bluuebunny/crossref_metadata_2025 huggingface dataset:
CASE REPORT: Adenocarcinoma arising in a Crohn’s stricture of the jejunum
Authors: Barwood Nigel , Platell Cameron
Published: March 2003

Patients with Crohn’s disease affecting the small intestine appear to have an increased risk of developing adenocarcinoma. However, it remains an uncommon complication of an uncommon disease. The diagnosis is difficult to make both pre‐ and intra‐operatively, and is most commonly made postoperatively on histopathology. Hence, at laparotomy, consideration should be given to performing a frozen section on all small bowel strictures due to Crohn’s disease to define the presence of dysplasia or cancer. This will assist the surgeon in deciding whether to perform a stricturoplasty or a resection.

© 1999 Blackwell Science Asia Pty Ltd
Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome
Authors: Nicholson Fiona B , Korman Melvyn G , Richardson Maureen A
Published: March 2003

Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective method of feeding via the stomach in situations where oral intake is not possible. Its simplicity has led to its potential use in areas of dubious clinical benefit. Our unit has faced a major increase in referrals for PEG insertion over the last 2 years. For this reason we decided to audit our PEG insertion procedures with regard to indications, complications, outcome and follow up. We studied 168 patients who had an initial PEG insertion during the period 1 February 1996–31 January 1998. The medical records of these patients were reviewed with regard to the procedure, antibiotic use and complications. All patients (or carers or next of kin) were contacted by telephone to provide details regarding late complications and follow up. There were 87 females and 81 males (aged 16–98 years, median age 70 years). At 2 years, 67% were alive. The most frequent indication for PEG insertion was a neurological condition, the commonest being stroke. Most patients received either ticarcillin/clavulanic acid or cephazolin antibiotic prophylaxis before and after the procedure. In six patients (3.6%) infection at the PEG site required intravenous antibiotics. Four of these six patients did not have antibiotic prophylaxis. Only two deaths could be directly related to the procedure. Three died within 7 days of the procedure due to unrelated medical complications. Sixteen patients died within 1 month, the majority of these patients did not leave hospital. One‐fifth of the patients (35/168) had their PEG removed due to the reestablishment of oral feeding, with median time of use, 4.3 months. It is a safe, effective feeding method in the elderly, but experience with case selection, the procedure and careful follow up remain essential. The use of prophylactic antibiotics resulted in few significant infections of the PEG site. Up to one‐fifth of patients will require their PEG only for a short term.
Autoimmune cholangitis with features of autoimmune hepatitis: Successful treatment with immunosuppressive agents and ursodeoxycholic acid
Authors: Li Chung‐Pin , Tong Myron J , Hwang Shinn‐Jang , Luo Jiing‐Chyuan , Co Ruth L , Tsay Shyh‐Haw , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

We report a 42‐year‐old Chinese female with elevated serum levels of liver aminotransferases, alkaline phosphatase, γ‐glutamyl transpeptidase, cholesterol and immunoglobulin M. Serum antimitochondrial antibody was negative, but antinuclear antibody was strongly positive. Liver histology showed features of both autoimmune cholangitis and autoimmune hepatitis. Combination therapy with immunosuppressive (prednisone and azathioprine) and choleuretic agents (ursodeoxycholic acid) was given. Serum aminotransferases and biliary enzymes showed much improvement after treatment. A follow‐up liver biopsy showed improvement of both hepatic necroinflammation and bile duct damage. Biliary enzymes rose after withdrawal of the immunosuppressive agents and declined again with reinstitution of prednisone. This case demonstrates that a combination of immunosuppressive agents and ursodeoxycholic acid may effectively treat patients with features of both autoimmune cholangitis and autoimmune hepatitis.
K‐ras codon 12 mutations in Barrett’s oesophagus and adenocarcinomas of the oesophagus and oesophagogastric junction
Authors: Lord Reginald Vn , O’Grady Roslynn , Sheehan Catherine , Field Andrew F , Ward Robyn L
Published: March 2003

Background
: Activation of the ras oncogene is commonly found in gastrointestinal tract cancers, but the role of ras in the development and progression of Barrett’s oesophagus and associated cancers is uncertain.

Methods
: The frequency of K‐ras codon 12 point mutations was assessed in 52 paraffin‐embedded tissues from 44 patients with oesophageal pathology. The specimens were classified pathologically as follows: adenocarcinoma of the oesophagus or oesophagogastric junction (n = 23), Barrett’s high‐grade dysplasia (n = 5), low‐grade dysplasia (n = 14), intestinal metaplasia (n = 4), normal oesophagus (n = 5) or normal stomach (n = 1). DNA was extracted from three consecutive sections of each paraffin block and mutations at bases 1 and 2 of K‐ras codon 12 were identified using a novel restriction endonuclease‐mediated selective polymerase chain reaction method.

Results
: Mutations were found in 7 of 23 (30.4%) adenocarcinomas and in 2 of 5 (40%) high‐grade dysplasia specimens. No mutations were found in specimens of low‐grade dysplasia, intestinal metaplasia without dysplasia, or normal oesophagus and stomach. There were no significant associations between the presence of mutations and clinicopathologic features in the patients with cancer. One patient who progressed from low‐grade to high‐grade dysplasia was found to have developed mutant K‐ras in the course of this transformation.

