bluuebunny/crossref_metadata_2025 huggingface dataset:
Fungal endophytes in woody roots of Douglas‐fir (Pseudotsuga menziesii) and ponderosa pine (Pinus ponderosa)
Authors: Hoff J. A. , Klopfenstein N. B. , McDonald G. I. , Tonn J. R. , Kim M.‐S. , Zambino P. J. , Hessburg P. F. , Rogers J. D. , Peever T. L. , Carris L. M.
Published: July 2004

The fungal community inhabiting large woody roots of healthy conifers has not been well documented. To provide more information about such communities, a survey was conducted using increment cores from the woody roots of symptomless Douglas‐fir (Pseudotsuga menziesii) and ponderosa pine (Pinus ponderosa) growing in dry forests on the eastern slope of the Cascade Mountains in Washington state, USA. Fungal isolates were cultured on standard media, and then were identified using a combination of molecular and morphological methods. Fungal genera and species identified in this study will provide baseline data for future surveys of fungal endophytes. Examination of internal transcribed spacer (ITS1 and ITS2) and 5.8S rDNA sequences and morphology of cultured fungi identified 27 fungal genera. Two groups predominated: Byssochlamys nivea Westling (20.4% of isolations) and Umbelopsis species (10.4% of isolations). This is the first report of B. nivea within large woody roots of conifers. Both taxa have been previously identified as potential biological control agents. Although some trends were noted, this study found no significant evidence of host species or plant association effects on total recovery of fungal endophytes or recovery of specific fungal taxa.
Soil compaction and chestnut ink disease
Authors: Fonseca T. F. , Abreu C. G. , Parresol B. R.
Published: July 2004

Chestnut ink disease caused by the oomycete Phytophthora cinnamomi, a soil‐borne pathogen of world‐wide distribution, accounts for the majority of disease problems on chestnuts in Portugal, limiting yield in a large number of stands and impeding establishment of trees in new areas. A survey was carried out in 32 chestnut stands in the Padrela Mountains of northern Portugal to investigate the relationship among ink disease occurrence, edaphic factors and management practices. A logistic regression function was employed to analyze the effect of soil attributes and management practices on the stand health status. Results showed that the main factors affecting disease were soil compaction (COMP), soil organic matter level (OM) and manuring practice (MA). A logistic model containing the soil variable COMP and the interaction term OM × MA correctly predicted the stand health status in 94%, or 30, of the 32 stands studied. The logistic function coefficients indicate that the probability of a stand having ink disease increases with increasing soil compaction and increasing soil organic matter content in stands where manuring is the usual practice.
Functional Molecular Biodiversity: Assessing the Immune Status of Two Sponge Populations (Suberites domuncula) on the Molecular Level
Authors: Schröder Heinz C. , Grebenjuk Vladislav A. , Binder Michael , Skorokhod Alexander , Batel Renato , Hassanein Hamdy , Müller Werner E. G.
Published: July 2004

Abstract.  Porifera (sponges) are sessile filter feeders living primarily in the marine environment. In this study the population diversity of one species, the demosponge Suberites domuncula, has been investigated in an isolated area, the Limski Canal (LC) near Rovinj (Croatia; Mediterranean Sea), in comparison to that in the open sea (OS), only 10–20 km apart from the LC. The immune competence of the S. domuncula specimens was studied in response to exposure to the bacterial endotoxin LPS. The level of phosphorylation of the p38 kinase from specimens collected in LC is significantly lower than that of OS animals. To confirm the biochemical data on the molecular level, the technique of identification of the differentially expressed transcripts in specimens from OS versus LC was applied. Most of the differently expressed transcripts coded for the allograft inflammatory factor‐1 (AIF‐1), a molecule involved in self‐self/self‐non‐self recognition also in S. domuncula. The level of gene expression of the AIF‐1 gene, determined by Northern blotting and quantitative ‘real‐time Q‐PCR’ revealed much higher values in the OS animals. Moreover, the degree of polymorphism in the AIF‐1 and in the adjacent tubulin locus was high in animals from both locations. Populations of S. domuncula therefore comprise a high genetic diversity even in closely located areas. This finding has prompted long‐term research activities in the Limski Canal, a defined marine protected area.
Giving voice to the burden of blame: A feminist study of mothers’ experiences of mother blaming
Authors: Jackson Debra , Mannix Judy
Published: July 2004

Mother blaming has been identified as a pervasive and serious problem and it is known that the professional literature has strong and entrenched mother‐blaming messages. Using a feminist approach, this paper explores mother blaming as it has been experienced by a group of mothers themselves. Analysis of narrative exposes mother blaming as a burden that complicates the already‐complex responsibilities that comprise mothering. Health providers are among those identified by women as being particularly likely to attribute problems with (even grown) children to maternal fault. Implications for practice and research are drawn from the findings of this paper.
Journeying to professionalism: The case of Irish nursing and midwifery research
Authors: Condell Sarah L
Published: July 2004

This paper gives a ‘discursive’ account of the contemporary development of nursing and midwifery research in the Republic of Ireland in the context of advancing professionalism. Initially, the paper views the landscape by placing research in the current framework of Irish nursing and midwifery. It then examines the map of our present location by documenting a baseline. It ascertains the signposts that are in place by exploring the strategic direction for development. Finally, it uses the compass to orienteer the route through the various obstacles by examining the challenges of the role of the joint appointee leading the implementation of the national Research Strategy for Nursing and Midwifery in Ireland.
A nursing intervention for the quality use of medicines by elderly community clients
Authors: Griffiths Rhonda , Johnson Maree , Piper Margaret , Langdon Rachel
Published: July 2004

