Internists, Preventive Medicine / Wellness
25 years of experience

Accepting new patients
Clinton Township
43421 Garfield Rd
Clinton Township, MI 48038
313-874-7210
Locations and availability (5)

Education ?

Medical School Score
Howard University (1985)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Board of Internal Medicine
American Board of Preventive Medicine

Affiliations ?

Dr. Gee is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Henry Ford Hospital
    2799 W Grand Blvd, Detroit, MI 48202
    • Currently 4 of 4 crosses
    Top 25%
  • Henry Ford Macomb Hospitals
    15855 19 Mile Rd, Clinton Township, MI 48038
    • Currently 4 of 4 crosses
    Top 25%
  • Henry Ford Health Systems
  • Publications & Research

    Dr. Gee has contributed to 118 publications.
    Title Teaching Trainers to Incorporate Evidence-based Medicine (ebm) Teaching in Clinical Practice: the Eu-ebm Project.
    Date September 2010
    Journal Bmc Medical Education
    Excerpt

    Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments.

    Title Urinary Ascites Following Caesarean Section: an Unusual Presentation of Bladder Injury.
    Date January 2010
    Journal European Journal of Obstetrics, Gynecology, and Reproductive Biology
    Title The Origin and Evolution of Modern Metabolism.
    Date March 2009
    Journal The International Journal of Biochemistry & Cell Biology
    Excerpt

    One fundamental goal of current research is to understand how complex biomolecular networks took the form that we observe today. Cellular metabolism is probably one of the most ancient biological networks and constitutes a good model system for the study of network evolution. While many evolutionary models have been proposed, a substantial body of work suggests metabolic pathways evolve fundamentally by recruitment, in which enzymes are drawn from close or distant regions of the network to perform novel chemistries or use different substrates. Here we review how structural and functional genomics has impacted our knowledge of evolution of modern metabolism and describe some approaches that merge evolutionary and structural genomics with advances in bioinformatics. These include mining the data on structure and function of enzymes for salient patterns of enzyme recruitment. Initial studies suggest modern metabolism originated in enzymes of nucleotide metabolism harboring the P-loop hydrolase fold, probably in pathways linked to the purine metabolic subnetwork. This gateway of recruitment gave rise to pathways related to the synthesis of nucleotides and cofactors for an ancient RNA world. Once the TIM beta/alpha-barrel fold architecture was discovered, it appears metabolic activities were recruited explosively giving rise to subnetworks related to carbohydrate and then amino acid metabolism. Remarkably, recruitment occurred in a layered system reminiscent of Morowitz's prebiotic shells, supporting the notion that modern metabolism represents a palimpsest of ancient metabolic chemistries.

    Title Evolution.
    Date February 2009
    Journal Nature
    Title Five Steps from Evidence to Effect: Exercising Clinical Freedom to Implement Research Findings.
    Date September 2008
    Journal Bjog : an International Journal of Obstetrics and Gynaecology
    Title Evolutionary Biology: the Amphioxus Unleashed.
    Date July 2008
    Journal Nature
    Title Ethics and the Sexual Countertransference.
    Date May 2007
    Journal The Journal of Analytical Psychology
    Excerpt

    In this paper I shall suggest that, in addition to 'conscience', the archetype of Eros plays an important part in 'benign relatedness' and that this is what constitutes an ethical attitude. I also propose that the idea of 'benign relatedness' can provide us with a workable concept for those serving on Ethics Committees especially when our Code of Ethics is unclear or limited. I attempt to show that the analytic attitude is essentially ethical and define what I see as the analytic attitude as a way of demonstrating this. By discussing the neurotic sexual countertransference and unconscious identity I hope to clarify the main reasons for unethical enactments. I use examples of ethical problems, including a personal experience, to illustrate the kinds that occur and lastly I discuss how mourning plays an important part in the resolution and avoidance of these problems.

    Title Progesterone for the Prevention of Preterm Birth: a Critical Evaluation of Evidence.
    Date February 2007
    Journal European Journal of Obstetrics, Gynecology, and Reproductive Biology
    Excerpt

    A systematic review of the literature identified nine randomised trials that evaluated the effects of progestational agents in the prevention of preterm delivery. These studies were of variable quality. Meta-analyses showed reductions in delivery rates before 37 weeks (OR 0.42, 95% CI 0.31-0.57) and 34 weeks (OR 0.51, 95% CI 0.34-0.77) as well as in respiratory distress syndrome (OR 0.55, 95% CI 0.31-0.96) with progestational agents. A cumulative meta-analysis showed that the treatment benefit for the outcome of delivery before 37 weeks exceeded the conventional level of statistical significance in 1975 (p<0.01); by 1985, the p-value was <0.001, and by 2003, it was <0.0001. Another cumulative meta-analysis in which the studies were added to the pooled analysis by decreasing quality score showed significant benefit even when the analysis was limited to just the highest quality trials (OR 0.47, 95% CI 0.33, 0.66, p<0.0001). An exploration of the applicability of the effects across various baseline risks using a L'abbe plot found that the benefit was consistent across a range of risks. A comprehensive review of both trial and observational data on harm did not show any demonstrable evidence of harm to mother and baby. Women at high risk of preterm birth should be recommended progestational agent therapy.

