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Biomedical subjects

S J Steele

Publications and source records attributed to S J Steele.

17 recordsLinked to original sources
PubMed1991

Quantitative determination of acid-labile DNA in cervical intraepithelial neoplasia.

Using a modified Feulgen hydrolysis procedure and integrating microdensitometry, the acid-labile nuclear DNA in exfoliated cervical epithelial cells was quantified in a range of histologically confirmed cervical intraepithelial neoplasia (CIN), invasive cancer, and normal controls. The mean relative optical densities obtained for each sample group showed an increase from normal epithelium, through CIN grades, to invasive cancer. Although there was some overlap between groups, the difference in the overall mean values between the adjacent groups was statistically significant. The sensitivity of the test was 87.1% with a specificity of 99.2% and a predictive value of 99.5%, with no false negatives in the severe dysplasia and cancer groups. Quantitative data allows the threshold value to be altered to vary the sensitivity and specificity according to prevailing requirements. This suggests the possibility of using quantitative acid-labile DNA measurements to improve existing screening for cervical precancer.

Cell Nucleus↗
PubMed1988

Outcome of pregnancy in underweight women after spontaneous and induced ovulation.

Low maternal weight before pregnancy and poor weight gain during pregnancy are known to result in an increased prevalence of low birthweight infants. Low body weight is also an important cause of amenorrhoea. The hypothesis that amenorrhoeic underweight women who become pregnant after induction of ovulation are more at risk of delivering low birthweight infants than underweight women who ovulate spontaneously was investigated. Forty one pregnant women in whom ovulation had been induced and 1212 in whom ovulation was spontaneous were studied. Women ovulating spontaneously whose weight was normal and who showed good weight gain during pregnancy (greater than 450 g a week) had the lowest incidence (6%) of babies who were small for gestational age. Underweight women (body mass index less than 19.1) who ovulated spontaneously had a threefold increased risk of delivering babies who were small for gestational age (18%). Overall, the women in whom ovulation had been induced had an even higher risk of babies who were small for dates (25%), and the risk was greatest (54%) in those who were underweight. The outcome of pregnancy is related to weight before conception, which in many cases reflects nutritional state; lack of spontaneous ovulation indicates an increased risk of producing a small for dates infant. The most suitable treatment for infertility secondary to weight related amenorrhoea is therefore dietary rather than induction of ovulation.

Body Weight↗
PubMed1979

Value of bromocriptine in unexplained primary infertility: a double-blind controlled trial.

In a double-blind controlled study, 47 women with unexplained primary infertility were allocated at random to treatment with either bromocriptine 2.5 mg twice daily (24 patients) or placebo (23). Both groups showed a fall in serum prolactin concentrations but the reduction was much greater in the bromocriptine-treated group. Neither group showed a change in serum oestrogen or progesterone concentrations. Bromocriptine significantly reduced the duration of the follicular phase of the menstrual cycle but had no effect on the luteal phase. Five women conceived during treatment with placebo and seven during treatment with bromocriptine, but analysis of the cumulative conception rates showed no significant difference between the groups. The women who conceived were significantly younger and had a significantly shorter history of infertility than the women who did not conceive, but subtracting the number of years of infertility from age eliminated this difference. The results show that bromocriptine in the dose and duration of administration used in the trial is of no value in unexplained primary infertility.

Adult↗
PubMed1978

The ward round.

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Consumer Behavior↗
PubMed1977

A sperm bank.

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Humans↗
PubMed1977

A comparison of the performance of three multiple choice question papers in obstetrics and gynaecology over a period of three years administered at five London medical schools.

Four, and later five, of the medical schools in the one multiple choice question (MCQ) paper in Obstertrics and Gynaecology to their students at the end of the Obstetrics and Gynaecology courses. The paper was amended twice after intervals of approximately 12 months. The results showed differences in performance between the five schools on questions and alternatives within questions, which were common to all editions of the paper (the "short" paper). These differences were also shown in the first two editions of the full paper (the "long" paper), but were not apparent in the third. There was a significant improvement in performance from the first to the second paper edition of the long by approximately 11%, but this was reversed from the second to the third edition, where there was a significant decrease in performance by approximately 4%. We cannot here exclude the possibility that this decrease in the third edition has resulted from sample bias. The rank order of the schools may result from differences in methods of teaching. It seems that such relative performance between London medical schools in contributed to by the differences in course legnth and by the occurence of mid-course test. It appears also that student performance in any of the schools has not been uniform over the period of the study, there being a peak during the period when the second edition of the paper was used. Variations in student selection occuring between schools may effect some of these differences. There was also a marked difference in students' performance between Obstetrics and Gynaecology. The short papers appeared easier than the full papers. Whilst this may due to the greater clarity of phrasing for the questions of the short paper, we also believe the subject matter of the short paper may be more relevant. A distinct effect could also be shown, over the period, due to improvements in the wording of the questions. It is possible that students perform better at Obstetrics than at Gynaecology.

