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Biomedical subjects

A N Campbell

Publications and source records attributed to A N Campbell.

At least 19 recordsLinked to original sources

The behaviour of Sal'nikov's reaction, P --> A --> B, in a spherical batch reactor with the diffusion of heat and matter.

The behaviour of a simple chemical reaction, occurring with the release of heat in a closed batch reactor, is considered for the situation when matter and heat are transported only by diffusive processes; thus, the reacting fluid has negligible velocity, so that heat transfer is by thermal conduction. The reaction is Sal'nikov's, which consists of two, consecutive first-order steps, producing a product B, from a precursor P, via an active intermediate A, in P --> A --> B. The first of these steps is assumed to be thermoneutral, with zero activation energy, whilst the second is exothermic, with an appreciable activation energy. These features make Sal'nikov's reaction the simplest to display thermokinetic oscillations that characterise many, more complex schemes, e.g. cool flames in hydrocarbon combustion. This study involves identifying the regions of parameter space, in which these oscillations in the temperature and the concentration of the intermediate A occur, by means of numerical simulation. These regions are compared with previous analytical stability analyses in one-dimensional systems. It was found that oscillations occur over a much larger range of conditions in the case considered here, i.e. a reactor with spherical symmetry, than in the simple 1-D case, previously studied by Gray and Scott (P. Gray and S. K. Scott, Chemical Oscillations and Instabilities, Clarendon Press, Oxford, 1990, pp. 264-291). In addition, approximate analytical solutions for the temperature and concentration of A are presented for two limiting cases of non-oscillatory behaviour. These analytical solutions have been verified by comparison with full numerical solutions of the governing equations.

Chemical Phenomena↗

Ophthalmic Pseudomonas infection in infancy.

Four infants developed invasive Pseudomonas aeruginosa ophthalmic infections between 5 and 90 days of age. Three died from septicaemia, and the fourth required enucleation of one eye. Absent red reflexes or other eye signs in a septicaemic infant merit urgent ophthalmological assessment for endophthalmitis, in particular, Pseudomonas.

Endophthalmitis↗

Leptomeningeal melanoma in childhood.

BACKGROUND: Malignant melanoma (MM) is one of the least common types of childhood cancer, accounting for less than 1% of all pediatric malignancies. Neurocutaneous melanosis (NCM) is a rare phakomatosis consisting of congenital abnormal pigmentation of the skin and meninges. The meningeal lesions are particularly prone to malignant change. METHODS: The authors describe 5 patients with NCM and 1 with primary leptomeningeal melanoma (LMM) seen at 2 treatment centers in the north of England over a 13-year period (1984-1997). RESULTS: The clinical features, progress, radiological findings, and treatment of these patients are discussed. All six died within eight months of their diagnosis, illustrating the difficulties faced in treating patients with these conditions. The authors reviewed the published literature on NCM, concentrating on the various therapeutic strategies that have been tried. Very little consistency in approach was found. Malignant skin lesions in NCM may be less responsive than primary malignant melanoma, but the small number of patients with primary LMM or brain metastases of MM make comparisons with NCM difficult. The authors' own series illustrates well the piecemeal nature of therapy for patients with these rare conditions. CONCLUSIONS: The rate of incidence of MM melanoma in the U.K. is increasing, and it will represent an increasing proportion of the pediatric oncologist's workload. A consistent approach to the therapy of patients with metastatic MM and NCM is needed if we are to have any hope of offering more than palliative therapy to these children in the future.

Central Nervous System Neoplasms↗

Questionnaire evaluation of feeding methods for cleft lip and palate neonates.

A questionnaire evaluation was undertaken of feeding methods used by the mothers of 25 neonates with cleft lip and/or palate. Most parents had problems feeding their babies, both with the quantity of food taken and especially with the time taken to feed; even after a period of 2 months over a quarter were still having problems with the quantity of feed and a third had not established a regular feeding pattern. Just over a half needed to change the feeding method from the one with which they started. Twelve of the 25 mothers tried to breast-feed but none of them was successful. The Haberman feeder was the most popular, being used by 18 mothers. An acrylic feeding plate was considered to be helpful by 6 of 11 mothers of babies with complete clefts but by only 1 of 9 mothers of babies with secondary palate clefts. Almost all the mothers were dissatisfied with the information they had received while in hospital and with the back-up when they went home.

