bluuebunny/crossref_metadata_2025 huggingface dataset:
Causes of elevated troponin I with a normal coronary angiogram
Authors: Bakshi T. K. , Choo M. K. F. , Edwards C. C. , Scott A. G. , Hart H. H. , Armstrong G. P.
Published: March 2003

Abstract

Background : The new definition of myocardial infarction (MI) emphasizes the pre‐eminent role of tropo­nin for diagnosis. Troponin rise indicates myocardial injury, but is not synonymous with infarction or ischaemia.

Aims : To review the precipitating event for tropo­nin elevation in patients with angiographically normal coronary arteries, in a district general hospital.

Methods : Consecutive patients with elevated tropo­nin I (TnI) who underwent angiography for suspected coronary disease were included in the present study if they had normal or mild disease (<50% diameter loss without complex features or thrombus). Precipitating event for TnI elevation was assigned on the totality of clinical evidence.

Results : Twenty‐one patients qualified, with an average age of 50 years (range 33−73). Sixty‐two per cent of participants were female. Troponin release was attributed to tachycardia in six patients, only two of whom had haemodynamic compromise. Physical exertion was the precipitating factor in two patients; pericarditis in two patients; and severe congestive heart failure in one patient. Ten of 21 patients had no identifiable cause for a rise in TnI concentration. Five of 21 patients had left‐ventricular wall motion abnormalities. There were no deaths or MI at 41 ± 24 weeks follow up.

Conclusion : Troponin is a sensitive marker of myocardial injury and may rise following apparently minor insults. A rise in TnI concentration may have a cause other than acute coronary syndrome and may occur without significant angiographic coronary artery disease. (Intern Med J 2002; 32: 520−525)
Helicobacter pylori: when is treatment now indicated?
Authors: Duggan A.
Published: March 2003

Abstract

The prevalence of Helicobacter pylori in Western societies has rapidly declined, as reflected by the consistent decline in peptic ulcer disease. Nevertheless, there remains a cohort of the elderly population with a high prevalence of H. pylori infection. While the benefits of H. pylori eradication for H. pylori‐associated duodenal ulcer disease is beyond dispute, a number of contentious areas remains. The aim of the present paper is to review the benefits of H. pylori eradication in clinical situations that may confront the non‐gastroenterologist. (Intern Med J 2002; 32: 465−469)
Clinical and experimental uses of umbilical cord blood
Authors: Lewis I. D.
Published: March 2003

Abstract

Umbilical cord blood (UCB) has been used successfully as an alternative source of haemopoietic stem cells (HSC) in allogeneic stem‐cell transplantation for the treatment of acquired and genetic diseases. Advantages of using UCB include: (i) no risk to the donor, (ii) no donor attrition, (iii) minimal risk of viral transmission and (iv) immediate availability. Early results have highlighted differences in engraftment rates and toxicity between UCB and other sources of HSC. These differences relate to the low cell dose in UCB and also to the intrinsic properties of UCB. In this article, the clinical outcome of UCB transplantation (UCBT) will be reviewed with a discussion of the biological characteristics of UCB that may account for some of the clinical outcomes. To overcome the limitations of low cell dose, novel approaches such as ex vivo expansion of HSC are being actively explored, and this will be summarized in the present study. Finally, the success of UCBT has led to the establishment of dedicated UCB banks worldwide and the regulatory issues surrounding this will be briefly discussed. (Intern Med J 2002; 32: 601−609)
Rapamycin in cardiovascular medicine
Authors: Ruygrok P. N. , Muller D. W. , Serruys P. W.
Published: March 2003

Abstract

The cellular action of rapamycin (sirolimus), a natural fermentation product produced by Strepto­myces hygroscopicus, is mediated by binding to the FK506 binding protein. By inhibiting a kinase known as the target of rapamycin, it restricts the proliferation of smooth‐muscle cells by blocking cell‐cycle progression at the G1/S transition.

The finding that rapamycin possesses both anti­proliferative and antimigratory activity suggests that it could contribute to the control of arterial re‐­narrowing after percutaneous intervention and control the vascular manifestations of chronic rejection in transplanted hearts.

The first clinical trials of implantation of rapamycin‐coated stents in obstructive coronary artery lesions have been reported and, in selected patient groups, it appears that the restenosis process has been abolished. Studies are underway to establish the benefits of rapamycin‐coated stents in day‐to‐day interventional practice, including small vessels, long lesions and patients with multivessel disease. With the addition of novel antiplatelet agents and delivery systems, it is possible that the two major limitations of percutaneous coronary intervention − restenosis and stent thrombosis − will be overcome.

Cardiac graft loss due to intimal hyperplasia and accelerated atherosclerosis remains the major limit­ation to long‐term survival following cardiac transplantation. Animal studies of rapamycin have suggested that this process can be reduced or abolished. Human studies of the efficacy of rapamycin in preventing both acute rejection and allograft arterial disease are in progress.

