bluuebunny/crossref_metadata_2025 huggingface dataset:
Farm and tractor‐related fatalities in children in South Australia
Authors: BYARD RW , GILBERT J , LIPSETT J , JAMES R
Published: November 2003

Objective:

To analyse the circumstances surrounding farm and tractor‐related childhood fatalities in South Australia, to identify potentially dangerous situations and to delineate prevention strategies.

Methods:

A retrospective search of files was conducted at the Women’s and Children’s Hospital Department of Histopathology from 1981 to 1996, and the State Coroner’s Office from 1988 to 1996.

Results:

Fifteen fatalities were identified comprising 11 boys and four girls (age range, 2 years 11 months to 13 years; average, 6 years). Activities prior to death included riding on a tractor/trailer (n=8); playing near a field grain storage bin (n=2); playing near machinery (n=2); sleeping in a car near a burn off (n=1); walking around a dam (n=1) and riding as a passenger on a motorbike (n=1). Causes of death included multiple skull fractures and cerebral damage (n=11), asphyxia (n=2), drowning (n=1) and incineration (n=1).

Conclusions:

The most dangerous activity involved children riding unrestrained on tractors; falls resulted in extensive injuries from tractor rear wheels or towed machinery. Allowing children on farms to ride on tractors or machinery only if there is a safe seat with a restraining harness would substantially reduce the number of fatal farm‐related childhood injuries in South Australia.
Isoflavone content of infant foods and formulas
Authors: KNIGHT DC , EDEN JA , HUANG JL , WARING MA
Published: November 2003

Objective:

The purpose of this study was to investigate the phytoestrogen content of different foods, formulas and drinks that may be consumed by infants during their first year of life in an attempt to define levels of exposure on different feeding regimens.

Methodology:

High performance liquid chromatography (HPLC) was used to determine the levels of genistein, daidzein, biochanin A, formononetin and equol in samples purchased from Australian supermarkets. Single lots of duplicate or triplicate samples of soy beverages, cow’s milks, infant formulas and infant yoghurts were analysed.

Results:

All foods tested contained isoflavones, at varying levels, suggesting that exposure to these compounds is almost ubiquitous. Casein‐based infant formulas contained between 0.001 and 0.03 mg L−1. Soy‐based infant formulas ranged from 17.2 to 21.9 mg L−1 with the values detected in yoghurt at similar levels to that of cow’s milk. For comparison, the soy‐based beverages (which are not recommended for use under 12 months of age) contained levels of isoflavones from 22.9 to 71.5 mg L−1.

Conclusions:

Given the relatively broad choice of infant foods becoming available, exposure to dietary isoflavones during the first year of life is virtually ubiquitous. The exposure may be higher if soy infant formulas are consumed, however, the levels attained appear to fall within normal physiological boundaries.
Treatment of acute asthma: Salbutamol via jet nebuliser vs spacer and metered dose inhaler
Authors: ROBERTSON CF , NORDEN MA , FITZGERALD DA , CONNOR FL , VAN ASPEREN PP , COOPER PJ , FRANCIS PW , ALLEN HDW
Published: November 2003

Objective:

To compare the efficacy of salbutamol delivered by jet nebuliser (JN) with salbutamol via a pressurised metered dose inhaler (PMDI) and a large volume spacer (Volumatic) for management of acute asthma.

Study population:

A total of 160 children aged from 4 to 12 years presenting to an Emergency Department with acute asthma.

Methods:

The study was of multicentre (n=5) randomised, double blind, parallel design. Children weighing less than 25 kg received salbutamol 2.5 mg via the JN or 600 μg (six puffs) from the PMDI. Children over 25 kg received salbutamol 5 mg via the JN or 1200 μg (12 puffs) via the PMDI. Clinical score (range 0–12) and PEF (over 7 years) were recorded at baseline and 15, 30, 45 and 60 mins post administration.

Results:

The improvement from baseline at 30 min in the clinical score was 1.87 for JN and 1.43 for PMDI (P=0.09) and at 60 min was 2.15 for JN and 1.12 for PMDI (P=0.0001). The improvement in PEF at 30 min was 51 L min−1 for JN and 27 L min−1 for PMDI (P=0.0007) and at 60 min was 57 L min−1 for JN and 31.5 L min−1 for PMDI (P=0.001).

Conclusion:

Administration of salbutamol via a PMDI and a large volume spacer device provides effective relief in the management of acute asthma in children, but to a lesser extent than a jet nebuliser. This difference may represent a dose response effect.
The sleep patterns of infants and young children with gastro‐oesophageal reflux
Authors: GHAEM M , ARMSTRONG KL , TROCKI O , CLEGHORN GJ , PATRICK MK , SHEPHERD RW
Published: November 2003

Objective:

Sleep disturbance in gastro‐oesophageal reflux disease (GORD) in infants and young children has not been systematically studied nor has this manifestation been compared with population norms.

Methods:

Sleep patterns of 102 infants and children aged 1 to 36 months with and without GORD, defined by pH monitoring, were analysed using the same questionnaire as in recent studies of normal sleep behaviour in this age range. Main outcome measures included time taken to settle at night, the number of night time wakenings requiring parental intervention, day time sleep patterns and parents problems with their childs’ sleep behaviour.

Results:

Compared with the population norms (n=3102), those with GORD (n=76) had greater prevalence of night time waking >3/night (50% vs 13% aged 3–12 months; 60% vs 10% aged 12–24 months, P<0.001), requirement of parental intervention (82% vs 55% aged 3–12 months, P<0.05; 92% vs 55% aged 12–24 months, P<0.001), significantly delayed onset of sleeping through the night, and greater prevalence of daytime sleep beyond 24 months. Similar but less striking differences were seen comparing those with (n=76) and without GORD (n=26).

