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Biomedical subjects

W W Dinsmore

Publications and source records attributed to W W Dinsmore.

At least 19 recordsLinked to original sources
PubMed1992

A placebo controlled observer blind immunocytochemical and histologic study of epithelium adjacent to anogenital warts in patients treated with systemic interferon alpha in combination with cryotherapy or cryotherapy alone.

OBJECTIVE: To examine biopsy specimens of tissue immediately adjacent to anogenital (AG) warts which had been treated with either cryotherapy plus subcutaneous interferon (IFN) alpha 2a or cryotherapy alone, for histological features of (a) human papilloma virus (HPV) infection (b) localised cellular immune responses, to further characterise any cellular immune infiltrates with tissue immunocytochemistry, and to relate any histological, immunocytochemical findings to the treatment response of nearby AG warts. DESIGN: A randomised placebo controlled observer blind study. SETTING: Genitourinary Medicine clinic, Department of Immunopathology, Royal Victoria Hospital, Belfast, N. Ireland. SUBJECTS: Thirty patients with AG warts; 16 treated with IFN alpha 2a plus cryotherapy, and 14 treated with cryotherapy alone. OUTCOME MEASURES: (1) Light microscopic features associated with HPV infection and local cellular immune responses. (2) Indirect immunofluorescence detection of the following cell surface markers: HLA DR, alpha one antitrypsin, CD1, CD3, CD4, CD8, CD22. (3) Clinical response of AG warts to treatment. RESULTS: In pre-treatment biopsies only non specific indicators of HPV infection (acanthosis, 29/30 biopsies, and hyperkeratosis, 7/30 biopsies) were seen on light microscopy. Mononuclear cells were seen both throughout the upper dermis and centred around dermal blood vessels in 19/30 (63.3%) biopsies, and infiltrating into the epidermis in 12/30 (40%) biopsies. On indirect immunofluorescence CD3, CD8, CD4 antigen was detected on the surface of cells throughout the upper dermis in 24/29 (82.7%), 15/29 (51.7%), and 3/29 (10.3%), of biopsy specimens respectively. CD3 antigen, CD8 antigen and CD4 antigen was detected on the surface of cells infiltrating into the epidermis in 18/29 (62%), 7/29 (24.1%), and 6/29 (20.7%) of biopsy specimens respectively. CD1 antigen was seen on the surface of dendritic cells throughout the epidermis in all specimens; CD1 positive cells infiltrated into the upper dermis in 5/29 (17.2%). HLA DR was detected on the surface of dendritic cells throughout the epidermis in 22/29 (75.9%) of specimens, and on the surface of cells scattered both diffusely throughout the upper dermis and centred around dermal blood vessels in all specimens. Alpha one antitrypsin (A1AT) antigen was seen on the surface of cells in the upper dermis in 6/29 (20.7%) of biopsy specimens; no cells expressing CD22 surface antigen were seen. The nature of this local cellular immune response was not altered by treatment of nearby warts with either cryotherapy alone or cryotherapy plus systemic IFN alpha 2a, or related to the therapeutic outcome of these warts. CONCLUSIONS: (1) No convincing histological evidence of HPV infection was seen in epithelium surrounding AG warts. (2) A predominantly T cell-mediated immune response (the target of which is uncertain) was seen in this perilesional epithelium. (3) In the dosage regimens used in this study, treatment of AG warts with either systemic IFN alpha 2a plus cryotherapy or cryotherapy alone did not appear to augment localised cellular immune responses (against any presumed subclinical HPV infection) in epithelium surrounding AG warts.

Adolescent↗
PubMed1992

Non-specific immunity in patients with primary anogenital warts treated with interferon alpha plus cryotherapy or cryotherapy alone.

Combination treatment of primary anogenital warts with subcutaneous interferon alpha 2a plus cryotherapy was no more efficacious than cryotherapy alone. Patients with primary AG warts showed no in vitro or in vivo suppression of non-specific immunity. In patients treated with interferon plus cryotherapy non-specific cellular immunity was stimulated, both in vitro and in vivo compared with patients treated with cryotherapy alone.

