bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac manifestations in tuberous sclerosis: A 10‐year review
Authors: QUEK SC , YIP W , QUEK ST , CHANG SK , WONG ML , LOW PS
Published: November 2003

Objective:

Tuberous sclerosis is a genetic disorder with multisystem involvement. The aim of this study was to focus primarily on the cardiac aspects of this condition.

Method:

This review included 10 children with tuberous sclerosis presenting to our department during a 10‐year period.

Results:

From our data, 80% were found to have cardiac involvement. There was an equal prevalence of neurologic complications.

Conclusions:

Cardiac tumours and seizures were the most common problems encountered. Whereas most patients had no symptoms referable to the cardiovascular system and required no active intervention, many of those with neurologic involvement needed appropriate treatment.
Transient erythroblastopenia of childhood associated with transient neurologic deficit: Report of a case and review of the literature
Authors: CHAN GCF , KANWAR VS , WILIMAS J
Published: November 2003

Objective:

Patients with transient erythroblastopenia of childhood (TEC) may also have a transient neurologic disorder. We present a case history and propose a mechanism for this syndrome.

Patient and Methodology:

We describe a 20‐month‐old girl with TEC and transient hemiparesis. Records from the period January 1993 through December 1994 were reviewed to identify other patients with TEC and to determine whether neurologic deficits were noted in these cases.

Results:

Of seven patients diagnosed with TEC over a 2‐year period, only one had a neurologic deficit. This child’s hemiparesis resolved within 24 h after the appearance of her symptoms. Her TEC resolved within 4 weeks, without long‐term sequelae. Our experience and review of the literature suggest that focal neurologic deficits in TEC patients are uncommon, transient, lack long‐term sequelae, and usually resolve prior to hematologic recovery.

Conclusions:

Previous reports suggested that the anaemia resulting from TEC might induce neurologic deficits. We suggest an alternative mechanism in which viral infection triggers a host immune response that independently leads to both TEC and neurologic abnormalities. Future studies should address the role of viral infection in TEC patients with focal neuropathies.
Humoral immune and clinical responses to food antigens following acute diarrhoea in children
Authors: AHMED T , SUMAZAKI R , SHIN K , NAGAI Y , SHIBASAKI M , FUCHS GJ , TAKITA H
Published: November 2003

Objective:

To investigate the effect of acute watery diarrhoea in children upon humoral immune responses to food antigens and the subsequent development of food allergy.

Methodology:

Serum antibodies to cows’ milk, β‐lactoglobulin, α‐lactalbumin, bovine serum albumin and ovalbumin were measured in 30 children with acute diarrhoea in the acute phase and 1 month after recovery. The children were followed for 1 year to assess the development of food allergy.

Results:

IgG antiβ‐lactoglobulin titres for the study group increased 1 month after recovery compared to the titres during the acute phase (P=0.02). Antibody concentration for the other antigens studied did not rise. Four children developed positive IgE antibodies to one or more of the allergens after the diarrhoeal episode, although the titres were very low. None showed evidence of allergy to cows’ milk or egg during the year‐long follow‐up.

Conclusions:

Acute diarrhoea in children resulted in increased production of IgG antibody to β‐lactoglobulin and had a priming effect for development of positive IgE antibody to cows’ milk. Clinical food allergy was not observed in any of the children during the year‐long follow‐up.
Child and parent perceptions of stimulant medication treatment in attention deficit hyperactivity disorder
Authors: EFRON D , JARMAN FC , BARKER MJ
Published: November 2003

Objective:

To evaluate child and parent perceptions of treatment with stimulant medication in a sample of children with attention deficit hyperactivity disorder (ADHD).

Methodology:

Child and parent perceptions questionnaires were completed for 102 subjects participating in a double‐blind, crossover trial of methylphenidate (MPH) and dexamphetamine (DEX).

Results:

Most children viewed medication effects favourably, although 12.7% and 18.8% of children reported feeling worse than usual when taking MPH and DEX, respectively. There was disagreement between the child’s and parents’ perceptions of response in over one quarter of cases. Most disagreements involved parents viewing the child’s response favourably, but the child rating reporting an unfavourable outcome. Side‐effects were the main determinant of children’s perceptions of adverse response.

Conclusions:

A substantial proportion of children with ADHD experience treatment with stimulant medication adversely. Side‐effects are the principal determinant of negative child perceptions. Parental report is usually in agreement with child report; however, parental report alone is not infallible in providing reliable information regarding effects as experienced by the child.
Boxing, youth and children
Authors: PEARN J
Published: November 2003

Boxing remains a popular spectator sport, success in which is achieved by the promotion of boxing in the childhood years. Despite the failure to ban boxing generally, there remains the realistic expectation that organised boxing by children below the age of consent (appropriately 16 years) is still achievable. There are two reasons for banning children under the age of 16 years from boxing. The first is that children have little awareness of risk, specifically the risk of chronic encephalopathy, which develops only after a lag period measured in decades or more. The second is that there is no place in contemporary society for a youth sport which has, as its primary goal, the infliction of acute brain damage on an opponent. This paper analyses the medical and ethico‐social issues implicit in this subject. Boxing, in historical perspective, has been an altruistic amateur sport for boys and male youths, and has a proud tradition. But in the context of social evolution, and in current perspective to prevent exploitation of underprivileged youths, the time has come for an absolute ban on underage boxing. Such is achievable even if adult boxing remains an Olympic and television sport for some time to come.
Prevention of serious bacterial infection in children with nephrotic syndrome
Authors: McINTYRE P , CRAIG JC
Published: November 2003

