bluuebunny/crossref_metadata_2025 huggingface dataset:
Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome
Authors: Varpula T. , Valta P. , Niemi R. , Takkunen O. , Hynynen M. , Pettilä V.
Published: June 2004

Background:  Airway pressure release ventilation (APRV) is a ventilatory mode, which allows unsupported spontaneous breathing at any phase of the ventilatory cycle. Airway pressure release ventilation as compared with pressure support (PS), another partial ventilatory mode, has been shown to improve gas exchange and cardiac output. We hypothesized whether the use of APRV with maintained unsupported spontaneous breathing as an initial mode of ventilatory support promotes faster recovery from respiratory failure in patients with acute respiratory distress syndrome (ARDS) than PS combined with synchronized intermittent ventilation (SIMV‐group).

Methods:  In a randomized trial 58 patients were randomized to receive either APRV or SIMV after a predefined stabilization period. Both groups shared common physiological targets, and uniform principles of general care were followed.

Results:  Inspiratory pressure was significantly lower in the APRV‐group (25.9 ± 0.6 vs. 28.6 ± 0.7 cmH2O) within the first week of the study (P = 0.007). PEEP‐levels and physiological variables (PaO2/FiO2‐ratio, PaCO2 , pH, minute ventilation, mean arterial pressure, cardiac output) were comparable between the groups. At day 28, the number of ventilator‐free days was similar (13.4 ± 1.7 in the APRV‐group and 12.2 ± 1.5 in the SIMV‐group), as was the mortality (17% and 18%, respectively).

Conclusion:  We conclude that when used as a primary ventilatory mode in patients with ARDS, APRV did not differ from SIMV with PS in clinically relevant outcome.
The effects of etomidate, thiopental, and propofol in induction on hypoperfusion–reperfusion phenomenon during laparoscopic cholecystectomy
Authors: Yagmurdur H. , Cakan T. , Bayrak A. , Arslan M. , Baltaci B. , Inan N. , Kilinc K.
Published: June 2004

Background:  A hypoperfusion–reperfusion human model is observed during and soon after laparoscopic surgery. The aim of the study was to research the preventive effects of etomidate, thiopental, and propofol in induction on hypoperfusion– reperfusion phenomenon during laparoscopic cholecystectomy.

Methods:  Thirty‐six consecutive ASA I–II patients were randomized into three groups of 12 patients each. Anaesthesia was induced with etomidate in group 1, thiopental in group 2, and propofol in group 3. Venous blood samples were obtained at different time points for measurement of plasma malondialdehyde (MDA) levels. Arterial blood and gastric juice samples were obtained for the calculation of gastric intramucosal pH (pHi). Also changes in aminotransferases, alkaline phosphatase and total bilirubin levels were assessed.

Results:  There was a significant decrease in pHi at 1 min before desufflation (BD) and 20 min after desufflation (AD) compared with before insufflation (BI) in all groups. Plasma level of MDA was significantly increased in group 1 at 1 min BD and 20 min AD compared with before induction of anaesthesia (baseline). Malondialdehyde levels were decreased significantly in group 3 and increased non‐significantly in group 2 at the same time points. Also AST and ALT levels were significantly increased in both groups 1 and 2 at 24 h postoperatively.

Conclusion:  Propofol with antioxidant activity may offer many advantages by scavenging reactive oxygen species and their metabolites in case of anticipated hypoperfusion–reperfusion phenomenon, such as would occur in laparoscopic surgery.
Network Structure and Airline Scheduling
Authors: Brueckner Jan K.
Published: June 2004

This paper provides a simple analysis of the effects of network structure on the scheduling, traffic, and aircraft size choices of a monopoly airline. The analysis shows that switching to a hub‐and‐spoke network leads to increases in both flight frequency and aircraft size, while stimulating local traffic in and out of the hub. In addition, HS networks are shown to be preferred by the airline when travel demand is low, when flights are expensive to operate, and when passengers place a high value on flight frequency but are not excessively inconvenienced by the extra travel time required for a connecting trip. The welfare analysis shows that the flight frequency, traffic volumes, and aircraft size chosen by the monopolist are all inefficiently low under both network types. Moreover, in the most plausible case, the monopolist's network choice exhibits an inefficient bias toward the HS network, apparently reflecting an excessive desire to economize on the number of flights.
Pseudonyms and Maoists
Authors: Murray Stephen O.
Published: June 2004

A response to Pettigrew et al., AT20(1)
Impact of tongue cleansers on microbial load and taste
Authors: Quirynen M. , Avontroodt P. , Soers C. , Zhao H. , Pauwels M. , Van Steenberghe D.
Published: June 2004

Objectives: Tongue cleaning has been advocated to improve oral malodor and to reduce reinfection of periodontal niches by eliminating tongue coating and/or reducing putrefaction by bacteria.

Material and Methods: This cross‐over, single‐blind study on periodontitis‐free, non‐smoking, subjects with habitual oral hygiene (n=16), evaluated the effect of tongue cleaning (with either plastic scraper or nylon multi‐tufted toothbrush), on the microbial load of the tongue dorsum (anterior and posterior of the sulcus terminalis), the extent of tongue coating, and taste sensation for bitter, sweet, salt, and sour. Both devices had been used twice daily for 2 weeks (toothbrush three forward–backward movements along the linea mediana and for each longitudinal third of the tongue; two strokes with the scraper along the linea mediana and along the borders of the tongue).

