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Biomedical subjects

A M Lake

Publications and source records attributed to A M Lake.

At least 19 recordsLinked to original sources
PubMed2004

Gross and cytological characteristics of normal canine anal-sac secretions.

A study was conducted to characterize the gross and cytological characteristics of secretions from normal canine anal sacs. Fifty dogs with no recent history of anal-sac disease were selected consecutively and their anal sacs manually expressed. Of the 47 dogs with known or estimated ages, 27 were < 1 year olds. However, these youngest dogs were not significantly different from the rest in cell counts, viscosity, or presence of dark or light solid portions of the secretions. For all dogs combined, the secretions typically contained 41 (median) corneocytes per 400x magnification microscopic field, lots of basophilic background debris, and a mixture of Gram-positive cocci (173 per field; median), Gram-positive rods (29 per field; median), and Gram-negative rods (two per field; median). Although median counts across 10 400x fields per sac indicated no leucocytes or yeasts, many of the normal dogs had an occasional 400x field with non-degenerate neutrophils and yeasts. Erythrocytes were not a feature of these anal-sac secretions, and mononuclear leucocytes were found only rarely. Extreme heterogeneity existed in gross colour, consistency and the amount of solid material. Thus, these latter parameters probably would not be valid indicators of anal-sac disease.

Anal Sacs↗
PubMed2001

Dietary protein enterocolitis.

Dietary protein enterocolitis generally presents in the 1st year of life with diarrhea, emesis, and irritability. When there is a delay in diagnosis, persistent exposure to the offending dietary antigen leads to increasing enteric inflammation manifesting as bloody diarrhea, anemia, dehydration, and failure to sustain normal patterns of weight gain and growth. The extent of enteric inflammation may be limited to mild proctitis, pancolitis, or true enterocolitis with esophagitis, gastritis, enteropathy, and colitis. The offending antigen is usually cow's milk protein or soy protein. A significant number of the infants are exclusively breast fed, especially those with proctitis. In older children, a wide variety of dietary proteins have been implicated. The inconsistency between allergists and gastroenterologists in the clinical definition of the syndrome remains a significant problem. To the allergist, the definition is based on clinical criteria, allergy testing, and response to double-blind food challenge, whereas to the gastroenterologist, it is defined by histologic criteria and the response of clinical and histologic manifestations to elimination diets. To further complicate the issue, European studies have emphasized the alterations in enteric permeability noted in both enteropathy and enterocolitis. In an effort to establish a unified approach, the International Life Sciences Institute sponsored a workshop in late 1998, which resulted in a document entitled "Classification of Gastrointestinal Disease of Infants and Children Due to Adverse Immunologic Reactions."

Child Welfare↗
PubMed2000

Food-induced eosinophilic proctocolitis.

Food-induced eosinophilic proctocolitis appears in the first 2 months of life with blood-tinged stools. Aside from occasional apparent pain on defecation and a few infants with moderate eczema, systemic features are absent. Indeed, aside from the diaper, the infant is generally described as well. Thus, in contrast to the infant with enterocolitis, features such as emesis, failure to thrive, significant anemia, and dramatic diarrhea are not seen. In contrast to infants with the other food-induced inflammatory diseases of the bowel, most symptomatic infants are exclusively breast fed. Proctoscopic examination reveals focal erythema, erosions, and/or the nodularity of lymphoid nodular hyperplasia of the rectosigmoid. Biopsies of the rectum and lower sigmoid reveal a characteristic infiltration of the mucosa and lamina propria with eosinophils, usually in excess of 6 to 10 per high powered field. Elimination of the offending protein from the diet of the infant, through use of an extensively hydrolyzed casein-based formula or the elimination of the protein from the diet of the mother of the breast-feeding infant, leads to clinical resolution of the bleeding within 72 to 96 hours. By 1 year of age the infants routinely tolerate an unrestricted diet, and the long term prognosis is excellent.

Biopsy↗
PubMed2000

Fournier gangrene associated with Crohn disease.

A 17-year-old boy presented with Fournier gangrene associated with previously undiagnosed Crohn ileocolitis. Fournier gangrene was managed by débridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. Microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with Crohn disease. Crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal.

Adolescent↗
PubMed1999

Chronic abdominal pain in childhood: diagnosis and management.

More than one third of children complain of abdominal pain lasting two weeks or longer. The diagnostic approach to abdominal pain in children relies heavily on the history provided by the parent and child to direct a step-wise approach to investigation. If the history and physical examination suggest functional abdominal pain, constipation or peptic disease, the response to an empiric course of medical management is of greater value than multiple "exclusionary" investigations. A symptom diary allows the child to play an active role in the diagnostic process. The medical management of constipation, peptic disease and inflammatory bowel disease involves nutritional strategies, pharmacologic intervention and behavior and psychologic support.

Abdominal Pain↗
PubMed1998

Dose-response to a two-component acellular pertussis vaccine in infants and comparison with whole-cell vaccine.

