bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of the Patterns of Alternative Therapy by the Elderly
Authors: Shin Kyung Rim , Jho Mi Young , Lee Gi Sook , Park Sun Young , Shin Su Jin
Published: December 2004

The purpose of this study was to examine the pattern of alternative therapy by the elderly. The data were collected from 15–25 May 2001 in Seoul, Korea. The instrument, developed by Shin (2000), was used to examine the patterns of alternative therapy. The collected data were analyzed by using the sas program. The findings revealed:

Over 66% (66.84%) of the elderly used alternative therapy.

In regard to the mind–body technique, exercise (19.85%) and praying or Bul‐Gong (16.79%) were most favored. Sa‐Gol (42.75%), ginseng (24.43%), and nok‐yong (24.43%) were the most favorable of the dietary therapies. Of the manual healing methods, ordinary acupuncture (48.83%), physical therapy (24.43%), moxibustion (20.61%) and hand acupuncture (12.98%) were most favored.

The greatest satisfaction of the alternative therapies was ordinary acupuncture (14.50%).

The rate of using alternative therapy was significantly different in regard to gender (P = 0.0493). It was concluded that alternative therapies may be effective independent nursing interventions to use with the elderly.
Recognition of expertise: An important concept in the acquisition of nephrology nursing expertise
Authors: Bonner Ann
Published: December 2004

The present article, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept of recognition of expertise. The study used grounded theory methodology and involved 17 registered nurses who were practising in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participant observations and interviews. According to nurses in this study, patients, doctors and other nurses recognized that some nurses were experts while others were not. In addition, being trusted, being a role model and teaching others were important components of being recognized as an expert nephrology nurse. Of importance for nursing, the results of the present study indicate that knowledge and experience are not sufficient to ensure expert practice; recognition of expertise by others is an important function of expertise acquisition.
Paediatric one lung ventilation in the prone position
Authors: TURNER M.W.H , BUCHANAN C.C.R , BROWN S.W
Published: December 2004

Pulmonary lobectomy in the presence of infected secretions requires isolation of the affected lung to prevent soiling of the healthy lung. In young children this is usually accomplished using a Fogarty embolectomy catheter. We report the successful combination of a Fogarty catheter, a tracheal tube and the prone position, which provided adequate ventilation and oxygenation as well as excellent surgical exposure.
Administration of atropine and onset of neuromuscular block produced by atracurium in infants
Authors: SIMHI ELIAHU , BRANDOM BARBARA , LLOYD MARK , WOELFEL SUSAN
Published: December 2004

In this prospective study we tested the hypothesis that atropine administration, which is known to increase heart rate and cardiac output in infants, will result in a faster onset of neuromuscular block with atracurium. Thirty infants scheduled for elective surgery had anaesthesia induced with nitrous oxide and halothane. Fifteen patients were given atropine and 15 patients acted as controls. All the infants were given atracurium 0.5 mg·kg−1, and neuromuscular block was recorded with the Datex 221 neuromuscular transmission monitor. Although atropine caused an increase in heart rate compared to the control group (median 164 [range 151–182]vs 120 [98–160]min−1 P<0.0001), there was not a statistically significant difference in the onset of neuromuscular block between the two groups. We conclude that onset of neuromuscular block after atracurium is determined mainly by noncirculatory factors and less by the circulation time to the muscle. The effect of atropine on the time course of neuromuscular block might be different with faster acting neuromuscular blockers.
Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants
Authors: ROETMAN KAREN , WELBORN LEILA , HANNALLAH RAAFAT , FINK ROBERT , NORDEN JANET , O’DONNELL REGINA
Published: December 2004

This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N2O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty‐six full term ASA PS I infants ages 1–12 months were studied. All received inhalation induction with N2O, O2 and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N2O, 30% O2 and halothane. Group II received 70% N2O, 30% O2, halothane and 2 μg·kg−1 fentanyl. Group III received 70% N2O, 30% O2 and 10 μg·kg−1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (Spo2 >90% for greater than 30 s). Decreased Spo2 occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO2 (TcCO2) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. Spo2 <90% and TcCO2 >9 kPa (70 mmHg) was more common in infants receiving 2 and 10 μg·kg−1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants <3 months old did not have a higher incidence of Spo2 <90% or significantly higher TcCO2 values when compared to infants >3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.
A randomized controlled trial of sedation in the critically ill
Authors: PARKINSON LYNN , HUGHES JULIE , GILL ANDREA , BILLINGHAM IMOGEN , RATCLIFFE JANE , CHOONARA IMTI
Published: December 2004

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty‐four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi‐squared P<0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/distressed) was significantly greater in the midazolam group (Chi‐squared P<0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.
Maxillary hypoplasia with unsuspected choanal atresia
Authors: VAS LAKSHMI , NAREGAL PHALGUNI , KARMARKAR S.M.
Published: December 2004

