bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Otitis Externa: Efficacy and Tolerability of N‐Chlorotaurine, a Novel Endogenous Antiseptic Agent
Authors: Neher Andreas , Nagl Markus , Appenroth Elisabeth , Gstöttner Michaela , Wischatta Martin , Reisigl Franz , Schindler Martin , Ulmer Hanno , Stephan Kurt
Published: April 2004

Objective: The study's objective was to test the tolerability and efficacy of the endogenous antiseptic N‐chlorotaurine (NCT) in comparison with a standard clinical treatment according to a phase IIb clinical trial protocol.

Study Design: The antimicrobial agent NCT was compared with the antibiotic component drops Otosporin (containing neomycin, polymyxin B, and hydrocortisone) for topical treatment of acute otitis externa in a randomized and rater‐blinded clinical study.

Methods: Fifty patients suffering from acute otitis externa were divided into two groups according to a randomized list. The test group was treated with 1 mL of 1% aqueous NCT solution, the reference group with 1 mL of Otosporin. The substances were applied to the external ear canal at one daily session until the signs of infection disappeared. Efficacy and tolerability were evaluated daily by visual analogue scale and a six‐step infection score. In addition, smears were analyzed to identify the causative pathogens.

Results: Both medications were equally well tolerated by the patients. The treatment was successful for all patients of the NCT group, whereas in one patient from the reference group, the infection did not disappear. The inflammation score improved more rapidly in the NCT group, which resulted in an earlier termination of the therapy. This difference became highly significant on days 4 to 7 (P < .01 each). Time needed for disappearance of inflammation (score 0) was 5.6 ± 1.6 (mean ± SD, range 3–9) days in the NCT group and 7.4 ± 1.6 (range 4–10) days in the Otosporin group (P < .001). As expected, micro‐biologic cultures from ear swabs revealed Pseudomonas aeruginosa (58%) followed by Staphylococcus aureus (18%) as the main causative pathogens.

Conclusions: NCT appears to be well tolerated and more effective than the therapy using antibiotic component drops. Because of its endogenous nature and its higher efficacy, NCT appears to be a good choice for topical treatment of acute otitis externa.
Middle Ear Pressure Changes after Nitrous Oxide Anesthesia and Its Effect on Postoperative Nausea and Vomiting
Authors: Nader Nader D. , Simpson George , Reedy Roberta L.
Published: April 2004

Objectives/Hypothesis: This study was designed to explore the relationship between changes in middle ear pressure associated with inhalational anesthesia and the incidence of postoperative nausea and vomiting (PONV).

Study Design: Prospective, randomized.

Methods: Middle ear compartment pressures were measured by tympanometry in 27 randomly assigned knee arthroscopy patients throughout the surgical procedure as well as into recovery.

Results: A positive correlation between the maximum positive pressure (MPP) and maximum negative pressure (MNP) gradient and PONV was demonstrated (P < .05). The incidence of PONV in the nitrous oxide (N2O) treatment group was 6 of 16 patients, whereas only 2 of 11 patients in the control group developed nausea, vomiting, and vertigo symptoms. Those patients that did not experience PONV demonstrated a median MPP of 155 with a median MNP of −52. The patients that experienced PONV exhibited a median MPP of 179 with a median MNP of −164. This demonstrates a significant increase in the incidence of PONV in the N2O treatment group.

Conclusions: Barometric changes in the middle ear contribute to the incidence of PONV induced by N2O.
Squamous Cell Carcinoma of the Oral Tongue in Young Patients
Authors: Popovtzer Aron , Shpitzer Thomas , Bahar Gideon , Marshak Gideon , Ulanovski David , Feinmesser Raphael
Published: April 2004

Objectives/Hypothesis: Cancer of the tongue is reported with increasing frequency in young people. The objective of this work was to study the biologic and clinical course of the disease in this group. The clinical course of the disease in this patient group remains controversial.

Study Design: A retrospective 30‐year review was made from data from a tertiary academic medical center.

Methods: A chart review was performed for 48 patients with oral tongue cancer. The following variables were compared: age, sex, tobacco and alcohol use, treatment, and outcome.

Results: Stage (T1,2‐N0) and treatment modality were similar in the two age groups, as was disease‐specific outcome. However, in the younger group, the clinical course followed two distinct patterns: extremely aggressive appearance with a 40% mortality rate within 2 years compared with 10.7% in the older group (P < .05) or indolent with freedom from disease for over 15 years.

Conclusions: Squamous cell carcinoma (SCC) of the oral tongue may be associated with a variable clinical course in younger patients. Although, in general, the disease‐specific outcome is similar to that of the older patients, some of the patients have an exceptionally aggressive disease. An extensive therapeutic regimen should be used in all cases.
Incidence of Methicillin‐Resistant Staphylococcus aureus Causing Chronic Rhinosinusitis
Authors: Manarey Casey R. A. , Anand Vijay K. , Huang Clark
Published: April 2004

Objective/Hypothesis: To identify the incidence of methicillin‐resistant Staphylococcus aureus (MRSA) causing chronic rhinosinusitis (CRS) and identify whether antibiotic use and previous endoscopic sinus surgeries (ESS) contribute to its development.

Study Design: A retrospective case control analysis, with the control group randomly selected and matched for age and sex.