Results: Two weeks of tongue brushing or scraping resulted in only negligible reductions in aerobic and anaerobic bacteria on the tongue (reductions <0.5 log). The amount of tongue coating, however, decreased significantly (p<0.05), with both devices. The taste sensation improved after 2 weeks of tongue cleaning, especially with the scraper (significant improvements for quinine and sodium chloride).

Conclusion: Tongue cleaning improves taste sensation and seems to reduce the substrata for putrefaction, rather than the bacterial load.
Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes
Authors: Rohsenow Damaris J. , Monti Peter M. , Martin Rosemarie A. , Colby Suzanne M. , Myers Mark G. , Gulliver Suzy B. , Brown Richard A. , Mueller Timothy I. , Gordon Alan , Abrams David B.
Published: June 2004

Aims  This clinical trial investigated effects of motivational enhancement treatment (MET) and group coping‐skills training (CST) tailored for cocaine dependence. Effects of MET were hypothesized to be greater with CST and for less motivated patients.

Design and interventions  A 2 × 2 design investigated two individual sessions of MET compared to meditation–relaxation (MRT), followed by four group sessions of CST versus drug education (ED), as daily adjuncts to intensive treatment.

Setting  The substance abuse program provided full‐day treatment with a learning‐theory and 12‐Step orientation.

Participants  Cocaine‐dependent patients were recruited.

Measurements  Assessment included treatment retention; change in cocaine‐related urge, self‐efficacy, pros and cons, and motivation; substance use and problems during 12‐month follow‐up.

Findings  Of 165 patients, follow‐up status is known for 90% (n = 149). Patients in MET with low initial motivation to change reported less cocaine and alcohol relapse and use days and fewer alcohol problems than MET patients with higher initial motivation. MET produced more employment improvement than MRT, with no other significant benefit for MET. Patients with higher motivation had more cocaine use and alcohol problems after MET than MRT. Group CST reduced cocaine and alcohol use during follow‐up for women only and reduced alcohol relapse for men and women.

Conclusions  MET is more beneficial for patients with lower initial motivation than for patients with high initial motivation. CST reduced cocaine and alcohol use for women only and reduced alcohol relapses, in contrast to results with lengthier individual CST.
Child day care risks of common infectious diseases revisited
Authors: Lu N. , Samuels M. E. , Shi L. , Baker S. L. , Glover S. H. , Sanders J. M.
Published: June 2004

Background  The increased risk of common infectious diseases associated with child day care attendance may vary by age, health plan and parent educational level. This study determined quantitatively the risk of diarrhoeal illness and upper respiratory infection (URI) among day‐care children in comparison with home‐care children. It examined the extent of risks in day‐care children under different conditions of three age groups, enrolled in two health plans, and from families of two levels of education.

Methods  The study subjects were recruited through two health plans: a Health Maintenance Organization (HMO) and the Medicaid program in Columbia, South Carolina of the USA. The sample was collected using a household survey of children, aged 5 years or younger. The participants were contacted bimonthly for 18 months with 435 attending out‐of‐home day care facilities and 753 being cared for at home. The potential confounding factors of family characteristics were controlled in examining the odds ratios for day care effect on common infections in children under different conditions.

Results  In general, risks of diarrhoeal illness and URI in day‐care children are greater than in home‐care children. Children younger than 1.5 years of age attending day care and covered by the Medicaid program are at the greatest risk. The difference in risks between day‐care and home‐care children, however, is reduced to an insignificant level for children older than 1.5 years of age and for children covered by the HMO health plan. Among day‐care children, those who are covered by the Medicaid program are at a significantly higher risk than those who are covered by the HMO health plan.

Conclusions  Although day‐care children in general suffer a greater risk of common infectious diseases, the extent of day care effect on risks of diarrhoeal illness and URI varies significantly by age and type of health insurance plan.
How great is the risk of abuse in infants born to drug‐using mothers?
Authors: Street K. , Harrington J. , Chiang W. , Cairns P. , Ellis M.
Published: June 2004

This prospective, cohort study reports early child protection and surveillance process markers for children born to self‐proclaimed drug‐using mothers.

Background  A strong association is reported between maternal drug use and child abuse in North American studies. There are no systematic data describing this association for the UK population. Given the heterogeneous nature of drug cultures and associated behaviour it is difficult to generalize from US data to the UK population.

Methods  The study group consisted of all women referred to a hospital‐based antenatal clinic for pregnant drug users. Infants of non‐drug users were matched for social class and gestational age. At 18 months the Bristol and surrounding area child protection registers and child health surveillance records were searched. Infants were coded as to whether they were the subject of an enquiry, case conference, registration, registration with subsequent deregistration, or taken into care.

Results  There were 68 infants of drug users and 127 infants of non‐drug users. Most (81%) of drug users were heroin and/or methadone users; half were using/had used intravenously. Child health surveillance uptake for both groups is lower than that reported for the Avon population as a whole during the study period, consistent with the relatively deprived populations represented. There is no statistically significant difference between the drug users and non‐drug users. The overall risk of child protection proceedings was higher in children of drug users than in children of non‐drug users. However, closer inspection of the data shows most of the excess risk is explained by the small group taken into care and the much larger group for whom the concerns were relatively shortlived as shown by their subsequent deregistration during the study period.

