bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemische Terbinafin‐Therapie von Dermatophytosen im Kindesalter
Authors: Wilmer A. , Wollina U.
Published: April 2009

Zusammenfassung. Terbinafin ist das erste oral anwendbare Antimykotikum der Allylamin‐Gruppe. Bei Erwachsenen ist eine gute Wirksamkeit und Verträg‐lichkeit bei Dermato‐ und Onychomykosen bekannt. Erfahrungen über die Anwendung in Kindesalter sind noch limitiert und eine Zulassung ist in den meisten Ländern bisher für diese Altersgruppe nicht erfolgt. Wir berichten über die systemische Terbinafin‐Therapie bei fünf Kinder mit unterschiedlichen Dermatophytosen. Fünf Kinder (Alter: 10 Monate bis 14 Jahre) mit mykologisch gesicherter Dermatophytose wurden mit Terbinafin systemisch behandelt. Die Dosierung war körpergewichtsadaptiert: 250 mg/d (> 40 kg), 125 mg/d (20–40 kg) und 62,5 mg/d (< 20 kg). Die Therapiedauer betrug 2–4 Wochen. 2/5 Patienten waren zuvor erfolglos mit Griseofulvin behandelt worden. Die Terbinafin‐Therapie führte zur kompletten klinischen und mykologischen Abheilung (5/5 Patienten). Nebenwirkungen fanden sich nicht. In der Nachbeobachtungszeit (9 Monate) trat kein Rezidiv auf. Insgesamt fand sich ein sicheres klinisches und mykologisches Ansprechen der systemischen Terbinafin‐Therapie bei gleichzeitig sehr guter Verträglichkeit.

Summary. Terbinafine is the first orally active allylamine. Though it is available since several years, experience in children is rather limited. We report about five cases of dermatophytoses in children successfully treated with oral terbinafine. Five children (age: 10 month to 14 years) with a clinical and mycological diagnosis of dermatophytosis were treated with oral terbinafine according to their body weight: 250 mg/d (< 40 kg), 125 mg/d (20–40 kg) and 62.5 mg/d (< 20 kg). The course of treatment was 2 to 4 weeks. In 2/5 patients previous systemic treatment with oral griseofulvin failed. Terbinafine therapy resulted in a complete clearance of mycotic infections (both clinical and mycological) in 5/5 children. No unwanted side‐effects were observed. During a nine month follow‐up no relaps occurred. In our five cases tolerability, clinical and mycological response of terbinafin therapy were excellent. Its penetration into sebum and only slow release from skin glands may explain the efficacy even in short‐time therapy.
Forschungsbericht zum Dr.‐Manfred‐Plempel‐Stipendium
Authors: Schaller M. , Korting H. C. , Schäfer W. , Sanglard D. , Hube B.
Published: April 2009

Zusammenfassung. Mittels RT‐PCR und spezifischen Primern wurde in einem in‐vitro‐Candidosemodell auf der Basis von humanem rekonstituiertem Schleimhautepithel das Expressionsverhalten der Gene SAP1‐6 und 8 im zeitlichen Verlauf untersucht und den histologischen Veränderungen gegenübergestellt. Der Proteinnachweis erfolgte immunelektronen‐mikroskopisch mittels eines monoklonalen Antikörpers. Im oralen Candidosemodell konnten 42 h nach Infektionsbeginn erstmals SAP1‐ und SAP3‐Transkripte zeitgleich mit dem Auftreten von ersten histologischen Veränderungen nachgewiesen werden. Eine zusätzlichc SAP6‐Expression, 6 h später, korrelierte histologisch mit dem Auftreten von zahireichen Hyphen und einer schweren Schädigung der oberflächlichen Epithelzellschichten. Nachfolgend fanden sich 60 h nach der Infektion SAP2‐ und SAP8‐Transkripte. Auf Proteinebene gelang der Nachweis von Sap‐Antigenen innerhalb der Candida‐ und der deutlich geschädigten Epithelzellen. Erste Versuche mit Proteasemutanten und Proteaseinhibitoren zeigten ein histologisch deutlich abgeschwächtes Schadensbild. In der klinischen Probe einer 29jährigen Patientin mit einer akuten oralen Candidose konnten entsprechend dem in‐vitro‐Expressionsmuster zum Zeitpunkt 48 h ebenfalls SAP1, 3 und 6 nachgewiesen werden. Die Aufarbeitung einer klinischen Probe einer chronischen Candidose eines HIV‐Patienten zeigte zusätzlich eine SAP2‐Expression. Aufgrund unserer Ergebnisse erscheint ein Zusammenhang zwischen der Expression bestimmter SAP‐Gene und dem Auftreten einer Läsion im Schleimhautmodell ebenso wahrscheinlich wie ein wesentlicher Beitrag während der in‐vivo‐Infektion.