    Title Developmental Biology: This Worm is Not for Turning.
    Date January 2007
    Journal Nature
    Title Evolution: Experiments in Botany.
    Date June 2006
    Journal Nature
    Title Moving to Inclusion.
    Date June 2006
    Journal Mental Health Today (brighton, England)
    Title Evolution: Careful with That Amphioxus.
    Date March 2006
    Journal Nature
    Title Evolution: Memories of Mammoths.
    Date February 2006
    Journal Nature
    Title Palaeontology: Data on a Plate.
    Date December 2005
    Journal Nature
    Title A Comparison of Foetal and Labour Outcomes in Caucasian and Afro-caribbean Women with Diabetes in Pregnancy.
    Date February 2005
    Journal International Journal of Clinical Practice
    Excerpt

    Materno-foetal complications have an increased prevalence in pregnancies complicated by diabetes. Ethnicity and cultural background may further affect these outcomes. In this study, we compared labour and foetal outcomes in Afro-Caribbean and Caucasian women with diabetes in pregnancy, using the Birmingham computerised database of diabetes in pregnancy. A retrospective analysis, covering the period 1990-2002, was employed. Foetal outcomes included early foetal loss, neonatal and perinatal mortality, congenital malformations and infant size at delivery. Labour outcomes assessed were mode and time of delivery. Overall, Afro-Caribbean women achieve similar results to Caucasian women. No significant differences were seen in foetal outcomes between the two cohorts or between diabetic subtypes. Afro-Caribbean women were more likely to have a vaginal delivery, but present later for their first antenatal visit compared with Caucasian women. Variations in culture or access to health care may account for these differences. An awareness of the specific needs of ethnic minorities is essential to ensure that this encouraging trend continues.

    Title Environmental Geography: Treeless at Easter.
    Date October 2004
    Journal Nature
    Title Redesigning Postnatal Care: a Randomised Controlled Trial of Protocol-based Midwifery-led Care Focused on Individual Women's Physical and Psychological Health Needs.
    Date March 2004
    Journal Health Technology Assessment (winchester, England)
    Excerpt

    To develop, implement and test the cost-effectiveness of redesigned postnatal care compared with current care on women's physical and psychological health.

    Title Effectiveness of Nifedipine Versus Atosiban for Tocolysis in Preterm Labour: a Meta-analysis with an Indirect Comparison of Randomised Trials.
    Date January 2004
    Journal Bjog : an International Journal of Obstetrics and Gynaecology
    Excerpt

    To explore the effectiveness of nifedipine compared with atosiban for tocolysis in preterm labour.

    Title Pregnancy in Women with Type 2 Diabetes: 12 Years Outcome Data 1990-2002.
    Date December 2003
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    Twelve years' outcome analysis of pregnancies in women with Type 2 diabetes in a multiethnic geographically defined area.

    Title Quality of Brief Guidelines Produced by Professional Bodies: a Study of the 'green-top' Guidelines by the Uk Royal College of Obstetricians and Gynaecologists.
    Date November 2003
    Journal Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology
    Excerpt

    Clinicians ignore lengthy guidelines and prefer pocket cards and concise pamphlets. However, brevity in guidelines may lead to deficiency in quality. Our objective, therefore, was to examine the quality of brief guidelines produced by professional bodies, using those produced by the UK Royal College of Obstetricians and Gynaecologists (RCOG) as an example. We assessed all 22 'green-top' guidelines, produced by September 2002, for quality using a validated 37-item appraisal instrument. This instrument evaluated the guidelines on three dimensions, namely rigour of development, context and content and applicability. Ten (45%), 18 (82%) and five (23%) of the 22 guidelines met at least half the quality criteria for rigour of development, context and content and applicability, respectively. We conclude that the brief guidelines were deficient in several specific quality items, particularly those in the applicability dimension. Guideline developers need to achieve the higher quality standards expected of professional bodies.

    Title Evolution: Ending Incongruence.
    Date November 2003
    Journal Nature
    Title From Minimal Background Diabetic Retinopathy to Profuse Sight Threatening Vitreoretinal Haemorrhage: Management Issues in a Case of Pregestational Diabetes and Pregnancy.
    Date November 2003
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    Deterioration of retinopathy is a recognized complication of pregnancy in Type 1 diabetes. We discuss management issues relating to a case of rapid sight-threatening progression of retinopathy in pregnancy complicated by pregestational diabetes.

    Title Zoology: You Aren't What You Eat.
    Date September 2003
    Journal Nature
    Title Incorporating the Views of Obstetric Clinicians in Implementing Evidence-supported Labour and Delivery Suite Ward Rounds: a Case Study.
    Date August 2003
    Journal Health Information and Libraries Journal
    Excerpt

    To implement evidence-supported delivery suite ward rounds using strategies to overcome barriers.

    Title Aspirin for Prevention of Preeclampsia in Women with Historical Risk Factors: a Systematic Review.
    Date July 2003
    Journal Obstetrics and Gynecology
    Excerpt

    To examine the effectiveness of aspirin in preventing perinatal death and preeclampsia in women with predisposing historical risk factors, such as previous history of preeclampsia, chronic hypertension, diabetes, and renal disease.

    Title Oxytocin Antagonists for Tocolysis in Preterm Labour -- a Systematic Review.
    Date May 2003
    Journal Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
    Excerpt

    Oxytocin antagonists have been shown to inhibit uterine contractions and delay preterm delivery. Our objective was to examine the clinical effectiveness and safety of oxytocin antagonists for tocolysis in preterm labour.

