bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral lactobacilli in chronic periodontitis and periodontal health: species composition and antimicrobial activity
Authors: Kõll‐Klais P. , Mändar R. , Leibur E. , Marcotte H. , Hammarström L. , Mikelsaar M.
Published: October 2005

Background/aims:  Lactobacilli are known to play an important role in the maintenance of health by stimulating natural immunity and contributing to the balance of microflora. However, their role in chronic periodontitis is unclear. We aimed to identify oral lactobacilli in chronic periodontitis and periodontally healthy subjects, and to determine their antimicrobial activity against putative oral pathogens.

Methods:  A total of 238 Lactobacillus isolates from the saliva and subgingival sites of 20 chronic periodontitis and 15 healthy subjects were collected. In all, 115 strains were identified using rapid amplified ribosomal DNA restriction analysis. Antimicrobial activity against Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia was assessed.

Results:  Lactobacilli belonging to 10 species were identified. The most prevalent strains in healthy persons were Lactobacillus gasseri and Lactobacillus fermentum and in chronic periodontitis patients, Lactobacillus plantarum. Obligately homofermentatives, particularly L. gasseri, were less prevalent in chronic periodontitis patients compared with healthy subjects (8% vs. 64% for L. gasseri, P < 0.01). Sixty‐nine percent of tested lactobacilli inhibited S. mutans, 88%A. actinomycetemcomitans, 82%P. gingivalis and 65%P. intermedia. The strongest antimicrobial activity was associated with Lactobacillus paracasei, L. plantarum, Lactobacillus rhamnosus, and Lactobacillus salivarius. The strains from periodontally healthy patients showed a lower antimicrobial activity against S. mutans than the strains from chronic periodontitis patients.

Conclusion:  The composition of oral lactoflora in chronic periodontitis and healthy subjects differs, with a higher prevalence of homofermentative lactobacilli, particularly L. gasseri, in the latter group. Both homo‐ and heterofermentative oral lactobacilli suppress the growth of periodontal pathogens, but the antimicrobial properties are strain, species and origin specific.
Active and passive immunization against oral Candida albicans infection in a murine model
Authors: Farah C. S. , Ashman R. B.
Published: October 2005

Background/aims:  Clinical and laboratory studies are consistent with a major role for cell‐mediated immunity in recovery from oral infection with Candida albicans, but the role of humoral immunity remains controversial. The purpose of this study was to establish the relative contributions of cellular and humoral immunity to protection against oral candidiasis in a murine model, and to determine whether host responses could be enhanced by different immunization strategies.

Results:  Active oral immunization was protective in BALB/c and CBA/CaH mice, reducing both fungal burden and duration of infection after secondary challenge, whereas systemic immunization failed to protect against subsequent oral challenge. Candida‐specific IgM was the predominant antibody detected in serum following both primary and secondary oral challenge; however, Candida‐specific salivary IgA was not detectable. Immunization by passive transfer of either lymphocytes or immune serum did not confer any significant protection against oral infection in either susceptible or resistant mouse strain.

Conclusion:  The data demonstrate a possible role for mucosa‐associated immunity following active immunization by the oral route, most likely exerted by local T lymphocytes resident in the oral mucosa, but there was no evidence to support a role for humoral immunity in protection against oral candidiasis.
Predominant presence of Streptococcus anginosus in the saliva of alcoholics
Authors: Morita E. , Narikiyo M. , Yokoyama A. , Yano A. , Kamoi K. , Yoshikawa E. , Yamaguchi T. , Igaki H. , Tachimori Y. , Kato H. , Saito D. , Hanada N. , Sasaki H.
Published: October 2005

Chronic alcohol consumption is known to be a major risk factor for cancers of the upper aerodigestive tract. The incidence of esophageal cancer (4.4%) in alcoholics is reported to be much higher than that in the Japanese population as a whole (0.0001%). This suggests the presence of specific factors in chronic alcohol consumption‐related carcinogenesis. Recently, data showing a significant correlation between Streptococcus anginosus and carcinogenesis in the upper aerodigestive tract have been reported. In this study, the ratio of S. anginosus to oral bacteria in the saliva of 38 alcoholic patients was investigated to determine if there is an association between alcoholic patients and S. anginosus infection. The level of S. anginosus in the saliva from 22 healthy people, 41 esophageal cancer patients, 32 gastritis patients, and 24 periodontitis patients was also investigated and compared to the level in alcoholic patients. In the saliva from esophageal cancer patients, the level of S. anginosus was not significantly different from that of healthy people. The levels of S. anginosus in periodontitis and gastritis patients were also similar. In alcoholics, however, there was an extremely high level of S. anginosus, suggesting that they, rather than healthy people and general esophageal cancer patients, have a high risk for S. anginosus infection.
Gastric antral vascular ectasia in 2‐yr‐old girl undergoing unrelated cord blood stem cell transplantation
Authors: Kuroiwa Yuki , Suzuki Nobuhiro , Mizue Nobuo , Hori Tsukasa , Endo Takao , Yoshida Yukinari , Tsutsumi Hiroyuki
Published: October 2005

