bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting the effects of intravesical instillation of saline on bladder lesion development in rats pre‐treated with BBN
Authors: ITOH YASUNORI , OKAMURA TAKEHIKO , TOZAWA KEIICHI , YAMADA YASUYUKI , KOHRI KENJIRO
Published: March 2003

Abstract Background: At present, immunotherapeutic agents such as bacillus Calmette‐Guerin (BCG) and anti‐tumor chemotherapeutic agents in saline are used intravesically in patients with bladder carcinoma. However, of greater significance is the possibility that the saline vehicle may itself promote carcinoma development in the bladder.

Methods: The potential promoting effects of intravesical instillation of saline were assessed in female F344 rats. The animals were divided into 3 groups, all of which received 0.05% N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine (BBN) in their drinking water for the first 10 weeks. They were then maintained without further treatment (group 1) or received intravesical instillations of 0.3 mL of saline or distilled water once a week for 6 weeks, 15 weeks after the end of the BBN treatment (groups 2 and 3). At 32 weeks, all the animals were killed and examined immunohistochemically with proliferating cell nuclear antigen (PCNA) antibody, as well as by routine histopathologic examination.

Results: Both the incidence and the number of bladder carcinomas were higher in the animals that received instillations of saline than in those who did not receive the instillations. Significant increases in tumor size were also noted for the saline‐treated groups, although this was not linked with the PCNA labeling index.

Conclusions: The results indicate that saline is a promoter of urinary bladder carcinogenesis either because of the catheterization or the fluid itself.
Nephron‐sparing tumorectomy for a large benign renal mass: A case of massive bilateral renal angiomyolipomas associated with tuberous sclerosis
Authors: Shiroyanagi Yoshiyuki , Kondo Tsunenori , Tomita Eri , Onitsuka Shiro , Ryoji Osamu , Ito Fumio , Nakazawa Hayakazu , Toma Hiroshi
Published: March 2003

Abstract A case of massive bilateral angiomyolipomas (AML) associated with tuberous sclerosis in a 33‐year‐old woman is reported. She was hospitalized because she had been experiencing abdominal fullness and epigastralgia. Several imaging studies revealed massive bilateral renal tumors and she was diagnosed as having renal AML associated with tuberous sclerosis. Left nephrectomy was carried out after renal arterial embolization for intratumor hemorrhage. Two years after left nephrectomy, nephron‐sparing surgery (tumorectomy) for right AML was done because of an increase in the size of the right renal AML and she hoped for a future pregnancy. The left kidney with AML weighed 5700 g and the right AML weighed 1700 g. Postoperative serous creatinine did not differ from that before operation and an increase in the size of the residual tumor was not observed 8 months after operation. We consider that tumorectomy is an effective therapy in patients with a very large tumor involving a solitary kidney.
Durable control of small cell carcinoma of the urinary bladder by gemcitabine and paclitaxel
Authors: Matsui Yoshiyuki , Fujikawa Keita , Iwamura Hiroshi , Oka Hiroya , Fukuzawa Shigeki , Takeuchi Hideo
Published: March 2003

Abstract We report a case of small cell carcinoma of the bladder for which new chemotherapeutic agents, gemcitabine and paclitaxel were effective without remarkable toxicity.
Spontaneously ruptured multilocular cystic nephroma
Authors: FUJIMOTO KEN , SAMMA SHOJI , FUKUI YOSHIHISA , YAMAGUCHI AKIRA , HIRAYAMA AKIHIDE , KIKKAWA AKIRA
Published: March 2003

Multilocular cystic nephroma is a relatively rare benign tumor of the kidney. An adult case of spontaneously ruptured multilocular cystic nephroma was reported. A 33‐year‐old woman who presented with a right flank colic attack. The preoperative diagnosis was spontaneously ruptured renal tumor. A right nephrectomy was performed. A multilocular cystic lesion, 10 cm in diameter, was found in the removed specimen, which had a hematoma inside and direct tumor extension into the renal pelvis. On microscopic examination, the surface of loculi was covered by a layer of hobnail epithelium, and septa were composed of fibrous tissue with dilated vessels, lacking in normal renal components. There were no signs of malignancy. The lesion extending into the renal pelvis showed the same microscopic findings. The final diagnosis was multilocular cystic nephroma. Two respects, spontaneous rupture and tumor extension into the renal pelvis, were unique to the present case. There has been no report of spontaneously ruptured mutilocular cystic nephroma. The tumor extension into the renal pelvis, however, has been found in several reports. This growth pattern might be one of the characteristics of this benign renal tumor.
Holmium laser enucleation for large (greater than 100 mL) prostate glands
Authors: Hettiarachchi Janaka A , Samadi Albert A , Konno Sensuke , Das Akhil K
Published: March 2003

Background:
To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands > 100 mL.

Methods:
Eighteen patients with preoperative prostate volumes > 100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention.

Results:
The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3‐week postoperative IPSS was 2.8, with minimum long‐term complications.

