bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of urethral recurrence found 15 years after radical cystectomy
Authors: Sakai Naoki , Yamada Tetsuo , Asao Takeshi , Murayama Tetsuo
Published: March 2003

Purpose
: A case of a urethral recurrence found 15 years after radical cystectomy is reported.

Methods/Results
: A 78‐year‐old man, who had undergone radical cystectomy at age 63, presented with urethral bleeding and positive cytology in urethral washing. The urethra was surgically resected. Pathologic examination revealed transitional cell carcinoma located in the distal and mid portion of the penile urethra.

Conclusion
: Evidence suggested that urethral recurrence resulted from the implantation from the primary bladder tumor; in addition, the urethral neoplasm had scarcely grown in the penile urethra for 15 years.
Laparoscopic removal of gonads in a Turner's syndrome mosaic female patient with isodicentric Y chromosome
Authors: Kawabata Gaku , Sato Michiaki , Okamoto Yasuyuki , Mizuno Yoshihito , Akematsu Tomotoshi , Okada Hiroshi
Published: March 2003

Abstract We report a case of laparoscopic adnexectomy in a prepubertal girl with an isodicentric Y chromosome and mosaic Turner's syndrome. This is the second reported case of laparoscopic adnexectomy in such patients.
Chromosomal variants among 1790 infertile men
Authors: Nakamura Yoshihiro , Kitamura Masaya , Nishimura Kenji , Koga Minoru , Kondoh Nobuyuki , Takeyama Masami , Matsumiya Kiyomi , Okuyama Akihiko
Published: March 2003

Abstract
Background:
The largest cytogenetic survey involving infertile men was undertaken to clarify whether chromosomal abnormalities, including autosomal abnormalities, affect semen qualities.

Method:
All male patients who visited an infertility clinic from 1990 to 1998 underwent chromosomal and semen analysis.

Results: Chromosomal abnormalities were found in 225 of 1790 patients (12.6%). The most frequent anomaly was Klinefelter syndrome (64 cases). Autosomal anomalies accounted for 126 cases. 46,XY,1qh(+) was the most common autosomal anomaly (30 cases) and its incidence was significantly higher than those of normal controls. The seminograms of these patients varied widely, with nine patients having azoospermia and three patients achieving natural pregnancies. It is not yet clear if this karyotype affects spermatogenesis.

Conclusion:
Autosomal anomalies as well as sex chromosomal abnormalities might affect spermatogenesis. Cytogenetic study is important before intracytoplasmic sperm injection.
Penile schwannoma
Authors: Sato Daisuke , Kase Takahisa , Tajima Masaharu , Sawamura Yoshikatsu , Matsushima Masahiro , Wakayama Megumi , Kuwajima Akira
Published: March 2003

Abstract Schwannoma of the penis is extremely rare. A 65‐year‐old man presented with a subcutaneous tumor of penile shaft without any other symptoms. Histopathologic examination of the excised tumor revealed benign schwannoma. No recurrence has been observed over the 6 months since the surgery.
One‐stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap
Authors: Hayashi Yutaro , Sasaki Shoichi , Kojima Yoshiyuki , Maruyama Tetsuji , Tozawa Keiichi , Mizuno Kentaro , Kohri Kenjiro
Published: March 2003

Background: Transverse preputial tubularized island flap (TPTIF) urethroplasty has been used for the repair of moderately severe hypospadias since Duckett described the procedure in 1980. In spite of the excellent results reported by Duckett, subsequent studies showed high complication rates. A TPTIF procedure modified to reduce the complication rate is presented.

Methods: Between 1996 and 1997, 13 boys with moderately severe hypospadias were repaired with the TPTIF procedure. Patient age ranged from 10 months to 3 years with an average age of 23 months. To prevent urethrocutaneous fistula, the neourethra was constructed with a two‐layer closure and the portion of anastomosis was wrapped between the native urethra and the neourethra with the tissue of the corpus spongiosum.

Results: The moderately severe hypospadias was repaired without complication in 12 of 13 patients. A urethrocutaneous fistula developed at the midshaft of the penis in one patient. No meatal stenosis, urethral stricture or diverticulum developed.

Conclusion: Transverse preputial tubularized island flap urethroplasty provided excellent cosmetic and functional results for moderately severe hypospadias, and postoperative complications could be decreased by the two‐layer closure of the neourethra and application of the wrapping technique of the proximal anastomosed portion with corpus spongiosum tissue.
Simultaneous bilateral laparoscopic adrenalectomy in ACTH‐independent macronodular adrenal hyperplasia
Authors: Shinbo Hitoshi , Suzuki Kazuo , Sato Takashi , Kageyama Shinji , Fujita Tomomi , Fujita Kimio
Published: March 2003

Laparoscopic surgery for urological conditions has now become popular worldwide. The case is reported of a 56‐year‐old woman who underwent simultaneous bilateral laparoscopic adrenalectomy for adrenocorticotropic hormone‐independent macronodular adrenocortical hyperplasia (AIMAH), followed by autotransplantation of resected adrenal gland fragments. Simultaneous laparoscopic adrenalectomies seem feasible for a patient with AIMAH because of its minimally invasive nature. However, autotransplantation of adrenal fragments failed in this patient with AIMAH.
GnRH analog, leuprorelin acetate, promotes regeneration of rat spermatogenesis after severe chemical damage
Authors: Udagawa Koichi , Ogawa Takehiko , Watanabe Takeshi , Yumura Yasushi , Takeda Mitsumasa , Hosaka Masahiko
Published: March 2003

Background:

Future fertility is a major concern for cancer patients who undergo intensive chemotherapy. There has been controversy about whether hormonal treatments may have protective effects against the severe spermatogenic damage caused by chemotherapy or irradiation. Recently, it has been proposed that gonadotrophin‐releasing hormone (GnRH) analogs administered after testicular damage stimulate the recovery of spermatogenesis. In this study, we have investigated the effects of GnRH agonist, leuprorelin, on the damage to spermatogenesis induced by busulfan.

