bluuebunny/crossref_metadata_2025 huggingface dataset:
Ruptured cerebral aneurysm not detected by magnetic resonance angiography in juvenile autosomal dominant polycystic kidney
Authors: Nakajima Fumitaka , Shibahara Nobuhisa , Arai Motohiro , Ueda Haruhiko , Katsuoka Yoji
Published: March 2003

Recently, it has been reported that magnetic resonance angiography (MRA) is useful for screening and following up cerebral aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD). However, a patient was encountered with a ruptured cerebral aneurysm that was not detected by routine MRA. The patient, a 29‐year‐old man with ADPKD, was followed up at our hospital for more than 5 years. Ten months after an MRA examination, he suddenly developed severe headache. Brain computed tomography revealed subarachnoid hemorrhage. Digital subtraction angiography detected an aneurysm with a diameter of approximately 2 mm in the anterior communicating artery. Clipping of the aneurysm was immediately performed and he recovered without sequela after operation. Magnetic resonance angiography is useful to detect cerebral aneurysms, but it can not detect aneurysms measuring less than 4 mm.
Post‐voiding repeated renal ultrasonography for slight hydronephrosis detected during screening for asymptomatic microhematuria*
Authors: Nishimura Taiji , Abe Hiroyuki , Miura Takafumi , Uchikoba Takushi , Tsuboi Narumi , Yamamoto Hideki , Kobayashi Kyoko
Published: March 2003

Background
: There is not a well established method for further screening of asymptomatic microhematuria found through annual health examinations. However, it is apparent that a large number of examiners are using ultrasonography for screening. When slight hydronephrosis is found through screening, it is difficult to determine whether further examinations, such as intravenous pyelography (IVP), should be performed. In this paper, we discuss the usefulness of post‐voiding repeated renal ultrasonography, which was applied to 57 patients with slight hydronephrosis found in a screening.

Methods
: Ultrasonography in the kidney and the urinary bladder at the ultrasound laboratory of Toma Hospital was carried out on a total of 1906 patients with asymptomatic microhematuria, which was found by routine annual health examination, from January 1996 to December 1998. Slight hydronephrosis was found in 57 (14 males and 43 females) of 1906 patients and post‐voiding repeated renal ultrasonography was carried out on all patients.

Results
: Slight hydronephrosis had disappeared and IVP was avoided in 22 (38.6%) of 57 patients. Of 35 cases in which slight hydronephrosis persisted after urination, there were no abnormalities on IVP in 32 patients, while abnormalities were found in three patients. Two of these had ureteropelvic junction stenosis and the remaining one had a ureteral stone.

Conclusion
: The results of this study indicate that post‐voiding repeated renal ultrasonography is useful for avoiding unnecessary further examination to determine whether upper urinary tract obstruction exists, when slight hydronephrosis is observed upon screening by simultaneous renal and urinary bladder ultrasonography for asymptomatic microhematuria.
Congenital vesicovaginal fistula
Authors: Asanuma Hiroshi , Nakai Hideo , Shishido Seiichiro , Tajima Eiji , Kawamura Takeshi , Kawamura Takeshi
Published: March 2003

Congenital vesicovaginal fistula is a very rare entity, the etiology of which has not been clearly elucidated because pathologic features have not been mentioned in previous reports. The case of a 4‐year‐old girl having incontinence resulting from a congenital vesicovaginal fistula joining with the left ectopic ureter from the hypoplastic kidney is described. This is thought to be the first presentation of congenital vesicovaginal fistula joining with ectopic ureter. A microscopic examination revealed the fistula consisting of transitional cell epithelium, suggesting an abnormal fusion of the ureteral bud and caudal end of the müllerian duct with the urogenital sinus.
Sonographically detected malignant transformation of a simple renal cyst
Authors: Sakai Naoki , Kanda Fumiyoshi , Kondo Keiichi , Fukuoka Hiroshi , Tanaka Toru
Published: March 2003

Abstract The clinical course is reported of a simple renal cyst which developed into a septated renal cyst, and finally to a cystic renal cell carcinoma. A 49‐year‐old man, who had been diagnosed as having a renal cyst, was found by repeated ultrasonography over 6 years to have solid components developing within the cyst. Radical nephrectomy was performed, and pathological examination confirmed cystic renal cell carcinoma (RCC). This case clearly shows a natural history of malignant transformation from a simple renal cyst, and emphasizes that careful follow‐up of renal cysts, especially of complicated renal cysts, is mandatory for successful treatment of RCC.
Progression of prostate cancer to neuroendocrine cell tumor
Authors: Tanaka Masashi , Suzuki Yoshio , Takaoka Katsuyuki , Suzuki Noriyuki , Murakami Shino , Matsuzaki Osamu , Shimazaki Jun
Published: March 2003

Abstract Background: The progression to endocrine therapy‐resistant prostate cancer is partly due to clonal change to neuroendocrine cell tumor. To elucidate this pathologic process, the clinical courses of four cases of neuroendocrine cell tumor that were found at autopsy are reported.

Methods: Between 1995 and 1999, autopsies were performed for 20 cases of prostate cancer. Lesions predominantly composed of a neuroendocrine cell tumor (small cell carcinoma) were found in four men. The clinical courses of these cases were compared to 16 other non‐neuroendocrine cell tumors (adenocarcinomas).

