Risk of hemolytic-uremic syndrome in children with neurologic disorders.
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Biomedical subjects
Publications and source records attributed to P J Smail.
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Twenty seven cases of haemolytic-uraemic syndrome (HUS) were admitted to the Royal Aberdeen Children's Hospital between 1978 and 1989. All cases were from the defined childhood population of the Grampian region of Northeast of Scotland. Thirteen cases were admitted during the 2-year period 1987-1988 (Group 1). Of the 13 cases, 9 (Group 1 a) were admitted within the 11-month period between August 1987 and June 1988, and were from a small area (7 miles radius) within and around the City of Aberdeen. Their mean age was 7.1 years. Twelve cases of HUS were admitted between 1978 and 1986 and 2 cases were admitted in 1989 (total 14 cases; Group 2). Mean age was 3.0 years with no geographical clustering. The average annual incidence for group 2 was 1.25 per 100,000 children 0-16 years old.
Two cases of reactive arthritis in association with cryptosporidial enteritis in childhood are reported. Oocysts of cryptosporidium should be sought when arthritis complicates diarrhoeal illnesses.
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The incidence of diabetes in children under 12 years of age has been studied in three regions of Scotland from 1976 to 1986. These areas represent more than half of the Scottish population of that age group. The overall annual incidence is 17.6 per 100,000, ranging from 16.8 in densely populated areas to 23.4 in more rural areas. Earlier studies have concerned the age group 0-18 years so the present results from a younger age group are, as expected, slightly lower but show the same trends. After a rise to 1983 there appears to have been a drop, but not in all areas. The danger of drawing conclusions from areas of low population or from short periods of time is stressed.
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We describe an 8-year-old boy with pre-pubertal gynaecomastia as the presenting feature of late-onset 21-hydroxylase deficiency, an association not previously reported. Although absolute oestrogen levels were not higher than previously described in 21-hydroxylase deficiency, the gynaecomastia may have arisen through a relative disproportion of the C18 to C19 steroids.
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An exercise test measuring energy expenditure was performed on a bicycle ergometer by 98 patients in the outpatient clinic. Results concordant with the final diagnosis were obtained in 89% of the 75 children referred because of short stature and in 65% of the 23 children with associated chronic disorders.
Dispersed adrenal cells from a 16 1/2 week anencephalic fetus, 7 fetuses with intact pituitaries and 3 adult subjects undergoing renal transplants were maintained in tissue culture and the steroidogenic responses to ACTH (0-10(3) pg/ml), with or without added estradiol (0-10(4) ng/ml) were evaluated. In the anencephalic preparation the response to ACTH was delayed, but by the fifth day production of cortisol, dehydroepiandrosterone (DHA) and DHA-sulfate was similar to that in the other cultured fetal adrenal cells. The addition of estradiol caused dose-related inhibition of cortisol production and concomitant increase in DHA and DHA-sulfate production. The adult adrenal cells in the presence of ACTH showed a much higher cortisol/DHA secretion ratio, but the addition of estradiol markedly reduced this ratio as in fetal cells. The data support the suggestion that the major factors which interact to impose the characteristic fetal pattern of adrenal steroidogenesis are ACTH and the synergistic effects of placental and intra-adrenal steroids (such as estradiol) which act to inhibit 3 beta-hydroxysteroid dehydrogenase activity.
Serum concentrations of dehydroepiandrosterone (DHA), DHA sulfate, and cortisol were measured in 52 chimpanzees (aged 0.5--10 yr), 76 Macaca mulatta (aged 0.25--5 yr), and 80 Macaca nemestrina (aged 0.5--9 yr). Sexual maturation was assessed by age and by the presence of menarche or the appearance of perineal turgescence in the females and by measurement of serum testosterone in the males. In an additional group of 10 young adult female M. mulatta, four repeated determinations of these same steroids at 30-min intervals demonstrated that the stress of capture and venipuncture caused a significant rise in serum levels of not only cortisol but also of DHA and DHA sulfate. The chimpanzees demonstrated an age-related rise in serum concentrations of DHA and DHA sulfate relative to cortisol which began before the onset of puberty and thus closely resembled human adrenarche. In M. mulatta, serum DHA levels showed no change with age, while DHA sulfate values decreased progressively both before and during puberty. The pattern in M. nemestrina was similar, with stable DHA and declining DHA sulfate levels before and during puberty. However, in the oldest group (aged 6--9 yr) of mature M. nemestrina, there was a significant postpubertal rise of both DHA and DHA sulfate with no change in serum cortisol. These data suggest that monkeys, just as higher primates, may show increasing adrenal secretion of C19 steroids at around 6--9 yr. This adrenarchal process appears to be completely independent of sexual maturation and probably merely reflects the influence of progressive adrenal growth and the resulting impact of changing intraadrenal steroid concentrations upon steroidogenesis in the zona reticularis.
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A case of long-standing mild hypothyroidism is described. This was caused by partial TSH deficiency probably of hypothalamic origin, with no other pituitary hormone deficiencies, although with a decreased response of FSH and LH to LHRH.
A case of a 4-year-old boy with trisomy of the long arm of chromosome 9 is described (46,XY, der (9), t (9;9) (q32;q12)). The trisomy is probably the result of a translocation of the long arm of the chromosome from one homologue to the other in a parental gonad. The clinical features of the child which include severe developmental retardation, bird-like facies, tapered fingers, and flexion contractures of the legs are similar to those of the few cases described of trisomy of the whole chromosome.
This paper illustrates the effect of a large influx of holidaymakers on a medical unit in Cornwall. Increasing numbers of visitors are coming to Cornwall and, unless adequate resources are allocated for their efficient medical care, the medical facilities available to the residents will suffer greatly.