bluuebunny/crossref_metadata_2025 huggingface dataset:
Emphysema Findings Associated with Heavy Asbestos‐Exposure in High Resolution Computed Tomography of Finnish Construction Workers
Authors: Huuskonen Olli , Kivisaari Leena , Zitting Anders , Kaleva Simo , Vehmas Tapio
Published: August 2004

Emphysema Findings Associated with Heavy Asbestos‐Exposure in High Resolution Computed Tomography of Finnish Construction Workers: Olli Huuskonen, et al. Finnish Institute of Occupational Health, Helsinki, Finland—Asbestos fibers are known to cause lung fibrosis, but their role in emphysema is unclear. We wanted to evaluate the relationship between asbestos exposure and emphysema by using high‐resolution computed tomography (HRCT). Conventional and high resolution CT was performed on 600 smoking construction workers with an asbestos‐related occupational disease. Emphysema subtypes (centrilobular, paraseptal, panlobular emphysema and bullae) were separately scored on a semiquantitative scale from 0 to 5, which scores were added up to yield the total emphysema score. Occupation, exposure duration, age, pack years and asbestosis diagnosis were analyzed in general linear models for possible associations with emphysema. The inter‐ (quadratic weighted kappa, κ qw=0.46–0.72) and intraobserver (κ qw=0.78– 0.94) agreements for the subtype‐scores and the reliability of the total score (Cronbach's alpha=0.87) were good. Insulators had a significantly higher paraseptal, panlobular and total score than the other occupational groups when adjusted for age and smoking. An asbestosis diagnosis was also a significant independent predictor of a higher total score. Emphysema was more common when workers had asbestosis or were heavily exposed to asbestos (insulators), but due to confounding factors the causative role of asbestos in emphysema needs further study.
Correlates of Occupational Injuries for Various Jobs in Railway Workers: A Case‐Control Study
Authors: Chau Nearkasen , Mur Jean‐Marie , Touron Christian , Benamghar Lahoucine , Dehaene Dominique
Published: August 2004

Correlates of Occupational Injuries for Various Jobs in Railway Workers: A Case‐Control Study: Nearkasen Chau, et al. National Institute for Health and Medical Research (Inserm), Unit 420, Faculté de Medicine, France—Few studies have simultaneously addressed the role of occupational factors, individual characteristics and living conditions in occupational injuries, and to the best of our knowledge none on railway workers. This survey assessed the roles of these factors in various types of injuries and for various jobs in French railway workers. This case‐control study was conducted on 1,305 male workers with an occupational injury during a one‐year period and 1,305 male controls. A standardized questionnaire was administrated by an occupational physician. Data were analyzed by the logistic regression method. The significant factors found for all the injuries combined were: young age (<30 yr) (adjusted odds ratio 1.47, 95% CI 1.01–2.14), 5 yr or less in present job (1.43, 1.15–1.78), sleep disorders (1.30, 1.08–1.57), current smoker (1.27, 1.08–1.50), and no do‐it‐yourself or gardening activity (1.23, 1.02– 1.48). Young age, sleep disorders, and smoking were common for several types of injuries. The role of these factors differed between various job categories. Among injured workers sick leaves of eight days or over were more frequent in current smokers and overweight subjects. In conclusion, young age, lack of experience, job dissatisfaction, sleep disorders, smoking, and lack of physical activity increase the risk of occupational injuries. The risks induced were related with jobs. Preventive measures concerning work conditions and these factors could be conducted in railway workers generally, and especially in workers most at risk. The occupational physician could make workers more sensitive to these risks and help them to improve their living conditions during medical examinations.
Serum Oxidant and Antioxidant Levels in Diesel Exposed Toll Collectors
Authors: Arbak Peri , Yavuz Ozlem , Bukan Neslihan , Balbay Oner , Ulger Füsun , Annakkaya Ali Nihat
Published: August 2004

Serum Oxidant and Antioxidant Levels in Diesel Exposed Toll Collectors: Peri Arbak, et al. Department of Chest Diseases, Abant Izzet Baysal University, Duzce School of Medicine, Turkey—It has been suggested that exposure to diesel exhaust may lead to adverse effects due to the generation of oxidants. To evaluate the end products of oxidative stress in DE exposure, toll collectors who are considered a high risk group in regard to occupational toxins were compared to controls who had office‐based occupations in the same company in this cross sectional study. A total of 38 toll collectors constituted the study group. All subjects were male. The toll collectors and 29 controls were similar regarding age, smoking status and duration of work. All subjects underwent a clinical examination and an interviewer‐administrated questionnaire regarding respiratory symptoms, past medical and occupational history, and pulmonary function tests were performed in all subjects. Serum malondialdehyde (MDA), nitrite+nitrate and vitamin E levels were measured. Toll collectors showed higher serum MDA (5.76 ± 2.15 µmol/L vs. 3.07 ± 0.76 µmol/L, p=0.0001) and nitrite+nitrate levels (96.50 ± 45.54 µmol/L vs. 19.32 ± 11.77 µmol/L, p=0.0001) than controls. Vitamin E levels were similar in toll collectors and controls (10.57 ± 3.44 mg/L and 9.72 ± 2.44 mg/L, respectively, p=0.267). There was no difference between groups in terms of the findings of clinical examinations and respiratory symptoms. In pulmonary function parameters, only peak expiratory flow (PEF) in toll collectors was significantly lower than that of controls (88.9% predicted and 104.2% predicted, respectively, p=0.012). In conclusion, we suggest that serum MDA and nitrite+nitrate levels may be used as biological markers of oxidative stress related to DE exposure, but prospective controlled clinical studies are necessary to clarify the possible association between concentrations of MDA and nitrite+nitrate and pulmonary diseases related to DE exposure.
Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey
Authors: Unalacak Murat , Altin Remzi , Kart Levent , Tor Meltem , Örnek Tacettin , Altunel Hisar
Published: August 2004