Methods: All patients undergoing an endonasal culture in a tertiary otolaryngology center between April 2001 and March 2003 for mucopurulent rhinosinusitis were identified. A chart review was undertaken to identify those patients with a positive MRSA culture result. An age‐ and sex‐matched control group was randomly chosen, and an interview was conducted to identify antibiotic use and previous ESS. A statistical analysis on these two variables was carried out using a t test and the Wilcoxon rank‐sum test.

Results: Two hundred eighty cultures were identified in 188 patients, and of these, 264 cultures in 173 patients met the inclusion criteria. There were 141 positive cultures and 13 positive MRSA cultures. The overall incidence of MRSA in this population was 9.22%. The mean number of antibiotic courses in the MRSA and the control groups was 33.2 and 26.7, respectively, which was not statistically significant (P = .43). The 95% confidence interval (CI) for this mean difference of 6.5 is −9.8 to 22.8. The mean number of ESS in the MRSA and control groups was 2.0 and 1.9, respectively, which was not statistically significant (P = .93). The 95% CI for this mean difference of 0.06 is −1.3 to 1.4.

Conclusions: We identified a 9.22% incidence of MRSA‐causing CRS. The frequency of antibiotic use and previous ESS were found not to be statistically significant causes of MRSA sinusitis. However, the 95% CI for antibiotic usage is skewed to the right, indicating a possible role for its contribution to the emergence of MRSA‐causing CRS.
More frequent issues
Authors: Cook Alan
Published: April 2004

Introduction to the January 1999 issue of
Notes and Records
.
Sir Benjamin Thompson, Count Rumford and the Royal Institution
Authors: Thomas J.M
Published: April 2004

On 19 September 1798, there arrived in London from Munich a 45-year-old, tall, blueeyed, handsome, American-born, opportunistic man of action. A former soldier and statesman, he was, by all accounts, ruthless and arrogant, callously cunning and devious, an unprincipled spy and a calculating womanizer; but he was also a philanthropist, a brilliantly effective social reformer, an ingenious inventor and an exceptionally innovative scientist. His name was Benjamin Thompson, better known as Count von Rumford of the Holy Roman Empire. He would found the Royal Institution.
Letters from the President: the correspondence of Sir Joseph Banks
1
Authors: Chambers N.
Published: April 2004

Nothing gives so just an idea of an age as genuine letters; nay, history waits for its last seal from them.Horace Walpole
2

Many scientific ideas have been described in works that have deeply affected the way we regard ourselves and the world. Even when a scientist has not been so influential, his writings might still be a rewarding source of interest. Indeed, they might have artistic worth and broad historical relevance of a kind that is rarely appreciated. Nothing could be more true of the 18th century, when the literary nature of science made the spread of knowledge and enquiry possible. At this time some men made voyages of discovery to distant lands. They collected, described and classified, imposing scientific order on the ‘New World’ as they went. The reports that were sent back excited readers in Europe eager to hear more of remote places, and not least those considering the form an imperial order might take. Meanwhile, other men crowded into societies dedicated to learning, or gathered their fellows together in correspondence. The mass of information available for scientists increased with their ability to draw on such web-like networks. A few became powerful through them, even manipulating the course of history. This combination of science and literature as a means of shaping events drew Sir Gavin de Beer's attention to one man: ‘It is curious that Banks should not yet have been recognized as one of the greatest letter-writers in the English language, but such he clearly was.’.
3
The Cavendish high-voltage laboratory 1935–39
Authors: Burcham W.E
Published: April 2004

The story of the development of high–voltage nuclear transmutation equipment in the Cavendish Laboratory and its use in l932 in J.D. Cockcroft and E.T.S. Walton's disintegration of lithium by protons has been told many times.
1
The pparatus, shown schematically in figure 1, was based on a transformer–rectifier–condenser multiplying circuit generating a steady potential of up to about 600 kV. Its success in the transmutation experiments was due largely to the penetration of the Coulomb barrier of the light target nuclei by the incident protons in accordance with the calculations of Gamow.
2
Extension of the disintegration work to heavier nuclei using a Cockcroft–Walton generator required higher voltages and by 1934, when many results had been or were about to be published, there was every enthusiasm for continuing high–voltage development. The steps that were taken in this direction in the Cavendish from 1935 until the beginning of the war in 1939 have not been so fully described, although the main events have been recorded.
3
The present article attempts to trace the expansion of the high–voltage laboratory over that four–year period, during which the author worked in the laboratory under M.L.E. Oliphant
4
and P.I. Dee.
5
It is a shortened version of a longer account which has been placed in the Churchill Archives Centre
6
together with a number of relevant documents held since 1939 by the author. In writing, use has been made of the author's personal notebooks and diary kept during the period covered.
Liver tumors escape negative control of proliferation via PI3K/Akt-mediated block of C/EBPα growth inhibitory activity
Authors: Wang Guo-Li , Iakova Polina , Wilde Margie , Awad Samir , Timchenko Nikolai A.
Published: April 2004

Liver tumor cells arise from normal hepatocytes that escape negative control of proliferation. The transcription factor C/EBPα maintains quiescence of hepatocytes through two pathways: inhibition of cdks and repression of E2F. Nevertheless, liver tumors and cultured hepatoma cell lines proliferate in the presence of C/EBPα. In this paper, we present evidence that the activation of the PI3K/Akt pathway in liver tumor cells blocks the growth inhibitory activity of C/EBPα through the PP2A-mediated dephosphorylation of C/EBPα on Ser 193, leading to a failure of C/EBPα to interact with and inhibit cdks and E2F. Mutation of Ser 193 to Ala also abolishes the ability of C/EBPα to cause growth arrest because of a lack of interactions with cdk2 and E2F–Rb complexes. These data provide a molecular basis for the development of liver tumors in which the activation of PI3K/Akt pathway neutralizes C/EBPα growth inhibitory activity.
Sequence‐based typing of exons 1–5 of a new HLA‐B allele, B*3927*
Authors: Voorter C.E.M. , van den Berg‐Loonen E.M.
Published: April 2004

