bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging and morphometric histologic analysis of prostate tissue composition in predicting the clinical outcome of terazosin therapy in benign prostatic hyperplasia
Authors: Isen Kenan , Sinik Zafer , Alkibay Turgut , Sezer Cem , Sözen Sinan , Atilla Serhan , Ataoglu Ömür , Isik Sedat
Published: March 2003

Abstract
Purpose:
To determine whether magnetic resonance imaging (MRI) or quantitative color‐imaged morphometric analysis (MA) of the prostate gland are related to the clinical response to terazosin.

Methods:
Thirty‐six male patients with symptomatic benign prostatic hyperplasia (BPH) with a serum prostate‐specific antigen level of 4–10 ng/mL underwent MRI with body coil, transrectal prostate ultrasonography and biopsy prior to terazosin therapy. For MRI‐determined stromal and non‐stromal BPH, the ratio of the signal intensity of the inner gland to the obturator internus muscle was evaluated. Histologic sections were stained with hematoxylin and eosin. The MA of the specimens was performed by Samba 2000. Results of the two techniques were interpreted according to the terazosin therapy results.

Results:
The mean stromal percentage was 60.5 ± 18.0%. No statistically significant relationship was found between the clinical outcome of terazosin and the MRI findings. The MA results showed a significant relationship between the percentage of stroma and the percent change of the peak urinary flow rate, but not with the percent change of the international prostate symptom score after terazosin therapy (P < 0.05).

Conclusion:
Magnetic resonance imaging alone is not sufficient in predicting the response to terazosin therapy. Morphometric analysis of BPH tissue composition can be used in predicting the clinical outcome of terazosin therapy but it is suitable only in patients for whom prostatic biopsy is necessary in order to rule out prostate cancer.
Effect of KMD‐3213, an α1A‐adrenoceptor antagonist, on the prostatic urethral pressure and blood pressure in male decerebrate dogs
Authors: Akiyama Katsuyoshi , Noto Hiromitsu , Nishizawa Osamu , Sugaya Kimio , Yamagishi Ryoichi , Kitazawa Makio , Tsuchida Seigi
Published: March 2003

Background: KMD‐3213 is an α1A‐adrenoceptor‐selective antagonist currently being developed for the treatment of urinary outlet obstruction in patients with benign prostatic hyperplasia. In the present study, the uroselectivity of KMD‐3213 was evaluated and compared with that of prazosin and tamsulosin in a decerebrate dog model.

Methods: Intercollicular decerebration was carried out in male mongrel dogs under anesthesia. The inhibitory effects of intravenously and intraduodenally administered compounds on the increase in intraurethral pressure (IUP) induced by electrical stimulation of the hypogastric nerve were estimated. Systemic blood pressure was measured simultaneously.

Results: The α1‐antagonists tested produced a dose‐dependent inhibition of the induced IUP response and decreased mean blood pressure (MBP). The ID50 of KMD‐3213, tamsulosin and prazosin for IUP (dose required to inhibit the increase in IUP by 50%) was 3.15, 1.73 and 11.8 μg/kg i.v., respectively, and the ED20 for the hypotensive effect (dose required to reduce MBP by 20%) was 8.03, 0.59 and 2.46 μg/kg i.v., respectively. The data indicate that uroselectivity (ED20/ID50) of KMD‐3213 is 12‐ and 7.5‐fold higher than that of prazosin and tamsulosin, respectively. When the drugs were administered intraduodenally, KMD‐3213 was sufficiently absorbed from the digestive tract and continued to demonstrate at least 3.8‐fold higher uroselectivity than tamsulosin.

Conclusion: Based on these findings, KMD‐3213 appears to be an effective orally active compound for decreasing urethral resistance during micturition that does not induce any negative cardiovascular effects in patients with benign prostatic hyperplasia.
Holmium:YAG laser endoureterotomy in the treatment of ureteroenteric stricture following Indiana urinary diversion
Authors: Yamada Yoshiaki , Honda Nobuaki , Hibi Hatsuki , Taki Tomohiro , Mitsui Kenji , Fukatsu Hidetoshi
Published: March 2003

A 57‐year‐old man who had received radical urethrocystectomy and Indiana urinary diversion 6 months earlier was treated for ureteroenteric anastomosis stricture (left side) using a Holmium:YAG laser via antegrade approach. The availability of small (6.9 Fr) flexible ureteroscope, as well as the use of the Holmium:YAG laser has facilitated the ability to precisely incise the stricture under direct endoscopic visualization. The technique is described for laser endoureterotomy in a patient with ureteroenteric stricture following Indiana urinary diversion.
Growth rates of primary and metastatic lesions of renal cell carcinoma
Authors: Oda Toshiro , Miyao Noriomi , Takahashi Atsushi , Yanase Masahiro , Masumori Naoya , Itoh Naoki , Tamakawa Mitsuharu , Tsukamoto Taiji
Published: March 2003

Abstract Background: The natural history and growth rate of renal cell carcinoma (RCC) have not yet been determined. The growth rates of primary lesions in incidentally found RCC were compared with those of metastatic lesions.

