bluuebunny/crossref_metadata_2025 huggingface dataset:
Necessity of re‐evaluation of estramustine phosphate sodium (EMP) as a treatment option for first‐line monotherapy in advanced prostate cancer
Authors: Kitamura Tadaichi
Published: March 2003

Abstract Estramustine phosphate sodium (EMP) was first introduced in the early 1970s for the treatment of prostate cancer, when EMP was supposed to have the dual effect of estrogenic activity and cytotoxicity. For the following decades, it was used mainly in hormone‐refractory cases, with a conventional dosage of 4–9 capsules/day, which showed a 30–35% objective response rate. However, a very limited number of cases have been reported that used EMP as a first‐line monotherapy in the conventional dosage. One study showed a response rate of 82%, which is at least as effective as conventional estrogen (diethylstilbestrol; DES) monotherapy. Nevertheless, EMP was almost abandoned for the treatment of prostate cancer because of severe adverse side‐effects, especially in the cardiovascular system and gastrointestinal tract.

Recently, two facts have become evident. First, EMP interferes with cellular microtubule dynamics but does not show alkylating effects. Second, EMP is able to produce a complex with calcium when dairy products are taken concomitantly with EMP, resulting in a decrease in the absorption rate of EMP from the gut. Many clinical trials have been undertaken without warning against concomitant dairy product intake since the introduction of EMP. This fact will jeopardize almost all the clinical trials performed before 1990. It is considered that response rates have been underestimated and better results could have been obtained because side‐effects decrease dose‐dependently.

Low‐dose EMP monotherapy (2 capsules/day) has been performed infrequently in previously untreated advanced prostate cancer. The only large trial by the European Organization for Research and Treatment of Cancer in 1984 was biased in selecting patients. Nevertheless, the response rate of EMP is comparable to that of DES. In this study, the adverse side‐effects of EMP were less than that of DES. Recently, a study was conducted at the University of Tokyo of 11 patients with advanced prostate cancer on low‐dose EMP as first‐line monotherapy. The study found that the mean serum prostate‐specific antigen level decreased to within the normal range by day 50; mean serum testosterone, leutinizing hormone and follicle‐stimulating hormone reduced to undetectable levels by day 20; and mean serum estradiol increased to a very high level within 1 week. These data implicate that low‐dose EMP can suppress quickly and adequately the pituitary–gonadal axis, although the antitumor effect has not as yet been elucidated.

For these reasons, it is necessary to re‐evaluate low‐dose EMP monotherapy in previously untreated advanced prostate cancer.
Is there a role for magnetic resonance imaging in renal trauma?
Authors: Ku Ja‐Hyeon , Jeon Youn‐Soo , Kim Min‐Eui , Lee Nam‐Kyu , Park Young‐Ho
Published: March 2003

Background:

Computed tomography (CT) has been the most informative imaging method in renal trauma. Despite the good sensitivity of magnetic resonance imaging (MRI) to the presence of hematoma, edema and ischemia, MRI has not been widely studied in patients with renal trauma. The present study was initiated to evaluate the role of MRI in patients with renal trauma.

Methods:

Between June 1998 and September 1999, CT and MRI were prospectively performed on 12 patients who suffered from renal trauma and the results reviewed.

Results:

The presence and size of perirenal hematoma could be detected by both CT and MRI. Magnetic resonance imaging could differentiate intrarenal hematoma from perirenal hematoma more accurately, and provided additional information about the hematoma as T1‐ and T2‐weighted MRI were able to determine recent bleeding in the hematoma by regional differences in signal intensity. Magnetic resonance imaging clearly revealed renal fracture with non‐viable fragment and detected focal renal laceration that was not detected on CT due to perirenal hematoma associated with renal infarction. However, although MRI had many advantages over CT, it had also major drawbacks, which were that it required longer imaging time and increased the cost.

Conclusions:

Magnetic resonance imaging may be useful in renal trauma. However, it is suggested that MRI should be limited to carefully selected patients, such as those with severe renal injury or equivocal findings on CT.
Adenocarcinoma arising from the prostatic duct mimicking transitional cell carcinoma
Authors: Ohyama Chikara , Takyu Shunichi , Yoshikawa Kazuyuki , Suzuki Hiroyoshi , Tezuka Fumiaki , Hasuda Akiyuki , Inaba Yasuo , Hoshi Senji , Orikasa Seiichi
Published: March 2003

Abstract A 71‐year‐old man was first diagnosed with primary transitional cell carcinoma of the prostate with a skip lesion on the distal urethra. The patient received three courses of intra‐arterial chemotherapy of cisplatin (CDDP) and pirarubicin (THP‐ADM) followed by a radical prostatectomy. Histopathologic examination of the prostatectomy specimen revealed adenocarcinoma invasion along the prostatic duct extending to the peripheral acini, which was diagnosed as ductal adenocarcinoma. The clinical and histopathologic features of this case are entirely different from usual adenocarcinomas of the prostate. This rare histopathologic feature should be recognized as ‘ductal carcinoma of the prostate’, to distinguish it from papillary adenocarcinoma or adenocarcinoma with endometrioid features. The patient has had no sign of recurrence 14 months after the operation. CDDP‐based chemotherapy followed by radical prostatectomy may be one of the promising therapeutic modalities for this rare entity.
Prostatic adenocarcinoma with marked neuroendocrine differentiation
Authors: Islam AHM Manjurul , Kato Haruaki , Hayama Masayoshi , Kobayashi Shinya , Ota Hiroyoshi , Nishizawa Osamu
Published: March 2003