Abstract:  A new human leucocyte antigen‐B (HLA‐B) allele, B*3927, was detected in three individuals of a Caucasian family by routine typing with sequence‐specific primers (SSP). Serological typing showed B27 Bw4 and B39 Bw6, whereas SSP detected only B*27 as well as the Bw4 and Bw6 motif. The sequence of exons 1–5 of the new allele was determined by allele‐specific amplification and sequencing. The new B*39 allele showed one nucleotide difference with B*390101 at position 299 in exon 2. Codon 100 changed from GAG to GTG, resulting in an amino acid substitution from glutamic acid to valine at position 76 of the mature protein. The haplotype carrying the B*3927 allele was A*010101, B*3927, Cw*120301, DRB1*0101 and DQB1*050101.
Identification of a new HLA‐C allele, Cw*0316, by sequence‐based typing
Authors: Voorter C.E.M. , Fischer G.F. , van den Berg‐Loonen E.M.
Published: April 2004

Abstract:  The presence of a new allele, Cw*0316, was detected in a Caucasian individual through an unusual association. Molecular typing of the individual by sequence‐specific primers and sequence‐specific oligonucleotides showed the presence of B*58, B*41 and Cw*17. Sequence‐based typing revealed the additional presence of another human leucocyte antigen‐C allele. The new allele showed four nucleotide differences with Cw*030202 at positions 559, 560, 589 and 594 in exon 3, leading to three codon changes, codons 187, 197 and 198. This resulted in two amino acid substitutions at positions 163 (L–T) and 173 (K–E) of the mature protein, which proved sufficient to abrogate serological reactivity with Cw3‐specific sera.
Identification of a novel MICA allele: MICA*051
Authors: Quiroga I. , Sweeney D. , Sutton P.M. , Chapple S.D.J. , Souto‐Grando J.P. , Barnardo M.C.N.M. , Fuggle S.V.
Published: April 2004

Abstract:  We have identified a novel MICA allele, MICA*051, detected by the polymerase chain reaction using sequence‐specific primers and characterized by sequence‐based typing. MICA*051 appears to be the result of a recombination between MICA*00801 and MICA*00701 at intron 2.
Polymorphism of HLA‐B27 in Taiwanese Chinese
Authors: Yang K.L. , Chen i‐H. , Hsiao C.K. , Cherng J.M. , Yang K.Z. , Chang C.C. , Yeh C.C. , Lin P.Y.
Published: April 2004

Abstract:  Heterogeneity of HLA‐B27 is represented by a family of 24 closely related alleles/subtypes. Frequency and disease association of these alleles with spondyloarthropathies differ among ethnic groups. Accurate investigation of frequencies of alleles is often hindered by the size and demographic region of sample tested. With an ever‐increasing number of B27 alleles being discovered, it is becoming imperative to establish disease association of each individual alleles and its biological importance. In a large number of normal healthy Taiwanese Chinese individuals (75,777) tested nationally, over a period of five years, in a single immunogenetics centre, we found additional B27 subtypes not revealed in a previous Taiwanese Chinese population study. The subtypes found in Taiwanese Chinese and the frequencies of each of the subtypes are reported.
Diversion of the Inferior Vena Cava Following Repair of Atrial Septal Defect Causing Hypoxemia
Authors: Thompson Ellen , Moritz Dennis , Perdue Romaine , Cansino Silvestre
Published: April 2004

Atrial septal defects (ASDs) are a common congenital abnormality, and operative repair is a routine, safe procedure. Diversion of the inferior vena cava (IVC) into the left atrium is an unusual complication following ASD closure. We report a case that illustrates the problem created by this right‐to‐left shunt. A middle‐aged woman underwent ASD repair. She developed hypoxemia postoperatively. A transthoracic echocardiogram confirmed a right‐to‐left shunt, found only with agitated saline injected into the femoral vein, not into the basilic vein. Surgical reexploration revealed a residual ASD diverting IVC flow into the left atrium, which was repaired with a pericardial patch. Echocardiography with agitated saline injected from the femoral vein is an easy method to diagnose this uncommon complication. (ECHOCARDIOGRAPHY, Volume 21, May 2004)
Posterior Mediastinal Spread of Bronchogenic Carcinoma Simulating a Mass Within the Left Atrium
Authors: Campos Paulo , D'Cruz Ivan A. , Dweik Husni W. , Shirwany Arsalan , Umpierrez Monica
Published: April 2004

(ECHOCARDIOGRAPHY, Volume 21, May 2004)
Portfolio of health advice for young people with disabilities transferring to adult care
Authors: Tan M. J. , Klimach V. J.
Published: April 2004

Background  The transition from paediatric to adult services for young people with complex disabilities is fraught with anxieties for families. To facilitate the transition process a portfolio comprising reports from parents, paediatrician and therapists was collected and given to the young person and family on leaving school.

Aim  To evaluate the young people and their parents’ views of the usefulness of portfolios in providing comprehensive picture of their health needs.

Methods  A prospective study was performed. Eight families were interviewed and semi‐quantitative feedback obtained using standardized questionnaires.

