bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic pancreatitis: Long‐term review of initial non‐operative management in children
Authors: Holland AJA , Davey RB , Sparnon AL , Chapman M , LeQeusne GW
Published: March 2003

Objective: To assess the safety and long‐term efficacy of an initial non‐operative approach to the management of pancreatic trauma in children.

Methodology: Retrospective case‐note review of children admitted to our institution with the diagnosis of pancreatic trauma over a 10‐year period from 1985 to 1994 inclusive.

Results: Fourteen children were identified with a diagnosis of traumatic pancreatitis. Eleven of the injuries were secondary to motor vehicle accidents or trauma from a bicycle handlebar. In seven patients there were associated intra‐abdominal injuries and in eight patients the traumatic pancreatitis was complicated by development of a pseudocyst. Three pseudocysts settled without intervention, two resolved with percutaneous external drainage and the remaining three required open surgery. The mean in‐patient stay was 21.2 days. The average length of follow‐up was 7.7 years with no observed long‐term complications.

Conclusions: Non‐operative management of traumatic pancreatitis in the absence of complete duct transection is safe in children and does not appear to be associated with adverse sequelae.
Centro‐temporal spikes in non‐epileptic children: A long‐term follow up
Authors: Verrotti A , Greco R , Altobelli E , Domizio S , Sabatino G , Morgese G , Chiarelli F
Published: March 2003

Objective: This study was undertaken in order to determine the natural evolution of centro‐temporal spikes (CTS) in a healthy paediatric population.

Methodology: Forty children and adolescents (mean age ± SD: 9.9 ± 4.1 years) with non‐epileptic disturbances (tics, headache, pavor nocturnus, vertigo, etc), who showed CTS during routine EEG recordings were studied. No patient suffered from seizures. A clinical and electroencephalographic follow‐up of at least 5.5 years was carried out in all subjects.

Results: At the follow‐up examination, 33 of the 40 cases (82.5%) had no CTS or other epileptic discharges in awake and sleep EEGs, while six subjects continued to show CTS discharges in sleep EEG. Among those subjects who showed persistence of CTS in sleep EEG, rolandic epilepsy developed in two cases, while all other subjects continued to be seizure free.

Conclusions: This study demonstrates that CTS can be present in non‐epileptic children and adolescents; in the majority of subjects this EEG abnormality disappears spontaneously and only a small percentage of subjects who have persistence of this pattern develops rolandic epilepsy.
An iron treatment trial in an Aboriginal community: Improving non‐adherence
Authors: Kruske SG , Ruben AR , Brewster DR
Published: March 2003

Objective: To compare supervised vs unsupervised oral iron treatment in anaemic Aboriginal children living in a remote community with a 40% prevalence of iron deficiency anaemia.

Methodology: A randomised unblinded clinical trial in children < 6 years presenting to a remote Health Centre with anaemia. Oral iron prescribed as a daily unsupervised dose (group A) was compared to twice weekly supervised administration (group B) over 12 weeks. Parenteral iron (group C) was reserved for failure of oral treatment.

Results: Only 3 of 25 children in group A responded to treatment compared to 23 of 26 children in group B (odds ratio = 7.7, 95% confidence interval 2.6–25.0). After six weeks of treatment, the mean haemoglobin rise was 0.96 g/L in group A compared to 10.9 g/L in group B and 12.4 g/L in group C. On entry to the study, 29.4% of subjects were underweight, 33.3% stunted and 35.3% microcephalic. The mean catch‐up in weight/height on iron treatment over the study was only 0.28 (0.08, 0.48) Z‐scores.

Conclusions: Oral iron as directly observed twice weekly treatment is superior to unsupervised therapy. In view of the poor compliance with unsupervised treatment and the high prevalence of iron deficiency anaemia (along with stunting and microcephaly) in Aboriginal children in northern Australia, we propose to undertake in partnership with communities a nutritional intervention program with a high energy weaning food fortified with micronutrients (iron, vitamin A, zinc, folate) as the most effective strategy to address these nutritional problems in the weaning period.
Human milk banks and evidence‐based medicine
Authors: Simmer K
Published: March 2003

Abstract: Human milk (HM) banks provide pasteurised milk from screened donors for infants in many countries but not in Australia. There are potential benefits and risks from feeding donor milk with the benefits most likely for preterm infants. A randomized clinical trial is required to provide conclusive evidence. Promotion of breast‐feeding with the establishment of HM banks may prove to be an important primary health care activities for infants in Australia.
Factors associated with recurrent hospitalization in chronically ill children and adolescents
Authors: Kelly AF , Hewson PH
Published: March 2003

Objectives: To determine factors associated with recurrent hospitalization in children with chronic illnesses in the Barwon Region.

Methodology: Patients with four or more admissions to the Geelong Hospital children’s ward over a 12‐month period were identified. Their records were reviewed and the opinions of involved staff (medical, nursing, psychiatry, psychology, and social work) were sought. Multidisciplinary discussions were held to identify factors precipitating or maintaining the need for hospitalization. The numbers, illnesses and profiles of those admitted recurrently were compared with the data from the Barwon Paediatric Consultation Profile from the same period, and with those patients seen by the local counselling service for young people with chronic illnesses.