Maxillary hypoplasia can pose considerable anaesthetic problems in securing the airway. The presence of concomitant, unsuspected choanal stenosis complicated the anaesthetic management of a 20‐day‐old baby for tarsorrhaphy.
The analgesic efficacy of an injectable prodrug of acetaminophen in children after orthopaedic surgery
Authors: GRANRY J. C , ROD B , MONRIGAL J. P , MERCKX J , BERNIERE J , JEAN N , BOCCARD E
Published: December 2004

The analgesic efficacy and safety of propacetamol, an injectable prodrug of acetaminophen, (paracetamol) were studied in 87 children (36 boys, 51 girls; age 6–13; mean age 9.5 years) immediately after limb surgery. Using a double‐blind, randomized, parallel group design, the effects of a single IV infusion of 30 mg·kg−1 propacetamol (i.e. 15 mg·kg−1 acetaminophen) were compared with a single injection of placebo (PL). Efficacy was assessed on pain scores rated on a four‐point verbal scale, a five‐point visual scale (faces) and on a four‐point relief verbal scale before administration (T0) and 0.25, 0.5, 1, 2, 3, 4, 5, 6 h after administration. At the end the global efficacy was rated by the physician on a five‐point verbal scale. Propacetamol was statistically superior to placebo on all assessment criteria. Seven side‐effects were recorded: five in the propacetamol group and two in the placebo group. 30 mg·kg−1 propacetamol provided a significantly greater analgesic effect than placebo in children after orthopaedic surgery.
Rectal paracetamol dosing regimens: determination by computer simulation
Authors: ANDERSON B.J. , HOLFORD N.H.G.
Published: December 2004

A pharmacokinetic dynamic simulation model was used to predict rectal paracetamol dosing schedules which would maintain steady state plasma concentrations of 10–20 mg·l−1. These plasma concentrations of paracetamol are known to reduce fever. The conventional dosing schedule of 15 mg·kg−1 four hourly was unsatisfactory. Steady state concentrations of 8–12 mg·l−1 were only reached after 16 h. A loading dose of 50 mg·kg−1 followed by 30 mg·kg−1 six hourly achieved plasma concentrations of 9–18 mg·l−1. Paracetamol is a mild analgesic. A higher plasma paracetamol concentration of 25 mg·l−1 is known to give satisfactory analgesia to 60% of children after tonsillectomy. This concentration can be reached after a loading dose of 70 mg·kg−1 and a maintenance dose of 50 mg·kg−1 8 hourly. Doses above 150 mg·kg−1·day−1 have been reported to cause reversible liver toxicity after 2–8 days and should not be sustained.
Global tissue oxygenation during normovolaemic haemodilution in young children
Authors: ALY HASSAN A. , LOCHBUEHLER H. , FREY L. , MESSMER K.
Published: December 2004

Sixteen patients (1–8 years) scheduled for major general surgery were chosen for the study. They were divided into two groups according to the replacement solution used for haemodilution (HD); whether 6% middle molecular weight hydroxyethyl starch (HES) or 6% dextran 60 (DEX). After induction of general anaesthesia and pulmonary artery catheterization, a precalculated amount of autologous blood was withdrawn while the patient's autologous blood was simultaneously replaced by either HES or DEX. Autologous blood was retransfused at a minimum haematocrit (Hct.) of 17% or at the end of surgery. The following parameters were measured and/or calculated before and after HD, every 20 min intraoperatively and hourly for 6 h postoperatively: heart rate (HR), mean arterial pressure (MAP), Cardiac index (CI), Hct., arterial and mixed venous oxygen content (CaO2, CvO2) and arterio‐venous difference of oxygen content (avDO2), oxygen delivery index (DO2I), oxygen consumption index (VO2I). The cardiovascular system remained stable. There was no significant difference as regards SvO2, despite a significant decrease in CaO2 to 10.8 and 10.0 ml·dl−1 (median values) due to reduction of haemoglobin concentration in the HES and DEX groups respectively. In spite of the low hct. values during surgery DO2I remained in normal range (median value 602 and 710 ml·min−1·m−2) in HEX and DEX group respectively. There was no significant change in VO2I after haemodilution (median value 212 and 243 ml.min−1·m−2) in either group. No statistically significant difference was noticed between either groups regarding: CaO2, CvO2, DO2I, VO2I, and no side effects of the colloids were observed. Isovolaemic haemodilution (Hct. approx;17%) is well tolerated by young children undergoing major elective surgery; global tissue oxygenation was preserved throughout the procedure and both solutions used for haemodilution were equally effective.
Oral premedication with midazolam in paediatric anaesthesia. Effects on sedation and gastric contents
Authors: RIVA JUAN , LEJBUSIEWICZ GLADYS , PAPA MERCEDES , LAUBER CLARISA , KOHN WOLF , DA FONTE MANUEL , BURGSTALLER HUGO , COMELLAS CARMEN , AYALA WALTER
Published: December 2004