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey: Murat Unalacak, et al. Department of Family Medicine, Zonguldak Karaelmas University, Faculty of Medicine, Turkey—To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X‐rays and pulmonary function tests were performed to evaluate patients’ related diseases and complications. Smoking status of the workers was as follows; Sixty‐nine never smokers (17.7%), 62 ex‐smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 ± 4.2 versus 15.0 ± 4.0). The most common reason for starting smoking was smoking interest (50%) and friends’ influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking—related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0–3 points), moderate (4–6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7 % respectively. Ex‐smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.
Seasonal Variation in Perceived Indoor Environment and Nonspecific Symptoms in a Temperate Climate
Authors: Mizoue Tetsuya , Andersson Kjell , Reijula Kari , Fedeli Cecilia
Published: August 2004

Seasonal Variation in Perceived Indoor Environment and Nonspecific Symptoms in a Temperate Climate: Tetsuya Mizoue, et al. Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University—Few epidemiological studies have examined the effects of season on symptoms typical of sick building syndrome (SBS). The present study aims to clarify seasonal variation in a perceived indoor environment and SBS symptoms in a temperate climate. A total of 116 workers were recruited from office buildings in southern Japan that presented no apparent serious indoor problems. A validated questionnaire was distributed four times, once at the end of each season. Seasonal effects on the perceived indoor environment and SBS symptoms were investigated with a parametric test for repeated measurement of categorical data. Logits were used as the response function, and were compared to overall logits to determine the relevant odds ratios (OR). The effect of season/building interaction was also evaluated. Significant seasonal variation in the perceived indoor environment was found for temperature, dryness, air stuffiness, and static electricity (p for season, <0.05), although the seasonal patterns for temperature and dryness differed according to the building (p for interaction, <0.05). Symptoms in the mucous membrane (eyes, nose, and throat) and skin increased considerably in the winter and spring (p for season, <0.05), whereas general symptoms varied little, but such seasonality of symptoms was not modified by the building factor. The associations between perception of indoor environments and mucous and skin symptoms became stronger during winter and spring. The present results suggest that perceived indoor environments, nonspecific symptoms and their associations are closely associated with the season among office workers in a temperate climate.
Long‐Term Persistence of Chromosome Aberrations in Uranium Miners
Authors: Mészáros Gabriella , Bognár Gabriella , Köteles G. J.
Published: August 2004

Long‐Term Persistence of Chromosome Aberrations in Uranium Miners: Gabriella Mészáros, et al. “Fodor József” National Public Health Center, “Frédéric Joliot‐Curie” National Research Institute for Radiobiology and Radiohygiene, Hungary— Chromosome aberration analyses were performed on blood samples from 165 active underground uranium miners between 1981 and 1985. After decommissioning the mine in 1997 chromosome aberration analyses were also included in the medical laboratory investigations of health conditions of 141 subjects between 1998 and 2002 within the framework of a follow‐up‐study. The numerical data are presented as functions of the exposure categories expressed in working level month up to 600. In the active groups the dicentric level was 7 to 12 times higher than in the unexposed population, the acentrics also higher with more than an order of magnitude, the frequency of total aberrations—including dicentrics, acentrics, rings, deletions, minits and numerical aberrations, i.e. both chromatid and chromosome type of aberrations were also well above the control level. In the group of former uranium miners although there were slight decreases in the dicentrics after 8 to 25 yr, the values were not significantly different from the values of active miners. The frequency of deletions was also maintained in the post‐mining period. The frequency of acentrics, however, decreased significantly, but even the lowest values remained 2–3 times higher than the values in the unexposed population. The possibility is suggested that for the long‐term persistence of cytogenetic alterations the permanent production and presence of clastogenic factors might be responsible. The comparison of the two datasets suggest a long‐term persistence of cytogenetic alterations above the population average values in a large fraction of persons investigated.
Investigations of Vitamin D Receptor Polymorphism Affecting Workers’ Susceptibility to Lead
Authors: Chuang Hung‐Yi , Yu Kuei‐Ting , Ho Chi‐Kung , Wu Ming‐Tsang , Lin Gau‐Tyan , Wu Trong‐Neng
Published: August 2004