Methods:

Fisher rats were treated with busulfan, 25 mg/kg, intraperitoneally. The effects of subcutaneous injections of leuprorelin before or after treatment were evaluated histologically 18 weeks later.

Results:

The percentage of ‘recovered’ seminiferous tubules was 27.7 ± 12.6% in control rats without leuprorelin and 26.9 ± 10.2% in rats with leuprorelin injected 4 weeks before busulfan. Rats in both groups showed poor recovery of spermatogenesis with an increase of intratesticular fluid. However, rats treated with leuprorelin three times (4 weeks apart) after busulfan showed an improvement of up to 56.5 ± 12.0% (P < 0.05). A focal but massive necrotic lesion in the testis was observed only in this group of rats.

Conclusions:

The results demonstrated that leuprorelin administered after chemical testicular damage enhanced the recovery of spermatogenesis. At the same time, a possible significant side‐effect of leuprorelin was noted.
Report of a 45, X male with monoorchism and distal hypospadias
Authors: Zhou Yun , Zhang Ya , He Jun
Published: March 2003

We present the rare case of a 5‐year‐old boy with a 45, X karyotype. The boy’s family pedigree analysis was unremarkable. On admission, he was 97.4 cm tall (2.0 SD below normal references) and weighed 13.9 kg (1.0 SD below normal references). Mild mental retardation was suspected on the PPVT scale. Physical examination revealed a well‐developed penis with subglanular hypospadias. His left testis was located well down at the bottom of the scrotum and the right testis was impalpable. Unilateral testicular agenesis and persistence of müllerian remnants within the hernia sac were noted on the previous records of inguinal exploration on the right side. The left testis was biopsied through a scrotal incision and prepubertal testicular tissue was confirmed. No ovary was found on laparotomy exploration. Hypospadias was repaired with meatal advancement and glanuloplasty (MAGPI) urethroplasty. His postoperative course was uneventful. Our report represents a rare case of a boy with a 45, X karyotype. Current theories for testicular development were reviewed.
Clinical study of transitional cell carcinoma of the prostate associated with bladder transitional cell carcinoma
Authors: HONDA NOBUAKI , YAMADA YOSHIAKI , OKADA MASAKI , AOKI SHIGEYUKI , KAMIJYO AYUMI , TAKI TOMOHIRO , MITSUI KENJI , HIBI HATSUKI , FUKATSU HIDETOSHI
Published: March 2003

Abstract Background: Transitional cell carcinoma of the prostate in patients with bladder cancer appears to influence the prognosis and affects the decision about therapeutic modality. Therefore, it is important to characterize transitional cell carcinoma associated with bladder cancer.

Methods: From April 1980 to December 1998, 81 male patients underwent total cystoprostatectomies for transitional cell carcinoma of the bladder. The 81 cystoprostatectomy specimens were examined to clarify the characteristics of prostatic involvement by transitional cell carcinoma. The extent, origin, mode of spread and risk factor of prostatic involvement as well as the prognosis were investigated. In 13 of 15 patients with prostatic involvement the prostate was examined by sequential step sections.

Results: Prostatic involvement was observed in 15 of 81 patients (18.5%). Prostatic
urethral involvement, invasion to prostatic duct/acinus, prostatic stromal invasion
and extraprostatic extension and/or seminal vesicle involvement were recognized in
12 (80%), 14 (93.3%), six (40%), and five (33.3%)
of the 15 patients, respectively. Twelve of the 15 patients (80%) with prostatic
involvement had papillary or non‐papillary tumors (i.e. carcinoma in situ)
both in the prostatic urethra and prostatic duct. In 10 of these 12 patients (88.3%),
there was contiguity between prostatic urethral and ductal tumors. Seven of the 23
patients (30.4%) with carcinoma in situ of the bladder showed prostatic
involvement, which increased to 50% in the presence of carcinoma in situ of the trigone or bladder neck.

Conclusions: Eighty per cent of the patients with prostatic involvement showed papillary or non‐papillary tumors both in the prostatic urethra and prostatic duct. There was a high level of contiguity between both tumors. Patients with carcinoma in situ of the trigone or bladder neck revealed significantly higher incidence of prostatic involvement.
Polytetrafluoroethylene patch sling for type 2 or type 3 stress urinary incontinence
Authors: YAMADA TAKUMI , KAMATA SHIGEYOSHI , NAGAHAMA KATSUSHI , ICHIYANAGI NOBUTAKA , HORIUCHI SUSUMU , SAITOH HIROSHI
Published: March 2003

Abstract Background: Surgical success rates and complications of anti‐incontinence surgery were evaluated according to the type of stress incontinence and the type of surgery.

Methods: From 1989 to 1998, we treated 137 women for stress urinary incontinence with anti‐incontinence surgery. Of the 137 patients, 110 had type 2 stress urinary incontinence and 27 had type 3 stress urinary incontinence. Of 110 patients with type 2 stress urinary incontinence, 57 underwent pubovaginal sling procedure and 53 were treated with the Gittes procedure. All of the patients with type 3 stress urinary incontinence underwent the pubovaginal sling procedure.

