bluuebunny/crossref_metadata_2025 huggingface dataset:
What child health nurses believe mothers with infants expect of them
Authors: Fägerskiöld Astrid M. , Wahlberg Vivian , Ek Anna‐Christina
Published: March 2003

Abstract The aims were to identify what the child health nurse believed was expected of her by women who had recently become mothers, primipara and multipara, to investigate which problems the nurse found most difficult to deal with and to analyse why they were difficult. The grounded theory method was employed for conducting interviews with 15 nurses. The data analysis showed that the nurses thought mothers expected care of the infant and the family from the nurse, comprising support, advice and child health assessments. What the nurses found most difficult to deal with were obstacles to interaction with mothers such as motherhood problems, hidden, social and organisational problems. They wanted to have a positive interaction with mothers to be able to fulfil the task of supporting parents and identifying risks to the child's healthy upbringing. This task places great demands on nurses' competence and knowledge about the child and family.
An Exploration and Description of the Manifestations and Nursing Management of Agitated Behaviour in Institutionalised Residents with Dementia
Authors: Keatinge Diana
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Home Health Care Utilization by the Elderly
Authors: Lee Taewha
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Psychophysiological Effect of Massage and Shiatsu While in the Prone Position with Face Down
Authors: Inagaki Junko , Yoneda Junko , Ito Misae , Nogaki Hiroshi
Published: March 2003

The purpose of this study was to examine the psychophysiological effects of shiatsu and massage while in the prone position. Twenty‐four healthy women gave informed written consent to participate. After resting in the prone position for 50 min, each subject was massaged and given shiatsu for 15 min and again rested for 15 min in the prone position. Every 5 min, skin temperature was measured along the neck and back. Blood pressure and pulse rate also were measured every 5 min throughout the procedure. A visual analog scale was used to assess the severity of pain experienced before the massage and shiatsu as well as at completion of the procedure. The subject's favorite sleeping posture and previous physical pain experienced during massage and shiatsu were assessed. The findings revealed that significant differences were found in skin temperatures (elevated 0.5 degrees) along the back after the procedure. Systolic blood pressure was found to be significantly lower after the massage and shiatsu when compared with systolic blood pressure prior to the procedure. No significant differences before and after the procedures were found in either the diastolic blood pressure or pulse rate. The procedure was found to give the subjects relief from pain. No significant differences were noted in the subject's favorite sleeping posture, the experience of previous physical pain, or the experience of the massage and shiatsu.
Health‐Care Policy for Korean Elderly
Authors: Choi Young Hee
Published: March 2003

Due to advances in medicine and economic development, the percentage of Korean elderly is increasing markedly. If preparation is not made for the coming aged society, there is a possibility that the development of the Korean nation will be hindered. The increase in the number of the elderly is increasing the social/national burden of providing medical care for the elderly. Meanwhile, with the trend toward the nuclear family, the increase of female participation in social activities, and the increase of elderly who live alone, it is difficult for nursing homes alone to solve the problem of providing support for the elderly. Long‐term medical treatment and care of the elderly has become the responsibility of both the government and society. Under these conditions, the Korean policy for elderly patients can be classified broadly into home care, community care, and institutional care. In order to prepare for the aged society, deficient facilities need to be supplemented and home care and community care need to be expanded so as to increase the communities’ ability to support the elderly . Homes, communities, government and the private sector should work together to provide integrated welfare and health care to the elderly.
Work sampling: Valuable methodology to define nursing practice patterns
Authors: Pelletier Dianne , Duffield Christine
Published: March 2003

Abstract The volatile clinical and managerial environment of today's health care system demands that the nursing sector regularly evaluates how staff deliver care. Management's central purpose is to support clinical core activities, striving for a reasonable balance between cost effectiveness and quality care. Various methodologies, such as work sampling and time‐and‐motion studies, have been used to explore work‐related activities. As a cost‐effective and useful methodology, work sampling warrants more in‐depth exploration of the various techniques involved to ensure nurse managers, clinicians and researchers appreciate the complexities of the approach and its potential to contribute to an understanding of nursing work. The present paper describes work sampling as a method, reviews its use through the literature and outlines some of its advantages and disadvantages in comparison to the time‐and‐motion methodology, a method similar in many ways. It is intended to enhance readers’ appreciation of work sampling's potential value to nurses and other health professionals, and to enhance the understanding of the difference between work sampling and time‐and‐motion studies.
Retroperitoneoscopic treatment of a retrocaval ureter
Authors: Mugiya Soichi , Suzuki Kazuo , Ohhira Tomoaki , Un‐No Toshiyuki , Takayama Tatsuya , Fujita Kimio
Published: March 2003

Background
: Retroperitoneoscopic surgery was performed on a 41‐year‐old man with a retrocaval ureter.

Methods
: The retrocaval segment of the ureter was retroperitoneoscopically separated and the ureter was reanastomosed using an automatic suture device.

Results/Discussion
: He returned to normal activities four days postoperatively. Postoperative excretory urography showed improvement of hydronephrosis and no residual stenosis.
Simultaneous bilateral renal pelvic tumors
Authors: TSUJIKAWA KOZO , MIYAKE OSAMU , MATSUMIYA KIYOMI , OKUYAMA AKIHIKO
Published: March 2003

Background: A 72‐year‐old man was admitted with gross hematuria. Investigations revealed bilateral renal pelvic tumors.

