bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete eradication of Aspergillus fumigatus from the lung in an immunocompromised patient by oral itraconazole
Authors: MOORE L , ELLIS D. H. , SUPPIAH R. , BYARD R. W. , TOOGOOD I. R. G.
Published: August 2010

Abstract Itraconazole is a new orally active antifungal agent shown to have in vitro and experimental activity against Aspergillus spp. This case report documents the successful eradication of biopsy‐proven invasive pulmonary aspergillosis in a 17 year old boy with acute lymphocytic leukaemia. Cerebral involvement by the fungal infection was suspected clinically but was not biopsy proven. Although the patient subsequently died following bone marrow transplant and Escherichia coli septicaemia there was no evidence of residual Aspergillus at autopsy.
Perianal group A streptococcal infection
Authors: GUPPY D. H.
Published: August 2010

Abstract Four cases of perianal group A streptococcal infection presented with typical features of this condition; but because of lack of recognition appropriate therapy was delayed. Once group A streptococcal infection was diagnosed there was a high frequency of relapses. The need for prolonged treatment is illustrated.
Adverse effects of neonatal transport between level III centres
Authors: HARDING J. E. , MORTON S. M.
Published: August 2010

Abstract The effect of neonatal transport between level III intensive care nurseries was studied by comparing the outcome of 40 infants inborn at a regional level III centre but transported to other level III nurseries for intensive care, with 80 matched inborn controls. Transport appeared to affect respiratory status adversely but transiently. However, transported infants grew less well than control infants (32% were below 3rd centile for weight at 36 weeks vs 15% of controls), were more likely to suffer periventricular haemorrhage (40 vs 21% of controls) and had a worse neurodevelopmental outcome (70% normal at follow up vs 83% of controls). It can be concluded that for infants inborn at the National Women's Hospital, Auckland, transport to another level III centre for intensive care is associated with an increased risk of adverse outcome.
Parental perception of the use and usefulness of a parent‐held child health record
Authors: VOLKMER R. E. , GOULDSTONE M. A. , NINNES C. P.
Published: August 2010

Abstract This study surveyed 313 parents to investigate how frequently parents used a parent‐held child health record, and whether they saw the record as useful. Since 1981, The Child, Adolescent and Family Health Service has distributed a Personal Health Record (PHR) to the parents of all children in South Australia. The PHR has provided each family with an ongoing record that has been consistently used for immunization, child health checks and child health screening. However, little is known about how parents view the PHR, its usefulness, and how frequently the record is used. Previous studies, generally conducted prior to, or shortly after, a parent‐held child health record was introduced, have shown a poor understanding of the uses of the PHR on the part of parents and a low level of use by health professionals such as general practitioners. In contrast, the results of this study show high levels of understanding of the health record on the part of parents, and an increase in the use of the health record by general practitioners over the 10 years since the record was introduced. Although moderated by the age of the child, the sections of the PHR seen as most useful (and the most frequently used) by parents were immunization, growth charts, progress notes and health checks.
Episodic central neurogenic hyperventilation in an awake child with systemic histiocytosis
Authors: HOOL G. J. , MARSH H. M. , GROOVER R. V. , BURGERT E. O. , SIMMONS P. S. , REESE D. F.
Published: August 2010

Abstract A 3 year old boy with systemic histiocytosis, diabetes insipidus and a lytic parietal bone lesion experienced episodes of central neurogenic hyperventilation 3 weeks after radiation to the head but was conscious and alert at presentation. At admission, the Pao2 was 133 mmHg, Paco2 was 8 mmHg and pH 7.65. Magnetic resonance imaging revealed a pontomedullary lesion that resolved during the ensuing year. Central neurogenic hyperventilation has not been described previously as a complication of systemic histiocytosis.
Variation in selected childhood surgical procedures: The case of tonsillectomy and management of middle ear disease
Authors: CLOSE G. R. , RUSHWORTH R. L. , ROB M. I. , RUBIN G. L.
Published: August 2010

Abstract  We examined rates of the most common ear, nose and throat (ENT) surgical procedures among NSW residents under 15 years ot age, against a background of concern for the relevance of differences in clinical practice to cost and quality of health care. We found significant (P<0.01) increases in the rate of procedures involving myringotomy (from 5.8/1000 to 7.6/1000) or adenoidectomy (from 5.6/1000 to 6.3/1000) between 1986 and 1989/90. Over this period the proportion of ENT procedures which involved myringotomy also increased significantly (P<0.01) from 53 to 60%. We found significant (P<0.01) differences in procedural rates between health areas when aggregated into inner and outer metropolitan and rural groups with the mean rate of procedures involving myringotomy highest in the outer metropolitan group in both years. The difference was not due to variation in patient insurance status, per capita hospital bed or staff numbers. We found no evidence that the National Health and Medical Research Council Tonsillectomy and Adenoidectomy Guidelines (first published in 1982) have been effective in influencing clinical practice. The rate of tonsillectomy had been declining in NSW since the late 1970s but has remained stable in recent years. Surgical intervention for middle ear disease is increasing.
Surfactant replacement therapy in neonates less than 32 weeks gestation: Effect on neonatal intensive care resource utilization
Authors: DIWAKER K. , ROBERTS S. , JOHN E.
Published: August 2010

Abstract  The effect of synthetic surfactant (Exosurf) replacement on complications from hyaline membrane disease (HMD) in infants <32 weeks gestation and their resource utilization within a neonatal intensive care unit was studied in 1991‐92. A control group was selected from infants admitted to the same unit during the preceding 3 years when Exosurf was not available. The infants were controlled for gestation, weight and severity of HMD.

