprit lesion morphology (mean lesion severity score 2.7 +/- 1.5 vs 2.8 +/- 1.6 in aspirin-treated patients). Large scale, randomized trials to assess the clinical utility of urokinase for unstable angina are warranted.

Angina Pectoris↗
PubMed1989

Constant pressure perfusion: a method to determine obstruction in the upper urinary tract.

In an effort to define a more physiological method to determine obstruction in the upper urinary tract, the technique of constant pressure perfusion was studied in the canine and porcine models. In contrast to the constant flow technique of Whitaker, constant pressure perfusion is independent of upper tract compliance, uses low fixed pressures (7 to 12 cm. water) in the renal pelvis and measures flow rates from the upper tracts. In the canine and porcine models constant pressure perfusion demonstrated increased sensitivity and better discrimination between normal and partially obstructed systems relative to constant flow. Pressures in nonobstructed canine and porcine renal pelves are normally low (less than 8 cm. water) for flow rates into the bladder of 1 to 5 cc per minute. When using constant pressure perfusion in systems with partial distal ureteral obstruction, low or no flow is appreciated across the obstruction at renal pelvic pressures of 7 to 12 cm. water. By constant flow obstruction is defined in the same systems but only after renal pelvic pressures exceed 15 to 20 cm. water. We believe that there is clear clinical applicability.

Animals↗
PubMed1989

Creation of a transverse colon--gastric composite reservoir: a new technique.

All existing continent urinary reservoirs utilize cecum and/or varying lengths of ileum. In patients who have received prior pelvic radiation therapy, continent diversion has not been feasible because those segments of bowel lie within the field of irradiation. We describe a new technique of continent diversion utilizing only bowel outside the field of pelvic irradiation. A urinary reservoir is constructed from reconfigured transverse colon. A tubularized segment of stomach is implanted beneath the taenia of the reservoir to provide a continent, catheterizable stoma. We describe this technique in detail and report our results in five dogs followed for a mean of 59 days.

Animals↗