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Biomedical subjects

A Kemp

Publications and source records attributed to A Kemp.

At least 19 recordsLinked to original sources

Drowning and near drowning in children in the United Kingdom: lessons for prevention.

OBJECTIVES: To determine the pattern of drowning and near drowning of children in Britain and identify means of prevention. DESIGN: Study of drowned and nearly drowned children under 15 years old. SETTING: United Kingdom, 1988 and 1989. SUBJECTS: Children under 15 years either drowning or admitted to hospital after a submersion incident. MAIN OUTCOME MEASURES: Number of nearly drowned children, obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Number of drowned children notified by the Office of Population Censuses and Surveys and other national epidemiological offices; information from coroners. RESULTS: 306 children had confirmed submersion incidents: 149 died and 157 survived after near drowning. The annual incidence in England and Wales was 1.5/100,000, and mortality 0.7/100,000. Mortality was lowest in public pools 6% (2/32) and highest in rivers, canals, and lakes (78%, 56/73). Most of the children (263, 83%) were unsupervised at the time of the accident. 208 (68%) children were under 5 years old. CONCLUSIONS: Drowning and near drowning of children are problems in the British Isles. Appropriate supervision and safety barriers seem important for preventing such accidents. Improving information on dangers of drowning given to parents through the child surveillance programmes, encouraging fencing or draining of garden ponds and domestic swimming pools, and increasing supervision of swimming in lakes, rivers, and beaches should reduce the number of accidents.

Adolescent

The management of acute laryngo-tracheo-bronchitis (croup): a consensus view.

The management of croup relies upon the traditional clinical skills of observation and examination. Parental involvement is essential and the appropriate reassurance of the patient is important. Endotracheal intubation is required only in a small percentage of children whose airway is compromised to such a degree as to produce fatigue and/or near occlusion.

Adrenal Cortex Hormones

Aedes albopictus and other mosquitoes imported in tires into Durban, South Africa.

The results of surveillance for immature stages of mosquitoes in samples of wet tires in 5 consignments imported into Durban from Japan is reported. Three of these consignments contained tires with immatures of Aedes aegypti, Ae. albopictus and Uranotaenia n. novobscura. The proportions of all the wet tires calculated to contain mosquitoes were 189/1,488 (13%), 20/813 (2.5%) and 13/1,032 (1.3%) which emphasizes the need for effective mosquito control measures to prevent Ae. albopictus escaping from such tires and establishing itself in Durban.

Aedes

Establishment in culture and characterization of a strain with mast cell and monocytic properties from the bone marrow of a child with diffuse cutaneous mastocytosis.

Bone marrow was isolated from a child with congenital mastocytosis. Upon prolonged in vitro culture, initially in the presence of interleukin-3 (IL-3), a population of relatively large fusiform, strongly adherent cells grew out plus a subpopulation of smaller nonadherent cells. The morphology of the adherent cells was not typical of fibroblasts, epithelial cells, nor of standard hematopoietic cell types, whereas the morphology of the nonadherent cells resembled mast cells. Neither cell type required the presence of IL-3 nor a feeder layer of fibroblasts for continued growth. Attempts to isolate the two populations were unsuccessful. This cell strain comprised of both cell populations has been termed human bone marrow-derived mastocytosis cells (HBM-M). These cells were found to possess some of the cytochemical, ultrastructural, and surface phenotypic features of degranulated mast cells. They reacted with the mast cell marker, monoclonal antibody YB5.B8, but not with the basophil specific monoclonal antibody Bsp-1 and released the inflammatory mediators histamine, leukotriene C4, prostaglandin D2, and platelet-activating factor constitutively. This release was not potentiated by immunologic- or nonimmunologic-activating stimuli. In addition, they exhibited cytochemical and surface phenotypic features of monocytes. Our results indicate that a population of abnormal proliferative cells exist in the marrow of this patient; that these cells may be responsible for the patient's pronounced systemic proliferation of mast cells and the associated symptoms; and that the cell's mast cell, monocyte properties may be indicative of a common bone marrow-derived mast cell/monocyte precursor.

Antibodies, Monoclonal

Increased production and immunohistochemical localization of transforming growth factor-beta in idiopathic pulmonary fibrosis.

