bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcome of bacillus Calmette‐Guérin perfusion therapy for carcinoma in situ of the upper urinary tract
Authors: MIYAKE HIDEAKI , ETO HIROSHI , HARA SHOJI , OKADA HIROSHI , KAMIDONO SADAO , HARA ISAO
Published: March 2003

Background: The objective of this study was to evaluate the efficacy of intrarenal bacillus Calmette‐Guérin (BCG) instillation for the treatment of carcinoma in situ (CIS) of the upper urinary tract.

Methods: Sixteen patients who were diagnosed as having CIS of the upper urinary tract were treated with intrarenal BCG instillation. BCG (80 mg) in normal saline was administered once weekly, 6 times in total as one course through a percutaneous nephrostomy tube in 5 patients, and a retrograde ureteric catheterization using a Single‐J or Double‐J stent in 2 and 9 patients, respectively.

Results: During the median follow‐up period of 30 months (range: 9–90 months), no patients died, and 13 patients remained cytologically negative in urine collected from the upper urinary tract after BCG treatment was completed. However, one of these 13 patients had CIS in the bladder and prostatic urethra 34 months after the BCG therapy and had to undergo radical cystectomy. The remaining 3 patients experienced recurrence in the upper urinary tract 4, 8, and 11 months after treatment, despite a favorable response to the initial BCG instillation. Of these 3 patients, one patient received an additional course of BCG therapy, while the remaining 2 underwent nephroureterectomy. Bladder irritability or a fever higher than 38°C was observed in 12 or 9 patients, respectively; however, such side‐effects were not clinically significant, and no patient received antitubercular treatment.

Conclusion: Intrarenal instillation of BCG appears to be effective and safe for treatment of CIS of the upper urinary tract; however, further experience and longer follow‐up studies of this treatment are required.
Inhibitory effect of clotrimazole on angiogenesis associated with bladder epithelium proliferation in rats
Authors: TAKEI SHUNSAKU , ISEDA TOKUHIRO , YOKOYAMA MASAYOSHI
Published: March 2003

Abstract
Background:
Up‐regulation of epithelial vascular endothelial growth factor (VEGF) expression was recently reported at an early stage of bladder carcinogenesis in rats. Subsequently, clotrimazole (CLT) was reported to exert an inhibitory effect on the in vitro proliferation of vascular endothelial cells stimulated by VEGF. The present study was performed to evaluate the effect of CLT on the initial stage of N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine (BBN)‐induced carcinogenesis of the urinary bladder in rats.

Methods:
Seven‐week‐old‐female Wistar rats were divided into both a control group and the other four groups that were allowed free access to drinking water containing 0.05%BBN. Two groups of rats (10‐CLT and 20‐CLT) received CLT (100 mg/kg per day) once daily by gavage for 10 and 20 weeks, respectively. The other two groups of rats (10‐BBN and 20‐BBN) were maintained on the same BBN‐containing drinking water for 10 and 20 weeks, respectively, without receiving CLT. After removing the urinary bladder of each rat, expression of VEGF and VEGF receptor FLT1, and new capillaries were examined by immunohistochemical staining. VEGF mRNA was detected by the reverse transcription polymerase chain reaction.

Results:
The ratio of VEGF‐positive cells and the expression of VEGF mRNA were lower in the 20‐CLT group than in the 10‐BBN group. Newly formed capillaries in the 20‐CLT group were significantly decreased compared with those in the 10‐BBN group.

Conclusion:
These quantitative data suggested that CLT can inhibit VEGF expression in vivo and hence inhibit angiogenesis in the early stages of bladder carcinoma.
Advanced ureteral cancer with complete remission achieved by taxan containing systemic chemotherapy
Authors: MATSUMURA KENTAROU , SUGIMURA KAZUNOBU , UCHIDA JUNJI , NAGANUMA TOSHIHIDE , NAKATANI TATSUYA
Published: March 2003

Abstract We report a case of advanced ureteral cancer successfully treated with systemic chemotherapy combined with irradiation. A 47‐year‐old man was diagnosed as having a right ureteral cancer at the clinical stage of T4, N2 and M1 (liver). A papillary tumor was also found in the bladder and the resected specimen showed a grade 1 transitional cell carcinoma. Although three cycles of methotrexate, vinblastine, pirarubicin and cisplatin (MVAC) gave partial response to the ureteral tumor, new metastases to the lung and pelvic bone were observed. The patient received 50 Gy external irradiation to the pelvis, 11 cycles of paclitaxel (270 mg) and cisplatin (60–80 mg) followed by four cycles of docetaxel (100 mg) and cisplatin. Thereafter, he underwent bone biopsy, partial hepatectomy, total nephroureterectomy and lymph node resection, by which a complete response was achieved pathologically. The patient has been alive without evidence of disease for 12 months.
Squamous cell carcinoma of the prostate
Authors: MOHAN HARSH , BAL AMANJIT , PUNIA RAJ PAL SINGH , BAWA AMARPREET SINGH
Published: March 2003

Abstract Squamous cell carcinoma of the prostate is rare, accounting for 0.5–1% of all prostatic cancers. It is highly aggressive and responds poorly to any mode of therapy. We present a case of squamous cell carcinoma of the prostate that developed in a patient with prostatic adenocarcinoma following radiation therapy.
Survival on long‐term oxygen therapy in chronic airflow limitation: from evidence to outcomes in the routine clinical setting
Authors: Crockett A. J. , Cranston J. M. , Moss J. R. , Alpers J. H.
Published: March 2003

Abstract

Background: Two previous randomized controlled trials (RCT) demonstrated that the administration of long‐term oxygen therapy (LTOT) improved survival in selected patients with hypoxic chronic obstructive pulmonary disease (COPD) or chronic airflow limitation (CAL).

