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J Edmonds

Publications and source records attributed to J Edmonds.

At least 19 recordsLinked to original sources
PubMed1992

Measurement of HLA class I expression in ankylosing spondylitis.

The importance of HLA-B27 in the pathogenesis of ankylosing spondylitis is uncertain: current evidence favours a role for the B27 molecule itself. The possibility that quantitative differences in HLA-B27 expression may exist between patients with ankylosing spondylitis, family members, and control subjects positive for B27 was examined using appropriate monoclonal antibodies, flow cytometry, and a 'model lymphocyte' coated with a known number of mouse immunoglobulin binding sites. No differences were found between the groups. HLA-A2, examined for comparison, was expressed in greater amounts than HLA-B27, but each contributed only 10-20% of the total class I antigens. Homozygotes expressed twice the amount of antigen expressed by heterozygotes. Synovial lymphocytes expressed more class I antigens than peripheral lymphocytes.

Family↗
PubMed1991

Use of the Pediatric Risk of Mortality score to predict nosocomial infection in a pediatric intensive care unit.

OBJECTIVE: To define infection rates in patients with Pediatric Risk of Mortality (PRISM) scores greater than and less than 10 on admission to the pediatric ICU (PICU). DESIGN: Descriptive. SETTING: An 18-bed PICU admitting patients of all ages except nonsurgical neonates; within a 585-bed tertiary care pediatric hospital. PATIENTS: Patients admitted to the PICU from July 1987 to February 1988 inclusive. Of 685 admitted, 480 were followed for greater than or equal to 72 hr. METHODS: The baseline state of the patients on admission was determined by a designated intensivist using the PRISM score. Other variables included age, length of stay, and hospital day of onset of infection. Infections were identified by a designated intensivist who undertook prospective daily bedside observation, chart, radiographic, and laboratory review. MEASUREMENTS AND MAIN RESULTS: Equal portions of patients had PRISM scores less than and greater than 10. Significantly more infections occurred in the high PRISM population (10.8% vs. 3.4%, p less than .001). This association held through age, service, and length of stay. Sensitivity, specificity, positive and negative predictive values of a PRISM score greater than 10 were 75%, 53%, 11%, and 97%, respectively. Bacteremias accounted for 36% of infections, skin/eye/drain site 22%, respiratory 16%, wound 15%, and urine 9%. The most prevalent organisms were coagulase-negative staphylococci (32%), Pseudomonas aeruginosa (23%), Candida sp. (20%), and S. aureus (9%). CONCLUSIONS: A PRISM score greater than 10 on PICU admission characterizes a population within the PICU at increased risk of infection. However, 93% of patients did not develop infection and thus, a negative predictive value of 97% yields little additional information.

Adolescent↗
PubMed1990

Autoantibodies in patients with juvenile chronic arthritis and their immediate family relatives.

Antibodies to nuclear antigens were assessed in 23 children with juvenile chronic arthritis (JCA) and 66 of their first degree relatives. Serum samples from 16 patients with JCA (70%) and nine relatives (14%) had antinuclear antibodies by indirect immunofluorescence. Antibodies against nuclear antigens in rabbit thymus extract or an erythroblastoid cell line (K562) were detected by countercurrent immunoelectrophoresis and immunoblotting in 16 patients (70%) and 39 family relatives (59%). Immunoblotting did not show any banding patterns common to all patients with JCA, though bands in the 43-45 kD range were detected in 5/23 patients. Anticardiolipin antibodies were found in 7/23 patients. In total, 18/20 families (90%) had members other than the probands with detectable autoantibodies. In five families immunoblotting showed common banding patterns between the probands and other members. This suggests that there might be an inherited trend towards autoimmune responses in some families of patients with JCA.

Antibodies, Antinuclear↗
PubMed1990

Spondyloarthropathies.

The spondyloarthropathies are disorders characterised mainly by sacroiliitis (with or without spondylitis), peripheral oligoarthritis, enthesopathy, absence of rheumatoid factor, certain extra-articular features such as iritis, and increased prevalence of HLA-B27. The diagnosis should be considered in patients, especially young people, with low back pain. A history of psoriasis, bowel dysfunction, eye problems and peripheral joint inflammation should point to the diagnosis.

Diagnosis, Differential↗
PubMed1990

Reproducibility of isokinetic muscle strength measurements in normal and arthritic individuals.

The serial reproducibility of an individual's isokinetic torque was assessed in order to establish a reliable baseline value for future comparison. Thirty-two controls and twenty arthritic patients were tested for their peak isokinetic torque on knee flexion and extension and hip flexion at three velocities on five occasions, at fortnightly intervals. The first test was found to provide a reliable baseline for controls and subjects who could generate a peak torque of 54 Newton meters (Nm) or more. The second test was found to be more representative of the series for groups containing weaker subjects. Variation related to torque: for subjects who generate a peak torque of 54 Nm or more, a range of +/- 20% accommodates the variability of 95% of tests. We conclude that a +/- 20% range applied to either the first or second test, depending on the nature of the group to be studied, serves as a representative baseline value.

Aged↗
PubMed1989

Evaluation of a new method of detection of nosocomial infection in the pediatric intensive care unit: the Infection Control Sentinel Sheet System.

To improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS). Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.8 and 7.0 respectively among 685 admissions; included are seven infections identified only through the ICSSS so that the "gold standard" became an amalgamation of the two systems. The sensitivity for detection of nosocomially-infected patients by bedside observation/chart review and ICSSS was 100% and 87% respectively. The sensitivity for detection of standard infections (blood, wound and urine) was 88% and 85% respectively. The sensitivity for detection of nosocomial infections at all sites was 94% and 72% respectively. Missed infections were minor (e.g., drain, skin, eye), required physician diagnosis (e.g., pneumonia), were not requested on the sentinel sheet (SS) (e.g., otitis media), related to follow-up of deceased patients or were minor misclassifications or failures to associate with device (e.g., central-line related). Daily PICU surveillance by the ICN required only 20 minutes a day. The ICSSS appears highly promising and has many unmeasured benefits.

