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Biomedical subjects

P Chamberlain

Publications and source records attributed to P Chamberlain.

At least 19 recordsLinked to original sources
PubMed1998

Prenatal sonographic diagnosis of skeletal dysplasias--a report of the diagnostic and prognostic accuracy in 35 cases.

Sonographic assessment of the skeleton is a routine part of fetal anomaly scanning. We report a series of 35 cases seen during a 7-year interval in which a skeletal dysplasia was suspected prenatally. In seven (20 per cent) of the 35 cases, a specific diagnosis could not be made either pre- or postnatally. Follow-up was incomplete in one case. In 32 (91 per cent) of the 35 cases, prenatal sonographic examination correctly predicted the prognosis, although in only 11 (31 per cent) of the 35 cases was the suggested prenatal diagnosis proven to be correct. The difficulty of making an accurate prenatal sonographic diagnosis in fetuses with suspected skeletal dysplasias throughout gestation, especially in the third trimester, and the importance of comprehensive multidisciplinary postnatal assessment in these cases are emphasized.

Abortion, Induced↗
PubMed1997

Conducting ecologically valid prevention research: recruiting and retaining a "whole village" in multimethod, multiagent studies.

Many prevention studies are now designed with complementary interventions in different settings. Evaluations of these interventions require assessing the child's behavior in each of these settings. Conducting these studies, therefore, may involve recruiting school districts, principals, classroom teachers, peers, parents, siblings, and in later years, employers and intimate partners. These participants may be considered natural raters or satellite subjects, depending on their degree of involvement. Issues of recruitment and retention thus are magnified in multimethod, multiagent studies. To illustrate these issues, findings are presented for three studies conducted with risk populations in the past decade at the Oregon Social Learning Center: a passive longitudinal study, a selected prevention study, and an indicated prevention study. Findings indicate that achieving high recruitment and retention rates for at-risk and high-risk subjects in multisetting studies is possible, and that a developmental approach should be taken to recruiting risk populations.

Adolescent↗
PubMed1997

Uterine cavity assessment prior to in vitro fertilization: comparison of transvaginal scanning, saline contrast hysterosonography and hysteroscopy.

A total of 44 patients undergoing in vitro fertilization (IVF) and requiring uterine cavity assessment agreed to have both saline contrast hysterosonography (SCHS) and hysteroscopy. SCHS was performed following a baseline transvaginal scan by injection of saline into the uterine cavity during continuous scanning. Hysteroscopy was performed with a flexible fiberscope with a 3.6-mm outer diameter; 38 of 44 women (86%) underwent both procedures. Hysteroscopy diagnosed intrauterine abnormalities in 16 women. SCHS was in complete agreement in 13 of 16 cases. As a screening test for any cavity abnormality, SCHS had a 87.5% sensitivity, 100% specificity, 100% positive predictive value and 91.6% negative predictive value. In 14 women, an abnormal uterine cavity was apparent on transvaginal scanning (TVS). However, TVS, unlike SCHS, could not (1) confidently diagnose submucosal fibroids in the presence of a uterus with multiple fibroids; (2) distinguish between a hyperplastic endometrium and a large polyp; or (3) differentiate between an arcuate and a septate uterus. In addition, ovarian pathology was diagnosed on TVS in five women: endometrioma (n = 1), complex cysts (n = 2) and polycystic ovaries (n = 2). SCHS is a simple, accurate, well-tolerated procedure that can be performed within a fertility unit, avoiding invasive and expensive diagnostic hysteroscopy. Significant findings can be treated by operative hysteroscopy prior to commencing an IVF treatment cycle.

Adult↗
PubMed1997

Is routine diagnostic laparoscopy for infertility still justified? A pilot study assessing the use of hysterosalpingo-contrast sonography and magnetic resonance imaging.

We assessed the value of hysterosalpingo-contrast sonography (HyCoSy) and magnetic resonance imaging (MRI) as alternatives to laparoscopy and dye insufflation with or without hysteroscopy in the investigation of infertility. A total of 19 women had all three procedures, in addition, one became pregnant after HyCoSy alone. The findings were: uterine fibroids (n = 5), minimal-mild endometriosis (n = 4) and moderate-severe endometriosis (n = 3) including one case of bilateral endometriomas, endometrial polyp (n = 1), polycystic ovaries (n = 2), bilateral dermoid cysts (n = 1), haemorrhagic corpus luteal cyst (n = 1) and minimal adhesions (n = 3). At laparoscopy, 31/37 tubes were patent and there was 84% concordance with the tubal patency findings at HyCoSy. The uterine fibroids and ovarian cysts were detected using transvaginal scanning; the endometrial polyp and a congenital uterine anomaly were identified using HyCoSy. These findings were detected using MRI, but in addition the technique distinguished the dermoid cysts from the endometriomas, identified the two other cases of moderate-severe endometriosis, fibroids <2 cm (n = 2) and adenomyosis (n = 5), and interpreted the haemorrhagic corpus luteum as an endometrioma. Our data suggest that women with normal HyCoSy and MRI findings have a normal pelvis and may not need routine surgical investigation.