Although nephrotic syndrome is well known as a predisposing factor to bacterial infection in children, especially peritonitis due to Streptococcus pneumoniae, data on the incidence of infection and the effectiveness of preventative measures are limited. With particular reference to pneumococcal disease, this review summarises the available data on the pattern and incidence of invasive bacterial infection in children with nephrotic syndrome, and the level of evidence for the use of penicillin chemoprophylaxis and pneumococcal immunisation. Although data on the effectiveness of pneumococcal immunisation in children with nephrotic syndrome are limited, the safety profile of this vaccine makes the risk–benefit ratio favourable to use of the current polysaccharide vaccine in those over 2 years of age. Conjugate pneumococcal vaccines are likely to be more effective, particularly in children under 2 years of age and should be available by the year 2000. Although penicillin prophylaxis against pneumococcal infection is not of proven benefit for nephrotic syndrome, it is beneficial in sickle cell disease without appreciable risk. Subgroups of patients with nephrotic sydrome most likely to benefit from twice daily phenoxymethyl penicillin prophylaxis include children under 2 years of age, with unresponsive or frequently relapsing disease, or who have had a previous episode of pneumococcal infection.
Outcome of closed head injury in Malaysian children: Neurocognitive and behavioural sequelae
Authors: ONG LC , CHANDRAN V , ZASMANI S , LYE MS
Published: November 2003

Objective:

To compare the neurobehavioural outcome of children aged 6–12 years with severe closed head injury [sCHI] (coma >24 h), mild‐to‐moderate head injury [mCHI] (coma <6 h) and orthopaedic controls.

Methods:

Twenty‐nine children in each group, matched for age, sex and ethnicity, were assessed using the Glasgow Outcome Scale (GOS), Weschler Intelligence Scale for Children (WISC‐III), Movement Assessment Battery for Children (Movement ABC), Wide Range Assessment of Learning and Memory (WRAML) and a standardised neurological examination 6 months post‐injury. Parental reporting of pre‐ and post‐injury behaviour was documented using the Child Behaviour Checklist (CBCL).

Results:

Seven (24.1%) children with sCHI and three (10.3%) orthopaedic controls had residual motor deficits. Three (10.3%) children with sCHI and none in the other groups faced problems with independent ambulation. Twenty‐seven (93.1%) of those with sCHI and all children in the other groups had GOS scores of good recovery or moderate disability. Twenty‐two (81.5%) sCHI, five (18.5%) mCHI and one (3.7%) orthopaedic control reported a deterioration in school performance. manovas identified a significant injury group effect for performance skills (P=0.007), verbal skills (P=0.002), memory and learning (P=0.001) and motor skills (P=0.001). Repeated measures anova for pre‐ and post‐injury CBCL scores showed significant differences related to somatic complaints (P=0.004), problems of socialising (P=0.003), delinquency (P=0.004), aggressiveness (P=0.010), thought (P<0.001) and attention (P<0.001). Post‐hoc univariate analysis showed the significant differences were between that of the sCHI children and the other two groups.

Conclusion:

Although most sCHI children seemed to have made good physical recovery, there were cognitive, motor, memory and learning difficulties and behavioural problems concomitant with a deterioration in school performance compared with those with lesser or no head injury. This highlights the need for better integrated rehabilitation services to enable a gradual return into mainstream school.
Aetiology of childhood proptosis
Authors: SINDHU K , DOWNIE J , GHABRIAL R , MARTIN F
Published: November 2003

Objective:

To retrospectively analyse causes of childhood proptosis and their investigations and treatment.

Methodology:

The records of children under 15 years of age presenting with proptosis to The Children’s Hospital, Camperdown, Sydney, were reviewed for the period 1983–92 inclusive.

Results:

Fifty‐seven cases of proptosis were found. In order of frequency the causes were: orbital cellulitis 22, thyroid eye disease 8, optic nerve±optic chiasm glioma 8, orbital rhabdomyosarcoma 7, metastatic neuroblastoma 4, orbital neurofibroma 3, orbital haemangioma 2, metastic Ewing’s sarcoma 2 and orbital dermoid cyst 1.

 Treatment depended on the cause (antibiotics, antithyroid drugs, chemotherapy, radiotherapy, surgery) and was multidisciplinary.

Conclusions:

The most common cause of proptosis in children presenting to The Children’s Hospital, Camperdown, Sydney, was infective orbital cellulitis. The most useful initial investigation was an orbital computed tomography scan. Treatment depended on the cause of the proptosis and was multidisciplinary.
Measles immunity and immunisation status in under‐5‐year‐old children in New South Wales: A population‐based study
Authors: FERSON MJ , ROBERTSON PW , DONOVAN JW
Published: November 2003

Objective:

To estimate the proportion of 1–4‐year‐old New South Wales children immune to measles and compare the documented immunisation history with serologically defined immune status.

