bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of non‐resectable hepatocellular carcinoma with autologous tumor‐pulsed dendritic cells
Authors: Ladhams Andrew , Schmidt Chris , Sing Garwin , Butterworth Lesley , Fielding George , Tesar Paul , Strong Russell , Leggett Barbara , Powell Lawrie , Maddern Guy , Ellem Kay , Cooksley Graham
Published: March 2003

Abstract Background: The response of hepatocellular carcinoma (HCC) to therapy is often disappointing and new modalities of treatment are clearly needed. Active immunotherapy based on the injection of autologous dendritic cells (DC) co‐cultured ex vivo with tumor antigens has been used in pilot studies in various malignancies such as melanoma and lymphoma with encouraging results.

Methods: In the present paper, the preparation and exposure of patient DC to autologous HCC antigens and re‐injection in an attempt to elicit antitumor immune responses are described.

Results: Therapy was given to two patients, one with hepatitis C and one with hepatitis B, who had large, multiple HCC and for whom no other therapy was available. No significant side‐effects were observed. The clinical course was unchanged in one patient, who died a few months later. The other patient, whose initial prognosis was considered poor, is still alive and well more than 3 years later with evidence of slowing of tumor growth based on organ imaging.

Conclusions: It is concluded that HCC may be a malignancy worthy of DC trials and sufficient details in the present paper are given for the protocol to be copied or modified.
[13C]‐Urea breath test without prior fasting and without test meal is accurate for the detection of Helicobacter pylori infection in Chinese
Authors: Ng Fook Hong , Lai Kam Chuen , Wong Benjamin Chun Yu , Wong Wai Man , Wong Siu Yin , Chow Kai Chiu , Yuen Siu Tsan , Leung Suet Yi , Lam Shiu Kum
Published: March 2003

Abstract Background and Aim: Conventional [13C]‐urea breath test ([13C]‐UBT) requires prior fasting and a test meal, which theoretically improves the accuracy of the test. However, recent studies have suggested that prior fasting and test meal may not be essential. We aimed to determine the accuracy of a new [13C]‐UBT protocol without fasting in Chinese.

Methods: Dyspeptic patients referred for upper endoscopy were recruited. The gold standard for Helicobacter pylori infection was the combination of Campylobacter‐like organism (CLO) test and histology. Group I (n
= 213) patients underwent [13C]‐UBT with prior fasting and with citrate acid test meal. Group II (n
= 123) patients underwent [13C]‐UBT without prior fasting but with test meal. Group III (n
= 90) patients underwent [13C]‐UBT without prior fasting and without test meal.

Results: The highest accuracy for groups I, II and III was 96.7, 95.1 and 95.5% using a cut‐off value of 5.0, 5.5 and 3.5, respectively. The sensitivities and specificities were 97.4 and 95.8% in group I, 93.3 and 96.8% in group II, and 96.5 and 93.9% in group III, respectively.

Conclusion: The [13C]‐UBT protocols without prior fasting and either with or without test meal produce highly accurate and reliable results in the Chinese population.
Clinical profile of primary sclerosing cholangitis in Singapore
Authors: Ang Tiing Leong , Fock Kwong Ming , Ng Tay Meng , Teo Eng Kiong , Chua Tju Siang , Tan Jessica Yi‐Lyn
Published: March 2003

Abstract Background and Aim: Primary sclerosing cholangitis (PSC) is a rare chronic disease in Singapore and its epidemiological profile has not been described previously. The present study aimed to define the demographic and clinical profile of patients with PSC in Singapore.

Methods: The case records of patients with PSC seen at Changi General Hospital were analyzed in terms of demographic profile, clinical presentation, clinical course, treatment and complications.

Results: Ten cases of PSC were diagnosed over a 10‐year period. The male:female ratio was 9:1. The median age of diagnosis was 49.5 years (mean: 50.9 years; range: 35–63 years). With regards to clinical presentation, seven patients had hepatobiliary sepsis, two patients had asymptomatic liver biochemistry abnormalities while one patient had cholestatic jaundice. Prevalence rate of perinuclear antineutrophil cytoplasmic antibody (pANCA) was 20%. Symptomatic inflammatory bowel disease (IBD) was diagnosed in 20% of PSC cases. Eight patients (80%) had intrahepatic ductal involvement while two patients (20%) had combined intrahepatic and extrahepatic ductal involvement on endoscopic retrograde cholangiopancreatography (ERCP). The prevalence rate of recurrent cholangitis was 30% while that of recurrent liver abscess, cirrhosis and common bile duct stricture were all 10%. The mean duration of follow up was 6.6 years with one death from liver failure.

Conclusion: The clinical profile of patients with PSC in Singapore appears to differ with other published data, with a greater number presenting with hepatobiliary sepsis and less frequent association with IBD and pANCA. It is hypothesized that this may be related to differences in environmental triggers and genetic susceptibility.
Pathology of fundic varices of the stomach and rupture
Authors: Arakawa Masahiro , Masuzaki Takao , Okuda Kunio
Published: March 2003

Background and Aim: Gastric varices, the rupture of which can be a fatal complication of portal hypertension, have not been well documented histopathologically. While cardiac varices develop in continuity with esophageal varices, fundic varices develop independently, having characteristic pathophysiology. Elucidation of the angioarchitecture of fundic varices will facilitate future improvement of treatment.

