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Neutralisers of endotoxin and of proinflammatory cytokines have had little success in the treatment of septic shock. Now work on adults in the USA (Journal of the American Medical Association 1997;277:482-7) has shown some benefit from a bradykinin receptor blocker, deltibant. In 27 patients with Gram negative sepsis given the highest dose of the drug the observed 28 day mortality was less than half of that expected. In the trial as a whole, which included over 500 patients, there was no significant effect on risk adjusted 28 day mortality.
Sir James Spence was clearly a much loved man who had in abundance the gift of inspiring people. One of those deeply affected by him was Dr F J W Miller, a former recipient of the British Paediatric Association’s James Spence medal, who shortly before he died in March 1996 submitted an article about Spence to the Journal of Medical Biography (1997;5:1-7). Spence was born on the Northumberland coast in 1892 and spent almost the whole of his life in Newcastle, dying there of lung cancer in 1954. He occupied the chair of child health from 1942 until his death. He was a holistic paediatrician before the word became much overused and was a leader in the emergence of paediatrics as a specialty in Britain.
A study of boys in a relatively deprived area of Montreal (Archives of General Psychiatry 1997;54:62-8) has shown significant correlations between behaviour at ages 6 and 10 and substance abuse between 10 and 15. In particular, adventurous (high novelty seeking) and reckless (low harm avoidance) behaviour were associated with later cigarette smoking, alcohol drinking, and abuse of other drugs. Assessment at age 6 could identify children for preventive input.
The factors underlying increased susceptibility to infection in patients receiving total parenteral nutrition (TPN) are not fully understood but work on mice (Archives of Surgery 1997;132:89-93) suggests that interference with neuropeptide mediated gut hormones may be important. Mice given the neuropeptide, bombesin, along with TPN had IgA mediated resistance to viral upper respiratory tract infection similar to that of enterally fed mice and much better than that of mice given TPN without bombesin.
In Islington, north London single mothers were twice as likely as married mothers to be working full time and yet twice as likely to be suffering financial hardship (Psychological Medicine 1997;27:21-33). Poor mothers were twice as likely to be depressed. Over a two year period 37% of single mothers suffered from clinical depression. Humiliating and entrapping severe life events were commonly linked to both poverty and single parenthood and often preceded the onset of depression while these factors all interreacted with low self esteem, poor social support, and recent marital stress or widowhood to increase the risk of chronic depression.
Better adjustment and higher self esteem in the mothers of children with learning difficulties attending a south London Portage-based project were not associated with use of a greater number of good coping strategies, because all of the mothers used such strategies; they were characteristic of those who used fewer poor coping strategies such as denial and non-adaptive distraction techniques (Journal of Mental Health1997;6:67-74). Single mothers were less likely to be well adjusted and poorly adjusted mothers were less likely to make full use of professional services. It is suggested that routine assessment should include measures of maternal mental health and self esteem so that extra help can be given to mothers who need it.
Early puberty in girls has been linked with disturbed body image, poor school performance, poor self image, smoking, drinking, and early sexual experience. In California (Journal of the American Academy of Child and Adolescent Psychiatry1997;36:255-62) girls with early onset of puberty were almost twice as likely to develop internalising symptoms (depression, anxiety, panic disorder, or disturbed self image).
Nearly all patients with rheumatic fever and many of their first-degree relatives are D8/17 positive (a high proportion of their B lymphocytes react with the monoclonal antibody D8/17). Now work in the United States (American Journal of Psychiatry 1997;154:402-7) has suggested that the same marker may be found in patients with childhood onset obsessive-compulsive disorder and/or Tourette’s syndrome. D8/17 positivity was found in all 31 such patients tested but in only one of 21 healthy controls.
A randomised study of 69 infants in Guatemala (American Journal of Clinical Nutrition1997;65:425-31) confirmed the beneficial effect of late cord clamping. Median haemoglobin values at 2 months were 100 g/l in babies whose cords had been clamped immediately after birth and 107 in those whose cords had been clamped when cord pulsation stopped (around one minute). Whether the baby was level with or below the placenta while waiting for cord pulsation to stop had no significant effect.
Respiratory syncytial virus has two main strains, A and B. During most epidemics both strains are isolated but strain A predominates. Researchers in New York State (Journal of Infectious Diseases 1997;175:814-20) have shown that strain A is over three times as likely to cause severe disease. Strain B infected infants rarely needed ventilatory support (1/90 v 13/107). Vaccine development is more likely to use strain B virus because of its lesser virulence.
Selection of patients with cystic fibrosis for transplantation depends on prediction of survival. Now workers in London (Thorax 1997;52:313-7) have produced a prognostic index derived from data on 403 patients seen between 1969 and 1987 and validated in 100 patients seen since 1988. The index is calculated using height, FEV1, FVC, white cell count, and presence or absence of hepatomegaly as variables and gives the probability of survival over 1 year.
Mutations in fibroblast growth factor receptor genes have been described in several syndromes (Crouzon, Apert, Pfeiffer, Jackson-Weiss) which include craniosynostosis. Now non-syndromic coronal craniosynostosis has been associated with a mutation (the C749G(Pro250Arg) mutation) in the fibroblast growth factor receptor 3 (FGFR3) gene on the short arm of chromosome 4 (Lancet 1997;349:1059-62). Of 26 patients (18 bilateral, eight unilateral) eight (31%) were heterozygous for the mutation. In two of the eight cases there was evidence of autosomal dominant transmission with variable expressivity and in the remaining six the mutation had arisen de novo.