Methods/Results: Via a midline incision, left nephroureterectomy with bladder cuff resection was performed for the large left‐sided tumor. The right small solitary right‐sided tumor was endoscopically resected simultaneously. Histologically, both tumors were grade 2 transitional cell carcinomas without muscular invasion.

Conclusion: There has been no evidence of recurrence or metastasis 30 months postoperatively.
Pelvic congestion syndrome caused by inferior vena cava reflux
Authors: Sugaya Kimio , Miyazato Tomonori , Koyama Yuzo , Hatano Tadashi , Ogawa Yoshihide
Published: March 2003

We present a female patient who had pelvic congestion syndrome caused by inferior vena cava reflux associated with tricuspid regurgitation, but without other symptoms or signs related to her tricuspid regurgitation. Bladder pumping therapy was effective in improving her symptoms.
Primary carcinoid tumor in a horseshoe kidney
Authors: Isobe Hideyuki , Takashima Hideo , Higashi Naotaka , Murakami Yukito , Fujita Kazuhiko , Hanazawa Kisaburo , Fujime Makoto , Matsumoto Toshiji
Published: March 2003

A case of primary carcinoid tumor arising within a horseshoe kidney in a 51‐year‐old woman is reported. The tumor was found incidentally by computed tomography (CT) during a check‐up for a suspected gall bladder polyp. Histologic, immunohistochemical and electron microscopic analyses of this tumor revealed features typical of carcinoid tumor. Primary carcinoid tumor of the kidney is extremely rare and only 32 cases were previously reported, including five cases in horseshoe kidneys. None of these five cases in horseshoe kidneys demonstrated any evidence of local or distant metastases and all were alive at the time of reporting without evidence of disease after up to 3 years of follow up. The present case, even with accompanying lymph nodal metastasis, also has had no evidence of local recurrence or distant metastasis for 3 years post operation. Primary carcinoid tumor arising within horseshoe kidneys appear to be more benign than those within non‐horseshoe kidneys.
Renal cell carcinoma in an L‐shaped kidney
Authors: Sugita Shyozo , Kawashima Hidenori , Nakatani Tatsuya , Yoshimura Rikio , Wada Seiji , Sugimura Kazunobu , Kishimoto Taketoshi
Published: March 2003

A 64‐year‐old man with a chief complaint of an asymptomatic abdominal mass was diagnosed as having a renal cell carcinoma in his L‐shaped kidney. He was successfully treated with partial nephrectomy following selective embolization of the feeder artery. It is thought to be the first reported case of renal cell carcinoma occurring in an L‐shaped kidney.
Complicating risk factors for pyelonephritis after extracorporeal shock wave lithotripsy
Authors: Fujita Kimio , Mizuno Takuji , Ushiyama Tomomi , Suzuki Kazuo , Hadano Shinsuke , Satoh Shigenori , Kambayashi Tomoyuki , Mugiya Soichi , Nakano Masaru
Published: March 2003

Purpose
: The score to predict the risk of post‐extracorporeal shock wave lithotripsy (ESWL) pyelonephritis was evaluated. The score was based on the multivariate analysis of risk factors available pre‐operatively. Stone size, pyuria, bacteriuria, previous pyelonephritis and other adjunctive procedures had been selected and scored.

Methods
: Three‐hundred and forty‐eight adult patients without active urinary infection undergoing ESWL therapy were studied. One of three regimens were selected by either doctor or patient: (i) no antimicrobial treatment; (ii) one dose of levofloxacin; or (iii) 1 week course of levofloxacin. Who and why selected it were described. Post‐ESWL fever over 38°C was defined as the unfavorable event.

Results/conclusion
: With increasing score, doctors recommend taking an antimicrobial. There were 11 bacteriuric patients and post‐ESWL pyelonephritis developed in one of them. Bacteria within the stone and post‐ESWL ureteral obstruction caused by the stone fragments were considered to be important in developing pyelonephritis. However, multiple factors were related with it. Although their decision was not based simply on the score, the score was confirmed to be useful in identifying the high‐risk patients and, therefore, to implement cost‐effective antimicrobial use.
Solitary fibrous tumor of the prostate
Authors: Sekine Hideaki , Ohya Kazuhiro , Kojima Shin‐Ichi , Mizuguchi Kunio
Published: March 2003

Abstract An extremely rare case of solitary fibrous tumor of the prostate is presented. The patient underwent a radical retropubic prostatectomy and has remained well with no evidence of recurrence during the last 18 months. This is the fifth reported case of such a lesion arising in the prostate.
Endocrine therapy for recurrence after definitive radiotherapy in patients with prostate cancer
Authors: Furuya Yuzo , Akakura Koichiro , Tanaka Masashi , Ichikawa Tomohiko , Igarashi Tatsuo , Murakami Shino , Ito Haruo
Published: March 2003

AbstractBackground:Long‐term results were analyzed to evaluate the role of endocrine therapy in the management of local and distant recurrence of prostate cancer following external radiation therapy.

Methods:Between 1976 and 1994, 92 patients with untreated prostate cancer underwent external beam radiation therapy alone. Endocrine therapy had been started when relapse was evident.

Results:Failure was seen in 35 of 92 patients: 10 local, 19 distant and six biochemical failures. Endocrine treatment was performed in 28 patients with nine local and 19 distant failures. The cancer‐specific survival rate from the endocrine treatment was 54.5% at 5 years. Prostate‐specific antigen level in 20 of 20 patients (100%) decreased to below the normal limit 3 months after the start of endocrine therapy. In univariate analysis, T classification was the most significant variable for cancer‐specific survival from the initial treatment.

