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N Saunders

Publications and source records attributed to N Saunders.

At least 19 recordsLinked to original sources
PubMed1992

Sleep disordered breathing and cognitive function in a retirement village population.

Sleep disordered breathing (SDB) may be associated with cognitive dysfunction in non-demented elderly people. A random sample of 96 retirement village residents were given both neuropsychological assessment and overnight sleep monitoring with a portable microprocessor based system (Vitalog PMS-8). Respiratory disturbance index (RDI) was calculated as the number of apnoeas and hypopnoeas per hour of sleep. RDI was not associated with 'memory', 'verbal', and 'motor' factors identified from the analysis of cognitive tests, but was associated with the 'cerebral efficiency' factor (R2 = 0.21, p less than 0.0001). Seventy-three subjects had repeat neuropsychological tests, median time to follow-up being 17 months. Baseline RDI did not predict changes in scores on the two factors identified from the second analysis. We conclude that mild to moderate disturbance of breathing during sleep is not associated with cognitive dysfunction in non-demented subjects.

Activities of Daily Living↗
PubMed1992

The prognostic value of fetal ultrasonography before induction of labour.

OBJECTIVE: To investigate whether ultrasound examination of the fetus and amniotic fluid before induction of labour can provide useful prognostic information about the course of labour and mode of delivery. DESIGN: A prospective observational study. SETTING: The delivery suite of St Mary's Hospital, London. SUBJECTS: 101 women undergoing induction of labour. MEASURED VARIABLES: Biparietal diameter, head circumference, abdominal circumference, occipital position, amniotic fluid volume and umbilical artery Doppler velocimetry waveforms. MAIN OUTCOME MEASURES: The outcome of labour was assessed in terms of the induction delivery interval, the mode of delivery and the incidence of abnormal cardiotocograms in labour. RESULTS: Seven women were delivered by emergency caesarean section early in the first stage of labour because of a significant abnormality of the fetal heart trace and these pregnancies were characterized by small fetal abdominal circumference measurements. Marked oligohydramnios was also noted in five of these seven subjects. Small or average size babies who were surrounded by an adequate volume of amniotic fluid tended to be born spontaneously, whereas the majority of operative deliveries for failure to progress in labour were associated with fetal abdominal circumference measurements > or = 340 mm. The mean Bishop score of women before labour who delivered spontaneously was not significantly different from the scores of women who had a forceps delivery or caesarean section. Abnormal cord Doppler waveforms were observed in only one instance. CONCLUSIONS: In women undergoing induction of labour, the measurement by ultrasonography of two variables (fetal abdominal circumference and amniotic fluid volume) may allow the prospective identification of pregnancies at increased risk of fetal distress or dystocia. If these findings can be replicated in early spontaneous labour than more rational utilization of resources may be possible in hospital based obstetric practice.

Amniotic Fluid↗
PubMed1991

Can we abandon Naegele's rule?

A pregnant woman may become anxious if she has not delivered by the date given to her by her physician. Much anxiety would be alleviated if a range of dates (38-42 weeks) was substituted for a specific date of delivery.

Anxiety↗
PubMed1990

Endoscopic localization of the squamocolumnar junction before cervical cone biopsy in 284 patients.

A preoperative examination of the endocervical canal was performed in 284 patients scheduled for excisional cone biopsy because of abnormal cervical cytology and unsatisfactory colposcopy. The information obtained regarding the depth of the new squamocolumnar junction (SCJ) was used to tailor the length of the cone specimen in an attempt to remove the entire transformation zone (TZ), and was associated with a low rate of incomplete disease excision. An analysis of the data generated by this study indicates that the position of the new SCJ is influenced by age, menopausal status, and the use of estrogen-containing medication.

Adult↗
PubMed1990

The potential for adjuvant therapy in early-stage cervical cancer.

