bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term results of percutaneous balloon dilation for ureterointestinal anastomotic strictures
Authors: Yagi Shizuo , Goto Toshihiro , Kawamoto Ken , Hayami Hiroshi , Matsushita Shinji , Nakagawa Masayuki
Published: March 2003

Background:
We determined the long‐term result of our percutaneous antegrade balloon dilation technique performed for adult patients with ureterointestinal anastomotic stricture between 1992 and 1997.

Methods:
Balloon dilation was performed on 13 ureterointestinal anastomotic strictures in 10 patients. After a nephrostomy was performed, a guide wire was introduced into the intestinal loop through the stenotic portion under direct observation using a ureterorenoscope. Dilation was performed using the Olbert balloon dilator (30‐Fr) inserted along a guide wire into the stenotic portion. A 20‐Fr or 22‐Fr multihole catheter was left for approximately 6 weeks. No major complications were encountered during or after these procedures. After removal of the indwelling catheters, the progress of each patient was followed for at least 14 months.

Results:
Additional dilation was necessary in three of 10 patients for the recurrent stricture. The balloon dilation was ineffective in two patients with a long stenosis of the ureter or a previous history of radiation therapy for uterine cancer. Eight of 10 patients showed satisfactory outcomes during the mean follow‐up period of 47.1 months.

Conclusions:
Based on these results, we believe that the balloon dilation could be the first line of treatment for strictures of uro‐digestive anastomosis, except for some patients with a long stenosis or a previous history of intrapelvic radiation.
Involvement of adrenomedullin induced by hypoxia in angiogenesis in human renal cell carcinoma
Authors: Fujita Yoshitsugu , Mimata Hiromitsu , Nasu Nobuyoshi , Nomura Takeo , Nomura Yoshio , Nakagawa Masayuki
Published: March 2003

Background: Adrenomedullin (AM) has pluripotent activities and is involved in the regulation of vasomotor tone, cell differentiation and embryogenesis. However, the expression and pathophysiological role of AM has not been determined in human renal cell carcinoma (RCC).

Methods: Twenty‐six RCC specimens and three cultured human RCC cell lines (A498, SN12C and KPK‐13) were analyzed. Expression of AM was determined by immunohistochemistry and reverse transcription–polymerase chain reaction (RT‐PCR) analysis. The correlation between AM expression and microvessel count (MVC) in RCC specimens was examined to determine if AM plays a role in tumor angiogenesis. The correlation between the expression of AM and vascular endothelial growth factor (VEGF) was also investigated. Lastly, the effect of hypoxia upon the mRNA expression of AM, VEGF and hypoxia inducible factor‐1 (HIF‐1) by RCC cell lines was determined.

Results: Immunohistochemistry indicated that AM and VEGF were primarily localized in the cytosol of RCC cells. AM and VEGF mRNA were detected in all RCC specimens and cultured RCC cell lines analyzed by RT‐PCR. There was a positive correlation between AM mRNA expression and MVC (r = 0.516, P = 0.0062), and between VEGF mRNA expression and MVC (r = 0.485, P = 0.0111). We also observed a positive correlation between AM mRNA expression and VEGF mRNA expression (r = 0.552, P = 0.0029). Hypoxia significantly induced AM and VEGF mRNA expression, although the increase of the AM mRNA level (10.6–26.7 fold) was markedly greater than that of the VEGF mRNA level (1.5–1.9 fold).

Conclusion: These results suggest that hypoxia‐induced AM plays a part in tumor angiogenesis in conjunction with VEGF and facilitates human RCC growth under hypoxic conditions.
Comparison of parameters to determine the cause of urinary disturbance in men with prostate volume less than 20 milliliters
Authors: HIRAYAMA AKIHIDE , SAMMA SHOJI , FUJIMOTO KEN , YAMAGUCHI AKIRA , AKIYAMA TATSUYA , FUKUI YOSHIHISA
Published: March 2003

Background: A pressure‐flow study, although a slightly invasive procedure, can evaluate bladder outlet obstruction and detrusor contractility. This study was conducted in men with a non‐enlarged prostate to determine the cause of urinary disturbance by less invasive examinations that might eventually replace pressure‐flow study.

Methods: Thirty‐six men with lower urinary tract symptoms were enrolled. Their prostate volume, estimated by transrectal ultrasonography, was less than 20 mL. All patients were examined using pressure‐flow study, free‐flowmetry, transrectal ultrasonography, prostate specific antigen and an interview using the International Prostate Symptom Score and Quality of Life Index. With determination of the cause for urinary disturbance, parameters that correlated with outflow obstruction or impaired detrusor contractility were sought.

Results: Twenty‐one (60%) of the 36 men were judged as having outflow obstruction, and 16 of these 21 men had normal detrusor function. Impaired detrusor contractility was observed in 17 men. Only three of these 17 men had no outflow obstruction. Four patients had an unstable bladder. All these four had normal detrusor contractility, but had outflow obstruction. Among the parameters examined, only the maximum flow rate in a flow metrogram (Qmax) correlated significantly with the degree of outflow obstruction (P = 0.04). The positive predictive value of Qmax for outflow obstruction was 65% at a flow rate of less than 10 mL/s, and 100% at that of less than 5 mL/s. No parameter correlated with detrusor contractility.

