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Biomedical subjects

R J Postlethwaite

Publications and source records attributed to R J Postlethwaite.

At least 19 recordsLinked to original sources
PubMed1992

Autoimmunity to glomerular antigens in Henoch-Schoenlein nephritis.

1. Henoch-Schoenlein nephritis and IgA nephropathy share clinical and immunological features, but the pathogenesis of neither condition is established. We have recently described IgG autoantibodies to glomerular components in active IgA nephropathy and have now sought evidence for a similar autoimmune component in Henoch-Schoenlein purpura. 2. Sera from 26 patients with Henoch-Schoenlein nephritis and six patients with Henoch-Schoenlein purpura without accompanying nephritis were studied and compared with sera from 20 patients with other forms of glomerulonephritis and 40 normal subjects. E.l.i.s.a.s were developed to detect IgA and IgG binding to the ligand from whole human glomeruli previously described, laminin, DNA, cardiolipin (diphosphatidylglycerol) and a panel of dietary constituents (BSA, alpha-caesin, beta-lactoglobulin, ovalbumin and wheat gliadin). 3. Sera from 16 of the 26 patients with Henoch-Schoenlein nephritis displayed increased IgG binding to the human glomerular extract compared with the normal control group (P < 0.001), whereas IgG binding was not significantly raised in the patients with Henoch-Schoenlein purpura without evidence of renal involvement. IgA binding was not raised compared with control subjects. Serum IgA and IgG binding to other potential autoantigens or antigens present on dietary constituents was not significantly different in patients with Henoch-Schoenlein nephritis or patients with Henoch-Schoenlein purpura without nephritis compared with control subjects. 4. Western blotting of the denatured and reduced glomerular extract revealed binding of IgG, from the sera of patients with active Henoch-Schoenlein nephritis, to glomerular components of M(r) 48,000 and 58,000, similar to the M(r) of the glomerular antigens identified in IgA nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Factitious illness: recognition and management.

An analysis of Munchausen syndrome by proxy is proposed, which involves a categorisation of parental behaviour in terms of desire to consult and ability to distinguish the child's needs from parents' own needs. The Munchausen syndrome by proxy case is proposed as one extreme of a much broader and commoner group for which the term factitious illness is used. An outline of assessment and investigation is given, applicable to all degrees of factitious illness, together with a model of collaboration between paediatrician and child psychiatrist. The role of the child psychiatrist is described. Collaboration results in a broader analysis of the situation which facilitates understanding and points the way to appropriate intervention.

Adult↗
PubMed1991

Detection of anti-epithelial cell antibodies in association with pediatric renal transplant failure using a novel microcytotoxicity assay.

We have developed a microcytotoxicity assay allowing sera to be screened for anti-epithelial cell cytotoxic antibodies. Cells from the epithelial cell line A549 were cultured overnight in Terasaki trays prior to the addition of the sera to be screened. Using this assay, 63 pediatric recipients of 78 renal transplants have been studied retrospectively. Seventeen transplants carried out in 13 patients were found to be associated with the production of antibodies reactive only against epithelial cells (AEC). Eleven of these transplants failed as compared with 19 failures out of 52 transplants not associated with AEC production (Fisher's p = 0.04). We conclude that transplantation in the face of pre-existing AEC should be approached with caution.

Autoantibodies↗
PubMed1991

Changes in psychosocial adjustment after renal transplantation.

The psychological aspects of transplantation were studied in 29 children and adolescents with functioning renal transplants. Most parents rated their child's physical health as considerably improved after transplantation. They also noted improvements in the child's behaviour and in the quality of family life. When compared with a sample of children being treated by hospital haemodialysis, children who had received transplants had more favourable parental views of behavioural and emotional adjustment, better parental psychiatric adjustment, and indications of superior child rated mood, self concept, and social functioning. Children who had received transplants did, however, show an increase in minor behavioural symptoms compared with healthy controls, and most parents required continuing psychological and social support as well as attention to physical aspects of the child's condition. Kidney transplantation is associated with improved psychosocial behaviour in children, but there is a continuing need for support for parents in dealing with minor psychological problems after the transplant.

Adaptation, Psychological↗
PubMed1990

Psychosocial issues in children on hospital haemodialysis: nurses' views.

