bluuebunny/crossref_metadata_2025 huggingface dataset:
Acetazolamide poisoning in a toddler
Authors: Baer E , Reith DM
Published: March 2003

Abstract: Acetazolamide ingestion and its sequelae have not been previously reported in children. A 12‐month‐old girl, weighing 10 kg, developed metabolic acidosis following ingestion of between 500 and 1250 mg of acetazolamide. The maximum base deficit recorded was 11.6. She was treated with sodium bicarbonate and recovered completely. Accidental poisoning should be included in the differential diagnosis of a child presenting with metabolic acidosis.
Bones, groans and blasts
Authors: Shanks D , Linke R , Saxon B
Published: March 2003

Abstract: A 14‐year‐old girl presented with the acute onset of gastrointestinal symptoms due to hypercalcaemia. Chest X‐ray revealed osteolytic lesions in the ribs which in conjunction with a normal parathyroid hormone level raised the possibility of malignancy. Despite the absence of blast cells in her blood film, the bone marrow biopsy was diagnostic of acute lymphoblastic leukaemia. She responded well to treatment with pamidronate and chemotherapy.
Growth of infants during the first 18 months of life in urban and rural areas of southern China
Authors: He M , Mei J , Jiang Z , Chen Q , Ma J , Dai J , Li M , Su Y , Lui SSH , Yeung DL , Anderson GH
Published: March 2003

Objective: Observe the growth pattern of infants from birth to 18 months.

Methodology: A prospective study was conducted from 1994 to 1996 in urban and township–rural areas of Guangdong Province, southern China, recruiting 568 and 257 newborn infants, respectively. Anthropometric data was collected at birth, 1.5, 4, 5, 6, 8, 10, 12, 15, and 18 months.

Results: The urban infants at birth had Z‐scores of weight for age (WAZ), height for age (HAZ) and weight for height (WHZ) below the National Center for Health Statistics (NCHS) median (P < 0.01). However, from 1.5 to 4 months, the WAZ and WHZ scores were above (P < 0.01), but by 7 months fell and remained at – 0.7 to – 0.8 SD below the NCHS median (P < 0.01). HAZ scores improved after birth, were at the NCHS median to 8 months (P = NS), and then decreased to 0.2–0.4 SD below the NCHS median (P < 0.01). Compared with the urban infants, the township–rural infants were lighter and shorter throughout the first 18 months of life, and from 8 months of age, were – 1 SD or more below the NCHS median.

Conclusions: Growth retardation was found in this sample of Chinese infants. The magnitude of growth retardation was greater for infants in the township–rural area compared with those in the urban area.
Asymptomatic bladder phaeochromocytoma in a 7‐year‐old boy
Authors: Bonacruz Kazzi G
Published: March 2003

Bladder phaeochromocytoma in a child is very rare. In the case presented here, it was an incidental finding in the youngest child reported in the literature. The phaeochromocytoma was located at the right ureterovesical junction causing obstruction, resulting in hydronephrosis. The dilemma in the diagnosis and management of this challenging condition is presented. The absence of typical symptoms of phaeochromocytoma is emphasized.
Inspired gas humidity during mechanical ventilation: Effects of humidification chamber, airway temperature probe position and environmental conditions
Authors: Todd DA , Boyd J , Lloyd J , John E
Published: March 2003

Objectives: To determine the inspired gas humidity during mechanical ventilation with: (i) four different humidification chambers; (ii) two airway temperature probe (ATP) positions; (iii) five different humidicrib temperatures; and (iv) insulating the inspiratory limb with bubble wrap.

Methodology: An observational study in the Neonatal Laboratory and Neonatal Intensive Care Unit, Westmead Hospital. The humidity of the inspired gas was measured at the proximal end of the endotracheal tube (ETT) during mechanical ventilation. Inspired humidity measurements were made with four different humidification chambers (Fisher & Paykel (F&P Healthcare Pty Ltd, Auckland, New Zealand) auto refill MR290, F&P manual refill MR310, Suruga (Suruga Inc. Humidifiers, Vincent Medical, Dongguan, China) manual refill MI‐20 and MI‐10F) with the humidity control (relative humidity setting) set at – 2. Measurements were made with the ATP positioned either; (A) at the distal end of the inspiratory tube inside the humidicrib or (B) outside the humidicrib 50 cm proximal to the ETT. The inspired gas temperatures were set at 36.5°C and at 39.0°C, respectively. For each of the different humidification chambers and ATP positions, inspired humidity measurements were made with the humidicrib temperature set at 30.8, 32.9, 35.2, 36.2, or 37.2°C. Two further sets of measurements were made, one with the inspiratory limb insulated with bubble wrap and the second set without bubble wrap.

Results: There were significant differences in inspired humidity with the four humidification chambers at both ATP positions at all humidicrib temperatures. Both Suruga humidification chambers produced significantly higher inspired gas humidities under most conditions. Positioning the ATP outside the humidicrib produced significantly higher inspired gas humidities than with the ATP inside the humidicrib. Insulating the inspiratory tubing with bubble wrap also significantly improved the inspired gas humidity.