Conclusions  Maternal drug use does not necessarily lead to unacceptable standards of parenting. More UK‐based research is needed to inform the risk assessment process for child protection.
Body weight perception among Bahraini adolescents
Authors: Al‐Sendi A. M. , Shetty P. , Musaiger A. O.
Published: June 2004

Background  This study examines the relationship between actual weight status and perceptions of body weight in Bahraini adolescents. The study also investigates the adolescents’ perceptions of parents’ and peers’ opinions of weight.

Methods  A cross‐sectional survey of 447 Bahraini male and female adolescents aged 12–17 years was conducted. Weight and height were measured and body mass index (BMI) was calculated. A short questionnaire was used to obtain their attitudes towards their weight status, as well as the attitudes of their parents and friends. The nine figure silhouettes illustration was used to measure perception of ideal body image and how it compares with their current body weight.

Results  The results revealed a significant discrepancy between adolescents’ perception of body weight and actual BMI. There was a tendency for teenagers to underestimate their weight status, which was especially noteworthy among the overweight and obese. More than half of the girls and about one‐third of the boys expressed discontent with their current body weight. One‐third (33.5%) and 26.6% of the adolescents thought that their parents and their peers, respectively, would consider them to be overweight or obese. The percentage of adolescents who reported parental or peer underestimation was higher among those classified as overweight or obese than it was among those who were of normal weight.

Conclusion  The study shows the existence of a distorted body image as reflected by failure of many overweight or obese adolescents to perceive themselves as such. Among Bahraini adolescents weight‐related beliefs and attitudes exist at two ends of the spectrum: a tolerance of obesity at one end and an exaggerated concern for its occurrence at the other.
Experience of Turkish parents about their infants’ teething
Authors: Baykan Z. , Sahin F. , Beyazova U. , Özçakar B. , Baykan A.
Published: June 2004

Aim  To evaluate Turkish parents’ experience about their infants’ teething; which symptoms they have seen and attributed to teething and how they have acted to manage these symptoms.

Methods  A questionnaire form was applied by face‐to‐face interview to 335 families who have children less than 18 months of age and have at least one tooth. They were asked questions to clarify the eruption time and sequence of primary teeth of their infants and whether their infants had some symptoms they attributed to teething.

Results  The mean eruption time of the primary teeth was 7.4 ± 2.0 months, with a range of 3–17 months. Teeth eruption time was found similar in both genders. Teeth eruption time of the term and preterm infants was similar. (P > 0.05). The first tooth erupted was the lower central incisor in the 288 infants (86.0%) and upper central incisor in 44 infants (13.1%). Most of the families (98.8%) reported that their children had suffered from at least one of the symptoms that were mentioned in the questionnaire. The most commonly reported symptom was increase in biting, followed by irritability and fever. Of the children who were taken to a health care centre, in 78.8% the symptoms were attributed to teething and in 7.1% a bacterial infection was found and antibiotics were prescribed.

Conclusion  When an infant at teething age has some symptoms, they may be attributed to teething but other possible causes must be ruled out first.
Understanding knowledge‐sharing breakdowns: a meeting of the quantitative and qualitative minds
Authors: Soller Amy
Published: June 2004

Abstract The rapid advance of distance learning and networking technology has enabled universities and corporations to reach out and educate students across time and space barriers. Although this technology enables structured collaborative learning activities, online groups often do not enjoy the same benefits as face‐to‐face learners, and their instructors often do not have time to actively support and mediate the online collaboration. This article demonstrates our capacity to computationally model, analyse, and support online student interaction, in particular knowledge sharing. A unique combination of qualitative analysis and artificial intelligence methods was designed to (a) recognize when students are having trouble learning the new concepts they share with each other, and (b) understand why they are having trouble, so that we might assist an instructor or intelligent coach in mediating group knowledge‐sharing activities.
Evaluating the use of synchronous communication in two blended courses
Authors: Cox Glenda , Carr Tony , Hall Martin
Published: June 2004

Abstract Residential universities are increasingly integrating online interaction within courses in the form of synchronous online chats, asynchronous online discussions and access to interactive resources. This article evaluates the educational effectiveness of online chats within a Humanities postgraduate course and a final year Commerce course. We consider the roles of course design, group dynamics, and facilitation style in the successful use of online collaboration within primarily face‐to‐face courses, as well as the potential for online collaboration within a blended course design to facilitate more inclusive learning conversations than are possible with exclusively face‐to‐face interaction.
Combining interaction and context design to support collaborative argumentation using a tool for synchronous CMC
Authors: Mcalister Simon , Ravenscroft Andrew , Scanlon Eileen
Published: June 2004

Abstract Empirical studies and theory suggest that educational dialogue can be used to support learners in the development of reasoning, critical thinking and argumentation. This paper presents an educational design for synchronous online peer discussion that guides student dialogue in ways that lead to improved argumentation and collaborative knowledge development. This design includes a mediating interface – or tool, linked to a broader set of online educational activities – a designed local context, where the latter aims to provide conditions that support argumentation. The approach is based on collaborative working and dialogue game approaches to discussion. Preliminary findings with UK Open University students showed the argumentation process was more coherent, varied, deeper and extended when using our interaction design compared with the use of a simple unstructured interface.
Allometric analysis of ciprofloxacin and enrofloxacin pharmacokinetics across species
Authors: Cox S. K. , Cottrell M. B. , Smith L. , Papich M. G. , Frazier D. L. , Bartges J.
Published: June 2004