    Title Women's Attitudes to Hiv Screening in Pregnancy in an Area of Low Prevalence.
    Date April 2003
    Journal Bjog : an International Journal of Obstetrics and Gynaecology
    Excerpt

    To identify factors that influence acceptance of the human immunodeficiency virus (HIV) screening test by pregnant women.

    Title Twin Pregnancy Outcome and Chorionicity.
    Date March 2003
    Journal Acta Obstetricia Et Gynecologica Scandinavica
    Excerpt

    Based on research of relatively poor quality, it is generally believed that dichorionic twins have lower perinatal mortality than monochorionic twins. We assessed the relationship between the pattern of perinatal loss in twin pregnancy and chorionicity.

    Title Genomics: Return of a Little Squirt.
    Date January 2003
    Journal Nature
    Title Low Dose Acetylsalicylic Acid in Prevention of Pregnancy-induced Hypertension and Intrauterine Growth Retardation in Women with Bilateral Uterine Artery Notches.
    Date January 2003
    Journal Bjog : an International Journal of Obstetrics and Gynaecology
    Title Progressive Evolution: Aspirational Thinking.
    Date January 2003
    Journal Nature
    Title Prediction of Vaginal Delivery Following Caesarean Section for Failure to Progress Based on the Initial Aberrant Labour Pattern.
    Date September 2002
    Journal European Journal of Obstetrics, Gynecology, and Reproductive Biology
    Excerpt

    To determine whether the pattern of cervical dilatation prior to caesarean section for 'failure to progress' can predict the outcome of subsequent labour.

    Title Biogeochemistry: That's Life?
    Date April 2002
    Journal Nature
    Title Effects of Redesigned Community Postnatal Care on Womens' Health 4 Months After Birth: a Cluster Randomised Controlled Trial.
    Date February 2002
    Journal Lancet
    Excerpt

    Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.

    Title Critical Appraisal in Clinical Practice: Sometimes Irrelevant, Occasionally Invalid.
    Date February 2002
    Journal Journal of the Royal Society of Medicine
    Excerpt

    A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills.

    Title Medical Journals and Effective Dissemination of Health Research.
    Date January 2002
    Journal Health Information and Libraries Journal
    Excerpt

    Clinical medical journals have not been effective in meeting the information needs of practitioners and bridging the gap between clinical research and practice. The slow adoption of results of clinical research is at least partly due to the failure of clinical journals to disseminate information in a way that would motivate practitioners to change practice. Although implementation is primarily a local process, medical journals are in a unique position to advance implementation by modifying their focus and adjusting their contents. Strategies that may be useful include publication of pre-appraised evidence summaries and 'clinical bottom-lines' and giving importance to systematic reviews and large evaluative research articles as they represent higher levels of evidence and have greater potential to change practice. Clinical journals should encourage researchers to consider how and by whom the findings will be used and provide information on implications for implementation such as possible strategies that may work, cost-effectiveness, side-effects and potential barriers to implementation. Medical journal publishers should explore ways to cooperate so that findings of landmark clinical trials could be shared thus reducing the 'scatter' of medical information. Electronic media offers numerous advantages such as quick accessibility and linking of information, and medical journals should capitalize on such innovations. There is a paradigm shift in health care practice as evidence is consciously and explicitly incorporated into individual patient care. Medical journals need to change to reflect this change in practice and provide practitioners with valid and relevant information.

    Title On Being Vetulicolian.
    Date December 2001
    Journal Nature
    Title Aspirin for the Prevention of Preeclampsia in Women with Abnormal Uterine Artery Doppler: a Meta-analysis.
    Date December 2001
    Journal Obstetrics and Gynecology
    Excerpt

    To determine the effectiveness of aspirin to prevent preeclampsia in women identified as high risk for preeclampsia by an abnormal second-trimester uterine artery Doppler examination.

    Title Conservative Management of Persistent Postnatal Urinary and Faecal Incontinence: Randomised Controlled Trial.
    Date October 2001
    Journal Bmj (clinical Research Ed.)
    Excerpt

    To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three months postnatally.

    Title Approaching St Vincent. Working Toward the St Vincent Targets.
    Date August 2001
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Title Palaeontology. Return to the Planet of the Apes.
    Date August 2001
    Journal Nature
    Title Obstetric Practice and Faecal Incontinence Three Months After Delivery.
    Date August 2001
    Journal Bjog : an International Journal of Obstetrics and Gynaecology
    Excerpt

    To determine whether obstetric and maternal factors relate to faecal incontinence at three months postpartum.

    Title Fetal and Maternal Outcomes in Indo-asian Compared to Caucasian Women with Diabetes in Pregnancy.
    Date January 2001
    Journal Qjm : Monthly Journal of the Association of Physicians
    Excerpt

    Maternal and fetal complications are increased when pregnancy is complicated by diabetes, and this may be further influenced by racial and cultural differences. We examined fetal and maternal outcomes in Indo-Asian and Caucasian women attending the same antenatal diabetes service to see if there were any differences. Women with diabetes mellitus (type 1, type 2 and gestationally-acquired disease) complicating pregnancy, registered at the combined diabetes/antenatal clinic of this University teaching hospital over the period 1990-1998 were included. Fetal outcomes examined were miscarriage <24 weeks, stillbirths, neonatal deaths up to 28 days of life, perinatal mortality, congenital malformations and size for gestational age. Maternal outcomes examined were rates of caesarean section and vaginal deliveries, and number of pre-term deliveries <37 completed weeks of gestation. Outcomes for Indo-Asian and Caucasian women were similar, with a take-home baby rate of 96% and 92%, respectively. There was no perinatal mortality in Indo-Asian women, who were more likely to have a vaginal delivery and less likely to have a baby large for gestational age. Pregnancies complicated by type 2 diabetes in both groups pose the greatest threat to a successful pregnancy outcome. Indo-Asian and Caucasian women attending the same antenatal diabetes service have comparable outcomes. Attendance for pre-pregnancy care needs to be encouraged to combat the high early pregnancy loss and congenital malformation rate identified, particularly in those with type 2 disease, irrespective of ethnicity.