Design:

Population based seroprevalence survey piggybacked onto the National Survey of Lead in Children. Immune status was determined by two different enzyme immunoassays on plasma samples from subjects.

Setting:

New South Wales, February‐March 1995.

Outcome measures:

Documented measles immunisation collected by interview survey and serologically defined immunity.

Results:

Of 689 survey subjects, 430 (62.4%) provided a blood sample. Adequate plasma remained for both assays for 347 children, of whom 279 (80.4%) were immune by both assays. Parents of 330 stated that their children were immunised, of whom 211 (63.9%) were able to produce corroborating records. Of these 211 subjects, 178 (84.4%) were immune compared to 87 (76.3%) of 114 without records (P=0.07).

Conclusions:

We estimate the prevalence of true measles immunity in 1–4‐year‐old NSW children to be only 80%, a level inadequate to prevent outbreaks of measles in urban populations. Both long term and immediate strategies are required to increase the prevalence of immunity among NSW children; these may include lowering the age of the routine second measles dose and mounting a mass measles immunisation campaign to include preschool aged children.
Expression of mesangial IgA nephropathy in a family with several HLA‐dentical members
Authors: FENTON‐LEE Carol A , PUSSELL Bruce A , BROWN Mark A , CHARLESWORTH John A
Published: November 2003

SUMMARY:The familial incidence of mesangial IgA nephropathy (IgAN) is well recognized. However, the genetic implications of this finding remain uncertain. We report a family of East Timorese origin where six out of eight members, including the mother and five first‐degree offspring, have had histologically proven mesangial IgAN. All eight members have undergone HLA A, B, C and DR typing as well as determination of C4 allotype. Among the offspring, there are HLA‐identical male twins (A11,‐; B13,15; Cw3,‐; DR2,3) and three HLA‐identical females (A11,‐; B13,27; Cw3,‐; DR2,3). Their C4 allotype is also identical (i.e. A3; B1,2,96 and A3; B1,96, respectively). There were histological and biochemical differences between the twins: subject ii‐2 showed focal mesangial proliferation on light microscopy and a 24 h urine protein excretion of 1–2 g on presentation while subject ii‐3 was normal at that time. the latter subsequently underwent a renal biopsy 15 years later and this showed changes only on immunofluorescence microscopy. There were major differences in expression of renal disease among the HLA‐identical sisters: two developed end‐stage renal failure (ESRF) by the age of 30 years, while the third retains normal renal function after 15 years follow‐up. the angiotensin converting enzyme (ACE) genotype was examined for insertion (I)/deletion (D) polymorphism; this showed that both patients with severe renal disease had the ID genotype and this was also present in the two unaffected female members. the study shows no relationship between the HLA A, B, C, DR, C4 supratype and progress of renal disease in this family with mesangial IgAN. Moreover, no association could be demonstrated between progress and the ACE genotype, although the number of patients involved was small. the data suggest that environmental factors and/or genetic/environmental interaction influence the severity of renal injury.
In vitro suppression of parathyroid hormone secretion by 22‐oxa‐calcitriol in human parathyroid hyperplasia due to uraermia
Authors: SATO Keisuke , TOMINAGA Yoshihiro , ICHIKAWA Fumihiko , UCHIDA Kazuharu , TAKEZAWA Jun‐ichi , TSUCHIYA Takeshi , KUBODERA Noboru , TAKAGI Hiroshi
Published: November 2003

SUMMARY: 22‐oxa‐calcitriol (OCT), a vitamin D analogue, suppresses parathyroid hormone (PTH) secretion and has less calcaemic activity than 1,25‐dihydroxyvitamin D3 [1,25(OH)2D3] in vivo. In this study, we evaluated the effect of OCT on PTH secretion in vitro using human hyperplastic parathyroid tissue obtained during surgery for advanced renal hyperparathyroidism and normal bovine parathyroid glands to compare the effects of 1,25(OH)2D3. 22‐oxa‐calcitriol suppressed PTH secretion by nodular hyperplastic parathyroid tissue and normal bovine tissue in a dose dependent manner, the same as 1,25(OH)2D3. We showed the additive effect of extracellular calcium level on suppression of PTH secretion by OCT and 1,25(OH)2D3. These results suggest that OCT suppresses PTH secretion, the same as 1,25(OH)2D3 not only in normal parathyroid cells but also on hyperplastic parathyroid cells.
The D‐allele of the ACE gene polymorphism predicts a stronger antiproteinuric response to ACE inhibitors
Authors: VLEMING Louis J , VAN KOOTEN Cees , VAN DIJK Marjan , HOLLANDER Daan AMJ , PAAPE Marion E , WESTENDORP Rudi GJ , VAN ES Leendert A
Published: November 2003