Conclusion: The only parameter that was a clear indicator of outflow obstruction was Qmax. Other indicators of detrusor contractility should be sought.
Extracorporeal shock wave lithotripsy treatment in paraplegic patients with bladder stones
Authors: Ki˙lci˙ler Mete , Sümer Fahri , Bedi˙r Selahattin , Özgök Yaşar , Erduran Doǧan
Published: March 2003

Background: Spinal cord injury patients are at increased risk of developing urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy (ESWL).

Methods: We examined 20 consecutive spinal cord injury patients (all male) undergoing ESWL for the treatment of bladder stones between April 1992 and May 2000. The mean number of shock waves administered in these 20 patients was 3600 and the shock power was 19 kW/s. All patients were treated without anesthesia. After ESWL, the bladder was irrigated with povidone iodine solution and stone fragments were evacuated through a 22F endoscopic sheath.

Results: All patients became stone‐free after ESWL. Stone fragments were observed in the urethra of 3 patients, which were removed by urethroscopy. No major complication was observed; however, 5 patients had minor hematuria (which subsided within 24 h) and subfebrile fever (37.2–37.5°C).

Conclusion: ESWL and transurethral bladder irrigation is a safe, effective and simple modality for the treatment of bladder stones in spinal cord injury patients.
Muscarinic M2 receptors inhibit Ca2+‐activated K+ channels in rat bladder smooth muscle
Authors: NAKAMURA TAKAYUKI , KIMURA JUNKO , YAMAGUCHI OSAMU
Published: March 2003

Purpose: To clarify the functional relationship between M2 muscarinic receptor and Ca2+‐activated K+ channel, we investigated the effect of carbachol (CCh) on the membrane current of rat bladder smooth muscle cells.

Methods: Rat bladder single smooth muscle cells were patch clamped with whole‐cell configuration.

Results: CCh (10 µmol/L) transiently induced an outward current in the presence of K+ in the pipette solution. A high Ca2+ concentration in the pipette solution persistently induced an outward current, which was inhibited by CCh. In the presence of M2 inhibitor, AFDX‐384, CCh induced the outward current persistently, indicating that M2 was involved in the current inhibition. In pertussis toxin pretreated cells, CCh did not apparently inhibit the outward current. The CCh‐induced outward current was inhibited by iberiotoxin, a selective inhibitor of large‐conductance Ca2+‐activated K+ channels (BKCa).

Conclusion: CCh induces BKCa, which is inhibited by M2‐ and Gi‐mediated signal transduction pathway. This M2‐mediated pathway may enhance contraction which is initiated by M3‐stimulation in rat bladder smooth muscle.
Role of transient hyperprolactinemia in the late follicular phase of the gonadotropin‐stimulated cycle
Authors: Takiguchi Shuji , Nakamura Yasuhiko , Yamagata Yoshiaki , Takayama Hisako , Harada Ayako , Sugino Norihiro , Kato Hiroshi
Published: March 2003

Background: Serum prolactin (PRL) concentration is known to transiently increase in rats; however, its change is obscure and the role of it is also unclear in women. We studied the relationship between estradiol (E2) and PRL production and the role of transient hyperprolactinemia in the late follicular phase of the gonadotropin‐stimulated cycle.

Methods: (1) Serum E2 and PRL concentrations were measured on an early follicular day and immediately before a human chorionic gonadotropin (hCG) injection in 60 patients with normoprolactinemia. Twelve of the 60 patients also received a gonadotropin injection with bromocriptine, and serum hormone levels were compared with those without bromocriptine. (2) Preovulatory serum E2 and PRL concentrations were compared between the natural and clomiphene treatment cycles in 14 hormonally normal women. (3) Changes of serum PRL concentrations were measured before and after E2 loading in five premature ovarian failure (POF) patients. (4) The E2 production by granulosa cells in the presence of PRL was measured.

Results and Conclusion: Serum E2 and PRL concentrations were significantly increased by the gonadotropin injection. Bromocriptine treatment completely inhibited the PRL increase, but further increased serum E2 concentration on the late follicular day. The E2 loading increased serum PRL levels in POF patients. The clomiphene treatment increased serum E2 but decreased PRL concentrations. Prolactin significantly decreased E2 production by granulosa cells. A feedback loop may exist between E2 and PRL to control the excess E2 production induced by gonadotropin injection. (Reprod Med Biol 2002; 1: 69–74)
Is there another chapter in the Helicobacter pylori/peptic ulcer disease story?
Authors: Clancy R. L. , Pang G.
Published: March 2003

Abstract

The role of Helicobacter pylori in the production of mucosal damage has largely been considered within a simple infection paradigm, because to date eradication has appeared to be a predictable outcome of antibiotic therapy. Changes in the epidemiology and management of peptic ulcer disease, however, require a more comprehensive framework to understand these shifting clinical patterns. The present review examines mucosal damage as an outcome of a complicated host–parasite relationship, with alterations in both parasite physiology and host defence mechanisms being keys to understanding disease patterns. (Intern Med J 2001; 31: 181–183)
Australian Medical Council: a view from the inside
Authors: Breen K. , Frank I. , Walters T.
Published: March 2003

Although it has an important role in maintaining medical standards, little is known about the work of the Australian Medical Council (AMC) by members of the medical profession. A non‐statutory standards authority, the AMC accredits medical schools in Australia and New Zealand, examines overseas‐trained doctors for registration purposes and advises Medical Boards and Health Ministers on registration issues. The AMC, in consultation with Specialist Medical Colleges and others, is currently working on a number of initiatives to ensure standards of medical training and practice, including procedures to recognize new specialties and to accredit externally specialist education and training courses. (Intern Med J 2001; 31: 243–248)
Fibre‐optic bronchoscopy in adults: a position paper of The Thoracic Society of Australia and New Zealand
Authors: Wood‐Baker R. , Burdon J. , McGregor A. , Robinson P. , Seal P.
Published: March 2003