Adjuvant therapy may potentially improve prognosis in women with early-stage cervical cancer who are at high risk of relapse after primary therapy. Patients with lymph node involvement at surgery are at high risk of recurrence and may benefit from adjuvant therapy, but many patients are treated with radical radiotherapy. At present there is no method of accurately identifying patients at high risk of recurrence in the latter group. A retrospective analysis of 141 surgically managed cases with stage I/II a cervical cancer is presented. The study aims were to characterize patients at high risk of relapse, identify independent prognostic variables predicting for relapse and, using these variables, develop a model, that would accurately predict high-risk patients. Univariate analysis identified depth of invasion, substage, lymph node involvement, lymphatic and blood vessel invasion and tumour differentiation as significant prognostic variables. After stratification for depth of invasion, which did not conform to the proportional hazards assumption implicit in the Cox model, Cox regression analysis showed substage, lymphatic and vascular invasion and histological tumour type to be independent prognostic variables. Using these variables, classification models were constructed that would be applicable to patients treated with either surgery or radiotherapy. Applying the models to 110 cases with greater than 18 months follow-up, 11/18 (61%) and 11/19 cases (58%) predicted as being at high risk of relapse have developed recurrence. Highly active chemotherapy is now available for this disease. We have demonstrated that combined bleomycin, ifosfamide and cisplatin (BIP) is one of the most active regimens in this disease. BIP produces cytoreduction in around 70% of patients with recurrent and primary advanced disease. Responses are achieved rapidly and acute radiotherapy toxicity is not enhanced by giving chemotherapy prior to radical local radiotherapy. A multicentre, prospective randomized trial testing the role of BIP as adjuvant therapy in patients with positive nodes at radical hysterectomy is now in progress. A complementary study testing the role of adjuvant chemotherapy in high-risk patients treated with radical radiotherapy is in preparation.

Adenocarcinoma↗
PubMed1990

Unsatisfactory colposcopy and the response to orally administered oestrogen: a randomized double blind placebo controlled trial.

Thirty-six women with dyskaryotic cervical smears and unsatisfactory colposcopy were randomly allocated to receive either 30 micrograms ethinyl oestradiol or placebo daily by mouth for 10 days. Thirty-four women were available for review (17 women in each of the two groups), full colposcopic inspection of the transformation zone was possible in a significantly greater proportion of the oestrogen treated group (70% versus 23%, P less than 0.01). As most diagnostic conizations are currently performed on the basis of unsatisfactory colposcopy, the use of oestrogen medication followed by colposcopic reassessment should permit a reduction in the number of patients subject to operation.

Adult↗
PubMed1990

Progressive congenital hypertrophy of the feet.

A case of progressive congenital hypertrophy of the feet was presented. From a diagnostic standpoint, this case was extremely challenging. Local gigantism was excluded from the diagnosis because the deformity was localized to both feet, with all components showing a concomitant increase in size. Furthermore, there was no evidence of neurofibromatosis or arteriovenous fistula formation. Other conditions leading to lower extremity hypertrophy, ie, Klippel-Trenaunay-Weber syndrome and other diseases associated with angiodystrophy, were excluded because of the absence of varicosities and cutaneous angiomas. There also was no evidence of an adrenal tumor or enchondromas. There was, however, a slight increase in the temperature of the left limb and an increase in the amount of vascular channels of the lower extremity, which may relate to an obscure form of angiodysplasia. Furthermore, the patient's mother took thalidomide during pregnancy, which has been shown to cause a large range of limb deformities. The authors believe that it is appropriate to classify this case as an idiopathic form of progressive congenital hypertrophy, localized to the feet of a 25-year-old Caucasian female. The goal of treatment is primarily two-fold. First, progressive narrowing of the forefoot should be obtained through closing wedge osteotomies. Second, multi-stage debulking of the muscle tissue should be performed, with associated skin reductions. The authors believe that this is the first reported case of bilateral muscular and bony hypertrophy of the feet, which was present at birth and continued to increase after the cessation of skeletal growth.

Adult↗
PubMed1990

Microcolpohysteroscopic tailoring of cervical conization.

The ideal cone biopsy should have its apex just above the transformation zone to ensure removal of all abnormal squamous and metaplastic epithelium in the endocervix, with only minimal normal glandular tissue included. The microhysteroscope has been shown to be useful in identifying the upper limit of the transformation zone within the canal, and this distance from the external os can be measured. However, this technique has not been evaluated to determine whether it can tailor cone length to this predetermined measurement. We report an observational analysis of 176 consecutive conizations in patients with colposcopically proved extension of abnormal epithelium high into the cervical canal. In 162 cases, the distance of the transformation zone from the external os could be measured with the microhysteroscope and its endocervicometer, permitting an attempt to tailor the cone length to this measurement plus a safety margin of 5 mm. There was good correlation between the intended cone length and the excised cone length, with 85% of the excised cones falling within 5 mm above or below the intended measurement. In 153 instances (94.4%), the excised cones had clear endocervical margins. Thus, tailoring of the cone length to the hysteroscopically determined measurement is feasible, thereby increasing the chances of complete excision while limiting cone size to the required minimum.

Adult↗
PubMed1989

Characteristics of protective immunity in mice induced by drug-attenuated larvae of Schistosoma mansoni. Antigen localization and antibody responses.