The aim of this study was to assess oral premedication with midazolam in paediatric anaesthesia. Sedation, quality of induction, recovery time, acceptance and effects on gastric contents were analysed. This prospective, double blind, at random and controlled study was performed in 107 children, aged between three and ten years. They were divided into: group 1 (control, n=29), group 2 (placebo) receiving 5 ml of water in the preoperative stage (n=40), and group 3 (midazolam) with 0.75 mg·kg‐1 midazolam by mouth (n=38). Two children refused to take medication. In children aged five years or more (n=48) of groups 2 and 3, acceptance of premedication was evaluated. The midazolam group showed a better level of sedation as compared with the placebo (P<0.05). The recovery time was similar for the two groups. There were no statistically significant differences in gastric pH or residual volume among the three groups. It is concluded that midazolam given by mouth is an efficient and safe drug for premedication in paediatric anaesthesia.
Video‐assisted thoracoscopic surgery for right middle lobectomy in children
Authors: GOMOLA ALEXANDRA , GALL OLIVIER , LE LARROQUET MICHE , CONSTANT ISABELLE , BALQUET PATRICK , MURAT ISABELLE
Published: December 2004

This case‐control study was designed to evaluate the potential advantages and disadvantages of video‐assisted thoracoscopic surgery for right middle lobectomy in children. Ten children (6.1±3.0 yr, mean±SD) who underwent right middle lobectomy under videoscopy were compared with 10 controls matched for age (6.8±3.5 yr) and operated by thoracotomy (muscle‐sparing technique) during the same period by the same surgeon. Operating time was significantly longer in the videoscopy group than in the thoracotomy group (146±28 mn vs 100±27 mn, P<0.001). Minimum oxygen saturation values were significantly higher in the videoscopy group whereas oxygen requirements did not differ between groups. Incidence of postoperative respiratory complications (mainly atelectasis) was similar in the two groups. No difference in postoperative analgesic requirements in the postoperative period was demonstrated. No real benefit or disadvantage of videoscopy over standard thoracotomy could be observed in this retrospective case‐control study.
Para‐umbilical block: a new concept for regional anaesthesia in children
Authors: COURREGES P. , PODDEVIN F , LECOUTRE D
Published: December 2004

This preliminary study describes a new technique to provide analgesia in children undergoing umbilical hernia repair. The para‐umbilical block consists of infiltrating the anterior cutaneous branches of the two tenth spinal roots over and under the rectus sheath far from the operative field. Intra and postoperative analgesia as well as operative conditions were assessed in 11 children 16.7±31 months old, weighing 8421±6941 g, the block being performed before surgery under light general anaesthesia. Intraoperative analgesia, operative conditions and recovery were good in all patients. Analgesia was adequate one h after surgery in ten patients, six h after surgery in eight. The block proved to be safe and on the whole effective in this short series. The study should proceed on a multi‐centre basis if possible. Indications can be extended.
Use of intravenous ketamine‐midazolam association for pain procedures in children with cancer. A prospective study
Authors: PELLIER I. , MONRIGAL J.P. , LE MOINE P. , ROD B. , RIALLAND X. , GRANRY J.C.
Published: December 2004

We evaluated the safety and efficacy of midazolam‐ketamine association to control pain induced by diagnostic procedures in paediatric oncology patients. 226 procedures were carried out in 92 patients aged three days to 18 years. Drugs were given i.v. by an anaesthesiologist. Midazolam dose was 25 μg??kg−1 and ketamine 0.5 to 2 mg??kg−1, depending on number and invasiveness of procedures. The mean dose of ketamine was 1 mg??kg−1. Mean duration of sedation was ten min. No complication was observed and analgesia was considered satisfactory in 89 out of 92 patients. These results indicate that midazolam‐ketamine is a safe and effective association in pain management for paediatric oncology patients and efficiently induces brief unconscious sedation with analgesia.
A wandering nasal prong—a thing of risks and problems
Authors: PECK D. J. , TULLOH R. M. , MADDEN N. , PETROS A. J.
Published: December 2004

We describe an unusual complication of nasal continuous positive airway pressure (nCPAP) ventilation in a preterm low birth weight neonate being weaned from respiratory support. The tube used to administer nasal CPAP became dislodged from its metal connector whilst in the nasopharynx and slipped into the stomach. After waiting eight days the tube showed no signs of passing spontaneously through the gastrointestinal tract and retrieval was then successfully achieved by means of a 3.5 mm paediatric fibreoptic bronchoscope without complication.
Fibreoptic bronchoscopy in sedated infants facilitated by an airway endoscopy mask
Authors: ERB THOMAS , HAMMER JÖRG , RUTISHAUSER MARKUS , FREI MD FRANZ J.
Published: December 2004

Fibreoptic bronchoscopy (FB) is frequently associated with a decline in Pao
2, whose degree and duration can be substantial especially in infants. The effect of a face mask, which allows the administration of 100% oxygen and continuous positive airway pressure during FB, on the incidence and severity of hypoxaemia was studied in thirty‐one consecutive infants. Sedation was provided by intravenous propofol titrated to allow patient comfort. A transient fall in Spo
2 <95% was recorded in 6/31 patients during endoscopy of the upper airway (lasting 1.6±1.1 min) and in 11/31 patients during endoscopy of the lower airways (lasting 1.4±1.1 min). Capillary blood gas analysis before and after endoscopy of the lower airways demonstrated an increase in the P
co
2 6.4±1.3 to 7.3±1.4 kPa (49±10 to 56±11 mmHg). The risk of hypoxaemia in sedated infants breathing spontaneously is low when 100% oxygen and continuous positive airway pressure are administered during FB.
The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome
Authors: Brimacombe Joseph , Gandini Donna , Keller Christian
Published: December 2004