Investigations of Vitamin D Receptor Polymorphism Affecting Workers’ Susceptibility to Lead: Hung‐Yi Chuang, et al. Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohisiung City, Taiwan—Gene polymorphism is an important factor that affects human susceptibility to toxins. For example, previous studies suggested that the ALAD genotype is an important factor affecting workers’ susceptibility to lead toxic effects, including hemopoietic and nervous system. But we have had few researches in Taiwan, though there are thousands of workers involved in lead‐related industries. On the other hand, although it is well known that lead deposits in the bone mineral component and interacts with calcium, vitamin D receptor may therefore be an important factor in the metabolism of lead. Some studies suggested that different vitamin D receptor genotypes have various kinds of receptor activity. The goal of this study was to investigate the polymorphism affecting workers’ susceptibility to lead. Three allelic variants of the VDR gene were defined by means of the polymerase chain reaction (PCR) and three restriction enzymes (ApaI, BsmI, and TaqI). We determined the relationships of different VDR genotypes (AA, Aa, aa, BB, Bb, bb, TT, Tt, and tt) to blood lead and the index of cumulative blood lead levels (ICL). Altogether we analyzed 544 workers’ VDR genotypes (BsmI, TaqI, and ApaI) and compared to their blood lead levels and ICL in the VDR genotypes. The results showed that workers had higher blood lead levels and ICL in the Apa I‐ aa genotypes, but this is not statistically significant when adjusted for potential confounding factors. Other characteristics, such as exposure status, smoking and alcohol drinking, were significantly associated with ICL and time‐weighted ICL. Regression analyses suggested that exposure status and personal habits (smoking and alcohol drinking) are still the major effects on blood lead parameters for lead workers rather than genotypes. In conclusion, VDR genotypes did not significantly affect the long term blood lead parameters after adjustment for all factors, but industrial hygiene improvement, including engineering control and health education, are the most important ways to protect workers’ health.
Development of Indigenous Local Exhaust Ventilation System: Reduction of Welders Exposure to Welding Fumes
Authors: Zaidi Shakeel , Sathawara Natvarbhai , Kumar Sunil , Gandhi Sumitra , Parmar Chimanlal , Saiyed Habibullah
Published: August 2004

Development of Indigenous Local Exhaust Ventilation System: Reduction of Welders Exposure to Welding Fumes: Shakeel Zaidi, et al. National Institute of Occupational Health, Indian Council of Medical Research (I.C.M.R), India—Two (portable and mobile) local exhaust ventilation (LEV) units were developed in collaboration with the Rural Technology Institute, Gandhinagar, India. Basically, each unit consists of three parts comprising an electric motor, a blower and a fume hood. In both units the motor is fixed in a rectangular iron frame in a foot‐mount position and equipped compactly with a blower, which in turn is connected to a fume hood through a flexible hosepipe. The portable unit is light in weight (50 kg) and has a cone shaped metallic fume hood. The mobile unit, on the other hand, differs from the portable model with respect to its weight (150 kg), size, RPM, voltage requirement, hood shape and size, and has a motor enclosure. The efficiency of the portable and mobile units on trial bases was tested by measuring the manganese concentration as a reference metal in welding fumes generated by electric arc welding. The concentration of manganese (mean ± SD) was 0.218 ± 0.06 μg/m3 in the general environment. In the workplace area where joining of metal objects by welding was done, the concentration of manganese was found to be 0.63 ± 0.09 and 3.75 ± 0.56 μg/m3 at a distance of 5 m and 2 m away from the site of operation, respectively. In the breathing zone it was 22.16 ± 20.90 μg/m3 which was reduced to 8.25 ± 4.5 μg/m3 after application of a portable LEV showing about 63% removal of the manganese concentration from the breathing zone of the welder. In another experiment conducted with a mobile LEV unit for heavy‐duty work, the concentration of manganese in the breathing zone without operating the mobile LEV was 70.06 ± 37.38 μg/m3 but was lowered to 8.29 ± 1.76 μg/m3 after operating the mobile LEV. This indicated an average removal of manganese content by about 88% from the breathing zone of the welder. In both the experiments locations of sample collection were similar.
Infant Heart Transplantation at Stanford: Growth and Neurodevelopmental Outcome
Authors: Fleisher Barry E. , Baum David , Brudos Ginger , Burge Mary , Carson Elaine , Constantinou Janet , Duckworth Josh , Gamberg Pat , Klein Pat , Luikart Helen , Miller Joan , Stach Brad , Bernstein Dan
Published: August 2004

Objective. To evaluate the growth and neurodevelopmental outcome of 18 surviving Stanford patients who received heart transplantations before their second birthday.

Methods. We compared the growth and neurodevelopmental outcome of these 18 patients with a second group of age-matched comparison patients who underwent other heart surgery requiring cardiopulmonary bypass.

Results. Difficulties with growth and development were more common in the transplant group as were neurologic abnormalities. Speech and language delays as well as hearing problems were also more common in the transplant group.