Results: Cure rates with the pubovaginal sling procedure were 82% in type 2 incontinence and 70% in type 3 incontinence. Cure rates with the Gittes procedure were 56%. The occurrence of de novo urge symptom and pelvic pain was low and bore no relation to either operative method or type of stress incontinence.

Conclusions: The pubovaginal sling procedure using the polytetrafluoroethylene patch was effective for type 2 or 3 stress urinary incontinence.
Endoscopic partial cystectomy for bladder leiomyoma using retroperitoneoscopic and transurethral procedures
Authors: MUROTA TAKASHI , KOMAI YOSHIHIRO , DANNO SHOZO , FUJITA ICHIRO , KAWAKITA MUTSUSHI , MATSUDA TADASHI
Published: March 2003

Retroperitoneoscopic partial cystectomy was performed to remove a leiomyoma in the right wall of the bladder in a 58‐year‐old man. The tumor was initially circumscribed with a mucosal incision using a transurethral resectoscope, and once the bladder wall had been penetrated with the resectoscope, the remaining procedures were performed retroperitoneoscopically. The bladder wall was closed using a retroperitoneoscopic suturing technique. Endoscopic partial cystectomy using both a transurethral incision and a retroperitoneoscopic resection is technically feasible in the treatment of small bladder tumors.
Stable maintenance of 5α‐reductase activity in long‐term subcultures of fibroblasts derived from the foreskin
Authors: Nakae Kazumi , Tsuji Motomu , Kuraoka Tetsuro , Cho Sooilu , Cunha Gerald R. , Shima Hiroki
Published: March 2003

Background: There is up to a 50‐fold variation in control subjects in current assays of 5α‐reductase activity which makes interpretation difficult. It was therefore attempted in this study to establish an assay method which produced stable 5α‐reductase activity in long‐term subcultured foreskin fibroblasts.

Methods: Foreskin fibroblasts were obtained from three boys with phimosis (control subjects), three patients with Reifenstein syndrome and one patient with 5α‐reductase deficiency (due to mutation L113P in exon 2 of the SRD5A2 gene). To maximize the number of cells in the DNA synthesis phase, cells were subcultured consistently to approximately 70% confluency. Thawed cells, frozen after the third subculture, were incubated for 24 h with [1β,2β‐3H] testosterone. 5α‐Reductase activity was expressed as the sum of formed [3H] 5α‐reduced metabolites (separated by thin‐layer chromatography).

Results: The full range of 5α‐reductase activity in controls and patients with Reifenstein syndrome was 3.44–15.59 pmol/h per mg protein: a 4.53‐fold variation. The activity in the patient with 5α‐ reductase deficiency was 0.52 pmol/h per mg protein.

Conclusion: By the cell culture methods used in this study, which aimed to increase the number of cells in the DNA synthesis phase, foreskin fibroblasts maintained a considerably stable level of 5α‐reductase activity during long‐term subculture. Therefore, this assay method can be used for differential diagnosis of 5α‐reductase deficiency from other relevant entities.
Ductal adenocarcinoma of the prostate associated with prostatic multilocular cyst
Authors: Matsui Yoshiyuki , Sugino Yoshio , Iwamura Hiroshi , Oka Hiroya , Fukuzawa Shigeki , Takeuchi Hideo
Published: March 2003

A case is reported here of ductal adenocarcinoma of the prostate forming a multilocular cyst, which responded well to androgen deprivation therapy.
Evidence‐based meta‐analysis of pharmacotherapy for benign prostatic hypertrophy
Authors: Ishizuka Osamu , Nishizawa Osamu , Hirao Yoshihiko , Ohshima Shinichi
Published: March 2003

Evidence‐based diagnosis and treatment have been proposed recently in various medical fields. Evidence‐based diagnostic and therapeutic guidelines for benign prostatic hypertrophy (BPH), one of the most common urological diseases, have been proposed in foreign countries. This paper examines common therapeutic drugs for BPH in Japan from the viewpoint of evidence‐based medicine (EBM).

The term ‘BPH’ and drugs indicated for BPH were used as key words to search related articles in the PubMed website. A total of 813 articles extracted as of October 2001 were examined. The articles were ranked in levels ranging from I–V, where Level I indicated a large randomized controlled trial and Level V indicated a non‐controlled case accumulation study.

Among the 813 articles extracted, 132 clinical articles were suitable for evaluation. There were many reliable articles on the effectiveness of α‐blockers. However, it seemed necessary to examine further how to choose the optimum α‐blocker for each clinical case and the combination of antiandrogen drugs with α‐blockers. It was also considered necessary to evaluate the effectiveness of drugs, such as eviprostat and hachimi‐jio‐gan, that are available only in Japan.

The present study evaluated the effectiveness of commonly available therapeutic drugs for BPH in Japan from a viewpoint of EBM.
Clinical features of renal cell carcinoma less than 25 millimeters in diameter
Authors: YAMADA YOSHIAKI , HONDA NOBUAKI , MITSUI KENJI , HIBI HATSUKI , TAKI TOMOHIRO , KAMIJYOU AYUMI , AOKI SHIGEYUKI , ABE TOSHIO , KATO KEITARO , NAKAMURA KOGENTA , KOKUBO HIROTO , NARUSE KATSUYA , TOBIUME MOTOI , FUKATSU HIDETOSHI
Published: March 2003

Background: We retrospectively investigated the clinicopathological features and prognosis of patients who underwent surgical treatment at our department for renal cell carcinoma (RCC) less than 25 mm in diameter.

