bluuebunny/crossref_metadata_2025 huggingface dataset:
A 12‐month profile of community paediatric consultations in the Barwon region
Authors: Hewson PH , Anderson PK , Dinning AH , Jenner BM , McKellar WJD , Weymouth RD , Gollan And Ra
Published: March 2003

Objective: To determine the profile of all consultations carried out in paediatricians’ offices in the Barwon region over a 12‐month period.

Methodology: The age, sex, category, diagnosis, and outcome of all non‐hospital‐based paediatric consultations carried out in the Barwon region were documented prospectively on a day by day basis. Relevant demographic data and information on Barwon children treated elsewhere were also collected. The frequency of different categories of illness, systems involved and groups of diagnoses was determined.

Results: A total of 14 711 consultations was carried out in the region with 10% of the childhood population having contact with the paediatricians during the year; 3135 new patients or problems were seen with 34.8% of all consultations involving behavioural problems and 76% of these relating to ADHD. The most frequent medical diagnostic group was CNS/disability being 16% of all consultations. At least 50% of the medical consultations involved chronic illness.

Conclusions: Behavioural difficulty, chronic disability, and learning problems represent a significant part of the workload of community‐based general paediatricians. Appropriate exposure during paediatric training should be given to these issues along with more sophisticated training in the medical, social and psychological complications of chronic illness and its effect on clients and families.
Pancreatic enzyme replacement therapy in cystic fibrosis: Australian guidelines
Authors: Anthony H , Collins CE , Davidson G , Mews C , Robinson P , Shepherd R , Stapleton D
Published: March 2003

Abstract: Pancreatic enzyme replacement therapy (PERT) is a major factor associated with achieving optimum growth and nutritional status in cystic fibrosis (CF) patients with pancreatic insufficiency and consequent malabsorption. Currently in Australian CF clinics policies for the usage of PERT vary considerably. This paper highlights the current issues related to fat absorption and use of PERT in CF. It also provides evidence to support the recommendation of a PERT dose based on a standard ratio of lipase units per gram of dietary fat consumed for individual patients. A consistent approach to PERT doses will facilitate identification of patients whose PERT intake increases their risk of fibrosing colonopathy and for whom gastroenterological review is warranted. Recent reports indicate that PERT intake can be reduced with a secondary improvement in growth and nutrition status as a consequence of increased dietetic input. These Australian guidelines for the judicious use of PERT in CF should lead not only to a refinement in nutritional management of patients with CF but should also facilitate an improvement in compliance with therapy due to sophistication in patient education materials. The Australian guidelines for the use of PERT in CF if correctly applied, will also provide patients and their families with a better understanding of the relationship between PERT and nutritional status.
Prader–Willi syndrome
Authors: Couper RTL
Published: March 2003

Prader–Willi syndrome is a multi system disorder characterized by neonatal hypotonia, later obesity, hyperphagia and mental retardation. It occurs sporadically, either as a result of microdeletion of chromosome 15p (70%) or as a result of maternal disomy of chromosome 15 (30%). The major problems encountered by parents are those of hyperphagia, food‐seeking and obesity, and conduct disorder, particularly tantrums or oppositional behaviour.
Low rates of hospitalization for asthma among Aboriginal children compared to non‐Aboriginal children of the Top End of the Northern Territory
Authors: Whybourne AM , Lesnikowski CL , Ruben AR , Walker AC
Published: March 2003

Objective: To determine the hospitalization rates from asthma for Aboriginal and Torres Strait Islander (ATSI) and non‐Aboriginal (non‐ATSI) children in the ‘top end’ of the Northern Territory and to determine the proportion of hospitalizations due to asthma.

Methodology: A retrospective review was undertaken of separation data from the Royal Darwin Hospital for the period July 1991 to June 1997. All children aged 1–9 years residing in the Darwin urban or rural district were included, with asthma identified by the International Classification of Diseases Version 9 codes 493.0–493.9.

Results: The overall average annual hospitalization rate per 1000 population with a principal diagnosis of asthma for ATSI children from rural areas (ATSI‐rural) was 2.6, 4.7 for ATSI children from urban areas (ATSI‐urban) and 5.5 for non‐ATSI children. These hospitalization rates were significantly different between ATSI and non‐ATSI children (rate ratio 0.72, 95% CI 0.59–0.86). On stratification for residence, the rates were significantly different between ATSI‐rural and non‐ATSI children (rate ratio 0.61, 95% CI 0.47–0.80) but not different between rural and urban dwelling ATSI children (rate ratio 0.76, 95% CI 0.54–1.07) or between ATSI‐urban children and non‐ATSI children (rate ratio 0.81, 95% CI 0.63–1.03). Asthma was diagnosed in 6.5% of ATSI admissions (4.0% for ATSI‐rural and 13.8% for ATSI‐urban) and 12.7% of non‐ATSI admissions.