Abstract A case is presented of prostatic cancer with marked neuroendocrine differentiation. Double‐labeled immunohistochemical staining was performed with prostate‐specific antigen and Chromogranin A. Both antibodies were localized to some of the cancer cells with Paneth cell‐like features. Furthermore, most of the cancer cells were positively stained with luminal cell marker CAM 5.2, suggesting that neuroendocrine cells originated from the prostatic luminal cells.
Aging and erectile dysfunction: The role of aging and concomitant chronic illness
Authors: Marumo Ken , Murai Masaru
Published: March 2003

Abstract Erectile dysfunction (ED) can have a strong negative effect on the well‐being and quality of life of the sufferer. Many factors may contribute to the development of this disorder; age in particular and also concomitant chronic illnesses including neurological, hormonal, arterial and cavernosal factors. An understanding of the prevalence and characteristics of risk factors for ED is required, in order to establish effective therapeutic strategies. However, the prevalence of ED depends on the definitions used and the use of an internationally established scale for the assessment of male sexual function is necessary to facilitate the comparison of data between different countries. Further epidemiologic research and analysis of individual risk factors is required. Such studies will clarify the interactive effects of organic factors and their probable etiology with the general physical, sociocultural and psychologic status of patients. These efforts will make it possible to design more effective future strategies for the treatment and prevention of ED.
Preoperative predictors of cancerous involvement of the neurovascular bundles in patients with localized prostate cancer
Authors: INOUE TAKAHIRO , HIOKI TAKUICHI , HAYASHI NORIO , TAKAHASHI SATORU , SHIRAI TOMOYUKI , SUGIMURA YOSHIKI
Published: March 2003

Abstract Background: The purpose of this study was to identify preoperative variables that would be useful in objectively selecting prostate cancer patients for nerve‐sparing prostatectomy.

Methods: Twenty‐six patients with clinical T1c–T2c cancers were evaluated for cancerous involvement in the region of the neurovascular bundles (NVB) from prostatectomy specimens. Preoperative prostate‐specific antigen (PSA) and pathologic features in systematic biopsy specimens also were reviewed.

Results: A total of eight (31%) patients had cancerous involvement in the region

of the NVB, including four on the right side, three on the left side and one on both

sides. The percentage of each biopsy specimen occupied by the cancer was scored from

zero to four and defined as the positive biopsy score. Preoperative PSA (P

= 0.046), mean positive biopsy score (total sum of positive biopsy score divided

by number of biopsy specimens; P = 0.001), number of cores containing cancer

(P = 0.011), percentage of cores involved (P = 0.036) and maximum positive

biopsy score (P < 0.001) were significant for predicting cancerous involvement in the NVB region using univariate analysis. However, only the mean positive biopsy score was independently significant according to multivariate analysis. To predict cancerous involvement in the region of each NVB, we found that ipsilateral mean positive biopsy score (total sum of corresponding positive biopsy score divided by number of ipsilateral biopsy specimens), number of cores involved on the ipsilateral side, percentage of cores involved on the ipsilateral side and maximum positive biopsy score on the ipsilateral side were significant predictive variables: the ipsilateral mean positive biopsy score being most appropriate for clinical practice.

Conclusion: Ipsilateral mean positive biopsy score in systematic biopsy specimens can be an appropriate variable for selecting patients with localized prostate cancer for nerve‐sparing prostatectomy.
Clinical efficacy and safety of sildenafil citrate (Viagra) in a multi‐racial population in Singapore: A retrospective study of 1520 patients
Authors: Lim Peter Huat Chye , Li Man Kay , Ng Foo Cheong , Chia Sing Joo , Consigliere David , Gooren Louis , Ng Kok Kit , Munisamy Malathy , Perianan Moorthy
Published: March 2003

Background: Sildenafil citrate (Viagra), a selective inhibitor of cGMP‐specific phosphodiesterase type‐5, has been used as an oral therapeutic drug for erectile dysfunction. The present paper is a clinical study of the success rate and side‐effects of the use of sildenafil in a multi‐racial population in Singapore.

Methods: From April 1999 to May 2000, 1520 patients were given sildenafil citrate. Of these, 912 patients (mean age, 54.6 years; age range, 22–99 years) were followed up and evaluated for clinical efficacy and safety of the drug. The mean duration of erectile dysfunction (ED) and follow‐up periods were 31.5 and 3.0 months, respectively.

Results: Satisfactory erections assessed by single global efficacy question (GEQ) occurred in 83% of patients, major side‐effects in the form of flushing (3.48%), headache (1.97%), blurred vision (1.25%), giddiness (1.18%), warmth (1.11%) and others (4.92%) were recorded in 127 patients (13.9%). Racially, Chinese men with ED had higher efficacy (85.7%), compared to Indian men (74.2%) and Malay men (72.8%). With respect to comorbid profiles, an efficacy of 77.8% (n = 271), 83.9% (n = 292), 86.4% (n = 44) and 83.3% (n = 199) was recorded in diabetic, hypertensive, ischemic heart disease patients and in benign prostatic hyperplasia patients, respectively. Patients who smoked (n = 135) and drank alcohol (n = 118) showed an efficacy of 80%. Baseline hormonal profiles of luteinizing hormone, follicle stimulating hormone, testosterone and prolactin did not affect the success rates of sildenafil citrate. Many patients had earlier received other forms of treatment (medicated urethral suppository for erection (MUSE; 84.9%); vacuum devices (86.8%), traditional medicines (100%) and other oral medications (89.2%)), but this did not influence the success rate of sildenafil citrate. But patients previously treated with prostaglandin‐E intracavernosal injections were less successful on sildenafil citrate (77.3%). In the total cohort, 50 mg sildenafil citrate was an effective dose in 49% of patients and 46.5% patients needed 100 mg sildenafil citrate, while 4.1% of the total cohort needed only 25 mg sildenafil citrate.