Results: Twenty‐seven children had four or more admissions over the 12 months; these represent 0.05% of the child population regionally, or 2% of those with chronic illness. They account for 8.7% of hospital admissions and 16% of inpatient days. Two‐thirds (18/27) had major psychosocial issues largely responsible for their admissions. A checklist was formulated of important medical, family, social, psychological, developmental, and institutional considerations. The most frequently identified psychosocial issues were medical dependency, psychological or medical problems affecting other family members, family and medical disparity regarding the treatment agenda, the lack of more intensive community supports, and medical controversy regarding best management.

Conclusions: Ongoing medicalization and medical dependency, driven both by staff and families, can perpetuate recurrent hospitalization. Further awareness and training in these issues and development of community resources will be necessary if this process is to be changed.
Congenital varicella syndrome in the absence of cutaneous lesions
Authors: Choong Cs , Patole S , Whitehall J
Published: March 2003

Abstract: A case of congenital varicella syndrome characterized by intrauterine growth retardation, ocular and neurologic abnormalities, but no cutaneous lesions is reported. This case highlights the risk of embryopathy from varicella infection during pregnancy in non‐immune women.
Small bowel injuries in children
Authors: Holland A J A , Cass D T , Glasson M J , Pitkin J
Published: March 2003

Objective: To determine the common features of small bowel injury (SBI) in childhood and the consequences of delayed diagnosis.

Methodology: A retrospective case review was performed of children with traumatic SBI between January 1988 and November 1999.

Results: Twenty‐eight patients were identified with SBI. Road trauma accounted for 71% of them. Tachycardia was present on admission in 82% of patients with SBI including all but one of the intestinal perforations. SBI was associated with a Chance fracture of the lumbar spine in three patients (11%). An abdominal computed tomography scan with intravenous contrast was abnormal in all patients with a perforation or mesenteric tear. Diagnosis was delayed in six patients, one of whom died as a result of sepsis from a small bowel perforation.

Conclusions: Persistent tachycardia with an appropriate mechanism of injury following blunt abdominal trauma requires active exclusion of SBI. Delayed diagnosis is associated with significant morbidity and mortality.
Analysis of the breath hydrogen test for carbohydrate malabsorption: Validation of a pocket‐sized breath test analyser
Authors: Lee Ws , Davidson Gp , Moore Dj , Butler Rn
Published: March 2003

Objective: To assess the validity and clinical application of a hand‐held breath hydrogen (H2) analyzer (BreatH2, Europa Scientific, Crewe, UK).

Methodology: Breath samples of patients referred to the Gastroenterology Unit, Women’s and Children’s Hospital, North Adelaide, South Australia, for confirmation of the diagnosis of carbohydrate malabsorption were analysed with the Quintron microlyzer (Quintron Instrument Co., Milwaukee, USA) and the BreatH2 analyser, using the Quintron microlyzer as the gold standard.

Results: Twenty‐nine breath H2 tests (BHT) were performed in 29 patients aged 2 months to 61 years. The sensitivity and specificity of the BreatH2 analyser in detecting a positive BHT using the Quintron microlyser as the gold standard were 0.90 and 0.95 with positive and negative predictive values of 0.90 and 0.95, respectively. There was one false positive and one false negative reading. Bland–Altman plots showed a high degree of agreement between the values obtained with two different methods.

Conclusions: The diagnosis of carbohydrate malabsorption, using a portable breath H2 analyser (BreatH2), achieved an acceptable degree of sensitivity and specificity, enabling it to be used where no alternative is available.
Hansenula anomala infection in a neonate
Authors: Wong A R , Ibrahim H , Rostenberghe H Van , Ishak Z , Radzi M J
Published: March 2003

Abstract: We present an unusual neonatal fungal infection, Hansenula anomala in a very low birthweight infant who underwent abdominal surgery for an omphalocele. Despite treatment with adequate doses of amphotericin B, the yeast continued to grow from the blood culture, and was only eradicated with the use of oral ketoconazole.
Medium‐term outcomes are comparable with short‐term outcomes in children with attention deficit hyperactivity disorder treated with stimulant medication
Authors: Efron D , Jarman Fc , Barker Mj
Published: March 2003

Objective: To compare the short‐ and medium‐term effects of psychostimulant medication in children with attention deficit hyperactivity disorder (ADHD).

Methods: Seventy‐three children with ADHD participated in a double‐blind crossover study of dextroamphetamine (DEX) and methylphenidate (MPH; results previously reported). At the completion of this study, subjects continued to take the preferred stimulant. Subjects were restudied 6–9 months later. The principal outcome measures were the Revised Conners’ Parent and Teacher Rating Scales.

Results: Fifty‐three families (73%) returned the follow‐up surveys. At 6–9 months, mean T scores were still significantly lower than the mean at baseline for all factors of both the CPRS‐R and CTRS‐R (P < 0.01). There were no statistically significant differences between scores at 6–9 months and scores at the completion of the corresponding medication period in the crossover trial.

Conclusions: After 6–9 months treatment with stimulant medication, ratings remained significantly better than at baseline. This suggests that the early benefits of stimulants are sustained for at least 6 months.
Errors in the certification of neonatal death
Authors: Hunt R , Barr P
Published: March 2003

Objective: To examine the precision of the perinatal death certificate (PDC) and ascertain the possible sources of error in the certification of neonatal deaths.

Methods: The ‘Main’ and ‘Other’ causes of death recorded on the PDC were obtained from the Registry of Births, Deaths and Marriages and compared with those from a clinicopathological summary (CPS) completed after all pending laboratory results and/or autopsy information were available.