Aims: The aim of the present study was to investigate whether the survival of CAL patients prescribed LTOT at Flinders Medical Centre (FMC) was gender and age related, and equivalent to that of the previous RCT.

Methods: A list of patients prescribed domiciliary oxygen therapy for CAL at FMC was generated from Respiratory Unit records and hospital financial records for the supply of this therapy. Survival was compared with that reported for the original RCT, and for Swedish and Belgian COPD patients. Factors influencing survival were studied.

Results: Five hundred and five (249 males, 256 females) patients were prescribed LTOT for CAL at FMC during the study period and included in the survival analysis. The patients were elderly with multiple comorbidities. Survival was less than for the control arms of the previous RCT (apart from the Medical Research Council Working Party (MRC) female group) but comparable with recent overseas data. Overall crude survival was 75.1%, 51.3%, 18.9% and 1.1% at 1, 2, 5 and 10 years respectively. Females experienced longer survival than males. Multivariate analysis indicated that age, forced expiratory volume in 1 s, body mass index (BMI) and the number of comorbidities were prognostic indicators for females; BMI was a prognostic indicator for males. A survival advantage existed for females using at least 19 h concentrator oxygen per day.

Conclusions: In routine practice, survival of unselected CAL patients with multiple comorbidities is less than that reported in the original RCT. (Intern Med J 2001; 31: 448–454)
Pharmaceutical industry‐sponsored meetings: good value or just a free meal?
Authors: Carney S. L. , Nair K. R. , Sales M. A. , Walsh J.
Published: March 2003

Abstract

Although the role of the pharmaceutical industry in continuing medical education (CME) has been debated for many years, industry CME funding continues to increase. Because of concern about the educational quality of industry CME, the Hunter Postgraduate Medical Institute (HPMI), an independent Newcastle and Hunter Valley CME provider, evaluated the use and quality of industry CME as reported by rural and urban general practitioners, physicians and psychiatrists. Furthermore, clinicians were asked if they supported increased industry‐funded independent CME. Sixty‐two per cent of general practitioners and 71% of psychiatrists attended at least three industry‐organized meetings each year, compared with 24% of physicians. Twenty‐five per cent of general practitioners attended five or more such meetings. Industry meetings were judged to be of good to excellent quality by 81% of generalists, 79% of physicians and 87% of psychiatrists. All clinical groups ranked the topic and then speaker as the most important reason for attending, with CME points, venue and the sponsor ranked lowest. Eighty to 90% of doctors supported a greater role of industry‐funded independent CME. Despite the absence of current data on the use and perceived benefits of industry CME, these preliminary results suggest that industry CME is playing an increasingly important role in clinician education. However, many clinicians and industry representatives support a greater role by independent postgraduate organizations in industry‐sponsored CME. (Intern Med J 2001; 31: 488–491)
Cost comparison of at‐home treatment of deep venous thrombosis with low molecular weight heparin to inpatient treatment with unfractionated heparin
Authors: Smith B. J. , Weekley J. S. , Pilotto L. , Howe T. , Beven R.
Published: March 2003

Abstract

Aims: Low molecular weight heparins (LMWH) permit safe and effective treatment of uncomplicated deep venous thrombosis (DVT) at home. The aim of this study was to evaluate the cost minimization, cost shifting and patient satisfaction associated with at‐home DVT treatment using the LMWH enoxaparin, compared to standard inpatient care in an Australian health‐care setting.

Methods: Subjects presenting with a principal diagnosis of uncomplicated DVT to the Emergency Department at The Queen Elizabeth Hospital, Adelaide, were recruited over 1997–1999. Costs to the hospital, to Federal funding (Medicare) and to patients were tracked prospectively, and satisfaction was also measured. Subjects were matched to historical controls (1994–1997) for age, gender and level of comorbidity (same or lower) by two medical officers who were blinded to costs. Control costs were obtained using the clinical costing system Trendstar®, and adjusted for consumer price index.

Results: Twenty‐eight subjects participated in the at‐home programme. Of these, 26 were discharged without any inpatient admission (including one who agreed to self‐injection) and two were admitted briefly. Audit demonstrated that only 29% of eligible subjects were managed at home. Mean (SEM) total treatment cost was $756 (76) per patient for at‐home, and $2208 (146) for controls. Minimal cost shifts to patients and to Medicare occurred, and satisfaction was high.

Conclusions: At‐home treatment of uncomplicated DVT using enoxaparin in an Australian metropolitan setting provides effective cost minimization, with little cost‐shifting. Our cost minimisation estimates are conservative as most at‐home subjects received enoxaparin twice daily (now used once per day) and controls had at least as high comorbidity. However, uptake of the at‐home programme was limited. (Intern Med J 2002; 32: 29–34)
Why is quality assurance so difficult? A review of issues in quality assurance over the last decade
Authors: Brown R. W.
Published: March 2003

Abstract

The quality assurance movement has been unable to produce major improvements in the realm of clinical practice because of an inability to make satisfactory measurements of process and/or outcome, together with the intrinsic difficulties associated with producing change. Progress in both these areas is likely to be slow. Improvements in the quality of care occurring as a result of the introduction of information technology into clinical practice may be seen more quickly. (Intern Med J 2002; 32: 331−337)
Video‐assisted thoracoscopic thymectomy for myasthenia gravis
Authors: Wright G. M. , Barnett S. , Clarke C. P.
Published: March 2003

Background: Thymectomy is an effective, but radical therapy for myasthenia. Video‐assisted thoracic surgery (VATS) may allow a minimally invasive altern­ative to the standard sternotomy approach.

