bluuebunny/crossref_metadata_2025 huggingface dataset:
Axillary block in children: single or multiple injection?
Authors: Carre P. , Joly A. , Cluzel Field B. , Wodey E. , Lucas M.M. , Ecoffey C.
Published: March 2003

The goal of this double‐blind prospective study was to compare the effect of a single injection versus multiple fractionated doses on the onset time and quality of motor and sensory block, obtained in 70 children anaesthetized with axillary block alone. The brachial plexus was identified with a peripheral nerve stimulator, and blocked with 0.5 ml·kg−1 of 1.5% lignocaine with adrenaline. In Group S (single injection), the total volume was injected after location of one nerve. In Group M (multiple fractionated doses), two nerves were located, including necessarily one nerve implicated in the surgical territory. Motor and sensory blocks were assessed according to Lanz's scale before surgery by a blinded observer. A block was considered complete if there was no feeling in at least three nerve territories at 30 min. No difference was found between groups for motor and sensory block quality. However the onset time of the block was faster after multiple fractionated doses (Group M, 25±7 min vs Group S, 29±4 min) and was faster in younger children (5–9 years: M=23±7 min vs S=28±5 min, 10–15 years: no difference). There was a significant difference in the quality of the sensory blockade of the musculocutaneous nerve: 18 versus 8 complete blocks, 10 versus 14 incomplete blocks, respectively for Group M versus Group S. No adverse effect was observed and analgesia was prolonged for more than 4 h. We can conclude that, unlike adults, fractionated doses in chilren bring no benefit to the quality of sensory and motor block. Selective block of the musculocutaneous nerve is recommended when a surgical procedure takes place in this territory.
Cardiocirculatory changes during videolaparoscopy in children: an echocardiographic study
Authors: Gentili A. , Iannettone C.M. , Pigna A. , Landuzzi V. , Lima M. , Baroncini S.
Published: March 2003

We examined cardiovascular changes associated with intra‐abdominal insufflation in 20 children (mean age 6.1 ± 4.7 years, ASA physical status I or II) undergoing laparoscopic surgery with general anaesthesia using echocardiography with a transthoracic approach. Intra‐abdominal pressure never exceeded 10 mmHg. Systolic blood pressure, diastolic blood pressure, endtidal CO2, peak, and mean airway pressure increased during intra‐abdominal insufflation (P < 0.001). Pneumoperitoneum was associated with increases (P < 0.001) in left ventricular enddiastolic volume, left ventricular end‐systolic volume and left ventricular endsystolic meridional wall stress. In addition, before, during and after intra‐abdominal insufflation, left ventricular fractional shortening and left ventricular ejection fraction, underwent slight, insignificant changes. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The sharp increase in intra‐abdominal pressure affects both preload and afterload, while systolic cardiac performance remains unchanged.
A dual epidural catheter technique to provide analgesia following posterior spinal fusion for scoliosis in children and adolescents
Authors: Tobias Joseph D. , Gaines Robert W. , Lowry Kent J. , Kittle Dian , Bildner Carl
Published: March 2003

Background: The authors report their experience with the use of a dual epidural catheter technique in controlling pain following long posterior spinal fusion and instrumentation for scoliosis in children and adolescents.

Methods: Following completion of the surgical procedure and prior to wound closure, the upper catheter was inserted with the tip directed cephalad to T1–4 while the tip of the lower catheter was positioned at the L1–4 level. As the surgical wound was being closed, the catheters were dosed with fentanyl and hydromorphone followed by a continuous infusion of ropivacaine plus hydromorphone. Postoperative pain was assessed every 2–4 h using a visual analogue score or an observational behavioural score (0=no pain, 10=worst imaginable pain). There were 14 patients ranging in age from 5–17 years (12.7 ± 3.5) and in weight from 19–68 kg (44.3 ± 17.5). The epidural catheters were left in place until the fifth postoperative day.

Results: The mean of the median pain score from each patient was 1.5 ± 1.6, 1.6 ± 1.5, 1.4 ± 1.3, 1.1 ± 1.1 and 0.9 ± 0.9, respectively, on postoperative days 1 through 5. The mean of the maximum pain scores was 3.5 ± 2.3 (range 0–7), 4 ± 1.6 (range 2–6), 3.1 ± 1.7 (range 1–6), 2.4 ± 1.5 (range 0–4) and 2.2 ± 1.4 (range 0–4), respectively, on postoperative days 1 through 5.

Conclusions: No adverse effects related to epidural analgesia were noted.
Review of ethics in paediatric anaesthesia: intensive care issues
Authors: Edgar J , Morton N S , Pace N A
Published: March 2003

This is the third of a series of three articles examining the recent changes in the law in relation to ethics and the practice of paediatric anaesthesia. The review covers, in a practical question and answer format, the topics of consent, research, intensive care issues and organ donation in children.
Anaesthetic management of a patient with myotonic dystrophy
Authors: White R.J. , Bass S.
Published: March 2003

A 13‐year‐old boy with myotonic dystrophy underwent insertion of a percutaneous gastrostomy feeding tube under general anaesthesia. We used a laryngeal mask airway and a spontaneously breathing technique with propofol total intravenous anaesthesia. Postoperative vomiting and aspiration, 12 h after the procedure, subsequently required intubation and ventilation. We discuss the anaesthetic management of this case and review the features of the disease to be considered when contemplating anaesthesia in such patients.
The difficult paediatric airway: a new method of intubation using the laryngeal mask airway™, Cook® airway exchange catheter and tracheal intubation fibrescope
Authors: Thomas Peter B. , Parry Martin G.
Published: March 2003