Conclusions: Significant differences in inspired gas humidity were found with the humidification chambers tested. The position of the ATP and the set temperature had a significant impact on the absolute humidity of the inspired gas. In general, higher inspired gas humidities were obtained with the ATP outside the humidicrib. However, condensation of water close to the ETT appeared at low humidicrib temperatures (< 36.2°C) with the ATP outside the humidicrib and extreme care should be taken that particulate water does not enter the lungs under these conditions.
Cerebral vasculitis in a child following post‐streptococcal glomerulonephritis
Authors: Wong W , Morris MC
Published: March 2003

Abstract: Cerebral vasculitis following acute post‐streptococcal glomerulonephritis (APSGN) is a rare neurological complication. An 11‐year‐old girl with biopsy proven APSGN developed an acute seizure disorder. Clinical and computed tomography findings were consistent with vasculitis.
The most difficult clinical situations: A survey of Victorian general paediatricians
Authors: Cooper CP , Hewson PH
Published: March 2003

Objective: To identify which clinical situations are the most difficult to manage for general paediatricians in Victoria, Australia.

Methods: Self‐administered questionnaires were sent to general paediatricians in Victoria. They were asked their opinions regarding what were the most difficult and the most dangerous clinical situations with which they deal.

Results: The response rate was 64% (63 out of 98 questionnaires sent). The general paediatricians surveyed believed that behavioural, developmental and psychosocial conditions were the most difficult to deal with; conduct disorder was the most nominated clinical category (26% of respondents). The ‘dangerous’ cases nominated were predominately traditional medical cases. The most commonly nominated category was sepsis and shock (21% of respondents). The most difficult and dangerous clinical situations overall for general paediatricians in Victoria appear to be in the areas of sepsis, child protection, paediatric and neonatal resuscitation, depression and suicide, raised intracranial pressure, intravenous fluid management, and communication with parents and adolescents.

Conclusions: The present survey provides useful information to help with training‐programme design and it gives trainee paediatricians an idea of what experienced paediatricians find difficult. Severe behavioural, family and social difficulties, as well as neonatal and childhood resuscitation, severe sepsis, raised intracranial pressure, and intravenous fluid management were the clinical situations most frequently described as difficult.
Clinical approach to inborn errors of metabolism presenting in the newborn period
Authors: Ellaway CJ , Wilcken B , Christodoulou J
Published: March 2003

Abstract: Inborn errors of metabolism are individually rare, but collectively are responsible for significant levels of paediatric morbidity and mortality. More than 400 biochemically diverse inborn errors of metabolism have been identified. Recent advances in the diagnosis and treatment of these disorders have substantially improved the prognosis for many of them. Paediatricians and neonatologists play a vital role in identifying which patients need to be investigated. The diagnosis of an inborn error of metabolism often needs to be established quickly in order to prevent death or permanent neurological sequelae, and this should be carried out in collaboration with a specialized unit. The present review provides a practical approach to the recognition and investigation of neonates in whom an inborn error may be present. We also provide guidelines for the stabilization and initial management of infants at high risk of a metabolic disorder.
Health‐service use by children with asthma over a 6‐month period
Authors: Spurrier NJ , Staugas R , Sawyer MG , Wakefield MA , Ruffin RE , Jureidini J , Arney F , Baghurst P
Published: March 2003

Objectives:  The present study aims to describe the use of health services by children with asthma, and examine disease‐specific, parental and sociodemographic variables associated with different levels of health‐service utilization.

Methods:  Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health‐care services for asthma.

Results:  At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty‐five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P = 0.05 and P = 0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P = 0.05 and P = 0.004, respectively).

Conclusions:  Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.
Use of a control chart to monitor diarrhoea admissions: A quality improvement exercise in West Kalimantan Provincial Hospital, Pontianak, Indonesia
Authors: Purba Munzir
Published: March 2003

Abstract Data on the number of admissions for diarrhoea each week to the West Kalimantan Provincial Hospital, Pontianak, Indonesia over a 5 year period, 1992–1996, were collected. After cleaning and exclusion of extreme values, transformation was then performed to ensure that the data were free of special cause variation and normally distributed. A control chart was then constructed to provide an ‘early warning’ system for hospital authorities in order to facilitate the management of the epidemic and to improve patient care.
The key elements in the development of a quality management environment for pathology services
Authors: Isouard Godfrey
Published: March 2003

Abstract There is increasing recognition that many quality management initiatives in health care are undertaken without the appropriate development of a responsive and supportive organizational environment. In the present study, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service of the hospital. Major changes were initially undertaken to develop a quality management environment. The four elements found to be important to the creation of the Total Quality Management (TQM) environment were change in management culture, development of teamwork, focus on customers, and continuous feedback to staff. The accomplishment of the TQM was assessed and confirmed using criteria developed by the Pathology Project TQM Team. As the TQM approach is process driven, it should be adaptable to other clinical situations and not just to pathology services. Potential barriers to achieving the required organizational environment are also explored.
Postgraduate courses in quality improvement: Achievements and future directions
Authors: Walker Rhonda , Johnson Natalie , Heller Richard F
Published: March 2003

Abstract Since 1996, the Centre for Clinical Epidemiology and Biostatistics at the University of Newcastle has offered courses in Quality Improvement in Health Care. The courses are offered at Graduate Certificate, Graduate Diploma and Masters levels, principally by distance learning. They offer training in research methods as well as the concepts and application of quality improvement. Feedback from students, many of whom are quality co‐ ordinators in Australian health care facilities, has been positive. Enrolments are taken mid‐year as well as at the beginning of the academic year.
Using clinical indicators to identify areas for quality improvement
Authors: Gibberd Robert , Pathmeswaran Arunasalam , Burtenshaw Kay
Published: March 2003