We report the successful use of the ClassicTM laryngeal mask airway to provide brief access to the intratracheal space for the administration of surfactant in two neonates with respiratory distress syndrome.
Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice?
Authors: Giuliano Karen K.
Published: December 2004

Abstract  The philosophy of Aristotle and its impact on the process of empirical scientific inquiry has been substantial. The influence of the clarity and orderliness of his thinking, when applied to the acquisition of knowledge in nursing, can not be overstated. Traditional empirical approaches have and will continue to have an important influence on the development of nursing knowledge through nursing research. However, as nursing is primarily a practice discipline, the transition from empirical and syllogistic reasoning is problematic. Other types of inquiry are essential in the application of nursing knowledge obtained by empirical scientific approaches and to understand how that knowledge can best be used in the care of patients. This paper reviews the strengths and limitations of syllogistic reasoning by applying it to a recently published study on temperature measurement in nursing. It then discusses possible ways that the empirical knowledge gained from that study and confirmed in its reasoning by logical analysis could be used in the daily care of critically ill patients. It concludes by highlighting the utility of broader approaches to knowledge development, including interpretative approaches and contemporary empiricism, as a way to bridge the gap between factual empirical knowledge and the practical application of that knowledge in everyday clinical nursing practice.
Popper and nursing theory
Authors: Allmark Peter
Published: December 2004

Abstract  Science seems to develop by inducing new knowledge from observation. However, it is hard to find a rational justification for induction. Popper offers one attempt to resolve this problem. Nursing theorists have tended to ignore or reject Popper, often on the false belief that he is a logical positivist (and hence hostile to qualitative research). Logical positivism claims that meaningful sentences containing any empirical content should ultimately be reducible to simple, observation statements. Popper refutes positivism by showing that there are no such simple statements. He is not a positivist. For Popper, the scientist begins with problems and puts forward trial solutions. These are subjected to rigorous testing aimed at falsifying them. A new theoretical position is then reached in which the scientist knows either that the trial solutions are false or that they have not yet been falsified. Science is characterized by the fact that it tests its ideas through attempted falsification. Non‐science tests its ideas through attempted refutation. Nursing theory is a mixture of science and non‐science. Popper's method requires rigorous testing of theory in both realms. As such, some nursing theory should be discarded. Popper's view faces at least two important criticisms. One is that a scientist can always reject an apparent falsification by instead altering some auxiliary hypothesis (e.g. denying the accuracy of the falsifying observation). Popper can deal with this argument by saying that defence of a theory in this way will eventually break down if the theory is false. The second criticism is that Popper's method does ultimately draw upon induction. This criticism is true, but his method can be usefully adapted. An adapted from of Popper's philosophy of science provides a good basis for nursing theory.
Immersed subjectivity and engaged narratives: clinical epistemology and normative intricacy
Authors: Nortvedt Per
Published: December 2004

Gadow's understanding of nursing as a relational narrative anchored in a dialectic between the fundamental subjectivity of the individual client and the objectification of his illness poses some interesting questions for nursing ethics and care. For Gadow, nursing is an encounter with the immediate vulnerability of the client and also lends it responsibilities to the medical objectification of illness aiming at disease treatment and control. Hence, nursing agency is divided between its responsibilities induced by the personal vulnerability of the patient and the more impersonal, but benevolent intention shaped by medical knowledge. Medical knowledge is impersonal in the sense that it is knowledge detached from the subjectivity of the patient. But how is nursing able to reconcile the interests derived from personal and experienced vulnerability with the more impersonal and often conflicting demands of medical knowledge? This question is even more intriguing because there seems to be an objective dimension within a patient's subjectivity itself: an autonomous person can critically evaluate his own subjectivity as a basis for informed self‐interest. The sick person is thus confronted with objectivity on two important levels: the objective facts of his disease and his detachment from his own experiential vulnerability when engaged in the critical evaluation of his self‐interest. This paper will discuss the normative dimensions of these complex and, frequently, conflicting perspectives from the theoretical perspectives of Thomas Nagel's normative responsibility and Sally Gadow's clinical epistemology and relational narratives. The empirical basis for the discussion will be an ongoing study of the ethical dimensions of pain relief and sedation in an intensive care unit.
Relational pedagogy. Embodiment, improvisation, and interdependence
Authors: Bergum Vangie
Published: December 2004