Summary. By means of RT‐PCR and specific primers the expression of SAP1‐6 and SAP8 was investigated with respect to the time course in an in vitro candidosis model based on reconstituted human mucosal epithelium. Corresponding morphological alterations of the epithelium were documented by light microscopy. The detection of Sap was performed immunoelectron microscopically using a monoconal antibody. In the oral candidosis model SAP1 and SAP3 transcripts were detected 42 h after inoculation corresponding to first histopathological changes. Additional SAP6 expression was observed six hours later concomitantly with germtube formation. Later on SAP2 ad SAP8 transcripts were found after 60 h. On protein level it was possible to demonstrate Sap antigens within Candida and markedly deteriorated epithelial cells. Initial experiments with proteinase mutants and proteinase inhibitors showed reduction of histological damage. In a clinical specimen obtained from a twenty nine‐year‐old female patient suffering from acute oral candidosis SAP1, 3 and 6 could be demonstrated corresponding to the findings in vitro after 48 h. Investigating a clinical specimen obtained from a lesion of chronic oral candidosis in an HIV‐infected patient also showed SAP2 expression. On the basis of our results a relationship between the expressi‐***
Leishmaniose der Lippen unter dem klinischen Bild einer Mykose
Authors: Linß G. , Richter C. , Janda J. , Gantenberg R.
Published: April 2009

Zusammenfassung. Ein 24jähriger Deutscher wies Ulzera mit schmerzhaften Schwellungen der Lippen auf ohne Beteiligung der Mundschleimhaut und der regionalen Lymphknoten. Drei Monate vorher hatte er Israel, Italien, Rumänien und Bulgarien bereist. Wegen des Nachweises von Candida species und Staphylokokken wurde er außerhalb mit Penicillin, Doxycyclin, Ciprofloxacin, Itraconazol und Prednisolon behandelt, ohne daß eine Besserung auftrat. Die Untersuchungen von Abstrichen und Biopsiematerial mittels Polarisati onsmikroskopie unter Ölimmersion nach Giemsafärbung und die PCR, die vom Robert‐Koch‐Institut Berlin durchgeführt wurden, ergaben den Nachweis von amastigoten Leishmanien, die später als Leishmania major spezifiziert werden konnten. Das Plasma‐IgE war erhöht, andere diagnostische Untersuchungen im Blut und von den Lippen waren unauffällig. Die Ulzera heilten unter Antimontherapie prompt ab.

Summary. A 24 years old German man was complaining of painful ulcers with infiltration of the lips without alteration of the oral mucosa and swelling of the regional lymph nodes. Three months earlier he had visited Israel, Italy, Romania and Bulgaria. He was treated with penicillin, doxycyclin, ciprofloxacin, itraconazole and prednisolone after detection of Candida spec, and staphylococci in another town without any effect. The smear and biopsy were sent to the Robert Koch Institute Berlin. Giemsa stain by phase contrast light microscopy with oil immersion showed extracellular amastigote leishmaniae with clearly stained kinetoplasts.
Vorkommen von Endomykosen im Obduktionsgut der Berliner Charité
Authors: Tietz H.‐J. , Brehmer Dana , Jänisch W. , Martin H.
Published: April 2009

Zusammenfassung. Im Obduktionsgut der Berliner Charité, einem Großklinikum mit durchschnittlich 1500 Krankenhausbetten und medizinischer Maximalversorgung, wurden in der Zeit von 1970–1993 insgesamt 93 autoptisch gesicherte Endomykosen diagnostiziert: 51 Candidosen (54,8%), 34 Aspergillosen (36,6%), 5 Crytococcosen (5,4%) 1 Zygomykose, 1 Trichosporose und 1 Coccidioidomykose. Dies entsprach einem Anteil von 0,7% der 13 375 verstorbenen Obduzierten in dieser Zeit. Die Obduktionsfrequenz lag bei 85,3%. In 3770 Fällen (2418 Erwaehsene und 1352 Kinder) erfolgte eine Hirnsektion. Bei nur 6 von 28 Patienten (18 Erwachsene, 10 Kinder) mit histologisch gesicherter zerebraler Mykose (11 Candidosen [39,3%], 10 Aspergillosen [35,7%], 5 Cryptococcosen [17,9%], 1 Trichosporose und 1 Coccidioidomykose) wurde eine adäquate klinische Verdachtsdiagnose gestellt. Etwa 80% der Mykosen des ZNS blieben somit zu Lebzeiten der Patienten unendeckt. Vor dem Hintergrund der weiter rückläufigen Obduktionsfrequenz in der Bundesrepublik Deutschland verlangen die in der vorliegenden Arbeit gemachten Beobachtungen nachhaltig die Erhöhung der Effizienz der mykologischen Lebzeitdiagnostik, in Klinik und Labor.

Summary. From 1970 to 1993, a total of 93 endomycoses confirmed by post‐mortem examination was diagnosed in the autopsy material of the Berlin Charité, a large hospital with an average of 1,500 hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.6%), five cryptococcoses (5.4%), one zygomycosis, 1 trichosporosis and one coccidioidomycoses. This corresponded to 0.7% of the 13,375 deceased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis [11 candidoses (39.3%), 10 aspergilloses (35.7%), five cryptococcoses (17.9%), one trichosporosis and one coccidioidomycosis]. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. Against the background of the continuing reduction in the frequency of autopsy in the Federal Republic of Germany, the observations made in the present paper underscore the demand for improved efficiency of mycological in‐vivo diagnoses in the hospital and laboratory.
Georg Fresenius und die Spezies Aspergillus fumigatus
Authors: Schmidt A.
Published: April 2009