Abstract Clinical indicators (CI) are increasingly being used to assess the quality of health care being provided by physicians and hospitals. However, a standardised reporting format and a methodology to assess the utility of the CI data has not been developed. This paper provides the reporting format that has been developed for the clinical colleges. The results for four surgical indicators are used to illustrate how the CI data can determine the potential to improve the quality of care. Numerical estimates of the potential gains that could be made are calculated by: (i) determining the outcome if the current mean rate was shifted to the rate for the best 20% of hospitals and (ii) identifying units with unusual variation in rates and shifting their rate to the average. All four indicators reveal gains that could impact on health policy and clinical practice.
Adjusting the balance in health‐care quality
Authors: Carruthers Annette E , Jeacocke David A
Published: March 2003

Abstract In an increasingly informed society there has been a growing interest by consumers in evaluating the quality‐of‐care provided by their practitioners. This task is complicated by an asymmetry in the technical knowledge required to assess health‐care quality between consumers and health providers. Recently attempts have been made to incorporate patient views into the assessment of quality to try and address this asymmetry. A number of quality initiatives have been developed to help provide consumers with markers of practitioner competency including professional training programmes and examinations, quality standards and quality assurance activities. International trends include federal funding for quality improvement activities within practices, and greater use of information technology to provide error warning systems for practitioners, to monitor practice patterns, and to promote better communication of information between health services. It is important in developing these new initiatives that ‘symmetrical’ approaches which capture consumers’ views on quality are employed.
Modelling the reciprocal water exchange between a river (Havel) and a lake (Tegeler See) during spring and autumn overturns
Authors: Lindenschmidt Karl‐Erich , Fröhlich Martin
Published: March 2003

A finite volume computer model (current flow and transport) was used to simulate the reciprocal water exchange between a river (Havel) and a lake (Tegeler See) appendaged to the river in Berlin, Germany. The discretization of the model control volume is 2‐D along the plane of the water surface, which restricts the modelling to time periods of complete overturn. The finite volume method does, however, allow a depth to be given for each volume cell. A k‐ε turbulence submodel was integrated into the model to calculate the distinct dispersion coefficients for each volume cell. As current flow measurements were unavailable, the model was verified indirectly by the transport simulation of dissolved chloride, a conservative substance. The results show that the Havel contributes up to 30% of the total inflow to Tegeler See when it is overturned. As the Havel is more heavily polluted with respect to phosphorus loading, this has negative implications to the water quality of Tegeler See. Suggestions are given for controlling the Havel inflow amount by increasing the output of the phosphate elimination facility, the second main inflow to Tegeler See. Its output has very low phosphorus concentrations and serves as a flushing function.
Identification of processes regulating the colour and colour change in an oligotrophic, hardwater, groundwater‐fed lake, Blue Lake, Mount Gambier, South Australia
Authors: Telfer Andrew L.
Published: March 2003

Blue Lake, located in Mount Gambier, South Australia, is the only known global example of a lake that annually changes colour in the blue end of the spectrum. A series of experiments, including Secchi depth readings, in situ spectroradiometric analysis and spectrophotometric analysis of water samples, were designed to identify the factors affecting the colour of Blue Lake and the processes that regulate these factors. Based on the results of these experiments, the processes controlling the colour and colour change in Blue Lake are described and quantified. Blue Lake colour was observed to change between AS 2700 Aqua during winter (April through to October) and Blue Bell during summer (December through to February). The colour change in Blue Lake is measurable and reflects primarily the regulation of the concentration of humic substances in the upper part of the lake by calcite precipitation. The calcite precipitation is driven by degassing of carbon dioxide from the epilimnion of the stratified lake in summer. The humic substances co‐precipitate with the calcite. Photodegradation of the humic substances may also occur.
Neuroimaging and neuropathology in epilepsy: With special reference to focal epileptogenic abnormalities
Authors: Nishio Shunji , Morioka Takato , Mihara Futoshi , Fukui Masashi
Published: March 2003

Modern diagnostic imaging techniques, such as computed tomography and magnetic resonance imaging (MRI) have had a profound impact on the management of patients with partial epileptic seizures. Among them, MRI has a prominent and often pivotal role in the evaluation of epilepsy because of its high sensitivity for detecting small or even subtle structural abnormalities. Current information on neuroimaging modalities with respect to neuropathologic features of well‐defined and important epileptogenic lesions, such as hippocampal sclerosis, developmental and vascular abnormalities, and neoplasms, was reviewed. With modern neuroimaging modalities, these pathologic changes can now be identified with a high degree of confidence.
Tuberculous brain abscess: A case report with a review of the literature in English
Authors: Shuangshoti Shanop Shuangshoti , Shuangshoti Samruay
Published: March 2003