Conclusions:

Sleep interruption occurs more frequently in infants and children with GORD than population norms. Objective evaluation of infants and children with sleep disturbance after the age of 3 months may avoid unnecessary over or under diagnosis of GORD. Systematic investigation of the contribution of GORD to sleep disturbance in infants and young children is warranted.
Cataracts in insulin‐dependent diabetes mellitus: Sixteen years’ experience in children and adolescents
Authors: MONTGOMERY EL , BATCH JA
Published: November 2003

Objective:

To report on cases of diabetic cataracts in a paediatric and adolescent population.

Methodology:

Medical histories of children and adolescents attending the Royal Children’s Hospital Diabetes Service who had developed cataracts between 1981 and 1996 were examined.

Results:

Nine cases of diabetic cataracts have been managed over the 16‐year time frame. Two cases presented at diagnosis of insulin‐dependent diabetes mellitus (IDDM) and one 3 weeks after. The remaining six presented 1.7–13 years (mean 5.17±4.02) after diagnosis of IDDM. All but one had exhibited poor control of their diabetes with high HbA1C values.

Conclusions:

Cataracts occurring in the paediatric and adolescent population, though uncommon, lead to marked morbidity. It is recommended that all children have an ophthalmological examination at diagnosis, particularly if they have had a long duration of symptoms before diagnosis. Persistently poor diabetes control and/or blurred vision are indications for prompt ophthalmological review.
The use of medication in children attending childcare in Western Australia
Authors: SLACK‐SMITH LM , READ AW , STANLEY FJ
Published: November 2003

Objective:

This paper reports on medication use and factors affecting use in a cohort of preschool children attending long daycare in centres and family daycare in homes.

Methodology:

A survey of parents representing 846 children under 6 years old in two types of childcare in Perth, Western Australia. The data were analysed using descriptive and logistic regression techniques to elucidate factors associated with use of medication.

Results:

Seventy‐three per cent of the children were reported to have used over‐the‐counter medication at some time, whilst current regular use of prescribed medication was 11%. This proportion is comparable to the limited available data for children of similar ages in Western Australia. For both medication categories, the use of medication was higher in long daycare than family daycare. In addition, many other characteristics differed between children in long daycare and family daycare. Initial analysis showed a number of significant associations between child and family factors and both categories of medication. Multivariable analyses indicated that the most important associations with medication use were with children’s illnesses. There was no significant difference between long daycare and family daycare for use of over‐the‐counter medication but attending long daycare was significantly associated with increased use of prescribed medication (OR=2.13; 95% CI 1.24–3.67) after illnesses had been taken into account.

Conclusion:

Medication use in children attending childcare is closely related to reported illness in the child.
Children’s understanding of sun protection behaviours: A comparative analysis
Authors: MORRIS J , BANDARANAYAKE M , McGEE R
Published: November 2003

Objective:

To investigate awareness of sun protection behaviours in a sample of primary school children in New Zealand.

Methodology:

Information was collected from 824 primary school children in New Zealand using a drawing and writing technique.

Results:

The data revealed a bias towards sunscreen as a method of sun protection compared with other methods such as clothing and the use of shade. Comparisons between results obtained from children resident in Australia and England indicated a greater awareness of sun protection methods amongst the children from Australia and New Zealand compared with those children living in England.

Conclusions:

Children as young as 5 and 6 can describe the consequences of overexposure to the sun, and can illustrate methods of sun protection. Sunscreen is seen as the main method of sun protection.
Developmental‐behavioural problems in general paediatrics
Authors: HOLT JM , McDOWELL MJ
Published: November 2003

Objective:

To determine the current role of private general paediatrics in the care of children with problems of development and behaviour.

Methods:

We surveyed all general paediatricians registered with the Australian College of Paediatrics to assess their current role in developmental‐behavioural (DB) problems—their rate of referrals, their role in the continuing management, and opinions regarding duration of training in this area.

Results:

Of 394 questionnaires sent, 284 replies were received (72%). From these 284 we analysed results for all 172 who spent more than 25% of their time in private general paediatric practice. On average, 32% of new referrals were for DB problems. With 10 DB clinical vignettes presented, paediatricians chose to continue to manage in conjunction with allied health services in 65% of cases. Other management choices included referral to a multidisciplinary team (16%), referral elsewhere (10%) and manage alone (7%). For training to be a general paediatrician, they indicated 3 months should be spent during basic training in each of the three areas of; DB paediatrics, developmental disabilities and child psychiatry (separately or concurrently); and 6 months of each during advanced training. Free comments highlighted lack of public allied health and psychosocial services.

Conclusion:

Private community‐based general paediatricians are deeply involved in this area of work. The results raise questions about services for training and for clinical collaboration between public and private child health providers.
Congenital malformations in Victoria, Australia, 1983–95: An overview of infant characteristics
Authors: RILEY MM , HALLIDAY JL , LUMLEY JM
Published: November 2003

Objective:

To provide an overview of the characteristics of Victorian infants born between 1983 and 1995 who are affected by one or more of 27 sentinel birth defects.

Methodology:

Using data on congenital malformations supplied to the Victorian Perinatal Data Collection Unit from multiple sources between 1983 and 1995, information was summarised for 25 231 infants (born at 20 weeks or more) and 1566 terminations of pregnancy before 20 weeks’ gestation.