Conclusions:A favorable outcome was achieved by endocrine therapy in patients who had relapsed after external beam radiation monotherapy. Even the recurrent tumor had a sensitivity to androgen. Patients with locally advanced disease (T2b and T3) had poorer prognosis than those with minimally extended disease (T1b and T2a).
Primary carcinoid of the testis associated with carcinoid syndrome
Authors: Hayashi Tokumasa , Iida Shizuka , Taguchi Jun , Miyajima Jiro , Matsuo Mitsunori , Tomiyasu Katsuro , Matsuoka Kei , Noda Shinshi
Published: March 2003

Abstract Testicular carcinoid is a rare disease accounting for less than 1% of all testicular neoplasms. It rarely manifests symptoms of carcinoid syndrome. Recent reports have noted that only 1.1–3.1% of testicular carcinoid tumors are complicated by carcinoid syndrome. In general, large tumor size and the presence of carcinoid syndrome are features associated with a malignant course. In the present case, pathological findings revealed pure carcinoid of the testis without metastasis. Moreover, watery diarrhea due to carcinoid syndrome disappeared and the serum serotonin level normalized following orchiectomy. The patient was followed up for 12 months with whole body computed tomography scan and assessment of serotonin levels. To date, there is no evidence of tumor recurrence. These findings suggest that monitoring serum serotonin levels may be useful as a marker during follow up of this type of tumor.
Successful treatment of low‐flow priapism associated with phenothiazine therapy
Authors: Kondoh Nobuyuki , Yoshimoto Tetsuro , Nojima Michio , Takiuchi Hidekazu , Ihara Hideari , Mori Yoshinori , Shima Hiroki
Published: March 2003

Abstract We present a case of low‐flow priapism that was successfully treated. A 21‐year‐old man with a history of schizophrenia was admitted with a painful complete erection. He had taken propericiazine, phenothiazine derivatives, before hospitalization and was treated with a glandular–cavernosal shunt (El‐Ghorab's procedure). Currently, he is able to have erections without any changes in his quality of life.
Malignant fibrous histiocytoma of the right spermatic cord: A case report
Authors: Sekine Yoshitaka , Ohki Kazunari , Okamoto Kohei , Nomura Masashi , Tomita Hikaru , Ohtake Nobuaki , Suzuki Kazuhiro , Kurokawa Kohei , Mashimo Masamichi , Saruki Kazuhisa , Morita Takahiro , Nakazato Haruki , Yokoo Hideaki , Yamanaka Hidetoshi
Published: March 2003

Abstract The patient was a 47‐year‐old male, who visited Hidaka Hospital with a chief complaint of swelling in the right inguinal region and the scrotum. With a diagnosis of a right spermatic cord tumor, right high orchiectomy was performed. Since an inflammatory type of malignant fibrous histiocytoma (MFH) was diagnosed from histopathological findings, chemotherapy and radiation therapy were performed as postoperative treatment. Malignant fibrous histiocytoma with the primary focus of the spermatic cords is a rare disease. To our knowledge, this is the 20th case of MFH of the spermatic cord in Japan (the 42nd in the world) and it is the second case of inflammatory type of MFH in Japan.
Value of prostate specific antigen α1‐antichymotrypsin complex for the detection of prostate cancer in patients with a PSA level of 4.1–10.0ng/mL: Comparison with PSA‐related parameters
Authors: Miyake Hideaki , Hara Shoji , Nomi Masashi , Arakawa Soichi , Kamidono Sadao , Hara Isao
Published: March 2003

Background:

The aim of the present study was to evaluate the usefulness of prostate specific antigen α1‐antichymotrypsin complex (PSA‐ACT) in the differential diagnosis of prostate cancer in patients with a PSA level of 4.1–10.0 ng/mL compared to several PSA‐ and PSA‐ACT‐related parameters.

Methods:

Serum samples were obtained from 103 patients with no evidence of malignancy on biopsy and 29 with histologically confirmed prostate cancer. All patients had pretreatment serum PSA levels between 4.0 and 10.0 ng/mL. The different forms of serum PSA, including total PSA (tPSA), free PSA (fPSA) and PSA‐ACT were measured using immunofluorometric techniques with different monoclonal antibodies against PSA and ACT. Furthermore, tPSA and PSA‐ACT densities of the whole prostate (PSAD and ACTD, respectively) and the f‐to‐tPSA and the f‐to‐PSA‐ACT ratios (F/T ratio and F/ACT ratio, respectively) were calculated.

Results:

The differences between patients with prostate cancer and benign prostatic disease were significant with respect to all six parameters examined in this study. Analysis of receiver operating characteristics revealed that the areas under the curve for PSA‐ACT, ACTD and the F/ACT ratio were larger than those for tPSA, PSAD and the F/T ratio, respectively. However, there were no significant differences in discrimination between benign and malignant diseases among these six parameters.

