Oedema and the aging prima donna.
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Edema↗
Biomedical subjects
J D Baum
Publications and source records attributed to J D Baum.
An ultrasonographic study of the organisation of sucking and swallowing by newborn infants.
Healthy infants' sucking, swallowing and breathing movements were observed ultrasonographically during breast- and bottle-feeding between two and five days after birth. Sucks were found to occur either on their own or in combination with a swallow. Swallows did not occur on their own. Younger babies' swallowing invariably was associated with a pause in breathing. Older babies generally showed better co-ordination of sucking, swallowing and breathing than younger ones, whether breast- or bottle-feeding.
Bottle Feeding↗
The risk of diagnostic radiation of the newborn.
The amount of diagnostic radiation received by neonates at a large maternity hospital in 1982 was calculated. The risk of inducing neoplasia is unlikely to be greater than one in 280,000 for each radiograph of chest or abdomen. Provided that the exposure of the newborn to radiation at the John Radcliffe Hospital is typical of the rest of the country, and excluding cardiac catheterisation and computed tomography, we estimate that at most one to two cases of malignant disease per year may be caused by diagnostic radiation in the United Kingdom. Genetic risks appear to be negligible. The risks of not using radiography in newborn patients outweigh the risks of inducing malignant or genetic disease.
Cardiac Catheterization↗
A multiple injection regimen using an insulin injection pen and pre-filled cartridged soluble human insulin in adolescents with diabetes.
A multiple insulin injection regimen using a self-contained injection device Novopen (Novo Industries, Bagsvaerd, Copenhagen, Denmark) was assessed in 11 adolescents (age range 12.1-16.9 years) with diabetes. Ten patients completed the 3-month study period and eight expressed a wish to continue with the regimen, finding that the advantages it offered out-weighed the inconvenience of multiple injections. Mean glycosylated haemoglobin fell over the 3 months of the study period from 13.7 +/- 2.7% to 11.7 +/- 3.4% (NS) and there was a trend towards lower mean blood values which reached significance at the pre-lunch measurement (p less than 0.02).
Adolescent↗
Insulin dependent diabetes in under 5 year olds.
Insulin dependent diabetes mellitus presenting in children under five years old exhibits several clinical and management features that differ from diabetes presenting in older children. In this review of the current population of the Oxford children's diabetes clinic, children with diabetes diagnosed aged 0- less than 5 years are compared with those diagnosed aged 5- less than 10 years to illustrate these differences. The mean annual age specific incidence of diabetes for children aged 0- less than 5 is 9.9/100 000 compared with 13.8/100 000 for the children diagnosed aged 5- less than 10. Although children with diabetes currently aged less than 5 comprise only 8% of the clinic population, such children ultimately make up 41% of the total number of children with diabetes aged under 15 attending the clinic. Diabetes diagnosed in children under the age of 5 seems to have increased in incidence over the past 10 years, exhibits a male preponderence (1.5:1), and shows an unusual seasonal variation in incidence with an autumn/early winter trough, late winter/early spring peak, and the absence of mid-summer trough seen in other age groups. First degree family history was positive in 16% of children diagnosed under the age of 5 compared with 10% of the group diagnosed aged 5- less than 10. In none of these children was the mother the affected relative.
Age Factors↗
Urine albumin to creatinine ratio-response to exercise in diabetes.
Albuminuria was studied in 40 diabetic children before and after a standardised exercise test, and also in 21 normal children; the results are expressed as geometric mean (95% range) of urine albumin:urine creatinine ratio (mg/mg). There was no significant difference between the mean resting albumin:creatinine ratio in the two groups, or between these ratios before and after exercise in the normal children. In the diabetic children, however, the mean urine albumin:creatinine ratio after exercise was significantly higher than both the value before exercise and the postexercise value of the normal children, with 10 of 40 diabetic children showing a value after exercise greater than the 95% range of the geometric mean of the control group. The diabetic children were also studied by random urine albumin:creatinine ratios and split (erect:supine) 24 hour urine collection; none was abnormal.