In a sample of 21 children and adolescents on hospital haemodialysis, nurses identified a substantial percentage of the children (about half) as having marked problems in psychological adjustment. Nearly half of the children were also regarded as showing poor compliance with aspects of treatment other than dialysis. More children were rated as disturbed by nursing than by research psychiatric assessments; there was limited congruence between nurses' and parent/child ratings of problems in physical well-being or in treatment compliance. The reasons for these discrepancies are explored. Our results highlight the importance that psychological aspects in the nursing of children with chronic renal failure on hospital haemodialysis are recognised.

Adolescent↗
PubMed1990

Access for peritoneal dialysis in neonates and infants.

A new catheter for peritoneal dialysis in neonates and infants was used on 28 occasions in 17 patients. Advantages over other catheters included easy safe introduction over a guide wire, absence of early leakage of dialysate, and the ability to change the catheter without creating a second abdominal wound.

Catheterization↗
PubMed1990

Home collection of urine specimens--boric acid bottles or Dipslides?

Sterile mid stream specimens of urine (MSSU) were obtained from 84 children in a hospital outpatient department. All 84 children collected urine at home by one of two Dipslide methods and by collection into boric acid within 24 hours of the hospital collected MSSU. The samples collected at home were posted to the hospital. Thirty six of the Dipslides (43%) and nine of the boric acid samples (10%) were not sterile but none had a pure growth of a single organism of greater than 10(5) organisms/ml. In addition, 17 of the Dipslides (20%) were returned with one or both media detached and therefore could not be relied upon to exclude urinary tract infection. In a second part to the study, 95 urines which showed a significant growth in primary culture were also cultured after storage in boric acid. Inhibition was noted in nine samples after storage in boric acid, seven of which were in underfilled bottles. Transport of specimens in boric acid produced less contamination than Dipslides but may inhibit growth in a small number of specimens. Technical failures with Dipslides were disappointingly high.

Adolescent↗
PubMed1989

Nephrotic syndrome: from toddlers to twenties.

63 patients with steroid-sensitive, biopsy-proven minimal-change nephrotic syndrome were followed for between 10 and 21 years. 2 died. All the survivors had normal renal function and blood pressure, and only 2 had a single attack. Frequent relapse was more common with young age of onset and in boys. The frequency of relapse fell rapidly over the first 4 years after diagnosis and then plateaued. Relapses continued into adult life. No definite endpoint to the disease could be defined although there was a linear relation between length of remission and risk of subsequent relapse.

Adolescent↗
PubMed1989

Haemolytic uraemic syndrome and the Thomsen Friedenreich antigen.

In three children with haemolytic uraemic syndrome (HUS), evidence of red cell polyagglutinability due to Thomsen Friedenreich antigen (T-antigen) exposure was demonstrated. This was suspected after difficulties in ABO typing and was confirmed using specific antisera. Further supportive evidence included elevation of plasma sialic acid, alteration in red cell surface charge and evidence of T-antigen exposure in the renal biopsy specimen of one patient. Although involvement of this antigen in the pathogenesis of HUS has been associated with a high mortality, all three children have made a complete recovery. With early recognition and subsequent avoidance of plasma products, prognosis of this condition may be improved.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1988

Psychiatric adjustment in children with chronic renal failure.

Problems in psychiatric adjustment were found to be more common in children and adolescents with chronic renal failure (22 subjects on hospital haemodialysis and 22 with less severe renal failure) than in healthy matched controls. There was a trend towards more definite and marked psychological difficulties in patients with more severe renal condition. However, the less severely physically ill children tended to have increased difficulties in school adjustment and they reported more feelings of loneliness. The findings have implications on the management of children with chronic renal failure.

Adaptation, Psychological↗
PubMed1988

How parents and families cope with chronic renal failure.

We studied the effects on the family of childhood chronic renal failure by contrasting children with varying degrees of severity of illness with healthy controls. Disruption of family life was most common in families with the more severely ill children (on hospital haemodialysis) and there was a tendency for more mental health problems in the parents in this group. Although more of these parents reported that the child's illness had had an impact on the marriage, marital break up was not related to illness status. There were indications that illness had resulted in an increase of subjective stress but also of support in a number of psychosocial areas for parents, especially those in the more severely affected group. Nevertheless at the time of assessment, fewer mothers in this group were deriving support from their social life and fewer fathers of ill children from their jobs or finances.

Adaptation, Psychological↗