bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐invasive markers of bone turnover and plasma cytokines differ in osteoporotic patients with multiple myeloma and monoclonal gammopathies of undetermined significance
Authors: Diamond T. , Levy S. , Smith A. , Day P. , Manoharan A.
Published: March 2003

Abstract

Aims: To determine whether various markers of bone turnover and/or plasma cytokines differ in patients with multiple myeloma (MM) compared with patients with monoclonal gammopathies of undetermined significance (MGUS).

Methods: We studied 22 MM patients and 18 MGUS patients presenting over an 18‐month period and compared their data with those from 20 age‐ and sex‐matched patients presenting with primary osteoporosis. According to the Salmon and Durie classification, there were eight patients with stage I, nine with stage II and five with stage III disease. All patients had densitometric evidence of osteoporosis and were classified according to bone marrow evidence of plasma cell dyscrasia. Measured variables included markers of bone formation and bone resorption, and plasma cytokines.

Results: Patients with MM and MGUS did not differ with respect to their mean age, male : female sex ratio, height, weight, serum calcium, 25‐hydroxyvitamin D and parathyroid hormone concentrations. Patients with MM had significantly lower concentrations of haemoglobin (109 vs 135 g/L) and serum transforming growth factor (TGF)‐β (261 vs 348 pg/mL) than patients with MGUS, and higher concentrations of serum paraproteins (31.1 vs 7.4 g/L), β2‐microglobulin (3.5 vs 2.2 g/L), % plasma cell numbers (35.3 vs 2.1%) and urinary deoxypyridinoline excretion rates (u‐DPYD; 7.7 vs 5.9 nmol/mmol creatinine; P < 0.05 for all comparisons). In multivariate analysis, the serum paraprotein (β coefficient = –0.067; 95% confidence intervals (CI), –0.019 to –0.005; P = 0.0012), u‐DPYD excretion rates (β coefficient = –0.012; 95% CI, –0.113 to –0.02; P = 0.0058) and serum TGF‐β concentrations (β coefficient = –0.002; 95% CI, –0.0002 to –0.02; P = 0.02) were the most important variables differentiating between MM and MGUS, after excluding lytic bone lesions, % plasma cell numbers and haemoglobin concentrations.

Conclusions: The well‐established criteria for diagnosing MM include the presence of lytic bone lesions, plasmacytosis, haemoglobin and paraprotein concentrations. The u‐DPYD excretion rate, a sensitive non‐invasive marker of bone resorption, may help in differentiating between MM and MGUS, as well as serving as a marker of underlying bone disease activity in these patients. (Intern Med J 2001; 31: 272–278)
Towards a molecular approach to gastric cancer management
Authors: Boussioutas A. , Taupin D.
Published: March 2003

Abstract

Gastric cancer is a leading cause of cancer death worldwide. Most patients with gastric cancer present with locally advanced and incurable disease, and overall survival is poor. Considerable research efforts towards the epidemiology and pathogenesis of gastric cancer have not been translated into treatment success. We discuss current concepts of the pathogenesis of gastric cancer and how recent research advances, in particular global gene expression strategies, may improve this understanding, and suggest a framework wherein these approaches may be used. (Intern Med J 2001; 31: 296–303)
What do physicians think about evidence‐based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners
Authors: Sintchenko V. , Iredell J. R. , Gilbert G. L. , Coiera E.
Published: March 2003

Abstract

Background: The analysis of factors that influence prescribing decisions is increasingly important. Antibiotic use is often based on limited evidence and lack of information about clinical decision‐making processes is an important obstacle to improving antibiotic utilization.

Aims: To compare the attitudes of intensive care unit practitioners (ICUP) and infectious disease practitioners (IDP) to antibiotic use and to the evidence‐ based information support.

Method: A postal survey conducted between March and July 2000 of ICUP and IDP representing all States and Territories in Australia.

Results: One hundred and fifty‐three of 224 clinicians returned the questionnaire (68.3% response rate). In choosing an antibiotic, IDP placed significantly more weight than ICUP on the in vitro susceptibility of the pathogen (P = 0.001), antibiotic cost (P = 0.05) and possible development of antibiotic resistance (P = 0.007). More than 95% of both groups believed that unit‐specific antibiotic susceptibility of endemic pathogens was an essential factor in rational prescribing, but only 68.5% of IDP and 38.7% of ICUP use microbiology laboratory databases. When in doubt about appropriate antibiotic use, 63.8% of ICUP seek and 76.3% usually follow the advice of IDP. Both groups agree that published antibiotic guidelines are useful, but IDP were more likely to consult them. ICUP were more likely to believe that guidelines are used to control clinicians rather than to improve quality of care (P = 0.001). A greater proportion of IDP (71.2%) than ICUP (52.5%) believed that antibiotic prescribing in their intensive care unit (ICU) was evidence based but most (91.8% and 86.9%, respectively) agreed that it should be.