Results: The outstanding features of the neuroendocrine cell tumors were: (i) survival was brief after relapse, although the duration of control by employing endocrine therapy varied; (ii) the prostate‐specific antigen level did not increase after relapse; and (iii) the sites of metastasis were similar to those of common adenocarcinomas.

Conclusion:

The progression to a neuroendocrine cell tumor indicated a poor prognosis and slight (if any) changes in the serum prostate‐specific antigen level. This tumor might not appear to respond to any therapeutic attempt.
Dartos flap interposition in the surgical repair of rectourethral fistulas
Authors: Yamazaki Yuichiro , Yago Rie , Toma Hiroshi
Published: March 2003

Abstract Background: Multilayer closures are important techniques in urethral fistula repair. We report our experience with dartos flap interposition in the repair of rectourethral fistula.

Methods/Results: A tip of a V‐shaped scrotal skin flap is mobilized and de‐epithelialized to develop a dartos flap. Two patients with a rectourethral fistula underwent fistula closure covered with this dartos flap. The surgical repair was successful in both cases and neither patient showed any late complication.

Conclusions: A scrotal dartos flap is well vascularized and easy to mobilize. We believe this technique is helpful in preventing postoperative complications following complex posterior urethral surgery.
Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume
Authors: Yuen John Shyi Peng , Ngiap James Tan Khiaw , Cheng Christopher Wai Sam , Foo Keong Tatt
Published: March 2003

Background: A filled bladder acts as an acoustic window for transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. The aim of this study is to evaluate the effects of bladder volume on transabdominal ultrasound measurements of these parameters.

Methods: Twenty‐two patients undergoing transurethral resection of the prostate (TURP) were studied. Under general anesthesia just before TURP, a transrectal ultrasound measurement of prostate volume was obtained. The bladder was then filled in a stepwise manner with 100, 200, 300, 400 and 500 mL. At each volume, the intravesical prostatic protrusion and prostatic volume were measured transabdominally using ultrasound.

Results: There was an obvious trend of decreasing mean transabdominal intravesical prostatic protrusions with increasing bladder volume. The mean transabdominal intravesical prostatic protrusion at bladder volumes 100, 200, 300, 400 and 500 mL was 9.1, 8.8, 7.4, 5.8 and 4.6 mm, respectively. The bladder volume at which maximum prostatic protrusion occurred was between 100 and 200 mL. The mean transabdominal prostate volume at the five increasing bladder volumes was 50.6, 48.7, 49.2, 47.9 and 41.4 mL, and these were correlated to transrectal prostate volume, particularly when the bladder volume was less than 400 mL.

Conclusions: Transabdominal ultrasound measurement of prostatic protrusion is dependent on bladder volume. Transabdominal ultrasound measurement of prostatic volume correlates well with the transrectal measurement of the same parameter when the bladder volume is less than 400 mL.
Hyperbaric oxygen therapy for Wegener's granulomatosis with cyclophosphamide‐induced hemorrhagic cystitis
Authors: Kuroda Isao , Kuwata Yoshihiro , Kakehi Yoshiyuki
Published: March 2003

A 49‐year‐old man with Wegener's granulomatosis, who had been treated with cyclophosphamide, was admitted to our hospital experiencing gross hematuria. The hemorrhage was refractory to multiple conventional treatments. It progressed but later was resolved after a course of hyperbaric oxygen therapy.
Penile metastasis of prostatic adenocarcinoma
Authors: ŞENKUL TEMUÇİN , KARADEMİR KENAN , Ş İLİT EMİR , İ ŞERİ CÜNEYT , ERDEN DOĞAN , BALOĞLU HÜSEYİN
Published: March 2003

Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.
Differences in length of stay for Hospital in the Home patients: comparing simple clinical coding with medical record review
Authors: Ioannides‐Demos L. L. , Addicott R. , Santamaria N. M. , Clayton L. , McKenzie M. , Fairley C. K.
Published: March 2003

Abstract

Aim: To determine whether the apparently longer length of stay (LOS) reported for patients with cellulitis managed in Hospital in the Home (HITH) compared with those managed as inpatients was correct.

Methods: Data, including LOS, from the Victorian In‐patient Minimum Database (VIMD) of all patients with cellulitis managed between July 1998 and June 1999 at a large metropolitan teaching hospital were analysed and compared with a retrospective medical record review of the same patients.

Results: In the VIMD data, there were 266 episodes of cellulitis during the study period. However, the medical record review found that six episodes were not separate, but rather a continuation of treatment for the same episode of cellulitis, and that 18 were not episodes of cellulitis, but were pilonidal sinus infections. In the VIMD data set, the mean LOS for patients treated in HITH was generally longer than that for inpatients (7.2 days vs 5.1 days, respectively, P = 0.002). However, in the retrospective medical record review, the LOS for patients treated in HITH was similar to inpatients (7.3 days versus 7.0 days, respectively, P = 0.68).

Conclusions: In contrast to the VIMD data, the medical record review demonstrated that, overall, patients with cellulitis had a similar LOS irrespective of whether they were managed at home or in hospital. This study confirms that caution is required in interpreting the VIMD data, highlights the importance of carefully monitoring the introduction of new treatment modalities and indicates areas for further research. (Intern Med J 2001; 31: 142–145)
The mind of a failing heart: a systematic review of the association between congestive heart failure and cognitive functioning
Authors: Almeida O. P. , Flicker L.
Published: March 2003

Abstract

Background: Congestive heart failure (CHF) is a frequent complication of most diseases of the heart. CHF is associated with impairment in several aspects of the quality of life of patients, including mood and cognitive performance. Early reports indicated that patients with CHF display deficits in memory and other intellectual abilities, although the clinical relevance of these findings remains unclear.

