bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of scintigraphy with 99mtechnetium galactosyl human serum albumin for staging of primary biliary cirrhosis and assessment of prognosis
Authors: Shiomi Susumu , Sasaki Nobumitsu , Tamori Akihiro , Habu Daiki , Takeda Tadashi , Nishiguchi Shuhei , Kuroki Tetsuo , Kawabe Joji , Ochi Hironobu
Published: December 2004

Background
: Conventional models for prediction of survival in patients with primary biliary cirrhosis (PBC) are based on the results of blood tests and on the clinical condition, which may be affected by treatment. We evaluated the usefulness of hepatic receptor imaging with [99mtechnetium]‐diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) for the staging and prognosis of PBC without the need for reference to laboratory test results.

Methods
: The subjects were 45 patients with PBC, 10 healthy subjects, 62 patients with chronic hepatitis and 144 patients with cirrhosis. Computer acquisition of gamma‐camera data was started just before the injection of 185 MBq [99mTc]‐GSA and was stopped 20 min later. Time–activity curves were generated from regions of interest (ROI) for the heart and liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver‐plus‐heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI 15 min after the injection by that of the heart ROI 3 min after the injection.

Results
: The median receptor index was higher in patients with PBC than in those with cirrhosis. Among patients with PBC, the receptor index was lower in those with stage IV disease than in those in stages I, II or III. The index of blood clearance was lower in patients with PBC than in those with cirrhosis. Among patients with PBC, the index of blood clearance was higher in those with stage IV disease than in those in stages I, II or III. The receptor index was correlated significantly both to the risk score of the Mayo model and to the prognostic index of the Japanese model. The index of blood clearance was also correlated significantly to this score and prognostic index.

Conclusions
: Hepatic receptor imaging with [99mTc]‐GSA is useful for the evaluation of hepatic functional reserve, staging of PBC and assessment of prognosis.

© 1999 Blackwell Science Asia Pty Ltd
Non‐alcoholic fatty liver syndrome: A hepatic consequence of common metabolic diseases
Authors: ANGELICO FRANCESCO , DEL BEN MARIA , CONTI RITA , FRANCIOSO SIMONA , FEOLE KATIA , MACCIONI DANIELA , ANTONINI TERESA MARIA , ALESSANDRI CESARE
Published: December 2004

Background and Aims: The association of liver steatosis with a number of common metabolic conditions has been suggested. The aim of the present study was to evaluate the clinical features of subjects with different severities of steatosis.

Methods: The present study was performed in 282 consecutive patients with ‘bright liver’ at ultrasonography and in 58 subjects without steatosis. They had no history of alcohol abuse and negative tests for the presence of hepatitis B and C virus. Patients underwent clinical examination, anthropometry, laboratory tests and routine liver ultrasonography. Steatosis was graded as absent, mild, moderate and severe.

Results: A progressive increase in the prevalence of obesity (P < 0.001), type 2 diabetes (P < 0.001), alanine aminotransferase (ALT) elevation (P < 0.001) and hypertriglyceridemia (P < 0.001), and a decrease of hypercholesterolemia (P < 0.05) was observed from the control group to the groups with mild, moderate and severe steatosis. More than half the subjects with liver steatosis had insulin resistance metabolic syndrome. Obesity, diabetes and hypertriglyceridemia were more common by 5.3‐fold, 4.0‐fold, and 6.7‐fold, respectively, in subjects with severe steatosis, as compared to controls. Prevalence of obesity, diabetes and hyperlipidemia was significantly higher in subjects with fatty liver and ALT elevation.

Conclusion: Fatty liver can be considered as the hepatic consequence of common metabolic diseases.

© 2003 Blackwell Publishing Asia Pty Ltd
Immune function in patients with acute pancreatitis
Authors: UEHARA SOICHIRO , GOTHOH KATSUHIRO , HANDA HIROSHI , TOMITA HIROSHI , TOMITA YOSHIMURA
Published: December 2004

Background: The aim of this study was to clarify the relationship between the balance of T‐helper (Th)1 and Th2 cytokines, and the numbers of CD4+ T and CD8+ T‐cells, and was investigated, together with the plasma concentration of the antigen, an apoptosis marker, in patients with mild and acute pancreatitis (AP).

Methods: Plasma concentrations of soluble (s) CD4, sCD8, sIL‐2‐R, IL‐12, IFN‐γ and sFas antigen were measured by ELISA, and CD4+ T, and CD8+ T lymphocyte counts were measured by flow cytometry.

Results: Both CD4+ T and CD8+ T‐cells were reduced in number; in the severe cases the reduction in the former was more pronounced. A significant positive correlation was noted among the concentrations of sCD4, sIL‐2‐R and IL‐12, and a significant positive correlation was also found between sCD4 and sFas. During the early stage of AP, the concentrations of sCD4, sCD8, sIL‐2‐R, IL‐12 and IFN‐γ increased more in the severe cases compared with those who had milder symptoms; however, these increases were moderated during the clinical course.

Conclusion: We considered that these Th1 type CD4+ T cells probably induce the activation of macrophages and further pro‐inflammatory reactions during the early stage of AP, as well as exerting direct cytotoxicity effects through Fas/Fas ligand expression.

© 2003 Blackwell Publishing Asia Pty Ltd
How reversible is hepatic functional impairment in autoimmune hepatitis?
Authors: COVERDALE SHIRLEY A , FIELD JACQUELINE , FARRELL GEOFFREY C
Published: December 2004

Background and Aims: We quantifed the short‐term effects of immunosuppressive therapy on hepatic metabolic function in autoimmune hepatitis to establish how long it takes to achieve maximum functional improvement.