Conclusion
: These results suggest that K‐ras codon 12 mutations may occur frequently in patients with Barrett’s oesophagus with high‐grade dysplasia or adenocarcinoma of the oesophagus or oesophagogastric junction. K‐ras mutation may be a late event in the Barrett’s metaplasia–dysplasia– adenocarcinoma sequence.
Recurrence of biliary symptoms after endoscopic sphincterotomy for choledocholithiasis in patients with gall bladder stones
Authors: Yi Sun Young
Published: March 2003

Background
: There are a few reports regarding the long‐term results of endoscopic sphincterotomy (EST). However, little data is available on the recurrence of biliary symptoms after EST for choledocholithiasis, in patients with gall bladder stones.

Methods
: All patients had gall bladder and common bile duct stones (n = 60; age 32–84 years, median age 55 years), and had received an EST. One group of these patients had a laparoscopic or open cholecystecomy (n = 39; group A), while the other group did not (n = 21; group B). The follow‐up period ranged from 5 to 54 months (average 22 months).

Results
: Complications included the recurrence of common bile duct stones, recurrent acute cholecystitis, postoperative bile leakage and papillary stenosis. Nine patients (15%) had a recurrence of biliary symptoms. Two significant prognostic factors for the recurrence of biliary symptoms were identified by multivariate analysis; namely an intact gall bladder and a dilated common bile duct. The recurrence rate of biliary symptoms in group B was 20.4%, while in group A it was 10.3% (P < 0.01). Patients with a larger than average common bile duct diameter (mean diameter 14 mm) were more prone to the recurrence of symptoms than those with a smaller common bile duct diameter (mean diameter 10 mm, P < 0.016). The hospital stay period was 8.9 ± 3.1 days in group A and 2.8 ± 1.9 days in group B (P < 0.01).

Conclusions
: Biliary symptom recurrence occurred in a considerable proportion of patients after EST for the treatment of choledocholithiasis, in patients with gall bladder stones. The prognostic factors associated with the recurrence of biliary symptoms were an intact gall bladder and a dilated common bile duct diameter. Regardless of their short stay in hospital, non‐cholecystectomy patients had a higher rate of recurrent biliary symptoms than cholecystectomy patients.
Serum amino‐terminal propeptide of type III procollagen and 7S domain of type IV collagen correlate with hepatic iron concentration in patients with chronic hepatitis C following α‐interferon therapy
Authors: Shimizu Ichiro , Omoya Toshihiro , Takaoka Tukasa , Wada Satoshi , Wada Hisanori , Taoka Masayo , Hayashi Hideki , Hayashi Shigehito , Honda Hirohito , Sano Nobuya , Ito Susumu
Published: March 2003

Background: It has been reported that chronic infection with hepatitis C virus is associated with excess iron deposits in the liver of subjects who are neither alcoholics nor recipients of blood transfusions. However, little is known about the relationship between hepatic iron concentration (HIC) and the serum levels of hepatic fibrogenesis markers, which were caused by interferon therapy for chronic hepatitis C. Therefore, changes in the serum amino‐terminal propeptide of type III procollagen (P‐III‐P) and the 7S domain of type IV collagen (7S‐IV) in 16 patients treated with α‐interferon (IFN‐α) were studied, and their HIC and histological assessment evaluated. Hepatic iron concentrations were measured by using liver biopsy specimens obtained before and 6 months after the cessation of treatment.

Methods and Results: Eight subjects (50%) who had normal alanine transaminase levels at 6 months after therapy showed significantly lowered HIC, and attenuated hepatic iron staining with decreased serum levels of P‐III‐P and 7S‐IV compared to the remaining subjects. The HIC was significantly correlated with the serum levels of P‐III‐P and 7S‐IV in all subjects.

Conclusions: These findings suggest that IFN‐α treatment may decrease stimuli for fibrogenesis, at least in part, by reducing the hepatic iron deposition in patients with chronic hepatitis C.
Isocitrate dehydrogenase as a marker of centrilobular hepatic necrosis in the experimental model of rats1
Authors: Chung Young‐Hwa , Kim Jeong A , Song Byung‐Cheol , Song Il Han , Koh Moon Soo , Lee Han Chu , Yu Eunsil , Lee Yung Sang , Suh Dong Jin
Published: March 2003

Background and Aims: Serum alanine aminotransferase (ALT) and aspartate aminotransferase may not detect centrilobular hepatic necrosis (CLN) of a mild degree because these enzymes are known to be located predominantly in the periportal area. The aim of this study was to evaluate the usefulness of plasma isocitrate dehydrogenase (ICDH), which is located predominantly in the centrilobular zone, as a marker of CLN.

Methods: In 56 adult male rats, centrilobular (n = 21) and periportal hepatic necrosis (PPN; n = 21) were induced experimentally by the intraperitoneal injection of bromobenzene and allylalcohol, respectively. Seven rats were used as solvent controls in both groups. Isocitrate dehydrogenase and ALT activities were measured in the plasma of rats with mild to moderate hepatic necrosis (17 CLN and 19 PPN). Isocitrate dehydrogenase and ALT were compared according to the sampling time (12, 24 and 48 h) and the location of hepatic necrosis. Ratios of ICDH/ALT were also calculated and compared between CLN and PPN groups at any time points.

Results: Plasma ICDH activities were higher in rats with CLN than in those with PPN. In contrast, plasma ALT levels were higher in rats with PPN than in those with CLN at 12 h and were similar in both groups after 12 h. The ICDH/ALT ratios were much higher in rats with CLN compared to those with PPN (P < 0.001). The ratios were above 1.0 in 13 of 17 rats (77%) with CLN in contrast to none of the 19 rats with PPN.

