bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural men and mental health: Their experiences and how they managed
Authors: Gorman Don , Buikstra Elizabeth , Hegney Desley , Pearce Susanne , Rogers‐Clark Cath , Weir Jim , McCullagh Bronwyn
Published: September 2007

ABSTRACT:  There is a growing awareness that a primary source of information about mental health lies with the consumers. This paper reports on a study that interviewed rural men with the aim of exploring their mental health experiences within a rural environment. The results of the interviews are a number of stories of resilience and survival that highlight not only the importance of exploring the individuals' perspective of their issues, but also of acknowledging and drawing on their inner strengths. Rural men face a number of challenges that not only increase the risk of mental illness but also decrease the likelihood of them seeking and/or finding professional support. These men's stories, while different from each other, have a common thread of coping. Despite some support from family and friends, participants also acknowledged that seeking out professional support could have made the recovery phase easier. Mental health nurses need to be aware, not only of the barrier to professional support but also of the significant resilience that individuals have and how it can be used.
Exploration of therapeutic interventions that accompany the administration of p.r.n. (‘as required’) psychotropic medication within acute mental health settings: A retrospective study
Authors: Curtis Janette , Baker John A. , Reid Amanda R.
Published: September 2007

ABSTRACT:  Within acute mental health settings, pro re nata (p.r.n.) ‘as required’ medication is a widely used adjunct to regular treatment plans, and is administered at the discretion of a registered nurse. However, there is concern that some orders may benefit staff more than patients by providing a ‘quick fix’ to compensate for inadequate therapeutic programmes. Previous authors assert that p.r.n. medication administration should not be the first line of action, but should be used when other less invasive interventions such as de‐escalation, talking, or separation from the group are unsuccessful. This project explored the occurrence of p.r.n. medication administration and the type of alternative therapeutic interventions that are documented as accompanying its administration. A retrospective 1‐month chart audit was undertaken for a cohort of inpatients in a 20‐bed mental health facility attached to a regional hospital in New South Wales, Australia. Forty‐seven patients (73.4%) received p.r.n. medication at least once, with a total of 309 doses of p.r.n. medication administered during this time. There were wide variations in the documented rationales, and for nearly three‐quarters (73%) of p.r.n. medication administrations, no other therapeutic intervention was documented as occurring prior to administration.
Impaired efflux of cholesterol from aged cells and its molecular mechanism: A basis for age‐related enhancement of atherosclerosis
Authors: Yamashita Shizuya , Hirano Ken‐ichi , Zhang Zhongyan , Tsukamoto Kosuke , Masuda Daisaku , Koseki Masahiro , Matsuura Fumihiko , Ishigami Masato , Nishida Makoto , Shimomura Iichiro
Published: September 2007

Aging is one of the risk factors for atherosclerotic cardiovascular diseases, however, its molecular mechanism is currently unknown. Many types of cells in the atherosclerotic lesions are considered to have various biological abnormalities such as impaired lipid homeostasis and slow cell proliferation, which may be related to senescence at cellular levels. One of the common characteristics of senescent cells in vitro is the alteration of actin cytoskeletons, which were reported to be involved in the intracellular transport of lipids. Cholesterol efflux from the cells is the initial step of reverse cholesterol transport, a major protective system against atherosclerosis. Recently, we demonstrated that Cdc42, a member of the Rho‐GTPase family, might be crucial for cellular lipid transport and cholesterol efflux based upon studies of Tangier cells that are deficient in ABCA1 gene. In the current review, we also indicate that the expression of Cdc42 is decreased in the cells from aged subjects in close association with the retarded intracellular lipid transport. Furthermore, the Cdc42 expression is reduced by culturing fibroblasts in vitro for a long duration. Werner syndrome (WS) is characterized by the early onset of senescent phenotypes including premature atherosclerotic cardiovascular diseases, although the underlying molecular mechanism for the enhanced atherosclerosis has not been fully understood yet. We examined the intracellular lipid transport and cholesterol efflux and the expression levels of cholesterol efflux‐related molecules in skin fibroblasts obtained from patients with WS. Cholesterol efflux was markedly reduced in the WS fibroblasts in association with an increased cellular cholesterol content. Fluorescent recovery after photobleaching technique revealed that intracellular lipid transport around Golgi apparatus was markedly reduced when using a C6‐NBD‐ceramide as a tracer. Cdc42 protein and its guanosine 5′‐triphosphate‐bound active form were markedly reduced in the WS fibroblasts. The adenovirus‐mediated complementation of wild‐type Cdc42 corrected the impaired cholesterol efflux, intracellular lipid transport and cellular cholesterol levels in the WS fibroblasts. These data indicate that the reduced expression of Cdc42 might be responsible for the abnormal lipid transport, which in turn might be related to the accelerated cardiovascular manifestations in WS patients. The current review focuses on the impaired efflux of cholesterol from aged cells and its molecular mechanism as a basis for age‐related enhancement of atherosclerosis.
Downregulation of klotho gene expression in streptozotocin‐induced diabetic rats
Authors: Ishizaka Nobukazu , Matsuzaki General , Saito Kan , Furuta Kyoko , Mori Ichiro , Nagai Ryozo
Published: September 2007

Objective:  The expression of klotho, which may function as an anti‐aging hormone, is most abundant in the kidney. We have investigated the regulation of klotho expression in the kidneys of diabetic rats.