Abstract:  Gastrointestinal bleeding is a common complication after hematopoietic stem cell transplantation (HSCT) and is often related to acute graft‐vs.‐host disease (aGVHD). Gastric antral vascular ectasia (GAVE), recently recognized as a complication after HSCT, is a rare cause of severe gastrointestinal bleeding, which has only been reported in adult patients so far. We report a 2‐yr‐old girl who developed GAVE after unrelated cord blood stem cell transplantation (CBSCT) as treatment of intractable Epstein–Barr virus‐associated hemophagocytic lymphohistiocytosis (EBV‐HLH). Her conditioning regimen for CBSCT consisted of etoposide, busulfan, and cyclophosphamide. She was doing well after CBSCT without recurrence and developed only grade I aGVHD. She suddenly developed coffee ground emesis, tarry stools and severe anemia 76 days after CBSCT. As antacids were ineffective, esophagogastroduodenoscopy was performed and revealed GAVE on day 97. Endoscopic coagulation therapy was performed twice; subsequently, she needed no further transfusions and there was no clinical recurrence of GAVE.
Fingerprick blood samples can be used to accurately measure tacrolimus levels by tandem mass spectrometry
Authors: Webb Nicholas J. A. , Roberts Denise , Preziosi Richard , Keevil Brian G.
Published: October 2005

Abstract: Regular monitoring of tacrolimus levels is an essential component of post‐transplantation follow up in children receiving this drug. We have developed a high performance liquid chromatography tandem mass spectrometry (HPLC T‐MS) methodology which measures whole blood tacrolimus levels using a 10 μL sample, thus allowing the use of fingerprick blood sampling. The aim of this study was to determine the degree of relationship between fingerprick and venous tacrolimus levels measured by HPLC T‐MS and venous levels measured using the Abbott IMx tacrolimus II assay (IMx). This has not previously been investigated. Blood samples were collected from children on five separate occasions. In addition to the routine venous IMx sample, a further venous and fingerprick sample were collected for tacrolimus level measurement by HPLC T‐MS. These were mailed to the central laboratory. One hundred and seventy‐two sets of triplicate samples were collected from 36 children (33 kidney, two kidney–pancreas and one kidney–heart). Linear regression analysis showed highly significant relationships between HPLC T‐MS venous and IMx venous levels (r2 = 0.83), HPLC T‐MS fingerprick and HPLC T‐MS venous levels (r2 = 0.85) and HPLC T‐MS fingerprick and IMx venous levels (r2 = 0.71) (all p < 0.0001). Bland Altman analysis showed a small, although statistically significant difference between measured values, fingerprick HPLC T‐MS levels being lower than venous IMx levels, the mean difference being 0.58 ng/mL (95% CI 0.26–0.91, t = 3.54, d.f. = 168, p = 0.0005 one sample t‐test). Precise conversion between the two techniques could be achieved using the regression formula; IMx venous level = 0.751 + 0.978. HPLC T‐MS fingerprick level. There is a strong significant relationship between fingerprick blood tacrolimus levels measured by HPLC T‐MS and venous blood levels measured by IMx, allowing the two to be used interchangeably for routine clinical purposes.
Treatment of acute tacrolimus whole‐blood elevation with phenobarbital in the pediatric liver transplant recipient
Authors: Quirós‐Tejeira Rubén E. , Chang I‐Fen , Bristow Lisa J. , Karpen Saul J. , Goss John A.
Published: October 2005

Abstract:  The toxicities associated with the chronic use of tacrolimus are well described in the literature; however, little is known about the management during an acute overdose. Phenobarbital is a long‐acting barbiturate metabolized in the liver by the cytochrome p450 3a4 system. It is known to enhance the rate of metabolism of itself and the clearance of drugs metabolized by p450 3a4. Because tacrolimus is a substrate of this particular isoenzyme, phenobarbital can be considered a potential option when rapid decreases in tacrolimus whole‐blood levels are desired. We hereby report our experience using intravenous phenobarbital in the management of two infants with acute elevations in their tacrolimus whole‐blood concentration following liver transplantation. Phenobarbital, through its up‐regulation of hepatic cytochrome p450 system increases the elimination of whole‐blood tacrolimus concentration in acute overdose situations.
Cytomegalovirus infection after allogeneic stem cell transplant in children
Authors: Haastrup Eva , Müller Klaus , Baekgaard Hanne , Heilmann Carsten
Published: October 2005

Abstract:  The aim of this study was to examine the frequency and the course of cytomegalovirus (CMV) infection and CMV disease in a group of pediatric and adolescent patients after allogeneic stem cell transplantation. Patients were treated according to a protocol including prophylactic high‐dose acyclovir in combination with preemptive administration of ganciclovir, based on weekly examinations of CMV antigenemia. A total of 110 consecutively transplanted patients, with a mean age of 9 yr (range 0–20) were treated according to the protocol. All patients were transplanted between March 1993 and January 2000 at the only Danish allotransplantation center. CMV infection occurred in 21.8% (24 of 110) of the patients. Three patients [12.5% (3/24)] developed CMV disease, all with pneumonitis and one with gastrointestinal disease as well. Mean time of disease onset was day +58. Treatment with ganciclovir was in general well tolerated. Late onset CMV disease was not documented. Multivariate analysis revealed that the use of unrelated donor transplants was significantly associated with an increased risk for CMV infection [hazard ratio (HR) 2.90, p = 0.03] and CMV infection was found to be a risk factor for transplant related mortality before day +100 (HR 10.70, p = 0.0015). Although high‐dose acyclovir in combination with antigenemia based preemptive treatment with ganciclovir resulted in a low incidence of CMV disease in pediatric and adolescent patients, CMV infection was a significant risk factor in stem cell transplantation with unrelated donors.
Long‐term results of basiliximab induction immunosuppression in pediatric liver transplant recipients
Authors: Ganschow Rainer , Grabhorn Enke , Schulz Andrea , Hugo Alexander Von , Rogiers Xavier , Burdelski Martin
Published: October 2005

