Biomedical subjects

E Wraige

Publications and source records attributed to E Wraige.

8 recordsLinked to original sources

PubMed2005

A proposed classification for subtypes of arterial ischaemic stroke in children.

The aim of this study was to propose a classification system for childhood arterial ischaemic stroke (AIS). Subtypes from the Trial of Org 10172 in Acute Stroke Therapy (TOAST) classification, previously shown to be applicable to children, were retained in the proposed Paediatric Stroke Classification (PSC). Additional important paediatric AIS aetiologies were identified from a literature review. Preliminary validation was performed by three raters who categorized clinical vignettes from 135 patients (66 male; median age 6.3 y, range 0.1 to 16 y). Eight aetiological subtypes were identified and defined, as follows: (1) sickle cell disease; (2) cardioembolic; (3) moyamoya syndrome; (4) cervical arterial dissection; (5) steno-occlusive cerebral arteriopathy; (6) other determined aetiology; (7) multiple probable/possible aetiologies; and (8) undetermined aetiology. There was very good agreement between the raters about categorization of the vignettes. Causes of disagreement were identified and final categories and definitions were modified accordingly. We conclude that the PSC enables the categorization of children with AIS into aetiological subtypes relevant to this age group. This will be useful in multicentre studies of natural history and treatment but will require further independent validation.

Adolescent↗

PubMed2003

Ischaemic stroke subtypes in children and adults.

Ischaemic stroke subtypes in children and adults were compared to determine the similarity in aetiologies. Thirty-six children (22 females, 14 males; median age 5 years 7 months, range 6 weeks to 15 years 10 months) and 50 adults (35 males, 15 females; median age 44 years, range 17 years 2 months to 49 years 11 months) who had presented with ischaemic stroke between 1995 and 2000, were categorized using a modified version of the Trial of Org 10172 in Acute Stroke Therapy (TOAST) classification. Proportions of patients in the subtypes of the TOAST classification system were significantly different in the two groups (chi2 test, p<0.01). The first three subtypes (large artery atherosclerosis, cardioembolic, and small vessel disease) accounted for the majority of adult strokes (27 of 50). In contrast, only three of 36 children were accounted for within these three subtypes. The majority of children (29 of 36) were classified within the 'other determined aetiology' subtype. Aetiology was undetermined in 12 of 50 adults compared with three of 36 children. Causes of ischaemic stroke in children and adults are distinct. A classification system for ischaemic stroke in children would be useful for collaborative studies.

Adolescent↗

PubMed2003

Arterial dissection complicating tonsillectomy.

Tonsillectomy is a frequently performed surgical procedure. Surgical complications can be serious. We report the case of a 7-year-old female who experienced an arterial ischaemic cerebral infarction following elective adenotonsillectomy.

Aortic Dissection↗

PubMed2002

Investigation of daytime wetting: when is spinal cord imaging indicated?

BACKGROUND: Most children with daytime wetting have detrusor instability. A minority have neuropathic vesicourethral dysfunction. The commonest cause is spina bifida, which may be closed. Clinical features suggestive of closed spina bifida include cutaneous, neuro-orthopaedic or lumbosacral spine x ray abnormalities, impaired bladder sensation, and incomplete bladder emptying. MRI is the ideal method for detecting spinal cord abnormality. It has been suggested that MRI spine is an unnecessary investigation in children with daytime wetting in the absence of cutaneous, neuro-orthopaedic, or lumbosacral spine x ray abnormalities. AIM: To clarify indications for magnetic resonance imaging (MRI) of the spine in children with voiding dysfunction. METHODS: Retrospective study of children with voiding dysfunction referred from the Guy's Hospital neurourology clinic for MRI spine between April 1998 and April 2000. Clinical notes and results of investigations, including urodynamic studies and MRI spine were reviewed. RESULTS: There were 48 children (median age 9.1 years). Closed spina bifida was detected in five, of whom four had neuropathic vesicourethral dysfunction confirmed by urodynamic studies. Impaired bladder sensation and incomplete bladder emptying were more frequent in these children than in those with normal MRI spine. One child with spinal cord abnormality had no cutaneous, neuro-orthopaedic, or lumbosacral spine x ray abnormalities. CONCLUSION: Spinal cord imaging should be considered in children with daytime wetting when this is associated with impaired bladder sensation or poor bladder emptying, even in the absence of neuro-orthopaedic, cutaneous, or lumbosacral spine x ray abnormalities.

Adolescent↗

PubMed2002

Idiopathic intracranial hypertension: is papilloedema inevitable?

Headaches and papilloedema are key features of idiopathic (benign) intracranial hypertension (IIH). We describe three children in whom IIH was diagnosed in the absence of papilloedema. Recognition of atypical cases of IIH is important because pressure lowering treatment may be effective.

Acetazolamide↗

PubMed2002

Fat oxidation defect presenting with overwhelming ketonuria.

Ketonuria accompanying hypoglycaemia is conventionally thought to exclude fat oxidation defects. We describe a 2 year old girl with hypoglycaemic encephalopathy in whom a diagnosis of very long chain acyl CoA dehydrogenase deficiency was suggested on the basis of acylcarnitine analysis despite massive ketonuria.

Acyl-CoA Dehydrogenase, Long-Chain↗

PubMed2001

Aromatic hydrocarbon "humps" in the marine environment: unrecognized toxins?

Gas chromatographic analysis of the hydrocarbons of environmental samples often reveals that unresolved complex mixtures (UCMs) or gas chromatographic "humps" of aliphatic and aromatic hydrocarbons are most abundant--yet little consideration seems to have been given to the possible toxicological impacts of hydrocarbon "humps". Here we show, using a well-accepted bioassay, that monoaromatic components of a UCM of hydrocarbons from a crude oil elicit a sublethal toxic response in a typical marine pollution indicator organism (the mussel, Mytilus edulis). Furthermore, coastal U.K. mussels shown previously to have unexplained impaired health contained high concentrations of UCMs, including monoaromatic UCMs. These findings may have important implications for our understanding of the toxicological sublethal effects of oil residues in the environment. Given the relatively resistant nature of UCM hydrocarbons, the effects of both acute oil spills and more chronic discharges may need further consideration.

Animals↗

PubMed2001

Hydrocarbon humps in the marine environment: synthesis, toxicity, and aqueous solubility of monoaromatic compounds.

A recent study has shown that some monoaromatic hydrocarbon constituents of the so-called unresolved complex mixtures (UCMs) or gas chromatographic humps, which are widespread in the marine environment, are toxic to the mussel Mytilus edulis. Here we describe the synthesis and toxicological assessment of 6-cyclohexyltetralin, 7-cyclohexyl-1-methyltetralin, and 7-cyclohexyl-1-n-propyltetralin, which contain structural features consistent with some monoaromatic UCM hydrocarbons. The compounds were all toxic to M. edulis when measured in the assay used previously to determine the toxicity of a monoaromatic UCM. The aqueous solubilities of the hydrocarbons in fresh and seawater at different temperatures were determined and found to range from about 10 to 110 microg/L (10-60 microg/L in seawater at 15 degrees C). Further studies of the aromatic UCM composition of a wide range of oils and oil residues are required to determine whether such alkylated compounds as 7-cyclohexyl-1-methyltetralin and 7-cyclohexyl-1-n-propyltetralin or their analogues are widespread in oils. If these aromatic compounds prove to be important in UCMs, toxicity experiments should be conducted with other biological end points and monitoring studies of pollutant hydrocarbons should probably include measurement of aromatic UCM hydrocarbons.

Animals↗