Conclusion: Oral sildenafil citrate has been shown to be an effective, safe and well tolerated drug in Singaporean men with ED, as in men from other parts of the world.
Medically and economically appropriate follow‐up schedule for prostate cancer patients after radical prostatectomy
Authors: NIWAKAWA MASASHI , TOBISU KEN‐ICHI , FUJIMOTO HIROYUKI , MATSUOKA NAOKI , KAKIZOE TADAO
Published: March 2003

Background
: Our goal was to determine the optimal frequency and method of follow‐up after radical prostatectomy to minimize medical cost without adversely affecting patients.

Methods
:

Two hundred and twenty‐one patients who underwent a radical prostatectomy with or without adjuvant androgen deprivation from 1989 to 1999 were selected for the study. Eighty percent of the patients received postoperative androgen deprivation. Tumor recurrence was strictly defined as detectable serum prostate specific antigen (PSA) and/or clinical findings such as local tumor detection or bone metastasis. Thirty of 221 patients experienced tumor recurrence. Risk of tumor recurrence, procedures for detection of recurrence, and PSA doubling time after biochemical failure were analyzed.

Results
:

None of the 30 patients who were examined showed definitive local recurrence or metastatic sites on the imaging study at the time of initial PSA detection, and there were no observed recurrences in the absence of detectable serum PSA. In patients who showed elevated PSA within 12 months after radical prostatectomy, PSA levels rapidly increased with doubling times ranging from 1.2 to 13.7 months. Excluding those patients, the doubling time of PSA levels ranged from 2.8 to 31.5 months.

Conclusions
:

Prostate specific antigen screening is sufficient to detect treatment failure after radical prostatectomy, irrespective of adjuvant hormone therapy. Based on the calculated doubling time, the longest advisable interval between checks of PSA levels is estimated to be four months within the first year after radical prostatectomy, and biannually or annually thereafter. Continuously elevated PSA levels or clinical symptoms indicate surveys for local recurrences and distant metastases.
Calcium oxalate monohydrate crystal binding substance produced from Madin‐Darby canine kidney cells
Authors: YAMAGUCHI SATOSHI , WIESSNER JOHN , HASEGAWA ANDREW , HUNG LINDA , MANDEL GRETCHEN , MANDEL NEIL
Published: March 2003

Abstract Background: The interaction between kidney urothelium and crystals is a critical event in the growth of renal calculi. When studying calcium oxalate monohydrate (COM) crystal binding to Madin‐Darby canine kidney (MDCK) cells in culture, we observed that crystals also attached to areas on the coverslips devoid of cells. This phenomenon could be the result of substances produced by the cells that adhere to the glass and subsequently bind COM crystals. We investigated the characteristics of this COM binding substance.

Methods: Media was collected from cultures of MDCK cells (conditioned media) and proteins were separated by high performance liquid chromatography. The molecular weights and purity of isolated proteins were determined by polyacrylamide gel electrophoresis. The conditioned media and each separated fraction were applied to glass and to MDCK cells and COM‐binding ability determined using 14C‐labeled crystals. The binding of radio‐labelled calcium oxalate dihydrate, brushite, uric acid, and apatite to coverslips were also studied.

Results: Fourteen times more COM bound to coverslips incubated with conditioned media than those with control media. The molecular weight of the protein bound to the glass was determined to be 200 kDa. The COM crystals binding to this protein was 1.5 µg/ng. Other crystals bound to a lesser extent. The incubation of cells with this protein inhibited COM binding by 39%.

Conclusion: The MDCK cells produce a 200‐kDa protein that has a high binding affinity for COM crystals. This protein binds to glass and is responsible for crystal binding to areas devoid of cells. This protein also has an inhibitory effect on COM binding to MDCK cells in culture.
Acquired haemophilia in South Australia: a case series
Authors: Burnet S. P. , Duncan E. M. , Lloyd J. V. , Han P.
Published: March 2003

Abstract

Of eight cases of acquired haemophilia presenting over an 8‐year period, six received immunosuppressive treatment, five with cyclophosphamide, vincristine and prednisolone (CVP). Five patients (four on immunosuppressive treatment) entered remission, two patients died and one was lost to follow up. Initially, the remissions were only partial. The median duration until partial remission was 10 weeks (range 1–55 weeks) and until complete remission was 35 weeks (range 2–59 weeks). Partial remission may proceed to complete remission without further chemotherapy. (Intern Med J 2001; 31: 556–559)
Parasitic worms of the central nervous system: an Australian perspective
Authors: Hughes A. J. , Biggs B. A.
Published: March 2003