Although considerable research and development work has been undertaken on the role of General Practitioners (GPs) and pharmacists in medication management, monitoring and referral, there is limited research into a role in medication management for community nurses. One hundred and thirteen older people living at home and receiving community nursing care were assessed for their knowledge of, and ability to manage their medication regimen. From these data, a nurse‐initiated intervention was developed that included nursing interventions and referral pathways to GPs for people who might benefit from a GP and/or pharmacist medication review. A subgroup of 24 participants with diminished knowledge of medications or ability to manage their regime (considered to be at risk of drug‐related problems) who were followed up, demonstrated an increase in knowledge, some alteration in compliance aids and with no statistically significant change in medication regime complexity. This paper details an approach to medication review and intervention suitable for community nurses that includes referral pathways within the medication team.
Ethics in nursing homes: Experience and casuistry
Authors: Slettebø Åshild , Haugen Bunch Eli
Published: July 2004

The purpose of the study was to further explore the methods that nurses use to solve ethically difficult care situations in nursing homes while the aim of this article was to present a model for nursing practice in such situations. Fourteen nurses from three nursing homes in Norway were observed and interviewed in order to discern the strategies they used to deal with ethically difficult care situations. To analyse this information, we used a constant comparative method until a grounded theory emerged. The nurses’ principal strategy was to apply earlier experiences while striving for the best outcome for the elderly patients. This article discusses this strategy and compares it to a theory of ethics called casuistry. We suggest that by using the method of experiences combined with casuistry in a more systematic way, nurses can develop acceptable solutions for difficult care situations in nursing homes.
The effectiveness of a pram‐walking exercise programme in reducing depressive symptomatology for postnatal women
Authors: Armstrong Kylie , Edwards Helen
Published: July 2004

The purpose of the research project was to examine the effects of exercise, social support and depression on postnatal women who reported experiencing postnatal depression. A 12‐week randomized, controlled trial was conducted investigating the effects of an exercise intervention group (a pram‐walking programme for mothers and their babies ) compared to a social support group (non‐structured sessions, similar to a playgroup). Participants in both groups had given birth in the past 12 months. Pretest data of physical fitness and structured questionnaires were compared to post‐test effects. The primary outcomes were to reduce the depressive symptomatology and improve fitness levels of participants in the pram‐walking group. Secondary outcomes were to improve the social support levels of the participants in both groups and explore women's views about the programmes. It was hypothesized that the pram‐walking group participants would improve their feelings of depression and fitness levels compared to the social support group, but that both groups would improve their perceived levels of social support. The results showed that mothers in the pram‐walking intervention group improved their fitness levels and reduced their level of depressive symptomatology significantly more than the social support group. There were no significant changes to social support levels for both groups. Therefore, a direct association between improvement in fitness was related to improvement in depression for the pram‐walking group. However, it is also suggested that other factors in combination with improvements in fitness influenced improvements in depression levels. It is recommended that pram‐walking programmes for mothers with postnatal depression be implemented as pilot research into existing available services.
Research and sudden infant death syndrome: Definitions, diagnostic difficulties and discrepancies
Authors: Byard RW , Krous HF
Published: July 2004

Abstract:  The diagnosis of causes of sudden infant death is an often complex and difficult process. Variable standards of autopsy practice and the use of different definitions for entities such as sudden infant death syndrome (SIDS) have also contributed to confusion and discrepancies. For example, the term SIDS has been used when the requirements of standard definitions have not been fulfilled. In an attempt to correct this situation recent initiatives have been undertaken to stratify cases of unexpected infant death and to institute protocols that provide frameworks for investigations. However, if research is to be meaningful, researchers must be scrupulous in assessing how extensively cases have been investigated and how closely cases fit with internationally recognized definitions and standards. Unless this approach is adopted, evaluation of research findings in SIDS will be difficult and the literature will continue to be beset by contradictions and unsubstantiated conclusions.
Iron status of young Vietnamese children in Australia
Authors: Nguyen ND , Allen JR , Peat JK , Beal P , Webster BH , Gaskin KJ
Published: July 2004

Objective:  The aim of this study was to estimate the prevalence of iron deficiency in Vietnamese children living in Australia and to identify risk factors associated with iron deficiency.

Methods:  A cohort of healthy term Vietnamese infants, were followed from birth (n = 210) to 18 months (n = 174) with anthropometry, dietary intake and feeding practices measured at seven time points. Socio‐demographic data were collected from the parents at the first home visit. At 18 months iron status was examined by full blood count and plasma ferritin concentration in 129/152 (85%) of the eligible children. Iron depletion was defined as a plasma ferritin level <10 µg/L. Iron deficiency without anaemia was defined as iron depletion plus MCV < 70fl and iron deficiency anaemia was defined as iron deficiency anaemia plus Hb < 110 g/L.