In an effort to determine the optimal dose of pertussis toxoid (PT) and filamentous haemagglutinin (FHA) for use in acellular pertussis vaccines we compared the immunogenicity and safety of acellular pertussis vaccine combined with diphtheria and tetanus toxoids containing 12.5 microg (DTaP-12.5) or 25 microg (DTaP-25) each of PT and FHA with a whole cell pertussis vaccine in infants immunized at 2, 4 and 6 months of age. Recipients of acellular vaccines developed higher anti-FHA concentrations and more rapid anti-PT serological responses that infants who received whole cell pertussis vaccine combined with diphtheria and tetanus toxoids (DPT). A dose response was noted; infants immunized with DTaP-25 developed significantly (P<0.03) higher anti-FHA and anti-PT levels than infants who received DTaP-12.5. No rise in the agglutinin titres was noted for recipients of the acellular vaccines although this vaccine stimulated increases in agglutinins when given as the fourth or fifth dose to children who had received three doses of DTP. The rates of erythema, induration, pain, irritability, crying, increased sleepiness, and decreased appetite were significantly (P</=0.05) lower in infants who received acellualr vaccines than in infants who received DTP. When the data from the injections at 2, 4 and 6 months of age were combined, no significant differences in the rates of any adverse event were noted for recipients of DTaP-12.5 or DTaP-25. The rates of most adverse reactions following DTP decreased from the first to the third immunization except fever, which increased. For acellular vaccine recipients, the rates of fever and erythema increased somewhat from the first to the third injection but remained far below the rates following DTP. The acellular vaccine was safe and immunogenic, and a dose-response effect was demonstrated.

Adhesins, Bacterial↗
PubMed1996

Nutritional considerations and management of the child with inflammatory bowel disease.

Crohn's disease and ulcerative colitis are chronic inflammatory diseases of the bowel often associated with significant malnutrition, particularly in children because of increased nutrient demands due to growth. We discuss the increasingly prominent role of nutritional support in inflammatory bowel disease (IBD). Issues that are addressed include the etiology of malnutrition in IBD, assessment and monitoring of patient nutritional status and the use of nutrition in the management of growth failure and as primary medical therapy.

Child↗
PubMed1992

Dose-response to acellular pertussis vaccine and comparison with whole cell pertussis vaccine at 15-24 months and 4-6 years of age. Acellular Pertussis Vaccine Study Team.

In a randomized double-blind trial 55 children of 15-24 months and 56 children of 4-6 years of age previously immunized with whole-cell DTP (WC-DTP) received acellular pertussis DTP vaccines containing 12.5 micrograms (AC-12.5) or 25 micrograms (AC-25) each of pertussis toxoid (PT) and filamentous haemagglutinin (FHA) per dose of WC-DTP. No differences in antibody responses or adverse events were noted for children who received AC-25 as compared with AC-12.5. All three groups had significant increases in pertussis agglutinins, but the geometric mean titre (GMT) for 4-6-year-old children who received WC-DTP was higher than the GMT for children who received acellular vaccine. No significant differences were noted in the GMT of antibodies to FHA or PT between children who received WC-DTP and recipients of acellular vaccine. The rates of several adverse reactions were significantly (p less than or equal to 0.05) higher for recipients of WC-DTP, and children given WC-DTP were significantly (p less than or equal to 0.00001) more likely to have received acetaminophen. These acellular vaccines are safe and as immunogenic for FHA and PT as WC-DTP when administered as the fourth or fifth dose to children who received three doses of WC-DTP in infancy. The lower (12.5 micrograms) dose of acellular vaccine was as effective as the higher (25 micrograms) dose in inducing antibodies to FHA and PT in children 15-24 months and 4-6 years of age.

Antibodies↗
PubMed1990

Cholestatic jaundice in the newborn.

Neonatal cholestasis or direct hyperbilirubinemia in the first 3 months of life is nearly always more pathologic than physiologic. This article reviews the extensive differential diagnosis of cholestatic jaundice and the approach to diagnosis. A sense of urgency is underscored by the value of early recognition and intervention in metabolic, iatrogenic, and anatomic disorders. The long-term management goals are reviewed, including indications for hepatic transplantation.

Humans↗
PubMed1989

Nutritional support for pediatric patients with inflammatory bowel disease.

Pediatric patients with ulcerative colitis and Crohn's disease often suffer from malnutrition and growth failure. This is particularly true in pubertal children. Chronic insufficient nutrient intake is most often the cause of growth failure. Both parenteral nutrition and defined enteral formulas are available to rehabilitate patients with malnutrition and growth failure. Assessment of nutritional status and growth and the use of parenteral nutrition and defined enteral formulas to reverse malnutrition, growth failure, and inflammation in pediatric patients with inflammatory bowel disease are discussed.

Adolescent↗
PubMed1988

Decreased height velocity in children and adolescents before the diagnosis of Crohn's disease.

Severe linear growth retardation occurs in 20%-30% of children with Crohn's disease, yet, it is unknown how often decreased height velocity precedes the diagnosis. The height velocities of 50 children and prepubescent adolescents with Crohn's disease were reviewed. Decreased height velocity antedated the diagnosis in 44 patients. Twenty-one patients had a reduction in height velocity before intestinal symptoms were noted. Additionally, 17 of 32 patients with attenuated linear growth had a reduction in height velocity before any weight loss. Linear growth impairment in Crohn's disease, more common than previously recognized, may precede weight loss and can be the earliest indicator of disease.

Adolescent↗
PubMed1988

Recognition and management of inflammatory bowel disease in children and adolescents.

Until such time as an etiology and specific therapy can be established, it is critical for the pediatrician to recognize the early clinical manifestations of IBD and to initiate appropriate therapy. Most affected children require consultative care with a gastroenterologist comfortable with the unique requirements of the child with IBD. It is our hope that early diagnosis and treatment will not only reduce the frequency and severity of complications, but also allow minimal interference in the child's quality of life.

Adolescent↗