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Biomedical subjects

R T Couper

Publications and source records attributed to R T Couper.

28 records · Page 2Linked to original sources
PubMed1995

Longitudinal evaluation of serum trypsinogen measurement in pancreatic-insufficient and pancreatic-sufficient patients with cystic fibrosis.

We studied serial measurements of serum cationic trypsinogen in patients with cystic fibrosis to assess the predictability of changes in individuals and the value of longitudinal measurement in defining pancreatic status. Three hundred twenty-nine patients with cystic fibrosis, aged 3 days to 40 years, had serum levels of trypsinogen measured on 2 to 12 occasions for periods ranging from 1 week to 7 years. Patients were classified into three groups on the basis of 72-hour fecal fat studies performed at the time of diagnosis. Two hundred thirty-three patients had pancreatic insufficiency (PI), 78 had pancreatic sufficiency (PS), and 18 had PS at diagnosis but acquired PI during follow-up (PS-->PI). Infants with PI had greatly elevated serum trypsinogen levels that fell sharply in the first years of life, so that by age 7 years more than 95% had subnormal values; individual patient values followed a predictable course similar to previously reported cross-sectional age-related values. In patients with PS, serum trypsinogen levels generally remained within or above the normal range and, after age 10 years, were well above the upper limit for PI patients. Within-patient variance was significantly greater (p < 0.0001) in patients with PS than in those with PI who were older than 7 years of age. Changes in patients within PS-->PI generally followed the pattern seen in patients with PI, but values in older patients tended to be in the higher range. We concluded that serial measurement of serum trypsinogen is a valuable tool for monitoring the pancreatic status of patients with cystic fibrosis and PS.

Adolescent↗
PubMed1994

Stroller safety.

OBJECTIVE: To assess the incidence and type of stroller injuries in South Australia and factors contributing to their occurrence. DESIGN: Retrospective review of South Australian Health Commission Injury Surveillance data for Adelaide Children's Hospital, Modbury Hospital and Queen Elizabeth Hospital (1986-1992); a prospective survey of 150 stroller users in three metropolitan shopping malls; and testing of backward tipping using loads determined by the AS/NZS 2088 standard. RESULTS: One hundred and forty-nine attendances for unintentional injury resulted from infants either falling out of strollers and prams, or from entrapment of digits in strollers. Eleven infants (7.4%) required admission. One hundred and five injuries (70%) occurred between nine and 15 months of age. Eighty-nine (60%) involved either head/facial/dental injuries or concussion. The survey showed that only 14 strollers (9%) were used correctly (children appropriately harnessed and no shopping on the handles). Five strollers tipped over while carrying an 8 kg load when a 5 kg weighted shopping bag was placed on their handles. One stroller tipped over when a weight of 2 kg was applied at the handle on a 12 degree ramp with an 8 kg load. Only 11 of the 23 strollers commercially available in Adelaide in October 1992 carried the non-mandatory stroller standard. CONCLUSION: Stroller accidents are a common source of injury and usually result from incorrect use. The stroller standard should be made mandatory and revised to include a shoulder harness, lower the centre of gravity and provide shopping storage.

Age Factors↗
PubMed1994

Traffic and noise in children's wards.

OBJECTIVE: To measure pedestrian traffic volumes and noise levels in paediatric open bay areas and discuss their impact on the care of sick children. METHODS: Between August and October 1992, we recorded the number and duration of entrances to two open bay areas comprising eight and ten beds respectively in a ward for infants and a ward for older children. Eight 24-hour periods (1200 to 1200) Friday to Saturday were assessed. Noise levels in decibels dB(A) were measured at 15-minute intervals. RESULTS: In an average 24-hour period, 5.5 (SD +/- 1.3) patients in the infants' ward and 9.5 (SD +/- 0.6) patients in the children's ward received 617 (SD +/- 85) and 683 (SD +/- 64) visits by 104 (SD +/- 20) and 110 (SD +/- 2) individuals respectively. The maximum numbers of visits per hour were 57 (SD +/- 14) and 54 (SD +/- 8) visits between 1500 and 1600 hours on Friday for each ward. Visits tended to be brief; 225 (SD +/- 23) and 217 (SD +/- 34) visits were of less than one minute's duration. The maximum noise levels of 57.3 dB(A) (SD +/- 6.3) and 64.6 dB(A) (SD +/- 3.5) occurred at 1000 Saturday and 1900 Friday and coincided with peak traffic volumes. CONCLUSIONS: Open bay areas generate high traffic volumes and coincident noise. Consideration should be given to either modifying or abolishing open bay areas and to general noise control measures.