Results  Seven out of eight young people and their families were satisfied with the portfolios they received. All of them found the portfolios worthwhile and useful. A quarter of the families would like to have been consulted more about the content of the individual reports.

Conclusions  Portfolios of health reports facilitate transfer of information when young people with disabilities move from paediatric to adult services. Ideally portfolios should be interagency, and include reports from education and social services.
Different meanings of respite: a study of parents, nurses and social workers caring for children with complex needs
Authors: MacDonald H. , Callery P.
Published: April 2004

Aim  To examine the meaning of respite care to parents of children with complex conditions and providers.

Methods  In‐depth interviews, participant observation and document review were used to collect data from nineteen mothers and seven fathers of children between the ages of 8 and 16 years who required complex care and from their respite providers, including thirteen nurses, and four social workers from three counties in North‐west England.

Results  Parents described three categories of respite: short breaks provided by the extended family or friends, short breaks (3–4 h) by an outside agency, and overnight respite outside of home. They highly valued overnight respite outside the home. There was some overlap but also notable differences between parents’ and providers’ categorizations of respite care and the value attached to different forms of respite provision. Parents and nurses valued overnight respite outside the home unlike social workers who preferred to provide respite without separating children from their families.

Discussion  Appropriate provision of respite care and communication with parents requires understanding of the meaning of respite to parents. The meanings attached to respite care by parents and providers should be considered in attempts to understand and address problems of inappropriate provision and/or dissatisfaction with respite services.
Re‐thinking family‐centred care across the continuum of children's healthcare
Authors: Franck L. S. , Callery P.
Published: April 2004

Background  The terms family‐centred care (FCC) and family‐centred services (FCS) are used interchangeably across the continuum of children's healthcare to encompass concepts of: parental participation in children's healthcare; partnership and collaboration between the healthcare team and parents in decision‐making; family‐friendly environments that normalize as much as possible family functioning within the healthcare setting; and care of family members as well as of children. However, authors from different professional and policy perspectives have used different definitions and literatures when arguing the evidence for FCC and FCS.

Method  A critical literature review and theoretical discussion exploring common concepts and issues forming the basis for a research agenda further strengthening of the evidence base for FCC. A systematic identification of constructs, concepts and empirical indicators is developed and applied to exemplars in pain and asthma that span the continuum of children's healthcare across acute and community settings.

Conclusions  The extent to which the concepts are supported by research and applied in practice remains unclear. We propose that re‐thinking of FCC is required in order to develop a more coherent programme of research into the application of FCC theory in children's healthcare.
Transforming growth factor‐β1 polymorphisms in Korean patients with systemic sclerosis
Authors: Lee E.B. , Kim J.Y. , Lee Y.J. , Abdallah A. , Lympany P. , Song Y.W.
Published: April 2004

Abstract:  Transforming growth factor‐β1 (TGF‐β1) plays an important role in the pathogenesis of systemic sclerosis (SSc). To investigate the role of TGF‐β1 gene polymorphisms in SSc, we genotyped six biallelic polymorphic positions (position −988, −800, and −509; and codons 10, 25, and 263) in 61 Korean SSc patients and in 148 healthy controls, using polymerase chain reaction‐sequence‐specific primers. Genetic polymorphisms were found at position −509 and codon 10 in Koreans. The allele frequencies of C/T at position −509 were 0.59/0.41 in patients and 0.56/0.44 in controls. The allele frequencies of C/T at codon 10 were 0.40/0.60 in patients and 0.50/0.50 in controls. In conclusion, no skewed distribution of TGF‐β1 gene polymorphisms was found in Korean patients with SSc.
Prevalence of Eimeria spp. in Sows at Piglet‐producing Farms in Germany
Authors: Daugschies A. , Imarom S. , Ganter M. , Bollwahn W.
Published: April 2004

The prevalence of Eimeria infections was investigated in an initial survey in 54 sow herds of small (five sows) to large (1600 sows) size by random sampling (n = 1204). All sows of four Eimeria‐positive medium‐sized farms (63 or 130 sows) were re‐examined 40–99 days after the first visit. A follow‐up survey over the whole reproductive cycle was subsequently performed in a positive herd of 130 animals where faecal samples of 43 sows were repeatedly collected on seven successive farm visits. In 44 farms (81.5%) parasite stages (eggs of strongylids, Trichuris, Ascaris, Strongyloides, oocysts of Eimeria and Isospora) were identified in sow faeces, strongylids being the most prevalent intestinal parasites (34 farms resembling 63%) followed by Eimeria spp. (28 farms resembling 52%). Of the 1204 random samples collected during the initial survey 8.6% contained Eimeria oocysts. Oocysts of E. polita and E. debliecki were present in each of 25 Eimeria‐positive samples selected for species differentiation. Eimeria suis was diagnosed in 84%, E. scabra in 60%, E. porci in 52%, E. perminuta in 49% and E. spinosa in 20% of these specimens. At the second visit the prevalence rates of Eimeria infections had either increased or decreased. In the follow‐up study Eimeria infections were found to be most frequent (82%) at the service station. At the quarantine unit and the gestation stable 50 and 48% of the 43 sows were Eimeria positive. The lowest prevalence of Eimeria infection was observed in the farrowing unit (14%). With respect to the reproductive state of the sows highest infection rates were seen 2 weeks after weaning (72%) continuously decreasing until 2 weeks after farrowing (14%). A periparturient rise of oocyst excretion was not observed. The infestation rate remained low until 1 week before weaning (16%). Low infection intensities clearly dominated. Clinical disease was not associated with Eimeria infection.
G and P Genotypes of Group A Rotavirus from Diarrhoeic Calves Born to Cows Vaccinated against the NCDV (P[1],G6) Rotavirus Strain
Authors: Barreiros M. A. B. , Alfieri A. F. , Médici K. C. , Leite J. P. G. , Alfieri A. A.
Published: April 2004

