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Biomedical subjects

I R Johnson

Publications and source records attributed to I R Johnson.

At least 55 records · Page 3Linked to original sources

Fetal weight estimation by echo-planar magnetic resonance imaging.

Fetal weight was estimated in utero in eleven singleton pregnancies by measurement of fetal volume with echo-planar imaging (EPI), a form of magnetic resonance imaging, and by ultrasound measurements. EPI estimates of fetal volume were closely correlated with actual birthweight (R = 0.97). The median difference (expressed as a percentage of actual birthweight) between actual and EPI-estimated birthweights was 3.0% (range 0.6-9.9); this discrepancy was significantly smaller than that found for ultrasonographic estimates (6.5% [1.7-17.8]; p < 0.01).

Birth Weight↗

The use of the hand-grip test for predicting pregnancy-induced hypertension.

To assess the potential of the hand-grip exercise test as a screening test for pregnancy-induced hypertension a prospective non-interventional study was carried out in a teaching hospital antenatal clinic. The hand-grip test was performed on 200 nulliparous, normotensive subjects at 28-32 weeks gestation. The main outcome measurement was the subsequent development of pregnancy-induced hypertension or pre-eclampsia. The sensitivity of the technique in predicting pregnancy-induced hypertension was 53% and the specificity was 94%. The sensitivity of the test in predicting pre-eclampsia was 80% and the specificity was 92%. The time-consuming nature of the hand-grip test probably restricts use of the technique to research studies where selection of a high-risk group is required.

Exercise Test↗

A three-year follow-up of children imaged in utero with echo-planar magnetic resonance.

A 3-year follow-up study was carried out on 20 children examined in utero with echo-planar magnetic resonance imaging when fetal compromise had been demonstrated or was suspected. There was no demonstrable increase in the occurrence of disease or disability (including hearing deficit) that could be related to echo-planar imaging techniques.

Child, Preschool↗

Estimation of fetal lung volume using echo-planar magnetic resonance imaging.

OBJECTIVE: To measure fetal lung volume by echo-planar magnetic resonance imaging (MRI). METHODS: Twenty singleton pregnancies were scanned on one occasion each using echo-planar imaging, a form of MRI. Cases of fetal growth restriction and macrosomia were excluded from the study. RESULTS: Lung volumes increased with gestational age from 21 mL at 23 weeks' gestation to a maximum of 94 mL at term. The relation between lung volume and gestational age was exponential. The ratio of lung volume to total fetal volume decreased with gestational age. CONCLUSION: The use of echo-planar imaging allows estimation of normal fetal growth; it has clear applications for the diagnosis of lung hypoplasia and potential use for the study of lung maturity.

Echo-Planar Imaging↗

The individualised birthweight ratio: a new method of identifying intrauterine growth retardation.

OBJECTIVE: To assess the effectiveness of the newly developed individualised birthweight ratio in identifying growth retarded infants. DESIGN: Prospective observational study. SETTING: Obstetric unit, City Hospital Nottingham. SUBJECTS: Two thousand eight hundred and thirty-five women delivered between December 1991 and July 1992 and the infants of 616 of these selected by virtue of their birthweight for gestation and individualised birthweight ratio centile positions. MAIN OUTCOME MEASURES: Skinfold thickness and ponderal index measurements, occurrence of abnormal fetal heart rate patterns, operative delivery due to fetal distress and the need for neonatal resuscitation. RESULTS: Using an individualised birthweight ratio less than the 10th centile as a cut-off results in 25% of those less than the 10th centile of birthweight for gestation being reclassified as normally grown. A slightly larger group are reclassified as small; significantly more of these infants have abnormal ponderal indices and skinfold thicknesses, suffer abnormal fetal heart rate patterns, operative delivery for fetal distress and need neonatal resuscitation than do those who are reclassified as normally grown. CONCLUSION: The individualised birthweight ratio combines the simplicity of birthweight measurement with the accuracy of clinical measurements in the identification of the growth retarded baby.

Birth Weight↗

Haemodynamic actions of a novel sino-atrial node function modulator, ZENECA ZD7288, in the anaesthetized dog: a comparison with zatebradine, atenolol and nitrendipine.