Adolescent↗
PubMed1994

High glucose and hyperosmolality stimulate hepatocyte growth factor secretion from cultured human mesangial cells.

Hepatocyte growth factor is a recently cloned potent mitogen to hepatocytes, but its extrahepatic roles are not completely defined. It causes proliferation of endothelial and epithelial cells implicating potential action in the glomerulus. We aimed to determine whether cultured human mesangial cells secrete hepatocyte growth factor and the effect of high glucose conditions. Mesangial cells were isolated from the normal cortex of a child's kidney. After differential glomerular sieving and trypsin digestion of glomeruli, mesangial cells were cultured in 20% fetal calf serum/RPMI. Glucose concentration in the medium was adjusted to 5 mmol/l, 11 mmol/l, 25 mmol/l or 5 mmol/l/20 mmol/l mannitol to correct for osmolality. After 0, 24, 48, 72 h incubation, hepatocyte growth factor was measured in the supernatant by enzyme immuno assay using recombinant hepatocyte growth factor and monoclonal antibodies to human hepatocyte growth factor. Hepatocyte growth factor was secreted by cultured mesangial cells. High glucose and hyperosmolar conditions caused a 100-200% increase in hepatocyte growth factor secretion at 48-72 h (p = 0.001). Hepatocyte growth factor secretion at 48 h in 5 mmol/l glucose was 16.46 +/- 1.09 ng/ml (mean +/- SEM), 11 mmol/l glucose: 32.98 +/- 4.54, 25 mmol/l glucose: 33.32 +/- 7.89, 5 mmol/l glucose/20 mmol/l mannitol: 34.05 +/- 3.64; at 72 h in 5 mmol/l glucose: 23.92 +/- 2.85 ng/ml, 11 mmol/l glucose: 28.26 +/- 2.03, 25 mmol/l glucose: 62.04 +/- 12.2, 5 mmol/l glucose/20 mmol/l mannitol: 45.76 +/- 6.25. Trypan blue exclusion demonstrated membrane integrity.(ABSTRACT TRUNCATED AT 250 WORDS)

Cells, Cultured↗
PubMed1994

Anticardiolipin and acquired protein S deficiency in early childhood.

A 27 month old child presented with left hemiplegia and was found to have deep cerebral venous thrombosis. The deep cerebral venous thrombosis resolved on warfarin. Elevated and fluctuating anticardiolipin antibodies as well as protein S deficiency were detected.

Antibodies, Anticardiolipin↗
PubMed1992

Decline of exocrine pancreatic function in cystic fibrosis patients with pancreatic sufficiency.

Patients with cystic fibrosis and pancreatic sufficiency were investigated for evidence of progressive pancreatic disease. From a cohort of 630 patients, 20 pancreatic-sufficient patients became pancreatic insufficient after an average duration of 5.6 y (range 0.6-20.6 y) from diagnosis. Among 54 patients documented to be pancreatic sufficient by direct pancreatic stimulation test, 47 remained pancreatic sufficient and seven developed pancreatic insufficiency. The patients who ultimately developed pancreatic insufficiency were younger and had greatly reduced outputs of enzyme, fluid, and electrolytes. Those who remained pancreatic sufficient showed enzyme secretion close to or within the non-cystic fibrosis control range. Twenty of these patients underwent a second pancreatic stimulation test after an average interval of 4 y (range 1.3-6.2 y). No significant alteration in enzyme, fluid, or electrolyte output was seen in the patients who remained pancreatic sufficient, but there was further reduction in enzyme and fluid output in the patients who developed pancreatic failure. In conclusion, the majority of pancreatic-sufficient patients with pancreatic enzyme secretion within the control range showed no deterioration of function over an extended time period. However, a small number of pancreatic-sufficient patients with reduced enzyme and fluid secretion are at risk of pancreatic failure.