SUMMARY: Angiotensin converting enzyme (ACE) inhibitors have additional renoprotective effects over other antihypertensive drugs in retarding the development and progression of diabetic and non‐diabetic nephropathies. This additional beneficial effect has been attributed to their antiproteinuric action. However, individual antiproteinuric responses to ACE inhibitors vary considerably. the mechanism underlying the variable response is unresolved. the role of the insertion/deletion (I/D) polymorphism of the ACE gene in this response was examined. the case series consisted of 96 patients (69 males, median age 46.5 years) on ACE inhibitors with an initial proteinuria in excess of 1.0 g/24h. A control series consisted of 103 patients (43 males, median age 40 years) with autosomal polycystic kidney disease. A second control series consisted of 82 patients (52 males, median age 39 years) with a diagnosis of insulin‐dependent diabetes mellitus (IDDM) without microalbuminuria after more than 15 years of IDDM. Angiotensin converting enzyme genotyping was performed by polymerase chain reaction (PCR) analysis of chromosomal DNA. the ACE genotype distribution (DD 44%, ID 28%, II 28%) in the case series was not in accordance with the Hardy‐Weinberg equilibrium (χ2= 17.2, P<0.001), whereas it was in both control series. the difference in ACE genotype distribution between the case series and both control series combined was significant as a result of an overrepresentation of patients with the DD genotype (χ2=9.2, P=0.01). the allele frequencies were compared in patients with a reduction of proteinuria above and below the median value of 45%. the antiproteinuric effectiveness of ACEI therapy in the whole group was greater in the presence of the D‐allele (OR 1.6, 95% CI 0.9‐2.9). the effect of the D‐allele was more pronounced in the subgroup of patients with an initial proteinuria in the non‐nephrotic range (relative risk 2.8, 95%CI 1.0‐8.0) and in patients not receiving diuretics (relative risk 2.3, 95% CI 1.1–4.5). In conclusion, the DD genotype seems to predispose the development of proteinuria in the presence of a kidney disorder. the presence of the D‐allele predicts a stronger antiproteinuric efficacy of ACE inhibitor therapy in patients with an initial proteinuria in the non‐nephrotic range and in the patients not requiring comedication with diuretics.
Merri Creek: Managing an urban waterway for people and nature
Authors: Bush Judy , Miles Barb , Bainbridge Brian
Published: November 2003

The restoration of Melbourne's Merri Creek demonstrates the potential for achieving environmental improvements through a process that integrates the technical, ecological and social aspects.
Volunteers in bird conservation: Insights from the Australian Threatened Bird Network
Authors: Weston Michael , Fendley Michael , Jewell Robyn , Satchell Mary , Tzaros Chris
Published: November 2003

Summary  Volunteers play an important role in recovery efforts on threatened Australian birds. We surveyed the demography, motivation and preferences of people registered with the Threatened Bird Network, a network dedicated to placing volunteers in recovery efforts. Most were employed or studying and were members of conservation or natural history groups. The main reason for volunteering was an interest in conservation, and most volunteers considered habitat conservation of primary importance. They preferred outdoor projects on highly threatened species and where organizers set clear goals, provided feedback and supervised in a friendly and helpful manner. We also surveyed the recovery projects to determine the extent of volunteer involvement required, and the expectations recovery teams had of volunteers. Volunteers made a major contribution to recovery efforts, with $3.4 million being directed to 32 recovery efforts in the period 1996−2000 − a contribution that has been increasing in recent years. Most activities involved surveying and searching and most activities were available in spring, which coincides with the breeding season of the taxa involved. Volunteers travelled considerable distances, yet only a few projects provided financial support.
Randomized, placebo‐controlled trial of intramuscular vitamin B12 for the treatment of hyperhomocysteinaemia in dialysis patients
Authors: Polkinghorne K. R. , Zoungas S. , Branley P. , Villanueva E. , McNeil J. J. , Atkins R. C. , McGrath B. P. , Kerr P. G.
Published: November 2003

Abstract

Background:  Plasma homocysteine is elevated in patients with end‐stage renal disease (ESRD) and is a risk factor for cardiovascular disease. Folic acid has been shown to partially reduce homocysteine levels in dialysis patients. It is not known whether vitamin B12 reduces homocysteine independent of folic acid in patients who are not vitamin B12 deficient.

Aim:  To determine whether 1 mg vitamin B12 lowers homocysteine in stable, chronic, haemodialysis patients independent of folic acid.

Methods:  Twenty‐eight haemodialysis patients were randomized to receive three doses of 1 mg vitamin B12 or 1 mL saline placebo in a double‐blind fashion at 1‐month intervals. Fasting plasma total homocysteine, folic acid, red‐cell folate, vitamin B12 and haemoglobin levels were determined prior to each dose and 4 weeks after the final injection. The study was powered to detect a 30% reduction in homocysteine over the 3 months.

Results:  Both the two groups were well matched with respect to total homocysteine levels, folic acid, red‐cell folate and vitamin B12 levels. Serum vitamin B12 levels were significantly higher in the treatment group compared to placebo (217.7 pmol/L; 95% confidence interval (CI) 103.0−332.5; P < 0.001) at the end of the trial but homocysteine levels were not significantly different (3.08 µmol/L; 95% CI −4.44−10.61; P= 0.406).