Methods:  Diabetes was induced by a single i.v. injection of streptozotocin (STZ) at a dose of 60 mg/kg. Renal klotho expression was investigated 8 weeks post‐STZ injection. Some rats were given losartan or deferoxamine from 5 weeks post‐STZ injection until sacrifice. Klotho expression was examined by Western blot analysis and quantitative reverse transcription‐polymerase chain reaction.

Results:  Expression of Klotho protein was reduced by approximately a third in the kidneys of diabetic rats compared to that of the untreated control rats. This downregulation was suppressed by either losartan or deferoxamine; these drugs also decreased the albuminuria. Histological study showed that, in the kidneys of the STZ‐induced diabetic rats, mRNA expression of klotho, albeit less intense than in the untreated control, was observed in the tubular epithelial cells, and was co‐localized with heme oxygenase‐1, an oxidative stress‐sensitive gene.

Conclusion:  Expression of klotho was downregulated in the kidneys of diabetic rats. An activation of the renin‐angiotensin system, altered iron homeostasis, and presumably enhanced oxidative stress, may play a role in this phenomenon.
Klotho gene delivery suppresses oxidative stress in vivo
Authors: Ohta Junsuke , Rakugi Hiromi , Ishikawa Kazuhiko , Yang Jin , Ikushima Masashi , Chihara Yukana , Maekawa Yoshihiro , Oguro Ryosuke , Hanasaki Hiroko , Kida Iwao , Matsukawa Naomichi , Ogihara Toshio
Published: September 2007

Objective:  Mice deficient in the klotho gene exhibit a syndrome resembling premature human aging. A recent report also suggested that klotho transgenic mice exhibited a long lifespan, which shows that klotho is an antisenescence gene. Previously, klotho has been reported to improve endothelial dysfunction, and also to have a preventive effect against oxidative stress. In the present study, we investigated the effect of klotho gene delivery on blood pressure and oxidative stress in vivo.

Methods:  Klotho plasmid was injected into the tail vein of mice and spontaneous hypertensive rats over 5 s.

Results:  Klotho gene delivery upregulated manganese superoxide dismutase protein expression and total superoxide dismutase activity in the aorta of mice compared with the control. It upregulated nitric oxide production, and downregulated lipid peroxide concentration in the serum of mice. When klotho plasmid was administered to spontaneously hypertensive rats, superoxide dismutase activity in the kidney and liver was significantly increased, and lipid peroxide concentration in the kidney and liver was significantly decreased, compared with the control. Klotho gene delivery in spontaneously hypertensive rats did not alter systolic blood pressure.

Conclusion:  These results suggest that klotho gene infusion into the tail vein of mice and rats has a suppressive effect against oxidative stress. These findings may provide a new insight into the therapeutic potential of klotho gene delivery in vivo to regulate oxidative stress.
Factors associated with use of percutaneous coronary intervention among very elderly patients with acute myocardial infarction: Lessons from the Tokai Acute Myocardial Infarction Study (TAMIS)
Authors: Hirakawa Yoshihisa , Masuda Yuichiro , Kuzuya Masafumi , Kimata Takaya , Iguchi Akihisa , Uemura Kazumasa
Published: September 2007

Background:  Although prior studies have shown that older patients with acute myocardial infarction (AMI) are less likely to receive percutaneous coronary intervention (PCI) than younger patients, the predictors of PCI use among the very elderly are unknown. We identified the predictors using data from the Tokai Acute Myocardial Infarction Study (TAMIS), a multi‐hospital retrospective study performed in Japan.

Methods:  All of the study subjects were patients hospitalized for newly diagnosed AMI at one of 13 acute care hospitals between January 1995 and December 1997. We abstracted the baseline and procedural characteristics from detailed chart reviews. Multivariate analysis was performed, controlling for the variables found to be significantly different between AMI patients aged 75 and over with and without PCI by χ2 test or unpaired Student's t‐test. We evaluated a total of 207 patients with PCI and 201 without PCI.

Results:  The univariable analysis abstracted four predictors: age, previous heart failure, hospital and maximum creatine phosphokinase. After multivariable adjustment, age (odds ratio [OR] = 0.89) and previous heart failure (OR = 0.36), and number of hospital beds (351–550, OR = 0.38; ≥551, OR = 0.17, respectively) were still independent predictors.

Conclusions:  Our results suggest that advanced age itself and number of hospital beds are important predictors of underuse of PCI among very elderly patients.
Usefulness of the Mini‐Nutritional Assessment (MNA) to evaluate the nutritional status of Japanese frail elderly under home care
Authors: Inoue Keiko , Kato Masahiko
Published: September 2007

Background:  The Mini‐Nutritional Assessment (MNA) has proved useful in Western countries to predict long‐term mortality of institutionalized elderly patients, as well as the elderly living at home. However, there are few reports on the usefulness of this evaluation in the elderly in Japan. Our objective was to examine the usefulness of the MNA to screen and diagnose malnutrition in the elderly in Japan and investigate the effect of nutritional status on their activities of daily living (ADL) and mortality.

Methods:  We recruited 181 frail elderly (62 men and 119 women) under home care whose age was 79.8 ± 8.8 years old. We assessed their nutritional status (anthropometric measurements, serum albumin, MNA) and ADL; then we followed up these patients for more than 2 years to see whether the MNA reflected their prognosis.

Results:  The MNA score correlated with anthropometric measurements, serum albumin and ADL (P < 0.01). The hazard ratio of mortality by all causes was significantly higher in the elderly with protein energy malnutrition (PEM) and risk for PEM, compared with well‐nourished elderly patients.