Conclusions: Our data suggested that the plasma ICDH/ALT ratio might be useful to differentiate between mild to moderate degrees of CLN from PPN, at least in the experimental model of rats.
Efficacy of treatment with chimeric monoclonal antibody (Infliximab) to tumor necrosis factor‐α for Crohn's disease in Japan: Evaluation by rapid turnover proteins, and radiologic and endoscopic findings
Authors: Asakura Hitoshi , Yao Tsuneyoshi , Matsui Toshiyuki , Koganei Kazutaka , Fukushima Tsuneo , Takazoe Masakazu , Hobara Reiko , Nakano Hiroshi , Okamura Shouzou , Matsueda Kei , Kashida Hiroshi , Makiyama Kazuya , Hiwatashi Nobuo , Kashiwagi Kazuhiro , Hibi Toshifumi
Published: March 2003

Background: Several studies have reported that the chimeric monoclonal antibody to tumor necrosis factor (TNF)‐α (Infliximab) is extremely valuable in the treatment of Crohn's disease. The aim of this study was to clarify the efficacy of this treatment in Japanese patients with Crohn's disease.

Methods: A 12‐week multicenter, open trial of Infliximab was carried out and involved 25 patients with moderate to severe Crohn's disease who were resistant to conventional treatment. Patients received a single 2‐h intravenous infusion of Infliximab at a dose of 1, 3, 5 or 10 mg/kg bodyweight. Clinical evaluation of this treatment response was defined as a reduction in the index of the inflammatory bowel disease (IOIBD) and of the Crohn's disease activity index scores (CDAI), and in serum levels of C‐reactive protein (CRP) at 2, 4, 8 and 12 weeks, and as an increase in serum levels of rapid turnover proteins as well as improvement of radiologic and endoscopic findings at 4 weeks.

Results: The IOIBD score was reduced after 4 weeks in 66.7% of the group receiving 1 mg/kg Infliximab, 71.4% in the group receiving 3 mg/kg, 80.0% in the group receiving 5 mg/kg, and 85.7% in the group receiving 10 mg/kg. Improvement was better maintained over 12 weeks in the 5 and 10 mg/kg groups compared with the 1 and 3 mg/kg groups. Similar results were obtained for the CDAI scores. Serum levels of rapid turnover proteins significantly increased to within the normal ranges after infusion in all groups. Seven of the 11 (63.6%) patients evaluated showed improvement of radiologic and endoscopic findings.

Conclusions: A single infusion of Infliximab was effective for the treatment of Japanese patients with Crohn's disease. Serum rapid turnover proteins reflected the clinical response to antibody for TNF‐α well.
Effect of endotoxin pretreatment on hepatic stellate cell response to ethanol and acetaldehyde
Authors: Quiroz Silvia C , Bucio Leticia , Souza Verónica , Hernández Elizabeth , González Elvira , GÓmez‐Quiroz Luis , Kershenobich David , Vargas‐Vorackova Florencia , Gutiérrez‐Ruiz MA. Concepción
Published: March 2003

Background and Aim:

The role of endotoxin in alcohol‐induced liver damage is well recognized. How pre‐exposure to endotoxin might affect alcohol injury is not known. We herein studied the effect of endotoxin pretreatment on hepatic stellate cell (HSC) response to ethanol and acetaldehyde.

Methods:

Rat HSC (CFSC‐2G) were exposed to media supplemented with 1 μg/mL lipopolysaccharide (LPS). This was followed by a 24 h exposure to media containing LPS plus 50 mmol/L ethanol or 175 μmol/L acetaldehyde. Lipid peroxidation, collagen, and tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6 and transforming growth factor (TGF)‐β1 secretion were determined at the end of both periods of exposure.

Results:

Lipopolysaccharide pretreatment did not modify lipid peroxidation induced by ethanol or acetaldehyde alone. Glutathione (GSH) content decreased to 4.2 ± 0.5 and 16.3 ± 0.8 nmol protein after exposure to ethanol or acetaldehyde alone, and decreased further with LPS pretreatment (2.4 ± 0.2 and 2.7 ± 0.3 nmol/mg protein, respectively). Oxidized GSH (GSSG) content increased in ethanol and acetaldehyde LPS‐pretreated cells only. Collagen secretion increased to 988 ± 82 and 1169 ± 91 μg/106 cells after exposure to acetaldehyde or LPS alone. Lipopolysaccharide pretreatment enhanced collagen secretion significantly in both ethanol‐ and acetaldehyde‐treated cells (969 ± 56 and 1360 ± 72 μg/106 cells, respectively). Interleukin‐6 production increased to 288 ± 48, 1195 ± 86 and 247 ± 35 pg/mL per 106 cells after ethanol, acetaldehyde and LPS exposure, and increased further with LPS pretreatment in ethanol‐exposed cells (680 ± 23 pg/mL 106 cells).

Conclusion:

Lipopolysaccharide pretreatment of HSC adds to the damage produced by ethanol and acetaldehyde by diminishing GSH content and increasing GSSG content, collagen and IL‐6 secretion.
Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization1
Authors: LEE JAE KYUN , CHUNG YOUNG‐HWA , SONG BYUNG‐CHEOL , SHIN JUNG WOO , CHOI WON‐BEOM , YANG SOO HYUN , YOON HYUN‐KI , SUNG KYU‐BO , LEE YUNG SANG , SUH DONG JIN
Published: March 2003

Background and Aims: The aim of this study was: (i) to define the characteristics of hepatocellular carcinoma (HCC) associated with recurrences following initial remission by transcatheter arterial chemoembolization (TACE); (ii) to evaluate the patterns of recurrences; and (iii) find a better surveillance method of detecting recurrent HCC.

