Child safety and demonstration homes.
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Accidents, Home↗
Biomedical subjects
A MacKellar
Publications and source records attributed to A MacKellar.
Late effects of childhood malignancies seen in Western Australia.
Eighty-nine pediatric oncology patients, in remission and off treatment for at least 4 years, were reviewed annually in the Late Effects Clinic of Princess Margaret Hospital for Children in Perth, Western Australia. Interval from time of diagnosis to follow-up ranged from 4 to 23 years (mean 10.8 years). Acute lymphoblastic leukemia (ALL) (40%) and Wilms' tumor (27%) were the most common primary malignancies in this group. Late sequelae included musculoskeletal abnormalities (23 children), growth hormone deficiency (11), second tumors (9), learning difficulties (7), puberty and fertility problems (4), and hypothyroidism (4). These complications were most often related to radiation therapy. The need for prolonged, regular follow-up of survivors of childhood malignancy for early detection of late sequelae and subsequent intervention is stressed.
Adolescent↗
Heterogeneity of murine bone marrow-derived mast cells: analysis of their proteinase content.
The expression of granule proteinases by murine bone marrow-derived mast cells (BMMC) grown in vitro was compared with that of serosal mast cells (SMC) from the peritoneal cavity. The granules in a proportion of BMMC (0.4-13%) and in all SMC were labelled with fluorescent antibodies against rat mast cell protease I (RMCP I). The granules of 1-47% of BMMC and 100% of SMC were labelled with antibodies against a 30,000 molecular weight (MW) murine intestinal mast cell proteinase (MIMCP). Four antigens from BMMC, ranging in MW from 28,000 to 32,000 and a single 28,000 antigen from SMC were detected on Western blot using anti-MIMCP antibodies. Only the 28,000 MW antigens from BMMC and SMC were visualized in blots probed with anti-RMCP I. BMMC grown in the presence of conditioned medium from activated splenocytes or from the WEHI-3B myelomonocytic cell line contained 52-118 ng and 3-25 ng MIMCP/10(6) cells respectively, whereas SMC lacked detectable MIMCP. The selective labelling of the 28,000 MW antigens in BMMC and SMC with anti-RMCP I and the variable expression of this antigen in BMMC as detected by immunofluorescence indicates that BMMC are not a homogeneous population of cells.
Animals↗
Intestinal mucosal mast cells in Nippostrongylus-infected mice: lack of sensitivity to corticosteroids.
Immune reactions to enteric nematodes, in which mast cells are thought to play an important role, are abrogated following corticosteroid treatment of host animals. This is probably due, at least in part, to inhibition of cytokine production by T cells. It has proved difficult to block worm expulsion in mice with corticosteroids. We have therefore examined the effects of corticosteroids on mast cell numbers and concentrations of the mast cell granule-specific serine protease Mouse Intestinal Mast Cell Protease (MIMCP) in the intestines of mice infected with Nippostrongylus brasiliensis. Mucosal mast cell (MMC) numbers and concentrations of MIMCP were unaltered by steroid treatment. This is in marked contrast to Nippostrongylus-infected rats which showed decreases in both mast cell numbers and concentrations of the rat mucosal mast cell protease RMCP II after steroid treatment. This suggests that differentiated murine MMC are less dependent on T cells than those of the rat.
Animals↗
Ovine haemopoiesis: the development of bone marrow-derived colony-forming cells in vitro in the presence of factors derived from lymphoid cells and helper T-cells.
Techniques for the development of ovine bone marrow-derived haemopoietic progenitor cells and in situ identification of colony morphology are described. Both mitogen stimulated lymphoid cells and antigen stimulated helper T-cells generated potent colony-stimulating activity in conditioned medium. Monocyte/macrophage, neutrophil, eosinophil, basophil/mast cell, neutrophil/monocyte and mixed phenotype colonies developed in stimulated bone marrow cultures in a conditioned medium dose-dependent manner. Neutrophil, monocyte/macrophage and eosinophil colonies were detected in greater numbers than the other types, with mixed colonies representing only around 1% of the total. Eosinophil colonies were particularly abundant when compared to published reports of the numbers obtained with similar cultures of 'normal' mouse or human bone marrow cells. This culture technique will allow a detailed analysis of both ovine colony-stimulating factors and of the distribution of haemopoietic progenitor cells in vivo.
