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Biomedical subjects

N McIntosh

Publications and source records attributed to N McIntosh.

At least 145 records · Page 8Linked to original sources
PubMed1983

Pulmonary air leaks in the newborn period.

Pneumothorax is common and frequently life threatening in the newborn. Other air leaks although less common are often more difficult to treat. Anticipation by close clinical and electronic monitoring of all newborn babies with pulmonary problems allows earlier detection with a greater chance of satisfactory treatment. The long-term outlook is good except after severe pulmonary interstitial emphysema when considerable pulmonary damage usually occurs.

Critical Care↗
PubMed1982

Plasma 25-hydroxyvitamin D and rickets in infants of extremely low birthweight.

Rickets is now a well-known entity in infants of very low birthweight. In a 1-year period (1981) 8 of 15 neonatal survivors whose birthweight was less than 1000 g (extremely low birthweight) developed rickets despite high supplementation with ergo-calciferol, 2000 units a day. At the time of radiological diagnosis their postnatal age was 8 (range 5-14) weeks, and they all had normal or high plasma concentrations of 25-hydroxyvitamin D (mean 80 nmol/l, range 40-160 nmol/l). Although 4 infants received alfacalcidol which healed the rickets, in 4 infants the rickets healed spontaneously without change in treatment. The results suggest that inadequate vitamin D supplementation is not the cause of rickets in such infants.

25-Hydroxyvitamin D 2↗
PubMed1979

Effect of tolazoline in severe hyaline membrane disease.

Tolazoline hydrochloride was given as a pulmonary vasodilator to 20 preterm infants with severe hyaline membrane disease requiring mechanical ventilation who developed persistent severe hypoxaemia. The drug was only given when deterioration persisted despite changes in ventilation techniques and thus there were no control infants. A significant improvement in arterial oxygenation was observed, particularly in those infants without intracranial haemorrhage or pneumothroax. Nine of 10 infants who had an obvious clinical response to tolazoline survived, whereas only 2 survived out of 10 who failed to respond, both being subsequently shown to have pneumothoraces. There appears to be a place for the use of tolazoline in a severely hypoxaemic infant with hyaline membrane disease who is being ventilated and in whom arterial oxygenation cannot be improved by further increase in the inspired oxygen concentration or by alteration of ventilator settings, provided pneumothorax has been excluded.

Female↗
PubMed1979

Medulloblastoma--a changing prognosis?

87 of 90 consecutive cases of medulloblastoma diagnosed at The Hospital for Sick Children, London, in the 10-year period 1965-74 were followed-up until death or until 1 January 1978. Only one patient survived in the 1st 5-year period and is a cure. In the 2nd 5-year period 17 (41%) of 41 patients presenting are alive and, of these, 11 are 5-year survivors (=39% of possible 5-year survivors). Reasons for this improvement are discussed; it is thought likely that the main contribution is improved radiotherapeutic techniques.

Brain Neoplasms↗
PubMed1977

Necrotizing enterocolitis. Controlled study of 3 years' experience in a neonatal intensive care unit.

During the 3 years 1972-74, 17 infants were treated for necrotizing enterocolitis (NEC) in the Neonatal Unit at University College Hospital. The incidence of the illness was 0.2% of live births in the hospital and 2.7% of those referred from elsewhere. The mean birthweight of the affected infants was 1832 g (range 878-3850 g) and mean gestational age 33 weeks (range 28-40 weeks). The illness was diagnosed at a mean age of 16 days (range 3-33 days). 14 infants (82%) survived. One infant developed NEC because of a volvulus, and another because of an apparently abnormal arterial supply to a segment of bowel. Each of the remaining 15 infants was matched with 3 control infants in order to see whether any factors predisposing to the development of NEC could be identified. Birth asphysia, the use of umbilical catheters, the length of time that these catheters were in place, and complications of catheterization were all significantly more frequent in the infants who developed NEC than in the controls. These findings support the view that hypoxia and ischaemia of the gut wall are important in the pathogenesis of NEC.

Birth Weight↗
PubMed1977

The developmental pattern of somatostatin in the embryonic and fetal rat pancreas.

The ontogenesis of immunoreactive somatostatin in the embryonic and fetal rat pancreas has been measured by radioimmunoassay following acid extraction. Somatostatin (GIF) is detectable at 14 days gestation at a concentration of 1.6 X 10(-3) ng/pancreas. At term the content is 3.8 ng/pancreas, by 2 days neonatally, 8.3 ng/pancreas, and in the adult rat, 71 ng/pancreas through the concentration (expressed per microgram DNA) is constant from 14-19 days of gestation and reaches a level characteristic of the fully differentiated pancreas by birth. The detection of GIF in cultured pancreatic explants in the absence of innervation indicates that synthesis can occur independent of neural influence.

Animals↗
PubMed1976

Controlled trial of continuous inflating pressure for hyaline membrane disease.

