bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in cell kinetic changes among renal cancer cell lines treated with interferon‐α
Authors: Kasuya Yutaka , Hosaka Yoshio , Matsushima Hisashi , Goto Toshitaka , Kitamura Tadaichi
Published: March 2003

Abstract Background: Interferon (IFN)‐α shows certain clinical effects on the treatment of renal cell carcinoma. The purpose of the present study was to investigate its direct effects and to compare the responses among different human renal cancer cell lines.

Methods: Three cell lines, ACHN, RCC10RGB and OS‐RC‐2, were incubated with IFN‐α and evaluated using MTT assay for cell proliferation and two‐color flow cytometry for cell‐cycle‐specific cyclin expressions coupled with DNA ploidy analysis.

Results: Interferon‐α inhibited cell proliferation and caused cell accumulation at S and G2/M phases. However, IFN‐α induced no significant change in cyclins D1, E, A or B1 expression. Interestingly, cell kinetic changes caused by IFN‐α were different among cell lines. Cell proliferation was suppressed most in ACHN, then RCC10RGB and least in OS‐RC‐2. Comparing DNA histograms, ACHN showed distinct increase of G2/M cells associated with elevation of late S cells. RCC10RGB showed a predominant increase of whole S cells accompanied with a slight increase of G2/M. OS‐RC‐2 showed a modest increase of S cells with a little change of G2/M cells. Chronological observation revealed that S‐phase increase and proliferative inhibition appeared on day 1 and day 3, respectively, in ACHN and RCC10RGB, and on day 5 in OS‐RC‐2.

Conclusions: Interferon‐α induced substantial cell kinetic interference directly in the tested human renal carcinoma cell lines. The degree of change was different according to the nature of the cell line. It may partly indicate the variety of the efficacy of IFN‐α treatment against renal cancers.
Use of various combinations of free, complexed and total prostate‐specific antigen levels as predictors of the pathologic stage of prostate cancer
Authors: Okegawa Takatsugu , Noda Haruhisa , Ohta Masaya , Kato Moriaki , Nutahara Kikuo , Higashihara Eiji
Published: March 2003

Abstract Background: The efficacy of various combinations of total, free and complexed prostate‐specific antigen (PSA) levels were assessed to predict the pathologic stage of prostate cancer.

Methods: Total PSA (tPSA), free PSA (fPSA) and complexed PSA (cPSA) levels were measured preoperatively in 52 patients with clinical localized prostate cancer who had undergone radical prostatectomy. Pathologic stages were classified as: organ‐confined (n = 27); capsular penetration (n = 14); seminal vesicle involvement (n = 8); involvement of the surgical margins (n = 10); and lymph node involvement (n = 3).

Results: The fPSA/tPSA and fPSA/cPSA ratios significantly differed between patients with organ‐confined disease and non‐organ‐confined disease (P = 0.035, P = 0.033, respectively) and between those with favorable versus unfavorable pathology (P = 0.001, P = 0.014, respectively), but tPSA, cPSA, fPSA and the cPSA/tPSA ratio did not. Using a fPSA/tPSA cutoff level of 11%, the prediction of organ‐confined disease would increase from 52 to 67% and the rate of predicting favorable pathology would increase from 42 to 62%. A fPSA/cPSA cutoff level of 12% would increase the rate of predicting organ‐confined disease to 79% and the rate of predicting favorable pathology would increase to 69%. The positive predictive value of the fPSA/cPSA ratio was higher than that of the fPSA/tPSA ratio, although the receiver operating characteristic curve of the fPSA/cPSA ratio was not different from that of the fPSA/tPSA ratio.

Conclusion: Although there was no predictive difference found between fPSA/tPSA and fPSA/cPSA ratio, both ratios may help predict the pathologic stage of prostate cancer.
Equivalent efficacy of mitomycin C plus doxorubicin instillation to bacillus Calmette‐Guerin therapy for carcinoma in situ of the bladder
Authors: Sekine Hideaki , Ohya Kazuhiro , Kojima Sin‐ichi , Igarashi Kazumasa , Fukui Iwao
Published: March 2003

Abstract Background: To elucidate the most efficient topical therapy for carcinoma in situ of the bladder, the efficacy of intravesical mitomycin C plus doxorubicin therapy was compared with bacillus Calmette‐Guerin (BCG) therapy. The clinical behavior of the tumor was analysed according to the histological grade.

Methods: Forty‐two patients with carcinoma in situ of the bladder were randomized to intravesical BCG (21 patients) or mitomycin C plus doxorubicin sequential therapy (21 patients) as first line treatment. The non‐responders underwent the subsequent instillation of the other intravesical therapy alternately. Of the patients, 27 had grade 2 and 15 had grade 3 cancer.

Results: Both topical therapies were equally effective with initial response rates of 86% (18/21) for BCG and 81% (17/21) for mitomycin C plus doxorubicin, irrespective of the tumor grade. Of seven initial non‐responders, five patients achieved a complete response by subsequent instillation, resulting in a total response rate of 95%. After a mean follow‐up of 47 months, five patients (12%) developed disease progression. The progression rates were not different between the topical therapies, but were significantly higher in grade 3 than in grade 2 cases.