Infants given Exosurf had a significant reduction in the incidence of pulmonary interstitial emphysema (PIE), and a marginal decrease in the incidence of pneumothorax. They required fewer days on the ventilator and consumed less of the scarce financial resources. There was no difference in the mortality rate among the two groups. The changes seen were more evident among those infants between 30 and 31 weeks gestation, compared to those <28 weeks.
The socio‐economic context of child injury in Australia
Authors: JOLLY D. L. , MOLLER J. N. , VOLKMER R. E.
Published: August 2010

Abstract  After the first year of life, injury is the leading cause of mortality in children and adolescents in Australia and a major cause of morbidity and hospitalization. Studies from Europe and North America and more recently New Zealand have demonstrated that injury rates differ between different socio‐economic groups, with a relatively consistent pattern of higher rates being found in lower socio‐economic groups. To date, the pattern of child injury morbidity by socio‐economic group has not been studied in Australia. Eighteen months of data from Brisbane and Melbourne collections of the National Injury Surveillance Unit data base were analysed and linked to census data from each postcode in the collecting area to calculate injury rates. Injury rates for each postcode were correlated with measures of disadvantage derived from the same census data. There was a consistent pattern of moderately strong statistically significant associations (Pearson correlation coefficients generally 0.30‐0.60) found between measures of disadvantage and injury rate at the postcode level of aggregation. This association was present across cities, age groups, type of injury and for those hospitalized as well as those treated as outpatients. It is apparent that residence in a low income area is a significant predictor of child injury in Australia.
An epidemiological survey of SIDS in the Sydney metropolitan area
Authors: ANDERSON S. C. , EDELMAN D. C. , MURRELL W. G. , O'NEILL C. C. , RAHILLY P.
Published: August 2010

Abstract  Records of 1049 cases of Sudden Infant Death Syndrome (SIDS) (100%) in the Sydney metropolitan area (SMA) from 1980 to 1989 were analysed in relation to ambient temperature, geographical distribution and socio‐economic scale. The SIDS rate varied between eastern and western Sydney and between statistical subdivisions; it peaked sharply in July, coinciding with the monthly mean minimum daily temperature (MMMDT; 6.5 and 5.4°C, respectively). The inverse linear relationship between the SIDS rate and the MMMDT for the regions and the subdivisions was highly significant (P<0.001). The SIDS rate showed a significant inverse linear relationship to two socio‐economic scales (allotment and house value) for 82 of the 87 suburbs (94%) of the SMA. Temperature, indicative of cold weather, was the major factor determining SIDS rates, and this, together with socio‐economic factors, largely explains the observed geographical distribution of SIDS rates in the SMA.
Measles vaccine efficacy study in a Canberra high school: A study following a measles outbreak
Authors: CHEAH D. , LANE J. M. , PASSARIS I.
Published: August 2010

Abstract  An outbreak of measles which occurred in Canberra between October and December, 1991, was investigated to estimate the public health utility of the vaccine. The measles vaccine efficacy was determined for the 13–15 year old children in a selected high school. During the outbreak, at least 82 Canberra children contracted measles. Teenage males accounted for 56% of total cases, and 22% of cases were confirmed by serology. The vaccine coverage in the high school studied decreased with increasing school years, varying from 85.8% in Grade 8 to 79.2% in Grade 10. The highest attack rate occurred in Grade 10 (66/1000). The vaccine efficacy for age 13–15 was estimated to be 72% (95% CI, 45–86%) but varied from 67 to 73%. Measles remains a serious disease of childhood in Australia. The elimination of measles is only partly dependent on the vaccine coverage of children. Issues relating to the effectiveness of vaccine are also important. A two dose vaccine strategy with the second dose of measles, mumps, rubella vaccine (MMR), given preferably in the last year of primary school or the first year of high school, is supported by the findings of this study.
Lack of agreement between two ethods of measuring haemoglobin
Authors: DAVESON A. J. M. , COLDIT2 P. B.
Published: August 2010

Abstract  Haemoglobin values are reported by the current generation of blood gas analysers used in many intensive care units. A comparison of one such machine against a reference found that there was a mean difference of 1.32 g/dL (95% confidence intervals –2.75‐0.9 g/dL) between the values reported. Haemoglobin values reported by blood gas machines may be inaccurate.
Deletion of the terminal segment of the long arm of chromosome 4 with aortic stenosis
Authors: HO N. K. , NG I. S. L.
Published: August 2010

Abstract  A dysmorphic Chinese baby girl was found to have deletion of the long arm of chromosome 4 (46XX, del[4] q33→qter). A review of various case reports of deletion of the long arm of chromosome 4 is reported and the clinical features are identified and compared. The earlier reports on this condition were that of deletion of the terminal segment of the long arm with break point occurring at q31. Since 1981, cases of deletion with break point at q33 have been reported.
Liver disease in association with neonatal lupus erythematosus
Authors: EVANS N. , GASKIN K.
Published: August 2010