Methods: Twelve stomachs with fundic varices, either resected or autopsied, were examined by injecting a barium‐gelatin solution into the vein that was forming varices, soft X‐rayed for the study of the vessel course, and then the stomach made into transparent preparations for stereoscopic study. Five fundic varices with a recognizable rupture site were studied histologically.

Results: Fundic varices could be classified into two types: Type I, single vein forming the supplying vessel, varix and draining vessel without changing caliber (eight cases) or plural veins supplying the varix (one case) and; Type II, many branching vessels existing beside the main supplying and draining vessels (three cases). Fundic varices exist in the submucosa with no enlarged vein in the lamina propria, and rupture occurs through the portion of the varix that protrudes into the stomach lumen penetrating the muscularis mucosae and lamina propria.

Conclusions: Fundic varices form with the supplying vessel, mostly singular, and the draining vessel is frequently a gastrorenal collateral. Fundic varices form in the submucosa, unlike esophageal varices, and perforate through the overlying muscularis mucosae and lamina propria.
Incidence of Sjögren's syndrome in Japanese patients with hepatitis C virus infection
Authors: NAGAO YUMIKO , HANADA SHINICHIRO , SHISHIDO SHYOICHIRO , IDE TATSUYA , KUMASHIRO RYUKICHI , UENO TAKATO , SATA MICHIO
Published: March 2003

Background and Aim: Hepatitis viruses induce not only chronic liver diseases but also the impairment of other organs and tissues as extrahepatic manifestations. In particular, hepatitis C virus (HCV) is involved in various extrahepatic manifestations. The purpose of the present study was to evaluate Sjögren's syndrome (SS) and lichen planus (LP) involvement, which are various extrahepatic manifestations in patients with liver diseases related to hepatitis B virus (HBV) or HCV.

Methods: We examined a total of 110 Japanese patients with chronic liver disease: 29 with HBV infections and 81 HCV infections.

Results: The prevalence of SS according to European and Japanese criteria in patients with chronic HCV infection was significantly higher than in patients with chronic HBV infection (European criteria: 25.9 vs 3.4%; P < 0.05, Japanese criteria: 21.0 vs 3.4%; P = 0.05). Lichen planus was observed in one (3.4%) of 29 patients with chronic HBV infection, and in 11 (13.6%) of 81 patients with chronic HCV infection. Simultaneously combined LP and SS occurred in 8.6% (seven of 81) of patients with HCV infection, but in none with HBV infection.

Conclusions: Clinicians should routinely follow the HCV‐infected patients, paying sufficient attention to the presence of SS and LP, and they should also carefully monitor their prognosis.
Revival of non‐surgical management of neonatal depressed skull fractures
Authors: Pollak L , Raziel A , Ariely S , Schiffer J
Published: March 2003

Abstract: The management of depressed skull fractures in the newborn infant can be controversial. We report on a neonate, born by Caesarean section with difficult head extraction, complicated by a parietal depressed fracture. This ‘ping‐pong’ fracture was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible treatment modalities for neonatal depressed fractures, being conservative or operative, will be discussed.
Childhood deaths and cargo barriers in cars
Authors: Byard RW , Bourne AJ , James R
Published: March 2003

Abstract: To analyse features of childhood deaths associated with the absence or presence of car cargo barriers, three cases were taken from the files of the Department of Histopathology at the Women’s and Children’s Hospital and State Forensic Science Centre, Adelaide, Australia, over a 5‐year period from January 1993 to December 1997. Case 1: A 6‐year‐old boy who was a rear passenger sustained fatal crush injuries from unrestrained luggage moving forward after an accident. No cargo barrier was in place. Cases 2 and 3: Two children aged 3 and 9 years, respectively, died from acute hyperthermia after they became trapped in the back of a station wagon with a fixed cargo barrier in place. Although car cargo barriers are excellent devices for preventing injury from unrestrained objects striking or crushing passengers, designing barriers that can be opened easily from the rear of the cabin would prevent children being trapped in potentially dangerous circumstances.
Salmonella meningitis and its complications in infants
Authors: Lee WS , Puthucheary SD , Omar A
Published: March 2003

Objective: To review the presenting features, complications and outcome of infants with Salmonella meningitis.

Methodology: Retrospective review of all cultures of cerebrospinal fluid positive for bacteria in children below 12 years of age, processed at the Department of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur from 1973 to 1997. Records of all cases positive for Salmonella species were retrieved and studied.

Results: Thirteen infants aged 3 days to 9 months with Salmonella meningitis were included. The median age of onset of symptoms was 4 months. The clinical and laboratory features were similar to other causes of bacterial meningitis. Salmonella enteritidis was the commonest serotype isolated. Nine infants developed fits, six of which were difficult to control. Other complications noted were hydrocephalus (five), subdural effusions (four), empyema (three), ventriculitis (two), intracranial haemorrhage and cerebral abscess (one each). The use of ampicillin and/or chloramphenicol and inadequate duration of therapy resulted in recrudescence or relapse in five infants. The overall mortality was 18%. The presence of empyema, intracerebral abscess, ventriculitis, hydrocephalus, and intracranial haemorrhage were associated with adverse neurodevelopmental sequelae or death. More than half of those who survived had normal long‐term outcome.

Conclusions: Infants who developed neurological complications as a result of Salmonella meningitis had significant mortality and adverse long‐term neurodevelopment outcome.
Accidental asphyxia in bed in severely disabled children
Authors: Amanuel B , Byard RW
Published: March 2003

Objective: To determine whether there are specific situations which may increase the risk of accidental asphyxia during sleep in children with physical and mental disabilities.