Methods: Sixteen patients who did not receive immediate surgical treatment for renal solid masses that were later proven to be RCC were reviewed retrospectively. All primary lesions of the 16 patients were found incidentally. For comparison, metastatic lesions were evaluated in another 16 patients with RCC. Of these, 11 underwent surgical treatment for the primary lesions.

Results: The growth rates of primary and metastatic lesions of RCC varied. They ranged from 0.10 to 1.35 cm/year for primary lesions and from 0.08 to 7.87 cm/year for metastatic lesions. The growth rate of primary lesions of incidentally found RCC was lower than that of metastatic lesions (P = 0.0159). The initial tumor diameter and pathological grade did not affect the growth rate of the primary lesion of incidentally found RCC. However, a close correlation was found between the growth rate of metastatic lesions and the pathological grade of the primary lesion in patients with metastasis.

Conclusions: The growth rate of incidentally found RCC varied. Some patients with the disease may be candidates for ‘watchful waiting’ when an immediate surgical treatment is not indicated, but they should be selected with great caution.
Effects of quercetin on the heat‐induced cytotoxicity of prostate cancer cells
Authors: Nakanoma Takashi , Ueno Munehisa , Iida Masahiro , Hirata Risa , Deguchi Nobuhiro
Published: March 2003

Background:

It has been demonstrated that prostate cancer cells are relatively sensitive to heat stress. We have reported that heat treatment at 43°C increases the expression of heat shock protein 70 (hsp70) in prostate cancer cells, leading to apoptosis. Hsp70 is a protein that protects cells against heat damage. Cells with lower levels of hsp70 have been shown to have a higher sensitivity to heat stress. Therefore, downregulation of hsp70 is expected to enhance heat‐induced inhibitory effects on cell growth. Quercetin has been reported to be an agent that inhibits hsp70 expression. The present study was undertaken to investigate the effects of quercetin and/or heat on the growth of prostate cancer cells in vitro.

Methods:

Three human prostate cancer cell lines were used: Lncap; PC‐3; and JCA‐1. The cells were treated with quercetin and/or heat. Alterations in the cell cycle and hsp70 expression were examined by means of flow cytometry (FCM). The apoptotic cells were detected by FCM using fluorescein isothiocyanate (FITC) labeled annexin V.

Results:

Treatment with quercetin alone resulted in an apparent decrease of hsp70‐positive cells and an increase of subG1 cells in JCA‐1 and LNcap cells. Quercetin inhibited an increase of hsp70 expression after heat treatment and increased the number of subG1 cells with lower levels of hsp70 in JCA‐1 and LNcap cells. Quercetin was found to enhance heat‐induced inhibitory effects on cell growth and heat‐induced apoptosis in both JCA‐1 and LNcap cells.

Conclusion:

These results suggest that quercetin may enhance heat‐induced cytotoxicity in prostate cancer cell lines through the inhibition of hsp70 production.
Proliferative activity, angiogenesis and nuclear morphometry in renal cell carcinoma
Authors: KIRKALI ZIYA , YORUKOGLU KUTSAL , OZKARA ESRA , KAZIMOGLU HATEM , MUNGAN UGUR
Published: March 2003

Abstract Background: Prognostic parameters other than tumor stage and grade are essential for renal cell carcinoma (RCC) patients. This study was undertaken to determine the usefulness of cellular proliferation, angiogenesis and nuclear morphometry in predicting the biological aggressiveness of RCC.

Methods: Surgical specimens of 70 patients with RCC were investigated by conventional histology, Ki‐67 immunostaining and stereological assessment of angiogenesis and mean nuclear volume.

Results: There was no difference in disease‐specific survival with respect to sex, age and
histopathological type (except sarcomatoid and other types). The survival was significantly
lower and the chance of metastases was higher in the group with higher proliferative
activity (P = 0.007). There was no relation between angiogenesis, mean nuclear volume, stage and survival. There was a significant relation between both Fuhrman and WHO grades, tumor stage and survival. Histopathological type, grade, angiogenesis and mean nuclear volume failed to predict recurrences and/or metastases. In multivariate analysis, only TNM stage and proliferative activity were found to be independent prognostic factors.

Conclusions: In addition to tumor grade and stage, proliferative activity of a given RCC may have the potential to identify patients with an impaired prognosis.
Significance of 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) for detection of renal cell carcinoma and immunohistochemical glucose transporter 1 (GLUT‐1) expression in the cancer
Authors: MIYAKITA HIDESHI , TOKUNAGA MASATOSI , ONDA HAJIME , USUI YUKIO , KINOSHITA HIDECHIKA , KAWAMURA NOBUO , YASUDA SEIEI
Published: March 2003

Abstract Objective: Positron emission tomography (PET) is now primarily used in oncological indication owing to the successful application of fluorine‐18 fluorodeoxyglucose (FDG) in an increasing number of clinical indications. Glucose transporter 1 (GLUT‐1) is recognized as a major early marker of cellular malignant transformation. The aims of this study were to assess whether FDG‐PET is a useful diagnostic tool for renal cell carcinoma and to compare the pathologic characteristics.