    Title Online Naming of Species Opens Digital Age for Taxonomy.
    Date December 2000
    Journal Nature
    Title Pregnancy Outcome in Women with Type 2 Diabetes Mellitus Needs to Be Addressed.
    Date November 2000
    Journal International Journal of Clinical Practice
    Excerpt

    Maternal diabetes mellitus (types 1 and 2) is the most chronic prevalent medical condition affecting the pregnant population and is associated with a less satisfactory pregnancy outcome for both mother and infant when compared with the non-diabetic population. Most reports have focused on women with type 1 disease, type 2 disease being perceived as a less serious condition. However, type 2 disease is far more common (and is increasing) in some areas of the UK, especially where there is a high proportion of women from the Indian subcontinent. This paper shows that pregnancy complicated by type 2 diabetes mellitus is a high-risk state, with miscarriage and congenital malformations almost twice that seen in type 1 disease. These adverse outcomes are contributed to by poor attendance for pre-pregnancy care, later booking for antenatal clinic and poor glycaemic control at booking. Offspring of pregnancies complicated by type 2 diabetes are more likely to be delivered before 37 weeks gestation and be large in size for gestational age. We must dispel the myth, in women of childbearing age and in their healthcare providers, that diabetes treated with diet and/or tablets (type 2) is a less serious problem than type 1 disease.

    Title Mitrates on the Move.
    Date November 2000
    Journal Nature
    Title Planned Vaginal Delivery Versus Elective Caesarean Section: a Study of 705 Singleton Term Breech Presentations.
    Date September 2000
    Journal Bjog : an International Journal of Obstetrics and Gynaecology
    Title Homegrown Computer Roots out Phylogenetic Networks.
    Date April 2000
    Journal Nature
    Title Benzodiazepine Use in Pregnancy and Major Malformations or Oral Clefts. Quality of Primary Studies Must Influence Inferences Made from Meta-analyses.
    Date November 1999
    Journal Bmj (clinical Research Ed.)
    Title Developing Postgraduate Medical Education for Trusts: a Secret to Long-term Success.
    Date April 1999
    Journal Health Manpower Management
    Excerpt

    The delivery of effective postgraduate education for doctors in trusts is becoming vital to secure the individual services of trusts. Increasingly, training requirements are impacting on the location of clinical services that NHS trusts provide. Failure to understand the benefits and drawbacks of providing postgraduate education could affect the long-term strategic direction of trusts. The paper seeks to identify the case for investment, the need to address key deliverables to secure effective postgraduate education and the need for clinicians and managers to evaluate the effectiveness of such training for their organisations.

    Title Palaeontology. The Face of Cinderella.
    Date January 1999
    Journal Nature
    Title Role of the Consultant Obstetrician in the Delivery Suite.
    Date December 1998
    Journal Journal of Management in Medicine
    Excerpt

    The role of consultant obstetricians is under considerable debate. This has particularly focused on the role of consultants in intrapartum care. The article explores the role of the consultant in delivery suite from the view point of a consultant, a clinical director, a training programme director and a chief executive. These viewpoints determine a range of common themes which mean the duties of consultants over their career lifecycle need to be addressed; the need to expand consultant posts; and the tensions which inevitably occur. The authors believe these need to be addressed because of the need to ensure consultant roles in delivery suite are developed as a key part of seeing quality improvement.

    Title Analysis of Nicotine and Cotinine in the Hair of Hospitality Workers Exposed to Environmental Tobacco Smoke.
    Date December 1997
    Journal Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine
    Excerpt

    The purpose of this study was to determine if hair nicotine and cotinine levels reflect relative exposure to environmental tobacco smoke (ETS) in subjects who worked in the hospitality industry, where public smoking was permitted. Hair samples from 26 subjects were analyzed by gas chromatograph/mass spectrometry techniques for nicotine and cotinine. An exposure gradient was shown for nicotine but not cotinine. Among nonsmokers, those working in bars where there are no public smoking restrictions had the highest hair nicotine levels, which were close to levels found in smokers. Nicotine measured in hair is useful as a biological marker for exposure to ETS from multiple sources. Bar workers in particular are exposed to high levels of ETS, which may adversely affect the health of nonsmokers.

    Title The Active Mismanagement of Labour.
    Date September 1996
    Journal British Journal of Obstetrics and Gynaecology
    Title Box of Bones 'clinches' Identity of Piltdown Palaeontology Hoaxer.
    Date August 1996
    Journal Nature
    Title Evolution. It's a Mole-rat, Jim, but Not As We Know It.
    Date May 1996
    Journal Nature
    Title Lophophorates Prove Likewise Variable.
    Date May 1995
    Journal Nature
    Title Management of the First Stage of Labour.
    Date March 1995
    Journal British Journal of Hospital Medicine
    Excerpt

    The management of delay in labour has been dominated by the use of oxytocin to augment the 'powers' of labour. However, this empirical approach has not been rigorously tested and 'failure to progress' remains a major clinical problem. A return to an analysis of the underlying pathophysiology is advocated.

