bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of renal cell carcinoma: A nation‐wide survey in Japan in 1997
Authors: Marumo Ken , Satomi Yoshiaki , Miyao Noriomi , Hasegawa Michihiko , Tomita Yoshihiko , Igarashi Tatsuo , Onishi Tetsuro , Nakazawa Hayakazu , Fukuda Momokuni , Ozono Seiichiro , Terachi Toshiro , Tsushima Tomoyasu , Nakamoto Takahisa , Kawamura Juichi ,   THE JAPANESE SOCIETY OF RENAL CANCER
Published: March 2003

Abstract Background: The present study was conducted to investigate the incidence of renal cell carcinoma by sex, age group and different regions in Japan.

Methods: The survey was conducted from the beginning of January 1997 to the end of December 1997. A total of 1306 Institutions in all 47 prefectures throughout Japan were requested to register cases.

Results: There were 6358 persons with renal cell carcinoma, consisting of 4372 men and 1986 women. The age‐specific incidence rates showed a peak in the age group of 65–70 years in both men and women. The crude incidence rates per 100 000 population for men and women were 7.1 and 3.1, respectively, and age‐standardized incidence rates per 100 000 population for men and women were 4.9 and 1.8, respectively. The incidence rates in the Hokkaido region were significantly higher than in other regions (P < 0.05), among which there was no significant difference in incidence rates.

Conclusions: The present study showed that the incidence rates of renal cell carcinoma in Japan were approximately the same as among Japanese in Los Angeles. The rates were, however, lower than North American and European countries, but higher than China, Central or South American countries and African countries. The reasons for the high incidence of renal cancer in the Hokkaido region are not entirely clear. Further epidemiologic research is required.
Renal transplantation with aged donors
Authors: Nakatani Tatsuya , Kim Taku , Takemoto Yoshiaki , Kishimoto Taketoshi
Published: March 2003

AbstractResearch indicates that aged heart‐beating cadaveric donors cause greater risk factors in kidney transplantation. The influence of age on the outcome of non‐heart‐beating (NHB) cadaveric renal transplantations has not yet been clarified. From July 1986 to May 1999, 63 patients who received cadaveric renal transplantation at Osaka City University Hospital and Osaka City General Hospital were divided into two groups according to their age. Renal function and graft‐survival rates of the two groups were compared. The mean values of nadir donor serum creatinine were significantly worse (P< 0.05) in the aged donor group. In the aged donor group the percentage of immediately functioning grafts was lower and the percentage of non‐functioning grafts was higher. During the first 10 years post‐transplant, graft survival in the aged donor group was significantly lower than that in the younger donor group. We conclude that cadaveric renal transplantation from NHB aged donors can be to the detriment of renal function and graft survival rates compared to transplantation from younger donors.
Transitional cell carcinoma of the renal pelvis forming tumor thrombus in the vena cava
Authors: Miyazato Minoru , Yonou Hiroyuki , Sugaya Kimio , Koyama Yuzo , Hatano Tadashi , Ogawa Yoshihide
Published: March 2003

Abstract A 47‐year‐old man presented with a left renal incidentaloma without hematuria. The tumor was complicated by inferior vena cava (IVC) thrombus extending from Th11 to L4. A temporary IVC filter was introduced prior to surgery. A midline incision was used to perform a left radical nephrectomy and en bloc lymphadenectomy with excision of the inferior vena cava from above the level of the left renal vein to 2.5 cm above the confluence of the common iliac veins. The pathological diagnosis was invasive transitional cell carcinoma. The tumor thrombus consisted of transitional cell carcinoma that histologically invaded the walls of the IVC. He died of cancer 17 months after the operation for the liver metastases. This is the 18th case report of such a presentation in the literature.
Tubularized incised plate urethroplasty for proximal hypospadias
Authors: Mizuno Kentaro , Hayashi Yutaro , Kojima Yoshiyuki , Tozawa Keiichi , Sasaki Shoichi , Kohri Kenjiro
Published: March 2003

Abstract
Objectives
: Numerous surgical procedures have been used to correct distal hypospadias. Among them, the tubularized incised plate urethroplasty (Snodgrass procedure) has become a mainstay for the repair of distal hypospadias. We applied the procedure to proximal hypospadias.

Methods
: Three patients with proximal hypospadias underwent a tubularized incised urethral plate urethroplasty. The location of the meatus was proximal penis in one, penoscrotal margin in one and scrotum in one. A perimeatal incision was made and the two paramedian incisions were extended to the tip of the glans. The skin of the penile shaft was dissected free to the penoscrotal junction and bands of fibrous tissue were excised until the corpus spongiosum proximal to the meatus was completely exposed inside the scrotum. The urethral plate was then incised in its midline from the tip of the glans to the hypospadiac meatus and was tubularized without tension. The neourethra was covered with a pedicle of subcutaneous tissue dissected from the dorsal skin or the scrotal skin to avoid fistula formation.

Results
: The tubularized incised urethral plate urethroplasty was carried out successfully in one stage on three patients with proximal hypospadias.

Conclusions
: The Snodgrass procedure is suitable for correcting hypospadias in patients with a healthy urethral plate. It is also suitable in patients with proximal hypospadias.
Clinical features of prostate cancer patients younger than 50 years: Report of seven cases
Authors: Kanto Satoru , Ohyama Chikara , Okada Yasuhiro , MitSukawa Shiro , Takemoto Jun , Hoshi Senji , Orikasa Seiichi
Published: March 2003

Abstract
Background
: The incidence of prostate cancer increases with age and latent cancer is common in older men. But clinical prostate cancer is rare in men aged < 50 years.