A 69‐year‐old man had a tuberculous brain abscess in the right frontal lobe as well as an underlying alcoholic cirrhosis of the liver. The abscess responded well to combined surgical excision and antituberculous treatment. A review of 42 patients, including this patient who had tuberculous abscesses of the central nervous system (CNS) disclosed 54% of classical (genuine, true or typical) lesions morphologically similar to the pyogenic abscess, and 46% of atypical lesions having granulomatous changes without caseous necrosis in the abscess wall. The size of the abscesses ranged from 2 mm to 5 cm across. Some abscesses contained 3–60 mL of pus. Most tuberculous abscesses resulted from hematogenous dissemination of tubercle bacilli from primary tuberculous foci outside the CNS; a few were probably related to direct extension of tuberculosis of the ear. Approximately 58% of patients were aged in the first three decades of life and 22% of patients were children of less than 15 years of age. The mean age was 31 years for both genders. The sexual ratio was 7:6 for males and females. The frontal lobe and cerebellum were the common sites of occurrence. Approximately 19% of patients with CNS tuberculous abscesses were associated with the acquired immunodeficiency syndrome (AIDS). Combined surgical extirpation and antituberculous drugs were the treatment of choice. Needle aspiration combined with appropriate antituberculous drugs have yielded satisfactory results in some patients. An intra‐operative smear and a stain of pus for acid‐fast bacilli is necessary for rapidly distinguishing between a tuberculous abscess and a pyogenic abscess as well as for proper immediate postoperative treatment. Geographically, the CNS tuberculous abscesses were scattered in many countries, particularly in India and the USA. Their increased incidence is expected in relation to the present prevalence of AIDS.
Ultrastructural characteristics of pineal parenchymal tumors
Authors: Fujioka Yasunori , Ozaki Yoshimaru , Saito Hisatoshi , Kashiwaba Takeshi , Nagashima Kazuo
Published: March 2003

The ultrastructures of four cases of pineocytoma/pineoblastoma were examined. In two cases of pineocytoma, in which synaptophysin immunoreactive fine granules were readily detected, there were numerous neuronal processes with dense core granules and synaptic junctions. This suggests that neuronal tumors, similar to central neurocytomas, could arise from the pineal neuroblasts or immature pinealocytes. In one case, vesicle‐crowned rodlets or so‐called ‘synaptic ribbon’ were frequently observed; these are a morphologic feature of pinealocytes, and further support the presence of tumors originating from mature pinealocytes. In one case of transitional pineocytoma/pineoblastoma, numerous annulate lamellae were observed, which may be attributable to cell growth of the neoplasm. The tangentially sectioned annulate lamellae showed particulate profiles which resembled virus particles. This observation may explain the virus‐like particles previously reported in pineal tumors. Thus, it is concluded that the ultrastructural examination is indispensable for diagnosis and for determining the cytological origin of pineal tumors.
Two autopsy cases of multiple cerebral tuberculomas
Authors: Shinmura Yuichiro , Tsutsui Yoshihiro , Nishikage Hirofumi , Maeda Matsuyoshi , Mokuno Kenji , Hirose Yoshikiyo
Published: March 2003

Two cases of multiple cerebral tuberculomas are described. A 59‐year‐old female had liver cirrhosis and was suspected of having metastatic tumors in the brain. A 65‐year‐old female had chronic renal failure and was diagnosed with miliary tuberculosis and treated with antituberculous drugs. In both cases, consciousness became disturbed gradually. Both patients were diagnosed with multiple cerebral tuberculomas after death. Histologically, both cases showed cerebral granulomas comprising epithelioid cells mixed with reactive astrocytes, and fibrous gliosis surrounding a core of caseous necrosis. These lesions were readily detected by Holzer staining. Some blood vessels around the granulomas showed vasculitis with lymphocyte infiltration in the walls and obliteration of the lumina by epithelioid cell proliferation. In this report, the unique histological features of the multiple cerebral tuberculoma are described and it is suggested that the obliterative vasculitis around them may have caused the disturbed consciousness.
Dementia of Alzheimer type with and without multiple lacunar infarctions: Evaluation of white matter lesions
Authors: Seno Haruo , Inagaki Takuji , Yamamori Chikako , Miyaoka Tsuyoshi , Horiguchi Jun
Published: March 2003

The white matter lesions in dementia of Alzheimer type (DAT) with and without multiple lacunar infarctions were studied relative to a normal control group. The frequency and distribution of white matter (WM) lesions in DAT (22 cases; mean age ± standard deviation (SD), 88.1 ± 5.8), DAT with multiple lacunar infarctions (DAT + CVD, 18 cases; mean age ± SD, 87.8 ± 6.0), and in a normal control group (17 cases; mean age ± SD, 85.2 ± 4.8) were evaluated. The frequency of myelin pallor (frontal, parietal and occipital lobes) was significantly higher in the DAT + CVD group than in the other groups (DAT and controls). There was no significant difference in the frequency of myelin pallor between the DAT and control groups. Therefore, it was concluded that the WM lesions in DAT are the result of ischemia rather than wallerian degeneration.
An autopsy case of Alzheimer's disease with a progressive supranuclear palsy overlap
Authors: Urasaki Kohji , Kuriki Ken , Namerikawa Michihito , Satoh Shin , Ikeguchi Kunihiko , Fukayama Masasi , Saito Ken , Nakano Imaharu
Published: March 2003