Methods: Nineteen consecutive patients who had renal cell carcinoma were examined using FDG‐PET preoperatively. The results of PET were then compared to the histology obtained after radical surgery and the immunoreactivity of GLUT‐1 was also studied.

Results: Pathologic examination confirmed that all 19 patients suffered from renal cell carcinoma. Increased FDG uptake was found in six of the 19 patients (31.5%). The immunohistochemical examination of GLUT‐1 in renal cell carcinoma produced different results in each patient. There was no correlation with GLUT‐1 immunoreactivity and FDG‐PET positivity.

Conclusion: These results suggest that FDG‐PET may not be a useful diagnostic tool for renal cell carcinoma.
Osteopontin regulates adhesion of calcium oxalate crystals to renal epithelial cells
Authors: Yasui Takahiro , Fujita Keiji , Asai Kiyofumi , Kohri Kenjiro
Published: March 2003

Abstract
Background
: The association of calcium crystals with renal tubular cells is an important factor during the formation of urinary stones. We previously reported the strong expression of osteopontin (OPN) on renal tubular cells in the stone‐forming kidney, suggesting that OPN plays a role in the crystal–cell interaction. In the present study, we examined the biological consequences of inhibiting OPN expression at the translational level on the formation and adhesion of crystals.

Methods
: We synthesized antisense OPN expression vector (pTet‐OPNas) using the tetracycline‐regulated expression system. The pTet‐OPNas was constructed using a mouse OPN cDNA sequence in an inverted (antisense) orientation. Two clones (NRK‐52E/ASs) were identified by transfection of pTet‐OPNas into NRK‐52E cells and they showed a marked reduction of OPN synthesis in the absence of tetracycline. Calcium oxalate (CaOx) crystal suspension was spread homogeneously on top of the NRK‐52E cells. After incubation, the association of CaOx crystals and cells was visualized by scanning electron microscopy.

Results
: Intact NRK‐52E cells, NRK‐52E cells transfected with empty vector and tetracycline‐treated antisense clones (NRK‐52E/ASs), under identical conditions, were associated with CaOx crystals. In contrast, the expression of antisense OPN prevented the association of CaOx crystals with NRK‐52E cells.

Conclusions
: Osteopontin plays a crucial role in the adhesion process of CaOx crystals to renal tubular cells in stone formation.
Hand‐assisted retroperitoneoscopic radical nephrectomy: Initial experience
Authors: KAWAUCHI AKIHIRO , FUJITO AKIRA , UKIMURA OSAMU , SOH JINTETSU , MIZUTANI YOICHI , IMAIDE YOICHIRO , MIKI TSUNEHARU
Published: March 2003

Abstract Objectives: To report our initial experience of hand‐assisted retroperitoneoscopic radical nephrectomy for stage T1 renal tumors.

Methods: The clinical data on 22 consecutive patients who had undergone hand‐assisted retroperitoneoscopic radical nephrectomy and 22 who had undergone open radical nephrectomy were reviewed. The operation was performed with a hand placed retroperitoneally through a pararectal longitudal 7–7.5 cm incision using a LAP DISC.

Results: The total operating time was between 2.3 and 5.8 h (mean: 3.4 h). The estimated blood loss was between 15 and 650 mL (mean: 170 mL). The complication rate was 9% (2/22). No conversions to open procedure occurred. In comparison to open radical nephrectomy, the operating time was similar (3.4 vs 3.9 h) whereas the estimated blood loss was significantly less in this procedure (170 vs 495 mL). During the convalescence period the patients revealed significantly less postoperative pain, shorter intervals to resuming oral intake and more rapid return to normal activities compared to the open radical nephrectomy patients.

Conclusion: Hand‐assisted retroperitoneoscopic radical nephrectomy is an effective and safe procedure for T1 renal tumors.
Cystosarcoma phyllodes of the seminal vesicle
Authors: ABE HIROYUKI , NISHIMURA TAIJI , MIURA TAKAFUMI , UCHIKOBA TAKUSHI , OHNO TOMOYASU , ISHIKAWA NORIYUKI , YOKOI KIMIYOSHI , OHAKI YOSHIHARU
Published: March 2003

Background: We report here an extremely rare case of cystosarcoma phyllodes of the seminal vesicle.

Methods: A 65‐year‐old man presented with urinary hesitancy, frequency and constipation. Clinical examinations including two needle biopsies were performed, and the patient had undergone open surgery.

