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Biomedical subjects

J Sills

Publications and source records attributed to J Sills.

At least 19 recordsLinked to original sources
PubMed2001

Neurological soft signs in mainstream pupils.

AIMS: (1) To examine the relation between neurological soft signs and measures of cognition, coordination, and behaviour in mainstream schoolchildren. (2) To determine whether high soft sign scores may predict children with significant problems in other areas. METHODS: A total of 169 children aged between 8 and 13 years from mainstream schools were assessed. They form part of a larger study into the outcome of meningococcal disease in childhood. Half had previous meningococcal disease and half were controls. Assessment involved measurement of six soft signs followed by assessment of motor skills (movement ABC), cognitive function (WISC-III), and behaviour (Conners' Rating Scales). RESULTS: Children having an age corrected soft sign score above the 90th centile were considered to have an excess of soft signs. When compared to the other children they had significantly worse scores on the other three measures. Median movement ABC score was 15.3 v 7. Mean total IQ scores were lower by 10.3 points. Median behaviour scores were significantly higher on both parental and teacher questionnaires. A soft sign score above the 90th centile had a sensitivity of 38% for detecting cognitive impairment, 42% for detecting coordination problems, and 25% for detecting possible attention deficit hyperactivity disorder. CONCLUSION: In this group of children higher scores on the soft sign battery were related to significantly worse performance on measures of cognition, coordination, and behaviour. However, although soft sign assessment may be of interest it cannot accurately predict which children are likely to have impairment in other areas.

Adolescent↗
PubMed1998

Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization.

PURPOSE: The authors reviewed their experience in the management of CDH after the introduction of early high-frequency oscillatory ventilation (HFOV) during the preoperative stabilization period and delayed CDH repair. METHODS: This is a retrospective analysis of 24 consecutive infants with CDH treated at University of California, Irvine Medical Center (UCIMC) during a 36-month period from January 1993 to December 1996. RESULTS: Two patients were excluded from the study: one fetus with a prenatal diagnosis was referred for fetal surgery; one infant received CDH repair at another institution 2 weeks before transfer to UCIMC. Eight (36%) infants were inborn, and nine (41%) had a prenatal diagnosis of CDH. Median gestational age was 40 weeks (range, 29 to 42 weeks). Median birth weight was 3,019 g (range, 1,205 to 4,337 g). The defect was left sided in 18 infants (86%). Twenty-one infants were intubated within 5 hours of life, 15 had an AaDO2 greater than 610, 11 had an oxygenation index greater than 40, and 11 had a pH of less than 7.2. The median ratio of pulmonary artery pressure to systemic blood pressure was 0.93 (range, 0.51 to 1.15) in 12 infants. Eighteen infants were placed on HFOV within a median of 1 hour of life. Nitric oxide was given to six infants and surfactant to eight. Four infants were referred for extracorporeal membrane oxygenation (ECMO). Repair of CDH was performed on infants at a median age of 33.5 hours (range, 5.5 to 322). Six (30%) received a prosthetic patch. Overall 18 of 22 infants survived (81%); three survivors received ECMO. Two infants of the survivor group had congenital heart anomalies: one ventricular septal defect (VSD) and one double-outlet right ventricle with a VSD. Of the four nonsurvivors, one had lethal cardiac anomalies and bilateral CDH, two had severe bilateral pulmonary hypoplasia (one received ECMO), and one infant was a 29-week premature baby who did not qualify for ECMO. CONCLUSION: We report a survival rate of 81% (18 of 22) with the management of CDH by delayed surgical repair, early postnatal HFOV, and selective referral for ECMO.

Extracorporeal Membrane Oxygenation↗
PubMed1997

Cytomegalovirus enteritis in a premature infant.