Methodology: Review of all cases where death was attributed to accidental asphyxia caused by unsafe sleeping situations in children listed in the Department of Histopathology database over a 10‐year period from March 1989 to February 1999.

Results: A total of 26 cases were found (M:F, 19:7; age range, 1–48 months; average age, 7.4 months). Of those cases, two involved children with significant mental and physical impairment. Case 1: A 4‐year‐old boy with Klippel–Trenaunay–Weber syndrome, macrocephaly and severe developmental delay, was found dead with his head hanging over a wooden board attached to the side of his bed. Case 2: A 4‐year‐old boy with lissencephaly and severe developmental delay was found dead wedged between a retractable mesh cot side and the side of his bed. In both cases the devices resulting in death had been put in place to prevent the boys from falling out of bed.

Conclusions: Accidental asphyxia in physically and mentally impaired children may be caused by devices that have been used to prevent injury from falling out of bed. Careful assessment of the specific developmental problems that children suffer should be undertaken before their beds are modified. It may be safer for these children either to have no barrier, or to have drop‐sided cots/beds that meet recognized safety standards.
Encephalocraniocutaneous lipomatosis (Fishman syndrome): A rare neurocutaneous syndrome
Authors: Amor D J , Kornberg A J , Smith L J
Published: March 2003

Abstract: Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital neurocutaneous syndrome comprising unilateral cranial lipomas, lipodermoids of the eye and brain abnormalities. A 3‐year‐old boy who presented at birth with a scalp lipoma and an ipsilateral epibulbar lipodermoid is described. Infantile spasms developed at 9 months of age and cerebral imaging showed thickened and calcified cortex at the right occiput and hemiatrophy of the right hemisphere. These features were consistent with ECCL. Most children with ECCL have significant developmental delay, but we have found that control of seizures was associated with a significant improvement in developmental outcome.
Umbilical cord blood lactate in normal infants: Comparison between two methods of measurement
Authors: Sinn JKH , Lloyd J , Todd DA , Lazarus R , Maesel A , John E
Published: March 2003

Objectives: Firstly, to determine the accuracy of the Radiometer ABL 625 lactate electrode (Radiometer Medical Pty Ltd, Nunawading, Victoria, Australia) by comparing the lactate values obtained by this method to those obtained with the Hitachi 917 lactate analyser (Boehringer Mannheim Corporation, Charlottetown, Prince Edward Island, Canada). Secondly, to determine the effect of delay in measurement on blood lactate levels.

Methodology: Umbilical venous (UCV) blood samples were obtained from healthy term infants delivered vaginally. Lactate levels were measured with the Radiometer ABL 625 lactate electrode in the Neonatal Intensive Care Unit, Westmead Hospital and with the Hitachi 917 lactate analyser in 49 paired samples. In addition 26 UCV blood samples were placed in ice slurry and a further 26 samples at room temperature and blood lactate was measured at 5‐min intervals for 30 min to determine the change of lactate levels with time.

Results: The lactate levels obtained from the Radiometer ABL 625 lactate electrode were consistently lower than the levels obtained from the Hitachi 917 lactate analyser (mean difference – 0.24), but the correlation was high (r = 0.97). The blood lactate levels increased at the rate of 0.012 mmol/L per min if the blood was left at room temperature. The lactate levels remained stable for 20 min if the blood was placed in ice slurry.

Conclusion: The Radiometer ABL 625 lactate electrode was easy to use and there was high correlation with the values obtained by the standard laboratory method. The blood specimen must be place in an ice slurry if a delay in analysis is anticipated.
Car window entrapment and accidental childhood asphyxia
Authors: Byard RW , James RA
Published: March 2003

Abstract: A 3‐year‐old boy was found hanging from a partly opened car window. Attempted resuscitation was unsuccessful. Postmortem reconstruction of events leading up to death indicated that the boy had slipped while standing on his tricycle and entrapped his head as he was attempting either to look into the car, or to climb in through the window. While it is not always possible to completely secure childhood environments, open cars should not be regarded as safe places for young children to play in or around when an adult is not in attendance. To minimize the chance of injury or death to children from parked cars, young children should be removed from vehicles and all windows and doors securely closed and locked, if they are to be left in the vicinity of the car to play unsupervised.
Partial monosomy 10q with partial trisomy 11q due to paternal balanced translocation
Authors: Maruyama K , Koizumi T , Ikeda H
Published: March 2003

Abstract: A male neonate with partial monosomy 10q and partial trisomy 11q, due to paternal balanced translocation, and who had cerebellar and olfactory lobe hypoplasia, cardiovascular defects, duodenal atresia and imperforate anus, is presented. To the best of our knowledge, this is the first report on this combination of chromosomal abnormalities.
Neonatal neuroblastoma presenting with respiratory distress
Authors: Li AM , Chang J , Kumar A
Published: March 2003

Abstract: A male infant presenting with respiratory distress was found to have primary thoracic neuroblastoma. This method of presentation in the newborn period is rare. His symptoms resolved spontaneously with conservative management. Full staging revealed a poorly differentiated stage 2 tumour with favourable cytogenetic markers.
Pseudo‐maple syrup urine disease due to maternal prenatal ingestion of fenugreek
Authors: Korman SH , Cohen E , Preminger A
Published: March 2003

Abstract: Fenugreek, maple syrup and the urine of maple syrup urine disease (MSUD) patients all share a characteristic odour originating from a common component, sotolone. Ingestion of fenugreek by mothers during labour resulted in a maple syrup‐like odour in their newborn infants, leading to a false suspicion of MSUD.
Children followed with difficulty: How do they differ?
Authors: Callanan C , Doyle LW , Rickards AL , Kelly EA , Ford GW , Davis NM
Published: March 2003

Objective: To determine if very low birthweight children followed with ease differ in any perinatal or sociodemographic characteristics, or outcomes, compared with children followed with more difficulty.