In this paper Gadow's philosophical themes are developed considering the pedagogical relation – the relation of teacher and student, nurse and patient, self and world. Relational pedagogy is discussed through exploration of embodiment (beingthe teaching), improvisation (doingthe teaching), and interdependence (locatingthe teaching in a reciprocal world as home). The pedagogical relation explores the lived space between teacher and learner, nurse and patient, where new knowledge is constructed. Such knowledge ‘resounds bodily’ and is always under construction.
Actualizing Gadow's moral framework for nursing through research1
Authors: Minicucci Daryl Sharp , Schmitt Madeline H. , Dombeck Mary T. , Williams Geoffrey C.
Published: December 2004

The purpose of this paper is to describe how Sally Gadow's perspectives on existential advocacy as the moral framework for the nurse–patient relationship were synthesized with a general theory of motivation, self‐determination theory (SDT), to inform the design of a study in which the influence of interpersonal care on the process of tobacco dependence treatment was explored. Consistent with the tenets of existential advocacy, participants who perceived their care providers as interpersonally sensitive and bringing more of their whole selves to the care encounter reported more autonomous motivation and felt competence for stopping smoking. The integration of existential advocacy with SDT, which led to the empirical work in which Gadow's ideas were actualized and her model supported, is described. Study findings are discussed in light of Gadow's philosophical views, and implications for nursing highlighted.
It happens when the stage sets collapse1
Authors: Schroeder Carole
Published: December 2004

Sally Gadow's tenure as professor of nursing at the University of Colorado Health Sciences Center during my doctoral studies radically changed my view on science, nursing, relationships, and most importantly, the world. In this paper, I use ideas stimulated by Gadow's classes to argue that recognizing ambiguity through an attitude of metaphysical revolt can free nurses to form relationships with patients who are complex subjects rather than objects to be treated. I will first discuss Camus’ ideas of absurdity from the Myth of Sisyphus, comparing the awake passions of Don Juan and the maniacal (and fatal) love of Romeo and Juliet (1955). Merleau‐Ponty's (1962) work on the dialectic of human sexuality sheds light on the intrinsic bodily ambiguity of human existence as seen through sexual attraction. de Beauvoir (1948) further lends insight into ideas of ambiguity, relationship, and freedom. Finally, I will argue that recognition of the intrinsic ambiguity of existence coupled with an attitude of metaphysical revolt may free nurses and patients from external frameworks that limit experience, impose meaning, and in the process, sever human relationship.
The safety and efficacy of pharmaceutical and herbal caffeine and ephedrine use as a weight loss agent
Authors: Greenway F. L.
Published: December 2004

Since passage of the Dietary Supplement Health and Education Act of 1994, the sale of herbal dietary supplements containing caffeine and ephedrine for weight loss has become widespread in the United States. Reports of adverse events associated with the use of these non‐prescription supplements have raised concerns in the United States regulatory community. Restricting the use of these products is now being considered. Such restriction should be based upon controlled clinical trials. This review of the literature in Medline relative to the use of caffeine and ephedrine in the treatment of obesity concludes that caffeine and ephedrine are effective in causing weight loss. Caffeine and ephedrine give equivalent weight loss to Diethylpropion and superior weight loss compared to dexfenfluramine. Caffeine and ephedrine have a long history of safe, non‐prescription use. The adverse events accompanying acute dosing are mild and transient. Adverse events with caffeine and ephedrine reach and remain at placebo levels after 4–12 weeks of continuous treatment, but data from randomized trials up to 6 months only are available. Obesity is chronic, requires chronic treatment, its incidence is increasing and it has few effective treatments. The benefits of caffeine and ephedrine in treating obesity appear to outweigh the small associated risks. Restriction of dietary herbal supplements containing caffeine and ephedrine, often with other ingredients, should be based on controlled clinical trials of these products.
Gourmand savants and environmental determinants of obesity
Authors: Myslobodsky M.
Published: December 2004

Obesity is an embodiment of a multifactorial problem with several intermediates in its casual pathway. Virtually all who have written on obesity have responded to four inter‐related factors: genetic, perinatal, environmental, and consumption‐expenditure energy imbalance. The message to take home is that while a molecular description of each participant of the obesity machinery seems achievable in principle, a complex model describing all of them is currently beyond our grasp. That is why the eradication of the obesity epidemic is seen in a more precise neuropsychological description of what is wrong with each subset of patients. This review proposes that the neuropsychiatric experience might be the most fundamental for it could help to refocus the view of obesity from ‘traditional’ environmental factors and lifestyle changes to those dominated by a more ‘individual‐centred’ perspective in which different modes of causal attribution are appropriate. This review advocates the idea of environmental dependency as a determinant of obesity, which has been an important idea in neurosciences for more than 30 years with roots in three important areas: psychological, neuropsychiatric, and experimental. The neuropsychology of obesity is yet to become part of today's agenda of obesity research.
How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement
Authors: Saris W. H. M. , Blair S. N. , Van Baak M. A. , Eaton S. B. , Davies P. S. W. , Di Pietro L. , Fogelholm M. , Rissanen A. , Schoeller D. , Swinburn B. , Tremblay A. , Westerterp K. R. , Wyatt H.
Published: December 2004

A consensus meeting was held in Bangkok, 21–23 May 2002, where experts and young scientists in the field of physical activity, energy expenditure and body‐weight regulation discussed the different aspects of physical activity in relation to the emerging problem of obesity worldwide. The following consensus statement was accepted unanimously.