BACKGROUND/PURPOSE: Up to 2.5% of newborn infants are cytomegalovirus (CMV) positive at birth. Five percent will be symptomatic at birth, including cytomegalic inclusion disease. Symptoms such as hearing loss and mental retardation will ultimately develop in 15%. METHODS: The authors describe a case of CMV enteritis in a 2.2-kg newborn that presented as necrotizing enterocolitis (NEC) and subsequently developed a colonic stricture. RESULTS: There are four reports of neonatal CMV enteritis in the nonEnglish-language literature. Cytomegalovirus enteritis has become prevalent among the immunosuppressed pediatric and adult patient population. CONCLUSIONS: We propose the addition of CMV to the list of pathogens responsible for NEC. A review of neonatal CMV infection is provided.

Cytomegalovirus Infections↗
PubMed1996

Pediatric rheumatology in the United Kingdom: data from the British Pediatric Rheumatology Group National Diagnostic Register.

OBJECTIVE: To establish a computerized national diagnostic register for pediatric rheumatology in the UK; to describe the demography and diagnostic classification of children referred to pediatric rheumatology clinics; to estimate the current incidence of juvenile arthritis (JA) in the UK. METHODS: A diagnostic register was established in 1989: 23 centers have contributed data on all new cases seen since they joined the register; 18 centers have also contributed data on all current attenders. For 2 centers with well defined catchment areas, the incidence of JA was estimated. RESULTS: A total of 4948 cases were registered, of whom 2962 (60%) were female. 1991 (40%) had a diagnosis of JA. The 2nd largest category was mechanical/orthopedic problems (24%). Pauciarticular juvenile chronic arthritis was the most common subtype of JA. Seropositive RA was rare. Tertiary referral centers saw proportionately more JA and district general hospitals saw proportionately more mechanical problems. The annual incidence rate for JA from 2 centers was 10/100,000, and for all rheumatic disorders was 32-42/100,000 children under age 16. CONCLUSION: The relative proportion of patient diagnoses varies between centers. Nevertheless, the incidence of hospital referred JA seems very uniform.

Adolescent↗
PubMed1995

Variable oxygenation response to inhaled nitric oxide in severe persistent pulmonary hypertension of the newborn.

The causes of variable responsiveness to inhaled nitric oxide (NO) in Persistent Pulmonary Hypertension of the Newborn (PPHN) are unknown. The changes in the severity of respiratory failure after the onset of inhaled NO (maximal dose 20 ppm) were studied in 13 consecutive neonates with severe PPHN. Response was defined as a sustained decrease of alveolar-arterial oxygen gradient (AaDO2) by > 20%, or a decrease in oxygenation index (OI) by > 40%. Six neonates had a rapid response within 30 min, three had an intermediate response within 8 h, and three had a delayed response within 12 h after the onset of NO. Three infants with birth asphyxia responded rapidly to inhaled NO. One infant with sepsis did not respond, and two with suspected sepsis had a delayed response. The infants with Meconium Aspiration Syndrome and idiopathic PPHN had a variable response time. Twelve neonates required 4 to 14 days of mechanical ventilation and survived. Infants with PPHN may benefit from a trial of inhaled NO therapy that exceeds 30 min. The variability of the response time to inhaled NO is likely to be multifactorial and dependent on the disease process associated with PPHN.

Administration, Inhalation↗
PubMed1993

Management of bacterial meningitis.