Methods
: Between 1988 and 2000, we studied seven cases of prostate cancer in men aged under 50 years. The clinicopathological results included: the first sign or symptom; prostate‐specific antigen (PSA) at the time of diagnosis; existence of abnormal digital rectal examination (DRE); the differentiation of the cancer and Gleason score; and the outcome of treatment.

Results
: Six cases were diagnosed as stage D2. One case was diagnosed as stage B2 and the patient underwent radical prostatectomy. None of the cases were detected by mass screening. The PSA at diagnosis was < 10 ng/mL in only one case and that patient underwent radical prostatectomy. Six cases were diagnosed pathologically as poorly differentiated adenocarcinoma. The only patient who survived more than 5 years underwent radical prostatectomy.

Conclusion
: Six of seven cases of prostate cancer were detected at advanced stage. Only one case was thought to be curable and this patient’s cancer was detected by chance occult blood test. Because young prostate cancer patients are potential candidates for radical prostatectomy and the sensitivity of PSA might be higher in young men, high‐risk groups could be screened by PSA.
Prolonged liver dysfunction caused by hemosiderosis in a renal transplant recipient
Authors: OGIHARA MASAHIKO , YANAGIDA TOMOHIKO , KAMATA TATSUHIKO , NAKAMURA TAKAYUKI , SUZUKI KAZUHIRO , HAGA NOBUHIRO , SUZUKI TAKAYUKI , YAMAGUCHI OSAMU
Published: March 2003

Background
: Liver dysfunction is a frequent complication that arises in the period following kidney transplantations, often resulting in death. We reported a case proving hemosiderosis as a cause of prolonged liver dysfunction after cadaveric kidney transplantation.

Methods
:

A 47‐year‐old man, who had been undergoing hemodialysis, was referred to our hospital on 2 November 1999. On the same day, cadaveric kidney transplantation was performed, and serum creatinine level reached a normal level within 2 weeks after surgery. However, serum transaminase gradually increased in the postoperative period. Serum ALT rose up to 116 IU/L on day 20 after the operation and 215 IU/L on day 30. Microscopic examination by needle biopsy revealed hemosiderosis of the liver. Recombinant human erythropoietin was administered and phlebotomy was performed. Liver function improved as a result.

Conclusion
:

Early histological diagnosis can be a useful marker in predicting the course of chronic liver disease.
Accuracy of transrectal ultrasound guided prostate biopsy: Histopathological correlation to matched prostatectomy specimens
Authors: Cam Kamil , Yucel Selcuk , Turkeri Levent , Akdas Atif
Published: March 2003

Background:
The Gleason grading system is currently the world’s most commonly used histological system for prostate cancer. It provides significant information about the prognosis. Therefore, Gleason score is accepted as an important factor in therapeutic decision‐making for prostate cancer. This retrospective study assessed the correlation of transrectal ultrasound (TRUS) guided biopsy and radical prostatectomy specimens in terms of Gleason scores.

Methods:
We reviewed the records of 103 patients who underwent radical prostatectomy due to clinically localized prostate cancer. The Gleason scores of the TRUS biopsies were compared with the respective Gleason scores of surgical specimen.

Results:
In 28.7% of cases, the TRUS biopsy score was the same as that of the radical prostatectomy specimen. The most significant discordance was the upgrading of well‐differentiated tumors after surgery in 71.7% of cases. However, in 81.8% of cases with high Gleason score on TRUS, biopsy was correlated with poorly differentiated tumor after surgery.

Conclusions:
Well‐differentiated tumors on TRUS biopsy did not correlate with the grades of final pathology in the majority of cases; however, a high Gleason score on TRUS biopsy usually indicated a poorly differentiated tumor on prostatectomy specimen. Therefore, the treatment algorithms for particularly well‐differentiated tumors should not be deduced from biopsy histology alone.
Renal oncocytomatosis in a long‐term hemodialysis patient treated by laparoscopic surgery
Authors: Shiga Yoshiyuki , Suzuki Koichiro , Tsutsumi Masakazu , Ishikawa Satoru , Gotoh Michihiro , Shimokama Tatsuro , Hattori Kazunori
Published: March 2003

A 50‐year‐old female, who had been on maintenance hemodialysis for 22 years, consulted our clinic because of a left renal mass detected incidentally by ultrasonography. Computed tomography (CT) demonstrated a solid hypervascular mass, suggesting a renal cell carcinoma (RCC), in the left atrophic kidney. Left hand‐assisted laparoscopic nephrectomy (HALN) was performed. The histopathological diagnosis was renal oncocytomatosis. Renal oncocytomatosis in a long‐term hemodialysis patient is extremely rare. We report the first case of renal oncocytomatosis in a long‐term hemodialysis patient treated with hand‐assisted laparoscopic nephrectomy.
Antecedents to hospital deaths
Authors: Hillman K. M. , Bristow P. J. , Chey T. , Daffurn K. , Jacques T. , Norman S. L. , Bishop G. F. , Simmons G.
Published: March 2003

Background: Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals.

Aim: This study aimed to document antecedent factors in hospital deaths in an attempt to identify potentially preventative factors.