Methodology: Consecutive children of birthweight < 1000 g or with gestational ages < 28 weeks born in 1991 (n = 51) or of birthweight < 1500 g born in 1992 (n = 166) at the Royal Women’s Hospital, Melbourne, surviving to 5 years of age, were assessed at 5 years of age, corrected for prematurity. Those who attended on the first mutually agreed appointment without substantial reluctance were considered to have been followed with ease. The remainder were considered to have been followed with difficulty. Outcomes included impairments such as cerebral palsy, blindness, deafness, and low IQ. Children had a disability if they had any of cerebral palsy, blindness, deafness requiring amplification, or an IQ more than 1 SD below the mean.

Results: Of the 217 survivors, 204 (94%) were assessed fully at 5 years of age. Of the 204 children assessed, 153 (75%) were followed with ease, and 51 (25%) with difficulty. Of data available in the perinatal period, significantly fewer children followed with more difficulty came from intact families, and more of their mothers had fewer than 12 years of schooling. More children followed with difficulty had a disability (41% compared with 19%), as they predominantly had lower IQ scores (mean difference in IQ – 12.7, 95% confidence interval – 18.0, – 7.4). The association between difficulty of assessment and both higher rates of disability and lower IQ scores remained after adjustment for significant perinatal and sociodemographic variables.

Conclusions: Children followed with difficulty can partly be recognized on several sociodemographic characteristics in the perinatal period, and have substantially worse sensorineural outcomes than those followed with ease. In any longitudinal study, the more incomplete the follow up, the lower will be the rate of adverse sensorineural outcome.
Cerebral palsy in Victoria, Australia: Mortality and causes of death
Authors: Reddihough DS , Baikie G , Walstab JE
Published: March 2003

Objective: To study the causes of death and the characteristics of children with cerebral palsy that had died over a 25‐year period in Victoria, Australia.

Methodology: Names of children that had died were collected from the Victorian Cerebral Palsy Register. Their hospital records were studied and information was gathered about age of death, motor impairment, the presence or absence of associated disabilities and cause of death.

Results: One hundred and fifty‐five children had died during the period 1970–95. The majority of children had severe spastic quadriplegia, intellectual disability and epilepsy. The predominant cause of death was pneumonia, although for many children who died at home the cause was unknown.

Conclusions: Children with cerebral palsy are a diverse group and those with a severe motor deficit have a reduced life expectancy. Lung disease remains an important cause of morbidity and mortality for this group. Further information about the causes of death is needed, particularly for those children that die at home.
Child injury morbidity in New Zealand, 1987–1996
Authors: Kypri K , Chalmers DJ , Langley JD , Wright CS
Published: March 2003

Objectives: New Zealand is one of a small number of countries that has a national hospital discharge database. The aim of this study was to use these data to provide an epidemiological description of child injury morbidity and to discuss options for prevention.

Methodology: Using national data, all public hospital admissions for the fiscal year 1995/6 were identified and grouped according to cause. This allowed identification of all children (0–14 years) hospitalized for injury in the period 1987–1996. Causes of injury, diagnoses and injury severity were examined in four age groups.

Results: Injury was the second leading cause of public hospital admissions. Children were hospitalized with injury at the rate of 1333 per 100 000 person‐years. The victims were predominantly male (61%). In all age groups, falls were the leading cause of morbidity. ‘Striking events’, motor vehicle traffic crashes and poisoning were also major contributors to the child injury toll. The commonest injury diagnosis was a fracture of the upper limb (25%), followed by intracranial injury (18%).

Conclusions: The leading causes of injury morbidity were noted to differ from previously reported leading causes of injury mortality. Review of the data in light of research literature suggests the need for policy changes to make alternatives to motor vehicle transportation safer and to encourage increased use of child restraints in order to reduce road traffic trauma. Legislation requiring child‐resistant packaging for all toxic medications and household products is necessary to reduce rates of child poisoning. Further research is required on policies concerning playground equipment heights and surfacing requirements, and on interventions for hot water scalds.
Low‐level lead exposure and children
Authors: Wigg NR
Published: March 2003

Abstract: The adverse effects of environmental lead exposure on the mental development of young children are well established. There is no safe level of blood lead below which children are not affected. Recent research expands our understanding of the impact of lead exposure continuing into later childhood, as well as its effects on children’s behaviour. However, social and other environmental factors also contribute to variance in measures of developmental and behavioural outcomes. Lead is associated with only modest effects on children’s development, but is a potentially modifiable risk factor. As environmental exposure to lead declines for the whole population, continued specific attention is needed for children living in industrial areas.
Multiple fractures in a 3‐month‐old infant with severe infantile osteopetrosis
Authors: Bodamer OAF , Bravermann RM , Craigen WJ
Published: March 2003

Abstract: A diagnosis of severe infantile, autosomal recessive osteopetrosis (I‐ARO) was made in a 3‐month‐old female based on characteristic radiological and histological findings. The finding of multiple fractures at presentation in this infant is highly unusual. Deficiency of carbonic‐anhydrase type II was excluded.
Ten years’ experience of persistent hyperinsulinaemic hypoglycaemia of infancy
Authors: Tyrrell VJ , Ambler GR , Yeow W‐H , Cowell CT , Silink M
Published: March 2003

Objective: To review the presentation, management and outcome of persistent hyperinsulinaemic hypoglycaemia of infancy seen at the Royal Alexandra Hospital for Children over a 10 year period.