Abstract  This report describes a patient with neonatal lupus erythematosus (NLE) in whom there was multisystem involvement including neonatal hepatitis. The hepatitis, defined pathologically as a giant cell hepatitis, presented with severe cholestasis, was unrelated to other known causes of neonatal hepatitis and resolved spontaneously by 6 months of age. Both mother and infant were positive for Sjogren syndrome A + B antibodies (SS‐A [Ro] and SS‐B [La]) as well as having high titres of antinuclear antibody (ANA). Three of the four cases described in the one previous report of this association were also ANA positive. This antibody may be a marker for the development of the hepatitis. Maternal and infant ANA status should be determined in cases labelled as idiopathic neonatal hepatitis to exclude undiagnosed maternal SLE as a cause of neonatal cholestasis.
FISH and the paediatrician
Authors: SMITH A
Published: August 2010

Abstract:Cytogenetics with banding techniques has, since the 1970s, identified patients with chromosome abnormalities and has contributed enormously to the understanding of phenotype‐karyotype correlations. However, one chromosome band could contain 20–50 genes. Fluorescencein situhybridization (FISH) bridges the gap in the area between the resolution obtained by conventional chromosome studies and purely DNA studies. Fluorescencein situhybridization provides paediatricians with the ability to delve more deeply into the aetiology of congenital abnormalities in children. This annotation aims to clarify the current applications of FISH in paediatric practice.
Primary course immunogenicity and reactogenicity of a new diphtheria‐tetanus‐whole cell pertussis vaccine (DTPw)
Authors: NOLAN T , HOGG G , DARCY M‐A , VARIGOS J , McEWEN J
Published: August 2010

Objective: To establish safety, immunogenicity, and batch stability of a reformulated whole cell pertussis based diphtheria‐tetanus‐whole cell pertussis (DTP) vaccine (nDTPw) compared to the currently marketed Australian DTPw vaccine (Triple Antigen™) in a three dose 2, 4 and 6 month primary immunization course. Reformulation was necessary to make the DTPw vaccine suitable for combination with hepatitis B and Haemophilus influenzae b vaccines.

Methods: Double blind randomized controlled trial in suburban Melbourne in 812 healthy infants recruited through maternal and child health centres, of whom 208 received Triple Antigen and 604 received nDTPw.

Results: Results for both reactogenicity and immunogenicity were similar and were not significantly different for the three batches of nDTPw. No new, serious, or unexpected adverse effect was recorded. Nearly twice as many nDTPw infants experienced no general reaction to the third dose (18%) compared to Triple Antigen™ (11%, P=0.06). An elevated temperature (≥38°C axillary) occurred in about three out of 10 babies overall, with rates being slightly higher for both vaccines after the second vaccination. Local reaction rates were significantly less common for nDTPw on days 2 and 3 following each of the three vaccinations. After dose three, 30% of nDTPw subjects experienced no local reaction compared to 20% of Triple Antigen™ subjects (P= 0.015, 95% Cl on difference 2%, 19%). Swelling after doses one and three occurred in 30% and 24% of Triple Antigen™ subjects, compared to 23% (P=0.07, 95% Cl diff 0%, 13%) and 14% (P=0.017, 95% Cl diff 2%, 17%) of nDTPw subjects. Tenderness after doses two and three occurred in 80%, and 78% of Triple Antigen™ subjects, compared to 71% (P= 0.04, 95% Cl diff 1%, 17%) and 68% (P=0.025, 95% Cl diff 2%, 19%) of nDTPw subjects. There was a significantly higher post immunization diphtheria antitoxin GMT (2.73 IU/mL) for Triple Antigen™ compared to nDTPw (1.89 IU/mL; P= 0.02), although no subject in either vaccine group had a tetanus or diphtheria antibody titre less than six times the protective level of 0.01 IU/mL following immunization. The nDTPw post immunization GMTs were significantly higher for Agg2, Fha, and pertactin compared to Triple Antigen™ geometric mean titres (GMTs).

Conclusion: nDTPw is a safe and immunogenic vaccine when compared to Triple Antigen™. The reformulated vaccine is an acceptable replacement for the currently marketed formulation, and for evaluation as a component of future combination vaccines.
Incidence of apnoea and bradycardia in preterm infants following DTPw and Hib immunization: A prospective study
Authors: BOTHAM SJ , ISAACS D , HENDERSON‐SMART DJ
Published: August 2010

Objective: To evaluate the incidence and severity of apnoea and bradycardia in hospitalized preterm infants following immunization at 2 months of age, and identify risk factors.

Methodology: A prospective study of 98 preterm infants, of gestational age 24–31 weeks, immunized at approximately 2 months post natal age with diphtheria‐tetanus‐whole cell pertussis vaccine (DTPw) in the neonatal intensive care unit (NICU) at King George V Hospital Sydney. Half the infants also received Haemophilus influenzae type b conjugate vaccine (Hib) simultaneously. All infants were monitored for apnoea and bradycardia in the 24 h periods pre‐ and post immunization.

Results: Only one infant had apnoea and/or bradycardia pre‐immunization compared with 17 post immunization. For 12 infants these events were brief, self‐limiting and not associated with desaturations (oxygen saturation <90%). However, for five infants (30%) these events were associated with oxygen desaturation and two of these infants required supplemental oxygen. The group that had apnoea and/or bradycardia and the group that did not were not significantly different in terms of gestational age, birth weight and other variables. Infants who received Hib together with DTPw were less likely to have apnoea and/or bradycardia than those given DTPw alone.