Aims: To audit prospectively the outcome of VATS thymectomy for myasthenia gravis in a unit specializing in advanced VATS techniques.

Methods: Twenty‐six patients underwent VATS thymectomy between 1997 and 2001. Most underwent preoperative plasma exchange therapy. Seventeen women and nine men with a median age of 36 years (range 17−71 years) had a right‐sided VATS approach to remove all anterior mediastinal fat and thymic tissue.

Results: There was no perioperative mortality and all procedures were concluded successfully, with one patient requiring sternotomy. Twenty‐five patients were extubated in theatre and one patient required 17 h of assisted ventilation. The other significant complication was a diathermy injury to the phrenic nerve, which recovered. Median postoperative stay was 4 days (range 2−6 days), with median postoper­ative chest drainage for 2 days (range 1−3 days). Three patients had progression of disease postoperatively. The remainder were asymptomatic (7), improved (14) or stable (2).

Conclusion: In a dedicated unit with neurological and intensive care support, VATS thymectomy is a safe, effective method of obtaining remission or improvement in myasthenia gravis (MG). While achieving the same surgical goal, this approach offers advantages of improved cosmesis, shorter recovery time and minimal chest wall disruption over the gold standard of sternotomy. Better patient acceptance of this minimally invasive technique may result in wider application of the benefits of thymectomy in MG. (Intern Med J 2002; 32: 367−371)
Multiple sclerosis is more prevalent in northern New Zealand than previously reported
Authors: Chancellor A. M. , Addidle M. , Dawson K.
Published: March 2003

Abstract

Background: There have been no studies of multiple sclerosis (MS) prevalence from New Zealand (NZ) in the past two decades, and only one in a northern NZ district. Our impression was that the local prevalence of MS was higher than previously published data would suggest. There is limited access to new treatments for MS in NZ.

Aims: The present paper aims to: (i) measure the prevalence of definite and probable MS in the Bay of Plenty (BOP), a North Island province, (ii) compare this with previous NZ studies, (iii) study the profile of disability in this population‐based group and (iv) determine the proportion of MS patients who receive government funding for modern drug treatment (β‐interferons).

Methods:  Patients were identified from a geograph­ically and demographically defined area of the North Island of NZ, using multiple sources of case ascertainment and modern diagnostic criteria. All clinical records were reviewed and data were supported by a telephone interview. All patients’ eligibility for ­government‐funded treatment with β‐interferon was considered.

Results:  Eighty‐six patients were identified as residents in BOP, NZ, on 15 January 2001. Excluding ‘possible’ cases, this represented a prevalence of 50/105 (95% confidence interval 40−62/105). Half of the population‐based cohort had a disability defined as ‘moderate to severe’ (i.e. aids needed to walk, unable to take more than a few steps, or worse). Eleven patients (13%) had a primarily progressive form of MS. Eleven patients (13%) had the relapsing−­remitting form of the disease and qualified for ­government‐funded treatment with β‐­interferon.

Conclusion:  The prevalence of MS in the defined region was twice as high as that reported from an adjacent area, the Waikato, 20 years previous. Our data will help to update NZ prevalence statistics and are of direct relevance to current funding issues for modern treatments which, in NZ, are presently limited to a proportion of patients with relapsing− remitting disease. (Intern Med J 2003; 33: 79−83)
Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from The Horn of Africa
Authors: Skull S. A. , Ngeow J. Y. Y. , Biggs B. A. , Street A. , Ebeling P. R.
Published: March 2003

Abstract

The prevalence of and risk factors for vitamin D deficiency were examined for recent adult immigrants from East Africa living in Melbourne. Demographic data were collected via a face‐to‐face questionnaire and risk factors predicting deficiency were examined. Suboptimal levels <25 nmol/L were found in 61 patients (53%; 74% of women; 20% of men). Lower levels were more likely in: (i) patients with a longer duration of residence in Australia, (ii) patients who were mostly covered when outdoors and (iii) women. Routine assessment for vitamin D deficiency should be considered for male and female immigrants from East Africa. (Intern Med J 2003; 33: 47−51)
Mutations in the acetolactate synthase genes of sulfonylurea‐resistant biotypes of Lindernia spp.
Authors: Uchino Akira , Watanabe Hiroaki
Published: March 2003