A controlled trial of elective intervention with continuous inflating pressure (CIP) was performed in infants with severe hyaline membrane disease who weighed more than 1000 g at birth. Infants entered the trial if their arterial oxygen tension (PaO2) fell below 60 mmHg while breathing a fractional inspired oxygen concentration (F1O2) greater than 0-95. 11 out of 12 infants in the CIP-treated group and 10 out of 12 in the control group survived. 7 treated and 6 control infants required mechanical ventilation. When CIP was started the Pao2 of the treated infants increased, and they breathed high concentrations of oxygen for a significantly shorter period than the control infants. During the 31-month duration of the trial 107 other infants with severe hyaline membrane disease were admitted who did not meet the criteria for entry to the trial. 37 survived after breathing high concentrations of oxygen (F1O2 greater than 0-60) spontaneously without any ventilatory assistance, and the remaining 70 infants were already being ventilated on their arrival in the unit, usually because they had required mechanical ventilation during transfer from other hospitals. The neonatal survival rate for those infants born in this hospital during the study period was 88% (50 out of 57 infants) and for those referred from other hospitals it was 69% (51 out of 74 infants). The maximum further increase in overall survival rate that might have been achieved in our population of infants if CIP had been initiated very early in the course of the illness was 5%--i.e. from 77% (101/131) to 82% (107/131).

Acid-Base Equilibrium↗
PubMed1976

Endocrinopathy in thalassaemia major.

Pituitary, adrenal, and pancreatic functions were investigated in 9 patients with thalassaemia major. 9 a.m. plasma ACTH values were 148-480 pg/ml (normal range 15-70 pg/ml). Cortisol and growth hormone response to insulin-induced hypoglycaemia was normal in all. 24-hour urinary excretions of 17-ketosteroids and 17-hydroxycorticosteroids were normal. There was normal cortisol response to intramuscular injection of ACTH. In a physiological adrenal stimulation test there was a significantly smaller response to each physiological dose of tetracosactrin. 4 patients had diabetic glucose tolerance tests--none are clinically diabetic. The mean plasma glucose utilization constant (Kgl=2-02) is significantly smaller than normal. Plasma insulin response both in the oral and the intravenous glucose tolerance test was significantly smaller than normal. The data were consistent with severe and widespread impairment of endocrine function and a plausible explanation would be iron deposition in endocrine organs. It is suggested that pituitary hyperfunction of ACTH secretion is due to target organ unresponsiveness which can be shown in its early stages only by a physiological test of the adrenal cortex. Skin pigmentation in thalassaemia seems to be due to the melanophore-stimulating effect of this raised plasma ACTH.

17-Hydroxycorticosteroids↗
PubMed1976

Beneficial effects of transfusing a patient with nontransfusion-dependent thalassaemia major.

A case of nontransfusion-dependent thalassaemia major is presented showing growth retardation, recurrent fractures, late onset of puberty, deafness, and endocrine impairment of pancreas and adrenal gland. Regular blood transfusion to maintain mean haemoglobin at about 11 g/de improvedd all these problems. It is suggested that this improvement was related to improve tissue oxygenation.

Adolescent↗
PubMed1976

Continuous monitoring of arterial oxygen tension using a catheter-tip polarographic electrode in infants.

An oxygen electrode mounted in the tip of an umbilical artery catheter was used in 36 newborn infants with severe respiratory illnesses, 28 of whom survived. Thirty-seven electrodes were used. The median age at insertion was 4 hours (range, 30 minutes to 122 hours). Three electrodes failed to work and they were removed or replaced, and two could not be properly evaluated. Thirty-two electrodes functioned satisfactorily for 10 to 190 hours (mean, 75 hours) after a one-point calibration against blood sampled through the catheter. Twenty-two did not need recalibrating before they were removed after 10 to 190 hours (mean, 88 hours. Four of the remaining ten electrodes were recalibrated once after 33 to 97 hours and then functioned until removed 15 to 55 hours later. The other six electrodes failed after 32 to 105 hours (mean, 49 hours). Complications were few. A total of 356 arterial blood samples, obtained after the initial calibration and before any recalibration was necessary, gave a correlation coefficient of 0.93 (P less than .0001) against an independent system for measuring arterial oxygen tension (Pao2) (Radiometer Type E.5046 oxygen electrode). We conclude that the catheter-tip electrode is a safe and reliable instrument for continuously recording Pao2 in newborn infants which much simplifies the management of serious respiratory illnesses.

Arteries↗
PubMed1975

Transport of newborn infants for intensive care.

During the three years 1972-4 222 newborn infants were transported to this hospital for intensive care. They were collected by trained staff using a specially modified transport incubator with an in-built mechanical ventilator and facilities for monitoring body temperature, heart rate, and inspired oxygen concentration. Two of the infants came from home and the rest from 41 hospitals from half a mile (0-8 km) to 50 miles (80-5 km) (median eight miles (12-9 km)) away. The mean birth weight of the infants was 1702 g (range 520-4040 g) and their mean gestational age was 32 weeks (range 24-42 weeks). The principal reasons for referral were low birth weight and severe respiratory illnesses. Altogether 109 (49%) of the infants needed mechanical ventilation in transit and another 38 (17%) needed it later. During the journey the condition of 88 (40%) of the infants was thought to improve, in 125 (56%) it was static and in nine (4%)--four of whom died--it deteriorated. A total of 142 infants (64%) survived the neonatal period. There was no correlation between the distance travelled and the survival rate. Seriously ill newborn infants may be transported safely to a referral centre within a radius of 50 miles, and the risks of the journey are negligible compared with the risks of leaving the infant in a hospital that is not staffed or equipped for neonatal intensive care.

Birth Weight↗