Results:  The prevalence of iron deficiency was iron depletion 19.4% (95% CI: 13.0%, 27.3%), iron deficiency without anaemia 3.1% (95% CI: 0.9%, 7.8%) and iron deficiency anaemia 3.9% (95% CI: 1.3%, 8.8%). Multiple regression analysis showed three significant predictors of iron deficiency: cows milk intake (negative effect), meat, fish or poultry intake (positive effect) and weight gain (negative effect). A cows milk intake ≥650 mL/day was a risk factor for iron deficiency.

Conclusion:  Prevalence of iron deficiency at 18 months was high despite appropriate infant feeding practices during the first year. Modification of the diet in the second year of life may decrease the risk of iron deficiency in Vietnamese children.
Asthma in emergency departments: Combined adult and paediatric versus paediatric only centres
Authors: Powell CVE , Raftos J , Kerr D , Rosengarten P , Kelly AM
Published: July 2004

Objective:  To compare the management of paediatric patients with mild or moderate asthma in paediatric‐only emergency departments (POEDs) to treatment in a mixed adult‐child emergency departments (mixed EDs).

Methods:  Prospective, observational study conducted in 36 Australian emergency departments (EDs) for 2 weeks in 2001. Children aged 1−15 years with acute asthma classified as mild or moderate severity. Details of demography, severity assessment, and type of treatment facility, treatment and disposition were collected. Analysis used descriptive statistics, comparison of proportions by χ2, and multiple logistic regression.

Results:  Two‐hundred and nine children were treated at POEDs and 257 at mixed EDs. The groups had similar severity. Spacers to deliver beta‐agonists were used more frequently in POEDs (67.5%vs 24.2%; P < 0.01). Children treated at POEDs with a mild attack were more likely to be admitted (20.6%vs 9.5%; P < 0.02) and given salbutamol (82.8% vs 71.9%; P = 0.03). For children with moderate asthma, oral steroid prescription on hospital discharge was more common for those treated in a mixed ED (81.0%v 95.7%; P = 0.01). Ipratropium bromide (IB) was widely used at both types of ED but more commonly used in mixed EDs (41.7%vs 54.9%; P < 0.01). There were no differences in length‐of‐stay, representation rate within one month and oral steroid use for attack. Less than 2/3 of children with mild asthma attacks received steroid treatment in the ED.

Conclusion:  Treatment was similar between the two types of ED. IB was overused in mild asthma and oral steroids were underused in moderate asthma, by both ED types. Spacers were under‐utilized in mixed EDs.
Predicting the need for ventilation in term and near‐term neonates
Authors: Morosini A , Davies MW
Published: July 2004

Objective:  To determine whether the need for respiratory support can be predicted by oxygen requirement within the first 72 h in term and near‐term infants.

Methods:  To mimic the population of infants that would often be delivered outside a tertiary centre we studied a retrospective cohort of infants ≥ 32 weeks requiring oxygen, divided into three groups: cot oxygen only, nasal continuous positive airway pressure (NCPAP) only, or intermittent positive pressure ventilation (IPPV). We recorded each infant's peak fraction of inspired oxygen (FiO2) − i.e. FiO2 in the first 72 h in the cot oxygen only group or maximum FiO2 prior to commencing the highest level of respiratory support. The peak FiO2 was used as a diagnostic test to predict any respiratory support or IPPV − sensitivity and specificity were calculated and receiver operating characteristic (ROC) curves plotted (FiO2 0.21−1.00) to identify the best balance point for prediction.

Results:  The cohort included 592 infants: 516 cot oxygen only, 46 NCPAP only and 30 IPPV. The proportion ventilated increased with increasing peak FiO2 − above 0.45 the proportion of infants ventilated exceeded 50%. To predict any respiratory support, the cut‐point balancing sensitivity and specificity was a FiO2 ≥ 0.35−58/136 required respiratory support (sensitivity = 0.76, specificity = 0.85, positive predictive value (PPV) = 43%, negative predictive value (NPV) = 96%). To predict IPPV the cut‐point was a FiO2 ≥ 0.5−28/47 treated with IPPV (sensitivity = 0.93, specificity = 0.97, PPV = 60%, NPV = 100%).

Conclusion:  The need for respiratory support can be predicted by oxygen requirement within the first 72 h in term and near‐term infants with reasonable sensitivity and excellent specificity.
Evolution of an adenovirus outbreak in a multidisciplinary children's hospital
Authors: Hatherill M , Levin M , Lawrenson J , Hsiao N‐Y , Reynolds L , Argent A
Published: July 2004

Objective:  To describe the course of an evolving adenovirus outbreak in a multidisciplinary children's hospital with a high‐risk patient population.

Methods:  Observational study in a 280‐bed university hospital during June 2002. Active case finding identified children with adenovirus infection. Data are median (interquartile range) or n (%). Adenovirus infection was diagnosed in 49 children, median age 12 months (4−33).

Results:  New cases were diagnosed over 26 days and peaked on day 17 (n = 15). Total infected inpatients peaked on days 17−21 (n = 36). Twenty‐three infections (47%) were community‐acquired and 26 (53%) hospital‐acquired. Thirty‐three children (67%) had a coexistent high‐risk condition. Median hospital stay before and after diagnosis was 9 days (3−18) and 9 days (4−29), respectively. Twenty‐two children (45%) were admitted to PICU. Overall hospital mortality was 22% (n = 11) and mortality attributed to adenoviral disease 12% (n = 6). Hospital mortality was similar between community‐ and hospital‐acquired infections (22% compared to 23%) (P = 1.0). Twenty children (41%) received intravenous immunoglobulin (IVIG). Children treated with IVIG had a longer hospital stay (median 40 days vs 14 days) than those who did not receive IVIG (P = 0.01). Neither PICU mortality (29%vs 12%), nor hospital mortality (35%vs 14%), differed significantly between IVIG treated and untreated children (P = 0.76 and P = 0.16, respectively).