Conclusions: Australian clinicians have positive views about evidence‐based prescribing and antibiotic guidelines. However, there are clinically significant differences in prescribing behaviour between ICUP and IDP. These may be explained by different disease spectra managed by each group or different cultures, training and/or cognitive styles. Improvements in the understanding of physicians’ information and decision support needs are required to strengthen evidence‐based prescribing. (Intern Med J 2001; 31: 462–469)
Hereditary colorectal cancer: keeping it in the family − the bowel cancer story
Authors: McGrath D. R. , Spigelman A. D.
Published: March 2003

Up to 20% of colorectal cancers are thought to have a genetic component. Several familial syndromes are known to confer an increased risk for colorectal cancer. Advances in our understanding of these syndromes has impoved the care delivered to, and the overall survival of, these patients. Genetic testing has great potential to further improve detection and direct subsequent preventative measures. The diagnosis, management and surveillance issues relating to some of the more commonly encountered syndromes − in particular Familial Adenomatous Polyposis and Hereditary Non‐Polyposis Colorectral Cancer − are reviewed.
Lack of clinical utility of the Siriraj Stroke Score
Authors: Hui A. C. F. , Wu B. , Tang A. S. y. , Kay R.
Published: March 2003

Background : The ability to distinguish between infarct and haemorrhage is essential to the management of acute cerebrovascular disease. In hospitals where emergency neuroimaging is not available, the use of stroke scores has been proposed to distinguish ischaemic from haemorrhagic stroke.

Aims : To determine the accuracy of the Siriraj Stroke Score in distinguishing ischaemic from haemorrhagic stroke in a cohort of Chinese patients.

Methods: We prospectively assessed and calculated the Siriraj stroke Score from 253 patients with acute stroke. The sensitivity, specificity, positive and negative predictive values of this score were determined.

Results : For cerebral haemorrhage, the sensitivity and specificity were both 90% or above, but the positive predictive value was not greater than 70%. For cerebral infarct, the sensitivity and specificity were around 80%, while the positive predictive value exceeded 90%. Analysis by plotting receiver operating characteristic curves failed to find other cut‐off points that would improve the performance of the Siriraj Stroke Score.

Conclusions: Considering the inconsistent results from this study and previous studies of the Siriraj Stroke Score, we suggest that scoring systems that only require a small number of variables are unlikely to achieve the level of accuracy needed for clinical decision‐making. (Intern Med J 2002; 32: 311−314)
Clinical features of Fabry's disease in Australian patients
Authors: Galanos J. , Nicholls K. , Grigg L. , Kiers L. , Crawford A. , Becker G.
Published: March 2003

Abstract

Background:  Anticipating the prospect of specific treatment, we studied a large group of Australians with Fabry's disease.

Aims: We aimed to: (i) document the clinical ­features of Fabry's disease in Australian patients, (ii) test the hypothesis that clinical features vary with specific mutation and blood group and (iii) assess small‐fibre peripheral nerve function.

Methods: A questionnaire was forwarded to all Australian patients known to us. Patients were invited to attend for clinical, renal cardiac, ophthalmological and neurological assessment.

Results: Sixty‐seven patients (29 men and 38 women) from 18 families participated. Diagnosis in index cases was delayed by ≥10 years in nearly all families. Common clinical features are: (i) episodic acropar­aesthesia (100% of hemizygotes; 53% of heterozygotes), (ii) anhydrosis (93%; 1%), (iii) characteristic rash (93%; 13%), (iv) renal disease (69%; 21%), (v) ischaemic heart disease (28%; 26%), (vi) palpitations (62%; 29%), (vii) mitral valve murmurs (37%; 23%) and (viii) premature cerebro­vascular disease (31%; 5%). Ophthalmic findings of cornea verticillata (96%; 76%) and anterior cataract (48%; 14%) were common. Findings were variable within and between families. In women, anhydrosis reliably predicts the presence of significant Fabry's renal disease. Small nerve fibre testing using quantitative sensory testing was clearly abnormal in 95% of male patients, and in those female patients with para­esthesiae.

Conclusions: Symptoms of anhydrosis, acroparaesthesiae, rash and renal disease suggest diagnosis of Fabry’s. Women are commonly symptomatic, and the advent of therapy highlights the practical advantage of earlier diagnosis. (Intern Med J 2002; 32: 575−584)
Strategy of Echinochloa oryzicola Vasing. for survival in flooded rice
Authors: Yamasue Yuji
Published: March 2003

Echinochloa oryzicola Vasing. (= Echinochloa phyllopogon Stapf ex Kessenko) is an obligate weed with an elaborated survival strategy in the flooded rice of Japan. In this review various adaptive characters of the weed, which comprise the survival strategy, are discussed through the life cycle. The weed is distributed only in flooded rice. Seeds (spikelets) buried in the soil exhibit annual cycles between dormant and non‐dormant state, and non‐dormant seeds recurrently appear in spring when rice growers start to prepare seedling beds and fields for rice transplanting. The non‐dormant seeds have unique characters metabolically adapted to submerged conditions to germinate and grow by the anaerobic respiration through alcohol fermentation. The weed has seemingly perfect mimicry of the rice plants throughout its development from seedling to heading, by which the weed escapes from manual weeding. In a rice paddy, the weed starts heading coincidentally with the rice plants at the period when the growers are reluctant to walk in the rice paddy to weed. Irrespective of plant height of the rice cultivar, the weed develops a few upper leaves above the rice canopy during the heading period of rice. This phenotypic plasticity of E. oryzicola in plant height is one of the characters conferring its competitive aggressiveness in flooded rice. When weeding is begun again after heading, the dormant weed seeds escape weeding by shattering and join the soil seedbank. The dormant seeds express the gene of an enzyme catalyzing ATP synthesis through the mitochondrial oxidative phosphorylation more abundantly, and have larger oxygen absorption and enzyme activity of the aerobic respiration than the non‐dormant seeds, suggesting that the dormant seeds maintain viability by the conventional aerobic respiration in the paddy soil drained from rice harvesting in fall to the next early spring. The various adaptive characters comprising the survival strategy of E. oryzicola in flooded rice consist of those inherited from the wild progenitor and those selected by the crop cultivation pressure. It is suggested that both the mimicry of the weed and the heading coincident with the rice plants have been acquired by the large selection pressure of frequent weeding, which has been done over the past hundred years. However, today, the manual weeding is substituted with herbicides, which cannot detect the mimicry and heading photoperiodic sensitivity. As a result, the dominant species of Echinochloa weeds in flooded rice is changing from E. oryzicola to Echinochloa crus‐galli var. crus‐galli that has neither mimicry nor photoperiodic sensitivity synchronizing to that of rice, but is more competitive against rice.
Natural hybridization in wild soybean (Glycine max ssp. soja) by pollen flow from cultivated soybean (Glycine max ssp. max) in a designed population
Authors: NAKAYAMA YUICHIRO , YAMAGUCHI HIROFUMI
Published: March 2003