The purpose of this study was to examine the allometric analysis of ciprofloxacin and enrofloxacin using pharmacokinetic data from the literature. The pharmacokinetic parameters used were half‐life, clearance and volume of distribution. Relationships between body weight and the pharmacokinetic parameter were based on the empirical formulaY = aWb, whereYis half‐life, clearance or volume of distribution,Wthe body weight andais an allometric coefficient (intercept) that is constant for a given drug. The exponential termbis a proportionality constant that describes the relationship between the pharmacokinetic parameter of interest and body weight. A total of 21 different species of animals were studied. Results of the allometric analyses indicated similarity between clearance and volume of distribution as they related to body weight for both drugs. Results of the current analyses indicate it is possible to use allometry to predict pharmacokinetic variables of enrofloxacin or ciprofloxacin based on body size of species. This could provide information on appropriate doses of ciprofloxacin and enrofloxacin for all species.
BK virus nephropathy in a patient with ABO‐incompatible renal transplantation
Authors: Itabashi Y , Sakai K , Kawamura T , Hyodo Y , Muramatsu M , Arai K , Aikawa A , Mizuiri S , Ohara T , Hasegawa C , Ishikawa Y , Hasegawa A
Published: June 2004

Abstract:  A 43‐year‐old woman with end‐stage renal disease originating from IgA nephropathy entered chronic haemodialysis therapy. She then received an ABO‐incompatible living related renal transplantation. Initial immunosuppression consisted of azathioprine, methylprednisolone and tacrolimus. At 155 days after transplantation, the azathioprine was changed to mycophenolate mofetil for continuous graft dysfunction. Furthermore, a total of three courses of anti‐rejection therapy was given. At 665 days after transplantation, diagnosis of BK‐virus nephropathy was made by immunohistochemical analysis and viral DNA assay. Therefore the immunosuppression therapy was reduced for graft dysfunction. All five renal biopsy specimens were examined retrospectively in order to determine when the BK virus nephropathy had developed. The expressions of SV40 large T antigens were detected from the third (117 days) to the fifth (665 days) biopsies, with increasing numbers of SV40 large T antigen positive cells. In addition, many cells contained inclusion bodies which were already present in the urinary sediment for 3 months post‐transplantation. Although it is difficult to make a diagnosis of early stage of BKVN, we have to consider with caution if urinary cells with inclusion body are seen. Awareness of BKVN at the earliest opportunity is important in order to avoid over‐immunosuppression.
A case of plasmacytic hyperplasia arising in a kidney allograft salvaged with immunosuppression reduction alone
Authors: Harada H , Miura M , Shimoda N , Seki T , Togashi M , Ogawa Y , Takada A , Tahara M , Sato H , Hirano T
Published: June 2004

Abstract:  Post‐transplant lymphoproliferative disorder (PTLD) is a well‐known complication of organ transplantation. Plasmacytic hyperplasia (PH) is thought of as the mildest form of PTLD; however, a graftectomy is necessary in most situations. We experienced an interesting case of PH arising in a kidney allograft, which could be relieved with a reduction in immunosuppression. A 27‐year‐old female underwent a living‐related kidney transplantation. A 3‐month non‐episode protocol biopsy unexpectedly showed the devastating appearance of polymorphic plasma cell infiltration into the graft intersitium, compatible with PH. The PH was located in the graft by radiographic examinations. The infiltration of plasma cell disappeared completely on the 6‐month graft biopsy specimen following immunosuppression reduction and the graft is functioning, although it was damaged by a subsequent acute rejection. Our present case indicates that some PTLD can be completely cured with a reduction in immunosuppression alone. The diagnostic modality for the evaluation of PTLD cell extinction is necessary to maintain graft function with adequate immunosuppression thereafter.
Different clinicopathological courses of two recipients of kidneys retrieved from the same non‐heart beating donor
Authors: Nishikido M , Noguchi M , Koga S , Kanetake H , Harada T , Taguchi T , Watanabe J , Matsuya F , Hayashi M
Published: June 2004

Abstract:  We report the clinicopathological courses of two recipients of kidneys retrieved from the same non‐heart beating donor (NHBD). A 52‐year‐old man received a renal transplant from an NHBD. The donor was a 66‐year‐old woman who died of subarachnoid haemorrhage. The recipient was immunosuppressed by basiliximab, tacrolimus (TAC), mycophenolate mofetil (MMF), methyl prednisolone (MP), and antilymphocyte globulin (ALG). On post‐operative day (POD) 21, haemodialysis therapy was withdrawn, however, their serum creatinine (s‐Cr) level failed to improve. Four transplant biopsies were performed (1 h and POD 46, 74, and 114). The biopsy showed tubular degeneration but no evidence of TAC nephrotoxicity. The last biopsy after discontinuation of TAC demonstrated acute rejection of borderline grade. The s‐Cr level at discharge was 5.0 mg/dL. The contra‐lateral kidney was transplanted into a 31‐year‐old female and showed early functioning, with an s‐Cr level at discharge of 1.8 mg/dL. Biopsy examination on POD 38 showed a recovery of tubular degeneration. The causes of delayed graft function and persistently high level of s‐Cr in Case 1 remain unclear. Various factors, including donor‐related factors, recipient‐related factors, TAC nephrotoxicity, acute rejection, and urinary tract infection could all be associated with this condition.
Different patterns of TCR β chain regulation following allo‐ and xeno‐transplantation
Authors: Guillet Marina , Gagne Katia , Lair David , Heslan Jean‐Marie , Doré Jean‐Christophe , Soulillou Jean‐Paul , Brouard Sophie
Published: June 2004