Conclusion:  The MNA was useful to screen the elderly for nutritional status because it reflected the ADL and the prognosis, as well as conventional nutritional indexes such as anthropometric values and serum albumin.
Successful remission using metyrapone in an elderly patient with Cushing disease accompanied by generalized edema
Authors: Ishikawa Motoko , Narita Takuma , Sato Takehiro , Sasaki Hiroshi , Miura Takeshi , Morii Tsukasa , Fujta Hiroki , Yamada Yuichiro , Kakei Masafumi
Published: September 2007

An 82‐year‐old woman was referred to our hospital because of hypoalbuminemia and generalized edema. Hypercortisolemia was subsequently found as the levels of serum cortisol and plasma adrenocorticotropic hormone (ACTH) sampled in a fasting morning were 140 pg/mL and 41.9 μg/dL, respectively. These hormones were not suppressed after taking low‐dose dexamethasone the previous night and increased to a mild extent in response to administration of corticotrophin‐releasing hormone, suggesting presence of pituitary adenoma producing ACTH (Cushing's disease). However, intrasella localization of pituitary adenoma could not be determined by magnetic resonance imaging. Soon after administration of metyrapone was started in an attempt to reduce her cortisol levels, the patient suffered from severe pneumonia. The pulmonary infection and peripheral edema were improved with decreases in cortisol levels by continuing metyrapone administration with antibiotics and finally she was discharged from the hospital on foot. Metyrapone is a useful therapeutic choice to achieve a remission of cortisol levels in the elderly patients with Cushing's disease in association with serious hypercortisolemia impending severe infection.
Improved cognitive function, mood and brain blood flow in single photon emission computed tomography following individual reminiscence therapy in an elderly patient with Alzheimer's disease
Authors: Tanaka Katsuaki , Yamada Yukiko , Kobayashi Yoshio , Sonohara Kazuki , Machida Ayako , Nakai Ryuhei , Kozaki Koichi , Toba Kenji
Published: September 2007

An 88‐year‐old man who was suffering from chronic renal failure and hypertension visited our memory clinic because of recent cognitive decline and a gradual decrease in his vitality and volition. His Mini‐Mental State Examination (MMSE) score was 22, his 15‐item Geriatric Depression Scale (GDS‐15) score was 10, and his Vitality Index (VI; full score, 10) was 6. We diagnosed Alzheimer's disease with depressive mood, and this was supported by findings of global brain atrophy by magnetic resonance imaging and decrease in brain blood flow in the posterior cingulated gyrus and frontal association area by single photon emission computed tomography (SPECT). After completion of a life review of the patient, individual reminiscence therapy was performed once a week for 2 months. After the therapy, a comprehensive geriatric assessment showed that cognitive function, depressive mood and decreased vitality had all markedly improved (MMSE, 29; GDS, 7; VI, 9). Moreover, SPECT showed improved brain blood flow, especially in the frontal lobe. We believe that this is the first case in which reminiscence therapy alone not only improved cognitive function and mood but also reduced neuroimaging abnormalities.
Fetal manifestations and poor outcomes of congenital cytomegalovirus infections: Possible candidates for intrauterine antiviral treatments
Authors: Maruyama Yuko , Sameshima Hiroshi , Kamitomo Masato , Ibara Satoshi , Kaneko Masatoki , Ikenoue Tsuyomu , Minematsu Toshio , Eizuru Yoshihito
Published: September 2007

Aim:  This retrospective study was performed to reveal the natural history of cytomegalovirus (CMV) infected fetuses during the perinatal period and to find prenatal findings associated with poor outcomes.

Methods:  33 neonates with CMV infection, born after 30 weeks of gestation, were registered from a total of 12 414 infants between 1995 and 2003. Maternal and neonatal medical records were reviewed regarding fetal growth; abdominal signs including ascites and hepatosplenomegaly; cerebral signs including ventriculomegaly, microcephaly, and calcification; and fetal heart rate monitoring, for signs which may have been detected by the standard obstetric ultrasonography. Univariate and multivariate analyses were performed to test for any associations between these manifestations and poor outcomes such as death and neurological damages.

Results:  Among the 33 infants, 6 died, 10 developed neurological damage including cerebral palsy (n = 8), epilepsy (n = 5), and hearing difficulties (n = 5), and the remaining 17 were normal. After adjusting for ganciclovir treatment and gender, death was 40‐fold more likely associated with infants having abdominal signs (OR 40, 95%CI 4.6–930) than those without abdominal signs. Similarly, poor outcomes (death or neurological damage) were more likely associated with infants having either abdominal or cerebral signs (OR 39, 95%CI 3.8–1323). Fetal growth restriction and non‐reassuring fetal heart rate patterns were not significantly associated with poor outcomes.

Conclusion:  The absence of abdominal signs guarantees the infant's survival. The presence of abdominal or cerebral signs is associated with poor outcomes, suggesting that these fetuses are possible candidates to receive in‐utero therapy of congenital CMV infection.
Results of endovascular treatment in cases of abnormal placentation with post‐partum hemorrhage
Authors: La Folie Trévor , Vidal Vincent , Mehanna Mayssoun , Capelle Marianne , Jaquier Alexis , Moulin Guy , Bartoli Jean Michel
Published: September 2007

Aim:  The purpose of this study was to evaluate the clinical success of selective arterial embolization in cases of post‐partum hemorrhage due to abnormal placentation.