The frequency of hybridization through pollen flow from the cultivated soybean to the wild soybean was evaluated for the purpose of assessment of the ecological risk of genetically modified crops. The flowering habits of three soybean cultivars and one wild soybean accession were monitored on an experimental farm. A cultivar and a wild accession, both of which flowered at a similar period, were then planted alternately in 5 × 12 arrays with 50 cm spacing on the farm. The seedlings of progeny seeds gathered from individual plants of the wild accession were used for an isozyme analysis to identify whether they were hybrid or not. In 23 plants of the wild accession, four plants produced hybrids (the incidence of hybridization = 17.4%). There was no directionality in hybridization. The hybridization rate per maternal plant varied from 0 to 5.89% with a mean of 0.73% for all maternal plants. The results indicate that natural hybrids are easily produced in a certain frequency by pollen flow from the cultivated soybean to the wild soybean under their simultaneous flowering with adequate pollinators.
Difficult intubation in an infant with Pierre Robin(r) syndrome and concomitant tongue tie
Authors: Jones Susan E. F , Derrick Gillian M
Published: March 2003

Intubation and airway difficulties may be assumed in infants with Pierre Robin syndrome. We report a case of a six month old cleft palate repair who also had a tongue tie which compounded the problem. He was eventually intubated using the two anaesthetist technique. The contribution of the tongue tie is assessed.
Reference values of gastric intramucosal pH in children
Authors: REINOSO‐BARBERO F. , CALVO C. , RUZA F. , LÓPEZ‐HERCE J. , BUENO M. , GARCÍA S.
Published: March 2003

To determine the reference values of gastric intramucosal pH (pHi) by tonometry in paediatric patients, we studied 17 children (nine males, eight females) with no systemic or gastrointestinal disease, aged six months to 12 years undergoing minor reconstructive surgery. Following anaesthetic induction a sigmoid tonometry catheter was inserted (Tonometrics, Inc.) into the stomach of the patients under direct vision. All children were normoventilated and were haemodynamically stable. After an equilibration period of 30 min, gastric pHi was calculated by applying the Henderson‐Hasselbalch equation on the Pco2 obtained with the tonometer and the bicarbonate from the arterial blood gas analysis. The mean gastric pHi in our patients was 7.35±0.06 (sd). The normal pHi in the general population is estimated to be 7.31–7.40, with a confidence interval of 99%. No correlation was found between pHi and arterial pH, bicarbonate or base excess. Under conditions of normal ventilation and haemodynamic stability, healthy children during general anaesthesia have gastric intramucosal values similar to those of adults.
Position of the internal jugular vein in children. A study of the anatomy using ultrasonography
Authors: MALLINSON C. , BENNETT J. , HODGSON P. , PETROS A. J.
Published: March 2003

The relative anatomy of the internal jugular vein (IJV) was studied in 25 patients undergoing cardiac catheterization under general anaesthesia, with the use of a portable ultrasound probe. In 14 of cases the IJV was anterior, 1 anterolateral and in 10 lateral to the carotid artery between the two heads of the sternocleidomastoid muscle. At the level of the cricoid cartilage, in six cases the IJV was anterior, three anterolateral and in 16 of children the IJV was lateral to the carotid artery. When attempting to cannulate the IJV, because of the variability in relationship of the IJV to CA the technique used should be modified depending upon the level at which cannulation is attempted. The position of the IJV in the child appears to be so variable extra care should be taken when cannulating the IJV and it should not be assumed that the techniques used in adults are directly transferable.
The laryngeal mask airway in the difficult paediatric airway: an assessment of positioning and use in fibreoptic intubation
Authors: Walker Robert W.M.
Published: March 2003

The laryngeal mask airway (LMA) was used in 34 children who presented with difficult airways and difficulty in intubation. All 34 children were a grade 3 or grade 4 Cormack and Leehane view at conventional laryngoscopy. The laryngeal mask airway was used as part of the anaesthetic technique. It was either used as the method of airway maintenance during a short procedure or as an aid to fibreoptic intubation. The results of its use in this group of patients showed that overall a good airway was obtained in 73% of patients and an adequate airway in 27%, and in no patient was a poor airway obtained. The fibreoptic positioning of the LMA, taken from the distal aperture of the laryngeal mask airway showed that, overall, in 29.5% of patients a full view of the glottis (grade 1) was obtained, in 29.5% of patients a partial view of the glottis (grade 2) was obtained and in 41% a view of the epiglottis only (grade 3) was obtained. In no patient was a view excluding the epiglottis obtained. In children with a mucopolysaccharide disorder, the number of children who had a grade 3 view increased to 54%. Children with a disorder other than mucopolysaccharidosis had a grade 3 view in only 17% of cases. Children with mucopolysaccharidoses had a grade 1 view in only 14% of cases compared with 58% in the group with other disorders. Of the 34 patients, 21 patients were intubated on 31 separate occasions. There were no failures. The complications of the fibreoptic intubation technique described are outlined.
The effect of propofol on intraoperative electrocorticography and cortical stimulation during awake craniotomies in children
Authors: Soriano Sulpicio G. , Eldredge Elizabeth A. , Wang Frank K. , Kull Lewis , Madsen Joseph R. , Black Peter McL. , Riviello James J. , Rockoff Mark A.
Published: March 2003