Concerns regarding toxicity, carcinogenicity, delayed healing and endothelialization remain. As with any new agent or technology, we must remain vigilant to late adverse side‐effects. (Intern Med J 2003; 33: 103−109)
Growth and development of Cuscuta chinensis Lam. and its impact on selected crops
Authors: Marambe Buddhi , Wijesundara Siril , Tennakoon Kushan , Pindeniya Dhammika , Jayasinghe Chandana
Published: March 2003

The growth and development of Cuscuta chinensis Lam., and the effects of the holoparasite on the growth and yield of tomato (Lycopersicon esculentum), chilli (Capsicum annuum) and rice (Oryza sativa) were investigated in pot experiments under glasshouse conditions. ‘Mature’ and ‘immature’ seeds of C. chinensis showed 15 and 47% germination, respectively. The independent life duration of seedlings from ‘immature’ seeds was 6 days shorter than ‘mature’ seeds (19 days). Cuscuta chinensis formed haustoria on chilli and tomato, but not on rice seedlings. Infection with three C. chinensis seedlings per host plant reduced leaf area, dry weight, carbon and nitrogen content by 78–84% and 27–44% in tomato and chilli plants, respectively. Dry weight of C. chinensis was 0.63 g per pot in tomato, and 0.24 g per pot in chilli. Carbon and nitrogen content of C. chinensis was 0.189 and 0.028 g per pot, respectively, when grown with tomato. When it was grown with chilli, the carbon and nitrogen content of C. chinensis was 0.001 and 0.007 g per pot, respectively. Cuscuta chinensis reduced the fruit yield of tomato and chilli by 72 and 29%, respectively. The results indicated that tomato is a preferred host of C. chinensis compared with chilli, and rice is not preferred. In the host–parasite associations, C. chinensis suppressed growth and yield of chilli and tomato by diverting the elaborated products of metabolism of the hosts.
Survival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery
Authors: KUMAR JAIN AJAI
Published: March 2003

A seven‐year‐old child with an airgun pellet injury to the upper part of the anterior chest wall was transported in a state of shock from a nearby hospital to this trauma centre. The nature and site of injury associated with engorged neck veins, hypotension, pulsus paradoxus and an enlarged liver suggested the possibility of acute pericardial tamponade. On arrival in the emergency room the child had a brief period of cardiac arrest revived by basic resuscitation procedures. Pericardiocentesis was negative in the emergency room. Emergency median sternotomy with pericardiotomy was done to relieve the tamponade which was peroperatively diagnosed to be due to a tear in the pulmonary artery close to its origin. Early clinical diagnosis, rapid surgical intervention in the operating room and efficient anaesthetic management within the ‘Golden Hour’ saved life. It is believed that this is the first report of survival of a paediatric patient with a gunshot penetrating trauma to the pulmonary artery leading to cardiac tamponade and a brief period of cardiac arrest.
Lung compliance during laparoscopic surgery in paediatric patients
Authors: MANNER T. , AANTAA R. , ALANEN M.
Published: March 2003

Insufflation of CO2 and positioning of patients induces changes in cardiovascular and respiratory function during laparoscopic procedures. This study was initiated to assess respiratory mechanics such as lung compliance and peak airway pressure (PIP) during laparoscopic surgery in paediatric patients. Ten consecutive patients (age 1–15 years) scheduled for laparoscopic procedure were included in this open prospective single‐group study. Anaesthesia was induced and maintained with intravenous infusions of propofol and alfentanil. Vecuronium was administered to maintain muscle relaxation. Head down tilt induced a mean decrease of 17% in lung compliance, which was further decreased by 27% from the baseline during insufflation of intraabdominal CO2 (intraabdominal pressure 12 mmHg). Coincidently, PIP increased by 19% and 32% from the baseline during Trendelenburg position and peritoneal insufflation. Lung compliance and PIP returned to their respective baseline values after removal of CO2 from the peritoneal cavity. Endtidal CO2 increased from a baseline value of 4.3 kPa to 5.4 kPa (33–42 mmHg) during surgery when ventilator settings were not altered. We conclude that insufflation of CO2 induces significant increases in peak airway pressure with simultaneous decreases in lung compliance.
Anaesthetic management of the surgical separation of a pair of thoracopagus‐cardiopagus twins
Authors: SUAN CRISTINA , OJEDA RAFAEL , GARCÍA‐PERLA J. L. , CERRO JESÚS , ROMERO DELIA , GILABERT JUAN , GONZÁLEZ AMPARO , CASAS GONZALO , SÁNCHEZ‐FELIPE LUIS , PEÑASCO FLORENCIO , REPULLO JOSE
Published: March 2003

We describe the anaesthetic management of the surgical separation of a pair of thoracopagus‐cardiopagus twins with a common right atrium and a myocardial tissue bridge containing vascular channels between their ventricles. One of them died during the procedure, the surviving twin is now two years old. The survival of one twin for two years without significant sequelae, after the surgical separation of twins with shared right atrium and fused ventricles, has not previously been reported. Careful preoperative assessment is essential to anticipate potential serious problems during the procedure.
Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane
Authors: Lapin Sanford L. , Auden Steve M. , Goldsmith L. Jane , Reynolds Anne‐Marie
Published: March 2003

We prospectively studied one hundred ASA physical status I–II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane. Patients given oral midazolam premedication had significantly longer recovery times, but no delay in discharge home compared with those not premedicated. However, children anaesthetized with sevoflurane and no premedication had an unacceptably high incidence (67%) of postoperative agitation. The use of oral midazolam preoperatively did decrease the amount of postoperative agitation seen with sevoflurane. We conclude that although sevoflurane does shorten recovery times, the degree of associated postoperative agitation makes it unacceptable as a sole anaesthetic for myringotomy surgery.
Skin conductance responses in paediatric Harlequin syndrome
Authors: PADDA GURPREET S. , CRUZ OSCAR A. , SILEN MARK L. , KROCK JEREMY L.
Published: March 2003