Methods: Of the 158 patients who underwent surgical treatment between April 1975 and April 1998, 16 (17 kidney, 10.1%) were included in this study. The study included 11 men and 5 women (ratio: 2.2). The age range was 35–76 years (average: age 53). The right kidney was involved in 9, left kidney in 6 and bilateral kidneys in 1 patient. The follow‐up period was 26–157 months (mean: 86 months).

Results: Thirteen tumors (81.2%) were incidental carcinomas. No patients had a tumor of rapid growing type. Radical nephrectomy was performed for 12 kidneys (70.6%), simple nephrectomy for 2 (11.8%) and partial nephrectomy for 3 (17.8%). Seven patients (43.7%) received interferon‐α as postoperative adjuvant therapy. All tumors were pathologically classified as expansive type; 11 (64.8%) as clear cell carcinoma; 3 (17.6%) cyst‐associated, and 3 (17.6%) papillary. Nine (52.9%) tumors were grade 1, and 8 (47.1%) were grade 2. Fourteen patients were pNo and V(–). The 5‐ and 10‐year survival rates were excellent (100%).

Conclusion: The features of small RCCs less than 25 mm were as follows: many tumors were incidental to clear cell carcinomas; all tumors were low grade, low stage and expansive type; no tumors showed acute phase reactants; and few tumors were of the solid type. Thus, the prognosis seemed to be excellent.
Retroperitoneoscopic nephrectomy for juxtaglomerular cell tumor
Authors: WATANABE MASATO , SUGI MOTOHIKO , MUROTA TAKASHI , KAWAKITA MUTSUSHI , SAKAIDA NORIKO , OKAMURA AKIHARU , MATSUDA TADASHI
Published: March 2003

We present a case of juxtaglomerular cell tumor (JGCT) in a 20‐year‐old woman. She presented with hypertension and elevated plasma renin activity. Computed tomography without enhancement by contrast medium detected a tumor at the center of the left kidney. Retroperitoneoscopic left nephrectomy was performed and postoperatively her blood pressure and plasma renin activity returned to normal. This is the first report of retroperitoneoscopic nephrectomy performed for a JGCT.
The Australian and New Zealand cardiac pacing and implantable cardioverter–defibrillator survey: calendar year 1997
Authors: Mond H. G. , Whitlock R. M. L.
Published: March 2003

Abstract

Background: A comprehensive pacemaker (PM) and implantable cardioverter–defibrillator (ICD) survey was undertaken in Australia (Aus) and New Zealand (NZ) for calendar year 1997.

Results: Compared to the 1993 survey, significant increases in implantation numbers were recorded. For 1997, the total new PM implanted was 6405 Aus (3834 in 1993) and 823 NZ (530 in 1993). The number of new pacemaker implants per million population was 345 Aus (216 in 1993) and 228 NZ (150 in 1993). Implantation centres increased between surveys from 49 to 92 in Aus and from seven to eight in NZ. There were smaller increases in pacemaker replacements between surveys with 735 in Aus (700 in 1993) and 126 in NZ (82 in 1993). In both countries, pacemaker implants were performed predominantly by non‐surgeons. New recipients aged > 80 years were approximately 25% Aus and 30% NZ. The predominant indications were high degree atrio‐ventricular block and sick‐sinus syndrome in both Aus and NZ. Dual chamber implants were 65% Aus and 55% NZ. The median hospital stay was about 2 days in Aus and 1 day in NZ. Pacing leads were overwhelmingly transvenous, bipolar and tined in both chambers. They were inserted via a cephalic vein cutdown in approximately 40% of cases in Aus and 49% in NZ. For ICD, the implants were 449 Aus (180 in 1993) and 31 NZ (10 in 1993) with new implants per million population being 24 Aus and eight NZ. A breakdown of data for the six Aus States is presented. (Intern Med J 2001; 31: 267–271)
Current perspectives on BRCA1‐ and BRCA2‐associated breast cancers
Authors: Phillips K. A.
Published: March 2003

The identification of two breast cancer predisposition genes, BRCA1 and BRCA2, in the mid‐1990s has led to a better understanding of the molecular pathogenesis of hereditary breast cancer and to a new era in breast cancer research. The present article reviews the current state of knowledge regarding the biology of BRCA1 and BRCA2, the cancer risks associated with carrying a pathogenic mutation in either of these genes and the possible genetic and environmental risk modifiers. The phenotypes of BRCA1‐ and BRCA2‐associated hereditary breast cancers are reviewed. Research into BRCA1‐ and BRCA2‐associated breast cancer is in its infancy and much remains to be learned, particularly about modifiers of genetic risk and the clinical implications of carrying a mutation in one of these two genes. Australia has an excellent research infrastructure in place, through the Australian Breast Cancer Family Study and the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer, to contribute substantially to future research in this area. (Intern Med J 2001; 31: 349–356)
Spinal Cord Injury Desk Reference: Guidelines for Life Care Planning and Case Management
Authors: Edis R.
Published: March 2003

By T.L. Blackwell, J.S. Krause, T. Winkler & S.A. Stiens. New York: Demos Medical Publishing, 2001. 291 pp. Price $A59.95 (Paperback). ISBN 1 888799‐49‐8
Temozolomide‐induced flare in high‐grade gliomas: a new clinical entity
Authors: Rosenthal M. A. , Ashley D. L. , Cher L.
Published: March 2003

