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Rogers BE, Mccarthy DW, Sharp TL, Kim J, Della Manna D, Kirkman R, Welch MJ. Evaluation of a 64Cu-labeled bombesin analogue for diagnosis of gastrin-releasing peptide receptor positive tumors by micropet imaging. J Labelled Comp Radiopharm 2012. [DOI: 10.1002/jlcr.2580440128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gupta S, Kirkman R. Intrauterine devices--perceptions overestimate the hazards. EUR J CONTRACEP REPR 2001; 6:231-3. [PMID: 11848653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
OBJECTIVE To look for any differences in attitudes to menopause and hormone replacement therapy (HRT) between Asian and Caucasian women standardised for educational background, socio-economic status and access to medical information. METHOD Self administered postal questionnaire sent to 144 women doctors (general practitioners) in defined geographical areas. RESULTS The overall response rate was 61%. Both Asian and Caucasian women responded in a similar manner for most aspects. A high proportion of these women doctors (over 75%) would seek HRT at the climacteric. More Asian respondents reported a fear of breast cancer (P=0.001), and that a woman feels less of a woman after the menopause (P=0.02). More Caucasian respondents felt positively about the potential for HRT to enhance enjoyment of life (P=0.01). CONCLUSIONS The lack of major differences between the ethnic groups in our sample suggests that variations reported elsewhere may be due to lack of knowledge and/or differences in socio-economic status.
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Affiliation(s)
- S Gupta
- Forest Healthcare NHS Trust, Hurst Road Health Centre, Lower Ground Floor, Hurst Road, Walthamstowe, London E17 3BL, UK
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Kirkman R. Pre-menarchal prescription of Dianette. J Fam Plann Reprod Health Care 2001; 27:115. [PMID: 12463222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Bonnar J, Freundl G, Kirkman R. Personal hormone monitoring for contraception. Br J Fam Plann 2000; 26:178-9. [PMID: 11001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
We examined women's preferences regarding the use of chaperones during intimate examinations by a female doctor or nurse in community-based family planning clinics. An anonymous questionnaire was completed before consultation and examination by 126 women attending five family planning clinics selected to cover a range of social and ethnic groups. The questionnaire explored women's views regarding intimate examinations by a woman and the presence of a chaperone. A clear majority (107 vs 19) of our community clinic users preferred to be alone with the woman doctor or nurse during an internal examination. There was no significant difference in preference or strength of feeling when analysed by age, ethnicity or previous experience.
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Guota S, Hogan R, Kirkman R. Experience of the first pelvic examination. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Flye MW, Pennington L, Kirkman R, Weber B, Sindelar W, Sachs DH. Spontaneous acceptance or rejection of orthotopic liver transplants in outbred and partially inbred miniature swine. Transplantation 1999; 68:599-607. [PMID: 10507476 DOI: 10.1097/00007890-199909150-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Results of clinical liver transplantation have shown that rejection and loss of human liver allografts occurs despite immunosuppression. Because genetic disparity and liver immunogenicity remain a matter of controversy, we reexamined the fate of outbred liver allografts without immunosuppression and used partially inbred miniature swine, in which the genetics of major histocompatibility complex (MHC) antigens have been characterized and can be controlled. METHODS Orthotopic liver transplantation was performed between pairs of outbred domestic farm pigs and between pairs of inbred miniature swine with genetically defined major histocompatibility (SLA) loci. A passive splenic and vena caval to jugular vein shunt with systemic heparinization prevented hypotension during the anhepatic phase. Immunological responses were monitored by mixed lymphocyte culture (MLC), CML, skin graft rejection, liver biopsies, and serial serum chemistries. RESULTS Median survival of technically successful liver allografts between pairs of outbred pigs (n=20) was 38 days and between partially inbred swine matched at the SLA locus (n=17) was 79 days. MLC responsiveness did not correlate with the development of rejection. Five of 20 (25%) outbred pigs and 6 of 17 (35%) MHC matched inbred miniature swine survived more than 100 days. In the long-term survivors, donor, but not third party, MHC matched skin graft survival times were prolonged. In contrast, all SLA-mismatched inbred recipients (n=26) died rapidly from massive liver rejection, with a median survival time of 9 days. In these rejecting animals, the marked MLC responsiveness to donor lymphocytes evident pretransplant diminished rapidly after transplantation, but an undiminished PHA responsiveness and a blunted third party MLC response persisted. CONCLUSION The length of survival and the degree and incidence of rejection were similar in outbred pigs and in SLA-matched inbred miniature pigs, indicating that the outbred animals were, therefore, probably closely related and shared relevant genes. However, survival was significantly shortened and liver allograft rejection was accelerated in SLA-mismatched inbred swine. These results indicate that major histocompatibility differences play an important role in the rejection of liver allografts, as is true for other vascularized grafts in the unimmunosuppressed recipient. The development of liver allograft rejection across non-MHC differences is variable and, when present, appears to be a chronic process.