We report a novel and simple application of skin conductance response (SCR) testing for diagnosis of a new‐onset iatrogenic Harlequin syndrome in an infant. Isolated ipsilateral facial pallor, complicated by thermally induced systemic sympathetic vasodilatation, and preferential lateral decubitus positioning, mimics harlequin colour change. Correct diagnosis as Harlequin syndrome with facial sympathetic interruption was demonstrated by diminution of SCR.
The caudal canal in children: a study using magnetic resonance imaging
Authors: Adewale L. , Dearlove O. , Wilson B. , Hindle K. , Robinson D.N.
Published: March 2003

The anatomy of the caudal (sacral extradural) space was studied in 41 children, using magnetic resonance imaging. The distance from the upper margin of the sacrococcygeal membrane to the dural sac, the length of the membrane and the maximum depth of the caudal space were each measured. Age, height, weight and body surface area were recorded and, using multiple linear regression (stepwise technique), equations predicting the length of the membrane and the distance between its upper margin and the lower limit of the dural sac were obtained. Wide variability limits the clinical usefulness of these equations. In all patients, the maximum depth of the caudal space was found to be at the upper margin of the sacrococcygeal membrane. No correlation was found between this maximum depth and the age, height, weight or body surface area of the child.
Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula
Authors: Vas Lakshmi , Naregal Falguni , Nobre Subita , Dongre Hanspal
Published: March 2003

The anaesthetic management of a left pneumonectomy in a 18‐month‐old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. Pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.
Is epidural analgesia associated with an improved outcome following open Nissen fundoplication?
Authors: Wilson G.A.M. , Brown J.L. , Crabbe D.G. , Hinton W. , Mchugh P.J. , Stringer M.D.
Published: March 2003

Postoperative epidural analgesia is increasingly popular in paediatric practice, although evidence of its benefit is scarce. We performed a retrospective analysis of a series of 104 consecutive open Nissen fundoplications, to determine whether mode of analgesia, epidural (n=65) or opioid infusion (n=39), influenced certain outcome measures, including intensive care utilization, duration of hospital stay, morbidity and mortality. The two groups were similar in terms of demographic characteristics and associated pathologies. Overall, morbidity and mortality (2%) rates were low. Mean duration of hospital stay was significantly greater for the opioid group, compared to those receiving epidural analgesia (13 vs. 8 days, P < 0.05). The number of patients who remained in hospital for more than 7 days was also significantly greater in the opioid group. Accepting the limitations of a retrospective study, these data suggest that epidural analgesia might be associated with an improved outcome following Nissen fundoplication and this merits a prospective study.
Ventilation strategy for video‐assisted thoracoscopic clipping of patent ductus arteriosus in children
Authors: Muralidhar K. , Shetty D.P.
Published: March 2003

Video‐assisted endoscopic techniques have reduced operative trauma in adult thoracic and general surgery but its application in children with congenital heart disease has been limited. We report the use of video‐assisted thoracoscopic (VAT) technique of clipping patent ductus arteriosus (PDA) in children. Forty patients with PDA were divided into two groups: during VAT surgery patients in group A [mean age=3.6 ± 2.4 (SD) years] were managed with right main stem bronchial intubation and those in the group B [mean age=3.7 ± 2.7 (SD) years] received low tidal volume‐high frequency ventilation using a Siemens 900C ventilator. The mean oxygen saturation (SpO2) observed during the surgical intervention was significantly lower in group A (90%) compared to group B (96.8%) while the surgical convenience was not different. We conclude that a low tidal volume–high frequency ventilation is acceptable and safe in patients with PDA undergoing VATS.
Evaluation of caudal anaesthesia performed in conscious ex‐premature infants for inguinal herniotomies
Authors: Bouchut Jean‐Christophe , Dubois Rémi , Foussat Christiane , Moussa Martine , Diot Nathalie , Delafosse Chantal , Claris Olivier , Godard Jean
Published: March 2003

Ex‐premature infants, before 45 weeks postconceptional age, are at high‐risk of apnoea after surgery. General anaesthesia increases the risk of apnoea. We evaluated the tolerance and the efficiency of caudal anaesthesia performed in 25 consecutive conscious ex‐premature infants for inguinal herniotomies. N2O/O2and EMLA cream are used to facilitate caudal puncture. Anaesthesia procedure, patient comfort and complications following the 24 postoperative hours were studied. We report good anaesthesia conditions without compromising the baby’s comfort and few perioperative complications. Only two infants with a prior history of apnoea or bronchopulmonary dysplasia had apnoea during and after surgery. A total spinal anaesthesia was the major complication in one infant and prolonged surgery requiring general anaesthesia was the main limitation of this technique in another child. The principal advantage of the procedure is to facilitate and simplify the postoperative management of the babies. The anaesthetic technique does not alter surgical conditions. Caudal epidural anaesthesia performed in awake high‐risk preterm infants is beneficial for these infants but requires experienced operators.
Early tracheal extubation after paediatric cardiac surgery: the use of propofol to supplement low‐dose opioid anaesthesia
Authors: Cray Steven H. , Holtby Helen M. , Kartha Vyas M. , Cox Peter N. , Roy W. Lawrence
Published: March 2003

Background: After institutional approval and parental consent, 103 children, aged 6 months to 18 years, who were undergoing repair of simple and complex congenital heart lesions using cardiopulmonary bypass (CPB) were studied and compared with a group of 135 children who had undergone similar surgery in our institution in the year before.

