bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression and somatic mutation on androgen receptor gene in prostate cancer
Authors: SEGAWA NAOKI , NAKAMURA MISA , SHAN LIANG , UTSUNOMIYA HIROTOSHI , NAKAMURA YASUSHI , MORI ICHIRO , KATSUOKA YOJI , KAKUDO KENNICHI
Published: March 2003

Background: Lack of androgen receptor (AR) expression or mutation on the AR gene creates the tendency for androgen independence and progression of prostate cancer. However, the association between the progression and AR expression or mutations is still controversial. In this study, we evaluated the prognostic significance of AR expression and mutations in prostate cancers.

Methods: Forty‐two prostate adenocarcinomas and three lymph node metastatic lesions sampled prior to hormonal therapy were included in this study; AR expression was analyzed immunohistochemically using an antibody against AR and the result was scored as the percentage of AR‐positive tumor cells in the total tumor cells. Polymerase chain reaction–single‐strand conformational polymorphism (PCR‐SSCP) analysis and DNA sequencing were used to detect AR mutations.

Results: Our study revealed the average AR expression in the prostate adenocarcinoma was 52.2 ± 27.1%, which was significantly lower than that in the adjacent non‐tumorous prostate tissue (68.3 ± 18.3% in average) (P < 0.001). A significant correlation was obtained between progression‐free survival and AR expression (P < 0.01). By SSCP analysis, three silent mutations (T649T, E709E and E711E) were detected in three separate prostate carcinomas.

Conclusion : We conclude that AR expression is a useful prognostic indicator for tumor progression. Androgen receptor mutation may be an uncommon molecular event in untreated prostate cancer in Japanese men.
Antitumor effect of reduction of 150‐kDa oxygen‐regulated protein expression on human prostate cancer cells
Authors: MIYAGI TOHRU , HORI OSAMU , KOSHIDA KIYOSHI , EGAWA MASAYUKI , KATO HIROAKI , KITAGAWA YASUHIDE , OZAWA KENTARO , OGAWA SATOSHI , NAMIKI MIKIO
Published: March 2003

Background: The 150‐kDa oxygen‐regulated protein ORP150, a new member of the heat shock protein family that functions as a molecular chaperone in the endoplasmic reticulum, was found to increase in infiltrating cancer cells. Since enhancement of ORP150 expression and the presence of vascular endothelial growth factor (VEGF) in human prostate cancer glands were immunohistochemically demonstrated, we examined whether transduced antisense ORP150 cDNA can reduce angiogenicity and tumorigenicity through suppression of VEGF secretion.

Methods: Human prostate cancer specimens were immunohistochemically stained with fluorescein isothiocyanate (FITC) for ORP150 or vascular endothelial growth factor (VEGF). An adenovirus vector (Ad) carrying antisense ORP150 cDNA (AdCA‐Antisense ORP150) was constructed and infected to prostate cancer DU145 cells. Expression of ORP150 in the cells was analyzed with western blotting and secretion of VEGF into the supernatant with an enzyme‐linked immunoabsorbent assay (ELISA). Angiogenicity was evaluated by chorioallantoic membrane (CAM) assay. A nude mouse xenograft model was used to examine tumorigenicity.

Results: Immunohistochemical study proved that the expression of ORP150 and VEGF was enhanced in the cytoplasm of prostate cancer cells. The Ad showed 100% transduction efficiency and minimum cytotoxicity when the cells were infected at a multiplicity of infection (MOI) of 20 for 24 h. Expression of ORP150 was substantially reduced by the antisense treatment. Secretion of VEGF into the culture supernatant was reduced to 30%. Consequently, the CAM assay showed relatively low angiogenicity, while marked suppression of tumor formation was observed in the xenograft model.

Conclusion: Adenoviral‐mediated antisense ORP150 cDNA transfer is well worth considering as an option for prostate cancer gene therapy.
Histologically benign but telomerase positive adrenal pheochromocytoma
Authors: HIRANO YASUHIRO , NOBATA SYUNSUKE , TAKAHASHI HISAYA , KAGEYAMA SHINJI , SUDOKO HIROSHI , USHIYAMA TOMOMI , SUZUKI KAZUO , FUJITA KIMIO
Published: March 2003

Adrenalectomy was performed on a 37‐year‐old woman with right adrenal pheochromocytoma. Although the histological diagnosis was benign, telomerase repeat amplification protocol (TRAP) demonstrated positive telomerase activity. Thirty‐five months after adrenalectomy, a recurrent tumor was found. Forty‐seven months after adrenalectomy, bone metastases also appeared. Malignant pheochromocytoma was clinically diagnosed. Our experience suggests that telomerase‐positive tumor cells are highly likely to repeat cell proliferation when they are left in the patient's body, and lead to recurrence. Therefore, telomerase‐positive tumors should be clinically treated as malignant even if they have been histologically diagnosed as benign.
Testicular sperm extraction using microdissection for non‐obstructive azoospermia
Authors: Hibi Hatsuki , Taki Tomohiro , Yamada Yoshiaki , Honda Nobuaki , Fukatsu Hidetoshi , Yamamoto Masanori , Asada Yoshimasa
Published: March 2003

Background
: Men presenting with non‐obstructive azoospermia (NOA) caused by germinal failure can now be treated in some cases using testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). However, TESE is a blind procedure that does not identify the focal sperm‐producing areas until excision of the testicular tissue. Microdissection TESE, which is the only method available for obtaining excised dilated seminiferous tubules under the operating microscope, improves sperm yield with minimal tissue excision in NOA patients.

