PubMed Health⌕ Search

Biomedical subjects

D R Phillips

Publications and source records attributed to D R Phillips.

At least 73 records · Page 4Linked to original sources
PubMed1997

Laparoscopic management of pelvic pathology during pregnancy.

Advanced operative laparoscopy is being performed increasingly for various indications and in diverse patient populations, including gravid women. In the United States approximately 1.6% to 2.2% of pregnant women require nonobstetric surgery for abdominal and pelvic pathology. Increasing numbers of case reports suggest the feasibility and safety of operative laparoscopy during pregnancy. We identified certain management issues specific to these procedures based on our experience with nine cases of operative laparoscopy in women with gestations up to 22 weeks.

Female↗
PubMed1997

Relationship of endometrial thickness with the menstrual timing of leuprolide acetate administration for preoperative preparation for hysteroscopic surgery.

STUDY OBJECTIVES: To assess the relationship of menstrual timing of administration of gonadotropin-releasing hormone (GnRH) agonist on the effectiveness of endometrial thinning and unwanted uterine bleeding. DESIGN: Prospective observational study. SETTING: Gynecology department of a community hospital. PATIENTS: One hundred consecutive women in a private practice, without submucous myomas, scheduled for transcervical endomyometrial resection or ablation. INTERVENTIONS: A GnRH agonist was administered at an unspecified time of the menstrual cycle. Transcervical hysteroscopic endomyometrial resection or ablation was performed 1 month later. MEASUREMENTS AND MAIN RESULTS: No significant statistical differences were seen in either the effectiveness of endometrial thinning or the occurrence or severity of unwanted uterine bleeding. CONCLUSIONS: A GnRH agonist as pretreatment for endomyometrial resection or ablation can be administered at any time during the menstrual cycle with similar efficacy. Timing of surgery can be at the mutual convenience of patient and physician.

Adult↗
PubMed1997

Ageing and aged care in the People's Republic of China: national and local issues and perspectives.

China's population is rapidly ageing at a time when former socialist collective provision and provision by the state in all sectors, especially in social welfare, is being radically reduced because of economic reform and financial stringency. The traditional Chinese approach to family care for elderly members is being encouraged but may be difficult because of smaller family sizes and the disruption of migration. This paper discusses some urban responses to pressures for change in care of elderly people, drawing on the example of Guangzhou (Canton) in southern China, which typifies many of the problems of caring for elderly people in times of social and economic change. It notes the development of homes and facilities for elderly people and the emergence of some prestige homes, often occupied by the better off, which have received both local and international investment. By contrast, the bulk of elderly people will not be adequately provided for by a declining public/collective sector. The dilemmas faced by the Chinese authorities attempting to stimulate local provision for all elderly people are identified.

Adolescent↗
PubMed1997

Laparoscopic leiomyoma coagulation-myolysis.

Leiomyomas, the most common solid pelvic tumors, occur in 25% to 30% of women during their reproductive years. Approximately 20% to 50% of these women experience symptoms that require treatment, with the most common complaints being menorrhagia, metrorrhagia, pelvic pressure, and the appreciation of a pelvic mass.

Journal Article↗
PubMed1997

Dysplasia epiphysealis hemimelica.

Dysplasia epiphysealis hemimelica is a rare developmental disorder affecting one or more epiphyses in a limb or a tarsal or carpal bone. It is due to abnormal cartilage proliferation with subsequent endochondral ossification and generally involves the medial or lateral half of the epiphysis. Our case involved the lateral aspect of the distal femoral epiphysis, which was managed with local resection.

Arthroscopy↗
PubMed1997

GP fundholding and prescribing in UK general practice: evidence from two rural, English Family Health Services Authorities.

BACKGROUND: Two separate prescribing budget regimes (part of GP fundholding and the indicative prescribing scheme) were introduced into UK general practice in April 1991 in an attempt to contain the growth in NHS expenditure on prescribed drugs. OBJECTIVES: The aims of this study are (i) to examine whether the fundholding scheme has been more effective at containing prescribing cost growth than the indicative prescribing scheme and (ii) to ascertain whether its implementation, at a practice level, has been affected by local circumstances and conditions. METHODS: Prescribing cost data were collected from two rural, English Family Health Services Authorities for the financial years 1990/1991 to 1993/1994. Exploratory analysis was performed using regression analysis and nonparametric statistical techniques. RESULTS AND CONCLUSIONS: Initially, the fundholding scheme has been the more effective at containing expenditure on prescribed drugs. However, the implementation of the schemes in rural areas has probably been affected by the existence of practices with permission to dispense drugs to their own patients, due to a lack of pharmacies in such areas.