Methods: Anaesthesia for study patients included fentanyl (< 20 μg·kg−1) and isoflurane. Infusions of propofol (median infusion rate 70 μg·kg−1·min−1) and morphine (median infusion rate 20 μg·kg−1·h−1) were started after weaning from CPB and continued postoperatively. Preestablished criteria were used in the intensive care unit (ICU) to assess readiness for tracheal extubation.

Results: Median time from admission to ICU to tracheal extubation was 5 h. Fifty‐six children were extubated within 6 h and 73 within 9 h of ICU admission. Mean ICU stay for study patients was 1.7 days [95% confidence interval (CI) 1.2–2.2] and 2.6 days (95% CI 2.3–2.9) in the comparison group (P<0.005).

Conclusions: We found the propofol regimen to be satisfactory with a shorted ICU stay for these patients.
Anaesthetic management of an adolescent for scoliosis surgery with a Fontan circulation
Authors: Vischoff Daniel , Fortier Louis‐Philippe , Villeneuve Edith , Boutin Christine , Labelle Hubert
Published: March 2003

Advances in the treatment of congenital heart disease have led to a new group of adolescents or adults patients with cardiac anomalies. The anaesthetic management of these patients can be challenging especially when they are scheduled for major noncardiac surgery inducing haemodynamic instability. We report the case of a 14‐year‐old boy scheduled for posterior spinal fusion for idiopathic scoliosis who underwent a Fontan operation in infancy for pulmonary atresia with right ventricle hypoplasia. The preoperative investigations and the anaesthetic management are described.
Bispectral index monitoring in children undergoing mild hypothermic cardiopulmonary bypass
Authors: Laussen Peter C. , Murphy Julia A. , Zurakowski David , Sullivan Lorna J. , Mcgowan JR Francis X. , Demaso David Ray
Published: March 2003

Background: In this prospective, cohort study of 15 children (median age 7.7 years, range 4.9–16.5 years) undergoing atrial septal defect repair, we evaluated changes in the Bispectral index (BIS) as a potential monitor of level of consciousness during cardiac anaesthesia.

Methods: Identical cardiac surgery, cardiopulmonary bypass (CPB) and anaesthetic techniques were used, including mild hypothermia and an early extubation protocol. BIS, mean arterial pressure, heart rate and tympanic temperature were recorded at baseline postinduction (Tbaseline), skin incision (Tincis), sternotomy (Tsternot), aortic cannulation (Tcann), nadir temperature (Tnadir), rewarmed (Trewarmed), immediate post‐CPB (TpostCPB), chest drain insertion (Tdrains), sternal wires (Twire), skin closure (Tclosed) and spontaneous movement (Tmove). As a measure of stress response, serum lactate, glucose, norepinephrine and epinephrine levels were measured at Tbaseline, Tsternot, Tcann, Tnadir, Trewarmed and Tdrains. Explicit memory testing was undertaken prior to hospital discharge.

Results: BIS increased significantly during the rewarming phase (Trewarmed versus Tbaseline and Tnadir, P<0.001). Lactate, epinephrine and glucose levels were also significantly elevated at Trewarmed. There were no correlations between BIS and the increase in epinephrine, lactate and glucose during rewarming, nor with changes in heart rate or mean arterial pressure during surgery. All patients had an uneventful recovery without evidence for explicit recall.

Conclusions: The increase in BIS during the rewarming phase could reflect an increase in conscious level, and is consistent with the reported risk for awareness during this phase of cardiac surgery.
How to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S‐ketamine versus clonidine
Authors: De Negri Pasquale , Ivani Giorgio , Visconti Ciro , De Vivo Paolo
Published: March 2003

Background: The aim of the study was to determine whether caudal S‐ketamine or clonidine prolonged analgesia together with ropivacaine.

Methods: Sixty‐three boys, aged 1–5 years, who were undergoing minor surgery, were allocated in order to receive one of three solutions for caudal anaesthesia. Group R received 2 mg·kg–1 0.2% ropivacaine; group C, 2 mg·kg–1 0.2% ropivacaine + clonidine 2 μg·kg–1; and group K, 2 mg·kg–1 0.2% ropivacaine + S‐ketamine 0.5 mg·kg–1.

Results: Postoperative analgesia assessed by CHEOPS lasted 701 min in group K (P < 0.05) compared with 492 min in group C and 291 min in group R. There were no significant differences between the groups for incidence of haemodynamic and respiratory alterations, motor block or sedation.

Conclusions: This study demonstrates that S‐ketamine 0.5 mg·kg–1 when added to 0.2% caudal ropivacaine provides better postoperative analgesia than clonidine without any clinically significant side‐effect.
Difficult tracheal intubation induced by maxillary distraction devices in craniosynostosis syndromes
Authors: Roche John , Frawley Geoff , Heggie Andrew
Published: March 2003

Background: Difficult intubation occurred during anaesthesia for removal of maxillary distraction devices in five of seven children with syndromal craniosynostoses (four with Apert, two with Pfeiffer and one with Crouzon syndrome).