Abstract

A transient deterioration in neurological status following commencement of chemotherapy for high‐grade gliomas has not been previously described. We report eight cases of transient deterioration following administration of temozolomide, a relatively new cytotoxic agent used in the treatment of high‐grade gliomas. We believe this represents the novel clinical entity of temozolomide‐induced tumour flare. (Intern Med J 2002; 32: 346−348)
Adjuvant therapy for high‐risk primary and resected metastatic melanoma
Authors: Hersey P.
Published: March 2003

Abstract

Patients with thick, primary melanoma and regional lymph‐node metastases are at moderate to high risk of recurrence and death, despite apparent complete surgical removal. Immune responses can be demonstrated against melanoma and this has prompted the conduct of a number of randomized trials of immunotherapy. Several trials have been completed and show minimal benefit in prolonging survival or recurrence from melanoma. Similarly, a large number of trials has been conducted to test the efficacy of α‐2‐interferon (IFN‐α2) in therapy. Clear benefit in recurrence‐free survival was shown in several trials, however there is a lack of convincing evidence of an effect on overall survival. Several trials of vaccine and IFN‐α2 therapy are still in progress and their results are awaited with great interest. The use of high‐dose IFN‐α2 therapy remains a contentious subject, however available evidence suggests the standard of care remains good surgical management. (Intern Med J 2003; 33: 31−41)
Herbicide pyrazolate causes cessation of carotenoids synthesis in early watergrass by inhibiting 4‐hydroxyphenylpyruvate dioxygenase
Authors: MATSUMOTO HIROSHI , MIZUTANI MORIHIRO , YAMAGUCHI TAKAHIRO , KADOTANI JUNJI
Published: March 2003

In aqueous solution, the herbicide pyrazolate [4‐(2,4‐dichlorobenzoyl)‐1,3‐dimethyl‐5‐pyrazolyl p‐toluenesulfonate] is rapidly hydrolyzed to destosyl pyrazolate (DTP), 4‐(2,4‐dichlorobenzoyl)‐1,3‐dimethyl‐5‐hydroxypyrazole, which is an active form of the herbicide. The objective of this study was to examine the effect of pyrazolate and DTP on carotenoids synthesis in susceptible weed, early watergrass (Echinochloa oryzicola Vasing.). Furthermore, their in vitro effect on 4‐hydroxyphenylpyruvate dioxygenase (HPPD) was determined. Roots of the plants at the two‐leaf stage were soaked for 24 h into pyrazolate (5 × 10–5 mol L−1) or norflurazon (10–6 mol L−1) solution containing 0.5% volume of acetone. At the first sampling time (3 days after treatment: 3 DAT), the chlorophyll content in the third leaves of pyrazolate‐treated plants were not different compared with the untreated control, but it was decreased between 3 and 6 DAT. The declining pattern of β‐carotene in the third leaf of early watergrass was very similar to that of chlorophyll. Both herbicides induced greater accumulation of phytoene in the third leaves of early watergrass 3 DAT, and the levels were kept until 9 DAT. However, feeding of homogentisate reduced the phytoene accumulation only in pyrazolate‐treated plants, suggesting the site of action of the herbicide located in the pathway of plastoquinone synthesis. In a HPPD assay, DTP revealed to inhibit the enzyme with an IC50 value of 13 nmol L−1 and that of pyrazolate was 52 nmol L−1. In the pyrazolate solution used in the assay, some of the herbicide possibly has been hydrolyzed to DTP. From the all results obtained, it is strongly suggested that pyrazolate inhibits carotenoids synthesis and causes bleaching on the developing leaves by the similar mechanism with norflurazon, but its action site is not phytoene desaturase and is HPPD.
Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics
Authors: HOLM‐KNUDSEN  , CARLIN  , McKENZIE FANZCA
Published: March 2003

This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam,n=480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. Distressed preoperative behaviour was a good predictor of DAI in all age groups. Premedication reduced the incidence of DAI in children aged 0.5–2 years old, and in older children who were distressed preoperatively. Induction in the Day Surgery Unit was associated with a reduction of the incidence of DAI in younger children. Children with DAI were more likely to suffer from distress at arousal (P=0.001). Average early recovery time was prolonged 4.4 minutes and average discharge time in daypatients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.
Recovery characteristics of propofol anaesthesia, with and without nitrous oxide: a comparison with halothane/nitrous oxide anaesthesia in children
Authors: CRAWFORD MARK , LERMAN JERROLD , SLOAN MARK , SIKICH NANCY , HALPERN LLOYD , BISSONNETTE BRUNO
Published: March 2003

Few studies have examined whether nitrous oxide influences the recovery characteristics of propofol anaesthesia. The present study examined the effect of nitrous oxide on the recovery characteristics of propofol anaesthesia, and compared these data with those for halothane/nitrous oxide anaesthesia. Sixty children aged 3–12 years were assigned at random to receive one of three maintenance regimens: propofol with or without nitrous oxide (70%) or halothane/nitrous oxide (70%). During propofol/N2O anaesthesia, the infusion rate of propofol (180±39 μg·kg−1·min−1) required to maintain the mean arterial pressure and heart rate within 20% of the baseline values was significantly less than that during propofol/O2 (220±37 μg·kg−1·min−1; P<0.005). The time from discontinuation of anaesthesia to eye‐opening (11±6 min), to response to commands (12±6 min), and to return of full wakefulness (21±10 min) after propofol/N2O were similar to those after propofol/O2, but significantly less (by approximately 30%) than those after halothane (P<0.05). The overall incidence of emesis after propofol/N2O (53%) was greater than that after propofol/O2 (17%, P<0.05) and comparable to that after halothane/N2O (58%). These data suggest that N2O has little effect on the rate of recovery after propofol, but significantly increases the incidence of postoperative emesis, thereby attenuating one of the main attributes of propofol anaesthesia.
Postoperative comfort in paediatric outpatient surgery
Authors: Kokinsky E , Thornberg E , Östlund A.l , Larsson L.e
Published: March 2003