Results:

During the 13‐year study period in Victoria, 3.2% of babies had at least one malformation. Congenital dislocation of the hip was the most common defect with a prevalence of 28.9 per 10 000 pregnancies or 1/346. Increase in birth prevalence between 1983 and 1995 is greatest in obstructive defects of the renal pelvis, hypospadias and the trisomies 21,13 and 18. Nearly 50% of pregnancies affected by anencephaly were terminated before 20 weeks compared to 26% affected by spina bifida. The perinatal mortality of infants born at 20 weeks or more with congenital malformations is more than 10 times greater than that of infants without any malformations. Males are more at risk of being born with a malformation than females. Congenital malformations are more common in infants of multiple pregnancies and those of low birthweight.

Conclusion:

This large data collection is a valuable source of information for perinatal epidemiologists, for providers of prenatal diagnostic services and for the care of the disabled. In addition, the continued reporting and monitoring of birth defects will allow for targeted research that may lead to a better understanding of their aetiology.
Paediatric assessment in a residential child and adolescent psychiatry unit
Authors: McDONALD CA , PATERSON* R , BAUER P , McDERMOTT B
Published: November 2003

Objective:

To document the health status, comorbidity and functional impairments experienced by a group of psychiatrically disturbed children and adolescents.

Methodology:

A detailed study of consecutive admissions to a residential unit over a two‐year period was undertaken. All admissions had a comprehensive paediatric, speech pathology and psychiatric assessment.

Results:

Compared to the general population, there was a significant history of developmental delay and low birthweight, but only a slightly greater prevalence of antenatal problems. Clumsiness (37%), severe speech and language disorder (32%), and hearing loss (15%) were prominent. Only 25% had no history of comorbid medical or neurological disorders.

Conclusion:

Children and adolescents presenting with moderate to severe mental health morbidity may have pre‐existing comorbid medical problems, as well as unrecognised difficulties and impairments in other skills areas. Multidisciplinary assessment and intervention should be an integral part of the residential programme.
Renal tuberculosis in an Australian‐born child
Authors: CHANG AB , GRIMWOOD K , HUTSON JM , JONES CL
Published: November 2003

This report describes a case of renal tuberculosis, complicated by hypertension and ureteric obstruction, in a previously well Australian born child. Despite antituberculous chemotherapy and ureteric stenting, there was a progressive loss of renal function in the right kidney until surgical nephrectomy allowed full recovery. A high level of clinical suspicion is necessary for a diagnosis of genitourinary tuberculosis. Ureteric cicatrisation and obstruction occasionally may occur with healing, and therefore serial renal tract imaging during treatment is necessary to detect this complication.
Glutaric aciduria type 1: An underdiagnosed cause of encephalopathy and dystonia–dyskinesia syndrome in children
Authors: HAUSER SEP , PETERS H
Published: November 2003

Two cases of glutaric aciduria type 1 (GA 1) are presented. GA 1 is probably underdiagnosed and misdiagnosed, and may explain a proportion of cases of extrapyramidal and ‘postencephalitic’ cerebral palsy. Most cases of GA 1 present with a severe dystonic–dyskinetic syndrome following an acute encephalopathy. Asymptomatic cases have also been described, complicating genetic counselling and prenatal diagnosis.

We raise awareness of GA 1 and stress that if clinically suspected, immediate institution of therapy may reduce late morbidity. Moreover, if recognised in the presymptomatic stage, early institution of treatment may prevent the onset of neurological symptoms. GA 1 is an inborn error of lysine and tryptophan catabolism, caused by deficiency of the enzyme, glutaryl coenzyme‐A dehydrogenase. Urine organic acid analyses may be negative. Blood acylcarnitine profile has recently been employed as a more sensitive test but was negative in both our patients. Enzyme assay remains the definitive diagnostic test.
Child rearing and cultural beliefs and practices amongst Thai mothers in Victoria, Australia: Implications for the sudden infant death syndrome
Authors: RICE PL , NAKSOOK C
Published: November 2003

Objective:

To examine the perceptions of sudden infant death syndrome (SIDS) and to describe the role of cultural beliefs and practices on child rearing amongst Thai mothers in Victoria, Australia.

Methodology:

In‐depth interviews and participant observation conducted with 30 Thai mothers during 1995–96.

Results:

SIDS was not known amongst these Thai mothers prior to migration to Australia. However, they were aware of SIDS when they gave birth here and all of them expressed fear about their baby’s death. Due to this fear, most mothers tended to follow Thai beliefs and practices strictly to prevent death. These included breast‐feeding, not leaving the infant alone at night‐time, placing the infant on the side or back to sleep, and bedsharing. It is considered that there are numerous evil spirits who may harm the infant, but some are benevolent and protect the newborn, such as ancestral spirits and the guardian angel of a child. Several Thai rituals are carried out to protect the newborn from ill health and death, including inviting the soul of the infant to reside in his or her body, and ritual clipping and shaving the hair of the newborn within the first month of life.

Conclusions:

Cultural beliefs, rituals and child‐rearing practices help Thai parents to overcome their fear of SIDS. Hypotheses derived from Asian parents’ child rearing practices may be useful in further SIDS research.
A population‐based survey of immunisation coverage in children aged 2 years and younger in New South Wales
Authors: SULLIVAN EA , CHEY T , NOSSAR V
Published: November 2003

Objective:

To provide a population‐based baseline of immunisation rates in children aged 2 years and younger in New South Wales (NSW) in 1992, permitting more accurate evaluation of the efficacy of current programmes.

