bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term follow up of gastric low‐grade mucosa‐associated lymphoid tissue lymphoma by endosonography emphasizing the application of a miniature ultrasound probe
Authors: YEH HONG‐ZEN , CHEN GRAN‐HUM , CHANG WEN‐DAU , POON SEK‐KWONG , YANG SHENG‐SHUN , LIEN HAN‐CHUNG , CHANG CHI‐SEN , CHOU GUAN
Published: March 2003

Background and Aims:  Endoscopic ultrasonography (EUS) is a useful tool for the evaluation of gastric wall infiltration including gastric lymphoma. The aims of this study were to characterize gastric low‐grade mucosa‐associated lymphoid tissue (MALT) lymphoma according to EUS findings and to evaluate the role of a miniature ultrasound probe in the long‐term follow up.

Methods:  From January 1994 to March 2002, 20 patients were proven to have gastric low‐grade MALT lymphoma. Endoscopic ultrasonography was performed with a conventional echoprobe and/or a miniature ultrasound probe for initial staging and a miniature ultrasound probe was performed during follow up. All patients positive for Helicobacter pylori received a 2‐week course of omeprazole, amoxicillin and clarithromycin.

Results:  Helicobacter pylori infection was found in 17 (85%) patients. In all patients, H. pylori was eradicated after treatment. Initial EUS showed significantly greater wall thickness (6.1 ± 3.0 mm) in MALT lymphoma patients when compared with control (2.8 ± 0.3 mm). The infiltrative patterns included wall thickening (3.5–14.1 mm) in 18 patients: stage E‐I1 in 16 (mucosa and/or submucosa), stage E‐I2 in one and stage E‐II in one. Complete regression of MALT lymphoma following treatment for H. pylori was noted in 14 patients, with a mean duration of 11.3 ± 9.1 months. Follow‐up miniature ultrasound probe sonography showed comparative reduction in wall thickness (P < 0.05).

Conclusions:  Endoscopic ultrasonography plays a valuable role in the initial staging and long‐term follow up of gastric low‐grade MALT lymphoma. The application of a miniature ultrasound probe enables adequate evaluation in the majority of these patients, with additional benefits.
Pneumocystis carinii pneumonia: Pitfalls of prophylaxis
Authors: MASSIE RJH , COOPER PJ , VAN ASPEREN PP , McINTYRE P
Published: March 2003

Pneumocystis carinii pneumonia (PCP) occurs commonly in immunocompromised patients. Sulfamethoxazole‐trimethoprim (SMX‐TMP) is effective prophylaxis, although PCP may still occur despite apparently adequate use. We report three cases of PCP which highlight some of the pitfalls of prophylaxis.
Residential mobility and sudden infant death syndrome
Authors: SCHLUTER PJ , FORD RPK , MITCHELL EA , TAYLOR BJ
Published: March 2003

Objective:

To examine whether permanent domicile change of the mother, thence the infant, or temporary relocation of the infant away from his or her usual place of residence affects the risk of sudden infant death syndrome (SIDS).

Design:

A case‐control nation‐wide epidemiological study.

Setting:

New Zealand between the years 1987–90.

Participants:

From the 485 SIDS diagnoses over this time, parents of 393 (81%) SIDS infants consented to participate and these comprise the cases. Controls were selected by randomly sampling 1800 infants from all babies born over 78% of the country. Parents of 1592 (88%) control infants participated.

Results:

Infants away from their usual address were 1.70 (95% CI: 1.09, 2.66) times more likely to die from SIDS than infants sleeping at home, after controlling for likely confounding factors. A partial explanation for this finding was that SIDS infants were less likely to have been mainly breast fed in the last two days and were less likely to have shared a room with at least one adult at the nominated sleep/death. Infants of mothers who shifted house after their birth, infants having mothers who shifted house within a year prior to the study interview date, and infants who slept at numerous different houses were associated with an increased relative risk for SIDS at the univariate level, but not after adjustment.

Conclusions:

Infants are less likely to die in their accustomed residential environment. This finding needs confirmation by other studies.
Reflex sympathetic dystrophy in a 12‐year‐old twin with comorbid conversion disorder in both twins
Authors: JAWOROWSKI S , ALLEN RC , FINKELSTEIN E
Published: March 2003

A case of reflex sympathetic dystrophy is presented in a 12‐year‐old girl with comorbid conversion disorder. Her identical twin also had a conversion disorder. This is the first reported case of coexistence of reflex sympathetic dystrophy and conversion disorder. It is important for clinicians to be aware that these conditions may coexist since the presentation of symptoms differ, even though there are shared features of treatment.
Paediatric resuscitation—by phone
Authors: TUTHILL DP , HEWSON M , WILSON R
Published: March 2003

Objective:

To ascertain the training and knowledge of paediatric resuscitation amongst all paediatric residents in New Zealand.

Method:

A validated national telephone survey.