Zusammenfassung. Die Spezies Aspergillus fumigatus wurde erstmals umfassend von G. Fresenius beschrieben. J. B. Georg W. Fresenius wurde 1808 in Frankfurt a. M. geboren und starb ebenda im Jahre 1866. Er studierte Medizin und promovierte 1829. Im gleichen Jahr ließ er sich als praktischer Arzt und Chirurg in Frankfurt a. M. nieder. 1831 nahme er eine Stelle als Botaniker am, Senckenbergischen medicinischen Institut***“an. 1831 wurde Fresenius ferner Leiter des Frankfurter botanischen Gartens. Neben seiner Mitarbeit im Institut für Garten‐ und Feldbau war er aktives Mitglied des, Mikroskopischen Vereines” in Frankfurt sowie der, Senckenbergischen medicinischen Gesellschaft. Während nahezu der gesamten Zeit war er außerdem als Armenarzt in Frankfurt tätig. Zu Fresenius' bedeutsamsten Schriften zählen, Die Flora von Frankfurt und die, Beiträge zur Mykologie. Letztere wurden von Fresenius zur Hundertjahrfeier der, Senckenbergischen Stiftung herausgegeben. Die Monographie umfaß 132 Seiten und enthält 13 exzellente lithographische Camera‐lucida‐Tafeln. Im dritten Teil dieser Monographie wird auch die Spezies A. fumigatus beschrieben. Fresenius war sowohl ein engagierter Arzt wie auch Naturforscher, der eine Vielzahl auch heutzutage noch gemäß dem, International Code of Botanical Nomenclature anerkannter Pilzspezies beschrieben hat.

The species Aspergillus fumigatus was first extensively described by G. Fresenius. J. B. Georg W. Fresenius was born in Frankfurt/Main, Germany, in 1808 and also died there in 1866. He studied medicine and finished his doctorate thesis (MD) in 1829. Afterwards he started his career as a physician and surgeon in Frankfurt/Main in the same year. In 1831 Fresenius became a university lecturer for botany at the, Senckenbergisches medicinisches Institut***; this institute specialized in botany. In this year Fresenius also became the director of the botanical gardens of Frankfurt/Main. Apart from his collaboration in the institute for agriculture he actively participated in the microscopical association of Frankfurt as well as the, Senckenbergische medicinische Gesellschaft. Almost over the whole period, Fresenius also worked as a physician taking care of miserable people. The outstanding publications of Fresenius are, Die Flora von Frankfurt (Flora of Frankfurt) and, Beiträge zur Mykologie (Contributions to Mycology). The monograph, Beiträge zur Mykologie was published by Fresenius as a dedication for the centennial celebrations of the Senckenberg foundation (“Senckenbergische Stiftung). It contains 132 pages and 13 excellent lithographic figures (Camera lucida). The third part of this monograph also contains the description of the species A. fumigatus. Fresenius was an engaged physician as well as an outstanding researcher and expert in natural sciences who described numerous new fungal species some of which are still accepted nowadays in accordance with the, International Code of Botanical Nomenclature.
Successful treatment of lymphomatoid papulosis with photodynamic therapy
Authors: Rodrigues Michelle , McCormack Christopher , Yap Lee‐Mei , Prince H. Miles , Roberts Hugh , Williams Richard , Foley Peter
Published: April 2009

A 40‐year‐old woman presented with a prolonged history of recurrent crops of erythematous papules and nodules on her abdomen, arms and legs. Histological examination of a cutaneous biopsy revealed Type A lymphomatoid papulosis. Over a 3‐year period, some of the patient's lesions had proven to be resistant to treatment with topical and intralesional corticosteroids and systemic agents including methotrexate, tetracycline and nicotinamide. These resistant lesions were treated with two sessions of methyl aminolevulinate photodynamic therapy given 1 week apart. Review 11 months post‐photodynamic therapy demonstrated complete clinical clearance at the treatment site. While photodynamic therapy is considered a standard non‐surgical treatment option for non‐melanoma skin cancers and has been described in a number of non‐oncological indications, this is the first report of its use in lymphomatoid papulosis.
Conditions masquerading as infantile haemangioma: Part 1
Authors: Frieden Ilona J , Rogers Maureen , Garzon Maria C
Published: April 2009

Infantile haemangiomas are among the most common growths during infancy. Their rapid growth during infancy and vascularity can easily cause confusion with other, less common growths. This article focuses on the myriad of diagnostic mimics of haemangiomas, including other vascular anomalies, benign growths, and malignancies.
Eczema workshops reduce severity of childhood atopic eczema
Authors: Moore Elizabeth J , Williams Allison , Manias Elizabeth , Varigos George , Donath Susan
Published: April 2009