Abstract: It has been shown that an induction therapy with the monoclonal anti‐interleukin‐2 receptor antibody basiliximab (SimulectTM) is capable to reduce the incidence of acute graft rejection in adult and pediatric liver transplantation (Ltx). However, data on long‐term results using basiliximab in children post‐Ltx are still pending. Therefore, the objective of our study was to report on the long‐term results of basiliximab induction therapy in pediatric liver transplant recipients. A total of 54 children received two single doses of basiliximab in addition to cyclosporine and prednisolone following Ltx. We analyzed the incidence of acute and chronic graft rejection that of post‐transplant lymphoproliferative disease (PTLD), and patient and graft survival. The follow‐up was 22–46 months. The historical control group (matched controls) consisted of 54 patients treated with a cyclosporine and prednisolone dual therapy. Patient survival was 53 of 54 in the treatment group and 51 of 54 in the controls. One patient was retransplanted in the treatment group vs. three patients in the control group. The incidence of acute graft rejection was 16.6% compared with 53.7% in the control group (p < 0.001), that of chronic rejection was comparable in both groups (one of 54 vs. one of 54). The incidence of steroid resistant rejection was four of 54 vs. six of 54 that of PTLD were one of 54 vs. zero of 54. There were no adverse effects observed, which could be related to the antibody treatment. We conclude that basiliximab provides safe and effective induction immunosuppression in pediatric liver graft recipients. Short‐ and even long‐term results are excellent.
Prospective monitoring of lipid profiles in children receiving pravastatin preemptively after renal transplantation
Authors: Butani Lavjay
Published: October 2005

Abstract: Hyperlipidemia is common after renal transplantation (Tx) and contributes to the increased cardiovascular morbidity seen in the post‐transplant period. Limited data are available on the utility of the statins in children after renal Tx. This 12‐month prospective study was undertaken to determine the efficacy of pravastatin in reducing dyslipidemia after renal Tx in children and to determine predictors of dyslipidemia after Tx. From August 2001 to April 2004, all 17 newly transplanted pediatric renal transplant recipients at our center were preemptively treated with pravastatin from the immediate post‐transplant period. Fasting lipid profiles were obtained at 1, 3, 6 and 12 months after Tx. Trends in the lipid profile were analyzed using the repeated measures general linear model (GLM). A historical cohort of pediatric renal‐transplant recipients not treated with pravastatin was used as the control population. The mixed effects GLM was used for multivariable logistic regression analyses to determine the independent effect of age, pretransplant cholesterol (Chol), body mass index (BMI), creatinine clearance (CrCl), and corticosteroid and tacrolimus doses on the development of dyslipidemia. The mean age of the children at Tx was 8.7 yr. The GLM analysis showed that with time, there was a significant decline in the total Chol, serum triglyceride (TG), LDL and also HDL‐Chol (p‐value <0.05 for each). Compared with the controls, the mean serum Chol was lower at all time points post‐transplant in the treated patients. However, despite treatment, the prevalence of hypercholesterolemia increased from 31% pretransplant to 53% at 1‐month, but declined thereafter to 6% at 3 and 6 months and 0% at 1 yr. Multivariable regression analyses showed the prednisone dose, pretransplant Chol and age to be the most important risk factors for the development of dyslipidemia. No child developed complications related to therapy. In summary, pravastatin is safe in the post‐transplant period in children and reduces serum Chol, LDL‐Chol and TG. An unexpected finding in our study was the decline in HDL‐Chol after Tx. Whether the preemptive use of the statins will result in lower cardiovascular morbidity, especially considering the concomitant reduction in HDL‐Chol remains to be determined.
Hepatoblastoma in a child with progressive familial intrahepatic cholestasis
Authors: Richter A. , Grabhorn E. , Schulz A. , Schaefer H. J. , Burdelski M. , Ganschow R.
Published: October 2005

Abstract:  End‐stage liver cirrhosis because of metabolic or infectious diseases predisposes to hepatic malignancies like hepatocellular carcinoma. We report the first case of hepatoblastoma incidentally detected in the explanted liver of a 2‐yr‐old child undergoing liver transplantation for cirrhosis because of progressive familial intrahepatic cholestasis (PFIC). The diagnosis was difficult to obtain. The hepatoblastoma was not seen on ultrasound examination of the cirrhotic liver. As we could confirm retrospectively, alpha fetoprotein (AFP) was found elevated prior to transplantation. Two years after successful transplantation, there are no signs of malignancy detectable by clinical and radiological methods. We conclude from this case that PFIC may induce hepatoblastoma and that children with liver cirrhosis should undergo routine screening of serum AFP concentration.
Serial signal‐averaged electrocardiography in children after cardiac transplantation
Authors: Bennhagen Rolf G. , Sörnmo Leif , Pahlm Olle , Pesonen Erkki
Published: October 2005

