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Biomedical subjects

P Hutchins

Publications and source records attributed to P Hutchins.

At least 19 recordsLinked to original sources
PubMed2000

Helping young children with special developmental needs.

BACKGROUND: Many parents worry about their children's abilities and whether their behaviour is normal. The range and complexity of behaviour and skills change rapidly in young children with individual patterns of development varying widely. Normal stages of development may be delayed or the expected sequence varied. This can be associated with neurological or genetic disorders or chronic illness but may sometimes reflect a family pattern. Recognition of vulnerability enables the child's special needs to be supported before a disorder becomes entrenched. Intervention is aimed at understanding and supporting the child, promoting success and approval and encouraging appropriate neurobiological development. OBJECTIVE: This article aims to: clarify the general practitioner role in coordinating appropriate support in collaborative management; describe the relative frequency of various developmental problems; describe the range of assisting services available; emphasise the importance of early recognition and referral; and highlight the interaction between communication disorders and behavioural problems. DISCUSSION: The family doctor may be able to identify problems early and assist parents in coordinating optimum help for their children. Often the GP is the one professional who has known the child from infancy and may know other family members with similar problems as well as understanding the cultural context. This gives the GP a central role in early recognition of developmental vulnerability and in maintaining long term review and modification of supports for the child and family.

Australia↗
PubMed1998

Clonidine overdose in childhood: implications of increased prescribing.

OBJECTIVE: To highlight the increase in the number of cases of clonidine overdose admitted to a specialist paediatric hospital, with particular reference to the clinical features, clinical course and circumstances surrounding the incident. METHODS: Cases of clonidine overdose were identified by review of the emergency department attendance register, the intensive care unit database and inpatient statistics collection. Case notes were reviewed to determine the clinical features, history and clinical course in each case. RESULTS: Fifteen patients experienced 16 overdoses during the period 1990-97 inclusive. Only one case occurred before 1994. Depressed level of consciousness and bradycardia were the most common clinical manifestations, and were observed in 75 and 88% of cases respectively. There were no fatalities. Five patients received naloxone. Other treatment modalities included gastrointestinal decontamination, atropine, ventilation and inotropic support. Fourteen cases occurred in association with medication prescribed for attention-deficit hyperactivity disorder (ADHD). CONCLUSION: Clonidine overdose is a potentially serious condition, often requiring intensive care management. Our experience suggests that it is a growing problem, related in part to its increased use in the treatment of ADHD. Preventive strategies, including raising the level of awareness of risks, changes to packaging and appropriate selection of patients for treatment, need consideration if further overdoses are to be prevented.

Adrenergic alpha-Agonists↗
PubMed1995

Cognitive function and academic performance in children with neurofibromatosis type 1.

The authors evaluated 51 consecutive children with NF1 (aged eight to 16 years) to determine the frequency of intelectual impairment and learning disability due to NF1 alone, the profile of learning disabilities and the effect of clinical variables. 40 children completed the full assessment protocol. There was no support for a profile of predominantly visuoperceptual deficits in the NF1 population. There was no discrepancy between verbal and performance IQ, and the deficits in function were wide ranging. Clinical variables such as age, sex, socio-economic status, disease severity, macrocephaly and family history of NF1 were not associated with cognitive deficits. These results emphasise the need for developmental evaluation to be included in the routine assessment of children with NF1.

Adolescent↗
PubMed1994

Survey on developmental-behavioural training experiences of Australian paediatric advanced trainees.

In order to monitor whether paediatric education has adapted to meet modern practice 91 paediatric advanced trainees were surveyed to elicit their satisfaction with developmental-behavioural (DB) training. A response of 69% was obtained to a postal questionnaire. The traditional imbalance persists, with trainees considering themselves significantly better informed in the medical disciplines (P < 0.001). Satisfaction with training in the 14 developmental disciplines surveyed is less (P < 0.001) and significantly more variable compared with 11 traditional medical disciplines (P < 0.01). Formal rotations in DB disciplines had been received by all respondents by the 7th year of training. However, 46-67% consider themselves ill-informed in learning/school problems, attention-deficit hyperactivity disorder, adolescent problems, paediatric rehabilitation and language impairment. Thirty-seven per cent found formal postgraduate instruction unhelpful. Paediatric advanced training gives exposure to, but unsatisfactory formal education, in developmental and behavioural paediatrics. Current initiatives for mandatory DB training have serious implications for achieving adequate resources and standards to meet clinical and training demands.