An intervention study was conducted to assess the effectiveness of a nurse‐led eczema workshop in reducing the severity of atopic eczema in infants, children and adolescents. Ninety‐nine new patients referred to the Dermatology Department of The Royal Children's Hospital in Melbourne, Australia, for the management of atopic eczema were randomized to receive care from an eczema workshop or a dermatologist‐led clinic. Patients were followed‐up 4 weeks after the intervention. The primary outcome was the severity of eczema as determined by scores obtained using the Scoring of Atopic Dermatitis (SCORAD) index at a 4‐week follow‐up visit. The secondary outcome was a comparison of treatments used in both clinics. At the 4‐week review the mean improvement in SCORAD was significantly greater in those patients attending the eczema workshop than those attending the dermatologist‐led clinic (−9.93, 95% confidence interval −14.57 to −5.29, P < 0.001). Significantly more patients from the eczema workshop improved from moderate severity eczema at baseline to mild at review. There was greater adherence to eczema management in the eczema workshop compared with the dermatologist‐led clinic. In this study, patients attending the eczema workshop had a greater improvement in eczema severity thanpatients attending a dermatologist‐led clinic, supporting collaborative models of service provision.
Vulval and perianal inflammatory linear verrucous epidermal naevus
Authors: Le Katie , Wong Li‐Chuen , Fischer Gayle
Published: April 2009

Inflammatory linear verrucous epidermal naevus (ILVEN) is a rare form of epidermal naevus. It occurs as a linear dermatitic or psoriasiform plaque, with onset usually in the first 5 years of life. Lesions are characteristically intensely itchy. We present a case of ILVEN occurring on the vulva and perianal region of a 6‐year‐old girl. The lesion was initially thought to be an area of lichenified dermatitis; however, treatment with even super‐potent topical corticosteroids did not significantly improve the inflammation. A biopsy was performed and histopathological examination showed characteristic features. ILVEN is frequently refractory to topical treatment and surgical excision of lesions may be an option for relief of symptoms. ILVEN occasionally presents in the inguinogenital region and in this area may, like many vulval naevi, be misdiagnosed as vulvitis, psoriasis, genital warts or sexual abuse.
Solitary mastocytoma occurring at a site of trauma
Authors: Tuxen Alana Jane , Orchard David
Published: April 2009

We describe a patient with a solitary mastocytoma arising at a site of trauma. The patient was born with the umbilical cord wrapped around her right thigh and subsequently developed a solitary mastocytoma in the exact site and distribution of this injury. The pathogenesis of mast cell proliferation in solitary mastocytoma is not completely understood. Cytokines released after injury, such as stem cell factor, may stimulate the proliferation of mast cells, as well as fibroblasts and melanocytes to form a mastocytoma. Mast cells in a newborn may be more sensitive to stem cell factor in the presence of cytokines released after injury due to an increased density of c‐kit receptors. We present our patient and review the literature to support a hypothesis that this condition represents a reactive, and not neoplastic, process.
An evaluation of the potential cost‐effectiveness of non‐invasive testing strategies in the diagnosis of significant liver fibrosis
Authors: Carlson Josh J , Kowdley Kris V , Sullivan Sean D , Ramsey Scott D , Veenstra David L
Published: April 2009

Background and Aim: To assess the clinical and economic outcomes of non‐invasive testing strategies in the diagnosis of significant liver fibrosis (Metavir score ≥ 2) compared with liver biopsy.

Methods: We developed a decision analytic model of non‐invasive testing strategies in a hypothetical patient population with genotype 1 hepatitis C virus infection, with no contraindications to liver biopsy. The testing strategies included a testing algorithm using the Fibrosure test, a non‐invasive measure of fibrosis, followed by liver biopsy for patients with indeterminate results, Fibrospect II, and Fibroscan. The primary outcomes were sensitivity, specificity, diagnostic accuracy (true positive + true negatives/total patients), and costs, evaluated from the health‐care payer perspective.

Results: The testing algorithm using Fibrosure was the most accurate non‐invasive strategy with a sensitivity, specificity, and overall accuracy of 84%, 87%, and 86%, respectively. In comparison with liver biopsy alone, there was a cost savings of approximately $770/person with the Fibrosure testing algorithm, but a net decrease in accuracy of 14%. Fibrospect II and Fibroscan had poorer accuracy (decreases of 12% and 4%, respectively) and lower costs (−$138 and −$357, respectively) compared with the Fibrosure algorithm. In uncertainty analyses in which biopsy sampling error was considered, the Fibrosure algorithm remained consistently less accurate (5–14% decrease).

Conclusions: The results of our study suggest that compared with liver biopsy, non‐invasive testing algorithms can result in short‐term cost savings, but the consequences of misdiagnosis in terms of health outcomes and treatment costs might outweigh the short‐term gains in cost and convenience.
Emotional intelligence, reactions and thoughts: Part 2: A pilot study
Authors: Akerjordet Kristin , Severinsson Elisabeth
Published: April 2009

This article, the second in a series of four, focuses on new mothers' perceptions of emotional intelligence, reactions and thoughts by means of a descriptive design. The study included 250 postnatal mothers (a response rate of 80%). The data were analyzed using descriptive and inferential statistics. The results show that, from a health promotion perspective, emotional intelligence might be an important component in relation to stress management and mental health. However, emotionally perceptive women seem to be affected by stress and depression to a greater extent. The relative strength of the associations between the scales also provides a valid and useful overall measure of new mothers' perceptions. Further validity scores for the scales must be obtained before any conclusions can be drawn.
The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies
Authors: SHARWOOD LISA N. , BABL FRANZ E.
Published: April 2009

Introduction:  The question of whether opioid analgesia should be given in patients with undifferentiated acute abdominal pain has been characterized by concerns about its efficacy and that signs used to determine accurate diagnosis may be masked by the drug. The objective of this review is to critically analyze pertinent pediatric randomized controlled studies considering this issue.