Abstract

The diagnosis and management of parasitic diseases of the central nervous system (CNS) is difficult, even for infectious diseases physicians and neurologists. Furthermore, few overviews of the spectrum of causative helminths and clinical syndromes have been published. In the present study, we review the seven most common parasitic diseases of the CNS: (i) cysticercosis, (ii) neuroschistosomiasis, (iii) paragon­imiasis, (iv) angio‐strongyliasis, (v) hydatid disease, (vi) sparganosis and (vii) gnathostomiasis. Major syndromes of parasitic disease of the CNS and their differential causes are discussed, including: (i) cystic lesions, (ii) enhancing granulomas (with and without creeping subcutaneous eruptions), (iii) eosinophilic meningoencephalitis and (iv) spinal cord disease. Specific risk factors that predispose to these infections are also discussed and particular attention is drawn to the situation in Australia. (Intern Med J 2002; 32: 541−553)
A timed reexpansion inspiratory manoeuvre (TRIM) for treating oxyhaemoglobin desaturation in children following a period of apnoea—studies in an animal model
Authors: McDONALD  , VAN DER WALT  , PARNIS
Published: March 2003

Our clinical experience has shown that the use of a constant distending airway pressure of 30 cm water for 10 s, termed a timed reexpansion inspiratory manoeuvre (TRIM), is often successful in correcting oxyhaemoglobin desaturation in anaesthetized children. The aim of this study was to assess the efficacy of TRIM in lambs. Following a standard relaxant anaesthetic, ventilation was stopped and oxyhaemoglobin saturation allowed to fall to 70% and the time taken to return to baseline was compared between three groups. The median time was 42.5 s when ventilation was restarted with 33% oxygen in nitrous oxide (33% group), 30 s when ventilation was restarted with 100% oxygen (100% group) and 22.5 s with a TRIM before restarting ventilation with 33% oxygen in nitrous oxide (TRIM group). The correction of desaturation was more rapid in the TRIM group compared with the 33% group (P<0.004) and the 100% group (P<0.003). Oxyhaemoglobin desaturation due to apnoea in anaesthetized lambs is more effectively treated with a TRIM than by increasing the inspired oxygen fraction.
Anaesthetic management of two paediatric patients with Hecht–Beals syndrome
Authors: Nagata Osamu , Tateoka Akiko , Shiro Ryoji , Kimizuka Mamori , Hanaoka Kazuo
Published: March 2003

We undertook the anaesthetic management of two children with Hecht–Beals syndrome for orthopaedic surgery under general anaesthesia. Both patients had arachnodactyly, kyphoscoliosis, and multiple congenital joint contractures, but limited mandible excursion was not obvious preoperatively in either, although mental retardation made it difficult for them to cooperate with mouth examination. They had no apparent difficulties with their mouths in daily activities. The anaesthesia records of one patient showed that intubation had been difficult in an earlier procedure. The other patient also had a history of difficult intubation, with slight tearing of the corners of her mouth during an intubation procedure. During slow induction of general anaesthesia with sevoflurane, face mask ventilation was easily performed. We attempted to visualize the larynx under anaesthesia with muscle relaxation, but we were unsuccessful because of the limited mouth opening. After several trials, blind oral intubations were fortunately successful in both patients. There were no postoperative problems with the airway.
Retracted: Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness
Authors: Fujii Yoshitaka , Saitoh Yuhji , Tanaka Hiroyoshi , Toyooka Hidenori
Published: March 2003

A history of motion sickness is one of the patient‐related factors associated with postoperative emesis. This prospective, randomized, double‐blind, placebo‐controlled study was undertaken to assess the efficacy of granisetron, a selective 5‐hydroxytryptamine type 3 receptor antagonist, for preventing postoperative vomiting after tonsillectomy in 120 children with (n=60) and without (n=60) a history of motion sickness. Patients received a single dose of granisetron (40 μg·kg−1) or placebo (saline) (n=30 of each) intravenously after an inhalation induction of anaesthesia. A complete response, defined as no vomiting, no retching and no need for another rescue medication, during the first 24 h after anaesthesia was 77% and 13% in patients with a history of motion sickness who had received granisetron or placebo, respectively; the corresponding incidence was 83% and 40% in those without it (P< 0.05; χ2 test with Yates’ continuity correction). No clinically serious adverse effects due to the study drug were observed in any of the groups. In conclusion, prophylactic antiemetic therapy with granisetron is effective for preventing postoperative emesis in children with a history of motion sickness as well as in those without it.
Paracetamol‐induced fulminant hepatic failure in a child after 5 days of therapeutic doses
Authors: Morton Neil S. , Arana Amaia
Published: March 2003

We report the case of a two and a half year‐old girl who developed fulminant hepatic failure following 5 days of regular oral ingestion of paracetamol, approximately 90 mg·kg−1·day−1. She presented with the typical findings of hepatomegaly, encephalopathy, high ammonia levels, high transaminases, hypoglycaemia and lactic acidosis. After stabilization, she was transferred to a specialist paediatric liver failure unit and fortunately she made a full recovery with intensive medical management.
Failure of the laryngeal mask to secure the airway in a patient with Hunter's syndrome (mucopolysaccharidosis type II)
Authors: BUSONI PAOLO , FOGNANI GIULIANA
Published: March 2003

We present a case‐study of a boy with Hunter's syndrome (mucopolysaccharidosis type II) and stridor in which a laryngeal mask airway (LMA) failed to secure airway control. A rigid bronchoscopy was performed and a polypoid formation discovered. We believe that the use of the LMA could explain the laryngeal obstruction in this child.
Computerized tomography of the lungs and arterial oxygen tension studies during apnoea in anaesthetized young lambs
Authors: Law R.C. , Van Der Walt J.H.
Published: March 2003