Conclusions: The hospitalization rate for ATSI children with asthma was significantly lower than for non‐ATSI children. Asthma plays a far less significant role in the spectrum of disease affecting hospitalized ATSI children compared to non‐ATSI children. There are significant differences in disease frequency between urban and rural resident ATSI children but less marked differences between urban resident ATSI children and non‐ATSI children. Further study is required if the underlying causes behind these differences are to be determined.
Intellectual disability in Western Australia
Authors: Bower C , Leonard H , Petterson B
Published: March 2003

Objective: To investigate the prevalence of intellectual disability in Western Australia (WA), its causes, prevention, and trends over time.

Methodology: Data from an administrative database of intellectual disability in WA were used to report on the trends in intellectual disability in childhood.

Results: The prevalence of intellectual disability was 8.3 per 1000 live births in 1980–90. For half the cases, there was no known cause for the intellectual disability. Down syndrome accounted for 14 to 15% of all cases. Since the introduction of newborn screening, no WA‐born child participating in the screening program has been diagnosed with intellectual disability as a result of either phenylketonuria or congenital hypothyroidism. The rate of autism spectrum disorders rose from three to six per 10 000 in the 1980–83 WA birth cohort to 10–13 per 10 000 for the 1989–92 cohort.

Conclusions: Recent linkage of this administrative database to the WA Maternal and Child Health Research Data Base provides a unique opportunity for more detailed investigation of intellectual disability and its risk factors in a large, well‐ascertained population of children.
Epilepsy and associated psychopathology in young people with intellectual disability
Authors: LEWIS JN , TONGE BJ , MOWAT DR , EINFELD Sl , SIDDONS HM , REES VW
Published: March 2003

Objective: This study aimed to investigate the role of epilepsy in psychopathology among an epidemiological sample of young people with intellectual disability (ID). The study also compared behavioural and emotional problems in young people on medication to control their epilepsy with those not on medication, and young people with epilepsy who were having current seizure activity with those with no current seizure activity.

Methodology: An epidemiological cohort of 392 participants, representative of the general Australian population of young people with ID, were used in the study. One hundred and fifteen individuals from this cohort were identified as suffering from epilepsy. The Developmental Behaviour Checklist was used to measure symptoms of behavioural and emotional disturbance.

Results: Results confirmed that young people with ID and epilepsy did not differ from controls without epilepsy on measures of psychopathology. Furthermore, those with epilepsy on medication had no difference in levels of problem behaviours than epileptics not on medication.

Conclusions: The results suggest that epilepsy has little or no influence on problem behaviours for young people with ID. Our attempt to understand the pathogenesis of behaviour problems in persons with ID may be better directed towards understanding genetic mechanisms than epilepsy pathologies.
A randomized controlled trial of azithromycin and amoxycillin/clavulanate in the management of subacute childhood rhinosinusitis
Authors: Ng Dkk , Chow P‐Y , Leung Lck , Chau K‐W , Chan E , Ho Jcs
Published: March 2003

Objective: Subacute childhood rhinosinusitis is a disorder commonly seen in children with allergic rhinitis. Antibiotics have been recommended as a major component of the treatment regime. The objective of the present study was to compare the effectiveness of a 3‐day course of azithromycin and a 2‐week course of amoxycillin/clavulanate in the treatment of subacute childhood rhinosinusitis.

Methodology: A randomized single‐blinded control study of subacute rhinosinusitis was conducted, comparing a 3‐day course of azithromycin and a 2‐week course of amoxycillin/clavulanate. Inclusion criteria were children aged between 5 and 16 years, duration of nasal blockage or discharge between 30 and 120 days, and abnormal sinus radiographs. All enrolled children were prescribed budesonide nasal spray (Rhinocort Aqua Nasal Spray, Astra Pharmaceuticals, Sodertalje, Sweden) as adjuvant treatment.

Results: Forty‐two children were recruited into the study and one defaulted on follow‐up. Failure occurred in 6 of 20 for the azithromycin group and 5 of 21 for the amoxycillin/clavulanate group. The odds ratio was 1.46 (95%CI 0.37–5.80, P = 0.73). No relapse occurred in azithromycin group and 5 of 21 in amoxycillin/clavulanate group. The odds ratio was 0.16 (95%CI 0.017–1.51, P = 0.18). Both antibiotics were well tolerated, however, two children, one from each group, complained of mild transient epigastric discomfort.

Conclusions: This small study did not provide evidence of a difference between 14 days of amoxycillin/clavulanate and 3 days of azithromycin. Larger studies will be needed to determine which, if any, antibiotic regimen should be used in treating subacute childhood rhinosinusitis.
Regional differences in outcome for very low‐birthweight infants: Do they persist at 7–8 years of age?
Authors: Darlow Ba , Horwood Lj , Mogridge N
Published: March 2003

Objective: To determine whether regional differences in early neonatal morbidity in a national cohort of very low‐birthweight (VLBW) infants persisted at 7–8 years of age.

Methods: Perinatal data collected prospectively from birth on all VLBW infants born in New Zealand in 1986 and admitted to a neonatal unit included the hospital principally caring for the infant: hospitals A–D being level III hospitals and ‘Other’ including the smallest level III and all level II hospitals. At 7–8 years of age, 298 surviving children (96% survivors living in New Zealand) were assessed at a home visit. Parents were given a comprehensive questionnaire to complete, the children underwent a visual examination and were tested with the Revised Wechsler Intelligence Scale for Children and the child’s teacher was sent a questionnaire to complete.