Conclusion: It appears likely that mitomycin C plus doxorubicin instillation has an equivalent efficacy to BCG as the initial therapy of carcinoma in situ and the combination of them would be the most efficient tr eatment for the disease. Moreover, histological grading would be clinically useful in defining the tumor characteristics and behavior of carcinoma in situ of the bladder.
Adrenal cyst: A review of the Japanese literature and report of a case
Authors: Tanuma Yasushi , Kimura Makoto , Sakai Shigeru
Published: March 2003

Abstract Adrenal cysts are a rare condition and are usually non‐functioning and asymptomatic. A 44‐year‐old man was referred from another hospital because a left retroperitoneal tumor was incidentally found by abdominal echography. Laboratory findings including adrenal hormonal study were within the normal range. It showed homogeneously low intensity on T1‐weighted images and high intensity on T2‐weighted images on magnetic resonance imaging (MRI). Angiography demonstrated that the tumor was avascular and of left adrenal origin. The patient was diagnosed with left adrenal cyst and was intensively followed up with plans for examination with diagnostic imaging.
Solitary fibrous tumor of renal pelvis
Authors: Yazaki Tsunetada , Satoh Satoshi , Iizumi Tatsuo , Umeda Takashi , Yamaguchi Yutaka
Published: March 2003

Abstract A 70‐year‐old Japanese man was referred because of a right renal mass of 2 years in duration. Imaging studies, including magnetic resonance imaging, revealed an ovoid mass, with relatively abundant vascularity, in the right renal pelvis. Right radical nephrectomy was done and a tumor measuring 6.0 × 4.5 × 4.0 cm was found in the renal pelvis. Solitary fibrous tumor (SFT) was highly suspected by histology. Immunohistochemical study using a monoclonal antibody directed against the human hematopoietic progenitor cell antigen (CD34) stain confirmed SFT. This is the first case of SFT of the renal pelvis.

Although SFT is extremely rare in urogenital organs, this tumor must be included in the differential diagnosis when we encounter urogenital tumors consisting of mesenchymal elements.
Endoscopic ureteral incision using the holmium:YAG laser
Authors: HIBI HATSUKI , KATO KEITARO , MITSUI KENJI , TAKI TOMOHIRO , YAMADA YOSHIAKI , HONDA NOBUAKI , FUKATSU HIDETOSHI
Published: March 2003

Abstract Background: We reviewed the results of endoscopic ureteral incision for benign ureteral stricture, ureteropelvic junction obstruction and ureteroenteroanastomotic stricture using the holmium laser.

Methods: We carried out endoscopic ureteral incision using the holmium laser through an 8‐Fr semirigid or 6.9‐Fr flexible ureteroscope on 17 ureters in 15 patients. Balloon dilatation was not necessary before insertion of the ureteroscope. The stricture was incised with the holmium laser using a 200–365 μm fiber through the working channel of the ureteroscope. After completion of the incision, a 12‐Fr double‐J catheter was left for 6 weeks. Thereafter patients were followed by renal scan and/or ultrasound and excretory urography at 3–6 month intervals.

Results: The mean operative time was 65 min (18–135 min). The stricture resolved completely in 86.7% of cases at an average follow up of 20.5 months (11–32 months).

Conclusions: The holmium laser endoscopic ureteral incision was associated with a good outcome in our series. We recommend this procedure to be employed initially because it is less invasive and has a favorable outcome.
Prognosis of conservative therapy of advanced interstitial cystitis: Experience of five cases
Authors: YAMADA TETSUO , MURAYAMA TETSUO
Published: March 2003

Abstract Background: It is generally believed that surgical procedures, particularly the more invasive ones, should be reserved for patients who fail to respond to conservative therapy by several established modalities. We studied whether conservative therapy was applicable to patients with interstitial cystitis (IC) in which an individual's awake bladder capacity decreases to 100 mL or less with vesicoureteral reflux (VUR).

Methods: Five cases that satisfied the criteria proposed by the National Institutes of Health were examined. The maximum awake bladder capacity was 50–100 mL (average, 74 mL). The bladder capacity under anesthesia was 70–300 mL (average, 199 mL). Only conservative treatments were carried out.

Results: The observation period ranged from 3 to 16 years with an average of 9 years. The awake bladder capacity ranged from 200 to 300 mL (average, 250 mL). The symptom index total score, which was previously 18.5, decreased to 5.5 and the problem index total score, which was previously 14.3, decreased to 3.5. Symptoms of bladder irritation improved. In four cases, VUR disappeared as the bladder capacity increased. Vesicoureteral reflux persisted in one case although its severity decreased and there was no fever.

Conclusion: The patients treated with conservative therapy were able to maintain an awake bladder capacity that was sufficient for acceptable quality of life and their symptoms of bladder irritation improved. This suggests that we should regenerate the original remaining bladder using conservative therapy, even if IC is in a late stage.
Arterial blood gases in extraperitoneal laparoscopic urethrocystopexy
Authors: Kocoglu Hasan , Goksu Sitki , Erbagci Ahmet , Pirbudak Lutfiye , Yuksek Mustafa Sahin , Oner Unsal
Published: March 2003

Background: The aim of this study was to investigate the effects of extraperitoneal laparoscopy and carbon dioxide insufflation on hemodynamic parameters, arterial blood gases and complications in urethrocystopexy operations.

Methods: Twenty‐five female patients who underwent extraperitoneal laparoscopic mesh urethrocystopexy operation for the correction of urinary incontinence were allocated to the study. Hemodynamic parameters were noted and blood gas analyzes were performed before the induction of anesthesia, 10 min after induction, 5 and 10 min after the beginning of carbon dioxide insufflation, at the end of carbon dioxide insufflation and 30 min after exsufflation.

