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  • 1
    Electronic Resource
    Electronic Resource
    The mortality and morbidity associated with umbilical cord prolapse (1995)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 102 (1995), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To examine the management of cord prolapse and its morbidity and mortality.Design Retrospective study of consecutive babies born after cord prolapse, identified using the Oxford Obstetric Data System, and those with registered handicap, identified by the Oxford Region Register of Early Childhood Impairments.Setting District maternity hospital managing more than 6000 deliveries annually.Subjects One hundred and thirty–two babies born after the identification of cord prolapse in the John Radcliffe Hospital between January 1984 and December 1992.Main outcome measures Survival rates, condition at birth assessed by Apgar scores at 1 and 5 minutes and blood gas values on cord blood samples, and incidence of major handicap at three years of age.Results The incidence of cord prolapse was 1 in 426 total births. There were six stillbirths and six neonatal deaths. One baby died as a result of birth asphyxia. The uncorrected perinatal mortality rate was 91 per 1000. Of 120 survivors, only one baby was known to suffer a major neurological handicap. Electronic cardiotocographs aided the diagnosis of cord prolapse in 41 % of cases. Apgar scores were better with a shorter diagnosis to delivery interval, but cord gas results did not correlate well with Apgar scores or the diagnosis to delivery interval.Conclusions Cord prolapse occurs with a relatively stable incidence in this population irrespective of changes in obstetric practices. Despite the high incidence of ominous cardiotocographs, low Apgar scores and acidaemia on blood gas analysis, the fetal outcome is not as poor as might be expected and mortality is predominantly attributable to congenital anomalies and prematurity rather than birth asphyxia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1995.tb10850.x
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  • 2
    Electronic Resource
    Electronic Resource
    Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study (1999)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 106 (1999), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae.Design A retrospective (1980–1986) and prospective (1987–1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time.Setting Obstetric units in two counties (three health districts) with similar annual numbers of matemities and the Regional Blood Transfusion Service antenatal serology laboratory.Participants Non-sentisitised Rhesus D negative pregnant nulliparae.Interventions Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county.Main outcome measures 1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme.Results Prophylaxis significantly reduced iso-immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0.14–0.53; P 〈 0.0001) and contemporary controls (OR 0.43, CI 0.22–0.86; P= 0.02). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty-two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill-health that result from very preterm birth should be considerable.Conclusion Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1999.tb08304.x
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  • 3
    Electronic Resource
    Electronic Resource
    Randomised trial of one versus two doses of prostaglandin E2 for induction of labour: 2. Analysis of cost (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To compare the impact upon maternity unit resources and finances of two protocols for induction of labour using prostaglandins.Design A prospective randomised trial comparing a single dose of prostaglandin E2 (2 mg) in the evening with two doses of prostaglandin E2 (2 mg), the second being given after six hours if labour had not started or the cervix was still unripe, followed if necessary by formal induction of labour by amniotomy and oxytocin infusion 14 to 20 hours after the initial prostaglandin E2 dose. Outcome for nulliparae and multiparae were analysed separately, by treatment intention.Setting A maternity unit in a district general hospital delivering 〉 6000 women annually.Participants Nine hundred and fifty-five women with viable singleton pregnancies and cephalic presentation at term without previous history of caesarean section who were advised to have labour induced with prostaglandins.Main outcome measures Costs incurred in managing all aspects of labour, including time spent on the antenatal ward and, in the delivery unit; costs associated with formal induction, augmentation of labour and epidural analgesia; costs of intrapartum maternal morbidity, mode of delivery and immediate neonatal care. Costs of postpartum hospital stay were estimated from unit statistics.Results The overall mean cost of induction of labour was £5.00 and £7.22 less per woman for nulliparae and multiparae, respectively, if the two dose regimen was used. The main reason for the differences was due to delivery suite costs from the slightly greater rate of assisted deliveries in the single treatment groups. In contrast, costs for neonatal care were marginally lower if only one prostaglandin dose was used.Conclusions The increased drug costs providing two prostaglandin E2 doses when required were off-set by reductions in the costs of other intrapartum interventions for both nulliparae and multiparae. The advantages of less time spent on the antenatal ward for multiparae when two prostaglandin E2 doses were used may be eliminated if amniotomy and oxytocin infusion was commenced six hours after the initial prostaglandin dose had been given if labour had not started.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb12069.x