Methods:  Six patients with persistent hemorrhage and abnormal placental implantation underwent uterine artery embolization over a period of three years.

Results:  In four patients, the placenta was left in place after a gentle attempt at removal and post‐partum hemorrhage was controlled during or shortly after the procedure. In all cases, embolization was possible even when there was previous arterial ligation (two cases). In one case, a hysterectomy was required at 21 d later due to uterus and bladder necrosis. Arterial embolization in cases of abnormal placental implantation remains an uncommon treatment and is less efficient in these cases than in normal placental implantation.

Conclusion:  Our results confirmed that even in cases of moderate bleeding, conservation treatment and embolization are possible, but that complications may be more common than in normal placentation.
Celecoxib versus magnesium sulfate to arrest preterm labor: Randomized trial
Authors: Borna Sedigheh , Saeidi Fatemeh Mir
Published: September 2007

Aim:  The effectiveness of the management of preterm birth remains an important health care issue, especially when considering that more than two thirds of singleton neonatal death occurs in preterm labor. The purpose of this study was to compare oral celecoxib with intravenous magnesium sulfate as tocolytic.

Methods:  This was a randomized study of patients who were between 24 and 34 weeks of gestation with preterm labor. One hundred and four pregnant women with preterm labor were randomly assigned to receive celecoxib 100 mg b.i.d. for 48 h or intravenous magnesium sulfate (MgSO4) for maximum of 48 h. Outcome variables included delay of delivery for 48 h and the incidence of side‐effects. Data was analyzed using the Student t‐test and the χ2 test.

Results:  There was no difference between the groups over the course of the study in demographic characteristics, cervical examination and amniotic fluid index. Labor was arrested for 48 h was in 42 (81%) and 45 (87%) of the patients in the celecoxib and magnesium sulfate groups, respectively (p‐0.298). There were no severe maternal or neonatal complications in either group.

Conclusion:  Celecoxib is as effective as magnesium sulfate for primary tocolysis.
Plasma levels of α‐defensins 1–3 are an indicator of neutrophil activation in pregnant and post‐partum women
Authors: Okazaki Takayuki , Ota Yoriko , Yuki Nobuhiro , Hayashida Ayako , Shoda Akiko , Nishikawa Masayoshi , Oshima Kyoko , Fukasawa Ichio , Watanabe Hiroshi , Inaba Noriyuki
Published: September 2007

Aim:  In severe preeclampsia and septic shock, excessively activated neutrophils are thought to injure tissue irreversibly. On the other hand, mild neutrophil activation is known to occur during normal pregnancy. The objective of this study was to determine whether elevated plasma levels of α‐defensins 1–3 could be used as an indicator of neutrophil activation in pregnant and post‐partum women.

Methods:  Defensin concentrations in 21 non‐pregnant women and men, 184 normal pregnant women, and 55 post‐partum women were quantified using an enzyme‐linked immunosorbent assay (ELISA). The expression of the surface markers, CD11b and Toll‐like receptor‐4 (TLR‐4), on the neutrophils were analyzed by flow cytometry in a cohort of subjects different from that used for the analysis of α‐defensin levels.

Results:  The concentrations of α‐defensins were significantly higher in women that were in labor than in any of the other subjects. These levels diminished after delivery, but remained significantly elevated at one month post‐partum. The expression of both CD11b and TLR‐4 was significantly higher in women in labor compared to non‐pregnant donors (controls). CD11b expression remained high on the third post‐partum day, while TLR‐4 expression fell to non‐pregnant levels.

Conclusion:  Our results suggest that there is a positive association between defensin levels and neutrophil activation in pregnant and post‐partum women.
Cervical intraepithelial neoplasia II‐III with endocervical cone margin involvement after cervical loop conization: Is there any predictor for residual disease?
Authors: Kietpeerakool Chumnan , Khunamornpong Surapan , Srisomboon Jatupol , Siriaunkgul Sumalee , Suprasert Prapaporn
Published: September 2007

Aim:  To determine the clinicopathological predictors for residual disease in women who have had cervical intraepithelial neoplasia (CIN) II‐III with endocervical cone margin involvement after loop electrosurgical excision procedure (LEEP).

Methods:  All of the women who had CIN II‐III on LEEP specimens with endocervical margin involvement, and underwent subsequent surgical treatment including repeat LEEP or hysterectomy at Chiang Mai University Hospital between May 2003 and June 2006 were reviewed.

Results:  During the study period, 85 women who matched the study inclusion were identified. The mean age was 48.6 years. Fifty‐two women (61.2%) were postmenopausal. The most common Pap smear before LEEP was high‐grade squamous intraepithelial lesion (HSIL) (65.9%), followed by squamous cell carcinoma (21.2%). Twenty‐five women (29.4%) had concurrent ectocervical and endocervical cone margin involvement. Residual disease was noted in 44 women (51.8%, 95%CI = 40.7–62.7) of whom six had unrecognized invasive squamous cell carcinoma, while the remaining 38 had CIN II‐III. Only extensive endocervical cone margin involvement (3–4 quadrants) was noted as the significantly independent predictor for residual disease (aOR = 14.2, 95% CI = 3.6–55.8; P < 0.001).