Results: There was no significant change in mean arterial pressure, peripheral oxygen saturation, arterial carbon dioxide pressure, and arterial oxygen saturation compared to preinsufflation and preinduction values. End‐tidal carbon dioxide pressure did not increase above 45 mm/Hg during carbon dioxide insufflation. Arterial oxygen saturation and partial oxygen pressure did not decrease. Subcutaneous emphysema, pneumothorax, pneumomediastinum and pleural effusion were not noted in any patient.

Conclusion: We conclude that, extraperitoneal laparoscopic urethrocystopexy is not associated with hemodynamic and respiratory impairment.
Kidney autotransplantation in a patient with renal pelvic and bladder carcinomas
Authors: Hayakawa Kunihiro , Ashimine Satoshi , Aoyagi Teiichiro , Miyaji Keisuke , Hata Makoto , Okano Tatsuya
Published: March 2003

A 66‐year‐old Japanese woman, whose left kidney was non‐functioning, was referred to us with a diagnosis of invasive bladder carcinoma and right renal pelvic carcinoma. The latter tumor was clearly packed in the renal calyx and was considered to be of low‐grade malignancy. Nephron preserving surgery of the right kidney was performed, followed by radical cystectomy and construction of an ileal conduit. The postoperative course was good, without significant complications. Renal function was restored and a postoperative imaging study showed a well‐functioning transplanted kidney. At present (20 months after surgery), the patient is doing well and has presented no signs of recurrence of the disease.
Prevalence of snoring and sleep‐disordered breathing in a group of commercial bus drivers in Hong Kong
Authors: Hui D. S. C. , Chan J. K. W. , Ko F. W. S. , Choy D. K. L. , Li T. S. T. , Chan A. T. , Wong K. K. , Lai C. K. W.
Published: March 2003

Objectives: To assess the prevalence of sleep‐­disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong.

Methods: Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at‐home sleep study using the Mesam IV device (Madaus Medizin−Elektronik, Freiburg, Germany).

Results: There were 207 men and nine women (mean age 42.4 ± 7.5 years; body mass index (BMI) 25.4 ± 4.5 kg/m2; ESS 5.3 ± 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring ≥ 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at‐home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) ≥ 5 per hour of sleep, (ii) 21 subjects (41%) had RDI ≥ 10 per hour of sleep, (iii) 12 subjects (24%) had RDI ≥ 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively ≥ 10% of the night. Ten subjects (20%) had RDI ≥ 5 and sleepiness at work, while five subjects (9.8%) had RDI ≥ 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI.

Conclusions: This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self‐reported sleepiness nor the ESS could identify subjects with SDB. (Intern Med J 2002; 32: 149−157)
Aminoglycosides in cystic fibrosis: a descriptive study of current practice in Australia
Authors: Phillips J. A. , Bell S. C.
Published: March 2003

Aim: To determine the diversity of clinical practice with respect to aminoglycosides in cystic fibrosis (CF) units within Australia.

Method: In April 1999, a questionnaire on the use of aminoglycosides was sent to 30 CF units across Australia. Information was collected about drug selection, dosing, monitoring and toxicity with intravenous administration.

Results: Completed surveys were received from 26 of the 30 units (response rate = 86%) and all units with > 40 patients. Tobramycin was the drug of choice in all but two centres where there was equivalent use of gentamicin and tobramycin. The survey demonstrated a trend in recent years to reduce the number of doses per day with 54% of centres prescribing once daily, 23% twice daily and 23% thrice daily regimens. Initial dosing was generally based on mg/kg per day (mean 8.8, range 7.5–10 mg/kg per day). Dosing by infusion occurred in 11 of 14 units using once‐daily dosing and there was equivalent use of bolus and infusion methods for multiple‐daily regimens. Drug monitoring depended on dosing regimen. Units using multiple daily regimens monitored using trough ± peak levels, whereas 50% of units using once‐daily dosing used two postdose levels to alter dose. Actual toxicity, in particular nephrotoxicity, ototoxicity and vestibular toxicity was reported by 19, 27 and 12% of units, respectively.

Conclusion: The prescribing, dosing and monitoring of aminoglycosides in CF across Australia varies greatly. This is likely to be due to a lack of definitive evidence as to the optimum use in this patient group. (Intern Med J 2001; 31: 23–26)
Chemotherapy and granulocyte colony stimulating factor‐mobilized blood cell infusion followed by interferon‐α for relapsed malignancy after allogeneic bone marrow transplantation
Authors: Grigg A. , Kannan K. , Schwarer A. P. , Spencer A. , Szer J.
Published: March 2003

Background: Interferon‐α (IFN) is known to promote graft‐versus‐host disease (GVHD) after allogeneic bone marrow transplantation (allo BMT). This property may also be used to enhance a graft‐versus‐leukaemia effect (GVL) after donor leucocyte infusion (DLI), a mode of therapy increasingly offered to patients relapsing after allo BMT.

Aim: The aims of the present study were to examine the efficacy and toxicity of IFN therapy administered after granulocyte colony‐stimulating factor (G‐CSF)‐stimulated blood cells given as DLI in patients with acute myeloid leukaemia (AML), chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL), acute undifferentiated leukaemia (AUL) and multiple myeloma relapsing after allo BMT.