Results: The final pathological diagnosis was cystosarcoma phyllodes of the seminal vesicle. Seven months after the operation, a chest X‐ray showed lung metastasis, and the patient died 11 months after the operation.

Conclusion: To our knowledge, only one case of cystosarcoma phyllodes of the seminal vesicle has been previously reported.
Molecular medicine in the 21st century
Authors: Semsarian C. , Seidman C. E.
Published: March 2003

When Watson and Crick proposed the double helix model for DNA structure in a 2 page Nature article in 1953, no one could have predicted the enormous impact this finding would have on the study of human disease. Over the last decade in particular, major advances have been made in our understanding of both normal biological processes and basic molecular mechanisms underlying a variety of medical diseases. Knowledge obtained from basic cellular, molecular and genetic studies has enabled the development of strategies for the modification, prevention and potential cure of human diseases. This brief overview focuses on the enormous impact molecular studies have had on various aspects of medicine. The inherited cardiac disorder hypertrophic cardiomyopathy is used here as a model to illustrate how molecular studies have not only redefined ‘gold standards’ for diagnosis, but have also influenced management approaches, increased our understanding of fundamental disease‐causing mechanisms and identified potential targets for therapeutic intervention. The near‐completion of the Human Genome Project, which identifies the 3.2 billion base pairs that comprise the human genome (the so‐called ‘Book of Life’), has exponentially heightened the focus on the importance of molecular studies and how such studies will impact on various aspects of medicine in the 21st century. (Intern Med J 2001; 31: 53–59)
Prevalence of malnutrition and 12‐month incidence of mortality in two Sydney teaching hospitals
Authors: Middleton M. H. , Nazarenko G. , Nivison‐Smith I. , Smerdely P.
Published: March 2003

Abstract

Aims: The objectives of the present study were to determine: (i) the prevalence of malnutrition in two Sydney teaching hospitals using Subjective Global Assessment (SGA), (ii) the effect of malnutrition on 12‐month mortality and (iii) the proportion of patients previously identified to be at nutritional risk.

Methods: A prospective study using SGA to assess nutritional status of eligible inpatients, from April to September 1997, with a 12‐month follow‐up to assess mortality. A total of 819 patients was systematically selected from 2194 eligible patients. Patients were excluded if they were under the age of 18, had dementia or communication difficulties, or were under obstetric or critical care. The main outcome measures were prevalence of malnutrition, 12‐month incidence of mortality, proportion of patients identified with malnutrition, and hospital length of stay (LOS).

Results: The prevalence rate of malnutrition was 36%. The proportion of malnourished patients was not significantly different between the two hospitals (P = 0.4). The actuarial incidence of mortality at 12 months after assessment was 29.7% in malnourished subjects compared with 10.1% in well‐nourished subjects (P < 0.0005). Malnourished subjects had a significantly longer median LOS (17 days vs 11 days, P < 0.0005) and were significantly older (median 71 years vs 63 years, P < 0.0005) than well‐nourished subjects. Only 36% of the malnourished patients had been previously identified as being at nutritional risk.

Conclusions: Malnutrition in Australian hospitals is a continuing health concern and is associated with increased LOS and decreased survival after 12 months. The present study revealed that malnourished patients were not regularly identified. Further studies are required to determine whether routine identification of malnutrition and subsequent nutritional intervention are effective in improving clinical outcomes in these individuals. (Intern Med J 2001; 31: 455–461)
Modifying infant stress responses to major surgery: spinal vs extradural vs opioid analgesia
Authors: WOLF ANDREW , DOYLE EDDIE , THOMAS ERIC
Published: March 2003

Twenty‐six infants due to undergo major abdominal or thoracic surgery under general anaesthesia were randomized to receive additional analgesia with group A) spinal/epidural analgesia; B) epidural analgesia or C) opioid analgesia with fentanyl. We wished to determine if spinal analgesia followed by epidural analgesia might result in more complete control of cardiovascular or stress responses than the other two treatment groups. Heart rate and blood pressure were recorded at five min intervals throughout surgery. Blood samples were taken for measurement of catecholamines and whole blood sugar on induction, 45 min after skin incision and at the end of surgery. Heart rate rose significantly at the start of surgery in groups B and C but not group A. Systolic blood pressures were higher in group C compared to A and B. The rise in plasma glucose concentrations was significantly different between the groups in the order C>B>A (P<0·05). A similar trend was seen in the plasma adrenaline and noradrenaline concentrations but this failed to achieve significance due to the limited sample size.
Pethidine‐associated seizure in a healthy adolescent receiving pethidine for postoperative pain control
Authors: KUSSMAN BARRY , SETHNA NAVIL
Published: March 2003