Abstract:  In patients with myocytolysis detected in endomyocardial biopsy, there is a tendency towards a shift of ventricular electrical axes from normal to strain pattern on surface ECG. Their 12‐lead signal‐averaged electrocardiogram (SAECG) show a significant increase in filtered QRS duration (QRSD) compared with those with specimens without myocytolysis. Late potentials were generally found more frequently in individual SAECG leads than in the vector magnitude. An increase in filtered QRSD and the presence of late potentials compared with a baseline study emphasizes the need for endomyocardial biopsy. Consequently, no change in these parameters may preclude the indication for endomyocardial biopsy.
Early transient leg swelling at the side of renal transplant in two children
Authors: Koster‐Kamphuis L. , van Die C. E. , van Der Vliet J. A. , Monnens L.
Published: October 2005

Abstract:  Two children are described with a huge leg swelling shortly after renal transplantation. The swelling was located at the side of the renal transplant. The swelling was caused by the compression of the iliac vein by the renal transplant combined with perirenal fluid collection. Doppler flow studies allow the exclusion of thrombosis as an explanation for the swelling. An aggressive treatment should be avoided. However, anticoagulation is required.
Identifying and improving non‐adherence in bipolar disorders
Authors: Colom F , Vieta E , Tacchi MJ , Sánchez‐Moreno J , Scott J
Published: October 2005

Objectives:  To review the definition of non‐adherence, its clinical and economic impact and identify its role and impact in clinical practice.

Methods:  A selective review of the literature as conducted of articles and literature known to the authors.

Results:  There is a paucity of studies examining specifically treatment non‐adherence and its consequences in bipolar disorder. Few studies have systematically examined ways in which treatment adherence can impact treatment and improve outcome.

Conclusion:  Non‐adherence is common in the management of bipolar disorder. Clinicians and Researchers alike need to remain alert and be aware of issues related to non‐adherence – in particular suicide. Like other course‐modifiers non‐adherence has to be considered, sought and addressed, and this is perhaps best done by including psychoeducation in routine clinical care.
Newer treatment studies for bipolar depression
Authors: Gao Keming , Calabrese Joseph R
Published: October 2005

Objective:  Depressive symptoms of bipolar disorder have more negative impact on a patient's life than manic symptoms. This review focused on the emerging efficacy data for treatments in bipolar depression.

Methods:  English‐language literature cited in Medline was searched with terms bipolar depression, clinical trial, and trial. Randomized, placebo‐controlled trials of newer studies with older agents and all studies with newer or novel agents were prioritized. Open‐label studies of novel agents presented at major scientific meetings were also included.

Results:  Olanzapine, olanzapine–fluoxetine combination (OFC), and quetiapine were superior to placebo in the acute treatment of bipolar depression. Lamotrigine only significantly reduced core symptoms of depression compared with placebo. Pramipexole, a dopamine D2/D3 receptor agonist and omega‐3 fatty acids, a polyunsaturated fatty acid, augmentation to mood stabilizer (MS) had superiority to placebo in reducing depressive symptoms. Topiramate augmentation of an MS was equally as effective as Bupropion‐SR. Patients treated with an MS responded well to the addition of agomelatine, a melatonin receptor agonist with 5‐HT2C antagonist properties. However, inositol and repetitive transcranial magnetic stimulation did not separate from placebo. Lamotrigine and olanzapine, and to a lesser extent, divalproex, are superior to placebo in preventing depressive relapses. All agents were relatively well tolerated.

Conclusions:  Olanzapine, OFC, and quetiapine are effective in the acute treatment of bipolar depression. Compared with lithium and divalproex, lamotrigine is more effective in preventing bipolar depression. Larger controlled studies of the other agents in the acute and maintenance treatment of bipolar depression are warranted.
Benefits and limitations of antidepressants and traditional mood stabilizers for treatment of bipolar depression
Authors: Goldberg Joseph F , Nassir Ghaemi S
Published: October 2005

Objective:  The aim of this paper was to review the rationales, risks, and benefits for using standard antidepressants versus mood stabilizing agents and/or atypical antipsychotics to treat bipolar depression.

Method:  A selective literature review was conducted using key terms and by reference known to the authors. Bibliographies of articles and book chapters were further scrutinized for relevant literature.

Results:  The strengths and limitations of current studies are described and critically reviewed in order to present optimal strategies for effective pharmacotherapy. Clinical factors that can mitigate or confound simple bivariate relationships between antidepressant use and outcome have seldom been examined using multivariate statistical techniques. For many of the key questions there is a paucity of informative literature and randomized clinical trials are of limited value in addressing some of the issues.

Conclusions:  Clinicians and investigators should be aware of the methodological shortcomings of existing studies. Decisions about the relative merits versus contraindications for antidepressant use should be made via more individualized, case‐by‐case profiling rather than by rigid prescribing practices.
Oxcarbazepine add‐on in the treatment of refractory bipolar disorder
Authors: Pratoomsri Wetid , Yatham Lakshmi N , Sohn Chang‐Ho , Solomons Kevin , Lam Raymond W
Published: October 2005

Objective:  To assess the effectiveness and safety of oxcarbazepine (OXC) in bipolar disorder (BD) and related conditions.

Methods:  We reviewed medical records of patients given OXC treatment between March 2003 and March 2005 at the University of British Columbia Hospital. Response to treatment was assessed retrospectively using the Clinical Global Impression of Severity (CGI‐S), and the Clinical Global Impression of Improvement (CGI‐I) scales.

