bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term results of mycophenolate mofetil as part of immunosuppressive induction therapy after liver transplantation
Authors: Langrehr Jan M. , Klupp Jochen , Glanemann Matthias , Junge Guido , Pfitzmann Robert , Bahra Marcus , Radtke Cornelia , Neumann Ulf , Neuhaus Ruth , Neuhaus Peter
Published: March 2006

Abstract: Background: The addition of mycophenolate mofetil (MMF) to the induction protocol resulted in a lower incidence of rejection episodes. However, the question whether MMF should be administered in combination with tacrolimus or cyclosporine has not been answered yet. In our study, we report on the long‐term results of triple induction therapy after orthotopic liver transplantation (OLT), consisting of MMF and low‐dose corticosteroids, in combination with either tacrolimus or cyclosporine.

Methods: Between March 1996 and April 1997, 120 consecutive patients, who underwent OLT at our institution, were enrolled in this study. Of these patients, 80 received triple induction therapy consisting of cyclosporine and MMF (40) or tacrolimus and MMF (40), in combination with low‐dose corticosteroids, whereas the remaining 40 patients served as ‘MMF‐free’ control group receiving dual induction therapy with tacrolimus and corticosteroids. Besides the eight‐yr follow‐up of patient and graft survival, clinical data were also reviewed for episodes of rejection and infection. Additionally, the early post‐operative pharmacokinetics of mycophenolic acid (MPA, immunological active metabolite of MMF) were evaluated.

Results: Long‐term results provided higher patient and graft survival after tacrolimus/MMF‐based induction therapy than after cyclosporine/MMF‐based induction therapy. However, the tacrolimus‐based control protocol yielded similar results and, therefore, no significantly superior effect was observed when MMF was added. The same observation was made for incidence of rejection and infection episodes. AUC andCmaxof MPA increased in combination with tacrolimus compared with cyclosporine.

Conclusions: Although pharmacological synergy between tacrolimus and MMF was observed, MMF showed no significant beneficial effects in the immunosuppressive induction protocol, neither in combination with tacrolimus nor with cyclosporine.
Size, acetylation and concentration of chitooligosaccharide elicitors determine the switch from defence involving PAL activation to cell death and water peroxide production in Arabidopsis cell suspensions
Authors: Cabrera Juan Carlos , Messiaen Johan , Cambier Pierre , Van Cutsem Pierre
Published: March 2006

Chitosan oligomers are known elicitors of plant defence mechanisms. In this work, chitooligosaccharides of different degrees of polymerization and degrees of acetylation were prepared and characterized by matrix‐assisted laser desorption ionization time‐of‐flight mass spectrometry. The effect of the degree of polymerization (DP), degree of acetylation and concentration of these chitooligosaccharides on defence activation in Arabidopsis thaliana suspension‐cultured cells was studied. Our study results show that fully deacetylated chitooligosaccharides (chitosan oligomers) induce, depending on their DP and concentration, phenylalanine ammonia‐lyase (PAL) activation, H2O2 synthesis and cell death in A. thaliana cell suspensions. The progressive reacetylation of the chitosan oligomer elicitors progressively impaired their ability to enhance H2O2 accumulation and cell death, but did not affect the activation of PAL.
Pinpoint targeted immunosuppression: anti‐CD20/MMF desensitization with anti‐CD25 in successful ABO‐incompatible kidney transplantation without splenectomy
Authors: Saito Kazuhide , Nakagawa Yuki , Suwa Michihiro , Kumagai Naoki , Tanikawa Toshiki , Nishiyama Tsutomu , Ueno Mitsuhiro , Gejyo Fumitake , Nishi Shin‐ichi , Takahashi Kota
Published: March 2006

Abstract: Background: In Japan, ABO‐incompatible (ABO‐I) kidney transplantation began in 1989; these transplantations have flourished because of the lack of cadaveric donors, and more than 600 cases were performed up to 2004. Splenectomy has been considered to be necessary for successful ABO‐I kidney transplantation, and the majority of pre‐conditioning protocols include splenectomy in Japan. However, we have lost some grafts due to antibody‐mediated rejection (AMR) accompanying explosive elevation of anti‐A/B antibody (Ab) titer even though the patients had a low pre‐operative Ab titer.

Patients and methods: We utilized two doses of anti‐CD20, rituximab, simply combined with mycophenolate mofetil (MMF)/low‐dose steroid desensitization started 1 month before surgery in ABO‐I kidney transplantation. Two sessions of pre‐operative Ab removal by double filtration plasmapheresis or plasma exchange were carried out. We performed six ABO‐I kidney transplantations without splenectomy. Anti‐A/B Ab titers were more than 16 to 32 times before treatment. We did not plan any post‐operative repeated Ab removal or intravenous immunoglobulin G (IVIG).

Results: Pre‐operative anti‐A/B Ab titers were successfully reduced to less than eight times in all cases. Except for one case in which we had to remove the graft due to aspiration pneumonia and methicillin‐resistant staphylococcus epidermidis (MRSE) sepsis, the other five cases did not experience antibody‐mediated rejection (AMR). An additional session of post‐operative Ab removal and/or IVIG was not necessary. In all patients, B cells (CD19+, CD20+, CD21+) and activated T cells (CD25+) were selectively suppressed, although CD3+, CD4+and CD8+ cell populations remained stable, thus we call our protocol “pinpoint targeted immunosuppression.” Plasma immunoglobulin level was also successfully suppressed, especially after 6 weeks of surgery.

