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Biomedical subjects

A Palmer

Publications and source records attributed to A Palmer.

At least 109 records · Page 6Linked to original sources
PubMed1992

Early teenage pregnancies in Hull.

OBJECTIVES: To determine the pattern, obstetric outcome and factors that predispose to pregnancies in young teenagers in Hull. DESIGN: Retrospective study of case records of pregnancies from 1977 to 1988 in girls aged 16 years or less and in a control group of nulliparous women aged 20-24 years. SETTING: Hull health district hospitals. SUBJECTS: 1,660 pregnant teenagers and 3,576 nulliparas aged 20-24 years. MAIN OUTCOME MEASURES: Ages at pregnancy, number of pregnancies per year, gestational age at booking and delivery, antenatal complications, mode of delivery, utilization of contraceptives and some social factors. RESULTS: Of the 1,660 pregnancies in the young adolescents, 59-6% were terminations. The youngest girl was 11. The average annual incidence of early teenage pregnancies was 10.5 per 1,000 girls aged 10-16 compared to 6.4 per 1,000 in England and Wales. Physical characteristics and pattern of antenatal care were similar in the study and control groups. Anaemia was 2.53 times as common in teenagers (95% CI 2.19-2.9; P < 0.0001) while hypertension alone was 1.7 times as frequent (95% CI 1.28-2.4; P = 0.002). Pre-eclampsia and proteinuric disorders were similar in the two groups. Apart from prolonged pregnancy, which was significantly less common in the index group, other gestational ages at delivery and birthweights were the same in both groups. The caesarean section rate in the index group was 0.56 times that in the control group (95% CI 0.4-0.75; P < 0.0001) but forceps deliveries were 2.37 times as common in the index group (95% CI 1.80-3.12; P < 0.0001). The uncorrected perinatal mortality rates were 13.6/1000 and 15.7/1000 in the index and control groups respectively. CONCLUSION: Early teenage pregnancies are common in Hull and, contrary to previous reports, are physically well tolerated by the early adolescents who book early and attend antenatal clinics regularly. Ineffective utilization and ignorance of contraceptive methods are contributory factors. We recommend that emphasis should be placed on providing contraceptive services for teenagers and adopting a more purposeful and holistic approach to sex education.

Abortion, Legal↗
PubMed1992

Electron microscopic localization of the multicatalytic proteinase complex in rat liver and in cultured cells.

The multicatalytic proteinase (MCP) prosome or proteasome is a large multifunctional complex which is believed to play a major role in non-lysosomal pathways of intracellular protein degradation and has recently been implicated in antigen processing. In this study, affinity-purified antibodies against rat liver MCP were used to investigate the localization of the proteinase both in rat liver and in growing human L-132 cells in culture, using electron microscopic immunogold techniques. Quantitation of the MCP in different subcellular localizations by morphometric analysis of electron micrographs showed the proportion in the nucleus to be 17% for hepatocytes and 51% for L-132 cells, demonstrating differences in the distribution of MCP in different cell types. In hepatocytes, 14% of the total MCP was found associated with the endoplasmic reticulum. The remainder was localized in the cytoplasmic matrix. Immunofluorescence studies with L-132 cells also showed a reaction in nuclei and cytoplasm. The localization of MCP is consistent with its proposed multiple functions in protein turnover, in the production of peptides for antigen presentation, and in RNA processing.

Animals↗
PubMed1992

The efferent cardiac lymphatic pathways in the macaque monkey.

In ten postmortem hearts of the Macaque monkey (M. mulatta), the coronary lymphatics were visualized using an India ink suspension in 2% gelatin. The left coronary lymphatic initially passed to the dorsal surface of the aortic arch. In five hearts, this lymphatic went directly to the cardiac lymph node, whereas in the others, it first ascended to the left superior tracheobronchial node and then interconnected with the cardiac lymph node. The right coronary lymphatic usually passed in front of the ascending aorta and common arterial (brachiocephalic) trunk and entered the cardiac lymph node. In two hearts, however, the right coronary lymphatic first ascended to an anterior transverse mediastinal node and from here lymphatics joined the cardiac lymph node. Those lymphatics that passed cephalad from the cardiac lymph node to the right anterior mediastinal nodes and the right paratracheal nodes ultimately emptied into the right venous angle. Those lymphatics that passed cephalad from the cardiac lymph node to the anterior transverse mediastinal nodes ultimately emptied into the left venous angle. In five other Macaque monkeys (M. mulatta and M. fascicularis) after marker injection (T1824 blue dye and micropulverized barium sulfate) into the living heart or pericardium, lymphatic drainage beyond the base of the heart could not be demonstrated. Whereas postmortem morphologic studies suggest that the monkey coronary lymphatic system is amenable to obstruction by removal of the cardiac lymph node and interruption of its adjacent lymphatic connections, effective methods for visualizing the mediastinal lymphatic collecting system in the living monkey must be developed before experimental cardiac lymphatic ablation can be accomplished in this species.

