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Biomedical subjects

D Harvey

Publications and source records attributed to D Harvey.

At least 19 recordsLinked to original sources

The development and interpretation of the summating potential response.

The development of cochlear responses in the mouse was investigated, recording from the round window. Positive summating potentials (SP) could be detected as early as 7 days after birth in some individuals, the first signs of negative SP occurred in mice aged 10 days, and compound action potentials were first detected at 11 days of age. These early responses were obtained with relatively low frequency stimuli (usually 6 kHz). All waveforms recorded from 20 day old mice could be interpreted as simple additions of positive and negative SP and compound action potentials, each with different amplitudes and latencies. Positive SP showed both fast and slow components. Our observations are consistent with the positive SP with only a fast component arising from the basal turn inner hair cells, the positive SP with fast and slow components being generated by both inner and outer hair cells in the basal turn, and the negative SP seen at low frequencies of stimulation originating from depolarisation of hair cells in the apical turn. Summating potentials may thus be useful for investigating inner and outer hair cell function separately in abnormal cochleas in which it is not known which cell type primarily is affected.

Acoustic Stimulation

The growth of low-birth-weight children.

The growth of 171 seven-year-old children, free from major disability, with a birth weight of 2000 g or less was examined and compared with that of their own parents and of normal-birth-weight peers. Measurements included height, weight, occipitofrontal circumference, biparietal, occipitofrontal and bi-iliac diameters, triceps and subscapular skinfold thickness. Low-birth-weight children were shorter than their parents whereas those of normal birth weight were taller. For all parameters, particularly weight, the low-birth-weight children were significantly less well grown. There was no significant relationship between occipitofrontal circumference and intellectual ability.

Anthropometry

Infantile meningitis in England and Wales: a two year study.

A two year prospective study identified 1922 cases of meningitis in children under 1 year of age. A further 201 cases were identified from other sources. The annual incidence of meningitis during the first year of life was 1.6/1000; during the first 28 days of life it was 0.32/1000, and among postneonatal infants it was 1.22/1000. The male:female ratio was 1.4:1. The overall case fatality rate was 19.8% for neonates and 5.4% for postneonatal infants. Two thirds of deaths identified in the study, 50% of all deaths, were not attributed to meningitis by the Office of Population Censuses and Surveys. Group B beta haemolytic streptococci (28%), Escherichia coli (18%), and Listeria monocytogenes (5%) were most frequently isolated from neonates and Neisseria meningitidis (31%), Haemophilus influenzae (30%), and Streptococcus pneumoniae (10%) from postneonatal infants. At 2-6 months of age N meningitidis meningitis was most common, and at 7-12 months H influenzae predominated. Meningitis caused by group B beta haemolytic streptococci occurred up to 6 months of age and had a consistent mortality of 25%. Neonatal meningitis due to Gram negative enteric rods had a mortality of 32%. Low birth weight was a significant predisposing factor for both neonates and postneonatal infants. In both groups mortality was significantly higher among children admitted in coma. There was no seasonal variation in incidence in either group. Neonates were treated with either group. Neonates were treated with either chloramphenicol (50%) or gentamicin (48%) usually in combination with a penicillin; 40% received a third generation cephalosporin. Of the 1472 postneonatal infants treated 84% received chloramphenicol with a penicillin and 10% received a third generation cephalosporin. Relapse occurred in 49 patients and three died. Eighteen babies coned as a result of raised intracranial pressure, including four neonates, and four died. Mortality among the 133 (7%) children who received steroids was significantly higher than in the rest of the study group.

Chloramphenicol

A high performance liquid chromatography system for the simultaneous assay of some antibiotics commonly found in combination in clinical samples.

Using a single reversed-phase HPLC column with a mobile phase of methanol and 100 mM phosphate buffer, concentrations of seven antibiotics (chloramphenicol, metronidazole, cefuroxime, cephalexin, ceftazidime, ampicillin and benzylpenicillin) which are commonly used clinically in combinations of two or more, can be assayed and results reported within one hour. No endogenous interference was detected in serum, urine or cerebrospinal fluid. The method was highly specific even in the presence of other drugs and metabolites commonly found in clinical samples and provides a rapid, simple technique suitable for use in routine microbiological practice.

Anti-Bacterial Agents

Disparity of amniotic fluid volume and fetal size: problem of the stuck twin--US studies.

The "stuck twin" phenomenon in monochorionic diamniotic (MCDA) pregnancies is characterized by marked disparity in both fluid volume and fetal size between the twin gestations. To determine the prevalence, sonographic characteristics, and clinical outcome of this phenomenon, discharge summaries, placental pathologic reports, and prenatal sonograms from 307 twin pregnancies were reviewed. Of 52 cases of MCDA pregnancies, 18 (35%) demonstrated marked disparity in amniotic fluid volume. In 16 of these 18 cases there was discordant twin growth, further suggesting the diagnosis of twin transfusion syndrome. All 16 cases and an additional nine cases supplied by another center demonstrated a small, morphologically normal fetus in an oligohydramniotic sac suspended anteriorly (72%) or laterally (28%) in the uterus. The amniotic membrane separating this twin from the larger twin in the polyhydramniotic sac was thin, closely applied to the smaller fetus, and difficult to detect. Perinatal morbidity was 100% for all twin pairs, and premature labor occurred in all cases. Perinatal mortality ranged from 88% for the larger/poly twin to 96% for the small/oligo twin.

Adult

Mode of delivery and the lecithin/sphingomyelin ratio.

Babies born by elective Caesarean section are more likely to develop the respiratory distress syndrome that babies born vaginally. We studied the amniotic fluid and pharyngeal lecithin/sphingomyelin (L/S) ratios in three groups of babies born at term: 20 were delivered vaginally after elective induction of labour; 20 were delivered by elective Caesarean section; and 14 by Caesarean section after spontaneous onset of labour. Babies born after induction of labour had higher pharyngeal L/S ratios than babies born by elective Caesarean section. Those born by Caesarean section after spontaneous onset of labour had significantly higher pharyngeal L/S ratios than those in both of the elective delivery groups. There were no significant differences in the amniotic fluid L/S ratios of the two groups who underwent elective delivery. Regression analysis showed a significant relationship between length of labour and increase in the L/S ratio. These results indicate that, during labour, there is a release of fetal lung surfactant into the airways.

Amniotic Fluid

Bubble clicking in pharyngeal aspirate compared with lecithin/sphingomyelin ratio.

Tracheal fluid flows into the pharynx, so surfactant can be measured in pharyngeal aspirate. The walls of bubbles in air-free water show rhythmic movements (bubble clicking) if they contain surfactant. Babies with respiratory distress syndrome (RDS) have very little lung surfactant which can be shown by a low lecithin/sphingomyelin (L/S) ratio. To investigate surfactant in newborn babies we analysed 125 pharyngeal aspirates for the L/S ratio and bubble clicking. Both tests became more positive towards term and were related to the incidence of RDS. Babies with birth asphyxia or mild respiratory difficulties had lower L/S ratios and less clicking than normal babies. Both investigations could be used to chart the course of RDS. The L/S ratio is a chemical measurement of surfactant. Bubble clicking, which takes only a few minutes, demonstrates surface tension effects.

Humans

Genetic risks.

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Age Factors