bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma transforming growth factor‐β1 concentrations in patients with chronic viral hepatitis
Authors: MURAWAKI YOSHIKAZU , NISHIMURA YUUKO , IKUTA YUJIRO , IDOBE YOUKO , KITAMURA YUKISATO , KAWASAKI HIRONAKA
Published: March 2008

Transforming growth factor (TGF)‐β1 is an important cytokine involved in the pathobiology of tissue fibrosis through its stimulation of the production of, and inhibition of the degradation of, extracellular matrix proteins. We examined the clinical usefulness of plasma TGF‐β1 concentration as a marker of fibrogenesis in patients with chronic viral hepatitis. Thirty‐five patients, 11 with minimal chronic hepatitis, 14 with mild chronic hepatitis and 10 with moderate chronic hepatitis and 20 healthy subjects were studied. Transforming growth factor‐β1 concentrations in platelet‐poor plasma were measured with a TGF‐β1 enzyme‐linked immunosorbent assay system kit after acid‐ethanol extraction. Plasma TGF‐β1 levels were significantly elevated in patients with mild and moderate chronic hepatitis, but not in those with minimal chronic hepatitis, compared with the levels in the controls. Plasma TGF‐β1 levels were increased in parallel with the histological degree of necroinflammation and of liver fibrosis. Plasma TGF‐β1 levels were positively correlated with blood levels of procollagen type III N‐peptide, and 7S fragment and central triple‐helix of type IV collagen. These results suggest that plasma TGF‐β1 level is a useful marker in assessing the situation of liver active fibrogenesis in patients with chronic viral hepatitis.
Intraductal ultrasonography for the diagnosis of proximal invasion in extrahepatic bile duct cancer
Authors: KUROIWA MASANORI , GOTO HIDEMI , HIROOKA YOSHIKI , FURUKAWA TUYOSHI , HAYAKAWA TETSUO , NAITOH YASUO
Published: March 2008

Intraductal ultrasonograpy (IDUS) was performed on 22 patients with extrahepatic bile duct cancer, using the percutaneous transhepatic approach. Intraductal ultrasonograpy images of the proximal invasion of the bile duct cancer were defined. In addition, three patients were examined through the peroral approach, to try to diagnose whether or not the cancer invaded to the bifurcation of the hepatic duct. Intraductal ultrasonograpy images obtained through the percutaneous approach could be classified into three patterns, types 1, 2 and 3, according to the features of the interior surface of the bile duct and the thickness of the bile duct wall. Type 1 images, which did not show protrusions into the bile duct lumen and had a bile duct wall of even thickness, were not likely to show bile duct cancer. Type 2 images showed protrusions of the tumour into the bile duct lumen and the surfaces of the protrusions were irregular. Type 3 images showed single or multiple low echoic papillary masses in the bile duct. Using the peroral technique, we considered all three cases to be type 1 and could diagnose that cancer had not invaded to the bifurcation of the hepatic ducts. From the results of this study, we suggest that proximal invasion of extrahepatic bile duct cancer can be diagnosed using IDUS.
Factors influencing Helicobacter pylori eradication with 2 week combination therapy of lansoprazole and amoxycillin: Intragastric distribution of colonization and gastric mucosal atrophy
Authors: SAITA HIROSHI , MURAKAMI MOTONOBU , TAKAHASHI YOUJI , SOU YASUNARI , KAITANI KAZUAKI , NISHIO KIYOSHI , KITA TORU
Published: March 2008

In Japan, gastric ulcers are often accompanied by marked gastric mucosal atrophy. We evaluated the dual therapy of double‐dose lansoprazole and amoxycillin for Helicobacter pylori eradication in Japanese ulcer patients and investigated the effects of intragastric distribution of H. pylori colonization and gastric mucosal atrophy on eradication with this combination therapy. Seventy‐six H. pylori‐positive ulcer patients received lansoprazole (30 mg) plus amoxycillin (500 mg) twice daily for 2 weeks (LA‐60 group), lansoprazole (30 mg once daily) plus amoxycillin (500 mg twice daily) for 2 weeks (LA‐30 group) or lansoprazole (30 mg once daily) for 6 or 8 weeks (LPZ group). Infection was evaluated by light microscopy, culture and biopsy urease tests. Helicobacter pylori colonization was classified as localized to the corpus (localized type) or involving the antrum and corpus (whole type). Fundic mucosal atrophy was graded according to endoscopic and histological features. Eradication was achieved in 67.6% in the LA‐60 group, 31.6% in the LA‐30 group, and 0% in the LPZ group, and moderate or severe histological gastritis was improved in the LA‐60 group. Eradication was better in localized‐type colonization (92%) than whole‐type (56%), and better with fundic mucosal atrophy (84%) than without, but poor in both whole‐type colonization and scanty mucosal atrophy (47%). The LA‐60 therapy achieves better eradication in Japanese ulcer patients with localized H. pylori colonization and/or gastric mucosal atrophy, which are likely to be important predictors for the successful eradication with dual therapy.
Salmonella hepatitis
Authors: PRAMOOLSINSAP CHUTIMA , VIRANUVATTI VIKIT
Published: March 2008