Animals↗
PubMed1991

Treatment of rapidly progressive glomerulonephritis by extracorporeal immunoadsorption, prednisolone and cyclophosphamide.

Ten patients with rapidly progressive glomerulonephritis and acute renal failure were treated with extracorporeal immunoadsorption, prednisolone, and cyclophosphamide. Three patients had systemic lupus erythematosus, five had microscopic polyarteritis and two had Wegener's granulomatosis. All ten patients were dialysis-dependent prior to immunoadsorption. Nine of ten patients rapidly regained renal function and seven continue to have independent renal function between 9 and 30 months after immunoadsorption. Three patients at presentation were not dialysis dependent. Despite treatment with methylprednisolone, cyclophosphamide, and oral prednisolone, renal function continued to deteriorate and they required dialysis. Immunoadsorption was then started without alteration in baseline immunosuppression. Within a mean of 4.6 days, range 3-7 days, renal function improved and the patients no longer required dialysis. Antineutrophil cytoplasmic antibodies and double-stranded DNA antibodies were rapidly removed by immunoadsorption. Only one patient with systemic lupus erythematosus and two with microscopic polyarteritis had significant resynthesis of antibody at 1 month post-immunoadsorption. Renal biopsy before and after immunoadsorption and immunosuppressive therapy showed resolution of glomerular crescents and no evidence of active disease. Immunoadsorption coupled with prednisolone and cyclophosphamide may be of value in the treatment of rapidly progressive glomerulonephritis.

Adult↗
PubMed1991

Compression therapy of limb edema using hydrostatic pressure of mercury.

A new apparatus for the treatment of edema of the extremities is described. The extremity is placed in a cylindrical vertical tank and isolated by a circumferential synthetic rubber membrane. The equipment is programmed to create a mold of the extremity using a slurry of plastic granules from a reservoir. Mercury is then pumped between the mold and the extremity, thereby exerting a pressure gradient on the extremity equal to the hydrostatic pressure of the mercury column. A computerized program forms the mold and runs several compression cycles for each treatment session. Twelve patients were treated (8 upper extremities, 4 lower extremities) on a weekly or semiweekly basis. Progress was followed with computed axial tomography scans, as well as measurements and photographs. Ten patients experienced significant immediate decrease in edema with each treatment. Wrapping or elastic support was required to prevent the return of edema between treatments. No pain, skin injury, or other complication of treatment was noted. The apparatus can safely provide short-term, immediate, significant improvement of extremity edema. Further studies will be necessary to determine long-term benefit.

Bandages↗
PubMed1991

[A comparison of the effects of verapamil and nifedipine on the quality of life].

Aspects of quality of life (symptoms, psychological well-being and activity) were evaluated by self-administered questionnaires in a 4 months randomized double-blind trial of titrated doses of verapamil slow release (n = 41) compared with nifedipine retard (n = 40). An untreated diastolic blood pressure of 95 to 115 mm Hg was required for inclusion in the trial. The mean age in both groups was 55 years. A significant difference between the two drugs was found in the average reporting of symptoms with an increase on nifedipine (p less than 0.01). The reporting of swollen ankles and flushing (p less than 0.05) increased on nifedipine, and nocturia (p less than 0.05) increased on verapamil. Measures of psychiatric morbidity tended to improve on verapamil and deteriorate on nifedipine. Only the change in cognitive function was significant between the drugs, being worse on nifedipine (p = 0.05). There was no difference between the two groups in the fall in diastolic blood pressure (average 18 mm Hg on nifedipine and 17 mm Hg on verapamil). There was a significantly greater fall in systolic blood pressure on nifedipine (23 mm Hg) compared with verapamil (13 mm Hg) (p less than 0.01). The two drugs differed in their effects on measures of quality of life. The improvements in symptomatic complaints and psychological well-being on verapamil may have been due to inclusion in a trial, although we cannot exclude the possibility of a drug effect. Conversely the increase in symptoms and self-assessed cognitive impairment on nifedipine were considered to be side-effects of the drug.

Adult↗
PubMed1990

A comparison of verapamil and nifedipine on quality of life.