Methods: The study was conducted at three separate acute hospitals. Demographics of all deaths were recorded over a 6‐month period as well as antecedent factors present within 0–8 and 8–48 h of all deaths including vital sign abnormalities, cardiorespiratory arrests and admission to intensive care. Separate analysis was performed on ‘not for resuscitation’ deaths.

Results: There were a total of 778 deaths, of which 549 (71%) were ‘not for resuscitation’. There were 171 (22%) deaths preceded by arrest and 160 (21%) preceded by admission to intensive care. Of the remaining deaths, 30% had severely abnormal physiological abnormalities documented. This incidence was 50% in the non‐do not resuscitate (DNR) subgroup. Concern about the patient’s condition was expressed in the patient’s notes by attending nursing staff and junior medical staff in approximately one‐third of non‐DNR deaths. Hypotension (30%) and tachypnoea (17%) were the most common antecedents in the non‐DNR deaths.

Conclusion: There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention. (Intern Med J 2001; 31: 343–348)
Origins and development of geriatric medicine in Australia
Authors: Lefroy R. B.
Published: March 2003

Abstract After a tentative beginning 50 years ago, geriatric medicine has become an accepted part of medical practice in Australia. It includes the rehabilitation of elderly people, general aspects of aged care in the community, undergraduate and postgraduate education and research. (Intern Med J 2001; 31: 422–425)
Myocardial perfusion imaging in evaluation of undiagnosed acute chest pain
Authors: Knott J. C. , Better N.
Published: March 2003

Abstract

Myocardial perfusion imaging is a relatively new technique in the emergency department management of acute chest pain. With improved sensitivity and specificity compared to traditional methods of risk stratification, an abnormal scan rapidly identifies individuals with acute perfusion abnormalities and allows the appropriate utilization of limited resources. Conversely, a normal scan allows prompt hospital discharge and is associated with excellent outcomes both in the short and medium terms. Acute chest pain myocardial perfusion imaging has been demonstrated to alter patient management and disposition and its routine use results in decreased costs in the intermediate risk population. (Intern Med J 2001; 31: 544–546)
Withholding oral fluids from children undergoing day surgery reduces vomiting
Authors: KEARNEY R , MACK C , ENTWISTLE L
Published: March 2003

The effect of withholding oral fluids on the incidence of postoperative vomiting was evaluated in 317 children undergoing day surgery. Children were randomized by cohort into one of two groups either drinking oral fluids or having oral fluids withhold for 4–6 h postoperatively. All patients received replacement intravenous fluids sufficient to cover the anticipated fasting period. Vomiting was assessed in hospital through to the first postoperative day. Compliance to the protocol was excellent. The incidence of vomiting in the group with fluids withheld was significantly less than (P<0.004) that of the group which drank (38%vs 56%). This difference was seen whether or not patients thought to be at high risk for postoperative vomiting (strabismus or adenoidectomy±tonsillectomy) were included in the analysis. The greatest effect of withholding oral fluids was seen in patients receiving opioids (P<0.001) where vomiting was reduced from 73% to 36%. Withholding oral fluids postoperatively from children undergoing day surgery reduces the incidence of vomiting.
Propofol infusion syndrome in children
Authors: Bray
Published: March 2003

Department of Anaesthesia, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKThe use of propofol infusions to sedate children in intensive care units has decreased after reports of deaths from myocardial failure. More recently it has been suggested that propofol might have been prematurely condemned. Information about 18 children who had received propofol infusions and suffered serious unwanted effects was used to define their common features. Three of the deaths occurred in one intensive care unit where propofol infusions had been used between 1987 and 1993. During this period 44 children with respiratory tract infections had been admitted to this unit and sedated for at least 48 h. Nine had received long‐term (>48 h), high‐dose (>4 mg·kg·1·h‐1) propofol infusions and three had developed progressive myocardial failure and died. There was a significant association between receiving a long‐term, high‐dose propofol infusion and developing progressive myocardial failure (Fisher's Exact Test, two‐tailed hypothesis, P=0.0128) although a causative relationship could not be proved.
The Univent tube for single‐lung ventilation in paediatric patients
Authors: HAMMER G. , BRODSKY J. , REDPATH J. , CANNON W.
Published: March 2003

A Univent bronchial blocker tube was used in a ten‐year‐old patient undergoing videothoracoscopy. Paediatric Univent tubes offer an alternative to balloon‐tipped catheters for providing single‐lung ventilation (SLV) in children too small for adult size double‐lumen tubes.
The usefulness of routine preoperative laboratory tests for one‐day surgery in healthy children
Authors: MENEGHINI L. , ZADRA N. , ZANETTE G. , BAIOCCHI M. , GIUSTI F.
Published: March 2003

Since 1984, laboratory tests have not been routinely required for healthy paediatric patients scheduled for one‐day surgery in our Paediatric Surgery Department. We reviewed the medical charts of all children ASA physical status 1 and 2 who underwent a minor surgical procedure in the last 15 years. We excluded all former preterm infants of less than 60 weeks postconceptual age. The series under examination includes two groups of patients: group A includes 1884 children who underwent routine preoperative laboratory tests; group B includes 8772 children who had preoperative, selected laboratory tests performed only when the child's history and/or clinical examination revealed some abnormalities. The following data were collected: demographic data, ASA physical status classification, surgical procedure, anaesthetic technique, major and minor complications, length of hospital stay, the difference between the expected length of hospitalization and the actual length, number and reasons for cancellations of surgery. On the basis of our experience we believe that a thorough clinical assessment of the patient is more important than routine preoperative laboratory screening, which should be required only when justified by real clinical indications. Moreover, this practice eliminates unnecessary costs without compromising the safety and the quality of care.
Hepatopulmonary syndrome and liver transplantation: a review of the peroperative management of seven paediatric cases
Authors: VAN OBBERGH L. , CARLIER M. , DE KOCK M. , OTTE J. , MOULIN D. , VEYCKEMANS F.
Published: March 2003