Methods: Intubation was assessed in terms of laryngeal view and an established intubation difficulty score and had been straightforward before device insertion. Difficulty was induced by trismus due to device insertion and by increased maxillary prominence. This was compounded by preexisting mandibular hypoplasia. Cephalometric analysis, with each child acting as their own control, demonstrated anterior displacement of the maxilla and increased maxillary vertical height, as well as increased protuberance of the maxillary incisors.

Results: All five difficult tracheal intubations were associated with preoperative Mallampati scores of 3 or 4 and the nine straightforward intubations with scores of 1 or 2. Maximal interincisor distance was less than the lower 95% confidence limit for age in all five children who were difficult to intubate at the time of device removal. No child had a failed intubation, but all had significantly increased intubation difficulty.

Conclusions: In view of the risks of trauma, hypoxia and aspiration associated with difficult direct laryngoscopy, we recommend elective fibreoptic intubation at anaesthesia for removal of maxillary distraction osteogenesis devices in these children.
Spinal versus peripheral effects of adjunct clonidine: comparison of the analgesic effect of a ropivacaine–clonidine mixture when administered as a caudal or ilioinguinal–iliohypogastric nerve blockade for inguinal surgery in children
Authors: Ivani G. , Conio A. , De Negri P. , Eksborg S. , Lönnqvist P.A.
Published: March 2003

Summary Background: The adjunctive use of clonidine to local anaesthetics has been reported to enhance analgesia both after spinal and peripheral administration. However, no attempt has been made to compare spinal and peripheral application of clonidine in the same surgical context in order to further explore the mechanism for the analgesic action of clonidine when administered together with local anaesthetics.

Methods: Using a prospective, randomized, observer‐blinded study design, 40 patients, aged 1–7 years, who were undergoing elective surgery for inguinal hernia repair or orchidopexy, were randomly allocated to receive either a caudal block (group C: n = 20; ropivacaine 0.2%, 1 ml·kg−1 + clonidine 2 µg·kg−1) or an ilioinguinal–iliohypogastric nerve block (group I: n = 20; ropivacaine 0.2%, 0.4 ml·kg−1 + clonidine 2 µg·kg−1) following the induction of a standardized sevoflurane based anaesthetic. Postoperative analgesia [maximum Objective Pain Scale (OPS) score and requirement for supplemental analgesia] and sedation (three‐point scale) were assessed at predetermined intervals during the first 24 h postoperatively.

Results: Fourteen children in group I and nine children in group C did not require rescue analgesia (P = 0.17). No difference in maximum OPS scores could be detected between the two study groups. The mean time to full recovery regarding sedation was 149 min and 153 min in groups C and I, respectively.

Conclusions: This pilot study demonstrates a trend for better postoperative analgesia following peripheral administration of clonidine compared with central application. However, the main mechanism for the adjunct analgesic effect of clonidine when administered together with local anaesthetics requires further study.
Infusion technology: a cause for alarm
Authors: Hee Hwan‐Ing , Lim Suan‐Ling , Tan Shani Sian‐Wei
Published: March 2003

Summary Background: Volumetric infusion pumps are widely used in paediatric practice. Tissue extravasation is a hazard. The occlusion pressure limit alarm, although not intended to detect extravasation, is the only warning sign present to indicate flow faults in the infusion systems.

Methods: Extravasations were created in the subcutaneous plane of 20 limbs of five piglets with normal saline via an infusion pump. Five flow rates were used with each piglet allocated to one: 100 ml·h−1, 200 ml·h−1, 300 ml·h−1, 400 ml·h−1, 500 ml·h−1. The occlusion pressure limit was first set at low and adjusted to medium, then to high, upon alarm activation. Line pressure at 5‐min intervals and upon alarm activation and volume of infusate given were measured. Limb diameters before and after infusion were measured.

Results: Six out of 20 cases failed to activate any alarm. The low, medium and high occlusion pressure limit alarms were activated in 14, 1 and 0 instances, respectively. The incidence of alarm activation is higher in the forelimb compared with the hindlimb (P=0.001). The tissue compliance and volume infused at alarm activation are significantly lower in the former (P < 0.05). Line pressure increases with increase in flow rates for the same limb (P=0.013 Fore, P=0.005 Hind).

Conclusions: Occlusion pressure limit alarm cannot reliably detect extravasation especially at sites with high compliance, low flow rates, even at low occlusion limit. Line pressure depends on interplay of site (compliance) and flow rate and is independent of volume extravasated. Users must be aware of the set occlusion pressure limit. Repeated clinical assessment remains vital.
Sedation and neuromuscular blockade in paediatric intensive care: a review of current practice in the UK
Authors: Playfor Stephen D. , Thomas David A. , Choonara Imti
Published: March 2003

Summary Background: Our aim was to investigate the current practice of sedation and neuromuscular blockade in critically ill children in paediatric intensive care units (PICUs) in the UK.

Methods: A postal questionnaire was sent to all PICUs in the UK.