Methods: Out of 230 consecutive HCC patients who underwent TACE, 77 with initial remission were followed prospectively for at least 12 months. We compared the recurrence rates according to the characteristics of the tumors and analyzed the locations of the recurrent HCC. The diagnostic efficacies of CT scans with serum AFP, angiography and Lipiodol CT scan in detecting recurrent HCC were also evaluated.

Results: Recurrent HCC was detected in 40 patients during a median period of 27 months. The recurrence rate of multinodular HCC was higher than the single nodular type. All six patients with portal vein thrombosis recurred. Even though 45% of recurrences were adjacent to original tumors, 63% were separated from them (8% at both). Hepatocellular carcinoma with heterogeneous Lipiodol uptake tended to recur at the site adjacent to the original tumors more frequently than HCC with homogeneous Lipiodol uptake. Only 18 of 40 recurrent HCC were initially detected by serum α‐fetoprotein (AFP) and CT scans: 19 by angiography and three only by Lipiodol CT scan.

Conclusion: Our data indicated that HCC of the multinodular type and with portal vein thrombosis recur more frequently following initial remission by TACE. It is also suggested that regular angiography in addition to serum AFP and CT scan may be valuable in detecting recurrent HCC. Other treatment modalities may need to be combined to ablate tumors completely and to therefore reduce recurrences, especially in HCC with heterogeneous Lipiodol uptake.
Transplantation for cystic fibrosis: Outcome following early liver transplantation
Authors: MILKIEWICZ PIOTR , SKIBA GRZEGORZ , KELLY DEIRDRE , WELLER PETER , BONSER ROBERT , GUR UFUK , MIRZA DARIUS , BUCKELS JOHN , STABLEFORTH DAVID , ELIAS ELWYN
Published: March 2003

Background and Aim Life expectancy in patients with cystic fibrosis (CF) has recently improved due to numerous factors, including a multidisciplinary approach to their management. Prolonged survival may have led to an increasing impact of liver disease on the prognosis of CF patients. The aim of this study was to assess the role of liver transplantation in patients with CF.

Methods The factors influencing outcome in 24 patients (15 adults and nine children) with CF who have received single liver transplantation, triple heart‐lung‐liver transplantation (tx) or died while being assessed for triple grafting, were analyzed.

Results Median age at tx in single liver recipients (13 years) was lower than in triple graft recipients (21 years) and those who died (23 years). All patients who received single liver tx made an excellent recovery, including significant improvement of their respiratory function (mean forced vital capacity (FVC) increased from 61% before transplantation to 82% of expected, 6–9 months after tx). Four out of five patients who received triple tx died (0–2 months) after operation. On the basis of our retrospective review, we propose modifications to an existing scoring system for liver tx assessment in CF by scoring additional points for elevated white blood count, bilirubin, and impaired pulmonary function. These changes will need to be evaluated prospectively to confirm their predictive value.

Conclusions Liver transplantation is effective therapy in young patients with cystic fibrosis, portal hypertension and hepatic dysfunction, and is indicated before a critical stage of deteriorating lung function is reached. In patients with both end‐stage liver and lung disease, triple tx has a poor prognosis. Pre‐emptive liver tx in younger patients with CF not only has a better outcome but improves lung function.
Correlation between serum levels of interleukin‐6 and vascular endothelial growth factor in gastric carcinoma
Authors: Huang Shih‐Pei , Wu Ming‐Shiang , Wang Hsiu‐Po , Yang Chang‐Shiu , Kuo Min‐Liang , Lin Jaw‐Town
Published: March 2003

Background and Aim:
Vascular endothelial growth factor (VEGF) and interleukin‐6 (IL‐6) are associated with the disease status of gastric carcinoma. However, their relationship remains unclear. This study aims to determine and correlate serum levels of VEGF and IL‐6 in gastric carcinoma.

Methods:
A total of 107 patients receiving gastrectomy entered this study. Serum levels of VEGF and IL‐6 were measured by using ELISA, and were analyzed by using the Student's t‐test to compare means and by Pearson correlation analysis to calculate correlation coefficients with respect to pathological characteristics including depth of tumor invasion, Laurén's classification, tumor location, Borrmann classification, and the status of lymph node metastasis.

Results:
Serum VEGF levels were significantly higher in patients with mixed type carcinoma (387.5 ± 176.9 vs 255.3 ± 154.1 pg/mL, P = 0.047) or lymph node metastasis (339.1 ± 205.1 vs 223.2 ± 197.4 pg/mL, P = 0.007). Serum IL‐6 levels were significantly higher in patients with Borrmann type IV carcinoma, compared with Borrmann type II and III carcinoma. In general, no correlation was noted between serum VEGF levels and IL‐6 levels (r = 0.142, P = 0.145), but significant correlation was found in patients with early gastric carcinoma (r = 0.627, P = 0.004) or mixed type carcinoma (r = 0.804, P = 0.016).

Conclusions:
This study supports the correlation between serum VEGF and IL‐6 levels in distinct subsets of gastric carcinoma patients, and indicates that IL‐6 may play a role for the angiogenesis of gastric carcinoma via modulation of VEGF.