Results:

Interviews were conducted with 96 out of a possible 109 paediatric residents. Most had been qualified less than 5 years and a third had received some training in paediatric resuscitation in the last year. The initial dose of intravenous adrenaline was known by 61% but only 10% knew the recommended ten‐fold increase in subsequent doses. Recognition of the importance of cervical spine management in trauma was poor. Correct resuscitation fluids and volumes were selected by 90%, though infusion rates were frequently too slow. Residents with paediatric qualifications and greater experience scored significantly higher.

Conclusion:

Many junior paediatric staff are inadequately prepared for resuscitating children. We believe improved regular training is required and that the introduction of a nation‐wide Advanced Paediatric Life Support course, subsequent to the completion of this survey, will lead to improved standards. Its effectiveness needs to be audited.
Antibiotics for sore throats?
Authors: DEL MAR CB , GLASZIOU PP
Published: March 2003

Although not explicit, recommendations in the new edition of Therapeutic Guidelines: Antibiotic1 have taken a lurch towards an evidence basis. What does this mean, and what is the basis of the recommendation that antibiotics be used for sore throat in very limited circumstances?
Does postoperative ventilation have an effect on the integrity of the anastomosis in repaired oesophageal atresia?
Authors: Beasley SW
Published: March 2003

Abstract: Several authors have claimed that the use of postoperative ventilation or graded withdrawal of respiratory support reduces the incidence of anastomotic complications after repair of oesophageal atresia, particularly where the gap between the oesophageal ends has been extensive or where the anastomosis has been constructed under tension. Careful review of their data reveals little objective evidence to either support or refute this contention. Many institutions are achieving low leakage rates following oesophageal anastomosis in oesophageal atresia, but to date there has been no controlled study to show that the use of neck flexion, muscle paralysis, intubation and assisted ventilation postoperatively influences the integrity of the anastomosis. The sequence of observations that led to the presumed relationship between postoperative ventilation and oesophageal leak is reviewed. It would appear that the effect of postoperative ventilation and paralysis on the oesophageal anastomosis is yet to be determined.
Alarm settings for the Marquette 8000 pulse oximeter to prevent hyperoxic and hypoxic episodes
Authors: Cust AE , Donovan TJ , Colditz PB
Published: March 2003

Objective: To determine safe and appropriate alarm limits for the Marquette 8000 pulse oximeter to prevent hyperoxic and hypoxic episodes in neonates. It is necessary to define these limits for each brand of oximeter because of the variance in nonuser adjustable calibration algorithms used in pulse oximeters.

Methodology: Oxygen saturation values obtained from a Marquette 8000 pulse oximeter (SpO2) were compared with simultaneous arterial blood gas PaO2 values obtained from blood gas analysis, for 322 samples in 24 consecutive neonates (median 30 weeks’ gestation).

Results: In order to prevent 95% of hyperoxic episodes (PaO2 > 90 mmHg), the upper alarm limit was 95% SpO2. Similarly, to prevent 95% of hypoxic episodes (PaO2 < 40 mmHg), the lower alarm limit was 95% SpO2. A sensitivity lower than 95% had to be accepted to develop an alarm range which prevented both hyperoxic and hypoxic episodes. To maintain PaO2 values between 40 and 90 mmHg, an appropriate alarm range of 94–97% SpO2 (90% sensitivity, 28% specificity) was established.

Conclusions: The relative merits of high sensitivity versus high specificity should be considered when determining appropriate alarm limits. Alarm limits which represent a balance between sensitivity and specificity will minimise false alarms and provide a clinically practical range. It would be useful for this type of information to be available for each brand of oximeter, to assist the user in determining appropriate alarm settings.
Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy
Authors: Flett PJ , Stern LM , Waddy H , Connell TM , Seeger JD , Gibson SK
Published: March 2003

Objective: To compare botulinum toxin A injections with fixed plaster cast stretching in the management of cerebral palsied children with dynamic (i.e. non‐fixed) calf tightness.

Methods: The settings were the Women's and Children's Hospital (WCH) and the Crippled Children's Association of South Australia (CCA), Adelaide, South Australia. Twenty children were selected by two paediatric rehabilitation specialists. A prospective, randomized, single‐blind controlled study, was carried out, with 10 children in each arm. The clinicians were blinded as to the allocated interventions.

The outcome measures for 6 months post intervention were clinical assessment, modified Ashworth Scale, Gross Motor Function Measure, 2 D‐video ratings using a modified Physical Rating Scale and a global scoring scale and a parent satisfaction questionnaire.

Results and Conclusion: Botulinum toxin A injections were of similar efficacy to serial fixed plaster casting in improving dynamic calf tightness in ambulant or partially ambulant children with cerebral palsy. The ease of outpatient administration, reduction of muscle tone and safety with botulinum toxin A was confirmed. Parents consistently favoured botulinum toxin A and highlighted the inconvenience of serial casting.
Calvarial tuberculosis
Authors: Ünüvar E , O˘guz F , Sadiko˘glu B , Sidal M , One¸s Ü , Tetikkurt S
Published: March 2003

Abstract: We report a six‐year‐old boy who presented with swelling of the forehead, and had calvarial tuberculosis, a rare form of tuberculous osteitis.
Disclosure of developmental disability: A study of paediatricians’ practices
Authors: Hasnat MJ , Graves P
Published: March 2003

Objective: To investigate paediatricians’ practices in disclosure of disability and the influences on their practices, including attitude to people with disabilities.