Aged↗
PubMed1996

Identification of retained N-formylmethionine in bacterial recombinant mammalian cytochrome P450 proteins with the N-terminal sequence MALLLAVFL...: roles of residues 3-5 in retention and membrane topology.

An N-terminal block to Edman degradation was observed when any of five different mammalian cytochrome P450 (P450) proteins was expressed in Escherichia coli using the N-terminal sequence MALLLAVFL... This block was also seen in Salmonella typhimurium. With all proteins examined, the block could be removed by mild acid hydrolysis (0.6--6 N HCl, 23 degrees C) to expose Met as the N-terminus, suggesting N-formylMet retention. The N-terminal peptide of a modified P450 1A2 ("mutant 1", containing a thrombin-sensitive site inserted at residue 25) was released with thrombin and analyzed by electrospray mass spectrometry and found to yield the M(r) expected for the N-formyl derivative (+/- 0.8 amu). The region of positions 3--5 was altered by random mutagenesis, and three P450 1A2-expressing clones were analyzed for nucleotide and amino acid sequences. The changes from LLL were to RER (P450 1A2a), VDS (P450 1A2b), and WRH (P450 1A2c); these all show slightly dissimilar hydropathy plots compared to the MALLLAVFL... sequence. Mutant P450 1A2a had the N-terminal Met removed to yield N-terminal Ala; P450 1A2b contained an unmodified Met at the N-terminus; P450 1A2c had an approximately 80% block of the N-terminal Met. Experiments with bacterial membranes containing expressed P450 1A2 mutant 1 and P450 1A2 mutant 2 (thrombin-sensitive site inserted at residue 46) suggest that thrombin site 2, but not 1, is sequestered in the membrane. Spheroplasts of bacteria expressing P450 1A2 and the mutants at positions 3--5 were treated with proteinase K; amino acid analysis indicated that no cleavage occurred. These results are interpreted in a model in which most of the mammalian P450 expressed in the bacterium is located in the cytosol, the region near residue 46 is in the inner membrane, the region near residue 25 is in the cytosol, and the N-terminus is either imbedded in the membrane or free in the cytosolic space, depending upon the sequence. However, the possibility that the differences in N-terminal processing are the result of direct changes in interactions with the deformylase and Met aminopeptidase cannot be excluded.

Amino Acid Sequence↗
PubMed1996

Outside-in integrin signal transduction. Alpha IIb beta 3-(GP IIb IIIa) tyrosine phosphorylation induced by platelet aggregation.

alpha IIb beta 3-(GP IIb IIIa) is the most abundant integrin expressed on platelets and plays a critical role in platelet aggregation and normal hemostasis. In response to platelet stimulation by agonists such as thrombin, alpha IIb beta 3 becomes a receptor for the adhesive proteins fibrinogen, von Willebrand factor, vitronectin, and fibronectin. Binding of extracellular matrix ligands allows the integrin to transmit a signal to the inside of the cell, but the exact mechanisms whereby integrins transduce these signals remains unclear. In this paper we demonstrate that the beta 3 subunit of alpha IIb beta 3 was phosphorylated on tyrosine residues in response to thrombin-induced platelet aggregation. However, tyrosine phosphorylation was not observed when platelets were stimulated by thrombin in the presence of an inhibitor of aggregation. Phosphotyrosine was only detected when platelets were solubilized under protein-denaturing conditions. A peptide corresponding to residues 740-762 of the beta 3 cytoplasmic domain was capable of binding the signaling proteins SHC and GRB2. GRB2 binding occurred only when both tyrosine residues (Tyr-747 and Tyr-759) were phosphorylated. SHC binding also occurred to a peptide monophosphorylated at Tyr-759. The data suggest that tyrosine phosphorylation of an integrin beta subunit may be important in initiating outside-in signaling cascades by inducing association of signaling components directly with the integrin.

Adaptor Proteins, Signal Transducing↗
PubMed1996

Adriamycin-induced DNA adducts inhibit the DNA interactions of transcription factors and RNA polymerase.