Conclusion: When considering immunization for preterm infants, the benefits of early immunization must be balanced against the risk of apnoea and bradycardia. We recommend that the cardio‐respiratory function of hospitalized infants born at less than 31 weeks gestation be monitored for 48 h post immunization.
Young Malaysian children with lower respiratory tract infections show low incidence of chlamydial infection
Authors: NGEOW YF , WEIL AF , KHAIRULLAH NS , YUSOF MY MOHD , LUAM L , GAYDOS C , QUINN TC
Published: August 2010

Objective: The incidence of Chlamydia pneumoniae and Chlamydia trachomatis infection was studied among infants and young children admitted to hospital for the management of lower respiratory tract infections, over a 12 month period.

Methodology: Respiratory secretions were examined for chlamydiae by cell culture, enzyme‐linked immunosorbent assay and polymerase chain reaction‐enzyme immunoassay. Sera were tested by micro‐immunofluorescence for chlamydial IgG, IgM and IgA. Other bacterial and viral pathogens were also looked for by standard cultural and serological methods.

Results: Of 87 patients aged 2 months‐3 years, an aetiologic diagnosis was made in 41 (47.1%). C. pneumoniae and C. trachomatis were each detected in 1 (1.2%) of the patients. Among common bacterial pathogens, Haemophilus influenzae (13.8%) and Streptococcus pneumoniae (8.1%) were the most frequently identified. Respiratory viruses and elevated Mycoplasma pneumoniae antibodies were found in 10.3% and 9.1% of patients, respectively.

Conclusion: Chlamydiae are infrequent causes of community‐acquired acute lower respiratory tract infections in infants and very young children in Malaysia.
The health of a group of young Australians in a New South Wales juvenile justice detention centre: A pilot study
Authors: FASHER AM , DUNBAR N , ROTHENBURY BA , BEBB DK , YOUNG SJW
Published: August 2010

Objective: To consider the health profile of a sample of young, largely male Australians as assessed on their admission to a New South Wales Juvenile Justice Detention Centre.

Method: A retrospective analysis of primary care nurse health records for 100 sequential admissions.

Results: Of the 97 males and three females (mean age = 15.9 years), 30 were Aboriginal and 39 did not live with either parent at the time of admission. Respiratory illness, such as bronchitis and asthma were common. These diagnoses were overshadowed by histories of significant physical injury. The sample was at high risk of sexually transmitted disease. Forty‐six per cent had prior contact with a mental health professional, 26% reported they had thought of suicide and 9% reported having attempted suicide. There was a high prevalence of substance abuse.

Conclusion: The health of these young Australians is at risk from every perspective. Improving the quality of their health assessments is an important issue for the clinicians who attend them as individuals and for policy makers who aim to reduce the considerable social and economic cost of juvenile crime. The discussion of these results from one centre has revealed opportunities to make such improvements. There is a need for a gathering of expertise to address the issue, preferably on a national basis.
Acne in Victorian adolescents: Associations with age, gender, puberty and psychiatric symptoms
Authors: KILKENNY M , STATHAKIS V , HIBBERT ME , PATTON G , CAUST J , BOWES G
Published: August 2010

Objectives: This study aimed to examine the associations between the frequency and severity of self‐reported acne and age, gender, puberty and psychiatric symptoms in Victorian adolescents.

Methodology: A sample of secondary schoolchildren in Victoria, Australia were surveyed using a computerized questionnaire. Developmental and psycho‐social factors associated with acne were recorded and analysed using logistic regression.

Results: The Victorian Adolescent Health Survey (1992) recorded the frequency and severity of self‐reported acne in 2491 students. Frequency of acne increased with age and pubertal development. For females commencement of menstruation was associated with increased frequency of acne. Asian born male students were less likely to report acne than Australian born males. Acne severity was coded into mild (students reporting acne sometimes on back or face) and moderate (students reporting acne often on face or back). Students reporting moderate acne were more likely to report a high level of psychiatric symptoms and were in the later stages of puberty.

Conclusions: This study confirms an association between the frequency and severity of self‐reported acne and stage of pubertal development. It showed also that students reporting moderate acne were more likely to report psychiatric symptoms of depression and anxiety.
Haemoptysis in healthy children due to unsuspected foreign body
Authors: DORE ND , LANDAU LI , HALLAM L , SOUEF PN LE
Published: August 2010

Abstract: Haemoptysis in otherwise healthy children is an uncommon event. Two cases of massive haemoptysis, subsequently requiring lobectomy, are discussed. In each case, foreign vegetable matter was identified despite previously normal bronchoscopy and minimal changes on chest radiograph.
A case of kernicterus in New Zealand: A predictable tragedy?
Authors: STANLEY TV
Published: August 2010

Abstract: A case of neonatal kernicterus due to glucose‐6‐phosphate dehydrogenase deficiency (G6PD) is described. Diagnosis was delayed as the primary healthcare attendant had no knowledge of this condition and its potential to cause rapidly escalating levels of bilirubin and as she was reassured by the lack of signs of systemic illness or anaemia. The baby has been left deaf, blind, intellectually handicapped, epileptic and paralysed due to athetoid cerebral palsy. The re‐organization of perinatal care in New Zealand, which has ted to neonates sometimes being managed solely by primary healthcare attendants with minimal training in paediatrics may have increased the risk of a late diagnosis of potentially devastating diseases such as this.
Yellow nail syndrome in infancy
Authors: PARADISIS M , ASPEREN P VAN
Published: August 2010