Methods:  A comprehensive literature search was conducted via Medline in October 2007, using the terms ‘abdominal pain’, ‘physical examination’, ‘analgesics’, ‘opioid’ and ‘appendicitis’. Other articles were identified using the bibliographies of papers found through Medline; alternate databases were searched but did not reveal additional studies.

Results:  A total of four trials were identified, and their validity and applicability were reviewed. In all studies, randomization to the analgesia group was associated with significant reduction in pain; one study showing no greater effect with opioid than placebo. All studies used a 10 cm Visual Analogue Scale to assess pain. All studies were only sufficiently powered to consider the primary outcome of opioid efficacy in abdominal pain vs placebo rather than diagnostic accuracy, although they all reported on diagnostic accuracy. Meta‐analysis of results for efficacy and accuracy was not possible due to the heterogeneity of study populations.

Conclusions:  A large, probably multi‐centred trial is needed to answer with sufficient power the question of whether opioid analgesia impairs diagnostic accuracy in children with undifferentiated acute abdominal pain.
Comparison of propofol‐fentanyl with propofol‐fentanyl‐ketamine combination in pediatric patients undergoing interventional radiology procedures
Authors: AYDIN ERDEN I. , GULSUN PAMUK A. , AKINCI SEDA B. , KOSEOGLU AYHAN , AYPAR ULKU
Published: April 2009

Background:  With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation.

Methods and materials:  Sixty consenting American Society of Anesthesia physical status I–III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double‐blinded, institutional review board approved protocol. Group 1 received propofol 0.5 mg·kg−1 + fentanyl 1 μg·kg−1 + ketamine 0.5 mg·kg−1, and group 2 received propofol 0.5 mg·kg−1 + fentanyl 1 μg·kg−1 + same volume of %0.9 NaCl intravenously.

Results:  While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus.

Conclusions:  In conclusion, addition of low dose ketamine to propofol‐fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.
National survey of pediatric breathing systems use in the UK*
Authors: MARSH DEBORAH FRANCES , MACKIE POPPY
Published: April 2009

Aims:  To determine current practice in the use of pediatric breathing systems in the UK.

Background:  Whilst the Ayres T‐Piece has been used extensively in pediatric anesthesia for nearly six decades, the circle system has undergone recent modifications. These have enhanced its suitability for pediatric use.

Methods:  A postal questionnaire was sent to all consultant members of the Association of Paediatric Anaesthetists (APA). This asked about standard breathing systems for induction, maintenance, and ventilation during anesthesia in three groups of children (neonates, infants, and older children less than 20 kg). Additional questions included if anesthetic rooms were used and scavenging routinely employed.

Results:  Replies were received from 337 members, giving a response rate of 75%. The T‐Piece was the predominant breathing system for induction in all age groups but the circle appears popular for maintenance, particularly in older children. Anesthetic rooms were used by 97% for induction and scavenging used by only 60% when using a T‐Piece.

Conclusions:  Despite significant improvements to the pediatric circle system and its practical advantages, the T‐Piece remains the commonest breathing system used in smaller children by UK members of the APA.
Validation of a theoretically derived model for the management of massive blood loss in pediatric patients – a case report
Authors: PATERSON NEIL A.
Published: April 2009

We present the case of a 5‐year‐old girl who was brought to hospital having suffered an intracranial bleed. She was found to have a large cerebral arteriovenous malformation which was unsuitable for coiling. Uncontrollable raised intracranial pressure refractory to all therapies necessitated surgery as a last resort. Massive hemorrhage eventuated during the procedure with the estimated loss of between five and six blood volumes, the majority occurring within the space of an hour and a half. We describe management using a locally developed protocol and correlate this with laboratory findings.
Ultrasound (US) guided transversus abdominis plane (TAP) block for paediatric inguinal hernia surgery – a pilot study
Authors: Fredrickson M.J.
Published: April 2009

Aim:  To assess the effectiveness of ultrasound guided TAP block compared to ilioinguinal block for inguinal hernia surgery.

Background:  The transversus abdominis plane block has been shown to provide effective intra‐ and postoperative analgesia following lower abdominal surgery [1‐3] and may be an acceptable alternative to the ilioinguinal block in the setting of inguinal surgery [4,5]. It has been suggested that the TAP block is easier to perform than the ilioinguinal block, while also facilitating in‐plane needle imaging [4].

Methods:  Subjects scheduled for inguinal hernia surgery were prospectively randomized to US guided ilioinguinal or TAP block using a total volume of 0.3 ml kg‐1 of 50 : 50 lignocaine 1%/ ropivacaine 1%. A single operator experienced in US guided regional anaesthesia performed all blocks. Muscle images were graded on a 4‐point scale (vivid or barely visible, 2 or 3 muscles). Surgery commenced 5 mins following block placement. Fentanyl 0.25 mcg kg‐1 was given PRN during surgery for an increase in heart rate, mean arterial pressure or respiratory rate >20% from postinduction values. Intravenous morphine was given in the PACU for nurse‐assessed moderate to severe pain or emergence agitation. Ibuprofen was given at home for parent‐assessed pain nonresponsive to paracetamol. Blinded observers assessed age appropriate pain score (0–10) in the PACU, day stay unit and during the first 24 h.