A healthy 17‐year‐old male received standard intermittent doses of pethidine via a patient‐controlled analgesia (PCA) pump for management of postoperative pain control. Twenty‐three h postoperatively he developed a brief self‐limited seizure. Both plasma pethidine and norpethidine were elevated in the range associated with clinical manifestations of central nervous system excitation. No other risk factors for CNS toxicity were identified. This method allowed frequent self‐dosing of pethidine at short time intervals and rapid accumulation of pethidine and norpethidine. The routine use of pethidine via PCA even for a brief postoperative analgesia should be reconsidered.
Efficacy and complications of morphine infusions in postoperative paediatric patients
Authors: Esmail Zahra , Montgomery Carolyne , Courtrn Colleen , Hamilton Don , Kestle John
Published: March 2003

The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients ≥5 three months of age (0.3–16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 μg·kg−1·h−1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0–3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.
The effect of syringe size on the performance of an infusion pump
Authors: Kim Dong Won , Steward David J.
Published: March 2003

This study investigated the effect of using three different sized syringes on the accuracy of fluid delivery when using an infusion pump at low infusion rates (1 ml·h−1). The study also measured the influence of the syringe size on the time to occlusion alarm, and on the size of the subsequent bolus dose that might be infused after relief of the occlusion which triggered the alarm. The use of a larger size syringe was found not to affect the accuracy of infusate delivery, but delayed the time to occlusion alarm and increased the size of the postocclusion bolus dose.
Anaesthetic management of an infant with anterior mediastinal mass
Authors: Vas Lakshmi , Naregal Falguni , Naik Veena
Published: March 2003

A substantial mediastinal mass in a small infant can create a dilemma regarding the safest mode of airway management. To ensure safety at all times, we adopted one lung ventilation for fear of compression of the carina and/or both main bronchi. Anaesthesia was maintained at a very light plane by the use of local nerve blocks to secure the airway and epidural analgesia for surgery until the tumour was moblized.
The management of extreme hypernatraemia secondary to salt poisoning in an infant
Authors: PAUT O. , ANDRÉ N. , FABRE P. , SOBRAQUÀS P. , DROUET G. , ARDITTI J. , CAMBOULIVES J.
Published: March 2003

We describe a five‐week‐old boy who had seizures and extreme hypernatraemia secondary to ingesting an improper home‐made formula. Initial sodium concentration was 211 mmol??l−1. Other clinical and biological features were moderate dehydration and renal insufficiency with generous urine output and high urinary sodium concentration. Fluid therapy with hypotonic dextrose solution corrected the volume deficit in 48 h and progressively decreased the serum sodium concentration. During ICU stay the patient developed recurrent episodes of seizures and pulmonary oedema requiring mechanical ventilation for five days. Recovery was complete with no abnormal sequelae after a ten‐month follow‐up. Salt poisoning is an unusual cause of extreme hypernatraemia. It can be safely managed with fluid therapy alone if urine output is preserved, with progressive decrease of serum sodium as target. If this condition is recognized, outcome should be favourable.
Continuous epidural butorphanol relieves pruritus associated with epidural morphine infusions in children
Authors: Gunter J.B. , Mcauliffe J. , Gregg T. , Weidner N. , Varughese A.M. , Sweeney D.M.
Published: March 2003

We examined the efficacy of epidural butorphanol to either prevent or relieve pruritus associated with epidural morphine infusion in children. Forty‐six children were randomized to receive either epidural morphine (M) or epidural M with butorphanol (B) for postoperative analgesia. They received bupivacaine and either M 50 μg·kg−1 or the same dose of M plus B 10 μg·kg−1. Following surgery, a continuous infusion of 0.1% bupivacaine with either M 20 μg·ml−1 or M 20 μg·ml−1+ B 4 μg·ml−1 was given at a rate of 0.3 ml·kg−1·h−1. Pain scores and pruritus scores were recorded every 4 h during epidural infusion. Subjects with a pruritus score=2 received diphenhydramine 0.5 mg·kg−1 i.v. and were switched to an alternate epidural infusion; subjects receiving M (group M) were switched to M+B while subjects receiving M+B (group B) were switched to hydromorphone (H) 4 μg·ml−1. There was no difference in the initial incidence of pruritus (group M 11/18; group B 13/28). No subject in group M required a second change of epidural infusion because of continued pruritus after being switched to M+B; five of 13 subjects in group B continued to experience pruritus after being switched to H and required a second change of epidural infusion or an alternate analgesic modality (P=0.038). The median pruritus score in the first 24 h after changing epidural infusions was 0 in subjects in group MΔ (changed from M to M+B) and 1 in subjects in group BΔ (changed from M+B to H; P=0.012). While the median sedation score in the first 24 h was 1 in both groups, there was a greater incidence of sedation scores of 2 in group B than group M (28%vs 12.3%; P=0.021). B 10 μg·kg−1 was not effective in preventing pruritus associated with bolus epidural administration of M 50 μg·kg−1 in children. B 1.2 μg·kg−1·h−1 was effective in relieving pruritus associated with continuous epidural infusion of M 6 μg·kg−1·h−1.
Fenoldopam for controlled hypotension during spinal fusion in children and adolescents
Authors: Tobias Joseph D.
Published: March 2003