Conclusions:
Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands > 100 mL.
Sarcomatoid carcinoma and carcinosarcoma of the urinary bladder
Authors: Ogishima Tatsuya , Kawachi Yoshio , Saito Akira , Suzuki Fujihiko , Ishi Kazuhisa , Tanaka Toru
Published: March 2003

Two cases, sarcomatoid carcinoma and carcinosarcoma, of the urinary bladder are reported. A 68‐year‐old man with sarcomatoid carcinoma underwent total cystectomy and was alive and had had no recurrence after 21 months. A 78‐year‐old woman with carcinosarcoma underwent total cystectomy, but she died from increasing multiple lung metastases 4 months after surgery. The histopathological characteristics of both neoplasms are reported and discussed.
Effect of administration mode (patient vs physician) and patient's educational level on the Turkish version of the International Prostate Symptom Score
Authors: Bozlu Murat , Doruk Erdal , Akbay Erdem , Ulusoy Ercüment , Çayan Selahíttín , Acar Deníz , Kanik Emíne Arzu
Published: March 2003

Objectives: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self‐administered by the patient. The effect of the patient's educational level on the IPSS was also evaluated.

Methods: One hundred and seven previously untreated patients with symptomatic benign prostatic hyperplasia (BPH) completed the Turkish version of the International Prostate Symptom Score (Turkish I‐PSS) and quality of life (QOL) questionnaires during a single office visit, first on their own and then with an interviewing physician. The patients were categorized into three groups according to their educational levels. Paired t‐tests were performed to compare the total IPSS (tIPSS) and QOL results between the two testing modes. IPSS and QOL scores resulting from both modes were compared using a kappa test. Differences between the physician‐assisted and self‐administered scores among the different educational groups were further compared using a one‐way anova test and Post Hoc Multiple Comparisons. To compare the objective effectiveness of tIPSS and QOL between the two testing modes, we selected the positive actual state, which was maximum urine flow (Qmax) of 15 mL/s or less and constructed receiver operating characteristics (ROC) curves for all patients. This estimation was constructed for each educational level.

Results: There were no statistical differences in IPSS and QOL values obtained by the patients or physicians (P > 0.05). The ROC areas for tIPSS were 0.94 and 0.93, and the ROC areas for QOL scores were 0.97 and 0.91 for information obtained by physicians and patients, respectively. When IPSS answers and QOL scores were evaluated separately, consistency was found across both modes of administration. However, there were lower levels of consistency in answers to IPSS questions 2, 5 and 6 (P = 0.59;0.42; 0.52, respectively). There was no significant difference among the aforementioned data in the educational groups.

Conclusion: Although the total IPSS and QOL scores were not affected by the different modes of administration, we recommend that the physicians should evaluate answers to questions 2, 5 and 6 carefully. The present study demonstrates that the educational level did not affect the IPSS and QOL when administered either by the physician or the patient.
Traumatic rhabdomyolysis resulting from continuous compression in the exaggerated lithotomy position for radical perineal prostatectomy
Authors: KIKUNO NOBUYUKI , URAKAMI SHINJI , SHIGENO KAZUSHI , KISHI HIROFUMI , SHIINA HIROAKI , IGAWA MIKIO
Published: March 2003

Abstract This report demonstrates a case of rhabdomyolysis as a result of the exaggerated lithotomy position during radical perineal prostatectomy. The pathogenesis, diagnosis, management, and preventive measures of rhabdomyolysis are also reviewed.
Ureteroenteric fistula after retrograde balloon dilatation of ureteral stricture
Authors: OH SEUNG‐JUNE , JEONG BYONG‐CHANG , KIM HYEON HOE
Published: March 2003

Advances in endourology have made transluminal balloon dilatation a safe and effective procedure for the treatment of ureteral strictures. Bilateral ureteral stricture was treated with retrograde balloon dilatation and ureteral stenting in a 59‐year‐old‐woman. The patient had previously undergone abdominoperineal resection and adjuvant radiotherapy due to rectosigmoid adenocarcinoma. Subsequently, unilateral ureteroenteric fistula was detected on follow‐up retrograde ureteropyelography. To our knowledge, this is the first case of ureteroenteric fistula after balloon dilatation for ureteral stricture in a patient with predisposing factors for compromised vascularity of the ureter.
Cell proliferation, apoptosis, angiogenesis and growth rate of incidentally found renal cell carcinoma
Authors: ODA TOSHIRO , TAKAHASHI ATSUSHI , MIYAO NORIOMI , YANASE MASAHIRO , MASUMORI NAOYA , ITOH NAOKI , SATO MASA‐AKI , KON SHIN‐ICHIRO , TSUKAMOTO TAIJI
Published: March 2003

Background: Our previous study showed that the growth rate of incidentally found renal cell carcinoma (RCC) varied, and that the initial clinical and pathological features did not predict subsequent growth of the carcinoma. The objective of this study was to determine the relationships between cell proliferation, apoptosis, angiogenesis and the growth rates of these RCC.

Methods: We examined cell proliferation, apoptosis, and angiogenesis in 16 incidentally found cases of RCC. Cell proliferation was assessed by immunohistochemical staining with a Ki‐67 antibody. Apoptosis was assessed by the terminal deoxynucleotidyl transferase (TdT) mediated deoxy‐UTP biotin nick end labeling (TUNEL) technique. The Ki‐67 labeling index (KI) and the apoptotic index (AI) were determined as the ratio of immunohistochemically positive cells per 1000 cancer cells. The KI/AI ratio was also determined. Angiogenesis was evaluated by CD34 immunostaining. Finally, we investigated the correlation between these parameters and the growth rate of primary lesions of incidentally found RCC.

