bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment adherence of youth and young adults with and without a chronic illness
Authors: Rosina Robyn , Crisp Jackie , Steinbeck Kate
Published: December 2004

The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence and concerns about living with their illness. A small correlational study was undertaken to compare the psychosocial functioning of young people, with and without chronic illness, aged between 12 and 24 years. Subjects were recruited from a metropolitan teaching hospital. Group 1 included 44 young people with chronic illness; Group 2 included 41 young people without chronic illness. Both groups were divided on the basis of age: younger (12–18 years, n = 24); older (19–24 years, n = 61) and sex (female = 43; male = 42). Subjects completed the Achenbach self‐report questionnaire as a measure of psychosocial functioning, and a second questionnaire constructed for this study to explore treatment adherence. Psychosocial functioning scores were found to be similar on the majority of subscales. Young women with chronic illness were, however, found to have significantly higher internalizing scores than young women without chronic illness. A significant negative relationship was found for the chronic illness group between internalizing scores and treatment adherence. The findings highlight potential areas of difficulty in psychosocial functioning of some young people with chronic illness. They also suggest the existence of a subgroup of young people with chronic illness who experience more problems than their peers. More research is needed to generate evidence about this possible subgroup to determine predictors of psychosocial functioning and test the timing and efficacy of psychosocial interventions.
Psychological hardiness, workplace stress and related stress reduction strategies
Authors: Lambert Vickie A. , Lambert Clinton E. , Yamase Hiroaki
Published: December 2004

Contending with stressful situations in the workplace is a common occurrence for all health care providers. Stress has numerous devastating effects on the workplace environment, as well as upon individuals who become victims of stress. However, enhancing psychological hardiness may facilitate an individual's ability to deal with workplace stress. Psychological hardiness, a personality style consisting of commitment, control and challenge, encourages human survival and the enrichment of life through development. This article provides an overview of psychological hardiness and workplace stress, and proposes strategies that one can use to enhance commitment, control and challenge in an effort to reduce the impact of stress.
Laryngotracheal stenosis in children after intubation. Report of five cases
Authors: WIEL E , VILETTE B , DARRAS J.A , SCHERPEREEL Ph , LECLERC F
Published: December 2004

Acquired laryngotracheal stenosis is a serious long term complication of tracheal intubation with an incidence of 0.7 to 8% in intubated children. We report five cases of subglottic stenosis over a 4.5‐year period and review the pathology and pathogenesis of the condition. A diagnosis of subglottic stenosis was suspected when extubation failed due to the onset of dyspnoea or laryngeal stridor. An incidence of 0.9% of all intubated children was observed. We conclude that the main components contributing to stenosis are pathologies with decreased mucosal capillary perfusion pressure and intubation conditions.
Propofol infusion vs thiopentone/isoflurane anaesthesia for prominent ear correction in children
Authors: WOODWARD W.M. , BARKER I. , JOHN R.E. , PEACOCK J.E.
Published: December 2004

Postoperative nausea and vomiting (PONV) frequently follows prominent ear correction under general anaesthesia in children. In a prospective, single‐blind study, we compared the incidence of PONV after propofol infusion anaesthesia with that following thiopentone induction and isoflurane maintenance in 30 children aged from four to 14 years randomly allocated to one of two groups. All the children were mechanically ventilated. Anaesthesia was supplemented in both groups with nitrous oxide and infiltration of the ears using a mixture of bupivacaine, adrenaline, and hyaluronidase. One child receiving propofol (group P) complained of nausea, compared with eight receiving thiopentone/isoflurane, (group T) (P=0.005), while three children in group P and ten in group T vomited before hospital discharge, (P=0.01). Eight children in group P were considered to be fit for discharge on the day of surgery as against four in group T, (not significant). Only four out of twelve children receiving opioid analgesia vomited.
Bilateral continuous paravertebral block used for postoperative analgesia in an infant having bilateral thoracotomy
Authors: KARMAKAR M.K , BOOKER P.D , FRANKS R
Published: December 2004