Abstract

Fibre‐optic bronchoscopy in adults is a common procedure in clinical respiratory practice. Under controlled conditions it is safe, resulting in relatively few significant adverse events. The present position paper updates guidelines previously published by The Thoracic Society of Australia and New Zealand and is based on evidence obtained by searching the Medline and Embase databases. The level of evidence to support recommendations is indicated in the text. Where no evidence has been found, the guidelines reflect the opinions of the authors. Specific recommendations are made regarding sedation and anaesthesia, the cleaning of bronchoscopes and the training of bronchoscopists. (Intern Med J 2001; 31: 479–487)
Increasing relevance of pharmacogenetics of drug metabolism in clinical practice
Authors: Pillans P. I.
Published: March 2003

Abstract

Much of the individual variation in drug response is due to genetic drug metabolic polymorphisms. Clinically relevant examples include acetylator status; cytochrome P450 2D6, 2C9 and 2C19 polymorphisms; and thiopurine methyltransferase deficiency. It is important to be aware of which drugs are subject to pharmacogenetic variability. In the future, population‐based pharmacogenetic testing will allow more individualized drug treatment and will avoid the current empiricism. (Intern Med J 2001; 31: 476–478)
Hepatocellular carcinoma and chemoembolization
Authors: Harris M. , Gibbs P. , Cebon J. , Jones R. , Sewell R. , Schelleman T. , Angus P.
Published: March 2003

Abstract

Background: Chemoembolization is often used in the treatment of hepatocellular carcinoma; however, there are limited data on its efficacy in an Australian setting.

Aims: To review retrospectively the experience of 21 patients with hepatocellular carcinoma who collectively had 36 chemoembolizations performed between October 1995 and February 1999 in a teaching hospital and liver transplant centre in Victoria.

Methods: Selective catheterization of the right or left hepatic arteries was performed. A mixture of cis‐platin 50 mg, epirubicin 50 mg, mitomycin C 10 mg, Lipiodol and gelfoam was injected. Computed tomography (CT) scans were performed at baseline and at 1–3 months after chemoembolization. Outcome measures included response rates, toxicity, progression‐free and overall survival.

Results: CT response rates: partial response 19% (n = 7), median duration 11 months (range 2+ to 37+); minor response 17% (n = 6), median duration 7 months (1+ to 12+); stable disease 42% (n = 15), median duration 3 months (1+ to 15 months); and progressive disease 22% (n = 8). Major toxicities included one case each of acute renal failure, contrast encephalopathy, gastric ulceration and hepatorenal failure. Median progression‐free survival was 3 months (range 0–37+). Median overall survival was 15 months (range 6–50+).

Conclusion: Chemoembolization has a role in the palliative treatment of hepatocellular carcinoma. Our response rates and toxicity data are consistent with those in the published literature. However, new treatments are needed and prevention of disease by reduction in the prevalence of chronic hepatitis B and C will be required to significantly reduce mortality from this tumour. (Intern Med J 2001; 31: 517–522.
Bronchoscopic dilatation in the management of benign (non‐transplant) tracheobronchial stenosis
Authors: Chhajed P. N. , Malouf M. A. , Glanville A. R.
Published: March 2003

Abstract

Background: Tracheobronchial stenosis in the adult patient is a recognized postoperative complication of sleeve resection or lung transplantation, but also occurs in medical conditions such as sarcoidosis, tuberculosis, postintubation/tracheostomy or postradiation.

Aims: To assess the response of bronchoscopic dilatation in the management of benign (non‐transplant) tracheobronchial stenosis and the longevity of symptomatic relief.

Methods: Eight patients underwent bronchoscopic dilatation for benign (non‐transplant) tracheobronchial stenosis. The indications were post‐tuberculous bronchostenosis (n = 3), post‐tracheostomy/endotracheal intubation strictures (n = 3), postradiation bronchostenosis (n = 1) and narrowing of the tracheal lumen following a muscle flap surgery for tracheoesophageal fistula (n = 1).

Results: Dilatation alone was effective in the management of four patients (50%). Two patients had stent placement postdilatation, one patient had tracheal resection and primary anastomosis and one patient had laser ablation for restenosis followed by balloon dilatation. All patients had clinical improvement. One patient was successfully weaned off mechanical ventilation and extubated. There was no procedure‐related mortality and all patients were alive and well at the time of reporting, with a mean duration since procedure of 123 ± 105 (range 8–340) weeks. The complications observed were granuloma formation at the site of laser excision and restenosis, each in one patient.

Conclusions: Bronchoscopic dilatation is a safe and effective modality in the initial assessment and management of benign tracheobronchial stenosis. Stent placement and Nd:YAG laser therapy complement a dilatation procedure in the combined bronchoscopic treatment of benign tracheobronchial stenosis. (Intern Med J 2001; 31: 512–516)
Sleep disorders: a potential role in New Zealand motor vehicle accidents
Authors: Yee B. , Campbell A. , Beasley R. , Neill A.
Published: March 2003

Background: The potential role of sleep disorders in New Zealand motor vehicle accidents (MVA) has not been systematically studied.