Aim: We reviewed systematically the medical literature with the aim of clarifying the association between CHF and cognitive functioning.

Methods: Systematic review of Medline database for studies published between 1966 and June 2000 using the following key words: congestive heart failure, cognition, cognitive disorders, memory, memory disorders, short‐term memory, attention.

Results: Thirteen studies reported cognitive information on patients with CHF, but only five met inclusion criteria for systematic review. Three reports described attention (total number of subjects = 369 patients and 882 controls) and memory scores (total number of subjects = 247 patients and 748 controls), two studies reported measures of general cognitive functioning (total number of subjects = 203 patients and 704 controls) and one reported the rate of cognitive impairment (total number of subjects = 88 patients and 987 controls). Pooled analysis indicated that CHF is associated with a pattern of generalized cognitive impairment that includes memory and attention deficits.

Conclusions: The results of the present review highlight the enormous paucity of systematic information about the association between CHF and cognitive functioning, with only five studies reporting data suitable for analysis. We expect that new case‐control and cohort studies will be designed to confirm the presence of cognitive impairment in patients with CHF and trust that this information will improve the management of CHF patients and our understanding of the mechanisms associated with cognitive decline in later life. (Intern Med J 2001; 31: 290–295)
Improving benzodiazepine prescribing for elderly hospital inpatients using audit and multidisciplinary feedback
Authors: Elliott R. A. , Woodward M. C. , Oborne C. A.
Published: March 2003

Abstract

Background: Benzodiazepines are commonly prescribed for older people. Inappropriate benzodiazepine prescribing may result in serious adverse effects, including confusion and falls.

Aims: To determine the prevalence and appropriateness of benzodiazepine prescribing for elderly inpatients at nine public hospitals in Victoria, Australia, and to assess the impact of multidisciplinary feedback on quality of benzodiazepine prescribing.

Methods: Clearance for the study was obtained from ethics committees of participating hospitals. Medication charts for 1301 patients aged 65 years and over were reviewed to identify patients prescribed a benzodiazepine. Using an evidence‐based indicator of prescribing appropriateness, cross‐sectional notes‐based audits were conducted at three time points (baseline, 4–8 weeks and 6 months). Feedback of baseline audit results was provided to medical, pharmacy and nursing staff at multidisciplinary meetings. Changes in benzodiazepine prescribing over the following 6 months were assessed.

Results: At baseline, benzodiazepines were prescribed for 36% of patients, and 20% of prescriptions were appropriate. Four to six weeks after feedback, the proportion of patients prescribed a benzodiazepine had not changed significantly (31%, P = 0.125); however, more prescriptions were appropriate (44%, P < 0.0001). For patients who were using a benzodiazepine prior to admission and had a contraindication, there were more attempts to withdraw or reduce the dose (47%vs 21%, P = 0.002) and more prescriptions were for acceptable indications (7.4%vs 2.6%, P = 0.024). Six months after feedback, appropriateness of prescribing remained improved compared with baseline (50%, P = 0.002).

Conclusions: Benzodiazepines were prescribed for approximately one in three elderly hospital inpatients and a large proportion was inappropriate. A multidisciplinary intervention based on audit and feedback improved prescribing and the impact of the intervention was still evident after 6 months. (Intern Med J 2001; 31: 529–535)
Surface‐active phospholipid: a Pandora’s box of clinical applications. Part II. Barrier and lubricating properties
Authors: Hills B. A.
Published: March 2003

In Part I, it was described how their configuration renders phospholipid molecules surface active and capable of acting at interfaces in addition to the ­liquid−air interface to which conventional theory has hitherto confined the study of ‘surfactant’ in the lung. Surface‐active phospholipid (SAPL) appears no different to comparable surfactants studied in the physical sciences for the highly desirable properties that their adsorption (reversible binding) can impart to solid surfaces.

In Part II, these properties are considered in sites where there is no air. Highly desirable properties include boundary lubrication (lubricity), release (antistick) and the ability of the strongly adsorbed and strongly cohesive SAPL linings to act as barriers against abrasion, corrosion and, possibly, against invasion by microorganisms. As the ‘sealant’, it could be the true barrier rather than the cells providing its mechanical support. Evidence is reviewed for SAPL providing the gastric mucosal barrier to acid in the stomach and preventing the digestion of Helicobacter pylori until that barrier is broken by bile in the duo­denum, where H. pylori cause ulcers. The concept that SAPL provides effortless sliding of many tissues, including pleura, pericardium and peritoneum is reviewed. Particular attention is paid to the load‐bearing joints, where a deficiency has been associated with osteoarthritis. The ability of the same SAPL lining to perform multiple roles is discussed in relation to the peritoneum, where it could provide the lubricant/release agent preventing surgical adhesions, while imparting semipermeability to ‘the membrane’ vital for peritoneal dialysis. In each site, the prophyl­actic use of exogenous SAPL is discussed for its potential clinical applications. (Intern Med J 2002; 32: 242−251)
Communicating in a multicultural society II: Greek community attitudes towards cancer in Australia
Authors: Goldstein D. , Thewes B. , Butow P.
Published: March 2003

Background: Open and full disclosure of information regarding diagnosis and prognosis is the prevailing approach to cancer patients. However, such a view appears contrary to the preferences of many ethnic groups in Australia.