We describe a new technique of intubation for use in difficult paediatric airway cases utilizing the laryngeal mask airway™, a Cook® Airway Exchange Catheter and a paediatric intubation fibrescope. This method has a number of potential advantages over previously described methods.
Anisocoria from transdermal scopolamine
Authors: Lin Yuan‐Chi
Published: March 2003

A transdermal scopolamine patch is an effective medication for relieving motion sickness, treating nausea and vomiting from chemotherapy and decreasing withdrawal side‐effects from wearing off opioids. A 14‐year‐old boy with chronic granulomatous disease and severe infection was admitted to the hospital because of left shoulder aspergillus’ infection and pain. The patient required high dose opioid to control the shoulder pain. A unilateral fixed and dilated pupil was noted. We assumed this to be related to the advancing central nervous system aspergillosis. After extensive neurological ‘work up’, we realized that the anisocoria was related to the transdermal scopolamine patch that we had prescribed for weaning off the opioid.
Morquio's syndrome and its anaesthetic considerations
Authors: Morgan Kathleen A. , Rehman Mohamed A. , Schwartz Roy E.
Published: March 2003

Summary Morquio's syndrome is an inherited disorder characterized by excessive excretion of keratan sulphate in the urine. The anaesthetic care of these patients should take into consideration respiratory, craniofacial, cardiac, skeletal, ocular and hepatic abnormalities. We report the case of a child with Morquio's syndrome who presented for stabilization of the cervical spine, and discuss the issues relevant to the anaesthesiologist.
Acute rhabdomyolysis after cardiac transplantation: a diagnostic conundrum
Authors: Cassidy J.V. , Bolton D.T. , Haynes S.R. , Smith J.H.
Published: March 2003

Summary A 13‐year‐old girl presented with right ventricular failure secondary to Ebstein's malformation (downward displacement of the tricuspid valve leaflets with adherence to the right ventricular muscle and redundancy or dysplasia of the tricuspid valve leaflets). She subsequently required a heart transplant but developed rhabdomyolysis early in the postoperative period and required ventilatory support for more than 3 weeks. A variety of causes were considered, but her condition improved only when cyclosporin was eliminated from the immunosuppression regimen. We believe it is likely that the rhabdomyolysis has been caused by cyclosporin. If so, this has occurred both earlier in the clinical course and at lower serum concentrations than previously described.
Single‐dose caudal anaesthesia for two infants undergoing diagnostic brain magnetic resonance imaging: high risk and nonhigh risk
Authors: Sites Brian D. , Blike George , Cravero Joseph , Andeweg Steven , Beach Michael
Published: March 2003

Summary  We present a case report of two infants given a bupivacaine caudal anaesthetic as a means of achieving sedation for a diagnostic brain magnetic resonance imaging (MRI). Patient 1 was born at 27 weeks of gestation and presented to our hospital at 39 weeks postconception with a history of bronchopulmonary dysplasia and apnoea/bradycardia spells. He was undergoing a brain MRI for the work up of persistent apnoea and craniofacial abnormalities. Patient 2 was a term infant at 42 weeks postconception undergoing a MRI for the work up of a seizure disorder. Both infants fell asleep shortly after placement of the caudal blocks and the studies were completed successfully without complications. Utilizing this technique, we avoided dealing with a potentially difficult airway (patient 1), exacerbating postoperative apnoea and the negative implications of intravenous sedation during a study where there is limited access to the patient's airway.
The use of xenologous amniotic membrane to repair canine corneal perforation created by penetrating keratectomy
Authors: Barros P.S.M. , Garcia J.A. , Laus J.L. , Ferreira A.L. , Salles Gomes T.L.
Published: March 2003

This study was performed to evaluate the use of glycerol‐preserved equine amniotic membrane as replacement for full‐thickness corneal defects in dogs. Eighteen mixed‐breed dogs were used. A perilimbal, full‐thickness, 5 mm square corneal defect was created surgically, and a donor implant of equine amniotic membrane of the same size and shape sutured in place with 10–0 nylon simple interrupted sutures. Corneal edema was observed near the implant 24 h after surgery, but was absent after 1 week. Granulation tissue and corneal vascularization superficial to the implant were noticed on postoperative day 7, but were absent on day 30. Corneal vascularization persisted until the end of the experiment. There was no fluorescein retention by postoperative day 30. There was slight clearing of the corneal implant by postoperative 30, and slight pigmentation of the donor implant observed at postoperative day 180. An acute inflammatory process as well as fibroblasts were present at early postoperative stages. At postoperative day 60 there was no inflammatory cellular infiltrate, but fibroblasts and fibrosis were present. Corneal architecture was restored at the end of the experiment, with a layering of the epithelium–stroma–debris of amniotic membrane–stroma–endothelium present, and pigmentation and vascularization present in the deep layers of the cornea. Although vascularization indicated some degree of graft rejection, the clinical and histological evidence indicates that the xenologous amniotic membrane can be useful as a tectonic graft in the repair of full‐thickness lesions of the cornea of dogs.
Presumed lipid retinopathy in a diabetic dog
Authors: Halenda R.M. , Moore C.P.
Published: March 2003