We describe the successful postoperative pain management in an 11‐month‐old infant who underwent bilateral thoracotomy, using continuous infusions of bupivacaine into two directly placed paravertebral catheters. Haemodynamic parameters and pain scores were measured 1–2 h for 60 h while the infusions were continued and, intermittently, blood samples were taken for subsequent measurement of serum bupivacaine concentrations. The technique provided effective pain relief and the infant required no other analgesia postoperatively. There were no adverse haemodynamic consequences or complications relating to either catheter placement or drug infusions. Serum concentrations of bupivacaine remained below toxic levels throughout the study period, though accumulation did occur.
Haemodynamic responses to sevoflurane compared with halothane during inhalational induction in children
Authors: KERN C. , ERB T. , FREI F.J.
Published: December 2004

We studied the haemodynamic changes during induction of anaesthesia in 50 ASA I and II children (1–12 yrs) undergoing minor elective surgery. The patients were randomly divided into two groups to receive either halothane (n=25) or sevoflurane (n=25) in a mixture of O2 and N2O (40:60) for mask induction of anaesthesia. Induction of anaesthesia was performed with an overpressure technique by administering rapid increases of gas concentrations, in increments of 1% up to 7% for sevoflurane and of 0.5% up to 3% for halothane. Induction was smooth and rapid in both groups but characterized by increases in heart rate and systolic blood pressure up to 20% especially in the sevoflurane group (P<0.05); these increases in the latter group were significant compared with baseline and the halothane group (P<0.05). No serious complications were observed. The authors conclude that more children experienced heart rate and blood pressure increases during the early stage of inhalational induction with sevoflurane compared with halothane.
Repair of ventricular septal defect in a child with severe pulmonary hypertension—response to inhaled nitric oxide
Authors: CREGG NUALA , CASEY WILLIAM
Published: December 2004

Nitric oxide (NO), was administered successfully, to a child with severe pulmonary hypertension, following surgical repair of a large ventricular septal defect. Inhalation of NO, 20–25 parts per million (ppm) was continued for 24 h, resulting in mean pulmonary artery pressure (PAP) of 25 mmHg and permitting a reduction in both ventilatory and inotropic support. Weaning of NO was commenced. At 5 ppm, administration was discontinued. An immediate and dramatic increase in PAP occurred. A similar pattern resulted on further attempts, demonstrating the extreme sensitivity of the pulmonary vasculature to the effects of inhaled low dose NO and the selectivity of the response.
Massive blood loss during tonsillectomy in a child with congenital venous malformation
Authors: FOLEY PETER , BESTE DAVID , FARBER NEIL
Published: December 2004

Tonsillectomy and adenoidectomy have become frequently performed outpatient procedures and are generally considered to have a low morbidity profile. Postoperative haemorrhage remains a rare but important complication, while intraoperative uncontrollable bleeding is extremely uncommon. A child with congenital vascular malformation of the lip and oropharynx undergoing tonsillectomy experienced massive blood loss, subsequent resuscitation and significant perioperative morbidity including a prolonged intensive care unit stay. Preoperative/preanaesthetic nasopharyngoscopic exam and magnetic resonance imaging did not reveal vascular prominence of the tonsils. Preoperative consideration of angiography or magnetic resonance angiography may be prudent to avoid this potentially fatal complication.
Diclofenac vs oxybuprocaine eyedrops for analgesia in paediatric strabismus surgery
Authors: MORTON N. , BENHAM S. , LAWSON R. , McNICOL L.
Published: December 2004

Forty children undergoing strabismus surgery as day patients were randomly allocated to receive oxybuprocaine 0.4% eyedrops or 0.1% diclofenac eyedrops for perioperative analgesia. A non‐invasive anaesthetic technique using the reinforced laryngeal mask airway was used. The study demonstrated that both topical analgesics provided good to excellent analgesia and the anaesthetic technique was associated with a relatively low incidence of nausea and vomiting. Complications were limited to two children who were admitted with persistent postoperative nausea and vomiting.
Perioperative considerations in a newly described subtype of congenital long QT syndrome
Authors: JOSEPH‐REYNOLDS ANN , AUDEN STEVE , SOBCZYZK WALTER
Published: December 2004