Results: The KI ranged from 7 to 73 (median, 20), AI ranged from 6 to 171 (median, 26), and microvessel density (MVD) ranged from 21 to 673 (median, 265) for incidentally found RCC. Ki‐67 labeling index, AI and MVD were not closely correlated to each other. Furthermore, these parameters were not associated with growth rates of incidentally found RCC. Only the KI/AI ratio was strongly correlated to the growth rate of incidentally found RCC (r = 0.709; P = 0.0083).

Conclusion : Our results suggest that the balance between cell proliferation and apoptosis partly determines the growth rate of primary lesions of incidentally found RCC.
Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder
Authors: SEREL TEKIN AHMET , SEVI˙N GüüVEN , PERK HAKKI˙˙ , KOŞAR ALIM , SOYUPEK SEDAT
Published: March 2003

Background: We describe a new operative technique for the surgical treatment of bladder cancer.

Methods: Male patients with invasive bladder cancer were managed by radical cystoprostatectomy using a technically different approach than the conventional method. The main feature of this method includes a small vertical incision between pubis and umbilicus, keeping the abdominal peritoneum closed during the surgery. Reperitonealization is done at completion to isolate the urinary anastomoses from the bowel anastomoses.

Results: Seventy‐six consecutive patients with bladder cancer underwent this operation. The mean operation time was 4 h 30 min and the mean hospital stay was 11 days. No mortality was seen in the early postoperative period. Only one patient developed serious bowel distension. Two patients developed pneumonia. Wound infection was seen in two patients. Two patients experienced hydronephrosis in the late period of follow‐up. Four patients developed pelvic lymphocele. There was no evidence of postoperative electrolyte loss in any of the patients. Three patients developed abdominal hernia and this was corrected with surgical treatment. Urodynamic evaluation of 15 patients showed a low capacity reservoir. All patients were continent during the daytime.

Conclusion: This technique keeps the abdominal peritoneum closed during radical cystoprostatectomy, preventing the patients from complications, such as infection, water and electrolyte imbalances. The technique also decreases the recovery time.
Extensive cutaneous metastasis of transitional cell carcinoma of the bladder
Authors: AKMAN YAVUZ , CAM KAMIL , KAVAK AYSE , ALPER MURAT
Published: March 2003

Abstract Cutaneous metastasis of bladder carcinoma is extremely rare. Iatrogenic implantations have been the main cause in the majority of cases of transitional cell carcinoma with cutaneous metastasis. Otherwise, primary cutaneous metastasis is accepted as the late manifestation of systemic spread. The present paper describes a case of relatively early and extensive skin metastasis of transitional cell carcinoma in a 78‐year‐old man. The patient had a histopathological diagnosis of poorly differentiated (grade III) muscle invasive transitional cell carcinoma with a staging of T2NOMO 6 months prior to presenting. He presented to our outpatient clinic with a 3‐month history of skin lesions as multiple, rubbery subcutaneous nodules. Radiological reinvestigation revealed no other metastatic site (including bone and lung), except for a metastatic nodule in the liver. The present paper reports an interesting and rare case of extensive skin metastasis of transitional cell carcinoma as the primary complaint.
Predictors of prostate cancer on repeat transrectal ultrasound‐guided systematic prostate biopsy
Authors: PARK SOO‐JEON , MIYAKE HIDEAKI , HARA ISAO , ETO HIROSHI
Published: March 2003

Abstract
Background:
We analyzed the outcome of repeated transrectal ultrasound (TRUS)‐guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies.

Methods:
Between January 1993 and March 2002, 1045 patients underwent TRUS‐guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate‐specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy.

Results:
Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy.

Conclusion:
Despite an initial negative biopsy, repeat TRUS‐guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA‐related parameters, or abnormal findings of DRE or TRUS.
Acute renal failure following ingestion of wild mushrooms
Authors: Mount P. , Harris G. , Sinclair R. , Finlay M. , Becker G. J.
Published: March 2003

We describe three cases of acute renal failure in young men who ingested wild mushrooms with the intent of producing hallucinations. Two cases remained dialysis dependent and, in these cases, renal biopsy revealed tubulointerstitial nephritis and ­fibrosis. Similar cases have been reported in other countries, but not in Australia. The most recognized mushroom nephrotoxin is orellanine, however the causative mushroom species and the actual toxin involved in these cases are unknown. (Intern Med J 2002; 32: 187−190)
Bilateral tubal pregnancies after the termination of intrauterine pregnancy following gamete intrafallopian transfer
Authors: Shibahara Hiroaki , Suzuki Tatsuya , Wada Tomoaki , Ohno Takashi , Yamauchi Ariko , Tsunoda Tetsuo , Takamizawa Satoru , Sato Ikuo , Shiraishi Satoshi
Published: March 2003

