bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary aspiration of a two‐unit bridge during a deep sleep
Authors: BAŞOǦLU Ö. K. , BUDUNELİ N. , ÇAǦIRICI U. , TURHAN K. , AYSAN T.
Published: May 2005

summary Aspiration of teeth and dental restorations is a recognized, yet an infrequent happening in the literature. Main reasons of aspiration are maxillofacial trauma, dental treatment procedures or ethanol intoxication and dementia. The present case of a 2‐unit bridge aspiration is however, not related with any trauma, dental procedure or systemic disease. A 37‐year‐old male patient had aspirated his bridge while sleeping and the bridge remained unidentified for 1 year despite the radiographic controls. He was then referred to the Chest Diseases Department of School of Medicine, Ege University and the radio‐opaque object in the right intermediate bronchus was diagnosed to be an aspirated dental prosthesis. Subsequent to the failure of the rigid bronchoscopy, the patient was referred to the Thoracic Surgery Department and had to be operated for retrieval of the foreign body.
Effects of flight behaviour on body temperature and kinematics during inter‐male mate competition in the solitary desert bee Centris pallida
Authors: Roberts Stephen P.
Published: May 2005

Abstract.  Body temperatures and kinematics are measured for male Centris pallida bees engaged in a variety of flight behaviours (hovering, patrolling, pursuit) at a nest aggregation site in the Sonoran Desert. The aim of the study is to test for evidence of thermoregulatory variation in convective heat loss and metabolic heat production and to assess the mechanisms of acceleration and forward flight in field conditions. Patrolling males have slightly (1–3 °C) cooler body temperatures than hoverers, despite similar wingbeat frequencies and larger body masses, suggesting that convective heat loss is likely to be greater during patrolling flight than during hovering. Comparisons of thorax and head temperature as a function of air temperature (Ta) indicate that C. pallida males are thermoregulating the head by increasing heat transfer from the thorax to the head at cool Ta. During patrolling flight and hovering, wingbeat frequency significantly decreases as Ta increases, indicating that variation in metabolic heat production contributes to thermal stability during these behaviours, as has been previously demonstrated for this species during flight in a metabolic chamber. However, wingbeat frequency during brief (1–2 s) pursuits is significantly higher than during other flight behaviours and independent of Ta. Unlike most other hovering insects, C. pallida males hover with extremely inclined stroke plane angles and nearly horizontal body angles, suggesting that its ability to vary flight speed depends on changes in wingbeat frequency and other kinematic mechanisms that are not yet described.
Substrate particle size affects pit building decision and pit size in the antlion larvae Euroleon nostras (Neuroptera: Myrmeleontidae)
Authors: Devetak Dušan , Špernjak Andreja , JanžekoviČ Franc
Published: May 2005

Abstract.  The larvae of the antlion Euroleon nostras are pit‐builders, constructing pitfall traps in loose sand. The number of pits and the pit diameter are recorded when larvae are kept in substrates with different particle sizes. The most convenient pit‐building sand fractions are two fractions with fine sand (≤ 0.23 mm; 0.23–0.54 mm). The largest pits are constructed in sand with a particle size of 0.23–0.54 mm. In this sand fraction, larvae of all three instars most readily build pits. No pits are constructed in sand with a particle size greater than 1.54 mm. First‐ and second‐instar larvae avoid building pits in substrates of particle size 1–1.54 mm, but third‐instar larvae construct pits in this sand fraction. It is assumed that the antlion is capable of distinguishing between substrate types and this hypothesis is tested by giving larvae the choice of building a pit in one of four particle‐size fractions. Larvae of all three instars prefer to build pits in the fraction with a particle size of 0.23–0.54 mm. Only third‐instar larvae build pits in all four fractions, but only occasionally in the coarser fraction.
Vibratory signals of four Neotropical stink bug species
Authors: Moraes Maria Carolina Blassioli , Laumann Raul Alberto , Cokl Andrej , Borges Miguel
Published: May 2005

Abstract.  The stink bugs Acrosternum impicticorne, Euschistus heros, Piezodorus guildinii and Thyanta perditor (Heteroptera: Pentatomidae) feed and mate on the same host plants and constitute major components of the soybean pest complex in Brazil. During mating, they communicate with species and sex‐specific vibratory signals whose spectral properties are characteristic of the subfamily Pentatominae. Songs differ between species in the time structure and amplitude modulation of their units. The repertoire of A. impicticorne, E. heros and T. perditor fits into the scheme described for most investigated stink bugs: females call with a sequence of pulses that differ between species in their duration and repetition rate, and males respond with courtship songs of species‐specific temporal structure and amplitude modulation of complex pulse trains. Female calling and male courtship songs are the main constituents of vibratory communication between sexes in the mating period. The other vibratory emissions appear to represent either transitional songs, support recognition during close‐range courtship, or are involved in male rivalry. The first recorded vibratory emissions of P. guildinii confirm that the genus Piezodorus represents an exception within the Pentatominae. Irregularly repeated female vibratory signals of P. guildinii do not trigger typical male courtship responses as they would in the small stink bugs Holcostethus strictus and Murgantia histrionica. On the other hand, complex rivalry with extensive frequency modulation of pulses, as also described in Piezodorus lituratus, opens a new insight into the role of vibratory communication in stink bugs.
Biological and psychological differences in the child and adolescent transplant recipient
Authors: Hsu Daphne T.
Published: May 2005