Conclusion. Multicenter prospective longitudinal neurodevelopmental outcome studies of infant heart transplant patients should be conducted to provide a more efficient basis for evaluating management protocols and assessment of long-term outcomes and of the need for early intervention services.
Early Developmental Outcomes After Newborn Encephalopathy
Authors: Dixon Glenys , Badawi Nadia , Kurinczuk Jennifer J. , Keogh John M. , Silburn Sven R. , Zubrick Stephen R. , Stanley Fiona J.
Published: August 2004

Objective. The aim of this study was to ascertain the early developmental status of children who have a history of newborn encephalopathy.

Methods. A longitudinal follow-up was conducted of a population-based, case-control study of children born in Western Australia between June 1993 and December 1996. The study included 276 term children (≥37 weeks’ gestation) with moderate or severe newborn encephalopathy and 564 unmatched term control subjects. The Griffiths Mental Development Scales was used to ascertain developmental status and a General Quotient (GQ) score. Outcome measures were the Griffiths developmental subscales, GQ, diagnosis of cerebral palsy, and mortality.

Results. Thirty-four patients and 1 control subject died before reaching assessment. Between June 1994 and December 1999, 195 (81%) eligible patients and 445 (79%) eligible control subjects were assessed. Statistically significant differences were found between patients and control subjects for GQ and all developmental subscales. Overall, 39% of patients had a poor outcome as defined by death, cerebral palsy, or a significant degree of developmental delay, compared with 2.7% of control subjects. Furthermore, 62% of those with severe encephalopathy had a poor outcome compared with 25% of those with moderate encephalopathy. Patients with a history of seizures were 3 times more likely to develop cerebral palsy than patients without. Overall, 28 (10.1%) of patients have cerebral palsy.

Conclusions. These data provide important prognostic information regarding survival and serious disability and indicate that newborn encephalopathy places children at significant risk of developmental delay by their second year. These findings also suggest that comprehensive clinical and educational assessments are required to enable appropriate educational provisions as these infants approach school entry.
Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma
Authors: Ortega Alexander N. , Gergen Peter J. , Paltiel A. David , Bauchner Howard , Belanger Kathleen D. , Leaderer Brian P.
Published: August 2004

Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.

Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages ≤12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, β2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.

Results. Black and Hispanic children received fewer β2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients’ race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in β2-agonist use by race and ethnicity changed little but became nonsignificant.

Conclusion. Even within private practices, patients’ race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful.
Testicular Torsion in an Adolescent With Fragile X Syndrome
Authors: Flynn Brian J. , Myers Scott M. , Cera Peter J. , Mowad Joseph J.
Published: August 2004

Fragile X syndrome (FraX) is the most common hereditary form of mental retardation. The clinical syndrome includes mental retardation, macroorchidism, and typical but variable facial features. Although macroorchidism has been recognized as a cardinal feature of FraX, descriptions of testicular pathology are rare. Testicular torsion is a relatively common surgical emergency in young men, peaking at the onset of puberty when the testes undergo a period of rapid growth. However, testicular torsion has never been associated with macroorchidism. We report the first known case of testicular torsion in a 14-year-old boy with FraX and macroorchidism. Although we are unable to establish a definitive relationship between macroorchidism and testicular torsion in an isolated case report, primary care takers of children with macroorchidism should be aware of this occurrence. We recommend measurement of testicular volume during annual evaluations of children and adolescents with macroorchidism. Acute scrotal pain or increased testicular volume should be promptly evaluated.
Does Abciximab Enhance Regression of Coronary Aneurysms Resulting From Kawasaki Disease?
Authors: Williams Richard V. , Wilke Venus M. , Tani Lloyd Y. , Minich L. LuAnn
Published: August 2004

Objective. Acute Kawasaki disease can result in the development of large coronary artery aneurysms that may persist. Abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, is associated with resolution of thrombi and vascular remodeling in adults with acute coronary syndromes. The purpose of this study was to compare changes in aneurysm diameter at early follow-up in patients who had Kawasaki disease and received abciximab in addition to standard therapy with those who were treated with standard therapy alone.

Methods. Patients with Kawasaki disease and large aneurysms were divided into 2 groups on the basis of acute therapy: 1) abciximab in addition to standard therapy and 2) standard therapy alone. Echocardiograms were reviewed for coronary aneurysms (lumen diameter 1.5 times that of the adjacent vessel). Maximum aneurysm diameter was determined during the acute/subacute phase of Kawasaki disease (<6 weeks) and at early follow-up (4–6 months). Regression of the aneurysm was defined as a decrease in lumen diameter, and resolution was defined as normalization of the vessel.

Results. Six patients had 20 aneurysms in the abciximab group, and 9 patients had 30 aneurysms in the standard therapy group. Early follow-up data were available for 19 of the 20 aneurysms in the abciximab group and 19 of the 30 aneurysms in the standard therapy group. Patients who were treated with abciximab demonstrated greater regression in aneurysm size at early follow-up than patients who were treated with standard therapy alone (percentage decrease: 41 ± 19% vs 17 ± 27%). In the abciximab group, 68% (13 of 19) of aneurysms resolved at early follow-up compared with 35% (7 of 19) in the standard therapy group.