It is well known that the prevalence of heterotopic pregnancies following assisted reproductive technology (ART) is much higher than among spontaneous pregnancies. Here, we illustrate a very rare case of bilateral simultaneous tubal pregnancies combined with intrauterine pregnancy (incomplete abortion) following gamete intrafallopian transfer (GIFT). In this case, unsuspected bilateral tubal pregnancies were diagnosed when laparotomy was performed 10 days after the termination of an intrauterine pregnancy. We conclude that a careful monitoring after the termination of an intrauterine pregnancy should be performed when the patient has prolonged genital bleeding, which might be a warning signal of heterotopic pregnancy existence even in patients without any risk factors of ectopic pregnancy. (Reprod Med Biol 2002; 1: 65–67)
Single institution outcomes of treatment of severe aplastic anaemia
Authors: Mollee P. , Woodward N. , Durrant S. , Lockwood L. , Gillett E. A. , Morton J. , Rowell J.
Published: March 2003

Background: In severe aplastic anaemia, the treatment of choice for young patients with a human leucocyte antigen‐matched sibling is now established as allogeneic bone marrow transplantation (BMT). In older patients and in those without a matched sibling donor, immunosuppressive therapy is the usual first option. ‘Alternative’ marrow donors are emerging as an option for those without a matched sibling donor.

Aims: To review 10 years of local experience in treating severe aplastic anaemia with BMT and immunosuppressive therapy with emphasis on long‐term outcomes.

Methods: A retrospective analysis was performed of all patients with severe aplastic anaemia presenting to the Royal Brisbane and Royal Children’s Hos‐ pitals between 1989 and 1999. Data were abstracted regarding patient demographics, pretreatment characteristics and outcome measures, including response rates, overall survival and long‐term complications.

Results: Twenty‐seven consecutive patients were identified, 12 treated with immunosuppression alone and 15 with BMT. In these two groups, transfusion independence was attained in 25% and 100%, respectively, with overall survival being 36% and 100%, respectively. Those treated with immunosuppression were significantly older (median 41.5 versus 22 years, P = 0.008). Long‐term survivors of either treatment had extremely low morbidity. Three patients carried pregnancies to term post‐transplant. Three patients received alternative donor BMT with correspondingly excellent survival.

Conclusions: Patients treated with allogeneic BMT for severe aplastic anaemia enjoyed extremely good long‐term survival and minimal morbidity. Patients treated with immunosuppressive therapy had a poorer outcome reflecting their older age and different usage of therapies over the past decade. Optimal treatment strategies for severe aplastic anaemia remain to be determined. (Intern Med J 2001; 31: 337–342)
Sentinel lymph node biopsy in patients with melanoma and breast cancer
Authors: Uren R. F. , Thompson J. F. , Howman‐Giles R.
Published: March 2003

Abstract

Sentinel lymph node biopsy (SNLB) is a new method for staging regional node fields in patients with cancers that have a propensity to metastasise to lymph nodes. The majority of early experience has been obtained in patients with melanoma and breast cancer.

The technique requires the close cooperation of nuclear medicine physicians, surgical oncologists and histopathologists to achieve the desired accuracy. It involves: (i) identification of all lymph nodes that directly drain a primary tumour site (the sentinel nodes) by the use of pre‐operative lymphoscintigraphy, (ii) selective excision of these nodes by the surgeon, guided by pre‐operative blue dye injection and a gamma detecting probe intra‐operatively and (iii) careful histological examination of the sentinel nodes by the histopathologist using serial sections and immunohistochemical stains.

If the nodes are normal it can be inferred with a high degree of accuracy that all nodes in the node field are normal. This means that radical dissections of draining node fields can be avoided in patients with normal lymph nodes.

A further advantage of lyamphatic mapping is that drainage to sentinel nodes in unusual locations is identified, leading to more accurate nodal staging than could be achieved with routine dissection of the closest node field. (Intern Med J 2001; 31: 547–553)
Stem cells in cardiovascular disease: from cell biology to clinical therapy
Authors: Semsarian C.
Published: March 2003

Human life begins as a single fertilized cell. As adult human beings we are profoundly complex. This journey from single cell to complex being is attributable to the role of stem cells (i.e. cells that produce all the different types of cells and tissues that make up the human body). Recent interest has focused on the development of stem cells as a therapeutic option in the treatment of disease. Due to their ability both to replace and/or repair damaged tissue, stem cell therapy provides an ideal means to improve therapy for cardiac disorders associated with heart muscle injury. In particular, pre‐clinical studies in animal models of acute myocardial infarction have shown great promise for both repairing damaged cardiac muscle and generating new blood vessel formation in the infarcted area. Stem‐cell research therefore holds great therapeutic potential and is relevant, not only to basic science researchers, but also to clinicians (who may need to consider such cell‐based therapy in the future) and to their patients. (Intern Med J 2002; 32: 259−265)
Knowledge, attitudes and experience associated with testing for prostate cancer: a comparison between male doctors and men in the community
Authors: Livingston P. , Cohen P. , Frydenberg M. , Borland R. , Reading D. , Clarke V. , Hill D.
Published: March 2003

Background:  Debate about testing for prostate cancer using prostate‐specific antigen (PSA) and digital rectal examination (DRE) continues. The evidence of benefit from screening for prostate cancer using PSA tests is inconclusive, and it is unclear how PSA can be used most effectively in the detection of prostate cancer. Given the lack of consensus, it is important that consumers understand the issues in a way that will permit them to decide whether or not to have a test and, if symptomatic, how their condition is managed.

Aims:  To compare prostate cancer knowledge, attitudes and testing experiences reported by male doctors and men in the community, despite the lack of evidence of a benefit.