Methodology: Interviews were conducted with 26 paediatricians regarding their disclosure practices and their experience, training, contact with children with significant disabilities and influences on practices. Anonymous self‐report questionnaires to the same group of practitioners relating to attitude to disability were also employed.

Results: Paediatricians’ practices in the disclosure process scored relatively low on an index based upon recommended practices. No significant relationships were found between index scores and the experience or training of the paediatrician or the amount of contact of the paediatrician with children with disabilities. However, more experienced paediatricians were found to be more likely to mention the practice of informing both parents together and the presence of a support person at the time of disclosure. Paediatricians having more contact with children with disabilities were more likely to mention that they would disclose disability in a child as soon as possible. The major modifying influences on disclosure practices were reported to be the intelligence of the parents and their emotional state of at the time of disclosure. Time was the most frequently reported constraint upon disclosure practices.

Conclusions: The low ‘disclosure practice index’ scores in this study are not necessarily an indication that practices are poor, as there are challenges to the validity of the advocated practices. There were few significant associations found between the practices of paediatricians in disclosure and their experience, training, contact with children with disabilities and attitude to people with disabilities.
Social factors associated with ethnic differences in alcohol and marijuana use by Vietnamese‐, Arabic‐ and English‐speaking youths in Sydney, Australia
Authors: Rissel C , McLellan L , Bauman A
Published: March 2003

Objective: To describe the use of marijuana and alcohol among Arabic‐ and Vietnamese‐speaking senior school students compared with English‐speaking background senior school students in Sydney Australia.

Method: A quantitative survey of 2573 school students attending Years 10 and 11 from 12 high schools with a high Vietnamese and Arabic population was conducted in Sydney in 1998. Self‐reported marijuana use, school and cultural background information was collected.

Results: Students from an English‐speaking background, both males and females, had almost double the prevalence of marijuana use (once or more) during their lifetime (48.3 and 43.6%), the 12 months (40.9 and 36.3%) and 1 month prior to survey administration (23.1 and 13.4%) than the group with the second highest frequency of use (students of European and other backgrounds). Female Vietnamese (7.3% lifetime use) and Arabic students (8.6% lifetime use) had the lowest marijuana use rates, which were less than half that of male Vietnamese (23.5% lifetime use) and Arabic students (28% lifetime use). A similar pattern was found for three types of alcohol use. Spending three or more evenings a week out with friends was associated with higher alcohol use for Vietnamese students (relative risk ratio of 2.76).

Conclusions: These results confirm lower marijuana and alcohol use among students from Vietnamese‐ and Arabic‐speaking backgrounds compared with students from an English‐speaking background. Harm minimization strategies may be learned from some migrant communities.
Paroxysmal non‐epileptic events in children: A retrospective study over a period of 10 years
Authors: Bye A M E , Kok D J M , Ferenschild F T J , Vles J S H
Published: March 2003

Objective: To determine the frequency, nature and clinical characteristics of paroxysmal non‐epileptic events in children diagnosed by video electroencephalogram (EEG) monitoring at a tertiary referral centre.

Methodology: A retrospective study of children with paroxysmal non‐epileptic events, aged 2 weeks to 17 years inclusive was undertaken. The study group consisted of children who had video EEG monitoring during a 10‐year period (1988–99). Telemetry files, medical charts, events recorded on video and record sheets were reviewed.

Results: A total of 666 children were analysed, 269 had epileptic events recorded, 285 had non‐epileptic events and 112 had no events recorded. In children with non‐epileptic events, 43% were developmentally delayed, 25% had an abnormal neurological examination and 40% had epilepsy. In the study sample an epileptiform interictal EEG was common (24%). The major subgroups of non‐epileptic events were: staring (34%), sleep phenomena – benign sleep myoclonus (15%), arousals (13%), motor tics (11%) and shuddering (7%). Developmental delay (57%) was common in children who presented with staring spells. A diagnosis of a specific non‐epileptic event was reached in 96% of cases.

Conclusion: Paroxysmal non‐epileptic events can cause diagnostic confusion, particularly in children with developmental delay, epilepsy or an epileptiform EEG. Accurate diagnosis can be reached in the majority of cases using video EEG monitoring.
Comparison of influenza A and influenza B virus infection in hospitalized children
Authors: Daley Aj , Nallusamy R , Isaacs D
Published: March 2003

Background: Influenza A and B viruses were cocirculating in Australia in the winter of 1997.

Objective: To compare the clinical and demographic features of children with influenza A or influenza B virus infection admitted to a paediatric tertiary referral centre.

Methodology: Retrospective chart review of 91 hospitalized children with culture‐proven influenza A or B virus infection during 1997.