Results: Neonatal survival was significantly greater in the two largest hospitals (A and B) and this difference in survival remained at 7–8 years of age after adjustment for perinatal factors (P < 0.05). There were no differences between hospitals in risks of long‐term sensorineural disability and behavioural or educational outcomes. There were interhospital differences in rates of visual problems and, after adjustment for confounding factors, there remained a marginally significant (P = 0.06) increased risk of myopia in hospital D.

Conclusions: Despite differences in early morbidity favouring larger hospitals, there were no substantive differences in long‐term (7–8 years) outcomes across a range of measures in this national cohort of VLBW infants.
Acquired central diabetes insipidus in children: A 12‐year Brisbane experience
Authors: Al‐Agha AE , Thomsett MJ , Ratcliffe JF , Cotterill AM , Batch JA
Published: March 2003

Objective: To study the clinical, endocrine and radiological features and progress of children presenting with acquired diabetes insipidus (CDI).

Methodology: Chart review of children presenting because of CDI to Brisbane paediatric endocrine clinics between 1987 and 1999.

Results: Thirty‐nine children (female/male ratio 21/18) aged 0.1–15.4 years (mean age 6.7 years) were identified. Aetiologies were head trauma or familial in eight cases (20.5%) each, central nervous system (CNS) tumours in five cases (12.8%), CNS malformations in four cases (10.2%), histiocytosis in three cases (7%) and hypoxia and infection in two cases (5.1%) each. Seven cases (17.9%) remain undiagnosed. Of the 32 (82%) cases with isolated anti‐diuretic hormone deficiency at presentation, 24 cases (61.5%) experienced no further endocrine deficit. Additional endocrine deficits occurred mainly in the tumour or undiagnosed groups. On follow‐up brain magnetic resonance imaging (MRI) scans in the seven undiagnosed cases, six patients had mild or no change and one patient had marked improvement of MRI findings. These changes occurred 10–48 months (mean 18 months) after presentation.

Conclusions: Children without an aetiological diagnosis for the uncommon condition of acquired CDI require careful follow‐up. More intensive investigation at presentation (e.g. estimation of cerebrospinal fluid human chorionic gonadotrophin) promises to lessen the number of such cases. Pituitary stalk biopsies should be reserved for those patients with progressive MRI changes. If these changes do not occur early, our experience suggests that follow‐up MRI scans may need to be performed only yearly.
Specific dangers associated with infants sleeping on sofas
Authors: Byard RW , Beal S , Blackbourne B , Nadeau JM , Krous HF
Published: March 2003

Aim: A study was undertaken to examine specific circumstances that may lead to accidental asphyxial deaths in infants on sofas.

Methods: Coronial files in South Australia (Australia) from 1989 to 1998, and files at the Office of the Medical Examiner in San Diego County (USA) from 1991 to 1998 were searched for all cases of infant deaths occurring on sofas.

Results: A total of 10 cases with complete death scene descriptions were found. Four deaths were attributed to sudden infant death syndrome and six deaths to accidental asphyxia, of which four involved shared sleeping with an adult. Lethal circumstances involved infants being overlayed by an adult (n = 2), wedged between an adult and the back of a sofa (n = 1), sleeping with an intoxicated/sedated adult (n = 2), wedged between pillows and the back of a sofa (n = 1), and wedged into the back of a sofa (n = 1).

Conclusions: Although shared sleeping of an adult with an infant on a sofa may result in accidental asphyxia, there is also the potential for wedging and accidental asphyxia of infants sleeping alone on a sofa. For this reason the use of sofas for both shared and solitary infant sleeping is discouraged.
Hypocarbia in the ventilated preterm infant and its effect on intraventricular haemorrhage and bronchopulmonary dysplasia
Authors: Erickson SJ , Grauaug A , Gurrin L , Swaminathan M
Published: March 2003

Objective:  To examine the relationship between PaCO2 levels in ventilated very preterm infants and (i) the incidence of severe intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL); and (ii) bronchopulmonary dysplasia (BPD).

Methods:  A retrospective cohort analysis of preterm infants comparing PaCO2 levels with the incidence of severe IVH/PVL and BPD was carried out on patients born at less than 29 weeks gestation from 1992 to 1994 and admitted to the tertiary neonatal intensive care unit at the King Edward Memorial Hospital (314 infants). During the first 96 h, PaCO2 levels were examined including lowest and highest PaCO2 levels, mean PaCO2 levels and duration of hypocarbia both pre‐ and post‐surfactant administration.

Results:  Of the 314 infants, there were 40 early neonatal deaths (less than 48 h) who were not included in the analysis. Of the 274 surviving infants, 72 (26%) infants had severe IVH. Infants whose PaCO2 fell below 30 mmHg at any stage in the first 48 h of life had an increased risk of severe IVH or PVL (odds ratio 2.38; 95% CI 1.27−4.49; P = 0.007). Of the 265 survivors to 36 weeks corrected gestational age, 134 (51%) had BPD. Infants with at least three PaCO2 values less than 30 mmHg in the first 24 h of life had an increased risk of BPD (odds ratio 2.21; 95% CI 1.05−4.57; P = 0.036).