An eight‐year‐old neutered male diabetic Cardigan Welsh Corgi was presented for bilateral mature cataracts. Phacoemulsification and intraocular lens implantation were performed routinely, and recovery was uneventful for several months except for lipemic aqueous flare which gradually resolved during the postoperative period. Five months following surgery the owner presented the dog for decreased vision. White retinal deposits were visualized ophthalmoscopically. Serum analysis revealed that the dog was concurrently markedly hyperlipemic. The patient's diet was changed from a high‐ to a low‐fat diet, following which diabetes control improved, hyperlipemia resolved, and the retinal deposits decreased markedly in size. The retinal deposits seen ophthalmoscopically are presumed to be lipid based upon their association with marked hyperlipemia, and the concurrent resolution of hyperlipemia and the fundic lesions.
Clinical, cytologic and histopathologic manifestations of protothecosis in two dogs
Authors: Schultze  , Ring  , Morgan  , Patton
Published: March 2003

Two cases of sudden onset of blindness associated with ocular protothecosis in dogs are reported. Both were adult, spayed female, mixed‐breed dogs that lacked the usual clinical signs of systemic infection with Prototheca species. Physical abnormalities at the time of presentation were limited to the affected eyes which had serous discharge, hyperemic conjunctiva, and aqueous flare. The pupillary light reflexes were slow, and the menace reflexes were absent. Both dogs had glaucoma. Results of complete blood counts and serologic titres for antibodies to Blastomyces dermatitidis and Histoplasma capsulatum were within reference intervals. Protothecosis was diagnosed by cytologic analysis of vitreous humor and was confirmed at necropsy. These two cases were unusual because of their presenting signs and prolonged course of disease progression.
Doppler imaging of the ophthalmic vasculature of the normal dog: blood velocity measurements and reproducibility
Authors: Gelatt‐Nicholson  , Gelatt  , MacKay  , Brooks  , Newell
Published: March 2003

The purpose of this study was to assess the feasibility and reproducibility of color Doppler imaging (CDI) of the vasculature of the normal canine orbit and eye. Eight normal Beagles were evaluated by Doppler imaging. The goals of the study were to determine the location, spectral waveform morphology, specific blood velocity parameters, and reproducibility for the ophthalmic and orbital vessels most frequently identified in the normal dog. Vessels identified a majority of the time (> 50%) included: external ophthalmic artery, dorsal external ophthalmic vein, ventral external ophthalmic vein, internal ophthalmic artery, anterior ciliary artery and vein, short and long posterior ciliary arteries, primary retinal arteries, and vortex veins. Other vessels imaged less frequently included: external ethmoidal artery (50%), and primary retinal veins (25%). For each blood vessel the time averaged velocity, peak systolic velocity, minimum diastolic velocity, pulsatility index, and resistive index were determined. The ophthalmic and orbital vessels have unique spectral waveforms and velocities which serve as a basis for identification. Reproducibility of the most commonly imaged vessels of the canine eye and orbit with Doppler imaging was high (< 10% variation). Doppler imaging has the potential for determining noninvasively and consecutively the blood velocity parameters found in orbital and ocular diseases, including orbital inflammations and neoplasms; intraocular inflammations and neoplasms; vascular diseases including systemic vascular disease (hypertension), vasculopathies, and anemia; the glaucomas; and documentable follow‐up after medical and/or surgical treatment of these diseases.
Congenital scleral staphyloma in a dog repaired with preserved homologous peritoneum
Authors: Barros P.S.M. , Safatle A.M.V.
Published: March 2003

A case of congenital scleral staphyloma was treated with a preserved homologous peritoneum graft. A 2‐year‐old female poodle with a blue‐gray mass in a dorsal and temporal position of the sclera of the left eye was evaluated. The repair of the scleral defect with a graft of preserved homologous peritoneum reduced the strabismus and the size of the staphyloma, and improved the cosmetic appearance of the eye.
SLO angiography: arterio‐venous filling times in monkey and minipig
Authors: Rosolen Serge G. , Saint‐Macary Gérard , Gautier Vincent , Le Gargasson Jean‐François
Published: March 2003

Confocal scanning laser ophthalmosocope (cSLO) is a new technique which enables ocular fundus image recording and dynamic retinal angiography to be performed. The ocular fundus image is acquired sequentially, point by point, and is reconstructed on a video monitor at the rate of 25 images per second. The aim of this paper is to evaluate the feasibility of measuring retinal arterio‐venous filling times (AVFT) with a I + Tech cSLO. Three young adult cynomolgus monkeys and three young adult Göttingen minipigs were used as experimental models. All animals were anesthetized using a zolazepam + tiletamine mixture injected intramuscularly; heart rate and rectal temperature were monitored and corneal irrigation was regularly performed. For all subjects, prior to examination, hematocrit and globe axial length were measured. The images were recorded, stabilized and analyzed. The retinal examination consisted of retinal images with 40° field cSLO, retinal fluorescein angiography and arterio‐venous 50% filling time measurements. For each subject all images were easily recorded while keeping the animals in a normally lighted room without having to use any additional optical device. AVFT using an I + Tech cSLO is easily performed in monkeys and minipigs. AVFT measurements in minipigs and monkeys are similar. These results suggest that minipigs can replace monkeys as an experimental species for AVFT investigations.
Subconjunctival filariasis due toOnchocercasp. in dogs: report of 23 cases in Greece
Authors: Komnenou Anastasia , Eberhard Mark L. , Kaldrymidou Eleni , Tsalie Eleftheria , Dessiris Angelos
Published: March 2003