Abstract:  Background:  In the concordant hamster‐to‐rat cardiac xenograft model, recipients treated with cobra venom factor for the first 10 days following transplantation and daily with Cyclosporine A (CsA) do not reject their grafts. However, when CsA is withdrawn on day 40, an acute cellular rejection occurs within 4 ± 1 days. Allografts performed in the same conditions are rejected within 18 ± 4 days.

Methods:  In this model, we have compared graft infiltrating T cells through both a quantitative (number of Vβ transcripts) and qualitative (CDR3 length distribution) assessment of the T cell receptor (TCR) β chain transcriptome in allo‐ and xeno‐transplantations.

Results:  We report striking differences in TCR usage at day 15 following allo‐ and xeno‐transplantation as well as during rejection following CsA withdrawal. The number of Vβ transcripts was high in both rejected allo‐ and xenografts. However, whereas in xenografts acute rejection occurred without skewing of Vβ CDR3 length distribution, T cells infiltrating allografts during rejection after CsA interruption had a highly altered CDR3 length distribution pattern. In addition, using a correspondence factor analysis of the β chain transcriptome, we show that some families can clusterize and can discriminate allo‐ or xeno‐patterns at the level of both the number of Vβ transcripts and the CDR3 length distribution.

Conclusions:  Our data show that, in vivo, even in the hamster‐to‐rat concordant combination, the anti‐xenograft T cell response is strong and will likely represent another challenge for xenotransplantation.
Initial experience with the human anti‐human CD154 monoclonal antibody, ABI793, in pig‐to‐baboon xenotransplantation
Authors: Knosalla C. , Ryan D.J.J. , Moran K. , Gollackner B. , Schuler W. , Sachs D.H. , Awwad M. , Schuurman H.‐J. , Cooper D.K.C.
Published: June 2004

Abstract:  Background:  ABI793 (ABI) is a human monoclonal antibody (mAb) specific for human CD154. To assess the suitability of ABI for baboon transplantation studies, we carried out in vitro studies to determine ABI's reactivity with baboon cells expressing CD154, performed in vivo pharmacokinetic studies in two baboons, and tested the effect of ABI administration on elicited antibody production in two baboons undergoing either pig hematopoietic progenitor cell (PBPC) or heterotopic heart transplantation.

Methods:  In vitro: Baboon peripheral blood mononuclear cells were activated in vitro to upregulate CD154, and binding of ABI to CD154 was measured by flow cytometry. In vivo: Serum levels of ABI were measured immediately before and 15 min after the intravenous administration of ABI (20 mg/kg) to two baboons over 28 days. Subsequently, ABI (25 mg/kg on days 0, 1, 4 and 7, and then 20 mg/kg every 5 days) was included in the immunosuppressive regimen in two pig‐to‐baboon transplants (PBPC or heart transplantation).

Results:  In vitro: ABI was almost non‐reactive to baboon T cells before stimulation, but bound to activated T cells. In vivo: In the pharmacokinetic study, trough levels of ABI (before the next dose) ranged between 190 and 580 μg/ml, and the estimated half‐life was 10–15 days. There was no apparent toxicity. Following pig PBPC or heart transplantation, no elicited antibody was detected while ABI was being administered or during several weeks of follow‐up.

Conclusions:  ABI functions in baboons, is well‐tolerated, and prevents an elicited antibody response to pig antigens.
Anaesthesia for cholecystectomy in two non‐parturients with Eisenmenger's syndrome
Authors: Kopka A. , McMenemin I. M. , Serpell M. G. , Quasim I.
Published: June 2004

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post‐operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.
Effects of post‐operative pain treatment using non‐steroidal anti‐inflammatory analgesics, opioids or epidural blockade on systemic and local immune responses in children
Authors: Vuori A. , Salo M. , Viljanto J. , Pajulo O. , Pulkki K. , Nevalainen T.
Published: June 2004

Background:  Many studies have been carried out on the effects of anaesthetic drugs and methods on the immune response, but pain and its relief also affect the immune response. We measured systemic immune responses in the blood circulation and local responses in the surgical wound when non‐steroidal anti‐inflammatory analgesics (NSAIDs), opioids or epidural blockade was used in the peri‐operative treatment of pain.

Methods:  Responses were measured in 51 children, aged from 2 to 12 years and undergoing major surgery under balanced anaesthesia. Bolus doses of diclofenac intravenously (i.v.) and rectally (NSAID group), continuous i.v. infusion of oxycodone (opioid group) or continuous epidural infusion of bupivacaine + fentanyl (epidural group) were used peri‐operatively for pain relief.