Until recently, hypoxaemia was considered as a relative contraindication for liver transplantation. The hepatopulmonary syndrome associated with a right to left shunt of blood through the lungs is reversible in adults and children after correction of the cirrhosis by liver transplantation. However, concerns have been raised regarding the risks of anaesthesia in such hypoxaemic patients. Since the peroperative management of children undergoing liver transplantation and suffering from hepatopulmonary syndrome and severe hypoxemia has never been described, we report here our experience in seven children. Despite the fact that severe arterial desaturation was recorded throughout the procedure, no major complications were recorded peroperatively. The postoperative intubation time was 58 ± 21 h, five children being extubated while still hypoxaemic. All seven patients reversed their hepatopulmonary syndrome after a mean postoperative period of 24±10 weeks. This shows that liver transplantation can be successfully achieved in severely hypoxaemic children and that postoperative correction of the right to left shunt is then obtained.
Oral midazolam premedication and postoperative behaviour in children
Authors: McGRAW TERRY , KENDRICK ANGELA
Published: March 2003

We examined the effect of oral midazolam premedication on postoperative behaviour. Seventy children (ASA Physical Status 1 and 2; aged 1–10 yrs) were assigned randomly in a prospective, blinded fashion to receive either midazolam 0.5 mg·kg−1 (maximum 10 mg) or placebo. Behaviour assessments were made prior to medication, during induction of anaesthesia and 15 min following arrival to recovery room. The baseline behavioural evaluation scores were not significantly different. The children receiving midazolam cried significantly less during induction (P≤0.02). At one week follow‐up, eight of 35 subjects receiving placebo had experienced adverse behaviour changes (nightmares, night terrors, food rejection, anxiety, negativism); 19 of 35 of the midazolam group experienced these changes (P≤0.02). At four week follow‐up, most behaviour changes had resolved. Children given preoperative oral midazolam were less likely to cry and fight while being anaesthetized, and preoperative sedation was associated with increased incidence of adverse postoperative behaviour changes.
Early intravenous cannulation in children during inhalational induction of anaesthesia
Authors: CHOUDHRY DINESH , STAYER STEPHEN , SCHWARTZ ROY , PASQUARIELLO CAROLINE
Published: March 2003

Intravenous cannulation is obtained in almost all patients scheduled for operative intervention under anaesthesia. In our practice, inhalational induction precedes cannulation in children in order to avoid pain and discomfort, and cannulation is delayed until the child is adequately anaesthetized in fear of precipitating laryngospasm due to painful stimulus of venepuncture in the light stage of anaesthesia. This study was performed on 150 patients between two to eight years of age to determine if there is a difference in the incidence of untoward incidents, if cannulation is performed when children are lightly anaesthetized (Early, Group E), as compared to when they are deeply anaesthetized (Late, Group L). In patients randomized to early cannulation, the results showed that there was a significantly shorter time from induction to venous cannulation, the halothane concentration was lower at the time of cannulation, there was a greater incidence of movement on cannulation and a greater incidence of changes in heart rate, blood pressure, and respiratory rate. There was no significant differences in the incidence of laryngospasm or in the success rate of intravenous cannulation between the two groups. We conclude that venous cannulation can be safely performed during the light stages of anaesthesia.
Difficult tracheal intubation following midface distraction surgery
Authors: Morris G.P. , Cooper M.G.
Published: March 2003

A case of difficult intubation in a patient with Apert syndrome, who had recently undergone bilateral internal midface distraction, is described. The 14‐year‐old boy had no antecedent history of such difficulty, despite numerous previous anaesthetics. We suggest that trismus due to temporalis muscle fibrosis, and the altered relationships of the maxilla and mandible following midface advancement, were causal.
A comparison of rectal and intramuscular codeine phosphate in children following neurosurgery
Authors: McEwan A. , Sigston P.E. , Andrews K.A. , Hack H.A. , Jenkins A.M.C. , May L. , Llewelyn N. , Mackersie A.
Published: March 2003

Codeine is frequently used for postoperative analgesia in children. Intramuscular injections are not ideal and the rectal route may be preferable. We compared rectal and intramuscular codeine administered following neurosurgery. 20 children (over 3 months) undergoing elective neurosurgical procedures, were randomized to receive either rectal or intramuscular codeine phospate (1 mg·kg−1) at the end of the procedure. Serum levels of codeine and morphine were assayed at intervals following administration (0, 30, 60, 120, 240 min). Fentanyl was the intraoperative analgesic and postoperative rescue analgesia was paracetamol, diclofenac and intramuscular codeine. The Children's Hospital of Eastern Ontario Pain Scale was used to assess analgesia. Peak codeine levels in both groups were observed at 30 min and morphine levels were consistently low. The plasma codeine levels were significantly greater at 30 and 60 min following intramuscular injection, and were associated with slightly better analgesia scores, but did not reach statistical significance. However, the peak plasma level occurred at similar times in both groups. Codeine is absorbed as rapidly via the rectal route compared with the intramuscular route but the peak levels are lower.
Recovery after paediatric daycase herniotomy performed under spinal anaesthesia
Authors: Kokki Hannu , Heikkinen Marja , Ahonen Riitta
Published: March 2003