A 74‐year‐old man developed abnormal forgetfulness, soon followed by unstable speech content and marked disorientation. At 77 years of age, the patient started to occasionally fall, an aspect of progressive supranuclear palsy. He then became bedridden. The patient eventually died of pneumonia at 79 years of age. Neuropathological examination revealed profiles of both progressive supranuclear palsy and Alzheimer's disease. Although the two conditions both belong to tauopathy, their pathologically proven combination was rare. Furthermore, the case had the possibility of being a subgroup of tauopathy.
Frequency and distribution of TUNEL‐positive neurons in brains of dementia with Lewy bodies: Comparison with those in brains of Alzheimer's disease
Authors: Katsuse Omi , Iseki Eizo , Suzuki Kyoko , Kosaka Kenji
Published: March 2003

The present study investigated the frequency and distribution of TUNEL‐positive neurons in brains of dementia with Lewy bodies (DLB) in comparison with those in brains of Alzheimer's disease (AD), Down syndrome (DS) and non‐demented elderly persons. In DLB brains, TUNEL‐positive neurons were increased in frequency compared with those in non‐demented elderly brains, and showed a distribution similar to those in AD and DS brains. DLB cases with TUNEL‐positive neurons showing severe Lewy pathology were all neocortical type, while DLB cases of the limbic type showing mild Lewy pathology did not demonstrate TUNEL‐positive neurons. In addition, we investigated the relationships between TUNEL‐positive neurons and pathological hallmarks of DLB or AD brains. TUNEL‐positive neurons had no Lewy bodies or neurofibrillary tangles, and were not located within amyloid deposits. These findings suggest that neuronal damage showing DNA fragmentations occurs in DLB brains as well as in AD and DS brains, and that it is accelerated by progression of Lewy pathology as well as Alzheimer pathology, although it is not directly related to their pathological hallmarks.
Effect of soluble form CTLA‐4 on spontaneous IgA nephropathy in ddY mice
Authors: Okano K , Nitta K , Horita S , Honda K , Abe R , Nihei H
Published: March 2003

The aim of the present study was to examine the role of CD28‐B7 signalling in the development of glomerulonephritis in ddY mice, an animal model for IgA nephropathy. To achieve this aim, we investigated whether the CTLA‐4 (CD152) fusion protein, which binds to B7.1 (CD80) and B7.2 (CD86), affects glomerular pathological changes (including IgA deposition), or functional parameters (such as serum creatinine and proteinuria). Each group (n = 4) was given either human CTLA‐4 fused with human IgG (CTLA4Ig) or control human IgG1. All treated groups of mice were injected intraperitoneally at a dose of 0.1 mg twice a week for the duration of the study. Mice given control human IgG1 progressively developed typical mesangioproliferative glomerulonephritis, with remarkable glomerular IgA deposits. In contrast, mice treated with CTLA4Ig showed a significant reduction in proteinuria and mesangioproliferative change, with an expansion of the mesangial matrix at 40 weeks of age. The serum IgA levels of these mice were considerably lower than those in mice given the control human IgG1. A direct immunofluorescence study showed the reduction of glomerular IgA deposits in CTLA4Ig‐treated mice. We have demonstrated for the first time that the development of spontaneously occurring IgA nephropathy can be prevented in ddY mice by blocking the CD28‐B7 interaction using a soluble form of CTLA4Ig. These results suggest that a costimulatory signal via CD28‐B7 may play a crucial role in the development and progression of IgA nephropathy.
Quantitative analysis of IgA1 binding protein in human serum by hypoglycosylated IgA1/Sepharose chromatography
Authors: Nakamura I , Iwase H , Hiki Y , Kobayashi Y
Published: March 2003

IgA nephropathy (IgAN) is a common disease characterized by predominant IgA deposits in the renal mesangium. It is well‐known that IgA1 among two subclasses, IgA1 and IgA2, is the dominant deposit in the glomeruli during IgAN. The most prominent structural difference between the IgA1 and IgA2 subclasses was the duplicated proline‐rich hinge portion and the characteristic O‐linked oligosaccharide chains on the IgA1 hinge portion. There are many reports on the presence of an incompletely glycosylated O‐linked oligosaccharide (s) on the IgA1 hinge region in some of the IgAN patients. It was also reported that the artificially deglycosylated IgA1 acquired binding ability for fibronectin, type IV collagen and laminin.

In this experiment, preparation and analysis of binding protein (IgA1‐BP) to the hypoglycosylated IgA1/Sepharose column were carried out. In order to examine the presence of the specific binding protein to the hypoglycosylated IgA1 in human serum, IgA1, asialo‐IgA1 and asialo‐agalacto‐IgA1/Sepharose column chromatography of normal human serum was carried out. A portion of the serum protein was bound to those columns and eluted with the buffer containing 1.0 M NaCl. About four times the amount of protein was eluted from the hypoglycosylated IgA1/Sepharose column than that from IgA1/Sepharose. Most of the eluted protein was IgG, and the IgG1 and IgG3 subclasses but neither IgG2 nor IgG4 was dominant (Fig. 1). The Protein A passed‐fraction (PAP fraction) of the IgA1‐BP seemed to contain proteins other than IgG, a detailed analysis of the PAP fraction was carried out. The PAP fraction was composed of a relatively large amount of IgA, IgM and complement C3 besides IgG. The relative content of IgG : IgA : IgM : C3 : C4 was 25 : 10 : 41 : 22 : 2 in the PAP fraction. Meanwhile, the Protein A bound‐fraction of IgA1‐BP was essentially composed of IgG (78%) and IgM (19%) (Fig. 2). Since the deposited IgA1 in IgA nephropathy patient was reported as hypoglycosylated IgA1, the obtained results might explain well the high frequency of copresence of IgM and C3 with the deposited IgA1 in IgAN patients. With respect to the IgA content in the IgA1‐BP from IgAN patients, it was significantly higher than that from other nephropathy patients (Fig. 3). Both of the samples contained a few microgram of abberant IgA per millilitre of serum.