Methods:

A cross‐sectional population‐based survey of 622 households from areas resident to over 73% of all children aged 4 years and younger in NSW.

Results:

Of the 322 households with children aged 3–24 months, 212 (66%; confidence interval (CI): 57–75%) were up‐to‐date with the recommended immunisation schedule, 68 (21%; CI: 15–27%) had not commenced any immunisation, and 42 (13%; CI: 9–17%) were partially immunised. Ability to read English (odds ratio (OR): 5.43; CI: 2.37–12.44) and receipt of hepatitis B immunisation (OR: 2.54; CI: 1.27–5.07%) were highly associated with up‐to‐date immunisation; whilst a history of any illnesses, frequent doctor visits in the past 12 months (OR: 0.47; CI: 0.27–0.85%) and older age (16–24 months) (OR: 0.26; CI: 0.12–0.50%) were less likely to be associated with up‐to‐date immunisation.

Conclusions:

In 1992 NSW had low levels of up‐to‐date immunisation. Significantly, one‐fifth of NSW families with children aged 3–24 months did not have a record of any immunisations. This could not be explained by delay in commencing immunisation. Poor competency in reading English was strongly associated with failure to immunise, suggesting that there had been inadequate targeting of immunisation campaigns in non‐English‐speaking communities.
The use of human glutathione S‐transferase A1 in the detection of cystic fibrosis liver disease
Authors: HUNG JCC , HOWIE AF , BECKETT GJ , SOOD M , HAMBLETON G , SUPER M
Published: November 2003

Objective:

To determine the value of serum human glutathione S‐transferase A1 (hGST A1) in the detection of cystic fibrosis liver disease (CFLD).

Methods:

Sixty‐three children (aged 0.5–16 years) with cystic fibrosis (CF) were screened prospectively for evidence of hepatobiliary abnormalities between February 1993 and February 1995. Comparison was made between clinical examination, abdominal ultrasonic scan, measurement of conventional liver enzymes (LFTs) and serum hGST A1 concentration in the detection of hepatobiliary abnormalities in children with CF.

Results:

The 5–95% concentration of serum hGST A1 was 1.7–4.27 μg L−1 for the control group. The hGST A1 levels in the CF patients were significantly higher than in the non‐CF group. Thirty‐eight (60%) children had detectable hepatobiliary abnormalities. Ultrasound scanning detected the highest number of abnormalities (41%), followed by hGST A1 (30%). The presence of clinical liver disease was found in 19% of the children. The estimated sensitivities of detecting CFLD by clinical method, ultrasound scan, serum hGST A1, and LFTs would be 32%, 68%, 50% and 16%, respectively.

Conclusions:

Serum hGST A1 measurement increases the sensitivity of detecting hepatic abnormalities when included with clinical and ultrasound evaluation although, in some cases with advanced liver disease, serum hGST A1 may be normal. Conventional liver enzyme tests add little information in the detection of CF liver disease.
Antenatal steroids, condition at birth and respiratory morbidity and mortality in very preterm infants
Authors: EE L , HAGAN R , EVANS S , FRENCH N
Published: November 2003

Aims:

To investigate (1) perinatal factors affecting condition at birth in very preterm infants (23–32 weeks) and (2) the relationship between poor condition at birth and neonatal respiratory morbidity and mortality.

Methodology:

Convenience sample (n=479) drawn from a geographic population inception cohort.

Results:

Antenatal steroid use reduced the risk of pH ≤7.20 [Adjusted Odds Ratio 0.29 (95% CI 0.17,0.50)], one minute Apgar <4 [0.54 (0.33,0.88)], and 5 min Apgar <7 [0.44 (0.23,0.84)]. Gestational age was significantly related to Apgar score but not cord arterial acid‐base status. No other perinatal factor was significant. Poor condition at birth was associated with an increase in the incidence and severity of hyaline membrane disease and death. These effects were lessened in those exposed to steroids.

Conclusion:

Antenatal steroid use is associated with improved condition at birth and reduces the deleterious effects of poor condition at birth on early respiratory morbidity and mortality.
The relationship of age to pathology in pelviureteric junction obstruction
Authors: DEWAN PA , NG KP , ASHWOOD PJ
Published: November 2003

Objective:

To ascertain the age distribution of the different pathological mechanisms which lead to the development of pelviureteric junction obstruction.

Methods:

A series of 165 kidneys in 158 children who underwent pyeloplasty for pelviureteric junction obstruction were reviewed. Those 132 renal units (127 children) with uncomplicated pathology were selected for further study. The operative records were reviewed for the underlying cause of obstruction and the age at operation.

Results:

Obstruction due to extrinsic compression by an aberrant lower pole vessel occurred in an older group (median age 67.3 mo) than those with a narrowing or angulation of the pelviureteric junction (median age 3.1 mo).

Conclusions:

Pelviureteric junction obstruction, secondary to a lower pole vessel presents at an older age. Doppler ultrasonography to detect a lower pole vessel may be of benefit in the management of equivocal cases of pelviureteric junction obstruction, particularly in prenatally diagnosed hydronephrosis.
Clonidine poisoning—an emerging problem: Epidemiology, clinical features, management and preventative strategies
Authors: ERICKSON SJ , DUNCAN A
Published: November 2003

Objective:

To ascertain whether the incidence of clonidine poisoning in children has increased given the probable increase in clonidine use for treatment of childhood behavioural disorders.