Aims: To trial a recruitment method and document the frequency of sleep disorders in drivers attending an emergency department with injury following MVA.

Methods: Injured drivers admitted to Wellington Hospital Emergency Department were prospectively recruited by letter and follow‐up telephone call. Data from a traffic accident, health and sleep questionnaire and polysomnography were collected and analysed using the SPSS statistical package.

Results: Of 120 eligible drivers, 40 (33%) completed the study protocol. The mean age of participants was 44 ± 17 years.
Non‐participants were younger (mean age 33 ± 14 years, P < 0.01) and more often of Asian or Pacific Island ethnicity (P < 0.01). Twenty‐seven (67%) felt unrefreshed on waking and 10 (25%) had an elevated Epworth Sleepiness Score (> 10/24). Six (15%) felt drowsy or fell asleep prior to the accident. Sleep disorders were common (40%): obstructive sleep apnoea 14 (35.9%), periodic limb movements of sleep three (7.7%), sleep restriction (< 6 h sleep on a regular basis) five (12.5%), and insomnia one (2.5%).

Conclusions: Daytime somnolence and sleep disorders were commonly found in drivers attending the Emergency Department after accidents resulting in injury. Driver fatigue and sleep disorders should be considered as a potential contributing factor in New Zealand MVAs. Recruitment of drivers following a MVA via the Emergency Department is challenging. Strategies to improve recruitment are discussed. (Intern Med J 2002; 32: 297−304)
Advance care planning in Australia: overdue for improvement
Authors: Taylor D. McD. , Cameron P. A.
Published: March 2003

Abstract

As the population of Australia ages, the issue of advance care planning (ACP) to improve medical management towards life's end becomes more important. However, ACP appears poorly developed in Australia. This article discusses ACP and advance directives in the context of the Australian experience and compares this with the experience overseas. It highlights the need for an improvement in ACP and recommends specific areas for discussion and research. (Intern Med J 2002; 32: 475−480)
Prevention of autoimmune attack and disease progression in multiple sclerosis: current therapies and future prospects
Authors: Pender M. P. , Wolfe N. P.
Published: March 2003

Abstract

Multiple sclerosis (MS) is an important cause of progressive neurological disability, typically commencing in early adulthood. There is a need for safe and effective therapy to prevent the progressive central nervous system (CNS) damage and resultant dis­ability that characterize the disease course. Increasing evidence supports a chronic autoimmune basis for CNS damage in MS. In the present study, we review current concepts of autoimmune pathogenesis in MS, assess current therapies aimed at countering auto­immune attack and discuss potential thera­peutic strategies. Among currently available therapies, β‐interferon and glatiramer acetate have a modest effect on reducing relapses and slowing the accumulation of disability in relapsing−remitting MS. β‐­Interferon is of doubtful efficacy in secondary progressive MS and appears to aggravate primary progressive MS, poss­ibly by increasing antibody‐mediated CNS damage through inhibition of B‐cell apoptosis. Mitoxantrone may reduce relapses and slow disability progression in relapsing−remitting and secondary progressive MS, but its use is limited by the risk of cardio­myopathy. There are currently no effective treatments for primary progressive MS. Many therapies that are effective in the animal model, experimental auto­immune encephalomyelitis (EAE), are either ineffective in MS or − in the case of γ‐interferon, lenercept and altered peptide ligands − actually make MS worse. This discrepancy may be explained by the occurrence in MS of defects in immunoregulatory mechanisms, the integrity of which is essential for the efficacy of these treatments in EAE. It is likely that the development of safe, effective therapy for MS will depend on a better understanding of immunoregulatory defects in MS. (Intern Med J 2002; 32: 554−563)
Laboratory cross‐contamination of Mycobacterium tuberculosis: an investigation and analysis of causes and consequences
Authors: Poynten M. , Andresen D. N. , Gottlieb T.
Published: March 2003

Abstract

Background:  The misdiagnosis of Mycobacterium tuberculosis infection has many ramifications. These include medical and psychological implications for patients and their families and financial and public health implications for health‐care institutions. Microbiology laboratory procedures should minimize the possibility of laboratory cross‐contamination of specimens and maximize the ability to recognize a cluster of false‐positive cultures. Newer molecular typing methods provide rapid, accurate and effective means of identifying false‐positive M. tuberculosis­cultures.

Aims:  To investigate a cluster of patients with positive M. tuberculosis cultures that were processed in the mycobacteriology laboratory on the same day.

Methods:  Five patients’ medical records and radiology results were reviewed to determine whether the cases were epidemiologically linked and whether there was clinical suspicion of tuberculosis. Restriction fragment length polymorphism (DNA fingerprinting) was performed using repetitive elements IS6110 and pTBN12. Laboratory processing procedures were analysed.

Results:  On the basis of DNA fingerprinting using IS6110, the isolates from all five patients were identical. Molecular typing using pTBN12 was performed on four of the five isolates. All four had identical patterns. There was no epidemiological link between the patients. At least three (and probably four) of the five patients were misdiagnosed with tuberculosis.