Results:  OXC was prescribed to 15 patients with bipolar I (n = 12), bipolar II (n = 2) and schizoaffective (n = 1) disorder who presented with depression (n = 9), mania (n = 3), hypomania (n = 1), or mixed state (n = 2). Six patients had Axis II diagnoses and 10 patients had a family history of mood disorders. Psychiatric co‐morbidity was found in four patients. The mean daily dose of OXC was 775 ± 556.11 mg/day and the mean duration of follow‐up was 31.60 ± 41.51 weeks. The OXC add‐on led to a significant reduction in symptoms as indicated by reduction in CGI‐S scores at 1 and 2 months. Nine of 12 patients at 1 month and seven of 14 at 1 or 2 months were much or very much improved on CGI‐I scale. One patient (7%) developed hyponatremia. Six patients (40%) experienced no side effects and three patients (20%) stopped the medication because of side effects.

Conclusion:  OXC was effective and well‐tolerated in refractory BD and schizoaffective disorder. These preliminary data are promising but controlled studies are needed to confirm its efficacy in refractory BD.
Executive functioning and theory of mind in euthymic bipolar disorder
Authors: Olley Amanda L , Malhi Gin S , Bachelor Jennifer , Cahill Catherine M , Mitchell Philip B , Berk Michael
Published: October 2005

Objectives: To examine the nature of executive deficits in euthymic patients with bipolar disorder (BD).

Methods: Fifteen euthymic BD patients and 13 controls were administered a battery of executive tasks including verbal fluency, Stroop, Theory of Mind (ToM) tests and selected subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Self‐report and clinician ratings of mood and social and occupational functioning were also obtained.

Results: There were no significant differences between BD patients and controls on the primary measures of the following executive tasks: verbal fluency, attentional set‐shifting, problem solving or planning. On secondary measures of speed, BD patients were slower to complete the first trial of the Stroop task (p = 0.001). Patients with BD committed more errors across all secondary measures. Patients performed poorly when compared with controls on tests of verbal ToM (p = 0.02), and although they performed non‐verbal ToM tasks at a level comparable to controls (p = 0.60), they were slower to initiate a response (p = 0.006). ToM was not significantly correlated with any measure of social and occupational functioning; however it correlated with the achievement scores of the CANTAB Stockings of Cambridge task (Pearson'sr = 0.68, p < 0.01).

Conclusions: Deficits found in euthymic bipolar patients suggest fronto‐subcortical pathway dysfunction. This is consistent with other neuropsychological and neuroimaging research that points to a trait deficit in BD. Further investigation is necessary perhaps using more real‐world tests.
Leigh syndrome: Anesthetic management in complicated endoscopic procedures
Authors: GOZAL DAVID , GOLDIN ERAN , SHAFRAN‐TIKVA SIGAL , TAL DALIA , WENGROWER DOV
Published: October 2005

Background : Leigh's syndrome, a disorder of infancy and childhood, is characterized by gray matter degeneration and focal brainstem necrosis. It presents with special clinical features such as developmental delay, nervous system dysfunction, respiratory abnormalities, and hypertrophic cardiomyopathy that can be a real challenge to the anesthesiologist. Anesthesia or sedation has rarely been reported in patients with Leigh disease. We report our experience in sedating five children with Leigh syndrome in seven procedures undertaken in the endoscopy suite (outside the operating room).

Methods : Five children with Leigh disease, three girls and two boys, have been referred to us for percutaneous endoscopic gastrostomy (PEG) insertion and or replacement (a total of seven procedures).The average age was 2.6 years with a range of 4 months to 6 years. Informed consent was obtained from the patient's parents or guardian. An anesthesia machine, scavenging system, O2 source and routine monitoring were available. Sedation was accomplished with propofol intravenous (i.v.) (0.5–1 mg·kg−1) maintained with a propofol infusion (50–100 μg·kg−1·min−1). The spontaneously breathing patients received oxygen through an oxygen facemask during the procedure and afterwards recovery was managed in the gastroenterology unit.

Results : All the children underwent the procedure without complications. One patient developed transient desaturation (SpO2 80%) for a few seconds. Body temperature, heart rate, arterial blood pressure, O2 saturation and endtidal CO2 were stable during the endoscopies. No special postprocedure management was required; the patients woke up at the end of the endoscopy and were able to drink and eat as usual.

Conclusions : This rare mitochondrial disease presents unique management problems to the anesthesiologist when using general anesthesia. Our patients were managed appropriately before endoscopy and underwent the procedure under deep sedation. No complications occurred. We concluded that deep sedation in the endoscopy suite was safe in this small series of patients with this rare disease.
Performance of a novel pressure release valve for cuff pressure control in pediatric tracheal tubes
Authors: DULLENKOPF ALEXANDER , BERNET‐BUETTIKER VERA , MAINO PAOLO , WEISS MARKUS
Published: October 2005

Background : Acute and chronic hyperinflation of tracheal tube cuffs represents a persistent risk factor for airway damage in children when cuffed tracheal tubes are used. In order to overcome this particular risk, a cuff pressure (CP) pop‐off valve has been designed to avoid CP exceeding 20 cmH2O.

Methods : The performance of the novel pop‐off valve has been evaluated in an in vitro set‐up during slow and rapid air insufflation by a syringe or a CP manometer or inadvertent compression of the cuff pilot balloon while measuring cuff and tracheal wall pressure (WP) in ID 3.0 mm cuffed tracheal tubes. Steady‐state performance was evaluated during nitrous oxide exposure of tracheal tube cuffs (ID 3.0 mm).