Conclusion:  The rapid spread of hospital‐acquired adenovirus underlines the importance of effective infection control measures. Despite nosocomial infection amongst high‐risk patients, mortality was similar to that of community‐acquired infection. Administration of immunoglobulin was not associated with demonstrable benefit. A prospective randomized trial would be required to resolve this issue.
Intelligence and achievement of children referred following sexual abuse
Authors: Jones DA , Trudinger P , Crawford M
Published: July 2004

Objective:  Little is known about the prevalence of intellectual and academic problems in sexually abused children. Such problems may have significant implications for their management. This study examined the prevalence of such problems in a population of Australian children referred for sexual abuse evaluation. The study also assessed the clinical utility of the Parents’ Evaluation of Developmental Status (PEDS) questionnaire as a screening tool for learning and developmental problems in this population.

Methods:  Over a 12‐month period, children referred for sexual abuse evaluation to the Mater Children's Hospital Child Protection Unit were enrolled and background demographic and abuse related data collected. The children then completed standardized psychometric assessments. Their parents completed Child Behavior Checklists (CBCL) and PEDS questionnaires. Day care providers and schoolteachers completed the corresponding Caregiver or Teacher Report Forms (TRF).

Results:  A total of 21 of the 35 eligible children completed the assessment during the study period. Mean scores for intelligence and academic achievement were within the average range. However, three (14%) of the tested children were intellectually impaired and three (14%) showed academic underachievement. Sixty‐two per cent of children had problems in the clinical range on the CBCL and 33% on the TRF. The PEDS showed a sensitivity of 64%, specificity of 60% with a positive predictive value of 77%.

Conclusion:  In this population of referred children, over one quarter showed problems with intellectual impairment or academic under achievement. Most of these children were not receiving learning support at school. A high index of suspicion is therefore required when assessing sexually abused children for comorbid intellectual and learning problems.
Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area
Authors: Valery PC , Masters IB , Chang AB
Published: July 2004

Objective:  Respiratory health of Indigenous and minority ethnic groups in affluent countries is poorer than their non‐minority counterparts and sleep disorders are no exception. In children, obstructive sleep apnoea has the potential to result in serious long‐term consequences. In 1999, we studied 1650 children and adolescents living in the Torres Strait and the Northern Peninsula Area, Australia. Here we report prevalence of snoring in these communities and relate its association with asthma symptoms.

Methods:  A population‐based cross‐sectional study was conducted in the Torres Strait region. Five indigenous communities were randomly selected and information was collected using a structured face‐to‐face interview based on a standardized questionnaire. There was a 98% response rate, and 1650 children, 0−17 years of age, were included in the study.

Results:  Overall, the prevalence of snoring was 14.2% (95% CI 12.5−15.9); 3.6% (95% CI 2.7−4.6) reported snorting, and 6% (95% CI 4.9−7.2) reported restless sleep. The prevalence of snoring was significantly higher among males (17.1% for males and 10.8 for females, P = 0.005). Children were five times more likely to have experienced snoring and snorting if they reported wheezing in the last 12 months.

Conclusion:  We conclude that the prevalence of symptoms suggestive of obstructive sleep problems is relatively high in children of this region. This highlights the need for awareness among the community patients and physicians about the problem of obstructive sleep‐disordered breathing, especially in children with asthma, and for the need for further studies to measure prevalence of sleep breathing disorders among Indigenous Australians.
Notification of patients with acute flaccid paralysis since certification of Australia as polio‐free
Authors: Whitfield K , Kelly H
Published: July 2004

Objective:  Surveillance of patients presenting with acute flaccid paralysis (AFP) is the World Health Organization (WHO) recommended method for the detection of incident cases of poliovirus infection. Australia was certified free of circulating poliovirus in 2000 but is required to continue AFP surveillance until global certification. Although Australia reached the WHO nominated surveillance target in 2000 and 2001, it was not reached in 2002. Notification rates between states have been variable. We aim to investigate the difference in notification rates by state to determine whether different rates reflect different patterns of disease or different approaches to reporting.

Methods:  Notification rates were reviewed by state for the years 1997−2002. The completeness of case ascertainment was reviewed from published studies. Key informants described differences in AFP reporting in states with consistent differences in notification rates.

Results:  Australia achieved 75% of the WHO surveillance target for AFP cases between 1997 and 1999 and 98% between 2000 and 2002. After 2000, Queensland achieved 150% of its target while Victoria achieved less than 50%. New South Wales reached its target over the entire 6 years but other states and territories were not as consistent. Although the formal process for AFP reporting is uniform throughout Australia, many differences in approach were identified between Victoria and Queensland.