In this prospective survey, recovery in hospital and at home was evaluated in 195 children aged 6 months to 10 years who had undergone herniotomy under spinal anaesthesia as a daycase procedure. Spinal anaesthesia was successful in most of the children, with only two patients being given general anaesthesia. Eighty‐three percent of the children had pain at home and 19% had moderate or severe pain. Eighty‐five percent of the children needed pain medication at home; the median dose of analgesics was 4 (1–9, 10th and 90th percentiles). Vomiting was noted in two of 195 children in hospital and in 10 of 192 children at home. Eleven children developed a mild position‐dependent headache. Most of the children (183/191) recovered their normal daily activities during the first three postoperative days. We conclude that spinal anaesthesia is a safe and effective technique for paediatric herniotomy. Moreover, pain is common following herniotomy and children should be given analgesics for the first two or three postoperative days.
Applications of intrathecal catheters in children
Authors: Tobias Joseph D.
Published: March 2003

Access to the intrathecal space may be required for sampling of cerebrospinal fluid for diagnostic purposes, for the administration of pharmacological agents, or for cerebrospinal fluid (CSF) drainage to lower intracranial pressure. The current report details five children in whom a percutaneously placed lumbar intrathecal catheter was used: (i) to provide intraoperative surgical anaesthesia instead of general anaesthesia (ii); to deliver intrathecal fentanyl to provide postoperative analgesia (iii); to provide chronic pain control during the terminal stages of metastatic malignancy; (iv) to allow repeated doses of intrathecal chemotherapy; and (v) to allow CSF drainage and prevent CSF leakage following frontal encephalocele repair. The indications and applications of intrathecal catheters in the paediatric aged patient are reviewed.
Increased levels of S‐100 protein after cardiac surgery with cardiopulmonary bypass and general surgery in children
Authors: Jensen Eva , Sandström Kerstin , Andréasson Svenerik , Nilsson Krister , Berggren Håkan , Larsson Lars E.
Published: March 2003

The aim of this study was to evaluate changes in concentrations of the neurospecific protein S‐100 in relation to cardiac surgery with cardiopulmonary bypass (CPB) and noncardiac general surgery in children below 3 years of age. Seventeen children underwent surgery for congenital heart disease and all survived without clinical signs of neurological complications. Samples for plasma concentrations of S‐100 in these patients were taken on three occasions in connection with surgery: before the start of surgery, after CPB and finally 16–20 h after CPB. In the noncardiac group of 31 children, S‐100 concentrations were measured on two occasions: before surgery and during surgery. In both groups, a significant increase in S‐100 concentrations was observed during surgery, although the increase in the CPB group was significantly higher than in the noncardiac group. The CPB group included four children with Down's syndrome who had higher mean S‐100 concentrations on all sampling occasions compared to the remaining patients. The peak S‐100 concentrations after cardiac surgery were related to the duration of CPB, the time from the termination of CPB to the first post‐CPB sample, as well as mean arterial pressure and cerebral arteriovenous lactate difference during rewarming. All the children studied (Down's patients excluded) had age‐dependent plasma concentrations of S‐100 measured before surgery. It can be concluded that CPB initiates a marked but transient release of S‐100 into the systemic circulation during open heart surgery in children who are not developing clinical signs of neurological sequelae.
Postoperative infectious complications in paediatric liver transplantation: a study of 48 transplants
Authors: Bouchut Jean‐Christophe , Stamm Didier , Boillot Olivier , Lepape Alain , Floret Daniel
Published: March 2003

We studied, retrospectively, postoperative infectious complications following paediatric liver transplantation at a single university centre. The objectives were to characterize the epidemiology of infection and to determine the associated risk factors during the early postoperative period, either the first postoperative month or the entire duration of paediatric intensive care unit (PICU) stay. Forty‐eight liver transplants were performed on 46 patients. Sixty‐three infections occurred in 32 patients who underwent 34 liver transplantations (1.36 infection/patient); 47 were bacterial, 6 fungal and 10 viral. The most common sites of infection were bloodstream (36.5%) and abdomen (30%). Gram‐positive bacteria (78%) predominated over gram‐negative bacteria (22%). Initial analysis revealed infection risk factors to be age <1 year, body weight <10 kg, extrahepatic biliary atresia, intraoperative transfusion > 160 ml·kg−1, mechanical ventilation > 8 days and PICU stay > 19 days. After stratified analysis, the main risk factor for infection was low body weight of the recipient.
Perioperative management of total parenteral nutrition, glucose containing solutions, and intraoperative glucose monitoring in paediatric patients: a survey of clinical practice
Authors: Ayers Jane , Graves Shirley A.
Published: March 2003

Infants and children, particularly those who are chronically ill and maintained on total parenteral nutrition (TPN), are at risk for perioperative hypoglycaemia [blood glucose < 2.2 mmol·l–1 (40 mg·dl–1)] and hyperglycaemia [blood glucose > 11 mmol·l–1 (200 mg·dl–1)]. We surveyed paediatric anaesthesiologists regarding their perioperative management of blood glucose and TPN in paediatric patients to determine the current practice and its perceived success. Questionnaires were mailed to all members of the Study Group on Pediatric Anesthesia and the response rate was 70%. Results indicate that the current perioperative management of blood glucose and TPN is somewhat varied. Furthermore, greater than 10% of those surveyed report that their management results in a variable response in the maintenance of normoglycaemia. While the detrimental effects of perioperative hypoglycaemia and hyperglycaemia are rare, they are serious. A Medline search shows that no studies have been published regarding perioperative management of paediatric patients receiving TPN, although it appears that clinical study is warranted.
Anaesthesia for a child with progeria
Authors: Nguyen Nhung H. , Mayhew James F.
Published: March 2003