Transforming growth factor-beta (TGF-beta) can regulate cell growth and differentiation as well as production of extracellular matrix proteins. Elevated production of TGF-beta has been associated with human and rodent chronic inflammatory and fibrotic diseases. Using immunohistochemical staining, we have examined lung sections of patients with advanced idiopathic pulmonary fibrosis (IPF), a disease characterized by chronic inflammation and fibrosis and demonstrated a marked and consistent increase in TGF-beta production in epithelial cells and macrophages when compared to patients with nonspecific inflammation and those with no inflammation or fibrosis. In patients with advanced IPF, intracellular staining with anti-LC (1-30) TGF-beta antibody was seen prominently in bronchiolar epithelial cells. In addition, epithelial cells of honeycomb cysts and hyperplastic type II pneumocytes stained intensely. Anti-CC (1-30) TGF-beta antibody, which reacts with extracellular TGF-beta, was localized in the lamina propria of bronchioles and in subepithelial regions of honeycomb cysts in areas of dense fibroconnective tissue deposition. The close association of subepithelial TGF-beta to the intracellular form in advanced IPF suggests that TGF-beta was produced and secreted primarily by epithelial cells. Because of the well-known effects of TGF-beta on extracellular matrix formation and on epithelial cell differentiation, the increased production of TGF-beta in advanced IPF may be pathogenic to the pulmonary fibrotic and regenerative responses seen in this disease.

Biopsy

Potential for dengue in South Africa: mosquito ecology with particular reference to Aedes aegypti.

Observations on prevalence, geographical distribution, utilization of artificial larval habitats and anthropophilism were made on diurnal mosquitoes at selected localities along the coast of Natal and inland in the Transvaal to identify potential vectors of dengue in South Africa. Larval collections made in artificial containers on the ground, the exposure of bamboo pots as ovitraps in trees and collection of mosquitoes biting man showed the following species as the most likely candidates for vectors: Aedes aegypti, Ae. demeilloni, Ae. simpsoni, Ae. strelitziae, Ae. furcifer, Ae. cordellieri and Eretmapodites quinquevittatus. The bamboo pots showed that Ae. aegypti and Ae. simpsoni were the most widespread species, occurring at 11 of 12 localities. Aedes aegypti was the most prevalent species with mean pot index of 60.3 +/- 9.8% (SE) and abundance index of 0.43 +/- 0.15 (SE). Aedes aegypti was frequently present as larvae in artificial containers at indices of 11-83% (mean 56.8 +/- 5.6%, SE) and was the most anthropophilic species with average biting rates of 10-29 per man-hour at 7 localities. Although Ae. aegypti was abundant in the pots at Ndumu (northern Natal) and at Skukuza (eastern Transvaal), the local populations were poorly anthropophilic at these localities. At some localities, populations of Ae. demeilloni, Ae. simpsoni and Ae. strelitziae had average biting rates of 5.4-9.6 per man-hour. Aedes furcifer was collected for the first time at Durban, extending its distribution southward to latitude 29 degrees 53' S.

Aedes

Measles immunization in children with clinical reactions to egg protein.

Thirty-five egg-sensitive children who received measles immunization without adverse sequelae are described. Thirty-two of the children had a history of immediate hypersensitivity reactions to egg protein, including 22 who developed a generalized reaction after oral exposure to egg. There were also 3 highly allergic children, with immediate hypersensitivity reactions to other food, who, despite having never been exposed to egg, developed large skin prick test wheals to egg white. Measles vaccine was given to all children without prior vaccine skin testing. There were no adverse reactions. It is suggested that measles vaccine can be given to children with a history of generalized or localized urticaria/angioedema on exposure to egg protein without prior skin testing.

Child, Preschool

Giant centrifugal miliaria profunda.

A 4-month-old developed rapidly enlarging, white plaques up to several centimeters in diameter in areas where occlusive tape had been applied, almost all on the sites of venous or arterial punctures. Microscopy demonstrated the features of miliaria profunda, with sweat duct occlusion and evidence of extravasation of sweat into the dermis. This clinical entity has not been described previously, and we suggest the name giant centrifugal miliaria profunda.

Humans

Familial Mediterranean fever in six Australian children.