Conclusion:  Microbiology laboratories should ensure that appropriate methodologies are in place to avoid cross‐contamination of specimens. Clinicians need to critically interpret any positive laboratory result, especially in an unlikely clinical setting. (Intern Med J 2002; 32: 512−519)
Dementia: an update to refresh your memory
Authors: Logiudice D.
Published: March 2003

Abstract

The number of people with dementia and cognitive impairment is predicted to rise exponentially in the future. The increasing awareness of dementia in the community has led to a better understanding of the impact of this condition on individuals, their families and their carers. There is burgeoning research in the pathogenesis of dementia, and advances have been made in pharmacological treatments for the management of symptoms, including behavioural and ­psychological disturbances. However, the mainstay of management rests in comprehensive clinical assessment, education, counselling and provision of support for those affected and their families. The present paper provides a clinical update on recent advances in diagnosis and management of the most common forms of dementia. (Intern Med J 2002; 32: 535−540)
Endoscopic ultrasound: diagnostic and therapeutic applications
Authors: Norton I. D. , Jones D. B.
Published: March 2003

Abstract

Endoscopic ultrasound (EUS) comprises several techniques of performing high‐frequency ultrasound via an endoscope placed in the gastrointestinal tract (oesophagus, stomach, duodenum and pancreaticobiliary tree and rectum). It has rapidly become an important tool in the investigation of a variety of lumenal disorders as well as locoregional staging of gastrointestinal malignancies. Needle biopsy of peri‐intestinal structures, such as lymph nodes and pancreatic masses, can also be performed under real‐time ultrasound control. To date, the utilization of this technology in Australia has been limited by cost constraints and a paucity of training opportunities.

EUS continues to be a rapidly growing area in clinical gastroenterology. Recent studies continue to define its role, particularly in the loco‐regional staging of a variety of malignancies. In addition, new instruments permit tissue sampling and a variety of therapeutic manoeuvres under direct ultrasound guidance. (Intern Med J 2003; 33; 26−32)
Integrated weed management: Quo vadis?
Authors: ZOSCHKE ANDREAS , QUADRANTI MARCO
Published: March 2003

The different components of Integrated Weed Management (IWM), such as crop selection, crop husbandry, plant nutrition, crop protection, farm hygiene, and the site‐specific conditions, all are factors having an influence on the successful adoption of the basic IWM concept. Farmers’ field activities, directly or indirectly, affect germination and development of weeds as well as weed population dynamics. However, also important non‐agronomic parameters indirectly affect weed management. They include farm structure, farmers’ personal targets and preferences, the provision and communication of technical know‐how, economics, but also demands from society and in the area of ecology. In the light of the many additional important influences and interactions, rather than thinking in terms of IWM, it seems appropriate to view crop production as a whole process, probably best defined as Integrated Crop Management (ICM). Boiling down the mass of information and outlining a rational, straightforward, easy‐to‐apply and cheap approach for the site‐specific weed management is needed for the successful implementation of IWM principles within the framework of ICM.
Phytotoxic effect of Parthenium residues on the selected soil properties and growth of chickpea and radish
Authors: Batish Daizy R. , Singh Harminder P. , Pandher Jasvir K. , Arora Vandana , Kohli Ravinder K.
Published: March 2003

The present study investigates the effect of residues of noxious weed Parthenium hysterophorus in soil as well as under laboratory conditions. Soils were infested with different amounts of Parthenium residues to determine the changes in soil chemistry, phenolic content and the phytotoxic effects on crops like chickpea (Cicer arietinum) and radish (Raphanus sativus). The modified soils and unmodified (control) soil were analyzed for pH, conductivity, organic carbon, organic matter, available nitrogen, phosphorus, potassium and micronutrients such as sodium, iron, manganese and zinc. The pH of all the modified soils decreased whereas the conductivity, organic carbon and organic matter increased. Further, the amount of sodium and potassium increased, whereas that of zinc decreased. In the soil infested with 4 g of Parthenium residue, the amount of available nitrogen decreased. The presence of significantly high amounts of phenolics in all modified soils indicated their possible interactions with soil chemical properties. This was also indicated by the correlation analysis between phenolics and various soil properties. The growth studies carried out in the modified soils indicated their phytotoxic nature, as seedling growth of both chickpea and radish was significantly decreased compared with seedlings grown in unmodified soils. The extracts prepared from Parthenium residues were also found to be phytotoxic to both the test crops and were also rich in phenolics. The presence of phenolics in Parthenium residues and their interference with soil chemistry upon release may be responsible for a decrease in the growth of radish and chickpea.
Propanil‐resistant barnyardgrass [Echinochloa crus‐galli (L.) Beauv.] in Sri Lanka: Seedling growth under different temperatures and control
Authors: MARAMBE B. , AMARASINGHE L.
Published: March 2003

Experiments were conducted to (i) evaluate the efficacy of propanil formulations available in Sri Lanka in controlling Echinochloa crus‐galli; (ii) study the seedling growth of propanil‐resistant (R) and ‐susceptible (S) biotypes of the weed under different temperatures; (iii) quantify the level of resistance in R biotypes and; (iv) to suggest alternative control measures for R biotypes. Field studies showed that retail propanil formulations (36% a.i., EC) applied at 2.7 kg a.i. ha−1 gave less than 30% control of E. crus‐galli collected from several locations of the north dry zone of Sri Lanka. Chemical analysis revealed that there was no adulteration of propanil formulations at the retailer level. Growth studies conducted in controlled environments indicated that per cent germination and seedling growth of R and S biotypes were similar at the day/night temperature regimes imposed. However, per cent germination for plants grown under a 34/31°C (day/night) regime was 27–29% higher compared to those grown at 28/24°C. At the higher temperature regime, R and S biotypes reached the 2–3 leaf stage five days earlier, and the 4–5 leaf stage seven days earlier.