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Affiliation(s)
- M W Flye
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
OBJECTIVE To establish what proportion of young girls who were prescribed the contraceptive pill at Manchester family planning clinics have first remembered, and second followed, advice also to use the condom for protection from sexually transmitted infection. METHOD An anonymous self-administered questionnaire was issued to all females up to the age of 25 years, who were already using the pill and who attended one of 20 different clinic locations. Questions included duration of present relationship, frequency of condom use and reasons for use or non-use. RESULTS The age of respondents ranged from 13 to 25 years, with one-third in the group of 17-19-year-olds. Out of 104 responses, condoms were used most of the time by 29 girls, occasionally by 42 and never by 33. Only 15 of the 104 knew the phrase 'double Dutch'. Dual use most of the time primarily for sexually transmitted disease protection was reported by 23 girls. Previous treatment for sexually transmitted disease was reported by 14 girls, of whom half never used condoms and only three now used condoms most of the time. In the group of girls using condoms occasionally, 70% were using condoms primarily to cover missed pills, antibiotics, etc. Extrapolating from the number of condoms used in the past month and the fact that 80% of girls obtained their condoms from the clinic, the extra cost to the family planning budget is over 14,000 Pounds (over 22,500 Ecu) per year. CONCLUSION Our result that 22% of young pill users regularly used condoms to protect from sexually transmitted diseases indicates that the message is understood, but the term 'double Dutch' is not.
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Affiliation(s)
- J Gregson
- Palatine Centre, University of Manchester, UK
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Bonnar J, Flynn A, Freundl G, Kirkman R, Royston R, Snowden R. Personal hormone monitoring for contraception. Br J Fam Plann 1999; 24:128-34. [PMID: 10023097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To determine the effectiveness and acceptability of personal hormone monitoring for contraception. DESIGN A large prospective study was carried out on personal hormone monitoring for contraception when used with abstinence during the identified fertile days. SETTING Three country study under the auspices of the departments of Obstetrics and Gynaecology of the Universities of Birmingham, Dublin and Dusseldorf SUBJECTS Seven hundred and ten women, median age 30, were recruited from the general population. They were required to have regular menstrual cycles (23-35 days) and to be delaying their next pregnancy. INTERVENTIONS Personal hormone monitoring consists of a hand held monitor and disposable test sticks which measure changes in urinary concentrations of oestrone-3-glucuronide and luteinising hormone. An algorithm estimated the fertile days which were displayed by a red light. OUTCOME MEASURES AND RESULTS One hundred and sixty two pregnancies occurred in 7209 cycles of use, of which 67 were method related pregnancies. The 13 cycle life-table method pregnancy rate (95 per cent CI) was 12. 1 per cent (9.3-14.8). The system allowed analysis of the effect of changes to the algorithm to modify the defined fertile period. As a result the algorithm was changed to increase the median warning of the luteinising hormone surge to six days. With the revised algorithm, half of the method pregnancies would have been prevented giving a calculated method pregnancy rate of 6.2 per cent (4.2-8.3) and method efficacy of 93.8 per cent. The continuation rate after 13 cycles was 78 per cent. CONCLUSION Personal hormone monitoring proved simple to use and will be of value to women who do not want to use other methods of contraception.
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Affiliation(s)
- J Bonnar
- Trinity College Department of Obstetrics and Gynaecology, Coombe Women's Hospital and St James's Hospital, Dublin 8, Ireland
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Abstract
OBJECTIVE To identify any adverse effect on bone density in long term users of depot medroxyprogesterone acetate (DMPA) for contraception. DESIGN Cross-sectional measurement of bone density in users with amenorrhoea of more than one year or any woman using DMPA for more than five years. SETTING Community Family Planning Clinics in Portsmouth and Manchester. POPULATION One hundred and eighty-five women aged 17-52 years (mean 33.3 years) who had used DMPA for between 1 and 16 years and were attending the clinics for further injections, between August 1994 and August 1996. METHODS Dual energy X-ray measurement of bone density of femoral neck and lumbar spine, and venous blood sample taken just prior to the next injection of DMPA. MAIN OUTCOME MEASURES Bone density of femoral neck and lumbar spine and serum oestradiol in relationship to years of DMPA use and duration of amenorrhoea. RESULTS Most women (n=153) had serum oestradiol levels < 150 pmol/l. Despite this, the mean bone density of the lumbar spine compared with the population mean for women aged 20-59 years gave a Z score (95% CI) of -0.332 (-0.510 to -0.154). There was no significant difference in the mean density of the femoral neck from the normal population mean. CONCLUSION Despite amenorrhoea and low serum oestradiol, this sample of long term DMPA users had bone density only minimally below the normal population mean. We therefore found no clinically important adverse effect on bone density and therefore no reason to recommend bone conserving measures, such as add-back oestrogen.