Methods and Results
: We performed this procedure on 16 NOA patients. All subjects underwent a microdissection TESE on the right testis, and triple biopsy on the left testis in consecutive fashion in order to compare the efficacy of microdissection TESE with that of a standard biopsy. Although dilated seminiferous tubules were presented in all patients, spermatozoa were retrieved in only a single patient by microdissection TESE. Furthermore, spermatozoa could not be identified by standard biopsies.

Conclusion
: In this series, microdissection TESE did not contribute to spermatozoa recovery in NOA patients. Further study is needed in order to arrive at a reliable assessment of microdissection TESE relative to a standard multiple biopsy in cases of NOA. (Reprod Med Biol 2002; 1: 31–34)
Quadriceps muscle wasting persists 5 months after total hip arthroplasty for osteoarthritis of the hip: a pilot study
Authors: Reardon K. , Galea M. , Dennett X. , Choong P. , Byrne E.
Published: March 2003

Aims: To determine whether additional muscle fibre wasting of the ipsilateral vastus lateralis muscle occurs in the early postoperative period after total hip arthroplasty for osteoarthritis of the hip and whether there is an improvement in preoperative measures of quadriceps muscle thickness, strength, pain and function over a 5‐month postoperative period.

Methods: Twelve patients had ipsilateral needle quadriceps biopsy for muscle morphology and bilateral quadriceps muscle thickness ultrasound preoperatively, 5 days and 4 weeks postoperatively and a further muscle thickness measurement at 5 months. Seven additional patients and five age‐matched control subjects had bilateral quadriceps muscle ultrasound thickness preoperatively, 6 weeks and 5 months postoperatively, with assessment of quadriceps muscle dynamometry, pain scores and Timed Up and Go (TUG) test.

Results: Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 × 10–7) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). Muscle morphology preoperatively showed type 2A and 2B muscle fibre atrophy on needle muscle biopsy, with further atrophy of all three fibre types (P = 0.029) at 5 days postoperatively associated with a fibre type shift from type 1 to 2A fibres (P = 0.0011) at 1 month. There was improvement in hip pain postoperatively and a significant improvement in the TUG test (P = 0.007). However, there was no improvement in muscle strength on dynamometry.

Conclusions: There is significant ipsilateral quadriceps atrophy and weakness with 2A and 2B fibre atrophy preoperatively in patients with osteoarthritis of the hip with exacerbation and further atrophy of all three fibre types 5 days postoperatively. Postoperative follow up showed that the reduction in ipsilateral quadriceps muscle thickness persisted at 5 months despite physical rehabilitation. Patients did note significant improvement in pain postoperatively and improvement on functional assessment with the TUG test. Other therapeutic strategies may have to be developed to reverse disuse muscle atrophy. (Intern Med J 2001; 31: 7–14)
Variegate porphyria in Western Australian Aboriginal patients
Authors: Rossi E. , Chin C. Y. B. , Beilby J. P. , Waso H. F. J. , Warnich L.
Published: March 2003

Background:  Survivors of shipwrecks along the Western Australian coast may have introduced a mutation for variegate porphyria into the Aboriginal population prior to first settlement.

Aims:  To assess the mutations responsible for variegate porphyria in Western Australian Aboriginal patients, particularly the R59W mutation, which is the most common cause of variegate porphyria in South Africa.

Methods:  New cases of porphyria were diagnosed by biochemical separation of porphyrin subtypes. Single‐stranded conformation polymorphism analysis and DNA sequencing of the protoporphyrinogen oxidase gene was performed on Aboriginal patients to define possible causative mutation sites.

Results:  Of the 296 new cases of porphyria diagnosed in Western Australia from 1978 to 1998, six had biochemically proven variegate porphyria. Three of those cases occurred in Aboriginal patients. Evidence for a possible fourth Aboriginal case of variegate porphyria is described. The R59W founder mutation respons­ible for over 90% of variegate porphyria in South Africa was excluded. Two new mutations that predicted amino acid substitutions with significant effects on enzyme function were detected in conserved regions of the protoporphyrinogen oxidase gene in one Aboriginal variegate porphyria patient and the possible fourth case.

Conclusion:  Results suggest that the mutations causing variegate porphyria in the Western Australian Aboriginal population occur sporadically and were not inherited from shipwrecked sailors. (Intern Med J 2002; 32: 445−450)
Guillain−Barré syndrome and hyponatraemia
Authors: Colls B. M.
Published: March 2003

Abstract

Background : Hyponatraemia is a recognized association of the Guillain−Barré syndrome (GBS) and is also known to occur after the administration of intravenous infusion of gamma globulin (IVIG), a treatment often used in management of GBS.

Aims : To document serum sodium concentration in GBS patients before, during and after management procedures (including IVIG) positive pressure ventilation (PPV) and the use of medications capable of causing a low serum sodium. To consider whether pseudohyponatraemia might be a contributory factor. To assess whether hyponatraemia is a predictor of poor outcome.

Methods : Clinical record audit of 84 patients with GBS admitted to Christchurch Hospital, New Zealand, over a 10‐year period.

Results : Serum sodium concentration was significantly low (<133 mmol/L) in 26 of 84 (31%) patients. In 12 of these cases the hyponatraemia developed during or after IVIG, suggesting that pseudo­hyponatraemia was a contributing factor. Six (7%) significantly hyponatraemic patients died, but no eunatraemic or slightly hyponatraemic patient died (P = 0.001). Six of 38 patients aged ≥50 years died, whereas none of the 46 patients aged <50 years died (P = 0.007). Five of 19 ventilated patients died but only one of 65 non‐ventilated died (P = 0.002).