Results:  The only difference related to the analgesic method was shorter duration of post‐operative leucocytosis and lower phytohaemagglutinin (PHA)‐induced lymphocyte proliferative responses in peripheral blood in the opioid group than in the NSAID or epidural groups. By contrast, time‐related alterations were seen overall in leucocyte and differential counts, lymphocyte and their subset counts, lymphocyte proliferative responses, and in serum cortisol, C‐reactive protein, plasma interleukin‐6 and group II phospholipase A2 concentrations and in the appearance of different cell types in the wound.

Conclusions:  Post‐operative pain treatments using diclofenac (NSAID), oxycodone (opioid) and epidural blockade have basically similar effects on systemic and local immune responses with only slight, probably clinically unimportant differences in children undergoing surgery under general anaesthesia.
Cutaneous alternariosis revealing acute myeloid leukaemia in an adult patient
Authors: Ioannidou D. , Maraki S. , Krüger Krasagakis S. , Stefanidou M. , Krasagakis K. , Alexandrakis M. , Tosca A.
Published: June 2004

We report a case of cutaneous alternariosis in a 69‐year‐old male patient. During hospitalization for treatment of the skin disorder, acute myeloid leukaemia was diagnosed. He received multiple chemotherapeutic agents but the leukaemia remained refractory to therapy and the patient died. The clinical picture, diagnosis and treatment of cutaneous alternariosis will be discussed and a review of the literature regarding patients with haematological diseases will be given.
Disseminated dermatophytosis caused by Microsporum gypseum in an AIDS patient: response to terbinafine and amorolfine
Authors: Galhardo M. C. G. , Wanke B. , Reis R. S. , Oliveira L. A. , Valle A. C. F.
Published: June 2004

A 51‐year‐old white male, native of Rio de Janeiro, Brazil, with advanced AIDS and in chronic use of imidazoles for oral candidosis, presented erythematous, desquamative, pruriginous plaques of 1 month evolution on the trunk, inguinal/crural region, and lower limbs. The diagnosis of dermatophytosis was based on the isolation of Microsporum gypseum from scales scraped from the skin lesions. The lesions regressed after 30 days treatment with itraconazole, 100 mg day−1. After interruption of this antifungal, the mycosis recurred 2 months later, along with a toe onychomycosis also caused by M. gypseum. Attempted reintroduction of itraconazole at higher dose was unsuccessful. Patient responded well to treatment with terbinafine 250 mg day−1 for 45 days. However, the medication had to be interrupted as a result of the emergence of a disseminated erythematous/papulous rash. Topical treatment with amorolfine cream was then performed, with a good clinical and mycological response.
Aspergillus endocarditis presenting as femoral artery embolism
Authors: Verghese S. , Maria C. F. , Mullaseri A. S. , Asha M. , Padmaja P. , Padhye A. A.
Published: June 2004

Fungal valvular endocarditis is an unusual cause of endocarditis, yet very important because of its historically poor prognosis. We report two fatal cases of fungal valvular endocarditis following cardiovascular surgery, presenting as femoral artery embolism. Aspergillus terreus and A. flavus were the causative agents of endocarditis in the two patients. Diagnosis was established very early by culture of the emboli and was confirmed later by isolation of the same Aspergillus species from the resected valve tissue.
Susceptibility of sequential Fonsecaea pedrosoi isolates from chromoblastomycosis patients to antifungal agents
Authors: Andrade Tânia S. , Castro Luiz G. M. , Nunes Ricardo S. , Gimenes Viviane M. F. , Cury Arlete E.
Published: June 2004

Fourteen Fonsecaea pedrosoi isolates from six chromoblastomycosis patients were submitted to susceptibility testing. Some patients were undergoing treatment with itraconazole (ITZ) and/or cryosurgery with liquid nitrogen. The antifungal agents amphotericin B (AMB), ITZ, fluconazole (FCZ), ketoconazole (KCZ), 5‐fluorocytosine (5‐FC), and terbinafine (TBF) were tested. AMB and FCZ showed less activity for all isolates. The most active agents were KCZ and TBF. Sequentially isolates from four patients presented ITZ minimal inhibitory concentration (MIC) higher than the previous ones; for two of these patients, response to therapy with this agent was not observed. These results suggest development of microbiologic resistance to ITZ in four instances, two of them coinciding with lack of clinical response to this drug.
Tinea capitis favosa in Poland
Authors: Niczyporuk W. , Krajewska‐Kułak E. , Łukaszuk C.
Published: June 2004

Tinea capitis favosa is uncommon in Europe. We describe two patients who had local alopecia caused by Trichophyton schoenleinii. In the first case, we observed good clinical response after griseofulvin treatment and in the second case after topical application of ciclopirox cream.
Inventing Adulthoods: A Biographical Approach to Understanding Youth Citizenship
Authors: Thomson Rachel , Holland Janet , McGrellis Sheena , Bell Robert , Henderson Sheila , Sharpe Sue
Published: June 2004