    Title Evolution. The Molecular Explosion.
    Date March 1995
    Journal Nature
    Title New Hominid Remains Found in Ethiopia.
    Date February 1995
    Journal Nature
    Title Uprooting the Human Family Tree.
    Date January 1995
    Journal Nature
    Title Nih 'should Rethink Pricing Clause'.
    Date January 1995
    Journal Nature
    Title Vertebrate Morphology. Return of the Amphioxus.
    Date September 1994
    Journal Nature
    Title Conference Trail Can Leave Behind a Good Image.
    Date September 1994
    Journal Nature
    Title The Effect of Cervical Contractions on the Generation of Intrauterine Pressure During the Latent Phase of Labour.
    Date July 1994
    Journal British Journal of Obstetrics and Gynaecology
    Title Dutch Model of Maternity Care. Dutch Model Limits Choice.
    Date April 1994
    Journal Bmj (clinical Research Ed.)
    Title Management of Severe, Early Pre-eclampsia: is Conservative Management Justified?
    Date February 1994
    Journal European Journal of Obstetrics, Gynecology, and Reproductive Biology
    Excerpt

    A retrospective analysis was performed to assess the fetal and maternal benefits of allowing women presenting with severe pre-eclampsia between 24 and 32 weeks to continue their pregnancy following treatment of their hypertension. Cases presenting in Oxford (conservative management) and in Birmingham (stabilisation and early intervention) were compared. Patients were considered to require treatment when their systolic blood pressure was > or = 170 mmHg systolic or > or = 110 mmHg diastolic, associated with at least 1+ proteinuria and hyperuricaemia. We compared gestation at delivery, birth weight and neonatal complications for each group, and any maternal morbidity. There were 28 patients in each group. Gestational age at delivery was significantly less in the group managed by early intervention. Those women managed conservatively gained a mean of 9.5 days (range 2-26 days; P < 0.05), and their birthweight was significantly greater (P < 0.05). There was a significant difference between the length of stay in the neonatal intensive care unit between the 2 groups (P < 0.05), the babies of those women managed conservatively staying a mean of 7.4 days less. There were fewer neonatal complications in those cases managed conservatively, the number of newborns with 1 or more complications in the early intervention group being 18 (64.3%), compared with 8 (28.6%) in the expectant management group (P = 0.0001). All of the women in the group managed by early intervention recovered with no severe complications. However, those women managed conservatively had a higher incidence of HELLP (2 cases) and ELLP syndrome (2 cases), 1 case requiring temporary renal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Why We Still Love Lucy.
    Date December 1993
    Journal Nature
    Title Parathyroid Hormone-related Protein As a Tumour Marker in Humoral Hypercalcaemia Associated with Occult Malignancy.
    Date November 1993
    Journal Postgraduate Medical Journal
    Excerpt

    The tumour-derived factor PTH-related protein (PTHRP) is the primary humoral factor responsible for hypercalcaemia in patients with solid tumours. In a woman presenting with anaemia and hypercalcaemia, the finding of raised plasma PTHRP and undetectable serum PTH concentrations led to further investigations and the subsequent identification of a uterine tumour. No evidence of tumour spread was found at operation, and removal of the tumour resulted in normalization of both serum calcium and plasma PTHRP. Expression of PTHRP by the tumour was shown by immunohistochemistry and in situ hybridization. We conclude that the identification of an occult tumour in a patient with hypercalcaemia and raised plasma PTHRP provides evidence of the diagnostic utility of PTHRP immunoassays in the investigation of patients with hypercalcaemia and suspected malignancy.

    Title Antibody Mediated Complete Congenital Heart Block in the Fetus.
    Date November 1993
    Journal Pacing and Clinical Electrophysiology : Pace
    Excerpt

    Complete congenital heart block (CCHB) affects 1:20,000-25,000 live births and is usually an atrioventricular block; 30-50% of fetuses with CCHB will have a structural anomaly, though recently attention has focused on the etiological influence of autoimmune disease, such as systemic lupus-erythematosus. The diagnosis is established by detailed two-dimensional ultrasound scanning of the heart to exclude anomaly coupled with M-mode echocardiography and Doppler blood velocity patterns in the major vessels to detect the uncoupling of atrial and ventricular rhythms. Risk factors for an affected child are discussed. A previously affected child, high titers of anti-Ro antibodies, the presence of anti-Ro (SS-A) and anti-La (SS-B), and maternal HLA DR3 confer high risk. Antibody mediated CCHB is irreversible. Plasmapheresis and immunosuppression have been attempted in affected mothers, with limited success, to reduce the likelihood of the fetus being affected, and steroids have been used to reduce the inflammatory reaction in the heart. In many cases the underlying pathology of the immune system adversely affects utero-placental function requiring careful monitoring of fetal well-being. CCHB renders fetal heart rate monitoring virtually useless, in the antenatal and intrapartum periods. Alternatives are explored.

    Title Cervical Contractions: the Response of the Cervix to Oxytocic Stimulation in the Latent Phase of Labour.
    Date October 1993
    Journal British Journal of Obstetrics and Gynaecology
    Excerpt

    To assess the cervical response to myometrial activity in early labour.