Results: Thirty‐six (56%) of 64 children with influenza A were under 12 months of age compared with seven (26%) of 27 children with influenza B virus infection (P = 0.02). Influenza B virus infection was more common in children with underlying medical problems (P = 0.01). Neurological manifestations were present in eight (12.5%) of 64 children with influenza A and none with influenza B virus infection (P = 0.09). There were no significant differences in signs and symptoms of children with influenza A and B virus infection, in severity of illness or in duration of hospital stay.

Conclusions: A greater proportion of children admitted with influenza A virus infection were under 12 months of age. Influenza B virus infection is associated more commonly with underlying medical disorders. It is not possible to differentiate between influenza A or B virus infection from presenting clinical signs and symptoms.
Gastroschisis: Early enteral feeds may improve outcome
Authors: Sharp M , Bulsara M , Gollow I , Pemberton P
Published: March 2003

Objective: Population‐based retrospective review of gastroschisis from 1986 to 1996.

Methods: This was a retrospective review of gastroschisis. Seventy cases were identified from the Birth Defects Registry of Western Australia (WA). Hospital medical records of live‐born cases were reviewed.

Results: The live‐born incidence of gastroschisis in WA was 2.1 per 10 000 live births for the period 1986–96. The incidence in mothers aged less than 20 years was 8.3‐fold that of women aged over 30 years (P < 0.0001). The incidence rate for the period 1995–96 was over twice the rate for 1986–88. Age at first enteral feed was significantly related with length of hospital stay and duration of total parental nutrition (TPN). Each day delay in commencing enteral feed was associated with an increase in hospital stay of 1.05 days and an increase in TPN duration of 1.06 days. The method of delivery of the infant, age at repair, length of anaesthetic time, duration of postoperative paralysis and gestational age was not associated with length of stay or TPN duration. The data were divided into two cohorts: (i) 1986–90; and (ii) 1991–96. There was a statistically significant reduction in hospital stay from a geometric mean of 45.7 (1986–90) to 22.9 days (1991–96).

Conclusions: Gastroschisis has a favourable outlook, with 89.7% survival of live births. Over the 10 year period studied, there has been a reduction in length of hospital stay and duration of TPN. The age at which the infant is first fed enteral feeds appears to be important in affecting the length of hospital stay and the duration of TPN, with delays associated with a longer hospital stay and longer TPN duration.
Neonatal resuscitation training program in Malaysia: Results of the first 2 years
Authors: Boo NY , Pong KM
Published: March 2003

Objectives: To determine the number of providers and instructors trained by the initial 37 core instructors during the first 2 years following the launch of the Malaysian Neonatal Resuscitation Program (NRP). To identify remediable problems which interfered with the propagation of the NRP in Malaysia.

Methodology: A prospective observational study carried out over a 2‐year period between 2 September 1996 to 2 September 1998. For every training course conducted, the instructors completed a NRP course report form (Form A) that documented the instructors involved in the course. For every participant who attended the course and successfully completed it, the instructors submitted a record form (Form B) that contained the name, hospital address, department, profession, place of work, language used for training and the marks obtained by the individual participant. After each course, completed forms A and B were returned to the NRP secretariat for compilation.

Results: Of the 37 core instructors, 35 (94.6%) carried out training courses in their respective home states. A further 513 new instructors and 2256 providers were trained subsequently. A total of 2806 health personnel from all 13 states of Malaysia were NRP‐certified during the first 2 years. However, 61.2% (n = 335) of the 550 instructors were inactive trainers, having trained less than four personnel per instructor a year. Most of the NRP‐certified personnel were either doctors (32.0%) or nursing staff (64.4%). More than 60% of these worked either in the labour rooms, neonatal intensive care units or special care nurseries. At least one person from all three university hospitals and all general hospitals, 89.3% (92/103) of the district hospitals, 3.5% (73/2090) of the maternal and child health services, and 21% (46/219) of the private hospitals and maternity homes, were trained in the NRP.

Conclusion: Dissemination of the NRP in Malaysia during the first 2 years was very encouraging. Further efforts should be made to spread the program to private hospitals and the maternal and child health services. In view of the large number of inactive instructors, the criteria for future selection of instructors should be more stringent.
Outcome following surgical closure of secundum atrial septal defect
Authors: Jones DA , Radford DJ , Pohlner PG
Published: March 2003

Objective: To assess the current outcome of surgical closure of secundum atrial septal defects (ASD) in an Australian paediatric population.

Methodology: A retrospective chart review of 87 children, aged 2 months to 15 years, was performed for surgery between August 1995 and March 1999.

Results: There were no deaths in the patients studied. Approximately one in four patients (24.1%) experienced complications requiring further management. Complication rates were similar to those published previously. However, one in nine patients (11.5%) required surgical drainage of a pericardial effusion. A total of five of 87 (5.7%) patients developed post‐pericardiotomy syndrome (PPS), of whom four required pericardiocentesis. The risk for developing a pericardial effusion requiring drainage or PPS was more than twice in children older than 5 years of age at the time of surgery compared to those aged under 5 years, although there was an insufficient number of subjects in the study to prove this statistically (Odds ratio 2.31).

