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Biomedical subjects

M Pillai

Publications and source records attributed to M Pillai.

At least 19 recordsLinked to original sources
PubMed2004

An assessment of the Down syndrome antenatal screening policies of East and West Gloucestershire between 1993 and 1999.

This retrospective observational study of registered pregnancies in Gloucestershire between 1 April 1993 and 31 March 1999 compares the impact of different Down syndrome antenatal screening policies on detection and amniocentesis rates. The screening policies in East and West Gloucestershire are based on early second-trimester maternal serum and maternal age screening, respectively. Maternal serum screening can identify a greater proportion of pregnancies affected by Down syndrome than a programme founded on age-based amniocentesis and 20 weeks' ultrasound. In addition, maternal serum screening of women older than 34 approximately halves the number of amniocenteses performed to detect one affected fetus. However, the proportion of pregnant women who have amniocentesis is nearly doubled by offering serum screening to women aged over 24 years. These findings of the impact of established second-trimester screening policies in low-risk populations provides an useful benchmark to compare the performance of screening procedures that will be introduced in the United Kingdom over the next 3 years.

Adult↗
PubMed2003

Platelet FcgammaRIIA His131Arg polymorphism and platelet function: antibodies to platelet-bound fibrinogen induce platelet activation.

The His131Arg polymorphism of platelet FcgammaRIIA affects the binding affinity of certain IgG subclasses. The Arg131 allele has been associated with (auto)immune thrombocytopenia and heparin-induced thrombocytopenia in some studies. Because FcgammaRIIA can transmit platelet activation signals, we studied platelet responsiveness from 73 healthy donors to determine if this polymorphism modulated platelet function. Platelet function was studied by agonist and shear-induced activation, and standard aggregation. FcgammaRIIA was genotyped by allele-specific PCR. Compared with His131, the Arg131 allele was associated with significantly greater binding of activation-dependent antibodies. This effect was most prominent for the receptor-induced binding site (RIBS) antibodies F26 (P < 0.0001) and RIBS1 (P = 0.0057), and the ligand-induced binding site antibody LIBS1 (P = 0.0367). Unexpectedly, Arg131-positive platelets did not show greater fibrinogen binding, platelet aggregation or shear-induced platelet activation. We considered whether enhanced Fc binding and FcgammaRIIA cross-linking were responsible for those discrepancies. The increased binding of the two RIBS antibodies to the Arg131 isoform was abolished by blocking FcgammaRIIA, and the FcgammaRIIA genotype effect on F26 IgG binding was lost when F26 F(ab')2 fragments were used. Furthermore, intact F26 and RIBS1 IgG directly and specifically induced P-selectin expression, and this effect was greatest in Arg131-positive platelets. We concluded that (a) the His131Arg polymorphism of FcgammaRIIA does not affect intrinsic platelet reactivity; (b) RIBS antibodies are able to cross-link FcgammaRIIA and activate platelets, and this activation has a modest effect on Arg131 platelets; and (c) flow cytometric based platelet assays may need to compensate for this FcgammaRIIA His131Arg effect on platelet activation.

Adult↗
PubMed1999

Electrokinetic lithotripsy: safety, efficacy and limitations of a new form of ballistic lithotripsy.

OBJECTIVE: To investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high-energy magnetic fields to propel an impactor to fragment calculi. PATIENTS AND METHODS: The records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi-rigid ureteroscope, through which a 3 F EKL probe was passed. RESULTS: A total of 148 stones (mean stone size 11.5 mm, range 6-40) in 121 patients were treated using the EKL. One patient was lost to follow-up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed-dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone-free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock-wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent. CONCLUSION: EKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi-rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of >/=4 mm after EKL.

Adolescent↗
PubMed1999

Laparoscopic ureterolithotomy: the Edinburgh experience.

