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author:("lachman, R")
BMJ : British Medical Journal  2008;336(7637):224.
PMCID: PMC2213840
2.  Antenatally diagnosed single kidney: lack of uniformity in postnatal management practice 
PMCID: PMC2082803  PMID: 16714741
single kidney; antenatal
3.  Postmortem diagnosis of chronic granulomatous disease: how worthwhile is it? 
Journal of Clinical Pathology  2005;58(12):1339-1341.
A previously healthy 11 year old boy died unexpectedly after a rapid course of progressive pneumonia. Postmortem microbiology and histopathology suggested an underlying diagnosis of chronic granulomatous disease. This was confirmed by neutrophil oxidative burst and gene mutation analysis of other family members, one of whom benefited from early bone marrow transplantation.
PMCID: PMC1770789  PMID: 16311362
chronic granulomatous disease; Burkholderia cepacia; palatal granulomatous mucositis; autoimmunity
4.  Implications of adopting the WHO 2006 Child Growth Standard in the UK: two prospective cohort studies 
Archives of Disease in Childhood  2007;93(7):566-569.
The WHO 2006 Child Growth Standard is based on data from international optimally nourished breastfed infants from birth to age 5 years.
To assess the potential effect of its use on weight and growth monitoring of UK children.
Full-term members of two population-based UK birth cohorts: the Children in Focus sub-cohort of the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 1335) and the Gateshead Millennium Baby Study (GMS; n = 923).
Growth data from birth to 5 years were converted into z-scores relative to the WHO 2006 standard.
Compared with the WHO standard, both UK cohorts had higher birth weights (mean z-scores: GMS, 0.17; ALSPAC, 0.34) and ALSPAC had higher birth lengths. After birth, length showed a good fit at all ages. By 2–4 months, both cohorts were similar in weight to the WHO median (mean WHO weight z-score at 4 months: GMS, 0.01; ALSPAC, −0.07), but thereafter the UK cohorts were heavier (mean WHO weight z-score at 12 months: GMS, 0.57; ALSPAC, 0.65). At age 12 months, the risk of being classified as underweight (weight <2nd centile) was considerably lower according to the WHO standard than by the UK 1990 Growth Reference (RR = 0.15, 95% CI = 0.07 to 0.32), and the risk of being classified as obese at 4–5 years (body mass index >98th centile) was slightly increased (RR = 1.35, 95% CI = 1.02 to 1.78).
Adoption of the WHO 2006 Growth Charts would set a markedly lower standard of weight gain beyond the age of 4 months for UK infants and could support efforts to avoid future childhood obesity. However, the WHO standard is not representative of size at birth in the UK.
PMCID: PMC2532956  PMID: 17908712
5.  Assessing immune responses to pneumococcal vaccines 
Archives of Disease in Childhood  2003;88(7):648-649.
PMCID: PMC1763169  PMID: 12818930
6.  Pneumococcal nasopharyngeal carriage in children following heptavalent pneumococcal conjugate vaccination in infancy 
Archives of Disease in Childhood  2003;88(3):211-214.
Aims: To ascertain whether the reduction in nasopharyngeal carriage of vaccine serotypes induced by pneumococcal conjugate vaccine (PnCV) administered to infants persists beyond the age of 2 years.
Methods: Non-randomised, unblinded controlled study of 2–5 year old children who had received three doses of heptavalent PnCV (7VPnCV) in infancy and 23-valent pneumococcal polysaccharide vaccine at 13 months, and unimmunised controls. Nasopharyngeal swabs were taken in summer (150 vaccinated subjects, 126 controls) and winter (143 vaccinated subjects, 188 controls). The swabs were cultured and serotyped for Streptococcus pneumoniae.
Results: Carriage rates (vaccinated subjects: 24.7% and 43.4%; controls: 27.0% and 41.0%, in summer and winter respectively) and carriage of vaccine serotypes (subjects: 10.0% and 30.0%; controls: 13.5% and 31.5%, in summer and winter respectively) were similar in the two groups.
Conclusions: Effects of vaccination in infancy on rates of nasal carriage of pneumococcus and serotype replacement in children living in a largely unvaccinated population are no longer evident by 2–5 years of age.