Propofol has been proposed as a sedative agent during awake craniotomies. However, there are reports of propofol suppressing spontaneous epileptiform electrocorticography (ECoG) activity during seizure surgery, while others describe propofol‐induced epileptiform activity. The purpose of this study was to determine if propofol interferes with ECoG and direct cortical stimulation during awake craniotomies in children. Children scheduled for awake craniotomies for resection of epileptic foci or tumours were studied. An intravenous bolus of 1–2 mg·kg−1 followed by infusion of 100–200 μg·kg−1·min−1 of propofol was administered to induce unconsciousness. Fentanyl (0.5 μg·kg−1) was administered incrementally to provide analgesia. After the cortex was exposed, the propofol infusion was stopped and the patient permitted to awaken. Cortical electrodes were applied. ECoG was recorded continuously on a Grass polygraph. Motor, sensory, language, and memory testing were done throughout the procedure. The cortex was stimulated with a hand‐held electrode using sequential increases in voltage to map the relevant speech and motor areas. We studied 12 children (aged 11–15 years) with intractable seizures. The raw ECoG did not reveal any prolonged β‐waves associated with propofol effect. Electroencephalogram spikes due to spontaneous activity or cortical stimulation were easily detected. Cognitive, memory and speech testing was also successful. We conclude that propofol did not interfere with intraoperative ECoG during awake craniotomies. Using this technique, we were able to fully assess motor, sensory, cognitive, speech and memory function and simultaneously avoid routine airway manipulation.
Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy
Authors: Soriano Sulpicio G. , Kaus Sarah J. , Sullivan Lorna J. , Martyn J.A. Jeevendra
Published: March 2003

The onset and time course of action of rocuronium in normal children and children receiving anticonvulsant drugs for prolonged periods was characterized. A single bolus dose of 0.6 mg·kg−1 rocuronium was administered i.v. to seven nonepileptic patients on no medication, and eight patients on chronic anticonvulsant therapy consisting of either phenytoin, carbamazepine, or both who were age and weight matched. Neuromuscular transmission was monitored by the evoked compound electromyography of the thenar muscles using train of four stimulation every 20 s. Recovery times of the first twitch to 10%, 25%, 50%, 75% and 100% of baseline values and recovery index were obtained. The onset times were 1.05±0.5 and 1.41±0.5 min for the control and anticonvulsant groups respectively and were not significantly different. Children receiving chronic anticonvulsant therapy had significantly shorter recovery index than the control group (control 10.4±5.1 min, anticonvulsant 4.8±1.7 min, P<0.05). Furthermore, the duration of recovery to 10%, 50%, 75% and 100% of baseline T1 values was less in the anticonvulsant drug group. Our data confirm resistance to rocuronium in children on chronic anticonvulsant drugs.
A review of anaesthetic technique in 15 paediatric patients with temporomandibular joint ankylosis
Authors: Vas Lakshmi , Sawant Pradnya
Published: March 2003

Temporomandibular joint ankylosis presents a serious problem for airway management. This relatively rare problem becomes even more difficult to manage in children because of their smaller mouth opening with near total trismus, and the need for general anaesthesia before making any attempts to secure the airway. A technique for securing the airway that combines local blocks for nerves of larynx and topical anaesthesia of upper airways for placement of these blocks, and minimal general anaesthesia for these manoeuvres, is described. For general anaesthesia, a combination of halothane and ether by spontaneous ventilation, using bilateral nasopharyngeal airways, was used. Because of the severe trismus, a tongue depressor or tip of a laryngoscope was used with a fibreoptic light source in the buccal sulcus to visualize the tracheal tube in the pharynx. Nasal forceps, with a smaller tip and narrower blade than Magill forceps was used to guide the tracheal tube towards the air bubbles coming out of larynx. No attempt was made to visualize the larynx, but its position was guessed from the direction of these air bubbles. We review the anaesthetic technique in 15 such cases of severe trismus managed successfully between 1986 and 1999.
Use of impedance cardiography to monitor haemodynamic changes during laparoscopy in children
Authors: Kardos Attila , Vereczkey Gábor , Pirót László , Nyirády Péter , Mekler Róbert
Published: March 2003

Methods: Haemodynamic changes were measured noninvasively using impedance cardiography (ICG) in 30 ASA I children during laparoscopic varicocelectomy under general anaesthesia. After induction and intubation, mechanical ventilation was started, then pneumoperitoneum (PP) was created. During the course of anaesthesia, values of endtidal CO2 pressue (PECO2), peak inspiratory airway pressure (PIP), heart rate (HR), mean arterial blood pressure (MABP), stroke volume index (SVI), cardiac index (CI) and systemic vascular resistance index (SVRI) were recorded at 1 min intervals. We analysed four periods: T1, before induction; T2, after induction; T3, during PP; T4, after desufflation of PP until awake.