Partial resistance to reinfection developed in mice with immature infections of Schistosoma mansoni treated with the drug Ro11-3128, whereas mice vaccinated with irradiated cercariae and treated in a similar way did not become immune. Persistence of drug-treated parasites in the skin and draining lymph nodes, which prolonged the opportunity for efficient Ag presentation, was necessary for the development of protective immunity. Death and clearance of parasites solely in the skin, was not sufficient to induce protection. The expansion in the number of lymphocytes in the skin-draining nodes after vaccination, was reflected in the contrasting levels of resistance induced by the different drug-treatment regimes. Challenge parasites were eliminated predominantly after they reached the lungs. An investigation of antibody reactivity revealed an immunodominant response against a doublet of Ag of Mr 97 to 99 kDa. Recognition of this complex by antisera from different groups of mice was not related to their immune status. Western blots and inhibition analysis showed that this doublet has epitopes in common with the Sm97/paramyosin protective Ag, originally identified by antisera reactivity from mice immunized with a nonliving vaccine.

Animals↗
PubMed1989

Adverse reactions to diphtheria, tetanus, pertussis-polio vaccination at 18 months of age: effect of injection site and needle length.

Adverse reactions after diphtheria, pertussis, tetanus, polio vaccination at 18 months of age were investigated in three groups: 74 children injected in the deltoid muscle with a 16-mm (5/8-in) needle, 64 in the anterolateral thigh with a 16-mm needle, and 67 in the anterolateral thigh with a 25-mm (1-in) needle. No significant differences in systemic reactions were observed. Severe pain occurred in 30.5% of the groups injected in the thigh compared with only 8.1% of the group injected in the arm (P less than .001). Children vaccinated in the thigh had decreased movement of the extremity significantly more often than those injected in the arm (49.9% v 25.6%, P less than .0005), and two thirds of the former limped for 24 to 48 hours. Redness and swelling were observed more often after injection in the arm than in the thigh (58.1% v 26.7%, P less than .0005). The only effect of changing needle length in the groups injected in the thigh was the occurrence of more redness and swelling in children vaccinated with the 16-mm needle compared with the 25-mm needle. Overall, parents rated more reactions as moderate to severe among children injected in the thigh than among children injected in the arm (64.2% v 37.9%, P less than .001). The deltoid muscle appears to be the preferred site for administration of diphtheria, pertussis, tetanus, polio vaccine at 18 months of age.

Arm↗
PubMed1988

Management problems associated with carcinoma of the cervix diagnosed in the second trimester of pregnancy.

A 29-year-old women presented in the second trimester of pregnancy with a stage IIB squamous carcinoma of the cervix. Fundal hysterotomy was performed with a view to radical radiotherapy the following week. The patient developed a pyometra in the postoperative period due to the position and nature of the tumor. Management strategies for dealing with similar cases are outlined.

Adult↗
PubMed1988

Diazotised [125I]iodosulphanilic acid is not a marker for the outer bilayer of the tegument of adult Schistosoma mansoni.

Diazotised [125I]iodosulphanilic acid (DISA), has been used to label the tegument surface of adult male Schistosoma mansoni in vitro. In a surface membrane fraction prepared by freeze-thaw, only a negligible amount of lipid material was labelled by DISA, and 15 labelled protein bands were detected, ranging in apparent molecular weight from 21,000 to 175,000. As a result of experiments using digitonin to extract surface material, DISA has been described as a marker for the outer bilayer of the schistosome tegument surface. However, we found that two surface membrane fractions obtained by digitonin extraction, which were expected to be enriched in either outer or inner bilayer, yielded almost identical sodium dodecyl sulphate-polyacrylamide gel electrophoresis autoradiographic patterns, with 13 labelled protein bands (21 to 64 kDa) detected in each. In addition, a large proportion of the label was not bound firmly to the worm surface, and although the intact worm surface restricted the access of the label to membrane proteins, nevertheless proteins of the inner bilayer were labelled. Thus, we conclude that DISA is not a marker for the outer bilayer.

Alkaline Phosphatase↗
PubMed1988

The management of multiple pregnancy in women with a lower-segment caesarean scar. Is a repeat caesarean section really the 'safe' option?

Multiple pregnancy occurring in a patient who has previously had a lower-segment caesarean section is an unusual sequence of events. Retrospective analysis over an 11-year period in Sheffield from 1975 to 1985, revealed 25 cases, a rate of 1 in 3300 deliveries. The caesarean section rate in this group of women rose from 20% (3/15) in the first six years to 70% (7/10) in the latter years for no obvious reason. This change in management did not produce any improvement in fetal outcome but there was an increase in maternal morbidity. This analysis and a review of available literature suggest that multiple pregnancy is not in itself an indication for elective repeat caesarean section.

Cesarean Section↗
PubMed1988

Eponyms.

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Eponyms↗