The Hutchinson–Gilford syndrome, commonly referred to as progeria, is a rare childhood syndrome that results in premature ageing. We focus on two anaesthetics administered to a child with progeria and a review of the available literature.
An audit of perioperative management of autistic children
Authors: Van Der Walt J. H. , Moran C.
Published: March 2003

Background: Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine.

Methods: We have developed a unique management program for autistic children admitted for medical and surgical procedures requiring a general anaesthetic. Details of each patient managed according to this program have been prospectively entered into an Autistic Register.

Results: An audit of this database shows that we have administered anaesthesia on 87 occasions for 59 autistic children over 4 years.

Conclusions: There is great variation in the severity of autism and hospital needs of these children. The focus is on early communication with the patient’s families, flexibility to individualize the admission process and anaesthetic plan with admission and early discharge on the day of surgery whenever possible. Oral midazolam is an effective premedication for the milder cases and oral ketamine is the most reliable for moderate and severe cases. Comparison of oral midazolam and ketamine shows no significant different postoperative recovery and hospital discharge times. Routine intravenous fluids and antiemesis prophylaxis with removal of the i.v. cannula before return to the ward are also seen as important steps to decrease stress and smooth the postoperative phase. This program has also successfully been extended to the management of problem children due to other causes.
Anaesthetic considerations for a child with combined Prader–Willi syndrome and mitochondrial myopathy
Authors: Sharma Ajeet D. , Erb Thomas , Schulman Scott R. , Sreeram Gautam , Slaughter Thomas F.
Published: March 2003

We report the anaesthetic management of a child with Prader–Willi syndrome and mitochondrial myopathy for open heart surgery. We used ketamine, fentanyl, rocuronium and caudal morphine together with a propofol infusion with no untoward effects. The implications of both conditions for anaesthesia are discussed.
Is the sitting or the prone position best for surgery for posterior fossa tumours in children?
Authors: Orliaguet Gilles A. , Hanafi Mohamed , Meyer Philippe G. , Blanot Stéphane , Jarreau Marie‐Madeleine , Bresson Damien , Zerah Michel , Carli Pierre A.
Published: March 2003

Background: The aim of this study was to compare complications in children operated for posterior fossa tumours in the sitting position with those in the prone position.

Methods: We retrospectively assessed the perioperative course of posterior fossa tumour (PFT) surgery according to the operating position. Sixty children were operated in the sitting position (SP) and 19 in the prone position (PP). Preoperative data were not different between groups.

Results: Patients in the PP group received a larger median (95% confidence interval) volume of intraoperative blood transfusion than patients in the SP group [200 (20–325) versus 0 (0–80) ml, P=0.04]. Intraoperative complications, as well as severe perioperative complications were more frequent in the PP group (P=0.01). The median duration of tracheal intubation [20 (18–24) versus 36 (18–72) h, P=0.037], of ICU stay [2 (2–3) versus 4 (2–5) days, P=0.02] and of hospital stay [11 (9–12) versus 14 (10–20) days, P=0.02] was longer in the PP group compared with the SP group.

Conclusions: PFT surgery in the sitting position in children is not associated with an increased number or severity of perioperative complications, while the postoperative course appears better in this position.
Respiratory complications during anaesthesia in Apert syndrome
Authors: Elwood Thomas , Sarathy Priya V. , Geiduschek Jeremy M. , Ulma George A. , Karl Helen W.
Published: March 2003

Background: Clinical experience with anaesthesia for a series of patients with Apert syndrome (craniosynostosis, midface hypoplasia and syndactyly) has not been reported previously.

Methods: In this review, 10 years of experience was examined at our hospital. There were 145 anaesthetics administered to 18 individuals.

Results: There were 16 complications (15 were perioperative wheezing) which occurred in seven patients. In four cases, surgery was cancelled due to intractable wheezing.

Conclusions: We could not demonstrate any benefit from preoperative administration of nebulized albuterol. Paediatric anaesthetists should be aware of this high incidence of respiratory complications in Apert syndrome.
Motion sickness and postoperative vomiting in children
Authors: BUSONI PAOLO , SARTI ARMANDO , CRESCIOLI MASSIMO , AGOSTINO MARIA ROSARIA , SESTINI GIUSEPPINA , BANTI SILVIA
Published: March 2003

Background: Motion sickness is considered an important risk factor for postoperative nausea and vomiting in children. The aim of this study was to verify the impact of motion sickness on the incidence of vomiting after routine surgery in children, and to compare the incidence of vomiting, after combined regional/general anaesthesia, using either halothane or sevoflurane.

Methods: We prospectively studied 420 children (369 males and 51 females) who received general anaesthesia and inguinal field block for common paediatric surgery. The children were randomly allocated into one of two groups (halothane or sevoflurane). In the 200 children in the first group (H), general anaesthesia was induced and maintained with halothane, whereas in the 220 children in the second group (S), anaesthesia was induced and maintained with sevoflurane.