In the present study, we describe a series of 23 cases of ocular subconjunctival parasitic granulomas in dogs, admitted to the Clinic of Surgery, Faculty of Veterinary Medicine of the Aristotle University of Thessaloniki, Greece, between 1997 and 2000. The ophthalmic manifestations in all animals were periorbital swelling, discomfort, photophobia, conjunctival congestion, and discharge. A more detailed examination revealed the presence of periocular masses (nodules) on the subconjunctival bulbar space. Granulomatous or cyst‐like formations were extracted surgically, and were found to contain thread‐like nematode parasites. A histologic and parasitologic examination of tissues and parasites was carried out. Diagnosis of parasitic granulomas was made and the parasite was identified asOnchocercasp. This is the largest series of cases reported of aberrantOnchocercainfections in dogs coming from one geographic location.
The occipital region in the basal Hymenoptera (Insecta): a reappraisal
Authors: Vilhelmsen Lars
Published: March 2003

The occipital region in representatives of all the ‘symphytan’ families and a few apocritans is investigated. A new character, the occurrence of occipital sulci, is described. The absence of occipital sulci and corresponding internal ridges is a putative synapomorphy for the Xiphydriidae, Orussoidea, and Apocrita. Independent loss has occurred in the cimbicid genus Zaraea.

The evolution of sclerotizations between the occipital and oral foramina in basal Hymenoptera is discussed. A postoccipital bridge, an internal structure formed by the fusion of the apodemes for the profurco‐postoccipital muscles, forming a ventral connection between the tentorial arms, is present in Cimbex, Cephoidea, and Syntexis. An external sclerotization, the hypostomal bridge, is present in Corynis, Cephoidea, ‘Siricoidea’, Orussoidea, and Apocrita. In Syntexis, the postoccipital and hypostomal bridges are continuous. It is difficult to decide whether a hypostomal bridge is also present in the Pamphilioidea, or the external sclerotization in this superfamily has evolved independently. In the Siricidae, Orussidae, and some Apocrita, a postgenal bridge largely replaces the hypostomal bridge. The postgenal bridge has evolved at least twice independently in the Hymenoptera.
Intraspecific variation and evolutionary trends of Alicornops simorrense (Rhinocerotidae) in Spain
Authors: Cerdeño Esperanza , Sánchez Begoña
Published: March 2003

The Spanish material of Alicornops simorrense constitutes the best representation of the species in Western Europe. It provides interesting data on the metrical and morphological intraspecific variation of A. simorrense and its evolutionary trends from late Middle Miocene to the early Late Miocene. From late Aragonian to early Vallesian, a slight increase in size is observed, but without clear limits among series. During the late Vallesian, A. simorrense evolved in central Spanish basins into a second species, A. alfambrense, greater in size and with more robust proportions. In the Vallés‐Penedés basin, A. simorrense shows a noticeable increase in size, while maintaining its proportions, during the Vallesian. A. simorrense was a very abundant species, an open woodland dweller, with gregarious behaviour, whose extinction was probably linked to the climatic change that took place at the end of the Vallesian and the beginning of the Turolian.
Nursing shortages and evidence‐based interventions: a case study from Scotland
Authors: Buchan J.
Published: March 2003

In this report, key aspects of change in the labour market for nurses in Scotland are examined, and an integrated policy framework intended to improve nurse recruitment, retention and utilization is outlined. The purpose of this article is to provide an overview of the dynamics of the nursing labour market in Scotland and to draw some more general messages from the evidence base on the effectiveness of interventions to improve recruitment and retention of nursing staff. The paper has three main elements: it provides a backdrop of key trends in the Scottish nursing labour market; it summarizes issues related to planning and nursing shortages, including an assessment of the utility of current indicators of recruitment and retention difficulties; and it reviews the main potential interventions to address nurse recruitment and retention difficulties, drawing from key research/evidence from UK and other English language sources. Five main interventions are examined: integrating the planning of the healthcare workforce; improving recruitment; incentives to improve retention; improving staff deployment; and improving utilization/skill mix.
The error of excessive proximity preference – a modest proposal for understanding holism
Authors: Cave Peter
Published: March 2003

Abstract This paper exposes some examples of continuing murky thinking concerning holism. The exposure is a prelude to noting the importance of proximity in causal explanations of illnesses and wounds. The paper then draws attention to how the proximate should not hold exclusive sway regarding what constitutes best nursing treatment and care. The error of excessive preference for proximity is shown to be an error, using as an example the treatment of leg ulcers. One component of holism that can be clearly expressed amounts therefore simply to the claim: resist the error of excessive proximity preference, resist the error of concentrating solely on nearness. It is left open whether there is any further sense to be gleaned from the holistic babble.
Labelled encounters and experiences: ways of seeing, thinking about and responding to uniqueness
Authors: Davis Anne J.
Published: March 2003