Methods : The primary method for ascertaining the attitudes of male doctors (MD) was a telephone survey, with some doctors electing to complete a written survey. Each MD was selected, at random, from a register of male practitioners aged ≥ 49 years of age. A total of 266 MD participated in the survey. The community sample (CS) was accessed using a telephone survey. Five hundred male Victorian residents aged ≥ 49 years of age participated in the study.

Results:

  Knowledge − Overall, 55% of the CS indicated ­correctly that prostate disease is sometimes cancer, compared to 83% of MD.

  Attitudes − Fifty‐five per cent of MD believed men should be tested for prostate disease at least every 2 years, compared to 68% of men in the CS.

  Testing experience − Forty‐five per cent of MD had been tested for prostate cancer in the past, and 92% of those tests were reported as negative. In the CS, 56% had been tested for prostate cancer in the past, and 78% of the results were reported as negative. The ­significant independent predictors of having had a prostate test among MD were: (i) age (≥ 60 years; odds ratio (OR): 1.59; 95% confidence intervals (CI): 1.30−1.88) and (ii) positive attitudes towards regular testing for prostate cancer (OR: 2.27; 95% CI: 1.98−2.56). The significant independent predictors for the CS were: (i) age (≥ 60 years; OR: 1.65; 95% CI: 1.40−1.89), (ii) being married (OR: 1.30; 95% CI: 1.00−1.60), (iii) knowledge that prostate disease was sometimes cancer (OR: 1.46; 95% CI: 1.26−1.66) and (iv) positive attitudes towards regular testing for prostate cancer (OR: 2.12; 95% CI: 1.90−2.34).

Conclusions: The results highlight that testing for prostate cancer is widespread in the community and in the medical profession. Further research should be undertaken to identify how to help men make fully informed decisions about prostate cancer testing. (Intern Med J 2002; 32: 215−223)
Legal Medicine, 5th edn
Authors: Vinen J.
Published: March 2003

American College of Legal Medicine Textbook Committee, S. Sanbor et al. St Louis: Mosby, 2001. 642 pp. Price $A379.50 (Hardback). ISBN 32301060‐1.
Medications taken by 26‐year‐olds
Authors: Thomson W. M. , Poulton R.
Published: March 2003

Abstract

Background: Most descriptive pharmacoepidemiological reports are from studies of older people, and little is known about medication use by younger adults.

Aims: The aim of the present study was to examine the prevalence of medication usage in the previous 2 weeks among young adults.

Methods: Detailed information was collected on medications taken by 26‐year‐old participants in the longstanding Dunedin Multidisciplinary Health and Development Study.

Results: At age 26, 980 (96.2%) of the surviving cohort participated; medication data were available for 978 individuals,of whom 78.1% had taken one or more prescribed or over‐the‐counter medi­cations. Medication use was higher among females.The most prevalent drug categories were analgesics (taken by 22.8% of the sample), hormonal contraceptives (21.9%; 44.7% offemales), nutrient supplements (17.6%) and anti‐asthma drugs (11.1%).

Conclusions: The prevalence and pattern of medi­cation use among younger adults differ from those reported for older age groups. Asthma appears to be the most prevalent chronic medical condition requiring pharmacological intervention (and for which medical care has been sought) among younger adults. The low rates of use of antidepressants and anxiolytics suggest that common psychiatric disorders may currently go unrecognized or untreated among young adults, and the high prevalence of ‘third generation’ oral contraceptive use among females is of particular concern. (Intern Med J 2002; 32: 305−310)
Upper gastrointestinal endoscopic ultrasound and its impact on patient management: 1990−2000
Authors: Kaffes A. J. , Mishra A. , Simpson S. B. , Jones D. B.
Published: March 2003

Background: Endoscopic ultrasound (EUS) is a relatively new method used in the investigation and staging of upper gastrointestinal tract (UGIT) disease.

Aims: To review practice and outcomes of EUS in an Australian university teaching hospital.

Methods: The first part of the study was a retrospective review of indications, safety, referral patterns and tech­nical difficulties of all EUS procedures performed at Concord Hospital, New South Wales, Australia, over a 10‐year period from 1990 to 2000. The second part of the study examined the impact of EUS on the management of 225 consecutive cases, as determined by a ­questionnaire completed by each of the referring doctors.

Results: A total of 537 EUS examinations was performed over the 10‐year period. Indications for EUS included: (i) assessment of oesophageal lesions (241), (ii) assessment of gastric lesions (184) and (iii) assessment of pancreaticobiliary (112) disease. Cancer staging was performed in 46.7% of oesoph­ageal and 31.4% of gastric cases. Sedation was achieved using intravenous midazolam (5.3 ± 1.3 mg; mean ± SD) and 52% of cases required additional intravenous pethidine (48.5 ± 10.0 mg; mean ± SD). Technical difficulties were encountered in 11% of cases and these were mainly related to non‐­traversable luminal stricturing. Of the 537 referrals, 48.2% were from within Central Sydney Area Health Services, and the remainder were from other Sydney hospitals, New South Wales regional centres and interstate. Of 225 questionnaires sent to referring doctors, 146 questionnaires were completed and returned for analysis. EUS aided staging of malignant disease, and confirmed or established a diagnosis in 86% of cases. The diagnostic accuracy of EUS was 76% when confirmed histologically. EUS avoided further diagnostic investigations in the majority of cases and in 25% of cases surgery was avoided. Fine‐needle aspiration biopsy (FNAB) during EUS would have been useful in 30% of cases. Overall, clinical decision‐making and management were changed in one‐third of cases.