Methods: We studied 14 newly diagnosed patients with autoimmune hepatitis (12 type 1, two type 2) by antipyrine clearance and conventional liver tests, then repeated studies at 3–6 month intervals during the first 18 months of immunosuppressive therapy.

Results: Low values for antipyrine clearance were found in 13 of 14 cases; serum albumin concentration was low in four, bilirubin raised in eight and prothrombin time prolonged in four. Following immunosuppressive treatment for 3 months, antipyrine clearance improved by 98% (standard error of the mean 24%), which was proportionally greater than for serum albumin, bilirubin or prothrombin time. Antipyrine clearance and serum albumin continued to improve after 6–12 months of immunosuppressive treatment in several cases, whereas there were no further improvements in alanine aminotransferase (ALT), bilirubin and prothrombin time.

Conclusions: In the short term, immunosuppressive therapy for autoimmune hepatitis markedly improves hepatic metabolic function, which is particularly striking for the sensitive metabolic test antipyrine clearance, but may also be seen with serum albumin. However, it may take up to 12 months to achieve maximal functional recovery. Management guidelines on autoimmune hepatitis should be extended to emphasize that changes in hepatic metabolic function, as well as ALT and γ‐globulin levels, be taken into consideration in the definition of remission.

© 2003 Blackwell Publishing Asia Pty Ltd
Transforming growth factor beta in hepatitis C virus infection: In vivo and in vitro findings
Authors: RAY SUMAR , BROOR SOHAN L , VAISHNAV YASH , SARKAR CHITRA , GIRISH RACHAKONDA , DAR LALIT , SETH PRADEEP , BROOR SHOBHA
Published: December 2004

Background: Hepatitis C virus (HCV) is a leading cause of chronic liver disease (CLD) worldwide. The chronicity is a result of viral persistence and the ability of the virus to escape from the immune mechanisms of the host. Transforming growth factor (TGF)‐β is a cytokine thought to be responsible for viral persistence and liver fibrogenesis.

Methods: The present study examined the levels of TGF‐β messenger (m)RNA by reverse transcription polymerase chain reaction (RT–PCR) in 35 liver biopsies and HCV‐transfected HepG2 cells.

Results: Transforming growth factor‐β mRNA was detected in nine liver biopsies from patients with chronic HCV infection, but was not detected in patients with non‐HCV‐related CLD or controls. On quantitation by semiquantitative PCR, TGF‐β mRNA levels ranged from 10−4.75 to 10−12.8 amol (10−7.46 ± 3.771) in liver biopsies of HCV‐related CLD. No significant difference in TGF‐β receptor levels was observed by RT–PCR in HCV‐ or non‐HCV‐related CLD by immunohistochemistry. To correlate these findings with in vitro experiments, levels of TGF‐β mRNA and its receptors were determined by RT–PCR in HepG2 cells transfected with HCV and hepatitis B virus (HBV) constructs, using mock‐transfected cells as control. The TGF‐β protein levels were quantitated in these cell supernatants by enzyme immunoassay. The TGF‐β mRNA and protein levels were two logs and approximately 30 times higher in HCV‐transfected HepG2 cells than in HBV‐ and mock‐transfected cells, respectively. The TGF‐β receptors in HepG2 cells were also downregulated in HCV‐transfected cells as compared with mock‐transfected cells.

Conclusion: These observations suggest upregulation of TGF‐β in HCV infection and a probable role for TGF‐β in the pathogenesis of HCV‐related CLD.

© 2003 Blackwell Publishing Asia Pty Ltd
Regulation of p21 and p27 expression by the hepatitis B virus X protein and the alternate initiation site X proteins, AUG2 and AUG3
Authors: LEACH J KEVIN , QIAO LIANG , FANG YOUWEN , HAN SONG LY , GILFOR DONNA , FISHER PAUL B , GRANT STEVEN , HYLEMON PHILIP B , PETERSON DARRELL , DENT PAUL
Published: December 2004

Background: The hepatitis B virus X gene has three in‐frame start codons encoding the pX, AUG2 and AUG3 proteins. The AUG2 and AUG3 genes are 5′‐truncated in respect to the full‐length pX gene; however, all three genes terminate at the same stop codon. The activity of pX as an oncogene is well characterized; however, less is known about the AUG2 and AUG3 proteins.

Methods: The effects of pX, AUG2 and AUG3 on p21Cip,1/WAF,1/MDA6 and p27Kip−1 cyclin kinase inhibitor (CKI) protein expression, and the impact they have on proliferation, were investigated in CHO K‐1 cells. CHO K‐1 cells were chosen because they can be transfected at 100% efficiency.

Results: p21‐ and p27‐luciferase reporter expression is modulated by increasing doses of the hepatitis B X proteins. At low concentrations of pX or AUG2, p21‐ and p27‐luciferase activity was increased, and at high concentrations, p21‐ and p27‐luciferase activity was decreased. Expression of the AUG3 gene showed a different profile: it was increasingly stimulatory with dose for both promoters. Western blot analyses demonstrated that p21 and p27 protein levels were modulated as predicted based on data generated in the promoter‐luciferase experiments. Tritiated thymidine labeling of DNA showed biphasic kinetics of incorporation in the presence of varying pX and AUG2 concentrations, whereas labeling decreased with AUG3 concentration. The growth inhibitory effect of pX expression was reduced by antisense ablation of either p21 or p27.