Conclusions:

In patients who have an intermediate serum PSA level, PSA‐ACT and its associated parameters may not be significantly superior in the differential diagnosis between prostate cancer and benign prostatic diseases compared to tPSA and its traditional relatives.
Mycobacterium tuberculosis infection of bilateral cervical lymph nodes after renal transplantation
Authors: Ishikawa Kiyohito , Hoshinaga Kiyotaka , Maruyama Takahiro , Izumitani Masanobu , Shiroki Ryoichi
Published: March 2003

We report the case of a 52‐year‐old man who underwent a renal transplantation and subsequently developed extrapulmonary tuberculosis. The immunosuppressive agent was intravenously administered continuously together with antituberculosis drugs. The tuberculosis improved and renal function has been well preserved for more than 3 years post transplantation.
Adrenal leiomyosarcoma extending into the right atrium
Authors: MATSUI YOSHIYUKI , FUJIKAWA KEITA , OKA HIROYA , FUKUZAWA SHIGEKI , TAKEUCHI HIDEO
Published: March 2003

Abstract Primary soft tissue sarcoma of the adrenal gland is very rare and aggressive. In right adrenal tumors, because of direct venous drainage into inferior vena cava, the tumor may invade the vena caval wall toward the right atrium. We present a case of adrenal leiomyosarcoma extending into the right atrium.
Adult‐onset idiopathic hypogonadotropic hypogonadism presented with erectile and ejaculatory disorder
Authors: KOBAYASHI TAKASHI , OKUNO HIROSHI , NISHIYAMA HIROYUKI , NAKAMURA EIJIRO , OGAWA OSAMU , KAWAHARA MASAHIRO , SHIMATSU AKIRA
Published: March 2003

A 37‐year‐old man who had fathered a child five years previously presented with erectile and ejaculatory disorder. Endocrinological examinations revealed isolated luteinizing hormone‐releasing hormone (LHRH) deficiency of hypothalamus, resulting in hypogonadotropic hypogonadism, and no causative abnormality was detected in imaging studies, including magnetic resonance imaging (MRI). Having a diagnosis of adult‐onset hypogonadotropic hypogonadism, the patient received pulsatile subcutaneous administration of gonadotropin‐releasing hormone (GnRH). Sperm analysis and serum level of testosterone improved to normal in a few months. His wife became pregnant using artificial insemination with her husband's semen 15 months after the beginning of the treatment.
Ultrasonographic changes of the female bladder neck during development
Authors: SUGAYA KIMIO , NISHIJIMA SAORI , ODA MASAMI , OWAN TOMOKO , ASHITOMI KATSUHIRO , MIYAZATO MINORU , MOROZUMI MAKOTO , HATANO TADASHI , OGAWA YOSHIHIDE
Published: March 2003

Background: Our previous study showed that the anteroposterior vesical wall angle (APVA) at the bladder neck on transabdominal ultrasonography varied widely between women. The present study examines whether the APVA changes during development in girls with a normal bladder.

Methods: Seventy‐four females aged 0–29 years with normal bladders were examined by transabdominal ultrasonography. They were divided into six age groups and their APVA was measured in the supine position by sagittal ultrasonography. Intravenous urography was conducted to examine bladder neck descent and bladder neck opening.

Results: The APVA ranged from 85 to 200°. The mean APVA in girls aged 0–4 years was 129 ± 30° (±SD) and the mean APVA in girls aged 5–9 years was 135 ± 25°. The mean APVA at ages 10–14 years was 161 ± 26°; at 15–19 years, 164 ± 33°; at 20–24 years, 164 ± 18°; and at 25–29 years, 163 ± 16°. The APVA values of these four groups were significantly larger (P < 0.05) than those of the two younger groups. No bladder abnormalities were found on intravenous urography.

Conclusion: The APVA was small in some girls under 10 years of age, but the APVA of girls aged over 10 years was similar to that in young adults. The APVA may reflect bladder base plate tone and be partially related to hormonal changes in females during development.
Benchmarking ambulance call‐to‐needle times for thrombolysis after acute myocardial infarction in Australia:  a pilot study
Authors: Kelly A‐M. , Kerr D. , Patrick I. , Walker T.
Published: March 2003

Background: Thrombolysis for patients with acute myocardial infarction (AMI) is of greatest benefit when treatment is commenced as soon as possible after symptom onset. The British Heart Foundation (BHF) recently set a benchmark recommending that eligible patients with AMI receive thrombolytic therapy less than 90 min after calling for medical assistance.

Aims: The purpose of this study was to compare the performance of an urban emergency service to this benchmark. A secondary objective was to determine whether patients treated outside this time were at a greater risk of mortality.

Methods: This study consisted of an explicit retrospective analysis of medical records for all patients who presented by ambulance to the Emergency Department (ED) of Western Hospital and received thrombolysis for AMI within 12 h of symptom onset. The study was conducted for the 18‐month period between 1 January 1999 and 30 June 2000. Information collected included times of: (i) symptom onset, (ii) call for ambulance, (iii) ambulance response, (iv) transport to hospital and (v) thrombolysis, as well as final diagnosis and in‐hospital mortality. For the purposes of this study, call‐to‐needle time (CTN) was defined as the time between calling the ambulance and commencement of thrombolytic therapy.

Results: One hundred and twenty‐seven patients met the inclusion criteria. Median CTN was 81 min (range 42−279 min). Sixty‐four per cent of patients were treated within the 90‐min benchmark. The relative risk of mortality for patients treated outside the 90‐min benchmark was 2.6 (95% CI 0.98−6.72).