Conclusions: Endoscopic ultrasound is an accurate, safe and useful imaging method in UGIT disease. The increasing demand for EUS and EUS‐guided FNAB suggests an expanding future for EUS in Australia. (Intern Med J 2002; 32: 372−378)
Utility of a weight‐based heparin nomogram for patients with acute coronary syndromes
Authors: Zimmermann A. T. , Jeffries W. S. , McElroy H. , Horowitz J. D
Published: March 2003

Abstract

Background:  Unfractionated heparin has been pivotal in the management of acute coronary syndromes (ACS), and continues to be used widely despite the emerging role of low molecular weight heparins (LMWH). The apparent superiority of LMWH over unfractionated heparin may, at least partially, reside in its more predictable achievement of therapeutic effect, with high rates of non‐therapeutic activated partial thromboplastin time (APTT) results being observed in the intravenous heparin treatment groups.

Aim:  To evaluate the impact of introduction of a weight‐based heparin nomogram developed for use in patients with ACS on frequency of ‘therapeutic’ APTT results.

Methods:  The effectiveness of an existing non‐weight‐based heparin nomogram in achieving a therapeutic APTT was compared sequentially with that of a weight‐based heparin nomogram in 89 and 84 consecutive patients admitted with a diagnosis of ACS.

Results:  Patients in whom heparin dosage adjustment was weight based rapidly achieved therapeutic APTT. The median time to achieve an APTT within the target range was 8.75 h in the weight‐based group versus >24 h in the non‐weight‐based group. Utilization of a weight‐based nomogram was associated with markedly increased proportions of readings within the therapeutic APTT range at 6 h and at 24 h (51%vs. 26% and 72%vs. 36%, respectively).

Conclusions:  The current study confirms the marked superiority of the weight‐based heparin regimen for treatment of patients with ACS. The nomogram dramatically facilitated the attainment of therapeutic APTT, and may represent the optimal method for titration of heparin dosage to individual heparin requirements in patients with ACS. (Intern Med J 2003; 33: 18−25)
Potential of weed seedbanks for managing weeds: a review of recent New Zealand research
Authors: Rahman Anis , James Trevor K. , Grbavac Nik
Published: March 2003

Weed seedbanks are the primary source of weeds in cultivated soils. Some knowledge of the weed seedbank may therefore be appropriate for integrated weed management programs. It would also be very useful in planning herbicide programs and reducing the total herbicide use. However, a number of problems are inherent in the estimation of the seedbank size for arable weeds that usually have annual life cycles. In a long‐term research project we have investigated the dynamics of weed seedbanks in corn fields for the past 8 years. Specific studies have included (i) developing cheap and efficient methods for estimating the weed seedbank; (ii) developing guidelines for efficient soil sampling (including the number and size of samples); (iii) influence of cultivation methods on weed seed distribution; (iv) mapping the spatial variability of the seedbank; (v) estimating the rate of seedbank decline for certain weed species; and (vi) assessing the potential of using the weed seed content in the soil to predict future weed problems. This paper reviews and summarizes the results of our research on the above aspects. The strong correlation between seedlings emerged in the greenhouse and seeds extracted in the laboratory for the most abundant weed species has demonstrated the potential for using the weed seed content of the soil to predict future weed infestations. The next step is to establish correlations with field emergence under commercial conditions using the sampling guidelines developed in our studies. Subsequently, we aim to offer the weed seedbank estimation as a commercial service to farmers for planning the most appropriate weed management options.
Metabolism and selectivity of rice herbicides in plants
Authors: Usui Kenji
Published: March 2003

Chemical weed control with effective and highly active herbicides has been very useful and convenient means. It has contributed to stable crop production and is labor saving. Recent herbicides have had characteristics such as high effectiveness without causing environmental pollution or harmful effects, and appropriate herbicides having high activity, low toxicity, high selectivity and being non‐persistent have been developed. The metabolism of rice herbicides used mainly in Japan, such as sulfonylurea, chloroacetamide, acylamide, urea, thiocarbamate, pyrazole, triazine, diphenyl ether, phthalimide, phenoxy, aryloxyphenoxypropionate, etc., is reviewed, and its involvement in selectivity is also discussed. The metabolism of herbicides is closely related to their activity and selectivity. Differential herbicide metabolism in plants is a contributing factor of selectivity between crops and weeds. Chemicals that are more detoxified in crops and/or more activated or less detoxified in weeds are considered as being effective and selective herbicides. The metabolism of various types of rice herbicides includes: oxidative reaction (ring and chain hydroxylation, O‐ and N‐dealkylation), hydrolysis and subsequent glucose conjugation, and glutathione conjugation in rice. These detoxicative activities are much higher in rice than weeds in paddies, and this leads to the selectivity of herbicides. Enzymes, oxidase, P‐450 mono‐oxygenase, esterase, acylamidase, glucosyl transferase, glutathione transferase, etc., play important roles in herbicide metabolism and selectivity.
Relationship between safening activity of dymron and fenclorim to pretilachlor and glutathione S‐transferase activity in rice
Authors: DENG FAN , YAMADA YUJI , USUI KENJI
Published: March 2003