Conclusions. Patients who were treated with abciximab demonstrated greater regression in aneurysm diameter at early follow-up than patients who received standard therapy alone. These findings suggest that treatment with abciximab may promote vascular remodeling in this population and warrants further study.
Pediatric Residents’ Career Intentions: Data From the Leading Edge of the Pediatrician Workforce
Authors: Pan Richard J. , Cull William L. , Brotherton Sarah E.
Published: August 2004

Objective. To determine factors influencing career choices by pediatric residents and how they may change the future pediatric physician workforce.

Background. Societal norms and policy decisions can influence the demographics of residents entering pediatric practice and resident career choices. Although predictors of physician career choice have been identified retrospectively by examining the characteristics of physicians in practice, little work has focused on the job selection factors important to pediatric residents when they make their postresidency career decisions.

Design/Methods. For 3 consecutive years (1997–1999), the American Academy of Pediatrics surveyed a national sample of 500 third-year residents, totaling 1500 residents. Data on resident characteristics, job selection attitudes, and career decisions were obtained, and trends for the past 3 years were examined.

Results. The percentage of residents intending to practice primary care remained constant at around 69% from 1997 through 1999. Female residents, US medical graduates, and residents married to nonphysicians were more likely to report primary care practice as their future clinical goal. These relationships were mediated by higher rates of a primary care practice goal among those who felt geographic location and future colleagues were very important and by lower rates among those who felt acceptable income, teaching opportunities, and research opportunities were very important. Six percent of residents entering general pediatrics were heading to rural locations.

Conclusions. With a projected increase in the number of female pediatricians and a decline in international medical graduates, our study suggests that pediatrics may continue to shift toward an increased proportion of general pediatricians. Lifestyle issues are a major factor influencing job choice and must be addressed.
A 16-Year Neonatal/Pediatric Extracorporeal Membrane Oxygenation Transport Experience
Authors: Wilson Bernard J. , Heiman Howard S. , Butler Thomas J. , Negaard Kathryn A. , DiGeronimo Robert
Published: August 2004

Objective. To characterize the population and survival of neonatal and pediatric patients transported by Wilford Hall Medical Center (WHMC) on extracorporeal membrane oxygenation (ECMO) since 1985.

Study Design. A retrospective chart, literature, and database review of pediatric and neonatal patients transported on ECMO by the WHMC ECMO transport team. In addition, a subpopulation analysis was performed comparing neonates with meconium aspiration syndrome (MAS) placed on ECMO at WHMC with those infants with MAS transported on ECMO. Characteristics of interest for this comparison included disease severity before ECMO, age at initiation of ECMO, survival, ECMO-related complications, and duration of ECMO support.

Results. Forty-two patients transported on ECMO were identified: 23 neonatal respiratory cases (survival 57%), 7 pediatric respiratory cases (survival 71%), 4 cardiac cases (survival 50%), and 8 extra-institutional ECMO transports (survival 63%). In the MAS subpopulation, there was significantly greater survival in the in-house group—97% (31/32)—than in the ECMO transport group—75% (9/12); there were no other significant differences between these groups. Overall, no ECMO-related complications leading to patient demise could be identified in the ECMO transport group.

Conclusions. ECMO transport, although demonstrating acceptable survival, is a risk-laden modality that should not replace early referral to an ECMO center.
Expression of Activation Markers and Cytokine mRNA by Peripheral Blood CD4 and CD8 T Cells in Atopic and Nonatopic Childhood Asthma: Effect of Inhaled Glucocorticoid Therapy
Authors: Gemou-Engesæth Vasso , Fagerhol Magne K. , Toda Masao , Hamid Qutayba , Halvorsen Sverre , Groegaard Jens B. , Corrigan Chris J.
Published: August 2004

Hypothesis. Activated CD8 as well as CD4 T cells contribute to the production of asthma-relevant cytokines in both atopic and nonatopic childhood asthma.

Objectives. To measure the percentages of peripheral blood CD4 and CD8 T cells expressing naïve/memory (CD45RA/CD45RO) and activation (HLA-DR, CD25) markers, as well as mRNA-encoding interleukin-4 (IL-4) and interleukin-5 (IL-5) in atopic and nonatopic childhood asthmatics and in nonasthmatic controls matched for age and atopic status; and to study the effects of inhaled glucocorticoid therapy of the asthmatics on these measurements.

Methods. Peripheral blood mononuclear cells were isolated from 17 atopic and 8 nonatopic stable (not acutely ill) asthmatics aged 7 to 16 years with moderate-to-severe disease and from 15 nonasthmatic controls matched for age and atopic status. Activation markers on CD4 and CD8 T cells were measured by flow cytometry, and expression of cytokine mRNA by in situ hybridization with CD4 and CD8 T cells were isolated using magnetic beads. Measurements were repeated in 18 of the asthmatics 4 to 6 months after initiation or escalation of inhaled glucocorticoid therapy for inadequately controlled asthma.