Conclusion: Anti‐CD20/MMF desensitization is safe and allows successful ABO‐I kidney transplantation without splenectomy.
Present status of ABO‐incompatible kidney transplantation in Japan
Authors: Takahashi Kota , Saito Kazuhide
Published: March 2006

Abstract: Background: We have been making continuous efforts in ABO‐incompatible kidney transplantation since 1989 to expand the opportunities for kidney transplantation from living donors in Japan.

Patients and method: From the Japanese registry, we reviewed the long‐term patient and graft survival of ABO‐incompatible kidney transplantation. This survey focused on 564 patients who received ABO‐incompatible kidney grafts from January 1989 to December 2003 in whom monitoring follow‐up could be achieved in 60 institutions all over Japan. The mean age of 367 (65%) male and 197 (35%) female patients at surgery was 34.5 yr. Pre‐operative anti‐A/B antibody (Ab) removal and splenectomy (n=553, 98%) were routinely performed combined with triple or quadruple immunosuppression using calcinurine inhibitor (CNI), anti‐metabolites and steroids with or without deoxyspurgualin (DSG) or anti‐lymphocyte Abs.

Results: The overall patient survival rate at 1, 3, 5 and 10 yr after transplantation was 94, 91, 88 and 81%, with overall graft survival rates of 86, 82, 74 and 53%, respectively. The graft survival rate was significantly higher in patients aged 29 and younger compared with those aged 30 and older. Children aged 15 or younger in particular have shown excellent graft survival rates at 1, 3, 5 and 10 yr of 90, 90, 86 and 76%, respectively. Patients with anticoagulation therapy (n=285) showed a significantly higher graft survival rate than those without anticoagulation (n=213), with 10‐yr graft survival rates of 59 vs. 48%. There were no significant differences between A and B incompatibility with respect to clinical outcomes. There were also no significant difference in numbers of human leukocyte antigen mismatches, induction and maintenance CNI (cyclosporin A (CYA) vs. tacrolimus) and donor/recipient relationships with respect to the outcomes. We divided the patients into five groups according to the transplanted year periods. The outcome of the most recent 124 cases since 2001 had dramatically improved, with 2‐yr graft survival of 94%, and there is a significant difference between the groups in 2001 onwards and the other four groups.

Conclusion: This study confirms that the long‐term outcome of ABO‐incompatible living kidney transplantation is excellent and is similar to that of ABO‐compatible cases. Recent data show that short‐term graft survival has also improved. ABO‐incompatible kidney transplantation is a radical, but safe and effective, treatment choice for end‐stage renal disease.
ABO‐incompatible kidney transplantation of an 8‐yr‐old girl with donor/recipient‐constellation A1B/B
Authors: Ahlenstiel Thurid , Offner Gisela , Strehlau Jürgen , Pape Lars , Froede Kerstin , Ehrich Jochen H. H. , Schwarz Anke , Heuft Hans‐Gert , Klempnauer Jürgen
Published: March 2006

Abstract: Background: Antigen‐specific immunoadsorption combined with rituximab offers the possibility for ABO‐incompatible kidney transplantation without splenectomy.

Patient and method: An 8‐year‐old mentally retarded girl with steroid‐resistant nephrotic syndrome and focal segmental glomerulosclerosis due to mitochondriopathy poorly tolerated hemodialysis. Paternal blood group A1B was incompatible with blood group B of the child. Therefore, we decided to perform the first ABO‐incompatible renal transplantation in a child in Germany using antigen‐specific immunoadsorption.

Rituximab (1 × 375 mg/m2) was administered 2 weeks before the first immunoadsorption (Glycosorb® ABO A‐column). Triple‐drug immunosuppression (tacrolimus, mycophenolate mofetil and prednisolone) was simultaneously started with immunoadsorption. Initial tacrolimus levels were targeted between 15 and 20 ng/ml. Before transplantation, six immunoadsorptions were applied on days −9, −7, −4, −3, −2 and −1. Intravenous immunoglobulin (0.5 g/kg) was administered preoperatively. After transplantation, three immunoadsorptions were performed on days +4, +6 and +8.

Results: Before transplantation, antibody (Ab) titers against paternal erythrocytes (20°C) were reduced from 1 : 64 to 1 : 4 by six antigen‐specific immunoadsorptions. After transplantation, we performed three more immunoadsorptions and the Ab titers were stable between 1 : 1 and 1 : 8. One, 2 and 8 months later we observed increases in the Ab titer up to 1 : 32 requiring no change in immunosuppressive therapy. No side effects of immunoadsorption were observed. The girl had excellent initial graft function with a serum creatinine of 55 to 70 μmol/l. Two weeks after transplantation, graft biopsy showed no signs of rejection; there was focal positivity for C4d only. Twelve months after transplantation, renal function was stable, with a serum creatinine of 117 μmol/l. Episodes of rejection or severe infections were absent.

Conclusion: ABO‐incompatible transplantation using antigen‐specific immunoadsorption and rituximab may serve as a suitable alternative for children urgently needing renal transplantation and missing a blood group‐compatible donor.
ABO‐incompatible live donor renal transplantation using blood group A/B carbohydrate antigen immunoadsorption and anti‐CD20 antibody treatment
Authors: Nordén Gunnela , Briggs David , Cockwell Paul , Lipkin Graham , Mjörnstedt Lars , Mölne Johan , Ready Andrew , Rydberg Lennart , Samuelsson Ola , Svalander Christian T , Breimer Michael E
Published: March 2006

Abstract: Background: Blood group ABO‐incompatible live donor (LD) renal transplantation may provide a significant source of organs. We report the results of our first 14 cases of ABO‐incompatible LD renal transplantation using specific anti‐A/B antibody (Ab) immunoadsorption (IA) and anti‐CD20 monoclonal Ab (mAb) treatment.