    Title Major Histocompatibility Complex. The Evolutionary Angle.
    Date October 1993
    Journal Nature
    Title Magnetic Resonance Imaging Pelvimetry: a Useful Adjunct in the Management of the Obese Patient.
    Date August 1993
    Journal British Journal of Obstetrics and Gynaecology
    Title Heart Rate Variability in Healthy Term Newborns: the Contribution of Respiratory Sinus Arrhythmia.
    Date April 1993
    Journal Early Human Development
    Excerpt

    Cardiorespiratory interactions in healthy full term newborns were investigated. Spectral analysis was used on heart rate and breathing data from 22 neonates 2-5 days old to reveal coincident frequencies in the breathing and heart rate variability (HRV) spectra, thus identifying respiratory sinus arrhythmia (RSA). The spectral description of HRV in healthy term newborns revealed a consistent and distinct RSA feature, with a mean contribution of over 30%. The contribution of RSA to HRV was dependent on breathing frequency and absolute RSA power. The mechanisms that produce this cardiorespiratory interaction are considered to be functionally active in the healthy term neonate.

    Title Leiomyosarcomas Have a Poorer Prognosis Than Mixed Mesodermal Tumours when Adjusting for Known Prognostic Factors: the Result of a Retrospective Study of 423 Cases of Uterine Sarcoma.
    Date October 1992
    Journal British Journal of Obstetrics and Gynaecology
    Excerpt

    To determine the survival data for the various tumour types of uterine sarcoma and determine the influence of various prognostic factors on survival.

    Title Prenatal Microbiological Risk Factors Associated with Preterm Birth.
    Date October 1992
    Journal British Journal of Obstetrics and Gynaecology
    Title Hydra and the Homeobox.
    Date September 1992
    Journal Nature
    Title Emergency Cervical Cerclage.
    Date September 1992
    Journal British Journal of Obstetrics and Gynaecology
    Title A New Technique for the Identification of Respiratory Sinus Arrhythmia in Utero.
    Date June 1992
    Journal Journal of Biomedical Engineering
    Excerpt

    Fetal heart rate (FHR) monitoring forms the basis of routine fetal assessment, particularly short-term variability in the interbeat interval which can be difficult to interpret. Respiratory sinus arrhythmia (RSA), the change in heart rate in response to breathing, contributes to short-term variability, and the presence of RSA in utero may reflect the functional integrity of the central nervous system. This paper describes the use of Doppler ultrasound to derive the required measures of fetal heart rate and fetal breathing movements and spectral analysis to identify RSA. Cases are presented to illustrate the results obtained both in the presence and absence of RSA.

    Title The Prevention of Preterm Delivery--can We Afford to Continue to Ignore the Cervix?
    Date June 1992
    Journal British Journal of Obstetrics and Gynaecology
    Title Insufficient Remodelling of the Uterine Connective Tissue in Women with Protracted Labour.
    Date June 1992
    Journal British Journal of Obstetrics and Gynaecology
    Title Statistical Cloud over African Eden.
    Date March 1992
    Journal Nature
    Title Epidural Analgesia--a Cause of Transient Impairment of the Utero-placental Circulation?
    Date February 1992
    Journal British Journal of Obstetrics and Gynaecology
    Title Retrospective Analysis of 318 Cases of Uterine Sarcoma.
    Date January 1992
    Journal European Journal of Cancer (oxford, England : 1990)
    Excerpt

    A study of data from 318 cases of uterine sarcoma presenting during a 10-year period (1967-1976) is reported. All but 6 of the patients had at least a 5-year follow-up (98% 5-year follow-up). Overall 5-year survival was 31%, with the major prognostic indicator being tumour stage. Despite the tendency for mixed mesodermal tumours to present in older women with more advanced disease, survival was not statistically different to those patients with leiomyosarcomas. Thus, the propensity for tumour dissemination in leiomyosarcomas should not be underestimated. Leiomyosarcomas are less likely to present with abnormal symptoms than are other sarcomas, and their occurrence as an incidental finding on histological examination underlines the need for an adequate inspection of the intra-abdominal contents at hysterectomy. The tendency to treat all sarcomas as if they were endometrial tumours may be fallacious, and an alternative classification (such as the TNM system) may be required. Recurrence of tumour tended to be at distant sites (distant:pelvic recurrence rate 3:1). Adjuvant radiotherapy is unlikely to alter distant disease foci, and thus the development of combination chemotherapeutic regimens using agents which have shown to result in tumour response seem warranted. Such trials will need to be organised on a multicentre basis to attain statistically evaluable numbers of patients.

    Title Fetal Heart Block Associated with Maternal Anti-ro (ss-a) Antibody--current Management. A Review.
    Date November 1991
    Journal British Journal of Obstetrics and Gynaecology
    Title Human Genome Meeting. The Price of Success.
    Date September 1991
    Journal Nature
    Title Freedom of Speech in the New Nhs.
    Date September 1991
    Journal Bmj (clinical Research Ed.)
    Title The Oedipal Complex in Adolescence.
    Date August 1991
    Journal The Journal of Analytical Psychology
    Title Scar Rupture in Labour After Previous Lower Uterine Segment Caesarean Section: the Role of Uterine Activity Measurement.
    Date June 1991
    Journal British Journal of Obstetrics and Gynaecology
    Excerpt

    A series of 12 trials of scar associated with scar rupture is reviewed. Uterine activity patterns were assessable in 10 of them. Clinical features and characteristics of the intrauterine pressure waveform and uterine activity are discussed in relation to the integrity of the scar.