© 2002 Blackwell Publishing Asia Pty Ltd
Psychosocial factors and childhood recurrent abdominal pain
Authors: BOEY CHRISTOPHER CHIONG‐MENG , GOH KHEAN‐LEE
Published: March 2003

Abstract
 
Recurrent abdominal pain in children is not a single condition but a description of a wide spectrum of clinical manifestations, some of which fit into a definite pattern, such as the irritable bowel syndrome, while others do not. Organic disorders may be present, but in the majority of children they cannot be detected. Although children with recurrent abdominal pain do not generally have psychological or psychiatric illness, there is a growing body of evidence to suggest that psychosocial stress plays an important role in this condition. This review will look into some of this evidence. The precise pathophysiology that results in abdominal pain is still not clearly understood, but the current belief is that visceral hypersensitivity or hyperalgesia and changes in the brain–gut axis linking the central and enteric nervous systems are important mechanisms.

© 2002 Blackwell Publishing Asia Pty Ltd
Simultaneous occurrence of adenoma, focal nodular hyperplasia, and hemangioma of the liver: Are they derived from a common origin?
Authors: DI CARLO ISIDORO , URRICO GIOVANNI S , URSINO VENERA , RUSSELLO DOMENICO , PULEO STEFANO , LATTERI FERDINANDO
Published: March 2003

Abstract  The association between hepatic hemangioma (HH) and focal nodular hyperplasia (FNH) or the association between FNH and hepatic adenoma (HA) has been reported. The authors report a case in which FNH, HH, and HA simultaneously appear in the liver. A 25‐year‐old woman was admitted to the Department of Surgery of the University of Catania (Italy), after presenting pain in the right hypocondrium. No therapy with oral contraceptives, no pregnancy and no abnormalities of the laboratory tests were found. Ultrasonography and computed tomography scans revealed four masses with the characteristics of HH, HA, FNH, and a hydatid cyst located, respectively, in segments II, IV, IV, and V of the liver. The surgical procedures performed were hemangioma and adenoma enucleation and en bloc resection of the FNH, hydatid cyst and gallbladder. No complications were recorded in the postoperative period and the patient was discharged from the hospital after 1 week. A pathological examination confirmed the preoperative diagnosis. To the best of our knowledge, the association of HH, FNH, and HA has never been reported. A common pathogenesis has clearly been demonstrated for hepatocytes and other cell types. The simultaneous presence of these three different kinds of tumor suggest that HH, FNH and HA could be the different expression of the same malformative anomaly.

© 2003 Blackwell Publishing Asia Pty Ltd
Parent beliefs about infant teething: A survey of Australian parents
Authors: Wake M , Hesketh K , Allen MA
Published: March 2003

Objective: Parents ascribe many infant symptoms to teething, despite little evidence to support such an attribution. We report current parental beliefs about teething and its management in a suburban Australian setting.

Methodology: A written questionnaire was given to all English‐speaking parents consecutively attending infant hearing testing sessions in one Melbourne municipality between August and October 1997. Approximately 90% of Victorian infants attend these sessions.

Results: Parents of 92 infants (mean age 9.9 months) completed questionnaires (97% response rate). Only one believed that teething causes no problems. Most (70–85%) believed that teething causes fever, pain, irritability, sleep disturbance, mouthing/biting, drooling and red cheeks; 35–55% reported nappy rash, ‘sooking’, ear pulling, feeding problems, runny nose, loose stools, and infections; and a few (< 15%) reported smelly urine, constipation, colic or convulsions. Symptoms reported for a parent’s own infant correlated almost perfectly with symptoms believed to be experienced by infants generally (r = 0.97, P < 0.001). Amount of infant distress when teething correlated with more ‘difficult’ infant temperament (r = 0.25, P < 0.05), and longer duration of symptoms per tooth correlated with parent distress (r = 0.26, P < 0.05). Paracetamol (60%) and topical analgesia (55%) were commonly used remedies. Parents diagnose teething more by the presence of ‘teething symptoms’ (65%) than by palpable (43%) or visible (36%) tooth eruption.

Conclusions: Teething is a distressing but ill‐defined phenomenon reported by almost all parents of young children, and most use some form of medication to manage it. Most symptoms are minor and relate to discomfort rather than physical illness, but a substantial minority still ascribes potentially serious symptoms to teething.
Magnetic resonance imaging findings in cerebral palsy
Authors: YIN R , Reddihough DS , Ditchfield MR , Collins KJ
Published: March 2003

Objective: To review all cases of cerebral palsy (CP) that had magnetic resonance imaging (MRI) over a defined period of time.

Methodology: The MRI brain scans of 42 children (12 premature, 30 full‐term) with CP were studied. The scans were performed at the Royal Children’s Hospital, Melbourne, between January 1995 and June 1996.

Results: Abnormalities were found in 39 of the 42 scans. Five children had cortical malformations and three children had white matter hypoplasia, indicating insults during the second trimester of pregnancy. Twenty‐one children had hypoxic–ischaemic lesions (eight premature, 13 full‐term) with patterns of periventricular leucomalacia, subcortical lesions or cortical infarction indicating insults perinatally or in the third trimester. Only 10 children had scans that could not be categorized into these groups.