Results : The novel CP pop‐off valve avoided cuff hyperinflation during rapid air volume changes and showed reliable performance during steady‐state nitrous oxide exposure to the tube cuff.

Conclusions : These preliminary results show that the CP pop‐off valve limits the effect of rapid, potentially dangerous manual cuff inflation maneuvers and reliably prevents CP exceeding the predetermined level of 20 cmH2O when exposed to nitrous oxide.
A prospective randomized blinded study of the effect of intravenous fluid therapy on postoperative nausea and vomiting in children undergoing strabismus surgery
Authors: GOODARZI MASHALLAH , MATAR MARLA M. , SHAFA MARK , TOWNSEND JANICE E. , GONZALEZ ISAAC
Published: October 2005

Background : Nausea and vomiting is a common postoperative complication that often necessitates the use of antiemetic agents.

Methods : In a prospective, randomized, double blind trial, the effect of perioperative fluid administration on postoperative adverse outcomes following anesthesia was studied. One hundred children undergoing strabismus repair were randomly assigned to receive 10 ml·kg−1·h−1 (control group) or 30 ml·kg−1·h−1 (superhydration group) of lactated Ringer's solution during the operation. During the first 24 h postoperatively, nausea and vomiting, thirst, pain, and fever were evaluated.

Results : Groups were similar with respect to demographic data, surgical procedures and baseline hemodynamic variables. In the first 24 h postoperatively, nausea and vomiting occurred in 27 patients (54%) of the control group and 11 (22%) of patients in the superhydration group (P = 0.001). Comparison of the superhydration group with the control group also showed a statistically significant benefit of superhydration on postoperative thirst (P = 0.0002) and fever (P = 0.02). The differences in nausea and vomiting, thirst, and fever remained significant after adjustment for age, gender, weight, and duration of surgery. There was no significant difference between the two groups in postoperative pain.

Conclusions : Intravenous superhydration administration is an inexpensive and safe therapy for reducing postoperative nausea and vomiting and discomfort.
Anesthetic management of patients with ornithine transcarbamylase deficiency
Authors: SCHMIDT JOACHIM , KROEBER STEFANIE , IROUSCHEK ANDREA , BIRKHOLZ TORSTEN , SCHROTH MICHAEL , ALBRECHT SVEN
Published: October 2005

Ornithine transcarbamylase deficiency (OTCD) is the most common inborn error of the urea cycle. Several specific factors require care during anesthesia in patients with this condition to avoid metabolic decompensation with acute hyperammonemia and encephalopathy. We report monozygous twins with severe neonatal‐onset OTCD undergoing general anesthesia twice each, with midazolam, s‐ketamine, fentanyl and isoflurane in combination with surgical field infiltration with ropivacaine. Alternative pathway medication and high‐caloric diet with 10% glucose solutions were continuously administered during the perioperative course. Both children were extubated within 10 min of the final suture, and their neurological state remained unchanged. Perioperatively, blood ammonia levels remained within the normal range.
Comparison of cuffed, uncuffed tracheal tubes and laryngeal mask airways in low flow pressure controlled ventilation in children
Authors: ENGELHARDT THOMAS , JOHNSTON GRAHAM , KUMAR MANISHA M.
Published: October 2005

Background : The use of low flow circle systems necessitates a ‘leak free’ breathing system which is commonly achieved by using a cuffed tracheal tube (TT). We hypothesized that low flow circle system anesthesia can equally effectively be achieved by using the LMA in pediatric anesthesia.

Methods : Following local ethics committee approval we randomly recruited 45 patients scheduled for elective surgery and requiring mechanical ventilation into three groups (cuffed TT, uncuffed TT and LMA group, n = 15). The size of the TT was determined by means of the formula (age/4) + 4.5 for uncuffed and (age/4) + 4 for cuffed TT whereas the size of the LMA size was dependent on weight. Following induction of anesthesia and muscle paralysis patients were ventilated with pressure controlled ventilation through a pediatric circle system and the lowest fresh gas flow (FGF) determined.

Results : The FGF achieved were (median and range) 0.20 (0.2–0.25) l·min−1 for the LMA group, 0.20 (0.2–0.4) l·min−1 for the cuffed TT group and 1.15 (0.2–4.75) l·min−1 for the uncuffed group. The differences between the LMA and cuffed TT compared with the uncuffed TT were significant (P < 0.0001 and P = 0.0002, respectively). The difference in FGF between LMA and cuffed TT was not significant.

Conclusion : We conclude that pressure controlled ventilation using an LMA is an alternative to a cuffed TT during low flow circle system anesthesia in children. Low FGF is unlikely to be achieved consistently using an uncuffed TT because of a substantial leak.
Cardiovascular collapse during ethanol sclerotherapy in a pediatric patient
Authors: WONG G.A. , ARMSTRONG D.C. , ROBERTSON J.M.
Published: October 2005

Ethanol sclerotherapy is a first line management therapy for low flow vascular malformations. It is usually performed under general anesthesia because of the pain associated with ethanol injection. Ethanol sclerotherapy frequently produces minor local complications but may rarely produce catastrophic cardiopulmonary complications. This report describes the cardiovascular collapse associated with an ethanol sclerotherapy procedure in an 11‐year‐ old child. The evidence for ethanol‐induced cardiovascular derangements is discussed.
The efficacy of caudal morphine or bupivacaine combined with general anesthesia on postoperative pain and neuroendocrine stress response in children
Authors: TEYIN ERKAN , DERBENT ABDURRAHIM , BALCIOGLU TANER , COKMEZ BERNA
Published: October 2005

Background : The aim of this study was to compare the effectiveness of caudal morphine and bupivacaine usage on surgical stress response in children undergoing abdominal and genitourinary surgery while keeping anesthesia depth constant utilizing the bispectral index analysis (BIS).