Results: The most commonly used sedative agents were midazolam in combination with morphine. Written clinical guidelines for the sedation of critically ill children were available in 45% of units. Sedation is formally assessed in 40% of units. Vecuronium is the most commonly used neuromuscular blocking agent. In the UK, 31% of critically ill children are likely to receive neuromuscular blocking agents. Depth of neuromuscular blockade is routinely assessed in 16% of patients.

Conclusions: Relatively few units possess clinical guidelines for the sedation of critically ill children, and only a minority formally assess sedation levels. Where neuromuscular blocking agents are administered, sedation is frequently inadequately assessed and the depth of neuromuscular blockade is rarely estimated.
Results of ophthalmologic screening examinations of German Pinschers in Finland – a retrospective study
Authors: Leppänen Minna , Mårtenson Jerker , Mäki Katariina
Published: March 2003

Objective To retrospectively review ophthalmologic findings in German Pinschers in Finland.

Animals studied One hundred and twenty‐two German Pinschers that had ophthalmologic examination performed according to the Finnish Kennel Club’s Eye Scheme before June 15, 1999.

Procedures A total of 154 eye examination reports of 122 dogs were analysed and all described findings were reported.

Results Persistent hyperplastic tunica vasculosa lentis (PHTVL) was diagnosed in 8.4% of all cases, and hereditary cataract (HC) in 6.5%. Even higher numbers of similar changes were reported by ophthalmologists; some of the dogs, however, were officially diagnosed as ‘free of symptoms’ of inherited ocular diseases. A relatively high number (4.5%) of dogs had reported changes in Y sutures. A pedigree analysis suggests recessive inheritance for both diseases. Because of missing information about many dogs in the pedigree, an autosomal incomplete inheritance pattern cannot be ruled out in either case.

Conclusions Both HC and PHTVL are inherited diseases in German Pinschers. Further studies are needed to determine the importance of the changes found in Y sutures. Discrepancies between the official diagnosis and described changes are probably partially due to the lack of familiarity with the published literature concerning this breed. Further studies are needed to ascertain the inheritance pattern for both diseases. So far breeding with affected animals should be avoided.
Multifocal retinopathy of Great Pyrenees dogs
Authors: Grahn  , Philibert  , Cullen  , Houston  , Semple  , Schmutz
Published: March 2003

Forty‐four related Great Pyrenees dogs were examined ophthalmoscopically. Focal retinal elevations, multiple gray–tan–pink subretinal patches, and discrete areas of tapetal hyper‐reflectivity were seen in 19 dogs, ranging from 13 weeks to 10 years of age. These lesions varied in size from focal spots that were barely visible with the indirect ophthalmoscope to areas that were larger than the optic disc. Complete blood cell counts, serum biochemical profiles, urinalyses, and blood pressure measurements were completed on four affected dogs and all were within normal reference ranges. Photopic and scotopic electroretinography was completed and the a‐wave and b‐wave amplitudes and latencies were similar for affected and age‐matched nonaffected Great Pyrenees and other normal dogs. Electroretinograms that were examined twice during a 3‐year period on three affected adult dogs did not reveal significant progressive deterioration of the a or b‐wave parameters. Fluorescein angiography was completed on four affected dogs of ages 1 (n = 2), 5, and 6 years. These angiograms were repeated in three of these dogs 1 year later. The blood ocular barrier was intact in these dogs but there was blocked choroidal fluorescence. Postmortem examination, light microscopy, scanning and transmission electron microscopy were performed on three affected puppies and two affected adult dogs. These examinations revealed that the lesions in the puppies were limited to bilateral multiple areas of retinal pigment epithelial vacuolation, hypertrophy, and apparent separation from Bruch’s membrane, and multiple serous retinal detachments. The affected adult dogs had focal retinal degeneration and retinal pigment epithelial hypertrophy, hyperplasia and pigmentation. Pedigree analysis and test mating confirm that this condition is inherited, probably as an autosomal recessive trait. This condition develops at ≈ 13 weeks of age and the focal areas of retinal detachment and retinal pigment epithelial vacuolation progress to permanent and stable focal areas of retinal degeneration, and retinal pigment epithelial hypertrophy and pigmentation.
Evaluation of tear film proteinases in horses with ulcerative keratitis
Authors: Strubbe  , Brooks  , Schultz  , Willis‐Goulet  , Gelatt  , Andrew  , Kallberg  , Mackay  , Collante
Published: March 2003

Ulcerative keratitis is a common and potentially blinding ocular disease of horses, capable of progressing to corneal perforation in as little as 24 h. This rapid stromal degeneration is mediated in part by exogenous and endogenous proteinases. We measured and compared the concentrations of two matrix metalloproteinases (MMP‐2 and MMP‐9) and a serine proteinase (neutrophil elastase) present in the precorneal tear film of normal horses and horses with rapidly progressing ulcerative keratitis. Precorneal tear film samples were collected from 23 ulcerated and 21 unaffected eyes of 23 horses with unilateral ulcerative keratitis, and from 33 normal eyes of 17 control horses. MMP‐2, MMP‐9, and neutrophil elastase were identified by casein and gelatin zymography and quantified by computerized image analysis. Median MMP‐9 levels were significantly higher in the precorneal tear film of young control horses vs. older control horses (P = 0.005). Median MMP‐2, MMP‐9, and neutrophil elastase levels were significantly higher in the precorneal tear film of ulcerated eyes when compared to age‐matched normal controls (P = 0.004, P = 0.001, and P = 0.012, respectively). Median MMP‐2 levels were also significantly higher in the precorneal tear film of contralateral eyes of affected horses when compared to age‐matched normal controls (P = 0.004). No significant differences in median proteinase levels were detected between ‘sterile’ ulcers and those from which bacteria or mixed infections (bacteria and fungi) were isolated. However, median MMP‐2 and neutrophil elastase levels were significantly higher in the precorneal tear film of eyes with ‘sterile’ ulcers when compared with ulcerated eyes from which fungi were isolated (P < 0.05). The results of this study support the use of topical antiproteinase therapy which targets both MMPs and serine proteinases in progressive equine ulcerative keratitis.
Ocular and periocular manifestations of leishmaniasis in dogs: 105 cases (1993–1998)
Authors: Peña M.T. , Roura X. , Davidson M.G.
Published: March 2003