Results. The percentages of CD4 T cells expressing CD45RO but not CD45RA were elevated in both asthma groups as compared with the relevant controls and were reduced in association with de novo or augmented inhaled glucocorticoid therapy. The percentages of CD8 T cells expressing both markers were not elevated in asthmatics as compared with controls. The percentages of both CD4 and CD8 T lymphocytes expressing HLA-DR and CD25 were elevated in the asthmatics as compared with controls, and significantly reduced in association with de novo or augmented inhaled glucocorticoid therapy. Elevated percentages of CD4 T cells expressing mRNA encoding IL-4 and IL-5, and CD8 T lymphocytes expressing IL-5, were found in asthmatics as compared with the controls. De novo or augmented inhaled glucocorticoid therapy was associated with significant reductions in the percentages of CD4 T cells expressing IL-5 and IL-4 mRNA, as well as improvements in lung function, symptom scores, and bronchial hyperresponsiveness to metacholine (PD20) in both the atopic and nonatopic asthmatics.

Conclusions. The data are consistent with the hypothesis that both activated CD4 and CD8 T cells are associated with child asthma, and that CD4 T cells make a greater contribution to IL-4 and IL-5 synthesis. Increased dosages of inhaled glucocorticoid resulted in clinical improvement in the asthmatics along with reduced T-cell activation and cytokine mRNA expression, suggesting a possible causal association.
Serum Luteinizing Hormone Rises Within Minutes After Depot Leuprolide Injection: Implications for Monitoring Therapy
Authors: Bhatia Suruchi , Neely E. Kirk , Wilson Darrell M.
Published: August 2004

Objective. To find the time of the serum gonadotropin peak after depot leuprolide injection in children and to show that depot leuprolide therapy can be monitored by measuring serum luteinizing hormone (LH) immediately after injections.

Study Design. We measured concentrations of leuprolide, LH, and follicle-stimulating hormone (FSH) at multiple time points before and after the first dose of depot leuprolide in 14 pubertal children beginning therapy. Gonadotropins and sex steroids were measured again after the fourth dose.

Results. Serum leuprolide, LH, and FSH levels rose rapidly after initial injection, reaching sustained elevations at 30 to 120 minutes. The median LH level increased from 2.1 mIU/mL at baseline to a peak of 27.5 mIU/mL at 45 minutes, and FSH increased from 5.2 to 16.5 mIU/mL. After 3 months on therapy, median serum LH after depot leuprolide injection was only 0.83 mIU/mL, similar to levels observed after intravenous or subcutaneous gonadotropin-releasing hormone stimulation in comparable subjects on depot leuprolide.

Conclusion. Our pharmacokinetic data demonstrate that free leuprolide present in a depot leuprolide injection is equivalent to gonadotropin-releasing hormone in stimulating a rapid rise in serum gonadotropin concentrations. We propose that a single serum sample for LH obtained 30 to 60 minutes after depot leuprolide injection in children provides a convenient and accurate assessment of treatment efficacy.
Delayed Umbilical Bleeding—A Presenting Feature for Factor XIII Deficiency: Clinical Features, Genetics, and Management
Authors: Anwar Rashida , Minford Adrian , Gallivan Louise , Trinh Chi H. , Markham Alexander F.
Published: August 2004

Objectives. The objectives of this study were 1) to assess the importance of an early diagnosis for factor XIII (FXIII) deficiency, and 2) to investigate the molecular basis and mechanism(s) of disease in the patients under study.

Methods. The case histories of 6 FXIII-deficient patients were examined to assess the influence of early versus delayed diagnosis and replacement therapy. The nucleotide sequence of the FXIIIA gene was determined to identify the underlying mutations responsible for the bleeding diathesis in each patient. Molecular modeling was used to predict the mechanism(s) of disease causation for each mutation.

Results. All cases presented with umbilical hemorrhage. Patients 1 to 3 were diagnosed, and their prophylactic therapy was commenced in infancy. Diagnosis in patients 4 to 6 was considerably delayed and, as a result, they continued to suffer from many bleeding symptoms. The FXIIIA gene mutations identified in these patients were as follows: a homozygous GAA→AAA mutation in codon 102 (Glu102Lys) in patient 1 and a homozygous AGC→AGG mutation in codon 295 (Ser295Arg) in patients 2 to 6. These mutations segregate with disease and are absent from the normal population, suggesting that they are likely to be disease-causing sequence changes. Computer modeling indicates that both the Lys102 and Arg295 mutants are unable to fold correctly, and probably result in unstable FXIIIA molecules.

