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Biomedical subjects

G Gilson

Publications and source records attributed to G Gilson.

17 recordsLinked to original sources
PubMed2000

Active management of labor: a cost analysis of a randomized controlled trial.

OBJECTIVE: To compare the costs of a protocol of active management of labor with those of traditional labor management. DESIGN: Cost analysis of a randomized controlled trial. METHODS: From August 1992 to April 1996, we randomly allocated 405 women whose infants were delivered at the University of New Mexico Health Sciences Center, Albuquerque, to an active management of labor protocol that had substantially reduced the duration of labor or a control protocol. We calculated the average cost for each delivery, using both actual costs and charges. RESULTS: The average cost for women assigned to the active management protocol was $2,480.79 compared with an average cost of $2,528.61 for women in the control group (P = 0.55). For women whose infant was delivered by cesarean section, the average cost was $4,771.54 for active management of labor and $4,468.89 for the control protocol (P = 0.16). Spontaneous vaginal deliveries cost an average of $27.00 more for actively managed patients compared with the cost for the control protocol. CONCLUSIONS: The reduced duration of labor by active management did not translate into significant cost savings. Overall, an average cost saving of only $47.91, or 2%, was achieved for labors that were actively managed. This reduction in cost was due to a decrease in the rate of cesarean sections in women whose labor was actively managed and not to a decreased duration of labor.

Costs and Cost Analysis↗
PubMed1999

Epidural analgesia and active management of labor: effects on length of labor and mode of delivery.

OBJECTIVE: To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients. METHODS: The charts of 255 women randomized to active management of labor (n = 125) or control protocols (n = 130) were reviewed and stratified to early epidural placement (up to 4 cm cervical dilatation) versus late placement (more than 4 cm). RESULTS: Women with early epidural placement had shorter labors than those with late placement (11.6 +/- 4.6 versus 13.2 +/- 5.6 hours; P = .02). Active management reduced the length of labor compared with controls regardless of epidural timing, with a reduction of 1.4 hours in early epidural placement (10.9 +/- 4.7 versus 12.3 +/- 4.3 hours; P = .04) and 3.6 hours in those with later placement (11.0 +/- 3.6 versus 14.6 +/- 6.2 hours; P = .004). Cesarean rates did not vary significantly (early 14.5% versus late 7.9%; P = .21). Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates. CONCLUSION: Early epidural placement did not affect lengths of labor or cesarean rates and was actually associated with shorter labor compared with late epidural placement. Women managed actively in labor, regardless of timing of epidural placement, had shorter labors than controls.

Adult↗
PubMed1998

[Prostatic cancer in the Grand Duchy of Luxembourg. Role of PSA].

We reviewed the trends in prostate cancer incidence and mortality in Luxembourg between 1983 and 1995 to discuss the importance of total and free PSA in early detection. The study was performed on all the new cases recorded by the National Cancer Registry (Registre Morphologique des Tumeurs). Total and free PSA were measured with the automated Immulite System (DPC, Los Angeles) using a chemoluminescent immunometric assay. The performance of free-to-total serum PSA was analysed by a hospital based study of 113 patients (55 PC, 58 BPH). The age standardized incidence rate increased from 29.3/100,000 in 1983 to 71.5/100,000 in 1995. Mortality rates only changed slightly. The widespread use of PSA testing from 1988 on is probably the main cause of this incidental increase; however no major changes in the age-specific-incidence have been found suggesting the absence of a systematic screening policy by the PSA. The superiority of free-to-total serum PSA ratio in discriminating between cancer and benign condition was confirmed. Early health-conscious man over 50 should be proposed prostate cancer screening by digital rectal examination and PSA. However a systematic screening policy cannot been recommended since a benefit in survival after early treatment has not yet been proven.

Adult↗
PubMed1997

Multicenter evaluation of a second-generation assay for cardiac troponin T.