Typhoid fever is often associated with abnormal liver biochemical tests, but severe hepatic involvement with a clinical feature of acute hepatitis is a rare complication. There have been more than 150 cases of salmonella hepatitis reported from both developed and developing countries. The documented incidence varies widely from less than 1% to 26% of patients with enteric fever. The possible associated factors for development of salmonella hepatitis are virulence of the organisms, delayed treatment and poor general health of the patients. The pathogenesis of severe hepatic involvement in salmonella infection may be multifactorial and includes endotoxin, local inflammatory and/or host immune reactions. Clinical jaundice in salmonella hepatitis usually occurs within the first 2 weeks of the febrile illness. Hepatomegaly and moderate elevation of transaminase levels are common findings. Extreme hepatic dysfunction with hepatic encephalopathy is a rare coexisting complication in salmonella hepatitis. A positive culture for salmonella from blood or stool is essential to differentiate salmonella hepatitis from other causes of acute hepatitis. Hepatic pathology is characterized by the presence of typhoid nodules with marked hyperplasia of reticuloendothelial cells. The prognosis is usually good as salmonella hepatitis responds well to a specific antibiotic therapy and jaundice resolves with clinical improvement. The clinical course can be severe with a mortality rate as high as 20%, particularly with delayed treatment or in patients with other complications of salmonella infection. As enteric fever is a common infection, the recognition of salmonella hepatitis is of clinical importance.
Biochemical and histological features of hepatitis G virus infection
Authors: KOBAYASHI MASAHIRO , CHAYAMA KAZUAKI , FUKUDA MIZUHO , TSUBOTA AKIHITO , SUZUKI YOSHIYUKI , ARASE YASUJI , KOIDA ISAO , SAITOH SATOSHI , MURASHIMA NAOYA , IKEDA KENJI , KOIKE HIROMI , HASHIMOTO MICHIE , MIYANO YUKIKO , KOBAYASHI MARIKO , KUMADA HIROMITSU
Published: March 2008

To assess the biochemical and histological characteristics of hepatitis G virus (HGV) infection, we examined four patients who were infected with HGV only (HGV group), and compared them with 16 patients infected with both HGV and hepatitis C virus (HCV; HGV + HCV group) and 18 patients infected with HCV only (HCV group). Biochemical examination showed a significantly low level of serum alanine aminotransferase (ALT) in the HGV group, and that the gamma‐glutamyl transpeptidase (γ‐GTP)/ALT ratio in the same group was significantly higher than in the other two groups. Although all three patient groups had a similar degree of liver fibrosis, both the degree of periportal inflammation and total histological activity index were significantly lower in the HGV group than in the other two groups. Fibrous enlargement of the portal tract without lymphoid infiltration and thin fibrous septa was characteristically observed in the HGV group. No significant difference was found between the HGV + HCV group and HCV group. Our results suggest that biochemical and histological changes in HGV infection are very mild and quite different from those of HCV infection.
Hepatocyte apoptosis and hepatic expression of transforming growth factor‐β1 mRNA during involution of hyperplastic rat liver induced by hepatocyte growth factor
Authors: NAGOSHI SUMIKO , YASUDA HISATAKA , SUDA JYUN , YAMANOBE FUMIO , OHNO AKIHIKO , HIGASHIO KANJI , FUJIWARA KENJI
Published: March 2008

Hepatocyte apoptosis occurs during involution of hyperplastic liver induced by administration of xenobiotic compounds in rats. With this hyperplasia and involution, hepatic transforming growth factor (TGF)‐β1 is reported to be expressed to stimulate hepatocyte apoptosis. In regenerating liver after partial resection showing no hyperplasia, such expression of TGF‐β1 is also seen. However, no hepatocyte apoptosis develops despite the high levels of TGF‐β1. When rats received an intravenous injection of human hepatocyte growth factor at 12 h intervals for 14 days, the hepatic DNA content was increased 12 h after the last injection to 140% of control. This DNA content was significantly decreased at 108 and 180 h after discontinuation of treatment. At 60 h after the last injection, the number of apoptotic bodies positive for nick end‐labelling of DNA in hepatocytes was significantly greater in treated rats than in control rats. Hepatocyte apoptosis was also identified electron micrographically. Hepatic TGF‐β1 mRNA levels in treated rats were significantly lower than in control rats at 12 h and then gradually increased towards control levels. We conclude that hyperplastic liver induced in normal rats by hepatocyte growth factor regresses with hepatocyte apoptosis and suppressed hepatic TGF‐β1 mRNA levels.
Case Report: Severe cholestatic jaundice induced by Epstein‐Barr virus infection in the elderly
Authors: EDOUTE YEOUDA , BARUCH YAACOV , LACHTER JESSE , FURMAN EIAL , BASSAN LUDISSIA , ASSY NIMER
Published: March 2008

Infectious mononucleosis due to Epstein‐Barr virus (EBV) is almost always a self‐limited disease, most commonly seen in young adults. Hepatitis is a well‐recognized complication of EBV infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. We report a 60‐year‐old man with severe cholestatic jaundice whose history, liver histology and laboratory findings suggested EBV infection. He also developed significant jaundice related to his hepatitis, but not to autoimmune haemolysis, a situation that led to diagnostic delay. Costly diagnostic laboratory tests and invasive procedures were performed to rule out a malignant extrahepatic biliary obstruction. Physicians need to be aware of this complication and EBV infection should be included in the differential diagnosis of cholestatic jaundice in the elderly.
Hepatobiliary tuberculosis
Authors: ALVAREZ SOL Z
Published: March 2008