Conclusions:  The risk of severe IVH/PVL was significantly increased by hypocarbia. There was also an association between hypocarbia and BPD, particularly when hypocarbia was prolonged. These findings suggest that avoidance of hypocarbia may reduce the incidence of severe IVH/PVL and BPD in preterm infants.
Evaluation of a community intervention programme for preschool behaviour problems
Authors: Elliot J , Prior M , Merrigan C , Ballinger K
Published: March 2003

Objectives: To evaluate an early intervention project focused on improving child prereading skills and parent behaviour‐management skills, for 4‐year‐old children in the western suburbs of Melbourne (Victoria, Australia).

Methodology: Following screening of a large sample of preschoolers, four groups were constructed: (i) children receiving a phonological skills‐based prereading package in their normal preschool programme; (ii) children whose parents attended six sessions of child behaviour management skill training; (iii) children who received both interventions; and (iv) a control group. Pre‐, post‐, 1 and 2 year follow‐up measures were taken to assess effects on child behavioural and learning adjustment.

Results and Conclusions: This community based intervention resulted in positive effects, despite being of low intensity, in achieving significantly less hyperactive/distractable behaviour in children from the combined intervention group at 2 years postintervention. Anxiety problems were also reduced at the post‐treatment phase. The prereading package did not demonstrate any effects on reading skills and was deemed to be insufficiently intensive to affect a population of disadvantaged preschoolers. This universal‐type of intervention was well accepted by the community, but there is need for further effort to increase recruitment of families of at‐risk children into such programmes.
Pseudomonas fluorescens pseudobacteraemia: A cautionary lesson
Authors: Smith J , Ashhurst‐Smith C , Norton R
Published: March 2003

Objectives: To describe an outbreak of pseudobacteraemia caused by Pseudomonas
fluorescens in a paediatric population. To document and highlight the effect this outbreak had on clinical management and the steps taken to determine the source.

Methods: A clinical and microbiological investigation was carried out into
a cluster of 38 pseudobacteraemias caused by Pseudomonas fluorescens in paediatric patients over a 10 month period.

Results: The source of the outbreak of pseudobacteraemia was found to be
contaminated lithium heparin tubes, which were being filled prior to the filling
of the blood culture bottle. Cultures of the same tubes yielded Pseudomonas fluorescens. As a result of the initial positive blood cultures, clinical management was altered in 18 cases. A staff education programme was instituted and eventually resulted in a cessation of the pseudobacteraemia.

Conclusions: Pseudobacteraemias are a major cause of potentially inappropriate therapy in febrile children. Attention to detail in the collection of blood cultures can help reduce this outcome. Staff involved in the collection of blood cultures need to be aware of this potential source of contamination.
Iatrogenic injury in childhood staphylococcal scalded skin syndrome
Authors: Holme SA , Davies JH , Mills CM
Published: March 2003

Staphylococcal scalded skin syndrome (SSSS) may cause significant morbidity in children. It is common practice for adhesive occlusive dressings to be used to apply topical local anaesthetic prior to venepuncture. We report two cases in which removal of these dressings from children with SSSS caused injury and discomfort in areas previously free from blistering. We recommend that an alternative method of topical anaesthetic application is used to minimize skin trauma in these patients.
Can a PC‐based model assist the management of waiting lists? Observations from a case study
Authors: CROMWELL DP , MAYS L
Published: March 2003

Abstract Routine statistics provide only limited support to doctors and managers responsible for the management of surgical waiting lists. Therefore, a study developed a PC‐based model that could assist medium‐term planning activities that, for example, aim to reduce excessive waiting times. The model allows the user to create scenarios that describe possible future activity levels and calculates how these will affect waiting list behaviour. A key feature of the model is that it recognizes that a waiting list consists of different categories of patients that move through the list at different speeds. The model can be used with routinely available data. The model was tested at three sites where it proved capable of providing valuable insights and assisting doctors and managers to better understand waiting list dynamics. However, although the model quantified the changes required to reduce waiting times, the sites could not always implement these changes owing to resource constraints.
The effects of a Seamless Model of management on the quality of care for emergency department patients
Authors: Browne G , Lam Lt , Giles H , Mccaskill M , Exley B , Fasher B
Published: March 2003

Abstract The aim of this study was to examine the effectiveness of the seamless model of management on the quality of care for emergency department (ED) patients. This was a pre‐ and postintervention study of comparing post intervention data with the baseline on several variables of interest. The intervention was the seamless model of ED management, designed and implemented as a response to the challenge of increasing work load at the ED. Information on patients’ waiting times, critical care performance, patients’ satisfaction and staff morale was collected at baseline and postintervention for comparison. The results indicated significant improvements on all outcome measures were found postintervention. The average waiting time reduced by 40%, from 92.1 to 55.3 min, as well as the time to craniotomy from 120 to 45 min for more severe patients. Complaints from patients were reduced by 80% and staff morale had improved with a 48% reduction in sick days and a 80% reduction in staff resignations. Ambulatory patients presenting to the department saw a 20% improvement in their waiting time. We report a successful restructuring process that used routinely collected clinical and administrative data to highlight problems. Using these data and through a systematic planning process, appropriate strategies for restructuring were developed by emergency staff in partnership with the hospital executive. Significant improvements in waiting time and patient care were clearly demonstrated.
Evidence‐based surgery at ASERNIP‐S. Can this improve quality in surgical practice?
Authors: Babidge Wendy , Maddern Guy
Published: March 2003