A total of 71 group A rotavirus field strains, detected by polyacrylamide gel electrophoresis and enzyme immune assay, were submitted to genotyping by a multiplex nested‐reverse transcription‐polymerase chain reaction (RT‐PCR). Faecal samples were obtained from calves with diarrhoea, between January 2000 and December 2001, from 14 dairy and beef cattle herds located in Mato Grosso do Sul, São Paulo and Paraná States, Brazil. Thirty‐five rotavirus field strains were detected in faeces from calves born to vaccinated dams with inactivated commercial vaccine containing the rotavirus strain P[1],G6 from seven herds while 36 rotavirus field strains were obtained from diarrhoeic calves from other seven herds without rotavirus vaccination. Identification of P and G rotavirus genotypes was possible in 94.3% (67/71) of the strains. However, G genotype could not be identified in two strains, P genotype in another strain and both genotypes were not detected in a third strain. P and G rotavirus genotype associations were identified in rotavirus field strains from non‐vaccinated and vaccinated herds at similar rates of 94.4% (34/36) and 94.3% (33/35), respectively. In non‐vaccinated herds binary combinations were P[1],G6 (three herds; 12 strains), P[1],G8 (three herds; six strains), P[5],G6 (two herds; 10 strains) and P[11],G8 (one herd; four strains). The genotype P[11],G6 was the most frequent (three herds; 12 strains) in vaccinated herds, followed by P[5],G6 (two herds; three strains), and P[11],G8 (two herds; eight strains). Mixed infections were observed in one non‐vaccinated herd (two strains) and in four vaccinated herds (10 strains). Identification of binary combinations was not possible in one strain from non‐vaccinated herds and two strains from vaccinated herds. Unusual genotypes were more frequent (91.4%) in non‐vaccinated herds than those from prototypes of bovine rotavirus strains. Nebraska calf diarrhoea virus (NCDV)‐like genotype was found in none of the rotavirus field strains detected in diarrhoeic calves born of vaccinated dams.
Growth of Streptococcus uberis in Skim Milk Obtained from Holstein and Jersey Dairy Cows During Different Stages of Lactation
Authors: Rambeaud M. , Almeida R. A. , Oliver S. P.
Published: April 2004

A study was conducted to determine if skim milk obtained from uninfected mammary glands of healthy Holstein and Jersey dairy cows during different stages of lactation influenced in vitro growth of Streptococcus uberis. Three strains of S. uberis (UT366, UT387 and UT888) were used to evaluate growth of S. uberis in skim milk from Jersey (n = 16) and Holstein (n = 15) cows in early (n = 11 cows), mid‐ (n = 8 cows) or late lactation (n = 12 cows). Growth of S. uberis in skim milk from Holstein and Jersey cows was similar (P = 0.385). However, growth of S. uberis was significantly lower in skim milk from mammary glands of cows obtained at mid‐ and late lactation compared with growth in skim milk obtained during early lactation (P = 0.007). Variation (P < 0.0001) in growth among different strains of S. uberis as well as a significant (P < 0.0001) stage of lactation by S. uberis strain interaction was observed. Results of this study provide evidence concerning the variability of S. uberis growth in skim milk obtained during different stages of lactation. Differences in the ability of S. uberis to grow in milk may be related to virulence of this important mastitis pathogen.
Noninvasive blood pressure measurement in the upper and lower limbs of anaesthetized children
Authors: SHORT J. A.
Published: April 2004

A group of 50 children, aged 5 months to 15 years, and who were undergoing routine surgery under general anaesthesia, were studied to investigate the difference in noninvasive blood pressure readings obtained from inflatable cuffs placed on the upper arm and the lower leg. In contrast to adult data, it was found that the blood pressure measured from the leg in children aged 8 years and under, was significantly lower than that measured from the arm. The leg cuff measurements could not, however, be reliably used to predict arm blood pressure.
Investigations using logistic regression models on the effect of the LMA on morphine induced vomiting after tonsillectomy
Authors: ANDERSON BRIAN J. , PEARCE STEPHEN , McGANN JOHN E. , NEWSON ANTHONY J. , HOLFORD NICHOLAS H. G.
Published: April 2004