The ED50 values from the dose–response experiments indicated that the R biotype was four times more resistant to propanil than susceptible ones. The resistance index (RI) did not vary significantly under different temperature regimes. Quinclorac (25% a.i., SC) applied at 200 g a.i. ha−1 and bispyribac‐sodium (10% a.i., SC) applied at 30 g a.i. ha−1 (recommended dosages) successfully controlled propanil‐resistant biotypes of E. crus‐galli. Conversely, oxadiazon and propanil (8% and 23% a.i., EC, respectively) applied at 280 + 805 g a.i. ha−1 did not result in satisfactory control.
Effects of rye cover crop residue and herbicides on weed control in narrow and wide row soybean planting systems
Authors: KOGER CLIFFORD H. , REDDY KRISHNA N. , SHAW DAVID R.
Published: March 2003

Α three‐year, non‐irrigated field study was conducted in 1998, 1999, and 2000 at the Southern Weed Science Research Unit farm, Stoneville, MS to study the effects of rye cover crop residue, soybean planting systems, and herbicide application programs on the control, density and biomass of several weed species and soybean yield. The soybean planting systems comprised 19 cm rows with high plant density, 57 cm rows with medium plant density, and 95 cm rows with low plant density. The herbicide programs evaluated were pre‐emergence, postemergence, pre‐emergence followed by postemergence, and no herbicide. Flumetsulam and metolachlor were applied pre‐emergence, and acifluorfen, bentazon, and clethodim were applied postemergence. The presence or absence of rye cover crop residue and a soybean planting system did not affect weed control of the species evaluated (browntop millet, barnyard grass, broadleaf signal grass, pitted morningglory, yellow nutsedge, Palmer amaranth and hyssop spurge), when herbicides were applied, regardless of the application program. In addition, rye cover crop residue was not an effective weed management tool when no herbicide was applied, because density and biomass of most weeds evaluated were higher than a no cover crop residue system. Among soybean planting systems, narrow with high plant density soybeans reduced density of grasses, broadleaf weeds and yellow nutsedge by 24–83% and total weed biomass by 38%, compared to wide with low plant density soybeans. Although weed pressure was reduced by narrow with high plant density soybeans, herbicide applications had the most impact on weed control, weed density and biomass. All herbicide programs controlled all weed species 81–100% at two weeks after postemergence herbicide applications, in comparison to no‐herbicide. Density of grasses and all broadleaf weeds as well as total weed biomass was lower with the pre‐emergence followed by postemergence program than these programs alone. Soybean yields were higher in the pre‐emergence followed by postemergence, and postemergence only programs than the pre‐emergence alone program. Planting crops in narrow rows is one cultural method of reducing weed pressure. However, even with the use of this cultural practice, prevalent weed pressure often requires management with herbicides.
Retracted: Comparison of granisetron and droperidol in the prevention of vomiting after strabismus surgery or tonsillectomy in children
Authors: FUJII YOSHITAKA , SAITOH YUHJI , TANAKA HIROYOSHI , TOYOOKA HIDENORI
Published: March 2003

This prospective, randomized, double‐blinded study evaluated the antiemetic efficacy of granisetron and droperidol in 80 ASA physical status I children, aged 4–10 years, undergoing strabismus surgery or tonsillectomy with or without adenoidectomy. After anaesthetic induction, the patients received either granisetron (40 μg·kg−1, n=40) or droperidol (50 μg·kg−1,
n=40) intravenously. The incidence of vomiting during the first 24 h after anaesthesia was 15% and 38% after administering granisetron and droperidol, respectively(r)(
P=0.02). The requirement for rescue antiemetic therapy for the treatment of two or more episodes of vomiting was 0% with granisetron and 18% with droperidol (
P=0.001). In conclusion, granisetron was superior to droperidol in reducing the incidence and frequency of postoperative vomiting in paediatric patients.
Salicylate toxicity masquerading as malignant hyperthermia
Authors: CANDY  , MORRISON  , PATON  , LOGAN  , LAWSON
Published: March 2003

We report a case of hyperpyrexia presumed due to topical salicylate toxicity occurring immediately following general anaesthesia for appendicectomy in an eleven year old boy. Some of the features strongly suggested the diagnosis of malignant hyperpyrexia.
A comparison of intramuscular tenoxicam with intramuscular morphine for pain relief following tonsillectomy in children
Authors: SUTHERLAND C. J. , MONTGOMERY J. E. , KESTIN I. G
Published: March 2003

A double blind trial was conducted to evaluate the analgesic efficacy of intramuscular tenoxicam for pain relief following tonsillectomy in children. Fifty children, aged 3–10 years, were randomly allocated to receive intramuscular tenoxicam 0.75 mg·kg−1 or intramuscular morphine sulphate 0.2 mg·kg−1 after induction of anaesthesia. Although the tenoxicam group required significantly more postoperative morphine (mean 57.8 μg·kg−1 compared with 26.9 μg·kg−1, P=0.025), the total morphine dose was significantly reduced after tenoxicam (57.8 μg·kg−1 compared with 226.9 ug·kg−1, P<0.0001). There was no difference between the quality of analgesia after discharge from recovery. The incidence of postoperative vomiting was significantly reduced after tenoxicam (20%) compared with morphine (71%).
Anaesthesia and Prader‐Willi syndrome
Authors: DEARLOVE O. R. , DOBSON A. , SUPER M.
Published: March 2003