Conclusion: This study showed that the BHF benchmark for CTN was not being met for over one‐third of patients in the study region, with potential impact on mortality after AMI. Further research is needed to establish: (i) whether there is relationship bet‐ween longer transportation times and mortality, (ii) whether the findings of this study may be applied to other regions and (iii) what strategies might be employed to reduce CTN. (Intern Med J 2002; 32: 138−142)
Haemochromatosis: iron still matters
Authors: Bassett M. L.
Published: March 2003

Our ability to detect those predisposed to haemochromatosis is greatly enhanced by testing for HFE mutations. Ironically, this diagnostic advance has led to some confusion regarding the criteria for diagnosis of haemochromatosis, with overreliance on genetic testing instead of investigations for iron overload. Because many people who are homozygous for the C282Y mutation, or compound heterozygous for the C282Y and H63D mutations, either do not express or only partially express the disease, it is essential to confirm a diagnosis of haemochromatosis on the basis of increased body iron stores. Liver biopsy remains the best method of confirming this and has an important role in the patient with either borderline iron overload or advanced disease. Persistent elevation of serum ferritin concentration in the absence of overt liver damage, inflammation or neoplasia, and estimation of mobilized body iron by repeated phlebotomy, are reasonable alternatives to liver biopsy. Although the precise definition of iron overload is debated, a diagnosis of haemochromatosis cannot be made without demonstrating increased body iron stores. (Intern Med J 2001; 31: 237–242)
Spondyloarthropathies: an overview
Authors: Stafford L. , Youssef P. P.
Published: March 2003

Abstract

Spondyloarthropathies are important and common inflammatory arthropathies that occur in approximately 2% of the population. They are often underrecognized. The diagnosis features the presence of asymmetrical, predominately lower limb arthritis and/or inflammatory back pain. The spondyloarthropathies can be subdivided into several disease subcategories, including ankylosing spondylitis, Reiter’s/reactive arthritis, psoriatic arthritis, inflammatory bowel disease‐associated arthritis and a large group of undifferentiated spondyloarthritis. The interactions between infectious agents and the individual’s genetic background are important aetiological factors. Therapies for these conditions include physical therapy, non‐steroidal anti‐inflammatories and disease‐modifying drugs. (Intern Med J 2002; 32: 40–46)
Control of nausea and vomiting after chemotherapy: what is the evidence?
Authors: Bartlett N. , Koczwara B.
Published: March 2003

Abstract

The control of nausea and vomiting is an important problem for patients undergoing chemotherapy. With the introduction of newer agents, including 5‐HT3 antagonists, nausea and vomiting control after chemotherapy has much improved but is not always optimal. While there is an intrinsic limitation to the efficacy of anti‐emetic drugs, their efficacy can be further reduced if the drugs are not used approp­riately. In some circumstances newer anti‐emetics may be unnecessary and better nausea and vomiting control may be established by use of older agents. This paper summarizes current evidence regarding the optimal approach to management of nausea and vomiting in patients undergoing chemotherapy. (Intern Med J 2002; 32: 401−407)
Trends and expectations for research and technology in the Asia‐Pacific region
Authors: Kim Kil Ung
Published: March 2003

The present paradigm in weed science should be restructured to meet the challenges of the 21st century for sufficient food production without environment hazards. The scope of weed science should be expanded to accommodate biotechnology in weed science, to breed genetically modified (GM) crops, allelopathic (weed‐suppressing) crops and highly competitive crops, and to utilize all the useful genes for bioproduction through re‐evaluation of the virtues of weeds and weed relatives. Adoption of GM crops needs further testing for all possible risks suggested. Risk assessment and monitoring of herbicides are needed in an agro‐ecosystem. International collaboration is needed to share information on weed management practices and to install international centers for weed inventory and farmer participatory training.
Differential glutathione S‐transferase isozyme activities in rice and early watergrass seedlings
Authors: Usui Kenji , Deng Fan , Nagao Akiko , Shim Ie Sung
Published: March 2003

Glutathione S‐transferase (GST) isozymes were investigated in one‐leaf‐stage rice (Oryza sativa L. cv. Nipponbare) and early watergrass (Echinochloa oryzicola Vasing) shoots after being induced by treatment with a combination of pretilachlor [2‐chloro‐2′,6′‐diethyl‐N‐(2‐propoxyethyl)acetanilide] and fenclorim (4,6‐dichloro‐2‐phenylpyrimidine) using DEAE‐Sephacel anion exchange chromatography. Non‐treated plants contained GST isozymes that had activity to the following substrates: three isozymes for l‐chloro‐2,4‐dinitrobenzene (CDNB), six isozymes for pretilachlor and three isozymes for fenclorim in rice shoots; and four isozymes for CDNB, three or four isozymes for pretilachlor and two or three isozymes for fenclorim in early watergrass shoots. Glutathione S‐transferase isozyme activities of non‐treated plants were higher in rice than in early watergrass, especially in the case of GST activity with fenclorim as a substrate. Pretreatment of rice roots with a combination of pretilachlor and fenclorim increased the activity of the constitutively expressed isozymes that exhibited activity with CDNB, pretilachlor and fenclorim. This pretreatment also caused the appearance of one new GST(fenclorim) isozyme. Pretreatment of early watergrass roots with a combination of pretilachlor and fenclorim produced almost no increase in activity of some constitutively expressed isozymes that exhibited activity to CDNB and fenclorim, although it partly increased the peaks to corresponding to pretilachlor. The induction of GST was higher in rice than that in early watergrass. These results indicated that the isozyme pattern and substrate specificity of GST isozymes in rice were different from those in early watergrass. Furthermore, the selectivity of pretilachlor between rice and early watergrass may be related to different constitutively expressed GST(pretilachlor) isozyme activities and the induction of GST(pretilachlor) isozyme activities in the combination treatment.
Oral transmucosal fentanyl citrate as an anaesthetic premedication when dosed to an opioid effect total opioid consumption
Authors: GINSBERG  , DEAR  , MARGOLIS  , DeL. DEAR  , ROSS
Published: March 2003