Conclusions: The relative expression level of pX, AUG2, and AUG3 impacts on CKI expression and cell proliferation. Our findings may explain why divergent effects of pX expression on growth have been observed by different groups, which may be related to relative pX expression levels.

© 2003 Blackwell Publishing Asia Pty Ltd
Comparison of Doppler ultrasonography and the hepatic venous pressure gradient in assessing portal hypertension in liver cirrhosis
Authors: CHOI YEUN JONG , BAIK SOON KOO , PARK DONG HOON , KIM MOON YOUNG , KIM HYUN SOO , LEE DONG KI , KWON SANG OK , KIM YOUNG JU , PARK JOONG WHA
Published: December 2004

Background and Aim: This prospective study aimed to determine whether Doppler ultrasonography can represent the hepatic venous pressure gradient (HVPG) as an assessment of the severity of portal hypertension and the response to terlipressin, which reduces the portal pressure in liver cirrhosis.

Methods: The HVPG and the Doppler ultrasonographic parameters, such as the portal venous velocity and the splenic venous velocity, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 138 patients with liver cirrhosis. The changes in the HVPG and the portal venous velocity after administering terlipressin were evaluated in 43 of the 138 patients. The patients who showed a reduction in the HVPG of more than 20% of the baseline were defined as responders to terlipressin.

Results: None of the Doppler ultrasonographic parameters correlated with the HVPG. Both the HVPG (28.0 ± 19.8%) and the portal venous velocity (29.7 ± 13.2%) showed a significant reduction after terlipressin administration. However, the portal venous velocity decreased significantly, not only in the responders (31.0 ± 12.0%) but also in the non‐responders (25.2 ± 16.4%).

Conclusions: Doppler ultrasonography does not represent the HVPG, and is therefore not suitable for replacing HVPG as a means of assessing the severity of portal hypertension and the response to drugs which reduce the portal pressure in liver cirrhosis.

© 2003 Blackwell Publishing Asia Pty Ltd
Efficacy of interferon‐α treatment in Japanese children with chronic hepatitis C
Authors: NAKASHIMA EISUKE , FUJISAWA TAKUJI , KIMURA AKIHIKO , KAGE MASAYOSHI , YAMATO YASUHIKO , MAEDA KOHJI , KUMAGAI MASAMI , USHIJIMA KOSUKE , YAMASHITA YASUHIRO , MATSUISHI TOYOJIRO
Published: December 2004

Background: We investigated the efficacy of natural interferon (IFN)‐α treatment in 34 Japanese children with chronic hepatitis C.

Methods: Thirty‐four children completed 6 months of therapy with natural IFN‐α and were followed for 12 months or longer. We examined the serum hepatitis C virus (HCV) RNA titer and liver histology before, during, and after IFN treatment.

Results: At 6 months after the cessation of IFN‐α treatment, 16 patients (47%) had normal serum alanine aminotransferase concentration and no detectable serum HCV RNA. There were no major side‐effects, excluding some influenza‐like symptoms during the IFN‐α treatment. Most genotype 2a patients had a complete response (80%). Moreover, patients who had a low HCV RNA titer (<102 copies/mL) after 1 month of IFN‐α treatment became complete responders at 6 months after the cessation of treatment. Histological improvement was observed in almost all patients after IFN‐α treatment.

Conclusion: Interferon‐α treatment is safe and effective for children with chronic hepatitis C and has no serious side‐effects. A HCV RNA concentration of <102 copies/mL after 1 month of IFN‐α treatment and genotype 2a may be useful predictors of long‐term IFN efficacy.

© 2003 Blackwell Publishing Asia Pty Ltd
Has education about Helicobacter pylori infection been effective? Worldwide survey of primary care physicians
Authors: HUANG JIAQING , LAM SHIU KUM , MALFERTHEINER PETER , HUNT RICHARD H
Published: December 2004

Background: Confusion exists among physicians about the management of Helicobacter pylori (H. pylori) infection. We aimed to survey primary care physicians’ (PCP) knowledge and management of H. pylori‐related diseases.

Methods: Four‐hundred and seventy randomly selected PCP from 29 countries were surveyed.

Results: The pathological role of H. pylori was of less concern in South Africa than the rest of the world (63% compared to 93%). The causal relationship between H. pylori and gastric and duodenal ulcers and gastric cancer was accepted by 81%, 85%, and 61% of respondents, respectively. Endoscopy was used by 62% of respondents to diagnose the infection. Histology was used by 61% of European participants for diagnosis compared to 3% in North American and 0% in South Africa. Proton‐pump inhibitor (PPI)‐based triple therapies were prescribed by 89% of respondents. Physicians in Oceania (35%) and South Africa (45%) were less concerned about bacterial resistance than respondents elsewhere. Sixty‐three percent of respondents considered H. pylori relevant to dyspepsia management and 66% treated new dyspepsia empirically, compared to 18% who chose endoscopic diagnosis and 13% who used a H. pylori test and treat strategy. For persistent or recurrent infection, 56% of South African physicians treated with another regimen compared to 33% of PCP from elsewhere. Ninety‐one percent of European participants agreed that current information on H. pylori management is helpful and 68% of PCP from other regions considered the information to be adequate.

Conclusions: Current guidelines on the management of H. pylori infection have been useful for PCP worldwide. Contrasting answers to some questions may reflect differences in health care systems, epidemiology and approaches to the management of H. pylori infection between countries.