Conclusion:  Maintaining AFP surveillance at the required WHO standard will be more likely in Australia if the populous states are able to notify cases at the same rate as Queensland (since 2000) and New South Wales (in general).
Perinatal cytomegalovirus hepatitis: To treat or not to treat with ganciclovir
Authors: Vanc̆íková Z , Kuc̆erová T , Pelikán L , Zikmundová L , Priglová M
Published: July 2004

Objective:  The use on ganciclovir for perinatal cytomegalovirus (CMV) infection is controversial. We aim to evaluate the use of ganciclovir treatment for neonatal CMV hepatitis.

Methods:  We present five infants with perinatally‐acquired CMV hepatitis as a single organ manifestation of CMV infection. The three more severely affected children, i.e. those with cholestasis and elevation of serum hepatic enzymes to more than twice the normal values, were treated for 15 days with intravenous ganciclovir.

Results:  The three treated infants improved clinically and CMV DNA in the blood disappeared during treatment. After cessation of ganciclovir treatment all of the patients had a relapse of the infection. The two untreated patients recovered completely.

Conclusion:  The long‐term outcome of infants with CMV hepatitis is unpredictable. Some patients have persistent liver injury despite ganciclovir therapy. Ganciclovir therapy did not prevent chronic liver disease in any of the patients in our study. Owing to the possible serious side‐effects the cost‐benefit of ganciclovir treatment should be carefully evaluated.
Bone mineral metabolism changes in epileptic children receiving valproic acid
Authors: Öner N , Kaya M , Karasalihoğlu S , Karaca H , Çeltik C , Tütüncüler F
Published: July 2004

Objective:  The aim of this study was to evaluate bone mineral density (BMD) in epileptic children receiving valproic acid (VPA) and to determine differences between osteopenic and non‐osteopenic children.

Methods:  Thirty‐three epileptic children, receiving VPA for at least 6 months, were compared with 33 healthy children for BMD. BMD was measured by dual‐energy X‐ray absorptiometry at lumbar vertebrae, femoral neck and greater trochanter. Serum calcium, phosphorus, alkaline phosphates, osteocalcin and VPA levels were also determined.

Results:  Patient's osteocalcin levels were significantly higher (P = 0.02) and femur and trochanter BMD values were significantly lower (P = 0.04 and P = 0.03, respectively). Duration of VPA therapy was significantly longer and doses of VPA were significantly higher in seven osteopenic patients compared with 26 non‐osteopenic patients. Osteopenic patients (4.6 ± 2.4 years) were younger than non‐osteopenic patients (7.8 ± 3.2 years) (P = 0.01).

Conclusion:  Long‐term and high dose VPA therapy may cause osteopenia, primarily in younger epileptic children. These patients should be followed closely by BMD measurements.
Iron status and haematological changes in adolescent female inpatients with anorexia nervosa
Authors: Kennedy A , Kohn M , Lammi A , Clarke S
Published: July 2004

Objectives:  (i) To investigate the incidence of iron deficiency (both latent iron deficiency and iron deficiency anaemia) in post menarchal female adolescent patients hospitalized with anorexia nervosa. (ii) To observe changes in iron status during refeeding.

Methods:  During the study period all post menarchal female patients admitted to the adolescent unit with anorexia nervosa were invited to participate. Ferritin, serum iron, transferrin and transferrin saturation were measured on admission and discharge. Haemoglobin, haematocrit, weight, and body mass index were monitored weekly.

Results:  All 12 eligible patients participated in the study. Four patients had elevated ferritin levels on admission. Ten of the 12 showed a statistically significant fall in serum ferritin at time of discharge compared with admission (P = 0.004). One of 12 patients had a low serum iron at presentation. All 12 had normal serum iron levels at discharge. Nine of the 12 subjects had a higher serum iron at discharge which was statistically significant (P = 0.046). There was no significant change in haemoglobin levels when comparing admission and discharge levels. Nine of the 12 patients however, transiently developed anaemia, at some stage during treatment.

Conclusions:  Iron deficiency is uncommon at both presentation and after nutritional rehabilitation in post menarchal adolescent females with anorexia nervosa. This is most likely due to increased iron storage secondary to the contraction of the circulating blood volume and reduced iron losses from (secondary) amenorrhoea. The fall in ferritin observed during treatment is due to haemopoiesis necessary to fill the increased blood volume associated with weight gain. This also results in normalization of the haemoglobin and haematocrit.
The value of a CT‐guided fine needle aspirate in infants with lung abscess
Authors: Levison J , Van Asperen P , Wong C , Harvey J , Halliday R
Published: July 2004

Objective:  To describe the range of pathogens isolated from a lung abscess in infants less than one year of age. To assess the role of direct culture from the abscess.

Methods:  The two index cases were managed in 2002. An institution‐based review was conducted of all infants up to one year of age diagnosed with a lung abscess between 1989 and 2002. Data sources were hospital's disease index and Neonatal Intensive Care Unit Audit database using ICD9 and ICD10 diagnostic codes for ‘lung abscess’.

Results:  Five infants, under the age of one year, were treated for a lung abscess. In the one case where the abscess was left‐sided it was associated with a congenital cystic adenomatoid malformation of the lung. Pathogens were isolated following direct culture of the abscess in four cases. In three cases a single pathogen was isolated: pseudomonas aeruginosa, staphylococcus aureus and haemophilus influenzae. In one case a mixture of escherichia coli, streptococcus milleri and an anaerobe, propionibacteria, were cultured. Antibiotic therapy was directed at the identified pathogen(s) in all four cases. There was no mortality or recurrence.