In developed countries the mortality from bacterial meningitis acquired outside the neonatal period is relatively low. In contrast, in developing countries it is often higher (20%-40%). In developed countries despite (and perhaps because of) the introduction of increasingly potent antimicrobials, the morbidity of bacterial meningitis has remained high. For example, up to 25% of patients with Haemophilus influenzae meningitis have some form of neurological deficit. Neisseria meningitidis is the major cause of bacterial meningitis in many areas of the world. A clone of Group A meningococcus has spread from China to cause the most recent major epidemic in Sub-Saharan Africa. Group B meningococcal infections causing sporadic meningitis are increasing in parts of Europe and South America. The mortality from meningococcal disease is greatest when there is a septicaemic component to the infection. Although antimicrobial chemotherapy is of major importance some adjuncts to therapy are beneficial. High dose corticosteroid therapy has been shown to decrease mortality in pneumococcal meningitis in an uncontrolled study and to speed recovery and decrease neurological sequelae in H. influenzae meningitis. Nevertheless to prevent infection would be of greater benefit. Prevention can be achieved by either chemoprophylaxis or immunoprophylaxis. Although safe and effective vaccines are available to prevent pneumococcal, H. influenzae (Hib) and Groups A and C meningococcal meningitis; apart from the protein conjugate Hib vaccine they are less effective in children under two years of age. There is no effective vaccine to protect against group B meningococcal meningitis.

Adolescent↗
PubMed1990

The rat FcR for monomeric IgG is preferentially expressed on red pulp macrophages in the spleen.

Rat monoclonal IgG2b immunoglobulins labelled with 125I or biotin were localized in the red pulp areas but were not found in the marginal zones of the white pulp of the spleen 8 hr after their i.v. injection. In cell suspensions made from the spleen, 90% of red pulp macrophages (M phi) bound 125I-IgG2b monomeric proteins in vitro, whereas similar estimates for marginal zone M phi were 12-30%. Red pulp and marginal zone M phi were distinguished primarily by monoclonal antibodies (mAb) ED2 and ED3, but also by their ability to take up FITC-labelled Ficoll in vivo.

Animals↗
PubMed1986

Perinatal development of myoinositol uptake into lung cells: surfactant phosphatidylglycerol and phosphatidylinositol synthesis in the rabbit.

It has been proposed that the high serum myoinositol promotes fetal growth and affects development of lung surfactant. However, it is unclear how the extracellular myoinositol becomes available in specific cells and whether there are developmental differences in myoinositol uptake. In the present study the mechanisms and perinatal development of intracellular myoinositol uptake into rabbit lung cells were investigated. Lung slices, lung explants, and type II alveolar cells were used. Evidence of saturable, sodium- and energy-dependent, and of non-saturable, sodium- and energy-independent myoinositol uptake was found. The nonsaturable uptake decreased by 67% during spontaneous maturation, as studied in lung slices. Beta-methasone (0.2 mg/kg days 26.3 and 27.3, to the doe) decreased by 65% the nonsaturable myoinositol uptake in 28-day-old fetuses. However, the saturable uptake revealed only small changes during perinatal development. The effect of extracellular myoinositol on surfactant phospholipid synthesis was evaluated in lung explants from 28-day-old fetuses, cultured for 2 days. In the presence of 10(-6) M dexamethasone the concentration of extracellular myoinositol, required for half-maximal inhibition of surfactant phosphatidylglycerol incorporation was higher than in explants grown without the hormone (approximately 0.4 versus 0.2 mM). However, in the microsomal fraction the phosphatidylglycerol incorporation was always inhibited by as low as 4 microM myoinositol. Myoinositol was taken up by isolated type II cells preferably by nonsaturable mechanism. The phosphatidylglycerol incorporation was less sensitive to extracellular myoinositol in adult than in fetal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1978

The occurrence of a ring 18, an accessory bisatellited fragment, and trisomy 21 within one sibship.

A family is presented in which there were three different chromosome abnormalities in the children although the parents were cytogenetically normal. The proband had the karyotype 46,XX, r(18) (p11q23), a phenotypically normal brother was 47,XY,+mar, and another brother was a typical case of Down's syndrome, karyotype 47,XY,+21. There is nothing in the parents' history that provides grounds for a hypothesis to explain the coincidence of the abnormalities.

Cells, Cultured↗
PubMedDate not supplied

The British version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the British language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. A total of 440 subjects were enrolled: 219 patients with JIA (17% systemic onset, 41% polyarticular onset, 33% extended oligoarticular subtype, and 9% persistent oligoarticular subtype) and 221 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the British version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