Results: After induction of anaesthesia a significant reduction of HR, MABP and CI was recorded. Creating PP together with the use of a 15° head down tilt resulted in a further drop in CI, mainly caused by the reduction of SVI, and an elevation of MABP and SVRI. We measured a 25% total decrease of CI.

Conclusions: Our patients tolerated this significant reduction of cardiac output well. We have demonstrated that ICG can be used to track the haemodynamic changes caused by PP in children, and suggest that this type of monitoring is useful in this group of age during laparoscopy.
The prone position is associated with a decrease in respiratory system compliance in healthy anaesthetized infants
Authors: Cox Robin G. , Ewen Alastair , Bart Bevin B.
Published: March 2003

Ten healthy (ASA I or II) anaesthetized infants undergoing clubfoot surgery were studied. General anaesthesia included rocuronium, nitrous oxide and isoflurane. Volume controlled ventilation (12 ml·kg−1) was delivered via a coaxial Mapleson‐D (Bain) system and a Datex AS/3 ventilator. Pulmonary mechanics were measured sequentially in the supine and prone positions using a Bicore CP‐100 pulmonary function monitor. Subjects had a mean age of 6 (± 2) months and a mean weight of 8.3 (± 1.4) kg. Dynamic compliance (CDYN) and static compliance (CSTAT) were both significantly lower in the prone position than in the supine position (P < 0.0005). Mean CDYN decreased from 14.9 ± 4.9 ml·cmH2O–1 (supine) to 11.6 ± 3.5 ml·cmH2O–1 (prone). Mean CSTAT decreased from 10.2 ± 2.8 ml·cmH2O–1 (supine) to 8.9 ± 2.3 ml·cmH2O–1 (prone). No clinically significant differences in gas exchange were noted, however, on repositioning.
Pharmacokinetics of oral diclofenac and acetaminophen in children after surgery
Authors: Rømsing Janne , Østergaard Doris , Senderovitz Thomas , Drozdziewicz Dominika , Sonne Jesper , Ravn Grete
Published: March 2003

Background: Our aim was to study the pharmacokinetics and pain scores following administration of single oral doses of either diclofenac or high‐dose acetaminophen (paracetamol).

Methods: In the morning, the day after tonsillectomy, children 5–15 years of age were randomized in a double‐blind manner to receive either diclofenac 1–2 mg·kg−1 (n=11) or acetaminophen 22.5 mg·kg−1 (n=10). Postoperative pain was assessed by self‐report and blood samples were drawn every 30 min for 4 h after medication.

Results: Large interindividual differences in maximum plasma diclofenac concentrations (Cmax) were found. Mean Cmax was 2.4±1.3 μg·ml−1 and mean tmax was 2±0.5 h. No significant reduction in pain score with diclofenac was seen at any of the assessments during the study period. Eight of 10 children achieved Cmax of acetaminophen within the 10–20 μg·ml−1 antipyretic range. Mean tabs was 0.7±0.3 h and mean Cmax and tmax were 12.7±3.8 μg ml−1 and 1.4±0.5 h, respectively. No significant reduction in pain score with acetaminophen was seen at any of the assessments during the study period.

Conclusions: The achieved concentrations of diclofenac and acetaminophen were not able to significantly reduce the children’s pain score during the 5 h postingestion study period. Analgesic plasma acetaminophen concentrations may be higher than those required for antipyresis.
Life threatening cardiopulmonary failure in an infant following protamine reversal of heparin after cardiopulmonary bypass
Authors: Boigner H. , Lechner E. , Brock H. , Golej J. , Trittenwein G.
Published: March 2003

Life threatening cardiopulmonary failure following protamine reversal of heparin after cardiopulmonary bypass (CPB) was reported to occur in adults but rarely in children. Atrial septal defect closure was performed in a 6‐week‐old infant erroneously suspected to suffer from right atrial thrombosis in addition. Protamine administration after CPB led to critical pulmonary hypertension and severe haemorrhagic pulmonary oedema resulting in severe hypoxia. Inhaled nitric oxide, together with high frequency oscillation ventilation supplemented by intravenous prostacycline, enabled complete recovery of cardiopulmonary and neurological function. Life threatening cardiovascular compromise after intravenous protamine can occur even in young infants which then require challenging paediatric critical care.
Critical incidents in paediatric anaesthesia: an audit of 10 000 anaesthetics in Singapore
Authors: Tay C.L.M. , Tan G.M. , Ng S.B.A.
Published: March 2003

Background: We undertook an audit of paediatric perioperative incidents in the first 10000 anaesthetics administered in KK Women’s and Children’s Hospital in Singapore between May 1997 and April 1999. The spectrum of surgery performed ranged from simple ambulatory surgery to open heart surgery for complicated congenital heart diseases.

Methods: An audit form is completed for every anaesthetic delivered and critical incidents are reported on the reverse blank page of the audit form. An anaesthetic incident was defined as ‘any incident which affected, or could have affected, the safety of the patient under anaesthetic care’.

Results: Two hundred and ninety‐seven critical incidents were reported. The majority of them happened in healthy patients (80.1% ASA I and II) scheduled for elective surgery (73.3%). Critical incidents in infants less than 1 year of age were four times as common as in older children (8.6% versus 2.1%). Incidents occurred mainly during maintenance (80.6%). There was no anaesthetic mortality. Respiratory events were the most common (77.4%) with laryngospasm accounting for 35.7%. Cardiovascular incidents (10.8%) included hypotension from haemorrhage and sepsis, and dysrhythmias. The incidence of equipment and pharmacologically related problems was low.