Conclusion:  Predisposing factors for a lung abscess in infancy include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by CT‐guided fine needle aspiration is recommended to direct appropriate intravenous medical therapy provided the abscess is located peripherally.
Development and use of a portable paediatric resuscitation card
Authors: McCallum Z , South M
Published: July 2004

Objectives:  Inaccuracy and delay in decision making in paediatric resuscitation has been previously demonstrated and may result in preventable death. We assessed several domains of paediatric resuscitation knowledge amongst a sample of tertiary hospital paediatric doctors, developed a portable aide‐memoire reference card containing reference normal values, including an algorithm for recognition and management of the seriously ill/arrested child, and assessed the ability of medical staff to use this card to obtain accurate information.

Methods:  A convenience sample of 46 members of the Royal Children's Hospital medical staff completed a questionnaire. Knowledge deficits identified were used to create a 9 × 6 cm, name tag sized, laminated card providing physiological parameters and information required for paediatric resuscitation. The card was then distributed to all medical staff. A sample of 18 doctors completed an identical questionnaire 4 months after introduction of the card. Pre‐ and post‐card results were analysed across a range of knowledge domains.

Results:  Basic calculations were incorrect in over 40% of all pre‐card responses. Seniority did not predict more correct answers. The post‐card group obtained significantly more correct answers than the pre‐card group.

Conclusion:  Medical staff wore, and were able to use the card to provide the correct values for paediatric resuscitation parameters. The use of a card significantly improved knowledge of the correct values for resuscitation data. This project has resulted in the card being issued to all medical and nursing staff and is now accessible via the Royal Children's Hospital internet at http://perseus.rch.unimelb.edu.au/genmed/resuscardontheweb.htm
Facial nerve paralysis secondary to acute otitis media in infants and children
Authors: Gaio E , Marioni G , De Filippis C , Tregnaghi A , Caltran S , Staffieri A
Published: July 2004

Abstract:  Nowadays, facial paralysis is an uncommon complication of acute inflammation of the middle ear, with an estimated incidence of 0.005%; it was not so rare in the pre‐antibiotic era, occurring in 0.5−0.7% of middle ear inflammatory processes. We would like to highlight this complication of acute otitis media, a common paediatric complaint. We present three new cases of facial palsy in children with acute otitis media and discuss the etiological mechanisms and different approaches to the treatment; a flow chart for facial paralysis in acute otitis media is also presented. Our three patients recovered completely after mastoidectomy (first two cases) and myringotomy with antibiotic therapy (third case). Facial paralysis is an uncommon complication of otitis media which requires appropriate care. Following our experience and revision of literature on the subject, antibiotic therapy and myringotomy are the first‐line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.
Hereditary pancreatitis in a family of Aboriginal descent
Authors: McGaughran JM , Kimble R , Upton J , George P
Published: July 2004

Abstract:  Hereditary pancreatitis is an autosomal dominant condition characterized by recurrent episodes of acute pancreatitis, usually starting in childhood. We present a family who was ascertained when an 11‐year‐old girl presented with an episode of acute pancreatitis. Her father and other family members had also had recurrent bouts of acute pancreatitis. Genetic testing revealed a pathogenic mutation in the cationic trypsinogen gene in the proband, her father and her paternal grandmother. As far as we are aware, this is the first Aboriginal kindred with mutation‐proven hereditary pancreatitis. Hereditary pancreatitis is an important differential diagnosis to consider in a patient with recurrent episodes of acute pancreatitis with no obvious precipitating cause. This family is of Aboriginal descent and the implications of the family's background are also discussed when considering the aetiology of the condition. We emphasize the need to ascertain a full family history from patients with a history of repeated episodes of acute pancreatitis and also emphasize the need to avoid ethnic stereotypes when assessing patients.
Isoniazid and hypoglycaemia in a premature infant
Authors: Ovalı F , Samancı N , Sevinç E , Dağoğlu T
Published: July 2004

Abstract:  Severe hypoglycaemia requiring more than 20 mg/kg per minute glucose infusion was seen in a premature infant. The infant was born to a woman with active tuberculosis, and she was on prophylactic isoniazid. Discontinuation of isoniazid resulted in prompt recovery of hypoglycaemia. Further pharmacological studies may be needed to establish a cause and effect relationship.
Adventitious knot formation complicating catheterization of the infant bladder
Authors: Levison J , Wojtulewicz J
Published: July 2004

Abstract:  Bladder catheterization is a common technique employed in obtaining urine for culture, monitoring urine output and for diagnostic radiological procedures. We present two cases of knot formation in male infants catheterized with a 5 gauge feeding tube. We discuss avoidance, recognition and management of this complication.
Aberrant methylation of p14ARF, p15INK4b and p16INK4a genes and location of the primary site in pulmonary squamous cell carcinoma
Authors: Furonaka Osamu , Takeshima Yukio , Awaya Hirokazu , Ishida Hajime , Kohno Nobuoki , Inai Kouki
Published: July 2004