PMCID: PMC1719498  PMID: 12598380
8.  Does cefotaxime eradicate nasopharyngeal carriage ofN meningiditis 
PMCID: PMC1763080  PMID: 12390931
9.  Safety of a new conjugate meningococcal C vaccine in infants 
Archives of Disease in Childhood  2001;85(5):391-397.
BACKGROUND—Group C conjugate meningococcal vaccines (Men C) were introduced into the UK primary immunisation schedule in November 1999.There has been extensive professional and public interest in their efficacy and safety.
AIM—To determine the occurrence of at least one uncommon adverse event in infants related to the administration of the Chiron Men C vaccine.
METHODS—A total of 2796 infants aged approximately 2 months were recruited into the study from areas in and around Sheffield and from Scotland. They were vaccinated with the Chiron Men C vaccine at 2, 3, and 4 months along with routine immunisations. Data on adverse events occurring one month after each dose were collected actively and prospectively and reviewed for possible relation to the vaccine.
RESULTS—There were no deaths. There were no serious adverse events considered definitely or probably caused by the vaccine. Four infants developed serious adverse events (hypotonia, screaming syndrome, maculopapular rash, and agitation, respectively) that were considered possibly related to the vaccine. All recovered completely. Adverse events were seen in 1804 children but were considered possibly related to the vaccine in only 49 (1.8%). On subsequent immunisation there were no recurrences of adverse events considered to be possibly related to the vaccine.

PMCID: PMC1718967  PMID: 11668101
10.  Neutrophil disorders and their management 
Journal of Clinical Pathology  2001;54(1):7-19.
Neutrophil disorders are an uncommon yet important cause of morbidity and mortality in infants and children. This article is an overview of these conditions, with emphasis on clinical recognition, rational investigation, and treatment. A comprehensive list of references is provided for further reading.
Key Words: neutrophil disorders • chronic granulomatous disease • neutrophil chemotaxis • phagocytosis
PMCID: PMC1731272  PMID: 11271792
11.  Lymphopenia in lymphatic malformations 
PMCID: PMC1718483  PMID: 10991755
12.  MMR vaccine and allergy 
PMCID: PMC1718199  PMID: 10648358
13.  Primary and Booster Mucosal Immune Responses to Meningococcal Group A and C Conjugate and Polysaccharide Vaccines Administered to University Students in the United Kingdom 
Infection and Immunity  2001;69(7):4337-4341.
Meningococcal group A+C capsular polysaccharide (PS) conjugate vaccines may prime for serum immunoglobulin G (IgG) memory responses to meningococcal capsular PS. It is not known whether these vaccines induce immunological memory at the mucosal level, which may be important in reducing nasopharyngeal carriage. Mucosal immune responses to meningococcal conjugate and PS vaccines in young adults were investigated. Healthy university students were randomized to receive either a groups A+C meningococcal conjugate vaccine (MACconj, n = 100) or a group A+C meningococcal PS vaccine (MACPS, n = 95). One year after the primary immunization, both groups were randomized again to receive a MACconj or a MACPS booster vaccination. Saliva samples were collected before and 1 month after the primary and booster vaccinations. Anti-meningococcal A (MenA) and C (MenC) PS IgA and IgG antibody levels were measured by a standard enzyme-linked immunosorbent assay. After the primary vaccination, salivary MenA and MenC IgG and MenA IgA concentrations were significantly increased after immunization with both MACconj and MACPS vaccines, but the salivary Men C IgA level was increased only after MACPS vaccine (P < 0.01). IgA responses to both serogroups were greater for MACPS than MACconj vaccine (P < 0.05), whereas no significant differences were seen for IgG responses. MenA IgG titers were higher after the MACPS booster in MACconj-primed subjects than after the MACPS primary vaccination, suggesting the presence of IgG memory. Antibody responses to a dose of either MACPS or MACconj were not significantly reduced in those previously given MACPS compared to the primary responses to those vaccines. Meningococcal A+C conjugate and PS vaccines induce significant mucosal responses in young adults. MACconj priming may induce IgG memory at the mucosal level, which is likely to be a reflection of an anamnestic serum IgG response. No evidence of mucosal hyporesponsiveness was observed after MACPS priming in this study.
PMCID: PMC98504  PMID: 11401971

Results 1-13 (13)