Results: There were 179 neonatal deaths during the 7 year period under review. The PDC and CPS main causes of death were concordant in 103 of 179 infants (58%) and discordant in the remaining 76 infants (42%). The PDC main cause of death was incorrectly classified in 61 of 76 infants (80%) with discordant findings and was incompletely classified in the remaining 15 infants (20%). The following discordancies were recorded for the 61 infants with an incorrect classification: (i) transposition of the ‘Main’ and ‘Other’ causes of death, resulting in a sequencing discordancy in 14 infants (23%); (ii) recording a non‐pathological condition as the main cause of death in 40 infants (66%); and (iii) recording an incorrect pathological condition as the main cause of death in seven infants (11%). Eight of the 61 (13%) incorrect classifications and four of the 15 (27%) incomplete classifications were associated with laboratory and/or autopsy data being unavailable when the PDC was completed.

Conclusions: The concordancy between the PDC and CPS would have increased from 58 to 91% if the ‘Main’ and ‘Other’ causes of death had been sequenced correctly, if the main cause of death had been ascribed to a pathological disease rather than a non‐pathological condition and if corrective information from pending laboratory tests and/or autopsy examination had been made available to the Registry of Births, Deaths and Marriages.
Spinocerebellar ataxia type 7: A distinctive form of autosomal dominant cerebellar ataxia with retinopathy and marked genetic anticipation
Authors: Grattan‐Smith PJ , Healey S , Grigg JR , Christodoulou J
Published: March 2003

Abstract: When a child presents with progressive ataxia, there is a broad differential diagnosis and a very long list of potential investigations. Spinocerebellar ataxia type 7 presenting in infancy is a rare condition where a presumptive diagnosis can be made based on the clinical features alone. These include rapidly progressive ataxia, retinopathy and autosomal dominant inheritance with marked genetic anticipation of paternal origin. The father of the infant may manifest minimal symptoms at a time when the infant is severely affected. Diagnosis is confirmed by the demonstration of an expansion of a CAG repeat in the coding region of the gene on chromosome 3p. We present a case to illustrate the diagnostic difficulties. Antenatal diagnosis was performed in two subsequent pregnancies.
Delayed presentation of an ingested foreign body causing gastric perforation
Authors: Lam P‐Y , Marks MK , Fink AM , Oliver MR , Woodward A
Published: March 2003

Abstract: Ingested foreign bodies may lead to perforation of the gastrointestinal tract. We present a case of a 14‐month‐old boy who presented with an unusual abdominal mass secondary to ingesting a foreign body 4 months previously. Abdominal computerized tomography scan was valuable in making this diagnosis.
Rotavirus encephalopathy: Pathogenesis reviewed
Authors: Goldwater PN , Rowland K , Power R , Thesinger M , Abbott K , Grieve A , Palombo EA , Masendycz PJ , Wilkinson I , Bear J
Published: March 2003

Abstract: Two cases of rotavirus gastroenteritis associated with neurological involvement, one with encephalitis (defined by abnormal neurological signs, cerebrospinal fluid (CSF) pleocytosis and detection of rotavirus genomic nucleic acid in the CSF) and one with a non‐inflammatory encephalopathy (defined by abnormal neurological signs, an entirely normal CSF and detection of rotavirus genomic nucleic acid in the CSF), are presented and used as a basis to review and explore potential pathogenetic mechanisms, including direct viral replication within neurons and indirect effects of the newly described rotavirus ‘enterotoxin’.
The changing pattern of diagnosis of infantile cholestasis
Authors: Stormon MO , Dorney SFA , Kamath KR , O'Loughlin EV , Gaskin KJ
Published: March 2003

Objective: Cholestatic liver disease in infancy is caused by a wide range of conditions. This study reviews the pattern of diagnosis of infants with cholestasis presenting to a tertiary referral paediatric hospital in Sydney, Australia, during a 12‐year period (1985–96).

Methodology: Infants aged less than 6 months with cholestasis were identified retrospectively from hospital records and data retrieved from the medical records.

Results: There were 205 infants identified as having cholestatic liver disease. The aetiology of the cholestasis was idiopathic in 25%, metabolic/genetic in 23%, and due to obstruction in 20%, parenteral nutrition in 20%, infection in 9% and bile duct hypoplasia in 3%.

Conclusions: This study highlights the changing patterns of diagnosis of cholestatic liver disease in infants at a tertiary paediatric facility, demonstrating that up to 50% of cases are now due to genetic/metabolic diseases or parenteral nutrition, and a high proportion are due to idiopathic disease.
Are there early features of autism in infants and preschool children?
Authors: Gray KM , Tonge BJ
Published: March 2003

Abstract: Autism is characterized by impairments in three areas: (i) reciprocal social interaction; (ii) communication; and (iii) repetitive and stereotyped patterns of interest and behaviour. Despite the finding that parents notice abnormalities and problems with their child's development at a very early age, research shows that diagnoses are often made at an age beyond that recommended for the commencement of early intervention. This paper reviews the range of studies that have sought to elucidate the early features of autism in young, preschool children. Impairments in the capacity for reciprocal social interaction involving preverbal, verbal and non‐verbal communication, and play and symbolic behaviour are the key features indicative of autism in infants and preschool children.
The child of uncertain sex: 17 years of experience
Authors: Al‐Agha AE , Thomsett MJ , Batch JA
Published: March 2003

Objective: To review the common clinical presentations, investigations and final diagnosis of children presenting with genital ambiguity.

Methodology: Retrospective search of the Royal Children’s Hospital, Brisbane, Australia, medical records and personal medical database of one of the authors (MJT) between 1982 and 1999.