Acetolactate synthase (ALS) is a key enzyme in the biosynthetic pathway of branched‐chain amino acids. A mutation of the ALS gene causing amino acid substitution at the position of proline in Domain A makes ALS less sensitive to sulfonylureas, which are ALS‐inhibiting herbicides. We cloned partial ALS genes from four Lindernia plants, L. dubia var. dubia, L. dubia var. major, L. micrantha and L. procumbens, for which biotypes resistant to sulfonylureas have been found in paddy fields. The clones were classified into two groups in each Lindernia plant: Als1 and Als2. Sequencing of the clones and alignment of deduced amino acid sequences with previously reported ALS of other species suggested that the cloned region contains an intron in both Als1 and Als2. Comparison of Als1 between resistant and susceptible biotypes showed that the proline of Domain A was replaced by alanine, serine or glutamine in all resistant biotypes of Lindernia plants, while it was conserved in all susceptible biotypes. This amino acid substitution in ALS encoded by Als1 is involved in the resistant mechanism of ALS to sulfonylurea in the four Lindernia plants.
Allelopathic activity of leaching from dry leaves and exudate from roots of ground cover plants assayed on agar
Authors: SHIRAISHI SAYAKA , WATANABE IZUMI , KUNO KATSUJI , FUJII YOSHIHARU
Published: March 2003

The effects of leaches from dry leaves of 71 ground cover plant species on lettuce were tested at the first screening. The inhibitory effects on radicle and hypocotyl elongations of lettuce varied with the different species of cover plants that were used. Eight species of Oxalis showed strong inhibitions (4–27% of untreated control on radicle elongation). Inhibitory activities of seven species of cover plants on three weed species, live amaranth (Amaranthus lividus), southern crabgrass (Digitaria ciliaris) and common lambsquarters (Chenopodium album), were tested at the second screening. Moss pink (Phlox subulata), trefoil (Oxalis brasiliensis), red spiderlily (Lycoris radiata), creeping thyme (Thymus serpyllum), European pennyroyal (Mentha pulegium), roman chamomile (Chamaemelum nobile) and star‐of‐Bethlehem (Ornithogalum umbellatum) were selected as donor plants because of their high inhibitory effects on lettuce growth and their usefulness as ornamental ground cover plants. Effects of leaches from dry leaves and exudates from the roots of these species were assayed on agar. Radicle elongations of all tested weed species were inhibited by leaches from trefoil and red spiderlily (8–31% and 14–24% of untreated control, respectively) and exudates from moss pink, trefoil and creeping thyme (11–43%, 31–74% and 22–67% of untreated control, respectively).
Differences in physiological responses to NaCl between salt‐tolerant Sesbania rostrata Brem. & Oberm. and non‐tolerant Phaseolus vulgaris L.
Authors: JUNGKLANG JARUNEE , USUI KENJI , MATSUMOTO HIROSHI
Published: March 2003

Sesbania rostrata (S. rostrata) Brem. & Oberm., a member of the Fabaceae family, has been used as a promising halophytic plant to ameliorate soil salinity in north‐east Thailand. To obtain information regarding the mechanism of salt tolerance, the physiological responses of S. rostrata to NaCl was compared with those of the salt‐susceptible species, kidney bean (Phaseolus vulgaris L. cv. Meal). Seedlings were grown hydroponically with 0, 50, 100 and 150 mm NaCl for 10 days and their effects on growth, chlorophyll content, fluorescence yield (Fv/Fm), inorganic elements and amino acid content were determined. The results showed that tolerance to NaCl was clearly different between the two plants. At the highest concentration (150 mm), the dry weight of S. rostrata was more than 50% greater than the control, whereas the kidney bean could not survive. Chlorophyll a content drastically reduced only in the kidney bean. The Fv/Fm of S. rostrata did not change with increasing concentrations of NaCl, but that of kidney bean decreased. Greater percentages (≥80%) of absorbed Na+ and Cl– were translocated and accumulated in the shoots of S. rostrata, but remained largely in the roots of kidney bean. The enhancement of contents of amino acids, including proline, with increasing NaCl was observed in both species. These results strongly suggest that the salt tolerance of S. rostrata is associated with the ability of the plant to translocate and sequester Na+ and Cl– in the shoot cells.
Anaesthetic and surgical airway management during tracheo‐oesophageal fistula repair
Authors: ANDROPOULOS DEAN , ROWE RICHARD , BETTS JAMES
Published: March 2003

A retrospective review of 61 cases of airway management for newborn tracheo‐oesophageal fistula (TOF)/oesophageal atresia repair is presented. Standard management included induction of general anaesthesia and muscle relaxation before tracheal intubation, rigid bronchoscopy, careful placement of the tracheal tube below the TOF if possible, and occlusion of the fistula with a Fogarty embolectomy catheter in certain high risk cases. Gastrostomy was not routinely performed. Ventilation proceeded without difficulty in 48 cases. Ventilation difficulties were encountered in 13 cases. Eight of the 13 cases had large TOF, and four had other causes of difficult ventilation not related to the fistula. No patient with a small TOF had ventilation problems because of the TOF. Three patients had a large TOF successfully occluded with an embolectomy catheter through the bronchoscope. There were no complications ascribed to this technique. An algorithm is suggested for anaesthetic‐surgical airway management in these cases.
Difficult airway in a patient with Marshall‐Smith syndrome
Authors: ANTILA  , LAITIO  , AANTAA  , SILVONIEMI  , PAKKANEN
Published: March 2003