Six Australian children fulfilled the diagnostic criteria for familial Mediterranean fever. None had a family history of the disease, but five children came from ethnic groups that typically were associated with the disease. The symptoms commenced before five years of age in all the children, and three children underwent unnecessary operations because of the symptoms of recurrent fever and abdominal pain. All six children benefited from colchicine prophylaxis by mouth. More cases can be expected to be recognized in Australia because of the large number of Australian children with a Mediterranean heritage.

Australia

Epithelial action potentials in embryos of the Australian lungfish.

The epithelial cells of the skin of embryonic Australian lungfish (Neoceratodus forsteri) between stages 30 and 39, are mechanosensitive and excitable, showing overshooting action potentials 400-800 ms long with a rapid rise followed by a slower repolarization (usually with a shoulder on the repolarizing phase), which propagate at around 10 mm s-1. This skin impulse system is very similar to that found in embryonic and larval Amphibia; the significance of this similarity is discussed.

Action Potentials

Human ehrlichiosis: prospective active surveillance in febrile hospitalized patients.

Between 1 April 1987 and 30 September 1988 prospective active surveillance of human ehrlichiosis was conducted among febrile patients hospitalized in southeast Georgia. If disease of the immune system, bacterial infection, pneumonia, or surgical illness was documented by the end of the first full day of hospitalization, the patient was excluded. Of 75 patients enrolled in the study, 8 (10.7%) had a fourfold rise or fall in titer to Ehrlichia canis (case-patients). The rate was 5.3 cases/100,000 population. Case-patients were more likely than noncase patients to have become ill in May or June (P = .008) and to report a recent tick bite (P less than .001). At hospital admission, case-patients had lower white blood cell counts (median, 4,450/mm3; P = .001), platelet counts (median, 133,000/mm3 P less than .001), and higher aspartate aminotransferase (median, 68 IU/ml; P = .004) and alanine aminotransferase levels (median, 62 IU/ml; P = .038).

Animals

Occurrence of platelet-activating factor (PAF) and an endogenous inhibitor of platelet aggregation in diffuse cutaneous mastocytosis.

We have identified PAF in the blister fluid from a patient with bullous mastocytosis, a rare form of mast-cell disease. We have found a novel endogenous inhibitor of platelet aggregation which obscured the presence of the PAF in unprocessed blister fluid and in ethanol or lipid extracts. The PAF was characterized by the demonstration of chromatographic, mass spectral and biological properties identical to those of authentic PAF. Thus this is the first demonstration of PAF in biological fluid from a patient with mastocytosis. High levels of immunoreactive prostaglandin D2 (PGD2) and histamine were also present in the blister fluid. The interaction between PAF and the inhibitor of platelet aggregation in patients with systemic mastocytosis may provide an explanation for some of the manifestations of the disease, in particular the episodic hypotension, cutaneous flushing and pallor.

Blister

Pulmonary aspiration studied by radionuclide milk scanning and barium swallow roentgenography.

We have examined the use of radionuclide milk scanning to detect aspiration and have compared the clinical features of patients with demonstrated aspiration with those of patients in whom aspiration was not demonstrated. One hundred twenty children underwent radionuclide milk scanning for three different clinical indications, namely, respiratory tract symptoms (n = 56), gastroesophageal (GO) reflux (n = 20), and near-miss sudden infant death syndrome (SIDS) (n = 44). Ninety-eight (82%) of the 120 patients had a GO reflux demonstrated on the radionuclide milk scan. The incidence of aspiration was high in the respiratory (23%) and near-miss SIDS groups (20%) but low in the GO reflux group (5%). Only four of the 19 patients with an aspiration-positive scan had an aspiration-positive barium swallow film. The clinical symptoms and signs of those patients with aspiration-positive results were not significantly different from those of patients in whom aspiration was not demonstrated. We conclude that radionuclide milk scanning is more sensitive than barium swallow roentgenography in detecting aspiration; however, the clinical significance of such aspiration is undetermined. In view of the high incidence of GO reflux demonstrated in the absence of aspiration by the use of radionuclide milk scanning, the sole finding of GO reflux in a child with respiratory tract symptoms should not be taken as presumptive evidence that aspiration is contributing to those symptoms.

Adolescent