The effect of intraoperative airway management on postoperative vomiting after tonsillectomy is unknown. Logistic regression was used in a retrospective study to investigate the effect of the laryngeal mask airway (LMA) on a morphine dose–vomiting response curve. Charts were reviewed in 351 children in whom the airway was managed with either a LMA (n=177) or a tracheal tube (n=174). A mean perioperative morphine dose of 0.10 mg·kg−1 (SD 0.09) was used in 248 children and a further 103 children were given no opioid. One hundred and eighteen of these 248 children vomited (47.6%) compared to 14 of 103 children given no morphine (13.6%). The probability of vomiting was related to morphine dose using logistic regression with both a linear and an Emax model. Both the calibration (Hosmer–Lemishow goodness of fit chi‐squared test λ2, P=0.81) and discrimination (area under the receiver operating characteristic plot, AUC ROC=0.67) of the Emax model were better than the linear model (λ2, P=0.49; AUC ROC=0.64). Pharmacodynamic parameter estimates for the Emax model were P0 (the baseline probability of vomiting) 0.139, Pmax (the maximal probability of vomiting due to morphine) 0.96, ED50 (morphine dose that induces an effect equivalent to 50% of the logit Pmax) 0.09 mg·kg−1. The probability of vomiting was 50% after morphine 0.125 mg·kg−1. The use of the LMA had no effect on this dose–response curve. A covariate analysis investigating propofol for induction or isoflurane for the intraoperative maintenance of anaesthesia, however, showed that both drugs shifted the curve to the right. The probability of vomiting was 50% after morphine 0.17 mg·kg−1 and 0.21 mg·kg−1 for the isoflurane and propofol use curves, respectively. The concomitant use of propofol and isoflurane, but not the use of the LMA, decreases the probability of vomiting due to morphine.
An unusual complication of a central venous catheter in a neonate
Authors: CUPITT JASON M.
Published: April 2004

The use of central venous catheters in neonates is associated with early and late complications. It is recognized that catheter tip migration and perforation of a viscus can occur at any time with a potentially fatal outcome. We present a case in which the successful placement of a central line was followed 2 weeks later by a sudden respiratory deterioration necessitating intubation and ventilation. The catheter tip had eroded through the wall of a pulmonary artery and a bronchus into the bronchial tree. The report highlights the serious morbidity arising from the use of central venous lines in neonates and stresses the importance of X‐rays in establishing the correct position of all catheters. A sudden change in the condition of a patient should raise the suspicion of a catheter‐related problem.
Diclofenac and flurbiprofen with or without clonidine for postoperative analgesia in children undergoing elective ophthalmological surgery
Authors: NISHINA KAHORU , MIKAWA KATSUYA , SHIGA MAKOTO , TAKAO YUMIKO , MAEKAWA NOBUHIRO , OBARA HIDEFUMI
Published: April 2004

We conducted a prospective, randomized study to compare the efficacy of preoperative diclofenac, flurbiprofen, and clonidine, given alone, as well as the combination of diclofenac and clonidine, and flurbiprofen and clonidine in controlling postoperative pain in 125 children. The patients (ASA I, 2–12 years) undergoing elective ophthalmological surgery were allocated to one of five groups: rectal diclofenac 2 mg·kg–1 following oral placebo premedication, i.v. flurbiprofen 1 mg·kg–1 following placebo premedication, oral clonidine premedication, rectal diclofenac 2 mg·kg–1 following clonidine, and i.v. flurbiprofen 1 mg·kg–1 following clonidine. The children received clonidine (4 μg·kg–1) or placebo 105 min before anaesthesia. Diclofenac or flurbiprofen was given immediately after induction of anaesthesia. Anaesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Postoperative pain was assessed by a blinded observer using a modified objective pain scale (OPS). No opioids were administered throughout the study. Rectal diclofenac 2 mg·kg–1 i.v. flurbiprofen 1 mg·kg–1, oral clonidine 4 μg·kg –1 provided similar OPS scores and requirement for supplementary analgesics during 12 h after surgery. Combination of oral clonidine and one of these nonsteroidal analgesics minimized postoperative pain. Our findings suggest that this combined regimen may be a promising prophylactic approach to postoperative pain control in children undergoing ophthalmological surgery.
An alternative for avoidance of general anaesthesia for infants when bilateral inguinal herniorrhaphy outlasts subarachnoid blockade
Authors: CASSADY JOSEPH F. , LEDERHAAS GEORGE
Published: April 2004

Former premature infants represent a high risk surgical population. In order to minimize the risk of postoperative apnoea, subarachnoid blockade without sedation is known to be preferable to general anaesthesia for former premature infants undergoing bilateral inguinal herniorrhaphy. However, subarachnoid blockade affords only a limited duration of reliable anaesthesia. Nonroutine surgical delays and technical difficulties cannot always be anticipated by the anaesthesiologist. When bilateral inguinal herniorrhaphy outlasts the anticipated duration of subarachnoid blockade, the anaesthesiologist is confronted with a dilemma. Infants are unable to complain verbally, so the extent of subarachnoid blockade may be difficult to assess intraoperatively. Introduction of sedation or general anaesthesia under these circumstances increases the risk of postoperative apnoea, thereby defeating the purpose of the original choice of anaesthesia. Several alternatives have been proposed, but all involve disadvantages. In this report of two cases, a new solution to this clinical dilemma is presented.
The effect of diverticular disease on the colonic J pouch
Authors: Da Silva G. M. , Kaiser R. , Börjesson L. , Colqhoun P. , Lobo C. , Khandwala F. , Thornton J. , Efron J. , Vernava A. M. , Weiss E. G. , Wexner S. D. , Gervaz P. , Nogueras J. J.
Published: April 2004

Objective  The aim of this study was to assess the impact of the diverticular disease (DD) on function and on postoperative complications of the colonic J‐pouch (CJP) with pouch‐anal anastomosis.

Methods  Patients who underwent a CJP between December 1990 and August 2001, were retrospectively reviewed. The presence of DD in the CJP was assessed on pouchogram prior to ileostomy closure. A questionnaire designed to evaluate the degree of continence (total incontinence score (IS): 0 = worst, 20 = best) and pouch evacuation (total evacuation score (ES): 0 = worst, 28 = best) was used for comparison between patients with DD and those without DD (NDD).