Conclusion:  Extensive endocervical cone margin involvement after LEEP for CIN II‐III is a strong predictor for residual disease. Therefore, the number of involved quadrants should be evaluated to plan further management.
Laparoscopy should be strongly considered for women with unexplained infertility
Authors: Nakagawa Koji , Ohgi Shirei , Horikawa Takashi , Kojima Rieko , Ito Megumu , Saito Hidekazu
Published: September 2007

Aim:  Women with unexplained infertility frequently become pregnant after diagnostic laparoscopy. In this study the effect of laparoscopic surgery on such women was evaluated by the pregnancy rate after laparoscopic surgery.

Methods:  A total of 47 unexplained infertile women underwent laparoscopic evaluation during the period August 2002 to January 2005 in our center. The percentage of positive laparoscopic findings and the pregnancy rate after laparoscopy were calculated. The patients were divided into 5 subgroups according to maternal age, pregnancy rates were calculated for each group, and compared with the outcome of assisted reproductive technology (ART) treatment for the same age groups.

Results:  In 87.2% of the women, laparoscopy revealed abnormal findings; endometriosis lesions, peritubal adhesions and tubal obstructions were found in 21, 17 and 3 cases, respectively. After laparoscopy 23 achieved pregnancy (pregnancy rate: 48.9%). The pregnancy rates of the groups at the age of 25 years old or less, 26–30, 31–35, 36–40 and over 41 years old were 100%, 75.0%, 45.5%, 27.2% and 0%, respectively. In the case of the 26–30 years old group, the pregnancy rate after laparoscopy was significantly higher than that in the ART treatment group (33.3%, P < 0.05).

Conclusions:  Laparoscopy should be strongly considered for examining women with unexplained infertility.
Morphometric study of GnRH analog/HMG/HCG effects on ultrastructure of human endometrial epithelium in early and mid‐luteal phase
Authors: Novin Marefat Ghaffari , Bazy Parviz , Rad Jafar Soleimani , Sarani Sir Ahmad , Farzadi Laya , Ghasemzadeh Aliyeh
Published: September 2007

Aim:  The aim of the present study was to investigate the effects of long protocol ovulation induction on the ultrastructure of the human endometrial epithelium on days luteinizing hormone (LH) + 4 and LH+ 6 of the menstrual cycle.

Methods:  Endometrial biopsies were obtained on days LH+ 4 (n = 9) and LH+ 6 (n = 10) from infertile women who were under standard long protocol with luteal phase supplementation with IM (intramuscular) progesterone, but where the embryo had not been formed or transferred, due to the male factor problem. Biopsies were also taken on days LH+ 4 (n = 5) and LH+ 6 (n = 5) from fertile women who had not received ovulation induction drugs as control groups. After preparation and taking light and electron micrographs from samples, qualitative and quantative evaluations (morphological and morphometric) were accomplished and the data was compared using the unpaired student t‐test.

Results:  Qualitative results showed the presence of the nuclear channel system, vacuoles of glycogen and giant mitochondria in all of the samples. Qualitative analysis showed that the volume fraction (Vv) of the euchromatin to the nucleus, the rough endoplasmic reticulum and the mitochondria to the cell, were not statistically different (P > 0.05) in samples taken on LH+ 4 in both control and test groups. The Vv of these features, however, to the cell in the test group was significantly (P < 0.05) higher than those in the control taken on LH+ 6.

Conclusions:  These results suggest that long protocol ovulation induction with luteal phase support with progesterone alter the normal development of the human endometrium in the mid luteal phase and could decrease the implantation success rate.
Major complications and outcome of diagnostic and operative transvaginal hydrolaparoscopy
Authors: Shibahara Hiroaki , Shimada Kazuhiko , Kikuchi Kumiko , Hirano Yuki , Suzuki Tatsuya , Takamizawa Satoru , Fujiwara Hiroyuki , Suzuki Mitsuaki
Published: September 2007

Aim:  Transvaginal hydrolaparoscopy (THL) has recently been developed as a less invasive alternative to conventional laparoscopy. There are some reports that described the usefulness and prognostic value of diagnostic THL in infertile women. Moreover, operative THL such as ovarian drilling for unovulatory women with polycystic ovarian syndrome (PCOS) to induce ovulation has also been found to be as effective as that by conventional laparoscopy. The risk of bowel injury and sepsis by transvaginal access with culdoscopy was higher than that with laparoscopy in the previous reports. The purpose of the present study was to examine the risk of diagnostic and operative THL according to two case studies with a literature review.

Methods:  The authors carried out diagnostic or operative THL in 177 infertile women, aged 22–43 years. Major complications during THL and a review of the literature were analyzed.

Results:  Two cases of bowel injury were diagnosed during diagnostic THL. No complication occurred during operative THL. In total, the incidence of bowel injury was 1.1%. The injuries were diagnosed during THL and treated expectantly under strict conditions in both cases. Ten studies in the literature reported a total of 4232 procedures, including 26 bowel injuries (0.61%) and one perforation of a retroflexed uterus (0.02%).