Methods : Following the approval of Institutional Review Board and informed parental consent, 28 children with ages ranging between 4 and 16 years with ASA physical status I and II , undergoing elective lower abdominal and genitourinary surgery were included in this study. Patients were randomized and separated into two subgroups. Before induction of anesthesia, patients were monitored for BIS. Epidural injection of 30 μg·kg−1 morphine in 1 ml·kg−1 saline for the first group (group M) and the same volume of (0.25%) bupivacaine for second group (group B) were administered via the sacral hiatus. We analyzed serum cortisol and glucose concentrations for evaluation of the stress response in the patients. Blood samples for cortisol and glucose were withdrawn at the beginning of induction (first samples), 40 min after surgical incision (second samples), and 40 min after end of the surgery (third samples). BIS scores of the patients were kept between 40 and 60 during the surgical procedure.

Results : Group B had significantly lower levels of cortisol than group M in the second samples. There was a significant increase in serum glucose level in group M compared with group B during the intraoperative and postoperative periods.

Conclusions : We conclude that, caudal administration of bupivacaine is more effective than morphine for attenuating intraoperative and postoperative stress response to surgery in children.
Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal
Authors: TOMASKE MAREN , GERBER ANDREAS C. , WEISS MARKUS
Published: October 2005

Background : Undiagnosed tracheobronchial foreign body aspiration (FBA) or delayed extraction can lead to serious morbidity. The aim of this study was to evaluate anesthetic and periinterventional morbidity of a straightforward regime using rigid bronchoscopy to rule out or remove a tracheobronchial foreign body in children with suspicion of FBA.

Methods : We retrospectively analyzed rigid bronchoscopy charts of children with suspicion of acute (≤24 h) and subacute (>24 h–2 weeks) tracheobronchial FBA (1990–2003). Patient characteristics, duration of fasting, technique/course of anesthesia induction, and duration/course of rigid bronchoscopy were taken. Anesthetic, periinterventional complications and length of hospital stay were noted. Data are given in median (range [interquartile range]).

Results : A total of 287 children were included in this study. Median age was 1.7 years (0.2–14.2 [1.2–2.5]); in 72.1% a tracheobronchial foreign body was found and removed. Fasting time before induction of anesthesia was 5 h (1–14 [4.0–7.0]). Anesthesia adverse events were seen in 0.7%, whereas periinterventional complication from rigid bronchoscopy was observed in 7.6%. Hospital discharge within 4 h after bronchoscopy was possible in 65.2%. Complications of delayed diagnosis (>24 h) were prolonged duration of rigid bronchoscopy because of severe mucosal changes or difficulties in foreign body extraction.

Conclusions : General anesthesia for rigid bronchoscopy to rule out a tracheobronchial foreign body in children carries low morbidity. Most of the complications originated from the foreign body itself especially in patients with late diagnosis. The risk for serious complications caused by retained foreign bodies outweighs the low morbidity of explorative rigid bronchoscopy in children with suspected FBA or children with prolonged cough or pulmonary infection unresponsive to medical treatment.
Anesthetic management of a child with chromosome 22q11 deletion syndrome
Authors: YOTSUI‐TSUCHIMOCHI HIROE , HIGA KAZUO , MATSUNAGA MATSUKO , NITAHARA KEIICHI , SHONO SHINJIRO
Published: October 2005

Chromosome 22q11 deletion syndrome (22q11DS) is a congenital anomaly characterized by cardiovascular, oropharyngeal, immunologic, endocrine, and neurodevelopmental abnormalities. We successfully managed a 6‐year‐old girl with 22q11DS with general anesthesia. Potential problems in anesthetic management of patients with 22q11DS are reviewed.
Comparison of ‘whoosh’ and modified ‘swoosh’ test for identification of the caudal epidural space in children
Authors: TALWAR VANDANA , TYAGI ROHIT , MULLICK PARUL , GOGIA ANOOP RAJ
Published: October 2005

Background : Caudal analgesia is widely used in pediatric anesthesia practice. The ‘whoosh’ test which uses air to identify the epidural space, has been recommended as a guide for successful needle placement. However, the use of air may be associated with an incidence of neurological complications. The ‘swoosh’ test avoids the injection of air and was originally performed using injection of a local anesthetic solution. A comparison was made between the ‘whoosh’ test and a modified ‘swoosh’ test using saline to identify the caudal epidural space in children.

Methods : We studied 60 children of either sex in the age group of 2–8 years undergoing inguinal herniotomy. During insertion of the caudal block, a stethoscope was placed over the lower lumbar spine to note the presence or absence of ‘whoosh’ or ‘swoosh’, by an independent observer who was blinded to the injection of 1 ml of air or saline which was given simultaneously by the operator into the caudal space. The operator's clinical impression of successful insertion of the needle was also recorded and correlated with the presence or absence of ‘whoosh’ or ‘swoosh’. In addition, the need for supplemental intraoperative analgesia was noted.