Thirty min prior to anaesthetic induction for surgery, children aged 4–12 years old were given a 10 μg·kg−1 oral transmucosal fentanyl citrate (OTFC) and were instructed to suck the OTFC until pruritus appeared (Group 2) or until the entire dose was consumed (Group 1). Sedation, apprehension and cooperation scores were rated, and vital signs including oxygen saturation were monitored until anaesthetic induction. The results showed that pruritus was present in 76% of children; however; in all but one child, it occurred after the OTFC had been completely consumed. There were no significant changes in oxygen saturation, but respiratory rate decreased from 19.6±1.7 to 18.4±1.3. Activity decreased significantly; however, cooperation and apprehension did not change. The conclusion was that pruritus cannot be used as an endpoint for OTFC effectiveness; however, OTFC dosed at 10 μg·kg−1 is effective in providing sedation without causing clinically significant changes in vital signs or oxygen saturation.
Comparison of morphine requirements for sedation in Down's syndrome and non‐Down's patients following paediatric cardiac surgery
Authors: GAKHAL BALVINDER , SCOTT CHRISTY SILVIUS , MACNAB ANDREW J.
Published: March 2003

Anaesthetists recognize that children with Down's syndrome require special management in a number of clinical situations. There is a widespread clinical impression that it is difficult to achieve adequate sedation and that, following cardiac surgery, these children require higher doses of morphine and additional sedative agents compared to patients without Down's syndrome. We conducted a retrospective chart review of 16 Down's syndrome and 16 matched non‐Down's syndrome children who underwent cardiac surgery between 1984 and 1991. The average dose of morphine (continuous infusion) administered per hour was higher in the Down's syndrome group than in the non‐Down's syndrome group. The difference was not statistically or clinically significant until the third postoperative day. Down's syndrome patients were more likely to still be receiving morphine on Day 3 than non‐Down's patients ( P<0.05). The Down's syndrome patients were also more likely to receive additional sedatives and skeletal muscle relaxants.
Tunnelling of caudal epidural catheters in infants
Authors: Vas Lakshmi , Naik Veena , Patil Bharati , Sanzgiri Savitha
Published: March 2003

The working conditions in the developing world necessitate the development of many adaptations and improvizations of accepted anaesthetic techniques to improve patient care. Subcutaneous tunnelling of caudally placed epidural catheters is one such improvization to prevent the soiling of the catheter by urine and faeces. This study compares the duration of retention of catheter in a group with tunnelled catheters with an untunnelled group. The absence of a catheter emerging through skin at the site of catheter insertion hastens healing thus prolonging the retention of catheter in the tunnelled group and soiling ceases to be a major problem.
Superior vena cava obstruction and liver transplantation in a child
Authors: Stewart Penelope C.H. , Baines David B. , Harrison Victor L.
Published: March 2003

We report a case of superior vena cava obstruction in a child, which was probably secondary to long‐term central venous cannulation. The obstruction was asymptomatic preoperatively, but became evident during liver transplantation, and complicated the intraoperative management. There is one other case report of this occurring in an adult in similar circumstances, and we believe that ours is the first report of such a presentation in the paediatric age group.
Traumatic pharyngo–oesophageal perforation in the newborn: a condition mimicking oesophageal atresia
Authors: Pumberger W. , Bader T. , Golej J. , Pokieser P. , Semsroth M.
Published: March 2003

Two newborn infants with traumatic perforation of the pharyngo–oesophageal region are presented. This injury was induced by pharyngeal suction catheters and/or vigorous attempts at nasogastric or tracheal intubation during resuscitation of the newborn. The true nature of this condition remained unrecognized and the babies were thus referred with a tentative diagnosis of oesophageal atresia. The perforation itself could be treated successfully without surgery, despite a severe complication in one infant resulting from inadvertent use of barium sulphate contrast medium. Raising awareness of the possibility of this injury should help in avoiding this complication by gentle and skilful action during newborn resuscitation, particularly in the premature infant.
Anaesthetic management of a 6‐week‐old child with unilateral pulmonary interstitial emphysema
Authors: Mccartney C.J.L. , Johnston G.
Published: March 2003

We report the case of a 6‐week‐old female infant suffering from respiratory distress related to cystic changes affecting the entire left lung. Anaesthesia was induced with sevoflurane in oxygen and spontaneous ventilation was maintained until intubation of the right main bronchus was secured. A left pneumonectomy was performed and the postoperative course was uneventful. The pathological diagnosis was pulmonary interstitial emphysema. This has not been previously reported in an otherwise normal child delivered uneventfully at term. The anaesthetic management of a child with a cystic lung lesion is discussed.
Persistent mydriasis following intravenous atropine in a neonate
Authors: Yung Michael , Herrema Idse
Published: March 2003

A neonate whose mother had recently taken amitriptyline developed fixed dilated pupils after a modest dose of intravenous atropine. Interaction of atropine with neonatal amitriptyline levels is suggested and evidence of neonatal effects from maternal antidepressant use is examined. There were no neurological sequelae, and the neonate’s pupils became reactive again after 7 h.
Positive test dose in a neonate with a caudally placed epidural catheter
Authors: Mancuso Thomas J. , Bacsik Julianne , Overbey Evelyn
Published: March 2003

