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Biomedical subjects

C J Richards

Publications and source records attributed to C J Richards.

At least 55 records · Page 3Linked to original sources
PubMed1990

Postpartum thyroid dysfunction and HLA status.

Nine-hundred-and-one women presenting in an antenatal clinic at the 60th week of pregnancy were tested for antithyroid antibodies. A group of 113 antibody-positive women and 108 antibody-negative age-matched controls were HLA typed and followed prospectively at 6-weekly intervals through pregnancy and for 12 months postpartum. Forty-five of the women developed biochemical evidence of postpartum thyroid dysfunction (PPTD) of whom 36 were antibody positive. Compared with a local control population (n = 600), and using multiplex analysis, there was a significant increase in the combinations HLA B8, DR3 and HLA A1, B8, DR3 from 22.5% to 40.0% (P less than 0.02) and from 18.6% to 35.6% (P less than 0.01) respectively in the women who developed PPTD. The well-recognized association of these haplotypes with other organ-specific autoimmune diseases provides further support for autoimmune events being implicated in the development of PPTD.

Autoantibodies↗
PubMed1990

IgG subclass distribution and relative functional affinity of thyroid microsomal antibodies in postpartum thyroiditis.

An association between the development of postpartum hypothyroidism and high levels of IgG1 subclass microsomal (M) antibodies has been reported. Using an assay designed to detect reasonable levels of all the four IgG subclasses, we found no differences in the proportion of each IgG subclass in M antibodies of patients with postpartum hyperthyroidism or hypothyroidism compared with control postpartum patients with M antibodies but no thyroid dysfunction. However the total amount of M antibody of each IgG subclass was elevated above the controls in the patients with thyroid dysfunction. The relative functional affinity of M antibodies did not differ between controls and patients with hypothyroidism but declined 5 and 10-12 months after delivery compared to values at 2 months. These results do not support the suggestion that the amount of IgG1 subclass M antibodies particularly determines the course of postpartum thyroiditis. Rather, the total M antibody level, in all four subclasses, is associated with clinical outcome. Resolution of the disease, despite persisting M antibodies, may occur in part because the relative functional affinity of these antibodies declines after delivery.

Antibody Affinity↗
PubMed1990

Basement membrane continuity in benign, premalignant and malignant epithelial conditions of the uterine cervix.

The pattern of basement membrane deposition in the uterine ectocervix was assessed in benign, premalignant and malignant conditions, using an indirect immunoperoxidase technique to detect laminin, an intrinsic basement membrane component. A semi-quantitative approach was used to assess the frequency of small breaks in the basement membrane. The cervical squamous epithelium in benign epithelial conditions has an almost completely continuous basement membrane, but the development of viral atypia or cervical intraepithelial neoplasia (CIN) is associated with the appearance of small basement membrane breaks. There is a correlation between increasingly severe CIN and increasing numbers of breaks, and there is a concurrent increase in the numbers of subepithelial inflammatory cells. The development of invasive neoplasm is associated with a sudden change to a fragmented pattern of basement membrane deposition, a finding which is of potential diagnostic use.

Basement Membrane↗
PubMed1990

Post-partum thyroiditis can be painful.

A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.

Adult↗
PubMed1989

Who are borderline patients?

"Borderline" is a term used with increasing frequency to describe certain difficult patients. It refers to a heterogeneous population of patients who tend to get involved in impaired doctor-patient relationships. Different areas of psychiatry have their own, often conflicting definitions of these disorders. Early trauma, neglect and genetic diatheses to axis I disorders commonly occur in the backgrounds of these patients. Most have a combination of factors. With the multiple different definitions and the potential for misuse of the term, it should be used with caution and with an understanding of what definition is being used. Treatment and prognostic implications need to be individualized.

Borderline Personality Disorder↗
PubMed1988

Postpartum thyroid dysfunction in Mid Glamorgan.