Postoperative conditions in hospital and at home were evaluated in 200 paediatric daycase patients by using questionnaires and telephone interviews. Pain was assessed by behaviour observation or a faces rating scale depending on age. Anaesthetic methods, nausea/vomiting, analgesics and parents’ aspects were also recorded. Seventy per cent of the patients received regional anaesthesia. Immediate postoperative analgesia was satisfactory in 75% of the children. When the effects of intraoperatively administered analgesics wore off at home almost half the children rated higher than mild pain. The increased degree of pain at home was especially pronounced after regional anaesthesia. The total incidence of nausea/vomiting was 28% and fentanyl caused nausea and vomiting in a significantly higher proportion of cases. The study points out that immediate postoperative comfort obtained by prophylactic analgesia needs to be followed by analgesics given on a continuous basis for the first days after surgery.
Effect of preoperative paracetamol on gastric volumes and pH in children
Authors: Anderson Brian J. , Rees Sheridan G. , Liley Andrew , Stewart Alistair W. , Wardill Mark J.
Published: March 2003

The effect preoperative paracetamol elixir has on gastric contents is unknown. Children presenting for elective adenotonsillectomy were randomized to receive either paracetamol elixir (40 mg·kg−1) 90 min before surgery or paracetamol suppositories (40 mg·kg−1) intraoperatively. Following induction of anaesthesia a 16 Fr multiple‐oriface orogastric tube was passed into the stomach and measure taken of the residual gastric volume and pH. The children had a mean age of 8.5 years (
SD 3.2) with a weight of 35 kg (
SD 16.5). Children given elixir (n=41) had a mean residual gastric volume of 0.083 ml·kg−1 (95% CI; 0.006, 1.24) and a pH of 1.83 (95% CI; 0.75, 4.49), while those given suppositories (n=40) had a mean residual gastric volume of 0.083 ml·kg−1 (95% CI; 0.008, 0.9) and a pH of 2.07 (95% CI; 0.84, 5.12). There was no significant difference between these two groups. Paracetamol elixir is rapidly absorbed in the gastrointestinal system of children and preoperative administration has no effect on gastric contents. Given paracetamol's slow equilibration rate constant from the central to the effect compartment, children may be given this medication preoperatively for routine surgical procedures.
Relative effectiveness of lignocaine–prilocaine emulsion and nitrous oxide inhalation for routine preoperative laboratory testing
Authors: Gall Olivier , Annequin Daniel , Ravault Nathalie , Murat Isabelle
Published: March 2003

We studied the impact of age‐related factors and the benefits of 50% nitrous oxide or EMLA cream in 108 children undergoing preoperative laboratory testing. Procedural pain was assessed by behavioural scores (CHEOPS) and pain intensity ratings. Age, preexisting behavioural distress and difficulty of venous access were significant predictors of outcome in univariate analysis. Nitrous oxide and EMLA cream were both effective in lowering pain related behaviour and pain ratings generated by the different adult observers and the children where applicable. EMLA cream was more effective than 50% nitrous oxide in children 1–4 years old. Although EMLA cream was responsible for a 28±5 min prolongation of waiting time at the clinic, the present results suggest that it should remain the first line intervention to alleviate pain from venepuncture in paediatric outpatients.
Heart block following propofol in a child
Authors: Sochala C. , VAN Deenen D. , DE Ville A. , Govaerts M.J.M.
Published: March 2003

We present the case of a nine‐year‐old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. Propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. Heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.
Incidence of nausea and vomiting in children after strabismus surgery following desflurane anaesthesia
Authors: Kuhn I. , Scheifler G. , Wissing H.
Published: March 2003

In a prospective, randomized parallel study, 60 ASA I–III children aged 1–17 years, scheduled for elective strabismus surgery, were anaesthetized with desflurane without prophylactic antiemetic medication. The objective of the study was to determine the incidence of postoperative nausea and vomiting after general anaesthesia with desflurane. To decide whether nitrous oxide further influences these symptoms, the patients were randomly assigned to two groups of 30 patients each. One group received desflurane in oxygen/air and a second group received desflurane in oxygen/nitrous oxide. In all children, after intravenous induction and tracheal intubation, anaesthesia was administered as minimal flow anaesthesia with oxygen and nitrous oxide or air according to the random plan. The patients were observed for 48 postoperative hours until their discharge from the ward. The overall incidence of nausea was found to be 37%, and vomiting was seen in 32% of all patients. No statistical correlation was found between the incidence of postoperative emesis and the administration of nitrous oxide or the duration of general anaesthesia. Instead, the incidence of vomiting was 2.5‐fold higher when surgery was performed on both eyes compared with one eye. The relatively low incidence of postoperative nausea and vomiting, as well as the quick recovery from anaesthesia, permitting an early discharge from the postoperative care unit to the ward, show desflurane to be a suitable volatile anaesthetic in strabismus surgery in children.
Electrocardiographic inscription of diaphragmatic contractions during anaesthesia
Authors: CASTA ALFONSO , McCANN MARY E.
Published: March 2003

An electrocardiographic artifact was noted on a child under general anaesthesia. The artifact was caused by rhythmic diaphragmatic contractions. A systematic approach to distinguish an artifact from a cardiac electrophysiological event is presented.
Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy
Authors: Reyle‐Hahn Matthias , Niggemann Bodo , Max Martin , Streich Rita , Rossaint Rolf
Published: March 2003