Aims: This study sought to examine the range of attitudes to cancer, its treatment and disclosure of information among unaffected Greek adults, as part of an ongoing project to develop culturally appropriate cancer care in Australia.

Methods: Respondents were recruited from first generation Australian residents. Twenty‐nine men and 29 women, half over and half under the age of 60 years, participated. Eight focus groups were conducted by a bilingual facilitator and supplemented with eight individual face to face interviews.

Results: Several areas of misunderstanding were identified concerning the causes and outcomes of cancer. Having a cancer was regarded as a source of shame. Disclosure of diagnosis, but less so prognosis, was favoured, and only to immediate family members. Family members translating for the doctor were reported to commonly alter or ‘soften’ the doctor’s message without the patient’s knowledge in order to protect the patient. Greek doctors were favoured, and open discussion of alternative medicines was sought.

Conclusions: The Greek community is the most established migrant community in Australia, but clearly many of their attitudes to cancer are at variance with what is considered good practice by clinicians. An increased awareness of cultural differences is needed to achieve optimal health outcomes in the diverse communities that make up modern Australia. (Intern Med J 2002; 32: 289−296)
Weeds and weed management in rice production in Japan
Authors: Shibayama Hidejiro
Published: March 2003

The area of paddy rice fields in Japan was 1.79 million ha in 1998 almost all of which was planted with young seedlings from nursery boxes by a mechanical rice transplanter. Japanese farmers controlled paddy weeds mainly by chemical herbicides, which were applied around 1.8 times in one growing season of rice by sequential treatment. The cost of herbicides was 35 320 ¥/ha on average, the main of which was ‘one‐shot’ herbicides, while weeding labor for the paddy field, including herbicide application, was 19.0 h/ha, or 29 976 ¥/ha in labor cost, in 1998. Under the Integrated Weed Management (IWM) for sustainable paddy rice production, other technologies for weed management are also recommended to paddy farmers, such as ecological or cultural, mechanical, biological methods and so on.
Trends and expectations for research and technology in weed science in Thailand
Authors: Chinawong Sombat , Suwanketnikom Rungsit
Published: March 2003

There are many possible ways to improve the economic crisis in Thailand, and it is agreed that development of agricultural production is ideal for improving the economic situation in an agricultural country such as Thailand. A strategic plan for agricultural and agro‐industry research is included in the national research agenda and can be classified into nine groups covering different research areas. Most research is based on the agricultural production of four main product groups: (i) crops; (ii) aquatic animals/plants and fisheries products; (iii) poultry, livestock and animal products; and (iv) forest resources. Trends in research and development in weed management for crop production will continue to support the food demands and the development of efficient production of quality products.
Preoxygenation before laryngoscopy in children: how long is enough?
Authors: MORRRISON JOHN , COLLIER EVAN , FRIESEN ROBERT , LOGAN LORALEE
Published: March 2003

The ideal preoxygenation period prior to laryngoscopy in children is unclear. This study was performed to determine an appropriate duration of preoxygenation for infants and children prior to laryngoscopy using endtidal oxygen (Fe′O2) criteria. Healthy paediatric patients for elective day surgery procedures were studied. An inflatable mask connected to an oxygen‐primed paediatric anaesthesia semiclosed circuit was placed on the face while patients breathed spontaneously during 6.min−1 oxygen flow. An Fe′O2 of 0.9 was considered the endpoint, and if not achieved in two min the protocol was ended. Fifty‐eight children were studied. Six patients never achieved an Fe′O2 of 0.9 and were not considered in the analysis. The times (in seconds with mean±sd and range) to achieve a minimum endtidal (Fe′O2) of 0.9 for under six months were 36±11.4(20–50), 7–12 months were 35.5±13.3(20–60),13–36 months were 42.6±18.7(20–90), 37–60 months were 50.8±18.5(30–90), >60 months were 68.4±24.1(30–100). Logistic regression curves were determined for each age group describing the probability of achieving an Fe′O2 of 0.9 against time of preoxygenation. All children with satisfactory mask fit were able to preoxygenate to an Fe′O2 of 0.9 within 100 s.
A comparison of three methods of analgesia in children having day case circumcision
Authors: McGOWAN  , MAY  , MOLNAR Z , CUNLIFFE
Published: March 2003

Sixty‐one children were randomized to receive one of three methods of analgesia for day case circumcision. Group 1 received a penile block, group 2 received a penile block plus diclofenac suppository and group 3 received a diclofenac suppository alone. CHEOPS pain scoring was performed in the recovery area, one h after awakening and two h after awakening. There was no difference between the groups except in the recovery area when group 3 cried more and had a higher pain score than group 2. Parental follow‐up questionnaires for the subsequent two days showed no difference in measured parameters between the groups.
Anaesthetic implications of Cornelia de Lange syndrome
Authors: CORSINI L. , DE STEFANO G. , PORRAS M. , GALINDO S. , PALENCIA J.
Published: March 2003