‘The current physical activity guideline for adults of 30 minutes of moderate intensity activity daily, preferably all days of the week, is of importance for limiting health risks for a number of chronic diseases including coronary heart disease and diabetes. However for preventing weight gain or regain this guideline is likely to be insufficient for many individuals in the current environment. There is compelling evidence that prevention of weight regain in formerly obese individuals requires 60–90 minutes of moderate intensity activity or lesser amounts of vigorous intensity activity. Although definitive data are lacking, it seems likely that moderate intensity activity of approximately 45 to 60 minutes per day, or 1.7 PAL (Physical Activity Level) is required to prevent the transition to overweight or obesity. For children, even more activity time is recommended. A good approach for many individuals to obtain the recommended level of physical activity is to reduce sedentary behaviour by incorporating more incidental and leisure‐time activity into the daily routine. Political action is imperative to effect physical and social environmental changes to enable and encourage physical activity. Settings in which these environmental changes can be implemented include the urban and transportation infrastructure, schools, and workplaces.’
Effects of sugar intake on body weight: a review
Authors: Vermunt S. H. F. , Pasman W. J. , Schaafsma G. , Kardinaal A. F. M.
Published: December 2004

Weight reduction programmes are mainly focused on reducing intake of fat and sugar. In this review we have evaluated whether the replacement of dietary (added) sugar by low‐energy sweeteners or complex carbohydrates contributes to weight reduction. In two experimental studies, no short‐term differences in weight loss were observed after use of aspartame as compared to sugar in obese subjects following a controlled energy‐restricted diet. However, consumption of aspartame was associated with improved weight maintenance after a year. In two short‐term studies in which energy intake was not restricted, substitution of sucrose by artificial sweeteners, investigated mostly in beverages, resulted in lower energy intake and lower body weight. Similarly, two short‐term studies, comparing the effect of sucrose and starch on weight loss in obese subjects did not find differences when the total energy intake was equal and reduced. An ad libitum diet with complex carbohydrates resulted in lower energy intake compared to high‐sugar diets. In two out of three studies, this was reflected in lower body weight in subjects consuming the complex carbohydrate diet. In conclusion, a limited number of relatively short‐term studies suggest that replacing (added) sugar by low‐energy sweeteners or by complex carbohydrates in an ad libitum diet might result in lower energy intake and reduced body weight. In the long term, this might be beneficial for weight maintenance. However, the number of studies is small and overall conclusions, in particular for the long term, cannot be drawn.
Pneumonitis complicating methotrexate therapy for pustular psoriasis
Authors: Ameen M , Taylor DA , Williams IP , Wells AU , Barker JNWN
Published: December 2004

We report a patient with pustular psoriasis who developed interstitial pneumonitis after receiving weekly methotrexate (MTX) therapy at an average dose of 20 mg for 26 years. The patient responded dramatically to withdrawal of the drug and administration of corticosteroids. Pulmonary toxicity is a rare adverse effect of MTX therapy and is particularly uncommon in psoriatics. As interstitial pneumonitis is a potentially fatal but reversible complication, early respiratory symptoms even in patients on low‐dose MTX treatment should be appropriately investigated.
Palmoplantar pustulosis: a clinicoepidemiological study. The relationship between tobacco use and thyroid function
Authors: Giménez‐García R , Sánchez‐Ramón S , Cuellar‐Olmedo LA
Published: December 2004

Background Palmoplantar pustulosis (PPP) is a skin disease characterized by chronically recurring sterile pustules on the palms and the soles. Although the aetiology of PPP is unknown, it is interesting to note the high prevalence of tobacco use in these patients. It would seem that there may be a relationship between PPP, autoimmune diseases and alterations of thyroid function.

Methods We studied a total of 17 patients with ages ranging from 28 to 67 years, diagnosed with PPP. Patients were interviewed about: autoimmune diseases, psoriasis and thyroid disease, tobacco use (classified as: A, non‐smoker; B, ex smoker; C, smoker of less than 20 cigarettes/day; D, smoker of more than 20 cigarettes/day). The patients were interviewed regarding the possible existence of a personal or family history of thyroid disease, determined using thyroid‐stimulating hormone, thyroxine, antithyroid antibodies (antimicrosomal and antithyroglobulin antibodies).

Results The majority of the patients smoked cigarettes (according to classification). Of the 12 patients for whom a thyroid study was performed three had been diagnosed with thyroid diseases, an increase in thyroid‐stimulating hormone in one case and two showed an increase in antimicrosomial antibodies.