Flexible fibreoptic bronchoscopy (FOB) has become a useful diagnostic and therapeutic procedure in children. We investigated 26 patients (3–14 years) for FOB using a new sedation strategy. All patients received oral premedication and inhalation of topical anaesthetic. Sedation for bronchoscopy was achieved with a continuous infusion of remifentanil and intermittent boluses of propofol. Propofol injection was repeated if sedation was inadequate. Sedation could be successfully performed in all children without adverse effects. Endtidal CO2 concentration and arterial oxygen saturation remained stable throughout the study. All children were awake 5±1.3 min after stopping remifentanil infusion. Sedation with remifentanil/propofol is a new sedation strategy for diagnostic flexible paediatric bronchoscopy in children with spontaneous ventilation.
Anaesthetic technique for transoesophageal echocardiography in children
Authors: Heard C.M.B. , Gunnarsson B. , Heard A.M.B. , Watson E. , Orie J.D. , Fletcher J.E.
Published: March 2003

Objective: To document the safety and efficacy of an anaesthetic technique in paediatric patients undergoing transoesophageal echocardiography (TOE).

Methods: Prospective descriptive study performed in a children’s hospital with all patients undergoing TOE. Topical analgesia of the pharynx was achieved with lidocaine. Anaesthesia was induced with midazolam (25 μg·kg−1), fentanyl (1 μg·kg−1), and propofol (0.5–1 mg·kg−1), followed by a continuous infusion of propofol (5–10 mg·kg−1·h−1).

Results: Thirty patients are reported. The mean age was 11.4 ± 5.1 years (range 1–22) and weight 40.5 ± 22.1 kg (range 10–110). All the patients tolerated the procedure well. Two patients experienced brief oxygen desaturations during induction, 10 patients coughed during the procedure, and six patients had significant muscle activity requiring supplemental doses of propofol. None of the patients experienced nausea or vomiting.

Conclusion: We conclude that our anaesthetic technique in spontaneously breathing paediatric patients during TOE is effective and appears to be safe in children with heart disease.
The effect on intraocular pressure of tracheal intubation or laryngeal mask™ insertion during sevoflurane anaesthesia in children without the use of muscle relaxants
Authors: Duman Ates , Ögün Cemile Öztin , Ökesli Selmin
Published: March 2003

Background: We studied the effects of sevoflurane on intraocular pressure after induction in children undergoing either tracheal tube (TT) or laryngeal mask airway (LMA™) insertion without a muscle relaxant

Methods: The study included 38 children. Anaesthesia was induced (8%) and maintained (3–4%) with sevoflurane in 100% O2. No muscle relaxant was used. A TT was inserted in group I (n=20), and an LMA in group II (n=18). IOPs were measured after induction, insertion of TT or LMA and at 1, 2 and 3 min thereafter. The heart rate, mean arterial pressures were also recorded.

Results: Intraocular pressures increased significantly in group I after TT (P < 0.01) and remained high until after 3 min. The pressures were similar in the LMA group at all measurements.

Conclusions: Sevoflurane does not prevent the increase in IOP after intubation without muscle relaxants. LMA does not increase IOP in children after sevoflurane induction.
Postoperative behavioural changes in children: comparison between halothane and sevoflurane
Authors: Foesel T. , Reisch H.J.
Published: March 2003

Background: A questionnaire, modified from the posthospitalization behavioural questionnaire, was sent to all parents of children under 8 years of age who had elective surgery in the hospital of Lahr during the years 1997 and 1998. The parents were asked about long lasting changes (more than 1 week) in their child’s behaviour after surgery.

Methods: The anaesthesia records of all these children were evaluated on the inhalational agent used (halothane or sevoflurane), the type of surgery, the sedative premedication used, the method of inducing anaesthesia and the use of opioids or nonopioids for pain therapy. Four hundred and fifty‐eight of 863 parents responded (53.1%) to the questionnaire. Four hundred and twenty‐seven children had minor ENT surgery and 31 minor urological surgery. Two hundred and eleven children received halothane and 214 sevoflurane as inhalational agent.

Results: The parents of 34 of the 211 children (16.1%) receiving halothane and 55 of 214 children (25.7%) receiving sevoflurane reported postoperative behavioural changes. This difference was highly significant (P=0.015).

Conclusions: We found that the children having sevoflurane anaesthesia were more likely to develop behavioural problems postoperatively than with halothane.The rate of postoperative behavioural changes was not influenced by the type of surgery, the sedative premedication used, the induction technique or the use of opioids or nonopioid pain therapy.
Anaphylactic shock due to cefuroxime in a patient taking penicillin prophylaxis
Authors: PROSSER DYLAN PARRY , GOMPELS MARK
Published: March 2003

We report a case of cardiovascular collapse in a homozygous sickle cell patient undergoing elective orthopaedic surgery, following the intravenous administration of cefuroxime. This patient had no known previous drug allergies. She had been taking prophylactic penicillin V on a daily basis, for 10 years and had encountered no problems. She had received cefuroxime on at least four previous occasions, for the treatment of chest infections, with no reported problems. Her serum mast cell tryptase, 1 h after the onset of anaphylaxis, was greater than 200 μg·l−1 (normal range 10–16). She was skin prick tested, 6 weeks after the event, to all the drugs administered during the course of the anaesthetic and reacted positively only to cefuroxime. Specific IgE levels for penicillin determinants and latex were negative (13 and 0 IU·ml−1, respectively UniCAP Pharmacia & Upjohn).
Pulmonary volume recruitment restores pulmonary compliance and resistance in anaesthetized young children
Authors: Marcus R. J. , Van Der Walt J. H. , Pettifer R. J. A.
Published: March 2003

Summary Background: Oxygenation and gas exchange are impaired after induction of general anaesthesia. A timed re‐expansion inspiratory manoeuvre (TRIM) improves pulmonary compliance and reverses haemoglobin oxygen desaturation rapidly in lambs.