Adult↗
PubMed1996

Contrast sonography for uterine cavity assessment: a comparison of conventional two-dimensional with three-dimensional transvaginal ultrasound; a pilot study.

OBJECTIVE: To compare conventional two- (2-D) and three-dimensional (3-D) scanning of the uterine cavity with and without saline contrast medium. DESIGN: Observational pilot study. SETTING: University-based fertility service. PATIENT(S): Ten IVF patients requiring uterine cavity assessment. INTERVENTION(S): Two-dimensional and 3-D transvaginal scans before and after injection of saline into the uterine cavity. MAIN OUTCOME MEASURE(S): Number and type of uterine cavity abnormalities detected by each technique. RESULT(S): The 2-D scanning suggested cavity abnormalities in 4 of 10 women (fibroids, 3; hyperechoeic thick endometrium, 1). The 3-D scanning confirmed these and revealed one additional abnormality suggestive of a uterine septum. The 2-D scanning with saline injection diagnosed abnormalities in 5 of 10 (uterine septum, 1; fibroids, 3; endometrial polyp, 1). The 3-D contrast scanning with saline did not add any further information to 2-D contrast scanning with saline. CONCLUSION(S): In this pilot study, 3-D scanning to assess the uterine cavity appeared to offer no advantages over conventional 2-D contrast sonography.

Female↗
PubMed1996

A comparison of patient tolerance of hysterosalpingo-contrast sonography (HyCoSy) with Echovist-200 and X-ray hysterosalpingography for outpatient investigation of infertile women.

The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 +/- 5.2 and 9.5 +/- 4.8 min and 9.4 +/- 5.2 and 11.5 +/- 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2 h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy 14/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 85%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time.

Ambulatory Care↗
PubMed1996

Antenatal diagnosis of cystic hygroma or nuchal pad--report of 92 cases with follow up of survivors.

Information on the outcome of pregnancy was collected on 92 fetuses with cystic hygroma or nuchal pad, identified prenatally. Forty three (47% of the total) were associated with abnormal karyotype. Twenty five (27%) had normal karyotype but an additional abnormality was identified on ultrasound scan. There were 10 liveborn babies in this group of whom seven had significant problems postnatally. In twenty four (26%) cases the cystic hygroma or nuchal pad was an isolated finding. Seventeen (89% of those in which the pregnancy was electively continued) were liveborn and reported to be normal. Those with a normal karyotype, no other anomaly identified on antenatal scan, and smaller non-septate lesions have a good prognosis.

Adult↗
PubMed1996

Hysterosalpingo-contrast sonography (HyCoSy) using Echovist-200 in the outpatient investigation of infertility patients.

This study describes the introduction of hysterosalpingo-contrast sonography (HyCoSy) as a first line outpatient investigation of uterine and tubal factors in two fertility units. 136 infertile women had transvaginal scanning before and during the intrauterine injection of contrast medium (Echovist-200). HyCoSy was successfully completed in 132 cases (97%) within a mean time of 12.6 +/- 8.4 (4-50) min. The uterus and its cavity appeared normal in 108 (82%) women. Uterine abnormalities in the remaining 24 women (18%) included structural abnormality (n = 7), fibroids (n = 12) and endometrial polyps (n = 5). A total of 261 fallopian tubes in 132 women were assessed: 186 (71%) appeared patent and 55 (21%) blocked. The remaining 20 (8%) could not be assessed for technical reasons. Polycystic ovaries and ovarian cysts were diagnosed in eight women. The most common adverse effect was mild/moderate pain, similar to period pain, with 24 (18%) women requiring simple analgesia. HyCoSy is a simple and well tolerated outpatient procedure. The technique provides clinically valuable information about tubal patency, ovarian and uterine abnormalities.

Ambulatory Care↗
PubMed1996

Omphalocele and pericardial effusion: possible sonographic markers for the pentalogy of Cantrell or its variants.