Results: Fifty‐one children aged 0.1–;14 (mean 3.9) years were identified. Twenty‐two cases had a 46XX karyotype, and commonly presented with an enlarged phallus (77.2%), urogenital sinus (63.6%) and labioscrotal fold(s) (40.9%). Congenital adrenal hyperplasia (CAH) was the most common final diagnosis (72.7%) . Twenty‐nine cases of genital ambiguity had a 46XY karyotype and commonly presented with palpable gonad(s) (75.8%), undescended testes (51.7%), penoscrotal hypospadias (51.7%) and a small phallus (41.3%). Androgen insensitivity and gonadal dysgenesis were the commonest final diagnosis both occurring at a frequency of 17.2%.

Conclusions: The results emphasize the importance of CAH as the most common diagnosis in 46XX cases presenting with ambiguous genitalia. Those with 46XY had a wider range of diagnoses. Despite thorough investigation, 23.5% had no definite final diagnosis made.
Passive exposure to tobacco smoke and bacterial meningitis in children
Authors: Iles K , Poplawski NK , Couper RTL
Published: March 2003

Objective: To determine whether an association exists between passive exposure to tobacco smoke and bacterial meningitis in childhood, in an Australian population.

Methodology: A retrospective, case‐controlled telephone survey of the parents of 71 children admitted to the Women’s and Children’s Hospital, North Adelaide, with bacterial meningitis between 1990 and 1999.

Results: The annual incidence of Haemophilus influenzae type b (Hib) meningitis decreased significantly during the study period (11.0 cases per year 1991–;93 and 1.5 cases per year 1994–;99, Fisher’s exact test; P < 0.001) whilst pneumococcal cases significantly increased (2.3 cases per year 1991–;93 and 4.9 cases per year 1994–;99, Fisher’s exact test; P < 0.001). Although comparable numbers of cases and controls came from smoking families (41%vs 45%), more cases came from bi‐parental smoking households (17%vs 8%; odds ratio (OR) = 2.20, 95% confidence interval (CI) 0.77–;6.24) and cases were more likely to live in households where parents smoked inside (27%vs 13%; OR 2.51, 95% CI 1.05–;6.03). In households where parents smoked, children who had had meningitis were significantly more likely to have parents who smoked inside the house, than children who had not had meningitis (66%vs 28%, Fisher’s exact test; P = 0.005).

Conclusion: This study suggests there may be an association between high levels of passive exposure to tobacco smoke and bacterial meningitis in Australian children. A study with larger numbers of affected children which quantifies passive exposure to tobacco smoke is needed to determine the strength of this association.
Functional status of school‐aged children with Down syndrome
Authors: Leonard S , Msall M , Bower C , Tremont M , Leonard H
Published: March 2003

Objective: To field test, in questionnaire format, the Functional Independence Measure for Children (WeeFIM, a schedule usually administered by interview) on parents of a cohort of school‐aged children with Down syndrome.

Methods: The parents of 211 Western Australian children with Down syndrome participated in the present study, representing 79.9% of all children with Down syndrome in the State. Subjects were identified using two sources: (i) the Birth Defects Registry; and (ii) the Disability Services Commission.

Results: The total WeeFIM score was 106.2 ± 17.0 (mean ±
SD) out of a possible 126. Girls scored higher than boys (108.6 vs 103.6;
P = 0.05). Scores increased across all age groups (P < 0.0001), even relative to normative data. Performance was strongest in the transfer and locomotion domains and weakest in social cognition.

Conclusion: We found that severe functional limitations are rare in school‐aged children with Down syndrome. Some support and supervision are required for complex self‐care, communication and social skill tasks. This study demonstrates the feasibility of using the WeeFIM for collecting population survey data in children with developmental disability. This may be useful for the longitudinal tracking of such populations, as well as the monitoring of response to interventions.
Tracheobronchography and angiocardiography of paediatric cardiac patients with airway disorders
Authors: Cheung YF , Lee SL , Leung MP , Yung TC , Chau AKT , Hui HKY
Published: March 2003

Objective:  We report our experience in combining tracheobronchography and angiocardiography in the assessment of a selected cohort of paediatric cardiac patients with problematic airway disorders.

Methodology:  The clinical records of 11 patients who underwent 17 studies at a median age of 5.5 months (range 3 months to 10.8 years) were reviewed. Tracheobronchography and angiocardiography were performed under general anaesthesia using a non‐ionic contrast agent. The findings were compared with those of flexible bronchoscopy and magnetic resonance imaging (MRI).

Results:  Seven patients had cardiac lesions associated with vascular anomalies potentially compressing the airway, while four had no identifiable aberrant or enlarged vessels. All examinations but one were performed without complications. Tracheobronchography demonstrated extrinsic vascular compression with secondary airway malacia in three (27%), intrinsic tracheobronchial stenosis in five (45%), and airway malacia in three patients (27%). Precise measurement of the airway calibre and real‐time fluoroscopic monitoring facilitated transcatheter tracheobronchial interventions (six balloon dilations, three stent implantations) in four patients. In conjunction with angiocardiography, cine‐tracheobronchography provided detailed information on the spatial relationship between vascular and airway structures in all patients; allowed dynamic assessment of airway malacia; and facilitated preoperative planning in six patients. In contrast, bronchoscopy failed to differentiate malacia from extrinsic compression in four patients (36%), while MRI, performed in six patients, was unsatisfactory in one due to a motion artefact and failed to diagnose airway malacia and extrinsic compression in three patients.