Results : Overall success rate of caudal block using the ‘whoosh’ and modified ‘swoosh’ tests was found to be 96.6% and 93.3%, respectively as judged by the lack of supplementary perioperative analgesia. The sensitivity, specificity and positive predictive value of the ‘whoosh’ test and clinical predictors of caudal placement was found to be 100% whereas the modified ‘swoosh’ test had a sensitivity of 93%, specificity of 50% and a positive predictive value of 96%. However, statistically there was no significant difference between the clinical predictors, ‘whoosh’ and the modified ‘swoosh’ test for identification of the caudal epidural space.

Conclusions : The modified ‘swoosh’ test is as reliable as the ‘whoosh’ test and we recommend it for identification of the caudal epidural space in children as it avoids injection of air into the caudal space.
A technique to improve the safety of laryngeal mask airway when used in lacrimal duct surgery
Authors: SUNDER RANI A. , JOSHI CHITTARANJAN
Published: October 2005

Background : Congenital obstruction of the lacrimal drainage system is present in approximately 6% of newborn. Syringing and probing is one of the common interventional modalities for this condition. Current literature states that syringing and probing is performed best with general anesthesia with tracheal intubation. We study a technique to improve the safety and efficacy of the laryngeal mask airway (LMA) in lacrimal duct surgery.

Methods : Sixty‐five ASA grade I‐II patients between 6 months and 10 years scheduled for syringing and probing were included after informed consent was obtained from the parents. After induction of anesthesia and confirmation of LMA position, a transparent suction catheter was inserted into the hypopharynx. Continuous suction was applied to the catheter. A total of 2–3 ml of 0.01% povidone–iodine solution was used for syringing. Staining of the catheter was regarded as a sign of patency of the duct.

Results : None of our patients had perioperative airway or respiratory complications.

Conclusions : Based on the results of our study, we suggest that the LMA can safely be used in lacrimal duct procedures. Using 0.01% povidone–iodine as irrigation fluid further increases the margin of safety.
Relationship between communities and processes; new insights from a field study of a contaminated ecosystem
Authors: Ramsey Philip W. , Rillig Matthias C. , Feris Kevin P. , Gordon Nathan S. , Moore Johnnie N. , Holben William E. , Gannon James E.
Published: October 2005

We used a 93‐year‐old mine waste contamination gradient in alluvial soil to explore the relationship between ecosystem level functioning and community structure in a chronically stressed ecosystem. The sensitivity of broad functional parameters (in situsoil respiration, microbial biomass, above and below ground plant biomass) and microbial diversity [phospholipid fatty acid (PLFA) abundance and richness] were compared. Functional responses were linear with respect to contaminants while thresholds were detected in the community structural response to contamination along the gradient. For example,in situsoil respiration was negatively and linearly correlated to contamination concentration (R = −0.783,P < 0.01), but changes in microbial community structure only became evident where contaminant concentrations were greater than 28 times above background levels. Our results suggest that functional redundancy does not prevent depression of ecosystem function in the long‐term.
Effects of macroalgal species identity and richness on primary production in benthic marine communities
Authors: Bruno John F. , Boyer Katharyn E. , Duffy J. E. , Lee Sarah C. , Kertesz Johanna S.
Published: October 2005

Plant biodiversity can enhance primary production in terrestrial ecosystems, but biodiversity effects are largely unstudied in the ocean. We conducted a series of field and mesocosm experiments to measure the relative effects of macroalgal identity and richness on primary productivity (net photosynthetic rate) and biomass accumulation in hard substratum subtidal communities in North Carolina, USA. Algal identity consistently and strongly affected production; species richness effects, although often significent, were subtle. Partitioning of the net biodiversity effect indicated that complementarity effects were always positive and species were usually more productive in mixtures than in monoculture. Surprisingly, slow growing species performed relatively better in the most diverse treatments than the most productive species, thus selection effects were consistently negative. Our results suggest that several basic mechanisms underlying terrestrial plant biodiversity effects also operate in algal‐based marine ecosystems, and thus may be general.
Quantitative assessment of phytopathogenic fungi in various substrates using a DNA macroarray
Authors: Lievens Bart , Brouwer Margreet , Vanachter Alfons C. R. C. , Lévesque C. André , Cammue Bruno P. A. , Thomma Bart P. H. J.
Published: October 2005

Detection, identification and quantification of plant pathogens are the cornerstones of preventive plant disease  management.  To  detect  multiple  pathogens  in a single assay, DNA array technology currently is the most suitable technique. However, for sensitive detection, polymerase chain reaction (PCR) amplification before array hybridization is required. To evaluate whether DNA array technology can be used to simultaneously detect and quantify multiple pathogens, a DNA macroarray was designed and optimized for accurate quantification over at least three orders of magnitude of the economically important vascular wilt pathogens Verticillium albo‐atrum and Verticillium dahliae. A strong correlation was observed between hybridization signals and pathogen concentrations for standard DNA added to DNA from different origins and for infested samples. While accounting for specific criteria like amount of immobilized detector oligonucleotide and controls for PCR kinetics, accurate quantification of pathogens was achieved in concentration ranges typically encountered in horticultural practice. Subsequently, quantitative assessment of other tomato pathogens (Fusarium oxysporum, Fusarium solani, Pythium ultimum and Rhizoctonia solani) in environmental samples was performed using DNA array technology and correlated to measurements obtained using real‐time PCR. As both methods of quantification showed a very high degree of correlation, the reliability and robustness of the DNA array technology is shown.