IgG subclass ratio in normal serum and IgA‐BP.

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Relative content of IgG, IgA, IgM, C3 and C4 in the PAP and PAB fractions of IgA1‐BP.

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Total amount of IgA1‐BP and content of IgA in IgA1‐BP prepared from nephropathy patients.

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Thus, the obtained results indicated hypoglycosylated IgA‐BP were IgG1, IgG3, IgA, IgM, C3.
Daily haemodialysis: dialysis for the 21st century
Authors: Lynn Kelvin
Published: March 2003

SUMMARY: Most patients with end stage renal disease (ESRD) currently undergo haemodialysis three times a week. In an effort to improve morbidity, mortality and quality of life in such patients, several small clinical studies have been conducted to evaluate the benefit of short daily haemodialysis (over 90–120 min) and nocturnal slow haemodialysis (overnight for 8–10 h). Although limited by study design and small patient numbers, the results of these studies offer promise that patients who undergo daily haemodialysis benefit from improved long‐term outcomes. The most striking benefits of daily haemodialysis are improved quality of life and better blood pressure control with fewer or no antihypertensive medications. Other advantages of daily haemodialysis include higher haemoglobin levels with lower erythropoietin dosages, better nutrition and improved energy as a result of more physiological and efficient dialysis. Nocturnal haemodialysis has also been reported to improve sleep apnoea and control plasma phosphate concentration. Economic advantages of daily haemodialysis arise as the result of lower medication costs and less expensive at‐home care. Early data suggest that there may be improvements in survival and reduced hospitalization in patients who receive daily versus conventional haemodialysis.
Perspectives of chronic renal failure
Authors: Kurokawa Kiyoshi , Nangaku Masaomi , Inagi Reiko , Miyata Toshio
Published: March 2003

SUMMARY:
End‐stage renal disease (ESRD) is a major source of morbidity and the increasing number of chronic dialysis patients is a significant health‐care issue in many developed as well as developing countries. In the present brief review the current status of chronic dialysis is discussed; and Japan and the USA, two major countries in which chronic dialysis programmes are well developed, are compared. Also discussed is the economic impact, the status of renal transplantation and its future possibilities, recent efforts to halt progression of chronic renal disease, in particular, diabetic nephropathy (which has become the major cause of ESRD in many developed countries), and future perspectives in renal research. It is hoped that, in the future, perhaps by the mid‐21st century, chronic dialysis may become the exception in therapy through our efforts.
Organizing context: nurses' assessments of older people in an acute medical unit
Authors: Parker Judith , Latimer Joanna
Published: March 2003

The paper presents findings from a study of how older people are assessed and cared for in an acute medical unit. The aim of the study was to reconsider nurses' assessment practices in relation to organisational context. Drawing together ethnographic methods with discourse analysis, the study develops an approach to studying nurses' assessment practices and aims to demonstrate that nurses go beyond entering their relationships with patients as individuals. Rather, nurses' assessments of patients can be considered as processes of alignment that help nurses accomplish complicit managerial and medical objectives, and shape their own identities.
In the name of Husserl: nursing in pursuit of the things‐in‐themselves
Authors: Yegdich Tania
Published: March 2003

In the name of Husserl: nursing in pursuit of the things‐in‐themselves

A perceived contradiction between the tenets of humanism and positivism secures phenomenology’s endorsement in nursing as an alternative methodology to the natural sciences. Nursing’s humanistic doctrine of valuing the individual is aligned with phenomenology in the belief that both projects investigate the subjective experiences of others. However, the belief that phenomenology opposes objectifying methods does not account for the different understandings of subjectivity that underpin various philosophic positions, such as humanism, phenomenology, hermeneutics and positivism. What is not recognised in nursing inquiry is that the same characteristics which belong to humanism and are subsequently attributed as belonging to phenomenology are grounded, philosophically, in a view that separates the person from her world. But rather than examining the premises on which phenomenology and humanism are based, nurse‐phenomenologists have simply yoked them together in a mutual alliance against a common enemy — Cartesian dualism. This paper focuses on Husserl and argues that the conceptual link between nursing as a humanistic discipline and Husserlian phenomenology cannot be sustained on philosophic and methodologic grounds. Far from being mutual allies, the philosophic underpinnings of humanism and Husserlian phenomenology offer two incommensurable views on the nature of subjectivity.
Nursing as normative praxis
Authors: Holmes Colin , Warelow Philip
Published: March 2003

Nursing as normative praxis

The purpose of this paper is twofold. First, it introduces a variety of concepts of ‘praxis’, and argues in support of those which reflect the normative dimension of the critical social perspective. This begins with the Aristotelian concept, and moves through a variety of sources, including Hannah Arendt and Paulo Freire, but focuses primarily, and uniquely in the nursing literature, upon the work of the Yugoslavian ‘praxis Marxists’. Second, specific ways of conceiving nursing as praxis are outlined, including political, aesthetic and ethical forms which have immediate import for nurses. The paper concludes with brief suggestions as to how these ways of conceiving praxis may be used by nurses to develop a more intimate and productive understanding of their own practices.
The increasing use of anticonvulsants in prophylactic treatment of bipolar disorder
Authors: YANG YONG‐YI , DENG HWEI‐CHUANG , WANG BI‐HWA
Published: March 2003