Conclusions: Future reviews of a larger patient population may be helpful to determine trends of perioperative events and whether quality assurance programs have made a difference.
Evaluation of a new paediatric scavenging valve
Authors: TANSER S.J. , JOHNSON A.
Published: March 2003

Background: Prolonged exposure to anaesthetic gases may be associated with adverse effects. Scavenging is in widespread use in adult anaesthesia but it has been more difficult to find a satisfactory solution for use in paediatric anaesthesia. The Exeter Paediatric T‐piece Scavenging (Exeter PTS) valve has been designed for use with a modified Jackson‐Rees system to allow connection to an active or passive Approved Gas Scavenging System.

Methods: Use of the Exeter PTS valve was evaluated in 35 spontaneously breathing paediatric patients (mean age 4.7 years, mean weight 16.7 kg) using each patient as their own control. Atmospheric pollution was measured using a Miran 1B infrared spectrophotometer.

Results: When using a modified Jackson‐Rees breathing system with an open‐ended bag, pollution levels of isoflurane exceeded the Occupational Exposure Standard of 50 p.p.m. When the Exeter PTS valve and an active scavenging system were used, pollution was significantly reduced to below 5% of the recommended limit.

Conclusions: We conclude that there is a need to reduce atmospheric pollution when using a modified Jackson‐Rees system in spontaneously breathing patients and that this can be achieved by use of the Exeter PTS valve.
Use of laryngeal mask airway for prolonged ventilatory support in a preterm newborn
Authors: FERNÁNDEZ‐JURADO MªISABEL , FERNÁNDEZ‐BAENA MARIANO
Published: March 2003

We present the case report of a preterm, low weight newborn with dysmorphic features and micrognathia in whom a laryngeal mask airway was inserted and maintained for 44 h for ventilatory support after several failed intubations. No complications associated with laryngeal mask airway use were apparent.
Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate
Authors: Takemura Hiroshi , Yasumoto Kazumasa , Toi Takashi , Hosoyamada Akiyoshi
Published: March 2003

Summary Background: A retrospective survey of 339 infants who had undergone primary plastic surgery for cleft lip and palate was performed to evaluate the concomitant preoperative assessment based on severity grading of the common cold and the correlation of cleft type with the incidence of perioperative respiratory complications.

Methods: We assessed the severity of common cold symptoms in the preoperative period using the Common Cold Score, which comprises 10 symptoms and findings. We then determined the association of the incidence of perioperative respiratory complications with the increasing severity of common cold symptoms and also compared the complication incidence in the three cleft types in healthy infants without a common cold.

Results: The incidence of perioperative respiratory complications was greater in the group with a suspected presence of a common cold. Infants with severer cleft, who had bilateral cleft lip and palate, even without common cold symptoms, had a significantly higher incidence of perioperative respiratory complications (8.9%) than infants with simple cleft lip (1.7%, P < 0.05).

Conclusions: Clinicians should consider postponing primary plastic surgery for cleft lip and palate in infants with a suspected presence of a common cold. Our results also suggest that the presence of a wide cleft is a risk factor for causing perioperative respiratory complications in infants with cleft lip and palate. We believe that a careful preoperative assessment of common cold symptoms in these infants can decrease the incidence of perioperative respiratory complications.
Incidence of postoperative nausea and vomitingin paediatric ambulatory surgery
Authors: Villeret I. , Laffon M. , Duchalais A. , Blond M.H. , Lecuyer A.I. , Mercier C.
Published: March 2003

Summary Background: We performed a prospective descriptive study over a 5‐month period to determine the incidence of postoperative nausea and vomiting (PONV) during the first 24 h following elective ambulatory paediatric surgery, excluding head and neck procedures.

Methods: Four hundred and seven patients, aged 15 days to 16 years, were analysed prospectively.

Results: The incidence of PONV was 9.4%, occurring most frequently during the first 3 h after anaesthesia and in hospital but rarely during the journey home. It was associated with age, previous history of PONV, tracheal intubation or use of the laryngeal mask airway (LMA™), controlled or manual ventilation, opioids and absence of oral intake of liquids or solids. Conversely, type of surgery, premedication, induction mode, association of regional anaesthesia, inhaled nitrous oxide, duration of anaesthesia, stay in the postanaesthesia care unit and duration of journey after discharge were not significantly associated with PONV.

Conclusions: PONV never induced complications or delayed patient discharge and curative treatment was rapidly effective.
Advances in topical glaucoma therapy
Authors: Willis A. Michelle , Diehl Kathryn A. , Robbin Terah E.
Published: March 2003

Significant advances have recently been achieved in the development of topical glaucoma medications. The primary advantage of a topical preparation is the reduced incidence of adverse systemic effects attributable to a given drug compared to its systemically administered counterpart. However, the strong protective barrier of the eye forces topical ophthalmic preparations to be highly concentrated and in some cases, they have the potential to produce unwanted systemic effects, particularly in smaller animals. Oral carbonic anhydrase inhibitors are commonly associated with adverse effects in both humans and animals. Two recently developed topical carbonic anhydrase inhibitors, dorzolamide and brinzolamide, have shown promise in reducing intraocular pressure in animals and systemic side effects are apparently limited with their use. The topical α2‐agonist apraclonidine, on the other hand, effectively reduces intraocular pressure in cats and dogs, but in its currently available form is likely to induce unwanted systemic effects. Latanoprost is a topical prostaglandin F2α analog that has proven effective in reducing intraocular pressure in dogs and horses, but while systemic side effects have not yet been reported, this topical preparation may exacerbate pre‐existing or concurrent ocular inflammatory disease.
Effects of metaraminol bitartrate on intraocular pressure in dogs under halothane anesthesia
Authors: Bolzan A.A. , Laus J.L. , Nunes N. , De Andrade C.P.
Published: March 2003