Dymron [1‐(α,α‐dimethybenzyl)‐3‐(p‐tolyl)urea] and fenclorim (4,6‐dichloro‐2‐phenylpyrimidine)
were found to exhibit a safening activity on the growth of rice (Oryza sativa
L.) seedlings against pretilachlor [2‐chloro‐2′,6′diethyl‐N‐(2‐propoxyethyl)acetanilide]
injury. By pretilachlor treatment at 10–6 and 10–5
mol L–1, the elongation of the third leaves of rice seedlings was
reduced by approximately 20 and 40%, and that of the fourth leaves was reduced
by approximately 40 and 80%, respectively. Upon the treatment of dymron at
3 × 10–6 and 10–5 mol L–1
in combination with pretilachlor, the growth inhibition was half alleviated in the
third leaves, and the length of the fourth leaves was almost recovered from 10–6
mol L‐1 pretilachlor injury, and was 20–25% recovered from
10–5 mol L–1 pretilachlor injury. Upon the treatment
of fenclorim at 3 × 10–6 and 10–5 mol L–1
in combination with pretilachlor, the growth inhibition of rice seedlings was almost
alleviated in both the third and the fourth leaves. This result indicated that dymron
and fenclorim showed almost the same safening effect on the fourth leaf growth against
10–6 mol L‐1 pretilachlor injury, although fenclorim
showed higher effects at higher concentrations of pretilachlor. Glutathione S‐transferase
(GST) activities in rice seedlings were investigated after being treated with a herbicide
and safener. By pretilachlor treatment at 10–6 and 10–5
mol L–1, the GST activity was approximately 32 and 72%
increased in roots, respectively, and a little increased (7–13%) in
shoots of two‐leaf‐stage rice seedlings. By dymron treatment at 3 × 10–6−10–5 mol L–1, the GST activity was 2–30% increased in roots, but was not increased in shoots. By their combination treatment, the GST activity was almost the same or less than that by treatment with pretilachlor alone. In contrast, by fenclorim treatment alone, the GST activity was 43–52 and 33–45% increased in roots and shoots of rice seedlings, respectively. By the combination treatment of pretilachlor and fenclorim, the GST activity was increased 73–126% in shoots and 101–139% in roots, and was much more increased in both shoots and roots compared with treatment of pretilachlor or fenclorim alone. It was found that dymron showed less effect in increasing the GST activity than fenclorim. It is also suggested that dymron did not increase the GST activity in shoots but did increase it slightly in roots, and showed almost no effect on GST increase by pretilachlor in shoots, or rather reduced the increase in roots. From the above results, fenclorim and dymron may have different mechanisms of safening effects on the protection of rice seedlings against pretilachlor injury.
A double blind comparison of droperidol and ondansetron for prevention of emesis in children undergoing orthopaedic surgery
Authors: GOODARZI MASHALLAH
Published: March 2003

Emesis is common in the postoperative period following epidural opioid and general anaesthesia. Eighty patients ages two to 14 years scheduled for major orthopaedic surgery were enrolled in a randomized, double‐blind study to compare the prophylactic effects of ondansetron, droperidol and a placebo for the prevention of postoperative emesis. Each child was assigned at random to one of the four treatment groups: ondansetron 100 μg·kg−1, ondansetron 50 μg·kg−1, droperidol 60 μg·kg−1 and saline control. Drugs were administered intravenously after the induction of anaesthesia. Anaesthesia was supplemented with epidural fentanyl, given as an infusion of 1 μg·kg−1 and continued for postoperative pain control. The incidence of vomiting in the immediate postoperative period was 25% with ondansetron (100 μg·kg−1), 40% with ondansetron (50 μg·kg−1) and droperidol and 70% with the control group. In the next 48 h the incidence of emesis increased to 30% for ondansetron (100 μg·kg−1), 55% with ondansetron (50 μg·kg−1), 65% with droperidol and 85% for the control group. Those patients who had multiple emesis necessitating a second dose of the same drug treatment showed no difference in the incidence of emesis relative to the control group. Ondansetron (50 μg·kg−1) and droperidol groups had lower incidence of PONV compared to the control group. The ondansetron (100 μg·kg−1) group had a significant decrease in the incidence of emesis. We conclude that the prophylactic administration of ondansetron (100 μg·kg−1) is more effective than droperidol and ondansetron (50 μg·kg−1) and superior to saline (P<0.02) for the prevention of emesis before epidural opioid and general anaesthesia.
Slow induction with sevoflurane was associated with complete atrioventricular block in a child with hypertension, renal dysfunction, and impaired cardiac conduction
Authors: MARUYAMA KOICHI , AGATA HIDEHARU , ONO KENJI , HIROKI KOICHI , FUJIHARA TAKANORI
Published: March 2003

We describe the appearance of complete atrioventricular block (CAVB) with sevoflurane and nitrous oxide during the slow induction in a ten‐year‐old male patient with hypertension, renal dysfunction, and impaired cardiac conduction. Sinus rhythm was restored following the washout of the anaesthetic gas. And CAVB recurred after the subcutaneous injection of lignocaine. The present report shows that sevoflurane should be treated with care like other inhalational anaesthetics as regards the effect on cardiac conduction.
Prolonged mivacurium neuromuscular block in children
Authors: LEJUS  , BLANLOEIL  , LE ROUX  , SOULARD  , MESGUISH  , BURNAT  , DUVALDESTIN  , PINAUD
Published: March 2003