Abstract The Australian Safety and Efficacy Register of New Interventional Procedures ‐ Surgical (ASERNIP‐S) project has been established to form a register of new surgical procedures which have been assessed for their safety and efficacy. The ASERNIP‐S project systematically reviews the evidence and produces recommendations on the future use of surgical procedures in clinical practice. Further data may be collected to provide information on the outcomes of procedures in use in Australia. Horizon Scanning of new and emerging techniques and technologies complements the ASERNIP‐S process. This research identifies procedures that will impact on clinical practice in the near future. Dissemination of information from ASERNIP‐S assessments, both locally and internationally, is important for quality improvement. The ultimate aim is for appropriate changes in practice to ensure the highest quality of Australian healthcare.
Variance analysis in clinical pathways for total hip and knee joint arthroplasty
Authors: Dalton Philip , Macintosh DJ , Pearson Belinda
Published: March 2003

Abstract Clinical pathways are being increasingly used for daily patient care. The pathways consist of a sequence of critical treatment events matched to the patient’s recovery. Variance analysis identifies deviations from the pathway and can be used for quality improvement and clinical audit. The aim of this study is to analyse the variances from clinical pathways in two common elective orthopaedic operations. A prospective variance analysis was performed from the clinical pathways of all patients undergoing total hip and total knee arthroplasty over a 12 month period. Variances were categorised according to their source and then further divided into serious and non‐serious variances. A total of 65 patients underwent total knee replacement during the study. Eleven serious variances were recorded in eight of these patients (12.3%) with a surprisingly high number of cardiac events. A total of 52 patients underwent total hip replacement with nine serious variances recorded in seven of these patients (13.5%). Clinical pathways can be used as a means of incorporating evidence‐based medicine into clinical practice. Variance analysis of the pathways can be utilised as a process of quality control and to improve patient outcomes. Serious variances within this study were higher than anticipated.
A system for systems is required for quality health systems
Authors: Ibrahim Joseph E
Published: March 2003

Abstract Improving quality of health‐care requires a systematic approach at many different levels within a health system. The levels range from the interactions between individual patient–health provider to the international stage. The provision of care within and between each level needs to be systematically organised if the quality of our health‐care is to improve. There is a need to develop a systematic approach to the multiple systems within health care. An organisational structure similar to the Cochrane Collaboration may provide the mechanism to better co‐ordinate all our efforts to improve health‐care quality.
The environmental state of Argentinean lakes: An overview
Authors: Quirós Rolando , Drago Edmundo
Published: March 2003

Due to the great climatic variety and the peculiar north–south orographic distribution, Argentinean lake systems include a wide diversity of aquatic environments. The deepest lakes are situated in the Andean Patagonia and Tierra del Fuego, and range from ultraoligotrophic to oligotrophic. Patagonian Plateau lakes are shallower than Andean lakes and usually range from mesotrophic to eutrophic. All lakes in the Chaco‐Pampa Plain are very shallow and range from eutrophic to hypertrophic or salt lakes. Most of the lakes situated in the central–western and northwestern arid regions are reservoirs or salt lakes, and range from mesotrophic to eutrophic. More than half of the northwestern reservoirs have very low dissolved oxygen concentrations in the hypolimnion during mid‐summer. Argentina has more than 400 lakes with surface area >5 km2, but for some of them not even major ion data are available. In order to synthesize and to extract general characteristics and patterns, issues have been selected which adequately reflect the character of the lake environment in Argentina. We divided Argentina according to geographical regions into six major divisions: Puna, Chaco‐Pampa Plain, Peri‐Pampean Sierras, Andean Patagonia, Patagonian Plateau, and Misiones Plateu and Brazilian Shield‐related systems. Most of the lakes situated in Patagonia are undisturbed lakes. However, the Chaco‐Pampa Plain lakes are usually lightly impacted by agricultural operations. Moreover, most of the reservoirs located in the Argentinean arid ‘corridor’ are highly impacted by agriculture. Other lakes in both north and south Argentina range from salt lakes, through dark humic‐stained lakes and large river floodplain lakes, to dilute high altitude glacial lakes. Argentina still has a larger proportion of its lake waters in natural conditions. However, expected developments for natural resources indicates that Argentinean goals for lake water management should include the preservation of some proportion of pre‐European natural lake environment, and the evolution of a stable, managed lake environment in the more developed regions.
Inle: A large Myanmar lake in transition
Authors: Su Myint , Jassby Alan D.
Published: March 2003