Cornelia de Lange syndrome is a congenital disease characterized basically by psychomotor retardation associated with a series of malformations (mainly skeletal craniofacial deformities together with gastrointestinal and cardiac malformations). We present the case of a patient who underwent trauma surgery, discuss the anaesthetic problems involved and their relationship to the malformations that constitute this syndrome.
Twelve hours of gastric ventilation: a recipe for disaster (a suggested remedy)
Authors: CROCKETT DOUGLAS , TAYS RENAE , BROCK‐UTNE JOHN
Published: March 2003

A forty‐three‐day‐old infant was intubated by the Neonatal Intensive Care Unit (NICU) staff. A nasogastric tube was in place for the duration. The patient's vital signs remained stable during 12 h of positive pressure ventilation. A Broviac catheter placement was scheduled in the NICU. The position of the tracheal tube (TT) was not verified prior to induction of anaesthesia. After the induction, the patient's condition deteriorated. The TT was found to be positioned within the oesophagus. A near catastrophe was successfully averted by discovering the malpositioned TT and replacing it with a properly positioned TT. We believe that had we clamped the existing nasogastric tube preoperatively, a noticeable abdominal distention would have occurred alerting us to a malpositioned TT. We suggest that clamping a preexisting nasogastric tube may have merit to alert one to a malpositioned TT.
Examination of acetaminophen for outpatient management of postoperative pain in children
Authors: RØMSING JANNE , HERTEL STEEN , HARDER ANNE , RASMUSSEN METTE
Published: March 2003

We have examined acetaminophen (paracetamol) dosing for outpatient management of posttonsillectomy pain in children. Forty children, 5–15 years of age, undergoing tonsillectomy and their parents were randomly assigned to use a scheduled administration of acetaminophen in weight appropriate doses, 60 mg·kg−1·24 h−1 orally, 90 mg·kg−1·24 h−1 rectally, or to use acetaminophen ‘as needed’ according to present standards (control group). Postoperative pain was assessed by the child using the poker chip tool for the first three days after discharge. The prevalence of pain amongst all the children was high. The second day after discharge 22%–64% of the children in the study group and 36%–73% of the children in the control group rated severe pain. Recommended dose ranges of acetaminophen do not provide sufficient pain relief in children following tonsillectomy. Further studies are required to determine, whether higher doses of acetaminophen or analgesics with different analgesic properties will lead to improved analgesia in children following tonsillectomy.
Metabolic and clinical responses to different types of premedication in children
Authors: Rautakorpi Pirkka , Manner Tuula , Kanto Jussi , Lertola Kalle
Published: March 2003

The metabolic and clinical responses to intravenously administered atropine+meperidine (pethidine), glycopyrrolate+meperidine, diazepam and placebo were examined in 76 healthy children. After atropine+meperidine and glycopyrrolate+meperidine administration, a significant antisialogogue effect, tachycardia and elevation in systolic blood pressure were observed. Diazepam decreased oxygen consumption (VO2) whereas atropine+meperidine increased both VO2 and energy expenditure (EE). The maximal effect of diazepam on VO2 was found 10 min after drug administration (mean difference from baseline –10.0%) and maximal effect of atropine+meperidine on VO2 and EE after 5 min (mean difference from baseline +6.0% and +3.3%, respectively). It is concluded that intravenous administration of meperidine with atropine or glycopyrrolate is followed by profound anticholinergic effects and such combinations do not appear to be suitable for clinical purposes. Although statistically significant, the alterations in VO2 and EE after diazepam and atropine+meperidine premedication can be considered clinically insignificant because they were of short duration and the measured changes represented only a fraction of fluctuation seen in normal values.
Fatal pulmonary haemorrhage during anaesthesia for bronchial artery embolization in cystic fibrosis
Authors: Mcdougall Robert J. , Sherrington Colin A.
Published: March 2003

Three children with cystic fibrosis (CF) had significant pulmonary haemorrhage during anaesthetic induction prior to bronchial artery embolization (BAE). Haemorrhage was associated with rapid clinical deterioration and subsequent early death. We believe that the stresses associated with intermittent positive pressure ventilation (IPPV) were the most likely precipitant to rebleeding and that the inability to clear blood through coughing was also an important factor leading to deterioration. Intermittent positive pressure ventilation should be avoided when possible in children with CF with recent significant pulmonary haemorrhage.
Observation of the correlation of postanaesthesia recovery scores with early postoperative hypoxaemia in children
Authors: XUE F. S. , TONG S. Y. , LIAO X. , LIU J. H. , ZHANG R. J. , AN G. , LUO L. K.
Published: March 2003

To observe the correlation of the postanaesthesia recovery score (PARS) with the incidence, and severity of early postoperative hypoxaemia in children, 1213 infants and children, ASA physical status I, aged three months to 14 years, scheduled for elective plastic surgery were included in this study. Arterial oxygen saturation (SpO
2) levels were recorded while children were breathing room air shortly after arrival in the recovery room (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120 and 180 min thereafter. The PARS was also determined on all patients when SpO
2 levels were recorded in the recovery room. On the basis of different PARS, children were divided into the three groups: Group 1 – children having the PARS of ≤6; Group 2 – children having the PARS of 7–9; and Group 3 – children having a PARS of 10. The results showed that during the early postoperative period, the incidence and severity of hypoxaemia correlated closely with the PARS. The lower the children's PARS, the higher the incidences of hypoxaemia (SpO
2=86–90%) and severe hypoxaemia (SpO
2≤85%). The incidences of hypoxaemia and severe hypoxaemia were 12.9% and 15.8%, respectively, in Group 1, 20.9% and 2.9% in Group 2, 0.8% and 0% in Group 3. There were significant differences among the three groups. Of the 91 children who required O2 supplementation in the recovery room because of low measured SpO
2, 69 had the PARS of ≤6, and 22 had the PARS of 7–8. It is concluded that if a patient has a PARS of 10, the patient will not need routine oxygen supplement because hypoxaemia will not occur.
Pulmonary artery catheter placement under transoesophageal echocardiography guidance
Authors: RIMENSBERGER PETER C. , BEGHETTI MAURICE
Published: March 2003

