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Biomedical subjects

R Conroy

Publications and source records attributed to R Conroy.

At least 19 recordsLinked to original sources
PubMed1997

Can 24-hour ambulatory blood pressure measurement predict the development of hypertension in primigravidae?

OBJECTIVE: To assess the role of 24-hour ambulatory blood pressure measurement in the mid-second trimester as a predictive test for the development of hypertension in pregnancy. DESIGN: Prospective intervention. SETTING: The Rotunda Hospital, Dublin. PARTICIPANTS: One thousand one hundred and two healthy primigravid women. INTERVENTION: 24-hour ambulatory blood pressure measurement at 18 to 24 weeks of gestation. MAIN OUTCOME MEASURES: The development of pre-eclampsia or gestational hypertension. RESULTS: A total of 1048 women had sufficient readings to be included in the final analysis. Of these, 23 (2.2%) developed pre-eclampsia, 64 (6.1%) developed gestational hypertension and 961 (91.7%) remained normotensive. Significantly higher ambulatory blood pressures were recorded in both the pre-eclamptic and gestational hypertensive group compared with the normotensive group. In addition, the gestational hypertensive group had significantly higher clinically measured blood pressure compared with the normotensive group. There were no differences between the pre-eclamptic and the gestational hypertensive group for any of the blood pressure parameters analysed. The best overall predictor for pre-eclampsia was 24-hour mean diastolic pressure which using a cutoff level of 71 mmHg gave a test with a sensitivity of only 22% and a positive predictive value of 15%. CONCLUSION: Because the absolute differences are small and the overlap between the hypertensive and normotensive groups large, ambulatory blood pressure measurement, in a healthy primigravid population, between 18 and 24 weeks of gestation is not a useful predictor of hypertension.

Adult↗
PubMed1995

Cardiovascular risk factor changes in the Kilkenny Health Project. A community health promotion programme.

The Kilkenny Health Project was a community research and demonstration programme which aimed to reduce risk of cardiovascular disease in a county in the south-east of Ireland with a total population of approximately 70,000. The health promotion programme was carried out in Kilkenny from 1985 to 1992. Outcome evaluation was by means of population surveys of independent samples of men and women aged 35 to 64 years in Kilkenny (n approximately 800) and in the reference county (n approximately 600) in 1985/1986 and in 1990/1991. Survey methods for health behaviour questionnaires and risk factor measurements were similar to those of the WHO MONICA Project. Mean systolic blood pressure (SBP) declined significantly (P < 0.01) in men and women in both counties, from 144.0 by 5.4 mmHg and from 143.2 by 5.4 mmHg in men and from 139.5 by 7.7 mmHg and from 136.5 by 6.6 mmHg in women in the intervention and reference counties. The prevalence of hypertension declined from 23.1% by 2.8% and from 26.1% by 6.0% in men in the two counties. Prevalence declined from 24.1% by 6.2% (P < 0.05) in women in the intervention county but was unchanged, increasing by 0.5% from 17.5%, in women in the reference county. Mean serum total cholesterol declined from 6.04 mmol.l-1 by 0.09 mmol.l-1 and from 6.00 by 0.44 mmol.l-1 (P < 0.01) in men and from 6.01 by 0.36 (P < 0.01) and from 5.90 by 0.31 (P < 0.01) in women in the intervention and reference counties, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A comparison of mass balance, pharmacokinetics and disposition of [14C(U)]- and [125I]recombinant human interleukin-2 in cynomolgus monkeys.

Recombinant human interleukin-2 (rHuIL-2) has been metabolically labeled with 14C amino acids in Escherichia coli and affinity purified on a rHuIL-2 receptor affinity column. The radiolabeled molecule had a specific radioactivity of 238 dpm/unit and the identical amino acid sequence and biological activity as unlabeled rHuIL-2. In this study, we used this labeled [14C(U)]rHuIL-2 and commercially available [125I]rHuIL-2 (identical in sequence to the [14C(U)]rHuIL-2) to compare the mass balance, pharmacokinetics, and disposition in cynomolgus monkeys. After a single intravenous bolus dose of 4 x 10(5) units/kg, serum samples were collected for 7 days and examined for biological activity, total radioactivity, and by molecular size exclusion chromatography. Urine and feces were analyzed for total radioactivity. When analyzed for biological activity, both [14C(U)]- and [125I]rHuIL-2 exhibited the following pharmacokinetic parameters: terminal elimination half-life of 1-2 hr, AUC0-infinity ranged from 2005 to 4659 units x hr/ml, clearance was 90-200 ml/hr/kg, and volume of distribution ranged from 103 to 163 ml/kg. Comparison of the pharmacokinetic profiles of the two radiolabels were very different from bioactivity, in that the elimination half-lives for radioactivity were approximately 8 days and 10 hr for [14C(U)]- and [125I]rHuIL-2, respectively. We conclude that the [14C(U)]rHuIL-2 was metabolized to constituent amino acids and recycled into newly synthesized proteins from our size exclusion chromatography studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1994

Employing a practice nurse--role and training implications in an Irish context.