Marshall‐Smith syndrome is a rare clinical disorder characterized by accelerated bone maturation, dysmorphic facial features, airway abnormalities and death in early infancy because of respiratory complications. Although patients with Marshall‐Smith syndrome have several features with potential anaesthetic problems, previous reports about anaesthetic management of these patients do not exist. We present a case, in which severe hypoxia developed rapidly after routine anaesthesia induction in an eight‐month‐old male infant with this syndrome. After several unsuccessful attempts the airway was finally secured by blind oral intubation. After 2 weeks, laryngeal anatomy was examined with fibreoptic laryngoscopy which revealed significant laryngomalacia. Laryngoscopy was performed without problems with ketamine anaesthesia and spontaneous breathing. The possibility of a compromised airway should always be borne in mind when anaesthetizing patients with Marshall‐Smith syndrome. Anaesthesia maintaining spontaneous breathing is safest for children with this syndrome. If tracheal intubation or muscle relaxation is required, precautions are needed to maintain a patent airway. Muscle relaxants should possibly be avoided before intubation.
Postoperative extradural infusions in children: preliminary data from a comparison of bupivacaine/diamorphine with plain ropivacaine
Authors: Moriarty A.
Published: March 2003

To try to decrease the incidence of side‐effects associated with postoperative extradural infusions of local anaesthetics in combination with opioids, we have used plain ropivacaine solutions in 200 children. The first 72 children received an infusion of bupivacaine 0.125%+ diamorphine 20 μg·ml−1, then 200 children received plain ropivacaine solutions. The children who received ropivacaine were found to have lower incidences of nausea, pruritus, urinary retention, and were less sedated, despite comparable analgesia. The management of plain ropivacaine for extradural analgesia is discussed.
Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children
Authors: López Gil M. , Brimacombe J. , Clar B.
Published: March 2003

We compared patient outcomes for propofol vs sevoflurane with the laryngeal mask airway (LMA) using either spontaneous breathing (SB) or pressure controlled ventilation (PCV). One hundred and twenty children undergoing minor surgery below the umbilicus were randomly assigned to receive either (1) propofol 3 mg·kg−1 followed by a maintenance infusion of 5 mg·kg−1·h−1, or (2) induction with sevoflurane 7% followed by maintenance with 1.7%. Following LMA insertion, patients were given atracurium and underwent PCV if surgery was expected to last ≥30 min. The following assessments were made: time to LMA insertion/removal, airway problems, cardiorespiratory effects and recovery characteristics. The first time insertion success rates were similar, but insertion time was shorter with sevoflurane (115±67 s vs 252±107 s, P < 0.0001). One patient coughed during placement, but there were no other problems during any phase of anaesthesia in any group. Heart rate was higher in the sevoflurane group following insertion, during maintenance and emergence (all P < 0.03). There were no differences in blood pressure and oxygen saturation among groups PECO2 in the SB group was unaffected by the agent used. Emergence was more rapid (232±104 s vs 348±127 s, P < 0.0001) and postoperative agitation more common (15%vs 0%, P=0.02) with sevoflurane. There were no differences in the Aldrete scores among groups. Patient outcome was similar for the SB and PCV groups. We concluded that the techniques described here using propofol and sevoflurane are equally suitable for induction and maintenance of anaesthesia with the LMA in children undergoing minor surgery below the umbilicus. Emergence is more rapid, but postoperative agitation more common with sevoflurane.
Can gastric intramucosal pH (pHi) predict outcome of paediatric cardiac surgery?
Authors: BICHEL THIERRY , KALANGOS AFKSENDIYOS , ROUGE JEAN‐CLAUDE
Published: March 2003

In forty‐two children undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), a gastric tonometer was used intraoperatively to estimate pHi, reflection of splanchnic perfusion. PHi monitoring was used to predict early postoperative complications. Intramucosal acidosis appeared after removal of the aortic clamp and remained after weaning of CPB. Fifteen children (group C) developed early postoperative life‐threatening complications. Twenty‐seven children (group NC) had no major complications. Retrospective data analysis showed a decrease of pHi during hypothermic CPB in the two groups but at completion of surgery, pHi was significantly lower in the group C (7.13??0.04 vs 7.31??0.001, P<0.001). Bypass and aortic clamp times were also longer in group C and intraoperative core temperature lower. Continuous automated tonometer gas analysis appeared more acurate for the monitoring of acute haemodynamic and respiratory changes and should probably improve the predictive value of tonometry in the future. Tonometry is highly sensitive and represents an interesting and minimally invasive monitoring for critically ill children.
The adult Bullard laryngoscope as an alternative to the Wis‐Hipple 1½ in paediatric patients
Authors: Shulman Brent , Connelly Neil Roy
Published: March 2003

This prospective, randomized study was undertaken to compare the adult Bullard laryngoscope (BL) with the Wis‐Hipple laryngoscope (WhL) in paediatric patients with regards to laryngeal view and time to intubation, and whether its efficacy was related to age or weight. Fifty patients scheduled for general anaesthesia between the ages of 1 and 5 years were examined. Patients were randomized into two groups: one group had an initial laryngoscopy via the WhL and then had a laryngoscopy and intubation using the BL; the second group had an initial laryngoscopy with the BL and then had a laryngoscopy and intubation using the WhL. The laryngeal view, attempts at intubation, time to intubation and the reason for any difficulty with intubation were recorded. Correlation was then sought relating attempts and time to intubation with age, and weight. Mean time to intubation was 20 ± 6 s in the WhL group and 26 ± 9 s in the BL group (P < 0.02). The majority of the patients had similar laryngeal views in both groups; three patients had a superior view with the BL. Failed intubations occurred in two BL patients; the tracheas were both intubated with the WhL. In one patient, intubation was not possible with the WhL but it was successful with the BL. Multiple passes of the tube off the BL most frequently occurred because of right aryepiglottic fold contact or anterior vocal cord contact. The latter appears to be more problematic when the adult BL is used in the paediatric population. No relationship was found between the time to intubation and age or weight. In an occasional child, the BL provides a superior laryngeal view and provides a means for a successful intubation when a failure with the WhL occurs. Although intubation of children aged 1–5 years takes longer with a BL than a WhL, the adult BL complemented the WhL laryngoscope in paediatric patients.
Retracted: Pretreatment with oral clonidine attenuates cardiovascular responses to tracheal extubation in children
Authors: Fujii Yoshitaka , Saitoh Yuhji , Tanaka Hiroyoshi , Toyooka Hidenori
Published: March 2003