Abstract:  Solid organ transplantation has become accepted therapy for the treatment of end‐stage organ dysfunction in children. As early management of the pediatric transplant recipient has improved, important age‐related differences in long‐term patient outcomes have become apparent. Late morbidity and mortality can, in most cases, be attributed to the consequences of long‐term immunosuppression: graft loss from under‐immunosuppression or an increased incidence of cancer, hypertension, renal failure or diabetes from over‐immunosuppression. Age‐related differences in both biological and psychological factors play an important role in the optimization of therapy in the transplanted child. Important age‐related differences have been demonstrated in all phases of pharmacokinetics: absorption, distribution, metabolism and elimination. Information regarding specific age‐related pharmacokinetic differences is lacking for many immunosuppressive medications. Further study using physiologically based pharmacokinetic (PBPK) models will lead to more specific recommendations for age‐based immunosuppression protocols. Non‐adherence is common among solid organ transplant recipients of all ages and the consequences of non‐adherence include increased rejection, late graft loss and death. The biological and psychological developmental changes that occur during adolescence place the transplanted adolescent at an even higher risk of non‐adherence and poor outcome than other age groups. Further studies to elucidate the importance of both age‐related pharmacokinetic and behavioral factors are needed to formulate therapeutic interventions that would improve adherence and patient outcomes.
Medication non‐adherence in the adolescent renal transplant recipient: A clinician's viewpoint*
Authors: Rianthavorn P. , Ettenger R. B.
Published: May 2005

Abstract:  Recent advancements in immunosuppression and surgical techniques have significantly improved the outcome of kidney transplantation in the pediatric population. Adolescents enjoy the best 1‐year graft survival of any age group. However, the long‐term transplant outcome in adolescents is disappointing. Non‐adherence with immunosuppressive medications is one of the most important contributing factors for graft rejection and loss in teenagers. The impact of non‐adherence is perceived to be far more powerful in adolescent transplant recipients than in the transplant population as a whole. To better understand adolescent non‐adherence, the process of transplantation must be placed in the context of adolescent development. Adolescents try to establish their identity and autonomy separately from the parents; however at the same time, adolescents with chronic illness require help, support and guidance from adults, including parents and medical personnel. Adolescents have limited ability to anticipate abstractly the long‐term consequences of their immediate actions. This inconsistency can create frustration in both adolescents and in the supporting systems around them. Despite the significant consequences of adolescent non‐adherence, research in this area is scarce. There are still no established definitions, standardized diagnostic methods and effective interventions to treat and prevent this problem. We propose the recommendations to approach the problems of adolescent transplant non‐adherence from the transplant clinician's viewpoint. With early identification and appropriate interventions, significant improvement in adolescent graft survival is possible.
Replacing calcineurin inhibitors with mTOR inhibitors in children
Authors: Sindhi Rakesh , Seward Joseph , Mazariegos George , Soltys Kyle , Seward Lynn , Smith Amy , Kosmach Beverly , Venkataramanan Raman
Published: May 2005

Abstract:  A highly selected subject group comprising pediatric recipients of liver (n = 36) and small intestine alone (n = 1) or multivisceral graft (n = 2) were converted to sirolimus maintenance therapy for tacrolimus‐related side effects (n = 32) or by primary intent (n = 7). Indications were nephrotoxicity (n = 14), primary intent (n = 7), post‐transplant lymphoproliferative disorder (n = 6), seizures (n = 4), recurrent acute rejection (n = 2), and cardiomyopathy (n = 1). Thirty subjects (78%) experienced successful conversion, with one subject requiring atorvastatin for hypercholesterolemia and hypertriglyceridemia. Nine subjects (22%) were converted back to tacrolimus for serious adverse events including acute rejection (n = 2), elevated liver function tests (n = 1), severe leucopenia (n = 1), non‐compliance (n = 2), recurrent malignancy/death (n = 1), steatohepatitis (n = 1), and thrombocytopenic thrombotic purpura (n = 1). Among subjects with nephrotoxicity, significant benefit was seen only in those subjects with shorter time to rescue after transplantation (n = 8 of 14 subjects). Additional benefits included a significant decrease in mean serum creatinine from pretransplant values for the entire population, and elimination of antihypertensive treatment in all five subjects receiving it prior to conversion. Hemoglobin, serum cholesterol and triglycerides, white cell counts and platelets remained within normal limits for the duration of follow‐up (36 month). Conversion from tacrolimus to sirolimus is successful in selected pediatric liver and intestine recipients. Chronic nephrotoxicity may be ameliorated by early conversion. Improvement in renal function and hypertension management, and absence of sirolimus‐related adverse events argue for prospective evaluation of regimens in which mTOR inhibitors are used without calcineurin inhibitors in children.
Current approaches to treatment of antibody‐mediated rejection
Authors: Jordan Stanley C. , Vo Ashley A. , Tyan Dolly , Nast Cynthia C. , Toyoda Mieko
Published: May 2005