Despite correct positioning pulmonary artery catheters may be displaced accidentally. Repositioning may prove to be difficult, especially when high pulmonary artery pressures are present. After failure of usual placement methods, transoesophageal echocardiography was used to guide repositioning of a displaced Swan‐Ganz catheter in the early postoperative course after cardiac surgery in a child. This technique proved to be useful in visualizing intracardiac catheter orientation and facilitating pulmonary artery catheter placement at bedside, avoiding transportation of a haemodynamically unstable patient.
Preoperative anxiety and volume and acidity of gastric fluid in children
Authors: Kawana Shin , Uzuki Mitsuru , Nakae Yuri , Namiki Akiyoshi
Published: March 2003

Forty‐three patients aged 3–6 years, undergoing minor surgery were studied. Parents staying with their children were asked to evaluate the anxiety of their children and themselves by a visual–analogue scale the night before surgery (VAS‐N) and just before premedication in the morning (VAS‐M). After induction, gastric fluid was collected and the volume and pH were measured. Patients with a VAS‐M lower than 5 were considered the low‐anxiety group ( L‐group; n=24) and the remainder comprised the high‐anxiety group (H‐group; n=19). The gastric volume of the H‐group was significantly lower than that of the
L‐group. No difference was found in pH. A significant overall correlation of VAS‐N was found between patients and their parents. These results suggest that the low level anxiety of children and their parents could not reduce the volume and acidity of gastric fluid and consequently the risk of aspiration pneumonia.
Anaesthesia and juvenile Huntington's disease
Authors: Gupta Kalpna , Leng Christopher P.
Published: March 2003

Juvenile Huntington's Disease (JHD) is an involuntary movement disorder that comprises both neurological and psychiatric symptoms. Whilst it has many similarities to Huntington's Disease, it is regarded as a separate clinical entity. The anaesthetic plan should be based on careful assessment of the important issues, including the risk of regurgitation and pulmonary aspiration, possible associated autonomic neuropathy, poor respiratory function and the avoidance of precipitating convulsions and clonic spasms. We describe the management of a 12‐year‐old girl with JHD scheduled for gastroscopy under general anaesthesia necessitating the use of suxamethonium. We suggest an alternative mechanism for the delayed recovery seen in our patient and in other adult case reports.
Perioperative management of a paediatric patient on the ketogenic diet
Authors: Mcneely James K.
Published: March 2003

The ketogenic diet has become commonplace for the treatment of paediatric patients with refractory epilepsy. I describe the perioperative management of a patient on the ketogenic diet. The basis, complications and anaesthetic implications of the diet are discussed.
An assessment of desflurane for use during cardiac electrophysiological study and radiofrequency ablation of supraventricular dysrhythmias in children
Authors: Schaffer Michael S. , Snyder Andrew M. , Morrison John E.
Published: March 2003

Desflurane has several properties making it a desirable agent for use in electrophysiological studies (EPS) for diagnosis and treatment of cardiac dysrhythmias. We studied 47 children, mean age 12.8±4.6 years, mean weight 52.9±24.0 kg, with clinical history of supra‐ ventricular tachycardia (SVT) during EPS using desflurane in a crossover comparison with fentanyl. The patients served as their own controls. All received oral premedication with lorazepam, and intravenous induction with thiopentone, rocuronium, and oxygen. Group 1 (n=24) were administered fentanyl 10 μg·kg−1 bolus i.v. with an infusion of 3 μg·kg−1·h−1 during initial EPS. Fentanyl was discontinued and desflurane, 6% endtidal, was administered and the EPS repeated. Group 2 (n=23) were initially administered 6% desflurane after induction, and following EPS the desflurane was discontinued and the patients administered fentanyl 3 μg·kg−1 bolus and EPS repeated (explanations of EPS abbreviations are provided). Desflurane reduced the mean arterial pressure (MAP) in all patients. In Group 1, desflurane shortened the sinus cycle length (SCL), i.e. increasing the heart rate, and atrial effective refractory period (AERP) while Group 2 demonstrated no such effect on AERP. There were no other significant differences between fentanyl or desflurane techniques in terms of EPS measurements. SVT was inducible with both agents in both groups. Desflurane seems an acceptable agent for use during EPS procedures.
The perioperative management of children with phaeochromocytoma
Authors: Hack H.A.
Published: March 2003