Results  Sixty‐six patients (47 males; 19 females) with a median age of 68 years (range 28–87 years) were included. The median follow‐up period was 22 months (range 2–106 months). Twenty‐four patients comprised the DD group and 42 were in the NDD group. The two groups were comparable for age, gender and time from ileostomy closure; all patients with postoperative chemoradiation therapy were in the NDD group. The total ES and IS total did not significantly differ between the two groups with a P‐value of 0.11 and 0.09 respectively. Furthermore, there was no significant difference in the total incidence of pouch complications between the two groups (3 strictures, 1 leak, 1 fistula in the NDD group vs. 1 pelvic sepsis in the DD group; P = 0.4).

Conclusions  The presence of DD in a CJP does not seem to impact pouch function or the postoperative complication rate.
Surgery for occult rectal prolapse
Authors: Brown A. J. , Anderson J. H. , McKee R. F. , Finlay I. G.
Published: April 2004

Objective  An ‘occult’ rectal prolapse may be diagnosed during investigation of altered bowel habit. It has been suggested that the outcome of surgery for these patients may be associated with results that are inferior to those achieved in patients with overt rectal prolapse. This study compares the results of surgery for ‘occult’ and overt rectal prolapse in terms of mortality, morbidity and change in bowel habit.

Patients and methods  A retrospective review was undertaken of consecutive patients undergoing surgery for rectal prolapse during the decade 1988–98. Resection rectopexy was the treatment of choice except in patients with faecal incontinence who underwent sutured rectopexy. Those patients who were unfit for an abdominal operation were offered a perineal procedure. Outcome measures were mortality, morbidity, prolapse recurrence, constipation and faecal incontinence. Data were retrieved from case note review, clinical assessment, telephone consultation or postal questionnaire.

Results  Rectal prolapse surgery was undertaken in 69 patients with an overt prolapse and 74 patients with an ‘occult’ prolapse. Patients in the ‘occult’ prolapse group were significantly younger than those with overt prolapse (P = 0.0002). There were significantly more perineal procedures in the overt prolapse group compared with the ‘occult’ prolapse group (54%vs 5%, P = 0.0001). There were no deaths within 28 days of surgery. Major surgical complications occurred in 5 patients (3.5%). Seven patients (10%) experienced recurrent prolapse. Rectal prolapse surgery reduced the incidence of St. Mark's grade 4 faecal incontinence from 38% to 19% in the overt prolapse group (P = 0.023) and from 49% to 22% in the ‘occult’ prolapse group (P < 0.001). Following surgery the incidence of constipation increased in the ‘occult’ group from 39% to 50% but decreased in the overt prolapse group from 42% to 35%.

Conclusions  Surgery for an ‘occult’ rectal prolapse is unlikely to benefit patients whose principle symptom is constipation. Approximately half of those patients whose ‘occult’ rectal prolapse is associated with faecal incontinence will have their bowel habit improved by prolapse surgery.
Colorectal cancer in the young: a 12‐year review of patients 30 years or less
Authors: Kam M. H. , Eu K. W. , Barben C. P. , Seow‐Choen F.
Published: April 2004

Objectives  As the incidence of young colorectal cancer is rising, a review of the characteristics of such malignancy in those under 30 years of age is timely at this stage.

Patients and methods  Thirty‐nine patients (21 M, 18 F) were operated upon over a 12‐year period in a single centre. The mean age was 25 years and median follow‐up was 20 months.

Results  Rectal bleeding, change in bowel habit and abdominal pain were the commonest symptoms. Six patients had a positive family history, while four others were diagnosed as index cases of familial adenomatous polyposis. Rectal tumours made up 43% of all colorectal cancers diagnosed. Seventy percent of patients presented at an advanced stage, but curative resection was attempted for 29 patients. Eight underwent palliative resections, 1 had an ileostomy while another underwent a bypass procedure. Eleven patients have died, 14 had no evidence of recurrent disease while 3 were still alive with recurrent disease.

Conclusion  Age does not affect survival, and early endoscopy is recommended for all with persistent symptoms. Early diagnosis, radical resection and adjuvant therapy still form the cornerstone in management of colorectal cancer in this age group.
Small bowel malignancies: A review of 29 patients at a single centre
Authors: Kam M. H. , Barben C. P. , Eu K. W. , Seow‐Choen F.
Published: April 2004

Objective  We analysed the incidence, clinical presentation and outcome of small bowel malignancies treated in the department.

Patients and methods  From July 1993 to December 2001, 29 patients with small bowel malignancies were operated upon. The median age was 60 years (30–87 years), and there were 11 males and 18 females. The more frequently used diagnostic investigations included barium contrast studies, and CT scanning.

Results  The most frequent complaint was abdominal pain, though other symptoms like abdominal mass, weight loss and change in bowel habit may also be present. Intestinal obstruction necessitated emergency operation in some cases. One case was treated as Crohn's stricture and two others, as irritable bowel syndrome for nearly 6 months before referral was made for surgery. Fifteen cases were secondaries to the small bowel, and forteen were primary small bowel malignancies. The secondaries were metastases from colorectal cancers (8), gynaecological cancers (5), breast (1) and transitional cell carcinomas (1). Of the 14 primary small bowel malignancies, there were 8 lymphomas, 4 adenocarcinaomas and 2 neuroendocrine tumours. Eleven of these patients were alive at mean follow‐up of 25 months (1–97 months) and 2 were lost to follow‐up. Only one of the secondary small bowel malignancies was alive at the time of review.