Tuberculosis is known to involve the liver in different ways. The term hepatobiliary tuberculosis refers to the localized form of hepatic tuberculosis as a distinct clinical entity, with signs and symptoms related to the hepatobiliary tract. Its clinical features and the different diagnostic aids used in its diagnosis are reviewed. Plain abdominal radiographs showing diffuse hepatic calcifications seen in approximately 50% of cases are almost diagnostic for hepatobiliary tuberculosis. Liver biopsies obtained either by ultrasound, computed tomography or laparoscopy, showing caseating granuloma usually establish the diagnosis. In the absence of caseation necrosis, a positive acid‐fast bacillus (AFB) or culture for Mycobacterium tuberculosis is needed to establish the diagnosis. A polymerase chain reaction assay for the identification of Mycobacterium tuberculosis in liver biopsy specimens is a new development. Treatment is similar to that used for pulmonary tuberculosis. Quadruple therapy (using four anti‐tuberculosis drugs) is recommended, generally for 1 year. For patients with obstructive jaundice, in addition to anti‐tuberculous treatment, biliary decompression should be performed either by stent insertion during endoscopic retrograde cholangiopancreatology, by percutaneous transhepatic biliary drainage or by surgical decompression whenever feasible.
Portal‐hypertensive gastropathy
Authors: TOYONAGA ATSUSHI , IWAO TADASHI
Published: March 2008

In the present article we describe updated information concerning the clinical feature of portal‐hypertensive gastropathy (PHG), which is characterized by mucosal and submucosal vascular dilatation without inflammation. Although this lesion represents non‐variceal bleeding, there is a wide variation of its prevalence. Portal pressure and some humoral factors may play important roles in its pathogenesis. Gastric acid secretory activity is reduced, whereas the gastric mucosal barrier is impaired. With regard to gastric mucosal haemodynamics, whether ‘overflow’ (i.e. active congestion) or ‘stasis’ (i.e. passive congestion) cause gastric mucosal hyperaemia is not known. A severe lesion is a potential source of bleeding, while mild lesions are of little clinical significance and endoscopic variceal obliteration aggravates PHG in some patients. In the treatment of PHG, pharmacological (e.g. propranolol), surgical (e.g. portosystemic shunt) and radiological (e.g. transjugular intrahepatic portosystemic shunt) procedures may be useful in preventing bleeding from PHG.
Reduced expression of thrombopoietin is involved in thrombocytopenia in human and rat liver cirrhosis
Authors: ISHIKAWA TORU , ICHIDA TAKAFUMI , MATSUDA YASUNOBU , SUGITANI SOICHI , SUGIYAMA MOTOYA , KATO TAKASHI , MIYAZAKI HIROSHI , ASAKURA HITOSHI
Published: March 2008

It is widely accepted that thrombocytopenia associated with liver cirrhosis is caused by increased platelet destruction in the enlarged spleen, but this issue has not yet been analysed sufficiently in terms of platelet production. Thrombopoietin is produced mainly in the liver and strongly promotes platelet production. We studied serum thrombopoietin and the levels of its mRNA in liver tissue of cirrhotic patients and also in a rat model of liver cirrhosis. Furthermore, to clarify the influence of the spleen, we investigated thrombopoietin mRNA in splenectomized rats. The serum thrombopoietin level in humans with liver cirrhosis was not significantly reduced instead of thrombocytopenia. The expression of thrombopoietin mRNA in liver tissue decreased with the progression of liver cirrhosis in both patients and the rat model and no compensatory expression was observed in other organs or nonparenchymal cells. The level of thrombopoietin mRNA did not differ significantly in splenectomized cirrhotic rats before or after administration of dimethylnitrosamine, but was lower than that in splenectomized rats without cirrhosis. We conclude that thrombocytopenia in liver cirrhosis is caused not only by platelet destruction but also by decreased platelet production, perhaps due to reduction of thrombopoietin mRNA in the liver.
Molecular epidemiology of hepatitis C in Australia
Authors: KABA SONGUL , DUTTA USHA , BYTH KAREN , CREWE EVELYN B , KHAN MAHBUB H , COVERDALE SHIRLEY A , LIN RITA , LIDDLE CHRISTOPHER , FARRELL GEOFFREY C
Published: March 2008

The aim of this study was to determine the distribution of hepatitis C virus (HCV) genotypes in Australian patients with hepatitis C and to identify factors associated with particular genotypes. Serum isolates of HCV‐RNA were genotyped using a commercial oligonucleotide hybridization (line probe) assay. Relationships between demographic factors, mode of HCV transmission and HCV genotype were assessed by logistic regression analysis. Among 463 patients with hepatitis C, 425 tested positive for HCV‐RNA and a single HCV genotype was identified in 420 cases. The patients' places of birth were Australia or New Zealand (62%), Asia (13%), Europe (12%), Mediterranean (6%), Middle East (6%) and other countries (<1%). The most common genotypes were type 1 (52%) or type 3 (32%); type 2 (9.3%), type 4 (5.5%) and type 6 (1.7%) were less common. Patients with genotype 1b were older (48 ± 13 years, P < 0.001) and patients with genotype 3 were younger than the remaining patients (37 ± 11 years vs 42 ± 12 years, P < 0.001). Among type 1 isolates, 1b was more common for patients born outside Australia compared with those born in Australia (50%vs 13%, P < 0.001) whereas non‐1b subtypes were more common among Australian‐born patients. Likewise, 21 of 23 (91%) patients with type 4 were from Egypt and six of seven (86%) with type 6 were from Vietnam. The relative importance of parenteral risk factors for HCV also varied according to geographic origin. Thus, a definite risk factor for HCV acquisition was identified in > 95% of Australian‐born patients, but in only 33% of Asian or Mediterranean‐born patients. Logistic regression analysis indicated that region of birth and risk factor (intravenous drug use or not) would allow 98% of type 4 cases and 76% of type 1b cases to be identified correctly. In summary, region of birth, patterns of migration over time and risk factors for transmission of HCV interact to determine the distribution of HCV genotypes in a multi‐racial community like Australia.
Expression of urokinase‐type plasminogen activator receptor and plasminogen activator inhibitor‐1 in gastric cancer
Authors: KAWASAKI KENTARO , HAYASHI YOSHITAKE , WANG YAO , SUZUKI SATOSHI , MORITA YASUSHI , NAKAMURA TAKESHI , NARITA KOICHI , DOE WILLIAM , ITOH HIROSHI , KURODA YOSHIKAZU
Published: March 2008