Conclusions: In this study sample of children with CP, MRI was useful in revealing underlying brain abnormalities, most of which were due to events in the third trimester or the perinatal period.
Rates of breastfeeding in Australia by State and socio‐economic status: Evidence from the 1995 National Health Survey
Authors: Donath S , Amir LH
Published: March 2003

Objective: To estimate rates of breastfeeding in the first year of life in Australia, according to state and socio‐economic status.

Methodology: Analysis of data from the 1995 Australian National Health Survey.

Results: Estimated breastfeeding rates are 81.8% on discharge from hospital, 57.1% fully breastfed at 3 months and 62.6% fully or partially breastfed at 3 months. At 6 months, it is estimated that 18.6% of babies are fully breastfed and 46.2% fully or partially breastfed. At 1 year, 21.2% of infants are receiving some breast milk. Comparison between states demonstrates that there is considerable variation in breastfeeding practice within Australia. Rates of breastfeeding also vary according to the socio‐economic status of the geographic area in which the child is living, with a strong inverse relationship between rates of breastfeeding and socio‐economic status.

Conclusion: Australia’s target for breastfeeding in the year 2000 is to have 80% of babies at least partially breastfed for the first 6 months of life. Although Australia has good rates of initiation of breastfeeding, these levels are not maintained over time, and it seems unlikely that we will reach the year 2000 targets.
Eclecticism in health services for developmental disorders
Authors: McDowell M
Published: March 2003

Abstract: The term ‘eclectic’, as applied to health care for children with developmental disorders, portrays an individualized, adaptive service response to local constraints and pressures. While this may appear appropriate for the local setting, the end result is a broad diversity of health care approaches. This paper discusses three separate processes that interact at a local level, increasing the likelihood of an eclectic local model of health care for this population of children. The first process draws from the direct clinical work. Variable training, knowledge and skills among health care providers, in combination with differing beliefs around the nature of the problems and their management leads to health care which directly reflects the attributes of the local clinicians. A separate, second process fuelling variability is the differing models of departmental responsibility across Australia – which Government departments fund which aspect of care for children with disabilities. The final process relates to funding streams for health care. State public health, federal Medicare and private insurance all support health services for children with disabilities, with the financial incentives (budgets compared to fee‐for‐service) driving a divergence of practice. This paper concludes that the external political, administrative and financial frameworks within which health care is constructed will continue to promote clinical eclecticism to a degree that would probably be considered unacceptable in other areas of child health care. The solution can only arise from within the clinical work itself, with greater clarity of understanding around the nature of the disorders, the outcomes for which health care takes responsibility, and an increasing focus on an evidence based set of approaches towards achieving these.
Children of renal transplant recipient mothers
Authors: Willis F R , Findlay C A , Gorrie M J , Watson M A , Wilkinson A G , Beattie T J
Published: March 2003

Objective: To assess the current physical status and developmental outcome of children born to mothers following renal transplantation.

Methodology: A cross‐sectional prevalence survey of 48 children born to 34 women transplanted at a single centre from 1971 to 1992 was performed. Data on maternal renal disease, immunosuppression, pregnancy, delivery and child development were collected using hospital records and parental questionnaire. Children underwent physical examination, urinalysis and urinary tract ultrasound examination (US).

Results: Maternal renal failure was due to reflux nephropathy/chronic pyelonephritis (16), chronic glomerulonephritis (eight) and other causes (10). All mothers received prednisolone immunosuppression, as sole therapy (one), as part of triple therapy (one). Sixteen (47%) received azathioprine/prednisolone and 16 (47%) cyclosporin/prednisolone. Twenty‐three girls and 25 boys aged 9 months to 18 years were studied (median age 5.2 years); 27/48 (56%) were born prematurely, 21/48 (44%) with birthweight (BW) < 2500 g 21/48 (44%) were small for gestation (BW < 10th centile). General health and physical assessment were unremarkable in 45/48 (94%) and 41/43 (95%), respectively. Development was considered normal in 47/48 (98%). Four of 40 (10%) had urinary tract abnormalities on US.

Conclusions: Despite a high incidence of preterm delivery, low birth weight, intrauterine growth retardation and urinary tract abnormalities, the overall outcome for children of renal transplant recipient mothers is good.
Prevalence of tuberculosis infection among homeless young people in central and eastern Sydney
Authors: Kang M , Alperstein G , Dow A , Van Beek I , Martin C , Bennett D
Published: March 2003

Objective: To determine the prevalence of tuberculosis (TB) infection among homeless young people (aged 12–25 years) in central and eastern Sydney.

Methodology: A cross‐sectional survey was conducted in 16 youth refuges and four drop‐in centres in Central and Eastern Sydney Health Areas and at the Cellblock Youth Health Centre, Glebe and the Kirketon Road Centre, Darlinghurst, New South Wales (NSW). Participants completed a questionnaire and underwent Mantoux testing.

Results: One hundred and forty‐one young people completed questionnaires and 139 received a Mantoux test; 112 (80.6%) had their Mantoux read and 10 (8.9%) were Mantoux positive (95% confidence interval 3.6–14.2). None of the risk factors examined were found to be associated with increased risk for TB infection.