Conclusions:  The usefulness of THL for diagnostic and operative purposes is in no doubt. However, informed consent should be obtained and vigilance before and during THL should be maintained, although it can be done on an outpatient clinic basis.
Intrauterine therapy with cytomegalovirus hyperimmunoglobulin for a fetus congenitally infected with cytomegalovirus
Authors: Sato Akira , Hirano Hideto , Miura Hiroshi , Hosoya Naoko , Ogawa Masaki , Tanaka Toshinobu
Published: September 2007

Reported herein is a case of hydrops fetalis in which the cord blood expressed cytomegalovirus (CMV) antigen. Fetal ascites was removed from an infected fetus with hydrops in utero and 2.5 g CMV hyperimmunoglobulin was administered into the fetal abdominal cavity at 28 weeks gestation. After immunoglobulin administration, fetal ascites vanished, preload index of the inferior vena cava decreased and platelet count of the infant increased. However, despite intrauterine therapy and intensive neonatal care, the infant died soon after birth. The expression of CMV antigen in the nucleus of polymorphonuclear leukocytes in fetal cord blood indicated that the fetal hydrops was caused by CMV infection. When symptomatic CMV infection of a fetus is suspected from serological and ultrasound findings, further examinations should be performed for the diagnosis. Intrauterine immunoglobulin therapy could be one of the therapeutic options for the affected fetus.
Nitric oxide metabolite levels in preterm labor
Authors: Chadha Sandeep , Jain Vanita , Gupta Indu , Khullar Madhu
Published: September 2007

Aim:  To investigate the role of nitric oxide metabolites as markers of infection in subjects with preterm labor or preterm premature rupture of membranes (PTPROM). PTPROM means that there was spontaneous rupture of fetal membrane before the onset of labor and gestational age was <37 weeks. This occurs because of imbalance between matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase. The cause of this imbalance that leads to degradation of collagen causing PTPROM is infection. The bactericidal, fungicidal, viricidal and tumoricidal activities of macrophages are determined in part by elaboration of nitric oxide, hence nitric oxide levels have been found to be increased in infections

Methods:  During an 18‐month period 50 women with preterm labor or PTPROM and 50 controls were enrolled prospectively. Blood and urine samples were obtained for analysis of nitric oxide metabolites. Patients with known causes of preterm labor were excluded.

Result:  The nitric oxide metabolites, which included both nitrite levels and citrulline levels were significantly higher both in blood as well as urine in patients with preterm labor and PTPROM compared to controls. Serum nitrite levels in subjects with preterm labor were 376.5 ± 345 nmol/L while in subjects with PTPROM they were 295.7 ± 161.1 nmol/L and in controls the levels were 62.7 ± 33.9 nmol/L. Serum citrulline levels in subjects with preterm labor were 5293.8 ± 2916.7 nmol/L; in PTPROM they were 6536.6 ± 609.91 nmol/L and in controls they were 949.8 ± 67.1 nmol/L. On comparing patients with preterm labor, those in whom preterm labor could not be inhibited had statistically significant higher levels of nitrite in both serum and urine (482.9 ± 387.7 nmol/L and 754.5 ± 336.5 nmol/L, respectively) compared to patients in whom labor could be inhibited (172.2 ± 61.9 nmol/L and 401.8 ± 236.9 nmol/L, respectively). The citrulline levels were also higher among the group who delivered preterm for both serum and urine (5355.4 ± 3229.7 nmol/L and 11 482.8 ± 2541.4 nmol/L, respectively) compared to patients in whom labor could be inhibited (5260.2 ±  2897.08 nmol/L and 10 651.4 ± 1502.7 nmol/L, respectively) but this did not reach statistical significance.

Conclusion:  Higher nitric oxide metabolites in women with preterm labor are marker of subclinical infection.
Perforated colon volvulus coiling around the uterus in a pregnant woman with a history of severe constipation
Authors: Iwamoto Ichiro , Miwa Katsuhiro , Fujino Toshinori , Douchi Tsutomu
Published: September 2007

A case of intestinal volvulus in both the sigmoid colon and cecum in a pregnant woman suffering from severe constipation is reported herein. The fetus was dead and the mother developed acute shock. The twisted sigmoid colon coiled twice around the uterus and was perforated. The mother died 10 h after the onset of severe abdominal pain. Volvulus should be considered when examining severe abdominal pain in a pregnant woman with a history of severe constipation. Early suspicion together with prompt intervention will minimize maternal and fetal morbidity and mortality of this rare complication of pregnancy.
Impact of maternal body mass index on obstetric outcome
Authors: Sahu Meenakshi T. , Agarwal Anjoo , Das Vinita , Pandey Amita
Published: September 2007

Aim:  The purpose of the present study was to correlate effect of maternal body mass index (BMI) on obstetric outcome. The studies conducted so far are from Western developed countries and there is a paucity of data from developing countries.

Methods:  A prospective evaluation was carried out of 380 women in one unit of a tertiary care teaching hospital in North India from May 2005 to June 2006 on the effect of maternal BMI on pregnancy outcome. BMI was calculated as weight (kg) divided by height (m2). BMI was used to characterize women as lean (BMI < 19.8 kg/m2), normal (BMI 19.9–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2) or obese (≥30 kg/m2).

Results:  Forty‐six women (12.1%) out of 380 were underweight, 99 (26.1%) were overweight, 30 (7.9%) were obese and the remaining 205 (53.9%) had normal BMI. Anemia (P = 0.02) and low birthweight (P = 0.008) was significantly present among lean women. Obese women had a significant risk for gestational diabetes (P = 0.0004), pre‐eclampsia (P = 0.004), cesarean delivery (P = 0.01) and macrosomia (P = 0.02).