Fenoldopam is a dopamine1 agonist whose pharmacological effects include vasodilation of the vascular beds of the kidney, mesentery, skeletal muscle, and coronary systems, resulting in a decrease in systemic vascular resistance and mean arterial pressure. The current retrospective review outlines the use of fenoldopam for controlled hypotension during anterior or posterior spinal fusion in 10 children and adolescents, aged 8–14 years and weighing 22–61 kg. Fenoldopam was infused at a starting dose of 0.3–0.5 μg·kg−1·min−1 and increased incrementally to achieve a mean arterial pressure (MAP) of 50–65 mmHg. The desired MAP was achieved in 4–11 min (7±2.5 min). The fenoldopam infusion was administered for 135–225 min (160±25 min) in doses ranging from 0.2 to 2.5 μg·kg−1·min−1. The mean fenoldopam infusion rate for the 10 cases varied from 0.5 to 1.4 μg·kg−1·min−1 (1.0±0.3 μg·kg−1·min−1). No excessive hypotension or clinically significant adverse effects were noted. Statistically significant, but clinically insignificant, increases in heart rate and decreases in PaO2 were noted during the fenoldopam infusion. The baseline heart rate increased from 87±13 b·min−1 to a maximum of 114±16 b·min−1 (P < 0.0001) during the fenoldopam infusion. In the six patients undergoing posterior spinal fusion, the baseline PaO2 decreased from 232±7 mmHg to a low of 199±11 mmHg (P=0.0004) during the fenoldopam infusion. Fenoldopam can be used to provide controlled hypotension during spinal surgery in children and adolescents. Future studies, with direct comparison to other commonly used agents, are needed to better define its advantages and disadvantages as well as its effects on estimated blood loss.
Serum glutathione S‐transferase alpha as a measure of hepatocellular function following prolonged anaesthesia with sevoflurane and halothane in paediatric patients
Authors: Iwanaga Yasuyuki , Komatsu Hisao , Yokono Satoshi , Ogli Kenji
Published: March 2003

We studied the effects of prolonged anaesthesia (4.3–7.7 h) with sevoflurane and halothane on hepatic function in 14 paediatric patients. Hepatic function was assessed using serum concentrations of liver‐specific glutathione S‐transferase alpha (GSTA) before and 0, 3 and 15 h after the end of anaesthesia. A transient significant increase in GSTA over baseline was observed in the sevoflurane group, but not in the halothane group, and the difference between the groups was not significant. These data suggest that, although statistically insignificant, the use of sevoflurane for prolonged anaesthesia in paediatric patients is more likely than halothane to be involved in damage to hepatic function.
Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies
Authors: Büttner W. , Finke W.
Published: March 2003

Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty‐six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two‐factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC‐curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC‐curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants’ Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs’α with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler–Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy‐one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92–0.96 and 0.74–0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.
Parental presence during anaesthesia induction for outpatient surgery of the infant
Authors: Palermo Tonya Mizell , Tripi Paul A. , Burgess Erika
Published: March 2003

We conducted a randomized controlled trial of parental presence during anaesthesia induction for outpatient surgery in 73 infants (aged 1–12 months). Effects of parental presence on infant and parental outcomes, including anxiety, health care attitudes and satisfaction with the anaesthesia and surgery experience were evaluated. Results demonstrated that parental presence had no impact on infant behavioural distress during induction. In addition, parents who were present demonstrated comparable anxiety levels and health care attitudes before and after surgery, as well as comparable levels of satisfaction with the surgical experience compared to parents who were absent during induction. We discuss reasons for the lack of treatment effects from parental presence, and new directions for future research to identify subgroups of children who may most benefit from the opportunity to have parents involved in the perioperative period.
Propofol/remifentanil versus propofol alone for bone marrow aspiration in paediatric haemato‐oncological patients
Authors: Keidan I , Berkenstadt H , Sidi A , Perel A
Published: March 2003

Background: This prospective randomized study was designed to evaluate the effects of adding remifentanil to the standard propofol‐based technique in the setting of paediatric haematology‐oncology outpatient clinic.

Methods: Eighty ASA III paediatric patients treated in the outpatient haematology‐oncology clinic requiring bone marrow aspiration were randomly assigned either to the propofol (P) or the propofol/remifentanil (PR) group. The quality of anaesthesia and recovery were evaluated.

Results: The total amount of propofol required to prevent patient movement was lower in the PR group. The time interval to eye opening and to home readiness was significantly lower in the PR group. Adverse respiratory events (RR < 10·min–1 or SpO2 < 90%) occurred significantly more in the propofol/remifentanil group.