Methods: Between October 1996 and September 1999, 27 patients (16 AML, four ALL, three CML, three multiple myeloma, one AUL) who relapsed after allo BMT were treated with chemotherapy followed by DLI, collected after G‐CSF stimulation in all but two cases. Subsequently, IFN was given to patients without significant GVHD or rapidly progressive disease. The outcome after DLI with regard to remission rate, disease‐free survival and GVHD was analysed.

Results: Eighteen patients received IFN following DLI, 14 of whom developed significant GVHD (grade II–IV acute or extensive chronic); thereafter, GVHD resolved with cessation of IFN alone in four patients, but 10 required systemic immunosuppression. Twenty‐three patients were given chemotherapy and DLI as initial treatment of relapse; 10 achieved complete remission (CR), in four patients this was only after the onset of GVHD. The other four patients received chemotherapy and DLI as a consolidation of a chemotherapy‐induced remission. The CR was durable only in patients with CML (3 of 3) and AML (4 of 8).

Conclusions: Treatment with IFN induced GVHD in the majority of patients receiving DLI. The induction of GVHD and GVL by this approach produced excellent results in patients with CML and modest results in AML, but appeared to be less effective in myeloma and ALL. (Intern Med J 2001; 31: 15–22)
Urinary symptoms and incontinence in an urban community: prevalence and associated factors in older men and women
Authors: Muscatello D. J. , Rissel C. , Szonyi G.
Published: March 2003

Abstract

Background: There is increasing recognition of the importance of a wide range of urinary symptoms in both men and women and that these symptoms are undertreated.

Aims: To determine the prevalence of and factors associated with urinary symptoms, including nocturia, urgency, urge and stress incontinence and, in men, urinary stream difficulties; and the prevalence of being bothered by the symptoms and ever seeking treatment for them.

Method: Household survey by computer‐assisted telephone interviews of people aged 41 years and over and living in inner metropolitan Sydney.

Results: Fifty‐three per cent (95% confidence interval (CI) 46–60) of men and 61% (95% CI 55–67) of women reported one or more symptoms in the previous month. In men, the most frequently reported symptoms were urgency (30%, 95% CI 24–36) and nocturia (25%, 95% CI 19–31). In women, stress incontinence (35%, 95% CI 29–41) and urgency (33%, 95% CI 27–39) were the most common symptoms reported. In men, the significant factors associated with reporting one or more symptoms, after adjustment for other variables, were age 60 years or more, no private medical insurance, obesity and fair or poor self‐rated health. For women, the significant associations were age 50–59 years, age 70 years or more, no private health insurance, high psychological distress and fair or poor self‐rated health.

Conclusions: Urinary symptoms are experienced by more than half of men and women aged over 40 in the central Sydney community, but many do not seek treatment. Such symptoms should be considered more broadly than the traditional focus on male ‘prostatism’ and female incontinence. (Intern Med J 2001; 31: 151–160)
On patient judgement
Authors: Mcdonald I. G. , Daly J.
Published: March 2003

Abstract

Clinical judgement, the keystone of medical expertise, is a hot topic. By contrast, patient judgement, also of central importance in health care, receives little attention. Patients have the last say concerning whether or not they seek medical treatment for symptoms, follow a doctor’s advice or accept reassurance. Delay in seeking help for serious symptoms, non‐compliance with treatment advice and failure of doctors to reassure many of the ‘worried well’ have long been recognized as serious problems. We argue that what is common to these important problems is patient judgement. Surveys yielding information about the average influence of a large number of individual variables do not do justice to the complex interaction of influences that can influence the judgements of an individual person under particular social circumstances. This is what explains the wide variety of patient reactions. From the medical standpoint, such unpredictable patient behaviour seems irrational. The patient perspective on the meaning of their actions is a hiatus in our knowledge, which is hampering the planning of effective interventions. Too few studies have sought the perspective of patients by asking them why they acted as they did. Thus, the wide spectrum of patient response in these situations in relation to personality, life experience and social context cannot be studied without interpretive field studies that include interview of patients with qualitative interpretation. (Intern Med J 2001; 31: 184–187)
An audit of the use of granulocyte colony‐stimulating factor in septic shock
Authors: Stephens D. P. , Fisher D. A. , Currie B. J.
Published: March 2003

Background: Granulocyte colony‐stimulating factor (G‐CSF) stimulates the production of neutrophils and modulates the function and activity of developing and mature neutrophils. In septic shock, the immune system can be considered one of the failing organ systems.G‐CSF improves immune function and may be a useful adjunctive therapy in patients with septic shock.

Aim: To evaluate the introduction of G‐CSF as an adjunct to our standard treatment for community‐acquired septic shock.

Methods: We performed a prospective data collection and analysis to determine whether the addition of G‐CSF to our standard treatment for community‐acquired septic shock was associated with improved hospital outcome, compared with an historical cohort ofsimilar patients. We included all patients admitted to the Intensive Care Unit (ICU) with community‐acquired septic shock between December 1998 and March 2000. Patients received 300 µg G‐CSF intravenously daily for 10 days in addition to ourstandard treatment for community‐acquired septic shock. G‐CSF was discontinued early if the patient was discharged from ICU before10 days or if the absolute neutrophil count exceeded 75 × 106/mL.