Bottle Feeding↗

Mitral stenosis. Evaluation and guidance of valvuloplasty by transesophageal echocardiography.

Percutaneous transvenous balloon mitral valvuloplasty is a well-established alternative to surgical commissurotomy for selected symptomatic patients with rheumatic mitral stenosis. This procedure normally is performed with fluoroscopic guidance; however, even the experienced operator can be misled by radiographic landmarks. The addition of on-line TEE during PBMV facilitates the success and safety of this procedure by guiding the transseptal puncture and the positioning of the dilating balloon catheters across the stenotic mitral valve. In addition to guiding the manipulation of catheters, on-line TEE is also useful for confirming the efficacy of valvuloplasty and for detecting complications. TEE during PBMV is feasible, safe, and well-tolerated by awake patients.

Catheterization↗

Malignant tumours in the neonate.

One hundred and two cases of neonatal cancers, representing 2% of all paediatric malignancies, were seen during a 60 year period at The Hospital for Sick Children, Toronto, Canada. The neonatal cancers included neuroblastoma (47%), retinoblastoma (17%), soft tissue sarcoma (12%), central nervous system tumours (9%), leukaemia (8%), and a few cases of Wilms' tumour, liver tumour, and miscellaneous tumours. The overall mortality from disease was 41%. Patients with retinoblastoma, Wilms' tumour, and neuroblastoma had the best prognosis. Forty three patients (42%) survived their neonatal cancers; all were treated with surgery or radiochemotherapy, or both, but none suffered long term major handicaps as a result of treatment. There was one instance of second malignancy of the thyroid gland induced by radiation. We conclude that although neonatal cancers are difficult management problems, many patients can be cured. Physicians should discuss with parents the possible risks associated with treatment before treatment is begun.

Female↗

Small intestinal transit time affects methotrexate absorption in children with acute lymphoblastic leukemia.

Serum methotrexate concentrations have been measured in 28 children with acute lymphoblastic leukaemia (ALL) following PO administration under standard conditions. Small-intestinal transit time, measured by the time taken for lactulose to pass from mouth to caecum, has been related with methotrexate absorption parameters. Small intestinal transit times ranged from 30 to 240 min. Children with longer transit times had later times of peak methotrexate concentration and tended to have a more erratic methotrexate absorption profile with two peaks. There appears to be an optimal transit time between 90 and 105 min for methotrexate absorption, with both faster and slower small-intestinal transit times producing lower peak concentrations as a fraction of the dose.

Adolescent↗

Extracranial metastases in childhood primary intracranial tumors. A report of 21 cases and review of the literature.

A clinical and pathologic review of primary intracranial tumors (917 cases in a 62-year period) at The Hospital for Sick Children, Toronto, identified 21 cases with systemic metastases (2.3%). This included 15 cases of medulloblastoma and 1 case each of astrocytoma, meningeal sarcoma, malignant melanoma, ependymoblastoma, teratoma, and endodermal sinus tumor, adding to the pediatric literature of 94 previously reported cases (72 medulloblastoma and 22 cases of other brain tumors). Like adults, children with medulloblastoma tend to develop bone and bone marrow metastases, while those with other brain tumors frequently invade adjacent tissues, and then spread to regional lymph nodes and the lungs. The prognosis is almost uniformly fatal, although prolonged palliation could be achieved with radiation and/or chemotherapy. The pathogenesis of systemic metastases is related to breakage of the blood-brain barrier, whether at surgery, or with tumor invasion into vascular channels, and especially with preoperative systemic-cerebrospinal fluid shunting. Thirteen of 16 patients who developed systemic metastases, including 5 with peritoneal involvement, had ineffective or no millipore filters within their shunts, suggesting their possible prophylactic role against tumor dissemination. A greater understanding of the pathogenesis of systemic metastases may aid the design of future effective preventive measures.

Adolescent↗

Spontaneous chylothorax in newborns.