An infant with a newly‐described subtype of congenital long QT syndrome is presented, along with her perioperative management on three separate occasions. During each anaesthetic characteristic arrhythmias occurred. The available literature and rational approaches to these high risk patients are reviewed.
Mivacurium in infants and children
Authors: GOUDSOUZIAN NISHAN
Published: December 2004

Mivacurium is the only available short‐acting nondepolarizing muscle relaxant in clinical use. It is a bis‐quaternary benzylisoquinolinium ester hydrolysed by plasma‐cholinesterase into inactive compounds. The ED50 and ED95 in children are about 50 μg·kg−1 and 90 μg·kg−1 respectively. In infants, they have a tendency to be lower. A standard intubating dose of 0.25 mg·kg−1 causes complete neuromuscular depression in 1.5–2 min, recovery to 5% in 6–10 min, and complete recovery in 15–20 min. The recent tendency is to use 0.3 mg·kg−1 to obtain better intubating conditions with slight prolongation of effect. Since the recovery profile of mivacurium is independent of the dose and duration, it is most suitable for administration by continuous infusion. The infusion requirement in children is 10–16 μg·kg−1 min−1, which is about twice that of adults. Cutaneous flushes from histamine release are commonly seen with the larger doses of mivacurium; however, the associated hypotensive effects are minimal and counteracted by the tracheal intubation. The duration of action of mivacurium is prolonged in patients with cholinesterase deficiency. Mivacurium's neuromuscular effects can be satisfactorily antagonized by edrophonium or neostigmine.
Pain and activity disturbance after paediatric day case adenoidectomy
Authors: KOKKI HANNU , AHONEN RIITTA
Published: December 2004

Over the past two decades outpatient surgery has become standard practice in paediatric surgery. Adenoidectomy is a common surgical procedure in children. In this prospective survey pain and pain‐related outcomes such as sleep and activity disturbance were evaluated in 167 children aged 1–7 years who had undergone adenoidectomy as a day case in Kuopio University Hospital. The survey questionnaire consisted of 76 structured questions about pain, pain medication, adverse effects and daily activities during first week after the operation. Eighty‐three per cent of children had pain at home and 17% of them had moderate or severe pain on a four point verbal rating scale. Eighty per cent of children used pain medication at home. Pain medication did not cause any major adverse effects. Over 90% of children were back to normal daily activities during the first three postoperative days and nearly all were able to drink during the whole postoperative period. We conclude that pain is a common problem after adenoidectomy in children but most of the children return to normal activities within three days.
Pain, nociception and the developing infant
Authors: WOLF ANDREW R.
Published: December 2004

The study of paediatric pain and the provision of safe but reliable analgesia for all age groups has become a central issue in paediatric anaesthesia. For the practising paediatric anaesthetist, this represents a major challenge: the developing infant is not a single discrete entity but one that changes constantly with increasing maturity of individual organs. Recent developments in both basic and clinical sciences has given valuable insights into this process, giving the clinician a firm basis to provide analgesia at all ages. This review looks at some of the most interesting recent developments in this field.
An epidural catheter introducer in children
Authors: YAMASHITA MASAO
Published: December 2004

Usefulness of an epidural catheter introducer was tested in paediatric epidural anaesthesia. We tried to place an epidural catheter in 100 infants and children. When catheter insertion was difficult, an epidural catheter introducer, which was made of a piece of 6‐Fr suction tubing, was utilized. The introducer is threaded over the epidural catheter down to the hub orifice of the epidural needle. The catheter can then be advanced into the epidural space through this introducer. In this way, we were able to place the catheter in 94 percent of patients. Even a simple introducer is effective in passing the epidural catheter into the epidural space in infants and children. Perhaps manufacturers should provide threading devices with catheters or epidural needles.
Evaluation of the efficiency of heat and moisture exchangers during paediatric anaesthesia
Authors: LUCHETTI MARCO , PIGNA ANTONIA , GENTILI ANDREA , MARRARO GIUSEPPE
Published: December 2004