Adolescent↗
PubMed1991

Scissor excision plus electrocautery of anogenital warts in prepubertal children.

Nineteen prepubertal children with anogenital (AG) warts were treated by scissor excision plus electrocautery under general anesthesia. Median posttreatment follow up was nine months. Minor clinical recurrences were seen in five (26.3%) children, all within three months after treatment. Recurring warts responded in all cases to home application of 0.5% podophyllotoxin (Condyline). Surgery plus electrocautery was well tolerated with no notable side effects. It is simple, safe, and efficacious, and is a suitable second-line treatment for AG warts in children.

Anus Neoplasms↗
PubMed1991

Subcutaneous interferon alpha 2a combined with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study.

OBJECTIVE: To compare patient tolerance and treatment efficacy of subcutaneous interferon (IFN) alpha 2a plus cryotherapy versus cryotherapy alone in treatment of primary anogenital (AG) warts. DESIGN: Randomised placebo controlled observer blind study. Statistical analysis was by chi square and Mann Whitney U tests. PATIENTS: 60 patients with newly diagnosed AG warts. INTERVENTION: 29 and 31 patients were treated with subcutaneous IFN alpha 2a plus cryotherapy or placebo injections plus cryotherapy, respectively. MAIN OUTCOME MEASURES: Clinical presence or absence of AG warts. Patients wart-free at 8 weeks were asked to re-attend at 12 weeks; those with persistent warts at 8 weeks were withdrawn from the study. RESULTS: At 8 weeks 60.7% (17/28 patients) of the IFN group and 67.9% (19/28 patients) of the placebo group were clinically wart-free (not significant); corresponding figures at 12 week review were 29.6% (8/27 patients) and 40% (10/25 patients) respectively (not significant). There was no difference in treatment response between males and females. Recurrence of warts at three month review, in patients cleared of warts at 8 weeks, was seen in 50% (8/16) and 37.5% (6/16) of patients in the IFN and placebo groups respectively (not significant). Multiple warts and the presence of perianal/anal canal warts, either alone or concurrent with warts on the genitalia, at first clinic attendance, were adverse prognostic indicators (p less than 0.001, and p = 0.05 respectively). Cervical human papilloma virus (HPV) infection, exophytic or subclinical, was present in 58.3% and 77.2% of females in the IFN and placebo groups respectively, at trial entry. Although these lesions were not directly treated, colposcopic resolution was seen in 12.5% of affected women, in both treatment groups, by the end of the 7 week treatment period. Systemic side effects were significantly more common in the IFN than in the placebo group, 50% versus 10.7% of patients (p less than 0.01). Severe influenza like symptoms occurred, after the first three injections only, in one patient treated with IFN; all other reported side effects were mild. CONCLUSIONS: Subcutaneous IFN alpha 2a combined with cryotherapy is no more effective than cryotherapy alone in the treatment of primary AG warts. The presence of multiple warts and perianal/anal canal warts are adverse prognostic indicators.

Anus Diseases↗
PubMed1991

Human immunodeficiency virus infection in Northern Ireland 1980-1989.

To 31st December 1989, 71 persons are known to have attended medical practitioners in Northern Ireland with a diagnosis of Human Immunodeficiency Virus (HIV) infection. Twenty-one of these persons have had the diagnosis of Acquired Immune Deficiency Syndrome (AIDS) and 11 have died. The distribution of reports in the "at risk" categories of homosexual/bisexual males, injecting drug users, heterosexual males and females was significantly different (p less than 0.001) from those reported in the United Kingdom as a whole. Of tests for HIV infection carried out in patients attending the genitourinary medicine department of the Royal Victoria Hospital between 1987-1989, 0.16% have been positive. The prognostic value of the T4 lymphocyte count at presentation for the subsequent development of AIDS was significant (p = 0.0011). The commonest AIDS indicator disease diagnosed was Pneumocystis carinii pneumonia which was seen in seven of the 21 patients (33%).