A high prevalence of postpartum thyroid dysfunction has been reported in several countries, but there have been no systematic studies of its prevalence in Britain. Among a group of 901 consecutive, unselected pregnant women thyroid autoantibodies were detected in 117 (13%) at booking. The clinical course of postpartum thyroid dysfunction, factors associated with its development, and its likely prevalence were defined in 100 of these women with thyroid antibodies and 120 women with no such antibodies who were matched for age. None of the women had a history of autoimmune thyroid disease. Normal reference ranges for thyroid function during pregnancy and post partum were established in the 120 women negative for thyroid antibodies. On the basis of these observations postpartum thyroid dysfunction was observed in 49 (22%) of the 220 women studied, and the prevalence in the total group of 901 women was estimated to be 16.7%. Thyroid dysfunction, mainly occurring in the first six months post partum, was usually transient and included both destruction induced hyperthyroidism and hypothyroidism. The development of the syndrome was significantly related to smoking more than 20 cigarettes a day and the presence of thyroid microsomal autoantibodies at booking. Of the 16 women with a family history of thyroid disease in whom thyroid microsomal autoantibody activity was detectable at booking, 11 developed thyroid dysfunction. Age, parity, presence of goitre at presentation, duration of breast feeding, and the sex and birth weight of the infant were not associated with the development of postpartum thyroid dysfunction. The mood changes experienced by women post partum may in part be associated with altered thyroid function during this time.

Adult↗
PubMed1988

Comparison of magnetic resonance imaging and ultrasound in evaluating follicular and endometrial development throughout the normal cycle.

A prospective study was undertaken to evaluate and compare magnetic resonance imaging (MRI) and ultrasound (U/S) in monitoring follicular and endometrial development during the normal menstrual cycle. Results of MRI, U/S, estradiol (E2), and progesterone were obtained from five ovulatory volunteers on days 4, 8, 12, 16, 20, and 24 of the cycle. On U/S, all the women had only one dominant follicle, whereas MRI was able to detect a secondary cohort of follicles in three of five volunteers. Endometrial development on U/S and MRI showed similar patterns of growth with an increase on MRI from 5.8 +/- 1.1 mm on day 4 to a mean peak of 10.3 +/- 1.7 mm on day 24. A distinct feature of MRI was the demonstration of a junctional zone (JZ), which has a pattern of growth that resembles that of the endometrium, with accelerated growth from day 8 to day 16 (5.1 +/- .7 mm to 6.7 +/- .7 mm). The JZ corresponds anatomically to the distribution of the arcuate vessels and may therefore represent changes in blood supply to the endometrium. MRI, similar to U/S, is noninvasive and does not involve any radiation exposure but provides new information on uterine changes in the normal cycle. At present, its clinical applications are limited.

Adult↗
PubMed1983

Growth, metabolic response, and development in very-low-birth-weight infants fed banked human milk or enriched formula. I. Neonatal findings.

Banked human milk has been widely used, although its composition and nutritional adequacy for preterm infants are uncertain. We randomized 76 healthy infants of less than or equal to 1500 gm birth weight to ad lib feedings of frozen BHM or a protein-mineral-calorie-enriched formula (Similac Special Care) designed to sustain intrauterine accretion rates; BHM contained 2.2 gm fat/100 ml and 60 kcal/100 ml (gross energy). Infants fed BHM ingested more milk (197 vs 165 ml/kg/day) but less gross energy (118 vs 143 kcal/kg/day); grew less rapidly in weight (15 vs 30 gm/day), length (0.7 vs 1.1 cm/wk), and head circumference (0.8 vs 1.2 cm/wk); and were discharged at a lower weight (2200 vs 2348 gm) and older age (61 vs 47 day) than infants fed formula (P less than 0.02). At 37 weeks' postmenstrual age, infants fed BHM were less responsive to Brazelton inanimate stimuli (mean total score 5.0 vs 7.5; P less than 0.02). With few exceptions, blood amino acids, pH, and serum electrolyte values were similar in both groups. The different caloric intake of our feeding groups may explain only part of the large difference in growth rate. Donor milk should not be fed to preterm infants unless it has been analyzed and the feedings shown to provide a nutrient intake considered appropriate to the needs of these infants.