Abstract:  Antibody‐mediated rejection (AMR) has recently been recognized as a significant and unique form of rejection that is not amenable to treatment with standard immunosuppressive medications aimed at modification of T‐cell function. Recent interest in AMR and the role of B cells in rejection has been aided by the concomitant discovery that C4d staining of renal biopsy tissue is strongly associated with AMR and a poor prognosis, and the emergence of desensitization protocols for treatment of highly human leukocyte antigen (HLA)‐sensitized patients. Treatment options include: (i) the use of high‐dose intravenous immunoglobulin (IVIG) which works by blocking anti‐HLA antibody activity and through complement inhibition, (ii) the use of Rituxan (anti‐CD20 chimeric antibody) to deplete B cells and interfere with antigen‐presenting cell (APC) activity of B cells subsequently decreasing T‐cell activation, and (iii) the use of plasmapheresis (PE) + anti‐cytomegalovirus (CMV) immunoglobulin G (IgG) or IVIG in lower doses. This protocol removes deleterious anti‐HLA antibodies and may also allow complexing of anti‐HLA with anti‐idiotypes in the anti‐CMV IgG. Although early, data support the efficacy of all three approaches. Many centers are now designing protocols that utilize a combination of all three agents. In summary, recent advances in the diagnosis and treatment of AMR has allowed for significant improvements in outcomes of a condition usually associated with rapid graft failure. However, much work needs to be done to better understand the immunologic processes leading to AMR and how current therapies can be best used to effectively prevent and treat it.
GSK‐3 activity in neocortical cells is inhibited by lithium but not carbamazepine or valproic acid
Authors: Jonathan Ryves W , Dalton Emma C , Harwood Adrian J , Williams Robin SB
Published: May 2005

Objectives:  Lithium (Li+) has been suggested to target the enzyme glycogen synthase kinase 3 (GSK‐3) as a mechanism of mood stabilization. Inhibition of GSK‐3 by a second mood‐stabilizer, valproic acid (VPA), has also been reported, but this effect is dependent on cell type. It is currently unknown if carbamazepine (CBZ) inhibits GSK‐3 activity. We have sought to compare the inhibitory effect of Li+, VPA and CBZ on GSK‐3 activity.

Methods:  We treated rat primary cultured neurones at three times therapeutic drug concentration with CBZ, VPA and Li+ and examined changes in GSK‐3 protein levels, activity and phosphorylation of downstream targets. To eliminate a possible direct effect of these drugs at higher concentrations, we also looked for direct inhibition of both GSK‐3 isoforms at a range of concentrations.

Results:  CBZ, VPA and Li+ did not change the levels of the GSK‐3 or produce an irreversible in vivo effect on GSK‐3 activity. Only Li+ inhibited the phosphorylation of a cytoskeletal target of GSK‐3, tau, whereas CBZ and VPA did not. Surprisingly, none of these drugs altered β‐catenin levels in these cells, a process attenuated by GSK‐3 activity. Finally, only Li+ directly inhibits GSK‐3 activity (both α and β isoforms) at therapeutic levels in direct biochemical assays.

Conclusion:  Thus we show that neither GSK‐3 nor the altered GSK‐3 signalling pathway can provide a common mechanism of action of mood‐stabilizing drugs in the mammalian brain.
Hashimoto's encephalopathy presenting with bipolar affective disorder
Authors: Müssig Karsten , Bartels Mathias , Gallwitz Baptist , Leube Dirk , Häring Hans‐Ulrich , Kircher Tilo
Published: May 2005

Objective:  We report on a rare case of Hashimoto's encephalopathy associated with a bipolar affective disorder.

Case report:  A 32‐year‐old woman presented with a bipolar affective disorder and Hashimoto's thyroiditis. Neurological investigations (magnetic resonance imaging of the brain and cerebrospinal fluid) did not reveal any pathological findings except for a pathological electroencephalogram (EEG). Despite consequent antidepressant treatment, the patient remitted only in conjunction with normalization of the EEG after short‐term treatment with high doses of prednisolone.

Conclusion:  In treatment resistant courses of disorders, the thorough clinical and laboratory investigation of our patient revealed a very efficient treatment strategy. Cases of Hashimoto's encephalopathy associated with the occurrence of a manic episode and hence with bipolar disorder are rare; this is the first reported case. However, clinicians should be alert to this possibility.
Bipolar affective disorder in a male with a deletion of Y chromosome – a case report
Authors: Olajossy Marcin , Olajossy‐Hilkesberger Luiza , Tkaczuk‐Włach Joanna
Published: May 2005

We report on a 25‐year‐old male with bipolar disorder, dysmorphic features and a deletion of the long arm of Y chromosome. A potential association between sex chromosome abnormalities and a susceptibility to major psychiatric disorders has been documented. However there have been very few reports on the coincidence of Y chromosome aberrations with bipolar disorder. Cytogenetic studies have contributed to the identification of several disease genes. Karyotyping of patients with bipolar disorder in order to identify candidate regions for linkage studies has been recommended.
Drug‐drug interactions as a determinant of elevated lithium serum levels in daily clinical practice
Authors: Wilting Ingeborg , Movig Kristian LL , Moolenaar Marieke , Hekster Yechiel A , Brouwers Jacobus RBJ , Heerdink Eibert R , Nolen Willem A , Egberts Antoine CG
Published: May 2005

Objective:  Lithium is a drug with a narrow therapeutic window. Concomitantly used medication is a potentially influencing factor of lithium serum concentrations. We conducted a multicentre retrospective case‐control study with the aim of investigating lithium‐related drug interactions as determinants of elevated lithium serum levels in daily clinical practice.