All 102 nurses known to be practising as practice nurses in the Republic of Ireland were sent a questionnaire for completion anonymously. A response rate of 56% was obtained. Over half the respondents had commenced practice nursing since the new General Medical Services contract in 1989 following a career break, the median duration of which was 5.5 years. Two thirds had completed midwifery training but only one was a qualified Public Health Nurse. An examination of the tasks performed by the respondents suggests that Irish practice nurses are already filling an extended role beyond their treatment room duties with 46% involved in smoking counselling, 74% in counselling on cholesterol and 37% involved in asthma care. Nurses providing antenatal care or taking cervical smears were not, however, more likely to have completed midwifery training.

Education, Nursing↗
PubMed1994

A comparative analysis of grading systems in renal adenocarcinoma.

While the histological grade of a renal cell carcinoma is of prognostic significance there is poor concordance amongst pathologists in the use of these grading systems. Many grading systems have been described, but none has achieved widespread acceptance. The objective of this study was to assess the degree of interobserver variation amongst four experienced pathologists in their use of four commonly applied grading systems. The pathologists reviewed a series of 88 cases of renal cell carcinoma. Grades were detailed on a proforma which consisted of a breakdown of each grading system. Cohen's kappa was calculated for each pair of observers for each system. The mean kappa scores for each system were compared using the Tukey honestly significant differences method. Mean kappa was highest for the grading system of Syrjanen and Hjelt and this grading system also had a higher mean kappa than two of the other systems tested. The most striking feature of the results was the degree to which the pathologists differed in their assessments. The grading system of Syrjanen and Hjelt was shown to be subject to less interobserver variability than other commonly used classifications and we are of the opinion that it should become the standard method.

Adenocarcinoma↗
PubMed1993

Twenty-four-hour ambulatory blood pressure measurement in a primigravid population.

OBJECTIVE: To establish the profiles of 24-h non-invasive ambulatory blood pressure measurement (ABPM) during the trimesters of pregnancy and the puerperium in normotensive healthy primigravidae. DESIGN: A prospective study in which 24-h ABPM was performed on five occasions in each subject: in the first trimester between 9 and 16 weeks' gestation; in the second trimester between 18 and 24 weeks; in the third trimester between 26 and 32 weeks and between 33 and 40 weeks; and finally at 6 weeks post partum. METHOD: One hundred and six Caucasian primigravid women who were normotensive at their first booking visit were recruited consecutively from the antenatal clinic and had 24-h ABPM performed with the SpaceLabs 90207 ambulatory system. RESULTS: Of the 106 women recruited, 98 completed 24-h ABPM on four of the five measurement occasions. Four women delivered prematurely before 33 weeks' gestation, thereby missing one ABPM measurement. Changes during pregnancy and the puerperium were assessed against the ABPM performed in the first trimester. There was no difference for daytime or night-time systolic blood pressure between 9 and 33 weeks, but it rose significantly from 33 to 40 weeks. At 6 weeks post partum, systolic blood pressure was not significantly different from the daytime pressure in the first-trimester ABPM but was raised significantly at night. Diastolic blood pressure decreased significantly between 18 and 24 weeks for both daytime and night-time. From 33 to 40 weeks it increased in parallel with systolic blood pressure, and at 6 weeks post partum it was raised significantly compared with first-trimester values for daytime and night-time. The nocturnal fall in blood pressure was preserved throughout pregnancy with a significant difference between daytime and night-time measurements present on all measurement occasions for systolic, diastolic and mean blood pressures and heart rate. There were significant differences between daytime ABPM and clinic blood pressure for both systolic and diastolic blood pressure up to 33 weeks. From 33 weeks until 6 weeks post partum there was no significant difference between daytime ambulatory and clinic blood pressures. CONCLUSION: This study provides reference values for ABPM in healthy primigravidae with generally uncomplicated pregnancies.

Adult↗
PubMed1993

Cloning and characterization of E2F-2, a novel protein with the biochemical properties of transcription factor E2F.