Computerized tomography (CT) of the lungs and arterial oxygen tension studies were performed during general anaesthesia in an animal model to understand changes in pulmonary atelectasis associated with anaesthesia in children during a 2 min apnoeic period. Six anaesthetized lambs were subjected to three periods of apnoea lasting 2 min each. A series of 10 mm CT transaxial views were taken at three levels of the chest and arterial blood gases were analysed at the start of the apnoeic period (baseline) and again every 30 s during the apnoeic period. The areas of atelectasis were measured using the extended Hounsfield scale. The results confirmed that significant background atelectasis was associated with general anaesthesia as found in adult human studies, but failed to demonstrate any increase in atelectasis during the period of induced apnoea. The decline in arterial oxygen tension in this study could be explained due to simple utilization of oxygen in keeping with physiological principles.
The effect of induced hypothermia on the duration of action of atracurium when given by infusion to critically ill children
Authors: Playfor S.D. , Thomas David A. , Choonara Imti
Published: March 2003

The aim of the study was to investigate the effect of induced hypothermia on the offset time of atracurium when given by continuous infusion to critically ill children. Over a period of 8 months, six mechanically ventilated children had a steady‐state infusion of atracurium discontinued. The offset time of atracurium was assessed by train‐of‐four (TOF) stimulation of the ulnar nerve; recording the time taken to reach a TOF ratio of 0.9. Nine assessments were carried out. The mean offset time of atracurium was 82 min. This was significantly longer than in patients with temperatures within the normal physiological range. When considering all assessments, performed both in hypothermic and normothermic patients, there is a strong correlation between rectal temperature and the offset time of atracurium. Prolonged moderate hypothermia has a very significant effect on the offset time of atracurium when given by infusion to critically ill children.
Acute pulmonary haemorrhage in an infant during induction of general anaesthesia
Authors: Tripi Paul A. , Modlin Sheryl , Sorenson W.G. , Dearborn Dorr G.
Published: March 2003

Pulmonary haemorrhage is a rare, life‐threatening complication of anaesthesia. This report describes the anaesthetic management of an infant who developed laryngospasm and pulmonary haemorrhage during general anaesthesia. The infant was subsequently found to have prior exposure to a fungus, Stachybotrys chartarum, which produces mycotoxins that may have produced capillary fragility in the infant's rapidly growing lungs.
Preliminary experience with the Doppler ultrasound guided vascular access needle in paediatric patients
Authors: Macintyre P.A. , Samra G. , Hatch D.J.
Published: March 2003

Percutaneous cannulation of the internal jugular vein (IJV) in infants and children may be technically difficult and can lead to complications. Various techniques exist to achieve successful cannulation and to reduce the rate of complications. We report the use of the Doppler ultrasound guided vascular access needle (the SMART needle) for IJV cannulation in 10 infants and young children (mean age 3.7 months) weighing less than 10 kg (mean weight 5.5 kg) who were to undergo cardiac surgery at Great Ormond Street Hospital for Children. Successful cannulation was achieved in six out of 10 patients with haematoma complicating the procedure in two patients. We believe this is the first reported use of this device for cannulation of the IJV in this patient group.
Paediatric lumbar epidurals: a comparison of 21‐G and 23‐G catheters in patients weighing less than 10 kg
Authors: Sage Frederic J. , Lloyd Thomas Adrian R. , Howard Richard F.
Published: March 2003

Using the database of our pain management team, we examined the records of 254 patients weighing between 4.5 kg and 10 kg who received an epidural for postoperative analgesia. We looked at the incidence of catheter related problems in two groups of patients in whom either a 21‐G (18‐G short Tuohy needle) or a 23‐G catheter (19‐G short Tuohy needle) was used. There was a significantly higher incidence of difficulty in threading the catheter, kinking and occlusion in the 23‐G catheter group. There were more leaks in the 21‐G catheter group but the difference was not significant and both groups had a comparable incidence of clinically relevant leakages. No dural tap or difficulty in using either needle were reported.
Spinal anaesthesia for insertion of a peritoneal dialysis catheter in a neonate
Authors: Mccormick A.S.M. , Thomas V.L.
Published: March 2003

A 5‐day‐old neonate born at term presented in renal failure for insertion of a peritoneal dialysis catheter. This was successfully achieved with spinal anaesthesia, with no intra‐ or postoperative complications. Regional techniques are considered suitable for an increasing variety of procedures in patients in whom the risks of general anaesthesia are significant.
Persistent anaphylactic reaction after induction with thiopentone and cisatracurium
Authors: Briassoulis George , Hatzis Tassos , Mammi Panagoula , Alikatora Anna
Published: March 2003

A 6‐year‐old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 μg·kg−1·min−1 was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE‐mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed.
Management of tracheal agenesis
Authors: De José María B. , Drudis R. , Monclús E. , Silva A. , Santander S. , Cusí V.
Published: March 2003

Complete tracheal agenesis is a very rare congenital anomaly that is only compatible with life in some cases with associated tracheo‐oesophageal or broncho‐oesophageal fistula. In most cases, concomitant congenital anomalies of the heart, digestive tract or genitourinary tract are present. It should be suspected in any neonate with a history of hydramnios, absent crying, respiratory distress and difficulty in intubation. The possibility for surgical correction or palliation rests on the extent of atresia present. We present a case of complete tracheal agenesis without tracheo nor broncho‐oesophageal fistula (type II by Floyd’s classification) – the diagnosis of which was prenatally suspected – and discuss the important features of the airway management of this condition.
The topics of international publications on paediatric anaesthesia from 1993 to 1998
Authors: Brambrink Ansgar M. , Ehrler Dirk , Dick Wolfgang F.
Published: March 2003