1. ZENECA ZD7288 (4-(N-ethyl-N-phenylamino)-1,2-dimethyl-6-(methylamino) pyrimidinium chloride, formerly ICI D7288) is a novel sino-atrial node function modulator which selectively slows sinus node rate. Its effects on haemodynamic function have been studied in pentobarbitone anaesthetized dogs, in comparison with zatebradine, atenolol and nitrendipine. 2. ZD7288 lowered heart rate in the dose-range 0.02 to 1.0 mg kg-1 i.v. from 152 to 77 beats min-1. Myocardial contractile function (measured as both dPLV/dtmax and right ventricular free wall developed force) decreased along with rate. Stroke volume increased as rate decreased. Cardiac output decreased at doses in excess of 0.2 mg kg-1, i.v. 3. These haemodynamic changes were reversed when heart rate reduction was reversed by atrial pacing and are, therefore, considered to be indirect consequences of heart rate changes induced by ZD7288. 4. The effects of zatebradine paralleled those of ZD7288 (heart rate reduced from 149 to 60.5 beats min-1 over the dose-range 0.02 to 1.0 mg kg-1, i.v.), except that dPLV/dtmax did not decrease with heart rate and increased during arial pacing. 5. Neither ZD7288 nor zatebradine had significant effects on atrio-ventricular conduction at intrinsic heart rates, but both significantly and dose-dependently prolonged the atrio-ventricular conduction interval during atrial pacing at 180 beats min-1. 6. The observed effects of atenolol were commensurate with removal of beta-sympathetic cardiac drive. Atrial pacing was found not to restore the pre-atenolol heamodynamic state completely. 7. Nitrendipine up to 0.2 mg kg- i.v. induced changes indicative of direct vasodilatation accompanied by reflex compensation, followed by cardiac depression at higher doses. Atrial pacing failed to compensate for the effects of vasodilatation, but caused atrio-ventricular conduction block at doses above 0.5mgkg-1, i.v.8.data show ZD7288 has marked heart rate slowing properties and that accompanying haemodynamic changes appear to be secondary to the rate changes, being reversed by atrial pacing even in the continued presence of the drug. Heart rate slowing without depression of contractile function should prove to be of benefit in the treatment of myocardial ischaemia, particularly in the presence of myocardial dysfunction.

Animals↗

The haemodynamic actions of ZENECA ZD7288, a novel sino-atrial node function modulator, in the exercising beagle: a comparison with zatebradine and propranolol.

1. ZENECA ZD7288 (4-(N-ethyl-N-phenylamino)-1,2-dimethyl-6-(methylamino) pyrimidinium chloride, formerly ICI D7288) is a novel sino-atrial node function modulator which selectively slows heart rate. 2. The haemodynamic effects of ZD7288 (0.1, 0.3 and 1.0 mg kg-1, i.v.) have been evaluated and compared with those of placebo (physiological saline), zatebradine (ULFS 49, 0.1, 0.3 and 1.0 mg kg-1, i.v.) and propanolol (0.03, 0.1, and 0.3 mg kg-1, i.v.) in beagles chronically instrumented for measurement of heart rate, aortic pressure, aortic flow and dPLV/dtmax. The dogs were trained to run at 6.5 k h-1 on a level treadmill for 5 min at half hourly intervals over a period of 4 h. Drugs were dosed cumulatively after the second, fourth and sixth exercise periods. 3. Control experiments demonstrated a degree of accommodation to repeated exercise over a period of 4 h. Resting heart rate decreased by 21 beats min-1, but heart rate response to exercise was maintained, whereas dPLV/dtmax at rest remained steady while the response to exercise decreased significantly (by 25% after 2 h, P < 0.05). 4. ZD7288 and zatebradine both decreased heart rate during exercise in a dose-dependent manner, whilst heart rate at rest did not differ from resting heart rates in saline dosed control animals. In contrast, heart rate at rest and during exercise were lowered equally by the lowest doses of propranolol (approximately by 30 beats min-1), and additional doses caused only minor additional decreases. The exercise-induced tachycardia was maintained within 12% of pre-dose levels, presumably by withdrawal of vagal tone.5. Cardiac inotropism, as indicated by dPLv/dt max, was not affected by ZD7288 or zatebradine at rest,although the inotropic response to exercise decreased in proportion to the decreases in exercise-induced tachycardia. Propranolol caused a marked dose-dependent decrease in the exercise-induced inotropic response (by 85% at 0.3mg kg-1).6. Whilst the sino-atrial node modulators increased stroke volume at rest, and augmented increases in response to exercise, propranolol did not affect resting stroke volume and decreased the responses to exercise.7. Cardiac output at rest and cardiac output increases during exercise were well maintained in the presence of ZD7288 and zatebradine in contrast to propranolol which induced a significant depression of cardiac output, both at rest and during exercise. Propranolol also caused significant systemic vasoconstriction.8. In conclusion, ZD7288 has haemodynamic actions comparable to those of zatebradine despite their chemical dissimilarity. ZD7288 may be of benefit in the treatment of ischaemic heart disease by reducing heart rate without impairing cardiac function.