A review of a case series of sixteen anaesthetics in eight cases was undertaken to determine whether children with Prader‐Willi syndrome present particular problems to the anaesthetist. Children in an early stage of the condition who are below their centile for weight present no specific problems. Children who are heavier than 97th centile weight have problems associated with their obesity: difficult intravenous access and sleep apnoea. Scoliosis was noted in both groups and was not associated with problems after minor surgery.
Onset of neuromuscular blockade and intubating conditions one minute after the administration of rocuronium in children
Authors: STODDART PETER , MATHER STEPHEN
Published: March 2003

In a blinded randomized study intubating conditions were compared at one min following intravenous induction with propofol and either suxamethonium 1.0 mg·kg−1, or rocuronium 0.6 mg·kg−1. Onset time to maximal twitch depression, % block at one minute and clinical duration (time to 25% recovery) were measured. Sixty children undergoing elective tonsillectomy were recruited. Onset time [42 s (SD 11 s)] and clinical duration [3.3 min (SD 1.0 min)] in the suxamethonium group was significantly (P<0.001) less than in the rocuronium group [92 s (41 s)] and [24.2 min (6.6 min)] respectively. The median twitch height at one minute for suxamethonium was 0% (range 0–8%) and significantly greater (P<0.001) at 5% (range 0–22%) for rocuronium. Despite this there was no difference in the intubating conditions at one minute with 25 excellent/5 good in the suxamethonium group and 27 excellent/3 good in the rocuronium group. We conclude that rocuronium 0.6 mg·kg−1 gives optimal intubating conditions at one minute in children.
Retracted: Prophylactic therapy with granisetron in the prevention of vomiting after paediatric surgery. A randomized, double‐blind comparison with droperidol and metoclopramide
Authors: FUJII YOSHITAKA , TANAKA HIROYOSHI
Published: March 2003

The antiemetic efficacy of droperidol, metoclopramide and granisetron was compared with placebo in the reduction of vomiting after paediatric surgery (the extremities; inguinal hernia; and phimosis) during general inhalational anaesthesia. One hundred children, ASA physical status I, 4–10 years of age, were enrolled in a prospectively, randomized, double‐blind investigation and assigned to one of four treatment regimens: placebo (saline, n=25), droperidol (50 μg·kg1, n=25), metoclopramide (0.25 mg·kg‐1, n=25) or granisetron (40 μg·kg‐1, n=25). These drugs were administered intravenously (iv) after inhalation induction of anaesthesia. A complete response, defined as no emesis and no need for another rescue antiemetic during the first 24 h after anaesthesia, occurred in 60%, 76%, 68% and 88% of patients who had received placebo, droperidol, metoclopramide and granisetron, respectively (P<0.05; overall Fisher's exact probability test). The incidence of adverse events postoperatively was not different among the treatment groups. In conclusion, granisetron 40 μg·kg‐1 is a better antiemetic than droperidol and metoclopramide when compared to placebo for the prevention of postoperative emesis in children.
Retracted: Combination of granisetron and droperidol for the prevention of vomiting after paediatric strabismus surgery
Authors: Fujii Yoshitaka , Saitoh Yuhji , Tanaka Hiroyoshi , Toyooka Hidenori
Published: March 2003

This study was undertaken to compare the efficacy of granisetron plus droperidol with each antiemetic alone for the prevention of vomiting after paediatric strabismus surgery. In a prospective, randomized, double‐blinded trial, 120 ASA physical status I children, aged 4–10 years, received granisetron 40 μg.kg− 1, droperidol 50 μg.kg− 1, granisetron 40 μg.kg− 1 plus droperidol 50 μg.kg− 1 (n=40 of each) intravenously after an inhalation induction of anaesthesia. A complete response, defined as no vomiting, no retching and no need for another rescue antiemetic medication, during 0–3 h after anaesthesia was 80% with granisetron, 45% with droperidol and 98% with granisetron plus droperidol, respectively; the corresponding incidence during 3–24 h after anaesthesia was 78%, 38% and 98% (P< 0.05; overall chi‐squared test with Yates continuity correction). No clinically important adverse events were observed in any of the groups. In conclusion, a combination of granisetron and droperidol was more effective than granisetron or droperidol as a sole antiemetic for the prevention of postoperative vomiting in children undergoing strabismus repair.
Preoperative psychological preparation for children undergoing ENT operations: a comparison of two methods
Authors: Hatava Pirkko , Olsson Gunnar L. , Lagerkranser Michael
Published: March 2003

A psychological preparation programme was developed for outpatient surgery in children. The purpose of this study was to determine if the programme could increase retrieval of information and reduce anxiety prior to ENT surgery. After ethical committee approval, 160 children and their parents were included. Eighty children (group 1) received conventional verbal information from an ENT nurse, and another 80 children (group 2) received specific information, including role‐play, from a nurse anaesthetist at a preadmission visit. Children’s and parents’ experience of premedication, operation theatre (OR), i.v.‐needle insertion and induction of anaesthesia were evaluated from a self‐rating questionnaire. The questionnaire included ratings for anxiety and satisfaction with information and care. The results indicate a clear improvement of the preoperative acquisition of knowledge in all age groups. When it comes to alleviation of fear, a positive effect of the preparation programme was noticed, especially among the younger children (< 5 years), while preoperative anxiety overall was a significantly smaller problem among the older children. The effects of the programme were also related to previous experience of anaesthesia and most beneficial among young children with such experience. Overall, the most negative procedure reported by the children was the i.m. injection for premedication (a routine which was abandoned as a result of the study), followed by the insertion of the i.v.‐needle. The parents experienced watching their child fall asleep during induction of anaesthesia as most negative, followed by the insertion of the i.v.‐needle. Parents also reported more satisfaction and less anxiety after having received specific information and preparation preoperatively. It was concluded that this preoperative preparation programme is useful in all age groups with regard to information, while alleviation of anxiety and fear was seen mainly among the younger children with previous experience of anaesthesia.
Clinical predictors of anaesthetic complications in children with respiratory tract infections
Authors: Parnis S.J. , Barker D.S. , Van Der Walt J.H.
Published: March 2003