Patients and treatment protocol: Recipients were blood group O (n=12), A (n=1) and B (n=1). Donors were A1 (n=2), A2 (n=3), A2B (n=1) and B (n=8), and all were secretor positive. Anti‐human leukocyte antigen (HLA) Ab panel reactivity was negative in all recipients except one. All recipients were pre‐treated with 3 to 6 IA sessions, using A or B carbohydrate antigen columns, until their anti‐A1/B RBC panel indirect antiglobulin test (IAT) titers were ≤8. CDC crossmatch was negative in all cases. Recipients received preoperative mycophenolic acid, and steroids/tacrolimus were started at transplantation. No splenectomy was performed. Eight recipients received one dose of anti‐CD20 mAb (rituximab, 375 mg/m2) pre‐operatively and 11 recipients had postoperative protocol IA.

Results:
In the initial protocol, anti‐CD20 mAbs were used only for recipients receiving A1 grafts. One B graft (HLA‐identical donor, 84% panel reactivity) was lost in a severe anti‐B Ab‐mediated acute rejection. Subsequently, the protocol included anti‐CD20 for recipients of both A1 and B grafts and postoperative protocol IA to all recipients. The subsequent 10 grafts had excellent function, giving a total graft survival of 13/14 (observation range 2 to 41 months). At 1 yr, mean serum creatinine was 113 μmol/l (n=8) and mean glomerular filtration rate was 55 ml/min/1.73 m2 (range 24 to 77). In the remaining five cases, with less than 1 yr follow up, mean serum creatinine was 145 μmol/l at 2 to 9 months follow up. Pre‐IA anti‐A/B titers were in the range of 2 to 32 (NaCl technique) and 16 to 512 (IAT). More than 90 IA sessions were performed in 14 recipients without any significant side effects. Recipient anti‐A/B titers returned after transplantation to pre‐IA levels or slightly lower. Postoperative renal biopsies were performed in 10 patients. In the 13 patients with long‐term function, one patient experienced cellular rejection (Banff IIB) at 3 months without anti‐B titer rise. This rejection was concomitant with low tacrolimus plasma levels and was easily reversed by steroids. In 8 of 10 cases, C4d staining was positive in peritubular capillaries.

Conclusion: Blood group ABO‐incompatible LD renal transplantation using A and B carbohydrate‐specific IA and anti‐CD20 mAbs has excellent graft survival and function.
Major ABO‐incompatible hematopoietic stem cell transplantation: study of post‐transplant pure red cell aplasia and endothelial cell chimerism
Authors: Mueller Regula J. , Stussi Georg , Odermatt Bernhard , Halter Jörg , Schanz Urs , Seebach Jörg D.
Published: March 2006

Abstract: Background: In contrast to human leukocyte antigen (HLA) matching, ABO‐blood group incompatibility plays a minor role in the success of allogeneic hematopoietic stem cell transplantation (HSCT). Incompatible ABH histo‐blood group antigens, expressed on recipient endothelial cells (EC) and donor erythroid progenitor cells, may represent targets for graft‐versus‐host disease (GVHD) and host‐versus‐graft reactions, respectively. The aims of the current study were to investigate: (1) red blood cell (RBC) engraftment and (2) EC chimerism as a potential result of replacement of recipient EC by donor bone marrow (BM)‐derived EC in a patient following major ABO‐incompatible (A to O) and gender‐mismatched HSCT, who died at day 350 of severe acute GVHD.

Methods: Blood counts and anti‐A/B isoagglutinin titers were analyzed repeatedly. Heart and BM specimens were obtained at autopsy. The expression of ABH histo‐blood group antigens was examined by immunhistochemistry, X/Y chromosomes were detected by chromogen in situ hybridization (CISH).

Results: RBC engraftment defined as appearance of 1% reticulocytes in the peripheral blood was delayed and correlated with anti‐donor isoagglutinin titers. Circulating hematopoietic cells were exclusively of donor origin demonstrating full donor hematopoietic chimerism, whereas EC in heart and BM blood vessels were exclusively of the recipient type.

Conclusions: Pure red cell aplasia (PRCA) after major ABO‐incompatible HSCT was caused by anti‐A/B isoagglutinins produced by recipient‐type plasma cells. Using ABO and gender mismatch for discrimination, heart and BM blood vessels demonstrated no evidence for EC chimerism 11 months after ABO‐incompatible HSCT. These findings suggest that EC replacement and chimerism do not represent major mechanisms responsible for tolerance induction after HSCT.
The Stockholm experience with ABO‐incompatible kidney transplantations without splenectomy
Authors: Tydén Gunnar , Kumlien Gunilla , Genberg Helena , Sandberg John , Sedigh Amir , Lundgren Torbjörn , Gjertsen Henrik , Fehrman Ingela
Published: March 2006

Abstract: Background: ABO‐incompatible kidney transplantations have previously only been performed after several pre‐operative sessions of plasmapheresis followed by splenectomy, and with the conventional triple‐drug immunosuppressive protocol being reinforced with anti‐lymphocyte globulin and B‐cell‐specific drugs. We have designed a protocol without splenectomy, based on antigen‐specific immunoadsorption, rituximab and a conventional triple‐drug immunosuppressive protocol.