Animals↗

Relative macrosomia identified by the individualised birthweight ratio (IBR). A better method of identifying the at risk fetus.

OBJECTIVE: To assess the effectiveness of a newly developed individualised birthweight ratio (IBR), which corrects for physiological birthweight determinants, in identifying infants at risk from the complications of macrosomia. DESIGN: Prospective observational study. SETTING: Obstetric unit, Nottingham City Hospital. SUBJECTS: 2835 women delivered between December 1991 and July 1992 and the infants of 624 of these, selected by virtue of their birthweight for gestation and IBR centile positions. MAIN OUTCOME MEASURES: Skinfold thickness and ponderal index measurements, operative delivery, shoulder dystocia, fetal trauma, impaired glucose tolerance. RESULTS: Using an IBR above the 90th centile as a cut off results in 2.4% of infants being reclassified as normally grown and 3.1% are reclassified as large. The IBR does not result in the identification of any more infants with abnormal ponderal indices or skinfold thicknesses than birthweight for gestation. It does, however, identify more of the infants at risk of operative delivery, shoulder dystocia, fetal trauma and impaired glucose tolerance. CONCLUSION: The IBR significantly improves upon birthweight for gestation in identifying infants who suffer from the complications of relative macrosomia.

Adult↗

A study of the effect of rotational forceps delivery on fetal acid-base balance.

OBJECTIVE: To determine whether Kiellands forceps rotational delivery causes a significant reduction in fetal pH or base excess, as compared to a control group delivered using non-rotational forceps. DESIGN: A prospective observational study. SETTING: A teaching hospital labor ward in the UK. METHODS: Fetal blood sampling was performed prior to delivery by Kiellands forceps (n = 26) or by non-rotational forceps (n = 24). Following delivery, the umbilical vein was sampled. OUTCOME MEASURES: The changes in fetal pH and base excess. RESULTS: No significant changes in pH were noted in fetuses delivered using Kiellands forceps or in those delivered using Neville Barnes forceps. However, whilst no changes in base-excess were found in the fetuses delivered using Neville Barnes forceps, there were significant changes in base-excess in those fetuses delivered using Kiellands forceps. CONCLUSION: This small study suggests that delivery by Kiellands forceps may result in a significant deterioration in fetal acid-base balance.

Acid-Base Equilibrium↗

Effect of the vascular endothelium on norepinephrine-induced contractions in uterine radial arteries from the nonpregnant and pregnant human uterus.

OBJECTIVE: Our purpose was to investigate the role of the endothelium in the human uterine arterial response to norepinephrine in the nonpregnant and pregnant states. STUDY DESIGN: Tissue was obtained from six pregnant and six nonpregnant women undergoing cesarean section or hysterectomy. Uterine radial arteries were isolated and subjected to norepinephrine dose-response curves with and without intact endothelium. RESULTS: Responses were obtained over a dose range of 10(-8) to 10(-4) norepinephrine. Initially there was no difference between vessels from pregnant and nonpregnant patients, but removal of the endothelium significantly increased the response in vessels from pregnant women. Addition of nitro-L-arginine methyl ester when the endothelium was intact did not alter the dose-response curves. CONCLUSIONS: In pregnancy human uterine radial arteries are more sensitive to norepinephrine than during the nonpregnant state. This increase is countered by an endothelium-derived relaxing factor. The factor is unlikely to be nitric oxide.