Details of the preoperative condition, in particular symptoms of respiratory tract infections (RTI), perioperative management and the occurrence of perioperative complications, were collected in a survey of 2051 children. Logistic regression was used to determine which variables were predictors of anaesthetic adverse events. 22.3% of the children had symptoms of an RTI on the day of surgery, and 45.8% had a ‘cold’ in the preceding 6 weeks. Logistic regression returned eight variables. They were method of airway management, parent states the child has a ‘cold’ on the day of surgery, child has nasal congestion, child snores, child is a passive smoker, induction agent chosen, child produces sputum, and whether reversal agent used. Orotracheal intubation was associated with an increased probability of complications when compared with laryngeal mask airway and facemask. RTI in the preceding 6 weeks did not increase probability of complications. Wheeze, fever, malaise and age could not be excluded as predictors in this study because children with these symptoms and infants with colds were effectively excluded from the study.
Perioperative considerations in a hypothyroid infant with hepatic haemangioma
Authors: Mason Keira P. , Koka Babu V. , Eldredge Elizabeth A. , Fishman Steven J. , Burrows Patricia E.
Published: March 2003

Hepatic haemangiomas in infants are rare. An infant with both a hepatic haemangioma and a severe hypothyroid condition, unresponsive to conventional thyroxine therapy, will be described. This case presented here is the perioperative management of a critically ill infant who had myocardial depression secondary to hypothyroidism and a hepatic haemangioma that required embolization. To our knowledge, this is the first published report describing intravenous triiodothyronine as a therapeutic modality to stabilize a hypothyroid infant prior to undergoing a general anaesthetic.
Prediction of difficult airway in school‐aged patients with microtia
Authors: Uezono Shoichi , Holzman Robert S. , Goto Takahisa , Nakata Yoshinori , Nagata Satoru , Morita Shigeho
Published: March 2003

Background: Because the ear and mandible develop from the first and second branchial arches and first branchial cleft, abnormalities of the ear may be a sign that intubation will be difficult. We hypothesized that children with microtia would have a greater incidence of difficult laryngeal visualization with conventional rigid laryngoscopy compared to those with normal facial anatomy.

Methods: We enrolled 93 consecutive school‐aged patients with microtia undergoing the first stage of total reconstruction of the auricle. Age‐matched patients with normal facial anatomy served as controls. Each patient was examined for the presence or absence of the five dysmorphic features of hemifacial microsomia: orbital asymmetry, mandibular hypoplasia, ear deformity, nerve involvement, soft tissue deficiency (OMENS classification). After a standardized induction of anaesthesia, the laryngeal view during rigid laryngoscopy was graded.

Results: The incidence of difficult laryngeal view was 42% in the patients with bilateral microtia, 2% in those with unilateral microtia and 0% in the controls.

Conclusions: There was a strong positive correlation between the number of involved abnormal anatomical components according to the OMENS classification and the degree of difficult visualization of the larynx in patients with both bilateral and unilateral microtia (Spearman rank order correlation coefficient=0.85 and 0.88, respectively).
Pain management in children with and without cognitive impairment following spine fusion surgery
Authors: Malviya Shobha , Voepel‐Lewis Terri , Tait Alan R. , Merkel Sandra , Lauer Anthony , Munro Hamish , Farley Frances
Published: March 2003

Background: We compared pain assessment and management practices in children with and without cognitive impairment (CI) undergoing spine fusion surgery.

Methods: The medical records of 42 children (19 with CI and 23 without) were reviewed and data related to demographics, surgery, pain assessment and management, and side‐effects were recorded.

Results: Fewer children with CI were assessed for pain on postoperative days (POD) 0–4 compared to those without CI (P < 0.002). Self‐report was used for 81% of pain assessments in children without CI, while a behavioural tool was used for 75% of assessments in cognitively impaired children. Children with CI received smaller total opioid doses on POD 1–3 compared to those without CI (P ≤ 0.02). Furthermore, children without CI received patient/nurse‐controlled analgesia for more postoperative days than children with CI (P=0.02).

Conclusions: Our data demonstrate a discrepancy in pain management practices in children with and without CI following spine fusion.
Cervical subcutaneous emphysema: an unusual complication of adenotonsillectomy
Authors: Miman Murat C. , Ozturan Orhan , Durmus Mahmut , Kalcioglu Mahmut T. , Gedik Ender
Published: March 2003

Removal of the tonsils and adenoid tissue because of recurrent infection and/or respiratory obstruction is one of the most commonly performed operations. A rare complication during this intervention is subcutaneous surgical emphysema. The awareness of anaesthesiologists and otolaryngological surgeons will protect the patient from serious consequences. We report our experience with this complication and provide a review of the literature.