    Title Cancer Therapy. Neutron-treatment Fund Axed.
    Date April 1991
    Journal Nature
    Title Chambon Among Winners of Swiss Prize.
    Date February 1991
    Journal Nature
    Title Placental Zinc in Normal and Intra-uterine Growth-retarded Pregnancies.
    Date September 1990
    Journal The British Journal of Nutrition
    Excerpt

    The zinc concentration of placental tissue and cord blood in sixteen mothers who gave birth to normal babies was measured. The blood volume of each placenta was estimated from measurements of haemoglobin concentration of placental homogenate and cord blood, and, by deduction, the Zn content of blood-free placental tissue was calculated. Results were compared with eleven mothers whose fetuses showed a low biparietal diameter velocity between 17 and 28 weeks gestation and with ten mothers who gave birth to intra-uterine growth-retarded (IUGR) babies. As expected, placental weight was significantly correlated with infant birth weight. Blood-free placental tissue contained about four times more Zn (approximately 10 micrograms Zn/g) than cord blood (approximately 2.5 micrograms Zn/ml). Concentrations of Zn in blood-free placental tissue were similar in all three groups, but the cord blood Zn of mothers producing IUGR babies was significantly lower than that of the other two groups. Results of the present study suggested that fetal growth retardation in the mothers studied could not be explained by differences in blood-free placental Zn concentration, but that there may be some association between lower cord blood Zn levels and intra-uterine growth retardation.

    Title Large Intrauterine Haematoma in Threatened Miscarriage. Frequency and Clinical Consequences.
    Date September 1990
    Journal British Journal of Obstetrics and Gynaecology
    Title Raised Maternal Serum Alpha-fetoprotein Levels During Pregnancy Following Treatment of an Endodermal Sinus Tumour. Case Report.
    Date June 1990
    Journal British Journal of Obstetrics and Gynaecology
    Title Us Medical Research Healthy.
    Date May 1990
    Journal Nature
    Title Postpartum Haemolytic Uraemic Syndrome Precipitated by Antibiotics. Case Report.
    Date April 1990
    Journal British Journal of Obstetrics and Gynaecology
    Title Palaeontology. Four Legs to Stand On...
    Date January 1990
    Journal Nature
    Title Fossils. Oldest Reptile to Leave Uk?
    Date January 1990
    Journal Nature
    Title Schizophrenia. Esf Scheme Criticized.
    Date December 1989
    Journal Nature
    Title Metabolic Changes in Asian Muslim Pregnant Mothers Observing the Ramadan Fast in Britain.
    Date September 1989
    Journal The British Journal of Nutrition
    Excerpt

    1. Metabolic changes associated with Ramadan fasting were studied in eleven Asian pregnant mothers. This was compared with a group of control mothers undergoing a normal physiological fast. 2. At the end of the Ramadan fast day there was a significant fall in glucose, insulin, lactate and carnitine, and a rise in triglyceride, non-esterified fatty acid and 3-hydroxybutyrate. When compared with the control group, none of the Ramadan mothers had a completely normal set of biochemical values at the end of the fast day. 3. Pregnancy outcome in the two groups was comparable. 4. We are wary of the metabolic departures from normal observed in the Ramadan fasting mothers. If asked we advise mothers to take up the dispensation from fasting during pregnancy which is allowed.

    Title The Aetiology and Clinical Significance of the Sinusoidal Fetal Heart-rate Pattern; Two Case Reports.
    Date September 1989
    Journal European Journal of Obstetrics, Gynecology, and Reproductive Biology
    Excerpt

    Two cases are presented in which sinusoidal heart-rate (SHR) patterns were recorded antenatally. In the first case the pattern was associated with severe maternal exertion and prolonged exposure to freezing temperatures. The pattern returned to normal within an hour of maternal recovery. The second case was associated with fetal death due to high-output cardiac failure associated with a large liver haemangioma. A hypothesis is proposed to link the aetiology for this heart-rate pattern which would explain these, and previously reported cases.

    Title A Model for the Generation of Intra-uterine Pressure in the Human Parturient Uterus Which Demonstrates the Critical Role of the Cervix.
    Date May 1989
    Journal Journal of Theoretical Biology
    Excerpt

    A mathematical model is presented which describes the relationship between intrauterine pressure and uterine wall tension. Wall tension is evaluated in terms of muscular contraction in an active myometrium and the modulating effect of a passive, compliant cervix. Using a computer programme which simulates the recruitment of contractile elements in the uterine wall, it is possible to generate theoretical pressure waveforms. The effects on these waveforms produced by changing cervical properties are demonstrated and compared with observed phenomena. The physiological and clinical implications are evaluated.

    Title Natural History Museum to Build Dna Database in London.
    Date January 1989
    Journal Nature
    Title The Management of Severe Disseminated Intravascular Coagulopathy Complicating Placental Abruption in the Second Trimester of Pregnancy.
    Date August 1988
    Journal British Journal of Obstetrics and Gynaecology
    Title Animal Guidelines.
    Date August 1988
    Journal Nature
    Title Acute Leukaemia During Pregnancy.
    Date March 1988
    Journal Lancet
    Title Massive Subchorionic Thrombohaematoma Presenting As a Placental Tumour. Case Report.
    Date January 1988
    Journal British Journal of Obstetrics and Gynaecology
    Title Uk Nuclear Operators Unhappy with Radiation Dose Advice.
    Date January 1988
    Journal Nature
    Title Xy-hermaphroditism with Unique Combination of Gonadal Tumours. Case Report.
    Date May 1987
    Journal British Journal of Obstetrics and Gynaecology
    Title Transplacental Effect of High-dose Immunoglobulin in Idiopathic Thrombocytopenia (itp)
    Date June 1986
    Journal Lancet
    Title Management of Postconization Cervical Stenosis by Laser Vaporization.
    Date January 1986
    Journal Obstetrics and Gynecology
    Excerpt