E2F is a mammalian transcription factor that appears to play an important role in cell cycle regulation. While at least two proteins (E2F-1 and DP-1) with E2F-like activity have been cloned, studies from several laboratories suggest that additional homologs may exist. A novel protein with E2F-like properties, designated E2F-2, was cloned by screening a HeLa cDNA library with a DNA probe derived from the DNA binding domain of E2F-1 (K. Helin, J. A. Lees, M. Vidal, N. Dyson, E. Harlow, and A. Fattaey, Cell 70:337-350, 1992). E2F-2 exhibits overall 46% amino acid identity to E2F-1. Both the sequence and the function of the DNA and retinoblastoma gene product binding domains of E2F-1 are conserved in E2F-2. The DNA binding activity of E2F-2 is dramatically enhanced by complementation with particular sodium dodecyl sulfate-polyacrylamide gel electrophoresis-purified components of HeLa cell E2F, and anti-E2F-2 antibodies cross-react with components of purified HeLa cell E2F. These observations are consistent with a model in which E2F binds DNA as a heterodimer of two distinct proteins, and E2F-2 is functionally and immunologically related to one of these proteins.

Amino Acid Sequence↗
PubMed1993

A case control study of malignant melanoma.

A case-control study of 100 cases of malignant melanoma (MM) and 100 matched controls has been completed. The male:female ratio of patients with MM was 1:2.4, which is similar to that found in other European studies and the mean age was 49.1 years (range 19-82 years). Significant differences were seen between cases and controls for area of residence and social class, more cases than controls came from rural areas (P = 0.007) and cases were of higher social class than controls (P = 0.003) and had attained a higher level of education (P = 0.005). Phenotypic differences between cases and controls were also observed, namely cases were more likely to have light coloured (blue/grey/green) eyes (P = 0.003) and to have had fair/red hair at age 20 (P = 0.004). Cases were also more likely than controls to dislike exposure to hot sun (P = 0.008) to report sunburning easily (P = 0.001) and to have experienced episodes of sunburn with blistering more frequently than controls (P = 0.01). History of longterm exposure to ultraviolet radiation (UV) through working outdoors, leisure activities, living abroad in sunny climates, or sun holidays was similar between cases and controls. This study supports evidence from elsewhere that episodes of acute sunburn in susceptible individuals increase risk of MM and that longterm regular exposure to UV which is important in non-melanoma skin cancer does not play a major role in the development of MM.

Adult↗
PubMed1993

Management of epiphrenic esophageal diverticula. A fifteen-year experience.

Epiphrenic esophageal diverticula represent an unusual cause of dysphagia, pain, and weight loss. Although commonly associated with motility disorders, distal esophageal diverticula also have been associated with reflux strictures or other lesions. To determine the most appropriate diagnostic evaluation and operative approach, we reviewed the recent 15-year experience with epiphrenic esophageal diverticula at our institution. Over the study period, 18 patients were diagnosed with pulsion epiphrenic diverticula. Nine patients (50%) with symptomatic diverticula were referred for surgical management. All referred patients were evaluated with preoperative manometry, endoscopy, and contrast esophagography. Diverticulectomy was performed via posterolateral thoracotomy in all patients, combined with myotomy in the 6 patients (67%) with abnormal manometric results and in 2 patients with normal manometric results. The third patient with normal manometric results underwent simple diverticulectomy. There was no operative mortality. One complication, a small esophageal leak, was managed successfully by early reoperation. All patients were free of dysphagia at discharge. Follow-up was obtained for 17 patients (94%) ranging from 3 months to 12 years. Good to excellent results (measured by relief of symptoms, weight gain, and absence of clinical recurrence) were seen in all 9 surgical patients; 6 of 9 nonsurgical patients remained or became symptomatic. This experience demonstrates the efficacy of surgical management of symptomatic epiphrenic esophageal diverticula. Diverticulectomy combined with selective myotomy permits excellent operative results and resolution of associated symptoms.

Deglutition Disorders↗
PubMed1991

Laser-assisted versus mechanical recanalization of femoral arterial occlusions.