The medical records of patients with bipolar disorders who received prophylactic drug treatments during three time periods from January 1983 to December 1984, January 1988 to December 1989, and from January 1993 to December 1994, were reviewed retrospectively. The percentage of lithium monotherapy sharply decreased from 96% (51/53) in the first study period to 51.9% (83/160) in the third study period. Carbamazepine monotherapy and combination of lithium and carbamazepine increased from 3.8% in the first study period to 45.6% in the third study period. These results suggest that anticonvulsants may become one of the major drug treatment strategies for bipolar disorder in the future.
Depression among caregivers of the elderly in need of care and their service utilization: A pilot study
Authors: ARAI YUMIKO , MIURA HIROKO , WASHIO MASAKAZU , KUDO KEI
Published: March 2003

Twenty‐four community residing elderly people in need of care, who were registered with the municipal welfare center in Miyagi Prefecture, Japan, and their principal caregivers participated in the study. The principal caregivers completed a self‐administered questionnaire involving their demographic status, provided data on their utilization of formal services and completed the Center for Epidemiologic Studies Depression Scale (CES‐D). The health visitors examined the activities of daily living (ADL) and mental status of these 24 elderly individuals. More than half the caregivers appeared to be depressed. The non‐depressed caregivers used significantly more services than the depressed caregivers even after the caregivers' age was statistically controlled.
Plasma concentrations of timiperone and its reduced metabolite in the patients on timiperone
Authors: SHIMODA KAZUTAKA , SOMEYA TOSHIYUKI , MORITA SACHIYO , HIROKANE GENTA , YOKONO AYA , SHIBASAKI MORIKAZU , TAKAHASHI SABURO
Published: March 2003

Plasma levels of timiperone (TIM) and reduced timiperone (RTIM) were determined in 10 schizophrenic patients who were treated with TIM. Activities of ketone reductase in red blood cells (RBC) were assayed using TIM and haloperidol (HAL) as substrates. Plasma levels of TIM and RTIM ranged from 3.2 ng/mL to 9.5 ng/mL and from 1.7 ng/mL to 7.6 ng/mL, respectively, and ∼four‐fold inter‐individual variations in RTIM/TIM (0.37–1.43, 0.67 ± 0.25) were observed. There were significant and positive correlations between plasma levels of TIM or RTIM with the daily doses of TIM (mg/kg body weight); TIM (ng/mL) = 19.5 × daily dose of TIM (mg/kg) + 1.3, r = 0.79, n = 18, P < 0.01; RTIM (ng/mL) = 13.1 × daily dose of TIM (mg/kg) + 0.7, r = 0.73, n = 18, P < 0.001). Given 0.3 mg/kg of TIM, a plasma level of TIM as 7.15 ng/mL was predicted, which is ∼60% that of HAL. The activity of TIM reductase in RBC was determined as ∼70% of HAL reductase in RBC, although the correlation between the activities of TIM reductase and HAL reductase in RBC was high (r = 0.98, n = 10, P < 0.001).
Posttraumatic stress disorder as a function of the traumatic event, posttrauma stress and pretrauma vulnerability
Authors: NOZOMU  , MIYAKE YUKO
Published: March 2003

We conducted two‐stage studies on disaster victims and firefighters in the aftermath of the 1995 Hanshin–Awaji Earthquake. Posttrauma stress, high neuroticism and peritraumatic dissociation were suggested as strong contributing factors to posttraumatic stress disorder symptoms in the later stage after the event.
Children and disasters: A developmental approach to posttraumatic stress disorder in children and adolescents
Authors: PYNOOS ROBERT S. , GOENJIAN ARMEN K. , STEINBERG ALAN M.
Published: March 2003

The present article reviews progress in the field of childhood traumatic stress and presents a developmental model of trauma in children and adolescents that can inform research, evaluation and treatment. Selected research findings from the UCLA Trauma Psychiatry Program are presented regarding the biology of posttraumatic stress disorder (PTSD) among adolescents, co‐morbid conditions and traumatic bereavement. A trauma/grief‐focused group‐psychotherapeutic approach for children and adolescents is described, with preliminary findings from treatment of children exposed to a catastrophic natural disaster and children exposed to chronic community violence.
Analysis of rapid eye movement periodicity in narcoleptics based on maximum entropy method
Authors: Honma Hiroshi , Ohtomo Norio , Kohsaka Masako , Fukuda Noriko , Kobayashi Riko , Sakakibara Satoshi , Nakamura Fumihiro , Koyama Tsukasa
Published: March 2003

We examined REM sleep periodicity in typical narcoleptics and patients who had shown signs of a narcoleptic tetrad without HLA‐DRB1*1501/DQB1*0602 or DR2 antigens, using spectral analysis based on the maximum entropy method. The REM sleep period of typical narcoleptics showed two peaks, one at 70–90 min and one at 110–130 min at night, and a single peak at around 70–90 min during the daytime. The nocturnal REM sleep period of typical narcoleptics may be composed of several different periods, one of which corresponds to that of their daytime REM sleep.
A case of neuroleptic‐induced unilateral akathisia with periodic limb movements in the opposite side during sleep
Authors: Yamashita Hidehisa , Horiguchi Jun , Mizuno Souichi , Kuramoto Yasunari , Yamawaki Shigeto , Inami Yasushi
Published: March 2003