Conclusions. We demonstrate the importance of recognizing delayed umbilical hemorrhage as a presenting feature for congenital FXIII deficiency, and the value of early diagnosis and prophylaxis. The bleeding disorder of patient 1 was attributable to a homozygous Glu102Lys mutation in FXIIIA. A homozygous Ser295Arg mutation in FXIIIA was responsible for FXIII deficiency in patients 2 to 6.
Successful Antiangiogenic Therapy of Giant Cell Angioblastoma With Interferon Alfa 2b: Report of 2 Cases
Authors: Marler Jennifer J. , Rubin Joshua B. , Trede Nikolaus S. , Connors Susan , Grier Holcombe , Upton Joseph , Mulliken John B. , Folkman Judah
Published: August 2004

We describe 2 cases of angioblastoma, a rare, destructive pediatric tumor, treated with interferon alfa 2b (IFNα2b). The first patient is a 10-month-old male who presented with an ulcerated palatal neoplasm that could not be completely resected. The second is a male neonate with a congenital tumor of the right hand that invaded the hypothenar eminence, destroying the fourth and fifth metacarpals. Biopsy in both patients was interpreted as giant cell angioblastoma. Angioblastoma is rare; there is only 1 reported case that necessitated amputation of an upper extremity, also initially recommended for our patient. Because there is little experience with chemotherapy, permission was granted to employ an antiangiogenic regimen of IFNα2b. The angiogenic protein, basic fibroblast growth factor (bFGF), was abnormally elevated in both patients.

Both patients received IFNα2b. In the first child, it was used after incomplete resection, because biopsy-proven tumor was present at the margin and in the nasopharynx. Biopsies 15 months after initiation of IFN2αb were negative for tumor. Therapy was stopped after 3 years. Eighteen months later, the patient remains disease-free. In the second child, IFNα2b was started after debridement of the ulcerated tumor. Over 11 months, the tumor completely regressed and there was bony regeneration of the metacarpals. The fifth digit was amputated because of damage to the metacarpophalangeal joint by the tumor. IFNα2b therapy was discontinued after 1 year of treatment, and the child remains disease-free 2 years and 8 months later.

In conclusion, this report demonstrates that: 1) a bFGF-overexpressing low-grade tumor can respond to IFNα2b in a manner similar to life-threatening infantile hemangiomas, 2) urinary bFGF levels can help guide IFNα dosage in such patients, and 3) although bFGF-mediated tumor angiogenesis is inhibited by IFNα, physiologic angiogenesis seems to be unaffected.
Delayed Childbearing and Its Impact on Population Rate Changes in Lower Birth Weight, Multiple Birth, and Preterm Delivery
Authors: Tough Suzanne C. , Newburn-Cook Christine , Johnston David W. , Svenson Lawrence W. , Rose Sarah , Belik Jaques
Published: August 2004

Objective. This study quantified the impact of delayed childbearing (maternal age ≥35 years) on population rate changes in low birth weight (LBW; <2500 g), preterm delivery (<37 weeks), multiple births, and small for gestational age (SGA; <10th percentile) in Alberta, Canada, between 1990 (N = 42 930) and 1996 (N = 37 710).

Methods. Data were obtained from the provincial notification of a live or stillbirth. Analyses included relative risk estimates and χ2 tests for trend. Potential confounding attributable to in vitro fertilization was investigated.

Results. The proportion of births to women ≥35 years of age was 8.4% in 1990 and 12.6% in 1996, a 51.2% increase. Among these women, LBW delivery increased 11%, and preterm delivery increased 14%. Delayed childbearing accounted for 78% of the change in LBW rate in the population and 36% of the change in preterm delivery rate in the population. Provincial multiple birth rates increased by 15% for twins and 14% for triplets. Delayed childbearing accounted for 15% of the twin increase and 69% of the triplet increase. When in vitro fertilization pregnancies were excluded, the change was 43% for preterm rates, 100% for LBW, 14% for twins, and 9% for triplets. Delayed childbearing did not contribute to changes in singleton SGA deliveries.

Conclusions. The findings suggest that the recent increase in LBW and preterm delivery is partly related to the population phenomenon of delayed childbearing. Maternal age was not related to changes in SGA, suggesting that the age effect is through pregnancy complications that lead to preterm delivery and LBW. Prospective parents should be informed about the higher risk for neonatal morbidity associated with delayed childbearing. Health care providers should be aware of the impact of delayed childbearing on health care resources.
Pediatric Resident Training in the Diagnosis and Treatment of Acute Otitis Media
Authors: Steinbach William J. , Sectish Theodore C.
Published: August 2004

Objective. To investigate the presence and characteristics of formalized curricula for pediatric resident education for the diagnosis and treatment of acute otitis media.

Design. A survey was mailed to the program directors of all 224 accredited US and Canadian pediatric residency programs. Questions focused on the development, components, and teaching of any otitis media curriculum. Program directors were also questioned about their approach towards evaluating resident competency of otitis media and their future plans for otitis media-related training.

Results. A total of 144 program directors (64%) responded to the survey. Among respondents, 59% had some form of formalized education related to the diagnosis or treatment of otitis media. These curricula primarily consisted of lectures by general pediatricians <3 times per year.