We report on the evaluation of the second-generation assay for cardiac troponin T (cTnT) on the Enzymun system. This new assay is completely specific for the cardiac isoform of TnT, utilizing two cardiospecific monoclonal antibodies. The assay time is reduced to 45 min. The interassay precision shows a median CV of 5.5%; 20% interassay CV was found between 0.05 and 0.1 microg/L. The cardiosensitivity of the second-generation cTnT assay in patients with ischemic myocardial injury appears equivalent when compared with the first-generation assay. We found no falsely positive results in patients with skeletal muscle damage including multitraumas, surgery patients, and marathon runners who showed highly increased values with the unspecific first-generation assay. In Duchenne disease cTnT was still increased, but to a much lower extent. cTnT remains increased in renal failure, but to a lesser degree than with the first-generation assay. The cause of this increase remains unclear. Although a cross-reactivity of skeletal muscle TnT in the second-generation assay could be excluded by our findings, minor myocardial damage or expression of the cardiac isoform of TnT in regenerating muscles cannot be ruled out in those cases with apparently falsely increased cTnT values. The second-generation cTnT assay is a step forward in the combination of cardiosensitivity and cardiospecificity in biochemical markers for diagnosis of heart disease.

Artifacts↗
PubMed1997

[The neuropathies of IgM monoclonal gammopathies].

A peripheral polyneuropathy is often associated with an IgM monoclonal gammapathy. The monoclonal protein often binds to carbohydrate epitopes on glycoproteins and/or glycolipids of the human peripheral nerve. The clinical syndrome is related to the antigen-specificity of the IgM protein. Detection of anti-myelin antibodies and further characterization of their immunogenic specificity provide an important aid in the differential diagnosis of late-onset chronic polyneuropathies.

Glycolipids↗
PubMed1993

[Heat shock proteins].

All cells, procaryotic and eucaryotic, respond to a rise in environmental temperature by a rapid synthesis of a set of specific proteins: the heat shock proteins (HSPs). These HSPs appear to be among the most conserved proteins in nature and certain members of the HSP family are present in non-stressed cells. These observations are reflecting the fact that HSPs serve vital physiological functions as well in normal cells as in stressed cells. In the past few years, various fields of medicine have shown growing interest in the role that the HSPs may play in cellular mechanisms. In this paper we are briefly summarizing the actual knowledge of HSP involvement in carcinogenic and immunological processes.

Heat-Shock Proteins↗
PubMed1990

Repair of acetyl-aminofluorene modified pBR322 DNA in Xenopus laevis oocytes and eggs; effect of diadenosine tetraphosphate.

Using Xenopus laevis oocytes and unfertilized eggs, we have developed a system which allows the study of DNA repair upon microinjection of pBR 322 DNA which has been previously modified in vitro by N-acetyl-aminofluorene, under controlled conditions. In unfertilized eggs, an efficient repair of pBR-18AAF DNA takes place, leading to a restoration of the transforming activity of the plasmid DNA towards Escherichia coli. The repaired DNA is even efficiently replicated, the egg being "activated" by the microinjection. In the oocyte, a partial repair is observed as shown by the incorporation of labelled dCTP in the modified plasmid DNA, even in the presence of aphidicolin, an inhibitor of DNA polymerase alpha. However, the repair appears to be very limited, since it does not restore the transforming activity of the modified plasmid DNA. This inefficient repair in the oocyte may be due to the rapid packaging of foreign DNA into a minichromosome and/or to a very low level of DNA polymerase beta. This system was used to study the effect of diadenosine tetraphosphate (Ap4A) on DNA repair. Ap4A seems not to interfere with repair processes in the oocyte, but significantly inhibits the replication following the repair of AAF-modified plasmid DNA in unfertilized eggs. These results suggest that Ap4A could be involved in switching off the replication machinery when DNA is badly damaged, thus helping to avoid the perpetuation of DNA modifications in the daughter cells. This hypothesis is consistent with many previous reports on the accumulation of dinucleoside polyphosphates under stress conditions, which are known to result in modification of DNA.

2-Acetylaminofluorene↗
PubMed1988

Is Ap4A involved in DNA repair processes?