Conclusions: The administration of intramuscular vitamin B12 over a 3‐month period does not result in any reduction of plasma homocysteine levels in haemo­dialysis patients independent of folate status, however reductions of <30% cannot be excluded by the present study. High‐dose folic acid remains the treatment of choice in reducing homocysteine, but whether this results in a reduction in cardiovascular events remains to be determined. (Intern Med J 2003; 33: 489−494)
Löfgren syndrome in Turkey
Authors: Yanardaǧ H. , Pamuk Ö. N. , Karayel T.
Published: November 2003

Abstract

In the 36‐year period between 1966 and 2002, 514 patients were diagnosed with sarcoidosis at Cerrahpala Medical Faculty, Gstanbul, Turkey, and of these 98 (19.1%) had Löfgren syndrome. The frequency of female patients with Löfgren was higher than the frequency among other sarcoidosis patients (female : male ratio 4.8vs. 1.64;P < 0.001). Erythema nodosum was diagnosed in 72.4% of the subjects and arthritis or arthralgia was diagnosed in 51%. Erythema nodosum and arthritis or arthralgia were more frequent in Löfgren; however, pulmonary parenchymal involvement was more frequent in other sarcoidosis patients (allP‐values < 0.001). (Intern Med J 2003; 33: 535−537)
Comparison of large‐ and small‐bore intercostal catheters in the management of spontaneous pneumothorax
Authors: Vedam H. , Barnes D. J.
Published: November 2003

Abstract

Background:  Spontaneous pneumothoraces (SP) are a common cause of presentation to emergency departments and subsequent hospitalization. In recent years there has been an increasing trend towards the use of small‐bore pleural catheters (PC) rather than conventional large‐bore intercostal catheters (ICC) in their initial management.

Aims:  To compare the effectiveness and complication rate of ICC and PC in the treatment of SP.

Methods:  A retrospective chart audit was conducted of 67 cases of SP admitted to the Royal Prince Alfred ­Hospital, Sydney, Australia, between 1 July 1997 and 30 June 2000. Demographic data were recorded, ­including: (i) patient age, (ii) smoking status, (iii) pneumothorax size, (iv) pneumothorax type and (v) aetiology. Outcome data relating to length of hos­pital stay (LOS) and treatment failure rates and comp­lications of treatment devices were also recorded.

Results:  Successful pneumothorax resolution was achieved (P = 0.72) in 20 of the 31 (65%) patients initially treated with a ICC, and in 26 of the 36 (72%) patients treated with a PC. The mean LOS in the ICC and PC group was 7 days and 5 days, respectively (P = 0.11). The complication rates in the PC and ICC group were 25% and 10%, respectively (P = 0.13), and the recurrence rates for each group were 17% and 6% (P = 0.20), respectively. However, the combined rate of complications and pneumothorax recurrence within 2 months was 42% in those initially treated with PC, compared with 16% in those treated with ICC (P = 0.04).

Conclusions:  PC were as effective as ICC in treating SP in terms of initial pneumothorax resolution and LOS. There were trends towards higher complication and recurrence rates in those treated with PC, but individ­ually these results did not reach statistical significance. However, the combined rate of complications and pneumo­thorax recurrence was significantly higher in those patients treated with the PC than in those treated with ICC. (Intern Med J 2003; 33: 495−499)
Hypertrophic cardiomyopathy: state‐of‐the‐art review, with focus on the management of outflow obstruction
Authors: Kovacic J. C. , Muller D.
Published: November 2003

Abstract

Significant advances in our understanding and management of hypertrophic cardiomyopathy have been made in the last decade, as the complex genetics and ­phenotype−genotype correlations that characterize the disease are gradually unravelled. The well‐described clinical heterogeneity of hypertrophic cardiomyopathy is now understood to be based on profound genetic vari­ability, with at least 10 genes and over 150 mutations implicated. Several new therapeutic tools have entered clinical practice. The implantable cardioverter‐­defibrillator is now strongly indicated in those at high risk of sudden arrhythmic death. Our ability to abort sudden death in this subgroup has placed added emphasis on risk stratification in newly diagnosed patients. New procedures have also been developed for the relief of outflow obstruction in patients with refractory symptoms and a significant subaortic outflow gradient. Although not as efficacious as the ‘gold‐standard’­surgical myectomy−myotomy, dual‐chamber pacemaker implantation can be of modest benefit in select patients. Percutaneous transluminal septal myocardial ablation is an emerging catheter‐based procedure for the relief of left ventricular outflow obstruction. Long‐term follow‐up data are still awaited. However, intermediate‐term results suggest equivalent efficacy to surgical ­myectomy−myotomy. (Intern Med J 2003; 33: 521−529)
Recommended Standards for Fetal Magnetocardiography
Authors: GRIMM BARBARA , HAUEISEN JENS , HUOTILAINEN MINNA , LANGE SILKE , LEEUWEN PETER VAN , MENENDEZ TERESA , PETERS MARIA J. , SCHLEUSSNER EKKEHARD , SCHNEIDER UWE
Published: November 2003