Adolescent↗
Memory blood glucose reflectance meter and computer: a preliminary report of its use in recording and analysing blood glucose data measured at home by diabetic children.
We report a portable blood glucose reflectance meter with a non-volatile memory designed to record and store for a period of up to 99 days measurements of blood glucose performed at home under everyday circumstances. This information can be transferred at intervals to a desk-top computer, when rapid and detailed analysis of blood glucose control can be made. The data can then be stored and analysed over a prolonged period of time, thereby facilitating studies of the relationship between blood glucose control and the development of diabetic microvascular disease.
Adolescent↗
A comparison of two methods of milk sampling for calculating the fat intake of breast-fed babies.
Fat intake at a breast feed was estimated by either sampling milk intermittently during the feed using a thin latex nipple shield ('shield method') or by expressing samples before and after the feed ('expression method'). These sampling techniques were compared within 30 mother/infant pairs using a randomized cross-over design. Mean fat intake estimated by the expression method was significantly greater than that estimated by the shield method (first breast P less than 0.0001, second breast P less than 0.002). This finding was partly explained by a significantly lower mean milk intake when the nipple shield was used, but the higher fat content of expressed milk samples compared to samples obtained during suckling also played a part. Use of the nipple shield confirmed that breast-milk fat content does not change in a predictable way during a feed. Nevertheless, for practical purposes, the advantages of studying changes in milk composition during the feed have to be set against the potential restrictive effect of the nipple shield system when it is used to sample intermittently during the feed.
Breast Feeding↗
Homozygous transcobalamin II deficiency maintained on oral hydroxocobalamin.
A case of transcobalamin II (TCII) deficiency in which a total absence of TCII was demonstrated both functionally and immunologically is reported. Unlike previously described patients, this child has been maintained on oral hydroxocobalamin, 2 mg daily, without any parenteral supplementation for the last five years. At the age of six years her development is normal and her health is good. Plasma cobalamin levels are in the range of 3,000 ng/L and most of this appears to be bound to a molecule, which on gel filtration, elutes with albumin. In an extended family study, a clear separation of heterozygotes from both the propositus and from normal subjects suggests that the underlying defect in this condition is confined to a single gene.
Administration, Oral↗
Helen House--a hospice for children: analysis of the first year.
Helen House, a hospice for children, opened in Oxford in November 1982. From then until December 1983 care was provided for 52 children with terminal illness, progressive and incurable illness, and very severe handicap. The children came from a wide area of the United Kingdom, and eight died during the year. The style of care provided in Helen House is based on that of the families in their own homes, with a minimum of rules, regulations, and routines. Terminal care follows the principles developed by hospices experienced in the care of adults. Despite the great sadness and distress associated with every child admitted, Helen House is neither a sombre nor a depressing place.
Adolescent↗
Specificity of surfactant deficiency in neonatal respiratory disorders.
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Diagnosis, Differential↗
Evaluating breast-milk intake by test weighing: a portable electronic balance suitable for community and field studies.
A K-Tron Digital Scale (Model DS-1) was used to weigh a group of 52 new born babies. The regression of the weights on true weights obtained with a Sartorius electronic balance 3806MP was 0.9911, with an estimated residual variance of 5.25. With the same babies weighed on a Marsden Weighmaster, the estimated residual variance was 68.93. Data from published studies on other balances are presented for comparison. The K-Tron is a reliable, portable, battery operated balance suitable for measuring milk intake by test weighing in homes or in the field.
Biometry↗
A family study of the association between insulin dependent diabetes mellitus, autoantibodies and the HLA system.
A family study of the patients attending a paediatric diabetic clinic was undertaken. Seventy-three percent of the index patients and their families provided samples for HLA typing and autoantibody analysis. The HLA types were analysed and correlated with the auto-antibody data. Ways of predicting which siblings are at risk of developing insulin dependent diabetes mellitus (IDDM) were sought. The antigen DR4 carries a higher relative risk and delta value (viz. 27 and 0.93) than any other antigen. The data did not support the notion of heterogeneity of IDDM on the basis of HLA types or autoantibody status. However, the majority of patients with a younger age of onset were DR4/DR4 homozygotes. The presence of ICA was a good marker for siblings at risk of developing IDDM. Some siblings who developed IDDM had ICA and CF-ICA for long periods of time before developing diabetes. The data supported an intermediate model of inheritance for IDDM.