BACKGROUND: The pentalogy of Cantrell consists of defects involving the diaphragm, abdominal wall, pericardium heart, and lower sternum. CASES: We report three cases of the pentalogy of Cantrell (variant form), involving an omphalocele complicated by an anterior diaphragmatic hernia. In two cases, a pericardial effusion was noted at antenatal scanning; the case without a pericardial effusion had an intact diaphragmatic pericardium at surgical repair. CONCLUSION: The presence of a pericardial effusion in association with an omphalocele should prompt a detailed search for other features of the pentalogy of Cantrell or its variants.

Abdominal Muscles↗
PubMed1995

Generation and characterization of monoclonal antibodies to human type-5 tartrate-resistant acid phosphatase: development of a specific immunoassay of the isoenzyme in serum.

We have characterized four monoclonal antibodies (mAbs) to the purple ("tartrate-resistant," band 5) acid phosphatase of the human osteoclast (TRAP) and used these to develop a specific serum immunoassay. All four mAbs are of high affinity (Ka = 1-5 x 10(8) L/mol) with a very fast Kassoc (0.2-2.0 x 10(5) L mol-1 s-1) and a moderate Kdissoc (1-3 x 10(-3) s). Two of the mAbs were selected to develop a time-resolved fluorescence immunoassay to measure serum concentrations of TRAP. The mean serum immunoreactive TRAP in a group of healthy premenopausal women and men was 3.7 +/- 1.8 micrograms/L (mean +/- SD) and 3.5 +/- 1.6 micrograms/L, respectively. Significantly higher concentrations of TRAP were found in postmenopausal women (6.3 +/- 2.3 micrograms/L) and in eight patients with Gaucher disease (19.3 +/- 4.7 micrograms/L). Further studies are required to investigate the value of serum TRAP as a marker of bone resorption.

Acid Phosphatase↗
PubMed1994

Prenatal determination of fetal rhesus D status by DNA amplification of peripheral blood of rhesus-negative mothers.

We have developed a sensitive PCR-based assay for the RhD gene and used it to detect circulating fetal cells from RhD-positive fetuses from peripheral blood of RhD-negative mothers. With further improvement in diagnostic accuracy, this assay may have implications in the management of RhD-sensitized pregnancies in women whose partners are heterozygous for the RhD gene. Further studies are required to determine the relationship between maternal anti-D levels and circulating fetal cell numbers.

Amniotic Fluid↗
PubMed1994

Hereditary multiple intestinal atresia--ultrasound findings and outcome of pregnancy in an affected case.

A case of multiple intestinal atresia is described. Dilatation of the bowel was observed at 17 weeks' gestation during routine ultrasound scan of a healthy Caucasian primigravida from a non-consanguineous marriage. Amniocentesis was performed. The karyotype was normal male and cystic fibrosis screening was negative. Regular scans were performed throughout the pregnancy and a simple bowel obstruction was suspected. The baby was delivered at 37 weeks' gestation in good condition. Initial clinical examination was normal but abdominal distension developed during the first day. At laparotomy, prepyloric septal atresia, a distal duodenal membrane, and multiple intestinal atresia were found. The baby died aged 4 days. Post-mortem examination of the abdomen confirmed the absence of lumen from long segments of the small intestine together with areas of colonic atresia. Histology and distribution were consistent with those reported in familial multiple intestinal atresia. The pitfalls in the interpretation of prenatal ultrasound scans and the possibility of prenatal diagnosis in future pregnancies are discussed.

Fatal Outcome↗
PubMed1994

Obliteration of the distal bile duct in the development of congenital choledochal cyst.

The authors report the first case of antenatally diagnosed choledochal cyst having evidence of early fetal bile drainage and complete obliteration of the distal bile duct. This disputes the traditional hypothesis of reflux of pancreatic enzymes and supports the recent theory of primary obstruction as the etiologic cause of choledochal cyst. Coexisting congenital hypothyroidism and pulmonary stenosis had not been reported previously.

Bile Ducts↗
PubMed1994

Use of pooled time series in the study of naturally occurring clinical events and problem behavior in a foster care setting.

Pooled time series is an underused analytic technique with the potential to increase researchers' ability to exploit clinical data. This article demonstrates the value of pooled time series by analyzing the behavior of youths in a specialized foster care treatment setting in response to a naturally occurring clinical event: changes in the number of youths living together in a treatment foster care setting. Pooled time series moves beyond typical clinical analyses with an increased capability of controlling statistically for complex within-subject effects and with a clinically useful measure of effect size. The complexity of the intrasubject data made it virtually impossible to determine the relevant significance (i.e., clinical meaning) of the clinical event by the use of standard n = 1 visual analysis procedures or standard statistical methods (e.g., chi square). After things such as autocorrelation and individual time trends were statistically controlled, each additional youth increased the number of problematic behaviors by one behavior per youth per day on the Parent Daily Report.

Adolescent↗