Current practice in Hodgkin's disease. The United Kingdom Children's Cancer Study Group.
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Adolescent↗
Biomedical subjects
M Radford
Publications and source records attributed to M Radford.
Skin rash associated with Candida guilliermondii.
We report a case in which the development of a skin rash in a neutropenic patient was associated with multiple blood culture isolates of Candida guilliermondii--an unusual isolate not previously documented to cause rashes.
Candida↗
Use of the multiple uptake gated acquisition scan for the preoperative assessment of cardiac risk.
A retrospective study was undertaken at three hospitals of 196 patients who underwent an operative procedure as long as 60 days after radionuclide determination (multiple uptake gated acquisition scan [MUGA]) of left ventricular ejection fraction (LVEF). Cardiac related mortality rates were 2.2 per cent among patients in group 1, LVEF greater than or equal to 55 per cent; 5.4 per cent in group 2, LVEF 36 to 54 per cent, and 19.5 per cent in group 3, LVEF less than or equal to 35 per cent (p less than 0.005). Statistically significant correlation between MUGA-derived LVEF and cardiac related mortality was found in veteran patients undergoing noncardiac surgical procedures (both vascular and nonvascular). There was no correlation between MUGA-derived LVEF and postoperative cardiac related mortality in cardiac surgical patients. A preoperative American Society of Anesthesiologists Physical Status Evaluation classification of IV or a preoperative pulmonary capillary wedge pressure of 20 centimeters of water or greater also predicted an increased risk of postoperative cardiac death. We advise preoperative MUGA scans for all patients in whom the results of preoperative history or physical examination suggest compromised ventricular function. We also advise pulmonary arterial catheter hemodynamic monitoring during the perioperative period for all patients with a preoperative MUGA-derived LVEF of less than or equal to 35 per cent.
Adult↗
Symptoms, atopy, and bronchial response to methacholine in parents with asthma and their children.
We have studied 50 children with one parent with asthma at a mean age of 6.4 years by symptom questionnaire and performed allergy skin testing and measurement of bronchial responsiveness to methacholine in both parent and child in 29-32 cases. Ninety eight per cent of the parents were receiving medication for asthma. Fifty one per cent had visited their doctor and 20% had taken more than five days off work in the previous 12 months; 12% had been admitted to hospital during the preceding 10 years. In the children the prevalences of wheeze, shortness of breath, and cough were all about double that found in a general population survey of children of similar age. Atopy was present in 90% of parents, but the prevalence of atopy among the children was not significantly different from the children in the general population. Eczema and hay fever, however, had high prevalences of 40% and 24%, respectively. Responsiveness to methacholine (provocation dose achieving 20% fall in forced expiratory volume in one second less than 6.4 mumol) was found in 93% of parents and 45% of children, which is compatible with a large increase compared with the general population. All atopic but only 50% of non-atopic children with symptoms of asthma responded to methacholine. These findings indicate that children who have one parent with asthma have roughly double the chance of developing clinical features of asthma compared with the general population and suggests that, in these children, a causal interaction occurs between atopy and bronchial hyper-responsiveness.
Asthma↗
Serum ferritin: an indicator of iron responsive anaemia in patients with RA?
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Anemia↗
Topical anaesthesia for venepuncture.
A topical anaesthetic cream was tested in a randomised, double blind, placebo controlled trial of 15 children. The severity of pain experienced during venepuncture was assessed, using visual analogue and verbal rating scales. The topical anaesthetic cream was found to be significantly superior to placebo using each form of assessment.
Administration, Topical↗
Vitamin K and Thrombotest values in full term infants.
The vitamin K dependent clotting factors were measured by the 'Thrombotest' on the second day of life in 72 healthy full term babies, half of whom had received vitamin K at birth. Forty eight of these were breast fed, and those not given vitamin K had significantly lower Thrombotest values than those who had received vitamin K. By contrast, administration of vitamin K did not affect the Thrombotest values in bottle fed babies, the values in treated and untreated babies being the same and of the same order as the level in those breast fed babies treated with vitamin K. Serial study of 18 normal breast fed babies tested at day 0 and day 2 showed a pronounced drop in the Thrombotest values in this period, which was prevented by one intramuscular dose of 1 mg vitamin K at birth. Although none of the neonates in this study showed haemorrhagic disease, nine of the 24 untreated breast fed infants had Thrombotest values below 10% on day 2, at which level bleeding has been reported.
Aging↗
Terminal care for children dying of cancer: quantity and quality of life.
Parents of 18 children who died of cancer in the last five years were interviewed. The mean duration of terminal care was 5.6 weeks, the median being two weeks. Most children died peace-fully at home after a brief but obvious period of deterioration. More counselling is needed for families in this situation.
Attitude to Death↗
A reconsideration of Doppler assessed gradients in suspected aortic stenosis.
To further define the clinical role of continuous wave Doppler echocardiography for determining aortic valve gradient, we studied 60 consecutive adult patients (age range 22 to 81 years, mean age 63) with suspected aortic stenosis within 24 hours of catheterization. Blind comparisons of Doppler peak and mean gradients by the simplified Bernoulli equation were made with catheterization peak-to-peak (r = 0.84), peak (r = 0.87) and mean (r = 0.84) gradients in a double-blind fashion. Despite these favorable correlations, Doppler peak gradient generally overestimated catheterization peak-to-peak gradient (1 to 53 mm Hg), making it impractical for clinical use. Doppler-catheterization correlations of peak and mean gradients were more favorable, with the least scatter noticed for mean gradient. The results of analysis of pooled data indicated that mean gradient may also be most specific for differentiating severe from less severe aortic stenosis. In this consecutive series where a full range of catheterization gradients was encountered, seven patients with predicted Doppler gradients were found to have none, which is best explained by the use of the simplified Bernoulli equation in patients with aortic insufficiency. These data indicate that prudence should be maintained when Doppler gradients alone are used for the assessment of aortic stenosis.