In gastric cancer, the urokinase‐type plasminogen activator (uPA) system plays important roles in invasion and metastasis, processes which entail proteolysis and adhesion. Both the urokinasetype plasminogen activator receptor (uPAR) and the plasminogen activator inhibitor‐1 (PAI‐1) are thought to be important factors in this system. To clarify the relationship between these two factors and gastric cancer invasiveness, we evaluated the expression of uPAR and PAI‐1 in 91 cases of gastric cancer by immunohistochemistry and in situ hybridization. Urokinase‐type plasminogen activator receptor‐mRNA, PAI‐1‐mRNA, uPAR and PAI‐1 protein were diffusely distributed in the cytoplasm of the cancer cells and concentrated at invasive foci. Urokinase‐type plasminogen activator receptor protein expression correlated with lymphatic, venous invasion (P<.01) and lymph node metastasis (P<0.05); uPAR‐mRNA expression correlated with lymphatic, venous invasion and lymph node metastasis (P<0.05). Plasminogen activator inhibitor‐1 protein expression correlated with lymphatic, venous invasion, lymph node metastasis and depth of invasion (P<0.01); PAI‐1‐mRNA expression was linked to lymphatic, venous invasion (P<0.01), lymph node metastasis and depth of invasion (P<0.05). This suggests that the proteolytic activity of uPAR and the cellular motility of PAI‐1 in gastric cancer cells may determine penetration of lymphatic and blood vessels, whereby lymph node metastasis may be promoted and that the promotion of cellular motility by PAI‐1 may influence the depth of cancer invasion.
Clinical significance of anismus in encopresis
Authors: CATTO‐SMITH ANTHONY G , NOLAN TERENCE M , COFFEY CAROLYN MM
Published: March 2008

Treatments designed to relieve paradoxical contraction of the anal sphincters during defecation (anismus) have had limited success in children with encopresis. This has raised doubts as to the clinical relevance of this diagnosis in childhood as anorectal dysfunction. Our aim was to determine whether, in patients who had treatment‐resistant encopresis, the presence of electromyographic anismus was associated with increased faecal retention. Sixty‐eight children with soiling (mean age 8.7 ± 2.06 years) were assessed by clinical examination, abdominal radiography and then with anorectal manometry. Patients with electromyographic anismus (n= 32; 47%) had significantly increased radiographic rectal faecal retention and were significantly less likely to be able to defecate water‐filled balloons. There were no significant differences in response to prior therapy, history of primary encopresis, behavioural adjustment or in sociodemographic data. Our results suggest that electromyographic anismus is associated with obstructed defecation and faecal retention.
Endoscopic diagnosis of lower intestinal lesions of leukaemia and malignant lymphoma
Authors: KISHIDA TERUYUKI , HOSHINO TETSUO , LI FENG , TANAKA SHU , SHINOZAWA ISAO , SHIBATA YOSHIAKI , TATSUGUCHI ATSUSHI , SATO JUN , FUJIMORI SHUNJI , YOSHIDA YUTAKA , KOBAYASHI MASAFUMI
Published: March 2008

There have been only a few endoscopic studies with respect to lower intestinal lesions of leukaemia and malignant lymphoma, although there have been many autopsy studies of these lesions. The aim of this study was to clarify these lesions using endoscopy. Colonoscopy was performed on 11 of 341 patients with leukaemia and on 32 of 105 patients with malignant lymphoma for frequent diarrhoea, anal bleeding or abnormal findings on barium enema examination, between April 1984 and September 1994. In eight of the 11 patients with leukaemia on whom endoscopy was performed, nine lesions were found; aphthoid ulcers, small ulcers or large tumours due to leukaemic infiltration were found in five, and colorectal adenoma was found in only one patient. Antibiotic‐associated haemorrhagic colitis or pseudomembranous colitis was found in one patient each. In 10 of the 32 patients with malignant lymphoma, 11 lesions were found. The following were found in one patient each: large lymphomatous tumours, a large lymphomatous ulcer, multiple small polypoid lesions, multiple lymphomatous polyposis; and colorectal cancer or adenoma in six patients. However, the autopsy findings in patients with both diseases were mostly pseudomembrane formation or ulcers due to fungal and/or bacterial infection. It is concluded that accurate endoscopic diagnosis of lower intestinal lesions in patients with leukaemia or malignant lymphoma is essential for staging and treatment of these diseases and for determining their prognosis. Most lesions in leukaemia are aphthoid and small ulcers are due to leukaemic infiltration or antibiotics; most lesions in malignant lymphoma are elevated lesions such as cancer, adenoma or lymphomatous lesions as determined by endoscopy. This is in contrast to pseudomembrane formation or ulcers due to fungal and/or bacterial infection which are detected at autopsy.
Total Parenteral Nutrition of Premature Infants 1. Requirement for Macronutrient Elements
Authors: JAMES B. E. , HENDRY P. G. , MacMAHON R. A.
Published: March 2008

James, B. E., Hendry, P. G., and MacMahon, R. A. (1979). Aust. Paediatr. J., 15, 62–66. Total parenteral nutrition of premature infants. 1. Requirement for macronutrient elements. Balance studies were performed for 6 essential elements (Na. K, Cl, Ca, Mg, P) on 5 premature infants, with birthweights less than 1200 g, who were fed entirely by vein with a formula based on L amino‐acid isomers. These studies determined the amounts retained when these elements were given intravenously.