Inle Lake is situated in the southern part of Shan State in Myanmar. It is the country’s second‐largest lake, home to more than 120 000 people and a large bird sanctuary and a major source of hydroelectric power for southern Myanmar. Several distinct environmental problems have arisen in the lake basin. A long‐term decrease in lake area has taken place over the last 30 years, probably because of siltation and climate. The drought of the last 2 years in particular has caused a drop in hydroelectric power output, which is affecting southern Myanmar. Many marginal parts of the lake are occupied by elephant grass mats (Saccharum spotaneum L.), known locally as kaing. These mats mature to form solid, floating islands, which are used for a unique form of agriculture but are also an increasing source of pesticide and fertilizer runoff into the lake. Textile cottage industries also abound, and both natural and manufactured dyes are discharged into the lake. Households, including many houses built on stilts in the lake, are a source of garbage and sewage. Livestock breeding also is a source of sewage. Shifting (taungyar) cultivation and village expansion has greatly increased erosion. Dredging is now necessary in many places and water clarity has decreased. The Inle carp (Cyprinus carpio intha), known locally as nga‐phane, plays an important role in the food supply, as well as being a cultural symbol of the local Intha people. Nga‐phane population abundance is currently low, probably because of changes in water chemistry and decreased clarity in the lake water. Partially because of the perceived potential for tourism, many sectors are now involved in lake rehabilitation and management.
Lake Jabel restoration project: Phosphorus status and possibilities and limitations of diversion of its nutrient‐rich main inflow
Authors: Kleeberg Andreas , Nixdorf Brigitte , Mathes Jürgen
Published: March 2003

External and internal phosphorus loading was studied in 1996 in the anthropogenically eutrophicated Lake Jabel, which is located in Mecklenburg (north‐eastern Germany). It has a dimictic 23‐m‐deep northern basin, a 19‐m‐deep middle basin and a 6‐m‐deep polymictic southern basin. The main tributary, Grabowhöfer Grenzgraben, which enters via a leaching field from a waste‐water treatment plant, has been identified as the major nutrient discharge (80% of total phosphorus loading) into the northern basin. The sediment is the second largest source of phosphorus for Lake Jabel, contributing 25.7%, 27.4% and 2.4% of the overall phosphorus load to the northern, middle and southern basins, respectively. Although the favoured diversion of the Grabowhöfer Grenzgraben would contribute to a reduction of 1.22 t P and 20.94 t NO3‐–‐N per year, it is mainly rejected for the following reasons. If the extreme monthly nitrate supply, between 4.84 and 189.6 mg N m‐2 day–1 ceased, the release of redox‐sensitive phosphorus in the northern basin would increase by a factor of 0.54, which is with 41.1% total phosphorus, twice as high as that in the middle basin. In addition, the nitrate supply can substantially lower the seasonal precipitation of stable iron sulphides, which would otherwise lower the concentration of redox‐sensitive phosphorus, but cannot change the phosphorus retention in the long term. Because of internal phosphorus sources, the diversion of the Grabowhöfer Grenzgraben would result in no substantial changes in the level of trophy.
Storage of ammonia in old sewer sediments
Authors: Dabrowski Wojciech
Published: March 2003

Nitrogen sources in combined sewers are briefly summarised. Some evidence of biodegradation including the ammonification of sewer sediment has been found from a new interpretation of field experimental data known from the literature. Gravel and sand sediments in combined sewers were found to be potential sources of ammonia, which is discharged through overflows.
Top‐down biological controls on tropical lake productivity
Authors: Hubble D. S. , Harper D. M.
Published: March 2003

Although productivity is primarily controlled by bottom‐up factors (nutrient levels), there are secondary effects caused by biological factors such as zooplankton grazing and algal self‐shading. The measurement of grazing effects and determination of the contributions of different nutrient pools should elucidate the roles of nutrient levels and biotic effects and also infer the relative importance of classical and microbial food webs. To produce a series of grazing intensity, after initial screening to remove macrozooplankton, lake water was filtered to remove remaining zooplankton. This was used to dilute whole lake water in a filtered : unfiltered ratios from 0:1 to 1:0, which was then incubated with nutrient enrichment. Results show an increase of up to 20% in productivity for surface midlake waters. To investigate grazing by nutrient dilution/deletion, grazing dilutions were again prepared; however, nutrients were added to produce three different conditions,+N +P (all nutrients), –N (nitrogen omitted) and –P (phosphorus omitted). From productivity measurements, the contributions of internal, external and recycled nitrogen and phosphorus nutrient pools were calculated. Sites at Hippo Point (HP) (midlake) and Malewa River inflow (MR) (near the mouth of the River Malewa) show little difference in the contribution of external nutrients, but remaining productivity is mostly fuelled by recycled nutrients at the MR site. Little difference was found between nitrogen and phosphorus‐limited conditions.
Lakes and society: The contribution of lakes to sustainable societies
Authors: Klessig Lowell L.
Published: March 2003