Methods:  Cases were patients with an increase of at least 50% in lithium serum concentrations resulting in an elevated lithium serum level of at least 1.3 mmol/L, and who were not suspected of a suicide attempt. Controls were patients who showed stable lithium serum levels within the therapeutic range. Use and start of non‐steroidal anti‐inflammatory drugs, diuretics, renin–angiotensin inhibitors, theophyllin and antibiotics were investigated as potential determinants of the elevated lithium serum levels. Irregularity in lithium dispensing pattern, change in lithium dosing regimen, age, gender, prescribing physician and laboratory parameters were investigated as potential confounders.

Results:  We included 51 cases and 51 controls in our study. Five (9.8%) controls and 15 (29.4%) cases used potentially interacting co‐medication [OR of 3.83 (95%CI 1.28–11.48)]. Start of potentially interacting co‐medication was observed in eight (15.7%) cases and in zero (0%) controls resulting in an OR of 20.13 (95% CI 1.13–359). After adjustment for co‐medication, irregularity in lithium dispensing pattern, change in lithium dosing regimen, and age, the statistically significant association was lost. We report an OR of 2.70 (95% CI 0.78–9.31) for use of concomitant medication, with a large contribution of antibiotic agents, and an OR of 3.14 (95% CI 1.15–8.61) for irregularity in lithium dispensing pattern.

Conclusion:  Use of co‐medication, especially antibiotics, tends to be associated with elevated lithium serum levels.
Pathways to care for patients with bipolar disorder
Authors: Bhugra Dinesh , Flick Gene R
Published: May 2005

Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely ‘filtering’ of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided.
Seasonal water level fluctuations: Implications for reservoir limnology and management
Authors: Geraldes Ana Maria , Boavida Maria‐José
Published: May 2005

With the purpose of finding out whether seasonal water level fluctuations could affect water quality in a reservoir subjected to those changes, trends in environmental variables and in phytoplankton and zooplankton assemblages were analysed. The reservoir's hydrological cycle was characterized by three regimes. The maximum level phase lasted from January to the beginning of June, the emptying phase existed between mid‐June to the beginning of September and the minimum level phase lasted from mid‐September to the beginning of the first autumn/winter rain events. The highest values of total phosphorus, soluble reactive phosphorus, nitrate, water colour and chlorophyll a were found during the minimum level phase. The phytoplankton assemblage was dominated by taxa typical of meso‐eutrophic environments during the emptying and minimum level phases. However, during the maximum level phase, taxa generally found in more oligotrophic systems were observed here also. Similar to other disturbed systems, the zooplankton assemblage was dominated by Rotifera, except in summer and autumn when the cladoceran Ceriodaphnia quadrangula and/or the copepod Tropocyclops prasinus became dominant. Although those shifts seem to be related to water level variations, further research is needed to evaluate to what extent they might also be induced by other seasonal factors acting independently of water fluctuations. Based upon the obtained data, suggestions for reservoir management are proposed.
Neutrophilic involvement in the damage to coronary arteries in acute stage of Kawasaki disease
Authors: Takahashi Kei , Oharaseki Toshiaki , Naoe Shiro , Wakayama Megumi , Yokouchi Yuki
Published: May 2005

Abstract 
Background
: There has been no morphological evidence that polymorphonuclear leukocytes (PMNL) infiltrate the coronary arterial lesions of acute Kawasaki disease (KD) patients, although clinical data indicate the activation of PMNL.

Methods
: The experimental materials consisted of eight autopsy patients who died during the acute phase of KD. Duration of the illness ranged from 6 to 32 days. The tissues were fixed and embedded in paraffin. Hematoxylin and eosin, elastica van Gieson and azan–Mallory stainings were performed for routine histological examination. In addition, antibodies to CD3, CD20, CD68 and neutrophil elastase were used for immunohistochemistry to identify infiltrating cells in arterial lesions.

Results
: The inflammatory cells that appeared in the coronary arterial lesions were mainly composed of macrophages in all patients. In addition, numerous neutrophils were also identified in the coronary arterial lesions of the patients who died 10 days after the onset of KD. Neutrophilic infiltration reached a peak earlier than the peaks of CD68+ macrophages, CD3+ T lymphocytes and CD20+ B lymphocytes.

Conclusions
: These results suggest that neutrophils are involved in the damage occurring to coronary arteries in the early stage of KD. Vasodilation might occur as a result of injury to vascular walls caused by neutrophils, as well as macrophages.
Poor correlation between hemolysis and jaundice in glucose 6‐phosphate dehydrogenase‐deficient babies
Authors: Jalloh Salamatu , Van Rostenberghe Hans , Yusoff Narazah M , Ghazali Selamah , Nik Ismail Nik Zainal , Matsuo Masafumi , Wahab Nor Akmal , Nishio Hisahide
Published: May 2005

Abstract
Background
: The role of hemolysis in the pathophysiology of neonatal jaundice (NNJ) in patients with glucose 6‐phosphate dehydrogenase (G6PD) deficiency has been questioned recently. The aim of the present study was to determine the contribution of hemolysis to the pathophysiology of jaundice in Malay neonates with G6PD deficiency and NNJ.