This study was designed to evaluate the effects of diazepam and clonidine orally given preoperatively on cardiovascular responses to tracheal extubation in children. Fifty children, ASA physical status I, aged 4–10 years, undergoing minor elective surgery (inguinal hernia, phimosis) received orally, in a randomized, double‐blind manner, diazepam 0.4 mg·kg−1 or clonidine 4 μg·kg−1 (n=25 of each). These drugs were administered 105 min before an inhalational induction of anaesthesia. The same standard general anaesthetic technique was employed throughout. The maximum changes in heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were less in patients who had received clonidine than in those who had received diazepam (HR, 12 vs 24; SBP, 14 vs 26; DBP, 9 vs 16; mean, P < 0.05). In conclusion, compared to diazepam given orally, pretreatment with oral clonidine attenuates haemodynamic changes associated with tracheal extubation in children.
Acute Horner syndrome due to thoracic epidural analgesia in a paediatric patient
Authors: Aronson Lori A. , Parker Gwenevere C. , Valley Robert , Norfleet Edward A.
Published: March 2003

A 4‐year‐old boy with coarctation of the aorta underwent surgical aortic arch repair with general anaesthesia and thoracic epidural analgesia. In the immediate postoperative period, the child developed a unilateral Horner syndrome which appeared to be related to the epidural infusion rate. Management of this patient as well as alternate aetiologies of Horner syndrome are described. Horner syndrome is a rare complication of epidural catheters and is often unrecognized, especially in children.
Prolonged somatosensory evoked potential depression following a brief exposure to low concentrations of inhalation anaesthetic in a 3‐year‐old child
Authors: Gillerman Richard , Duncan John , Bolton James
Published: March 2003

A 3‐year‐old child was brought to the operating room for removal of a brainstem juvenile pilocytic astrocytoma. Following inhalation induction and intubation, he was maintained on 0.5% isoflurane. Somatosensory evoked potentials (SSEPs) were recorded but unobtainable initially and up to 90 min after all inhalation agents were discontinued. The operation was cancelled and the patient was transported to the paediatric intensive care unit (PICU). Subsequent PICU testing revealed a depression of amplitude with propofol and absence of potentials with 0.5% isoflurane. He returned to the operating room, was induced with propofol, and maintained with a propofol: nitrous oxide:fentanyl technique. This anaesthetic technique allowed adequate tumour resection with appropriate monitoring of SSEPs. These findings suggest that a total intravenous anaesthetic technique may be preferable for resection of spinal cord tumours where SSEPs are monitored.
Percutaneous central venous catheterization in small infants: axillary block can facilitate the insertion rate
Authors: Messeri Andrea , Calamandrei Marco
Published: March 2003

Central venous cannulation through a peripheral vein is the technique of choice in awake nonsedated critically ill infants. Such a technique has a high failure rate. We undertook a retrospective study to determine whether a brachial plexus block performed via the axillary approach could improve the success rate for the insertion of a central venous catheter from a peripheral vein of the upper limb in small infants. Data from 128 infants, submitted or not submitted to the axillary block, were analysed. The failure rate for insertion of the central venous catheter was 27% in the group without the use of the axillary block and 9% with the axillary block (P < 0.05). The use of brachial plexus block via the axillary route, although evaluated retrospectively, improves the success rate for the insertion of small diameter central venous silicon catheter from a peripheral vein of the upper limb in small infants.
Comparison of three techniques for internal jugular vein cannulation in infants
Authors: Verghese Susan T. , McGill Willis A. , Patel Ramesh I. , Sell Jeffrey E. , Midgley Frank M. , Ruttimann Urs E.
Published: March 2003

Central venous cannulation allows accurate monitoring of right atrial pressure and infusion of drugs during the anaesthetic management of infants undergoing cardiopulmonary bypass. In this prospective, randomized study, we compared the success and speed of cannulation of the internal jugular vein in 45 infants weighing less than 10 kg using three modes of identification: auditory signals from internal ultrasound (SmartNeedle, SM), external ultrasound imaging (Imaging Method, IM) and the traditional palpation of the carotid pulsation and other landmarks (Landmarks Method, LM). The cannulation time, number of attempts with LM and SM techniques were greater than those with IM technique. The incidence of carotid artery puncture and the success rate were not significantly different among the three groups. In infants, a method based on visual ultrasound identification (IM) of the internal jugular vein is more precise and efficient than methods based on auditory (SM) and tactile perception (LM).
Aspiration and regurgitation prophylaxis in paediatric anaesthesia
Authors: Engelhardt T. , Strachan L. , Johnston G.
Published: March 2003

Background: Surveys of aspiration prophylaxis in paediatric anaesthesia do not exist.