© 2003 Blackwell Publishing Asia Pty Ltd
Rapid absorption of luminal polyamines in a rat small intestine ex vivo model
Authors: UDA KATSUHIRO , TSUJIKAWA TOMOYUKI , FUJIYAMA YOSHIHIDE , BAMBA TADAO
Published: December 2004

Background and Aim: Not only biosynthesis, but also uptake from the intestinal lumen, are important polyamine sources. However, there has been no information regarding dynamic polyamine transport in the small intestine. We evaluated polyamine uptake from the small intestine using a rat ex vivo model.

Methods: The organ block consisting of the small intestine and blood vessels was used. The isolated small intestine was placed in a warmed saline bath and perfused in a non‐circulating manner via the superior mesenteric artery. Radio‐labeled putrescine, spermidine or spermine (7.4 × 104 Bq), with 1.0 mL of phosphate buffer saline (pH 7.4) was instilled into the jejunal lumen for 1 min. Blood samples from the portal vein were collected and sample radioactivity was determined. In another experiment, an immunohistochemical study of polyamine was performed.

Results: After 14C‐polyamine instillation, radioactivity in the portal vein samples immediately increased and then decreased gradually. The absorptive pattern did not differ among the three polyamines. The recovery rates from radioactivity at the portal vein among the three polyamines were approximately 61–76% during the initial 10 min after the administration of 14C‐polyamine, and were not different from each other. Aminoguanidine, which inhibits putrescine degradation, significantly suppressed initial putrescine uptake and recovery percentage. The intraluminal administration of spermine caused an increase in the immunoreactivity of the spermine antibody in the intestinal villi.

Conclusion: Luminal polyamines were rapidly absorbed by the intestinal mucosa and then subsequently transferred into the portal vein using a rat ex vivo model. The prior administration of aminoguanidine significantly inhibited initial putrescine transport into the portal vein.

© 2003 Blackwell Publishing Asia Pty Ltd
Evidence for the critical role of interleukin‐12 but not interferon‐γ in the pathogenesis of experimental colitis in mice
Authors: TOZAWA KOTARO , HANAI HIROYUKI , SUGIMOTO KEN , BABA SATOSHI , SUGIMURA HARUHIKO , AOSHI TAIKI , UCHIJIMA MASATO , NAGATA TOSHI , KOIDE YUKIO
Published: December 2004

Background and Aims: The imbalance between helper T (Th)1/Th2 cytokines has been observed in human inflammatory bowel disease and various animal models. Because interleukin (IL)‐12 and interferon‐γ (IFN‐γ) productions are known to be a hallmark of Th1‐dominant intestinal inflammation such as 2,4,6‐trinitrobenzene sulfonic acid (TNBS)‐induced colitis, we strictly addressed the roles of IFN‐γ and IL‐12 in the development of colitis, employing knockout mice with IFN‐γ receptor (IFN‐γR) or IL‐12 p40 gene disruptions and mice administered with neutralizing monoclonal antibodies (mAbs) against IFN‐γ or IL‐12.

Methods: To induce colitis, 2.5 mg of the hapten reagent TNBS in 50% ethanol was administered into the colon. Two milligrams of rat anti‐mouse IFN‐γ mAb, rat anti‐mouse IL‐12 mAb, or control rat IgG were administered intraperitoneally into mice before TNBS administration. Change in the body weight of mice was evaluated and the degree of inflammation of the colon of these mice was investigated histologically. Immunohistochemical and immunofluorescence analyses were performed to detect CD4+ T cells, macrophages and IL‐12 in TNBS‐induced colitis lesions. The profile of Th1 and Th2 cytokine expressions in colonic tissues was examined by cytokine‐specific semi‐quantitative reverse transcription‐polymerase chain reaction (RT‐PCR).

Results: Single rectal administration of TNBS developed significant colitis in IFN‐R–/– mice and anti‐IFN‐γ mAb‐pretreated mice, as well as control wild‐type mice. Conversely, administration of TNBS produced no signs of colitis in IL‐12 p40–/– and anti‐IL‐12 mAb‐pretreated mice.

Conclusions: IL‐12, but not IFN‐γ, plays a pivotal role in the pathogenesis of TNBS‐induced colitis.

© 2003 Blackwell Publishing Asia Pty Ltd
Intestinal barrier: An interface between health and disease
Authors: FARHADI ASHKAN , BANAN ALI , FIELDS JEREMY , KESHAVARZIAN ALI
Published: December 2004

Abstract The intestine constitutes the largest interface between a person and his or her environment, and an intact intestinal barrier is thus essential in maintaining health and preventing tissue injury and several diseases. The intestinal barrier has various immunological and non‐immunological components. The epithelial barrier is one of the most important non‐immunological components. Hyperpermeability of this barrier is believed to contribute to the pathogenesis of several gastrointestinal disorders including inflammatory bowel disease, celiac disease and food allergy. Hence, assessing barrier integrity is of the utmost importance. One of the more quantitative gauges for this assessment is transepithelial permeability of various molecular probes, among which sugars are commonly used. Measures of intestinal permeability might also be useful as markers for assessment of prognosis and follow up in various gastrointestinal disorders. The present article is a review of the normal and abnormal functioning of the intestinal barrier, the diseases that can result from loss of barrier integrity, and some promising agents and strategies for restoring barrier normality and integrity.