Results: A total of 36 patients with community‐acquired septic shock, an average Apache 2 score of 26.7, and a predictedmortality of 0.79, were treated with G‐CSF from December 1998 to March 2000. Hospital mortality was 31% compared with an historical cohort of 11 similar patients with a hospital mortality of 73% (P = 0.018). In the subgroup of patients with melioidosis septic shock, the hospital survival improved from 5% to 100% (P < 0.0001).No significant adverse events occurred as a result of the administration of G‐CSF.

Conclusion: G‐CSF is a safe adjunctive therapy in community‐acquired septic shock and may be associated with improved outcome. The use of G‐CSF in septic shock should undergo further investigation to define subgroups of patients who may benefit from G‐CSF. The use of G‐CSF in patients with septic shock due to Burkholderia pseudomallei is recommended. (Intern Med J 2002; 32: 143−148)
Management of complicated parapneumonic effusions and thoracic empyema
Authors: Cameron R. J.
Published: March 2003

The optimal management of loculated para­pneumonic effusions and empyema includes breakdown of adhesions to effect drainage of infected pleural fluid. The use of fibrinolytics intrapleurally appears to enhance intercostal tube drainage, reducing the requirement for subsequent surgical mechan­ical debridement. This article discusses the evidence for intrapleural fibrinolytics, their good safety profile and the practicalities of dose and administration. It also reviews early surgical intervention, which may be indicated for medical treatment failure and, some would argue, as a suitable alternative to other medical interventions. (Intern Med J 2002; 32: 408−414)
Beyond angioplasty: novel developments in interventional cardiology
Authors: Lowe H. C. , Burkoff D. , Khachigian L. M. , MacNeill B. D. , Hayase M. , Oesterle S. N.
Published: March 2003

Two specific areas in interventional cardiology have, until recently, remained problematic. First is the emerging issue of the so‐called ‘no option’ patient, considered untreatable by conventional percutaneous coronary intervention (PCI) or surgery. Second is the long‐standing dilemma of restenosis following PCI. Strategies addressing these two critical areas have been the subject of intense research efforts recently. Several important breakthroughs are being made in the important areas of novel revascularization techniques, antirestenotic agents and stent‐based delivery methods. It is conceivable that these novel developments will soon mean that a broader range of patients can be treated, and that the issue of restenosis will now be seriously challenged. (Intern Med J 2002; 32: 470−474)
What is the prognosis of mild normocytic anaemia in older people?
Authors: Wilkinson T. J. , Warren M. R.
Published: March 2003

Abstract

Background:  There is reduced survival for people with all types of anaemia and it has been shown that there is a low yield from investigations for older people with normocytic anaemia. However, the longer‐term outcomes of people with mild normocytic anaemia are not known.

Aims:  To determine the 5‐year prognosis of older people with mild normocytic anaemia, compared with non‐anaemic controls.

Methods:  This was a prospective cohort study, with some retrospective data collection, comparing 52 people aged ≥65 years (haemoglobin 100−119 g/L; mean cell volume 80−99 fL) without an obvious cause at presentation with 52 non‐anaemic controls. The incidence of death, new malignancies and significant illnesses was compared between the two groups, 5 years later.

Results:  Anaemic patients were less likely to be living at home at baseline. Although survival was lower for the anaemic group at all follow‐up times, these differences were not significantly different. Over 5 years, there were no significant differences between groups in the types of problems that developed.

Conclusions:  A mild normocytic anaemia in older people, in the absence of an obvious cause, is not associated with significant differences in outcomes but is associated with poorer independence and a trend to lower survival. We suggest it may therefore be a marker of frailty in older people. (Intern Med J 2003; 33: 14−17)
Resistance of Rotala indica Koehne var. uliginosa Koehne to sulfonylurea herbicides
Authors: BLANCAVER MA. ESTELA A. , ITOH KAZUYUKI , USUI KENJI
Published: March 2003

The present paper aims to quantify the degree of resistance development in Rotala
indica Koehne var. uliginosa Koehne to sulfonylurea (SU) herbicides based
on whole plant responses. Seeds of resistant (from Omagari City, Akita Prefecture,
Japan) and susceptible (from Tsukuba City, Ibaraki Prefecture, Japan) R. indica
plants were seeded in 200 cm2 pots. The plants, at the 1.5 leaf stage,
were blanket‐applied with different rates of three sulfonylurea herbicides: bensulfuron
methyl (BSM), pyrazosulfuron ethyl (PSE) and imazosulfuron (ISN). Of the three herbicides,
the weed appears to have developed the highest degree of resistance to BSM. The resistant/susceptible
(R/S) values based on mortality, root length and dry weight are consistently highest
at 197, 157 and 101, respectively. Responses based on shoot length, however, showed
a higher R/S value for PSE. Roots of R. indica are more sensitive to higher
rates of SU herbicides than the shoots. Indeed, a high degree of resistance to SU
herbicides have evolved in R. indica, for which the recommended field rates are not enough for effective control of the weed.
Intra‐specific variation in morphological characteristics and growth habitat of newly and accidentally introduced velvetleaf (Abutilon theophrasti Medic.) into Japan
Authors: KUROKAWA SHUNJI , SHIMIZU NORIHIRO , UOZUMI SUNAO , YOSHIMURA YOSHINORI
Published: March 2003