Conclusions : Significant hyponatraemia occurred in 26 (31%) of the patients, but in 12 of these it appeared likely that pseudohyponatraemia caused by IVIG was a contributing factor. Hyponatraemic patients have a poorer prognosis than eunatraemic patients, however it is difficult to separate this factor from other poor prognostic factors (older age and PPV). (Intern Med J 2003; 33: 5−9)
Historical review of rice herbicides in Japan
Authors: Matsunaka Shooichi
Published: March 2003

A historical review on rice herbicides in Japan was conducted. Rice cropping patterns (transplantation and flooded or dry‐direct seedings) are described, followed by a comparison of the economics of hand weeding and herbicide use. Changes of herbicide chemicals, formulations and application methods are also described. Weeds resistant even to herbicides designed for use with rice agriculture were found. Mode of action and selectivity mechanism of these herbicides are discussed from the standpoint of fish toxicity, which is especially important in rice culture. Finally, a view for the future is presented.
Herbicide‐resistant genetically modified crop: assessment and management of gene flow
Authors: Kwon Y.w , Kim D.S. , Yim K.‐O.
Published: March 2003

Genetically modified (GM) crops have become a reality in our cropping system. The experiences with GM oilseed rape have shown that gene flow from a GM crop causes genetic contamination of non‐GM crops and natural flora. This review summarizes technically available methods for gene flow assessment and proposes possible management methods. Methods for direct monitoring of gene flow include direct bioassay of plants and detection of phenotypic and molecular genetic markers contained in GM crops. A recent green fluorescent protein (GFP) marker technique can be powerful in monitoring gene flow as GFP inserted into a plant can be observed macroscopically under UV light. Appropriate analysis of data from direct assessment may give more useful information to mitigate gene flow. Observation with direct method provides real‐time data and mathematical‐statistical approaches may enable the long‐term consequence to be predictable. Although an estimated gene flow is less than an acceptable level, gene flow must be maintained as low as possible with a systematic management. The management should be conducted stepwise; selection of gene flow‐proof GM crops in the stage of development, risk assessment and regulation in the registration stage, cultural management, produce handling/transportation and a long‐term monitoring in cropping stage. Promising methods for developing gene flow‐proof GM crops include conferring cleistogamy and chloroplast transformation to mitigate pollen flow, and breeding non‐ or minimum shedding cultivars to mitigate seed dispersal. We strongly suggest that very high expression of a transgene or stacking multiple transgenes in the chloroplast could disturb the function of normal physiology, hence decreased performance of the GM crop. Before the approval of GM crops, proposed GM crops must go through the risk assessment. If the estimated risk of a GM crop exceeds an acceptable level, approval must be suspended. Once a GM crop is allowed for commercial release, additional efforts must follow, such as a continued long‐term monitoring of the impact of GM crop cultivation, crop and herbicide rotations, GM crop‐suited cultural practices, ‘right‐time’ harvest, and all necessary gene flow‐preventive practices. Such a systematic management incorporating various methods for the stages of GM crop utilization will minimize the risk of gene flow.
Purple nutsedge tuber sprouting
Authors: NISHIMOTO ROY K.
Published: March 2003

Purple nutsedge (Cyperus rotundus L.) tubers remain viable for several years and serve as its principal means of survival. The maintenance of high moisture content is essential to tuber survival. Apical dominance influences bud dormancy within a tuber and in a chain of tubers, and dormancy increases with tuber age. Several growth inhibitors were identified in tubers, but their role in tuber dormancy has not been established. Moisture levels in soil must increase to a critical level before sprouting occurs, but excess soil moisture deters sprouting. Oxygen may be a limiting factor for tuber sprouting in waterlogged soils. Although light is not a requirement for sprouting, it has promoted sprouting. Temperature regulates sprouting; no sprouting occured below 10°C and above 45°C. Optimum sprouting occurred between 25 and 35°C when provided with constant temperatures. However, daily alternating temperatures greatly stimulated sprouting. A daily short duration (0.5 h) of high temperature increased sprouting to nearly 100%, whereas less than 50% sprouting occurred without the daily high temperature pulse. Bud break occurred readily for most tubers at 20°C and in nearly 100% of the tubers with a single 0.5 h exposure to a high temperature (35°C) pulse. However, most buds did not elongate if the tuber remained at 20°C. Bud elongation occurred at higher temperatures, and daily alternating temperatures stimulated shoot elongation up to eightfold greater than at the respective mean constant temperatures. Daily soil temperature fluctuation may be a major signal for purple nutsedge emergence, such as when the plant canopy is removed, or when soils are solarized. Future research is needed to determine tuber sprouting for different ecotypes, and on the role of the rhizome chain. Systems to manipulate sprouting may provide new strategies for purple nutsedge management.
Germination and seedling emergence of glyphosate‐resistant and susceptible biotypes of goosegrass (Eleusine indica[L.] Gaertn.)
Authors: ISMAIL B.S. , CHUAH T.S. , SALMIJAH S. , TENG Y.T. , SCHUMACHER R.W.
Published: March 2003