Conclusions: The addition of remifentanil improved the conditions during the procedure and reduced the total amount of propofol, as well as the time to home readiness. However, the addition of remifentanil is associated with an increased risk of respiratory depression.
Postoperative nausea and vomiting in paediatric ambulatory surgery: sevoflurane versus spinal anaesthesia with propofol sedation
Authors: Oddby E , Englund S , Lönnqvist P A
Published: March 2003

Background: Descriptive data report a very low rate of postoperative nausea and vomiting (PONV) following spinal anaesthesia in children. In an attempt to corroborate this observation, we designed a prospective randomized study to compare spinal anaesthesia with intravenous propofol sedation (SA) (n=21) to inhalational sevoflurane anaesthesia (IA) (n=19) with regard to PONV and postoperative analgesia in children (aged 3–12 years) undergoing ambulatory inguinal surgery.

Results: No difference was found concerning the number of patients experiencing PONV in each group (SA 1/21 versus IA 5/19;P=0.085). However, spinal anaesthesia was associated with a reduced number of PONV episodes (1/21) compared with inhalation anaesthesia (8/19) (P=0.014) and the need for supplemental postoperative analgesia with ketoralac was significantly lower in the SA group (3/21) compared to the IA group (14/19) (P < 0.001). Despite these benefits of spinal anaesthesia compared with inhalational anaesthesia, spinal anaesthesia did not decrease the time to discharge from the ambulatory surgery unit [SA 161 (SD 51) min, IA 164 (SD 41) min;P=NS] and the overall PONV experience was rated as ‘no problem’ by all patients, except one, regardless of anaesthetic protocol used.

Conclusions: Despite the reduced number of emetic episodes and the better immediate postoperative analgesia associated with spinal anaesthesia, no difference could be identified between the two different anaesthetic protocols regarding time to discharge or overall patient satisfaction. Thus, despite minor advantages associated with spinal anaesthesia with propofol sedation, both anaesthetic regimen appear equally suitable for use in the paediatric outpatient setting.
Postal survey of cuffed or uncuffed tracheal tubes used for paediatric tracheal intubation
Authors: Orliaguet Gilles A. , Renaud Estelle , Lejay Marc , Meyer Philippe G. , Schmautz Emmanuelle , Telion Caroline , Carli Pierre A.
Published: March 2003

A postal survey of the use of cuffed or uncuffed tracheal tubes for tracheal intubation in children and infants was performed to investigate the criteria used for deciding the choice of tube and the manner of inflating the cuff in the case of use of a cuffed tracheal tube (CTT). From 200 questionnaires despatched, replies were received from 130 paediatric anaesthesiologists (response rate 65%). In paediatric practice, the CTT was routinely used by 25% of respondents for more than 80% of their patients, while more than 37% of respondents use them in less than 20% of the cases. The three main criteria used for inflating a cuff were: (i) the presence of a leak, (ii) the type of surgery associated with the presence of a leak and (iii) the patient’s age associated with the type of surgery and the presence of a leak. These criteria were specified, respectively, by 32%, 24% and 18% of the respondents. The cuff was inflated in response to a leak in 18% of the cases and as a response to a pressure manometer in 15% of the cases. Few paediatric anaesthesiologists use a cuffed tracheal tube routinely for tracheal intubation in children, and fewer actually use a pressure monitoring device, while it is suggested that the cuff pressure should be monitored in case of CTT.
Ketamine for short ambulatory procedures in children: an audit
Authors: Gloor Andreas , Dillier Claudia , Gerber Andreas
Published: March 2003

Background: The purpose of this audit was the evaluation of recovery and discharge times and the identification of perioperative events related to anaesthetics with intravenous ketamine and midazolam.

Methods: In our institution, we use this method as a routine technique for short ambulatory emergency or elective procedures. Two hundred children, aged 1–16 years, were included. Ninety percent of the study patients underwent emergency procedures.

Results: Most perioperative events were minor and easily corrected. Intraoperatively, most events were related to respiration, including oxygen desaturation, apnoea or laryngospasm. Vomiting, vertigo, visual disturbances, nightmares and hallucinations were observed in the postoperative period. Serious complications requiring hospital admission or further interventions in the postoperative period were rare. Mean recovery time was 100 min (range 20–325) and mean discharge time 130 min (range 25–360).

Conclusions: Intravenous ketamine plus midazolam is a suitable, simple and fast anaesthetic technique for short, painful ambulatory procedures. Considering the possibility of potentially serious respiratory complications, it should be performed only by qualified anaesthesia staff who are trained in advanced airway management.
Initial experience with dexmedetomidine in paediatric‐aged patients
Authors: TOBIAS JOSEPH D. , BERKENBOSCH JOHN W.
Published: March 2003

We present preliminary clinical experience with the use of dexmedetomidine, an α2 adrenergic agonist, in children. Dexmedetomidine was administered in three clinical scenarios: (i) to provide sedation during mechanical ventilation; (ii) intraoperatively for controlled hypotension during an orthopaedic surgical procedure; and (iii) to provide sedation during an invasive procedure. Preliminary data from studies in the adult population, its physiological effects and potential applications in paediatric anaesthesia and critical care are discussed.
Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia
Authors: COLE JENNIFER W. , MURRAY DAVID J. , McALLISTER JOHN D. , HIRSHBERG GARY E.
Published: March 2003

Background: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia.