Methodology: A retrospective review of 20 subjects was performed. As well as laboratory data, data were collected on clinical presentation, medical and surgical management and developmental outcome.

Results: Twenty subjects (11 male) were identified with presentation at a median age of 1.5 months (range 0–10 months), with 10 (50%) presenting in the first week of life. Only 20% of patients were large for gestational age. Diagnosis was made on the basis of high glucose requirements and inappropriately high insulin levels at the time of hypoglycaemia. Eight (40%) responded well to diazoxide treatment alone, seven (35%) received diazoxide in combination with other short‐term medical therapy initially and five (25%) required pancreatectomy (repeat surgery in three). Those who required surgery had a higher mean birth weight. Infants presenting in the first week of life were less likely to respond to diazoxide. At the time of last review, eight (40%) of those treated medically had ceased all treatment. Two of the five cases requiring pancreatectomy now require insulin treatment. Neurodevelopmental assessment was normal in 11 (55%), mild delay was found in six (30%) and moderate or severe delay was found in three (15%).

Conclusions: Persistent hyperinsulinaemic hypoglycaemia of infancy remains a major diagnostic and management challenge. Early suspicion and recognition is critical with definitive investigation and medical therapy to avoid hypoglycaemia, with pancreatectomy in medically unresponsive cases. Normal neurodevelopmental outcome was found in only 55% of cases.
Prone versus supine sleep position: A review of the physiological studies in SIDS research
Authors: Galland BC , Taylor BJ , Bolton DPG
Published: March 2003

Abstract:  A number of physiological studies, published over the last 10 years, have investigated the links between prone sleeping and sudden infant death syndrome (SIDS). This review evaluates those studies and derives an overview of the different affects of sleeping prone or supine in infancy. Generally, compared with the supine, the prone position raises arousal and wakening thresholds, promotes sleep and reduces autonomic activity through decreased parasympathetic activity, decreased sympathetic activity or an imbalance between the two systems. In addition, resting ventilation and ventilatory drive is improved in preterm infants, but in older infants (>1 month), there is no improvement in ventilation, and in 3‐month‐old infants, the position is adverse in terms of poorer ventilatory drive (in active sleep only). The majority of findings suggest a reduction in physiological control related to respiratory, cardiovascular and autonomic control mechanisms, including arousal during sleep in the prone position. Since the majority of these findings are from studies of healthy infants, continued reinforcement of the supine sleep recommendations for all infants is emphasized.
Incapacitation or death of a socially isolated parent or carer could result in the death of dependent children
Authors: Byard Rw
Published: March 2003

Abstract:  A study was undertaken to investigate features of infant and childhood fatalities that were a consequence of care by socially isolated adults suffering from significant medical conditions. Autopsy records at the Forensic Science Centre in Adelaide from July 1996 to June 2001 were searched for all cases where infants or children had died as a result of the incapacitation or death of an adult carer. A total of two cases were found, involving three children. The carers were aged 51 years (grandfather) and 20 years (mother) and had died at home from ischaemic heart disease and epilepsy, respectively. The children were all boys and were aged 1 year, 2.5 years and 3 years. The child victims had died of dehydration following the adult deaths. These cases demonstrate that infants and young children in the care of socially isolated and unwell adults could be at risk of significant injury or death if the carer dies or becomes incapacitated. The provision of medical‐emergency buttons for such families, and/or the setting up of regular contact with medical clinics or neighbours are steps that could be taken to diminish the risk of such an outcome.
Milk formulas in acute gastroenteritis and malnutrition: A randomized trial
Authors: Kukuruzovic RH , Brewster DR
Published: March 2003

Objective:  To compare three low‐lactose milk formulas differing in osmolality and degree of protein hydrolysis in the treatment of diarrhoea and malnutrition in subjects with high rates of lactose intolerance, osmotic diarrhoea and a tropical/environmental enteropathy.

Methods:  A randomized double‐blind trial of 180 Aboriginal children under 3 years of age admitted with acute diarrhoea and/or malnutrition was carried out. The intervention milk formulas were: (i) De‐Lact, a low‐osmolality lactose‐free formula; (ii) O‐Lac, a lactose‐free formula; and (iii) Alfaré, a partially hydrolysed formula. Outcome measures were diarrhoeal severity, weight gain, formula palatability and changes in intestinal permeability (L/R ratios).

Results:  The duration of diarrhoea in days (mean; 95% confidence interval) was significantly longer on Alfaré (8.5; 7.0−10.0) compared to De‐Lact (6.1; 5.0−7.2) and O‐Lac (6.9; 5.6−8.1; P = 0.04). There were no differences in mean intake between formulas, but palatability of Alfaré was significantly worse (P < 0.01) than the other formulas. Over the trial 5 days, improvement in L/R ratios was significantly greater (P = 0.05) for De‐Lact (18.6; 10.6−26.6) than for Alfaré (8.5; 2.1−14.9). Weight gain was not significantly different between the three formulas, except in a malnourished subgroup who had better weight gain on De‐Lact (P = 0.05).