Conclusions We have been able to demonstrate a high prevalence of thyroid dysfunction and tobacco use in patients with PPP.
Chronic cutaneous sclerodermoid graft‐versus‐host disease: evaluation by 20‐MHz sonography
Authors: Gottlöber P , Leiter U , Friedrich W , Bunjes D , Schulz A , Kerscher M , Peter Ru
Published: December 2004

Background Chronic graft‐versus‐host disease (GVHD) is an immunological disorder frequently occurring as a late consequence of allogeneic bone marrow transplantation. Two variants, cutaneous lichenoid and sclerodermoid, have been described, based on clinical and histopathological examinations. It is, however, difficult to determine non‐invasively the degree of cutaneous GVHD in vivo. Ultrasonographic methods have recently provided us with the means for objective and non‐invasive monitoring of the dynamics of many chronic skin diseases.

Aim, patients and methods In five patients with chronic cutaneous sclerodermoid GVHD skin thickness was measured with a 20‐MHz B‐mode ultrasound scanner (DUB 20S, taberna pro medicum, Lüneburg, Germany) in a clinically well‐defined target skin lesion. Additionally cutaneous GVHD was assessed histologically before and after treatment.

Results In all patients before treatment the corium of sclerotic skin was thicker than the corresponding areas of healthy skin. The skin thickness was increased from 45% to 83%. In the subcutaneous tissue proper echo‐rich reflexes were prominent, representing the correlate of subcutaneous fibrotic trabeculae. In all patients ultrasonographic evidence of regression was shown (decrease of skin thickness by 18–83%). Moreover, it was demonstrated that quantitative assessment of skin thickness is feasible.

Conclusions In this paper we describe the detailed sonographic features of cutaneous sclerodermoid GVHD for the first time. As the method is simple and non‐invasive, repeated examinations are possible. This provides the basis for monitoring treatment effects and efficient follow‐up in these chronically progressive clinical conditions after bone marrow transplantation.
Ano‐genital granulomatosis: the counterpart of oro‐facial granulomatosis1
Authors: Van De Scheur MR , Van Der Waal RIF , Van Der Waal I , Stoof TJ , Van Deventer SJH
Published: December 2004

Ano‐genital granulomatosis encompasses the previously recognized clinical entities of vulvitis granulomatosa, posthitis granulomatosa, and ano‐perineitis granulomatosa. We report three patients with ano‐genital granulomatosis. The pathological features of the disease are lymphoedema and the presence of non‐caseating giant cell granulomas. These granulomas are histologically indistinguishable from those found in both Crohn's disease and sarcoidosis, therefore, patients with ano‐genital granulomatosis with accompanying gastro‐intestinal or pulmonary symptoms should be investigated for the presence of Crohn's disease or sarcoidosis, respectively. The value of ano‐genital granulomatosis as a unifying clinicopathologic concept is to provide a label for the affliction as well as to stimulate a careful search for possibly underlying systemic disorders, thus also permitting a more specific approach to therapy.
Dyskeratosis congenita associated with three malignancies
Authors: Baykal C , Kavak A , Gülcan P , Büyükbabani N
Published: December 2004

Dyskeratosis congenita is a rare inheritable disorder characterized by abnormalities of the skin, nails and oral mucosa. Aplastic anaemia resulting from bone marrow hypoplasia is a frequent cause of death. Squamous cell carcinoma developing from leukoplakia and visceral malignancies are other complications of the disease. We report here a case of dyskeratosis congenita in a man who developed three neoplasias of different systems over a period of many years. Squamous cell carcinoma and gastric adenocarcinoma manifested 17 years after the man was diagnosed with Hodgkin's disease.
Acantholytic dyskeratotic naevi following Blaschko's lines: a mosaic form of Darier's disease
Authors: Gilaberte M , Puig L , Vidal D , Alomar A
Published: December 2004

Darier's disease (DD) is an autosomal‐dominant skin disorder characterized by loss of adhesion between epidermal cells and abnormal keratinization. Several patients with unilateral, linear, ‘zosteriform’ or localized lesions have been reported. We report three cases of DD in a localized pattern corresponding to mosaicism type 1 according to Happle's classification and review the literature about the genetic cause of DD and DD in a ‘zosteriform’ pattern.
Perforating calcific elastosis
Authors: Caldas Lopes L , Lobo L , Bajanca R
Published: December 2004

A 69‐year‐old white multiparous woman presented a reticulated yellowish patch with scattered keratotic papules on her abdomen. Histopathological examination demonstrated pseudoxanthoma elasticum (PXE)‐like changes. The diagnosis of perforating calcific elastosis (PCE) was made based on the absence of a personal and familial history of PXE. PCE is a localized acquired dermatosis and is considered to be a distinct clinical entity.
Hypertrichosis in females applying minoxidil topical solution and in normal controls
Authors: Dawber RPR , Rundegren J
Published: December 2004

Background  Hypertrichosis has been reported more frequently in females than in males who use minoxidil topical solution (MTS) for the treatment of androgenetic alopecia (AGA). This article examines the occurrence of MTS‐induced hypertrichosis in females.

Methods  Data from placebo‐controlled clinical trials in females (up to 5% MTS) were analysed based on spontaneous reports of hypertrichosis/facial hair and investigators’ inquiries (solicited) about the presence of any new hair growth on body parts other than the scalp. A postmarketing drug surveillance database for MTS was also examined for reports of hypertrichosis/facial hair.