The safe anaesthetic management of a child with a phaeochromocytoma requires an understanding of the pathophysiology of the disease, together with a thorough knowledge of its pharmacology, in order to avoid or minimize the potentially harmful cardiovascular changes that may occur during anaesthesia. Although there is a considerable amount of information on the management of the adult with phaeochromocytoma, much less has been written concerning children with the disease. Children differ significantly from adults in the incidence, location, presentation and management of this condition and these differences are discussed here together with some of the more controversial issues of management.
Local and systemic immune response to surgery under balanced anaesthesia in children
Authors: Mattila‐Vuori Armi , Salo Matti , Iisalo Eila , Pajulo Olli , Viljanto Jouko
Published: March 2003

We studied perioperative changes in the immune response and compared changes in the peripheral blood with those in the wound in 20 boys (0.5–3 years) during elective inguinal surgery under balanced anaesthesia. Blood samples were drawn before premedication, immediately, and 4 or 24 h after anaesthesia. Cells from the wound were harvested with the Cellstick device, removed from the wound 4 (n=10) or 24 h (n=10) after anaesthesia. We found decreased lymphocyte counts in the peripheral blood, increased percentages of activated T lymphocytes and B lymphocytes, and decreased percentages of total T lymphocytes, T helper cells and T cytotoxic cells. The percentages of T helper cells and B lymphocytes were lower in the wound than in blood. Mitogen‐induced lymphocyte proliferative responses decreased. This study demonstrates perioperative changes in the immune response in children and, as a new finding, that immune effector cells in the blood and in the wound are in a dynamic balance.
Intraspinal haematoma following lumbar epidural anaesthesia in a neonate
Authors: Breschan Christian , Krumpholz Ruth , Jost Robert , Likar Rudolf
Published: March 2003

A neonate with chromosomal 9 abnormality and omphalocele received a lumbar epidural catheter after laparotomy. Several attempts were needed to establish this catheter. Bleeding occurred from the operative wound after surgery. Using an epidural infusion with ropivacaine 0.1% for 48 h postoperative pain relief was sufficient. Four days after epidural catheter removal, dysfunction of the sacral parasympathetic nerves was noted. Motor and sensor function of the lower limbs were unaffected. Magnetic resonance imaging showed a localized intraspinal haematoma in the lower lumbar region.
Acid–base, electrolyte and metabolite concentrations in packed red blood cells for major transfusion in infants
Authors: Sümpelmann R. , Schürholz T. , Thorns E. , Hausdörfer J.
Published: March 2003

Methods: Acid–base, electrolyte and metabolite concentrations were determined in 100 U of packed red blood cells (RBC) preserved in extended‐storage media to be used for major transfusion in paediatric and cardiac surgery.

Results: In fresh RBC, low pH, bicarbonate (cHCO3−), base excess (BE) and high glucose values were observed all outside the physiological range. With lengthening storage duration, values of pH, cHCO3−, BE, sodium and glucose decreased and carbon dioxide, potassium and lactic acid concentrations increased [mean ± SD (range): storage duration 6.7 ± 3.8 (1–17) days, pH 6.79 ± 0.1 (6.53–6.99); mmol·l–1: cHCO3− 11.1 ± 1.5 (6.2–14.5), BE − 29.2 ± 4.1 ([−39.4] − [−20.9]), potassium 20.5 ± 7.8 (4.2–43.6), glucose 24.1 ± 6.1 (16.7–29.2), lactic acid 9.4 ± 4 (4.3–21.4)].

Conclusions: Massive and rapid transfusion of RBC may lead to a severe burden of hydrogen ions, carbon dioxide, potassium, glucose and lactic acid and this can be avoided by cell saver blood processing, when autologous erythrocytes from the operative field are saved and substrate load and storage lesions from packed red blood cells are minimized in one step by washing.
Anaesthetic management of a child with a positive family history of malignant hyperthermia for posterior fossa surgery in the sitting position
Authors: Wootton M.A. , Lockie J.
Published: March 2003

A 6‐year‐old boy with a positive family history of malignant hyperthermia presented for posterior fossa craniectomy and excision of medulloblastoma. A nontriggering anaesthetic was therefore planned using infusions of propofol and remifentanil and a vapour free anaesthetic system delivering an oxygen/air mixture. The surgery was carried out with the child in the sitting position.
A novel thermoregulatory system maintains perioperative normothermia in children undergoing elective surgery
Authors: Nesher Nahum , Wolf Tamir , Uretzky Gideon , Oppenheim‐Eden Arieh , Yussim Elliott , Kushnir Igal , Shoshany Gideon , Rosenberg Benno , Berant Moshe
Published: March 2003

Background: Body heat loss during anaesthesia may result in increased morbidity, particularly in high‐risk populations such as children. To avoid hypothermia, a novel thermoregulatory system (Allon) was devised. We tested the safety and efficacy of this system in maintaining normothermia in children undergoing routine surgical procedures.

Methods: The system consists of a computerized body, which receives continuous afferent data, i.e. core (rectal) temperature. These data are then compared with a preset temperature (37°C) and a microprocessor heating/cooling unit warms/cools the temperature of circulating water in a garment that is specially designed to allow maximal coverage of body surface area, without impingement on the surgical field. Water temperature to the garment was limited to a maximum of 39.5°C. Continuous perioperative monitoring of skin and rectal temperature, heart rate and blood pressure was performed. Postoperative shivering and adverse effects were also assessed.

