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Biomedical subjects

R J Postlethwaite

Publications and source records attributed to R J Postlethwaite.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1987

Response of circulating immune complexes to food challenge in relapsing IgA nephropathy.

The response of circulating immune complexes (CIC) to food challenge was assessed in 15 subjects with IgA nephropathy (IgAN) and recurrent macroscopic haematuria. CIC were measured by solid-phase C1q binding assay (SP-C1q), immunoglobulin class-specific polyethylene glycol (PEG) precipitation assays (PEG-G, PEG-A, PEG-M) and by an antigen (ovalbumin)-specific radioimmunoassay after acid dissociation (OA-IC). CIC were measured when the subjects were fasting and hourly for 6 h after a test meal containing eggs. All 15 subjects were tested while clinically quiescent (remission) and 6 were tested again during episodes of macroscopic haematuria (relapse). The PEG-A CIC response to food challenge was significantly exaggerated in IgAN remission compared with controls at 3-6 h after food. There were also non-significant increases in PEG-G, though not in PEG-M. Paired data showed further exaggeration of PEG-G, PEG-A and PEG-M responses to food during IgAN relapse, but significance was not attained if the findings in 1 subject were separated. In this individual a florid clinical relapse with transient decline in renal function was associated with very high levels of PEG-IC, and only in this patient in relapse was OA-IC detectable, confirming that some PEG-precipitated material represented antigen-antibody complexes containing food antigen.

Adolescent↗
PubMed1987

Vascular access for acute haemodialysis.

Vascular access for acute haemodialysis was required on 29 occasions in 26 children over a six year period. Comparison was made of the forms of vascular access employed, these being the Scribner shunt, the Hickman line, and percutaneous polyvinylchloride cannulae. The Hickman catheter was used to provide vascular access in 17 patients (mean age 8.8 years (range 2.5-16 years) and mean weight 25.5 kg (range 7.7-60 kg)) and allowed adequate haemodialysis to occur. Only one catheter had to be removed because of infection, and no other serious complications were encountered. These results show the superiority of the Hickman catheter as vascular access for acute haemodialysis in children.

Adolescent↗
PubMed1986

Sequential study of the IgA system in relapsing IgA nephropathy.

Cellular and immunochemical parameters of the IgA system were studied in 15 subjects with IgA nephropathy (IgAN) and 15 agematched controls. In IgAN remission no abnormalities of the IgA system were detectable by the methods used. In IgAN relapse, [macroscopic hematuria associated with upper respiratory tract infection (URTI) (N = 6)] there were rises in IgA-bearing B-lymphocytes (three of six), T helper/suppressor cell ratio (six of six) and pokeweed mitogen-induced IgA production (four of six). Total serum and salivary IgA were unchanged. Serum IgA profile (HPLC-ELISA) showed increases in polymer IgA (three of six). No such changes were found during URTI in controls. These findings support the view that an exaggerated IgA response to mucosal antigen challenge initiates glomerular damage and hematuria in IgAN.

Adolescent↗
PubMed1985

Renal function in diabetes mellitus.

Glomerular filtration rate, day and night-time albumin excretion, and blood pressure were estimated in 83 children with diabetes mellitus and compared with measures of glycaemic control, age, and duration of disease. Careful attention was paid to definition of normal values in age matched controls. The glomerular filtration rate was greater than normal, and correlated with duration of disease, but not with albumin excretion or blood pressure. Daytime albumin excretion correlated with duration of disease and glycosylated haemoglobin, but not with age, glomerular filtration rate, or blood pressure. Night-time albumin excretion was significantly raised and correlated with duration of disease, glycosylated haemoglobin, mean blood sugar concentration, and M value but not with age, glomerular filtration rate, or blood pressure. Diastolic blood pressure was significantly raised but was not correlated with any other measured variable. We have confirmed abnormalities of renal function in a children's diabetic clinic. The measurement of overnight albumin excretion rates may provide a sensitive early indicator of renal damage.

Adolescent↗
PubMed1985

Long term prognosis of recurrent haematuria.

A long term follow up study of 100 children referred with recurrent haematuria for at least one year to two regional paediatric nephrology units is described. The mean duration of follow up was 8.2 years. An adequate renal biopsy was obtained in 96 and eight cases of Alport's syndrome and 10 of IgA nephropathy were diagnosed (20% and 26% respectively of the biopsies examined by electron microscopy and immunofluorescence). Five patients developed end stage renal failure and six hypertension requiring treatment, with the occurrence of these complications increasing progressively with increasing duration of follow up (1% at five years compared with 12% at 10 years). Adverse prognostic features were persistence of microscopic haematuria, proteinuria at presentation, and appreciable changes on renal biopsy. Eighty four patients had first degree relatives tested for haematuria; 30% of these families had another affected member. With long term follow up recurrent haematuria is associated with considerable morbidity and potential mortality.

Adolescent↗
PubMed1985

Albumin analysis in serum of haemodialysis patients: discrepancies between bromocresol purple, bromocresol green and electroimmunoassay.

The analysis of serum albumin by bromocresol purple (BCP), by bromocresol green (BCG), and by electroimmunoassay (EIA) has been compared in a mixed group of 100 hospital patients. Good agreement between the immunochemical and BCP methods, but a positive bias with the BCG method led to routine use of the BCP method. In a group of 19 paediatric patients on chronic haemodialysis the mean BCP-albumin was found to be lower than the true albumin, as determined by EIA, whereas the positive bias using the BCG method remained. The difference between BCP-albumin and EIA-albumin in the haemodialysis group varied from 0 to -13 g/L (mean -7.1 g/L) but was effectively constant for most patients over a 3-month period. Possible mechanisms and necessary further investigations are discussed.

Adolescent↗
PubMed1984

Modulation of cellular immune function by cyclophosphamide in children with minimal-change nephropathy.

Cyclophosphamide is widely used to induce a remission of minimal-change nephropathy, but concerns have been raised about whether its effects on cellular immunity persist after treatment is discontinued. We studied functional and numerical measures of cellular immunity in children who had minimal-change nephropathy with frequent steroid-responsive relapses and were receiving cyclophosphamide (2.5 mg per kilogram of body weight per day for eight weeks). Sequential studies during such treatment showed that cyclophosphamide caused lymphopenia, particularly among T helper cells, resulting in a significant fall in the immunoregulatory (helper/suppressor) cell ratio. This change persisted 1 to 3 months after cyclophosphamide was discontinued, but measures of immune function reverted to normal after 6 to 12 months. Children with minimal-change nephropathy in long-term remission had no difference in T-cell subpopulations, lymphocyte responses to mitogens, or suppressor-cell function that could be attributed to the disease itself or to the previous use of cyclophosphamide.

Child↗