Methods: The protocol called for a 1‐month pre‐transplantation conditioning period, starting with one dosage of rituximab and followed by full‐dose tacrolimus, mycophenolate mofetil and prednisolone. Antigen‐specific immunoadsorption was performed on pre‐transplantation days −6, −5, −2 and −1. After the last session, 0.5 g/kg of intravenous immunoglobulin (IVIG) was administered. Postoperatively, three more apheresis sessions were given every third day.

Results: Twenty‐one patients have received transplants with this protocol. The ABO‐antibodies (Abs) were readily removed by the antigen‐specific immunoadsorption and were kept at a low level post‐transplantation by further adsorptions. There were no side effects, and all but one patient have normal renal transplant function.

Conclusions: We conclude that after one infusion each of rituximab and IVIG, and antigen‐specific immunoadsorption, blood‐group incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy, and with excellent short‐ and long‐term results.
First two ABO‐incompatible living renal transplantations using splenectomy, rituximab, plasmapheresis and IVIG as a preconditioning regimen: a single center experience in the Balkans
Authors: Ivanovski Ninoslav , Popov Zivko , Masin‐Spasovska Jelka , Dimcevska Anita Hristova , Kolevski Perko
Published: March 2006

Abstract: Background: Due to the growing organ shortage in the Balkans and still underdeveloped cadaver transplantation, we started accepting living expanded criteria renal donors including elderly, marginal and unrelated donors (spouses, etc). The ABO‐incompatible renal transplantation was initiated last year. The first two successful cases are presented.

Methods: A 40‐yr‐old mother (blood group A1B) and a 57‐yr‐old husband (blood group B) were considered as suitable donors for an 18‐yr‐old daughter (blood group B) and a 52‐yr‐old wife (blood group O). Both the recipients had a relatively long dialysis treatment before the surgery. The anti‐A1 and anti‐B titer of isoaglutinins was 1 : 64 in both the recipients before the procedure. A routine laparoscopic splenectomy was performed 40 and 45 days before the transplantation, without any complications. In the 10 days pre‐conditioning period, rituximab was administered in a single dose of 375 mg/m2. At the same time four to five plasmaphereses were performed to reduce the isoaglutinins to below 1 : 4. On the last night before the surgery intravenous immunoglobulin (IVIG) in a dose of 0.5 g/kg/bw was administered. Standard induction and maintenance therapy was introduced (Dacllizumab, CyA‐Neoral, MMF and steroids) according to the accepted policy in our transplant center. The routine plasmaphereses were performed in the first 2 weeks after transplantation to keep the isoaglutinins titer below 1 : 8.

Results: Ten and 6 months after the surgery both recipients are doing well. Their graft function remains stable (actual serum creatinin 140 and 230 μm/L, respectively). In the 1 month protocol biopsy a subclinical cellular and mild vascular rejection occurred, and both recipients were treated by steroid pulse therapy. One to two additional plasmaphereses were performed. The regularly monitored anti‐A1 and anti‐B isoaglutinins titer was kept below 1 : 8 during a period of follow‐up.

Conclusion: The first short‐term results fully justify the ABO‐incompatible living renal transplantation. The authors consider ABO‐incompatible transplantation as a safe and promising procedure which may, together with expanded criteria living donors, ameliorate the actual donor shortage in the region.
Application of the mixed venous blood concentration equation in desflurane anesthesia
Authors: Wu C. C. , Ho W. M. , Hung W. T. , Yang N. C. , Hwang K. L. , Wong K. C.
Published: March 2006

Background:  We have previously proposed an equation derived from Fick's law and Lin's concept of effective blood concentration (EBC) to calculate the mixed venous blood concentration (MVBC) of isoflurane. Desflurane has a lower blood/air partition coefficient than isoflurane and, as such, promotes a faster induction and recovery from anesthesia. In this study, we investigated the application of the MVBC equation to predict the MVBC of desflurane.

Methods:  We maintained anesthesia with a fixed inspired concentration (CI) of desflurane (10%) during cardiac anesthesia in 11 patients. In order to measure the real concentrations of desflurane in mixed venous blood, pulmonary arterial blood samples were collected at different time points via a Swan–Ganz catheter for gas chromatographic‐mass spectrometric determination. The relationship between the calculated concentrations and the actual blood sample concentrations of desflurane in mixed venous blood was investigated. Lin's EBC method was also used and the results were compared with those of MVBC.

Results:  The calculations from our derived MVBC equation and the actual blood concentrations showed a similar kinetic pattern; the concentration levels were approximately the same and correlated well (r = 0.89) during anesthesia. However, the EBC method failed to accurately estimate the actual blood concentrations.