The authors report two cases of prolonged neuromuscular block after administration of mivacurium in children with previously undiagnosed plasma cholinesterase deficiency related to homozygous atypical genotype. Their anaesthetic management is described as well as determination of the phenotype of both children and their family.
The use of propofol infusions in paediatric anaesthesia: a practical guide
Authors: McFarlan Charles S. , Anderson Brian J. , Short Timothy G.
Published: March 2003

Children require higher infusion rates of propofol than adults to maintain clinical anaesthesia. We aimed to produce a manual infusion regimen capable of maintaining a steady‐state blood concentration of 3 μg ml−1 in children aged 3–11 years. Pharmacokinetic parameter estimates were taken from published studies of infusion data in children and used in a pharmacokinetic simulation programme to predict likely propofol blood concentrations during infusions. A variability of 5% was allowed about the target concentration of 3 μg ml−1. A loading dose of 2.5 mg·kg−1 followed by an infusion rate of 15 mg·kg−1·h−1 for the first 15 min, 13 mg·kg−1·h−1 from 15 to 30 min, 11 mg·kg−1·h−1 from 30 to 60 min, 10 mg·kg−1·h−1 from 1 to 2 h and 9 mg·kg−1·h−1 from 2 to 4 h resulted in a pseudo‐steady state target concentration of 3 μg·ml−1 in children 3–11 years. We were unable to predict similar rates by applying size models to adult data. The context sensitive half‐time in children was longer than in adults, rising from 10.4 min at 1 h to 19.6 min at 4 h compared to adult estimates of 6.7 min and 9.5 min, respectively. Children require higher infusion rates than adults to maintain steady state concentrations of 3 μg·ml−1 and have longer context sensitive half‐times than adults. These differences can be attributed to altered pharmacokinetics in this age group.
Hemifacial microsomia: anatomical prediction of difficult intubation
Authors: Nargozian Charles , Ririe Douglas G. , Bennun Ricardo D. , Mulliken John B.
Published: March 2003

Hemifacial microsomia (HFM) is associated with a difficult airway. We hypothesized that a difficult intubation would be predicted by radiographic evaluation of the severity of mandibular hypoplasia. A retrospective review of anaesthetic and surgical records of 102 children with HFM from 1986 to 1996 was conducted for radiographic classification of mandibular hypoplasia and degree of difficulty with intubation. Intubation was classified as Grade A—easy, Grade B—difficult, or Grade C—very difficult. The mandibular anatomy was categorized as Type I—‘mini‐mandible’, Type II—abnormal condylar size and shape, or Type III—absent ramus, condyle, and temporomandibular joint. In the 82 patients with HFM, 70% were classified as Grade A, 21% had Grade B and 9% had Grade C airways. No patients with Type I mandible had Grade C airway, while 25% of the patients with Type III mandible had Grade C airway. The correlation of the degree of airway difficulty with mandibular type was significant (P=0.001). In 20 patients with bilateral mandibular hypoplasia, 30% had Grade A, 35% had Grade B, and 35% had Grade C airways. We conclude that radiographic classification of mandibular deformity is a useful adjunct for preoperative prediction of airway difficulty in the management of children with unilateral HFM.
Complications of emergency tracheal intubation in severely head‐injured children
Authors: Meyer ;philippe G. , Orliaguet Gilles , Blanot Stéphane , Jarreau Marie‐Madeleine , Charron Brigitte , De Sauverzac Rodolphe , Carli Pierre
Published: March 2003

A high incidence of unsuccessful attempts and complications has been reported when emergency tracheal intubation (ETI) is performed outside the hospital in severely injured children. The aim of this prospective series was to analyse the incidence and related risk factors of complications of emergency tracheal intubation. The time to complete successful ETI and occurrence of incidents, e.g. cough reflex, hypoxia or spasm were related to the experience of the physician performing intubation and the use of drugs to facilitate ETI. The incidence of hypoxia, hypercarbia, postintubation complications such as extubation stridor and long‐term sequelae were noted. Of the 188 children, 78% were successfully intubated at the site of the accident, 10% upon arrival at a local hospital from where they were secondarily transferred and 12% upon admission to our trauma centre. The most severely injured children were intubated in the field in 98% of cases without failure, nor life‐threatening complications related to ETI. The experience of the operator influenced the number of attempts and the time to complete successful intubation. Immediate incidents were noted in 25% of children, e.g. cough in 18%. The regimen of drugs, but not level of consciousness, influenced the incidence of immediate incidents; without drugs, more than 67% experienced incidents. Early tracheal intubation and controlled ventilation resulted in adequate ventilation upon arrival (mean PaO2 of 35.8±24 kPa, mean PaCO2 of 4.35±1 kPa). Long‐term complications, including transient stridor upon extubation in 33% of the cases, and laryngeal granuloma or tracheal stenosis, were comparable to those in other series. ETI in shocked patients and pulmonary infection in hospital, but not the technique of ETI, increased the risks of long‐term complications. Emergency tracheal intubation can be performed safely in the field, and results in adequate ventilation during transportation of severely injured children, provided that it can be performed by trained physicians using adequate drugs to facilitate intubation.