Methods
: Four groups of babies were included in the study: (i) G6PD deficient with NNJ; (ii) G6PD deficient without NNJ; (iii) G6PD normal with NNJ; and (iv) normal controls. Babies with other known causes of jaundice were excluded from the study. All subjects underwent the following investigations on day 3–5 after birth: hemoglobin level (Hb), serum bilirubin level, carboxyhemoglobin (CO‐Hb) concentration, reticulocyte count and full blood picture. The results of the investigations were compared between the groups using SPSS version 11.

Results
: Babies with G6PD and jaundice had a similar percentage of CO‐Hb to babies with G6PD without NNJ or babies with normal G6PD and NNJ (1.76 ± 0.40% vs 1.66 ± 0.31% and 1.67 ± 0.28%, respectively; P: 0.23 and 0.41, respectively). Total Hb levels and reticulocyte counts were not significantly different between the groups. The blood film showed more (even though not reaching significance) hemolysis in the G6PD patients but results of the blood film were very similar for G6PD patients with and those without NNJ.

Conclusion
: Hemolysis is not a main determinant of neonatal jaundice in G6PD‐deficient babies.
Airway lavage with exogenous surfactant in an animal model of meconium aspiration syndrome
Authors: Zhang Erquan , Hiroma Takehiko , Sahashi Takeshi , Taki Atsuko , Yoda Tatsuya , Nakamura Tomohiko
Published: May 2005

Abstract
Background
: Meconium aspiration syndrome (MAS) is a major cause of respiratory morbidity and mortality in term infants, and occasionally causes serious respiratory disturbance. Viscous meconium debris in the trachea interferes with ventilation, and chest physiotherapy (CPT) is effective for removing secretions from the trachea. The effects of conventional exogenous diluted surfactant lavage combined with CPT were evaluated in a MAS animal model in a randomized controlled study.

Methods
: Twenty‐three MAS model adult Japanese rabbits were randomized into three groups and artificially ventilated for 3 h with the following treatments: group 1, suction only (n = 7); group 2, surfactant lavage (n = 7); group 3, surfactant lavage with CPT (n = 7). Surfactant lavage was performed by infusing 2 mL/kg of diluted Surfactant TA (Surfacten; 6 mg/mL) into the trachea over approximately5 s, then performing gentle manual bagging six times, and aspirating the tracheal contents using a suction catheter. This procedure was performed four times in four different positions (total, 8 mL/kg). In group 3, CPT (squeezing) was performed during expiration of manual bagging in surfactant lavage.

Results
: In group 3, PaO2 improved significantly (P < 0.05) at all time points compared with those in the other groups. Oxygenation index (OI) in group 3 improved significantly (P < 0.05) at all time points except after 0.5 h compared with that in group 1, and at 2, 2.5, and 3 h compared with that in group 2.

Conclusions
: A combination of exogenous surfactant lavage and CPT (squeezing) improves respiratory disturbance in MAS.
Infected cephalohematoma of newborns: Experience in a medical center in Taiwan
Authors: Chang Hung‐Yang , Chiu Nan‐Chang , Huang Fu‐Yuan , Kao Hsin‐An , Hsu Chyong‐Hsin , Hung Han‐Yang
Published: May 2005

Abstract
Background
: The objective of the present retrospective study was to clarify the clinical course, major pathogens, and other infections associated with infected cephalohematoma.

Methods
: From January 1978 to December 2003, records of all newborns were reviewed for evidence of an infected cephalohematoma, based either on local signs of infection or a diagnostic tap that yielded pus. Patients were divided into two groups: those seen in the early period (1978–1990) and in the late period (1991–2003).

Results
: Twenty‐eight newborns with infected cephalohematoma were identified, 14 each in the early and late periods. The mean age at onset was 17.8 ± 13.9 days. The most common local findings were erythema (79%), increasing size of the hematoma (68%), and a fluctuant mass (46%), while fever (64%), poor appetite (39%) and irritability (18%) were the common systemic signs. Common laboratory findings included leukocytosis (82%) and an elevated C‐reactive protein (61%). Escherichia coli was the most common pathogen (16 patients, 57%) and was isolated significantly more frequently in the late period (early period: 36%, late period: 79%, P < 0.05). Staphylococcus aureus was the second common pathogen (five patients, 18%). Ten patients (36%) had other associated infection: eight had sepsis, three had meningitis, and one had osteomyelitis. In the early period three patients (11%) died.

Conclusions
: Clinicians should be aware that cephalohematoma is a potential site of infection. The incidence of associated system infection is high and may result in mortality. Appropriate diagnostic and therapeutic measures should be undertaken promptly if there are infectious signs.
COMPLICATIONS OF INTESTINAL MILKING: EXPERIMENTAL MODEL
Authors: Aysan Erhan , Demir Mete , Kinaci Erdem , Basak Fatih
Published: May 2005

Background:  Intestinal milking is a frequently used method in abdominal surgery for various purposes; although it is frequently used for eliminating distension, moving faeces, bezoar or other foreign objects proximal or distal, there are no experimental or prospective studies in the surgical literature with respect to complications of the method. The purpose of the present study was to investigate complications of the milking process in an experimental model.