Conclusions: Most patients have an uncomplicated postoperative course following surgical closure of secundum ASD. However, a significant minority (24.1%) do develop complications requiring further management and have a correspondingly longer period of hospitalization. Patients older than 5 years of age were identified as being potentially at greater risk for the development of PPS or a pericardial effusion requiring drainage. Further research needs to be performed to clarify this.
Laboratory enhanced surveillance for meningococcal disease in Victoria
Authors: Robinson Priscilla , Griffith Julia , Taylor Kath , Carnie John , Jolley Damien , Hogg Geoff , Nolan Terry
Published: March 2003

Objective: To describe the epidemiological and microbiological characteristics and notification patterns of invasive meningococcal disease (IMD) in Victoria between 1990 and 1999.

Methods: Cases of IMD occurring between 1990 and 1995 identified in any of three databases were combined, matching where possible. Statistical modelling provided estimates of cases missing from all datasets. Notification sources for 1999 and 2000 cases were identified. Cases identified from notification and laboratory results provided the data to describe IMD epidemiology between 1990 and 1999.

Results: Between 1990 and 1995, 479 cases of IMD were identified. Three individual datasets each identified between 62 and 82% of cases and 47% of cases were identified in all three datasets. Statistical modelling estimated that between 37 and 83 additional cases were not identified by any dataset. Serogroup B and C strains caused 63 and 33% of culture‐positive cases, respectively, with a substantial rise in serogroup C cases in 1999. Epidemiological characteristics remained relatively constant between 1990 and 1998, but an increase in patient age was seen in cases with serogroup C disease in 1999. In addition to three clonal strains seen elsewhere, an additional strain was identified that was unique to Victoria. Since January 1999, only 72% of notifications have come from treating doctors.

Conclusions: Meningococcal disease is of increasing public health significance in Victoria. Laboratory enhanced notification has improved case identification and detailed microbiological information has improved our understanding of the changing epidemiology of this disease. Collaboration with laboratories and other agencies, active investigation of putative cases and microbiological monitoring are important elements in supporting public health decisions about the control of IMD.
Neonatal ascites and hyponatraemia following umbilical venous catheterization
Authors: Mohan MS , Patole SK
Published: March 2003

Abstract:  The complications associated with umbilical venous catheterization in neonates range from pericardial effusion, portal hypertension, and peritoneal perforation with ascites, to Wharton's jelly embolism. The case of a term neonate who developed ascites and severe hyponatraemia (serum sodium 119 mmol/L) most probably following peritoneal perforation by an umbilical venous catheter is reported. The presenting feature was convulsions associated with dilutional hyponatraemia, probably following absorption of a large quantity of ascitic fluid across the peritoneum. Conservative management was associated with gradual recovery over 24 h. The case highlights that, irrespective of the route, excessive administration of salt‐free fluids can lead to dilutional hyponatraemia with adverse consequences. The present case illustrates the importance of confirming intravascular positioning of umbilical catheters by ensuring free flow of blood on aspiration, to prevent/detect inadvertent peritoneal perforation. Ideally, echocardiographic confirmation of optimal intravascular placement of such catheters is preferred as radiographic confirmation is reported to be unreliable.
Diaphragmatic paralysis in extremely low birthweight neonates: Is waiting for spontaneous recovery justified?
Authors: Jog SM , Patole SK
Published: March 2003

Abstract: Mortality and morbidity associated with surgical management of patent ductus arteriosus (PDA) in neonates has been reported to vary from 0% to 44%. Complications like pneumothorax, pleural effusion, recurrent nerve and phrenic nerve injury are associated with surgical closure of PDA. An extremely low birthweight neonate with diaphragmatic paralysis following phrenic nerve injury during surgical closure of PDA is reported. Delay in diaphragmatic plication for over two weeks while waiting for spontaneous recovery was associated with significant morbidity including chronic lung disease. The controversies associated with timing of diaphragmatic plication in high‐risk neonates are discussed.
Variations in bronchiolitis management between five New Zealand hospitals: Can we do better?
Authors: Vogel AM , Lennon DR , Harding JE , Pinnock RE , Graham DA , Grimwood K , Pattemore PK
Published: March 2003

Objectives:  To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement.

Methods:  Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed.

Results:  Out of the 409 infants admitted overnight, 8% had been born ≤32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986−1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001).