Adriamycin is known to specifically induce DNA interstrand cross-links at 5'-GC sequences. Because 5'-GC sequences are a predominant feature of 5'-untranslated regions (transcription factor-binding sites, promoter, and enhancer regions), it is likely that adriamycin adducts at GC sites would affect the binding of DNA-interacting proteins. Two model systems were chosen for the analysis: the octamer-binding proteins Oct-1, N-Oct-3 and N-Oct-5, which bind to ATGCAAAT and TAATGARAT recognition sites, and Escherichia coli RNA polymerase binding to the lac UV5 promoter. Electrophoretic mobility shift studies showed that adriamycin adducts at GC sites inhibited the binding of octamer proteins to their consensus motifs at drug levels as low as 1 micoM, but no effect was observed with a control sequence lacking a GC site. Adriamycin adducts at GC sites also inhibited the binding of RNA polymerase to the lac UV5 promoter. Adriamycin may therefore function by down-regulating the expression of specific genes by means of inactivation of short but critical motifs containing one or more GC sites.

Antibiotics, Antineoplastic↗
PubMed1996

A scanning electron microscope investigation of the effects of pollutants on the hepatopancreatic ceca of Gammarus pulex (L.).

Scanning electron microscope studies were performed on the peripheral muscle network (myoepithelium) of the hepatopancreatic ceca of Gammarus pulex (L.) exposed to lindane, copper, or 3, 4-dichloroaniline (3,4-DCA) for a 24-hr period. The structural integrity of the myoepithelium of gammarids from control and test treatments was assessed using semiquantitative techniques. The lowest observed effect concentrations for structural changes were determined as 29.8 microg liter-1 lindane, 55 microg liter-1 copper, and 8.7 mg liter-1 3,4-DCA. The sensitivity of the bioassay and the significance of the morphological changes observed in the hepatopancreatic ceca of G. pulex are discussed.

Aniline Compounds↗
PubMed1996

The effect of dilute vasopressin solution on blood loss during operative hysteroscopy: a randomized controlled trial.

OBJECTIVE: To assess the effect of intracervical injection of dilute (0.05 U/mL) vasopressin solution on blood loss during operative hysteroscopy. METHODS: In a randomized, double-blind study, dilute vasopressin solution or placebo (normal saline) was injected into the cervical stroma of 106 women before dilation of the cervix in preparation for operative hysteroscopy. Intraoperative bleeding was calculated by dividing the number of red blood cells per milliliter of outflow distention fluid by the number of red blood cells per milliliter of the woman's blood immediately before the procedure and multiplying this quotient by the total amount of outflow fluid collected. Pressures were kept constant with a hysteroscopic infusion pump. RESULTS: The mean (+/-standard error of the mean) intraoperative blood loss of the treated (vasopressin) and control (placebo) groups was 20.3 +/- 4.1 mL (range 0-135) and 33.4 +/- 5.4 mL (range 0-290), respectively. The volume of distention fluid intravasation in the treated and control groups was 448.5 +/- 47.0 mL (range 30-1410) and 819.1 +/- 79.7 mL (range 20-1977), respectively. The operating time in the treated and control groups was 31.1 +/- 1.2 minutes (range 18-52) and 34.1 +/- 1.3 minutes (range 19-65), respectively. For all three outcome measures, the differences between the two groups were statistically significant, but for visual clarity of the uterine cavity during surgery, the difference was not significant. CONCLUSION: Administration of dilute vasopressin solution (0.05 U/mL) to the cervical stroma significantly reduces blood loss, distention fluid intravasation, and operative time during hysteroscopy. Further evaluation is required to determine the optimum dosage.

Adult↗
PubMed1996

Policy issues in the private health sector: examples from long-term care in the U.K.

The international trend towards private markets in health care can be illustrated very clearly by developments over the last decade in the U.K., where the balance of health care provision has shifted from a predominantly free, public and comprehensive system to more of a mixed economy model. The shift can be attributed to a variety of factors, and not government policy alone. The relationship between the private and NHS sectors of health care is not a simple one and there are both positive and negative implications of the public-private mix. The growth of private hospitals and acute beds has dominated debates about private health care, but further policy issues have emerged in relation to the significant growth in private residential and nursing home care. This paper briefly reviews developments in private health care and then explores the key policy issues associated with this development. Secondly, an analysis of developments in the private residential care sector is undertaken highlighting the relationship between the public and private sectors of care provision. Policy issues pertaining to the long-term care sector of private health care are raised, including the regulation of residential care, regulatory models, enforcement and quality, and standards of care. Lessons for the regulation of private health care generally are considered and the implications for the private sector of a growing trend towards market deregulation are explored. Future models of long-term care are discussed and the likely balance between the public and private sectors explored.

