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  • 2000-2004  (7)
  • 1
    Electronic Resource
    Electronic Resource
    Obstetric cholestasis, outcome with active management: a series of 70 cases (2002)
    Oxford, UK : Blackwell Science Ltd
    BJOG 109 (2002), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.Design Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed.Setting Antenatal population of three London hospitals between August 1999 and April 2001.Population Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology.Methods All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded.Results Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4–39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21–40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated.Conclusions Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2002.01368.x
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Comparison of the arrhythmogenic effects of tauro- and glycoconjugates of cholic acid in an in vitro study of rat cardiomyocytes (2004)
    Oxford, UK and Malden, USA : Blackwell Science Ltd
    BJOG 111 (2004), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Obstetric cholestasis is associated with intrauterine death. In obstetric cholestasis, primary bile acids are more commonly conjugated with taurine than glycine, while glycoconjugates predominate in normal pregnancy. Using an in vitro model of rat cardiomyocytes, we compared the effect of tauro- and glycoconjugated cholate on cardiomyocyte rhythm, contraction amplitude and network integrity. We demonstrated that taurocholate had a more marked effect on all of these parameters, and the effects of the glycoconjugates were fully reversible while those of tauroconjugates were not. The increased proportion of tauroconjugated bile acids in obstetric cholestasis may contribute to the aetiology of the intrauterine death associated with the condition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2004.00166.x
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Dexamethasone and ursodeoxycholic acid protect against the arrhythmogenic effect of taurocholate in an in vitro study of rat cardiomyocytes (2003)
    Oxford, UK : Blackwell Science Ltd
    BJOG 110 (2003), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To establish whether the therapeutic agents ursodeoxycholic acid and dexamethasone protect cardiomyocytes from taurocholate-induced arrhythmias in an in vitro model.Design Laboratory study.Setting Imperial College London, Hammersmith Campus.Sample Neonatal rat cardiomyocytes.Methods Using scanning ion conductance microscopy, we measured the rate, rhythm, amplitude of contraction and calcium dynamics of ventricular myocytes from one to two day old rats. Cells were pre-incubated for 16 hours in dexamethasone (80 or 800 nM) or 0.1 mM ursodeoxycholic acid before adding taurocholate at different concentrations (0.3–4.5 mM).Main outcome measures Changes in rate and amplitude of contraction, calcium dynamics and rhythm.Results Taurocholate at concentrations of up to 3 mM induces abnormal changes including reductions in rate, amplitude of contraction, abnormal calcium dynamics and dysrhythmias. Although dexamethasone had no immediate protective effect on these changes, pre-incubation with dexamethasone was protective. Ursodeoxycholic acid pre-incubation was protective at taurocholate concentrations up to 1 mM.Conclusion The therapeutic agents dexamethasone and ursodeoxycholic acid appear protective against the arrhythmogenic effect of taurocholate on cardiomyocytes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1471-0528.2003.02273.x
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Infant cortisol response after prolonged antenatal prednisolone treatment (2004)
    Oxford, UK and Malden, USA : Blackwell Science Ltd
    BJOG 111 (2004), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Prednisolone is widely used to treat medical conditions in pregnancy, despite the lack of long term safety studies on infants. Animal studies have shown that antenatal glucocorticoid treatment can cause in utero growth restriction and up-regulation of the offsprings' hypathalamic–pituitary–adrenal axis. We recruited women treated antenatally with prednisolone, and followed 12 of the infants up to four months, using routine infant vaccinations as a stressor. Birthweights were similar to controls (n= 289, uncomplicated, singleton term pregnancies), as were infants' baseline and stress-induced cortisol levels. Mothers rated their infants as less difficult and more adaptable than controls. This study provides initial reassurance about the safety of prednisolone in pregnancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2004.00288.x
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis (2001)
    Oxford, UK : Blackwell Science Ltd
    BJOG 108 (2001), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Obstetric cholestasis is a liver disorder unique to pregnancy, which typically presents with pruritus. However, pruritus is common in pregnancy and the diagnosis of obstetric cholestasis is confirmed by finding abnormal liver function. We report 10 cases in which pruritus occurred before any abnormality in liver function tests (including total serum bile acids) and discuss the implications of this for clinical practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2003.00281.x
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Quality in paediatric anaesthesia: a pilot study of interdepartmental peer review (2003)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 58 (2003), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary A pilot to assess a process of interdepartmental peer review of paediatric anaesthetic departments in the United Kingdom was undertaken. Departments were assessed in relation to the standards which should characterise anaesthetic departments throughout the country. Examples of good practice and areas for further development were identified. Peer review visits were conducted by teams which included medical and non-medical members. The importance of the inclusion of lay people in such visits is being increasingly recognised. All of those who participated in the process felt their time had been usefully spent, and they were enthusiastic for the process to continue.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2003.03186.x
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  • 7
    Electronic Resource
    Electronic Resource
    Daclizumab as escape therapy for late acute kidney rejection in the presence of FK506 nephrotoxicity (2000)
    Springer
    Transplant international 13 (2000), S. 169-171 
    Details
    ISSN: 1432-2277
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050317
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