Conclusions:  In these Aboriginal children with diarrhoea and growth failure, a low osmolality milk was associated with better outcomes and a partially hydrolysed formula with less improvement in mucosal recovery, suggesting that cow's milk protein intolerance is not contributing to greater diarrhoeal severity or enteropathy in Aboriginal children.
Palivizumab prophylaxis of respiratory syncytial virus infection in high‐risk infants
Authors: Vogel AM , Lennon DR , Broadbent R , Byrnes CA , Grimwood K , Mildenhall L , Richardson V , Rowley S
Published: March 2003

Abstract:  Palivizumab prophylaxis significantly reduces hospitalization for respiratory syncytial virus (RSV) disease in preterm infants. However, palivizumab is very expensive. Data from a New Zealand cost‐effectiveness analysis were considered by representatives of the Infectious Diseases and Immunisation, Fetus and Newborn, and Respiratory Committees of the Paediatric Society of New Zealand. Prophylaxis in all high‐risk groups was associated with net cost. The consensus panel recommends that the priority for palivizumab be given to babies discharged on home oxygen with chronic lung disease, followed by babies born at 28 weeks or less gestation.
Use of hypoallergenic formula in the prevention of atopic disease among Asian children
Authors: Chan YH , Shek LPC , Aw M , Quak SH , Lee BW
Published: March 2003

Objective: To determine the effect of a partially hydrolysed formula on
genetically predisposed children, with respect to the development of atopic clinical
manifestations and in vitro testing of serum IgE levels (total and milk‐specific).

Methods: One hundred and ten infants were randomly assigned to receive either partially hydrolysed formula or standard infant formula, and were prospectively monitored from birth for clinical atopic symptoms and serum IgE levels.

Results: Eczema occurred less frequently in infants receiving partially
hydrolysed formula. This was significant (P < 0.05) at 3, 6, 9, 12, 18
and 24 months. However, the significance decreased with time, although it almost
reached statistical significance at 30 months by the Kaplan–Meier survival
function (log–rank statistic, 3.46; P = 0.063). Although wheezing occurred
less frequently in infants receiving partially hydrolysed formula, compared to those
receiving standard infant formula, the difference did not reach statistical significance
(P > 0.05).

Conclusions: Exclusive feeding of hypoallergenic milk formula in the first 4 months of life has a protective effect in terms of the development of atopic dermatitis in the first 2 years of life, compared to feeding with cow’s milk formula.
The time of presentation of wound infection after cardiac surgery
Authors: HALL JC , HALL JL , EDWARDS MG
Published: March 2003

Clinical experience indicates that many wound infections present relatively late after cardiac surgery. Hence, timing may be an important issue in using this outcome as a clinical indicator. A database of 1000 patients who underwent cardiac surgery was accessed to ascertain baseline characteristics, the type of surgery, and the time of presentation of wound infections. The overall incidence of wound infection was 5.9% (59/1000). Only 36% (21/59) of the wound infections presented while the patient was in hospital. Diabetics were more likely to have a late presentation of a wound infection (the median time of presentation of wound infections (more than 17 days), i.e. 10/29 (33.4%) versus 98/971 (10. 1%), Fisher’s exact test P < 0.01). Wound infection can only be regarded as a reliable clinical indicator after cardiac surgery if patients are reviewed with care for 6 weeks after surgery.
Limnological comparison of a new reservoir with one almost 40 years old which had been totally emptied and refilled
Authors: Geraldes A. M. , Boavida M. J.
Published: March 2003

In the present study, several limnological characteristics of a reservoir filled for the first time are compared with those of another reservoir totally emptied after being full for almost 40 years and then refilled. Three phases were considered during the study, determined by the filling and emptying in the oldest reservoir: (i) filling phase, from August to October 1994; (ii) regular water‐level phase, from December 1994 to April 1995; and (iii) emptying phase, from May to July 1995. Several forms of phosphorus, phosphatase, chlorophyll a, and phytoplankton and zooplankton composition were determined. Trophic states of the two reservoirs were compared. Major limnological differences were not found between these two artificial lakes. In fact, physical factors such as temperature, chemical parameters such as the several forms of phosphorus measured, and biologically derived variables such as chlorophyll a and phosphatase activity exhibited similar patterns and values in both reservoirs, as well as practically the same relationships among those.
Lake restoration in Denmark
Authors: Søndergaard Martin , Jeppesen Erik , Jensen Jens Peder , Lauridsen Torben
Published: March 2003