Hepatoma tissue culture (HTC) cells were incubated in the presence of the alkylating agent N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) to study the variations in the bisnucleosides polyphosphates (Ap4X) pool size. A transient but sensitive accumulation of these compounds is observed; if 3-aminobenzamide (3AB) which is a potent inhibitor of the ADP-ribosyltransferase (ADPRT) is added after the MNNG treatment, a more pronounced and persistent accumulation of Ap4X can be seen. A moderate heat-shock (30 min at 43 degrees C) results also in a small accumulation of Ap4X but the shape of the accumulation curve is quite different and the increase of the Ap4X pool is not sensitive to the presence of 3AB. However, both MNNG treatment and hyperthermia cause a marked inhibition of protein synthesis. On the other hand, the ADPRT activity is enhanced in the presence of MNNG whereas hyperthermia has little or a slightly inhibitory effect on this activity. These results suggest that MNNG treatment triggers an Ap4X accumulation in eukaryotic cells different from that observed after heat-shock and it seems likely that these compounds are involved in the DNA excision repair system in which the ADPRT enzyme is also implicated.

Adenine Nucleotides↗
PubMedDate not supplied

Will cervicovaginal interleukin-6 combined with fetal fibronectin testing improve the prediction of preterm delivery?

OBJECTIVE: We sought to investigate if determination of cervicovaginal interleukin-6 (IL-6) levels would enhance the positive predictive value of fetal fibronectin (fFN) for preterm birth. METHODS: A prospective cohort study was undertaken of 135 women between 24 and 34 weeks gestation with symptoms of suspected preterm labor. Cervicovaginal secretions were collected for both IL-6 and fFN and measured by immunoassay and ELISA, respectively. Outcome variables included preterm delivery in less than 48 h, within 7 days, and prior to 37 weeks. Statistical analysis was performed with Fisher's exact test, regression for logarithmic transform levels, and multivariate logistic regression. ROC curves were created for IL-6 levels. RESULTS: IL-6 and fFN levels were both elevated in cervicovaginal secretions of women with symptoms of preterm labor. IL-6 values >100 pg/ml resulted in a odds ratio for delivery at <37 weeks of 1.57 (95%CI=0.89-2.75, P=.11), whereas fFN values >50 ng/ml resulted in a preterm delivery risk of 4.58 (95%CI=1.54-13.35, P=.003). Combining IL-6 and fFN results did not improve upon the predictive value of fFN alone for preterm birth [odds ratio 4.00 (95%CI=1.31-12.17, P=.015)]. CONCLUSION: Cervicovaginal IL-6 levels did not provide any additional, independent effect on the prediction of preterm birth beyond that of fFN testing alone.

Cervix Uteri↗
PubMedDate not supplied

Late second stage rupture of the uterus and bladder with vaginal birth after cesarean section: a case report and review of the literature.

Rupture of a uterine scar during labor with concomitant severe injury to the maternal bladder has been reported sporadically. Previously reported cases have been diagnosed under a variety of conditions, commonly at the time of repeat Cesarean delivery. A case of maternal bladder rupture diagnosed following forceps-assisted vaginal delivery after Cesarean is presented. Severe bradycardia developed suddenly in the second stage of labor. Rupture of the uterine scar was diagnosed after sudden onset of severe lower abdominal pain with delivery of the placenta. At laparotomy, extensive injury to the bladder was found and successful repair of both injuries was performed. A review of previously reported similar cases with their mechanism of injury and presentation is presented. Serious maternal bladder injury at the time of uterine rupture remains a risk of attempted vaginal delivery after prior Cesarean section.

Adult↗
PubMedDate not supplied

First clinical results with Enzymun-Test for free PSA.

BACKGROUND: Prostate Specific Antigen (PSA) is widely used for the detection and monitoring of prostate cancer (CAP) but PSA is elevated in many patients with benign prostatic hyperplasia (BPH). The measurement of free PSA may improve the discrimination between CAP and BPH. MATERIAL AND METHODS: Free PSA (F-PSA) and total PSA (T-PSA) were measured using kits based on the Enzymun-Test principle. The patient population was composed of 38 untreated CAP patients, 76 BPH patients and 29 prostatitis patients. RESULTS: At cut-off levels of 0.15 for the F-PSA/T-PSA ratio and 10 ng/ml for T-PSA the specificity and sensitivity for detecting CAP were respectively 87% and 84% for F-PSA/T-PSA ratio and 80% and 63% for T-PSA. CONCLUSION: The F-PSA/T-PSA ratio is more powerful at discriminating between CAP and BPH than T-PSA alone and may contribute to a reduction in unnecessary invasive techniques.

Aged↗