Traditionally adulthood and citizenship have been synonymous. Yet adulthood is changing. In this paper we explore how young people's evolving understandings of adulthood may contribute towards an understanding of citizenship within the broader context of increasingly extended and fragmented transitions. The paper draws on a unique qualitative longitudinal data set in which 100 young people, from contrasting social backgrounds in the United Kingdom, have been followed over a five-year period using repeat biographical interviews. We present first the themes that emerged from a cross-cut analysis of the first of three rounds of interviews distinguishing between relational and individualised understandings of adulthood. We then present a model we developed to capture the ways that young people sought out opportunities for competence and recognition in different fields of their lives. Finally a case study that follows a young woman through her three interviews illustrates how these themes can appear in an individual trajectory. We offer the model and case study as a way of exploring a more subjective approach to citizenship in which participation is not deferred to some distant future in which economic independence is achieved, but is understood as constantly constructed in the present.
The centre cannot hold: tales of hierarchy and poetic composition from modern Rajasthan
Authors: Snodgrass Jeffrey G.
Published: June 2004

In this article I examine Bhat myths and legends concerning kings and bards. Bhats are low‐status praise‐singers from the Indian state of Rajasthan. In exploring these tales, I examine my informants’ ideas about an issue which has long been seen as a central conundrum of Indian caste theory: how best to characterize the status of those with priestly standing in relation to those classed as warriors and kings. In their stories, Bhats demonstrate the ways in which high‐caste persons such as kings are utterly dependent on bardic services – thus rendering performers like themselves central, and kings peripheral. With respect to the debate about whether kings or priests rank first in South Asian schemes of rank and primacy, Bhats themselves think in terms of a third class of persons: bards. Further, I suggest that, in arguing for the social centrality of linguistically talented bards, my informants display a consciousness that is particularly attuned to the discursive construction of social hierarchies. Finally, I seek to explain why Bhats, who are bards of former untouchables now living in an ostensibly modern, casteless democracy, still speak so persistently of kings and royal bardship. My answer to this is that, in fabricating fictive royal bardic identities, present‐day Bhats are able to appropriate roles and statuses now abandoned by the former elite bards of post‐Independence Rajasthan.
The communal and the sacred: women's worlds of ritual in Uzbekistan
Authors: Kandiyoti Deniz , Azimova Nadira
Published: June 2004

This article analyses women's participation in life‐cycle, religious, and propitiatory rituals in Uzbekistan against the background of the ‘politicization’ of custom under the Soviet regime and fluctuations in official policies towards Islam since the post‐Soviet period. Despite changes in official discourse, the resilience of women's rituals may be explained in terms of their embeddedness in local notions of communal participation and their role in the day‐to‐day reproduction of communal life. In the post‐Soviet period, ritual has become a site both for the assertion of authentic Uzbek identity and for the display of growing disparities in wealth and status through the medium of consumption, leading to propaganda campaigns against ostentation. Although the thinking behind these initiatives is very different from that of Soviet modernizers, they, too, place ritual life at the centre of Uzbek sociality and target women as the custodians of local custom.
Idolatry and the Polemics of World‐Formation from Philo to Augustine
Authors: Miller Isaac
Published: June 2004

This article examines the association of idolatry with erroneous ideas about the natural world in the writings of late antique Jewish and Christian authors. It follows two polemical genres. The first is the hexaemeral commentaries composed by Philo of Alexandria, Basil of Caesarea and Augustine, which positioned the hexaemeron against the background of natural philosophy and used various critiques of idolatry to revise or refute pagan natural philosophy. The second genre is that of heresiology initiated by Irenaeus of Lyon and adapted by Augustine to refute Gnostic and Manichaean cosmological myths and disregard for the creation account in Genesis. The article analyses a variety of ways in which the prohibitions against idolatry figured in methodological questions about how to conceptualize the natural world, how to locate the sources of conceptual error, and how to distinguish those errors from truth.
Congenital syphilis presenting with nephrotic syndrome and leucocytoclastic vasculitis
Authors: Çam H , Taytan Y , Aji DY , Bilgi Z , Aydemir E , Demirkesen C
Published: June 2004

Nephrotic syndrome is a well‐recognized entity in congenital syphilis but leucocytoclastic vasculitis has not yet been described. We report a case of nephrotic syndrome and leucocytoclastic vasculitis associated with congenital syphilis in a 45‐day‐old male infant who did well after treatment with intravenous penicillin.
Elephantoid oedema of the eyelids
Authors: Marzano AV , Vezzoli P , Alessi E
Published: June 2004

We describe a male patient with rosacea who had a 2‐year history of persistent bilateral oedema of the eyelids, leading to an elephantoid condition with blepharoptosis. An upper eyelid blepharoplasty was performed, but swelling progressively recurred over a few months. Based on the case history, clinical appearance and histological findings, rosaceous lymphoedema was considered to be the diagnosis. The latter is a bilateral, solid oedema of the mid‐third of the face, regarded as a rare complication of rosacea. It is thought to occur as a result of chronic inflammation and lymphatic stasis, but its exact aethiopathogenesis remains elusive. Predominant eyelid involvement, causing severe visual impairment as in our patient, is unique.
Cutis verticis gyrata secondary to acne scleroticans capitis
Authors: Ulrich J , Franke I , Gollnick H
Published: June 2004

We report the case of a 35‐year‐old patient with secondary cutis verticis gyrata (CVG) that histologically presented as acne scleroticans capitis. Clinically, the diagnosis of acne conglobata was made. The CVG developed under systemic corticosteroid treatment of an ulcerative colitis. Corticosteroids were discontinued and a therapeutic attempt was made with isotretinoin. Although under this treatment the conglobate acne healed, the CVG remained unaltered. Dermatosurgical intervention by a scalp reduction plasty finally resulted in a marked improvement of symptoms and acceptable cosmetic outcome.
Treatment of head and neck dermatitis comparing itraconazole 200 mg and 400 mg daily for 1 week with placebo
Authors: Svejgaard El , Ølholm Larsen P , Deleuran M , Ternowitz T , Roed‐Petersen J , Nilsson J
Published: June 2004

Background  Head and neck dermatitis (HND) is a variant of atopic dermatitis often seen in young adults. A hypersensitivity to Malassezi antigens is considered to be of pathogenic importance. Previous mostly uncontrolled studies have shown that oral antimycotics might be of use in this condition.