Methods:  Forty‐four outbred, 8‐month old Wistar albino male rats with weights ranging between 195 and 225 g were used. Four rats were used for preliminary study. The other 40 rats were divided into two equal groups. In the study group (n = 20), a plastic sphere, 3 mm in diameter was sent to the stomach via oro‐gastric tubes. This sphere was then moved into the cecum by milking. In the control group rats (n = 20) the small intestines were manipulated at 1‐cm intervals but milking was not performed.

Results:  In the study group six rats (30%) developed grade 1, 11 rats (55%) developed grade 2, and three rats (15%) developed grade 3 peritoneal adhesion. In the control group, 18 rats (90%) had no adhesions and only two rats (10%) developed grade 1 adhesion (χ2 = 34, P < 0.0001). In the study group, four rats (20%) had small bowel obstruction, whereas no rats in the control group developed small bowel obstruction (Fisher's P > 0.05). Peritoneal smear culture was positive in 11 rats (55%) in the study group, whereas it was positive in two rats (10%) in the control group (Fisher's P < 0.01).

Conclusions:  Intestinal milking is a process that can cause severe peritoneal adhesions and peritoneal contamination, which may lead to small bowel obstruction. Avoiding milking to the extent possible in eliminating distension intraluminal material that may cause obstruction, and preferring alternative methods is important for reducing postoperative morbidity.
MANAGEMENT OF SUPERFICIAL BLADDER CANCER IN VICTORIA: 1990 AND 1995
Authors: Frydenberg Mark , Millar Jeremy L. , Toner Guy , Bolton Damien , Syme Rodney , Thursfield Vicky J. , Giles Graham G. ,   and Urology Study Committee of the Victorian Co‐operative Oncology Group, Cancer Council of Victoria
Published: May 2005

Background:  A retrospective survey of medical practitioners was undertaken to describe the tumour characteristics, management and outcomes of all superficial bladder cancers newly diagnosed in 1990 and in 1995 in Victoria.

Methods:  Cases were identified from the population cancer registry. The survey was conducted in 1999 and the cohort followed up until 2000 to obtain at least 5 years of follow‐up data on all patients, in particular to identify recurrence of tumour as assessed at surveillance cystoscopy and progression to muscle invasive cancer.

Results:  Tumour recurrence was observed in 390/610 patients (63.9%), of whom 56.9% had their recurrence noted at the first check cystoscopy. Ultimately 43 (6.3%) of patients progressed to invasive disease, with this subgroup demonstrating 5‐year overall survival of 35% (95% confidence interval (CI) 21–49%). Ultimately survival was proportional to the extent of tumour invasion, being greater in low‐risk patients (76%, 95% CI 72–80%, mucosal disease only) than in high‐risk patients (46%, 95% CI 36–56%, lamina propria invasion noted at diagnosis).

Conclusions:  In low‐risk subgroups of patients with superficial transitional cell carcinoma, the frequency of surveillance cystoscopy may be able to be reduced to levels in accordance with established European guidelines without a likely impact on patient survival. Where progression to muscle invasive disease does ensue, more aggressive management may be warranted in order to try to improve survival.
BIOGLUE: A REVIEW OF THE USE OF THIS NEW SURGICAL ADHESIVE IN THORACIC SURGERY
Authors: Passage Jurgen , Tam Robert , Windsor Morgan , O'Brien Mark
Published: May 2005

Background:  Alveolar air leaks and broncho‐pleural fistulae after thoracic surgical procedures contribute significantly to hospital morbidity and mortality. BioGlue has offered the thoracic surgeon an alternative to the products presently used to reduce the incidence of these complications. This retrospective study reviews our experience with this new adhesive.

Methods:  Forty patients upon whom BioGlue was used were identified through operation records. Pre‐, intra‐ and postoperative data were collected to establish use, indications and outcome.

Results:  The predominant underlying pathology was malignancy. In 32 patients BioGlue was used during the primary procedure while in the remaining eight, persistent air‐ or lymph‐leak led to a further procedure requiring the use of glue. The indications for BioGlue use were alveolar air leak (36), broncho‐pleural fistula (2) and lymph leak (2). There was one death. In 35 out of 36 patients with alveolar air leak, BioGlue controlled the leak at the site of application.

Conclusions:  Our results in this particular patient group indicate that BioGlue is a reliable adjunct in the reduction of alveolar air leaks. Although further studies are necessary to establish the role of BioGlue in thoracic surgery in comparison to other sealants, these initial results are promising.
MERKEL CELL CARCINOMA: IMPROVED OUTCOME WITH ADJUVANT RADIOTHERAPY
Authors: Veness Michael J. , Perera Lakmalie , McCourt Junie , Shannon Jennifer , Hughes T. Michael , Morgan Gary J. , Gebski Val
Published: May 2005

Background:  Merkel cell carcinoma is an aggressive primary cutaneous neuroendocrine carcinoma. Patients remain at high risk of locoregional and distant relapse despite treatment. Most studies support the incorporation of locoregional adjuvant radiotherapy in reducing the risk of relapse.