There was a significant correlation between the input and retention of each of these elements, and the data obtained have been used, by analogy with fetal growth, to derive tentative recommendations for the rate of infusion of these elements into the small premature infant.
Nutritional Studies During Early Childhood Feeding Practices During Infancy, and Their Relationship to Socio‐Economic and Cultural Factors
Authors: BOULTON T. J. C. , COOTE L. M.
Published: March 2008

Boulton, T. J. C. and Coote, L. M. (1979). Aust. Paediatr. J., 15, 81–86. Nutritional studies during early childhood. II. Feeding practices during infancy, and their relationship to socio‐economic and cultural factors. The results are presented of an analysis of socio‐economic and ethnic factors which are related to the practices of infant‐feeding. The results include the prevalence figures for breast‐feeding and an analysis of the different types of milk formulation used through the first year of life. The type of milk formula used related to the level of the mother's education, her country of origin, and the language spoken at home. Breast‐feeding was continued longer by mothers with tertiary education (p<0.001), and for less time by mothers born in southern Europe (p<0.05). The age of such mothers on arrival in Australia was significantly related to the duration of breast feeding (p<0.05). It is proposed that the influence of these observed relationships may lead to the establishment early in life of certain patterns of nutrient intake with possible long term effects. These may contribute to the differences in incidence of nutritionally based disorders with socio‐economic and ethnic status.
Fetal Erythrocyte Lifespan
Authors: HARRISON K. L.
Published: March 2008

Harrison, K. L. (1979) Aust. Paediatr. J., 15, 96–97. Fetal erythrocyte lifespan. The demonstration of fetal erythrocytes in the maternal circulation by the Kleihauer technique after feto‐maternal macrotransfusion provides a means of measuring the lifespan of those cells produced at the time of the haemorrhage. Two cases of massive feto‐maternal haemorrhage at 40 weeks gestation and one at 36 weeks gestation are used, together with a published case at 34 weeks gestation. to show that erythrocyte lifespan is quite short in fetal life and increases during the third trimester to be 80 to 90 days in a full term infant.
Childproof Safety Barriers An ergonomic study to reduce child trauma due to environmental hazards
Authors: NIXON J. W. , PEARN J. H. , PETRIE G. M.
Published: March 2008

Nixon, J. W., Pearn, J. H. and Petrie, G. M. (1979).
Aust. Paediatr. J., 15, 260–262 Childproof safety barriers. An ergonomic study to reduce child trauma due to environmental hazards. Trauma is the biggest killer of young children in Australia. An ergonomic study has been undertaken to test the ability of 500 Australian children to pass safety fences of various heights. Eighty per cent of 2 year olds, the modal age for child drowning, cannot climb a 60 cm (2 ft) fence. Twenty percent of 3 year olds can climb a 1.2 (4 ft) barrier. Cumulative frequency curves for the ability to climb safety barriers, by age. are presented. The Median age for negotiating a 1.4 m (4 ft 6 in) safety fence is 4 years. It takes on average only 12 seconds for a five year old to climb a 1.2 m safety fence and 17 seconds to climb a 1.4 m barrier. Predictions for the reduction in child trauma are given, if safety legislation were introduced to cope with modern environmental hazards. If a 90 cm barrier protects an enviromental hazard, child trauma will be reduced by 65%, and by 75% if a 1.4 m barrier is used. Specifications for compulsory safety devices vary from region to region, but public acceptance demands a minimum of interference with both physical freedom and with aesthetics.
The Aicardi Syndrome in a 47, XXY Male
Authors: HOPKINS I. J. , HUMPHREY I. , KEITH C. G. , SUSMAN MARLEEN , WEBB G. C. , TURNER ELIZABETH K.
Published: March 2008

Hopkins, I. J., Humphrey, I., Keith, C. G., Susman, M., Webb, G. C. and Turner, E. K. (1979). Aust. Paediatr. J., 278–280. the Aicardi syndrome in a 47, XXY male. The Aicardi syndrome is reported for the first time in a male child. His chromosomal analysis revealed a 47, XXY karyotype. This finding supports the suggestion that this condition is due to a newly mutated X‐chromosomal dominant gene. The existence of a 47, XXY chromosomal constitution in this male allows heterozygous expressions of the gene as in the female.
Chronic renal disease in childhood: doubts, hopes and expectations
Authors: ADLER ROBERT
Published: March 2008

The outlook for patients with chronic renal disease has altered dramatically with the technological advances of the past 25 years. The implications for children with end‐stage renal disease and their families are explored in the light of the available literature and the author's clinical experience.
Alcohol consumption of Tasmanian High School pupils
Authors: LYNCH PATRICK , WOODWARD DAVID , WATERS MALCOLM , KIRK ISOBEL , MACLEAN ANDREW , ROCKCLIFFE WENDY , REID PATRICIA
Published: March 2008

ABSTRACT. A report of the findings of a sample survey of alcohol consumption by Tasmanian High School pupils (age 12–16) in 1979.

The sample of 646 boys and 565 girls was drawn from 14 Tasmanian High Schools and is considered to be representative of High School pupils in that State. The main findings are that

a marked increase in drinking particularly by boys occurs between age 14 and 15.

by age 11 the majority of boys and girls have had their first drink, and there is a tendency to more widespread early experimentation with alcoholic drinks over the period 1975–1979.