Aged↗
PubMed1996

Laparoscopic management of benign cystic teratomas during pregnancy.

OBJECTIVE: Our purpose was to evaluate the surgical management and outcome of laparoscopic removal of benign cystic teratomas during pregnancy. STUDY DESIGN: The records of women with benign cystic teratomas who were managed with operative laparoscopy during pregnancy were reviewed. RESULTS: Twelve women had laparoscopic removal of a benign cystic teratoma during pregnancy. Gestational ages at surgery ranged from 9 to 17 weeks, with a mean of 14 weeks. Cyst size ranged from 5 to 13 cm, with a mean of 8.5 cm. Intraoperative rupture of the cyst occurred in 10 of 12 (93%) women. No patient had evidence of chemical peritonitis. The mean operating time was 87 minutes and the mean postoperative hospital stay was 44 hours. No intraoperative or postoperative maternal or fetal complications occurred. CONCLUSIONS: Laparoscopic removal of a benign cystic teratoma of the ovary may be safely accomplished during pregnancy. In spite of a significant risk of cyst rupture, careful operative technique followed by copious irrigation of the pelvis may avoid chemical peritonitis and potential adverse sequelae.

Adult↗
PubMed1996

Laparoscopic bipolar coagulation for the conservative treatment of adenomyomata.

STUDY OBJECTIVE: To assess the effectiveness of treating adenomyomata with laparoscopic bipolar coagulation. DESIGN: Prospective, observational study. Setting. The gynecology department of a community hospital. PATIENTS: Ten women, each with severe dysmenorrhea, chronic menorrhagia, and adenomyomata diagnosed by magnetic resonance imaging. INTERVENTIONS: Laparoscopic bipolar coagulation of adenomyomata. MEASUREMENTS AND MAIN RESULTS: The mean (+/- SEM) total adenomyoma volume before leuprolide acetate administration was 119 +/- 16 cm3 (range 6-190 cm3); after 3 months of therapy this was reduced to 86 +/- 8 cm3 (range 6-162 cm3, p <0. 0001) a 27.7% reduction. Further reduction occurred 7 to 12 months postoperatively to 31 +/- 3.4 cm3 (range 3-155 cm3, p <0.0001), a 73.9% reduction from baseline. Twelve months postoperatively, seven (70.0%, p <0.05) women had continued resolution or significant reduction of dysmenorrhea and resolution of menorrhagia. One woman (10.0%) with unresolved dysmenorrhea and menorrhagia required hysterectomy, and two (20.0%) with recurrent menorrhagia required resection of the endomyometrium; one continued to have menorrhagia but refused further surgical or medical treatment. CONCLUSIONS: Conservative treatment obviated the need for major surgery in 90% of women with adenomyomata, but further evaluation of this technique is necessary to determine its definitive role.

Adenomyoma↗
PubMed1996

Magnetic resonance imaging for diagnosing adenomyomata.

STUDY OBJECTIVES: To evaluate the accuracy of magnetic resonance imaging (MRI) for diagnosing nodular adenomyosis by percutaneous myometrial biopsies. DESIGN: Prospective observational study. SETTING: Gynecology department of community hospitals. PATIENTS: Twenty women with severe dysmenorrhea, chronic menorrhagia, and an MRI diagnosis of adenomyomata. INTERVENTIONS: Several laparoscopically guided, percutaneous myometrial biopsy specimens were taken in an attempt to confirm histologically an MRI diagnosis of adenomyoma; and resectoscopic endomyometrial biopsy specimens were taken in an attempt to confirm an MRI diagnosis of adenomyosis. MEASUREMENTS AND MAIN RESULTS: Eighteen (90%) of the 20 women had an MRI diagnosis of adenomyosis histologically confirmed by myometrial biopsy. The remaining two (20.0%) had an MRI diagnosis of adenomyosis histologically confirmed by endomyometrial biopsy. CONCLUSIONS: An MRl diagnosis of adenomyoma was confirmed by transabdominal uterine biopsy in most patients. These results, when combined with those obtained by resectoscopic endomyometrial biopsy, established a diagnosis of adenomyosis in all patients.

Adenomyoma↗