Methods:  Between 1980 and 2002, 86 patients diagnosed with Merkel cell carcinoma were treated with curative intent at Westmead Hospital, Sydney. Multivariate analysis was performed using Cox regression analysis. Disease‐free survival and overall survival was calculated using Kaplan–Meier survival curves.

Results:  Median age at diagnosis was 75 years (range 46–89 years) in 49 men and 37 women. Median duration of follow up was 31 months (range 6–153 months). Fifty‐one (59%) patients presented with a primary lesion, 19 (22%) with a primary lesion and clinical nodal disease and 16 (19%) with lymph node metastases from an unknown primary. A total of 47 of 86 (55%) relapsed with regional nodal relapse, the commonest site of first relapse. Local relapse was similar for patients undergoing surgery (5/37; 14%) compared with surgery and adjuvant radiotherapy (3/25; 12%). Nodal relapse occurred in 14 of 36 (37%) treated with surgery compared with 7 of 38 (18%) patients treated with surgery and adjuvant radiotherapy. Patients treated with surgery and adjuvant radiotherapy experienced a better median disease free survival compared to those undergoing surgery alone (10.5 months vs 4 months; P < 0.01). The 5‐year overall and disease‐free survival rate for the entire study population was 47% and 25%, respectively. Twenty‐six patients (30%) died as a result of Merkel cell carcinoma.

Conclusion:  Merkel cell carcinoma is an aggressive skin cancer. The addition of adjuvant radiotherapy markedly improves regional control rates and should be considered best practice.
SMALL BOWEL PERFORATION DUE TO A PLASTIC BREAD BAG CLIP: THE CASE FOR CLIP REDESIGN
Authors: Tang Anthony P. H. , Kong Andrew B. , Walsh David , Verma Ratan
Published: May 2005

Complications of ingested plastic bread bag clips include small bowel perforation, obstruction, dysphagia, gastrointestinal bleeding and colonic impaction. There have been at least 10 cases of small bowel perforation reported in the published literature. The present paper reports this unusual cause of bowel perforation, which we believe could be prevented by improving the design of this relatively modern device or even by changing the method of sealing bread bags altogether. Interestingly, the date on the offending bread bag clip preceded the presentation of the patient by 2.5 years.
INEQUALITIES IN RURAL HEALTH CARE: DIFFERENCES IN SURGICAL INTERVENTION BETWEEN METROPOLITAN AND RURAL WESTERN AUSTRALIA
Authors: Ng Jonathon Q. , Hall Sonja E. , Holman C. D’Arcy J. , Semmens James B.
Published: May 2005

Background:  To compare surgical procedure rates between metropolitan and rural/remote residents in Western Australia (WA).

Methods:  The WA Data Linkage System was used to identify all patients who underwent a procedure for cataract, ureteric calculi or urinary outflow obstruction symptoms for the time periods 1981–2000, 1981–1997 and 1981–1995, respectively. Age‐standardized procedure rates were calculated and Poisson regression modelling was used to estimate effects of locality of residence and demographic covariates.

Results:  Overall, rural/remote patients underwent first‐time procedures for cataract (IRR 0.92; 95% CI 0.90–0.94), ureteric calculi (0.76; 0.72–0.80), or urinary outflow obstruction (0.71; 0.69–0.74) less frequently than patients in the metropolitan area. They were also significantly less likely to undergo multiple procedures for cataracts (0.90; 0.88–0.91) and ureteric calculi (0.69; 0.67–0.73).

Conclusion:  A distinctly reduced level of surgical intervention was found in rural patients for three generally non‐life threatening conditions. The reasons for this require further investigation.
EXPERIENCE OF SENTINEL NODE BIOPSY ALONE IN EARLY BREAST CANCER WITHOUT FURTHER AXILLARY DISSECTION IN PATIENTS WITH NEGATIVE SENTINEL NODE
Authors: Soni Naresh K. , Spillane Andrew J.
Published: May 2005

Aims:  The aims of surgical therapy of breast cancer are loco‐regional tumour control and staging. Axillary staging is still considered the single most important prognostic indicator in breast cancer. Surgical removal of axillary nodes remains the standard way to assess their involvement in most centres. The morbidity associated with axillary dissection (AD) is well recognized. In recent years sentinel node biopsy (SNB) has evolved. Multiple studies suggest it has the same accuracy as AD in axillary staging and less morbidity in early breast cancer (EBC). SNB has become the standard of practice in EBC in many parts of the world. In Australia, the preference has been to wait for the results of the Sentinel Node versus Axillary Clearance (SNAC) trial as well as other international trials before accepting SNB as a standard of care. The experience of a single surgeon with SNB alone in EBC without further completion axillary dissection (CAD) in negative sentinel node (SLN) is described in the present paper.

Methods:  An audit was done of the senior author's prospective data from the Royal Australasian College of Surgeons database. Other information was added retrospectively from case notes.