A comprehensive compilation of the current international literature on paediatric anaesthesia is still lacking. It was the aim of this study to identify all publications with a focus on paediatric anaesthesia, and to determine the spectrum of topics, as well as the publication type and language for the period between 1993 and 1998. All articles published in 12 major anaesthesia journals were evaluated and, additionally, a computerized, Internet‐based Medline‐search was performed using selected keywords. The analysis was limited to original articles, case reports, reviews and editorials. For the period between 1993 and 1998, a total of 2259 (377 per year) publications on paediatric anaesthesia were identified in 295 different journals, the majority of which were on the topic of ‘providing anaesthesia’ in children (n=1424, 63.0%). In contrast, publications on, for example, ‘postanaesthesia care’ (6.3%), and ‘organizational aspects of paediatric anaesthesia’ (2.2%) were rare. Most articles were written in English (85.1%), and more than 50% reported original data (57.1%). Our results suggest that several topics may be of interest for future research and communication in the field of paediatric anaesthesia and new results should be published in English to reach a large international readership.
Inadvertent administration of intravenous ropivacaine in a child
Authors: Thong Weng Y. , Pajel Victoria , Khalil Samia N.
Published: March 2003

Following abdominal surgery with inhalation anaesthesia and epidural ropivacaine analgesia, inadvertent intravenous (i.v.) administration of ropivacaine occurred in a 1‐year‐old boy. The child spent 75 min in the postanaesthesia care unit and was transferred to the paediatric intensive care unit. Two hours after transfer, it was noted that the epidural tubing was connected to the peripheral i.v. line. The child remained awake, vital signs were stable, and his oxygen saturation ranged from 96–98% on room air. The epidural catheter was removed. He did not require further pain relief for the next 10 h.
Regional anaesthesia decreases the need for postoperative mechanical ventilation in very low birth weight infants undergoing herniorrhaphy
Authors: Huang Jeffrey Jianhong , Hirshberg Gary
Published: March 2003

Background: We were interested to know whether regional anaesthesia allowed improved respiratory function postoperatively in very low birth weight babies.

Methods: We performed a retrospective study to examine the association between regional anaesthesia and postoperative ventilation after herniorrhaphy in very low birth weight infants. Thirty‐four prematurely born infants underwent herniorrhaphy from 1995 to 1997 at St Louis Children Hospital. Eighteen patients had general anaesthesia, 16 had regional anaesthesia. The mean gestational age was 26 weeks, mean postconceptual age at surgery was 38 weeks, mean birth weight was 860 g.

Results: There was significant difference in postoperative ventilation support requirements between the two study groups (7/18 versus 1/16, P < 0.05).

Conclusions: Regional anaesthesia decreases the need for postoperative ventilatory support requirements in very low birth weight infants undergoing herniorrhaphy.
The slipping rib syndrome in children
Authors: Saltzman Daniel A. , Schmitz Michael L. , Smith Samuel D. , Wagner Charles W. , Jackson Richard J. , Harp Susan
Published: March 2003

The slipping rib syndrome is an infrequent cause of thoracic and upper abdominal pain and is thought to arise from the inadequacy or rupture of the interchondral fibrous attachments of the anterior ribs. This disruption allows the costal cartilage tips to sublux, impinging on the intercostal nerves. Children with this entity are seldom described in the literature. We present a retrospective review of 12 children and young adults with slipping rib syndrome and a systematic approach for evaluation and treatment.
The use of the cuffed oropharyngeal airway in paediatric patients
Authors: BUSSOLIN L , BUSONI P
Published: March 2003

Background: The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suitable for anaesthetized adult patients undergoing either spontaneous or mechanical ventilation. There are few reports on the use of the COPA in children. In this study, the authors assessed the COPA in paediatric patients undergoing minor surgery.

Methods: The same anaesthesiologist inserted the COPA in 40 consecutive paediatric patients, ASA I and II, aged 1.8–15.3 years. (7.4 ± 3.9), after induction of anaesthesia with N2O/O2/sevoflurane. COPA size was chosen by measuring the distal tip of the device at the angle of the jaw with the COPA perpendicular to the patient's bed. The proper positioning of the COPA was assessed by observing thoracoabdominal movements, regular capnograph trace, the reservoir bag movements and SpO2 > 94% with a fraction of inspired oxygen of 0.5. Anaesthesia was maintained with 1 MAC halothane, sevoflurane, or isoflurane in N2O/O2 (50%) and the patients were spontaneously breathing. The stability of the COPA following changes in head, neck and body position was tested. We recorded the duration time for COPA insertion, the side‐effects of placement of the COPA and during the intraoperative period, the number of attempts, the type of manipulation in order to provide an effective airway and postoperative symptoms, such as the presence of blood on the device, sore throat, neckache, jaw pain and PONV.