Abstract: This report describes an infant with clinical features consistent with the yellow nail syndrome (YNS), a rare autosomal dominant disorder. He presented at birth with congenital lymphoedema and was referred at 6 months of age for investigation of recurrent cough and wheeze. He had clinical and radiological evidence of bilateral pleural effusions and a pericardial effusion. Following a lung biopsy and pericardial window these were shown to be manifestations of his lymphatic abnormality. He also had persisting middle ear effusions causing conductive deafness requiring hearing aids and secondary immunodeficiency requiring regular immunoglobulin infusions.
Paediatric cardiopulmonary resuscitation: Recent changes to guidelines
Authors: Tibballs James
Published: August 2010

Abstract:  Recommended cardiopulmonary resuscitation guidelines for infants and children by health‐care personnel have been updated following an extensive review of the science of resuscitation. Notable changes include a change to a single chest compression‐to‐ventilation ratio of 15:2, a single DC shock (2 J/kg) strategy for shockable rhythms followed by immediate uninterrupted cardiopulmonary resuscitation for 2 min, use of amiodarone (5 mg/kg) for DC‐shock resistant rhythms, the routine use of carbon dioxide detection to confirm correct endotracheal tube placement and the use of therapeutic hypothermia if the victim fails to resume consciousness after resuscitation.
Severe iron‐deficiency anaemia in adolescents: Consider Helicobacter pylori infection
Authors: Cardamone Michael , Alex George , Harari Michael D , Moss William P , Oliver Mark R
Published: August 2010

Aim:  This article describes the association of severe iron‐deficiency anaemia with Helicobacter pylori gastritis.

Results:  We report three children who had symptomatic iron‐deficiency anaemia with no obvious clinical cause and refractory to iron replacement therapy. All three underwent a diagnostic endoscopy and were found to have H. pylori gastritis. Histopathology confirmed inflammatory changes consisting of dense bands of clusters of plasma cells within the lamina propria and two of the three adolescents were noted to have numerous H. pylori in gastric crypts and glands. Two of the three cases had a urease positive test. Iron deficiency was successfully corrected following antibiotic eradication of H. pylori infection.

Conclusions:  This case series highlights the importance of considering H. pylori infection as a cause of refractory iron‐deficiency anaemia in adolescents, even in the absence of gastrointestinal symptoms.
Hepatic derangement following N‐Acetylcysteine enemas in an infant with cystic fibrosis
Authors: Cooke Andrew , Deshpande Aniruddh V , Wong Chris KF , Cohen Ralph
Published: August 2010

We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid – small bowel atresia and developed severe faecal impaction in the post – operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.
‘Halving the heel pricks’: Evaluation of a neonatal jaundice protocol incorporating the use of a transcutaneous bilirubinometer
Authors: Hartshorn David , Buckmaster Adam
Published: August 2010

Aim:  This study aimed to assess the impact of implementing a new jaundice protocol incorporating the use of the Konica Minolta/Air Shields JM 103 Jaundice Meter (JM103) (Konica Minolta Sensing Inc., Osaka, Japan) in the setting of an Australian post‐natal ward.

Methods:  A before‐and‐after study was completed following the introduction of a protocol integrating the use of the JM103 monitor on to the post‐natal ward. Eligible infants were ≥36 weeks gestation, >24 h and <8 days of age. The number of Total Serum Bilirubin tests (TSBRs) were compared for the 12 months prior (T1) with a 6‐month period and 6 months after protocol introduction (T2). Transcutaneous bilirubin (TcBR) results were also collected in T2. Rates of phototherapy and peak TSBRs at commencement were also compared as measures of safety.

Results:  Four hundred and twenty‐six of the 2197 live births in T1 required one or more TSBRs compared with 119 of the 1169 live births in T2. This represents an odds ratio of 0.47 (95% confidence interval 0.38–0.58) for infants in T2 having ≥1 TSBR compared with T1. There was no difference between the groups for rates of phototherapy (3.8% vs. 3.0%; P= 0.2) nor any difference between the groups for peak SBR during phototherapy (301.9 µmol/L (standard deviation, SD 58) for T1 vs. 303.2 µmol/L (SD 54) for T2; P= 0.45). The estimated cost saving per year is $6966.00.

Conclusion:  TcBR measurement in conjunction with our protocol significantly reduces painful procedures and costs without increasing the risk of delaying treatment with phototherapy.
Molecular phylogeny ofIsodon(Lamiaceae) in Japan using chloroplast DNA sequences: recent rapid radiations or ancient introgressive hybridization?
Authors: MAKI MASAYUKI , YAMASHIRO TADASHI , DOHZONO IKUMI , SUZUKI KAZUO
Published: August 2010

Phylogenetic relationships between 14 taxa ofIsodon(Lamiaceae) occurring in Japan and South Korea were examined using sequence variations in 11 chloroplast DNA regions. The phylogenetic tree based on the sequence of 6478 bp did not reflect a previous taxonomic treatment of the genus at the section level: the three main clades contained species in different sections. Furthermore, individuals from different populations in the same species were rarely monophyletic in the tree. In addition, individuals forming monophyletic groups did not show geographical proximity. Lineage sorting of chloroplast DNA variations following rapid divergence of the taxa is likely to have caused complex phylogeny of the taxa, which was reconstructed in the present study. Another possible explanation could be ancient introgressions and resultant chloroplast capture.
BRONCHOSCOPIC APPEARANCE OF ACUTE TRACHEOBRONCHIAL COMPRESSION BY AN ENDO‐OESOPHAGEAL TUBE
Authors: Ti T. K.
Published: August 2010