© 2003 Blackwell Publishing Asia Pty Ltd
Modelling the effects of artificial mixing and copper sulphate dosing on phytoplankton in an Australian reservoir
Authors: Lewis David M. , Elliott J. Alex , Brookes Justin D. , Irish Anthony E. , Lambert Martin F. , Reynolds Colin S.
Published: December 2004

An artificially destratified reservoir was simulated with the freshwater phytoplankton model PROTECH (Phytoplankton Responses To Environmental Change). The chosen site for validation was a highly managed drinking water supply reservoir (Myponga Reservoir, South Australia). Chemical dosing using copper sulphate (CuSO4) and artificial mixing via an aerator and two raft‐mounted mechanical surface mixers (hereafter referred to as surface mixers) are used at Myponga to manage water quality, in particular the threat of cyanobacteria growth. The phytoplankton community was adequately modelled and showed that the community was dominated by species tolerant of low light doses (R‐type strategists). The light limitation in the water body was found to be the controlling factor on phytoplankton succession. Subsequently, small fast‐growing species and larger motile phytoplankton (C and CS‐type, respectively) do not have the opportunity to dominate under all simulated conditions, diminishing the need for CuSO4 dosing. These simulations demonstrated that the individual and combined impact of the management strategies reduces the total algal biomass, but have minimal effect upon phytoplankton functional‐type succession, and R‐type species continued to dominate under all simulated scenarios. It was concluded that, due to the light‐limitation and current nutrient availability in Myponga Reservoir, the probability of persistent populations of undesirable scum‐forming cyanobacteria is minimal, even in the absence of artificial control.
Lake management in Italy: the implications of the Water Framework Directive
Authors: Premazzi G. , Dalmiglio A. , Cardoso A. C. , Chiaudani G.
Published: December 2004

This paper constitutes the first consideration of the implications of the lake management in Italy arising from the requirements of the Water Framework Directive (WFD), in comparison to the provisions of existing national legislation. As a matter of fact, the Italian decrees anticipated the principles of the WFD and have substantially modified the legislation in the field of water in Italy. Important changes were introduced, both in the monitoring systems and in the classification methods for surface waters. The environmental quality status will be determined not only by monitoring the aqueous matrix, but also the sediment and the biota. The new WFD is the major piece of European Union (EU) legislation with environment at its core; it will guide the efforts for attaining a sustainable aquatic environment in the years to come. In the WFD one can see elements from all the different forces that guided the reform of EU water policy: environmental protection, deregulation and subsidiarity. Moreover, elements of the economic instruments approach (introduction of the cost recovery principle), quantitative concerns (setting of minimum flow objectives for rivers and abstraction limits for ground waters) and the quest for integration (river basin management with representation of all stakeholders) are all reflected in the WFD. The paper summarizes the present condition of the most important lakes in the Italian lake district and also highlights the case of Lake Varese, representing a unique case of lake management in Italy. Preliminary results show that there are very few examples dealing with the elements thought appropriate to lake water assessment as required by the WFD. The application of the objectives of the type specified is a largely unknown issue.
Microvasculature of the human cerebral white matter: Arteries of the deep white matter
Authors: Nonaka Hiroko , Akima Michio , Hatori Tsutomu , Nagayama Tadashi , Zhang Zean , Ihara Fumie
Published: December 2004

The vascular architecture of the human cerebral deep white matter was studied using soft X‐ray and diaphanized specimens, achieved by intra‐arterial injection of barium and vascular stain respectively, and also by electron microscopic examination of the corrosion cast of arteries in normal adult brains. The deep white matter arteries passed through the cerebral cortex with a few branches to the cortex and ran straight through the white matter. The arteries concentrated ventriculopetally to the white matter around the lateral ventricle. Anastomoses were noted around the ventricular wall at the terminals of the deep white matter arteries. No centrifugal branches irrigating the periventricular white matter from the lenticulo‐striate arteries were observed in the present study. The presence of anastomoses among the terminal branches of deep white matter arteries protects against ischemic change or infarction in this area from an occlusion of a single deep white matter artery. This may lead to development of terminal zone infarction from ischemia or vascular diseases, affecting multiple deep white matter arteries. The subcortical and deep white matter arteries had thick adventitial sheaths and large adventitial spaces in the white matter but not in the cortex. The presence or absence of the adventitial space is regarded as another characteristic difference between the arteries in the white matter and cortex. This difference may influence pathological changes in vascular lesions in these respective areas.
Microvasculature of the human cerebral meninges
Authors: Nonaka Hiroko , Akima Michio , Nagayama Tadashi , Hatori Tsutomu , Zhang Zean , Ihara Fumie
Published: December 2004

In the present study, the human cerebral meninges were rich in blood vessels, but no capillaries were noted. The meningeal arteries ran over the veins where they crossed. Several arterial anastomoses existed on the cortical surface. The meningeal arteries were classified into four parts; the conducting artery approximately 700 µm in diameter, distributing artery approximately 200 µm in diameter, precortical artery approximately 60 µm in diameter and cortical artery approximately 30–40 µm in diameter. A single distributing artery supplied the area of approximately 3.5 × 2.0 mm on the brain surface. They further ramified into precortical arteries which stemmed cortical arteries. These precortical arteries had the distributing area of 1 mm2 and this distributing area was the same size as the width of human ocular dominant column of the visual cortex. Constriction, like a sphincter, was observed at the bifurcation of the distributing arteries. The cerebral blood vessels, which regulated the blood flow and reacted to autonomic nerve stimuli, seemed to correspond to the distributing arteries.
Creutzfeldt–Jakob disease with florid plaques after cadaveric dura mater graft
Authors: Mochizuki Yoko , Mizutani Tomohiko , Tajiri Nobuo , Oinuma Toshinori , Nemoto Norimichi , Kakimi Shigeo , Kitamoto Tetsuyuki
Published: December 2004

