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J Leake

Publications and source records attributed to J Leake.

At least 19 recordsLinked to original sources
PubMed2004

Lectin receptors for endometrial H-type 1 antigen on goat conceptuses.

PROBLEM: The goal of this study was to determine if caprine conceptuses express lectin-like receptors for endometrial H-type 1 (HT1) antigen. METHOD OF STUDY: Conceptus tissues were collected during the apposition, adhesion and attachment phases of placentation and evaluated using immunofluorescence microscopy. RESULTS: Conceptus staining for the trisaccharide lacto-N-fucopentaose-1 was strong and uniform during apposition of fetal and maternal tissues but changed by day 25 of pregnancy when large aggregates of intense staining were observed. Monoclonal antibodies to galectin-3 did not stain conceptus tissue during the apposition phase but intense punctate staining was observed after day 25. Strong uniform staining for Lewis Y antigen was detected only on day 17 of pregnancy. CONCLUSION: Conceptus tissue expresses potential receptors for endometrial HT1 antigen. Carbohydrate-lectin interactions may facilitate attachment of the apical surfaces of uterine epithelial cells and trophectoderm during the early stages of placentation.

Animals↗
PubMed1998

Evaluation of febrile children with petechial rashes: is there consensus among pediatricians?

BACKGROUND: The evaluation of febrile children with petechial rashes evokes controversy. Although many of these children have viral infections, on occasion such patients may be infected with Neisseria meningitidis. OBJECTIVE: To investigate differences in practice trends for the evaluation and management of non-toxic-appearing febrile children with petechial rashes among pediatric specialty groups. METHODS: We surveyed 833 pediatricians in 4 specialties [community (CGP) and academic (AGP) general pediatrics, emergency medicine (EM) and infectious diseases] regarding 4 hypothetical non-toxic-appearing febrile children ages 1, 2, 5 and 7 years. The patients differed with regard to clinical appearance, distribution of petechiae and complete blood count results. We compared specialty group responses, adjusting for practice setting, population size and years in practice using multiple logistic regression analysis. RESULTS: The survey was completed and returned by 416 (50%) pediatricians. There was substantial variation in the evaluation of the 2 younger febrile children without clear sources for their petechiae. For the 1-year-old the overall blood culture (BCx) rate was 82%, with the EM group (91%) more often requesting BCx than either the CGP (76%) or AGP (73%, P=0.001) groups. The overall hospital admission rate was 31%, with CGP less often requesting admission than infectious disease pediatricians (22% vs. 40%, P=0.007). In the regression analysis the only significant difference between groups was in BCx rate between the EM and AGP groups. For the 2-year-old the overall rate of BCx was 95%, lumbar puncture was 41% and admission was 44%, with no significant differences among groups. For the scenarios involving the 2 older febrile children with sources for their petechiae, the majority of respondents chose neither lumbar puncture nor admission. There was disagreement regarding BCx, both within and between groups, although most of the between group differences did not persist in the regression analysis. CONCLUSIONS: There are substantial differences among pediatricians in the evaluation of young non-toxic-appearing febrile children with petechial rashes. Although there are some differences between pediatric subspecialties, most of these differences do not persist after adjusting for practice setting, population size and physician experience.

Adult↗
PubMed1994

Immunocytochemical and serological expression of CA 125: a clinicopathological study of 40 malignant ovarian epithelial tumours.

Elevated serum levels of the tumour-associated antigen CA 125 occur in more than 80% of cases of ovarian carcinoma. The antigen can be demonstrated in formalin-fixed tissue using the monoclonal antibody OC 125, which localizes it to the surface membrane or cytoplasm. This study was performed to determine the relationship between pre-operative serum levels of CA 125 and the subsequent immunocytochemical findings in the surgical specimen. Paraffin-wax embedded sections from 40 consecutive borderline and frankly malignant ovarian epithelial tumours were stained with OC 125. The pattern and distribution of immunostaining were investigated in relation to histological appearances. Serous tumours showed a 100% correlation between immunocytochemical findings and elevated serum levels of CA 125. Amongst the other histological types, correlation was less good; mucinous tumours and undifferentiated carcinomas showed a poor correlation. Immunostaining within tumours was heterogeneous and only loosely related to morphological appearances. Our finding suggests that, with the exception of serous tumours, immunolocalization of CA 125 is insufficiently sensitive to provide reliable clinical guidance to the likely value of serum CA 125 monitoring on follow-up.

Adult↗
PubMed1993

Papillary cystic cancer of the pancreas: diagnostic difficulties.

Pancreatic tumors rarely present in childhood. Diagnostic difficulty and inappropriate treatment may result especially when the lesions have a cystic component. Two cases of papillary cystic carcinoma of the pancreas in teenage girls are presented. Optimal treatment of such lesions in the head of pancreas consists of partial pancreaticoduodenectomy preserving the pylorus when possible.

Adolescent↗
PubMed1992

Crescentic glomerulonephritis in children.