Conclusions. Although otitis media is the most common disease seen by practicing general pediatricians, the Residency Review Committee in Pediatrics does not mandate formal otitis media-related training. Aside from informal case-by-case education, this survey demonstrated that only slightly more than half of all pediatric residency programs have some formalized resident education of this common pediatric problem, and most of those curricula are infrequent lectures.
A New Look at Myelomeningoceles: Functional Level, Vertebral Level, Shunting, and the Implications for Fetal Intervention
Authors: Rintoul Natalie E. , Sutton Leslie N. , Hubbard Anne M. , Cohen Brian , Melchionni Jeanne , Pasquariello Patrick S. , Adzick N. Scott
Published: August 2004

Objective. Previous reports have suggested that 80% to 85% of patients who have a myelomeningocele (MMC) and undergo surgical repair after birth develop hydrocephalus and require the placement of a ventricular shunt. However, the rate of shunting as a function of spinal level is not well established. We sought to determine the distribution of postnatally repaired MMC lesions as characterized by both functional and radiologic assessment, as well as the incidence of shunting when patients were categorized according to these 2 methods.

Methods. A retrospective chart review of 297 patients who were born with open MMCs and followed in the spina bifida clinic at the Children’s Hospital of Philadelphia was performed. The presence or absence of a shunt was determined for each patient. Functional spinal level was determined by the best-recorded neurologic examination and vertebral level by spine radiographs.

Results. The overall rate of ventricular shunting was 81%. The level of the lesion significantly affected the incidence of shunting, with more cephalad lesions correlating with higher rates. This was true both for functional and radiologic categorizations. A significantly higher shunt rate was found among patients with sacral lesions when categorized by radiologic rather than functional criteria. In 86% of patients, the functional level was found to be equal to or higher (worse) than the radiologic level.

Conclusions. This study describes the natural history of ventricular shunting in MMC patients with relation to both radiologic and functional criteria. Fetal MMC closure is being performed in some centers in an attempt to decrease the incidence of shunting and to improve leg function in selected patients. The present data may serve as a comparison group and aid in the design and analysis of a prospective trial to assess the efficacy of this new procedure.
Self-Esteem of Adolescents Who Were Born Prematurely
Authors: Saigal Saroj , Lambert Michael , Russ Chad , Hoult Lorraine
Published: August 2004

Objective. To determine whether there are any differences between the self-esteem of a cohort of adolescents who were extremely low birth weight (ELBW) in comparison with term controls (Cs); and to test the associations between self-esteem and several predefined predictor variables.

Background. Self-esteem is considered to play a significant role in psychological adjustment and scholastic success. Little information exists on how adolescents who were ELBW regard themselves.

Design/Methods. Longitudinal follow-up of a regional cohort of 132/169 (78%) ELBW survivors and 127/145 (88%) sociodemographically matched Cs, born between 1977 and 1982. Measures: Harter Adolescent Self-Perception Profile (1988) with 9 dimensions, including Global Self-Worth, socioeconomic status (Hollingshead), height-for-age and weight-for-age z scores, and Wide Range Achievement Test—Revised (WRAT-R; Reading, Spelling, and Arithmetic). Data Analysis: General linear model multiple analyses of covariance were performed to determine whether significant relationships existed between the 9 self-esteem dimensions and the independent variables of birth weight status and gender, and the covariates of age, socioeconomic status, physical development, and academic achievement.

Results. Global Self Worth was similar for ELBW and Cs (means: 3.1 and 3.2). Multivariate effects revealed no interactions, but significant main effects emerged for birth weight status, gender, weight-for-age z scores, age in months, and for all 3 WRAT-R subtests, all effect sizes medium to large.

Follow-up analysis of covariance revealed medium-size gender effects for athletic competence (means: 3.1 and 2.6), and physical appearance (means: 2.9 and 2.5), where boys rated themselves significantly higher on both domains; and age effects, where older teens rated themselves better for job competence. Significant but small effect sizes emerged for the following: 1) weight-for-age z scores, where heavier youth rated themselves higher on close friendships, 2) gender, where girls had higher ratings for close friendships, 3) birth weight, where Cs rated themselves higher on athletic competence, and 4) WRAT-R math effect, where children with higher math scores rated themselves better on scholastic competence.

Conclusions. Overall, ELBW teenagers do not differ significantly from C teenagers on most dimensions of self-esteem. Gender effects emerged on some Harter domains.
Stature at Time of Diagnosis of Type 1 Diabetes Mellitus
Authors: DiLiberti John H. , Carver Koryn , Parton Elaine , Totka Joan , Mick Gail , McCormick Kenneth
Published: August 2004

Objective. To assess the stature of children with type 1 diabetes mellitus at diagnosis.

Methods. We collected data from 451 records of children who were examined in a pediatric diabetes clinic and used data from the Third National Health and Nutrition Examination Survey for 10 522 children as control group. Analytical techniques included linear and logistic regression modeling. A semiquantitative meta-analysis evaluated 38 earlier publications that contain information on height at the onset of diabetes.

Results. Children <1 year of age were shorter than their peers by 1 standard deviation, whereas those from 3 years to near puberty were taller by approximately 0.3 standard deviation. Adjusting for parental height caused this difference to disappear for the older children but not for the infants. The meta-analysis results paralleled these observations.

Conclusions. Taller children generally seem to experience increased risk for development of diabetes mellitus type 1, except perhaps during infancy or early adolescence. This observation may have implications regarding pathogenesis of this disorder.