Abstract The main ideas explored here include conceptualizing the patient, the idea of the unique patient and the use of theory, individual uniqueness and stereotype, and uniqueness embedded within routine. These ideas give direction to this paper and serve to raise ethical and epistemological questions about clinical nursing and nursing education.
A ‘quiet’ crisis in health care: developing our capacity to hear
Authors: Ceci Christine , McIntyre Marjorie
Published: March 2003

Abstract In this paper we suggest that it is a mistake to understand the current situation in nursing as primarily a problem of ‘shortage’, a problem which may be solved through supplying ‘more nurses, faster’. This way of thinking is understood as reflecting an invalidation of nurses and nursing and, by fostering false beliefs about nursing, as functioning to exacerbate rather than resolve the current situation. Unlike many mainstream conceptualizations of the current situation in nursing, we begin by understanding the experiences and concerns of nurses as meaningful. Feminist and hermeneutic philosophies, as well as Foucauldian perspectives on discourse, encourage us to take seriously the gender relations of power through which nursing comes to be articulated and to cultivate ways of thinking which can generate more productive analyses of the current situation in nursing. Rather than accepting instrumental understandings of nursing as adequate, we question the everyday beliefs and assumptions, the dominant discourses at work both in the world and in ourselves, which allow the suffering of nurses to be thought irrelevant and their concerns to remain unheard. We theorize both why the suffering of nurses can be considered irrelevant in this way and the difference it would make were we to take the experiences of nurses seriously. This undertaking requires that we reflect on that which constrains – and enables – the ways we are able to write, speak and think about nursing.
Derrida and the tasks for the new humanities: postmodern nursing and the culture wars
Authors: Peters Michael
Published: March 2003

Abstract Jacques Derrida is perhaps the foremost philosopher of the humanities and of its
place in the university. Over the long period of his career he has been concerned
with the fate, status, place and contribution of the humanities. Through his deconstructive
readings and writings he has done much not only to reinvent the western tradition
by attending closely to those texts which constitute it but also he has redefined
its procedures and protocols. This paper first introduces the notion of postmodern
nursing, its relation to the culture wars and some of the main characteristics of
so‐called poststructuralism, considered as a response to the scientific pretensions
of structuralism. Secondly, it provides some background to Derrida, who Althusser
believed to be the most important French philosopher of the 20th century. Thirdly, it explores a recent essay where Derrida outlines seven programmatic theses or what he calls ‘seven professions of faith’ for the new humanities. Finally, and very tentatively, it suggests what such a view might contribute to the nursing humanities.
Role of Ceramides 2 and 5 in the Structure of the Stratum Corneum Lipid Barrier
Authors: Moore David J. , Rerek Mark E. , Mendelsohn Richard
Published: March 2003

We utilized Fourier transform infrared (FTIR) spectroscopy to investigate headgroup and chain interactions in model SC lipid barriers containing equimolar amounts of deuterated hexadecanoic acid, cholesterol, and ceramide 2 (non‐hydroxy sphingosine) or ceramide 5 (α‐hydroxy sphingosine). In the ceramide 2 model the thermotropic response of the CD and CH
stretching modes indicates that hexadecanoic acid begins to disorder at 42°C while ceramide 2 remains ordered until 52°C. Additionally, splitting of the CD
bending and CH
rocking modes provides evidence for separate orthorhombic hexadecanoic acid and ceramide domains. The ceramide amide I mode (1650 cm
) is split into two components indicating strong intermolecular hydrogen bonding between headgroups. In the ceramide 5 model, the CH
and CD
stretching frequencies again reveal highly conformationally ordered ceramide 5 and hexadecanoic acid chains. Splitting of both the CD
bending and CH
rocking modes is observed. However, the CH
rocking frequencies indicate distorted packing of the ceramide. The collapse of these highly ordered phases, and the onset of conformational disorder, occurs at 50°C for both ceramide 5 and hexadecanoic acid. The amide I and II frequencies of ceramide 5 indicate strong H‐bonding, although neither mode is split. Our results demonstrate that model SC lipid systems have quite different physical properties depending on whether they contain ceramide 2 or 5. From this we infer that ceramide 2 and 5 make distinct contributions to the structural biophysics of the SC lipid barrier. Our observation of ordered lipid domains is also consistent with the recently proposed domain mosaic model of the skin barrier.
Humectancies of d‐tagatose and d‐sorbitol
Authors: Lu Y.
Published: March 2003

Synopsis

Most toothpastes contain either d‐sorbitol or glycerin, or both, as humectants. Both compounds are about half as sweet as sucrose. This level of sweetness is not as intense as desired by most people when brushing teeth. Therefore, many brands of toothpaste add saccharin, a high‐intensity sweetener, to increase product sweetness to acceptable levels. While this combination provides the required bulk, humectancy and sweetness, the last characteristic suffers from the widely perceived metallic, or bitter, aftertaste of saccharin. d‐tagatose, a full‐bulk, low‐calorie, sucrose‐like sweetener with about twice the sweetness of d‐sorbitol, and which does not promote tooth decay, holds promise as a sole sweetener for toothpastes. The only untested aspect of this use of d‐tagatose was its humectancy, the characteristic that retains the required level of moisture in toothpaste. The current study was made to investigate this important property, to make a direct comparison of the humectancies of d‐tagatose and d‐sorbitol as pure substances, and to determine whether the humectancy of d‐tagatose is sufficient to counter the crystallizing potentiation of the abrasives used in toothpastes.