Arginine↗

The individualised birthweight ratio: a more logical outcome measure of pregnancy than birthweight alone.

OBJECTIVE: To provide a new outcome measure for pregnancy specifically related to the individual. DESIGN: Computer analysis of physiological factors affecting birthweight. SETTING: Two provincial teaching hospitals (University and City Hospitals, Nottingham) and an associated district general hospital (Derby City Hospital) serving a defined catchment area in the East Midlands. SUBJECTS: All women delivering in the above hospitals since the start of computerised obstetric records: 31,561 women with gestational age verified by early pregnancy ultrasound scan data. MAIN OUTCOME MEASURES: Calculation of the predicted birthweight taking into account maternal and fetal physiological factors. Derivation of the individualised birthweight ratio (actual birthweight divided by predicted birthweight expressed as a percentage) for each individual baby. RESULTS: The individualised birthweight ratio redefines as normally grown 41% of babies below the 10th centile of crude birthweight for gestation. Other babies previously regarded as normal are redefined as growth retarded. At the upper end of the distribution 46% of those above the 90th centile of birthweight for gestation are redefined as normally grown. CONCLUSIONS: The predicted birthweight can be calculated for an individual pregnancy at a given gestation. The standardised comparison between this predicted birthweight and the actual birthweight is a more logical reflection of the normality of intrauterine growth and therefore more logical as an outcome measure for pregnancy than crude birthweight for gestation.

Adolescent↗

Echo-planar imaging of the human fetus in utero.

We have demonstrated that echo-planar imaging can be used to produce high-quality snapshot images of the human fetus in utero in a fraction of a second. These images are free of motional artifact or blurring and allow detailed depiction of fetal structures in normal and pathological pregnancies.

Fetal Heart↗

Study of internal structure of the human fetus in utero by echo-planar magnetic resonance imaging.

The ultrafast echo-planar magnetic resonance imaging technology, developed and built in Nottingham, has been used to produce the first snapshot images of the human fetus in utero. The imager, operating at a proton resonance frequency of 22 MHz, produces transaxial views in 64 or 128 milliseconds. These images comprise either 64 x 128 or 128 x 128 pixels with an in-plane resolution of 3 x 3 mm2. The slice thickness is 10 mm. Fetal scans of up to 32 contiguous slices are produced in a few minutes. These have been used to study the internal structure of the uterus and the fetus in a range of cases with gestations ranging from 26 weeks to term. Echo-planar imaging seems particularly suitable as an imaging modality since its high speed obviates image blurring arising from fetal motion.

Fetal Diseases↗

Epidemiological changes in cervical carcinoma with particular reference to mucin-secreting subtypes.

The histology of all 242 new cases of cervical carcinoma presenting to the Nottingham hospitals during two 2-year periods (1976-1977 and 1986-1987) has been reviewed and histochemical staining for mucins has been performed. Unlike previous studies these cases represent an unselected population and are primary referrals. The relative proportion of adenocarcinomas did not change significantly during the decade studied. Mucin secretion was identified in 64 cases previously diagnosed as squamous cell carcinoma. The proportion of carcinomas arising in patients aged 45 or younger increased significantly in the latter period. A disproportionate increase in the incidence of adenocarcinomas and other mucin-secreting subtypes was observed in this age group. These results confirm that the incidence of cervical carcinomas in young women is increasing. Mucin expression in cervical carcinomas is common, even in the absence of obvious glandular morphology.

Adenocarcinoma↗

Echo planar imaging of the human fetus in utero at 0.5 T.

The snap-shot capability of the echo-planar imaging technique is used to freeze motion effectively in human fetal studies in utero. These first results obtained at 0.5 T demonstrate diagnostic quality images without the need for averaging. Although averaging improves the image signal to noise ratio, it is shown that significant image blurring is produced even when only eight separate images are averaged over a period of a few seconds. Results are presented showing anatomical detail of the internal organs of the fetus. Some pathology is also demonstrated. These results were obtained using the modulus blipped echo-planar single-pulse technique (MBEST). Running at 10 frames/second, the modulus version of the fast low-angle excitation echo-planar technique (FLEET) is used to produce ungated fetal cardiac movies.

Female↗