Lake restoration in Denmark has involved the use of several different restoration techniques, all aiming to improve lake water quality and establishing clear‐water conditions. The most frequently used method, now used in more than 20 lakes, is the reduction of zooplanktivorous and benthivorous fish (especially roach (Rutilus rutilus) and bream (Abramis brama)) with the objective of improving the growth conditions for piscivores, large‐sized zooplankton species, benthic algae and submerged macrophytes. Piscivore stocking (mainly Esox lucius (pike)), aiming especially at reducing the abundance of young‐of‐the‐year fish, has been used in more than 10 lakes and frequently as a supplement to fish removal. Hypolimnetic oxidation, with oxygen and nitrate, has been undertaken in a few stratified lakes and sediment dredging, with the purpose of diminishing the internal phosphorus loading, has been experimented with in one large, shallow lake. Submerged macrophyte implantation has been conducted in some of the biomanipulated lakes to increase macrophyte abundance and distribution. Overall, the results from lake restoration projects, in the mainly shallow Danish lakes, show that external nutrient loading must be reduced to a level below 0.05–0.1 mg P L–1 under equilibrium conditions to gain permanent effects on lake water quality. By using fish removal, at least 80% of the fish stock should be removed over a period of not more than 1–2 years to obtain a substantial effect on lower trophic levels and to avoid regrowth of the remaining fish stock. Stocking of piscivores requires high densities (>0.1 individuals m–2) if an impact on the plankton level is to be obtained and stocking should be repeated yearly until a stable clear‐water state is reached. The experiments with hypolimnetic oxygenation and sediment dredging confirm that internal phosphorus loading can be reduced. Experience from macrophyte implantation experiments indicates that protection against grazing by herbivorous waterfowl may be useful in the early phase of recolonization.
Pathology of a dissecting intracranial aneurysm
Authors: Sakata Noriyuki , Takebayashi Shigeo , Kojima Masaru , Masawa Nobuhide , Suzuki Keiji , Takatama Masamitsu
Published: March 2003

The pathological findings of six autopsy cases of dissecting intracranial aneurysm are studied. Clinically, all cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited rupture of the vertebral artery and subarachnoid hemorrhage. Two types of lesion were present. First, all cases showed the formation of a dilatated pseudoaneurysm with widespread disruption of the entire arterial wall, which was composed of thin adventitia. Second, a medial disruption of the arterial wall and subadventitial dissecting hemorrhage, which formed a false lumen and stenosis of the ‘true’ lumen of the artery, was also found. However, these lesions were found to be connected to the site of rupture. The autopsy cases within 1 day of onset of intracranial dissecting aneurysm showed the formation of fibrin thrombus, a marked degree of leukocyte infiltration and necrosis of the arterial wall at the site of the lesion. The cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration. No arteriosclerosis was found in any lesion studied. These data suggest that the disruption of the entire arterial wall might initially occur and cause medial disruption and subadventitial hemorrhage. Hypertension and arteriosclerosis might function as causal and protective factors in the pathogenesis of dissecting intracranial aneurysms, respectively.
An autopsy case of postencephalitic parkinsonism of von Economo type: Some new observations concerning neurofibrillary tangles and astrocytic tangles
Authors: Haraguchi Takashi , Ishizu Hideki , Terada Seishi , Takehisa Yasushi , Tanabe Yasuyuki , Nishinaka Tetsuya , Kawai Kensuke , Kuroda Shigetoshi , Komoto Yasunobu , Namba Masuyuki
Published: March 2003

An autopsied case of postencephalitic parkinsonism of von Economo type with a 71‐year duration is reported. Several cases of postencephalitic parkinsonism of von Economo type have been reported in Japan but this is the first reported case from western Japan. The patient was a Japanese man who was 74 years of age at the time of death. He developed encephalitis of unknown etiology at the age of 3 years. The first symptom was antisocial behavior, which developed at 30 years of age. At the age of 40 years, the patient showed progressive parkinsonism. Neuropathological findings disclosed marked neuronal loss with gliosis in the substantia nigra, locus ceruleus, and raphe nuclei, as well as the appearance of neurofibrillary tangles in the aforementioned areas. There were also widespread tuft‐shaped astrocytes (Tu‐SA) in the central nervous system, including the thalamus. Tuft‐shaped astrocytes are considered to represent non‐reactive astrocytes because the distributions of neurofibrillary tangles (NFT) and Tu‐SA are clearly different. Therefore, the primary astrocytic lesions in postencephalitic parkinsonism of von Economo type may be more widespread. Ultrastructurally, the Tu‐SA consisted of straight filaments, 15 nm in width, which formed tight bundles. Ultrastructurally, NFT in this case revealed paired helical filaments but straight filaments, 15 nm in width, which were also found in the neurons of the substantia nigra.
An autopsy case of Alzheimer's disease presenting with primary progressive aphasia: A clinicopathological and immunohistochemical study
Authors: Li Feng , Iseki Eizo , Kato Masanori , Adachi Yoshiki , Akagi Masao , Kosaka Kenji
Published: March 2003

This report describes an autopsied Alzheimer's disease (AD) patient with primary progressive aphasia (PPA) as an early symptom. The patient developed a progressive speech disturbance at the age of 70 years, and difficulty in comprehension became apparent 2 years later. Magnetic resonance imaging scan disclosed asymmetrical brain atrophy, predominantly on the left temporal lobe. At the age of 74 years, the patient's dementia rapidly progressed with parkinsonism and he died after a disease duration of 6 years. At autopsy, the brain showed a marked temporo‐frontal lobe atrophy, predominantly on the left side. There was severe neuronal loss with gliosis and tissue rarefaction in the atrophied cerebral cortex and amygdala. Many neurofibrillary tangles with neuropil threads were found in the cerebral cortex. Numerous amyloid deposits were distributed throughout the cerebral cortex, accompanied by amyloid angiopathies. This patient was clinically diagnosed with temporal lobe‐dominant Pick's disease, although the possibility of corticobasal degeneration was made. The neuropathological diagnosis was AD with asymmetrical brain atrophy and widespread amyloid angiopathies.
Age‐related changes of cornu ammonis 1 pyramidal neurons in gerbil transient ischemia
Authors: Tamagaki Chiharu , Murata Akira , Asai Satoru , Takase Katsunori , Gonno Kazutoshi , Sakata Tetsuji , Kinoshita Toshihiko
Published: March 2003