The humectancies of d‐tagatose and d‐sorbitol were tested through measuring their water activity (aw) vs. water content. By comparing their desorption curves, d‐tagatose was seen to have a humectancy equal to that of d‐sorbitol when aw in the d‐tagatose solution was above 0.62. d‐Tagatose was then tested in toothpastes containing typical abrasives to determine whether the abrasives would induce crystallization of the sweetener. The addition of 20–25% wt/wt of d‐tagatose to the Tom of Maine's toothpastes imparted a satisfactory sweetness. It was found that, within that range of concentration, d‐tagatose retained its humectancy, and did not crystallize in the popular brands of commercial toothpastes tested. Thus, d‐tagatose could be used as a humectant sweetener in toothpastes, although further work on a final toothpaste formula will be necessary to check stability and flavour factors.
Paleolithic diets: a sceptical view
Authors: Nestle Marion
Published: March 2003

Some anthropologists have suggested that humans are genetically determined to eat diets quite different from those of today. Very little human evolution has occurred in the past 15,000 years. However, diets have changed dramatically and in parallel with a shift in disease patterns from infectious diseases and diseases associated with nutrient deficiencies, to chronic degenerative diseases associated with excessive and unbalanced intake of energy and nutrients. This review examines some of the archaeological evidence relating to the diets of early man and other primates, and current hunter‐gatherer societies. Knowledge of the relative proportions of animal and plant foods in the diets of early humans is circumstantial, incomplete, and debatable and there are insufficient data to identify the composition of a genetically‐determined optimal diet. The evidence related to Paleolithic diets is best interpreted as supporting the idea that diets based largely on plant foods promote health and longevity, at least under conditions of food abundance and physical activity.
The human gut flora in nutrition and approaches for its dietary modulation
Authors: Kolida Sofia , Tuohy K. , Gibson Glenn R.
Published: March 2003

Concepts about human nutrition have changed significantly during the past few decades, especially in the developed world. There is a shift from the concept of ‘adequate’ to ‘optimal’ nutrition. Thus, diet is not only considered as a means of survival but also as a way of achieving better health and quality of life.

The human colonic microbiota has a central role in both health and nutrition. It is unique in complexity and function in the body. More than 500 different bacterial species inhabit the human gut, some considered beneficial, others benign, and others detrimental to host health. There is a delicate balance between the host and the colonic microflora, which not only acts as a protective barrier against infection, but also provides up to 7–10% of the host's daily energy requirements through the fermentation of carbohydrates that escape digestion in the upper gastrointestinal tract. Functional foods targeting the colon focus on the development and prevalence of bacterial species that are considered beneficial to human health, namely, bifidobacteria and lactobacilli. Three approaches for the modulation of human gut flora are reviewed here: probiotics, prebiotics and synbiotics, along with methods for improved characterization and analysis of the intestinal microbiota.
IGD food labelling initiatives on food allergens and food safety
Authors: Gatenby Sue
Published: March 2003

Summary An Institute of Grocery Distribution initiative on food labelling has recently addressed two areas of public concern – the presence of allergens in foods and general food safety. Voluntary Guidelines on Labelling, developed by cross‐sector working groups in these areas, have recently been published and are briefly summarised in this paper.
Biology of Chronic Lymphocytic Leukemia
Authors: Caligaris‐Cappio Federico
Published: March 2003

B‐cell chronic lymphocytic leukemia CLL) lies at the cross‐roads of hematology, immunology and oncology for at least three major reasons: a) it is the prototype of human malignancies that primarily involve defects in the induction of apoptosis; b) CLL patients develop a severe immunodeficiency with progressive hypogammaglobulinemia; and c) they have a high prevalence of autoimmune phenomena. Recent advances in the biology of the malignant cell in CLL lead to a scenario comprised of two basic elements: first, CLL cells are optimally organized to survive in their niches because their ability to undergo apoptosis is severely hampered; second, they have a microenvironment‐dependence that promotes their extended survival, a situation that arises most probably through direct cell‐to‐cell contacts. In addition, CLL cells themselves are the major accessory cells in CLL, but are inefficient antigen‐presenting cells. This latter defect may provide a clue to reinterpret the events of immunodeficiency and autoimmunity.
Management of Acquired Aplastic Anemia
Authors: Gordon‐Smith E. C. , Marsh J. C. W.
Published: March 2003

Acquired aplastic anemia is an uncommon disorder of unknown pathogenesis characterized by peripheral blood pancytopenia and a hypocellular marrow, where normal hematopoietic tissue is replaced by fat cells. About 15% of cases follow exposure to drugs or a hepatitic‐like illness. The differential diagnosis includes congenital aplastic anemia, myelodysplastic syndrome (MDS) or leukemias presenting with hypocellular phase and, rarely, antibody‐mediated pancytopenias. Support with blood products and the avoidance and treatment of infection provide the essential platform for more definitive therapy. Allogeneic stem cell transplantation from a human leukocyte antigen (HLA)‐matched sibling donor is the most appropriate first‐line treatment for children and young adults (< 45 years of age) with severe or very severe aplastic anemia. Immunosuppression with antilymphocyte globulin or antithymocyte globulin followed by cyclosporine is the most appropriate treatment for the remaining patients. The response to therapy is determined mainly by the severity of the disease and is independent of the etiology. Immunosuppressive therapy is equally effective in older patients as in younger. Sibling transplantation is successful in 70–90% of cases — the results seem to improve year by year. About two out of three patients respond to a first course of immunosuppressive therapy, but relapse or late complications occur in 25–40% of patients so treated over 10 years. In patients who do not respond to the first course of immunosuppression, subsequent courses can be given with the expectation of success, although the response is slow. Late complications include the emergence of abnormal clones, e.g. paroxysmal nocturnal hemoglobinuria, MDS and acute leukemia. The place of stem cell transplantation from unrelated volunteer donors has yet to be properly defined.
GENETIC PROFILEOF ACUTE MYELOID LEUKEMIA
Authors: Mecucci Cristina , Rosati Roberto , Starza Roberta La
Published: March 2003