Conclusion:  Both lean and obese women carry a risk for adverse pregnancy outcome, therefore pregnant women should maintain a normal BMI to achieve a healthy pregnancy outcome.
High‐frequency stimulation of the subthalamic nucleus prolongs the increase in striatal dopamine induced by acute l‐3,4‐dihydroxyphenylalanine in dopaminergic denervated rats
Authors: Lacombe Emilie , Carcenac Carole , Boulet Sabrina , Feuerstein Claude , Bertrand Anne , Poupard Annie , Savasta Marc
Published: September 2007

High‐frequency stimulation of the subthalamic nucleus (STN‐HFS) is a powerful approach for treating the motor symptoms of Parkinson's disease (PD). It results in clinical improvement in patients with PD, further reducing the l‐3,4‐dihydroxyphenylalanine (L‐DOPA) requirement and thus L‐DOPA‐induced dyskinesia. However, it remains unclear how STN‐HFS modifies the response to L‐DOPA. We investigated the effect of STN‐HFS on striatal extracellular concentrations of dopamine and its metabolites following acute L‐DOPA administration in intact or partially dopaminergic denervated (DA‐PL) rats. L‐DOPA treatment significantly increased striatal dopamine levels in intact and DA‐PL animals, with the maximal effect observed 1 h after L‐DOPA injection. This increase was more pronounced in DA‐PL rats (ipsilateral to the lesion) than in intact animals. It remained fairly stable 1 h after the maximal effect of L‐DOPA and then decreased towards basal values. STN‐HFS in intact rats had no effect on the maximal L‐DOPA‐induced increase in striatal extracellular dopamine concentration or the return to basal values, the profiles observed being similar to those for non‐stimulated intact animals. Conversely, STN‐HFS amplified the L‐DOPA‐induced increase in striatal dopamine levels during the stimulation period (1 h) in DA‐PL rats and this increase was sustained throughout the post‐stimulation period (2.5 h), without the return to basal levels observed in stimulated intact and non‐stimulated rats. These new neurochemical data suggest that STN‐HFS interferes with L‐DOPA effects, probably synergically, by stabilizing dopamine levels in the striatum and shed light on the mechanisms of STN‐HFS in PD.
Clinical validation of the Multidimensional Assessment of Pain Scale
Authors: RAMELET ANNE‐SYLVIE , REES NANCY WILLIE , MCDONALD SUE , BULSARA MAX K. , HUIJER ABU‐SAAD HUDA
Published: September 2007

Background:  The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postoperative pain in critically ill preverbal children. Following preliminary psychometric testing, additional validation of this 5‐category 10‐point scale was required. This article reports the results of a follow‐up validation study that aimed to evaluate the clinical validity and utility of the MAPS.

Methods:  The MAPS includes five categories and was tested in response to analgesics in a convenience sample of 19 postoperative critically ill children (94% intubated) aged between 0 and 31 months at a tertiary referral hospital in Western Australia. Convergent and concurrent validity was tested using the MAPS, Faces Legs Activity Cry Consolability (FLACC), and Visual Analog Scale observer (VASobs). Clinical utility of the MAPS was also evaluated.

Results:  The Multidimensional Assessment Pain Scale scores decreased significantly by four points (40% of total score) after the administration of a potent dose of morphine (P < 0.001). Agreement measurements between MAPS and FLACC and MAPS and VASobs showed that the risk of measurement error was small. Internal consistency of the MAPS would improve if the physiologic item was deleted (Cronbach’s α 0.79–0.64). However, the actual values of heart rate, systolic, mean, and diastolic arterial pressure were shown to decrease significantly (7–14% decrease) at 15, 30, and 60 min after a potent bolus of morphine (P < 0.001). The MAPS also demonstrated clinical feasibility.

Conclusions:  This study showed that ‘MAPS like FLACC and VASobs decreases similarly following rescue morphine. MAPS‐revised can be recommended for clinical application.
The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions
Authors: INGELMO PABLO , LOCATELLI BRUNO GUIDO , FRAWLEY GEOFF , KNOTTENBELT GRAHAM , FAVARATO MORENO , SPOTTI ANGELICA , FUMAGALLI ROBERTO
Published: September 2007

Background:  There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double‐blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery.

Methods:  One hundred and forty‐one children scheduled for lower abdominal and urological surgery were randomized to receive 0.4–0.6 ml·kg−1 epidural, 0.25% bupivacaine, 0.2% bupivacaine, 0.25% levobupivacaine or 0.2% levobupivacaine. Initial epidural volumes, onset times; hemodynamic consequences, postoperative pain scores and degree of residual postoperative motor block were all recorded.

Results:  There were no significant differences in the proportion of children with effective analgesia after incision [0.20% bupivacaine 97%, 0.25% bupivacaine 94%, 0.20% levobupivacaine 91%, 0.25% levobupivacaine 92% (P = 0.73)] when a median volume of 0.55 ml·kg−1 was used. There was no association between the volume used for thoracic, lumbar, or sacral epidural anesthesia and the effectiveness of the agents used. There was a significantly greater incidence of pain on awakening with the 0.2% solutions compared with the 0.25% solutions, but no differences in the incidence of residual motor block between groups.

Conclusions:  While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
Long‐term use of an intravenous ketamine infusion in a child with significant burns
Authors: WHITE MICHELLE C , KARSLI CENGIS
Published: September 2007

We report the use of an intravenous ketamine infusion for 37 days in a 9‐year‐old child with 42% body surface area burns. Ketamine was administered both in the intensive care unit and the surgical ward and provided high quality analgesia as an opioid adjunct. Throughout the long duration of administration, the child did not develop tolerance or experience psychomimetic side effects and weaning of the ketamine infusion was achieved rapidly, without evidence of withdrawal. This case demonstrates the safe and effective use of long‐term intravenous ketamine in a child with significant burns on a surgical ward. We have focused the discussion on the issues of tolerance and weaning of long‐term ketamine infusions in children.
Children who refuse anesthesia or sedation: a survey of anesthesiologists
Authors: LEWIS IAN , BURKE CONSTANCE , VOEPEL‐LEWIS TERRI , TAIT ALAN R.
Published: September 2007

Background:  Few articles have addressed the issue of the child who refuses anesthesia or sedation for surgery. A survey of members of the Society for Pediatric Anesthesia in the USA was conducted regarding their experience with pediatric refusal and assent for surgery.