Methods:

Cases of clonidine poisoning requiring hospital admission between 1985–95 inclusive were reviewed and demographic data pertinent to each admission were recorded. A literature review was also performed, with particular emphasis on incidence, clinical presentation and management of clonidine poisoning.

Results:

There were 14 cases of clonidine poisoning during the specified period eight cases presenting in the last 2 years. These eight children or their siblings had been prescribed clonidine for behavioural disorders. The most common signs at presentation were alteration of concious state (71%) and bradycardia (50%). Nine children were given activated charcoal while seven cases underwent gastric lavage or induced emesis. Although six children were admitted to intensive care, length of hospital stay was less than 24 h in all cases and all had a favourable outcome.

Conclusion:

We concluded that the incidence of clonidine poisoning had increased over the specified period and that, based on our results, this was likely to be due to an increase in clonidine use in childhood behavioural disorders. Based on our data and that from literature review it was evident that there are inconsistencies in the management of clonidine poisoning and that safety measures, namely packaging and education, are inadequate given the increasing profile of clonidine use.
T cells direct macrophage recruitment and giant cell formation but not proliferation in experimental crescentic glomerulonephritis
Authors: HUANG Xiou Ru , TIPPING Peter G , HOLDSWORTH Stephen R
Published: November 2003

SUMMARY: The role of T cells in directing macrophage recruitment and proliferation and giant cell formation was studied in crescentic glomerulonephritis (GN) in rats. Development of GN was associated with a significant glomerular influx of T cells and macrophages and crescent formation. Multi‐nucleated giant cells (MGCs) were also prominent in glomeruli and most frequently associated with crescents. Their phenotype suggested that they were derived from recently recruited blood monocytes. the majority of glomerular macrophages and MGCs showed evidence of recent proliferation. T cell depletion using anti‐CD5 or anti‐CD4 monoclonal antibodies significantly reduced T cells and macrophage accumulation, crescent formation (anti‐CD5 treated 12 ± 4.0%; anti‐CD4 treated 13 ± 3.0%; control 64 ± 10%; P<0.001) and MGC formation [anti‐CD5 treated 0.06 ± 0.01 cells per glomerular cross section (c/gcs); anti‐CD4 treated 0.06 ± 0.01 c/gcs; control treated 1.2 ± 0.1 c/gcs; P<0.001]. the proliferation index (fraction of cells expressing proliferating cell nuclear antigen) of macrophages and MGCs was not affected by T cell depletion (macrophage proliferation index: anti‐CD5 treated 0.88 ± 0.04; anti‐CD4 treated 0.83 ± 0.02; control 0.85 ± 0.02; MGC proliferation index: anti‐CD5 treated 0.84 ± 0.06; anti‐CD4 treated 0.86 ± 0.04; control 0.90 ± 0.05). These studies demonstrate that glomerular macrophage recruitment, MGC and crescent formation are dependent on T helper cells but proliferation of macrophages and MGCs is independent of T cells. This suggests that the major mechanism for T cell induced macrophage accumulation in crescentic GN is via directing their recruitment rather than their local proliferation. Giant cell formation, which is also predominantly T cell dependent, appears to be independent of their proliferative activity.
DNA fragmentation reduced by antioxidants following ischaemia‐reperfusion in the isolated perfused rat kidney
Authors: KADKHODAEE Mehri , GOBÉ Glenda C , WILLGOSS Desley A , ENDRE Zoltán H
Published: November 2003

SUMMARY: The role of oxygen‐derived free radicals (OFR) in modifying structure and function after ischaemia‐reperfusion (IR) injury was studied in isolated perfused rat kidneys (IPRK). Control kidneys were studied after 20 min of ischaemia followed by 15 or 60 min of reperfusion. the xanthine oxidase inhibitor allopurinol and the hydroxyl radical scavenger dimethylthiourea (DMTU) were used to prevent OFR‐related damage. Morphological injury was assessed in cortex, inner and outer medulla and compared with indices of global renal function (inulin clearance, fractional sodium excretion and renal vascular resistance). Apoptosis was assessed using both morphological criteria and in situ end‐labelling (ISEL) to identify DNA fragmentation. Tubular damage, as evidenced by cellular blebbing, tubular cast formation, epithelial necrosis, and occasional apoptosis, was greatest in the straight proximal tubule and thick ascending limb (TAL) in the outer zone of the outer medulla. Pretreatment with allopurinol or DMTU did not significantly improve renal function. However, structural damage and luminal debris were diminished in allopurinol‐ and DMTU‐treated kidneys. These changes may lead to functional improvement after more prolonged reperfusion. In situ end‐labelling was more frequent in distal tubular epithelial cells after IR than either morphological evidence of apoptosis or necrosis. Decreased ISEL was observed after pretreatment with both allopurinol and DMTU. the data demonstrate that OFR produce DNA damage after IR, increasing ISEL. This probably represents reversible DNA damage rather than incipient apoptosis. Thus, antioxidants reduce or prevent DNA and cellular injury after IR and may reduce functional impairment after prolonged reperfusion.
The effect of 24,25 dihydroxyvitamin D3 on calcium efflux: the role of protein kinase C
Authors: DRANITZKI‐ELHALEL Michal , WALD Hanna , SPRAGUE Stuart , POPOVTZER Mordecai M
Published: November 2003