Lake management is typically approached from a biophysical perspective. Lake managers ask how lakes can be managed to sustain their ecological functions. The social value of lakes is usually given less attention. The present paper begins the analysis at the other end of the lake and society connection by posing the question: what social needs must be met to sustain society? The primary social needs of sustainable societies are outlined and then the contribution of lakes to each need is discussed. Lakes can only provide optimal social benefits if management decisions recognize the full set of potential contributions lakes can make to society and those management decisions are integrated to provided balanced attention to all values that lakes provide. The present paper expands the domain of values beyond the traditional environmental and recreational contributions of lake management to also include aesthetics, education, economic opportunity, emotional security, cultural opportunity, individual freedom and spirituality. Citizen involvement is essential in broadening the conceptualization of the lake values and in implementing integrated management plans.
Lake Toba: Need for an integrated management system
Authors: Saragih Bungaran , Sunito Satyawan
Published: March 2003

Lake Toba is the largest year‐round lake in South‐East Asia and the largest volcanic lake in the world. The Lake Toba catchment area faces an environmental crisis characterized by widespread deforestation, drought, decline of the water level, water quality degradation, invasive species and loss of biological diversity. More than half of the Lake Toba catchment area is classified as land at high erosion risk. Widespread poverty gives people little room to think beyond day‐to‐day needs and is an instrument for unsustainable methods of fishing and growing food. The Lake Toba catchment area is not managed as an integrated whole, but rather as four separate districts. Guidelines and orders tend to come from the government in Jakarta rather than being developed locally with stakeholder involvement. Differences in approach between government and non‐governmental organizations (NGOs) have resulted in friction and mistrust between the two. Local, national and international NGOs have been the biggest contributors to increasing the awareness of the need for an integrated approach to managing the lake. Technical exchanges with Lake Champlain have facilitated an exchange of experience of managing a large lake watershed, the transfer of low‐cost alternative technologies for managing waste water in small communities and development of new approaches to pulp and paper mills on both lakes. The Lake Toba Heritage Foundation’s priorities include establishing a research and monitoring programme, creating a science and education centre, and developing better coordination among central, provincial and district levels of government.
Greek Lakes: Limnological overview
Authors: Zacharias Ierotheos , Bertachas Ilias , Skoulikidis Nikolaos , Koussouris Theodoros
Published: March 2003

The Institute of Inland Waters in Greece has investigated the physical, chemical and biological characteristics of major Greek lakes, with regard to water use, quality and trophic status. Based on this and other limnological investigations, Greek lakes can be divided into three categories: warm monomictic deep lakes, warm monomictic shallow lakes, and dimictic shallow lakes. The water quality of some Greek lakes demonstrates the presence of high concentrations of nutrients and heavy metals, with reduced concentrations of diluted oxygen. High concentrations of ammonia, nitrate and phosphate are found in many lakes, while anaerobic hypolimnia are usually found in shallow lakes. Phosphorus is the main nutrient responsible for eutrophication because it is the limiting factor in most of the lakes that were investigated.
Ultrastructural changes in endothelial cells of cerebral microvessels after exposure to nitric oxide donor
Authors: Anuntasethakul Thiraporn , Srikiatkhachorn Anan , Maneesri Supang , Patumraj Suthiluk , Kasantikul Vira
Published: March 2003

It has been largely accepted that nitric oxide (NO) plays an important role in cerebral vasomotor control. NO has also been proposed to be a significant chemical in the process of endothelial cell injuries in various pathological conditions. Although the toxic effect of high concentrations of NO has been shown, only a few ultrastructural studies have been reported. The purpose of this study is to demonstrate physiological and pathological changes in cerebral microvessels after exposure to a high dose of NO donor. Glyceryl trinitrate, a NO donating chemical, was administered intravenously (10 mg/kg) to experimental rats. The vasomotor response was monitored by in vivo fluorescein videomicroscopy and ultrastructural changes were studied using transmission electron microscopy. The result showed long‐lasting vasodilatation of pial microvessels. The greatest response was observed in microvessels with baseline diameter of less than 10 μm compared with microvessels of a larger diameter (P = 0.003). Exposure to NO donor produced considerable changes in the ultrastructure of cerebral microvessels. Such morphological changes were characterized by increased pinocytosis, increased microvillous formation, mitochondrial swelling, doming of the endothelial surface, swelling of the perivascular astrocytic foot plate and partial separation of endothelial cells from the adjacent brain tissue. These results confirm the cytotoxic effect of NO on cerebral endothelial cell and further elaborate the role of this substance in endothelial cell injury observed in various conditions.
Astroblastoma: Report of a case with microsatellite analysis
Authors: Shuangshoti Shanop , Mitphraphan Woranart , Kanvisetsri Somruetai , Griffiths Lisa , Navalitloha Yot , Pornthanakasem Wichai , Mutirangura Apiwat
Published: March 2003

A 5‐year‐old girl who developed progressive headache, vomiting, and left hemiparesis was found to have a cystic tumor with an enhanced mural nodule in the right frontoparietal region on a computed tomography examination. The lesion was histologically and ultrastructurally verified as an astroblastoma, an uncommon neuroepithelial tumor of uncertain origin. Molecular analysis using 17 microsatellite markers on chromosomes 9, 10, 11, 17, 19, and 22 showed loss of heterozygosity at the D19S412 locus on the long arm of chromsome 19. This observation suggests that there is a tumor suppressor gene in this chromosomal region, which plays a role in the pathogenesis of astroblastoma.
Support of axonal regrowth by endogenous mechanisms following spinal cord injury in adult rats
Authors: West Norman R , LeBlanc Victoria , Collins George H
Published: March 2003