The bronchoscopic appearance of a patient who developed acute respiratory distress following the insertion of a pulsion endo‐oesophageal tube is described. Intubation of the lower thoracic oesophagus causes cardiooesophageal incompetence, which is considered important in causing aspiration pneumonia. The selection of a suitably sized tube is important as a possible means of preventing tracheobronchial compression.
Phenotypic and genetic analysis of the cerebellar mutant tmgc26, a new ENU‐induced ROR‐alpha allele
Authors: Swanson Douglas J. , Steshina Ekaterina Y. , Wakenight Paul , Aldinger Kimberly A. , Goldowitz Dan , Millen Kathleen J. , Chizhikov Victor V.
Published: August 2010

ROR‐alpha is an orphan nuclear receptor, inactivation of which cell‐autonomously blocks differentiation of cerebellar Purkinje cells with a secondary loss of granule neurons. As part of our ENU mutagenesis screen we isolated the recessive tmgc26 mouse mutant, characterized by early‐onset progressive ataxia, cerebellar degeneration and juvenile lethality. Detailed analysis of the tmgc26−/− cerebella revealed Purkinje cell and granule cell abnormalities, and defects in molecular layer interneurons and radial glia. Chimera studies suggested a cell‐autonomous effect of the tmgc26 mutation in Purkinje cells and molecular layer interneurons, and a non‐cell‐autonomous effect in granule cells. The mutation was mapped to a 13‐Mb interval on chromosome 9, a region that contains the ROR‐alpha gene. Sequencing of genomic DNA revealed a T‐to‐A transition in exon 5 of the ROR‐alpha gene, resulting in a nonsense mutation C257X and severe truncation of the ROR‐alpha protein. Together, our data identify new roles for ROR‐alpha in molecular layer interneurons and radial glia development and suggest tmgc26 as a novel ROR‐alpha allele that may be used to further delineate the molecular mechanisms of ROR‐alpha action.
Impairment of CaMKII activation and attenuation of neuropathic pain in mice lacking NR2B phosphorylated at Tyr1472
Authors: Matsumura Shinji , Kunori Shunji , Mabuchi Tamaki , Katano Tayo , Nakazawa Takanobu , Abe Tetsuya , Watanabe Masahiko , Yamamoto Tadashi , Okuda‐Ashitaka Emiko , Ito Seiji
Published: August 2010

Ca2+/calmodulin‐dependent protein kinase II (CaMKII) is a key mediator of long‐term potentiation (LTP), which can be triggered by N‐methyl‐d‐aspartate (NMDA) receptor‐mediated Ca2+ influx. We previously demonstrated that Fyn kinase‐mediated phosphorylation of NR2B subunits of NMDA receptors at Tyr1472 in the dorsal horn was involved in a neuropathic pain state even 1 week after nerve injury. Here we show that Y1472F‐KI mice with a knock‐in mutation of the Tyr1472 site to phenylalanine did not exhibit neuropathic pain induced by L5 spinal nerve transection, whereas they did retain normal nociceptive responses and induction of inflammatory pain. Phosphorylation of NR2B at Tyr1472 was only impaired in the spinal cord of Y1472F‐KI mice among the major phosphorylation sites. There was no difference in the Ca2+ response to glutamate and sensitivity to NMDA receptor antagonists between naive wild‐type and Y1472F‐KI mice, and the Ca2+ response to glutamate was attenuated in the Y1472F‐KI mice after nerve injury. Autophosphorylation of CaMKII at Thr286 was markedly impaired in Y1472F‐KI mice after nerve injury, but there was no difference in phosphorylation of CaMKII at Thr305 or protein kinase Cγ at Thr674, and activation of neuronal nitric oxide synthase and microglia in the superficial layer of spinal cord between wild‐type and Y1472F‐KI mice after the operation. These results demonstrate that the attenuation of neuropathic pain is caused by the impaired NMDA receptor‐mediated CaMKII signaling in Y1472F‐KI mice, and suggest that autophosphorylation of CaMKII at Thr286 plays a central part not only in LTP, but also in persistent neuropathic pain.
Differential participation of temporal structures in the consolidation and reconsolidation of taste aversion extinction
Authors: Garcia‐delaTorre Paola , Rodríguez‐Ortiz Carlos J. , Balderas Israela , Bermúdez‐Rattoni Federico
Published: August 2010

The extinction process has been described as the decline in the frequency or intensity of the conditioned response following the withdrawal of reinforcement. Hence, experimental extinction does not reflect loss of the original memory, but rather reflects new learning, which in turn requires consolidation in order to be maintained in the long term. During extinction of conditioned taste aversion (CTA), a taste previously associated with aversive consequences acquires a safe status through continuous presentations of the flavor with no aversive consequence. In addition, reconsolidation has been defined as the labile state of a consolidated memory after its reactivation by the presentation of relevant information. In this study, we analyzed structures from the temporal lobe that could be involved in consolidation and reconsolidation of extinction of CTA by means of new protein synthesis. Our results showed that protein synthesis in the hippocampus (HC), the perirhinal cortex (PR) and the insular cortex (IC) of rats participate in extinction consolidation, whereas the basolateral amygdala plays no part in this phenomenon. Furthermore, we found that inhibition of protein synthesis in the IC in a third extinction trial had an effect on reconsolidation of extinction. The participation of the HC in taste memory has been described as a downmodulator for CTA consolidation, and has been related to a context–taste association. Altogether, these data suggest that extinction of aversive taste memories are subserved by the IC, HC and PR, and that extinction can undergo reconsolidation, a process depending only on the IC.
Time course of allocation of spatial attention by acoustic cues in non‐human primates
Authors: Populin Luis C. , Rajala Abigail Z.
Published: August 2010