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  • 4
    Electronic Resource
    Electronic Resource
    Authors' Reply (1996)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 103 (1996), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1996.tb09929.x
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  • 5
    Electronic Resource
    Electronic Resource
    Reducing hospital stay after abdominal hysterectomy (1996)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 103 (1996), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1996.tb09673.x
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  • 6
    Electronic Resource
    Electronic Resource
    Survey on repeat prescribing for acid suppression drugs in primary care in Cornwall and the Isles of Scilly (1999)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 13 (1999), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: : Repeat prescriptions for acid suppression therapy represent an important burden on health care resources.〈section xml:id="abs1-2"〉〈title type="main"〉Aim: To determine the prevalence of acid suppression therapy and its indications by general practitioners (GPs) in a larger sample of practices than previous studies.〈section xml:id="abs1-3"〉〈title type="main"〉Method: Practices in Cornwall and the Isles of Scilly were invited to identify the number of patients on repeat prescription for acid suppression drugs in their practice, to review the indication for treatment in a sample of 50 patients, and to indicate the mode of review of these patients.〈section xml:id="abs1-4"〉〈title type="main"〉Results: Out of 77 practices, 42 (55%) participated in the study. Overall, 5% of patients were authorized to receive a repeat prescription for acid suppression drugs. Repeat rates varied between practices, from 1.68% to 11.11%. Repeat rates increased with age and were higher in men than in women. Only 41% of patients had a proven diagnosis of gastro-oesophageal reflux disease or peptic ulcer. A review of notes was the most frequent way (36%) stated by GPs to review acid suppression therapy.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusion: The repeat rate found in our study was higher than that found in previous studies. A high proportion of older patients in Cornwall, as well as a continuing increase in the prescription of acid suppression drugs, may account for these results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.1999.00524.x
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  • 7
    Electronic Resource
    Electronic Resource
    Randomised trial of one versus two doses of prostaglandin E2 for induction of labour: 1. Clinical outcome (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To compare the outcome of induction of labour using a single versus two doses of prostaglandin E2 vaginal gel.Design Prospective randomised trial comparing a single dose of prostaglandin E2 2 mg vaginal gel in the evening with two doses of prostaglandin E2 (2 mg), the second being given after six hours if labour had not started or the cervix was still unripe. Amniotomy and oxytocin titration were performed when necessary for both protocols. Nulliparae and multiparae were analysed separately by treatment intention.Setting A maternity unit in a district general hospital annually delivering 〉 6000 women.Participants Nine-hundred and ninety-five women with viable singleton pregnancies and cephalic presentation at term without previous history of caesarean section who were advised to have labour induced with prostaglandins.Main outcome measures Need for formal amniotomy and oxytocin augmentation, use of epidural analgesia, rate of intrapartum interventions, mode of delivery and neonatal condition at birth.Results For multiparae two prostaglandin doses resulted in a significant reduction in the need for formal amniotomy (15%vs 30%) and oxytocin augmentation (28%vs 38%) compared with those receiving a single dose; there was no significant difference for nulliparae. Other interventions during labour, length of labour, and mode of delivery were similar in both protocols. Failed induction occurred only in nulliparae and was similar in both protocols (1%). There was no discernible difference in fetal or neonatal outcome although passage of meconium was more common in labour if two doses had been given, as was neonatal admission to the special care baby unit.Conclusions There was little clinical benefit from inducing labour with two doses of prostaglandin E2 at a six-hour interval, compared with a single dose. There may be financial advantages with a two-dose regimen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb12068.x
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  • 8
    Electronic Resource
    Electronic Resource
    Transforming growth factor-β response and expression in junctional and oral gingival epithelial cells (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of periodontal research 32 (1997), S. 0 
    Details