Methods: Twenty children of less than 2 years of age were given a standardized ventilated general anaesthetic. After 15 min of anaesthesia they were randomized to receive either a TRIM or 100% oxygen for 3 min. Dynamic pulmonary compliance and airway resistance were measured.

Results: Pulmonary compliance fell by 12% and airway resistance rose by 12% during 15 min of ventilated general anaesthesia. 100% oxygen caused a further fall of 9% in compliance (P=0.016), whilst TRIM resulted in a 30% increase in compliance (P < 0.01). The changes in airway resistance with 100% oxygen and TRIM were not statistically significant.

Conclusions: This study shows that TRIM increases pulmonary compliance during standardized ventilated general anaesthesia.
The BCH Epidural System, a safe system for epidural infusion analgesia in children
Authors: Llewellyn N. , Liley A. , Dickson U. , Moriarty A.
Published: March 2003

Epidural infusions in children are usually delivered by syringe drivers because of the lower volumes of local anaesthetic solutions used in children rather than in adult practice. Recently concern has arisen both via the media and anecdotally over a number of adverse events associated with intravenous administration of bupivacaine. We have designed and validated a system that should significantly reduce the possibility and incidence of this adverse effect.

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[ The system is based on the reversal of the standard luer‐lock system. ]

A female 60 cc syringe is connected to a reversed 150 cm infusion line that is connected to a male epidural filter. The filter connects with standard epidural infusion catheters. The reversal of the luer‐lock system requires that devices are also available for the initial doses of local anaesthetic, for the preparation of the epidural infusion syringe and for administration of rescue boluses of local anaesthetic.

With this system it is extremely unlikely that the epidural syringe or infusion catheter can be connected to an intravenous line. It is also less likely that intravenous drugs may be connected to the epidural filter.
Partial orbital rim resection, mesh skin expansion, and second intention healing combined with enucleation or exenteration for extensive periocular tumors in horses
Authors: Beard W. L. , Wilkie D. A.
Published: March 2003

Ocular and periorbital sarcoids and squamous cell carcinoma are common in equine practice. Extensive involvement of periorbital tissues often necessitates removal of the globe if the function of the eyelids can not be maintained with tumor removal alone. This report describes a modification of the standard enucleation or exenteration technique for cases in which there is insufficient skin to achieve primary closure following complete surgical excision. The caudal portion of the dorsal orbital rim is protuberant; partial excision with an osteotome facilitates skin closure by decreasing the size of the wound. Mesh expansion of skin via multiple rows or parallel stab incisions can also be used as an adjunct to facilitate closure. Four horses underwent enucleation or exenteration using the orbital rim resection and mesh skin expansion techniques for extensive periocular tumors that were unresponsive to prior treatments. Follow‐up intervals ranged from 6 to 42 months and no horses had tumor regrowth.
A test of monophyly of the gutless Phallodrilinae (Oligochaeta, Tubificidae) and the use of a 573‐bp region of the mitochondrial cytochrome oxidase I gene in analysis of annelid phylogeny
Authors: Nylander Johan A. A. , Erséus Christer , Källersjö Mari
Published: March 2003

A 573‐bp region of the mitochondrial gene cytochrome c oxidase subunit I (COI) of two species of Inanidrilus Erséus and four species of Olavius Erséus (Phallodrilinae, Tubificidae) is used in a parsimony analysis together with a selection of 35 other annelids (including members of Polychaeta, Pogonophora, Aphanoneura, and the clitellate taxa Tubificidae, Enchytraeidae, Naididae, Lumbriculidae, Haplotaxidae, Lumbricidae, Criodrilidae, Branchiobdellida and Hirudinea), and with two molluscs as outgroups. The data support the monophyly of the Olavius and Inanidrilus group, with a monophyletic Inanidrilus. However, parsimony jackknife analyses show that most of the other groups are unsupported by the data set, thus revealing a large amount of homoplasy in the selected gene region. Practically no information is given of within/between family relationships except for a few, closely related species. This suggests that the analysed COI region is not useful, when used alone, for inferring higher level relationships among the annelids.
Revision of the subgenus Neosynaptops Voss of Euops Schoenherr (Coleoptera, Curculionoidea, Attelabidae) from the Papuan region
Authors: Riedel Alexander
Published: March 2003

The subgenus Neosynaptops Voss of Euops Schoenherr is revised. It contains two previously described species, E. cupreosplendens Macleay and E. viridiceps Voss, plus seven new ones: E. doertheae sp. n., E. gladiator sp. n., E. paraviridiceps sp. n., E. punctaticeps sp. n., E. similis sp. n., E. waigeoensis sp. n. and E. wapogae sp. n. A lectotype is designated for E. viridiceps Voss. The species are described and the characters relevant for their identification, especially the male genitalia, are illustrated. A key to the species is provided. Three distinct types of proventriculi found in species of Neosynaptops are illustrated. A cladistic analysis is performed which confirms the monophyly of Neosynaptops. The most important apomorphies are the punctate‐rugose sculpture of the gena and the longitudinal costae on the ventral surface of the rostral base. The group is restricted to New Guinea and some small neighbouring islands.