Spatial attention mediates the selection of information from different parts of space. When a brief cue is presented shortly before a target [cue to target onset asynchrony (CTOA)] in the same location, behavioral responses are facilitated, a process called attention capture. At longer CTOAs, responses to targets presented in the same location are inhibited; this is called inhibition of return (IOR). In the visual modality, these processes have been demonstrated in both humans and non‐human primates, the latter allowing for the study of the underlying neural mechanisms. In audition, the effects of attention have only been shown in humans when the experimental task requires sound localization. Studies in monkeys with the use of similar cues but without a sound localization requirement have produced negative results. We have studied the effects of predictive acoustic cues on the latency of gaze shifts to visual and auditory targets in monkeys experienced in localizing sound sources in the laboratory with the head unrestrained. Both attention capture and IOR were demonstrated with acoustic cues, although with a faster time course than with visual cues. Additionally, the effect was observed across sensory modalities (acoustic cue to visual target), suggesting that the underlying neural mechanisms of these effects may be mediated within the superior colliculus, a center where inputs from both vision and audition converge.
Recommended use of morphine in neonates, infants and children based on a literature review: Part 2–Clinical use
Authors: KART TRINE , CHRISTRUP LONA L. , RASMUSSEN METTE
Published: August 2010

The indication for morphine use is primarily pain, but also a combined analgesic and sedative effect may be the rationale behind morphine administration. Paediatric morphine regimens have been reported for children with postoperative pain, pain related to cancer, sickle cell crisis pain, burns and AIDS. No dose response curve for morphine in neonates, infants or children has been established, and different levels for the minimum effective plasma concentration have been estimated. The side effects observed in neonates, infants, and children are similar to those observed in adults, and neonates do not seem to be more susceptible to respiratory depression than older children. Despite shortcomings in the knowledge of the pharmacodynamics of morphine, it can be considered safe to administer morphine to neonates, infants or children. Initial regimens has been calculated from the pharmacokinetic parameters of morphine, but treatment must be adjusted according to analgesic effect and incidence of side effects.
Psoas compartment block in children: Part I – description of the technique*
Authors: SCHUEPFER GUIDO , JÖHR MARTIN
Published: August 2010

Background : Until recently only small series of psoas compartment blocks (PCB) in children have been reported. A high incidence of epidural spread as an important side effect was noted. A series of 100 consecutive blocks using new standardized landmarks is reported.

Methods : In 100 consecutive children (5.9–106 kg) PCB was performed using a nerve stimulator. In the lateral position, the needle was inserted between the medial 2/3 and the lateral 1/3 on a line from the spinous process of L4 to the posterior superior iliac spine. The blocks were performed by residents in training under supervision of one specific designated pediatric anesthetist.

Results : All blocks were clinically successful. In 64% only one attempt was necessary, in 26 patients two attempts were necessary and in 10 patients more than two attempts were necessary. In 16% a vascular puncture occurred. In one patient with a dense unilateral block a partial epidural spread occurred. No serious complications were observed during the perioperative period.

Conclusions : The described new technique has a very high success rate with no relevant side effects. Although only one case of epidural spread occurred, PCB remains an invasive technique with the potential for serious complications.
Perioperative management of a child with short‐chain acyl‐CoA dehydrogenase deficiency
Authors: TURPIN BRIAN , TOBIAS JOSEPH D.
Published: August 2010

Short‐chain acyl‐CoA dehydrogenase (SCAD) is a mitochondrial enzyme that catalyzes the dehydrogenation of short chain fatty acids (4 to 6 carbons in length) thereby initiating the cycle of β‐oxidation. This process generates acetyl‐CoA, the key substrate for hepatic ketogenesis or ATP production by the Kreb's cycle. A deficiency of SCAD results in the build‐up of potentially cytotoxic metabolites including ethylmalonic acid, methylsuccinyl CoA and butyryl‐carnitine. The end‐organ involvement is heterogeneous, but most commonly includes hypotonia with possible lipid myopathy and developmental delay. Other reported complications include dysmorphic craniofacial features, hypoglycemia, seizures, scoliosis, hypertonia and hyperreflexia, cyclic vomiting and myocardial dysfunction. We present a 23‐month‐old girl with SCAD deficiency, who required posterior fossa decompression for type 1 Chiari malformation. The potential perioperative implications of SCAD deficiency are reviewed.
Intraoperative pediatric blood transfusion therapy: a review of common issues. Part I: hematologic and physiologic differences from adults; metabolic and infectious risks
Authors: BARCELONA SANDRA L. , THOMPSON ALEXIS A. , COTÉ CHARLES J.
Published: August 2010

Pediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss ≥one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. This paper is divided into two parts: part 1 presents an overview of the physiologic and hematologic differences between children and adults as well as an overview of the metabolic consequences of blood transfusions, risks of disease transmission, and blood compatibility issues.
The temperature and humidity of inspired gases in infants using a pediatric circle system: effects of high and low‐flow anesthesia
Authors: HUNTER TED , LERMAN JERROLD , BISSONNETTE BRUNO
Published: August 2010

Background:  The effects of low‐flow anesthesia on the temperature and humidity of the inspired gas in infants during mechanical ventilation is unknown. This study was designed to evaluate the temperature and humidity of the inspired gas in infants using a pediatric circle absorber system with high and low fresh gas flow (HFGF and LFGF) anesthesia.