Results
Ilioinguinal
TAP

n
12
8

Images: ‘vivid + 3 muscles’ (n%)
58
100

Block time, s (mean)
91
48

Intraoperative fentanyl (n%)
66
63

Worst PACU pain score (median)
2.5
0

PACU morphine required (n%)
17
25

Worst day stay unit pain score (median)
1
5

Doses paracetamol/ibuprofen /24 he (mean)
2.2/0.4
1.5/0.8

Conclusions:  Interim results support ongoing evaluation of the TAP block for inguinal hernia surgery.

References

1 Shibata Y, Sato Y, Fujiwara Y, Komatsu T. Transversus abdominis plane block. Anesth Analg 2007; 105: 883; author reply 883.

2 McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Life JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007; 104: 193–197.

3 Hubbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound‐guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 2007; 35: 616–617

4 Fredrickson MJ. Early experience with the transversus abdominis plane block in children. Pediatric Anesthesia 2008; 18: 891.

5 Banal V. The efficacy of transversus abdominis plane after inguinal surgery. http://www.asra.com/abstracts/spring2008: A59 2008.
Across Nationalisms: Nascent Conceptualisation, Rudimentary Cross-Regional Historicisation
Authors: Behar Moshe
Published: April 2009

If nations are non-preordained configurations of socio-political collectivities then they cement – or fragment – as a consequence of two core sets of on-the-ground interactions: those taking place within a national movement among contending intra-national constituents; and those taking place between competing national movements, typically over territory. A third set of on-the-ground socio-political interactions has received less attention in the study of the phenomenon of nationalism: I term it ‘dynamics across nationalisms’. If such dynamics are explored in conjunction with the more prevalent study of interactions within and between nationalisms, they can shed brighter explanatory light on the phenomenon of national consolidation/disintegration.
The Plight of Iraq's Mandaeans and Honderich's Principle of Humanity
Authors: Nashi Suhaib , Bolender John
Published: April 2009

Due to persecution, Sabean Mandaeans have fled Iraq in large numbers. Although there is widespread suffering and vulnerability in Iraq, the Mandaeans are a special case, since they have no safe enclave within Iraq to which they can return and their pacifism makes them especially vulnerable to violence. Ted Honderich's Principle of Humanity is used to argue that countries able to do so, meaning wealthy Western nations in particular, should take steps to guarantee the Mandaeans a safe homeland where they can not only live but also maintain their cultural identity.
Disagreeing to Agree: Financial Crisis Management within the ‘Logic of No Alternative’
Authors: Macartney Huw
Published: April 2009

The article argues that amid a cacophony of analyses of the causes of the current financial crisis, those daring to consider its implications and outcomes are decidedly cautious. Fundamentally, crisis managers appear intent on treating this as a minor glitch in an otherwise functioning market. This is a controversial claim. Nonetheless it is the legacy of the perception that neoliberalism is ‘the only alternative’; it emphasises the need, however, for truly alternative voices in the ad hoc settlements and negotiations. The article argues that, through the lenses of historical materialism, this crisis is the inevitable result of the prolonged period of credit expansion and financial market reform in recent decades. With this in mind it suggests that the economists and state managers who established these conditions are themselves both unlikely to and incapable of reversing them.
Germany's Social Democrats in Search of a New Party Programme
Authors: Pautz Hartwig
Published: April 2009

This article explores the development of the meaning of social justice in the German Social Democratic Party's (SPD) discourse by juxtaposing the 1989 Berlin Programme with various programmatic initiatives by the party leadership and with the new 2007 Hamburg Programme. In order to understand the context in which the meaning of social justice changed, the article also outlines some of the social policy changes under Gerhard Schröder's SPD-led governments between 1998 and 2005.
LANDSAT Sub‐pixel Analysis in Mapping Impact of Climatic Variability on Prairie Pothole Changes
Authors: Zhang Bo , Schwartz Franklin W , Tong Daoqin
Published: April 2009

The Prairie Pothole Region in the United States contains millions of seasonal, semi‐permanent, or permanent lakes and wetlands that typically range in size from 0.1 to 10 ha. These lakes and wetlands are vulnerable to climate change, especially in our study area in South Dakota, in which a period of deluge following a sharp drought considerably expanded the areal extent of prairie pothole lakes during the last decade of the twentieth century. Preliminary estimates of lake areas, determined using LANDSAT 5 and 7 images, had appreciable errors especially for the smallest of these lakes. This article describes a new sub‐pixel approach integrated with a CART (Classification and Regression Tree) model using a GIS (Geographical Information System) to quantify mixed water pixels along lake boundaries to improve area estimations for pothole lakes. Errors in estimated area were typically 10% or less for lakes greater than 1 ha in size. An analysis of lakes in our study area demonstrates how lake area changed with the transition from drought to deluge. Small lakes exhibited a distinct seasonal variation in contrast to large lakes that tended to follow precipitation trends more broadly. The total water area of lakes is consistent with broad variation in rainfall.
Girls with honour‐related problems in a comparative perspective
Authors: Schlytter Astrid , Linell Hanna
Published: April 2009