Effects of environmental factors on the germination and seedling emergence of glyphosate‐resistant (R) and ‐susceptible (S) biotypes of Eleusine indica (L.) Gaertn. were examined under laboratory and greenhouse conditions. The R biotype exhibited a higher germination percentage compared with the S biotype at constant temperatures of 20 and 35°C under dark conditions, and alternating temperatures of 30/25°C, and 35/25°C during a 12 h photo period. For both biotypes, germination was optimal at alternating temperatures of 30/20°C and 35/20°C. However, there was no significant difference (P > 0.05) in the germination between the R and S biotypes at these temperature regimes. The germination of both biotypes was inhibited by osmotic stress imposed by a water potential of −0.80 MPa. When the moisture stress was released and the seeds were subsequently transferred to distilled water, the germination was enhanced to approximately 90% and 16% for the R and S biotype seeds, respectively. Higher emergence rates were obtained in shallow seed depths (0 or 2 cm) compared to deep depths. Emergence percentage of the R biotype was higher than that of the S biotype at 0 cm and 2 cm depths. The maximum emergence percentage of the R biotype was higher than that of S biotype when seeds were sown on the surface of either loamy or clay loam soil taken from three different sites.
Electrocardiographic artefact with SSEP monitoring unit during scoliosis surgery
Authors: CHOUDHRY D.K. , STAYER S.A , REHMAN M.A , SCHWARTZ R.E
Published: March 2003

A case of somatosensory evoked potential (SSEP) induced electrocardiographic artefact simulating supraventricular tachycardia (SVT) is described in a three year old girl with Goldenhar syndrome, during anterior thoracoscopic discectomy with posterior spinal fusion for scoliosis. Adenosine was administered for this misinterpreted EKG with coincidental cessation of SVT like trace.
Ropivacaine in paediatric surgery: preliminary results
Authors: IVANI GIORGIO , MERETO NADIA , LAMPUGNANI ELISABETTA , DE NEGRI PASQUALE , TORRE MICHELE , MATTIOLI GIROLAMO , JASONNI VINCENZO , LÖNNQVIST PER
Published: March 2003

In a double blind study 40 patients, aged 1–9 years, undergoing elective minor surgery were examined and randomly divided in two groups (20 children each). After light general anaesthesia Group 1 received caudal injection of bupivacaine 0.25% 2 mg·kg−1 while Group 2 received 0.2% ropivacaine 2 mg·kg−1. No differences were observed in demographic data, HR, BP and duration of surgery; the onset time of anaesthesia was 12 min and 9 min in Group 1 and 2 respectively. Ten patients in Group 1 received paracetamol in the first 24 h after surgery while only two children in Group 2 needed analgesic; even the duration of analgesia in the patients requiring paracetamol was superior in group 2 (520 min vs 253 min). No motor block was apparent at awakening in either group and no side effect was noticed. In conclusion ropivacaine seems to be an effective and safe drug in paediatric regional anaesthesia.
Paediatric preoperative teaching: effects at induction and postoperatively
Authors: MARGOLIS JUDITH , GINSBERG BRIAN , DEAR GUY , ROSS ALLISON , GORAL JANET , BAILEY ANN
Published: March 2003

In a randomized controlled trial at Duke University and University of North Carolina Hospitals, 143 two to six year old children undergoing elective ambulatory surgery were randomized into a control group who received routine preoperative teaching or an intervention group who received an interactive teaching book. Changes in behaviour were measured by a Vernon behavioural questionnaire preoperatively and again two weeks postoperatively. A Global Mood Score was assessed in the preoperative holding area, at arrival into the operating room, and at the time of mask induction. The children in the control group were significantly more aggressive postoperatively than the intervention group (P<0.05). Children who received the interactive teaching book exhibited higher levels of anxiety on the day of surgery, but fewer behavioural changes two weeks following surgery. Parents in the intervention group reported that preoperative teaching helped their child (87%) and themselves (83%).
Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery
Authors: Goodarzi Mashallah
Published: March 2003

The safety and side‐effects profile of epidural administration of a hydrophilic (morphine), highly lipophilic (fentanyl) and a drug with intermediate hydrophilic and lipophilic activity (hydromorphone) were compared in 90 children undergoing orthopaedic procedures. Ninety patients were randomly assigned (30 in each group) to receive epidural morphine, hydromorphone, or fentanyl for postoperative analgesia. Respiratory effects, nausea, somnolence, urinary retention, pruritus and visual pain scales were evaluated and compared during a 30‐h period following surgery. In the morphine group, 25% showed respiratory depression with oxygen saturation below 90% but there was no incidence of respiratory depression in the fentanyl or hydromorphone groups. Somnolence was prominent in some of the patients in all the groups, but was more prolonged in the morphine group. Statistically, there was no significant difference in nausea between the groups, but pruritus was more severe and frequent in the morphine group. The incidence of urinary retention in the morphine group was higher compared with the fentanyl and hydromorphone groups. In conclusion, epidural hydromorphone, demonstrating less side‐effects, is preferable to morphine and fentanyl for epidural analgesia in children.
Anaesthesia with midazolam and S‐(+)‐ketamine in spontaneously breathing paediatric patients during magnetic resonance imaging
Authors: Haeseler G. , Zuzan O. , Köhn G. , Piepenbrock S. , Leuwer M.
Published: March 2003