Animals↗
Head injuries in children and implications for their prevention.
Between October 1986 and September 1987, 7,967 children presented to the emergency department of the Princess Margaret Hospital for Children for the first time with injuries. Head injuries had been sustained by 3,187 (40%). The data was collected by use of a special form distributed by the nursing staff and completed by parents and medical staff. Information was obtained about the age and sex of the patients, the nature of the injury, the site of occurrence, the activity at that time, and the context in which it took place. The use, or otherwise, of safety devices was also recorded. Injury severity was classified as follows: minor treated in casualty department (80.7%); moderate, admitted to general ward (17.1%); severe, admitted to intensive care (2.2%). Examination of the data showed certain recurring problems, ie, surfaces onto which children fell, bicycles, playgrounds, sporting injuries, vehicle accidents, inadequate supervision. Implications for prevention are (1) improved home design, particularly flooring and furniture; (2) better planning of home surroundings, play areas, and equipment; (3) determination of age at which children are capable of riding bicycles and coping with traffic; (4) extension and enforcement of restraint regulations to protect children in vehicles; (5) better supervision of children engaged in sports and recreational activities, and use of safety devices; (6) increased community awareness of the frequency of head injuries, and knowledge of how the numbers can be reduced and the severity diminished; and (7) improved knowledge of child growth and development, and better supervision by all care-givers.
Accidental Falls↗
Undescended testis: how history and examination may influence treatment.
This paper reports a prospective study of 114 boys with 126 undescended testes. The aims were to identify the position of the testis in the first year of life, to document cases of apparent ascent of the testes following a scrotal position in infancy, and to determine whether knowledge of the position of the testis in infancy might be used as a guide in later management. In 92 instances the position of the testis at birth, at 6 weeks and at 1 year of age was recorded; 84 were considered undescended and eight were in the scrotum. There was no clear indication of the position of the testis in the remaining 34. When the position of the testis was known to be undescended from birth to the end of the first year, response to hormonal therapy was disappointing. However, when there was a history of prior descent or when there was no clear information about the position in the first year of life, response to hormonal therapy was rewarding (57%) and this therapeutic modality is recommended prior to surgery for this group of patients.
Age Factors↗
Pain relief for the pediatric surgical patient.
Modern techniques available for the relief of pain following major surgical procedures or trauma in childhood receive scant attention in pediatric surgical textbooks. A range of options for pain relief have been offered to children in our hospital, which include: regional analgesia; appropriate use of intermittent intramuscular narcotic injections; and variable-rate intravenous narcotic infusions. Since 1982 regional analgesia has been used in more than 2,000 patients following operations on the penis and in the inguinoscrotal region. Two hundred forty five children with fractured femora have been managed using femoral nerve blocks. Intermittent intramuscular narcotic injections are the most common method of pain relief. However, the variable nature of children's pain frequently results in an unsatisfactory outcome. Variable-rate intravenous narcotic infusions were introduced in 1982 and the first 155 infusions in 144 patients have been analyzed. The protocol and method of administration are described along with the dosage and problems encountered during the introduction of the technique. It has now been employed postoperatively in 242 more patients and many infusions have been commenced in the emergency department, intensive care, and neonatal units bringing the total number of infusions to more than 600. Assessment of effective pain relief has been made on the basis of observation and comment by parents and patients and by medical and nursing staff. The steady increase in demand for the use of this technique is an index of its value. It is concluded that there is a real need to improve pain relief for children by better education of medical and nursing staff and inclusion of this important subject in pediatric surgical text books.