The purpose of this retrospective study was to determine the prevalence, type, and prognosis of ocular lesions associated with leishmaniasis in dogs. One hundred and five dogs (24.4% of all cases of leishmaniasis diagnosed during the study period) had ocular or periocular leishmaniasis, and 16 dogs (15.2% of ocular cases) had only ocular lesions and systemic signs were not apparent. Anterior uveitis was the most common manifestation and other prevalent findings included blepharitis and keratoconjunctivitis. Several distinct variations of eyelid lesions were seen including a dry dermatitis with alopecia, diffuse blepharedema, cutaneous ulceration, and discrete nodular granuloma formation. In some cases with keratoconjunctivitis, corneal lesions clinically resembled nodular granulomatous episclerokeratitis. Twenty‐seven of the 34 cases with ocular lesions had improvement in signs following systemic antiprotozoal and topical anti‐inflammatory therapy, although many cases with anterior uveitis required long‐term topical therapy. Response of ocular signs correlated highly with overall, systemic response to therapy. Ophthalmic manifestations of systemic leishmaniasis are common in the dog, and this disease should be considered in the differential diagnosis of most adnexal and anterior segment ocular inflammatory lesions in dogs in endemic areas.
Retrobulbar tumors in dogs and cats: 25 cases
Authors: Attali‐Soussay Katia , Jegou Jean‐Pierre , Clerc Bernard
Published: March 2003

Twenty‐five cases of retrobulbar tumors are presented and discussed. Affected animals were dogs and cats (average 10.7 years). No breed or sex predisposition was noted. The most common clinical signs were exophthalmos (84%), conjunctival hyperemia (40%), protrusion of the nictitating membrane (28%), exposure keratitis (20%) and fundus abnormalities (20%). Diagnostic tools included fine needle aspiration, radiography, ultrasonography, computed tomography and histology. Surgical treatment by orbitotomy or exenteration was combined with chemotherapy and radiotherapy in some cases. The prognosis was poor with low survival times: 1 month in cats, and 10 months in dogs, with a high rate of euthanasia (35%) at the time of diagnosis.
Fluorouracil as a treatment for corneal papilloma in a Malayan tapir
Authors: Karpinski Lorraine G. , Miller Christine L.
Published: March 2003

A 26‐year‐old, wild caught, male Malayan tapir at the Miami Metrozoo with bilateral corneal papillomas was serially immobilized and given subconjunctival injections of fluorouracil. Over the course of 17 weeks five bilateral injections of 25 mg fluorouracil were given. This treatment caused regression of the corneal lesions as evidenced by decreased lesion diameter, decreased corneal vascularity, increased corneal clarity, and improved visual function. No adverse drug effects were observed.
Correction of eyelid coloboma in four cats using subdermal collagen and a modified Stades technique
Authors: Wolfer J. C.
Published: March 2003

Four feline cases of bilateral eyelid coloboma were treated with injectable subdermal collagen and a modified Stades technique. This new technique was found to be easy to perform and the long‐term results appear to be similar to other published reports.
Phylogeny and the evolution of calling songs inGryllus(Insecta, Orthoptera, Gryllidae)
Authors: Desutter‐Grandcolas Laure , Robillard Tony
Published: March 2003

Acoustic signalling is the most important communication modality for crickets. While it has been studied intensively, few authors have analysed the evolution of cricket acoustic signals within a macroevolutionary perspective, still fewer with respect to its phylogenetic aspects. This may be due in part to the lack of acoustic and phylogenetic data; there are also difficulties involved in applying phylogenetic methods to acoustic data. The most critical aspect may be describing calls using characteristics consistent with current criteria for homology. In this paper we discuss, in relation to the evolution of the North American species ofGryllus, the reliability of these criteria and describe songs using two complementary sets of characters: (i) general structure (carrier frequencies and main temporal features), and (ii) ‘special quality’ (particular features at a lower structural level).
The changing epidemiology of HIV infection in injecting drug users in Dublin, Ireland
Authors: Clarke S , Keenan E , Bergin C , Lyons F , Hopkins S , Mulcahy F
Published: March 2003

Introduction Injecting drug users (IDUs) represent 41.6% of the total cohort of HIV‐infected patients in Ireland. Between January 1999 and December 2000, referrals to the largest tertiary centre for HIV infection in Dublin have increased dramatically. This has occurred on a background of a reduction in the overall incidence of HIV infection in Ireland between 1990 and 1998. Here we describe the changing epidemiology of HIV disease in IDUs and explore potential aetiological factors.