During a 22-year period, 12 cases of spontaneous chylothorax in newborns were diagnosed at a large pediatric tertiary care center. Seven infants had right-sided effusions; only one effusion occurred on the left. Severe bilateral accumulations occurred in four nonimmune hydropic premature infants. The diagnosis was made by the milky appearance and/or the presence of more than 80% lymphocytes in the pleural fluid. Early diagnosis of the pleural effusion as chyle was associated with a less protracted course than when diagnosis was delayed. The total pleural fluid losses varied from 130 to 3,308 mL. Initial treatment included chest taps and/or drains in all the infants and mechanical ventilation in six. Oral feedings with standard or medium-chain triglyceride formulas were given in five; total parenteral nutrition was administered in seven. The conditions of two infants with copious and persistent drainage improved following surgery. All but one infant survived, and the chylothoraxes never recurred.

Chylothorax↗

Mechanical vibration and sound levels experienced in neonatal transport.

Exposure of neonates to sound and to mechanical vibration was measured while transferring the neonates to a regional referral unit by ambulance and by rotary wing and fixed wing aircraft. Recordings were made during different phases of each type of transportation and were analyzed later. In the nursery, sound levels ranged from 72 to 74 dBA (A-weighted decibel level) (77 to 81 dB), while in transit, levels were higher at 78 to 99 dBA (90 to 110 dB), depending on the means of transport. Vibration was measured in the horizontal and vertical axes relative to the neonate in different frequency ranges. The vibration acceleration magnitude ranged from 0.4 m/sq s to 5.6 m/sq s, depending on the axis and type of transport; the maximum obtained was in rotary wing transport. When compared with adult tolerance levels, both sound and vibration exposure of the neonate are high and potentially hazardous. Further evaluation of vibration stress and means of attenuating sound and vibration in transport infant incubators is desirable to enhance the safety of transported infants.

Aircraft↗

Selective bronchial intubation for pulmonary emphysema.

Two neonates with respiratory distress syndrome developed unilateral pulmonary interstitial emphysema causing mediastinal shift and compressive atelectasis. Treatment with contralateral bronchial intubation for five days proved to be life saving.

Bronchi↗

A case of neonatal herpes simplex with pneumonia.

A case of neonatal herpes simplex infection is discussed that presented as pneumonia, with subsequent development of skin lesions. The virus was isolated from skin scrapings. In spite of treatment with vidarabine, skin lesions continued to develop, and central nervous system involvement occurred. Acyclovir therapy led to prompt resolution of symptoms.

Acyclovir↗

Aggressive fibromatosis in childhood. Computed tomographic findings in three patients.

Three children with aggressive fibromatosis are presented and the value of computed tomography in defining the extent of the lesions and for follow-up and treatment planning is discussed. Aggressive fibromatosis is a nonmetastasizing fibrous lesion with a propensity for local invasion and recurrence after surgery. The lesions usually have a poorly defined margin on computed tomography and the attenuation coefficient is less than that of muscle with poor enhancement following intravenous administration of contrast material.

Adolescent↗

Autoerythrocyte sensitization.

We have seen six examples of autoerythrocyte sensitization in children that allow a definition of the disorder in the pediatric age group. The typical skin lesion is a painful, erythematous bruise that starts after minor trauma or surgery and often involves an area away from the injury site. The skin manifestations can be debilitating, and reappear unpredictably for an indefinite period. Somatic symptoms can be associated with the bruising. Usually the children have a disturbed psychological background. Characteristically, multiple detailed investigations are performed before the diagnosis is made. An intradermal injection of autologous red cells may or may not give a "positive" ecchymotic reaction. Pediatric patients seem to respond well to psychotherapy, which is usually the only effective form of treatment.

Adolescent↗

Low flow oxygen therapy in infants.

Fifty one infants who were oxygen dependent after treatment for neonatal respiratory disease were entered into a study programme where 100% oxygen was delivered at low flow through a nasal catheter. Thirty five (69%) of the infants were discharged home and the remainder were either discharged to a convalescent hospital or back to their peripheral referring hospital. Excluding repeat admissions for monitoring or for the treatment of acute infections, 2760 hospital days (79 days/patient) were saved, representing a financial saving of $11990 (pounds 6500) per treated infant. A home low flow oxygen therapy programme has benefits to the infant/parent relationship, provides a more constant flow of oxygen than conventional methods, and the early hospital discharge represents a considerable financial saving.

Birth Weight↗