Methods: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5‐point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery.

Results: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying.

Conclusions: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery.
Niemann‐Pick disease: a rare problem in anaesthesiological practice
Authors: Bujok Lilianna‐Szuba , Bujok Grzegorz , Knapik Piotr
Published: March 2003

Summary We describe the problems encountered during general anaesthesia in a 2‐year‐old boy who was suffering from an extremely severe form of Niemann‐Pick disease. Attention focused on respiratory difficulties and intubation problems. The usefulness of the lateral position and the limits of the Mallampati score in this case are discussed.
Uptake pharmacokinetics of the Fentanyl Oralet® in children scheduled for central venous access removal: implications for the timing of initiating painful procedures
Authors: Wheeler Melissa , Birmingham Patrick K. , Dsida Richard M. , Wang Zhao , Coté Charles J. , Avram Michael J.
Published: March 2003

Summary Background: The Fentanyl Oralet® (Abbott Laboratories, Abbott Park, IL, USA) is an oral transmucosal drug delivery system. We previously examined pharmacokinetic parameters of children who had completed consumption of the Fentanyl Oralet®. The present study was designed to clarify pharmacokinetic parameters during the consumption phase to determine if there is an optimal administration time before painful procedures.

Methods: Patients, aged 3–10 years, who were scheduled for elective removal of central venous access devices under general anaesthesia, received a Fentanyl Oralet® (fentanyl 10–15 µg·kg−1). Plasma fentanyl concentrations were measured by radioimmunoassay. Data from blood samples obtained during and after consumption of the Fentanyl Oralet® from 17 patients in the present study were combined with data from our previous study to better characterize both the consumption and postconsumption concentration versus time profiles.

Results: Estimated fentanyl bioavailability (mean ± SD) was low (36.1 ± 0.4%), as were peak plasma concentrations (1.03 ± 0.31 ng·ml−1), suggesting that many children swallowed a large fraction of the dose. This led to a relatively late and variable peak concentration time of 53 ± 40 min. In addition, because of the apparently large degree of gastrointestinal absorption, concentration versus time curves were wide and flat.

Conclusions: The wide and flat concentration versus time profile may allow flexibility in the timing of a painful procedure following Fentanyl Oralet® administration. However, the variability of the time to peak concentration makes it difficult to suggest a minimum interval between Fentanyl Oralet® consumption and the start of a painful procedure.
Validating the Derbyshire Children's Hospital Pain Tool: a pilot study
Authors: Peden Vanessa , Vater Mair , Choonara Imti
Published: March 2003

Summary Background: The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the clinical area, and it is applicable for use in children of all ages within the postoperative setting. The pain assessment chart encompasses pain assessment by utilizing facial expression, body movement and verbal expression. An exploratory study was performed to define its reliability and validity.

Methods: The research nurse (V.P.) assessed 40 children aged 1–5 undergoing minor and intermediate surgery comparing the Toddler Preschooler Postoperative Pain Scale and the DPC. Assessments were performed preoperatively and for 4 h postoperatively. Any analgesia administered postoperatively was recorded.

Results: All the children scored 0 preoperatively with both pain scales, thus demonstrating known groups validity. There were 116 dual assessments by the research nurse using both pain scales. There was a strong correlation (r = 0.89) demonstrating convergent validity. There was a significant correlation between 182 joint assessments by the research nurse (V.P.) and the nursing staff using the DPC (Spearmans rank correlation, 0.81) and the Cronbach alpha coefficient ranged from 0.83 to 0.98. Construct validity was demonstrated by a fall in the mean pain scores from 1.8 to 0.1 following analgesia in 19 children.

Conclusions: This exploratory study suggests the DPC holds construct, convergent and known groups validity and is a reliable pain assessment tool for children aged 1–5 years undergoing minor and intermediate surgery.
Comparative morphology of epicorneal conjunctival membranes in rabbits and human pterygium
Authors: Roze Maurice , Ridings Bernard , Lagadic Marie
Published: March 2003

A rarely described ocular lesion in the rabbit is presented following the observation of four cases. It is a membrane of conjunctival origin that advances progressively, without adhering, towards the center of the cornea. Clinically the lesion in rabbits looks like pterygium in man, but with several differences: in rabbits, the conjunctival fold is absolutely free and does not penetrate into the superficial corneal layers. It originates from all the limbal circumference in a symetric growth. The cornea itself remains unaltered. The fold consists of fibroblasts and collagen. The microscopic findings suggest the lesion is possibly of a collagenous dysplasia.