Results: The Allon system was used in 38 patients aged 3 months to 14 years undergoing surgery under general anaesthesia lasting more than 30 min. Fifty to 80% body surface area was covered by the garment. Mean operative and postoperative core temperatures were 36.9 ± 0.5°C and 36.7 ± 0.5°C, respectively. Intraoperative skin temperatures were maintained at 34.4 ± 2.7°C. The average core‐ to‐periphery intraoperative gradient was 2.9 ± 4.9°C. Postoperative shivering was absent in 36 cases and mild in two cases. No device‐related adverse effects were observed.

Conclusions: Perioperative thermoregulation using the Allon system is safe and effective in maintaining body temperature within a narrow range in children undergoing brief surgical procedures.
The anaesthetic management of a deliberately created bronchoatmospheric fistula in bilateral pulmonary hydatids
Authors: Jacob Rebecca , Sen Sudipta
Published: March 2003

Postoperative empyema and bronchopleural fistula are well known complications after surgery for pulmonary hydatid disease. The pneumonostomy technique of deliberately creating a bronchoatmospheric fistula after removal of the parasite has been used to prevent these complications. This technique, however, is an added anaesthetic challenge, especially if the child presents again for surgery before this fistula has healed. We describe the anaesthetic management of such a case where controlled increase of the resistance to the air leak via the fistula during intermittent positive pressure ventilation helped circumvent these problems.
Start‐up delays of infusion syringe pumps
Authors: Neff T , Fischer J , Fehr S , Baenziger O , Weiss M
Published: March 2003

Background: We performed a bench experiment to investigate the extent of start‐up delays in fluid delivery for four different syringe pumps after initially placing the infusion syringe in the syringe pump.

Methods: Pump performance was determined at an infusion rate of 1 ml·h−1 with and without a fluid bolus delivered by the infusion pump prior to connecting the infusion line to the simulated patient.

Results: The time (mean ± SD) from starting the pump up to first fluid delivery (t1) differed considerably between pumps (from 6.75 ± 4.4 to 57.2 ± 28.6 min) as did the time to steady state fluid delivery (t2) (from 19.6 ± 9.3 to 76.3 ± 29.0 min). Applying an initial bolus of 2 ml before connecting the line to the simulated patient practically eliminated the delay in fluid delivery (t1 ranging from 0.3 ± 0.1 to 1.1 ± 0.8 min). This manoeuvre also reduced the time to steady flow delivery (t2 from 6.0 ± 3.1 to 11.1 ± 4.3 min, P<0.001) and minimized the differences between syringe pumps.

Conclusions: Syringe pump design affects start‐up delay times because of free play of the syringe. These delays can be eliminated by a start‐up bolus of 2 ml prior to connecting the infusion line to the patient.
The choice of inhalation anaesthetic for major abdominal surgery in children with liver disease
Authors: Green D. W. , Ashley E. M. C.
Published: March 2003

Many children with liver disease undergo major abdominal surgery. Maintenance of anaesthesia is thus an important consideration in this surgical population. Despite a comprehensive and painstaking review of the literature, a sound evidence base, on which a choice of inhalation anaesthetic may be made, is lacking due to limited research in these patients. Differences between the more recent agents such as isoflurane, sevoflurane and desflurane are minor. Sevoflurane is favoured in paediatric practice for gaseous induction, but desflurane or isoflurane are marginally the preferred agents for maintenance of anaesthesia in children with liver disease undergoing major abdominal surgery. However, on the evidence that exists, much of it admittedly in animals and in adults, all three are preferable to halothane in this group of patients. More work is needed in this area before sound conclusions can be drawn and one agent proved to be definitely superior to the others.
Idiopathic Horner’s syndrome in collie dogs
Authors: Herrera  , Suranit
Published: March 2003

Seven cases of idiopathic Horner’s Syndrome in the Collie are described. Five males and two females presented with unilateral miosis, ptosis of the upper eyelid, enophthalmos and protrusion of the third eyelid. Thorough examination, pharmacological testing with phenylephrine, complete blood counts and radiography of the tympanic bullae and thorax were performed. The etiology was not identified in any of the cases. Clinical signs improved with pharmacologic testing within 20–40 min. In five dogs, total resolution of clinical signs was observed at 4 and 16 weeks after their initial appearance. Pharmacological testing suggested that the deficit could be at the preganglionic neuron.
Effects of intramuscular sedative and opioid combinations on tear production in dogs
Authors: Dodam  , Branson  , Martin
Published: March 2003

The effect of commonly used sedation protocols on tear production rate was evaluated in dogs. Schirmer I tear tests were examined before and after intramuscular injection of acepromazine and oxymorphone (ACE + OXY;n = 7), diazepam and butorphanol (DIA + BUT;n = 8), and xylazine and butorphanol (XYL + BUT;n = 8). Two Schirmer I tear tests were also performed 15–25 min apart in dogs which received no sedative drugs (control;n = 4). Tear production rate decreased to 15 ± 2, 17 ± 1, and 6 ± 1 mm min−1, respectively, while control animals averaged 21 ± 2 mm min−1at the same time point. Because XYL + BUT profoundly decreased tear production rate, we evaluated the two drugs separately. While BUT mildly decreased tear production when given alone to dogs (18 ± 1 mm min−1;n = 5), xylazine had no effect on tear production. Thus it appears that the two agents act synergistically to decrease tear production rate in dogs. Moreover, sterile ocular lubricant or tear replacement should be used during XYL + BUT sedation.