The effects of metaraminol bitartrate on intraocular pressure (IOP) were studied in dogs anesthetized with halothane. Forty‐five healthy, adult, mixed‐breed dogs, of both sexes, were divided into three groups of 15 dogs each (GI, GII and GIII) and maintained under general anesthesia with halothane after tranquilization with levomepromazine and induction with thiopental. Saline (0.9%) was administered intravenously (IV) to GI through continuous infusion, at a velocity of 0.125 mL kg−1 min−1. GII and GIII received metaraminol 0.004% IV, at a dose of 5 μg kg−1 min−1, at 0.125 mL kg−1 min−1 and at a dose of 2 μg kg−1 min−1, at 0.06 mL kg−1 min−1, respectively. IOP was measured by applanation tonometry (Tono‐Pen) before and during anesthesia. Results showed that IOP decreased in GI, increased in GII, and remained at basal levels in GIII. Continuous infusion of metaraminol at 2 μg kg min−1 maintained IOP at pretest levels, while infusion at 5 μg kg−1 min−1 produced an elevation of IOP.
Corneoconjunctival transposition for the treatment of feline corneal sequestra: a retrospective study of 17 cases (1990–1998)
Authors: Andrew Stacy E. , Tou Sandra , Brooks Dennis E.
Published: March 2003

Objective

To describe and evaluate the use of corneoconjunctival transposition as a surgical treatment for corneal sequestra in cats.

Animals studied

Fifteen cats (17 eyes) of various breeds and ages with corneal sequestra treated surgically with corneoconjunctival transposition.

Procedure

Retrospective medical records study.

Results

Median age was 39 months. Eight patients were castrated males, five were spayed females, and two were intact females. The left eye was affected in eight cats, the right eye was affected in five cats, and both eyes were affected in two cats. Mean (± SD) sequestrum diameter was 4.4 ± 2.4 mm (range 1–10 mm) and the sequestrum was located centrally in all cases. Sequestra occurred in the superficial stroma in 8/17 corneas, in the anterior one third of the stroma in 3/17 corneas, and in the middle one third of the stroma in 6/17 corneas. Median duration of clinical signs prior to presentation was 39 days (range 14–1095 days). Median time to healing, defined as the number of days from surgery to cessation of medical treatment, was 34 days (range 25–86 days). There were no recurrences and minimal scar formation.

Conclusions

Corneoconjunctival transposition is a valid procedure for surgical treatment of corneal sequestra in cats. The procedure results in excellent cosmesis and functional vision with no recurrences.
Pectinate ligament dysplasia and narrowing of the iridocorneal angle associated with glaucoma in the English Springer Spaniel
Authors: Bjerkås Ellen , Ekesten Björn , Farstad Wenche
Published: March 2003

ObjectiveThe aim of the study was to evaluate if tonometry and gonioscopy could serve as predictors of later glaucoma development in the English Springer Spaniel, a breed prone to developing primary glaucoma.

Animals studiedGonioscopy was performed on 279 English Springer Spaniel dogs, 119 males and 160 females, with clinically normal eyes. In addition, 14 dogs, five males and nine females were examined for glaucoma.

ResultsA positive relation between pectinate ligament dysplasia (PLD) and narrowing of the relative width of the ciliary cleft (RWOCC) and also between PLD, RWOCC and age was demonstrated. The prevalence of PLD was 25.5%, which is higher than in other breeds reported. A positive association was demonstrated between PLD and glaucoma, as well as between narrowing of the RWOCC and glaucoma. Glaucoma was not observed in dogs with normal appearance of the iridocorneal angle. English Springer Spaniels related to dogs with glaucoma show more narrowing of the RWOCC and more PLD than unrelated dogs.

ConclusionThis study demonstrates the positive association between PLD and glaucoma, between narrowing of the iridocorneal angle and glaucoma and the effect of age on the iridocorneal angle. Mating of dogs with normal iridocorneal angles appears to reduce the presence and degree of abnormal appearance of the iridocorneal angle in the offspring. However, breeding only dogs with normal iridocorneal angles without consideration of their relationship to dogs with glaucoma is not a guarantee for preventing glaucoma in the offspring.
Canine choroidal melanoma with metastases
Authors: Hyman Jennifer A. , Koch Seth A. , Wilcock Brian P.
Published: March 2003

A 3‐year‐old‐female, spayed Golden Retriever was examined for a unilateral retinal detachment with exophthalmos. Ultrasonographically, a mass was detected with

intra‐ and extraocular extension. The orbit was exenterated and the dog recovered uneventfully. Histopathologic diagnosis was a primary choroidal melanoma with orbital extension, however, the behavioral and cytologic features were benign. Routine examinations postsurgically were nonremarkable. Twenty‐one months after surgery the dog was euthanized for respiratory collapse with radiographic signs of metastasis. Necropsy revealed black lesions in the lung and liver. Histopathologic diagnosis was metastatic melanoma with morphology and behavior identical to the primary choroidal melanoma. This is the first definitive case of a canine choroidal melanoma with metastasis.
The basal Ichneumonidae (Insecta, Hymenoptera): 28S D2 rDNA considerations of the Brachycyrtinae, Labeninae, Paxylommatinae and Xoridinae
Authors: Quicke D. L. J. , Lopez‐Vaamonde C. , Belshaw R.
Published: March 2003

