Transient hyperphosphatasaemia.
Transient hyperphosphatasaemia is usually a chance finding arising from the use of biochemical screening profiles. Clinical correlates in cases so far described have been non-specific.
Biomedical subjects
Publications and source records attributed to L J Arthur.
Transient hyperphosphatasaemia is usually a chance finding arising from the use of biochemical screening profiles. Clinical correlates in cases so far described have been non-specific.
Low maternal plasma and urinary oestrogen concentrations in pregnancy are usually indicative of fetal problems, either placental insufficiency or fetal adrenal hypoplasia. Paediatricians, however, should follow obstetricians in becoming increasingly aware that deficiency of placental steroid sulphatase activity, a condition related to X linked ichthyosis, may produce the same abnormalities.
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A 10-year-old boy, with widespread soft tissue tumours of bone, developed hypophosphataemic rickets due to impaired renal tubular reabsorption of phosphate. Biopsy of the largest tumour showed a nonosteogenic fibroma. We believe this boy is another example of 'tumour rickets', as other causes of rickets were excluded clinically and biochemically. Cases of rickets or osteomalacia associated with a tumour, have generally been reported to be cured by surgical removal of the tumour, implicating it as the cause of rickets or osteomalacia. Owing to the large number of tumours in this boy, surgical removal was not possible, and he required large doses of vitamin D, together with oral phosphate, before his rickets healed. It is suggested that the tumour produces a phosphaturic hormone.
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A scheme for dealing with cases of non-accidental injury in children in the Derby clinical area has been operating since 1971. A stable team of doctors, policemen, and social workers deal with each case. The parents are told at once that battering is suspected, and the police and social services department co-operate closely in establishing the facts, supporting the family, and protecting the child. A psychiatric assessment of the parents may help social workers decide on the long-term care of the child, and the forensic physician is invaluable if the case has to go to court. The team has made three recommendations about prevention and management of these cases: a specialist social service team should be set up to deal with these children and regain the skills and knowledge lost when children's departments were abolished in 1971; babies should be routinely weighed naked in infant welfare clinics; and juvenile courts should be able to order a psychiatric report on the parents in care proceedings.
Ketamine hydrochloride 2 mg/kg, together with atropine 0.2 mg, has been given intravenously on 100 occasions on a general paediatric ward. No serious side effects occurred. Dreams followed in 4 children but did not reduce acceptability of the drug. In our hands it has greatly reduced the pain and distress of children undergoing many routine medical procedures, particularly the dread which builds up when these have to be repeated in the same child. It has also produced close to ideal conditions for the operator, and probably increased his efficiency by reducing the emotional strain which occurs when doing painful things to a frightened patient.
Strict criteria for the diagnosis of temporary gluten intolerance are formulated in the light of the case of an 8-week-old infant with severe diarrhoea and failure to thrive, who recovered on an elimination diet that was gluten-free. 8 weeks later an oral challenge with 2.5 g twice daily of powdered gluten for one day produced diarrhoea, weight loss, and impaired xylose absorption. Gluten was successfully reintroduced into the diet 9 months later without incident. Jejunal histology remains normal after 26 months of a daily diet that contains 5 to 10 g gluten.
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