Results: There were 79 children with a prior history of motion sickness (MS+) and 341 without such a history (MS–). In the MS+ population, the incidence of vomiting was similar in both H and S groups, being around 33%. However, repeated episodes of vomiting in MS+ children were more frequent when halothane was used. In the MS– group, the incidence of vomiting was significantly greater in the H group (19%) than in the S group (8%).

Conclusions: In the postoperative period, we found that MS+ children vomit more than MS– children, regardless of the inhalation anaesthetic used. However, MS– children displayed a higher incidence of vomiting when halothane was used rather than sevoflurane.
Noninvasive intraoperative monitoring of carbon dioxide in children: endtidal versus transcutaneous techniques
Authors: NOSOVITCH MACE A , JOHNSON JOEL O , TOBIAS JOSEPH D
Published: March 2003

Background: The current study prospectively compares the accuracy of the intraoperative use of transcutaneous (Tc) and endtidal (PE) CO2 monitoring during surgical procedures in 30 paediatric patients, ranging in age from 6 months to 15 years (6.15 ± 4.35 years) and in weight from 4.7 to 73 kg (24.9 ± 18.2 kg).

Methods: Following calibration and an equilibration time for the TcCO2 monitor, arterial blood gas samples were obtained as clinically indicated. A total of 64 sample sets (PaCO2, PECO2 and TcCO2) were obtained from the 30 patients.

Results: The PECO2 to PaCO2 difference was 0.6–0.9 kPa (4.4 ± 7.1 mmHg) while the TcCO2 to PaCO2 difference was 0.36–0.38 kPa (2.8 ± 2.9 mmHg) (P=NS). The difference between the PaCO2 and PECO2 was 0.4 kPa (3 mmHg) or less in 37 of 64 sample sets while the difference between the PaCO2 and TcCO2 was 0.4 kPa (3 mmHg) or less in 49 of 64 sample sets (P=0.038). Linear regression analysis of PECO2 vs. PaCO2 revealed a slope of 0.434, r=0.8761, r2=0.7676. Linear regression analysis of TcCO2 vs. PaCO2 revealed a slope of 0.914, r=0.9472, r2=0.8972.

Conclusions: Although in most circumstances, both noninvasive monitors of PCO2 provided a clinically acceptable estimate of PaCO2, TCCO2 provided a slightly more accurate estimate of PaCO2 during intraoperative anaesthetic care in children.
The efficacy of caudal ropivacaine 1, 2 and 3 mg·ml−1 for postoperative analgesia in children
Authors: BOSENBERG A , THOMAS J , LOPEZ T , LYBECK A , HUIZAR KARIN , LARSSON L.E
Published: March 2003

Background: The aim of this double blind, randomized, comparative study was to assess the analgesic efficacy and incidence of motor block after caudal block using three different concentrations of ropivacaine, 1, 2 and 3 mg·ml–1, in children 4–12‐year‐old.

Methods: One hundred and ten children ASA I–II, scheduled for inguinal surgery, were included in the study. After induction of a standardized general anaesthetic technique, all patients received 1 ml·kg–1 of the ropivacaine solution for a caudal block and were assessed for 8 h after the injection.

Results: The ropivacaine was well tolerated in all patients. Median time to treatment with analgesics was 3.3, 4.5 and 4.2 h in the 1, 2 and 3 mg·ml–1 groups, respectively. During the first 4 h, the pain scores for both a 6‐graded faces scale and a 4‐graded observer scale were higher in the 1 mg·ml–1 group than the 3 mg·ml–1 group. The median sensory block reached T12 in all groups 1 h after the caudal block. Thereafter, the speed of regression was correlated with the ropivacaine concentration. In the patients with a sensory block from T12 and above, the median time to treatment with analgesics was longer than in the children with a sensory block below T12. The incidence of motor block was 28% in the 3 mg·ml–1 group in comparison with 0 and 13% in the 1 and 2 mg·ml–1 groups.

Conclusions: It was concluded that 1 ml·kg–1 of ropivacaine 2 mg·ml–1 for caudal block provided satisfactory postoperative pain relief after inguinal surgery in 4–12‐year‐old children. Ropivacaine 1 mg·ml–1 showed less efficacy while the use of ropivacaine 3 mg·ml–1 was associated with a higher incidence of motor block with minimal improvement in postoperative pain relief.
Perioperative management of a child with very‐long‐chain acyl‐coenzyme A dehydrogenase deficiency
Authors: STEINER L.A. , STUDER W. , BAUMGARTNER E.R. , FREI F.J.
Published: March 2003

Very‐long‐chain acyl‐coenzyme A dehydrogenase deficiency is an inborn error of fatty acid metabolism. The clinical presentation of this disease in children is either a severe form with onset of symptoms in the first months of life, cardiomyopathy, metabolic acidosis, myopathy and a high mortality, or a less severe form manifesting mainly with hypoglycaemia. Perioperative fasting and (even emotional) stress can trigger metabolic decompensation through the altered metabolism of endogenous fatty acids resulting in hypoglycaemia, acute cardiac and hepatic dysfunction and rhabdomyolysis. We report the perioperative management of a 9‐year‐old boy suffering from the severe form of this disease who underwent circumcision. Metabolism was kept stable in this child by using a glucose–electrolyte infusion throughout the perioperative period to avoid the biochemical consequences of fasting and a benzodiazepine–opioid technique combined with regional anaesthesia to minimize the stress response. Considering reports about a possible interference of propofol with fatty acid oxidation and to avoid the unnecessary administration of fatty acids, propofol should not be used in these patients.
Extrapolation of cardiac index from analysis of the left ventricular outflow velocities in children: implication of the relationship between aortic size and body surface area
Authors: Wodey Eric , Senhadji Lotfi , Carre François , Ecoffey Claude
Published: March 2003