Schlytter A, Linell H. Girls with honour‐related problems in a comparative perspective Int J Soc Welfare 2010: 19: 152–161 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

The aim of this study was to learn to perceive the indicators of honour‐related problems in a girl's everyday life. Our investigation included all girls aged 13–18 years who were about to be taken into care in 2006. The comparative analysis was based on 37 County Court cases in Stockholm County. The girls' exposure to harm in 13 of the 37 cases could be coupled to the demands and values of the honour culture. All the girls in the ‘honour’ group had been victims of mental abuse; they were more isolated than the girls in the ‘other reason’ group and none of the girls in the ‘honour’ group chose to meet their parents in court. We found that the honour culture life situation is new to the social services, which for these girls can mean that they do not have access to the same legal protection as other girls.
Social expenditures and public administration: are local social assistance costs in Sweden a matter of organisation?
Authors: Minas Renate
Published: April 2009

Minas R. Social expenditures and public administration: are local social assistance costs in Sweden a matter of organisation? Int J Soc Welfare 2010: 19: 215–224 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

This study examines the connection between organisational factors and local social assistance expenditures in Swedish municipalities. The organisation of social assistance units, particularly those for the intake of social assistance inquirers, and the possible implications for local social assistance costs are highlighted. The study is based on interview data from medium‐sized Swedish municipalities combined with register data covering the years from 1997 to 2001. The results show that socioeconomic factors have an overall dominant effect, but also that organisational factors co‐vary with local social assistance expenditures. The results show a cost‐reducing effect for special intake units: firstly, when these units are analysed together with other forms of specialisation and secondly, when staff resources are taken into account. Thus, specialised intake organisation by itself does not play a cost‐reducing role, but does so in combination with certain other factors that characterise the internal organisation of the social welfare office.
Intervening in youth problem behavior in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth
Authors: Olsson Tina M.
Published: April 2009

Olsson TM. Intervening in youth problem behavior in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth

Int J Soc Welfare 2010: 19: 194–205 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

Within the context of a randomized trial, this study assessed the costs of treating conduct disorder with multisystemic therapy (MST) or treatment as usual (TAU) for 156 youth in Sweden. From the perspective of the municipal Social Welfare Administration, all intervention costs were collected for the 6‐month period starting at randomization. MST was found to cost, on average, US$8,847 per youth. A course of intervention including MST was found to cost significantly more (US$5,038 per youth) than TAU. Although MST was found to reduce the use of and costs associated with non‐placement interventions, MST was not found to reduce the use of or costs associated with placement interventions. This is contrary to findings reported from studies undertaken in the USA. Intent‐to‐treat (ITT) and treatment‐of‐treated (TOT) analyses are presented.
Against difference and diversity in social work: the case of human rights
Authors: Webb Stephen A.
Published: April 2009

This article argues that the politics of the ‘right to difference’ and celebration of diversity in social work is a malign tendency that is symptomatic of the malaise of postmodernism and other fashionable trends in human rights discourse. It is suggested that a normative concept of human rights as worked through postmodern preoccupations with difference and diversity is a morally bankrupt perspective. The fixation of the ‘right to difference’ in social work runs parallel with neoliberalism with its celebration of diversity. The article offers a set of conceptual devices for rethinking social work ethics through the writings of Alain Badiou. His subtractive ontology of truth is presented as an essentialist alternative to the relativist discourses of difference. If social work is to recover a progressive stance, we must reinstall the concepts of sameness and equality. Therefore, social work should be ‘indifferent to differences’ by transcending the politics of difference.
Implicit regularization of the incomplete oblique projections method
Authors: Scolnik H. D. , Echebest N. E. , Guardarucci M. T.
Published: April 2009

The aim of this paper is to improve the performance of the incomplete oblique projections method (IOP), previously introduced by the authors for solving inconsistent linear systems, when applied to image reconstruction problems. That method employs incomplete oblique projections onto the set of solutions of the augmented system Ax−r=b, and converges to a weighted least squares solution of the system Ax=b. Many tomographic image reconstruction problems are such that the limitation of the range of rays makes the model underdetermined, the discretized linear system is rank‐deficient, the nullspace is non‐trivial, and the minimal norm least squares solution may be far away from the true image. In a previous paper, we have added a quadratic term reflecting neighboring pixel information to the standard least squares model for improving the quality of the reconstructed images. In this paper we replace the quadratic function by a more general regularizing function avoiding the modification of the original system. The key idea is to perform a joint optimization of the norm of the residual and of the regularizing function in each iteration. The theoretical properties of this new algorithm are analyzed, and numerical experiments are presented comparing its performance with other well‐known methods. They show that the new approach improves the quality of the reconstructed images.
A survey on vertex coloring problems
Authors: Malaguti Enrico , Toth Paolo
Published: April 2009

This paper surveys the most important algorithmic and computational results on the Vertex Coloring Problem (VCP) and its generalizations. The first part of the paper introduces the classical models for the VCP, and discusses how these models can be used and possibly strengthened to derive exact and heuristic algorithms for the problem. Computational results on the best performing algorithms proposed in the literature are reported. The second part of the paper is devoted to some generalizations of the problem, which are obtained by considering additional constraints [Bandwidth (Multi) Coloring Problem, Bounded Vertex Coloring Problem] or an objective function with a special structure (Weighted Vertex Coloring Problem). The extension of the models for the classical VCP to the considered problems and the best performing algorithms from the literature, as well as the corresponding computational results, are reported.
Suicidality and Epilepsy: A Complex Relationship that Remains Misunderstood and Underestimated
Authors: Kanner Andres M.
Published: April 2009