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The junctional (JE) and oral gingival (OGE) epithelium show distinct morphological phenotypes and express different cell surface and keratin markers. Transforming growth factor-β (TGF-β) has been shown to stimulate extracellular matrix formation and inhibit proteolytic matrix degradation in periodontal wound healing. To elucidate potential roles of TGF-β in gingival epithelial regeneration and reattachement, the present study examined the effects of TGF-β on JE and OGE cell growth and determined the patterns of expression of mRNAs for the TGF-β isotypes β1, β2 and β3 and TGF-β receptor types I, II and III. Primary cell cultures were initiated from JE and OGE and the cell phenotypes confirmed using monoclonal antibodies to specific keratins. TGF-β induced a significant growth inhibition in OGE cells derived from 6 different patients with a mean inhibition of 46% and a range of 16–70% (p=0.031). Although responses varied between patients, in general maximum inhibition occurred at 10 ng/ml TGF-β. JE cells from 5 patients showed no significant growth inhibition by TGF-β (p=0.125). Greater expression of TGF-β2 and receptor type I mRNA was found in OGE than JE cells and thus appeared to be associated with differentiating epithelial cells. JE cells expressed more TGF-β type II receptor specific mRNA than did OGE cells, but TGF-β1 mRNA expression was similar in JE and OGE cells. JE or OGE cultures derived from 2 of 3 patients showed expression of mRNA for the TGF-β type III receptor. TGF-β3 mRNA was not detected in any of the JE or OGE samples examined. The greater sensitivity of OGE than JE to the growth inhibiting effects of TGF-β correlated with higher expression of receptor type I mRNA which, together with the type II receptor, is required for sensitivity to growth inhibition by TGF-β. The results suggest that, in addition to structural differences, the development of functional differences in the responses of JE and OGE to TGF-β may be associated with the formation of JE from OGE cells and the reformation of attachement after periodontal surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-0765.1997.tb00579.x
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  • 9
    Electronic Resource
    Electronic Resource
    Influence of retinoic acid on the expression of cytokeratins, vimentin and ICAM-1 in human gingival epithelia in vitro (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of periodontal research 31 (1996), S. 0 
    Details
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Phenotypic differences exist in viva between junctional (JE) and oral gingival (OGE) epithelia and an in vitro system has been developed that maintains phenotypic differences. This system, which permits in vitro studies of factors that may influence the epithelial phenotype, was used to investigate the effects of retinoic acid (RA) on epithelial expression of various markers known to distinguish JE from OGE. Primary cultures of JE and OGE were initiated from defined gingival regions and were subcultured and grown for 48 h in 96-well plates or on multiple-well slides. Control cultures were grown in medium supplemented with delipidized serum and all-trans RA was added to experimental groups. Other cultures were grown in a defined RA-free medium. Cultures were examined using monoclonal antibodies against cytokeratins, vimentin, and ICAM-1 and binding displayed by indirect immunocytochemical staining. Staining reactions were assessed by direct microscopic observation and assayed by spectrophotometric quantitation. The results showed that RA had minor effects on the marker expression of JE but markedly enhanced expression of cytokeratins 8, 18, 19, vimentin and ICAM-1 in OGE. These markers, which normally distinguish JE from OGE, were expressed at levels approaching or exceeding those of control JE cultures. These observations indicate that RA responsive mechanisms affect the phenotypes expressed by epithelia in vitro and suggest that such mechanisms may be related to the different phenotypic patterns expressed by gingival epithelia in vivo.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-0765.1996.tb00468.x
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  • 10
    Electronic Resource
    Electronic Resource
    Achromatic neurons in the cortex of progressive supranuclear palsy (1995)
    Springer
    Acta neuropathologica 90 (1995), S. 615-619 
    Details
    ISSN: 1432-0533
    Keywords: Progressive supranuclear palsy ; Achromatic neurons ; Corticobasal degeneration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Achromatic neurons (AN) in the cerebral cortex are a characteristic feature of several neurodegenerative conditions including Pick's disease, corticobasal degeneration and some cases of primary progressive aphasia. Although AN are occasionally seen in some other diseases, their presence in progressive supranuclear palsy (PSP) has not been previously documented. We found significant numbers of AN in the cerebral cortex of five out of seven cases which had been diagnosed pathologically as PSP. The identification of AN was greatly facilitated by the use of neurofilament immunohistochemistry. The entorhinal and transentorhinal cortices were most frequently involved, but in several cases AN were also seen throughout the neocortex. The presence and number of AN roughly correlated with a history of clinical dementia. This suggests that cortical AN may be a common and important pathological finding in PSP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00318574
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