A randomized clinical trial was performed to test the hypothesis that a laser-heated probe is superior to standard techniques to reopen occluded femoral arteries. Twenty patients were treated with a standard guidewire and balloon dilation method. In a second group of 20 patients, the laser probe was initially used as a nonheated mechanical device. If the probe was unsuccessful in mechanically reopening the artery, an Argon laser was activated to heat the probe. The mean length of occlusion was 15.9 +/- 10.3 cm. The success rate for the laser probe was 15 of 20 (75%), which was not significantly different from the standard method, 19 of 20 (95%). Most of the success in the laser-probe group was due to the probe's mechanical properties. The laser probe was successful as a cold, mechanical device in 13 of 15 (87%) arteries. It was necessary to heat the probe in 5 patients. When heated, the laser probe assisted recanalization in 2 but perforated the artery in 3 cases. The results of this randomized trial do not support the hypotheses behind the use of the thermal laser probe. The laser probe functions primarily as a mechanical device. The thermal activation does not significantly improve the success rate without increasing the risk of perforation. This small additional benefit does not justify the large cost of current thermal laser devices. This controlled study also demonstrates a higher success rate in long occlusions than previous reports of mechanical balloon recanalization. This is due to a combination approach of retrograde and anterograde probing of the occluded segment.

Adult↗
PubMed1991

The Kilkenny Health Project: a community research and demonstration cardiovascular health programme.

Ireland has one of the highest death rates in the world from coronary heart disease (CHD) and has not shared in the rapid decline in mortality which has occurred in other countries. The Kilkenny Health Project was established as a community-based research and demonstration programme for cardiovascular disease prevention in County Kilkenny and as a pilot project for future national initiatives. The first phase of the health promotion programme in Kilkenny is being carried out between 1985 and 1990. Changes in behaviour and in factors associated with CHD will be estimated by the difference in changes over time between Kilkenny and the reference area, as measured by independent random sample surveys of men and women aged 35 to 64 years. CHD and stroke events, fatal and non-fatal, will be registered in both areas from 1987-1992. The Project has studied attitudes to CHD and its prevention. Health behaviours have been studied in adults and in post-primary school pupils. Risk factors for CHD have been measured in adults in accordance with the methods of the international MONICA Project. It has been demonstrated that health and education professionals can incorporate preventive activities and health education into everyday practice.

Adult↗
PubMed1991

Registration of myocardial infarction and stroke in the Kilkenny Health Project: methodology.

A myocardial infarction and stroke register was established in January 1987 as part of the evaluation of the Kilkenny Health Project. This is a community programme which aims to reduce risk factors for coronary heart disease. The register records acute myocardial infarction and stroke in residents of County Kilkenny and of the reference county. This will provide accurate estimates of the incidence of these diseases and of trends over time. Methods used comply with the protocol in use by the WHO MONICA Project. This will allow comparison of the incidence of coronary heart disease and stroke in this register with that in other MONICA locations, including that in Belfast, Northern Ireland. Information is obtained from sources in hospitals and the community about relevant history, symptoms and investigations. Information about deaths is also obtained from these sources, and from coroners, death registers and the Central Statistics Office. Appropriate steps are taken to ensure confidentiality of the information. Each event satisfying the MONICA diagnostic criteria for myocardial infarction and stroke is coded in accordance with the MONICA protocol, categorised and registered.

Adult↗
PubMed1991

A heart health assessment programme in general practice in County Kilkenny, Ireland.

The Kilkenny Faculty of the Irish College of General Practitioners and the Kilkenny Health Project have established a Health Assessment Programme (HAP) to standardise the examination and recording of coronary heart disease (CHD) risk factors in general practice. Criteria were agreed for classification and coding of demographic data, relevant medical history and risk behaviours. Height, weight and blood pressure are measured and venous blood sample is taken for total cholesterol estimation. The assessment is followed by appropriate counselling. The HAP was first targetted at men and women aged 40 to 49 years. During the first 16 months of the programme, 2102 assessments were carried out by 41 general practitioners, which represents 29% of the target group. Those taking part had a lower social class distribution when compared with participants in the KHP baseline survey in 1985. There were no significant differences between the two groups in smoking prevalence or in the distribution of body mass index. Median cholesterol was 5% lower in the HAP group than at the baseline survey. 16% of the HAP clients had diastolic blood pressures of 90 mm Hg or more. The HAP has demonstrated that it is feasible to measure CHD risk factors in a variety of general practice settings. The format facilitates a preventive orientation and has proved acceptable to patients.

Adult↗
PubMed1991

Heparin inhibition of von Willebrand factor-dependent platelet function in vitro and in vivo.