Conclusions:  The results demonstrate that our equation, but not the EBC method, may be useful for estimating pulmonary blood concentrations of desflurane. The clinical significance and the importance of the method merit further investigation.
Chronic Eosinophilic Dermatitis in the Scrotal Area Associated with Stephanofilariasis Infestation of Charolais Bull in France
Authors: Watrelot‐Virieux D. , Pin D.
Published: March 2006

A species of stephanofilaria is recorded as the cause of chronic eosinophilic dermatitis in the scrotal area of one charolais bull in France. Macroscopical and histopathological description of the lesion are given with a brief description of the parasite.
In vitro and in vivo Effects of Lufenuron on Dermatophytes Isolated from Cases of Canine and Feline Dermatophytoses*
Authors: Zur Gila , Elad Daniel
Published: March 2006

Lufenuron is a benzyl‐urea phenol compound that inhibits chitin synthesis and is used as an insecticide. Its efficacy in the therapy of dermatophytosis in dogs and cats was evaluated in several clinical studies, with contradictory results. We assessed the in vitro susceptibility of dermatophytes isolated from dogs and cats to lufenuron, and the clinical response of skin lesions to the drug. Dermatophyte cultures isolated from clinical cases were exposed to lufenuron by three different methods: direct application and application of whole blood or subcutaneous tissue samples obtained from a lufenuron‐treated healthy dog. No inhibition of dermatophyte growth was observed in any of the samples after 1 week of incubation. Eight dogs and six cats with skin lesions were included in the in vivo survey. Results indicated that six of seven skin lesions that were diagnosed as being caused by dermatophytes did not respond to lufenuron whereas six of seven skin lesions that were not caused by dermatophytes improved. We concluded that lufenuron, in the way it was administered in this study, had no inhibitory activity on dermatophytes in vitro or in vivo and its clinical use as an anti‐fungal agent is questionable. An immunomodulatory effect of the drug is, however, possible.
Clinical Evaluation of a Peptide‐ELISA based upon N‐terminal B‐cell Epitope of the VapA Protein for Diagnosis ofRhodococcus equiPneumonia in Foals
Authors: Phumoonna T. , Muscatello G. , Chicken C. , Gilkerson J. R. , Browning G. F. , Barton M. D. , Heuzenroeder M. W.
Published: March 2006

A total of 227 field samples from naturally exposed foals aged between 3 weeks and 6 months were used in an evaluation of a peptide‐based enzyme‐linked immunosorbent assay (ELISA) for diagnosis ofRhodococcus equiinfection. A biotinylated peptide derived from the virulence‐associated protein A (VapA) ofR. equi, a horse pathogen, was synthesized and designated as PN11‐14. The peptide corresponds to the N‐terminal B‐cell epitope TSLNLQKDEPNGRASDTAGQ of the VapA protein. Based upon a serum immunoglobulin (Ig)G titre of 512 as a positive cut‐off value for theR. equiinfection, the ELISA provided the overall sensitivity of 47.62%, specificity of 69.67% and an accuracy of 59.47% with a positive predictive value of 57.47% for trueR. equipneumonia. The assay was improved by detecting VapA‐specific IgGb antibodies against N‐terminal B‐cell epitope of the VapA protein rather than IgG antibodies. The VapA‐IgGb ELISA showed the overall sensitivity of 70.47%, specificity of 72.13% and accuracy of 71.36% with a positive predictive value of 68.52%. Diagnosis ofR. equidisease in 6‐week‐old foals showed that the VapA‐IgGb ELISA provided an increasing trend (P = 0.0572) in sensitivity of 82.4% in comparison with the VapA‐IgG ELISA which showed the sensitivity of 58.8%. However, differences in specificity of both tests were statistically insignificant (P = 0.357) as analysed by the McNemar test. These results indicated that detection of VapA‐specific IgGb antibodies may be a better predictor ofR. equidisease in foals.
Echinococcus multilocularis in Austrian Foxes from 1991 until 2004
Authors: Duscher G. , Pleydell D. , Prosl H. , Joachim A.
Published: March 2006

The prevalence rates of Echinococcus multilocularis in foxes (n = 5600) evaluated in several Austrian surveys conducted between 1991 and 2004 were analysed for spatial and temporal differences. Data from early studies (1993–1997) in which the intestinal scraping technique (IST) was utilized were compared with data from recent (1999–2004) investigations, which made use of the shaking in a vessel technique (SVT), and it was assessed whether or not the infection rates of Austrian foxes had increased between the investigated intervals. In total, data from 85 districts are presented and both the retrospective and recent data are available from 39 of these districts. A Bayesian hierarchical model of parasite prevalences is presented which (i) accounts for differences in the sensitivity of IST and SVT, (ii) incorporates spatial auto‐correlation between neighbouring districts, (iii) investigates the possibility of a temporal shift in the infection status of foxes, and (iv) quantifies uncertainty at each level of the model. The national average prevalence rates in the mid‐1990s and at the turn of the millennium were 2.4% (95% confidence intervals 1.1–4.8) and 3.9% (95% confidence intervals 1.5–8.4) respectively. Above average prevalence rates were observed in the western and the northern parts of the country. Evidence is also presented for a temporal augmentation of the prevalence rates in some districts in the northern and eastern parts of the country. These findings are in concordance with several investigations in other European states where both newly emerged areas and elevated levels of transmission in existing endemic areas have been found. None of the districts investigated here showed significant evidence of a drop in prevalence.
Transgenic analysis of the medaka mesp‐b enhancer in somitogenesis
Authors: Terasaki Harumi , Murakami Ryohei , Yasuhiko Yukuto , Shin‐i Tadasu , Kohara Yuji , Saga Yumiko , Takeda Hiroyuki
Published: March 2006