We present a case of a neonate with an epidural catheter placed via the caudal route after induction of general anaesthesia in whom the test doses of epinephrine‐containing local anaesthetic was positive on two occasions. Remarkable tachycardia was noted after each of two separate injections through the catheter. Blood was never aspirated from the catheter and placement was without difficulty. After the catheter was removed, blood was noted at the tip.
Retracted: The efficacy of oral clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery
Authors: Handa Fumi , Fujii Yoshitaka
Published: March 2003

We evaluated the efficacy of clonidine given orally preoperatively for preventing postoperative vomiting (POV) in children undergoing propofol‐nitrous oxide anaesthesia for strabismus surgery. Sixty children, ASA physical status I, aged 2–12 years, received diazepam, 0.4 mg·kg–1 or clonidine 4 μg·kg–1 (n=30 each) orally, in a randomized double‐blind manner. These drugs were given 105 min before an inhalational induction of anaesthesia. A complete response, defined as no POV and no need for rescue antiemetic medication, during 0–24 h after anaesthesia was 67% with diazepam and 93% with clonidine, respectively (P=0.024). No clinically adverse event was observed in any of the groups. In summary, pretreatment with oral clonidine enhances the antiemetic efficacy of propofol for the prevention of POV after paediatric strabismus surgery.
Transoesophageal echocardiographic monitoring during paediatric cardiac surgery: obtainable information and feasibility in 532 children
Authors: Sloth Erik , Pedersen Jens , Olsen Kirsten Hjortholm , Wanscher Michael , Hansen Ole Kromann , Sørensen KELD E.
Published: March 2003

Background: We hypothesized that transoesophageal echocardiography (TOE) performed by the anaesthesiologists would be beneficial for monitoring purposes during paediatric cardiac surgery. We present the results for the first 5 years in 532 consecutive children.

Methods: The probe was successfully inserted in 99% of cases and remained in the oesophagus for 211 min on average (range 10–555 min).

Results: Insignificant valve leak, single‐ or biventricular failure and volume depletion were the most common new findings due to TOE. Changes in inotropic strategy and volume replacement were the most frequent interventions. In 45% of the cases, new information was disclosed and, in a total of 8% of cases, decisive information was provided. Except for tracheal extubation in one child who was uneventfully reintubated, no severe complications were identified.

Conclusions: These data stress the safety and ease of performing TOE in children undergoing cardiac surgery. There is evidence for benefit from TOE findings to potentially enhance the therapeutic basis.
Perioperatively acquired methaemoglobinaemia in a preterm infant
Authors: Voelker Cynthia A. , Brown Lee , Hinson Roger M.
Published: March 2003

Methaemoglobinaemia is an uncommon cause of neonatal cyanosis. A case that illustrates the aetiology, diagnosis, and treatment of this condition is presented.
Severe epiglottic prolapse and the obscured larynx at intubation
Authors: Vaz F.M. , Neumann A.M. , Albert D.
Published: March 2003

Laryngomalacia is the most common congenital anomaly of the larynx and usually involves prolapse of the arytenoids, so‐called `posterior laryngomalacia'. Most cases resolve with growth of the child and maturation of the larynx, although, rarely, significant airway obstruction can be present. Severe laryngomalacia preventing intubation is rarely encountered. We report a case of a difficult emergency intubation secondary to `anterior laryngomalacia' in a 4‐month‐old boy in whom the epiglottis prolapsed posteriorly and became trapped in the laryngeal introitus. The child was referred with a diagnosis of laryngeal atresia on the basis of the intubating laryngoscopic view of no apparent epiglottis or laryngeal inlet. The child was transferred with a tube in the oesophagus that kept the child oxygenated. At the time, oxygenation was felt to be due to a coexisting tracheo‐oesophageal fistula, although this was eventually found not to be the case.
An Audit of Preoperative Behaviour and Premedication Practise at Great Ormond Street Hospital
Authors: Meyer T.E. , Lakheeram I.
Published: March 2003

Introduction  Despite advances in anaesthesia many children are distressed at induction of anaesthesia (1). The use of paediatric premedication has declined considerably over the last ten years (2). The aim of our audit was to look at preoperative behaviour and premedication practice at our institute.

Method  One hundred and seventy seven patients undergoing elective procedures in the main theatre suite at the hospital were audited. This therefore excluded cardiac and neuroanaesthesia. Behaviour scores in the anaesthetic room prior to and at induction were assessed by the operating department assistants. We looked at frequency, type, dose and timing of premedication. The induction method, age and previous anaesthesia were noted. Parents routinely accompany children at induction of anaesthesia.

Results  Overall 75% of children had satisfactory behaviour scores in the anaesthetic room dropping to 47% at induction. The graph shows the age distribution and associated behaviour scores. Of the patients with satisfactory behaviour scores all received their premedication between 20 and 60 min prior to induction. Three patients in the unsatisfactory behaviour group received their premedication outside this optimal time. Children who had had previous anaesthetics (76%) had worse behaviour scores than those with none both in the anaesthetic room and at induction with satisfactory scores of 71% vs. 84% and 44% vs. 51 % respectively. Those having gas inductions (63%) had worse behaviour scores at induction compared with children having intravenous induction with satisfactory scores of 42% vs. 52% respectively. 12% of all children audited received a sedative premedication. 16 received Midazolam 0.5 mg/kg, 3 Temazepam 10 or 20 mg and 1 Triclofos 50 mg·kg−1 all given orally. The premedication rate for children with previous anaesthetic experience was 14% vs. 5% in those with none.