Fetal magnetocardiography (FMCG) is increasingly being used in research and diagnostics of fetal heart function. Currently, FMCG is the only noninvasive procedure available, comparable to postnatal ECG, which can be used to assess cardiac electrophysiology during the second and third trimester of pregnancy. For a reliable evaluation and full clinical acceptance of this new technique, large numbers of patient investigations are required which can only be obtained in multicenter studies. An international standard protocol is needed to allow pooling of sufficient data and to permit the comparison of studies performed in different centers. This article provides recommended standards for FMCG in the fields of data acquisition and data analysis. (PACE 2003; 26:2121–2126)
Comparison of Impedance Minute Ventilation and Direct Measured Minute Ventilation in a Rate Adaptive Pacemaker
Authors: SIMON RON , NI QUAN , WILLEMS ROGER , HARTLEY JESSE W. , DAUM DOUGLAS R. , LANG DOUGLAS , WARD KEVIN , GILL JASWINDER
Published: November 2003

Respiration rate (RR) and minute ventilation (MV) provide important clinical information on the state of the patient. This study evaluated the accuracy of determining these using a pacemaker impedance sensor. In 20 patients who were previously implanted with a Guidant PULSAR MAX group of pacemakers, the telemetered impedance sensor waveform was recorded simultaneously with direct volume respiration waveforms as measured by a pneumatometer. Patients underwent 30 minutes of breathing tests while supine and standing, and a 10‐minute ergonometer bicycle exercise test at a workload of 50 W. Breathing tests included regular and rapid‐shallow breathing sequences. RR was determined by a computerized algorithm, from impedance and respiration signals. The mean RR by impedance was 21.3 ± 7.7 breaths/min, by direct volume was 21.1 ± 7.6 breaths/min, range 7–66, the mean difference of RR measured by the impedance sensor, as compared with the true measurement, being 0.2 ± 2.1 breaths/min. During the entire exercise, the mean correlation coefficient between impedance (iMV) and direct measured MV was 0.96 ± 0.03, slope 0.13 ± 0.05 L/Ω and range 0.07–0.26 L/Ω. Bland‐Altman limits of agreement were ± 4.6 L/min for MV versus iMV with each patient calibrated separately. The correlation coefficient for iMV versus MV over the entire 10 minutes of exercise, including the initial 4 minutes of exercise, was 0.99. The transthoracic impedance sensor of an implanted pacemaker can accurately detect respiration parameters. There was a large variation between subjects in the iMV versus MV slope during a bicycle exercise test, whereas for each subject, the slope was stable during submaximal bicycle exercise. (PACE 2003; 26:2127–2133)
Catheter Intramural Needle Radiofrequency Ablation Creates Deeper Lesions than Irrigated Tip Catheter Ablation
Authors: THIAGALINGAM ARAVINDA , CAMPBELL CRAIG R. , BOYD ANITA , ROSS DAVID L. , KOVOOR PRAMESH
Published: November 2003

Radiofrequency ablation of the left ventricle using an endocardially placed electrode is unable to reliably create transmural lesions even with active electrode cooling. To produce deeper radiofrequency lesions, the authors developed and tested a prototype intramural needle ablation catheter that had a distal 1.1‐mm diameter straight needle that could be advanced 12 mm into the myocardium. Freshly excised hearts from eight male sheep were perfused and superfused with oxygenated ovine blood. Ablations were performed for 60 seconds with the prototype catheter and a conventional 5‐mm irrigated tip ablation catheter at target temperatures of 90°C and 50°C, respectively. The ablation lesions were bisected and stained with blue tetrazolium to assess lesion geometry. The irrigated tip ablation catheter required significantly more power than the intramural needle ablation catheter (37.7 ± 7.3 vs 6.4 ± 2.1 W, P < 0.01). Intramural needle lesions were significantly deeper (12.5 ± 3.0 mm vs 8.3 ± 2.1 mm, P < 0.01) but less wide (3.9 ± 1.1 mm vs 11.5 ± 2.0 mm, P < 0.01) than irrigated tip lesions. There was a high incidence of crater formation (74%), popping (45%), and myocardial charring (29%) during irrigated tip ablation; these phenomena were not observed during intramural needle ablation. The intramural needle ablation catheter creates significantly deeper but narrower lesions without evidence of tissue boiling. This technology may be particularly useful for ablation of ventricular tachycardia originating from regions where tissue depth is increased, like the ventricular septum. (PACE 2003; 26:2146–2150)
Biventricular Pacing:
Authors: KISTLER PETER M. , MOND HARRY G. , CORCORAN SUSAN J.M.
Published: November 2003

Cardiac desynchronization therapy has established benefits in the management of symptomatic heart failure patients, although left ventricular lead placement remains challenging. We present a case report involving apparent biventricular pacing via the great cardiac vein, which through an appreciation of the surface ECG, revealed dual site right ventricular pacing. (PACE 2003; 26:2185–2187)
OncoSurge: a strategy for long‐term survival in metastatic colorectal cancer
Authors: Alberts S. , Poston G.
Published: November 2003

OncoSurge is a combined modality strategy for the management of colorectal cancer with hepatic metastases. It has emerged as a result of new and expanded patient selection criteria for resectability of metastases, coupled with more effective neoadjuvant and postoperative chemotherapy. By bringing together these developments in surgery and medical oncology, the new approach promises to increase significantly the resectability rate and long‐term survival in colorectal cancer patients with liver metastases.