Data on patients with crescentic glomerulonephritis (greater than 50% glomeruli with crescents), referred to the Hospital for Sick Children during the past 13 years, were reviewed. Thirty patients (13 male, 17 female) aged 3.7-15.7 years (mean 9.5) were evaluated. Initial clinical features included: oedema (24/30), hypertension (19/30), gross haematuria (15/30), oliguria (15/30) and a decreased glomerular filtration rate (GFR less than 30 ml/min per 1.73 m2) (22/30). Henoch-Schönlein purpura was present in 9 patients, microscopic polyarteritis in 3, polyarteritis nodosa in 1, Wegener's granulomatosis in 1, systemic lupus erythematosus in 1, post-streptococcal glomerulonephritis in 2, mesangiocapillary glomerulonephritis in 7, anti-glomerular basement membrane glomerulonephritis in 2, and 4 were idiopathic. In 10 patients 50%-79% of glomeruli were affected by crescentic changes (group 1) and in the remaining 20, 80% or more (group 2). The crescents were cellular, fibrocellular or fibrous, and the degree of sclerosis was assessed. Patients in both groups were treated with plasma exchange, corticosteroids, anticoagulants, cyclophosphamide and azathioprine in different combinations. On follow-up, 3 patients were dead, 1 was lost to follow-up, 12 were on dialysis/transplant programmes, 4 had a GFR of less than 30 and 10 a GFR of more than 30 ml/min per 1.73 m2. In our experience, 50% progressed to end-stage renal failure. The interval between disease onset and start of treatment was a prognostic factor for outcome. Fibrous crescents were associated with a worse outcome than fibrocellular crescents (P less than 0.05). Outcome was not, however, related to the percentage of glomeruli affected (P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Congenital esophageal stenosis due to tracheobronchial remnants: a rare but important association with esophageal atresia.

Congenital esophageal stenosis caused by tracheobronchial remnants occurred in eight children, six of whom had associated esophageal atresia and/or tracheoesophageal fistula. Symptoms usually began in early infancy but delayed diagnosis was a common feature. The mean lag period between presentation and definitive operation was 4.6 years (range, 1 month to 16 years). Errors in diagnosis were common. Six were initially diagnosed as having inflammatory strictures secondary to reflux esophagitis. Seven children were subjected to repeated esophagoscopy and bouginage of the "stricture" (mean no. = 3.4), with invariable failure to ameliorate dysphagia. Antireflux procedures were performed in three patients. In all children, symptoms were dramatically relieved following resection of the stenotic segment or esophageal replacement. Although a rare entity, congenital esophageal stenosis due to tracheobronchial remnants should be considered a possibility in patients with esophageal stricture, presumed to be inflammatory in nature, which fails to respond to standard therapy.

Adolescent↗
PubMed1992

Brown bowel syndrome: a late complication of intestinal atresia.

Two children, aged 11 years, who originally had jejunal atresia corrected in the neonatal period, developed massive dilatation of the proximal small intestine. This resulted in circular muscular hypertrophy with lipofuscin deposits giving the typical appearance of "brown bowel." The condition was associated with malnutrition and vitamin E deficiency. Because of relatively short bowel, the condition was treated by limited resection and extensive tapering of the dilated segment, end-to-end reanastomosis, vitamin E supplementation, and intensive nutritional support.

Child↗
PubMed1990

Clinicopathologic review of twelve children with nephropathy, Wilms tumor, and genital abnormalities (Drash syndrome).

The clinicopathologic and radiologic features of 12 children with complete and incomplete forms of Drash syndrome are reported. Their common denominator was a nephropathy. Four had the full triad, consisting of nephropathy, Wilms tumor, and genital abnormalities; five had nephropathy and genital abnormalities, and three had nephropathy and Wilms tumor. Of the 11 children who had proteinuria, eight had the nephrotic syndrome. Of the 10 whose condition progressed to end-stage renal failure, seven were less than 3 years of age. The histologic features of Wilms tumor were favorable in all seven children, and the tumor was bilateral in three. Of the nine patients who had genital abnormalities, eight had 46,XY karyotype and either ambiguous genitalia (six patients) or normal female phenotype (two). One other patient had a normal 46,XX female karyotype and phenotype but had both müllerian and wolffian structures and a streak ovary. Nine patients had a distinct pelvicaliceal abnormality not previously reported as a feature of this syndrome. Other congenital abnormalities were aniridia, mental retardation, deafness, nystagmus, and cleft palate. This syndrome must be considered in any infant with unexplained nephropathy, particularly in young phenotypic female infants and in those children with ambiguous genitalia or Wilms tumor with an early presentation.

Child↗
PubMed1990

Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy.

Methotrexate with folinic acid rescue was used to terminate a clinically diagnosed cervical pregnancy while preserving reproductive capability in a young female patient. The chemotherapy was well tolerated except for transient elevation of liver enzymes. Beta HCG titers fell rapidly and became negative by 13 days. This is the first report showing successful treatment of a cervical pregnancy with single-dose chemotherapy. The literature is reviewed and discussed.

Abortion, Therapeutic↗
PubMed1989

Peripheral T-cell lymphoma in childhood. A clinicopathological study of six cases.