Because of its non‐invasive nature and ease of regulation, a closely monitored cryogenic method of tissue injury was used to create a degree of spinal cord injury within which there would be an extended regrowth of axons. The parameters of cooling used in the present study resulted in an injury length of 1 cm through which 3 mm of measured axonal regrowth and 8 mm of observed regrowth occurred over a 56‐day period in the ascending fibers of the dorsal column of the mature rat. This was associated with the development of a cellular matrix consisting of macrophages, macroglia and Schwann cells which gradually expands within the injured area initially dominated by macrophages. It is the authors' impression that the presence of a substantial microglial component within the macrophage population may be a significant factor in the success of the axonal regrowth. Under this influence and that of the invading axons, the astrocyte, which provides the immediate cell support to the growing axon, can be maintained in a functional state that is supportive and not obstructive to the axon, presumably through the recruitment of astrocyte precursors from an indigenous stem cell population. These tissue changes indicate that adult mammalian spinal cord tissue does have the capacity to develop on its own a matrix capable of supporting the regrowth of axons.
Diabetic renal disease in transitional and disadvantaged populations
Authors: Nelson Robert G
Published: March 2003

Diabetes mellitus has reached epidemic proportions throughout much of the world, and people from developing countries and disadvantaged groups from developed countries are affected disproportionately. Not only is diabetes more common in these populations, but it develops at an earlier age. Accordingly, patients have more years of life in which to develop the chronic complications of diabetes and the risk of complications is often further enhanced by limited access to health care. Renal disease is a frequent consequence of diabetes in these populations, and a number of factors related to poverty, malnutrition and accelerated lifestyle changes may lead to even greater rates in the future.
Elective withdrawal of cyclosporin following renal transplantation: A single centre experience
Authors: STOVES John , NEWSTEAD Charles G , WILL Eric J , DAVISON Alexander M
Published: March 2003

SUMMARY: Withdrawal of cyclosporin in the early post‐transplant period may provoke acute graft dysfunction, although the reported incidence is variable. We have reviewed our experience of 212 renal transplant recipients to determine the incidence of early post‐withdrawal acute graft dysfunction and examine which factors predict it. Gender, age at initiation of withdrawal, timing and duration of withdrawal, pre‐withdrawal immunosuppression, doses of prednisolone and azathioprine at initiation of withdrawal and, during the first 6 months post witfidrawal, episodes of prior acute transplant rejection, human leucocyte antigen match and previous renal transplantation were considered. In classifying acute graft dysfunction, a 50% increase in serum creatinine from baseline was taken as a minimum criterion, and additional evidence (biopsy, fine needle aspirate, response to immunotherapy) was sought for evidence of a link with cyclosporin withdrawal. Acute graft dysfunction was documented in 28 (13.2%) patients, 26 episodes occurring within 4 months of completion of cyclosporin withdrawal. the mean time interval from transplantation to initiation of withdrawal was significantly shorter in this group (239 vs 299 days, P < 0.02). the median withdrawal period was of similar duration in the groups with and without acute dysfunction, but for the subgroup of patients previously on triple therapy (cyclosporin, prednisolone and azathioprine, n= 78), withdrawal had occurred more rapidly in those with dysfunction (25 vs 67 days, P < 0.05). None of the remaining variables that were considered had a significant effect on outcome, although subgroups tended to be small. Cyclosporin withdrawal may be safer if delayed until after the first post‐transplant year with gradual dose reduction over a period of months.
Factors affecting haemodialysis‐access survival in a single centre retrospective cohort study
Authors: LAWRENCE Christopher , CHOW Josephine , SURANYI Michael
Published: March 2003

SUMMARY: A retrospective review was undertaken in the prevalent haemodialysis population of an Australian Tertiary Renal Unit of patients who started haemodialysis between April 1994 and September 2000. the study aimed to assess the factors affecting the choice of long‐term arteriovenous haemodialysis access, and the factors influencing access survival. Data were obtained from clinical charts and Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. the minimum follow up was 3 months. There were 71 patients studied (66.2% male, 22.5% diabetic, mean age 56.9 years). Late referral (<3 months) patients constituted 35.2%. Only 39% of patients were Australian born. Seventy‐one patients had a total of 96 new vascular access operations, and 57 revision operations. of the 71 first‐access procedures, 56 were native fistulae and nine were synthetic grafts. Only 31% of long‐term vascular access was in place 6 weeks or longer prior to the start of dialysis. of 25 subsequent (new) access placements, only eight were fistulae and 17 were grafts. Diabetes, peripheral vascular disease and coronary artery disease all significantly predisposed to the placement of synthetic grafts. First native fistulae had superior survival to subsequent native fistulae. Subsequent fistulae had a significant rate of early loss, but were then stable. Survival of native fistulae was always superior to synthetic grafts (P= 0.0072). First synthetic graft survival was similar to the survival of subsequent grafts. Although native fistulae are already favoured for first access, these results suggest that native fistulae should more often be considered for subsequent (secondary) access.