Surgery for colorectal liver metastases should now be considered across a range of clinical circumstances that would historically have been contraindications to resection. These contraindications include multiple or bilobar metastases, large tumour size, a Dukes stage C or poorly differentiated primary tumour, synchronous detection of metastases with the primary tumour, disease in elderly patients, or a resection margin of less than 1 cm. None of these criteria should necessarily exclude a patient from resection, because although they may be associated with a less favourable prognosis they do not exclude the possibility of long‐term survival. Non‐resectable extrahepatic disease and portal lymph node involvement, however, remain contraindications to resection in most circumstances.

Retrospective studies of neoadjuvant therapy have indicated that a regimen based on low dose oxaliplatin, 5‐fluorourucil (5‐FU) and leucovorin increased the overall resectability rate of patients presenting with hepatic colorectal metastases from 20% to 30%, with 13.6% of patients with unresectable metastases becoming eligible for curative resection. More recently, studies using more potent oxaliplatin‐based regimens have reported significantly higher resectability rates of at least 40%, with 5‐year survival of 50% reported in one large study among patients whose liver metastases were resected after initial neoadjuvant therapy for unresectable tumours. Following resection, postoperative therapy based on a combination of hepatic artery infusion (HAI) and systemic chemotherapy reduces hepatic recurrence and increases survival, but more potent systemic therapy is required to reduce the rate of extrahepatic recurrence. Studies are now in progress combining HAI with oxaliplatin‐based systemic therapy to address this issue.

By combining a more inclusive approach to surgery with more effective neoadjuvant and postoperative chemotherapy, the OncoSurge treatment model is likely to increase significantly the number of patients with hepatic colorectal metastases who can be treated with curative intent, and thus has the potential to improve overall patient survival.
New oxaliplatin‐based combinations in the treatment of colorectal cancer
Authors: Cassidy J. , Hochster H.
Published: November 2003

The synergism between oxaliplatin and 5‐fluorouracil (5‐FU)/leucovorin in the treatment of colorectal cancer raises the prospect of further clinically effective combinations. Phase I/II trials of capecitabine, an oral fluoropyrimidine, plus oxaliplatin have established this combination (XELOX) as an effective treatment for advanced disease, with response rates of over 50% in first line therapy. Phase III studies of XELOX are now in progress, while further studies are investigating the combined use of oxaliplatin and a second oral fluoropyrimidine, UFT, after positive phase I/II results. Studies of combined oxaliplatin and irinotecan treatment have reported response rates varying from 25% to 60% in second‐line therapy of treatment resistant metastatic disease, and 42% in first line therapy. The optimum dosing combination of these two agents has yet to be determined however, and in many patients it is likely that greater overall survival will be achieved by using them in successive lines rather than in combination. Clinical studies have also demonstrated clinically significant response rates when oxaliplatin is combined with other agents including raltitrexed and mitomycin C.

Alongside these novel chemotherapeutic combinations, a range of biological therapies is now being investigated in combination with oxaliplatin in advanced colorectal cancer. Cetuximab (C225) is a monoclonal antibody that inhibits signalling through the epidermal growth factor receptor (EGFR), a pathway that has been associated with a variety of pathological process in cancer including dysregulated growth, differentiation, angiogenesis, cell motility and cell adhesion. Studies of second‐line therapy combining oxaliplatin and cetuximab in advanced disease and in patients with unresectable liver‐only metastases are in progress in the United States. A phase I/II study is also investigating the combined use of oxaliplatin and ZD1839 (‘Iressa’), a small molecule inhibitor of the EGFR specific tyrosine kinase activating the same pathways. Anti‐angiogenesis agents are also being studied intensely. A key angiogenic pathway in the stimulation of tumour growth is the vascular endothelial growth factor (VEGF) pathway, inhibited by the monoclonal antibody bevacizumab. Phase II first line and phase III second line studies of oxaliplatin in combination with bevacizumab are now in progress. Oxaliplatin is being investigated in combination with a number of other classes of biological agent, including the proteasome inhibitor PS‐341. The sudden appearance of a wide range of chemotherapeutic and biological agents with activity against colorectal cancer presents many challenges to the current system of clinical trials, given the large number of permutations requiring prospective testing. However, by building upon the encouraging results achieved using oxaliplatin plus 5FU/leucovorin, the introduction of new agents will eventually translate into significantly improved clinical outcomes.
An analysis of child consumers in Turkey
Authors: Özgen Özlen
Published: November 2003

This research was conducted on 402 children going to kindergarten and primary schools with the purpose of analysing the children's interests, responsibilities, economic resources, purchasing activities, and socialization agents and purchase influences as consumers. Data were collected using a questionnaire, which was prepared by considering some previous research. The questionnaire was applied to subjects through face‐to‐face individual interview. The data were analysed by using explanatory variables, including age, gender, socio‐economic status and family type. Findings indicated that consumer socialization of children was connected to selected demographic characteristics, especially age, and they were surprisingly independent and influential consumers. The results of this study are important for those involved in children's and adults’ markets, and for consumer educators.
A review of the ‘consumer interest’ in organic meat
Authors: Brennan Carol , Gallagher Kelly , McEachern Morven
Published: November 2003