Somitogenesis is a critical step during the formation of metameric structures in vertebrates. Recent studies in mouse, chick, zebrafish and Xenopus have revealed that several factors, such as T‐box genes, Notch/Delta, Wnt, retinoic acid and FGF signaling, are involved in the specification of nascent somites. By interacting with these pathways, the Mesp2‐like bHLH transcription factors are transiently expressed in the anterior presomitic mesoderm and play a crucial role in somite formation. The regulatory mechanisms of Mesp2 and its related genes during somitogenesis have been studied in mouse and Xenopus. However, the precise mechanism that regulates the transcriptional activity of Mesp2 has yet to be determined. In our current report, we identify the essential enhancer element of medaka mesp‐b, an orthologue of mouse Mesp2, using transgenic techniques and embryo manipulation. Our results demonstrate that a region of approximately 2.8 kb, upstream of the mesp‐b gene, is responsible for both the initiation and anterior localization of mesp‐b transcription within a somite primordium. Furthermore, putative motifs for both T‐box transcription factors and Notch/Delta signaling are present in this enhancer region and are essential for activity.
Sweat testing for cystic fibrosis: A review of New Zealand laboratories
Authors: Mackay Richard , George Peter , Kirk Jean
Published: March 2006

Background:  Evolving diagnostic criteria for cystic fibrosis, broadening of the populations being tested and the need to interpret intermediate sweat test results have imposed a much greater need to standardize the collection and analysis of sweat.

Aim:  To identify variations in sweat testing in New Zealand laboratories and compare these with guidelines from the UK and the USA.

Methods:  All laboratories in New Zealand offering sweat testing were identified and data collected from these laboratories by structured questionnaire.

Results:  There were no New Zealand laboratories that conformed to either set of guidelines. Inconsistencies were observed in minimum sweat quantities, the nature of the iontophoresis solution, the sweat electrolytes analysed, quoted reference ranges and recommendations made as a consequence of the result.

Conclusions:  Conformity to the guidelines would help to minimize variation in sweat testing in New Zealand. Performance of a sufficient number of tests to maintain expertise is critical, but geographical constraints make patient travel to distant centres difficult in a small, scattered population. A possible solution, where numbers permit, may be the collection of sweat locally, with referral to a major laboratory for analysis. This is only possible with adequate training in collection and follow‐up audit of the sweat testing procedure both in the collection and in the analytical phase.
Measles immunity and immunisation status in Australian children 1 to 4 years of age
Authors: Hogg Geoffry G , Darlington, Raelene J , Hogg Katharine G , Lester Rosemary
Published: March 2006

Aim:  Determine measles seropositivity and vaccine coverage in children aged 1 to 4 years inclusive. Compare data in those who produced immunisation records and those who relied on parental recall. Establish variables associated with seropositivity.

Methods:  Design: Population‐ and area‐based, cluster sample of 1‐ to 4‐year‐olds; households surveyed by trained interviewer. Setting: Australia‐wide, excluding New South Wales. Questionnaires completed between February and April 1995. Subjects: 2117 completed questionnaires were returned for children aged 1 to 4 years, 923 of whom provided a sufficient blood sample for analysis.

Results:  Overall seropositivity was 86% for the 923 children tested and was strongly associated with previous immunisation (P < 0.001) and age (P < 0.001), but not with parental report of a previous measles diagnosis (P = 0.581). Eight hundred and forty‐three (91%) reported previous measles immunisation, with 760 (90%) of these testing seropositive. Four hundred and ninety‐one (55%) parents/guardians produced immunisation records, while 400 (45%) relied on recall. Immunised children whose parents relied on recall were equally likely to be seropositive as children whose parents produced records. The 923 children tested were representative of the 2117 who completed questionnaires in all factors except age, where children below 2 years old were under represented (P < 0.001).

Conclusions:  These data support the current second routine measles immunisation prior to school entry, and reinforce the need to promote the first routine dose to achieve measles elimination.
Clinical course of hospitalised children infected with human metapneumovirus and respiratory syncytial virus
Authors: Morrow Brenda M , Hatherill Mark , Smuts Heidi EM , Yeats Jane , Pitcher Richard , Argent Andrew C
Published: March 2006

Aim:  To describe the clinical presentation and outcomes of hospitalised patients infected with human metapneumovirus (hMPV) and human respiratory syncytial virus (hRSV) in a tertiary hospital in Cape Town, South Africa.

Methods:  hMPV was identified in 17 respiratory specimens submitted for viral studies during the period 2001–2003. These patients’ medical folders were retrospectively reviewed for clinical, radiological and laboratory data, together with a convenience sample of 20 hRSV‐infected patients.

Results:  hMPV‐infected patients were older than those infected with hRSV (P = 0.04) and required a longer hospital stay (P = 0.02). Presenting clinical signs and symptoms were similar between groups. Fourteen (87.5%) hMPV‐ and 16 (80%) hRSV‐infected patients presented with co‐morbid and/or immunosuppressive conditions (P ≥ 0.5). The most common abnormalities on chest radiographs in both groups were bronchial wall thickening, focal consolidation and atelectasis. Six (37.5%) hMPV‐ and 11 (55%) hRSV‐infected patients required admission to the paediatric intensive care unit (P > 0.1) with five (31.3%) hMPV‐ and eight (40%) hRSV‐infected patients requiring intubation and ventilation (P > 0.5). Three (18.7%) hMPV‐patients and three (15%) hRSV‐infected patients died during this admission (P > 0.5). All hMPV‐infected patients who died had significant co‐morbid conditions.

Conclusions:  These data confirm that hMPV is a significant respiratory pathogen in this setting, with similar presentation and outcome to hRSV infection. This is the largest report of hMPV infection causing significant morbidity, prolonged hospital stay and death, associated with underlying risk factors.
Doses of systemic corticosteroids in hospitalised children with acute asthma: A systematic review
Authors: Zhang Linjie , Mendoza Raúl A
Published: March 2006

Aim:  To present the doses of systemic corticosteroids reported by clinical trials in hospitalised children with acute asthma and to assess the possible relationship between doses of corticosteroids and clinical responses.