Results:  Between December 2000 and December 2003, 154 EBC cases (153 patients) underwent SNB alone. An average of four SLN was removed. Of these cases, 31.8% had positive SLNs (excluding 2.6% cases that had isolated tumour cells), of these, 93.9% had metastases (39.1% micro‐ and 60.9% macro‐metastases) in axillary‐SLN (ASLN) and almost all of these had CAD. ASLNs were the only positive nodes in 73.9%. Extra‐ASLN retrieved in 68.8% of 34% demonstrated on lymphoscintigraphy. Of these, 12.1% were positive (6.1% micro‐ and macro‐metastases each), all internal mammary. Mean follow up was 22.1 months. There was one local‐regional‐systemic and one systemic recurrence over this time.

Conclusion:  SNB has a valid role in staging of the axilla particularly in low‐risk patients. After adequate self audit, SNB offers a minimal morbidity and reliable method of axillary staging. Patients choosing SNB alone must understand that the long‐term results of the randomized controlled trial are still pending for level I evidence of long‐term efficacy.
DEEP DEPRESSION: MAPPING, WEATHER FORECASTING AND THE BEAGLE
Authors: Beasley A. W.
Published: May 2005

This paper traces the voyage of HMS Beagle under the command of Robert FitzRoy, in which Charles Darwin travelled as naturalist. It examines FitzRoy's subsequent career and the coincidence that he, and two other hydrographers connected with the vessel, fell prey to depression.
THE KENNETH FITZPATRICK RUSSELL MEMORIAL LECTURE: ‘Of Books and Libraries: A reflection inspired by surgeon William Bland's copy of Manec's Treatize on the Ligature of Arteries’
Authors: Mellick Sam
Published: May 2005

Kenneth Russell, bibliophile, anatomist, surgeon and historian helped to acquire Leslie Cowlishaw's historical library for the College, and subsequently cared for and catalogued the collection. One book in the collection is especially interesting as it bears the name of every owner since 1656; another belonged to William Bland of Sydney, sometime surgeon, convict, educator and legislator, whose surgical ability and inventive mind stimulated this reflection on libraries and book lovers. Bland was almost certainly Australia's first vascular surgeon.
Conceptualising Lifelong Learning: a reflection on lifelong learning at Lund University (Sweden) and Middlesex University (UK)
Authors: ABUKARI ABDULAI
Published: May 2005

Lifelong Learning has in recent years become a fundamental element of many educational policy strategies aimed at achieving the goal of socio‐economic development. The role of universities in this is viewed by some as crucial and requires some attention. This article examines the concept of lifelong learning and suggests another way in which it could be conceptualised. It further reflects on how two European universities understand and implement lifelong learning and the implications for European regional educational policies in view of the knowledge society.
A Conceptual Schema Language for the Management of Multiple Representations of Geographic Entities
Authors: Friis‐Christensen Anders , Jensen Christian S , Nytun Jan P , Skogan David
Published: May 2005

Multiple representation of geographic information occurs when a real‐world entity is represented more than once in the same or different databases. This occurs frequently in practice, and it invariably results in the occurrence of inconsistencies among the different representations of the same entity. In this paper, we propose an approach to the modeling of multiple represented entities, which is based on the relationships among the entities and their representations. Central to our approach is the Multiple Representation Schema Language that, by intuitive and declarative means, is used to specify rules that match objects representing the same entity, maintain consistency among these representations, and restore consistency if necessary. The rules configure a Multiple Representation Management System, the aim of which is to manage multiple representations over a number of autonomous federated databases. We present a graphical and a lexical binding to the schema language. The graphical binding is built on an extension to the Unified Modeling Language and the Object Constraint Language. We demonstrate that it is possible to implement the constructs of the schema language in the object‐relational model of a commercial RDBMS.
Analysing Product‐Specific Behaviour to Support Process Dependent Updates in a Dynamic Spatial Updating Model
Authors: Arnold Lesley M , Wright Graeme L
Published: May 2005

A scale‐independent database that allows derived maps to be dynamically updated from a centrally maintained data source is an appealing alternative to traditional map revision techniques, which by today's standards are costly and inefficient. This paper presents a dynamic spatial updating model that supports automated updating of non‐standard maps in a scale‐independent database‐centric map production environment. Maps derived from the database are not separate data sets, but rather active views of the database. Each derived map is displayed in a unique way by implementing cartographic operations at the map level. While the operations applied require user involvement for strategic cartographic decisions, and algorithmic initiation and control, the technique allows geographic data to be processed cartographically without affecting the geometric integrity of the database. Each time a derived map is opened it retrieves the spatial data (and updates) from the database and applies the unique cartographic representation methods that persist on the individual derived maps. Database updates are automatically triggered to cartographic products, as process dependent updates, according to their individual product‐specific behaviour. This paper investigates product‐specific behaviour (product multiplicities) and the cartographic processing requirements to support dynamic spatial updating techniques in an object‐oriented map publishing environment. These techniques are implemented in an off‐the‐shelf software environment using ArcGIS.
Deriving Directional Variance from Covariance Matrix
Authors: Li Xingong
Published: May 2005

Directional variance characterizes the dispersion of a sample of directions. The derivation of directional variance, as it has appeared in the directional statistics literature, is from a geometric and intuitive approach. This short note presents a new derivation from the covariance matrix of directions. It provides a connection from directional variance to the covariance matrix of unit vectors.