The source of the velvetleaf spreading its distribution rapidly and causing serious problems in forage fields all over Japan since the mid 1980s was thought to be a new accidental introduction of seeds from velvetleaf mingled in some imported grains from the USA and Australia. However, velvetleaf used to be cultivated as a fiber crop until the 1880s. We examined the intraspecies variations, such as morphological characteristics and growth habits, using accessions previously collected and obtained from imported grains. Using principal component analysis (PCA), the accessions were classified into crop type and weed type. The crop type capsule was mostly an ivory color, and the weed type was mostly an ebony color. The crop type showed characteristics of a fiber crop, such as an erect form, uniform flowering and a low seed dormancy rate. Conversely, the imported grains were classified into the weed type which showed a strong weedy nature, such as branched form, long flowering period, high reproductive ability and a high dormancy rate. These results suggest that the new introduction is different from the indigenous fiber crop, and may possibly be the source of the present invasive velvetleaf because of its strong weedy nature. However, further studies comparing the new introduction directly with the present velvetleaf are necessary.
Respiratory function in children during recovery from neuromuscular blockade
Authors: WITHINGTON DAVINIA , DAVIS G. , VALLINIS PETER , DEL SONNO PINA , BEVAN JOAN
Published: March 2003

Residual neuromuscular blockade is a major risk factor for respiratory insufficiency. We examined the relationship between neuromuscular and respiratory function in 18 ASA I or II children aged 2–4 years. Lung function was measured by pneumotachography and transpulmonary pressure, neuromuscular transmission by first twitch response ratio (T1:T1) and train‐of‐four ratio (TOFR), before and at specific points in recovery from vecuronium paralysis. The tidal volume was directly related to maximal inspiratory pressure at occlusion (PIocc), P<0.001, whereas the minute ventilation (VE) was related to the respiratory drive (P0.1), P<0.001. The best predictors of minute ventilation were the P0.1 (r=0.57), and the TOFR (r=0.62). PIocc and P0.1 correlated closely (r=0.889, P=0.002) but TOFR and T1:T1 did not correlate with either. Our results show that the occlusion pressure measurements, P0.1 and PIocc, were good predictors of both VE·kg−1 and respiratory work.
Oliguria during corrective spinal surgery for idiopathic scoliosis: the role of antidiuretic hormone
Authors: Cregg Nuala , Mannion David , Casey William
Published: March 2003

Patients undergoing surgery for idiopathic scoliosis were studied to determine the incidence and aetiology of oliguria during the perioperative period and to evaluate the efficacy of low dose dopamine in preventing its occurrence. Thirty patients, aged 6–18 years undergoing elective surgery were studied. Anaesthesia was standardized. Patients were randomized to receive either dopamine infusion (3 μg·kg−1·min−1) (Group A) (n=15) or dextrose infusion (control) (Group B) (n=15). Serum and urinary electrolytes and osmolalities and serum antidiuretic hormone (ADH) concentrations were measured. Urine output and haemodynamic parameters were recorded. Intraoperative oliguria occurred in 7% of patients in Group A and 47% in Group B (P < 0.05). Postoperative oliguria occurred in 20% of patients in Group A and 47% in Group B (P > 0.05). Urine and serum biochemical analysis revealed a statistically significant decrease in serum sodium and osmolality (P < 0.005) and an increase in urinary sodium and osmolality in both groups. Serum ADH concentrations were increased in both groups (P < 0.05), returning to baseline 18 h postoperatively. We conclude that oliguria during corrective spinal surgery occurs in association with excess ADH secretion as opposed to perioperative hypovolaemia. Dopamine increases urine output in the perioperative period but does not prevent the release of ADH and its subsequent biochemical effects.
The epidural dorsomedian septum as a possible cause for unilateral anaesthesia in an infant
Authors: Finkel Julia C.
Published: March 2003

Unilateral epidural anaesthesia occurring in an infant is reported. An epidurogram revealed the presence of a midline structure suggestive of the dorsomedian septum. Epidural anatomy is reviewed and implications for threading epidural catheters in infants are discussed.
A comparison of two concentrations of bupivacaine and adrenaline with and without fentanyl in paediatric inguinal herniorrhaphy
Authors: Joshi Wandana , Connelly Neil R. , Dwyer Michael , Schwartz Donald , Kilaru Prasad R. , Reuben Scott S.
Published: March 2003

This study was designed to determine whether administration of caudal bupivacaine with fentanyl would have any effect on analgesia in paediatric patients undergoing inguinal herniorrhaphy repair. Fifty‐six outpatient paediatric patients undergoing inguinal hernia repair were evaluated. Patients received, in a randomized manner, 1 ml·kg−1 of either bupivacaine 0.25% or 0.125% with or without fentanyl 1 μg·kg−1. There was no difference in pain scores in the hospital, the night of surgery, or 24 h postoperatively nor was there a difference in the oral analgesics administered between any of the groups. There was a higher incidence of vomiting at home in both 0.25% bupivacaine groups irrespective of the use of fentanyl. The 0.125% bupivacaine group had significantly more patients who received intravenous fentanyl in the PACU than did the other three groups (P<0.001). Increasing the concentration of bupivacaine from 0.125% to 0.25% increased the incidence of postoperative vomiting. We recommend that clinicians utilize bupivacaine 0.125% with 1 μg·kg−1 fentanyl as the caudal injectate in paediatric patients undergiong inguinal hernia repair.
Brachial plexus birth injuries: anaesthesia for surgical nerve reconstruction and preoperative myelography and computed tomographic myelography
Authors: Hazama Ayako , Kinouchi Keiko , Kitamura Seiji , Fukumitsu Kazuo
Published: March 2003