Acquired Immunodeficiency Syndrome↗
PubMed1989

Hepatitis B immunisation in northern Ireland: an epidemiological and economic analysis.

The availability of active immunisation against hepatitis B has stimulated demand for protection among health care workers. The vaccine remains expensive, and widespread immunisation will divert scarce resources from elsewhere. The arguments in favour of widespread immunisation of health care workers are based on studies from areas with prevalences of infection and carriage which are much higher than in Northern Ireland. This study was carried out to provide a rational basis for deciding who should be offered immunisation. The epidemiology of hepatitis B infection in Northern Ireland is examined. The incidence of hepatitis B in Northern Ireland is one of the lowest in the world. The evidence for an increased risk of infection among health care workers throughout the world is reviewed. The risk of infection varies widely among different countries and there is evidence that increased awareness of the hazards of sharps injuries and the introduction of safe handling techniques have substantially reduced the risk. An economic analysis suggests that a widespread programme of hepatitis B immunisation in Northern Ireland compares unfavourably with other health care interventions.

Cost-Benefit Analysis↗
PubMed1989

An open study to assess the acceptability and effectiveness of miconazole 1,200 mg single ovule in the treatment of acute vaginal candidosis.

The efficacy and acceptability of a single dose 'ovule' formulation of miconazole in the treatment of acute vaginal candidosis has been assessed in 42 patients attending a GU clinic. The signs and symptoms of vaginal candidosis were assessed by the investigator at an initial visit, and at seven and 28 days post-treatment. A high vaginal swab was taken at each visit, for routine microbiology. Patients also rated their symptoms daily for seven days post-treatment. The cure rate at Day 7 was approximately 88 per cent, with the recurrence rate at Day 28 estimated as 16 per cent of those cured. All patients found the single dosage formulation easy to use, and the majority thought the ovule effective as a treatment for their vaginal candidosis.

Administration, Intravaginal↗
PubMed1987

Anogenital warts: epidemiology, treatment and association with cervical atypia.

In Northern Ireland in 1984 anogenital warts were diagnosed in 592 (352 male, 240 female) genitourinary medicine clinic attenders. Of these patients, 561 were heterosexual, 28 homosexual and three male bisexual. In the male patients 290 had penile warts, 67 meatal warts, 59 perianal warts, 25 anal canal warts and five rectal warts. In the female patients, 193 had vulval warts, 27 vaginal warts, 25 cervical warts, 107 perianal warts, 30 anal canal warts and one a rectal wart. Sexual partners were brought to the clinic by 345 patients and of these 93 male and 100 female partners had genital warts.The mean time from exposure to development of warts was 17 weeks SE +/- 1.5 (range 1 week - 12 months). As treatment, podophyllin 25% was used alone in 218 patients, and 132 were known to have had clearance of warts. At least one other sexually transmissible infection was found in 407 (69%) of patients. Cervical smears were taken in 164 women and were abnormal in 40 (24%). Cervical cytology was recorded in 89 regular sexual partners of male patients and was abnormal in 23 (26%).

Female↗
PubMed1986

Gastrointestinal hormones in alcoholic patients with and without liver disease.

To assess the effects of both alcoholism and liver disease on gastroentero-pancreatic hormones, fasting and post-prandial concentrations were analysed in the following four groups: (1) Alcoholic subjects with liver disease; (2) Alcoholic subjects without liver disease; (3) Control subjects with liver disease; (4) Control subjects without liver disease.Liver disease was associated with increased fasting serum glucose, plasma insulin, pancreatic polypeptide, gastrin and vasoactive intestinal polypeptide. Alcoholism in the absence of liver disease did not influence either the fasting or post-prandial concentrations of serum glucose, plasma gastrin, insulin, pancreatic polypeptide, gastric inhibitory polypeptide, N- and C-terminal glucagon or vasoactive intestinal polypeptide. Alcoholism with liver disease depressed plasma gastric inhibitory polypeptide concentrations. The results suggest that the abnormalities in gastroenteropancreatic hormone in alcoholics are likely to be related to liver disease which is often concurrent.

Adult↗