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Biomedical subjects

R S Trompeter

Publications and source records attributed to R S Trompeter.

At least 55 records · Page 3Linked to original sources
PubMed1989

Antenatal screening for hepatitis B is medically and economically effective in the prevention of vertical transmission: three years experience in a London hospital.

We describe our experience over a three-year period in the detection of antenatal patients with hepatitis B virus (HBV) carriage, and the successful prevention of vertical transmission in the infants of HBsAg-positive women. Nine of the 26 infants born to HBsAg-positive mothers were considered to be at high risk of infection. Eight of these nine remained HBsAg-negative after passive or passive/active immunization. The majority of infants tested had anti-HBs antibody titres above 10 i.u./l from the first month. In comparison with the cost of caring for patients with chronic hepatitis B infection and decompensated cirrhosis, non-selective testing of pregnant women for HBsAg is found to be cost effective.

Carrier State↗
PubMed1989

[Triple immunosuppression in renal transplantation in children: 3 years' experience].

Cyclosporin A in combination with low-dose steroid therapy and azathioprine was given to 50 children who received 53 renal transplants. In spite of a limited period of observation, the use of cyclosporin A, either on a post operative intravenous regime or on oral regime when primary graft function is achieved, has no significant influence on graft survival rate, which is 82% after 1 and 2 years, utilising cadaver donors. Vascular complications were responsible for the loss of 4 grafts and were associated with the use of kidneys from young donors, rather than the type of immunosuppressive agents used.

Adolescent↗
PubMed1987

A review of drug prescribing in children with end-stage renal failure.

This review provides a guideline for the prescribing of drugs in children with end-stage renal failure. The altered physiology of renal failure affects the metabolism of most pharmacological agents and modification of the drug dosage or extension of the prescribed drug interval become necessary with declining glomerular filtration rate (GFR). Most dose adjustments are dependent on a knowledge of renal function since GFR is inversely proportioned to the elimination rate constant of a drug. The details of drugs listed by generic name are those commonly used in paediatric practice, and the recommendations for dose adjustments are related to a reduction in GFR and not to body mass. Familiarization with the normal dose prescription of any drug used in paediatric practice is therefore necessary when referring to the table.

Child↗
PubMed1985

Long-term outcome for children with minimal-change nephrotic syndrome.

A retrospective study was undertaken to assess the outcome of a cohort of 183 unselected children who presented with the nephrotic syndrome between 1963 and 1969. All subjects showed minimal glomerular changes in biopsy samples and were given conventional steroid therapy. Information was available on 152 children, now aged 14-32 years. Activity persisted longer in patients presenting at an early age. The outcome for most of the children was favourable. Only 10 patients (5.5%), all of whom presented with initial symptoms before their 6th birthday, continued to have steroid-responsive relapses in adult life. There were 11 deaths, of which 7 (4% of the series) were from avoidable complications of the disorder.

Adolescent↗
PubMed1985

Familial juvenile nephronophthisis, Jeune's syndrome, and associated disorders.

Fourteen patients with familial juvenile nephronophthisis are described, eight of whom displayed one or more additional disorders. One boy with short limbed dwarfism and an abnormal chest was considered to have Jeune's syndrome; review of the published reports supports the view that nephronophthisis is the principal cause of renal failure in this disorder. Another patient with renal failure and retinitis pigmentosa at presentation developed progressive neurological and neuromuscular impairment leading to the discovery of ragged red fibre disease (mitochondrial cytopathy). Cardiomyopathy was present in this and one other patient. Tapeto-retinal degeneration, hepatic fibrosis, cerebellar ataxia, and oculomotor apraxia were among the other disorders encountered. Three patients presented in extremis with acute heart failure and irreversible oligo-anuria and this complication developed in another child who was already known to have nephronophthisis. Awareness of this disease and its associations is important for early diagnosis and appropriate management.

Adolescent↗
PubMed1983

Renal transplantation in very young children.