Methods: A postal survey was sent out to all UK members of the Association of Paediatric Anaesthetists (APA) to assess current practice. We asked about minimum fasting times for liquids and solids/milk, their routine acid aspiration prophylaxis and perceived risk factors for emergency and elective surgery in children those less than 1 year old and those aged 1–14 years. We also asked if the APA member had more than 10 years experience in paediatric anaesthesia.

Results: One hundred and two (55.1%) APA members replied out of a total of 185 questionnaires sent. Eighty‐eight (88/102) were considered valid. Fasting in emergencies is approximately 4 h for solids/milk and 2 h for clear liquids. Fasting for elective surgery is between 5 and 6 h for solids/milk and 2 h for clear liquids. Pharmacological methods to reduce the risk of aspiration are not used. Mechanical methods vary from 40–50% for cricoid pressure and 20–30% for nasogastric aspiration if a tube is present. The presence of a hiatus hernia is perceived by over 80% as a risk factor, previous aspiration by over 60%, difficult intubation, cerebral palsy and sepsis by 20–30%.

Conclusions: Perceived risk factors vary with ‘experience’: hiatus hernia, difficult intubation and cerebral palsy are less important whereas previous aspiration and renal failure appear to be more important for paediatric anaesthetists with less than 10 years in paediatric anaesthetic practice.
A comparison of single dose caudal tramadol, tramadol plus bupivacaine and bupivacaine administration for postoperative analgesia in children
Authors: Gunduz M , Ozcengiz D , Ozbek H , Isik G
Published: March 2003

Background: Our aim was to compare the effect of single dose caudal tramadol, tramadol plus bupivacaine and bupivacaine on the management of postoperative pain in children.

Methods: Sixty‐three children in ASA groups I–II, between the ages of 1 and 5 were evaluated for postoperative pain randomly divided into three groups as follows: In group T, only tramadol was given caudally; in group TB, tramadol–bupivacaine was given caudally; in group B, bupivacaine was given alone. Pain was evaluated by using the paediatric objective pain scale (POPS). Sedation was evaluated with a 5‐point test. There were no differences with age, weight, haemodynamic and respiratory parameters between groups.

Results: For 24 h postoperatively, the POPS value showed no statistically significant difference among groups (P > 0.05). Postoperative analgesia was maintained for 24 h. Nausea and vomiting was found to be higher in the tramadol group than in the bupivacaine group and tramadol–bupivacaine group (P < 0.001 and P < 0.01, respectively).

Conclusion: Tramadol used caudally is as effective as bupivacaine in the management of postoperative pain in children and the addition of tramadol to bupivacaine, when both drugs were administered caudally, did not prolong the duration of action of bupivacaine and is a safe agent in children.
Parents’ preferences for participation in decisions made regarding their child’s anaesthetic care
Authors: Tait Alan R. , Voepel‐Lewis Terri , Munro Hamish M. , Malviya Shobha
Published: March 2003

Background: The traditional paternalistic approach to medical decision‐making is moving towards a climate of greater patient and/or surrogate involvement. Despite this, there is considerable debate regarding patient preferences for participation in medical decision‐making and its effect on patient satisfaction and outcome. This study was designed to examine parents’ preferences for participation in decisions regarding their child’s anaesthetic care and to determine if active participation is associated with greater parental satisfaction.

Methods: Three hundred and eight parents of children scheduled to undergo elective surgical procedures were asked to complete a questionnaire detailing information regarding their preferences for participation in decisions made regarding their child’s anaesthetic care. Parents were classified as being passive, shared, or active decision makers.

Results: Overall, parents evidenced a preference for shared decision‐making with the anaesthetist. Parents preferred to be passive with respect to intraoperative pain management but active with respect to their presence when their child wakes up. There were no differences between active, shared and passive decision‐makers with respect to their satisfaction with anaesthetic care and their participation in decision‐making. However, 32.1% of parents stated that they would have preferred more involvement in decision‐making. These parents were significantly less satisfied with their child’s care than those who felt that their participation had been adequate.

Conclusions: This study highlights specific areas in which parents would prefer a more active role in decision‐making and, as such, may serve to focus anaesthetists’ efforts to educate parents with respect to the various options available for their child’s care.
Survey of the use of oesophageal and precordial stethoscopes in current paediatric anaesthetic practice
Authors: Watson Agnes , Visram Anil
Published: March 2003

Background: The aim of the study was to examine the use of oesophageal and precordial stethoscopes for monitoring in current paediatric anaesthetic practice in the UK and Ireland.

Methods: A postal survey of members of the Association of Paediatric Anaesthetist of Great Britain and Ireland was undertaken.

Results: One hundred and forty‐five questionnaires were returned with a response rate of 67.4%. Some 35.2% of anaesthetists never use an oesophageal or precordial stethoscope and the majority of the remaining 64.8% use one in less than one‐third of their practice.

Conclusions: Use of the stethoscope as a continuous monitor has decreased and most anaesthetists feel it has been superseded by other monitoring. However, almost one‐third of anaesthetists recorded critical incidents they had been involved with where an oesophageal or precordial stethoscope detected the incident early. Complications of these monitoring devices were rare and the main factors limiting their use was the presence of better monitoring, such as pulse oximetry and capnography, and lack of availability.
Downfolding of the epiglottis induced by the laryngeal mask airwayTM in children: a comparison between two insertion techniques
Authors: Tsujimura Yasue
Published: March 2003

Background: The purpose of this study was to compare the incidence of the downfolding of the epiglottis in children during insertion of the laryngeal mask airway (LMATM) using the standard technique and an alternative technique with the cuff partially inflated.