OBJECTIVE: To review our experience with laparoscopic ureterolithotomy. PATIENTS AND METHODS: Since 1993, we have performed laparoscopic ureterolithotomy in 14 patients with ureteric stones. Laparoscopy was carried out in nine patients as a salvage procedure after failed ureteroscopy (six), shock wave lithotripsy (two), or both (one), and in five patients as a primary procedure for large stones (mean 27.2 mm, range 18-40). Patients in the former group had already undergone a mean of 1.88 procedures (range 1-4). Laparoscopic ureterolithotomy was carried out via a transperitoneal approach. Associated ureteric strictures were incised at the time of ureterotomy. RESULTS: All procedures were completed laparoscopically and all patients were rendered stone-free after a single procedure. The mean operative duration was 105 min. Ureteric strictures were incised in three patients, in two of whom dilatation was subsequently required; all three had a successful result. There were three minor complications. CONCLUSIONS: Laparoscopic ureterolithotomy can be a safe and effective procedure; it should be considered as a primary procedure for large mid- and upper ureteric stones.

Adult↗
PubMed1997

Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study.

OBJECTIVE: To assess the efficacy and safety of transurethral needle ablation of the prostate (TUNA) for patients with symptomatic benign prostatic hyperplasia (BPH) in a multicentre trial. PATIENTS AND METHODS: Seventy-six patients were recruited from five centres; all were treated with the TUNA system consisting of a powered radiofrequency generator and a TUNA catheter. The patients were evaluated prospectively using the international prostate symptom score (IPSS), uroflowmetry, quality-of-life score, and other variables, and followed for a mean of 12 months after treatment. RESULTS: Sixty-eight patients were available for follow-up: TUNA produced significant improvements in the IPSS (median 22 before, to 7.5 after treatment). urinary flow rate (mean 8.7 before, to 11.6 mL/s after treatment) and quality-of-life score (median 5 before, to 2 after treatment) at 12 months. CONCLUSIONS: If these early promising results are maintained. In the medium to long term, TUNA therapy will be a useful low-morbidity alternative for patients with symptomatic BPH.

Aged↗
PubMed1992

Absence of fetal breathing and abnormal fetal behavior in prolonged preterm ruptured membranes: case report.

A case is described where prolonged serial observations were carried out on a fetus, between 26 and 3.5 weeks' gestation, the membranes having been ruptured from 23 weeks. No fetal breathing or cyclical activity was observed, and there was no evidence of development of linkage between the fetal behavioral state variables. This was not associated with respiratory morbidity in the neonatal period, but subsequently with severe developmental delay, microcephaly, myoclonic epilepsy and hearing impairment. Absence of fetal breathing may be a more important predictor of prenatal neurological abnormality than of respiratory morbidity following birth.

Journal Article↗
PubMed1992

The development of ultradian rhythms in the human fetus.

OBJECTIVE: Our objective was to determine the normal sequence of neurobehavioral development in the human fetus between 14 weeks' gestation and delivery. STUDY DESIGN: The study was performed by longitudinal ultrasonographic observation of 45 low-risk singleton fetuses. RESULTS: During the first half of the midtrimester there was a high rate of spontaneous movement that appeared randomly distributed. By the end of that trimester an increase in the duration of intervals of quiescence resulted in activity appearing cyclically distributed, with the duration of quiet cycles progressively increasing to term. Fetal mouthing and breathing were linked with cyclic behavior from the time of their emergence. Fetal heart rate pattern A could be recognized from around 32 weeks, due to a reduction in baseline variability in quiet cycles after 30 weeks, whereas pattern B could be recognized several weeks earlier. From the time cyclic behavior and heart rate patterns could be recognized, intervals of coincidence of the fetal behavioral state variables increased progressively with advancing gestation.

Activity Cycles↗
PubMed1991

Bizarre fetal behaviour associated with lethal congenital anomalies: a case report.

Prolonged recording of behaviour was performed in a fetus at 36 weeks gestation, who was severely small for dates with no apparent aetiology. Detailed analysis of fetal behaviour was grossly abnormal. Behavioural states were absent and there were no intervals during which linkage of the state variables was demonstrated in a total of 120 min of observation. On repeated conventional biophysical testing the non-stress test was normal and the biophysical score was equivocal, varying from 4/10 to 8/10. Following delivery a lethal multiple congenital abnormality syndrome was identified. Close linkage of the fetal behavioural state variables is almost universal by this gestation, and has been associated with a good outcome in high-risk fetuses. Behavioural recordings may have a useful role in the evaluation of such fetuses, particularly where the aetiology is not apparent.