A review of the pathological material from 42 children with non-Hodgkin's lymphoma seen over a 44 month period revealed 10 large cell tumours. Of these, six were classified as peripheral T-cell lymphoma, an entity rarely reported in childhood. Three patients were boys and three girls (median age 9.5 years), and extranodal presentation was a feature of two patients. Five had high-grade tumours; of these, three were classified as large cell anaplastic, Ki-1 positive and two as pleomorphic large cell. The remaining patient had a low-grade tumour of angioimmunoblastic type. T-cell subsets were examined in three cases and showed the following phenotypes: CD4-, CD8-; CD4+, CD8-; CD4-, CD8+. Three of the patients with high-grade tumours died, with a mean survival of 22 weeks. The remaining patients are alive and clinically disease-free for between 10 and 24 months after treatment.

Antibodies, Monoclonal↗
PubMed1989

Dental insurance and its effects among the elderly in Ontario.

This paper examines the association between dental insurance, dental utilization and oral health outcomes among elderly people living independently in two communities in Ontario. Dental insurance had no independent effect on use of dental services, dissatisfaction with oral health status or clinically defined treatment needs. However, dentate attenders were less likely to be dissatisfied with their oral health and less likely to need dental treatment than those defined as non-attenders. One unexpected finding was that the dentate elderly had higher levels of utilization than is often reported in the literature but still had high levels of treatment need.

Aged↗
PubMed1987

The effect of valproic acid on the 5-hydroxyindoleacetic, homovanillic and lactic acid levels of cerebrospinal fluid.

In this study the cisternal cerebrospinal fluid (CSF) contents of 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) were sequentially measured in free-moving rats which were administered 50-500 mg X kg-1 valproic acid. Animals receiving 100-500 mg X kg-1 valproic acid showed significant increases in CSF 5-HIAA and HVA content, with maximal accumulation rates of 1.80-2.10 and 0.25-0.30 nmol X ml-1 X h-1, respectively, being reached at the 250-mg X kg-1 dose. The combination of valproic acid 500 mg X kg-1 and probenecid 300 mg X kg-1 failed to increase the accumulation rates of 5-HIAA and HVA over those seen with valproic acid 500 mg X kg-1 or probenecid 300 mg X kg-1 alone. This pattern of change indicates that valproic acid and probenecid share a common site of action in blocking the clearance of 5-HIAA and HVA from CSF. The tranquillizer diazepam produced progressive increases in CSF 5-HIAA and HVA content which suggested a similar action to that of valproic acid and probenecid. The anticonvulsants phenytoin and phenobarbital produced selective increases in 5-HIAA, whereas the tranquillizer chlorpromazine produced proportionally larger increases in HVA, changes which seem to indicate a more selective effect of these drugs on the serotonergic or dopaminergic systems, respectively. Valproic acid was associated with increases in CSF lactate which occurred in the absence of similar increases of blood or tissue lactate. This indicated that valproic acid, like probenecid, can inhibit the monocarboxylic acid transport system which removes lactate from the CSF.

Animals↗
PubMed1987

Granulomatous sialadenitis of the major salivary glands. A clinicopathological study of 57 cases.

Fifty-seven of 469 major salivary glands excised for various reasons were found to contain granulomas. The aetiologies were tuberculosis (eight parotid, one sublingual), sarcoidosis (two parotid), calculous duct obstruction (34 submandibular), carcinomatous duct obstruction (four submandibular, one sublingual) and undetermined (four submandibular, three parotid). The tuberculous glands showed caseation in the majority of cases but two cases consisted predominantly of discrete granulomas with minimal necrosis. The sarcoid granulomas were typically non-caseating but a few were centrally necrotic. The cases of calculous and carcinomatous duct obstruction contained single to multiple small granulomas which contained mucin and were related to ruptured ducts. It is suggested that the frequency of calculi and the mixture of serous and mucous acini in the submandibular gland account for the distribution of obstructive granulomas. This study establishes calculous sialadenopathy as a major cause of granulomatous sialadenitis.

Adolescent↗
PubMed1986

Chronic untreated tuberculous meningitis.

We describe a 34-year-old man who suffered from tuberculous meningitis for 2 years without receiving antituberculous medication. Our case is compared with other forms of indolent or benign variants of the disease.

Adult↗
PubMed1981

Vancomycin blood levels during cardiac bypass surgery.

Because of the allergic reaction that some patients have to penicillin and cephalosporins, there is a need for an alternative antimicrobial agent to protect the patient who undergoes coronary artery bypass grafting from infection perioperatively. Vancomycin, a bactericidal antibiotic active against gram-positive organisms was studied in 13 men who underwent aortocoronary bypass grafting. For 60 minutes from the time the patient arrived in the operating room, vancomycin (15 mg/kg) was given intravenously. Blood levels were assayed up to 12 hours thereafter. Adequate antistaphylococcal levels of the drug were maintained throughout operation. Twelve hours later levels were subtherapeutic. There was no cardiovascular, cutaneous or renal toxicity. Two patients had minor wound infections.

Adult↗