Conclusions:  Tracheobronchography is relatively safe in paediatric cardiac patients. Combined tracheobronchography and angiocardiography, a less operator‐dependent imaging modality compared to bronchoscopy and MRI, delineated the airway and vascular anatomy in detail; facilitated preoperative planning; and permitted transcatheter tracheo‐bronchial interventions. The dynamic capability of tracheobronchography supplements that of flexible bronchoscopy and MRI in the diagnosis of airway malacia.
Effect of low versus normal birthweight on menarche in 14‐year‐old Polish girls
Authors: Koziel S , Jankowska EA
Published: March 2003

Objective:  The relationship between intrauterine growth retardation and sexual maturation has not been completely established. The aim of the present study was to compare menarche in 14‐year‐old Polish girls of low and normal birthweight, along with an evaluation of the impact of socio‐economic status and body mass index (BMI).

Methods:  We studied 1060 girls (177 pre‐ and 883 post‐menarche) aged 13.5−14.5 years. These girls attended the 7th grade of randomly selected primary schools in Wroclaw, Poland. The BMI was used as a measurement of general adiposity. The cut‐off value of the 10th percentile of birthweight for gestational age was used to differentiate between girls born small for gestational age (SGA) and girls with a birthweight appropriate to gestational age (AGA). Parental education level and other measures were used to assess socio‐economic status (SES).

Results:  Birthweight (OR = 2.54; 95% CI 1.22−5.28) and BMI at the age of 14 years (OR = 7.93; 95%CI 4.67−13.48) were factors affecting the onset of menarche among the 14‐year‐old girls.

Conclusion:  Polish girls born small for gestational age are more likely to have experienced menarche by the age of 14 years, compared with their peers of normal weight at birth. These findings seem to be consistent with the hypothesis that the age of menarche is, to some extent, set by patterns of gonadotropin release, established prior to birth. Additionally, the age of menarche varies depending on levels of fat accumulation during childhood and adolescence.
Diagnosis and management of paediatric hepatitis C virus infection
Authors: Kesson AM
Published: March 2003

Abstract:  Hepatitis C virus (HCV) infection in children is uncommon and there are few guidelines indicating optimal management. It is estimated that 125−250 children are infected vertically with HCV in Australia each year and very few of these children are diagnosed and followed medically. Without accurate diagnosis and follow up, these children cannot be offered optimal care, and are at risk of presenting in adult life with significant liver pathology and long‐term sequelae.
Hedgehog in the human: A possible explanation for the VATER association
Authors: Arsic D , Qi BQ , Beasley SW
Published: March 2003

Abstract: Foregut malformations are relatively common anomalies, occurring
in 1 in 2000–5000 live births. The adriamycin‐induced rat model of the VATER
association has provided a means of studying the morphogenesis of a variety of major
congenital structural abnormalities similar to those seen in humans with VATER association.
The secreted glycoprotein, Sonic hedgehog (Shh), may act as an endodermal signal
that controls gut and lung patterning. Mice with targeted deletion of Shh
have foregut defects that are consistent with those produced by administration of
adriamycin. It is possible that mutations induced by adriamycin may result from the
breakdown of the Shh signalling pathway.
Rebreathing potential of infant mattresses and bedcovers
Authors: Colditz PB , Joy GJ , Dunster KR
Published: March 2003

Objective: To establish the CO2 dispersion and retention properties of some mattresses and bed coverings commercially available in Australia.

Methods: Five mattresses were studied in (i) an in vivo model in
which an infant’s head was covered by a headbox, rebreathing was allowed to
occur, and the final steady state CO2 concentration was measured; and
(ii) an in vitro model in which 5% CO2 in a headbox was
allowed to disperse, and the time taken for the concentration to reach 1%
was measured. Five types of bedcover were studied in (i) an in vivo model
in which an infant’s head was covered by a bedcover and the final steady state
CO2 concentration was measured; and (ii) an in vitro model in which
5% CO2 under a bedcover was allowed to disperse, and the time taken for the concentration to reach 1% was measured.

Results: The steady state CO2 concentrations ranged from 0.6%
to 3.0% for the mattresses (P < 0.05). The time for CO2
to disperse ranged from 5.5 min to 30.4 min (P < 0.05). Steady state CO2
concentrations ranged from 2.5% to 3.6% for the bedcoverings (P
> 0.05). The time for CO2 to disperse ranged from 5.4 min to 7.7 min
(P > 0.05).

Conclusions: Some commercial cot mattresses and bedcoverings allow high
concentrations of CO2 to accumulate in rebreathing environments. Some
mattress types studied were more diffusive to CO2, whereas there was no difference between the bedcovers studied. This may have implications for vulnerable infants at risk of sudden infant death syndrome.
Idiopathic pulmonary haemosiderosis: An Oriental experience
Authors: Yao T‐C , Hung I‐J , Wong K‐S , Huang J‐L , Niu C‐K
Published: March 2003

Objectives:  Idiopathic pulmonary haemosiderosis (IPH) is a rare but potentially lethal disorder. A retrospective analysis of documented cases of IPH in our hospital was conducted in order to study the clinical spectrum and radiographic features, and to explore therapeutic strategies.

Methods:  A retrospective chart review was carried out, collecting medical records of patients with pulmonary haemo­siderosis at Chang Gung Children's Hospital (CGCH), a tertiary children's hospital in northern Taiwan. Secondary causes of pulmonary haemosiderosis were excluded.