This study evaluates the efficiency of heat and moisture exchangers (HMEs) in allowing adequate humidification and warming during anaesthesia in children. Eighteen paediatric patients undergoing anaesthesia were divided into two groups: group A ten patients: infants up to 10 kg→Hygrobaby HME; group B 8 patients: children above 10 kg→Hygroboy HME. The following parameters were evaluated: body temperature (bT), room temperature (rT), fresh gas temperature, HME warm‐up time, inspired and expired gases temperature and humidity, conserving efficiency, and duration of anaesthesia. Gas temperatures were recorded by means of a recorder fitted with four thermal probes. Humidity values were mathematically derived. The correlation between efficiency and rT, bT, and fresh gas temperature was computed. In both groups the inspired gases temperatures were below 30??C. Inspired absolute humidity was never more than 28 mgH2O??l−1. The conserving efficiency was good (0.93 in both groups). A positive correlation was found between efficiency and fresh gas temperature. HMEs did not meet the minimum standards for humidity and heating during anaesthesia in children, although their conserving efficiency was found to be satisfactory.
A comparison of halothane and isoflurane for gaseous induction of anaesthesia in infants
Authors: BAGSHAW O. N. T. , STACK C. G.
Published: December 2004

Sixty‐four ASA 1 and 2 infants between the ages of 44 weeks postconceptual age and one year presenting for routine, elective surgery were randomly anaesthetized with either 3% halothane in oxygen (Group H) or 5% isoflurane in oxygen (Group I). Patients in Group I took a mean (sd) time of 70.1(13.6) s to loss of eyelash reflex and 80.0 (13.5) s to tolerating the face mask, compared with 80.2 (17.7) s and 93.4 (20.5) s in Group H (P=0.028 and 0.0072, respectively). There were no significant differences between the groups for preinduction or induction state, lowest oxygen saturation, or the incidence of airway related complications or interventions. This study demonstrates that 5% isoflurane in oxygen induces anaesthesia in infants more quickly than 3% halothane in oxygen, without any increase in the incidence or severity of airway‐related complications.
The influence of breathing system filters on paediatric capnography
Authors: HARDMAN J.G. , MAHAJAN R.P. , CURRAN J.
Published: December 2004

Breathing system filters are in common use during paediatric anaesthesia. Expired gas sampling from the patient side of these filters may contaminate and saturate the sampling line, while sampling from the machine side may cause underestimation of end‐tidal carbon dioxide (P
ECO
2). The aim of this investigation was to elucidate the degree of underestimation of P
ECO
2 induced by sampling from the machine side of a breathing system filter. Ten spontaneously breathing children and ten children receiving mechanical ventilation under general anaesthesia were studied. P
ECO
2 was higher at the patient side of the filter in both ventilated and spontaneously breathing groups (P<0.002 for each). The bias in measuring at the machine side of the filter was significantly greater in the spontaneously breathing children as compared with the mechanically ventilated children (−1.8 vs −0.7 kPa; P<0.004).
Open heart surgery; pump prime effects and cerebral arteriovenous differences in glucose, lactate and ketones
Authors: SANDSTRÖM KERSTIN , NILSSON KRISTER , ANDRÉASSON SVENERIK , LARSSON LARS E
Published: December 2004

This study included 17 young children, who were operated with cardioplumonary bypass for congenital heart defects and were cooled to 20°C or 25°C. No glucose, except for the pump prime solution, was administered during surgery. Samples of arterial blood, cerebral venous blood from the jugular bulb and mixed venous blood from the bypass circuit were obtained and analysed for concentrations of glucose, lactate and ketones as well as oxygen saturation. The prime content of lactate significantly contributed to the arterial lactate concentrations, which together with the cerebral arteriovenous (A‐V) lactate differences remained elevated throughout the bypass period. The prime content of glucose had less influence on the arterial concentrations and these did not increase until the rewarming period, when indications of gluconeogenesis from lactate were found. Arterial ketone concentrations also increased during rewarming in parallel with significant cerebral uptake of ketones. The lowest cerebral A‐V glucose, lactate and oxygen saturation differences were found at the target minimum temperature and this effect was significantly more pronounced in the patients cooled to 20°C.
Comparison of three techniques for induction of anaesthesia with sevoflurane in children
Authors: DUBOIS MARIE‐CLAUDE , PIAT VÉRONIQUE , CONSTANT ISABELLE , LAMBLIN OLIVIER , MURAT ISABELLE
Published: December 2004