Understanding genomic events and the cascade of their effects in cell function is crucial for identifying distinct subsets of acute myeloid leukemia and developing new therapeutic strategies. Conventional cytogenetics, fluorescence in situ hybridization investigations and molecular studies have provided much information over the past few years. This review will focus on major genomic mechanisms in acute myeloid luekemia and on the genes implicated in the pathogenesis of specific subtypes.
Dermatoscopy in the diagnosis of pigmented skin lesions: a new semiology for the dermatologist
Authors: Carli P , De Giorgi V , Soyer Hp , Stante M , Mannone F , Giannotti B
Published: March 2003

Dermatoscopy or epiluminescence microscopy (ELM), is a noninvasive method that enables clinicians to evaluate fully – by means of a magnified oil immersion diascopy – numerous morphological features, not visible with the naked eye, which enhance the diagnosis of nearly all pigmented skin lesions. In recent years, a burst of research activity in this topic has been carried out, dealing with different aspects, and new frontiers, of this technique. First, a continuous refinement of dermatoscopic terminology is undertaken, paying particular attention to the diagnostic performance of dermatoscopy at peculiar anatomical sites and to the building of different dermatoscopic algorithms aimed at a simplified diagnosis of melanoma, even for less experienced observers. Another point of interest concerns the possible role of dermatoscopy in the pre‐operative assessment of melanoma thickness. Finally, promising data about the role of digital equipment in the follow up of melanocytic skin lesions as well as in the automated diagnosis of pigmented skin lesions have been recently reported. This paper should enable readers to become familiar with the procedure and terminology of ELM in the diagnosis of pigmented skin lesions encouraging a greater understanding of different methods (pattern analysis, algorithms) in the diagnosis of melanoma using ELM.
Cheilitis granulomatosa
Authors: Van Der Waal RIF , Schulten EAJM , Van De Scheur MR , Wauters IMPMJ , Starink TM , Van Der Waal I
Published: March 2003

Cheilitis granulomatosa is a rare inflammatory disorder with unclear aetiology. It is a disorder characterized by recurrent or persistent swelling of one or both lips that may be part of the Melkersson–Rosenthal syndrome or may be a manifestation of Crohn’s disease. An overview of the clinical features, histopathology, differential diagnosis, management strategies and prognosis of cheilitis granulomatosa is presented and discussed with regard to the literature.
Hepatitis B and hepatitis C virus infections in dermatological patients in west Sicily: a seroepidemiological study
Authors: Bongiorno MR , Pistone G , Aricò G
Published: March 2003

Objectives To evaluate the relative frequencies and molecular epidemiological features of viral hepatitis types B and C in dermatological patients in our geographical area.

Methods We determined the hepatitis B virus (HBV) and hepatitis C virus (HCV) antibodies and the hepatitis B virus surface antigen (HBsAg) in a cohort of 677 dermatological patients admitted to the Department of Dermatology of Palermo. An 8‐mL blood sample was taken from all subjects. The following assays were used: HBsAg, anti‐HB core (antigen) (anti‐HBc), anti‐HB surface (antigen) (anti‐HBs), anti‐HB early (antigen) (anti‐Hbe) and anti‐HCV antibodies using enzyme‐linked immunosorbent assay.

Results One hundred and eighty‐nine (27.91%) of the 677 dermatological patients were positive for anti‐HBc, anti‐HBs, anti‐HBe and/or anti‐HCV antibodies. In particular 22% (149 patients) were anti‐HBc, anti‐HBs or anti‐HBe positive, reflecting exposure to HBV, and six patients (0.88%) were chronic carriers of HBsAg; 2.36% of the dermatological patients (16 persons) were anti‐HCV positive. Tests showed that 24 subjects (3.52%) were infected with hepatitis B or C. The peaks in the age bands were in the 55–80‐year‐old age groups.

Conclusions This study confirms a high rate of HBV and HCV exposure with chronic carriers in our dermatological patients. We assume that the high prevalence of HCV and HBV in dermatological patients is more likely to be age related than to represent a true and direct association with dermatological diseases in general. Definite conclusions will only be available after large epidemiological studies that can establish or refute an aetiological and pathogenetic role of HBV and HCV in certain skin diseases associated with liver infection.
Development of oesophageal involvement in a subject with pemphigus vulgaris: a case report and review of the literature
Authors: Palleschi GM , Cipollini EM , Lotti T
Published: March 2003

We present the case of a 50‐year‐old‐man with pemphigus vulgaris involving the oropharyngolaryngeal mucosa and oesophagus. Oesophageal involvement of pemphigus vulgaris is relatively uncommon, especially in subjects in clinical remission, and has been rarely described in the literature. Endoscopic examination should be performed to avoid inappropriate therapy due to misdiagnosis of steroid‐induced oesophagitis and peptic ulcers.
Local treatment of chronic cutaneous leg ulcers with recombinant human granulocyte‐macrophage colony‐stimulating factor
Authors: Bianchi L , Ginebri A , Hagman JH , Francesconi F , Carboni I , Chimenti S
Published: March 2003

Aim To test the efficacy and safety of recombinant granulocyte‐macrophage colony‐stimulating factor (rHuGM‐CSF) in the treatment of chronic cutaneous leg ulcers.