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Affiliation(s)
- B Gbolade
- Palatine Centre, University of Manchester, UK
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Vincenti F, Kirkman R, Light S, Bumgardner G, Pescovitz M, Halloran P, Neylan J, Wilkinson A, Ekberg H, Gaston R, Backman L, Burdick J. Interleukin-2-receptor blockade with daclizumab to prevent acute rejection in renal transplantation. Daclizumab Triple Therapy Study Group. N Engl J Med 1998; 338:161-5. [PMID: 9428817 DOI: 10.1056/nejm199801153380304] [Citation(s) in RCA: 749] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Monoclonal antibodies that block the high-affinity interleukin-2 receptor expressed on alloantigen-reactive T lymphocytes may cause selective immunosuppression. Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically to the alpha chain of the interleukin-2 receptor and may thus reduce the risk of rejection after renal transplantation. METHODS We administered daclizumab (1.0 mg per kilogram of body weight) or placebo intravenously before transplantation and once every other week afterward, for a total of five doses, to 260 patients receiving first cadaveric kidney grafts and immunosuppressive therapy with cyclosporine, azathioprine, and prednisone. The patients were followed at regular intervals for 12 months. The primary end point was the incidence of biopsy-confirmed acute rejection within six months after transplantation. RESULTS Of the 126 patients given daclizumab, 28 (22 percent) had biopsy-confirmed episodes of acute rejection, as compared with 47 of the 134 patients (35 percent) who received placebo (P=0.03). Graft survival at 12 months was 95 percent in the daclizumab-treated patients, as compared with 90 percent in the patients given placebo (P=0.08). The patients given daclizumab did not have any adverse reactions to the drug, and at six months, there were no significant differences between the two groups with respect to infectious complications or cancers. The serum half-life of daclizumab was 20 days, and its administration resulted in prolonged saturation of interleukin-2alpha receptors on circulating lymphocytes. CONCLUSIONS Daclizumab reduces the frequency of acute rejection in kidney-transplant recipients.
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Affiliation(s)
- F Vincenti
- University of California, San Francisco 94143-0116, USA
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Kirkman R. Contraceptive provision for the older woman. Adv Contracept 1996; 12:173-7. [PMID: 8910659 DOI: 10.1007/bf01849660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R Kirkman
- University of Manchester, Palatine Centre, UK
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Kirkman R. [Oral contraceptives and women 35 years of age and older]. Adv Contracept 1993; 9 Suppl 1:59-64. [PMID: 8512031 DOI: 10.1007/bf02035629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- R Kirkman
- University of Manchester, Palatine Centre, Reino Unido
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Abstract
Sexually transmitted diseases (STDs) are a major cause of ill health in women and their sexual partners and children. Contraceptive methods alter in various ways the risk of acquiring STD but assessment of the odds ratio is difficult due to the many confounding factors. Spermicides have been reported to kill a wide range of bacteria and viruses including HIV in vitro and to protect in vivo from infection by gonorrhoea, chlamydia and pelvic inflammatory disease (organisms unspecified). Spermicides will not cure pre-existing infections. Condoms and diaphragms will give some protection from bacterial and viral infections in all parts of the genital tract. Hormonal contraception and tubal ligation give protection to the upper genital tract but not the cervix. Carcinoma of the cervix follows the same pattern as STDs. The risk of pelvic infection in intrauterine device users is discussed in the chapter by Bromham (pp 100-123, this issue).
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Affiliation(s)
- R Kirkman
- Department of Obstetrics and Gynaecology, University of Manchester, UK
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Abstract
We estimated the incidence of intestinal necrosis in 752 hospitalized patients who had received sodium polystyrene sulfonate (SPS). Of these 752 patients, 117 were exposed within 1 week of surgery. Two cases of intestinal necrosis were discovered, both in patients who had received orally administered SPS in sorbitol within 1 week of surgery. Based on these two cases, the postoperative incidence of intestinal necrosis associated with SPS was 1.8%. For comparative purposes, we identified 862 patients who had undergone hemodialysis, renal transplantation, or cardiac transplantation, but did not receive SPS. No cases of idiopathic intestinal necrosis were found in this second group (P = 0.014). These data suggest that SPS in sorbitol-associated intestinal complications may be a relatively common occurrence in postoperatively exposed patients.
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Affiliation(s)
- B B Gerstman
- Department of Health Science, San Jose State University 95192-0052
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Kishen M, Kirkman R. Costing out the clinics. Health Serv J 1989; 99:882-4. [PMID: 10294119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Fisher F, Kirkman R, Smith C. Who works in family planning clinics? BMJ 1985; 291:753-4. [PMID: 3929926 PMCID: PMC1416629 DOI: 10.1136/bmj.291.6497.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kirkman R, Bromham D, Fisher F, Toogood SJ. Job sharing and the future of community health doctors. West J Med 1984. [DOI: 10.1136/bmj.289.6457.1542-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Leight GS, Kirkman R, Rasmusen BA, Rosenberg SA, Sachs DH, Terrill R, Williams GM. Transplantation in miniature swine. III: effects of MSLA and A-O blood group matching on skin allograft survival. Tissue Antigens 1978; 12:65-74. [PMID: 360485 DOI: 10.1111/j.1399-0039.1978.tb01301.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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