A patient with dura‐associated Creutzfeldt‐Jakob disease (D‐CJD) which occurred about 15 years after a dura mater graft is reported in the present study. The prion protein gene analysis disclosed no mutation. The D‐CJD was atypical in: (i), the long interval between the onset of ataxia and the occurrence of dementia; (ii), the presence of transient myoclonus; and (iii), the presence of florid plaques in the brain. The electron‐microscopic findings showed bundles of amyloid filaments which radiated from the center of the plaques without degenerating neurites. This case of D‐CJD may belong to a new subtype of D‐CJD.
Albumin fragments in normal rat urine are derived from rapidly degraded filtered albumin
Authors: CLAVANT Steven P , GREIVE Kerryn A , NIKOLOVSKI Julijana , REEVE Shane , SMITH A Ian , COMPER Wayne D
Published: December 2004

SUMMARY: Filtered albumin is excreted as a heterogeneous population of albumin‐derived molecules resulting from degradation during renal passage. In order to understand the dynamics of this degradation process, albumin clearance was studied over a short‐term (minutes) and a long‐term (7 days) by both radioactivity and radioimmunoassay. The radiolabelled material in the urine was also analysed extensively by using size exclusion chromatography, size selective filtration and high performance liquid chromatography. These studies demonstrate that during renal passage, albumin degradation to fragments in the size range of 500–10 000 occurs in a matter of minutes. The fragments are  not detected by using radioimmunoassay. Steady state excretion rates or fractional clearance of radiolabelled albumin occur over a similar time period. Both rates of degradation and approach to steady‐state clearance, while rapid, were considerably slower than the transit time for molecules in the Bowman's capsule and early tubular lumen. The results are consistent with an extremely rapid lysosomal uptake of filtered albumin, and degradation and regurgitation of the albumin‐derived peptide fragments into the tubular lumen prior to excretion.
Role of nitric oxide and prostaglandin E2 in acute renal hypoperfusion
Authors: TOKUYAMA Hirobumi , HAYASHI Koichi , MATSUDA Hiroto , KUBOTA Eiji , HONDA Masanori , OKUBO Ken , TAKAMATSU Ichiro , OZAWA Yuri , SARUTA Takao
Published: December 2004

SUMMARY: Although acute renal ischaemia alters the production of various paracrines, there has been little investigation examining the role of intrarenal vasoactive substances. In the present study, we investigated the role of intrarenal nitric oxide and prostaglandins in modulating the acute renal hypoperfusion‐induced alterations in renal function. After a 90% clipping of the left renal artery for 60 min, the clip was released, and the renal haemodynamics and sodium excretion were evaluated in both clipped and non‐clipped kidneys of anaesthetized dogs. Furthermore, the changes in renal contents of nitrate/nitrite (NOx) and prostaglandin E2 (PGE2) were assessed by using the renal microdialysis technique. The release of the clipping elicited a gradual recovery of renal plasma flow and glomerular filtration rate, and a sustained increase in fractional sodium excretion (FENa) in the clipped kidney. Renal interstitial NOx was reduced in both the cortex (from 8.2 ± 1.1 to 2.5 ± 0.3 µmol/L, P < 0.01) and medulla (from 10.1 ± 0.9 to 3.1 ± 0.2 µmol/L, P < 0.01), but the levels gradually elevated after declamping. The treatment with nitro‐l‐arginine methylester only modestly impaired the recovery of renal plasma flow (RPF; at hour 4) and glomerular filtration rate (GFR; at hours 3 and 4 after declamping), without affecting FENa. Conversely, the renal PGE2 levels increased prominently upon the onset of ischaemia (medulla, from 149 ± 19 to 378 ± 39 pg/mL, P < 0.01; cortex, from 107 ± 13 to 302 ± 34 pg/mL, P < 0.01). Furthermore, the pretreatment with a non‐specific cyclo‐oxygenase (COX) inhibitor, sulpyrine, and a COX‐2‐specific inhibitor, NS398, prominently inhibited the increases in FENa induced by the acute renal arterial clipping in a similar manner. In conclusion, in acute renal hypoperfusion, nitric oxide (NO) plays a permissive role in the recovery of the renal haemodynamics. In contrast, sustained increases in renal PGE2 in both clipped and non‐clipped kidneys indicate that the COX‐2‐mediated PGE2 contributes importantly to the failure of the sodium reabsorption in response to acute renal hypoperfusion.
Transcultural nursing in Australian nursing curricula
Authors: Pinikahana Jaya , Manias Elizabeth , Happell Brenda
Published: December 2004

As a result of the fact that Australia is a multicultural society with many people who come from non‐English speaking backgrounds (NESB), the objective of the present study was to discuss the extent to which transcultural nursing education is incorporated into undergraduate nursing curricula. A survey was undertaken to determine the availability of nursing modules for undergraduate nursing students through Australian university websites on ‘transcultural nursing’ or related modules. Although the inclusion of these modules into nursing education provide an opportunity for nurses to perceive and respond to different patient behaviors in multicultural societies, it is not sufficient to understand the complexity of the health care needs of a multicultural society. The survey findings suggest that many universities have not included transcultural nursing modules in their nursing curricula. To address this problem, more transcultural nursing modules need to be introduced into nursing curricula and nursing academics need to refine their attitudes about the importance of cultural aspects of patient care within nursing education.
A lesson in investigation of the airway
Authors: MacINTYRE P.A.
Published: December 2004