Methods: Eighty paediatric patients were randomized into two groups and were anaesthetized using the LMA inserted with one of the two techniques.

Results: There was no difference in the successful rate of insertion, fibreoptic findings and the lowest intraoperative SpO2 between the two groups.

Conclusions: The partially inflated cuff insertion technique does not increase the incidence of the downfolding of the epiglottis in children and would be an acceptable alternative to the standard technique.
The effects of an educational programme on the anxiety and satisfaction level of parents having parent present induction and visitation in a postanaesthesia care unit
Authors: CHAN CONNY S. M. , MOLASSIOTIS ALEXANDER
Published: March 2003

Background: In Hong Kong, some hospitals have established the practice of Parental Presence Induction (PPI) and visitation in Postanaesthesia Care Units (PACU) for children receiving surgery. The literature indicates that parents reported extreme anxiety and discomfort after being present at induction of anaesthesia and suggests that it would seem appropriate to devise a programme of education to reduce anxiety for parents.

Methods: A quasi‐experimental pretest and post‐test design was employed. Parents in the experimental group received an educational programme about the role and expectations of parents having PPI and visitation in PACU together with an information pamphlet. The comparison group received routine (verbal) instructions. The Chinese version of the State and Trait Anxiety Inventory and the Parental Satisfaction with Care Questionnaire were used to assess parents' anxiety and satisfaction with care.

Results: A total of 50 parents (mostly mothers) were recruited. Twenty‐five were allocated in the intervention group and 25 in the comparison group. The children were aged 1–9 years with a mean age of 2.9 years. There were 46 male and four female children. The results demonstrate that parents who received an education programme reported a decrease in anxiety (P < 0.001) and an increase in their satisfaction with the care provided (P < 0.001). A significant negative relationship (r=−0.61, P < 0.001) between parental anxiety postoperatively and the satisfaction with care score was also obtained, suggesting that lower levels of parental anxiety are associated with higher levels of satisfaction.

Conclusions: The study suggests that an educational programme preparing parents for their child's induction of anaesthesia and visitation to the PACU should be offered, as it can reduce their anxiety with the practice of PPI and visitation in the PACU and increase parents' satisfaction with care.
Reversible coma in children after improper baclofen pump insertion
Authors: ANDERSON KEITH J. , FARMER JEAN‐PIERRE , BROWN KAREN
Published: March 2003

We report the occurrence of delayed postoperative coma in five of nine consecutive children following surgery for insertion of baclofen infusion pumps. We suspect that improper technique resulted in an inadvertent administration of an intrathecal baclofen bolus. We suggest ways to minimize this risk.
Priorities for disclosure of the elements of informed consent for research: a comparison between parents and investigators
Authors: TAIT ALAN R. , VOEPEL‐LEWIS TERRI , ROBINSON ANGELA , MALVIYA SHOBHA
Published: March 2003

Background: Disclosure is a key element of the informed consent process. This study examines and compares the priorities for disclosure of the elements of informed consent between parents of paediatric research subjects and investigators.

Methods: The study sample comprised 184 parents who had been approached for permission to allow their child to participate in a clinical anaesthesia or surgery study. Parents were asked to rank 11 elements of informed consent that they believed were most important for them to know before allowing their child to participate in a research study. In addition, 38 investigators were asked to rank, in order of importance, the same elements that they felt were most important for parents to know.

Results: The results showed that risk was the most important element considered by both parents and investigators. However, parents placed significantly greater importance on knowledge of the potential benefits to their child (direct) and to other children (indirect) compared with investigators, and less importance on the details of the protocol and the element of voluntariness.

Conclusions: These results demonstrated differences in the priorities for disclosure of the elements of consent between parents and investigators. As such, they may be important in directing the investigator to focus on the elements that are most important to parents and thus maximize their ability to provide truly informed consent.
Tolerance of the rabbit cornea to an n‐butyl‐ester cyanoacrylate adhesive (Vetbond®)
Authors: Ollivier Franck , Delverdier Maxence , Regnier Alain
Published: March 2003

Objective
 An n‐butyl‐ester cyanoacrylate adhesive available for veterinary surgery (Vetbond®, 3M) was tested in rabbits for corneal irritation.

Procedures
 Two experimental procedures were used on 24 rabbits: injection of the adhesive into an intralamellar corneal pocket (n = 10) and application of the glue to a mid‐stromal corneal defect (n = 14). In both experiments the eyes were examined for 20 days for evidence of corneal irritation and tolerance. At the end of each experiment, histopathologic studies were performed on all corneas.

Results  The corneal reaction to the intrastromally injected cyanoacrylate was characterized clinically by slight edema and vascularization localized to the vicinity of the adhesive. A moderate foreign body‐type reaction was found histologically. Following application of the adhesive to a central stromal defect, the treated corneas remained totally clear and histopathologic examination showed that the healing process was not altered compared to the controls. The mean retention time of the glue patch was 14 days.

Conclusions  Intrastromal injection and surface application to a corneal defect of n‐butyl‐ester cyanoacrylate to a corneal defect induced only a mild inflammatory response and did not interfere with the reparative process. These findings suggest that this surgical adhesive would be acceptable for treating corneal ulcerations in animals.