Results  In the clinical trials involving a total of 1333 females, spontaneous reports of hypertrichosis/facial hair were noted for 50 (4%) females in a dose‐related pattern of response (5% MTS > 2% MTS > placebo). Nine females (seven and two in the 5% MTS and 2% MTS groups, respectively) discontinued treatment because of hypertrichosis/facial hair. Solicited reports of excessive hair growth (primarily facial) also showed a dose‐related pattern of response. Post‐marketing data showed a lower occurrence (0.5%) of hypertrichosis/facial hair than in the clinical trials. Of interest, in one clinical trial, 27% of the females enrolled (MTS and placebo treated) had facial hair growth reported at baseline.

Conclusions  Females with some hirsutism are particularly prone to seek treatment for AGA, and this may explain the high occurrence of hypertrichosis/facial hair found in the MTS clinical trials. Furthermore, some demographic groups of females are prone to develop facial hair and the problem of unwanted facial hair growth seems to be underestimated. Some females may have hair follicles that are very sensitive to MTS and should use the lowest strength of MTS (2%) to help avoid unwanted hair growth. The hypertrichotic effect of MTS on other sites than the scalp, including the face, is reversible and does not always require discontinuation of therapy.
Tufted hair folliculitis associated with pemphigus vulgaris
Authors: Jappe U , Schröder K , Zillikens D , Petzoldt D
Published: December 2004

Tufted hair folliculitis (THF) is a rare disease which is characterized by the emergence of multiple hairs from widely dilated follicular orifices surrounded by an inflammatory infiltrate resulting in scarring alopecia. The pathogenesis is not yet fully understood. Although colonization with Staphylococcus aureus could not always be detected and systemic treatment with antibiotics alone is not sufficient, this microorganism is considered to play an important role. Around 30 patients with THF have been reported since the first publication. We present a patient with pemphigus vulgaris who developed THF. To our knowledge, this is the fourth case with an association of these two entities. Amongst other causing mechanisms, the autoimmune reaction may play an important role for the development of THF.
Erythema measurements may allow early diagnosis of diabetes mellitus in adult psoriatics
Authors: Avci O , Caliskan S , Caliskan M
Published: December 2004

Background  We have observed that the erythema in subjects with psoriasis vulgaris associated with non‐insulin‐dependent diabetes mellitus (NIDDM) presents a mostly deep‐red to purple hue instead of the typical pink to red tones. We carried out a descriptive clinical study, including 141 patients with psoriasis vulgaris to quantify these colour differences.

Methods  Mean erythema index values were established for the psoriatic plaques of adult subjects using an optoelectronic method. Non‐diabetic psoriatics underwent an oral glucose tolerance test (OGTT), and based on the results of the oral OGTTs, the subjects were divided into three groups: 18 psoriatics with NIDDM, 16 psoriatics with impaired glucose tolerance (IGT) and 107 psoriatics with normal glucose tolerance. The mean erythema index value was calculated for each group and the findings were compared.

Results  The differences in the erythema were found to be highly significant between the group of subjects with psoriasis having normal glucose tolerance and both those with IGT and those with NIDDM (P < 0.01 and P < 0.01). The differences in the erythema were also highly significant between the psoriatic group with normal glucose tolerance and the group of 34 psoriatics with IGT and NIDDM all together (P < 0.01).

Conclusions  Individuation of the various hues of erythema in psoriatics by careful dermatological examination or routine measurements of lesional erythema may alert the physician to possible IGT in the presenting subject, and this may affect disease severity.
Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases
Authors: Aerts A , Decraene T , Van Den Oord JJ , Dens J , Janssens S , Guelinckx P , Flour M , Degreef H , Garmyn M
Published: December 2004

We describe two patients in whom chronic radiodermatitis with therapy‐resistant ulceration of the right scapular region developed, following percutaneous coronary intervention with fluoroscopic imaging. Contrary to most reported cases in the literature, which involve numerous cardiac catheterization procedures, in both patients described here the total radiation dose was given during two successive procedures, involving difficult and prolonged coronary intervention with stent implantation. In both cases, local treatment of the ulcerative lesions was insufficient, necessitating excision of the radiodermatitis area and replacement with a skin graft, with good therapeutic result. The incidence of radiodermatitis after percutaneous coronary interventions is rising with the increasing number and complexity of these procedures. The main risk factor is a long duration of fluoroscopy using the same incidence. The skin lesions encompass a wide spectrum, ranging from erythema, telangiectasia, atrophy, hyperpigmentation and hypopigmentation to necrosis, chronic ulceration and squamous cell carcinoma. The lesions can appear from 15 days to 10 years after the procedure. To prevent radiation‐induced injury, the radiation dose has to be limited and monitored. Also, careful inspection of the skin at the site of exposure is necessary and the radiographic beam has to be restricted to the smallest field size. A good clinical follow‐up at regular intervals is important after long and complicated procedures.