SUMMARY: 24,25 dihydroxyvitamin D3 (24,25(OH)2D3) is more abundant than 1,25(OH)2D3 in the serum. 1,25 dihydroxyvitamin D3, a potent calciotropic metabolite of vitamin D, has been shown to induce calcium efflux from bone. This action is probably mediated, in part, by protein kinase C (PKC). to determine whether 24,25(OH)2D3 affects calcium flux in bone, neonatal rat calvaria were cultured and the effect of 24,25(OH)2D3 on calcium flux and signal transduction pathways were evaluated. Compared with a control, 24,25(OH)2D3 (108 mol/L) inhibited basal net calcium efflux. 24,25 dihydroxyvitamin D3 also inhibited net calcium efflux induced by the phorbol ester 12 Myristate 13‐Acetate (PMA). Translocation of PKC from the membrane to the cytosolic fraction was rapidly and transiently induced by 24,25(OH)2D3. However, 24,25(OH)2D3 had no effect on cyclic AMP (cAMP) production. In conclusion, 24,25(OH)2D3 has a direct effect on bone by inhibiting net calcium efflux which is probably mediated by the deactivation of PKC.
Physical functional status and factors contributing to disability in Japanese chronic dialysis patients
Authors: OKADA Tomonari , NAKAO Toshiyuki
Published: November 2003

SUMMARY: Four hundred and eight non‐hospitalized chronic dialysis patients were surveyed to evaluate functional status by the modified Karnofsky Performance Scale (KPS), and the correlation of clinical variables with functional status and the factors contributing to disability were assessed. Sixty‐seven patients (16.4%) had a score less than 75, which indicated limited daily activities inside the home. the percentages of diabetic patients significantly increased in those with a low KPS level (P<0.0001). the mean KPS was significantly lower in the older age group, however there were no significant differences in the mean KPS among groups with different duration of dialysis except for between non‐diabetic patients less than 5 years and those longer than 20 years. Serum urea nitrogen, serum creatinine, serum albumin and intra‐dialytic weight gain tended to be lower in patients with a low KPS level. Visual impairment and muscle weakness of the extremities was the most common factor contributing to disability in diabetic patients and non‐diabetic patients scoring less than 75, respectively. In addition, osteoarticular impairment was characteristically associated with disability in non‐diabetic patients. In conclusion, although a great number of chronic dialysis patients maintain a good functional status, there is a small percentage of patients with poor physical activities. the aetiology of poor functional status is multifactorial, and visual impairment for diabetic patients, muscle weakness and osteoarticular impairment for non‐diabetic patients require special attention and efforts to ameliorate various factors which negatively affect functional ability in these patients are needed.
Adequacy of terrestrial fauna surveys for the preparation of Environmental Impact Assessments in the mining industry of Western Australia
Authors: Fraser Jason L. , Thompson Graham G. , Moro Dorian
Published: November 2003

Summary  The Western Australian Environmental Protection Authority has indicated that terrestrial fauna surveys undertaken for the purpose of preparing Environmental Impact Assessment (EIA) are providing inadequate information for decision‐makers to assess development impacts on biodiversity and ecosystems. This study examined the current standard of terrestrial vertebrate fauna surveys undertaken as the basis for preparing an EIA. In the absence of a protocol to assess current standards of terrestrial fauna surveys, ‘best practice’ was defined and quantified through consultation with an ‘expert panel’. Data from fauna surveys contained in 15 recent EIA reports from the Goldfields region of Western Australia were critically examined to determine the extent of compliance with ‘best practice’. The majority of surveys performed poorly against the established criteria. A few reports addressed many of the issues comprehensively, however, at least 50% failed to mention or adequately address a high proportion of criteria considered essential, including searches of government databases, detection of rare/endangered fauna and multiseasonal sampling. All reports failed to employ sufficient trapping effort at both the biotope and landscape scales to adequately assess terrestrial vertebrate fauna biodiversity. These results indicate the need to redress minimum standards for terrestrial fauna surveys in order to meet the expectations of the EIA process.
The medical emergency team: does it really make a difference?
Authors: Cretikos M. , Hillman K.
Published: November 2003

Abstract

Hospital systems are failing the critically ill. This has been well documented in many countries around the world, with detailed reports of suboptimal care prior to intensive care and high rates of serious adverse events, including death. These events are potentially preventable, but insufficient attention has been directed towards developing solutions to these important problems to date.

The medical emergency team (MET) is a system approach that promotes early and appropriate inter­vention in the care of critically ill hospital patients. The benefits of the MET in terms of absolute in‐patient ­mortality and cardiac arrest rates are not yet well‐defined, although preliminary studies are promising.

The MET does provide a potentially beneficial impact on many other aspects of patient care. These benefits include: (i) facilitating an integrated and coordinated approach to patient care across the hospital, (ii) increasing awareness of at‐risk patients, (iii) encouraging early referral of seriously ill patients to clinicians with expertise in critical care and (iv) providing a foundation for quality initiatives for hospital‐wide care of the seriously ill.