An association is observed between drinking behaviour and health outcomes of drinking as perceived by the students.
Screening for learning problems in the first year at school
Authors: ROSSITER E. J. R. , LUCKIN J.
Published: March 2008

ABSTRACT. This is an interim report on screening for learning problems in the first year at school. It forms part of a prospective study of convulsions, epilepsy and learning disorders which commenced in 1970.

Poor correlation between teacher and parent opinion as to school readiness, activity, clumsiness and inco‐ordination is shown. For example, in only 2% did both parent and teacher consider a child over‐active.

The problems encountered by teachers suggests a need for a wider variety of learning experience for children starting school than presently offered in Victoria.
Family responses and mechanisms of adjustment following death of children with cancer
Authors: JURK IMAS H. , EKERT HENRY , JONES H. JULIE
Published: March 2008

ABSTRACT. In this study of the effects of death of a child from malignancy on the immediate family, it was found that 62 of 93 families wished to participate and that, in 50%, there was evidence of family dysfunction. Factors that appeared to be associated with dysfunciton included older parental age, lower educational achievement, previous social and psychological disturbances, poor family communication and lack of support from within the family by one or other of the parents. In 45% of the families, one or other sibling showed an abnormality of behaviour which was usually transient. The deceased children in the study had not been informed of their imminent death. In those families in which the parents perceived that their child knew that he was dying, there was a significantly higher incidence of family disturbance. In the absence of prospective clinical trials on the effects on the child and the family of informing the child that he was dying, it is not possible to draw conclusions on the above finding.
Atlanto‐axial dislocation with spinal cord compression in Down syndrome
Authors: SHIELD L. K. , DICKENS D. R. V. , JENSEN F.
Published: March 2008

ABSTRACT. An 8‐year‐old female with Down syndrome presented with progressive spastic quadriparesis. Compression of the upper cervical spinal cord was due to atlanto‐axial dislocation and she died despite operative intervention. Details of clinical, radiological and pathological features are presented.
Congenital left coronary artery — right ventricular fistula
Authors: ADAMS PHILIP , MORRIS LLOYD , ROSS IAIN
Published: March 2008

ABSTRACT. The case of a neonate with heart failure and myocardial ischaemia due to a large coronary artery fistula is reported. ECG monitoring and Thallium — 201 imaging indicated pre‐operative myocardial ischaemia. The diagnosis was confirmed by cardiac catheterization. Successful surgical ligation of the fistula was performed at the age of 10 days and to our knowledge is the first successful ligation in the neonatal period. Follow up Thallium — 201 imaging was normal. Repeat cardiac catheterization demonstrated complete closure of the fistula and normal left ventricular function.
Chediak‐Higashi syndrome in a Chinese infant
Authors: YIP WILLIAM C. L. , LEE Y. S. , TAY JOHN S. H. , WONG H. B.
Published: March 2008

ABSTRACT. Chediak‐Higashi syndrome in Chinese has not been previously reported in the English literature. A 14‐month Chinese girl who presented with partial oculocutaneous albinism and Pseudomonas infection was found to have the classical intracytoplasmic inclusion bodies in the leucocytes by light and electron microscopy. Other characteristic features typical of this syndrome included hepatosplenomegaly, defective chemotaxis, and coarse but sparse melanin granules in hair shaft. She was also found to have hypertriglyceridaemia, a rare lipid abnormality occasionally reported in children suffering from this syndrome.

Despite vigorous therapy with high dose ascorbate, corticosteroid and intravenous antibiotics, she died in the accelerated phase of Pseudomonas septicaemia.
Infant health and family functioning in a poor socio‐economic status multi‐ethnic municipality
Authors: CARMICHAEL ALLAN , WILLIAMS HOWARD E.
Published: March 2008

ABSTRACT. In a longitudinal epidemiological study of 272 infants in a poor socio‐economic, multi‐ethnic municipality, the physical growth of infants was found to be within a normal range. Two percent of infants had major, and 2% minor developmental delays due mainly to congenital defects or psychosocial disturbance or neglect in the home. Although there was a high prevalence of episodic, continuing and recurrent illness, this caused little serious morbidity. The most significant finding was that approximately one third of mothers perceived their infants to have moderate or severe behavioural disturbances which were signficantly associated with their own psychological ill‐health.

The findings from this urban population contrasted with previous studies. Serious infective illnesses, associated with poor physical and psychosocial environments, were no longer major health problems. These organic diseases in infants were largely replaced by behavioural and developmental disturbances, also associated with psychosocial problems in families.
Patterns of illness in an infant population in a poor socio‐economic status multi‐ethnic municipality
Authors: CARMICHAEL ALLAN , WILLIAMS HOWARD E.
Published: March 2008

ABSTRACT. The prevalence and patterns of illness and behavioural disturbances in a birth cohort of 273 infants followed longitudinally are reported. Four percent of infants showed serious morbidity, due to congenital abnormality, chronic illness or gross psychosocial disturbance in the family. Episodic and continuing or recurrent illness was common, but caused little serious morbidity and did not impair growth.

Behavioural disturbances manifested by feeding, crying and sleeping difficulties were also common, 22% of all infants being moderately affected and 13% severely affected. Mothers were more concerned by these disturbances than by organic illness.