Bias↗
PubMed1988

Low molecular weight IgM in juvenile chronic arthritis.

Low molecular weight IgM, the monomeric subunit of pentameric IgM, was clearly detected by immunoblotting and filtration chromatographic techniques in six patients with juvenile chronic arthritis and in trace quantities in a further eight of 24 patients studied. This low molecular weight IgM moiety contributed up to 33% of the total circulating IgM and was strongly associated with raised serum concentrations of IgM and the presence of antinuclear antibodies, extractable antinuclear antibodies, and rheumatoid factor. Immunoblot analysis of positive serum samples showed small quantities of other low molecular weight oligomers of IgM in addition to monomeric IgM. It is postulated that the presence of low molecular weight IgM in the serum of patients with juvenile chronic arthritis reflects a disorder of the intracellular assembly of IgM subunits during a stimulated IgM immune response. The pathogenetic role of low molecular weight IgM remains uncertain.

Antibodies, Antinuclear↗
PubMed1988

Myocardial performance after repair of congenital cardiac defects in infants and children. Response to volume loading.

The hemodynamic response to increasing left atrial pressure by volume loading was evaluated in 70 children during the first 24 hours after repair of congenital cardiac defects. The children were grouped into four diagnostic categories: atrial septal defect or pulmonary valve stenosis (n = 8), ventricular septal defect (n = 36), complete transposition after Mustard's operation (n = 13), and tetralogy of Fallot (n = 13). Within 2 hours of bypass, both cardiac index and left ventricular stroke work index were adequate and increased appropriately with volume loading in all four diagnostic groups. The atrial septal defect group demonstrated a similar response to volume loading 4 and 24 hours after bypass. However, the other three diagnostic groups had a higher filling pressure, lower cardiac index and stroke work index, and a depressed response to increasing preload 4 hours postoperatively, which indicated a deterioration in cardiac performance. The deterioration was maximal between 4 and 12 hours after bypass, and performance tended to recover 24 hours postoperatively. The transposition group had a more profound depression in cardiac performance than the other two groups. Within the ventricular septal defect group, smaller children (body surface area less than 0.36 m2) had a more profound depression in performance than larger children. These results demonstrate a significant alteration in cardiac performance during the first 24 hours after repair of congenital cardiac defects in children. These changes should be considered when postoperative management is being planned.

Cardiac Output↗
PubMed1986

Results of inpatient pediatric resuscitation.

We retrospectively reviewed the results of 42 cardiopulmonary arrests occurring over 1 yr in the general ward of a pediatric hospital. These data were compared to those of a similar study done 10 yr previously in the same institution. Patients were divided into those having pure respiratory arrest and those who also had cardiac arrest. In the most recent series, overall 6-month survival was 17%; however, only 9% of the cardiac arrest patients survived. Ten years previously, the survival rate from cardiac arrest was 11%. In both series, pure respiratory arrest had a significantly better outcome than cardiopulmonary arrest, and predictors of nonsurvival were a duration of arrest greater than 15 min and the administration of more than one iv bolus of epinephrine. During the more recent series, sepsis and upper airway problems produced fewer arrests. There was one neurologically damaged survivor in each study period. Our study confirms that the outcome of pediatric cardiac arrest is poor when arrest occurs in the hospital.

Adolescent↗
PubMed1985

Effects of mechanical ventilation on cardiopulmonary function in children after open-heart surgery.

The reduction in functional residual capacity (FRC) after anesthesia and thoracic surgery may result in atelectasis, hypoxia, and respiratory failure. Mechanical ventilation reverses the FRC reduction but may also decrease cardiac output and increase the pulmonary vascular resistance index (PVRI) in some patients. The cardiopulmonary effects of stopping mechanical ventilation after open-heart surgery were studied in 17 children. FRC, arterial pH, and PaO2 were significantly reduced, while PaCO2, oxygen consumption, and right ventricular stroke work index significantly increased. Mean FRC on spontaneous respiration was below normal despite continuous positive airway pressure. PVRI increased significantly in patients whose FRC fell below 22 ml/kg on spontaneous respiration. The PVRI increase was most marked in patients with pre-existing pulmonary vascular disease. These results confirm the value of appropriate mechanical ventilation in the early postoperative management of children undergoing open-heart surgery, particularly those with pulmonary vascular disease.

Cardiac Output↗
PubMed1985

Clinical features and followup study of HLA-B27 positive patients presenting with peripheral arthritis.

A comparison was made between HLA-B27 positive patients with peripheral arthritis and patients with ankylosing spondylitis (AS). The distribution of peripheral joint involvement in HLA-B27 positive seronegative arthritis was not the same as that in AS; significant differences were also noted in the sex ratio and incidence of uveitis. Followup of the patients with peripheral arthritis revealed that 25% had developed a further criterion for Reiter's syndrome, 45% had persistent seronegative arthritis and in 55% the arthritis had resolved.

Adolescent↗
PubMed1985

Anti-Ro (SS-A) antibodies and congenital complete heart block.

Maternal anti-Ro (SS-A) antibodies have been implicated in the pathogenesis of congenital complete heart block. When congenital complete heart block occurs, SS-A antibodies are almost always present in maternal and fetal serum, although not all infants of SS-A antibody positive mothers are affected. We describe a situation in which antibodies to SS-A were present in high titre in both maternal and fetal serum, although there was no evidence of heart block in the infant. This is the first report of a normal infant in whom maternally derived SS-A antibodies have been documented in high titre.

Adult↗