Surgical nerve reconstruction for brachial plexus birth injuries and preoperative myelography and computed tomographic (CT) myelography require special anaesthetic considerations. Anaesthesia and medical records were retrospectively reviewed for the infants who underwent myelography, CT myelography (n=37) and microsurgical nerve reconstruction (n=34) at our institution from January 1993 to August 1996. Anaesthetic considerations include long duration of operation, perioperative respiratory complications and plaster application which makes reintubation difficult. Myelography for diagnosis requires a specific positioning of the patient with the head fixed in a midline and prone position.
Localized tracheomalacia as a complication of the Cole tracheal tube
Authors: Brewis C. , Pracy J.P. , Albert D.M.
Published: March 2003

The Cole tracheal tube is designed for use in neonates. Subglottic stenosis is a recognized complication of prolonged use of the tube. We report a case of tracheomalacia as a further complication of prolonged use of the tube. A 4‐month‐old infant with a history of repeated failed extubation and multiple medical problems was found to have an unusual region of severe inspiratory collapse localized to the upper 1 cm of the trachea. This was felt to be the result of pressure from the shoulder of the Cole tube which had been used for prolonged intubation. A tracheostomy was performed to bypass the collapse, but the infant subsequently died due to other medical problems.
Outcomes after single injection caudal epidural versus continuous infusion epidural via caudal approach for postoperative analgesia in infants and children undergoing patent ductus arteriosus ligation
Authors: LIN YUAN‐CHI , SENTIVANY‐COLLINS SANDRA K. , PETERSON KRISTI L. , BOLTZ M. GAIL , KRANE ELLIOT J.
Published: March 2003

Adequate postoperative analgesia enhances deep breathing and minimizes respiratory complications after thoracotomy. This study compares postoperative outcomes after single injection caudal epidural vs continuous infusion epidural via caudal approach for postoperative analgesia in infants and children undergoing thoracotomy for patent ductus arteriosus (PDA) ligation. A retrospective chart review was performed for 27 children who had undergone PDA ligation. The children were divided into three groups. We compared patient demographics, surgical duration, anaesthesia duration, length of ICU stay, incidence of emesis requiring treatment, time required to establish regular oral intake, requirement for supplemental intravenous opioids during the first postoperative day, and length of hospital stay. For paediatric patients undergoing PDA ligation, postoperative analgesia with continuous infusion epidural via caudal approach produced shorter ICU stay, less occurrence of postoperative emesis, earlier oral intake, elimination of intravenous opioid supplementation, and shorter hospital stay compared with single injection caudal epidural techniques.
Laparoscopic fundoplication in children: anaesthetic experience of 51 cases
Authors: Rowney David A. , Aldridge Louise M.
Published: March 2003

We report the anaesthetic management and outcomes of our first 51 laparoscopic fundoplications. Case records of the 50 patients (one redo), median age 6 years (5 months to 20 years), were reviewed. Median duration of anaesthesia was 120 (60–300) min. During the procedure, the heart rate and blood pressure increased by more than 20% over baseline in 18% and 12% cases, respectively. Median increase in P ECO2 was 1.0 (0.3–2.3) kPa [7.6 (2.3–18) mmHg]. After surgery, all but one of the patients were managed on a normal surgical ward. Postoperative analgesia requirement was oral or rectal analgesics in 89% of patients and ceased within 48 h of surgery in 95% patients. Median time to discharge home from day of operation was 2 (
1–9) days. We conclude that laparoscopic fundoplication in children is well tolerated, there is no requirement for routine postoperative high dependency care and analgesic requirements are minimal.
Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane
Authors: Cravero Joseph , Surgenor Stephen , Whalen Kate
Published: March 2003

This study was designed to compare the emergence characteristics of sevoflurane with halothane anaesthesia in paediatric patients having no surgical intervention. We randomized 32 ASA I or II paediatric outpatients scheduled for magnetic resonance imaging scans to receive either halothane or sevoflurane anaesthesia. The primary outcome measure was the percentage of patients with emergence agitation, as defined by two different criteria. Time to discharge from the postanaesthesia care unit (PACU) and the secondary recovery unit (SRU) were compared. Sevoflurane patients had a greater incidence of emergence delirium when a high threshold for agitation was defined (33% vs. 0%, P = 0.010) and a lower threshold for agitation was applied (80% vs. 12%, P < 0.0001). Discharge times from the PACU and the SRU were not different. We conclude that there is an increased incidence of emergence agitation with sevoflurane anaesthesia compared to halothane independent of any painful stimulus.
Parental opinions regarding the route of administration of analgesic medication in children
Authors: Seth N. , Llewellyn N.E. , Howard R.F.
Published: March 2003

Parents were asked about the acceptability of different routes of administration of analgesia for their children. Their opinions were also sought regarding the need for consent and of the sources and quality of information provided to them perioperatively. Questionnaires before and after surgery were administered to 150 consecutively recruited parents. The majority (58%) of parents considered the rectal route to be the most unpleasant way of giving medication, compared to 19% for intramuscular and 11% and 9% for intravenous and oral, respectively. Over 70% thought additional consent, either verbal or written, is not necessary for administering medication by any route. The best information was received verbally in the opinion of 90%. Contrary to expectations, the rectal route was the most unpopular of all in this study. Parents’ limited knowledge and experience may be important determining factors. Despite their negative opinions, parents did not consider separate consent necessary for the rectal or any other route.
Assessment of pain by parents in young children following surgery
Authors: Morgan Joanna , Peden Vanessa , Bhaskar Kanta , Vater Mair , Choonara Imti
Published: March 2003

Background: We asked parents to assess pain in young children following surgery.

