Biomedical subjects
Publications and source records attributed to D J Lloyd.
A case of mosaic trisomy 8 is described and the accuracy of flask culture and in situ culture techniques in detecting chromosomal mosaicism in tissues discussed. The advantages of the in situ method are illustrated and the importance of mixed colonies in defining mosaicism highlighted. The implications for prenatal diagnosis of mosaicism are pointed out.
As far as the authors are aware this is the first report of the insertion of an active NOR into a non-acrocentric chromosome, although a simple translocation involving an active NOR has been previously recorded. More specifically, this case involves the non-reciprocal translocation of the centromere and stalk of an acrocentric into 12p, generating an apparently stable dicentric chromosome. The insertion is seen in three generations and may be relatively genetically benign. The abnormality is fully described by G and sequential C banding, DA/DAPI fluorescence, kinetochore staining, and Ag-NOR staining, and the findings are discussed in the light of the limited published reports of insertion in man.
Preterm infants are at increased risk from rickets. Radionuclide bone scanning is a useful aid in suspected cases. It offers advantages over conventional radiology in terms of sensitivity, radiation dose and extent of examination. Unsuspected fractures of clinical or medicolegal significance may be detected. Two cases are described in which the technique confirmed the diagnosis and assisted management.
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The absorption and utilisation of dietary fat as an energy supplement was studied in 15 healthy preterm infants. They were given two formulae for periods of one week. The standard low solute feed supplied 6 g fat and 476 kJ (114 cal) per kg. The high energy feed supplied 10 g of the same fat and 623 kJ (149 cal) per kg. Fat supplementation resulted in increased absorption (significantly higher chylomicron levels) without steatorrhoea or metabolic disturbance, apparently unchanged differential absorption of fatty acids, and a significantly higher rate of weight gain (mean 25.9 +/- 4.6 compared with 20.3 +/- 4.4 g/24 h). A high energy formula prepared with supplements of complex dietary fat is therefore of potential value in ensuring the adequate nutrition and growth of preterm infants.
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Despite many attractive hypotheses, neonatal necrotising enterocolitis (NNEC) remains a disease of unknown aetiology. By means of the immunofluorescent direct sandwich technique we have demonstrated immune complex deposition in the small vessels of the diseased bowel wall. We believe this is the first report of evidence of an immunological reaction occurring in this disease.
Between January, 1969, and May, 1974, 11 of 1208 low-birth-weight infants had early onset group-B streptococcal septicaemia. All 11 infants were of less than 35 weeks gestational age and 9 presented with the clinical and radiological signs of idiopathic respiratory distress syndrome. 10 died. Antibotics were given to 3 infants only, but not before the age of 12 h. From June, 1974, infants less than 35 weeks gestational age, and from January, 1977, infants less than 2500 g, received systemic penicillin by 2 h of age after throat, ear, umbilical, rectal, and blood cultures. Penicillin was continued for 10 days if group-B streptococci were isolated but was stopped at 48 h of age if all cultures were negative. Between June, 1974, and November, 1977, there was 1 case of septicaemia and no death from group-B streptococal infection in the 983 low-birth-weight infants born during this period. These data suggest that systemic penicillin from birth prevents low-birth-weight infants from dying of group-B streptococcal infection.
Group B streptococcus is now recognized as a major cause of serious neonatal infection. Between January 1973 and July 1979 35 infants with 'early onset' group B streptococcal infection were admitted to the Special Nursery, Aberdeen Maternity Hospital. Ten infants died, nine of whom were of low birth weight. Current research is directed towards defining 'high risk' groups and establishing an effective means of prevention. The concept of early administration of antibiotics to 'high risk' infants, particularly those of low birth weight, is recommended. While there is already evidence in support of the effectiveness of such an antibiotic policy, the nature of protective immunity and the place of immunoprophylaxis have yet to be clarified. Analysis of our data suggests that vaginal carriage of group B streptococcus is not associated with the mother's blood group but there appears to be an increased incidence of neonatal group B streptococcal infection in infants of mothers of blood group B.
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Recent reports indicate that the group B haemolytic streptococcus has now assumed a major role in neonatal septicaemia in the United Kingdom. Of particular concern are the absence of premonitory signs, the fulminating nature of the infection and the high mortality. 31 cases from which this organism was isolated during the first week of life included 5 cases of neonatal septicaemia, 4 of which proved fatal. An attempt was made (a) to identify the group of neonates at greatest risk and (b) to formulate guidelines for early detection and treatment. Study indicates the importance of apnoea as a sign of infection particularly in those infants who are preterm, of low birth weight and asphyxiated. There is need for aggressive bacteriological screening and early administration of antibiotics to prevent the high mortality from group B streptococcal infection.
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