Showing papers by "Wishaw General Hospital published in 2010"

Levels of neonatal thyroid hormone in preterm infants and neurodevelopmental outcome at 5 1/2 years: millennium cohort study.

Abstract: Context: Transient hypothyroxinemia is the commonest thyroid dysfunction of premature infants, and recent studies have found adverse associations with neurodevelopment. The validity of these associations is unclear because the studies adjusted for a differing range of factors likely to influence neurodevelopment. Objective: The aim was to describe the association of transient hypothyroxinemia with neurodevelopment at 5.5 yr corrected age. Design: We conducted a follow-up study of a cohort of infants born in Scotland from 1999 to 2001 ≤34 wk gestation. Main Outcome Measures: We measured scores on the McCarthy scale adjusted for 26 influences of neurodevelopment including parental intellect, home environment, breast or formula fed, growth retardation, and use of postnatal drugs. Results: A total of 442 infants ≤34 wk gestation who had serum T4 measurements on postnatal d 7, 14, or 28 and 100 term infants who had serum T4 measured in cord blood were followed up at 5.5 yr. Infants with hypothyroxinemia (T4 le...

Exaggerated adrenarche in a cohort of Scottish children: clinical features and biochemistry

Abstract: Summary Objective To investigate the reported association between exaggerated adrenarche (EA) and reduced foetal growth and to identify possible risk factors for future morbidity in Scottish children with clinical features of EA. Design Three-year prospective study. Measurements Auxology, blood pressure (BP), biochemical analysis of blood and urine, pelvic ultrasound in girls. Results Fifty-two patients were recruited of whom one girl had nonclassical congenital adrenal hyperplasia (17-OHP 17 nmol/l) and one had insufficient blood for analysis. The final cohort comprised 42 girls of mean (SD) age 7·7 (0·99) and eight boys of 8·8 (0·67) years. Mean (SD) birth weight was 3·27 (0·49) and 3·10 (0·76) kg in girls and boys respectively. Height/weight SDS were 1·13/1·69 in girls and 1·69/1·88 in boys. Mean systolic/diastolic BP was 107·8/60·4 (50th–75th centile) in girls and 115·5/63·9 (75th–91st centile) in boys. Uterine and ovarian development was prepubertal. Median serum dehydroepiandrosterone sulphate (DHEAS) was 2·1 and 4·1 μmol/l, androstenedione 3·1 and 3·8 nmol/l in girls and boys respectively, with DHEAS within the reference range/undetectable in 18/2 and androstenedione in 12/6 patients. Fasting insulin was 9·0 and 15·0 mU/l in girls and boys respectively, with concomitant low normal SHBG. Anti-Mullerian hormone (AMH) was 15·7 pmol/l in 27 girls, compared with 5·0 pmol/l in normal girls aged 5–8 years. Conclusions Our Scottish EA cohort showed female predominance, no evidence of reduced foetal growth, a tendency to overweight with commensurate mild hyperinsulinaemia and modest elevation of serum androgens in some patients. We have found raised AMH levels in the girls, indicating advanced ovarian follicular development.

A methodology to establish a database to study gene environment interactions for childhood asthma

Abstract: Background Gene-environment interactions are likely to explain some of the heterogeneity in childhood asthma. Here, we describe the methodology and experiences in establishing a database for childhood asthma designed to study gene-environment interactions (PAGES - Paediatric Asthma Gene Environment Study).

The effect of intensive glycaemic control on cardiovascular outcomes

Abstract: The relationship between glycaemia and cardiovascular disease remains controversial. For patients with type 1 diabetes in the Diabetes Control and Complications Trial, intensive glycaemic control reduced microvascular outcomes and, on longer term follow-up, a significant reduction in macrovascular events was observed. For patients with recently diagnosed type 2 diabetes, the findings in the United Kingdom Prospective Diabetes Study were similar; intensive glycaemic control reduced microvascular events during the intervention phase of the study, and a reduction in macrovascular events was observed on longer follow-up. More recently, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation study showed a microvascular benefit of more intensive blood glucose control in patients with longstanding diabetes, whereas the Action to Control Cardiovascular Risk in Diabetes study showed harm if this was performed rapidly, with increase in weight, hypoglycaemia and mortality. Collectively, these studies suggest that slow and steady intensive control of glycaemia improves outcomes in people with diabetes, and that to reduce mortality this should be commenced early in the management of patients with type 2 diabetes.

Bitter pill to swallow: a case of accidental poisoning with digitalis purpurea.

Abstract: While digitoxicity secondary to therapeutic use is frequent, due to its distinctive appearance and unpleasant taste accidental ingestion of digitalis purpurea (foxglove) is uncommon. This report relates the case of two previously healthy individuals who inadvertently consumed significant quantities of digitalis in its plant form. Both men presented in first-degree atrioventricular block and had digoxin levels of 4.9 μg/litre, but were otherwise stable and made unremarkable recoveries with repeated dose activated charcoal.

Effective awake thoracic epidural anesthetic for major abdominal surgery in two high-risk patients with severe pulmonary disease--a case report.

Abstract: Awake thoracic epidural anaesthesia as the sole anaesthetic technique was successfully employed for two high risk surgical patients with chronic obstructive pulmonary disease undergoing abdominal surgery. The procedure was tolerated well and the anaesthetic technique which has been shown to reduce intra-operative and post-operative cardiac, respiratory and gastrointestinal complications, may have significantly contributed to the prompt, complication free recovery experienced by both patients. We report two cases of awake major abdominal surgery in two high-risk surgical patients with severe pulmonary disease, performed effectively under thoracic epidural anaesthesia as a sole technique. The first case was an elective open sigmoid colectomy in a sixty one year old cancerous patient with chronic obstructive pulmonary disease [COPD] and recent thoracotomy for a wedge resection of a bronchial adenocarcinoma [pT1NoMx]. The second case was an emergency open cholecystectomy in an adult patient with end-stage COPD. Reviewing the literature, no similar cases were reported recently.

Peroxisomal Disorder-Unusual Presentation as Failure to Thrive in Early Infancy

Abstract: Failure to thrive is not uncommon in Paediatric practice and often leads to multiple investigations to find the underlying cause. We report an infant who presented mainly with mild dysmorphism, failure to thrive and elevated Alanine Transferase (ALT) in early infancy. She was diagnosed to have a peroxisomal biogenesis disorder on further investigation. Peroxisomal disorders represent a spectrum of conditions with absent or abnormal function of intra-cytoplasmic organelles called Peroxisomes. Clinical presentation is quite varied, depending on both the type and severity. We describe the clinical presentation of this case, followed by a brief discussion on Peroxisomal disorders.

Pisiform fracture: an uncommon wrist injury.

Abstract: A 48-year-old woman presented to the emergency department complaining of wrist pain after a fall onto her outstretched hand. Examination revealed generalised carpal tenderness with a reduction in wrist movements. Following an x-ray she was diagnosed as having a carpal ligament sprain and …