Determining groundplan morphological and biological features can depend on knowing which groups are derived most basally within that group. Within the Ichneumonidae, several subfamilies variously have been postulated as occupying a basal phylogenetic position or possessing largely plesiomorphic morphologies and biologies (e.g. Labeninae), and therefore potentially exemplifying ancestral life‐history stategies. Sequence data from the D2 variable region of the nuclear 28S rDNA gene have been used to examine basal relationships in the family. Paxylommatinae and Xoridinae consistently appear as basal within the family under both maximum parsimony and neighbour‐joining analyses. Labeninae sensu Wahl (1993: ) often appear near the base of the Ichneumonidae but never as the sister group of the remainder of the family. The Brachycyrtinae, recently removed from the Labeninae by Wahl (1993), appear as part of the informal ichneumonoid group of subfamilies in the most parsimonious trees but this was not statistically significant using the likelihood‐based, Kishino‐Hasegawa test compared with a monophyletic Labeninae + Brachycyrtinae. Biologies of labenines and brachycyrtines are discussed in relation to those of putative relatives.
Three species ofIsotoma(Collembola, Isotomidae) based on morphology, isozymes and ecology
Authors: Simonsen Vibeke , Krogh Paul Henning , Filser Juliane , Fjellberg Arne
Published: March 2003

Morphological markers and isozymes were used for identifying three presumed species of theIsotomagenus. Morphological traits separated three taxa of the genus. 10 isozymes determined by at least 11 loci were analysed from each taxon, and 2 loci were taxon‐specific, supporting the hypothesis that the three taxa represented three species. The genetic variation found within the taxa measured as fraction of polymorphic loci at the 99% level was 0.82, 0.55 and 0.55 with the corresponding observed heterozygosity 0.15, 0.09 and 0.12. Two populations of the same taxon from Denmark and Norway, respectively, were very closely related. Additional ecological criteria, obtained from a literature survey, also revealed pronounced differences between the three taxa. Due to these facts three distinct species are proposed, namelyI. anglicanaLubbock 1862,I. ripariaNicolet 1841 andI. viridisBourlet 1839.
Turtles as diapsid reptiles
Authors: Rieppel Olivier
Published: March 2003

Recent molecular studies of amniote relationships show turtles to be diapsid reptiles, related to the archosauromorph branch of saurian phylogeny. This conflicts with palaeontological data which shows turtles to be related either to anapsids, or to the lepidosauromorph branch within diapsids. Archosauromorph relationships of turtles have previously been proposed on the basis of neontological (mostly soft anatomy) characters. This paper reviews the neontological character evidence for turtle relationships and shows that most, but not all, of these characters are invalid in the reconstruction of turtle relationships within Amniota.
A new taxon,capricornia(Hesionidae,Polychaeta), illustrating the LITU (‘Least‐Inclusive Taxonomic Unit’) concept
Authors: Pleijel Fredrik , Greg W. Rouse
Published: March 2003

Phylogenetic taxonomy is applied for the systematization of a newHesionidae, rather than the traditional Linnean system, with an apomorphy‐based definition of the name and without reference to rank. It is argued that biological diversity is better represented without species concepts, but that it is useful to specify when a name refers to a smallest known clade which currently cannot be further subdivided; for this we apply the newly introduced concept LITU (Least‐Inclusive Taxonomic Unit) for the new taxon. LITUs are made identifiable by being italicised with lower‐case initial letter; all other taxon names are italicised with capital initial letter. TheHesionidaeis accordingly namedcapricornia, new taxon, and was found in shallow water at One Tree Island, Capricorn Group, southernmost part of the Great Barrier Reef.capricorniais small (length < 2 mm), and exhibits a number of larvalHesionidaecharacters, but is characterized by large paired ventrally situated penes on segment 9 in adult males. A cladistic parsimony analysis based on morphological characters ofcapricorniaand a selection of otherHesionidaeindicates that it belongs withinGyptiniPleijel 1998, and is the sister group ofAmphidurosHartman (1959).
Evidence for convergent evolution of brooding in a unique gastropod from Lake Tanganyika: anatomy and affinity ofTanganyicia rufofilosa(Caenogastropoda, Cerithioidea, Paludomidae)
Authors: Strong Ellen E. , Glaubrecht Matthias
Published: March 2003

Tanganyicia rufofilosais an enigmatic gastropod endemic to Lake Tanganyika and unique among lake species in possessing a brood pouch within the head‐foot. However, the only existing anatomic studies of the species are incomplete. Hence, the affinity of this species to other Tanganyikan gastropods and the evolution of viviparity among limnic Cerithioidea are unclear. The anatomic redescription and reinterpretation of reproductive homologies presented here revealed several features from the midgut and kidney that are informative concerning the phylogeny of Lake Tanganyika gastropods. In addition, the complex reproductive anatomy of both sexes is described. A rare accessory gland is present in males that is hypothesized to function in spermatophore formation and to be homologous to the ‘penis’ of some cerithioideans, an otherwise predominantly aphallic group. The structurally unique brood pouch, restricted to the mesopodial portion of the foot, is described and demonstrated to be unknown among viviparous cerithioideans. In contrast to the view that the cerithioideans of Lake Tanganyika represent an endemic radiation of Thiaridae, based on these new dataT. rufofilosaappears to be allied to the Paludomidae.