Abnormalities, Multiple↗
PubMed1991

Human fetal mouthing movements: a potential biophysical variable for distinguishing state 1F from abnormal fetal behavior; report of 4 cases.

In late pregnancy, when fetal behavioural states are well developed, human fetuses spend about one third of their time in a quiescent state, 1F. In healthy fetuses biophysical tests often appear suboptimal if recording happens to occur in this state, and as a result prolonged recording may be necessary. We have examined fetal mouthing movements during state 1F in 65 fetuses beyond 36 weeks, with and without risk factors, but in whom there was no immediate evidence of compromise. We found that periodic rhythmical mouthing movements were a characteristic feature of state 1F, occurring in 93.0% of episodes, when the fetal mouth was visible. This compares favourably with variables of the biophysical profile, which were less likely to be satisfactory in state 1F - fetal breathing 53.8%, fetal movements 46.2%, fetal heart rate 69.2%, and overall biophysical score of 8 or 10, 60.0%. We identified objective evidence of fetal compromise (of various aetiologies) in four other fetuses of the same gestational age, and mouthing movements were absent in all four.

Adult↗
PubMed1991

Continuation of normal neurobehavioural development in fetuses with absent umbilical arterial end diastolic velocities.

Detailed serial observations of behaviour were made in four singleton fetuses who were very small for dates and who had persistently absent umbilical artery end diastolic velocities for 2 to 9 weeks duration. All were born preterm for deteriorating maternal disease, and in two there were additional fetal indications for delivery. Behavioural comparison with 45 low risk singleton fetuses, at comparable gestations, revealed no significant differences in the development of behavioural cycles, the proportion of time spent in quiet cycles, or the amount of fetal breathing. None of the fetuses developed an abnormal heart rate pattern. We conclude that prenatal neurobehavioural development may continue apparently unimpaired in the presence of absent umbilical artery end-diastolic velocity of several weeks duration. Long term data of infant outcome are necessary before the clinical significance of this can be assessed.

Apgar Score↗
PubMed1991

Intracranial haematoma resulting from lightning stroke.

Intra-cerebral haemorrhage due to lightning stroke is extremely rare. We report a 45 year old woman who developed intracranial haemorrhage due to a direct lightning stroke. This was proved by CT scan. The haematoma was evacuated surgically, resulting in full neurological recovery of the patient.

Brain Edema↗
PubMed1990

Are the behavioural states of the newborn comparable to those of the fetus?

Comparisons were made between ultrasound behavioural recordings of 18 healthy term fetuses and recordings of the same variables of the same individuals at 3 to 5 days postnatally. Statistical comparison of the frequency of eye movements, limb and body movements revealed that the fetal states 1F and 2F were comparable to quiet sleep (S1), and rapid eye movement (REM) sleep (S2), respectively in the newborn. Comparisons between the fetal states and wakefulness were less clear-cut. The heart rate in each of the three states in the fetus was about 20 beats per min higher than in the corresponding postnatal state, although the patterns were similar. States 1F and 2F accounted for a higher percentage of the fetal observations (86%) than states S1 and S2 in the neonatal observations (64%), but the ratio of the different types of sleep was similar in both recordings (30% quiet sleep to 70% REM sleep). State S3 (quiet awake) always and only occurred in the postnatal observations in association with feeding. No comparable behaviour occurred during the prenatal observations (2050 min in 18 fetuses). Numerically the movements observed in S5 (crying) were not significantly different from 2F, however qualitatively there were marked differences, and also S5 was characterized by a heart rate pattern quite unlike anything observed prenatally (often with a rate in excess of 200 beats per min). We postulate that S3 and S5 are postnatal behavioural adaptations to extrauterine existence.

Behavior↗