We report on a patient with schizoaffective disorder who developed unilateral akathisia. This is the first case report of a patient with neuroleptic‐induced unilateral akathisia on whom an all‐night polysomnogram was recorded. On the polysomnogram we observed right side periodic limb movements (PLM) with left side unilateral akathisia, and after her akathisia disappeared, the PLM also disappeared. Brain MRI findings and neurological findings were within normal limits. The pathogenetic lesion causing akathisia could not be elucidated.
Two cases of HLA‐DR2‐negative hypersomnia manifesting sleep‐onset rapid eye movement periods in the multiple sleep latency test
Authors: Yoshida Yasushi , Kuroda Kenji , Mandai Masaharu , Satani Seiji , Emura Narutsugu , Ueda Satoshi , Matsumura Hitoshi , Yoneda Hiroshi
Published: March 2003

We encountered two cases expressing excessive daytime sleepiness (EDS) and manifesting two or more sleep‐onset rapid eye movement (REM) periods in the multiple sleep latency test. Unbearable daytime sleepiness occurred abruptly, which usually led to short‐lasting naps, after which the patients felt refreshed. The EDS was successfully reduced by treatment with methylphenidate. In spite of these features similar to narcolepsy, these cases of REM hypersomnia did not present cataplexy or other auxiliary symptoms of narcolepsy, and, furthermore, the class‐II human leukocyte antigen DR2 appeared to be negative.
Effects of a small dose of triazolam on P300
Authors: Hayakawa Tatsuro , Uchiyama Makoto , Urata Jujiro , Enomoto Tetsuro , Okubo Junji , Okawa Masako
Published: March 2003

Ten healthy men (mean age, 33.9 years) participated in two experimental sessions cross‐overed randomly in a double‐blind manner: one with the placebo and another with 0.125 mg of triazolam (TRZ). Resting electroencephalography and event‐related potential under oddball paradigm were recorded before the drug administration, and 1, 2, 4, 6 and 8 h after that. P300 waveforms were analyzed by peak amplitudes and 30‐ms bin data. Triazolam may cause cognitive dysfunction without general sedation or apparent sleepiness, and this effect appeared 2 h, 4 h and 6 h, most prominently 6 h, after TRZ administration.
Re‐entrainment of circadian rhythm of plasma melatonin on an 8‐h eastward flight
Authors: Takahashi Toshiharu , Sasaki Mitsuo , Itoh Hiroshi , Sano Hidetaka , Yamadera Wataru , Ozone Motohiro , Obuchi Keita , Nishimura Hiroshi , Matsunaga Naoki
Published: March 2003

To estimate the process of re‐entrainment we measured the melatonin rhythm on an eastward flight. After the baseline study, 24‐hour blood sampling of six male subjects was done on the first and fifth days. During the daytime the subjects were exposed to natural zeitgeber outdoors every day except the blood sampling day. They were analyzed with an illuminometer when under the bright light condition. Four of the six subjects showed orthodromic re‐entrainment, another subject showed antidromic re‐entrainment, and the other subject kept the baseline pattern of plasma melatonin. The rate of re‐entrainment in orthodromic re‐entrainment was about 55 min per day. Measuring the circadian rhythm of plasma melatonin has clarified the inter‐individual re‐entrainment difference.
Effects of prone and supine position on sleep characteristics in preterm infants
Authors: Goto Kazuya , Maeda Tomoki , Mirmiran Majid , Ariagno Ronald
Published: March 2003

The purpose of this study was to address the influence of sleep position on sleep characteristics in preterm infants. We studied 16 infants at a mean post‐conceptional age of 36.5 weeks. Infants were successfully recorded with videopolysomnograph in the supine and prone position. Between the two positions, there were no significant differences in percentage of active sleep and quiet sleep (QS), the occurrence of arousal, and the incidence of apnea. The first QS after the feeding was longer in the prone position. The sleep position could affect sleep characteristics but not respiratory characteristics in preterm infants.
Evaluation of the auto continuous positive airway pressure efficacy by upper airway pressure measurement
Authors: Miyazaki Soichiro , Itasaka Yoshiaki , Ishikawa Kazuo , Togawa Kiyoshi
Published: March 2003

The efficacy of auto continuous positive airway pressure (CPAP) was prospectively evaluated in 11 obstructive sleep apnea cases by the upper airway pressure measurement. Their apnea plus hypopnea index decreased from 68.3 ± 20.2/h to 0.5 ± 0.9/h during manually adjusted and 9.6 ± 14.5/h during auto CPAP. The intraesophageal pressure decreased from −88.0 ± 34.0 cmH2O to −11.9 ± 7.2 cmH2O during manually adjusted and −26.0 ± 13.7 cmH2O during auto CPAP. The manually adjusted CPAP level was 9.1 ± 1.7 cmH2O and the maximum pressure of the auto CPAP was 9.4 ± 2.0 cmH2O. Auto CPAP could automatically detect the optimal CPAP level. However, the efficacy of the auto CPAP was less than that of the manually adjusted CPAP.