Conclusions:  Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.
Towards safer drug prescribing, dispensing and administration in hospitals
Authors: Thornton PD , Simon S , Mathew TH
Published: March 2003

Abstract A multidisciplinary workshop was held in order to identify strategies likely to produce a reduction in adverse drug events, by targeting hospital systems involved in drug prescribing, dispensing and administration. Strategies identified at the workshop included: (i) improving the education and practice development of medical and nursing staff, concerning drug therapy and safe prescribing principles; (ii) introducing and using information technology and electronic prescribing processes; (iii) implementing the Australian Pharmaceutical Advisory Council (APAC) national guidelines to achieve the continuum of quality use of medicines between hospitals and the community; (iv) enhancing the importance of medication history taking as a routine part of the admission process; (v) instituting individual patient supply as the standard method of drug distribution in hospitals; and (vi) stimulating the hospital‐based clinical pharmacy workforce.
Functional status and health service planning
Authors: Snow L , Walker M , Ahern M , O’Brien E , Saltman Dc
Published: March 2003

Abstract Functional status indicators have been proposed as instruments to aid health service planning for patients. This study examines functional status at three points surrounding an acute health episode: admission, discharge and 3 months post discharge from a community hospital. The aim of the study is to determine the most appropriate time to measure functional status to assist health service planning. A longitudinal cohort study was conducted at Manly Hospital, Australia. Four hundred patients aged 65 years and over representing a 10% random sample of all hospital admissions in a 10‐month period were interviewed on admission, discharge and 3 months post discharge. Repeated measure multiple analysis of variance identified a decline in functional status between admission and discharge. At 3 months post discharge functional status had improved to levels higher than admission. Functional status assessment at discharge can assist consumers, clinicians, health planners and health insurers to make effective decisions to maximize health outcomes.
A survey of surgical audit in Australia: Whither clinical governance?
Authors: Eno Louise M , Spigelman Allan D
Published: March 2003

Abstract A postal survey was undertaken to determine the extent of surgical audit in Australian public hospitals in the context of clinical governance. Participants were 88 surgical units from 74 Australian public hospitals in 1998 with more than 70 beds. The main outcome measures were performance of audit, methods used, frequency, documentation and perceived adequacy of resources and comparison of performance with Royal Australasian College of Surgeons requirements for re‐certification. The main findings were that most units performed audit, but over two‐thirds declared that they had insufficient resources to conduct audit according to College requirements, while a substantial proportion did not comply with other published guidelines for the conduct of audit meetings. The conclusion from this survey is that surgical audit will be unable to play its part in quality initiatives inherent in the clinical governance concept unless appropriately resourced.
A brief analysis of clinical pharmacy interventions undertaken in an Australian teaching hospital
Authors: Alderman Christopher P , Farmer Christopher
Published: March 2003

Abstract Selected clinical pharmacy interventions undertaken during a 30‐day data capture period were analysed, seeking to gain a greater understanding of the nature of the drug‐related problems involved. Pharmacists were asked to record only interventions that were of potentially major significance. A total of 67 interventions were submitted for analysis. In 28 cases (41.7% of the initial total) the intervention reports were excluded from further analysis after initial review. For the remaining 39 interventions, 20 patients (51%) were under the care of a medical unit, and cardiovascular/antithrombotic agents accounted for 17 reports (43.5%). The majority of interventions were implemented at the time of inpatient medication order review by the clinical pharmacist (n = 25, 64%). The most common category of drug‐related problem addressed in the interventions related to the prescription of inappropriately high doses of the correct drug for the patient (n = 17, 43.6%). Deficiencies in technical knowledge accounted for less than 25% of all cases.
The impact on fish stocks of river regulation in Central Asia and Kazakhstan
Authors: Petr Tomislav , Mitrofanov Valery P.
Published: March 2003

Fisheries in arid countries of Central Asia and in Kazakhstan have a relatively short tradition of less than 100 years. However, during this period, water resources, originating largely from snow and icemelt, have been subject to large‐scale engineering interference required by the growing demands for the expansion of irrigated agriculture. Storage and diversion of flow into irrigation systems have affected original fish stocks through changes in river discharges, blockage of migratory pathways by dams and barrages, increase in dissolved salt content and agrochemicals in drainage waters. In order to boost the indigenous fish stocks, which often give poor yields, fishery managers transferred a number of fish species from other parts of Asia within the ex‐Soviet Union. In order to improve the food base for such fish, fish food organisms such as mysids, gammarids and molluscs were also transferred. The introductions often increased fish yields only temporarily or interfered with the indigenous stocks. In addition to valuable fish species, unwanted fish were sometimes brought in. Where river basins became interconnected through canals, fish faunas of these basins intermingled through immigration of species. The new fish communities now form a mixture of indigenous and introduced fish, where one can rarely assume that a balanced state has been achieved. The priority of the governments remains the use of water for irrigation and hydropower production, which leaves fishery managers in the unenviable position of adjusting the management to the continuously changing situation, which is often unpredictable. In order to increase fish production present government strategies focus on the rehabilitation of rivers and terminal lakes with the aim of arresting and reversing the process of salinization of waters and of maintaining water level in lakes. This allows fishery managers to develop strategies for optimizing fish yields under more stable conditions. With the new efforts to revitalize the Aral Sea, the large artificial terminal lakes established from drainage and wash waters, will become of minor importance for fisheries, as their salinity will increase beyond the tolerance level of most fish. However, in freshwater reservoirs and lakes, including those formed from seepage in depressions near irrigation canals, there is considerable potential for raising fish yields. Culture‐enhanced methodologies, when introduced, should also lead to substantial increases in fish production from these water bodies.
Management issues in the Lake Titicaca and Lake Poopo system: Importance of developing a water budget
Authors: Revollo Mario M.
Published: March 2003