Body Weight↗
PubMed1983

Bladder training--3 years on.

Fifty-six patients with the "urge syndrome" were reviewed between 1 and 5 years after in-patient treatment by bladder training. There was an overall initial cure/improvement rate of 85%. The best long-term results were obtained in those with objectively stable bladders before treatment. Forty-three per cent of patients with reduced detrusor compliance and idiopathic instability relapsed after initial improvement. Those with primary instability or with associated degenerative disease responded poorly to treatment.

Adolescent↗
PubMed1982

Factors associated with urinary incontinence in women.

Possible aetiological factors for urinary incontinence were examined in a prevalence study among a random sample of 1000 women aged 18 and over. Infective factors were not markedly associated with incontinence but mechanical factors such as parity and obesity were. No association was found, however, between a history of perineal damage at childbirth and incontinence. Women with incontinence had on average a higher score for a 'neuroticism' trait elicited by questionnaire than women without the disorder.

Adolescent↗
PubMed1981

The prevalence and severity of urinary incontinence in women.

One thousand and sixty women aged 18 or over, randomly selected from a defined geographical area in South Wales, were interviewed at home about their urinary symptoms. Ninety-five per cent co-operated, of whom 45% admitted to some degree of incontinence. "Stress' incontinence was reported by 22% of women, "urge' incontinence by 10%, and both types combined--"complex'--by 14%. In most women urinary loss was both small and infrequent but 5% of all women experienced a loss sufficient to necessitate a change of clothes; in 2.6% such loss occurred daily. Over 3% of all women reported that incontinence interfered with their social or domestic life but only half of these had sought medical advice.

Adolescent↗
PubMed1979

Fetal breathing movements and fetal distress.

Twenty-seven pregnancies were monitored by antenatal cardiotocographs, daily fetal movement counts and an assessment of fetal breathing activity by real time scanning, and the results of these tests were related to the development of fetal distress during the first stage of labour. The proportion of time during which fetal breathing movements were present, determined over only a short period of time, was found to be a useful predictor of fetal behaviour during a labour.

Female↗
PubMed1979

Bicarbonate hemodialysis using a sorbent regenerative system.

In light of the concern about the use of acetate in dialyzate a simplified means of performing acetate-free hemodialysis has been developed using the sorbent regenerative system (RED). Fifteen sorbent bicarbonate hemodialyses free of acetate were performed on two patients for 4 or 6 hours. The initial dialyzate mixture contained 135 mEq/l NaHCO3 only. The infusate cations of K, Ca and Mg were in the form of chloride salts. A 30-minute titration of the sorbent cartridge with the bicarbonate dialyzate was necessary to release the excessive hydrogen ion from the cartridge which allowed the dialyzate bicarbonate to stabilize. The dialyzate Na fell during titration but rose during dialysis. The dialyzate Cl rose throughout titration and dialyses. The plasma bicarbonate rose significantly by the end of 4 and 6 hour dialyses. The blood pO2 and pCO2 did not change during dialysis and a significant rise in blood pH resulted. We conclude that bicarbonate dialysis is feasible and relatively easily accomplished in the sorbent system.

Bicarbonates↗
PubMed1979

Inadequate removal of methanol and formate using the sorbent based regeneration hemodialysis delivery system.

The sorbent based hemodialysis delivery system was shown to be ineffective for the treatment of methanol intoxication. Clinical and in vitro studies showed rapid saturation of the sorbent cartridge for methanol and formate adsorption. Methanol and formate clearances were four fold less than achieved with the recirculating single pass delivery system. The sorbent delivery system should not be used for methanol intoxication.

Formates↗