Results: Successful COPA insertion at the first attempt was 90% and at the second attempt in the remaining 10%. The most frequent airway manipulations were head tilt in 27.5% (obtained by a pillow under shoulders) and chin lift in 5%. No complications both at COPA placement nor during the intraoperative period were observed. On the basis of weight and age, the COPA size was no. 8 in 50%, no. 9 in 30%, no. 10 in 12.5%, and no. 11 in 7.5%. The COPA demonstrated stability after changes in head, neck and body position. Postoperative complications were the presence of blood stains in one case and PONV in six cases (15%).

Conclusions: The COPA is an extratracheal airway device suitable in paediatric patients undergoing general anaesthesia with spontaneous ventilation for minor surgery and other painful procedures. This study shows that for paediatric patients: (i) complications seem to be rare; (ii) the COPA allows hands free anaesthesia; (iii) specific indication for the COPA could be obese patients with a small mouth; and (iv) COPA sizing can be easily established by the weight or age of the patients.
Diffusion of ketoprofen into the cerebrospinal fluid of young children
Authors: KOKKI HANNU , KARVINEN MARKO , JEKUNEN ANTTI
Published: March 2003

Background: The objective was to examine whether or not ketoprofen enters the cerebrospinal fluid after a single oral dose of 1 mg·kg–1 syrup, and to find out what is the lowest plasma concentration that will achieve a measurable level in the cerebrospinal fluid.

Methods: We measured ketoprofen concentrations both in plasma and cerebrospinal fluid of 10 young and healthy children (aged 9–86 months) after surgery with spinal anaesthesia. Samples of cerebrospinal fluid were collected 30 min after drug administration, at the same time as venous blood samples. A validated high‐performance liquid chromatography method with a lower limit of 0.02 μg·ml–1 was used to detect ketoprofen concentrations in cerebrospinal fluid and plasma.

Results: Ketoprofen was detectable in the cerebrospinal fluid only in the child who had the highest plasma concentration, 7.4 μg·ml–1, while at plasma concentrations 6.5 μg·ml–1 or less, cerebrospinal fluid (CSF) concentrations remained unmeasurable. The detected CSF/plasma ratio was 0.008.

Conclusions: These results indicate that ketoprofen at a dose of 1 mg·kg–1 is too low to produce measurable CSF levels within 30 min of oral administration.
Retracted: Preoperative oral granisetron for the prevention of vomiting following paediatric surgery
Authors: Fujii Yoshitaka , Tanaka Hiritoshi
Published: March 2003

Background: We evaluated the efficacy of granisetron, 5‐hydroxytryptamine type 3 receptor antagonist, given orally, preoperatively, for the prevention of postoperative vomiting in children undergoing general anaesthesia for surgery (inguinal hernia, phimosis‐circumcision).

Methods: In a randomized, double‐blinded manner, 100 children, ASA physical status I, aged 4–11 years, received orally placebo or granisetron at three different doses (20 μg·kg–1, 40 μg·kg–1, 80 μg·kg–1) 60 min before surgery (n=25 of each). The same standard general anaesthetic technique was used.

Results: The percentage of patients being emesis‐free during 0–6 h after anaesthesia was 56% with placebo, 64% with graniseron 20 μg·kg–1 (P=0.773), 88% with granisetron 40 μg·kg–1 (P=0.027) and 92% with granisetron 80 μg·kg–1 (P=0.01); the corresponding rate during 6–24 h after anaesthesia was 60%, 68% (P=0.768), 92% (P=0.02) and 92% (P=0.02) (P‐values versus placebo). No clinically serious adverse events were observed in any of the groups.

Conclusions: In summary, preoperative oral granisetron 40 μg·kg–1 is effective for the prevention of vomiting following paediatric surgery (inguinal hernia, phimosis‐circumcision). Increasing the doses to 80 μg·kg–1 provides no demonstrable additional benefit.
Time‐course of action of rocuronium 0.3 mg·kg−1 in children with and without endstage renal failure
Authors: Driessen Jacques J. , Robertson Eric N. , Van Egmond Jan , Booij Leo H.D.J.
Published: March 2003

Background: The time‐course of the neuromuscular effects of rocuronium 0.3 mg·kg−1 during nitrous oxide‐halothane anaesthesia in children with and without renal failure is unknown. This study compared the neuromuscular blocking effects in these groups.

Methods: The study was approved by the Hospital Ethical Committee. In the control group, 14 healthy children without renal disease were scheduled for various elective surgical procedures. Sixteen children with endstage renal failure, 14 of whom were already on renal dialysis, were scheduled for (re)placement of dialysis catheters (n=14) or for renal transplantation (n=2). Anaesthesia was induced and maintained with halothane and nitrous oxide in oxygen. Acceleromyographic thumb adduction after supramaximal ulnar nerve stimulation was recorded using train‐of‐four stimulation every 15 s. The onset time, the time to recovery of the first twitch to 25% or 75% and to recovery of a train‐of‐four ratio of 0.7 after rocuronium 0.3 mg·kg−1 were measured. Statistical analysis was performed with Student's t‐test. P < 0.05 was considered statistically significant.

Results: The onset time was longer in children with renal failure (139 s, SD=71) than in control children (87 s, SD=43) (P=0.02). There were no significant differences in the duration of action of rocuronium between children without renal failure and in 15 out of 16 children with renal failure.

Conclusions: In children with renal failure, aged over 1 year, a single bolus dose of rocuronium 0.3 mg·kg−1 does not cause a prolonged block, but has a slower onset than in healthy children.
Detection of peripherally inserted central catheter occlusion by in‐line pressure monitoring
Authors: Arai Junichi , Mouri Youko , Miyamoto Yasuyuki
Published: March 2003

SummaryBackground: Peripherally inserted central catheters (PICC) are being increasingly used in neonatal practice. Their use is not without technical difficulty. This report describes the use of continuous pressure monitoring to detect catheter occlusion in critically ill neonates.