Lake Titicaca is the largest freshwater lake in South America and the highest of the world’s large lakes. The Desaguadero River links Lake Titicaca to lakes Urur Uru and Poopo and, in wet years to the Coipasa Salt Marsh. Lake Titicaca is bordered by both Bolivia and Peru. The main international lake management problem for the Lake Titicaca/Desaguadero River/Lake Poopo system involves the use of water resources. The maximum usable flow in the Titicaca basin (only 20–25 m3 s–1), is dramatically less than the estimated demand. Water transfer and irrigation projects will have to be strictly prioritized on the basis of environmental, social, economic and hydrological criteria. Establishing the overall volume and demand for water in the Titicaca system has been critical to making good management decisions. Agreements for the study and management of Lake Titicaca between Peru and Bolivia date back to 1955 when both countries signed a document declaring ‘the indivisible and exclusive joint ownership of both countries of the waters of the lake’. Over time, the two countries agreed to create a Binational Autonomous Authority that would have full autonomy for Titicaca–Desaguadero/Poopo system decisions related to implementing the master plan that they had developed. Although it is hard to quantify conservation success in large lake regions, water use projects are being prioritized, city wastewater pollution in the Bay of Puno is being reduced and ameliorated and a large biodiversity project through the Global Environment Facility is underway.
Mitochondrial encephalomyopathy
Authors: Goto Yu‐ichi
Published: March 2003

Mitochondrial encephalomyopathy is a disease based on multisystemic mitochondrial dysfunction. Pathologic, biochemical and molecular genetic approaches to the disease have revealed the complex features of the phenotype and its relationship to the genotype. Last decade's great success of the mtDNA study must move research of the disease into the next phase.
Creutzfeldt–Jakob disease
Authors: Kitamoto Tetsuyuki
Published: March 2003

It is valuable to summarize the milestone study of prion diseases done in Japan for review in the journal Neuropathology in 2000. Many studies done in Japan promote world prion research activity, and also influence further research projects in other groups abroad. In this review the author focuses on the transmission experiment, the discovery of abnormal prion protein localization in the synaptic structures or follicular dendritic cells, and the genetic analysis of prion protein gene for the establishment of familial prion diseases.
Severe brain atrophy in a case of thalamic variant of sporadic CJD with plaque‐like PrP deposition
Authors: Yamashita Mariko , Yamamoto Toru , Nishinaka Kazuto , Udaka Fukashi , Kameyama Masakuni , Kitamoto Tetsuyuki
Published: March 2003

A 30‐year‐old woman presented with ataxic gait and progressive mental deterioration, and 3 years later developed myoclonus in the limbs. Subsequently, she lapsed into an akinetic state and died more than 6 years after the onset of disease. The brain weighed 670 g, and preferential degeneration was found in the medial thalamus and the inferior olivary nucleus. In the cerebrum and cerebellum, gliosis and neuronal depletion were only mild and disintegration of the parenchymal structures was inconspicuous, despite pronounced atrophy. The patient had methionine homozygosity at codon 129 of the PrP gene and protease‐resistant PrP type 2 in the brain. On PrP immunostaining, plaque‐like deposits were detected in the cerebral and cerebellar cortices. Severe brain atrophy such as in the present case has never been described in the thalamic variant of sporadic CJD.
The cellular pathology of Parkinson's disease
Authors: Takahashi Hitoshi , Wakabayashi Koichi
Published: March 2003

Parkinson's disease (PD) is a common neurodegenerative disorder of unknown cause that occurs in adults. The presence of Lewy bodies (LB) in association with nerve cell loss in the substantia nigra and various other regions of the nervous system is a diagnostic hallmark of the disease. In 1997, a mutation was identified in the α‐synuclein gene in families with autosomal dominant PD. Subsequent immunohistochemical studies have revealed that all of the LB in familial and sporadic PD contain the gene product α‐synuclein: abnormal filaments that constitute LB were clearly recognized by antibodies against α‐synuclein. Moreover, it was shown that the glial cells, both astrocytes and oligodendrocytes, are also affected by α‐synuclein pathology. Recently, a novel protein, synphilin‐1, has been identified that interacts with α‐synuclein. Interestingly, synphilin‐1 immunohistochemistry has demonstrated that this protein is present in the central core of classical (brainstem) LB, which are composed mainly of densely packed vesicular structures. The role of both α‐synuclein and synphilin‐1 in normal conditions has yet to be clarified.
Degeneration of retinal neuronal processes and pigment epithelium in the early stage of the streptozotocin‐diabetic rats
Authors: Aizu Yoshinori , Oyanagi Kiyomitsu , Hu Jianguo , Nakagawa Hachiro
Published: March 2003