Methods Five patients with chronic cutaneous leg ulcers were recruited for this 4‐month study using only rHuGM‐CSF to treat the ulcers. One patient had a neuropathic‐diabetic ulcer, and four had long‐standing vascular leg ulcers.

Results The patient with the neuropathic diabetic ulcer showed complete healing after 1 month of treatment. The other four patients with vascular leg ulcers with a long history of ulceration had a poor prognosis for healing. The first, with three venous ulcerative lesions, presented complete resolution of one ulcer and stabilization of the other two; the second and third patients, with large vascular ulcers, improved with more then 50% reduction of the mean diameter of the ulcers; the fourth patient, with one large venous ulcer, did not show any improvement.

Conclusions Pathogenesis, size and duration of the ulcers seemed to be the most important parameters regarding wound repairing capability of rHuGM‐CSF. None of the ulcers increased in size and none of the patients developed clinical side‐effects or peripheral blood cell count abnormalities during the treatment. All the results described were stable after 6 months of follow up. The absence of peripheral leucocyte count variation and the size‐dependent therapeutic effect indicate that the drug exercises local rather than systemic actions.
The role of psychological factors in palmoplantar pustulosis
Authors: Sáez‐Rodríguez M , Noda‐Cabrera A , Álvarez‐Tejera S , Guimerá‐Martín‐Neda F , Dorta‐Alom S , Escoda‐García M , Fagundo‐González E , Sánchez‐González R , García‐Montelongo R , García‐Bustínduy M
Published: March 2003

Objective
 
The aim of the present study was to find out whether emotional stress is related to palmoplantar pustulosis (PPP).

Subjects and methods
 
Our 21 patients with palmoplantar pustulosis and 21 age‐ and sex‐matched controls were studied with the help of a psychological interview and two psychological tests: Eysenk's Personality Questionnaire for Adults (EPQ‐A) and Inventory of Situations and Response of Anxiety (ISRA).

Results
 
Anxiety, ranging from moderate to severe was higher in PPP patients than in controls (P < 0.001).

Conclusion
 
Our findings seem to indicate that stress may be related to exacerbation of the palmoplantar pustulosis.
Current treatments and perceptions of genital herpes: a European‐wide view
Authors: Strand A , Barton S , Alomar A , Kohl P , Kroon S , Moyal‐Barracco M , Munday P , Paavonen J , Volpi A
Published: March 2003

A European panel of physicians reviewed the current treatments and perceptions of recurrent genital herpes (GH) across the continent. The panel consisted of specialists in dermatology and venereology from France, Finland, Germany, Italy, Norway, Spain, Sweden and the UK. A wide variety of factors that influence GH management were considered, including different health delivery systems, funding and cultural differences. The poor awareness of GH among both the general public and physicians was highlighted. The effectiveness of GH management was then examined from a patient's viewpoint, including the confirmation of the diagnosis, information and counselling about GH, as well as prescriptions for treatment. It was agreed that both physicians and patients often feel uncomfortable about discussing the disease, and that a European‐wide effort is needed to re‐educate patients and physicians about GH. The panel identified clear and unmet needs to manage a patient with clinical recurrences and to attempt to reduce the risk of GH transmission. Finally, resiquimod, an immune response modifier, was considered as a potential treatment option for GH.
Long‐term remission of recalcitrant tumour‐stage mycosis fungoides following chemotherapy with pegylated liposomal doxorubicin
Authors: Tsatalas C , Martinis G , Margaritis D , Spanoudakis E , Kotsianidis I , Karpouzis A , Bourikas G
Published: March 2003

Advanced stage mycosis fungoides (MF) generally has a poor prognosis, and currently there is no standard treatment available. Here we report the case of a young woman with recalcitrant tumour‐stage MF (T3, stage IIb) whose disease was unresponsive to several therapeutic modalities, but who has showed sustained clinical response to pegylated liposomal doxorubucin. No severe infectious complications have been observed. The use of this drug in tumour‐stage MF should be investigated further.
Healthy Ageing – Adults with Intellectual Disabilities: Ageing and Social Policy
Authors: Hogg J. , Lucchino R. , Wang K. , Janicki M.
Published: March 2003

This report has been prepared by the Ageing Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities (IASSID) in collaboration with the Department of Mental Health and Substance Dependence and the Programme on Ageing and Health, World Health Organization (WHO), Geneva, Switzerland, and all rights are reserved by the above mentioned organization. The document may, however, be freely reviewed, abstracted, reproduced or translated in part, but not for sale or use in conjunction with commercial purposes. It may also be reproduced in full by non‐commercial entities for information or for educational purposes with prior permission from WHO/IASSID. The document is likely to be available in other languages also. For more information on this document, please visit the following websites: ,  and .