Adolescent↗
Management of secondary diabetes mellitus after total pancreatectomy in infancy.
We report five children who required total pancreatectomy in the neonatal period for life threatening hypoglycaemia. Subsequent diabetes was managed with once daily subcutaneous insulin, oral pancreatic extract, and a controlled carbohydrate diet. Daily home blood glucose profiles in four of these children were different from those of 14 C-peptide negative children with type 1 insulin dependent diabetes--in the pancreatectomy group there was less variation in blood glucose throughout the day with a fall after breakfast as against a rise after breakfast in the type 1 group. Hyperglycaemia (greater than 10 mmol/l) with or without ketonaemia was extremely rare in the pancreatectomy group. Despite neonatal convulsions, physical growth and development have been normal. Hypoglycaemia, usually after food refusal, has been a major problem. In addition, there have been considerable emotional and family disturbances despite the excellent metabolic control, which presumably reflect the cumulative difficulties in managing such young children with diabetes.
Blood Glucose↗
Doctors' views on diabetes.
Children with diabetes may be managed by either paediatricians or adult physicians with a particular interest in diabetes. This study compares the views of these two groups of doctors on juvenile onset diabetes. A questionnaire was given to all doctors attending two conferences, one primarily for paediatricians and one primarily for adult physicians with a particular interest in diabetes. Adult physicians estimated morbidity and mortality from juvenile onset diabetes to be significantly higher after 30 years than did paediatricians. The two groups of doctors also differed in the target blood glucose concentrations they considered optimal for diabetic children--more paediatricians opted for higher values than did adult physicians. The findings of this study support the view that paediatricians and adult physicians view juvenile onset diabetes differently. The origin of these differences is uncertain but may relate to the contrasting clinical experiences of the two groups of specialists.
Attitude of Health Personnel↗
Comparison of human versus porcine insulin in treatment of diabetes in children.
The blood glucose control obtained when using semi-synthetic monocomponent human insulin (insulin A) was compared with that using standard monocomponent porcine insulin (insulin B) in 14 children in a double blind crossover study. At the start of the study age, duration of diabetes, insulin dose, and daily carbohydrate intake were the same in both groups. After a one month run in period of standard treatment with porcine insulin the children were randomly divided into group 1 (three months of insulin A followed by three months of insulin B) and group 2 (three months of insulin B followed by three months of insulin A). During each treatment period blood glucose control was assessed by clinical symptoms, glycosylated haemoglobin, and home blood glucose monitoring. Although a significant difference in the period after lunch during 24 hour blood glucose profiles suggested a shorter onset time and faster peak action time of human insulin, no significant difference in the overall diabetic control was seen between the two types of insulin. There was a trend towards improved blood glucose control (irrespective of insulin) as the trial progressed. No clinical reactions to human insulin occurred, and there was no significant difference in the daily insulin dose between porcine and human insulin.
Adolescent↗
Social and emotional complications in a clinical trial among adolescents with diabetes mellitus.
Observations are reported on the social and emotional events occurring among children with diabetes mellitus and their families while taking part in a demanding clinical trial. Participants were selected on the basis of: (1) age over 10 years, (2) "informed consent," (3) cooperation with diabetic care, and (4) family stability. Despite endeavours to apply these criteria, it subsequently emerged that one father had doubts about his daughter participating; one family was suffering from severe marital discord; a girl (11 years) and a boy (10 years) were unexpectedly distressed by the venepunctures required; and another girl (13 years) was falsifying the results of her urine tests. All the families wished to complete the trial, and only one did not because of recurrent hypoglycaemia. The psychosocial problems encountered during the trial were unpredictable and occurred despite selection. Documentation of these problems allowed appropriate emotional support to be offered to the children and their families and provided for a fuller and more reliable interpretation of the trial results than would have been possible from the numerical data alone.
Adolescent↗