Attitude of Health Personnel↗
PubMed1994

Specific learning disability in children with neurofibromatosis type 1: significance of MRI abnormalities.

To determine whether previously reported areas of increased T2 signal intensity on MRI examination in children with neurofibromatosis type 1 (NF 1) are associated with deficits in development and learning common in this population, we evaluated 51 children with NF 1 (aged 8 to 16 years). Forty children completed the full assessment protocol (MRI, medical, psychometric, speech therapy, and occupational therapy assessments). The mean Full Scale IQ scores for the entire study population showed a left shift compared with the normal population, and the distribution of IQ scores was bimodal, suggesting that there are two populations of patients with NF 1--those with and those without a variable degree of cognitive impairment. There was no association between lower IQ scores and any clinical variable. Areas of increased T2 signal intensity unidentified bright objects (UBO+) were present in 62.5% of the study population, and their presence was not related to clinical severity, sex, age, socioeconomic status, macrocephaly, or family history of NF 1. However, compared with children without areas of increased T2 signal intensity (UBO-), the UBO+ group had significantly lower mean values for IQ and language scores and significantly impaired visuomotor integration and coordination. Children with areas of increased T2 signal intensity were at a much higher risk for impaired academic achievement. Children without increased T2 signal on MRI (UBO-) did not significantly differ from the general population in any measure of ability or performance. Areas of increased T2 signal on MRI represent dysplastic glial proliferation and aberrant myelination in the developing brain and are associated with deficits in higher cognitive function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Ventilator-dependent children.

The issue of the ventilator-dependent child is a relatively-new one in Australia. Ventilator-dependent children pose complex and unique ethical, medical, economic and psychological problems. The experience of two Australian centres that are involved with the care of ventilator-dependent children is reported. Most of these children now are being cared for at home. Aspects of home care are outlined. After the initial period, the technical aspects are not a problem for most parents for whom the major issues are the provision and funding of nursing support. The complex ethical issues that are involved are discussed. It is concluded that undergoing ventilation at home rather than in a hospital appears to make the best of an otherwise almost-intolerable situation for ventilator-dependent children, but that much more information is required about the outcome for these children and the long-term psychosocial impact of this treatment.

Adolescent↗
PubMed1989

Altered microvascular response to adenosine in the spontaneously hypertensive rat.

Adenosine is a well-known locally active vasodilator metabolite. A major role in blood flow regulation has been ascribed to adenosine. This investigation compared the dose-response curves to adenosine in the cremaster of spontaneously hypertensive rats (SHRs) with Wistar-Kyoto rats (WKYs) at an age when cardiac output and blood flow of the SHR have been shown to be increased (6 weeks). Each concentration (10(-5), 10(-4), and 10(-3) M) was injected retrograde through the femoral artery as a bolus of 100 microliters/sec and 300 microliters/3 sec. Changes in arteriolar diameter were recorded for 3 min. Continuous monitoring techniques enabled detection of differences between strains using an average of the 3-min response (DAVG) and the 3-min response pattern. In contrast, no interstrain differences were observed using the peak diameter response (DMAX). SHRs exhibited a reduced sensitivity to adenosine which was apparent in the dose-response curves based on DAVG with 3-sec injections (P less than 0.02). There was no difference with 1-sec injections. Analysis of the 3-min response pattern showed that SHRs also returned to control diameters faster than WKYs, except at the highest dose when vessels of both strains remained dilated. These results are consistent with the role of metabolic (vasodilator) autoregulation in hypertension. If extracellular adenosine is washed out in the SHR, intraarterial injections of the same concentration of adenosine would cause a reduced response in SHRs.

Adenosine↗
PubMed1982

Flat small intestinal mucosa and autoantibodies against the gut epithelium.

A male infant, aged 1 year 3 months, was admitted to the hospital with protracted diarrhoea, vomiting, and weight loss. The diarrhoea and vomiting coincided with an outbreak of acute diarrhoea and vomiting affecting other family members. Biopsy showed a flat small intestinal mucosa which did not respond to a diet free of gluten, cow's milk, and eggs, or during 8 weeks of intravenous alimentation. Steroids were given, and courses of nalcrom and later cimetidine, but these did not produce any significant improvement. A rare IgG autoantibody specific for gut epithelium was found, which, when present, was associated with a cytological abnormality of crypt enteroblasts. The autoantibody disappeared after treatment with cyclophosphamide, and the cytological abnormality subsequently diminished. However, the mucosa remained severely abnormal and has been so for 23 months. It is possible that an autoimmune reaction against the patient's small intestinal mucosa has led to persistence of the enteropathy.