Objective  To evaluate the efficacy of itraconazole in the treatment of HND in a randomized, double‐blind, placebo‐controlled trial.

Patients  Adult patients with HND were included. Systemic steroids and oral/topical antimycotics were avoided 1 and 2 months prior to the trial. Topical steroids were not allowed in the head and neck area within 2 weeks. Patients in generally good health were included and female patients had to have had a negative urine pregnancy test. The patients signed an informed consent.

Study design  The study included a 7‐day treatment period and a follow‐up period of 105 days. Control visits were carried out on days 3, 7 and 14 and after 15 weeks.

Methods  The SCORAD index (one for the head and neck area and one for the remaining surface area) and global evaluations by patient and investigator were used for clinical evaluation at each visit. Prick tests with Malassezia antigens and Candida albicans antigen were carried out at the start of the trial and included positive and negative controls. The patients were randomized into three groups, which were treated with 400 mg itraconazole daily, 200 mg itraconazole daily or placebo, respectively, for 7 days.

Results  The number of patients included was 53: 18 had 200 mg itraconazole daily, 17 had 400 mg itraconazole daily and 18 placebo. At days 7 and 14, significant improvement was seen in the SCORAD of the head and neck area for the groups given 400 mg itraconazole daily (P = 0.0385 and P = 0.0134), and 200 mg daily (P = 0.0104 and P = 0.0006). Patients in the placebo group improved slightly (P = 0.0785). At day 14, comparison of improvement of SCORAD of the head and neck area between all three groups showed a significant difference in favour of the 200 mg itraconazole group compared to the placebo group (P = 0.0318). The prick test was positive for Pityrosporum ovale in 37% and negative for C. albicans in all patients.

Conclusions  One week of treatment with 200 or 400 mg itraconazole as a single treatment has a significant effect on the head and neck area. Compared to placebo there was a significant improvement in SCORAD of the head and neck area in favour of the 200 mg itraconazole group after 14 days. The important observation seems to be that antifungal systemic treatment has a significant SCORAD reduction of atopic dermatitis, irrespective of the presence of allergy.
Intralesional 5‐fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo‐controlled, single‐blind randomized study
Authors: Isçimen A , Aydemir EH , Göksügür N , Engin B
Published: June 2004

Background  The treatment of viral warts remains challenging. A variety of treatment modalities have been used with a range of success. Fluorouracil has been shown to be effective in treating warts but the method of its delivery directly onto the affected tissue has been of little efficacy. We evaluated the safety and efficacy of intralesional 5‐fluorouracil in the treatment of verrucae.

Methods  Seventy‐six patients with a total 315 verrucae were randomized to receive either a 5‐fluorouracil, lidocaine and epinephrine (5‐FU + LE) mixture or serum saline injection into the paired verrucae in the same patient. The mixture of 5‐FU (4 cm3, 50 mg/mL), lidocaine (1 cm3, 20 mg/mL) and epinephrine (0.0125 mg/mL) was injected into the base of the wart using a mantoux needle. Each lesion was infiltrated with either of the solutions once a week for up to a maximum of 4 weeks, and the patients were followed up for 6 months.

Results  Complete response was noted in an average of 70% of the verrucae treated with the 5‐FU + LE mixture and in 29% of those in the placebo group (P < 0.001). No clinically significant systemic and local adverse effects occurred. Pain and burning were noted as an immediate injection pain. Recurrence rates were evaluated and no statistically significant difference between the two groups was found.

Conclusions  The results demonstrate that treatment of verrucae with 5‐FU + LE mixture is safe and effective.
The politics of engagement between Islam and the secular state: ambivalences of ‘civil society’1
Authors: Turam Berna
Published: June 2004

The paper reveals contemporary transformations of the interaction between Islam and secular states from opposition to engagement. In‐depth ethnographic evidence challenges the predominant juxtaposition of Islam against the secular state. Following micro‐sites of interaction between the Gülen movement and the state from Turkey to Kazakhstan, my fieldwork revealed a continuum of engagements between them. The paper analyses the engagements ranging from contestation and negotiation to co‐operation. The case illustrates the extent to which scholarly interest in opposition and clash has left a wide‐ranging variety of state–Islam interaction understudied with regard to civil society. It also reveals the conditions under which effective Islamic horizontal organizations have provided the platforms of vertical engagements with the secular states. The major argument of the paper is that both civil and uncivil outcomes in the Muslim world are primarily shaped by the nature of state–Islam interaction. The evidence suggests that the key to understanding the relationship between Islam and civil society is the state.