Methods This is a retrospective study, collecting all data relating to new HIV diagnoses occurring in IDUs, referred to the GenitoUrinary Medicine and Infectious Diseases (GUIDE) clinic between 1987 and 2000. We calculated 6‐month incidence rates of new HIV diagnoses in IDUs referred to the GUIDE clinic and performed a more detailed analysis of those patients diagnosed between January 1999 and December 2000, documenting age, sex, time and place of diagnosis, drug use history and primary drug of misuse, needle sharing history, attendance at a drug treatment clinic, prior HIV testing history, hepatitis B and hepatitis C status, and CD4 cell counts and HIV RNA levels at diagnosis.

Results The number of new HIV diagnoses in IDUs increased fivefold between 1995 and 2000. Moreover, 40% of patients diagnosed since then have been under 22 years old. There has also been a significant reversal of the initial male to female ratio seen in the initial epidemic of the 1980s.

Conclusion There has been a significant increase in the incidence of HIV infection in IDUs between 1995 and 2000. Similar trends have been described recently in other risk groups. The aetiology of these trends is multifactorial, and a multidisciplinary, rejuvenated approach is required to focus on improving health education to reduce both sexual and needle sharing practices.
Long‐term efficacy and safety of ritonavir/indinavir at 400/400 mg twice a day in combination with two nucleoside reverse transcriptase inhibitors as first line antiretroviral therapy
Authors: Lichterfeld M , Nischalke HD , Bergmann F , Wiesel W , Rieke A , Theisen A , Fätkenheuer G , Oette M , Carls H , Fenske S , Nadler M , Knechten H , Wasmuth J‐C , Rockstroh JK
Published: March 2003

Objective To determine the long‐term antiretroviral efficacy and tolerability of dual protease inhibitor (PI) therapy with indinavir (IDV)/ritonavir (RTV) at 400/400 mg twice a day (BID) in combination with two nucleoside reverse trancriptase inhibitors (NRTIs).

Design and methods In an open‐label, uncontrolled multicentre clinical trial, antiretroviral therapy naive patients (n = 93) with a high median baseline HIV‐1 RNA level of 210 000 copies/mL (range 17 000–2 943 000) and a median CD4 cell count of 195 copies/µL (range 4–656 copies/µL) were started on a regimen of either zidovudine (ZDV)/lamivudine (3TC) (49%), stavudine (d4T)/3TC (38%) or d4T/didanosine (ddI) (14%) plus RTV and IDV, each at 400 mg BID. CD4 cell counts and HIV RNA were determined at 4‐week intervals for a duration of 72 weeks. Statistical analysis was performed on treatment as well as by intent to treat, where missing values were counted as failures.

Results HIV RNA levels below the limit of detection were achieved in 59.5% (< 80 copies/mL) and 63% (< 500 copies/mL) of patients according to the intent to treat analysis at week 72. In the on treatment analysis, the proportion of patients reaching an undetectable viral load was 94.5% (< 80 copies/mL) and 100% (< 500 copies/mL), respectively. Apart from diarrhoea and nausea, serum lipid abnormalities were identified as the most prominent adverse reaction. No cases of nephrotoxicity occurred during the entire observation period of 72 weeks.

Conclusions Our results demonstrate that quadruple therapy with RTV/IDV and two NRTIs induces potent, durable and safe HIV suppression and might be particularly beneficial as a first line therapy for patients with a high baseline viral load.
Thymic activity in late‐stage HIV‐1 infected individuals receiving highly active antiretroviral therapy: potential effect of steroid therapy
Authors: Pido‐Lopez J , Pires A , Nelson M , O'Moore E , Fisher M , Gazzard B , Aspinall R , Gotch F , Imami N
Published: March 2003

Objective Our objective was to monitor the effect of steroid therapy on the thymic output and function of late‐stage HIV‐1‐infected patients undergoing highly active antiretroviral therapy (HAART).

Design The indirect measurement of T cells that have recently emigrated from the thymus as a means of quantifying thymic output, and therefore thymic function, was achieved through use of the polymerase chain reaction‐based signal joint T cell receptor rearrangement excision circles (sjTREC) assay. Proliferative capacity and interleukin (IL)‐2 and IL‐4 production by T cells after antigenic, mitogenic and IL‐2 stimulation were also analysed.

Method Measurements were made of sjTREC levels in peripheral blood mononuclear cell DNA samples from five HIV‐1 infected patients (one on steroid therapy prior to and at the time of sample extraction) receiving HAART. IL‐2 and IL‐4 production and proliferative capacity were also measured in three patients, including the patient receiving steroids.

Result The sjTREC assay gave an extremely weak result for the patient on steroids but, under the same assay conditions, provided clear, positive readings for the four patients not on steroids. Comparison of the patients' cytokine profiles revealed that IL‐2 production was generally low or absent in all three patients tested but that IL‐4 production was significantly higher in the patient given steroids. Functional potential as revealed by proliferation assays showed very low or absent cellular proliferation.

Conclusion The thymic contribution to the restoration of T lymphocyte numbers, particularly during the treatment of HIV‐1 infection, may become compromised if thymic inhibitory factors such as steroids are used. Furthermore, the use of steroids may also favour the development of a T helper 2 response, which could prove particularly undesirable during HIV‐1 infection.