Methods:  An electronic search of MEDLINE databases (January 1949–February 2005) and Cochrane Controlled Clinical Trials Register (February 2005) was undertaken using a combination of indexing terms related to systemic corticosteroids and acute asthma. Studies were selected if they met the following criteria: (i) randomized controlled trial; (ii) children aged 1–18 years and admitted to hospital for acute asthma; and (iii) treatment group consisting of systemic corticosteroids.

Results:  Nine trials were included for this review. There was considerable variation between the reported doses of systemic corticosteroids. Only two trials assessed clinical responses to different doses of systemic corticosteroids. Both trials failed to show any therapeutic advantage of higher doses over lower doses. The results of the two trials were not suitable for pooling.

Conclusions:  Current data are not sufficient for establishing dose–response relationship of systemic corticosteroids in hospitalised children with acute asthma. Larger randomized trials are needed.
Kawasaki disease in New Zealand
Authors: Heaton Paul , Wilson Nigel , Nicholson Ross , Doran John , Parsons Alan , Aiken Geoff
Published: March 2006

Aim:  To determine the epidemiology, management and outcome of Kawasaki disease (KD) in New Zealand.

Design:  Prospective audit using New Zealand Paediatric Surveillance Unit (NZPSU) Reports.

Setting:  Single country 2‐year epidemiological study.

Patients:  All patients diagnosed with KD in New Zealand reported to the NZPSU from January 2001 to December 2002.

Main outcome measures:  Incidence of KD; time to diagnosis; use of intravenous immunoglobulin; cardiac features and outcome.

Results:  Forty‐nine new cases were identified. The annual incidence was 8.0 cases/100 000 children aged less than 5 years. Age at onset was less than 5 years in 86% of cases. Incidence was 4.6/100 000 for children of European origin, 9.6 for Maori, 12.2 for Pacific Islanders and 32.2 for children of East Asian origin. KD was diagnosed at a median of 6 days from onset of illness. 89% had fever and four or more diagnostic features. All patients had at least one echocardiogram: There was one small (2%) coronary artery aneurysm only; 13 (26%) had mild coronary artery dilatation. Thirty‐five per cent did not have an echocardiogram performed four or more weeks from illness onset. 45 (92%) cases received intravenous immunoglobulin at median day six. There was one death due to occlusive coronary artery disease in a 3‐month‐old boy with atypical symptoms in whom KD was diagnosed at post‐mortem.

Conclusions:  The incidence of KD in New Zealand is defined with significantly variable risk according to ethnicity. Most patients received appropriate rapid diagnosis and treatment but there was considerable variation in practice in regard to number and timing of echocardiograms. There was a low coronary artery aneurysm rate (2%). Accelerated vaso‐occlusive disease was responsible for the single fatality in an atypical case.
Antibiotic prescribing rates for acute otitis media in a paediatric emergency department
Authors: Steinmann Kai , Babl Franz E
Published: March 2006

Objective:  To audit antibiotic prescribing rates for acute otitis media (AOM) at a tertiary paediatric emergency department (ED).

Methods:  All children who presented to the ED in 2002 (during defined 4‐week periods in spring, summer, autumn and winter) and were given a diagnosis of AOM were eligible for analysis. Data were extracted retrospectively, providing information on demographics and antibiotic therapy.

Results:  A total of 306 patients with AOM were available for analysis. Forty‐three children (14%) were <1 year, 69 (23%) 1–2 years, and 194 (63%) > 2 years of age. Sixty‐eight patients (22%) were receiving antibiotics prior to presentation to the ED, and antibiotics were prescribed for 206 (67%). Antibiotic prescribing was independent of patient age.

Conclusions:  Despite ready access to clinical guidelines that recommend an expectant approach for children with AOM who are older than 1 or 2 years of age, antibiotic prescribing rates were high in the ED.
Are general practitioners equipped to detect child overweight/obesity? Survey and audit
Authors: Gerner Bibi , McCallum Zoe , Sheehan Jane , Harris Claire , Wake Melissa
Published: March 2006

Aim:  To ascertain the extent to which general practitioners (GPs) routinely weigh, measure and calculate body mass index (BMI) in children, and to assess the accuracy and accessibility of their anthropometric equipment.

Methods:  A convenience sample of 34 GPs from 29 primary care family medical practices in Melbourne, Australia, completed a questionnaire regarding their routine anthropometric practice for 5–10‐year‐old children and perceived role in managing childhood overweight and obesity. Practice audits (April–June 2002) assessed the accuracy and accessibility of anthropometric equipment.

Results:  Forty‐four per cent of GPs reported regularly weighing children; 38% regularly measured children's height. Only one regularly calculated children's BMI. Formal training in child anthropometry and servicing of anthropometric equipment was rare. The majority of equipment was accessible. Stadiometers on average measured the height of a ‘short’ pole (true height 92.68 cm) as 92.52 cm (SD = 0.8), and measured the height of a ‘tall’ pole (true height 157.64 cm) as 157.55 cm (SD = 0.9). On average, calibration weights of 20 kg and 80 kg were recorded as 19.7 kg (SD = 0.6) and 79.2 kg (SD = 1.5) respectively. Despite these shortcomings, these GPs generally felt they played a key role in managing overweight in children.