Curriculum↗
PubMed1977

Management of hyperprolactinaemic amenorrhoea.

Results of treatment of 52 patients with amenorrhoea associated with hyperprolactinaemia are presented. All patients had a detailed radiological examination of the pituitary fossa, including lateral tomography in every patient and air encephalography in those in whom a pituitary tumour was suspected. There were 17 patients with untreated pituitary tumours, 5 patients with previously treated pituitary tumours and persisting hyperprolactinaemia, and 30 patients with normal pituitary radiology. Patients with pituitary tumours were treated either by transsphenoidal or transfrontal surgical extirpation of the tumour, followed, if necessary, by external irradiation and/or bromocriptine, Four patients were treated with external irradiation as primary therapy, and three patients who did not wish to conceive were treated with bromocriptine as primary therapy. Patients with normal radiological appearances were treated with bromocriptine as primary treatment. Ovulatory menstrual cycles developed in 42 patients and there were 19 pregnancies. Those ovulating but not conceiving had adequate nonendocrine factors to account for the disparity. Failure of response was seen in 10 patients and was due to inadequate fall of prolactin in response to surgery (2 patients), external irradiation (3 patients) and bromocriptine (1 patient), and gonadotrophin deficiency which developed after surgery in 3 patients but was present pre-operatively in 1. The relative merits of treatment by surgery, external irradiation and bromocriptine are discussed and a policy of treatment outlined.

Adult↗
PubMed1976

Clinical and endocrine features of hyperprolactinaemic amenorrhoea.

The clinical, radiological and endocrine findings in thirty-five women with hyperprolactinaemia and amenorrhoea are described. Twelve patients had radiological evidence of a pituitary tumour and six were tested after pituitary ablation. Seventeen patients with hyperprolactinaemia and normal pituitary X-rays were also studied. None was on any drug known to increase prolactin secretion and all patients were euthyroid when tested. Basal serum prolactin concentrations were high in the group with untreated pituitary tumours and in those with normal X-rays. The levels were variable in the post-ablation cases. The increase of prolactin after TRH was subnormal in all of the groups. Serum oestradiol concentrations were low in most patients and nineteen of twenty-one patients tested had no withdrawal bleeding after treatment with a progestogen. Mean serum gonadotrophin concentrations (basal and after LHRH) were normal in twenty-nine patients but subnormal in four post-ablative cases. Anovulatory responses to clomiphene were obtained in nineteen of twenty patients tested. Fifteen patients were treated with bromocriptine; twelve ovulated and eight became pregnant; two not responding had impaired LH and FSH production. Hyperprolactinaemic amenorrhoea is a common disorder with characteristic endocrine features. Galactorrhoea is unusual (30%). Treatment with bromocriptine lowers prolactin concentrations and rapidly repairs the reproductive defect.

Adult↗
PubMed1975

Very early termination of pregnancy (menstrual extraction).

Very early termination of pregnancy was performed on 424 women in three London teaching hospitals. Altogether 90% of the women were no more than 14 days overdue, and 67% of these had histological evidence of pregnancy. The procedure differed little in technique or its acceptability to the patient from termination done later in the first trimester. The similar incidence of complications suggested that it is not an alternative to conventional contraception. The response of patients, general practitioners, and referral agencies, however, indicated that there is a definite need in the community for a very early termination service.

Abortion, Induced↗
PubMed1975

Incidence and significance of hyperprolactinaemia in women with amenorrhea.

Serum prolactin and gonadotrophin concentrations were measured by radioimmunoassay in 106 women with amenorrhoea. Prolactin was normal in those with weight related disorders, primary ovarian failure, those with a variety of systemic diseases and in those in whom amenorrhoea followed treatment with the oral contraceptive and in unexplained primary amenorrhoea. Gonadotrophin concentrations in the above patients were normal except in those with primary ovarian failure. Prolactin was elevated in eight of forty patients (20%) with functional secondary amenorrhoea and was greatly raised in all but one of the thirteen women in this series with pituitary tumours (five of whom were studied only after treatment). Only three patients in each of the last two groups had galactorrhoea. Gonadotrophin levels were normal or slightly raised in all of the hyperprolactinaemic patients apart from those studied after hypophysectomy. Four hyperprolactinaemic patients (three with pituitary tumours and one with functional amenorrhoea) who did not have galactorrhoea have been treated with bromocriptine. Prolactin secretion was reduced in all patients and, in the two with normal gonadotrophins, ovulatory menstruation was resumed. One became pregnant in the second ovulation cycle after starting treatment. We conclude that, despite the rarity of galactorrhoea, hyperprolactinaemia is common in patients with functional amenorrhoea and in those with pituitary tumours. Treatment with bromocriptine in patients with normal gonadotrophins restores ovulation when the infertility is due to prolactin excess.

Adult↗