Methods: Assessments were carried out by both parents and an independent assessor using a behavioural observational scale.

Results: Forms were returned from the parents of 42 children aged 1–5 years. There were 123 joint assessments and there was a strong correlation between the scores by the observer and the parents (r2=0.84). Twenty‐nine children experienced pain following discharge from hospital.

Conclusions: Our findings suggest that parents can assess pain in young children following surgery. The management of pain following discharge from hospital can be improved.
Continuous axillary block for upper limb surgery in a patient with epidermolysis bullosa simplex
Authors: Diwan Rishi , Vas Lakshmi , Shah Tejal , Raghavendran Sreekrishna , Ponde Vrushali
Published: March 2003

We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4‐year‐old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g·dl–1 and blood chemistry was normal. She had no history of oral bullae, although a younger sibling had died of Bart syndrome with oral lesions. She was sedated with nasal midazolam 0.5 mg·kg–1. All pressure points were cushioned. Inhalational anaesthesia was given by holding a mask above her face. Only oximetry and capnography were monitored. ECG and noninvasive blood pressure monitoring were avoided. The intravenous cannula was fixed by sutures. An epidural catheter of 0.63 mm OD (21‐G) was passed into the axilla for continuous axillary block. Intra‐ and postoperative course was uneventful with slight bullae at the i.v. site and at the fixator which healed without further damage. The axilla remained free of problems. Continuous peripheral plexus or nerve blocks can be an option in these difficult patients, and can minimize the amount of general anaesthesia along with problems of airway handling and potential subsequent mucosal lesions. The postoperative period was pain free and comfortable.
Caffeine intoxication in a premature neonate
Authors: Ergenekon Ebru , Dalgiç Nazan , Aksoy Erhan , Koç Esin , Atalay Yildiz
Published: March 2003

Caffeine, which has a wide range between therapeutic and toxic levels, is a widely used medication for prevention and treatment of apnoea of prematurity. Despite its safety, caffeine overdose and intoxication has been previously reported in the literature. We present a 30‐day‐old 28‐week preterm newborn who was exposed to 300 mg·kg–1 caffeine base by mouth accidentally. The patient exhibited agitations, irritability, tachycardia, tachypnoea, diuresis, electrolyte abnormalities, hyperglycaemia and metabolic acidosis, for which he received supportive treatment. No seizure activity was observed. The effects of intoxication lasted for 96 h and then completely resolved.
‘D‐shaped’ and ‘reverse‐D‐shaped’ pupil in a cat with lymphosarcoma
Authors: Nell  , Suchy
Published: March 2003

A 7‐year‐old female spayed European shorthair cat was presented because of visual reduction and a green reflex in the right eye. Examination revealed a ‘D‐shaped’ pupil in the right eye and a ‘reverse‐D‐shaped’ pupil in the left eye. Both eyes showed fibrinous anterior uveitis with exudates in the anterior chamber and precipitates on the posterior surface of the cornea. In both eyes a chorioretinitis was diagnosed which caused partial retinal detachment and peripapillary oedema in the left eye. Histopathology revealed intestinal and ocular lymphosarcoma. The aberrant pupil shapes which persisted after death were due to infiltration of the iris stroma and were not caused neurologically. The observation that in both eyes only the medial parts of the iris were affected could not be explained.
Antioxidant profile of cataractous English Cocker Spaniels
Authors: Barros  , Angelotti  , Nobre  , Morales  , Fantoni  , Barros
Published: March 2003

Cataracts have been attributed to oxidative injury in proteins and lipids. Primary defenses that directly protect the lens against oxidative damage include small molecule antioxidants (vitamin C, vitamin E, glutathione and carotenoids) and antioxidant enzymes (superoxide dismutase, catalase, and the glutathione enzyme systems – glutathione peroxidase, glutathione reductase and glucose‐6‐phosphate dehydrogenase). In humans, low plasmatic levels of vitamin C, vitamin E and carotenoids have been associated with a high risk of senile cataracts. Dogs are more prone to develop cataracts. A decrease in antioxidant defenses could be responsible for increased lens oxidation and cataract development. In this study we report the levels of erythrocytic enzymatic antioxidants (superoxide dismutase, catalase, glutathione peroxidase and glucose‐6‐phosphate dehydrogenase) and plasma vitamin C as well as malondialdehyde, in normal and cataractous English Cocker Spaniel dogs. Plasma vitamin C levels were consistently lower in cataractous dogs (20.17 μm ± 8.2 μm) when compared with normal dogs (24.1 μm ± 9.4 μm). These results indicate a possibly decreased synthesis in vitamin C, leading to lower aqueous humor levels of this vitamin. Considering that vitamin C levels in the aqueous humor may be responsible for lens antioxidant maintenance, and that these levels are obtained from plasma secretion through the ciliary epithelium, decreased plasma levels may indicate a decrease in the antioxidant capacity of the aqueous humor.