Adolescent↗
PubMed1991

Cardiac rhabdomyomata and megacystis-microcolon-intestinal hypoperistalsis syndrome.

Multiple cardiac rhabdomyomata were discovered on necropsy tissue review of a previously well child with megacystis-microcolon-intestinal hypoperistalsis syndrome, who died unexpectedly at home at 40 months of age. Multiple cardiac rhabdomyomata occur rarely and have not previously been reported with this syndrome. They are most frequently associated with tuberous sclerosis. The finding of multiple cardiac rhabdomyomata in this patient suggests the possibility that these two rare conditions may be associated. Putative gene loci for tuberous sclerosis have been assigned to the long arms of chromosomes 9 and 11 and it is possible that the cardiac rhabdomyomata seen in this patient are a serendipitous indicator of the location of the megacystis-microcolon-intestinal hypoperistalsis gene.

Chromosome Mapping↗
PubMed1989

Late gastrointestinal bleeding and protein loss after distal small-bowel resection in infancy.

Four children who underwent extensive small-bowel resection in infancy developed recurrent iron deficiency anemia due to gastrointestinal bleeding between 4 and 12 years later. The initial resections were required for multiple ileal atresia (n = 2) and gastroschisis (n = 2). Three patients have had melena and one had persistently guaiac-positive stools. Three patients had protein-losing enteropathy, and in one there was persistent hypoalbuminemia. Colonoscopy identified circumferential ulcerative lesions at the surgical anastomosis (n = 2) and at laparotomy another patient had well-defined linear ulcers close to the surgical anastomosis. Histology demonstrated focal ulceration with chronic inflammation, but did not show granulomata, crypt abscesses, or malignancy. Multiple imaging procedures and gastroduodenoscopy failed to identify an alternative bleeding source. Medical therapy including iron, antacids, sucralfate, H2 antagonists, and cholestyramine was ineffective. Two patients have undergone anastomotic resection. One experienced symptomatic recurrence 4 months after surgery. Repeat colonoscopy found ulceration at the new anastomosis with similar histology. The other patient remains asymptomatic 7 months postsurgery. Recurrent gastrointestinal hemorrhage due to anastomotic ulceration, of unknown etiology, appears to be a late complication of small-bowel resection in infancy.

Abdominal Muscles↗
PubMed1989

Clinical response to the long acting somatostatin analogue SMS 201-995 in a child with congenital microvillus atrophy.

A 27 month old girl with congenital microvillus atrophy received two courses of SMS 201-995, a synthetic long acting analogue of native somatostatin, in an attempt to decrease profuse secretory diarrhoea. During the first trial at 13 months of age fluid and electrolytes administered by parenteral infusion were decreased as measured by water and faecal electrolyte losses. During the second trial of SMS 201-995 at 19 months fluid and electrolyte input were held constant for 14 days. Stool volume declined from 275 ml/kg to 161 ml/kg. Reductions in output of stool electrolytes (Na+, K+, Cl-) were accompanied by an increase in urine fluid output and increased excretion of urinary Na+. Subsequent administration of SMS 201-995 for a nine month period was not associated with adverse side effects or an impairment of growth velocity. These findings suggest that SMS 201-995 may be useful therapy in infants with high output diarrhoea as a result of congenital microvillus atrophy.

Atrophy↗