Early pathological and electro‐physiological changes of the retina in the streptozotocin (STZ)‐diabetic rats were investigated through optical and electron microscopy in two strains and electro‐retinography in one strain. In Sprague–Dawley (SD) rats 1 month after the onset of diabetes, the thickness of the inner plexiform layer (IPL) and photoreceptor segment layer (PSL) was significantly reduced by 9.9% and 18.9%, respectively (P < 0.01, P < 0.05). In Brown–Norway (BN) rats STZ‐diabetic for 1 month, the thickness of the IPL was also significantly reduced by 15.7% (P < 0.05). Cytochemical study using peanut agglutinin (PNA), a lectin binding selectively to the cone photoreceptor‐associated domains of the inter‐photoreceptor matrix, revealed a marked reduction in intensity, number and length of the PNA‐binding cone photoreceptors. Electron microscopy showed deepened hollows in the basal infoldings of the retinal pigment epithelium (RPE) of STZ‐rats diabetic for 1 month and large concavities into the cytoplasm in STZ‐rats diabetic for 6 months. Blood vessels in the retina and choroid were unremarkable. Single‐flash electro‐retinogram revealed a reduction in the amplitudes of a‐ and b‐waves of electro‐retinogram (ERG) of 1 month STZ BN rats (P < 0.05). These findings indicate that the degeneration of rods/cones in the PSL and RPE are the most prominent pathological alteration sites in the early stage of diabetic rats.
Modelling future renal dialysis requirements under various scenarios of organ availability in Australia
Authors: Branley P , Mcneil J J , Stephenson Dh , EVANS2 Sm , BRIGANTI1 Em
Published: March 2003

SUMMARY: The rate of dialysis uptake in Australia has been increasing and in 1996 was 77 per million people per year (pmp). The rate of kidney transplantation in Australia is at the same time falling. We have developed a computer model to enable predictions of the number of dialysis patients to 2007, under several scenarios of organ availability. We also aimed to examine the cost implications of the predictions. The number of existing and new dialysis and transplant patients was obtained from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for the years 1988–95. Age‐stratified transition coefficients for dialysis uptake, transplantation, graft failure and dialysis and transplant death were calculated for this time period. Data from 1995 were used as the baseline year in the application of the model and the calculated transition coefficients applied for this year. Scenarios of organ availability examined were the current trend continued, stabilization of the current Australian rate (23 pmp), the South Australian rate (35 pmp) achieved nationally and the Spanish rate (47 pmp) achieved nationally. Validation of the model using 1997 data was performed. Direct costs for dialysis and transplantation were obtained from a major teaching hospital in Melbourne. The number on dialysis is predicted to increase from 5648 in 1998 to 11 803 by 2007. If the transplant rate is increased from 23 pmp to ‘the world best practice transplantation rate’ (47 pmp) the predicted dialysis number in 2007 would be 8476. This is associated with a direct cost saving in comparison to the current trend of 82 million dollars (1998 Australian dollars). Assuming the Australian population increases as predicted and that current trends in dialysis uptake and transplantation continue, dialysis numbers are predicted to more than double over the next 10 years. In order to limit the potential human and economic cost of renal replacement therapy, this model indicates that attempts to increase organ availability are worthwhile.
Angiotensin II further enhances type IV collagen production stimulated by platelet‐derived growth factor and fibroblast growth factor‐2 in cultured human mesangial cells
Authors: Yamabe H , Osawa H , Kaizuka M , Tamura N , Tsunoda S , Shirato K , Tateyama F , Okumura K
Published: March 2003

SUMMARY: Angiotensin II (Ang II) is considered to play a role in the development of glomerulosclerosis, which is characterized by excessive accumulation of mesangial matrix after mesangial cell proliferation. We have reported that platelet‐derived growth factor (PDGF) and fibroblast growth factor‐2 (FGF‐2) stimulate type IV collagen production by cultured human mesangial cells (HMC). Although Ang II is well known to have a mitogenic effect in various kinds of cells, its role in the production of extracellular matrix is still undetermined. This study was designed to examine the effect of Ang II and its interaction with PDGF and FGF‐2 in type IV collagen production by HMC. Cultured HMC were incubated with Ang II with or without PDGF or FGF‐2 for 72 h and type IV collagen, fibronectin and laminin in the cell supernatants were measured. Ang II (10−6–10−8) itself did not change the production of type IV collagen, fibronectin, laminin and transforming growth factor‐β. PDGF and FGF‐2 enhanced type IV production, although they did not stimulate the production of fibronectin and laminin. Ang II further increased the stimulating effect of PDGF and FGF‐2 in type IV collagen production in a dose‐dependent manner. This effect of Ang II was completely blocked by Ang II type I receptor antagonist (Losartan). These data imply that Ang II is a potent stimulator of type IV collagen production by HMC in the presence of growth factors.
Management of membranous nephropathy
Authors: Cattran Daniel
Published: March 2003

SUMMARY: The Management of membranous nephropathy requires a recognition of its natural history and an ability to predict those pationts with the worst prognosis. Treatment of those at risk of progression with immunosuppressive drugs should be accompanied by additional conservative risk reduction strategies such as dietary protein restriction, blood pressure reduction, angiotensin‐converting enzyme inhibitors and lipid‐lowering agents. Anticoagulants should also be considered as well as medications to reduce drug toxicity.