The findings of illness in infants in this study were similar to those of a recent New Zealand study but differ from older overseas studies in which serious infective illness with high mortality was much more common. It is probable that these differences are largely explained by improvement in living conditions.
Nutrition in the first year of life in a multi‐ethnic poor socio‐economic municipality in Melbourne
Authors: WILLIAMS HOWARD E. , CARMICHAEL ALLAN
Published: March 2008

ABSTRACT. In a longitudinal epidemiological study of 304 consecutively born infants in a poor socio‐economic multiethnic municipality (Brunswick) nutrition was suboptimal in approximately 50%. This was mainly due to a high failure rate establishing effective lactation in the 82% of mothers who commenced breast feeding, but also to the early and frequent feeding of solids, usually refined carbohydrates, and minimal use of fresh fruit and vegetables.

The low rate of breast feeding to 6 months in Brunswick (16% compared with the State of Victoria average of 27%) was associated with demographic changes due to immigration. Of the 304 mothers, 62% were born overseas, most had limited schooling, no working skills, and 50% were unable to speak English. Successful breast feeding was postively correlated with better education and working skills while early introduction of solids and canned food was negatively correlated.

Professional advice and influence in infant feeding was very limited as most mothers decided their feeding methods on their own preferences or their experience with other children, or on advice from their own mothers or relatives.

These findings indicate that it will be a slow and complex task to change attitudes and teach poorly educated mothers, especially immigrants with limited English, the importance of optimum nutrition.
Jaundice: a 10 year review of 41,000 live born infants
Authors: PALMER DIANE C. , DREW JOHN H.
Published: March 2008

ABSTRACT. A review is presented of jaundiced newborn infants during the 10‐year period to 1980. Included are those whose serum bilirubin level was 154 μmol/l or more. Of 41,057 live births, 4,406 (10.7%) infants had hyperbilirubinaemia. The most common (19.9;%) aetiological factor was prematurity, followed by ABO erythroblastosis 7.1%; sepsis 3.4%; Rhesus erythroblastosis 2.7%; bruising 2.2%; multifactorial 1.0% and glucose‐6‐phosphate dehydrogenase deficiency 0.5%. Treatment was not undertaken in 2,855 (64.7%) infants, but 1,419 (32.2%) received phototherapy alone, 122 (2.7%) infants received both exchange transfusion and phototherapy and 10 (0.2%) infants received exchange transfusion alone. Of the infants requiring exchange transfusion 50.0% had Rhesus erythroblastosis, 28.0% ABO erythroblastosis, 10.6% jaundice of prematurity and the remainder were due to a variety of causes. Sixty‐three (1.4%) infants died, with two deaths being related to the hyperbilirubinaemia, as their death was due to necrotizing enterocolitis following exchange transfusion. Phototherapy proved safe with no deaths directly attributable to its use.
When does reflux oesophagitis occur with gastro‐oesphageal reflux in infants? A clinical and endoscopic study, and correlation with outcome
Authors: RYAN PATRICK , LANDER MERVYN , ONG T. H. , SHEPHERD ROSS
Published: March 2008

ABSTRACT. To evaluate the clinical and endoscopic features of peptic oesophagitis associated with gastro‐oesophageal reflux (GOR) in infants and children, and to correlate these features with outcome of GOR, we selected 62 patients with GOR aged 21 days to 10 years (median 6.5 months) with symptoms suggesting oesophagitis from a group of 126 patients with GOR for fiberoptic endoscopy. Clinical presentation, clinical features, investigations and management and outcome were recorded by computer‐aided analysis. Of the 62 patients studied, 34 (55%) had oesophagitis. Of these, nine had macroscopic ulceration and desquamation, 23 had macroscopic erythema and friability and two had strictures. Comparing those with and without oesophagitis, common clinical symptoms associated with oesophagitis included excessive crying, irritability and/or sleep disturbance often presenting as “colic” (85%), failure to thrive (41%), haematemesis (29%), and abnormal head and back posturing (7%). Maternal distress was common with GOR and oesophagitis in infants and three cases presented with child abuse. Four cases had associated neurological deficit. Of the 28 cases with minimal or no oesophagitis at endoscopy, 26 (93%) responded satisfactorily to conservative management whereas only 14 of 34 (41%) of the group with oesophagitis responded to conservative management including the use of cimetidine. The remainder of this group required antireflux surgery. We conclude that peptic oesophagitis is an often unrecognised important complication of GOR in infants and children which, apart from causing considerable morbidity may adversely affect prognosis. We emphasize the importance of diagnostic endoscopy in selected cases to detect pathological GOR, particularly where irritability, “colic”, sleep disturbance and haematemesis accompanies GOR as other diagnostic tests detect only the presence or absence of GOR, and are poor predictors of oesophagitis. Management of GOR in infants should include measures to prevent this important complication, and careful follow‐up of established cases seems prudent.
Cardiovascular manifestations of Kawasaki disease Royal Children's Hospital, Melbourne, experience 1974‐1981
Authors: CARMAN PAUL , MENAHEM SAMUEL
Published: March 2008

ABSTRACT. A review was undertaken of all patients with Kawasaki disease admitted to the Royal Children's Hospital. Their cardiovascular manifestations were reviewed and found to be similar to those reported overseas. The series totalled 21 patients, including five who developed cardiac failure. There were three deaths. Treatment varied but was mainly supportive though low dose aspirin has increasingly been used.
Ear anomalies, deafness and facial nerve palsy in infants of diabetic mothers
Authors: O'LOUGHLIN E. V. , LILLYSTONE D.
Published: March 2008

ABSTRACT. ABSTRACT. Two children with an unusual combination of ear anomalies, deafness and facial nerve palsy are described. They are both children of insulin dependent diabetic mothers. There is no other family history of genetic deafness Or congenital anomaly. The defects in both children may be accounted for by abnormal embryological development of the petrous temporal bone. It is postulated that poor metabolic control of the diabetes has led to these malformations.
The needs of the sexually abused child
Authors: ROBERTSON SUZANNE I.
Published: March 2008