Aberrant methylation of cytosines in CpG islands of the promoter regions of tumor suppressor genes is found in human tumors as a common mechanism of gene silencing. We investigated the methylation status of the chromosome 9p21 gene cluster (p14ARF, p15INK4b and p16INK4a genes) by methylation‐specific polymerase chain reaction in 20 central and 40 peripheral types of pulmonary squamous cell carcinoma (SqCC) in order to determine the differences between the pathogeneses of the central and peripheral types of SqCC. The frequencies of methylation were 30% for the p14ARF gene, 20% for the p15INK4b gene and 40% for the p16INK4a gene in the central type and 25% for the p14ARF gene, 10% for the p15INK4b gene and 38% for the p16INK4a gene in the peripheral type. Cases in which there was methylation of the p16INK4a gene had a higher smoking index in the peripheral type (P = 0.007). This trend was not detected in the central type. Methylation of two or three genes was observed in 55% of methylation in at least one gene of the central type but in only 17% of the peripheral type. This overlap methylation of the chromosome 9p21 gene cluster was found more frequently in the central type (P = 0.02). These findings suggest one of the epigenetic differences between the central and peripheral types of SqCC.
Coexpression of heparanase, basic fibroblast growth factor and vascular endothelial growth factor in human esophageal carcinomas
Authors: Mikami Shuji , Ohashi Kenichi , Katsube Ken‐ichi , Nemoto Tetsuo , Nakajima Motowo , Okada Yasunori
Published: July 2004

Heparan sulfate (HS), which is degraded by heparanase, plays an important role in cell adhesion, insolubility of the extracellular matrix (ECM) and as a reservoir for various growth factors such as basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF). In the present study, we examined the immunohistochemical expression of heparanase, bFGF and VEGF, and evaluated the correlation between their expression and microvessel density (MVD) in human esophageal carcinomas. Heparanase, bFGF and VEGF were immunolocalized predominantly to the carcinoma cells, but they were also localized to the endothelial cells of microvessels near the carcinoma cell nests. In carcinomas with invasion of the muscular layer or adventitia, heparanase staining was stronger at the invasive areas of carcinomas than the intraepithelial spread. Expression of heparanase and bFGF and the degree of MVD were associated  with  tumor  invasion,  lymph  node  metastasis  and pathological stages. Cases with positive staining for heparanase, bFGF or VEGF tended to have a higher MVD than those without staining, and carcinomas with concomitant expression of heparanase, bFGF and VEGF showed the highest MVD. The level of heparanase mRNA expression was directly correlated with the MVD. In addition, heparanase‐positive cases had a higher positive ratio of bFGF and VEGF compared with the heparanase‐negative cases. These data suggest the possibility that heparanase may contribute to not only cancer cell invasion but also angiogenesis probably through degradation of HS in the ECM and release of bFGF and VEGF from the HS‐containing ECM.
Immunohistochemical analysis of thymidylate synthase, p16INK4a, cyclin‐dependent kinase 4 and cyclin D1 in colorectal cancers receiving preoperative chemotherapy: Significance of p16INK4a‐mediated cellular arrest as an indicator of chemosensitivity to 5‐fluorouracil
Authors: Kamoshida Shingo , Matsuoka Hiroshi , Shiogama Kazuya , Matsuyama Atsuji , Shimomura Ryoichi , Inada Ken‐ichi , Maruta Morito , Tsutsumi Yutaka
Published: July 2004

High expression of thymidylate synthase (TS) is allegedly associated with the chemoresistance to 5‐fluorouracil (5‐FU) in colorectal cancers. However, low TS expression does not necessarily imply chemosensitivity. Inactivation of p16INK4a correlates with poor prognosis in various cancers. We immunohistochemically evaluated the relationship between the expression of TS, p16INK4a, CDK4 and cyclin D1 and the effect of 5‐FU‐based chemotherapy in colorectal cancers. After antigen retrieval, immunoperoxidase staining was performed on the paraffin‐embedded, biopsy and surgical specimens of 37 advanced colorectal cancers preoperatively treated with peroral administration of 5‐FU derivatives. As a control group, 31 colorectal cancers without preoperative treatment were analyzed. High TS expression was found in 23 (74%) of 31 tumors resected from histological non‐responders and in 19 (61%) of 31 controls but in none of six responders. High p16INK4a expression was seen in 83% of the responders, 52% of the non‐responders and 32% of the controls. The TS‐low/p16INK4a‐high phenotype was noted in 83% of the responders, but only in 3% of the non‐responders (P = 0.0001). Induction of p16INK4a expression after chemotherapy was predominantly seen in the responders. Neither CDK4 nor cyclin D1 expression was related to the chemotherapeutic effects. In conclusion, the combination of low expression of TS and induction of p16INK4a after chemotherapy can be important indicators of the sensitivity to 5‐FU‐based chemotherapy in colorectal cancers.
Phenotypic alterations of mucins and cytokeratins during gallbladder carcinogenesis
Authors: Chang Hee Jin , Kim Sun Whe , Lee Byung Lan , Hong Eun Kyung , Kim Woo Ho
Published: July 2004