    In 18 patients with symptomatic cervical stenosis after conization, laser vaporization of the stenotic segment was performed. Total relief of symptoms was achieved in 12 patients and partial relief in four. In seven cases there was no evidence of stenosis at follow-up, and in a further nine cases the degree of stenosis was less. In seven cases it was possible to visualize the squamocolumnar junction at follow-up. This had not been possible in any cases before the procedure. Vaporization using the carbon dioxide laser provides a useful conservative management technique for postconization stenosis.

    Title The Interaction Between Cervix and Corpus Uteri in the Generation of Intra-amniotic Pressure in Labour.
    Date May 1984
    Journal European Journal of Obstetrics, Gynecology, and Reproductive Biology
    Excerpt

    Theoretically, the response of the cervix to myometrial activity should affect the intra-amniotic pressure waveform. Clinical assessment of cervical response, in 80 induced labours, has been correlated with various waveform parameters. More abrupt and more rapid rises in intra-amniotic pressure are associated with the non-responding cervix. The clinical implications are discussed.

    Title Placental-type Alkaline Phosphatase in Pregnancy and Malignancy Plasma: Specific Estimation Using a Monoclonal Antibody in a Solid Phase Enzyme Immunoassay.
    Date September 1983
    Journal Clinica Chimica Acta; International Journal of Clinical Chemistry
    Excerpt

    A solid-phase enzyme immunoassay has been developed using a monoclonal antibody with specificity only for the placental-type alkaline phosphatase isoenzyme (Pl-ALP). This assay is uniquely sensitive, having a lower limit of detection of 0.1 U/l (approximately 0.07 micrograms/l) Pl-ALP. All plasma samples from healthy non-pregnant individuals had undetectable Pl-ALP levels whereas, in pregnancy, a wide range (0-400 U/l) of Pl-ALP levels was noted for 208 maternal plasma samples from 12 weeks gestation to term. There was no significant difference in circulating Pl-ALP levels between severe pre-eclamptic and normal pregnancy. Low levels of Pl-ALP (0.1-4.7 U/l) were found in 31 of 217 plasmas from human malignancies. Within these, 23 of 65 (35%) histologically-proven ovarian carcinoma patients were positive.

    Title Uterine Activity Plotted on an Inductograph As an Aid to Management of Labour.
    Date June 1980
    Journal British Journal of Obstetrics and Gynaecology
    Excerpt

    By combining uterine activity data with an "inductograph" it is possible to distinguish between normal progress and at least three different types of delayed progress during the early stage of stimulated labour. Delayed progress may be associated with optimal, insufficient or, sometimes, excessive uterine activity. The patterns described facilitate early recognition and management of clinical problems such as cephalopelvic disproportion, undue cervical resistance, inadequate myometrial activity, and impending fetal distress.

    Title Perineal Pain After Epidural Analgesia in Labor.
    Date February 1979
    Journal Midwives Chronicle
    Title Antenatal Diagnosis of Fetal Duodenal Atresia by Ultrasonic Scan.
    Date January 1979
    Journal British Medical Journal
    Title Water Content, Raffinose, and Dehydrins in the Induction of Desiccation Tolerance in Immature Wheat Embryos
    Date
    Journal Plant Physiology
    Excerpt

    Desiccation tolerance is initiated in wheat (Triticum aestivum L.) embryos in planta at 22 to 24 d after anthesis, at the time that the embryo water content has decreased from about 73% fresh weight (2.7 g water/g dry weight) to about 65% fresh weight (1.8 g water/g dry weight). To determine if desiccation tolerance is fully induced by the loss of a relatively small amount of water, detached wheat grains were treated to reduce the embryo water content by just a small amount to approximately 69% (2.2 g water/g dry weight). After 24 h of such incipient water loss, subsequently excised embryos were able to withstand severe desiccation, whereas those embryos that had not previously lost water could not. Therefore, a relatively small decrease in water content for only 24 h acts as the signal for the development of desiccation tolerance. Embryos that were induced into tolerance by a 24-h water loss had no detectable raffinose. The oligosaccharide accumulated at later times even in embryos of detached grains that had not become desiccation tolerant, although tolerant embryos (i.e. those that previously had lost some water) contained larger amounts of the carbohydrate. It is concluded that desiccation tolerance and the occurrence of raffinose are not correlated. Immunodetected dehydrins accumulated in embryos in planta as desiccation tolerance developed. Detachment of grains induced the appearance of dehydrins at an earlier age, even in embryos that had not been made desiccation tolerant by incipient drying. It is concluded that a small reduction in water content induces desiccation tolerance by initiating changes in which dehydrins might participate but not by their interaction with raffinose.

    Title Microrna-210 Regulates Mitochondrial Free Radical Response to Hypoxia and Krebs Cycle in Cancer Cells by Targeting Iron Sulfur Cluster Protein Iscu.
    Date
    Journal Plos One
    Excerpt

    Hypoxia in cancers results in the upregulation of hypoxia inducible factor 1 (HIF-1) and a microRNA, hsa-miR-210 (miR-210) which is associated with a poor prognosis.


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