ABSTRACT. The incidence of sexual abuse in childhood, and its short and long term effects dictate that paediatricians increase their awareness of the needs of the sexually abused child. Case examples are given from experience at one children's hospital illustrating a range of situations which vary with the relationship of the abuser to the child. Factors thought to influence outcome are described. The needs demonstrated are correlated with management recommendations, including those made in a recent Australian report.
Revised intrauterine growth curves for an Australian hospital population
Authors: KITCHEN WILLIAM H. , ROBINSON HUGH P. , DICKINSON ANN J.
Published: March 2008

ABSTRACT. Intrauterine growth curves require periodic revision because of changes in population, socio‐economic factors and technology used in obstetric care. Anthropometric measurements were derived from consecutive livebirths in the Royal Women's Hospital in 1979 and all those born before 35 weeks in 1977 and 1978; at gestational ages less than 30 weeks, data previously published was also incorporated. Infants were included if an ultrasonic examination of the uterus had been performed in the first 20 weeks of pregnancy or gestation based on “certain” menstrual history was confirmed clinically. From data on 3120 infants, intrauterine growth curves from 24‐‐42 weeks' gestation were prepared; compared with births in the same hospital in 1966, there was generally an elevation of all centiles, particularly so for the 10th centile for weight after 37 weeks' gestation. Factors in the infant such as sex and ethnic origin and also maternal factors, especially pregnancy weight and height should be considered when using standard intrauterine growth charts.
Neonatal hypotension: two years’experience in a neonatal intensive care nursery
Authors: SMITH JAMES E. H. , JOHN ELIZABETH
Published: March 2008

ABSTRACT. Routine measurement of blood pressure in high risk neonates admitted to the intensive care nursery during a 2 year period resulted in detection of 18 infants with persistent hypotension requiring definitive treatment. The perinatal events in these babies were compared to those in a control group of infants. No single well defined factor responsible for neonatal hypotension could be found in the antenatal period or during labour. However 14 of the 18 babies were asphyxiated at the time of admission compared to 6 of 18 controls (p<0.02). Seventeen of 18 babies were preterm. Treatment consisted of maintenance of ventilation, oxygenation and acid‐base status, volume expansion when indicated and inotropic agents. Nine of the 18 hypotensive babies died compared to 1 of 18 controls. Failure to respond within a few hours of commencement of treatment indicated poor prognosis.
Race‐associated differences in drinking behaviour
Authors: WALKER STUART H.
Published: March 2008

ABSTRACT. An evaluation of the oral intake and the need for alternative therapy in aboriginal and white (European ancestry) children hospitalized for dehydration due to diarrhoea revealed significant differences in drinking behaviour. In a retrospective study of 120 children (36 aboriginal), the white children were far more likely to require an alternative mode of fluid administration (39 of 86 white versus 3 of 34 aboriginal). In a prospective study, although treated in the same manner by the same staff, during the first eight hours after admission white children had a mean oral intake of 2.9 ml/kg/hr (range 0.4‐‐6.6, S.D. 1.6) whereas the aboriginal children had a mean oral intake of 6.1 ml/kg/hr (range 2.2‐‐9.2. S.D. 2.1). The drinking behaviour of children varies with racial and/or cultural background. This should be considered in designing and administering rehydration solutions.
Breastfeeding and oral contraceptives: Tasmanian survey
Authors: COY J. F. , MAIR C. H. , RATKOWSKY D. A.
Published: March 2008

ABSTRACT. A survey of 772 Tasmanian mothers was carried out to determine whether there was any connection between the mother's use of oral contraceptives and her ability to breastfeed her child. It was found that 80% of the 243 mothers combining breastfeeding with the use of oral contraceptives were able to breastfeed their children for at least 3 months. Of these, all but 15 mothers used pills containing only progestagen. It is concluded that the progestagen‐only oral contraceptive is compatible with lactation and that a mother using this type of pill will probably be able to breastfeed her baby.
Pulmonary function following staphylococcal pneumonia in children
Authors: SOTO MANUEL , DEMIS TIM , LANDAU LOUIS I.
Published: March 2008

ABSTRACT. Twenty three subjects with proven staphylococcal pneumonia (19 with empyema) were studied 12–25 years after the original infection. Clinical radiological, and lung function status and airway response to histamine inhalation was assessed. No clinical or radiological changes resulted from the original staphylococcal infection. No subject had physiological evidence of chronic lung disease and there was no evidence of an increased incidence of airways hyperreactivity.
Urethral ectopic ureter with a ureteric valve
Authors: AHMED SAEED , SMITH ANTHONY
Published: March 2008

ABSTRACT. An unusual case of a urethral ectopic ureter in a girl is reported. Only the upper half of the ureter was a megaloureter, the distal half being stenosed. The appearances were consistent with the presence of a ureteric valve.
Torsade de pointes and asystole in a child with complete heart block and prolonged QT interval
Authors: NIKOLIC GEORGE , ARNOLD JOHN , COLES DAVID M.
Published: March 2008

ABSTRACT. Three‐year‐old girl with eight month history of convulsive syncope due to complete heart block, prolonged QT interval and paroxysms of ventricular tachycardia is described. An episode of torsade de pointes tachycardia followed by asystole was documented. The symptoms and electrocardiographic abnormalities were controlled by pacemaker therapy.

The subset of “congenital heart block'’patients with prolonged QT interval is at high risk of sudden death and should be regarded as a previously unrecognized form of Romano‐Ward syndrome.