The study aims to provide a critical review of the literature on the consumer interest in the UK in organic food, with a particular focus on organic meat. Given that people are more likely to purchase products if they have faith in them, the regulation of organic food standards is reviewed to explore issues affecting consumers. This is followed by a review of the organic meat sector. Aspects of the consumer interest considered in this paper include consumer information, consumer access, consumer safety, consumer choice and consumer representation. As the literature on organic food/meat in the UK is extensive, it was therefore necessary to be selective with regard to the publications suitable for this review. Most of the literature selected for this paper has been drawn from UK publications, although several European and international sources have also been used. The review found that there is a considerable level of interest in the UK organic meat sector. As the regulation of organic food produced is set at varying standards across the European Union, this could lead to consumers being misled regarding the quality of products offered. It was also found that, although consumers perceive organic foods as healthier, more nutritious and tasting better than non‐organic products, the literature shows that this may have only a limited basis on fact. Contamination of organic products with pesticides and even genetically modified ingredients is always possible. Organic farmers are permitted to use other ingredients in organic meat products that may be harmful to health. Escherichia coli and Salmonella risks associated with conventional meat also appear to affect organic meat. Consumers need clear, accurate and reliable information about organic meat. They also need to be provided with safe products, a choice of organic products, access to organic products and to be represented effectively.
A 40Ar/39Ar laser probe study of micas from the Sesia Zone, Italian Alps: implications for metamorphic and deformation histories
Authors: REDDY S. M. , KELLEY S. P. , WHEELER J.
Published: November 2003

Two samples from the Eclogite Micaschist Complex (EMC) and the Seconda Zona Diorito–Kinzigitica (IIDK) of the Sesia Zone have been studied using a high‐spatial resolution laser probe 40Ar/39Ar technique with the aim of investigating the complexities of argon behaviour in metamorphic rocks and comparing their thermal histories. Data from a single large phengite grain from the EMC show a range of ages from mid‐Jurassic to Upper Cretaceous. These ‘apparent age’ variations are spatially related to both location

within the grain and to intragrain microstructure. Modelling of the data shows that the profile formed

by the diffusion of an excess argon component into the grain, parallel to the mica cleavage. Profile

asymmetry is explained by temporal variations in microstructural development enabling excess argon to

enter the grain at different times in different places. The temperatures of the initiation of deformation

and the possible time‐scales for the deformation can be calculated as a function of cooling rate. All

estimates suggest deformation at greenschist facies, in accord with the observed retrograde mineral assemblage. Absolute temperature estimates for deformation vary by less than 22 °C for different cooling rates

of 10 and 30 °C Ma−1 but vary by 80 °C with different estimates of diffusion parameters. The duration

of deformation was for at least 2 Ma at 10 °C Ma−1 or 0.7 Ma at 30 °C Ma−1. Biotites from the IIDK

sample record a Permian to Upper Cretaceous age range that correlates with grain size, the smallest

grain sizes yielding the youngest ages. This relationship is best explained by a partial resetting of biotites

during an Alpine thermal event initiated not more than 70 Ma ago. Modelling of these data suggest that

the sample never exceeded 300 °C during the Alpine. The profoundly different thermal histories of the

two units—the EMC recrystallized at 550 °C whilst the IIDK remained below 300 °C—suggests that

they may not have been juxtaposed until much later than the eclogite facies metamorphism.
Review and classification of structural controls on fluid flow during regional metamorphism
Authors: OLIVER N. H. S.
Published: November 2003

Mechanisms for kilometre‐scale, open‐system fluid flow during regional metamorphism remain problematic. Debate also continues over the degree of fluid flow channellization during regional metamorphism, and the mechanisms for pervasive fluid flow at depth. The requirements for pervasive long‐distance fluid flow are an interconnected porosity and a large regional gradient in fluid pressure and hydraulic head (thermally or structurally controlled) that dominates over local perturbations in hydraulic head due to deformation. In contrast, dynamic or transient porosity interconnection and fluid flow accompanying deformation of heterogeneous rock suites should result in moderately to strongly channellized flow at a range of scales, of which there are many examples in the literature.

Classification of fluid flow types based on scale and degree of equilibration between fluid and rock, wallrock permeability, and mode of fluid transport contributes to an understanding of key factors that control fluid flow. Closed‐system fluid behaviour, with restricted fluid flow in microcracks or cracks and limited fluid–rock interaction, occurs over a range of strains and crustal depths, but requires low permeabilities and/or small fluid fluxes. Long‐distance, open‐system fluid flow in channels is favoured in heterogeneous rocks at high strains, moderate (but variable) permeabilities, and moderate to high fluid fluxes. Long‐distance, broad, pervasive fluid flow during regional metamorphism requires that the rocks are not accumulating high strains and have high permeabilities, low permeability contrasts, and high fluid fluxes. The ideal situation for such fluid flow is in situations where the rocks are undergoing stress relaxation immediately after a major deformation phase. In the mid‐crust, fairly specific conditions are thus required for pervasive fluid flow. During active orogenesis, structurally controlled fluid flow (with focused open systems surrounding regions of closed‐system behaviour) predominates in most, but not all, regional metamorphic situations, at a range of scales.