Suicidality in people with epilepsy is significantly more frequent than in the general population. The relation between suicidality and epilepsy is multifactorial and bidirectional. The purpose of this review is to highlight the most important psychiatric, pharmacologic, and epilepsy-related variables linked to the increased suicidal risk among these patients.
Systemic Cooling to Treat Status Epilepticus: An Old Idea Becomes a Hot Topic
Authors: Miller John W.
Published: April 2009

Hypothermia for Refractory Status Epilepticus. Corry JJ, Dhar R, Murphy T, Diringer MN. Neurocrit Care 2008;9(2): 189–197. INTRODUCTION: Status epilepticus (SE) can be refractory to conventional anticonvulsants, requiring anesthetic doses of medications to suppress seizures. This approach carries significant morbidity, is associated with a high fatality rate, and may not always control SE. Hypothermia has been shown to suppress epileptiform activity experimentally, but has not previously been used as a primary modality to control SE in humans. METHODS: Four patients with SE refractory to benzodiazepine and/or barbiturate infusions were treated with hypothermia (target temperature: 31–35°C) using an endovascular cooling system. All received continuous EEG monitoring, three were on midazolam infusions and one had recurrent seizures on weaning from pentobarbital. RESULTS: Therapeutic hypothermia was successful in aborting seizure activity in all four patients, allowing midazolam infusions to be discontinued; three achieved a burst-suppression pattern on EEG. After controlled rewarming, two patients remained seizure-free, and all four demonstrated a marked reduction in seizure frequency. Adverse events included shivering, coagulopathy without bleeding, and venous thromboembolism. Two death occurred, neither directly related to hypothermia; however, immunosuppression related to the use of barbiturates and hypothermia may have contributed to an episode of fatal sepsis in one patient. CONCLUSIONS: Hypothermia was able to suppress seizure activity in patients with SE refractory to traditional therapies with minimal morbidity. It appears promising as an alternative or an adjunct to anesthetic doses of other agents, but requires further study to better evaluate its safety and efficacy.
Infantile Spasms: A Critical Review of Emerging Animal Models
Authors: Stafstrom Carl E.
Published: April 2009

Infantile spasms is a developmental epilepsy syndrome with unique clinical and EEG features, a specific pattern of pharmacological responsiveness, and poor outcome in terms of cognition and epilepsy. Despite the devastating nature of infantile spasms, little is known about its pathogenesis. Until recently, there has been no animal model available to investigate the pathophysiology of the syndrome or to generate and test novel therapies. Now, several promising animal models have emerged, spanning the etiological spectrum from genetic causes (e.g., Down syndrome or Aristaless-related homeobox [ARX] mutation) to acquired causes (e.g., endogenous and exogenous toxins or stress hormones with convulsant activity or blockade of neural activity). These new models are discussed in this review, with emphasis on the insights each can provide for understanding, treating, and preventing infantile spasms.
The Cadherin Superfamily and Epileptogenesis: End of the Beginning?
Authors: Cooper Edward C.
Published: April 2009

X-Linked Protocadherin 19 Mutations Cause Female-Limited Epilepsy and Cognitive Impairment. Dibbens LM, Tarpey PS, Hynes K, Bayly MA, Scheffer IE, Smith R, Bomar J, Sutton E, Vandeleur L, Shoubridge C, Edkins S, Turner SJ, Stevens C, O'Meara S, Tofts C, Barthorpe S, Buck G, Cole J, Halliday K, Jones D, Lee R, Madison M, Mironenko T, Varian J, West S, Widaa S, Wray P, Teague J, Dicks E, Butler A, Menzies A, Jenkinson A, Shepherd R, Gusella JF, Afawi Z, Mazarib A, Neufeld MY, Kivity S, Lev D, Lerman-Sagie T, Korczyn AD, Derry CP, Sutherland GR, Friend K, Shaw M, Corbett M, Kim HG, Geschwind DH, Thomas P, Haan E, Ryan S, McKee S, Berkovic SF, Futreal PA, Stratton MR, Mulley JC, Gecz J. Nat Genetics 2008;40(6):776–781. Epilepsy and mental retardation limited to females (EFMR) is a disorder with an X-linked mode of inheritance and an unusual expression pattern. Disorders arising from mutations on the X chromosome are typically characterized by affected males and unaffected carrier females. In contrast, EFMR spares transmitting males and affects only carrier females. Aided by systematic resequencing of 737 X chromosome genes, we identified different protocadherin 19 ( PCDH19) gene mutations in seven families with EFMR. Five mutations resulted in the introduction of a premature termination codon. Study of two of these demonstrated nonsense-mediated decay of PCDH19 mRNA. The two missense mutations were predicted to affect adhesiveness of PCDH19 through impaired calcium binding. PCDH19 is expressed in developing brains of human and mouse and is the first member of the cadherin superfamily to be directly implicated in epilepsy or mental retardation.