Adolescent↗
Intussusception in children: a review of 91 cases.
This is a retrospective study of 91 patients treated for intussusception between 1982 and 1984. Criteria for inclusion in the study were the finding of a classical radiological appearance on Barium enema examination or the presence of an intussusception at operation. The clinical features are described. A protocol of management first reported in 1983 was followed with 90 of 91 patients submitted to a diagnostic and/or therapeutic Barium enema. As a result of recent experience, the protocol has been modified in selected patients at the discretion of the surgeon and the radiologist. A success rate of Barium enema reduction of 78% was achieved, which is higher than in previous Princess Margaret Hospital studies; there was recurrence of the intussusception in 12 patients following hydrostatic reduction. Further Barium enema reduction was successful in 11 and operation in one. There was no mortality and minimal morbidity.
Barium Sulfate↗
Wound and intraperitoneal infection following appendicectomy for perforated or gangrenous appendicitis.
A series of 158 children, who were operated on for perforated or gangrenous appendicitis between 1980 and 1984 inclusive, are reviewed. A protocol of management, based on the results of bacteriology of the perforated appendix was introduced and the guidelines followed in all but four instances. Eight patients (5.0%) developed postoperative infections, either in the wound or intraperitoneally. The frequency of infection was affected by the adherence to protocol, as 50% of the infections occurred in patients who did not receive preoperative antibiotic prophylaxis. The use of drainage also contributed to the frequency of wound infection. Thorough peritoneal lavage and meticulous surgical technique should reduce the need for drainage.
Anti-Bacterial Agents↗
Diagnosis and management of atypical mycobacterial lymphadenitis in children.
One hundred and thirty children with superficial atypical mycobacterial lymphadenitis have been treated between 1958 and 1974. The introduction of Double Mantoux testing has provided a reliable means of differentiating human and bovine from atypical infection and has enabled us to cease the routine use of antituberculous drugs. Adequate local surgical excision has become the treatment of choice.
Child↗
Congenital diverticulum of the pharynx simulating esophageal atresia.
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Diagnosis, Differential↗
Cerebrovascular amyloidosis in scrapie-affected sheep.
Cerebrovascular amyloidosis (CA) was found in the cerebral and cerebellar cortices in 11 of 20 sheep, of six different breeds, with naturally-occurring scrapie. The occurrence of the lesion did not appear to be influenced by the age of the sheep. This was not seen in 20 brains from age- and breed-matched sheep with other conditions. Furthermore, it was not found in 20 sheep experimentally infected with scrapie by sub-cutaneous inoculation, or in 22 sheep with natural scrapie in a closed breeding group, but it was present at low frequency in a production flock, closed apart from the introduction of rams. It is concluded that this lesion is strongly associated with sheep scrapie disease, but that its occurrence varies between different groups of scrapie sheep. A major source of this variation is likely to be the strain of the agent, though other factors may be involved as has been shown for cerebral amyloidosis in experimental mouse scrapie.
Amyloidosis↗
Bicycle-spoke and "doubling" injuries.
A "doubling" injury is the result of two persons, usually two children, but often an adult and a child, riding on a bicycle. The most-common variety is the "bicycle-spoke injury" which is sustained when the passenger's foot is caught in the spokes of the wheel. Between August 1, 1986 and July 31, 1987, 43 children (mean age, 55 months) attended the Emergency Department of Princess Margaret Hospital for Children with such an injury. None of the bicycles had spoke-guards. Sixteen children were admitted to hospital: eight children required skin grafts and four children required repair by sutures. Nineteen (44%) of the children had bare feet when they were injured. The healing time ranged from seven to 365 days with an average of 56 days, which was long enough to ruin a child's holiday. This injury can be prevented. "Doubling" is dangerous and should be prohibited where seats and spoke-guards are not available. The attention of parents and the community should be drawn to the potentially-serious nature of these injuries.
Athletic Injuries↗