Results:  Five patients were diagnosed as having IPH over a 25‐year period. The classical triad of IPH was found at initial presentation in only 2/5 patients. One patient had well‐established pulmonary fibrosis, but no pulmonary symptoms. The clinical course of IPH was exceedingly variable, with a mean delay of 9 months before diagnosis was made. Bronchoalveolar lavage (BAL) confirmed IPH in 3/5 patients. Immunological abnormalities were noted in two patients, without progression to immune disorders during follow up. While using corticosteroids alone, 4/5 patients continued to have recurrent bleeding episodes. All five patients required immunosuppressive therapy for maintenance of a symptom‐free period, but survived to a mean follow up of 2 years.

Conclusions:  Early definitive diagnosis and aggressive immunosuppressive therapy of IPH are imperative in order to avoid pulmonary fibrosis and mortality in IPH. A chest radiograph should be included in a serial work‐up of unexplained anaemia in children. An examination using BAL can confirm IPH and high‐resolution thoracic computed tomography scans are useful for early detection of pulmonary fibrosis.
An evaluation of outcome after severe trauma
Authors: Hall John C , Dobb Geoffrey , Hall Jane L
Published: March 2003

Abstract There is a perception that patients with severe trauma either die soon after the trauma or survive. This study evaluated 123 patients with severe trauma until 6 months after discharge from the Intensive Care Unit (ICU). At baseline, the median Injury Severity Score was 29 (interquartile range 20–38) and the median Acute Physiology and Chronic Health Evaluation II score was 13 (interquartile range 9–15). Injuries related to road transport accounted for 79% (97/123) of the injuries and the patients were predominantly male (66%) and young (75% < 38 years of age). The median stay in ICU was 11 days. Ten per cent of the patients (12/123) died during the study period, but one‐quarter of the deaths were in hospital after discharge from ICU and one‐quarter of the deaths occurred after discharge from hospital. It is impossible to carefully document the mortality due to severe trauma unless the survivors of ICU are reviewed after discharge from hospital.
Dryland lakes1
Authors: Williams William D.
Published: March 2003

Dry regions of the world, that is, hyper‐arid to subhumid regions that are mostly warm to hot and so‐called ‘drylands’, cover almost 50% of the total land area. They are inhabited by human populations that are approaching one billion worldwide. Despite low rainfall levels, dry regions have some of the world’s largest lakes and reservoirs. They also have the widest variety of standing water types that include permanent freshwater lakes and reservoirs, temporary freshwater lakes, and permanent and temporary saline lakes. Many characteristics of these waters are different from waters in temperate, better‐watered areas, upon which most limnological knowledge is based. Notwithstanding many economic, scientific, ecological and other values, lakes in drylands are subject to extensive and intensive anthropogenic impacts. Included are almost all those affecting lakes in temperate, tropical and subtropical regions, as well as some impacts more or less confined to dryland lakes, especially salinization. These anthropogenic impacts and their importance have not been fully recognized at national and international levels.
Refilling, ageing and water quality management of Brucher Reservoir
Authors: Scharf Wilfried
Published: March 2003

Refilling of the formerly oligo‐mesotrophic, softwater Brucher Reservoir commenced in April 1993 and took 11 months to completely fill. A severe ‘trophic upsurge’ in the sense of nutrient enrichment (phosphorus, dissolved organic material) as a result of the decomposition of the inundated vegetation occurred. However, algal crop and phosphorus utilization efficiency, expressed as chlorophyll concentrations per unit of total phosphorus, remained very low. In the absence of any fish stock, a single species, Daphnia galeata, monopolized the resources. Sustained by the detritus food chain, daphnids exerted a severe‚‘top‐down’ control upon phytoplankton, thereby preventing any net algal growth. In 1994, artificial mixing prevented the occurrence of anoxic water conditions and internal nutrient enrichment of the lake. Although the decay of the inundated vegetation was still of importance, phosphorus concentrations in the water column approached equilibrium with the external input while dissolved organic material concentrations clearly declined. That year, the reservoir became stocked with minnows, sun bleak (Leucaspius delineatus) and trout. As food limitation, as a result of reduced heterotrophic production, became more severe in the face of an increasing predation pressure, the daphnid population density declined, resulting in a decreasing but still adequate community filtering rate providing pronounced ‘clear‐water phases’ of up to 10 m that were features of the period 1995–1997. Although D. galeata defended its key position in the food web, its life‐history traits (e.g. body size) changed. Submerged macrophytes, which since 1995 gradually colonized suitable areas of the reservoir, provided a favourable refuge for minnows from trout predation that resulted in reduced predation pressure upon pelagic daphnids. However, in 1998, ungrazeable algae became prominent, adversely affecting transparency. That year, the significant inverse relationship between chlorophyll : total phosphorus ratios and daphnids became uncoupled during the summer (July–August) by indigestible chlorococcalean algae. Nevertheless, the fishery management that was implemented was successful in sustaining not only the lowest yield of algae at the given nutrient concentration but also the most favourable species composition with respect to water quality.
Screening of Azolla strains for tolerance to ammonium
Authors: Shiomi Nobuyuki , Kitoh Shunji
Published: March 2003

Sixty‐seven strains of seven species of Azolla were screened for tolerance to ammonium ion on the basis of their growth on the medium with or without 20 mmol/L ammonium. Azolla nilotica was the most sensitive species followed by Azolla rubra. Azolla pinnata var. pinnata was the most tolerant species. Twelve tolerant strains in Azolla mexicana, Azolla caroliniana, Azolla microphylla and A. pinnata var. pinnata were selected. No tolerant strain was found in Azolla filiculoides containing native strains in Japan.
Muscular dystrophy
Authors: Arahata Kiichi
Published: March 2003