The MET also empowers nursing staff and junior medical staff to call for immediate assistance in cases where they are seriously concerned about a patient, but may not have the experience, knowledge, confidence or skills necessary to manage them appropriately. (Intern Med J 2003; 33: 511−514)
Distinct Clinical Features in the Recipients of the Implantable Cardioverter Defibrillator in Taiwan:
Authors: TSAI CHIA‐TI , STEPHEN HUANG SHOEI K. , LIN JIUNN‐LEE , LAI LING‐PING ,   Taiwan ICD Registry Investigators
Published: November 2003

Little information about the ICD is available from the Asian Pacific region. The purpose of this study was to characterize the clinical features in ICD patients in Taiwan and to compare these features with those in patients in the Western populations, mainly the Canadian Implantable Defibrillator Study (CIDS), the Antiarrhythmics versus Implantable Defibrillator (AVID) trial, and the Cardiac Arrest Study Hamburg (CASH) trial. From February 1995 to October 2001, 101 ICDs were implanted in 92 patients (78 [84%] men) in 12 hospitals. Clinical presentations included sudden cardiac death due to VF/VT in 35 (38%) patients, syncopal VT in 25 (27%), drug refractory nonsyncopal VT in 27 (29%), and unexplained syncope with inducible sustained VT/VF in 5 (6%). The mean age was significantly younger than that in CIDS or AVID (59 ± 16 vs 63 ± 9 years in CIDS, P = 0.02; vs 65 ± 11 years in AVID, P < 0.001), but was comparable to that in CASH (59 ± 16 vs 58 ± 11 years in CASH, P = 0.75). The mean LVEF was significantly higher than that in CIDS or AVID (48 ± 19% vs 34 ± 15% in CIDS, P < 0.001; vs 32 ± 13% in AVID, P < 0.001), but was comparable to that in CASH (48 ± 19 vs 46 ± 19% in CIDS, P = 0.83). The ICD patients in the current study also showed a higher incidence of normal heart (23 vs 4% in CIDS, P < 0.001; vs 3% in AVID, P < 0.001; vs 9% in CASH, P < 0.001) and cardiomyopathy (41% vs 10% in CIDS, P < 0.001; vs 15% in AVID, P < 0.001; vs 11% in CASH, P < 0.001), but a lower incidence of coronary artery disease (29% vs 83% in CIDS, P < 0.001; vs 82% in AVID, P < 0.001; vs 73% in CASH, P < 0.001). During a mean follow‐up of 28 ± 24 months, 13 (14%) patients died. Older age was the only factor associated with poorer survival after ICD implantation. Forty‐seven (51%) patients received appropriate ICD discharges during follow‐up. History of prior myocardial infarction was the only factor associated with an earlier first appropriate ICD discharge and LVEF < 0.35 the only factor associated with subsequent poorer survival after the first ICD discharge. In conclusion, this study demonstrated many distinct clinical features in our ICD population that were different from those in the Western populations. (PACE 2003; 26:2083–2090).
Comparison of Automatic Repolarization Measurement Techniques in the Normal Magnetocardiogram
Authors: SMITH FIONA E. , LANGLEY PHILIP , TRAHMS LUTZ , STEINHOFF UWE , BOURKE JOHN P. , MURRAY ALAN
Published: November 2003

Multichannel MCG noninvasively measures cardiac magnetic field strength from many sites at the body surface, potentially providing useful regional information about ventricular repolarization. Previous work on ECGs has shown that automatic techniques for repolarization measurement are better than manual measurement at discriminating patients with cardiac conditions from normal subjects. Although automatic repolarization measurement techniques have been quantified for ECGs, no comparative data exists for the MCG. In this study four different automatic repolarization (QT) interval techniques for detecting T wave end in the MCG were compared. The influence of MCG filtering on the automatic algorithms was also quantified. MCGs were obtained at 49 sites over the heart from 23 normal subjects. Automatic measurements of the repolarization (QT) interval were made following the addition of different high pass (0.25, 0.5, 1 Hz) and low pass (100, 60, 40, 30 Hz) filters. There were consistent differences between automatic techniques in the unfiltered data amounting to greatest mean difference of 52.3 ms. Low pass filtering significantly increased the automatic repolarization (QT) interval relative to unfiltered measurement by 6.5 (3.2) ms (mean SD) for 100 Hz, 6.0 (3.0) ms for 60 Hz, 8.1 (3.2) ms for 40 Hz, and 8.8 (3.1) ms for 30 Hz across all techniques. High pass filtering significantly decreased the value by −2.6 (6.0) ms for 0.25 Hz, −5.5 (5.3) ms for 0.5 Hz, and −17.1 (7.8) ms for 1 Hz. Automatic measurements of repolarization (QT) in the MCG differ between techniques and are influenced by filtering. These effects should be considered when comparing results. (PACE 2003; 26:2096–2102)
Significance of External Cardioversion Induced Atrial Tachyarrhythmias
Authors: BREMBILLA‐PERROT BÉATRICE , BEURRIER DANIEL , HOURIEZ PIERRE , DE LA CHAISE ARNAUD TERRIER , LOUIS PIERRE , NIPPERT MARC , MUHANNA YIAD , SELTON‐SUTY CHRISTINE , SADOUL NICOLAS , ANDRONACHE MARIUS
Published: November 2003