Animals↗
PubMed1982

Suppressor cells in asthmatic children.

Peripheral blood mononuclear cells (PBMC) from thirteen asthmatic children, and from normal control subjects, were pre-incubated with and without concanavalin A (con A), washed, and cultured with fresh allogenic PBMC from healthy donors. The con A pre-treated cells from fifteen of seventeen normal controls clearly suppressed the blast transformation response to con A by normal allogeneic PBMC. However, con A-generated suppressor activity was found in only seven of the asthmatic patients studied, most of whom could be classified as "short-term' asthmatics. It is thus possible that either dysfunction or a reduction of the (con A)-inducible, T-suppressor cell subpopulation in peripheral blood is frequent among "long-term' asthmatic patients. This may suggest that a different pathogenesis may be operating in early-onset, long-continued asthma, when compared with those investigated early in the course of asthma which has begun later in childhood.

Adolescent↗
PubMed1982

Traveller's diarrhoea with a vengeance in children of UK immigrants visiting their parental homeland.

Six healthy children, born in the UK, travelled to their parental homeland and developed a severe form of traveller's diarrhoea. This was characterised by rapid loss of weight and chronic diarrhoea. On return to this country, investigation in 5 of them showed an abnormal, small intestinal mucosa. There was a high incidence of pathogens and potential pathogens found in stools and duodenal juice. Immunodeficiency was found in 2 of them. Small intestinal mucosal damage related to gut infection in previously well children appears to be of cardinal importance in the interaction between chronic diarrhoea and malnutrition. This observation may point the way to future research into the primary role of gut infection in the initiation of the cycle of malnutrition and chronic diarrhoea in developing communities.

Body Weight↗
PubMed1980

Oral solutions for infantile gastroenteritis--variations in composition.

Four different carbohydrate electrolyte solutions were provided for children under 18 months with acute gastroenteritis treated as outpatients. Osmolality and sodium content were measured in samples of solutions as given by the parents. All types of feed were made up with marked inaccuracy. Osmolality was sometimes unacceptably high in solutions containing glucose, while the highest osmolality for sucrose solutions hardly exceeded the correct value for glucose solutions. Most parents could use a sachet with reasonable accuracy although there were still wide extremes of errors. The ideal preparation for use in developed countries may be a sachet containing sucrose and electrolyte, particularly if such sachets could be made generally available and not just for use in hospitals and clinics.

Administration, Oral↗
PubMed1980

Salivary theophylline estimation in the management of asthma in children.

Simultaneous sampling was performed to determine whether saliva could replace plasma in the monitoring of theophylline dosages. Forty-eight children with moderate to severe asthma received oral theophylline preparation (usually sustained release) on a daily basis. They provided simultaneous saliva and plasma samples at routine out-patient visits. Saliva and plasma theophylline concentrations showed a wide variation between individuals, and their ratios also differed. Saliva theophylline concentrations below 7 micrograms/ml reflect plasma concentrations below 10 micrograms/ml, i.e. sub-therapeutic, while saliva concentrations above 7 micrograms/ml are consistent with therapeutic dosage. Estimation of saliva theophylline concentration on routine visits avoids the discomfort of blood sampling. It reflects whether daily oral theophylline dosage in childhood asthma is below or within the therapeutic range. The need for changes in dosage and the degree of patient-compliance with therapy can be usefully indicated.

Adolescent↗
PubMed1979

Comparison of oral sucrose and glucose electrolyte solutions in the out-patient management of acute gastroenteritis in infancy.

Seventy-three children under the age of 18 months presenting with acute gastroenteritis were given an electrolyte mixture with added sucrose or glucose in a randomized double-blind trial. The time taken to recovery in those sucessfully treated as out-patients was identical. However, of the 34 who received glucose, 11 (32%) required admission compared with 7 (18%) of the 39 who received sucrose. There was a wide range of osmolality of the made-up feeds, indicating inaccuracy in diluting the solutions as prescribed, but this did not in general correlate with need for admission. Sucrose-electrolyte solution is at least as effective as a glucose-electrolyte solution for the out-patient management of acute gastroenteritis in infancy. The cheapness and easy availability of sucrose commends its use in developed and developing countries.

Acute Disease↗
PubMed1979

New fathers.

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Family↗