Methods: In‐line venous pressure of the PICC line was monitored by pressure transducer in neonates; 28‐gauge 20 cm PICC or 29‐gauge 25 cm PICC were used.

Results: In‐line pressure of the PICC was monitored 64 times in 50 neonates. Increases in the in‐line pressure were observed when the catheter tip was against the vessel wall and the catheter was obstructed partially or completely. Decreases were observed when the infusion syringe was changed and when an inappropriate infusion rate was set. Two infants experienced marked variations of blood pressure due to intermittent catheter occlusion of the tip against the vessel wall. These infants were receiving dopamine via a PICC line.

Conclusions: In critically ill infants, in‐line pressure monitoring of the PICC is helpful in detecting the occlusion of the catheter.
Jet ventilation for anterior paediatric scoliosis surgery
Authors: Hübner Bernard L. , Anderson Brian J. , Stuart Catherine , Janssens Maurice M.L.
Published: March 2003

Summary Single‐lung anaesthesia for thoracotomy is usually achieved with endobronchial intubation, a double‐lumen tube or an endobronchial blocker. High‐frequency jet ventilation (HFJV) is seldom described for thoracotomy in children, although it is used for both laryngology procedures in the operating room and as a ventilation mode in intensive care. HFJV was used in three children, aged 10–12 years, who presented for scoliosis correction involving thoracotomy. The jet ventilation catheter was passed through a tracheal tube to reduce the risk of outflow obstruction and allow a smooth conversion to intermittent positive‐pressure ventilation when required. Mean airway pressures measured at the tip of the HFJV catheter were at or below 4 cmH2O. Surgical opening of the nondependent lung pleura resulted in sufficient collapse of the pulmonary parenchyma with the patient in the lateral decubitus position for the surgical procedure. Arterial blood gas analyses performed during thoracotomy were within normal limits, with no CO2 retention. HFJV is an alternative ventilation strategy for thoracotomy in children because of its unique ability to deliver small tidal volumes at low mean airway pressures via a narrow catheter.
Life threatening tension pneumoperitoneum from intestinal perforation during air reduction of intussusception
Authors: Ng E. , Kim H.B. , Lillehei C.W. , Seefelder C.
Published: March 2003

Summary We present a case report of a child with intussusception who underwent air reduction which was complicated by bowel perforation. Life threatening tension pneumoperitoneum developed rapidly and immediate needle decompression was life saving in this case. The pathophysiology of hyperacute abdominal compartment syndrome is discussed.
Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach
Authors: Fleischmann E. , Marhofer P. , Greher M. , Waltl B. , Sitzwohl C. , Kapral S.
Published: March 2003

Summary Background: Brachial plexus blockade is a well‐established technique in upper‐limb surgery. In paediatric patients, the axillary route is usually preferred to infraclavicular approaches because of safety considerations. Recent reports on a lateral infraclavicular approach offering greater safety in adults prompted us to perform a prospective randomized study to assess the analgesic efficacy of axillary vs lateral vertical infraclavicular brachial plexus (LVIBP) blocks in paediatric trauma surgery.

Methods: Forty paediatric trauma patients (ASA physical status I and II, age range 1–10 years) scheduled for forearm or hand surgery were randomly assigned to either axillary brachial plexus (ABP group) or LVIBP group blocks using 0.5 ml·kg−1 ropivacaine 0.5%. Sensory blockade was evaluated by a visual analogue score and Vester–Andersen's criteria, the distribution of sensory and motor blockade was evaluated by a simplified pinprick test and motor tests.

Results: In the LVIBP group, Vester–Andersen's criteria were met by 100% of children, compared with 80% in the ABP group (P=0.035). Based on all assessable children, sensory blockade in the primary sensory regions of various nerves was significantly more effective in the LVIBP group (axillary: P < 0.0001; musculocutaneous: P=0.002; medial brachial cutaneous; P=0.008). Motor blockade was also significantly more effective (axillary: P < 0.0001; musculocutaneous: P=0.003). No major complications were observed in either group.

Discussion: We conclude that LVIBP blocks can be safely performed in children and that they add to the spectrum of sensory and motor blockade seen with the axillary approach.
Pectinate ligament dysplasia (PLD) and glaucoma in Flat Coated Retrievers. I. Objectives, technique and results of a PLD survey
Authors: Read R.A. , Wood J.L.N. , Lakhani K.H.
Published: March 2003

Pectinate ligament dysplasia (PLD) in dogs is a congenital ocular abnormality affecting the iridocorneal angle, the presence of which may be associated with adult‐onset primary glaucoma. This paper describes the objectives, methods and results of a survey of PLD in Flat Coated Retrievers in the UK, including the technique used for gonioscopic assessment of the degree of PLD. In a random sample of 389 Flat Coated Retrievers, 34.7% were found to have a degree of PLD. In a ‘target’ sample of 48 Flat Coated Retrievers (close relatives of dogs from the random sample with high degrees of PLD, or dogs presented with primary glaucoma), 83.3% were found to have a degree of PLD. The percentage of animals with a degree of PLD was only 6.0% in a ‘control’ sample of 100 dogs from other breeds. The relationship between PLD and canine glaucoma is discussed.