Conclusions: In this sample of homeless young people in central and eastern Sydney, the Mantoux positivity rate appears to be higher than the general population in NSW, but they would not currently be considered a high‐risk group for TB infection.
Plasminogen activator inhibitor type‐1 and interleukin‐6 in haemolytic uraemic syndrome
Authors: Martin Aa , Woolven Bl , Harris Sj , Keeley Sr , Adams Ld , Jureidini Kf , Henning Ph
Published: March 2003

Objective: Because haemolytic uraemic syndrome (HUS) is an important cause of renal dysfunction in children, the availability of prognostic markers of disease severity could assist in identifying those at risk of developing long‐term sequelae. The aim of this study was to test the hypothesis that plasma levels of plasminogen activator inhibitor type‐1 (PAI‐1) and interleukin‐6 (IL‐6) in children at the time of diagnosis of HUS would predict renal function outcome in terms of glomerular filtration rate (GFR).

Methodology: Fourteen children suffering from diarrhoeal HUS were studied. Plasma samples were assayed for PAI‐1 and IL‐6, and GFR was measured at intervals after discharge from hospital. Twelve months following their recovery from HUS, the children were allocated to one of two outcome groups depending on whether GFR was above (Good Outcome, n = 9), or below (Poor Outcome, n = 5) 80 mL/min per 1.73 m
2.

Results: Elevated concentrations of PAI‐1 were found in 4 of 5 Poor Outcome and 4 of 9 Good Outcome children. At the same time, increased concentrations of IL‐6 were observed in 3 of 5 Poor Outcome and 3 of 9 Good Outcome children. Renal function continued to be compromised in four Poor Outcome children 36 months after diagnosis.

Conclusions: Our data show that PAI‐1 and IL‐6 are elevated in the plasma of some children at the time of diagnosis of HUS, but that neither is a definitive prognostic marker of poor outcome 3 years later.
Athetoid quadriplegia and literacy
Authors: Beal S , Zeitz H , Connell T , Zschorn M
Published: March 2003

Objective: To compare literacy levels in athetoid quadriplegic (AQ) patients born in the 1960s and 1970s with those born in the 1980s and 1990s.

Methodology: Nine patients with AQ born between 1966 and 1972 were compared with eight patients born between 1983 and 1991.

Results: Reading difficulties were found in almost all patients with AQ, despite normal intellect. Those in the earlier period were for the most part functionally literate, while those in the later period were functionally illiterate.

Conclusions: Specific and intensive reading education may be required in patients with AQ to obtain functional literacy.
Breastfeeding failure in a longitudinal post‐partum maternal nutrition study in Hong Kong
Authors: Chan Sm , Nelson Eas , Leung Ssf , Li Cy
Published: March 2003

Objective: To describe factors associated with breastfeeding failure during the first 6 months post‐partum in a sample of Hong Kong Chinese women participating in a longitudinal study of maternal nutrition.

Methodology: Forty‐four Hong Kong Chinese lactating mothers who intended to breastfeed exclusively for at least 3 months were recruited and followed for 6 months post‐partum. Demographic data were compared with 20 mothers who intended to use formula feeding. Mothers were followed up at 2 and 6 weeks and 3 and 6 months and details of infant feeding practices were obtained. Information was sought on breastfeeding management in hospital, reasons for discontinuation of breastfeeding or for providing supplements to babies and intention to seek, and sources of, lactation support.

Results: Thirty‐nine mothers who planned to breastfeed completed the follow up. Compared with mothers in the formula‐feeding group, breastfeeding mothers were more likely to be professionals or housewives. Continuation of any breastfeeding (total and partial) was noted in 30 (77%), 22 (57%), 16 (41%) and 12 (31%) mothers at 2 and 6 weeks and 3 and 6 months post‐partum, respectively. The majority (97%) of mothers stated that they were given information on the benefits and management of breastfeeding. However, late initiation of breastfeeding and providing supplements to babies were common. Perceptions of insufficient milk supply (44%), breast problems (31%) and being too tired (28%) were the main reasons stated for stopping breastfeeding or for providing supplements to babies. Midwives from the postnatal wards and hotlines were the main sources of lactation support.

Conclusions: These results highlight difficulties in sustaining breastfeeding, either exclusive or partial, in Hong Kong Chinese women. Despite being recruited on the basis of intending to exclusively breastfeed for 3 months, less than half these mothers were still breastfeeding and only approximately one‐third were exclusively or predominantly breastfeeding at 3 months. More needs to be done within the hospital environment to initiate breastfeeding immediately after birth and to avoid giving unnecessary supplements and more effort is needed to foster a mother’s confidence, commitment and knowledge of breastfeeding.
A ‘chronic disorder’ health‐care model for children with complex developmental disorders
Authors: McDowell M , Klepper K
Published: March 2003

Objectives: To conceptualize, develop and evaluate a ‘chronic disorder’ clinical model of health services for children with ‘low‐severity’ developmental disorders assessed and treated within a public Child Development Unit.

Methodology: Concepts of family empowerment, child resiliency and the management of clinical complexity were explicitly incorporated into the service model and the clinical strategies in order to address long‐term goals of prevention and health promotion. To explore the efficacy of this model, a telephone audit survey was conducted of parents of 42 children seen sequentially through this modified service.

Results: Parent data indicate a high level of satisfaction with the integrated, individualized assessment processes and effective transmission of information through both written reports and dedicated discussion visits. A treatment methodology based on parent chosen treatment goals for short and long time‐frames was experienced as achievable and successful.