Adult↗
Production of human chorionic gonadotrophin by a hepatoblastoma resulting in precocious puberty.
A two year old boy presented with precocious puberty associated with hepatoblastoma. Serum concentrations of beta human chorionic gonadotrophin and alpha-fetoprotein were raised. An aggressive chemotherapeutic regimen resulted in useful palliation and interesting changes in the beta human chorionic gonadotrophin and alpha-fetoprotein concentrations. In contrast to a previous report, the ultrastructure of the tumour showed frequent Golgi apparatus but no other electron dense membrane bound vesicles.
Carcinoma, Hepatocellular↗
Psychoanalysis and the science of problem-solving man: an appreciation of Popper's philosophy and a response to Will (1980).
Popper's philosophy has been often misrepresented in the debate about the scientific status of psychoanalysis by pseudo-Popperians who use the idea of falsifiability without rejecting positivism and inductive logic. The debate itself is misconceived because it is based on the outdated positivist assumption that what is not science is not important. Partially submerged by this, however, is a very important debate about method. The issues are clearly focused by what is here called "Hill's problem', that of finding a common framework in which the contributions of organic, psychodynamic and social psychiatry can be discusses and applied to clinical problem solving. Will's paper brings out many fundamental problems. This reply discussed misapprehended aspects of Popper's world view and introduces his plural interactionalist metaphysical research programme. It demonstrates the close similarity of Popper's view of science which Lorenz calls 'hypothetical realism' with Bhaskar's 'transcendental realism' which Will advocates for psychoanalysis. The differences hinge on concepts of explanation and the methods of theory testing. It is here argued that Popper's view is better fitted for the task Will proposes. The resemblance of 'hypothetical realism' to the clinical tradition further demonstrates its applicability to Hill's problem.
Humans↗
Sudden infant death in Southampton and an evaluation of the Sheffield scoring system.
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Adult↗
Maternal antibody and respiratory syncytial virus infection in infancy.
One hundred newborn infants were studied prospectively for 1 year for evidence of infection with respiratory syncytial virus (RSV). The indirect membrane fluorescence technique was used to determine specific antibody in sera. Infection was shown in 29 cases. In 31 infants exposed to an RSV epidemic season, there was no evidence of infection. Maternal antenatal sera were also tested, and wide range of IgG antibody to RSV was found. Mean titre of maternal IgG antibody to RSV was significantly higher (P less than 0.001) in those mothers whose babies remained uninfected than in those whose babies had proved RSV infection before 6 months of age. Babies born to mothers with high levels of IgG antibody to respiratory syncytial virus were protected against infection with this virus during the first months of life when the risk of severe disease was greatest.
Adult↗
Origin of handicap in young children.
A survey was carried out of all infants born in Southampton and South-west Hampshire Health District in 1975 to assess the incidence and cause of handicapping conditions at age 2-3 years. Twenty-four infants were identified with major handicap. A prenatal cause was identified in 15 cases, a perinatal cause in 5 cases, and a postnatal cause in 2 cases. No cause was identified in 2 cases. The incidence of cerebral palsy was 1.2 per 1000 live births. There was some evidence for a perinatal cause in half of them.
Accidents↗
Perinatal mortality and one-year infant morbidity.
Perinatal mortality in Southampton and South-west Hampshire Health District fell from 20.8 per 1000 total births in 1970 to 11.3 per 1000 in 1976. This was atributable mainly to a fall in the stillbirth rate, but also to a recent fall in the neonatal death rate in the first week. All infants born in 1975 who had any problems in the perinatal period were followed up for one year. Of the 12 children identified at one year as having a major handicap, eight suffered from problems of prenatal origin, two from problems associated with preterm delivery, and two from other conditions acquired during the perinatal period. As two-thirds of the major handicaps arose from congenital abnormalities, preterm delivery and low birth weight were not the main causes of major handicap.
Congenital Abnormalities↗
Sensory feedback does not cause selective adaptation of human "command neurons".
It has been proposed that body movements are partly controlled by a neural hierarchy, with cells at successively higher levels controlling increasing numbers of muscles engaged in functionally equivalent responses. In addition to physiological support for the hypothesis, obtained from infrahuman species, evidence from human subjects has been obtained in the form of negative transfer between successive similar responses. This negative transfer has been attributed to selective adaptation of "command neurons" in the human motor system. The present experiment found no evidence for negative (or positive) transfer between passive and active movements, suggesting that selective adaptation of human command neurons is caused by efference rather than afference.
Adolescent↗
T-cell leukaemia in a young boy presenting with central nervous system symptoms.
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Cerebrospinal Fluid↗
Effect of salbutamol in infants with wheezy bronchitis.
Using the technique of whole body plethysmography, lung mechanics were measured in a group of infants with wheezy bronchitis. Compared with a group of normal infants previously studied, airway resistance and thoracic gas volume were found to be raised. Nebulized salbutamol was then administered and measurements were repeated when it was found that there was no objective improvement. It is concluded that salbutamol may not be an effective form of treatment of wheezy bronchitis in young infants and the reasons for this are discussed.
Airway Resistance↗