We evaluated safety and efficacy of a sedation technique based on rectal and intravenous S‐(+)‐ketamine and midazolam to achieve immobilization during Magnetic Resonance Imaging (MRI). Thirty‐four paediatric patients were randomly assigned to undergo either the sedation protocol (study group) or general anaesthesia (control group). Imaging was successfully completed in all children. Children in the study group received a rectal bolus (0.5 mg·kg−1 midazolam and 5 mg·kg–1 S‐(+)‐ketamine) and required additional i.v. supplementation (20 ± 10 μg·kg–1·min–1 S‐(+)‐ketamine and 4 ± 2 μg· kg−1· min−1 midazolam), spontaneous ventilation was maintained. Transient desaturation occurred once during sedation and four times in the control group (P=0.34). P
ECO2 was 5.3 ± 0.5 kPa (40 ± 4 mmHg) in the study group and 4.1 ± 0.6 kPa (31 ± 5 mmHg) in the control group (P < 0.001). Induction and discharge times were shorter in the study group (P < 0.001), recovery times did not differ significantly between the groups. Our study confirms that a combination of rectal and supplemental intravenous S‐(+)‐ketamine plus midazolam is a safe and useful alternative to general anaesthesia for MRI in selected paediatric patients.
Effects of i.v. metoclopramide, atropine and their combination on gastric insufflation in children anaesthetized with sevoflurane and nitrous oxide
Authors: Suga Akihiko , Tanaka Makoto , Toyooka Hidenori
Published: March 2003

Methods: To determine effects of i.v. metoclopramide, atropine and their combination on the airway pressures at which gastric insufflation occurs in children, 45 healthy infants and children (ASA I) received an inhalational induction of anaesthesia with sevoflurane, N2O and O2. A blinded observer used a stethoscope to auscultate over the upper abdomen for any air entry. First, proximal airway pressure was slowly increased by closing the pop‐off valve of the anaesthesia machine until gas was heard entering the stomach (pop‐off point, control measurement). If the peak inspiratory pressure reached 40 cm H2O, the patient was to be excluded from the study. Then, all subjects randomly received i.v. atropine 0.01 mg·kg–1, metoclopramide 0.2 mg·kg–1, or atropine 0.01 mg·kg–1 plus metoclopramide 0.2 mg·kg–1 (n=15 each), and determination of the pop‐off point was repeated 5 min later. The stomach was evacuated before each measurement.

Results: Atropine significantly decreased the pop‐off point [from 21 ± 3 to 19 ± 2 cm H2O (mean ± SD), P < 0.05], while metoclopramide significantly increased the pop‐off point (from 20 ± 3 to 26 ± 6 cm H2O, P < 0.05). The combination of metoclopramide and atropine did not alter the pop‐off point (from 20 ± 2 to 19 ± 5 cm H2O).

Conclusions: Since metoclopramide exerts only mild effect on the pop‐off point, cricoid pressure still remains the standard anaesthetic practice to prevent gastric insufflation in children. Prophylactic i.v. metoclopramide may be restricted to, and its clinical usefulness should be determined in, symptomatic patients with gastro‐oesophageal reflux.
Monitoring of pacemaker induced changes in cardiac output with inspired to endtidal oxygen difference in paediatric cardiac surgery patients
Authors: Bengtsson Jan , Edberg Karl Erik , Nilsson Boris , Bengtson Jan Peter
Published: March 2003

Methods: Fourteen children aged 4–15 months were studied after corrective cardiac surgery. Heart rate was increased by 20% with an external pacemaker. Cardiac output (CO) was measured with thermodilution. Oxygen saturation was measured in systemic artery (SaO2), central vein (ScvcO2) and pulmonary artery (SvO2). Inspiratory to endtidal oxygen difference (FI‐ETO2) was measured using a paramagnetic technique. SvO2 was measured continuously using a spectrophotometric technique.

Results: CO increased in three patients and decreased in 11 patients during pacing. Regression between ΔCO and Δ(1/Sa‐vO2), Δ(FI‐ETO2/Sa‐vO2), Δ(FI‐ETO2/Sa‐cvcO2) showed r=0.70, r=0.76 and r=0.75, respectively. ΔCO exceeded 10% in 17 of 26 interventions. Changes in FI‐ETO2 of equal direction as changes in CO occurred in 12 of these 17 interventions.

Conclusions: Estimations of CO changes, based on SvO2, can be enhanced if changes in FI‐ETO2 are also measured. ScvcO2 instead of SvO2 gives equivalent results. Sudden changes in FI‐ETO2 after pacemaker initiation or termination can predict the direction of CO changes.
Accuracy and limitations of continuous oesophageal aortic blood flow measurement during general anaesthesia for children: comparison with transcutaneous echography‐Doppler
Authors: Wodey Eric , Gai Valerie , Carre François , Ecoffey Claude
Published: March 2003

Background: Because it is noninvasive and easy to use, oesophageal Doppler ultrasonography appears to be a worthwhile alternative for continuous assessment of cardiac output measurement during anaesthesia. A new oesophageal Doppler‐echography device (Dynemo 3000™, Sometec, Paris, France) can simultaneously determine aortic diameter and aortic blood flow at the same anatomical level (DEeso). The purpose of this study was to assess the accuracy and the potential limitations of this device during general anaesthesia among 20 children, using transcutaneous Doppler‐echocardiography for comparison (DEtra).

Methods: The reproducibility of paired measurements of mean aortic blood flow velocity (MAFV), aortic diameter (ØAo) and aortic blood flow (ABF) was analysed with both methods. Second, haemodynamic values were measured simultaneously in a blinded manner by both methods before and after surgery.

Results: The percent change (%Δ) in MAFV and ABF was calculated with both methods for each child. The age and weight of children included in this study was 8.3 ± 2.5 years and 27 ± 8 kg, respectively. Intraoperator reproducibility of MAFVtra, ABFtra, MAFVeso and ABFeso, was 5.0 ± 4.1%, 7.0 ± 5.6%, 20.1 ± 17.5% and 22.0 ± 16.6%, respectively. ABFtra was significantly linked to ABFeso (R=0.55, P < 0.01). Bias ± SD of ABF measurements between both methods was 2.2 ± 1.1 l · min−1. %ΔABFtra was significantly linked to %ΔABFeso (R=0.62, P < 0.01). The bias ± SD inherent to %ΔABF measurements with both methods was −0.02 ± 18%.