Conclusions: These data suggest that the service goals of an integrated team process, parent empowerment and effective clinical collaborations may be achievable from a health care setting. A change in emphasis from remedial treatment to adaptation, health promotion and tertiary prevention is integral to these strategies. The concepts, clinical model and evaluation are presented to stimulate discussion around the question of what child health services are attempting to achieve for children with complex developmental disorders.
Ascertainment of birth defects: The effect on completeness of adding a new source of data
Authors: Bower C , Silva D , Henderson T R , Ryan A , Rudy E
Published: March 2003

Background: The Western Australian (WA) Birth Defects Registry aims for complete ascertainment of birth defects in WA, but the proportions of birth defects in rural areas and in Aboriginal children are lower than in metropolitan and non‐Aboriginal children. The effect on ascertainment of adding data from the Rural Paediatric Service (RPS) was investigated.

Method: A file of all cases of birth defects for children born 1980–1997 and recorded on the RPS database was linked to the Registry.

Results: The addition of this new data source had little effect on the overall prevalence of birth defects (an increase from 5.38 to 5.41%). There was a slightly greater effect on the prevalence of birth defects in rural residents (4.67%–4.76%) and Aboriginal children (4.55–4.78%), although the prevalence for each of these groups is still less than for metropolitan residents and non‐Aboriginal infants, respectively. All major categories of birth defects were represented in the new cases and, in general, their addition made little difference to the prevalence of each category. The exception was fetal alcohol syndrome, which increased from 0.13 per 1000 to 0.18 per 1000 once the 21 new cases from the RPS were added.

Conclusion: Complete ascertainment of birth defects is important in developing and evaluating preventive programs, and in investigating clusters of birth defects.
Sudden infant death syndrome (SIDS) in South Australia 1968–97. Part 2: The epidemiology of non‐prone and non‐covered SIDS infants
Authors: Beal S M , Baghurst P , Antoniou G
Published: March 2003

Objective: To identify the risk factors for infants who die suddenly and unexpectedly, but whose deaths are not related to prone position, or having the head covered.

Methodology: A case‐control study was designed in which the cases were infants who had died of sudden infant death syndrome (SIDS) in South Australia between January 1974 and December 1997, who were found not prone, not bed sharing and with the head not covered. The controls were two infants for each case, born in the same year and found in the prone position (again not bed sharing and with the head not covered).

Results: Sudden unexpected death in infancy is rare in non‐prone infants with the head not covered, occurring on average twice a year in South Australia, where there are 18 000–21 000 births per year. In this group there was a higher percentage of infants with features associated with low socio‐economic groups (teenage pregnancies and maternal smoking), sibling SIDS, suspicion of non‐accidental injury and the presence of minor congenital anomalies, especially cardiac anomalies.

Conclusions: The majority of unexpected deaths in infancy can be prevented by not allowing infants to be unobserved in prone position, and by preventing them from getting their faces covered. For the few infants not found in these positions, a careful investigation should be made for malformations or non‐accidental injury.
Cisapride treatment for gastro‐oesophageal reflux in children: A systematic review of randomized controlled trials
Authors: Gilbert R E , Augood C , MacLennan S , Logan S
Published: March 2003

Abstract: The aim of the systematic review was to determine the effect of cisapride compared with placebo or other non‐surgical therapies for the treatment of symptoms of gastro‐oesophageal reflux in children. We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Science Citation Index and reference lists for randomized controlled trials which compared cisapride with placebo or other non‐surgical therapy in children. We included only trials which reported reflux‐related symptoms as an outcome, provided that cisapride was administered orally for at least 1 week. Seven trials (286 children in total) compared cisapride with placebo. Two trials reported good concealment of treatment allocation. The pooled odds ratio for the ‘same or worse’ symptoms was 0.34 (95%CI 0.10, 1.19). There was substantial heterogeneity between studies (P < 0.00001) and the funnel plot was asymmetrical. Adverse effects (mainly diarrhoea) were not significantly increased with cisapride (pooled odds ratio (OR) 1.80: 0.87, 3.70). The reflux index was significantly reduced in children treated with cisapride (weighted mean difference –6.49: –10.13, –2.85). One study (50 children) compared cisapride with gaviscon plus carobel: the OR for the ‘same or worse’ symptoms was 3.26 (0.93, 11.38). There was no clear evidence that cisapride reduced symptoms of gastro‐oesophageal reflux. As smaller, poorer quality studies were biased in favour of a positive treatment effect, the pooled OR overestimated the potential benefits of cisapride. There was some evidence to suggest that gaviscon plus carobel may be a more effective option than cisapride.
James Parkinson (1755–1824): A pioneer of child care
Authors: Pearn J , Gardner‐Thorpe C
Published: March 2003

Abstract: James Parkinson (1755–1824) of Parkinson’s disease, is well recognized as a pioneer of clinical neurology; and is even more famous as a founder of modern palaeontology. We have reviewed from primary sources his extensive contributions to clinical child care and his pioneering advocacy for child welfare, protection and safety. His writings, outreach and advocacy for children’s health characterizes him as one whose influence was an important springboard from which evolved the modern specialty of paediatrics. Parkinson was one of the first to write on child‐rearing practices and in this context antedated Benjamin Spock by 150 years. Parkinson was a pioneer of child safety and the prevention of childhood trauma. He wrote of the resuscitation of near‐drowned children and of first aid for injured children. This critical analysis reviews his pioneering description of child abuse and the development of post‐abuse hydrocephalus. He wrote the datum description (in English) of the pathophysiology and pathology of appendicitis in children, of fatal rabies in children and highlighted the risk of death even when the biting dog was not clinically rabid. His advocacy for social reform for children’s welfare was courageous and pioneering. James Parkinson, hitherto unacknowledged, was a significant founder of the evolving discipline of paediatrics and child health.