Muscular dystrophy is a group of genetically determined muscular disorders marked by progressive wasting and weakness of the skeletal muscle, but which often affect cardiac and smooth muscles or other tissues. The patterns of inheritance are either dominant or recessive although the gene may be defective because of a new mutation. Growing evidence revealed the marked heterogeneity of the muscle disorders, and considerable numbers of Japanese scientists and physicians have contributed to the research progress in muscular dystrophy. Among these the discovery of an increased serum creatine kinase activity in muscular dystrophy opened the way for the most reliable laboratory test for muscular dystrophy in 1959, and subsequently accelerated progress in a broad range of research areas in medicine. Progress in modern genetics and molecular pathology provided another breakthrough in muscular dystrophy research and, in 1987, dystrophin was identified, a deficiency of which causes DMD. The present review article highlights contributions of Japanese scientists to muscular dystrophy research.
Immunohistochemical study of human rabies
Authors: Jogai S , Radotra BD , Banerjee AK
Published: March 2003

Rabies is a communicable disease that is almost always fatal. In its classic form, rabies is well recognized, but cases presenting with a paralytic illness mimic Landre's Guillain–Barre syndrome and in such cases the diagnosis remains in doubt. This problem is further compounded when the history of dogbite is not forthcoming. At autopsy rabies can be diagnosed by subjecting fresh tissue to virologic investigations or examining formalin‐fixed paraffin‐embedded tissue sections for the presence of characteristic inclusions; that is, the Negri bodies. However, these inclusions are not present in all cases. Hence, the need arises for a better method for diagnosis. The present study utilized immunohistochemistry as a diagnostic tool using both monoclonal and polyclonal antirabies antibodies in 20 cases of rabies encephalomyelitis. The diagnosis of rabies could be confirmed in 17 cases (85%) based on neuropathologic findings alone. In contrast, immunohistochemistry yielded positive results in all cases. Moreover, the amount of rabies viral antigen was much more abundant than could be expected from the histopathologic findings. Thus immunohistochemistry is a rapid, safe, sensitive and specific technique for the diagnosis of rabies.
Distribution and dynamic process of neuronal cytoplasmic inclusion (NCI) in MSA: Correlation of the density of NCI and the degree of involvement of the pontine nuclei
Authors: Yokoyama Teruo , Kusunoki Jun‐ichi , Hasegawa Kazuko , Sakai Haruhiko , Yagishita Saburo
Published: March 2003

MSA is a sporadic degenerative disease that occurs in striatonigral degeneration (SND), SDS and most cases of sporadic OPCA. Oligodendroglial inclusion is a hallmark of MSA. Recently there have been a small number of reports of neuronal argyrophilic inclusions. To clarify the distribution and dynamic process of neuronal cytoplasmic inclusions (NCI), 31 cases of MSA were studied using histology, immunohistochemistry, and electron microscopy. The inclusions were exclusively found in the pontine nucleus and there was a correlation between the incidence of NCI and the severity of OPCA, but not of SND. NCI were increased to some extent in the cases with moderate OPCA and decreased in number in proportion to devastation of the pontine nuclei. Immunohistochemical and ultrastructural features of NCI were virtually identical to those of glial cytoplasmic inclusions (GCI), which gives some clues to the pathogenesis of MSA. It is tempting to interpret this as NCI playing a significant role in the degenerative changes of the neurons at least in the pons. Further systematic studies on NCI in the other brain regions are necessary to elucidate the pathogenesis of neuronal degeneration in MSA.
Adult T‐cell lymphoma involving the leptomeninges associated with a spinal cord schwannoma
Authors: Nagashima Toshiko , Mori Masamitsu , Fujimoto Makoto , Nunomura Mitsuru , Sakurai Yasuo , Okada Yuki , Itoh Tomoo , Sawa Hirofumi , Stan Alexsandru C , Nagashima Kazuo
Published: March 2003

Adult T‐cell lymphoma (ATL‐L) developing initially in the meninges is rare. An autopsy case of ATL‐L with an acute onset of meningitis and generalized lymphadenopathy in association with a cervical cord schwannoma is reported here. A 78‐year‐old woman with sensori‐motor weakness of both arms over a 1‐year period, developed febrile episodes and drowsiness with neck stiffness. Lumbar puncture revealed an increased protein content (161 mg/dL) and increased cell count (463/3) consisting of 99% of lymphocytes which contained atypical lymphocytes with multilobulated nuclei (‘flower cells’), which are characteristic of ATL‐L. Viral titers were positive only for HTLV‐I antibodies (serum 3 640: CSF 3 16). Biopsy of an enlarged retroperitoneal lymph node revealed malignant lymphoma of the T‐cell type. Brain MRI was negative, whereas an intradural extramedullary mass was found at the C4 level. With a diagnosis of ATL‐L stage IV, chemotherapy was commenced, which was effective in reducing the generalized lymphadenopathy as well as the cervical mass and restoring the CSF findings to normality. The cervical cord mass was verified to be a solitary schwannoma, and ATL‐L involvement was found not only in the leptomeninges, but also within the cervical cord schwannoma.
Truncated NF2 proteins are not detected in meningiomas and schwannomas
Authors: Bakker Michael A den , Tilborg Angela AG van , Kros Johan M , Zwarthoff Ellen C
Published: March 2003