Only 5% of children received an atropine premedication 20–40 mcg·kg−1 orally. Only 1 of the 14 children age 6 months and 2 of the 14 children age 6 months−1 year were premedicated with atropine.

Discussion  As a paediatric tertiary referral centre, many of the patients have previous experience of anaesthetics and have ongoing medical problems Our audit found that many of these children, especially age 1–3, are distressed at induction of anaesthesia despite methods shown to reduce peri‐operative anxiety, including play specialists. It also confirms the perceived trend for decreasing use of sedative and anticholinergic premedication. However several papers report decrease in distress at induction (1) especially in high‐risk groups (2) without undue delays in awakening and discharge using midazolain premedication.

Conclusion  It was decided that a more child friendly anaesthetic room with pictures, toys and other distractions would be helpful. There may also be a need to increase the use of sedative premedication in high‐risk groups especially preschool children.
Parents' perceptions and use of analgesics at home after children's day surgery
Authors: Kankkunen Päivi , Vehviläinen‐Julkunen Katri , Pietilä Anna‐Maija , Kokki Hannu , Halonen Pirjo
Published: March 2003

SummaryBackground: Children are found to suffer from unnecessarily severe postoperative pain following day surgery. Reasons for parents' insufficient use of analgesics may be based on misleading perceptions of children's analgesics. The purpose of this study was to describe parents' perceptions and use of analgesics for children after discharge at home.

Methods: In this survey, 840 questionnaires were given to parents, and answers from 201 mothers and 114 fathers whose children, aged 1–6 years, had undergone day surgery in 10 Finnish hospitals are presented.

Results: One‐third (36%) of the children were assessed as having moderate or severe postoperative pain after discharge. More than three‐quarters of the parents had given analgesics to the child. Analgesics were given mostly to children who were assessed to have pain and found to have several types of pain behaviour. Most of the parents had accurate perceptions of children's analgesics, but some of them had misleading perceptions of the nature and adverse effects of children's analgesics, which were related to giving analgesics to the child. Fathers, more often than mothers, seem to have such misleading perceptions.

Conclusions: Parents tended to give analgesics to children who actually needed pain alleviation. Parents' perceptions of children's analgesics were mostly accurate. However, misleading perceptions of children's analgesics also exist among the parents. These misleading perceptions appear to decrease parents' use of children's postoperative pain medication.
Periocular neurofibrosarcoma in a horse
Authors: Strubbe D. Todd
Published: March 2003

A periocular neurofibrosarcoma was debulked and treated with intralesional cisplatin in a 5‐year‐old Thoroughbred mare. The horse presented with a 1‐year history of a large slowly progressing subcutaneous mass over the right supraorbital process. The mass was surgically debulked, and intralesional cisplatin (1.0 mg/cm3) was injected in 3 doses at 2 weeks, 5 weeks, and 8 weeks postoperatively. No recurrence was noted over a 15‐month follow‐up period. Histopathology of the mass indicated neurofibrosarcoma.
Modulation of proteolytic activity associated with persistent corneal ulcers in dogs
Authors: Willeford  , Miller  , Abrams  , Vaughn
Published: March 2003

Canines affected with corneal lesions demonstrate increased proteolytic activity at the affected site. Canines that develop persistent corneal ulcers and maintain elevated levels of proteolytic activity respond to protease inhibitor therapy with polysulpated glycosaminoglycan, PSGAG. In this study, the proteolytic activity expressed in lacrimal fluid of canines was evaluated as normal (1.15 U mL−1) or healed (1.19 U mL−1). Six of the 26 dogs affected with persistent corneal ulcers, however, had a protease level consistent with the unaffected control animals. These dogs did not appear to respond to PSGAG therapy. Two pathophysiologies for persistent corneal ulcers are indicated. Identifying which mode is active could help determine the therapeutic treatment needed.
Tonometry in three herbivorous wildlife species
Authors: Ofri  , Horowitz  , Kass
Published: March 2003

Tonometry was performed to estimate intraocular pressure (IOP) in 12 Nubian ibexes (Capra ibex nubiana), 10 Grant zebras (Equus burchelli ) and five Arabian oryxes (Oryx leucoryx), using both applanation (Tono‐Pen) and/or indentation (Schiotz) tonometers. Animals were anesthetized with a mixture of etorphine hydrochloride and acepromazine maleate. Mean (± SD) IOP in the ibex was 17.95 ± 4.78 mmHg (24 eyes, indentation tonometry). In the zebra, indentation tonometry (20 eyes) yielded a mean IOP of 25.30 ± 3.06 mmHg, and applanation tonometry (six eyes) yielded a mean IOP of 29.47 ± 3.43 mmHg. In the oryx, indentation tonometry (five eyes) yielded a mean IOP of 22.68 ± 8.15 mmHg, and applanation tonometry (10 eyes) yielded a mean IOP of 11.76 ± 3.43 mmHg. There were no significant effects of gender, age, weight, side or reading number on the IOP measured in any of the three species. No significant differences were found between the IOP of the three species, nor between the readings of the two instruments, although some of theP‐values were close to the significance level.