Conclusions: These results suggest that this new oesophageal Doppler method is unsuitable to measure accurately absolute CO values and relative CO changes in children during anaesthesia.
Teaching and supervising tracheal intubation in paediatric patients using videolaryngoscopy
Authors: Weiss Markus , Schwarz Uwe , Dillier Claudia M. , Gerber Andreas CH.
Published: March 2003

In 85 patients (mean age 4.6 ± 3.1 years, range 0–10 years), a prototype of a new videolaryngoscope was used to provide a display of the intubation procedure in a paediatric anaesthesia teaching unit. The device provided important information to the teacher about the trainee’s problems related to direct laryngoscopy, difficulties with tube insertion into the larynx as well as the need and extent for anterior laryngeal pressure. Because the videolaryngoscope did not impair the normal intubation procedure, it seems to be a safe and a benefical tool for teaching and supervising tracheal intubation in children. In addition, it provides a potentially useful aid during difficult laryngoscopy, since the monitor view of the vocal cords was significantly better compared with a direct laryngoscopic view (P < 0.001).
Anaesthesia in a child with Hutchinson–Gildford progeria
Authors: Liessmann C D
Published: March 2003

Hutchinson–Gildford syndrome is an extremely rare condition characterized by the appearance of accelerated ageing. Reports of general anaesthesia in a child with progeria within the last 20 years in the English‐spoken literature are very rare. We report a case of general anaesthesia in a 12‐year‐old boy with this condition. The child had a past history of failed intubation. Key points in the management of anaesthesia in progeria are discussed.
Anaesthesia for phaeochromocytoma removal in a 5‐year‐old boy
Authors: MATSOTA P. , AVGERINOPOULOU‐VLAHOU A. , VELEGRAKIS D.
Published: March 2003

We describe the case of a 5‐year‐old boy with phaeochromocytoma of the left adrenal gland, treated surgically by removal of the tumour under general anaesthesia. Phaeochromocytoma is a particularly rare tumour in children and surgical excision is the definitive treatment. We discuss the clinical and laboratory characteristics of the case, the diagnostic approach, the preoperative and intraoperative management and the postoperative course.
Comparison of fast versus slow rewarming following acute moderate hypothermia in rats
Authors: Eshel Gideon , Reisler Gad , Berkovitch Matitiahu , Shapira Shlomo , Grauer Ettie , Barr Joseph
Published: March 2003

Background: The aim of this study was to compare the biochemical and physiological responses of fast vs. slow rewarming from moderate hypothermia in anaesthetized rats.

Methods: Anaesthetized rats were surface cooled to 28 °C, for 20 min, then rewarmed either quickly over 30 min or slowly over 120 min with monitoring of vital signs, systemic vascular resistance (SVR), cardiac output, biochemical changes and activity for 31 days.

Results: At hypothermia, cardiac output decreased to 77 ± 38 ml·min–1 and lactate increased to 4.62 ± 4.73 mmol·l–1. Fast rewarming caused an abrupt increase in cardiac output (270 ± 24 ml·min–1) and a sharp drop in SVR (325.6 ± 23.3 dyne·s–1·cm–5), compared with a smoother course with cardiac output (142 ± 18 ml·min–1, P < 0.01) and SVR (662.8 ± 41.0 dyne·s–1·cm–5, P < 0.01), measured during slow rewarming. Lactate failed to return to normal values (upon returning to normothermia) (2.5 ± 0.75 mmol·l–1) only in the fast rewarming group. In both groups, activity in the open field was not different from control rats.

Conclusions: In rats, moderate hypothermia for 20 min does not appear to cause lasting biochemical or behavioural consequences, whether rewarming lasted over 30 or 120 min. However, there was a greater early change in cardiac output and heart rate, due to systemic vasodilatation in the fast rewarming animals. These acute changes may have consequences in patients with compromized cardiovascular reserves.
Comparison of pre‐ and postoperative administration of ketoprofen for analgesia after tonsillectomy in children
Authors: KOKKI HANNU , SALONEN AARRE
Published: March 2003

Background: Tonsillectomy is commonly performed in children, but unfortunately it is associated with intense postoperative pain. The use and optimal timing of nonsteroidal anti‐inflammatory drugs (e.g. ketoprofen) during tonsillectomy is controversial.

Methods: We evaluated the safety and efficacy of ketoprofen in 109 children, aged 3–16 years, during and after tonsillectomy in 1998–2000. Standardized anaesthesia was used. Forty‐seven children received ketoprofen 0.5 mg·kg–1 at induction (preketoprofen group) and 42 children after surgery (postketoprofen group), followed by continuous ketoprofen infusion of 3 mg·kg–1 over 24 h in both groups; 20 children received normal saline (placebo group). Oxycodone was used for rescue analgesia.

Results: Pre‐ and postketoprofen groups did not differ in experienced pain or in opioid consumption in the first 24 h after surgery; demonstrating that ketoprofen did not have a pre‐emptive effect. Patients in the placebo group received 30 more oxycodone doses than did patients in the ketoprofen groups, but the difference was not significant (P=0.074). Two patients (5) in the postketoprofen group had postoperative bleeding at 4 h and 26 h, respectively. Both patients required electrocautery to stop bleeding. Neither the incidence nor the severity of adverse events differed between study groups.