Neurofibromatosis type 2 is caused by mutations in the NF2 tumor suppressor gene. The NF2 gene encodes a 595‐aminoacid protein, presumably functioning as a membrane‐organizing element. Theoretically, the majority of mutations found in the NF2 gene should lead to a truncated protein product. Using immunoprecipitation with an antibody raised to N‐terminal sequences of the NF2 protein, the authors sought to demonstrate the presence of truncated NF2 proteins in tumors. From 17 of 19 tumors (14 meningiomas and five schwannomas), 12 of which have previously been shown to harbor truncating NF2 mutations, wild‐type NF2 protein was immunopreci‐pitated. From two tumors no protein was precipitated. Truncated NF2 proteins were not observed. The authors conclude that mutant NF2 proteins are unstable and undergo accelerated degradation.
Imaging and pathology in pediatric neurological disorders
Authors: Mizuguchi Masashi , Takashima Sachio
Published: March 2003

Radiologic and pathologic findings correlate well in many pediatric neurologic disorders. However, there are some exceptions. Radiologic techniques are unable to visualize or identify pathologic changes in some diseases (e.g. status marmoratus and subdural fluid collection), whereas pathologic examination fails to clarify the histologic substrate of radiologic abnormalities in other conditions (e.g. Fukuyama‐type congenital muscular dystrophy and neurofibromatosis type 1). Although studies to solve these issues have met with practical difficulties, important progress has recently been made on some disorders such as Fukuyama‐type congenital muscular dystrophy and acute necrotizing encephalopathy.
Parkinson’s disease mimicking senile dementia of the Alzheimer type: a clinicopathological study of four autopsy cases
Authors: Tsuchiya Kuniaki , Ikeda Kenji , Niizato Kazuhiro , Watabiki Sadakiyo , Anno Midori , Taki Kazuhiro , Haga Chie , Iritani Shuji , Matsushita Masaaki
Published: March 2003

This report concerns four Japanese autopsy cases of Parkinson’s disease (PD) mimicking senile dementia of the Alzheimer type. Three patients with a clinical diagnosis of senile dementia of the Alzheimer type developed memory disturbance as the initial sign, and a patient with a clinical diagnosis of atypical senile dementia presented with hallucination and delusion as the initial sign. Dementia was evident in all four patients, and slight parkinsonism appeared in the middle to late stages of the disease in two patients. Macroscopical examination of the brain disclosed slight depigmentation of the substantia nigra and pro‐minent depigmentation of the locus ceruleus in all four cases. Histological examination of the four patients showed neuronal loss with astrocytosis and the appearance of Lewy bodies in the substantia nigra, locus ceruleus, and dorsal vagal nucleus. The nucleus basalis of Meynert was involved in three cases, in which this structure was examined. The total Lewy body scores of the four cases were 1 in three cases and 0 in the other, compatible with PD. Massive appearance of senile plaques, consistent with Braak stage C, was found in one case, and the slight appearance of senile plaques, consistent with Braak stage A, was evident in two cases. One case had no evidence of senile plaques. In all four cases, slight neurofibrillary changes were present in the limbic areas, compatible with Braak stages II to III. Based on these clinicopathological findings and a review of the literature, we concluded that PD simulating Alzheimer’s disease without overt parkinsonism rarely exists. Furthermore, we postulate that the clinical features of PD are more widespread than previously believed.
Immunohistochemical characterization of pineal parenchymal tumors using novel monoclonal antibodies to the pineal body
Authors: Yamane Yuko , Mena Hernando , Nakazato Yoichi
Published: March 2003

To characterize the immunohistochemical nature of pineal parenchymal tumors (PPT), we examined nine cases of normal pineal bodies and 23 cases of PPT using several neuronal and glial antibodies and 10 novel monoclonal antibodies raised against human pineal tissue. The PPT were classified into four pineocytoma, five pineal parenchymal tumor of intermediate differentiation (Int‐PPT), and 14 pineoblastoma. The pinealocytes, parenchymal cells of the pineal body, were labeled with five neuronal and seven pineal monoclonal (from PP1 to PP7) antibodies in the normal pineal bodies. The subjects ranged from 3 to 85 years old, 12 female and eight male subjects were studied. Antibodies to glial cells PI1, PI2 and PX1, stained interstitial cells of the pineal body. Many of the PPT showed positive immunostaining for pinealocyte‐associated antigens and neuronal markers. The intensity of immunostaining showed some association with the degree of differentiation of the tumor, but there was a considerable variety of staining from case to case. The pineocytomas are more immunopositive than are the Int‐PPT or pineoblastoma for neuronal and pinealocyte‐associated antibodies. In particular the neurofilament protein (NFP)68 kDa, PP1 and PP6 showed significant differences of reactivity between pineocytoma, Int‐PPT and pineoblastoma, when compared in groups showing extensive positive staining (positive staining in almost all areas of the tumor). By using three representative antibodies, anti‐NFP68kDa, PP1 and PP6, we were able to make a clear distinction between pineoblastoma, Int‐PPT and pineocytoma. Glial fibrillary acidic protein (GFAP), PI1 and PI2 antibodies only occasionally showed a small number of positive cells in the tumor, and thus we considered these cells to be non‐neoplastic interstitial cells or reactive astrocytes entrapped in the tumor. Our data suggest that the glial differentiation of PPT may occur, but that it seems to be a very rare event.