In order to evaluate the significance of altered expression of mucin and cytokeratin during gallbladder carcinogenesis, we characteriazed the expressional profiles of MUC1, MUC2, MUC5AC, MUC6, CK7 and CK20 in 33 normal mucosa, 31 adenomas, 55 dysplasias and 131 carcinomas of the gallbladder. In normal gallbladder mucosa, the expressions of MUC5AC and MUC6 were diffuse and MUC1 expression was absent. However, in adenomas, dysplasias and carcinomas, the expressions of MUC5AC and MUC6 tended to decrease, whereas MUC1 expression was elevated. MUC2 and CK20 were infrequently expressed in all of the gallbladder epithelia, but adenomas expressing MUC2 and/or CK20 were more frequently associated with carcinomas and showed a higher grade of atypia than those without these antigens. In carcinomas, MUC1 expression was related to invasive growth, lymph node metastasis and a non‐papillotubular type, whereas MUC6 expression was related to non‐invasive growth. CK7 was diffusely expressed in almost all lesions, but carcinomas with a loss of CK7 expression showed poor survival. In conclusion, normal gallbladder mucosa has a gastric phenotype, but during carcinogenesis and tumor progression, the gastric phenotype is gradually lost and the aberrant expression of MUC1 occurs. The intestinal phenotype is not common in the gallbladder.
Mechanism of transepithelial elimination of elastic fibers in keratoacanthoma
Authors: Ohashi Amiko , Ishizaki Masamichi , Kawana Seiji , Fukuda Yuh
Published: July 2004

Transepithelial elimination of elastic fibers is frequently seen in keratoacanthoma. However, the mechanism underlying this elastic fiber transport is not yet fully understood. We investigated the process by comparing the related features of 27 cases of keratoacanthoma, eight cases of squamous cell carcinoma and 11 cases of seborrheic keratosis (control). Microscopically, transepithelial elimination of elastic fibers was specifically observed in keratoacanthomas. Elastic fibers were surrounded by keratoacanthoma cell membrane and were ultrastructurally associated with hemidesmosomes and the basement membrane. Collagen fibrils were also observed within small, membrane‐delineated vesicles within cells in the lower layers of the tumor. Also noted was strong expression of matrix metalloproteinase‐1, which was detected by immunohistochemical analysis and in situ hybridization. Western blotting showed significantly stronger labeling of matrix metalloproteinase‐1 in samples of keratoacanthoma than in normal epidermis. In contrast, squamous cell carcinomas and seborrheic keratosis exhibited none of the aforementioned characteristics. We propose that keratoacanthoma cells entrap, lift and eliminate elastic fibers as they proliferate and keratinize toward the epidermal surface, while simultaneously phagocytosing collagen fibrils. In that regard, matrix metalloproteinase‐1 appears to play a key role in the degradation of collagen fibrils.
Immunohistochemical analysis of 14‐3‐3 sigma and related proteins in hyperplastic and neoplastic breast lesions, with particular reference to early carcinogenesis
Authors: Simooka Hanako , Oyama Tetsunari , Sano Takaaki , Horiguchi Jun , Nakajima Takashi
Published: July 2004

In order to confirm the role of 14‐3‐3 sigma (σ) as a tumor suppressor in breast carcinogenesis, we have studied the expression of 14‐3‐3σ immunohistochemically in usual ductal hyperplasia (UDH), ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) breast lesions. Immunostaining for estrogen receptor alpha (ERα), p53 and estrogen‐responsive RING finger protein (Efp) was also carried out. Immunohistochemically, expression of 14‐3‐3σ was seen in 92% UDH lesions and gradually decreased from 65% in DCIS to 23% in IDC. The expression of ERα decreased gradually from UDH to DCIS to IDC, while p53 showed an inverse staining pattern to that of ERα. The expression of Efp showed no significant difference among the three breast lesions. Hence, the present immunohistochemical study confirmed 14‐3‐3σ as a tumor suppressor in breast carcinogenesis. A similar immunohistochemical analysis was then carried out on columnar cell hyperplasia with atypia (CCHA), in which the expression pattern of tumor suppressor 14‐3‐3σ, ERα and p53 suggested that it might be possible that CCHA is a precancerous lesion.
Oncocytic adrenocortical carcinomas: A pathological and immunohistochemical study of four cases in comparison with conventional adrenocortical carcinomas
Authors: Song Sang Yong , Park Sunhoo , Kim Seong Rim , Suh Yeon‐Lim
Published: July 2004

Clinicopathological features of four cases of oncocytic adrenocortical carcinomas were studied. All tumors were large, circumscribed tumors with average size and weight of 11.5 cm and 586 g, respectively. The cut surfaces were yellow or brown and tan with areas of hemorrhage, necrosis, fibrosis, myxoid and cystic change. The tumor cells were exclusively oncocytic with a diffuse or compact and solid arrangement. Nuclear atypia was identified but mitosis was rare. Capsular invasion was identified in all tumors and vascular invasion was identified in one tumor. All tumors were immunoreactive for vimentin and inhibins. Immunoreactivity for pancytokeratin, synaptophysin and S‐100 protein was variable and focal. All tumors had low proliferative indices, of less than 1%, and were negative for p53 protein. Ultrastructurally, the cytoplasm of tumor cells showed numerous mitochondria in a compact arrangement. Oncocytic adrenocortical carcinomas showed a similar sex ratio, slightly older mean age, similar left predilection, slightly smaller size and lighter weight compared with the conventional carcinomas. We suggest that most oncocytic adrenocortical carcinomas might be low‐grade malignancies with less aggressive histological features compared with conventional carcinomas. However, they should be excised completely because of the likelihood of recurrence and metastasis during the follow‐up period.