Methods:  Twenty infants participated in this observational, sequential, cross‐over study. Each infant was mechanically ventilated with a Kion Anesthesia Workstation, using a pediatric anesthesia circle circuit with both HFGF (6 l·min−1) and LFGF (0.6 l·min−1) technique. Airway temperature was recorded continuously at 16 sites throughout the breathing circuit. The relative humidity of the inspired gas was measured at the elbow connector adjacent to the CO2 sampling line.

Results:  The mean airway temperatures of the inspired gas and the changes in mean airway temperatures throughout the breathing circuit during HFGF and LFGF did not differ significantly. The mean relative humidity of the inspired gas at steady state using a LFGF technique, 33.7 ± 3.6%, was approximately threefold greater than it was with a HFGF technique, 11.9 ± 5.1% (P < 0.05).

Conclusions:  Low‐flow anesthesia with a pediatric circle system in infants neither increases the temperature of the inspired gas, nor achieves the minimum humidity of 50% reported to prevent ciliary damage, although the humidity during LFGF did increase threefold compared with HFGF. To maintain the temperature and humidity of the inspired gas during mechanical ventilation in infants, passive or active gas humidification should be used.
Moyamoya disease and anesthesia
Authors: BAYKAN NIGAR , ÖZGEN SERDAR , SERPIL USTALAR Z. , DAǦÇINAR ADNAN , MEMET ÖZEK M.
Published: August 2010

Moyamoya disease is a condition that results from bilateral stenosis or obstruction of the intracranial arteries at the base of the brain. Patients exhibit ischemic symptoms, and vascular reconstruction is the therapy of choice. Surgical treatment for Moyamoya disease is often complicated by cerebral ischemia, so the goal in perioperative management is to maintain the balance between oxygen supply and demand in the brain. This report presents three cases of Moyamoya disease in patients under 3 years of age, and discusses anesthesia management issues for pediatric patients with this condition.
A 10‐year‐old child with status asthmaticus, hypercapnia and a unilateral dilated pupil
Authors: UDY ANDREW
Published: August 2010

This article reports the case of a 10‐year‐old child with an exacerbation of asthma requiring mechanical ventilation. His immediate course was complicated by significantly elevated arterial CO2 tensions and a unilateral dilated pupil. A computed tomography scan of his brain failed to demonstrate any evidence of intracranial hypertension or cerebral edema, and he went on to make an uncomplicated recovery, with no evidence of neurological sequelae. The most likely diagnosis appeared to be local contamination with ipratropium when he was receiving frequent nebulizers prior to mechanical ventilation. Similar cases reported in the literature are reviewed, with a discussion of clinical management, implications of permissive hypercapnia and neurological complications in ventilating asthmatic patients and the importance of safe drug handling by staff members.
Does dexmedetomidine prevent emergence delirium in children after sevoflurane‐based general anesthesia?
Authors: SHUKRY MOHANAD , CLYDE MATHISON C. , KALARICKAL PHILIP L , RAMADHYANI USHA
Published: August 2010

Background : Emergence agitation or delirium (ED) is a frequent phenomenon in children recovering from general anesthesia (GA). Dexmedetomidine, an alpha2 receptor agonist, has analgesic and sedative properties that might be helpful in the management of ED. We studied the effects of a continuous perioperative infusion of 0.2 μg·kg−1·h−1 dexmedetomidine on the incidence of ED in 50 children aged 1–10 years scheduled for sevoflurane‐based GA.

Methods : Following inhalation induction of GA, the children were randomly assigned into dexmedetomidine or placebo Groups D and S, respectively. The infusion of 0.2 μg·kg−1·h−1 dexmedetomidine or equal volume of saline was started after securing the airway. Depth of anesthesia was maintained by adjusting the concentration of sevoflurane to achieve a Bispectral Index Score of 40–60. Intraoperative hemodynamics were recorded every 5 min and the trachea was extubated at the end of the procedure. Perioperative pain management was determined by the blinded anesthesia team, and the study drug infusion was maintained for 15 min following the postanesthesia care unit (PACU) admission. ED and pain scores were evaluated by a blinded observer.

Results : The incidence of ED was statistically significantly different between the two groups, 26% in Group D Vs 60.8% in Group S (P = 0.036). Additionally, the number of episodes of ED was lower in Group D (P < 0.017). Pain scores and the times to extubate and discharge from PACU were the same.

Conclusions : The perioperative infusion of 0.2 μg·kg−1·h−1 dexmedetomidine decreases the incidence and frequency of ED in children after sevoflurane‐based GA without prolonging the time to extubate or discharge.
Intraoperative hyperthermia in a child with neuroblastoma
Authors: MAYHEW JAMES F.
Published: August 2010

The development of intraoperative hyperthermia has been reported in association with blood malignancies. This is case report of hyperthermia in a child with neuroblastoma, which was not an episode of malignant hyperthermia as determined by arterial blood cases and physiologic vital signs.