Conclusions: This study demonstrates that ketoprofen did not have a preemptive effect and, at the dose used, did not perform statistically significantly better than placebo.
Pulmonary Doppler flow velocity pattern during caudal epidural anaesthesia in children
Authors: OZASA HIROSHI , HASHIMOTO KEISHI , SAITO YOJI
Published: March 2003

Background: Haemodynamic effects of caudal anaesthesia in children have not been fully investigated. In the present study, we evaluated pulmonary haemodynamics during caudal anaesthesia in otherwise healthy children using Doppler‐echocardiography.

Methods: Fifteen children undergoing elective lower abdominal surgery were randomly divided into two groups: nine children received 1.5% lidocaine and six physiological saline in the caudal epidural space. General anaesthesia was slowly induced and maintained using nitrous oxide and sevoflurane in oxygen. An epidural catheter was inserted into the caudal epidural space. Haemodynamic data including those with echocardiography were measured before and after epidural administration of lidocaine or saline.

Results: Mean blood pressure, enddiastolic diameter of the left ventricle, ejection fraction of the left ventricle and mean velocity circumferential fibre shortening did not change in either group following caudal epidural block. Indices of pulmonary Doppler flow velocity, including peak velocity of pulmonary flow and acceleration‐to‐ejection time ratio, demonstrated a significant decrease after caudal lidocaine, but not after saline.

Conclusions: Our data suggest that pulmonary Doppler flow velocity changes during caudal epidural anaesthesia, probably due to an increase in the pulmonary arterial resistance.
A survey of parental satisfaction during parent present induction of anaesthesia for children undergoing cardiovascular surgery
Authors: Odegard Kirsten C. , Modest Sally A. , Laussen Peter C.
Published: March 2003

Methods: To assess parental reaction and possible complications of parent present induction (PPI) for children undergoing cardiovascular surgery, the parents of 183 patients were provided with a questionnaire to complete after they had participated in PPI. Questions included: prior experience with PPI, which member of the staff initiated the plan for PPI, parental role in the process, how prepared parents felt, and overall satisfaction.

Results: PPI was successfully performed in the 183 patients surveyed. No parent was asked to leave the operating room because of respiratory or haemodynamic complications; 77.6% of the parents had no prior experience with PPI; however, 91.8% were aware of their role in the operating room, 94.5% were aware how their child would be anaesthetized and 96.7% felt prepared for their role and believed that this was a positive experience for themselves and their child.

Conclusions: This prospective survey demonstrated a high level of parental acceptance and satisfaction for PPI in children undergoing cardiovascular surgery, with a low incidence of untoward events, despite the underlying congenital heart disease. Further work is necessary to objectively characterize anxiety levels associated with induction of anaesthesia in this group of patients and parents.
Thoracic epidural catheters placed by the caudal route in infants: the importance of radiographic confirmation
Authors: VALAIRUCHA SONGYOS , SEEFELDER CHRISTIAN , HOUCK CONSTANCE S.
Published: March 2003

Background: Cephalad advancement of epidural catheters to the thoracic region via the caudal route has been shown to be feasible in neonates and small infants. This has allowed many young infants to receive thoracic level epidural analgesia with dilute local anaesthetic solutions using the simpler caudal approach. Since radiographic confirmation of the catheter tip is routine at this institution, we wished to determine how often radiographic studies led to adjustment or replacement of the epidural catheter.

Methods: After institutional review board approval, we retrospectively reviewed the medical records of neonates and infants less than 6 months of age who had thoracic or lumbar epidural analgesia via the caudal route between August 1995 and January 2000. Demographic data were recorded, including age, weight and type of surgery. The epidural catheter type, tip location by radiograph and any manipulation of the catheter after the radiograph were also noted.

Results: During the study period, a total of 115 infants were identified as having received caudal placement of a thoracic catheter. Radiographic studies were available for 86 of these infants. The position of 28 (32%) of the epidural catheters was considered to be inadequate after review of the confirmatory radiograph. Ten of these catheters were determined to be in the high thoracic or cervical region and were pulled back to the desired level. Seventeen of these catheters were coiled in the lumbosacral area and 15 of these were replaced at an adequate level. One catheter was found to be outside the epidural space in the presacral area. No correlation could be found between age, weight, type of catheter or type of surgery and the need for catheter manipulation.

Conclusions: Even in young infants, radiographic determination of the catheter tip appears warranted when thoracic catheters are placed via the caudal route.
The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children
Authors: Özbek Hayri , Bilen Ahmet , Özcengiz Dilek , Günes Yasemin , Özalevli Mehmet , Akman Hasan
Published: March 2003

Background: Our aim was to compare the effect of single dose caudal ketamine, alfentanil or a mixture of both drugs in the treatment of pain after hypospadias repair surgery in children.

Methods: The group comprised 109 boys, ASA I–II, aged 1–9 years, who were undergoing hypospadias repair surgery as day cases. The children were randomly divided into three groups for postoperative analgesia: group 1, only alfentanil (20 μg·kg–1) was given caudally; group 2, ketamine (0.5 mg·kg–1) alone; and group 3, alfentanil (20 μg·kg−1)–ketamine (0.5 mg·kg–1) was given caudally. The analgesic effect of caudal block was evaluated using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and sedation was assessed using a five‐point sedation score. The first analgesic requirement time and the number of supplementary analgesics required by each child in a 24‐h period were also recorded.