Conclusion  Small bowel malignancy is a rate entity with pre‐operative diagnosis remaining difficult. Early surgical intervention with a high index of suspicion is required to improve survivial.
Extramammary Paget's disease of the perianal region
Authors: Tulchinsky H. , Zmora O. , Brazowski E. , Goldman G. , Rabau M.
Published: April 2004

Objective  Perianal Paget's disease (PPD) is a rare entity. The standard treatment for either in situ or invasive extra mammary Paget's disease (EMPD) is surgical excision. Local recurrence and morbidity from surgery, especially in the elderly, can, however, be high. The aim of this article is to review our experience with PPD and question the currently preferred treatment approaches in light of its histopathology and therapeutic outcome.

Patients and methods  A chart review of our patients with PPD from 1996 to 2002 was carried out to determine their outcome after treatment. Data from review of the literature are presented.

Results  Five patients with in situ disease (four females, median age 68 years) were diagnosed as having PPD. A complete surgical excision was attempted in 4 patients and the fifth was treated by photodynamic therapy. At present, all patients are alive, two are free of disease, one has persistent disease and two have local recurrence.

Conclusion  Considering the significant rate of recurrence even after wide local excision, the extent of surgery needed and the good prognosis with long‐term survival, we question whether nonsurgical modalities should be considered in place of surgery as primary treatment for noninvasive PPD, with radical surgery being reserved for failures or invasive disease.
Survival of rectal cancer patients in Denmark during 1994–99
Authors: Harling H. , Bülow S. , Kronborg O. , Møller L. N. , Jørgensen T. ,   the Danish Colorectal Cancer Group
Published: April 2004

Objective  As survival from rectal cancer in Denmark is below the European average, we analysed survival during the period of 1994–99 focusing upon improvement strategies.

Method  All patients with a first‐time rectal cancer were registered in a national database during this 5‐year period. In the observational cohort study, data on patient age and gender, tumour stage, surgical procedures, adjuvant radiotherapy, anastomotic leakage, 30‐day mortality and long‐term survival were evaluated.

Results  The database comprised 5021 patients. Sixty‐four percent had a localized tumour. Less than a third of patients with fixed tumours had pre‐operative radiotherapy and curative surgery was achieved in 70%. Anastomotic leakage occurred in 13%, and 30‐day mortality was 4% following abdominoperineal or anterior resection and 11% following a Hartmann's procedure. The relative 5‐year survival in the entire series was 39% in males and 47% in females, respectively. Following curative surgery the relative 5‐year survival was 55% in males and 63% in females, respectively. Survival was 71% in the subset of patients receiving curative total mesorectal excision.

Conclusion  The average tumour stage upon diagnosis was probably more advanced compared to the other Nordic countries and pre‐operative radiotherapy was administered to a minority of patients with fixed tumours. The anastomotic leakage rate was relatively high, whereas the 30‐day mortality was comparable to other studies. Survival from rectal cancer in Denmark is still less favourable compared to the other Nordic and several European countries but improved from 1996 and onwards.
Stapled anopexy for short segment Hirschprungs disease in adults
Authors: Stiven P. H. , Carne P. W. G. , Frizelle F. A.
Published: April 2004

Traditional treatment of short segment Hirschprungs disease in adult consists of major resectional procedures, often with the use of a temporary stoma. Patients with this disease may have significant morbidities that increase their risk of post‐operative morbidity and mortality. In an attempt to minimize the procedural related morbidity, we describe the application of the stapled anopexy technique to treat short segment Hirschprungs disease.
Pouchitis
Authors: Macafee D. A. L. , Abercrombie J. F. , Maxwell‐Armstrong C.
Published: April 2004

Pouchitis is one of the commonest and most debilitating complications of a restorative proctocolectomy. The cause remains elusive, though a number of approaches have been shown to alleviate the condition. This review outlines current evidence relating to pouchitis, obtained from randomised and nonrandomised studies. Medline, the Bath Information Data Service (BIDS) and PubMed were searched using the keywords ‘pouchitis’ and ‘inflammatory bowel disease’. In addition, articles were cross‐referenced, and the abstracts of recent colorectal meetings studied.
‘Building a Better World’
Authors: Nossal Gustav
Published: April 2004

Garran Oration  Royal Institute of Public Administration Australia  National Conference, 29 November ‐1 December 2003
Radical Mastectomy in 20 Ruminants
Authors: Cable Christina S. , Peery Kara , Fubini Susan L.
Published: April 2004

Objective—To describe a surgical technique for radical mastectomy in ruminants and to report experience and outcome in 20 animals.

Study Design—Retrospective study.

Animals—Seventeen goats and 3 cows.

Methods—Medical records of ruminants that had radical mastectomy between June 1, 1987 and June 1, 2003 were reviewed. Follow‐up information was obtained by telephone interview of owners.

Results—One animal died within 24 hours from complications of gangrenous mastitis and another died from necrotizing cellulitis. Eighteen animals were discharged and follow‐up information was available for 15 animals; 12 animals lived at least 1 year postoperatively.

Conclusions—Ruminants with severe but localized diseases of the udder did well after radical mastectomy. The procedure was well tolerated, made the animals more comfortable, and potentially prolonged their lives as pets.

Clinical Relevance—Radical mastectomy can be a safe and effective procedure for ruminants with udder disease, with few complications.