Thirteen cadaver and three live-donor renal transplants were undertaken in fifteen children aged less than 5 years, of whom seven were younger than 3 years. Mean weight of the recipients was 11.5 kg; six weighted less than 10 kg at operation. Mean age of the cadaver donors was 13.5 years. Bilateral nephrectomy was undertaken before or at the time of transplantation in eight recipients; ten required dialysis before transplantation. Five grafts were lost in four patients, three owing to long-segment renal-artery stenosis possibly due to chronic rejection. After mean follow-up of 1.2 years the mean plasma creatinine of the ten functioning grafts was 64 mumol/l with a mean estimated glomerular filtration rate of 70 ml/min/1.73 m2. Careful circulatory control to avoid hypovolaemia or hypervolaemia and the maintenance of a high urine flow rate immediately post-transplant have prevented the graft loss due to thromboses or primary non-function previously reported with cadaver grafts in young children. Postoperative growth has been encouraging.

Adolescent↗
PubMed1983

Haemolytic-uraemic syndrome: an analysis of prognostic features.

Seventy-two children with the haemolytic-uraemic syndrome were seen between 1969 and 1980 at The Hospital for Sick Children and Guy's Hospital, London. They probably constitute the majority of such cases in south-east England during that period. Boys and girls were affected equally, the mean age at presentation was 3.5 years, and a peak incidence of the disorder in summer months was observed. In 52 (72%) there was a history of diarrhoea at onset. Fifty-seven (78%) were managed by dialysis. Fifty (70%) of the 72 children had a favourable outcome with complete recovery, 3 (4%) died in the acute phase of the illness, 8 (11%) had residual hypertension or chronic renal failure, and 11 (16%) never recovered renal function. The probability of complete recovery of renal function was analysed by logistic regression which indicated that younger age, presentation in the summer months, diarrhoea at onset and, in those patients who were dialysed, a short prodromal illness were associated with a good outcome. Further analysis of the interaction among these variables in the patient group as a whole indicated that diarrhoea favoured a good outcome among boys but not girls.

Acute Kidney Injury↗
PubMed1983

Normal values for plasma creatinine concentration related to maturity in normal term and preterm infants.

Creatinine concentration was measured by a kinetic method in 475 plasma samples obtained from 260 term and preterm infants during the first 2 months post-natal age. In term infants plasma creatinine fell from 88 +/- 4.4 mumol/L (mean + SEM) at birth, to 60 +/- 1.9 mumol/L by the fourth day remaining stable thereafter; in preterm infants creatinine fell to 86 +/- 7 mumol/L by the fourth day. Analysis of pooled data from all infants of more than 4 days post natal age revealed a progressive fall in creatinine with increasing post conceptual age. The normal range of values varies with post conceptual age and was not influenced by gestational age at the time of birth.

Age Factors↗
PubMed1982

Neurological complications of arterial hypertension.

During a 10-year period 45 children were identified as having had neurological complications associated with severe arterial hypertension. Convulsions were the most common complication, occurring in 42 (82%) children. Two (4%) children each presented with a facial palsy and 2 (4%) with alterations in the level of consciousness. Nineteen (42%) presented with epileptic seizures as the first sign of arterial hypertension. The prognosis for children having had a single episode of hypertensive encephalopathy was good. Long-term follow-up showed no permanent neurological deficit on physical examination, and no focal abnormality on brain scan by computerised tomography. Psychometric analysis similarly failed to show any significant difference in cognitive assessment between children having had an episode of hypertensive encephalopathy and a control group with chronic renal disease, although reading skills were generally behind for chronological age and the average IQ was about 90 in both groups.

Adolescent↗
PubMed1981

Gonadal function in boys with steroid-responsive nephrotic syndrome treated with cyclophosphamide for short periods.

Semen analysis was undertaken in 19 men over the age of 18 years who had been treated during childhood for steroid-responsive nephrotic syndrome with a single course of cyclophosphamide 3 mg/kg bodyweight for 8 weeks. A further 4 men who received two such courses of treatment were also studied. Plasma total androgens and gonadotropins were also determined. A comparison group consisted of medical students investigated as potential donors for artificial insemination. Lower ejaculate volumes and sperm densities with a higher percentage of immotile and abnormal forms were detected in patients who had received cyclophosphamide. However, the abnormalities were not severe enough to suggest infertility. Plasma total androgens were lower in the patients, but there were no differences in gonadotropic hormones. The data suggest that a course of treatment with cyclophosphamide known to influence the natural history of the nephrotic syndrome is not necessarily followed by a severe abnormality of sperm production; nevertheless, great caution is still required in the use of the drug.

Adolescent↗