Conclusions:  Self‐reported practice by these GPs falls well short of 2003 National Health and Medical Research Council guidelines recommending bi‐annual measuring of all children in the primary care setting. The variability of anthropometric equipment audited could result in widely discrepant BMI values, leading to serious misclassification of many children's weight status.
H‐type tracheoesophageal fistula masquerading as achalasia cardia in a 13‐year‐old child
Authors: Ng Joanne , Bartram Jack , Antao Brice , Everard Mark , Shawis Rang
Published: March 2006

Abstract:  H‐type tracheoesophageal fistula is rare. Although symptoms are present from birth, its rarity and overlap of symptoms with other respiratory conditions makes diagnosis difficult and delayed. We report a case of H‐type fistula in a 13‐year‐old girl that was detected incidentally during investigations for achalasia cardia.
Unrecognised infection in a cystic fibrosis patient
Authors: Asiah Kassim , Hanifah Yasmin A , Norzila Mohamed Z , Hasniah Latif , Rusanida Awang
Published: March 2006

Abstract:  We report a 17‐year‐old Malay boy with cystic fibrosis who over a 14‐month period experienced worsening respiratory symptoms and deteriorating lung function. Burkholderia pseudomallei was eventually isolated from his sputum. He improved clinically following treatment for meliodosis and his lung function returned to normal.
Combination pharmacotherapy for severe neonatal pulmonary hypertension
Authors: Filan Peter M , McDougall Peter N , Shekerdemian Lara S
Published: March 2006

Abstract:  Pulmonary hypertension can complicate the early clinical course in newborn infants with congenital diaphragmatic hernia. We report the successful use of combination therapy with enteral sildenafil and intravenous prostaglandin E1 in a preterm infant with severe pulmonary hypertension and right heart failure early after congenital diaphragmatic hernia repair.
Haemolytic uraemic syndrome: An overview (Review Article)
Authors: AMIRLAK IRADJ , AMIRLAK BARDIA
Published: March 2006

SUMMARY:  Haemolytic uraemic syndrome (HUS) is the most common cause of acute renal failure in children. The syndrome is defined by triad of microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure (ARF). Incomplete HUS is ARF with either haemolytic anaemia or thrombocytopenia. HUS is classified into two subgroups. Typical HUS usually occurs after a prodrome of diarrhoea (D+HUS), and atypical (sporadic) HUS (aHUS), which is not associated with diarrhoea (D–HUS). The majority of D+HUS worldwide is caused by Shiga toxin‐producing Esherichia coli (STEC), type O157:H7, transmitted to humans via different vehicles. Currently there are no specific therapies preventing or ameliorating the disease course. Although there are new therapeutic modalities in the horizon for D+HUS, present recommended therapy is merely symptomatic. Parenteral volume expansion may counteract the effect of thrombotic process before development of HUS and attenuate renal injury. Use of antibiotics, antimotility agents, narcotics and non‐steroidal anti‐inflammatory drugs should be avoided during the acute phase. Prevention is best done by preventing primary STEC infection. Underlying aetiology in many cases of aHUS is unknown. A significant number may result from underlying infectious diseases, namely Streptococcus pneumoniae and human immunedeficiency virus. Variety of genetic forms include HUS due to deficiencies of factor H, membrane cofactor protein, Von Willebrand factor‐cleaving protease (ADAMTS 13) and intracellular defect in vitamin B12 metabolism. There are cases of aHUS with autosomal recessive and dominant modes of inheritance. Drug‐induced aHUS in post‐transplantation is due to calcineurin‐inhibitors. Systemic lupus erythematosus and catastrophic antiphospholipid syndrome may also present with aHUS. Therapy is directed mainly towards underlying cause.
Incidental calcifying fibrous tumor of the stomach presenting as a polyp
Authors: Elpek Gülsüm Özlem , Küpesiz Gökben Yildirim , Ögüs Mehmet
Published: March 2006

Calcifying fibrous tumor (CFT) is an uncommon lesion of uncertain cause and pathogenesis that has a unique histological appearance. These lesions are described mainly in the subcutaneous or deep soft tissues, followed by subserosal locations. Intrinsic visceral CFT is extremely rare. Herein is described a rare case of CFT that involved the gastric wall, along with a review of the literature. An incidental small polypoid lesion was excised during urgent surgery for penetrating injury at the lesser curvature in a 25‐year‐old man, previously healthy. The lesion was a well‐demarcated, small (10 mm) tumor that occupied the submucosa. The characteristic histopathological features and the presence of spindle cells that express factor XIIIa allowed a diagnosis of CFT to be made. The present case and the review revealed that, despite their frequent subperitoneal location, intra‐abdominal CFT might present as intrinsic visceral lesions and might be found incidentally. These lesions tend to be smaller when compared to their symptomatic counterparts. The diffuse factor XIIIa expression in CFT might be useful to differentiate this entity from other intra‐abdominal soft‐tissue tumors in problematic cases. Although rarity of intrinsic visceral CFT necessitates new cases to determine their exact biological behavior, the present case highlights their presence in the stomach as a symptomless small polypoid lesion.
Anesthesia for sickle cell disease and congenital myopathy in combination
Authors: FANNING REBECCA , O'DONNELL BRIAN , LYNCH BRIAN , STEPHENS MICHAEL , O'DONOVAN FRANCES
Published: March 2006

We report on the perioperative management of anesthesia and analgesia in a child with sickle cell disease and a congenital myopathy, presenting for corrective orthopedic surgery. The case illustrates two valuable points of interest: the many benefits of regional anesthesia in complex medical cases and the successful use of tourniquets in children with sickle cell disease.