Results: No statistical differences were found in demographic characteristics, haemodynamic and respiratory parameters, objective pain scores, postoperative sedation scores and duration of surgery among the groups. The median time to first analgesia was significantly shorter in group 1 than in groups 2 and 3 (P=0.009, P=0.001). Significantly more patients in group 1 required additional postoperative analgesia (paracetamol 15 mg·kg–1) compared with groups 2 and 3 (P < 0.001).

Conclusions: Caudal administration of ketamine 0.5 mg·kg–1 with or without alfentanil in children produced satisfactory postoperative analgesia without respiratory depression or other side‐effects.
Uveitis and pupillary block glaucoma in an aphakic dog
Authors: Strubbe Todd
Published: March 2003

Unilateral uveitis with pupillary occlusion and secondary glaucoma was treated with neodymium:YAG laser iridotomy and iridencleisis in an aphakic 2‐year‐old male Miniature Schnuauzer. The dog presented 4 months after bilateral phacoemulsification with a complaint of blepharospasm of the left eye. Examination revealed anterior uveitis with pupillary occlusion and iris bombé. A slit‐lamp mounted Q‐switched Nd:YAG laser was used to create a central iridotomy to deepen the anterior chamber and an iridencleisis was performed to recreate a pupil. The eye remained visual and normotensive over a 6‐month follow‐up period.
Ulcerative keratitis associated with qualitative tear film abnormalities in cats
Authors: Cullen  , Njaa  , Grahn
Published: March 2003

Three cats with indolent corneal ulcers and one cat with bilateral corneal sequestration and normal aqueous tear production were found to have rapid tear break‐up times (BUTs). Tear BUTs in clinically affected cats averaged 2.5 ± 1.29 s and 2.33 ± 0.58 s for the right and left eyes, respectively. Palpebral conjunctival biopsies were harvested from consistent sites from each eye of affected cats (n = 7 affected eyes), and age‐and breed‐matched controls (n = 2 unaffected eyes). Light microscopy revealed a marked decrease to complete absence of conjunctival goblet cells (average goblet cell (GC):epithelial cell (EC) density = 18:50), conjunctival epithelial dysplasia, squamous metaplasia, and neutrophilic and mononuclear cell submucosal infiltration in affected cats. Specimens from the control cats had an average GC:EC density of 34:50, and minimal submucosal inflammatory infiltrate. The corneas (n = 7 eyes) healed following surgical keratectomy with (n = 2 eyes) or without (n = 1 eye) conjunctival pedicle flaps, superficial keratectomy and striate keratotomy with (n = 2 eyes) or without (n = 2 eyes) third eyelid flaps, and mucinomimetic tear supplementation (n = 5 eyes). Goblet cell regeneration was confirmed after 5 months of mucinomimetic supplementation (n = 2 eyes). The etiology for these mucin deficiencies remains unknown.
Treatment of presumed iris melanoma in dogs by diode laser photocoagulation: 23 cases
Authors: Cook Cynthia S. , Wilkie David A.
Published: March 2003

A semiconductor diode laser was used to cause remission of isolated presumed iris melanoma in 23 dogs. All cases presented as unilateral areas of raised iris hyperpigmentation, ranging in size from 2× 3 mm to 4×12 mm. Cases were treated using a diode laser delivery system through either an operating microscope adapter (OMA) or a laser indirect ophthalmoscope (LIO) with a 20D lens. Laser treatment was delivered ‘to effect’ using power ranging from 80 to 1000 mW and cumulative durations up to 14 min, 31 s (14:31). Immediate shrinkage of the mass was noted following treatment. Five cases required more than one laser treatment with three eyes receiving two treatments and two eyes receiving three treatments. Follow‐up from the last laser treatment ranged from 6 months to 4.5 years during which time the lesions exhibited no enlargement. Minor complications related to laser treatment were seen, including: dyscoria, iris hyperpigmentation, and corneal edema due to collateral hyperthermia. Glaucoma and cataract formation were not observed. Non‐invasive diode laser photocoagulation appears to be a safe and effective method of treatment for isolated, pigmented iris masses in dogs.
Intraocular pressure in normal llamas (Lama glama) and alpacas (Lama pacos)
Authors: Nuhsbaum M.T. , Gionfriddo J.R. , Powell C.C. , Aubin M.L.
Published: March 2003

Objective:To determine the mean intraocular pressure in llamas (Lama glama) and alpacas (Lama pacos) using applanation tonometry.Animals studied:Ten llamas and 10 alpacas.Procedures:Intraocular pressure (IOP) was measured with a Tono‐Pen™ XL (Mentor Ophthalmics, Inc., Norwell, MA, USA). Three values, with 5% variance, were recorded for each eye. Least‐squares means were determined for IOP for each eye of llamas and alpacas. Controlling for age, differences between left and right eye were analyzed usinganova. Two age groups were established, less than 5 years and greater than 5 years. The effect of age on IOP within each group was analyzed by linear regression. Probability values of less than 0.05 were considered significant.Results:Comparison of mean IOP between right (n = 20) and left eyes (n = 20), independent of species type, showed no differences in IOPs for llamas and alpacas. Mean IOP declined with increasing age in llamas and alpacas. Mean IOPs for 20 eyes in 10 llamas was 16.96 ± 3.51 mmHg. Mean IOP for 20 eyes in 10 alpacas was 16.14 ± 3.74 mmHg. Mean IOP for all eyes (n = 40), independent of species, was 16.55 ± 3.55 mmHg. The range of IOP in normal llamas and alpacas within 2 SD (95% of the population) was 14.89±18.21 mmHg.Conclusions:There was no significant difference in IOP between alpacas and llamas. Mean IOP in both species decreased with increased age.