Background: It has recently been reported in critically ill patients that a linear relationship exists between cardiac index (CI) measured with thermodilution and mean aortic blood flow velocity (MAFV). This hypothesis can be validated mathematically only if the aortic area (AA index) indexed to body surface area (BSA) remains constant and if the relationship between aortic diameter (ØAo) and BSA is nonlinear. However, several other equations have described the relationship between BSA and, respectively, ØAo and aortic area (AA) in children. The aim of this study was to determine if the relationships calculated between BSA and aortic size in children (without left ventricular outflow tract abnormality) could validate the hypothesis that MAFV and CI are well linked linearly, leading to its use to determine CI.

Methods: Two hundred and thirty‐two measurements performed in 126 children and infants were retrospectively analysed. ØAo was measured in the long axis view at the annulus using two‐dimensional mode echocardiography with a 5‐MHz transducer. Various linear and nonlinear relationships between BSA and, respectively, ØAo, ØAoindex, AA and AAindex were determined based on a nonlinear regression method with a model as follows: y=a(xc) + b. The comparisons between regressions were conducted based on the estimation error.

Results: The relationships between ØAo and BSA appeared nonlinear and was well described by: ØAo=2.96(BSA1/4) – 1.31 with a non‐zero y‐intercept and ØAo=1.64(BSA1/2) with a zero y‐intercept. In contrast, the relationships between AA and BSA were linear. The AAindex was not linked to BSA and can be considered as constant. The coefficient a of the equation appeared similar to those obtained mathematically with the relationship previously described between MAFV and CI.

Conclusions: The hypothesis that CI can be extrapolated to the measurement of MAFV appears valid as regards the relationships calculated between aortic size and BSA in children without left ventricular outflow tract abnormality.
The rotational technique with a partially inflated laryngeal mask airway improves the ease of insertion in children
Authors: NAKAYAMA SHIN , OSAKA YOSHIKO , YAMASHITA MASAO
Published: March 2003

Background: This study compared the ease of insertion of the laryngeal mask airway (LMA™) with a partially inflated cuff using the standard `nonrotational' technique versus the rotational technique.

Methods: One hundred and forty‐five children undergoing anaesthesia using the LMA were randomly assigned to either method. The cuff was partially inflated in both groups. The ease of insertion was assessed by the time taken to complete the LMA insertion, the number of attempts before successful placement and the occurrence of complications.

Results: The success rate of insertion at the first attempt was higher in the rotational technique group (99% versus 79%, P < 0.05). All patients in the rotational group had the mask inserted within two attempts. On the other hand, three patients had the mask inserted on the first attempt with the rotational technique after three unsuccessful attempts by an anaesthesiologist with the standard `nonrotational' technique. Insertion technique made no difference on insertion time.

Conclusions: The rotational technique was associated with a higher success rate for insertion and a lower incidence of complications in children. Using the rotational technique with a partially inflated cuff could be the first‐choice approach in paediatric patients.
Home care for chronic respiratory failure in children: 15 years experience
Authors: APPIERTO L. , CORI M. , BIANCHI R. , ONOFRI A. , CATENA S. , FERRARI M. , VILLANI A.
Published: March 2003

Background: Advances in paediatric intensive care have reduced mortality but, unfortunately, one of the consequences is an increase in the number of patients with chronic diseases. It is generally agreed that home care of children requiring ventilatory support improves their outcomes and results in cost saving for the National Health Service.

Methods: Since 1985, the Children's Hospital Bambino Gesù of Rome has developed a program of paediatric home care. The program is performed by a committed Home Health Care Team (HHCT) which selects the eligible patients for home care and trains the families to treat their child. During the period January 1985 to January 2001, 53 children with chronic respiratory failure were included in the home care program. Of these, seven patients were successively excluded and six died in our intensive care unit (ICU), while one still lives in our ICU since 1997. The results obtained in the remaining 46 children are reported.

Results: The pathologies consisted of disorders of respiratory control related to brain damage (26%), upper airways obstructive disease (26%), spinal muscular atrophy (22%), myopathies and muscular dystrophies (6.5%), bronchopulmonary dysplasia (6.5%), tracheomalacia (6.5%), central hypoventilation syndrome (4.3%) and progressive congenital scoliosis (2.2%). Of these 46 patients, 34 children are mechanically ventilated and the median of their ICU stay was 109.5 days (range 54–214 days), while the remaining 12 children were breathing spontaneously and the median of their ICU stay was 90.5 days (range 61–134 days). We temporarily readmitted six patients to our ICU to perform scheduled otolaryngological surgery, eight patients for acute respiratory infections and two patients for deterioration of their neurological status due to high pressure hydrocephalus for placement of a ventriculoperitoneal shunt; these 16 patients were discharged back home again. Two other patients were readmitted for deterioration of their chronic disease and died in our ICU, while seven patients died at home.

Conclusions: Thirty‐seven children are still alive at home and four of them improved their respiratory condition so that it was possible to remove the tracheostomy tube. Our oldest patient has now achieved 15 years of mechanical ventilation at home.