1. Aspects of quality of life (symptoms, psychological well-being and activity) were evaluated by self-administered questionnaires in a 4 month randomised double-blind trial of titrated doses of verapamil slow release (n = 41) compared with nifedipine retard (n = 40). An untreated diastolic blood pressure of 95-115 mm Hg was required for inclusion in the trial. 2. The mean age in both groups was 55 years. A significant difference between the two drugs was found in the average reporting of symptoms with an increase on nifedipine (P less than 0.01). The reporting of swollen ankles and flushing (P less than 0.05) increased on nifedipine, and nocturia (P less than 0.05) increased on verapamil. Measures of psychiatric morbidity tended to improve on verapamil and deteriorate on nifedipine. Only the change in cognitive function was significant between the drugs, being worse on nifedipine (P = 0.05). 3. There was no difference between the two groups in the fall in diastolic blood pressure (average 18 mm Hg on nifedipine and 17 mm Hg on verapamil). There was a significantly greater fall in systolic blood pressure on nifedipine (23 mm Hg) compared with verapamil (13 mm Hg) (P less than 0.01). 4. The two drugs differed in their effects on measures of quality of life. The improvements in symptomatic complaints and psychological well-being on verapamil may have been due to inclusion in a trial, although we cannot exclude the possibility of a drug effect. Conversely the increase in symptoms and self-assessed cognitive impairment on nifedipine were considered to be side-effects of the drug.

Adult↗
PubMed1989

Effect of graft perfusion with two CD45 monoclonal antibodies on incidence of kidney allograft rejection.

In a blind trial, 77 patients were randomised to receive first cadaver kidney allografts that had been perfused either with a pair of CD45 monoclonal antibodies (mAbs), in an attempt to reduce the immunogenicity of passenger leucocytes, or with control human albumin solution. No complications of mAb perfusion were observed. Patient and allograft survival were similar in both groups. Rejection episodes were recorded in 7 (18%) of the patient with mAb perfused allografts compared with 24 (63%) of the controls.

Animals↗
PubMed1989

Removal of anti-HLA antibodies by extracorporeal immunoadsorption to enable renal transplantation.

10 highly and persistently sensitised patients awaiting renal transplantation underwent extracorporeal immunoadsorption to remove anti-HLA antibodies. 7 patients have since received transplants. Only 1 allograft has been lost because of rejection, and there have been no serious side-effects attributable to treatment. Extracorporeal immunoadsorption may therefore be of considerable value in the management of highly sensitised patients.

Adult↗
PubMed1989

The visual field in chronic simple glaucoma and ocular hypertension; its character, progress, relationship to the level of intraocular pressure and response to treatment.

Nine hundred and twenty-nine patients with chronic simple glaucoma or ocular hypertension were followed for one to thirteen years using the King's College Hospital glaucoma data base. The 30 degree visual field was divided into twelve clinical zones. The field sensitivity and its change as measured by the mean differential threshold both in these zones and overall was followed to determine the pattern and progress of field loss in eyes diagnosed initially as chronic simple glaucoma or ocular hypertension. The findings were related to other similar analyses in which the mean differential threshold in chronic glaucoma was found to correlate significantly with the initial intraocular pressure and its progress with the mean follow-up intraocular pressure under treatment. Inferences were drawn regarding the nature of chronic simple glaucoma and ocular hypertension and their management.

Adult↗
PubMed1989

Low-dose oral sotalol for monomorphic ventricular tachycardia: effects during programmed electrical stimulation and follow-up.

The effects of oral sotalol were compared with the findings obtained in the baseline study of a group of 26 consecutive patients with sustained monomorphic ventricular tachycardia or ventricular fibrillation and inducible ventricular tachycardia. The mean age was 62 years and the mean ejection fraction 33%. The number of non-inducible patients after sotalol administration (mean dose of 251 +/- 81 mg day-1) was 13 out of 21 (62%). The cycle length of the induced tachycardia changed from 293 +/- 32 to 303 +/- 41 ms (non-significant (NS]. The coupling interval of the first extrastimulus did not lengthen for the subgroup with persistent inducibility. The number of patients requiring defibrillation during the induction study did not decrease on (2/8) or off drugs (6/22). After the first administration of oral sotalol, two patients developed polymorphic ventricular tachycardia or torsade de pointes and one suffered from left ventricular failure. Long-term treatment with sotalol was given to 15 non-inducible patients, and two inducible patients, combined with an AICD or a pacemaker. Over a mean follow-up period of 13 months, three recurrences were observed in these 17 patients, including the patient with the AICD. This represents an efficacy of 82% for patients chronically treated with a low dose of oral sotalol.

Administration, Oral↗