Tracheobronchography is not a new radiological investigation but is seldom used in ventilator dependent infants. It is a simple, safe and accurate investigation of the airways. Its potential in this group of patients is demonstrated in the case described.
A fibreoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway
Authors: WALKER R.W.M , ALLEN  , ROTHERA M.R
Published: December 2004

Children with mucopolysaccharidoses present the anaesthetist with both a difficult airway and often an impossible intubation using conventional techniques. A technique for airway management and tracheal intubation is described utilizing the Brain laryngeal mask airway, the fibreoptic bronchoscope, a guide wire and a ureteral dilator. Two case reports of children with mucopolysaccharidoses are presented who were managed successfully with this technique. The advantages of the technique are discussed.
Postoperative analgesia with preoperative oral ibuprofen or acetaminophen in children undergoing myringotomy
Authors: BENNIE RUTH , BOEHRINGER LEIGH , McMAHON SUSAN , ALLEN HELEN , DIERDORF STEPHEN
Published: December 2004

Previous studies have shown over 70% of children require analgesics following bilateral myringotomy and tube placement (BM&T). This double‐blind, placebo‐controlled study compared the postoperative analgesic effects of preoperatively administered oral acetaminophen or ibuprofen. Forty three ASA I or II children age six months or older scheduled for elective BM&T were randomized to receive acetaminophen (paracetamol) 15 mg·kg−1, ibuprofen 10 mg·kg−1, or placebo. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) upon arrival to the PACU and at 5, 10, 15, 30, 45, and 60 min. CHEOP scores did not differ between the groups at any time. There was no difference in the number of children receiving rescue analgesia. This study showed no benefit of preoperatively administered oral ibuprofen 10 mg·kg−1 or acetaminophen 15 mg·kg−1 over placebo for the relief of postoperative pain in children undergoing BM&T.
Hangman's fracture in a paediatric patient: considerations for anaesthesia
Authors: ZANETTE GASTONE , ORI CARLO , ZADRA NICOLA , GIUSTI FRANCA , PITTONI GIOVANNI
Published: December 2004

Cervical spine injuries are quite uncommon in children. When occurring, these lesions are of particular concern for the anaesthesiologist. This case refers to an hangman's fracture diagnosed in a four‐month‐old female infant, which probably occurred at birth. We describe the anaesthetic management adopted in this infant undergoing diagnostic procedures and conservative treatment. The problems related to airway control and the anaesthetic management utilized to diagnose and treat this unusual paediatric pathology are highlighted.
Plasma concentrations after rectal administration of acetaminophen in preterm neonates
Authors: LIN YUAN‐CHI , SUSSMAN HOWARD , BENITZ WILLIAM
Published: December 2004

Acetaminophen is frequently administered to infants and children for its antipyretic and analgesic properties. Oral administration is the route of choice in daily practice. In some circumstances this is impractical. Rectal administration of acetaminophen is an alternative route. This study measures plasma concentrations following rectal administration of acetaminophen 20 mg·kg−1 (10% Infants’ Tylenol Drops, McNeil Consumer Product Co., diluted with an equal volume of sterile water) in five preterm neonates. Serial arterial blood samples were obtained at 0, 15, 30, 60, 120, and 240 min. Pharmacokinetic parameters were (mean±sd): Cmax (maximum plasma concentration) of 8.38±3.92 μg·ml−1 and Tmax (time to reach maximum plasma concentration) of 78.0±40.2 min. Our results show that 20 mg·kg−1 of acetaminophen rectally results in low plasma levels in preterm neonates.
Anaesthetic management of children with Joubert syndrome
Authors: HABRE WALID , SIMS CRAIG , D’SOUZA MICHAEL
Published: December 2004

We report the anaesthetic management of two children with Joubert syndrome. Children with this syndrome have abnormalities of respiratory control due to changes in the brainstem and cerebellum. They are extremely sensitive to the respiratory depressant effects of anaesthetic agents, including nitrous oxide. Anaesthesia using inhalational induction, controlled ventilation, avoidance of opioids, and close postoperative monitoring is recommended.
High spinal anaesthesia for repair of patent ductus arteriosus in neonates
Authors: WILLIAMS R.K. , ABAJIAN J.C.
Published: December 2004

General anaesthesia with high dose narcotics has traditionally been used for repair of patent ductus arteriosus (PDA) in high risk neonates. Spinal anaesthesia in infants has generally been limited to cases involving the lower abdomen and lower extremities. Regional anaesthesia for PDA repair could potentially offer a more rapid recovery and the possibility of blunting the stress response in this vulnerable group of patients. High spinal anaesthesia with tetracaine was utilized as an alternative to general anaesthesia in a series of fifteen consecutive patients. Patient demographics, medication dosages, level of anaesthesia, intraoperative and immediate postoperative data were obtained and recorded in a prospective fashion. Spinal anaesthesia was achieved in all patients. The average dose of tetracaine was 2.4 mg·kg−1. Two patients early in the series had an inadequate level and received supplemental isoflurane. The remainder of the patients received either no or minimal supplementation to the basic technique. Cardiovascular status of the group was very stable with minimal changes in blood pressure noted. Recovery was rapid. All three patients who were not intubated at the time of surgery were extubated soon after surgical repair was completed. No complications of the technique were noted. High spinal anaesthesia is a safe and effective alternative to general anaesthesia in high risk neonates. This technique may offer the advantage of a faster recovery time and a protective effect on the neonatal stress response. In addition the stability of this technique may encourage the use of higher levels of spinal anaesthesia in infants than has traditionally been used.
A simple homemade lighted stylet for neonates and infants: a description and case report of its use in an infant with the Pierre Robin anomalad
Authors: COOK‐SATHER SCOTT , SCHREINER MARK
Published: December 2004