External cardioversion is used to stop VT or VF in emergency. Supraventricular tachyarrhythmias are sometimes noted after cardioversion in patients known to be previously in sinus rhythm. The purpose of the study was to evaluate the significance of supraventricular tachyarrhythmias induced by external cardioversion. The study population consisted of 22 patients who developed supraventricular tachyarrhythmias after transthoracic cardioversion (300 J) delivered to stop a VT or VF induced by electrophysiological study. Defibrillation used monophasic waveform. Supraventricular tachyarrhythmias complicated 6% of cardioversions for VT; before cardioversion, all patients were in sinus rhythm. After cardioversion, three patients developed a paroxysmal reentrant supraventricular tachycardia (PSVT), which was stopped by atrial pacing. The remaining patients developed AF that lasted from 3 minutes to 24 hours (n = 4). One patient remained in AF. AF developed after a sinus pause or bradycardia, which was due to the interruption of VT or VF in nine patients or was noted just when VT or VF stopped (n = 10). The analysis of clinical data indicated that all three patients who presented a PSVT had a history of PSVT. Among patients who developed a sinus pause dependent AF, two had a history of AF. Among ten patients who developed AF at the time of cardioversion, three had a history of AF. During follow‐up (1–9 years), no patient without a history of AF developed spontaneous AF, but patients with history of tachycardias had arrhythmia recurrences. The mechanism of cardioversion related tachycardias can be a pause related dispersion of atrial refractoriness or an adrenergic reaction induced by VT or VF, factors that precipitate arrhythmias in patients with history of atrial arrhythmias (one third of patients). In conclusion, supraventricular tachyarrhythmia is relatively frequent after external cardioversion for ventricular tachyarrhythmia, has no prognostic significance in patients without previous history of atrial arrhythmias, but in those with history of tachycardias is associated with a high risk of recurrence. (PACE 2003; 26:2111–2115)
Permanent Pacemakers:
Authors: HILDICK‐SMITH DAVID J.R. , SATCHITHANANDA DUWARAKAN K. , NEWELL STUART A. , GRACE ANDREW A. , MURGATROYD FRANCIS D. , PETCH MICHAEL C.
Published: November 2003

The aim of this study was to assess if atrial leads whose “J” configuration has straightened significantly on the postprocedural chest X ray should be repositioned. Between January 1996 and December 1997, 445 patients underwent dual chamber pacemaker implantation at the Papworth Hospital. Postprocedural chest X rays were available in 410 of these. The degree of straightening of the tip of the atrial lead was assessed from the lateral chest X ray and was graded as mild (−10 to +10 degrees from the horizontal), moderate (+10 to +30 degrees), or severe (≥+30 degrees). Patients were followed with regard to atrial sensing and pacing characteristics, lead displacements, and lead revisions. Fifty‐two (12%) patients had some degree of straightening (graded mild, moderate, severe) of the atrial lead on the postprocedure chest X ray (passive fixation in 48, active 4). Of these, 12 patients underwent next day lead repositioning, 5 of whom had abnormalities of pacing and/or sensing parameters. Seven patients therefore underwent repositioning of the atrial lead despite normal pacing parameters in view of lead straightening alone. Of the 12 patients who underwent repositioning, 3 still had lead straightening after the second procedure. The cohort for follow‐up consisted of 43 patients (24 [56%] men, age 69 ± 11 years at the time of implant) who were left with significant atrial lead straightening but adequate atrial parameters. Straightening was mild in 26 patients, moderate in 10, and severe in 7 patients. At implant the P wave amplitude was 4.8 ± 2.4 mV. Follow‐up was for 4.8 ± 2.1 years, a total of 178 patient years. At final follow‐up, the P wave amplitude was 2.7 ± 1.3 (P < 0.05 vs implant). Censoring events occurred in 16 cases, comprising 11 deaths (none suspected to be pacemaker or lead related), 3 cases of persistent atrial fibrillation, 1 system extraction for infection, and 1 lead extraction for erosion. There were no cases of inadequate atrial lead sensing or pacing in the remaining patients. Irrespective of the degree of lead straightening on the postoperative lateral chest X ray, atrial leads should not be repositioned unless there are abnormalities of pacing or sensing parameters. (PACE 2003; 26:2142–2145)
Atypical Flutter:
Authors: COSÍO FRANCISCO G. , MARTÍN‐PEÑATO ARTURO , PASTOR AGUSTÍN , NUÑEZ AMBROSIO , GOICOLEA ANTONIO
Published: November 2003

Understanding of typical flutter circuits led the way to the study of other forms of macroreentrant tachycardias of the atria, and to their treatment by catheter ablation. It has become evident that the ECG classification of atrial flutter and atrial tachycardia by a rate cutoff and the presence or absence of isoelectric baselines between atrial deflections is not a valid indicator of tachycardia mechanism. Macroreentrant circuits where activation rotates around large obstacles are the most common arrhythmias found in patients with atypical forms of flutter or atrial tachycardia, especially after surgery for congenital heart disease, however, focal mechanisms can also be found. Large areas of low voltage electrograms, suggestive of severe myocardial damage (fibrosis or infiltration) can be found in many atypical macroreentrant tachycardias at the center of the circuit. Many of these circuits can be mapped precisely, critical isthmuses can be defined, and effective catheter ablation can be performed. The need to match activation maps with anatomy precisely, makes computer assisted, anatomically precise mapping a useful tool. Entrainment techniques have to be used sparingly to avoid tachycardia interruption. In complex cases, ablation can be done in sinus rhythm, after definition of conducting channels between low voltage areas and scars or anatomic obstacles. Long‐term prognosis is uncertain and depends on the underlying pathology. (PACE 2003; 26:2157–2169)
Use of Intracardiac Echocardiography in Guiding Radiofrequency Catheter Ablation of Atrial Tachycardia in a Patient After the Senning Operation
Authors: KEDIA ANITA , HSU PAMELA Y.F. , HOLMES JOANNA , BURNHAM DEE , WEST GAIL , KUSUMOTO FRED M.
Published: November 2003

A patient with D‐transposition of the great arteries developed drug refractory atrial tachycardia 12 years after a Senning operation. Electrophysiological study confirmed the presence of atrial baffle‐tricuspid valve isthmus dependent reentrant intraatrial tachycardia. Intracardiac echocardiography facilitated initial identification of structures, catheter positioning, and identification of the atrial baffle‐tricuspid valve isthmus. (PACE 2003; 26:2178–2180)