The intravenous administration of heparin to patients before open heart surgery reduced ristocetin cofactor activity by 58% (P less than 0.01, t test), and this impairment of von Willebrand factor-dependent platelet function was closely related to plasma heparin levels (r2 = 0.9), but not to plasma von Willebrand factor (vWF) levels. We hypothesized that heparin may inhibit vWF-dependent platelet hemostatic functions by directly binding vWF in solution and interfering with vWF-GpIb binding. Using the in vitro techniques of ristocetin-induced platelet agglutination, fluorescent flow cytometric measurement of vWF-platelet binding, and conventional radioligand binding assays we observed that heparin inhibited both vWF-dependent platelet function and vWF-platelet binding in a parallel and dose-dependent manner. Heparin also inhibited platelet agglutination induced by bovine vWF and inhibited the binding of human asialo-vWF to platelets in ristocetin-free systems. The inhibitory potency of heparin was not dependent upon its affinity for antithrombin III, but was molecular weight dependent: homogeneous preparations of lower molecular weight were less inhibitory. Heparin impairment of vWF function may explain why some hemorrhagic complications of heparin therapy are not predictable based on techniques for monitoring the conventional anticoagulant effects of heparin.

Agglutination↗
PubMed1991

Sex steroids, adiposity and smoking in the pathogenesis of idiopathic hirsutism and polycystic ovary syndrome.

Hyperestronemia may be central to the development of polycystic ovary syndrome. The present study was designed to examine whether increased availability of androstenedione or increased aromatase closely associated with adiposity, plays the dominant role in the development of hyperestronemia. We measured plasma androstenedione, estrone and the estrone/androstenedione ratio (an indirect index of peripheral aromatase activity), in 141 patients with idiopathic hirsutism and in 88 patients with polycystic ovary syndrome. Estrone levels were higher in polycystic ovary syndrome, 250.4 +/- 129 (mean +/- standard deviation) than in idiopathic hirsutism, 210.6 +/- 119 pmol/l, p less than 0.05. Plasma androstenedione levels were higher in polycystic ovary syndrome, 8.24 +/- 3.5, than in idiopathic hirsutism, 7.1 +/- 1.7 nmol/l, p less than 0.0025. However, the estrone/androstenedione ratio was similar in the two groups. In all patients who smoked, androstenedione was higher, 8.14 +/- 3.22 than in nonsmokers, 6.99 +/- 2.96 nmol/l, p less than 0.005. Smokers had a lower body mass index, 23.9 +/- 2.3, than non-smokers 25.6 +/- 4.8 kg/m2, p less than 0.025. However, estrone levels were similar in smokers and in non-smokers. These data indicate that elevated estrone is more closely related to increased availability of androstenedione than to increased aromatase activity. While cigarette smoking appears to increase androstenedione levels, it may inhibit aromatase activity either directly or indirectly because of an associated reduction in adiposity. However, since the relative frequency of polycystic ovary syndrome and idiopathic hirsutism was similar in smokers and non-smokers, smoking did not appear to reduce estrone bioactivity as had been claimed.

Adrenal Glands↗
PubMed1990

Does intensive medical therapy influence the outcome in unstable angina?

Three hundred and forty-six patients of all ages and both sexes were admitted to coronary care with documented unstable angina. Management was conservative, without the routine use of beta-blockers or calcium antagonists. Mortality was 3.2%, and the nonfatal myocardial infarction rate was 10.1% during the first 28 days. After one year, coronary mortality was 10.5% with a nonfatal infarction rate of 13.1%. Twenty-six patients were subjected to coronary artery bypass surgery, eleven during the first 28 days and fifteen subsequently. No patient underwent coronary angioplasty. The factors influencing immediate and long-term prognosis in these patients were studied. Persistence of pain in hospital, previous chronic angina, and age had an adverse effect on outcome. A total of 143 patients complained of persistent pain lasting for 24 hours or more. The use of beta blockers or calcium antagonists in patients with persistent pain exceeding five days did not appear to influence outcome. The current widespread adherence to "intensive medical treatment," including the routine use of beta blockers and calcium antagonists, is questioned.

Adrenergic beta-Antagonists↗
PubMed1990

The health and risk factor status of industrial employees.

2,183 employees from 13 Irish industries volunteered to take part in a risk factor identification and health counselling programme. Data are presented about the risk factor profile of the group. Alcohol abuse, overweight and hyperlipidaemia were prevalent, particularly among men. Hypertension, although relatively infrequent, was commoner among men and, like hyperlipidaemia and obesity, increased significantly with age. The subjects who smoked cigarettes accounted for 33% of the population studied, while 21% were ex-smokers, with substantially more ex-smokers among men than women. Only 22% of subjects took adequate exercise. Work stress was unusual but personal stress common. Only 75% of subjects used their seat belts regularly and the majority received no regular dental care. The role of industrial health programmes in disease prevention and health education, and in providing benefit to industry, is examined. Recommendations are made about effective means of encouraging healthy living in an industrial environment.

Adult↗