The glossoptosis and micrognathia associated with Pierre Robin anomalad can make tracheal intubation by conventional laryngoscopy quite difficult. Lighted stylets may be helpful in the successful intubation of infants with this anomalad, but those currently available that are small enough to accommodate 3.0 mm ID tracheal tubes have two major drawbacks limiting their utility: an insufficiently rigid stylet component and a nonadjustable, overly bright light. We describe a lighted stylet that can be easily assembled in the operating room which overcomes these problems and allowed us to successfully intubate a six‐day‐old with severe Pierre Robin anomalad.
Use of intravenous immunoglobulins as an adjunct in the conservative management of chylothorax
Authors: H. FRCSA(I)  , PAES M. L. , HAYNES S.
Published: December 2004

Two children who developed chylothorax after surgery for congenital heart disease are presented. The conservative management of chylothorax is reviewed and the use of immunoglobulins in the treatment of sepsis is discussed. One patient survived.
A rare case of upper airway obstruction in an infant caused by basal encephalocele complicating facial midline deformity
Authors: SHIMIZU TOMOAKI , KITAMURA SEIJI , KINOUCHI KEIKO , FUKUMITSU KAZUO
Published: December 2004

A four‐month‐old male infant with basal encephalocele of the transsphenoidal type presented with upper airway obstruction and facial midline deformity, including cleft lip, cleft palate, hypertelorism and exophthalmos. Basal encephalocele is a rare disease, and usually not detectable from the outside. In this case, initially the cause of an upper airway obstruction was considered to be posterior rhinostenosis, and posterior rhinoplasty with inferior nasal conchectomy was scheduled. However, in preoperative examination, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a bony defect in the sphenoidal bone and a cystic mass in communication with cerebrospinal fluid, herniating into the nasal cavity through the bony defect. The mass was diagnosed as a transsphenoidal encephalocele, the scheduled operation cancelled, and tracheostomy performed for airway management. The possibility of basal encephalocele should be considered in the case of upper airway obstruction with facial midline deformity.
Can a dose of 2μg??kg−1> caudal clonidine cause respiratory depression in neonates?
Authors: BRESCHAN CHRISTIAN , KRUMPHOLZ RUTH , LIKAR RUDOLF , KRASCHL RAIMUND , SCHALK HANNES V.
Published: December 2004

A case of multiple life‐threatening postoperative apnoeas in a term neonate undergoing inguinal herniorrhaphy and orchidopexy who received light inhalation anaesthesia combined with caudal block with 1 ml.kg‐1 ropivacaine 0.2% plus 2 μg??kg−1 clonidine is reported. The patient showed no apparent risk factors for postanaesthetic apnoea. Oxycardiorespirography five days after surgery only showed minor abnormalities. Clonidine though administered caudally in the usual dose of 2 μg??kg‐1 appeared to be the most likely cause for postanaesthetic apnoea in this neonate.
Gadow's contribution to our philosophical interpretation of nursing
Authors: Bishop Anne H. , Scudder Jr John R.
Published: December 2004

Sally Gadow influenced our work when we first began exploring the meaning of nursing philosophically. In this article, we discuss two major themes of Gadow's work that have influenced us: existential advocacy and treating the body objectively without reducing the patient to the moral status of an object. Our treatment of these issues is appreciative but not uncritical. We argue that existential advocacy makes an important contribution to the meaning of nursing but that it cannot be its essential meaning. We contend that Gadow, by making self‐direction the essence of care, tends to diminish the intersubjective nature of care. Then we show how Gadow recovers the intersubjective nature of care by disclosing how nurses and patients both become subjects in personal relationships, even when tending to the body objectively. We show how hermeneutic phenomenology, which we favour, can contribute to Gadow's existential phenomenology by using examples from nursing practice to disclose the meaning of nursing. Gadow's major contribution to our work has been in the ways her work has evoked creative thought from us concerning the meaning of nursing.
Gadow's relational narrative: an elaboration
Authors: Hess Joanne D.
Published: December 2004

Nurse philosopher Sally Gadow (1999) has proposed the relational narrative between patient and nurse as a ‘postmodern turn’ for nursing ethics. She has conceptualized this moral approach as the construction by patient and nurse of a coauthored narrative describing the good they are seeking, as well as the means to achieve this good. The purpose of this article is to provide an elaboration of Gadow's seminal conceptualization of relational narrative based on her writings and those of other philosophers. The article will further develop relational narrative's foundations in relationship and narrative and will explore engagement as a dimension essential to its creation and growth. The elaboration first builds on the notion of relationship as foundational to this postmodern moral perspective. Narrative then is advanced as being at the heart of the patient–nurse relationship and their relational narrative, based on an exploration of narrative's role in the moral realm as an epistemology for patient and nurse. Finally, the dialogic and embodied engagement expressed by a relational narrative is developed as a critical element of the ethic.