This study reports that postischemic apoptotic cell death of the hippocampal cornu ammonis (CA) 1 neurons is delayed in aged gerbils. Age‐related changes in the process of CA1 neuronal death following transient ischemia was studied. Two groups of Mongolian gerbils were used in this study, which compared adult (4‐month‐old) and aged (24‐month‐old) animals by hematoxylin–eosin stain, in situ nick‐end labeling (TUNEL method) and electron microscopy. In the process of neuronal death, neuronal loss of the aged group was histologically less severe than that of the adult group. TUNEL‐positive cells were found on days 3–5 after ischemia in the adult group, while they were still found on day 7 in the aged group. The apoptotic process of the aged group was delayed compared to the adult group. Furthermore, lipofuscin was ultrastructurally observed inside the apoptotic body 5 days after ischemia in CA1 pyramidal neurons of the aged group. It is likely that colocalization of lysosomal enzyme cathepsin D with lipofuscin might be associated with the age‐related alteration of lysosomal system in the neurons. Altogether these data suggest that age‐related lysosomal changes might affect the apoptotic cascade process in postischernic CA1 neurons.
Gamma knife radiosurgery for neuroepithelial tumors: Radiological and histological changes
Authors: Uematsu Yuji , Fujita Koji , Tanaka Yoshiyuki , Shimizu Mina , Oobayashi Shinji , Itakura Toru , Kubo Kenji
Published: March 2003

Gamma knife radiosurgery (RS) has been introduced as a modern therapy for brain tumors. However, the effects of RS for neuroepithelial tumors are still obscure. The present study investigates the radiological and histological changes after RS to elucidate the biological effect. There were seven cases (two males and five females), ranging from 4 to 71 years with a mean age of 33 years. Two cases were located in the brainstem, another two in the cerebellum, and one each in the thalamus, the hypothalamus, and the frontal lobe. Histologically, two cases had gangliogliomas, four astrocytomas (1 pilocytic, 1 fibrillary, 2 anaplastic), and one glioblastoma. RS was performed after surgery with a central dose of 30–36 Gy. All cases were evaluated radiologically on MRI before and after RS. Four cases (3 astrocytomas and 1 glioblastoma) which neurologically deteriorated after RS were reoperated. These cases were examined using HE and immunohistochemical studies with antibodies of CD34, α‐smooth muscle actin (SMA), p53, p2l and MIB‐1 on the sections before and after RS. MRI demonstrated perifocal edema and intratumoral hypointensity on T2 weighted imaging (T2WI), suggesting radionecrosis in most of the cases within 6 months after RS. In the central part of the RS, destructive changes were observed in the tumor cells and endothelial cells: decrease in the tumor cell population, coagulation necrosis, and fibrinoid degeneration of vascular walls were revealed. In the peripheral part, however, some tumors contained viable tumor cells intermingled with blood vessels showing endothelial and pericytic proliferations. The increase of MIB‐1 staining index was found in only one case. The p2l immunoreactivity was increased in endothelial cells, although the p53 immunoreactivity was unchanged. These results suggested that radionecrosis occurred earlier and more frequently in neuroepithelial tumors after RS than after conventional radiation.
Low‐sodium haemodialysis without fluid removal improves blood pressure control in chronic haemodialysis patients
Authors: Farmer Ckt , Donohoe P , Dallyn P , Cox J , Kingswood Jc , Goldsmith Dja
Published: March 2003

SUMMARY: Hypertension is an important and well‐established risk factor for both cardiovascular and cerebrovascular disease. Hypertension is much more common in patients on renal replacement therapy than in the general population. Up to 80% of patients on renal replacement therapy are hypertensive and about 50% of dialysis patients die from cardiovascular causes. Salt and water overload are major factors exacerbating hypertension in the dialysis population. This was a prospective crossover study of 10 patients examining the effect of haemodialysis for 2 weeks using usual (Na+ 138–140 mmol/L) sodium dialysate with a 2‐week period of low (reduced by an average of 5 mmol/L Na+ to 133 mmol/L on average) sodium dialysate on inter‐dialytic ambulatory blood pressure (ABPM) and trans‐thoracic bioimpedance (TTB). Ten patients, mean age 67 years, completed the study (two women and eight men). No patient became severely hyponatraemic during the study period. Mean 48 h inter‐dialytic blood pressure (BP) fell from 141/83 to 133/78 (P < 0.01). Mean arterial BP measured immediately prior to TTB fell from 92.8 mmHg to 87.5 mmHg (P < 0.01) during the low‐sodium haemodialysis period. Afterload (systemic vascular resistive index – SVRI) measured by TTB fell significantly during the low‐sodium haemodialysis period (SVRI on Na+‐140 = 3426 cf. Na+‐134 = 2281; P = 0.01). Dialysate sodium reduction without extra fluid removal had a beneficial effect on inter‐dialytic 48‐h blood pressure in chronic stable haemodialysis patients. Lowering dialysate sodium reduced the systemic vascular resistance index as measured by TTB. Reduction of dialysate sodium was well tolerated, although mild dizzines and cramps did occur. These data suggest that sodium overload and water overload may have independent effects on BP and that simple‐to‐achieve and modest changes in dialysate sodium could usefully augment the action of antihypertensives in dialysis patients.