Methods:  Structured response and open‐end questions were used in a confidential postal survey to assess the following: details of cancellations, the use of, and attitudes to, physical restraint at induction, premedication, the management of a hypothetical case of child refusal and individual techniques used for uncooperative children.

Results:  Surveys were received from 453/852 anesthesiologists for a 57% response rate. Nine percent and 45% of respondents had cancelled one or more cases for child refusal in the past year and during their entire career respectively. Forty‐four percent of respondents used restraint in the majority of children <1 year of age, whereas only 2% did so in children >11 years. Respondents were more uncomfortable with restraint in older children and less likely to proceed with induction. Twelve years was the median age when respondents would respect the child’s refusal to proceed.

Conclusions:  Cancellation of planned surgery because of child refusal is not uncommon. It is important to recognize the potentially uncooperative child, particularly older children with developmental delay or a lack of understanding. Discussion with child and parents, selective use of premedication and different induction agents, distraction, play techniques, gentle restraint and the option of cancellation and review should all be considered.
Premedication in children: a comparison of oral midazolam and oral clonidine
Authors: ALMENRADER NICOLE , PASSARIELLO MAURIZIO , COCCETTI BRUNO , HAIBERGER ROBERTA , PIETROPAOLI PAOLO
Published: September 2007

Background:  Oral premedication is widely used in pediatric anesthesia to reduce preoperative anxiety and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but good results have also been reported with clonidine. The aim of the present study was to compare clinical effects of oral midazolam and oral clonidine.

Methods:  We performed a prospective open study in 64 children who were randomly assigned to receive either oral midazolam 0.5 mg·kg −1 (group M) or oral clonidine 4 μg·kg −1 (group C) prior to mask induction. Drug acceptance, preoperative sedation and anxiolysis, quality of mask acceptance, recovery profile and parental satisfaction were evaluated.

Results:  The taste of oral clonidine was judged as significantly better; 14% of children rejected oral midazolam. Onset of sedation was significantly faster after premedication with midazolam (30 ± 13.1 min) than with clonidine (38.5 ± 14.6 min), but level of sedation was significantly better after premedication with clonidine. Quality of mask induction was equally successful in both groups. A steal‐induction was performed in 66% of patients of group C, but none in group M. We observed a trend towards an increased incidence of emergence agitation after premedication with midazolam. Parental satisfaction was significantly higher in group C.

Conclusions:  In this study, premedication with oral clonidine appeared to be superior to oral midazolam. Quality of mask acceptance was comparable between groups, but oral clonidine was better accepted by the child, produced more effective preoperative sedation, showed a trend towards better recovery from anesthesia and had a higher degree of parental satisfaction.
Intentional use of intra‐arterial medications when venous access is not available
Authors: JOSHI GAYATRI , TOBIAS JOSEPH D.
Published: September 2007

The difficult or impossible establishment of venous access is occasionally encountered in the pediatric population, especially in patients exposed to repeated surgical procedures or those with underlying comorbid features. Potential options in such situations include the intramuscular, intraosseous (IO), and intratracheal administration of medications. Although IO access is accepted as the route of choice in emergency situations, its use is not universally accepted in the operating room setting when the administration of medications is nonemergent. We report the intentional and elective use of the intra‐arterial (IA) administration of vecuronium, atropine, fentanyl, and fluid during the provision of anesthesia for two infants with severe cyanotic congenital heart disease in whom venous access could not readily be obtained. The potential role of IA administration of medications is discussed and previous reports from the literature are reviewed.
Sensory phenotype assessment in a young girl affected by congenital insensitivity to pain (CIPA)
Authors: BACHIOCCO VALERIA , ROSALBA BERGAMASCHI , CRISTINA MONDARDINI MARIA , GABRIELE BRONZETTI
Published: September 2007

Sensory phenotype was assessed in a young girl affected by congenital insensitivity to pain (CIPA) scheduled for an open surgical drainage. The sensory profile showed that only the Aβ fibers were functioning normally, whereas Aδ and C fibers did not respond to nociceptive stimuli. On the basis of these findings and the results of cardiovascular reflexes, she was submitted to abscess incision and debridement under midazolam sedation alone. She did not report pain or other discomfort during surgery. The sensory (and sympathetic) assessment may have a high potential value in planning anesthesia and analgesia in children with CIPA. This psychophysical procedure could be introduced as standard component of clinical evaluation before surgery.
Antiretroviral therapy and the human immunodeficiency virus – improved survival but at what cost?
Authors: Bradbury R. A. , Samaras K.
Published: September 2007

Patients infected with human immunodeficiency virus are living longer since the introduction of combination antiretroviral therapy more than a decade ago – but at what cost? Highly active antiretroviral therapy has been associated with lipodystrophy and associated metabolic derangements such as dyslipidaemia, insulin resistance and diabetes. These complications are likely to contribute to an increased risk of premature and accelerated atherosclerosis with growing concern about potential cardiovascular consequences.