This study was designed to evaluate the clinical characteristics of three induction techniques using sevoflurane in children scheduled for tonsillectomy: incremental induction with sevoflurane(2,4,6,7%) in 100% O2 (group IC‐O2; n=23); induction with high concentration of sevoflurane in 100% O2 (group HC‐O2; n=22); and induction with high concentration of sevoflurane in a mixture of O2:N2O(50:50) (group HC‐N2O; n=20). Induction was well accepted and well tolerated in most children. The addition of nitrous oxide resulted in faster loss of consciousness (P< 0.001) compared to the other induction techniques and in a tendency for reduced excitement compared with the same rapid technique without nitrous oxide
(P=0.053). Time to tracheal intubation was identical in the three groups and intubation conditions were scored as good in most children. During the early induction phase, an increase in SAP and HR was observed in the three groups. Changes were maximal at two min after the beginning of induction in the three groups. SAP and HR values were back to baseline values at the time of tracheal intubation. In conclusion, the addition of nitrous oxide to a high sevoflurane concentration decreases the time to loss of eyelash reflex, tends to reduce the incidence of excitement and is not associated with an increased incidence of respiratory complications even in patients with obstructive airway.
Transcutaneous carbon dioxide monitoring during diabetic ketoacidosis in children and adolescents
Authors: McBride Mary E. , Berkenbosch John W. , Tobias Joseph D.
Published: December 2004

Objective : Our aim was to evaluate the utility of transcutaneous CO2 (TC‐CO2) monitoring in following the response to therapy in children and adolescents in diabetic ketoacidosis (DKA) requiring ICU admission.

Methods : During therapy for DKA, TC‐CO2 was monitored and compared with the serum bicarbonate values (HCO3−). As clinically indicated, serum electrolytes including serum HCO3− were drawn and at the same time, the TC‐CO2 value was recorded. Using the TC‐CO2 value and the equation (PaCO2 = 1.5 × HCO3− + 8), a calculated HCO3− value was determined. The measured serum HCO3− value was subtracted from the calculated HCO3− value and the absolute difference was recorded. The difference between the measured serum HCO3− and the calculated HCO3− was analysed using analysis of variance after stratification for serum HCO3− values and patient age ranges. Calculated to serum HCO3− values were compared using linear regression analysis. In addition, serum HCO3− values were plotted against TC‐CO2 values to derive an equation from these data which would relate the TC‐CO2 values to the measured serum HCO3−.

Results : The cohort included 28 patients ranging in age from 1.6 to 21 years (9.4 ± 4.7 years) and in weight from 13 to 96 kg (35.6 ± 18.2 kg). Two additional patients were not included as the initial TC‐CO2 values were inaccurate because of tissue hypoperfusion. In the remaining 28 patients, the absolute difference between the calculated bicarbonate and serum bicarbonate values was 1.5 ± 1.2 mmol·l−1. The difference was ≤2 mol·l in 74.4% of samples and ≤5 mmol·l−1 in 99.2%. No difference in the value between the calculated and measured serum HCO3− was present according to serum HCO3− value or patient's age. Linear regression analysis of calculated HCO3− against serum HCO3− revealed a slope of 0.95 and an r2 value of 0.88. Linear regression analysis using serum HCO3− against TC‐CO2 resulted in the following equations:
image

Conclusions : TC‐CO2 correlates with serum HCO3− and can be used to follow therapy in children and adolescents in DKA.
Conjoined twins – the anaesthetic management of 15 sets from 1991–2002
Authors: Thomas Jenny M , Lopez J Tessa
Published: December 2004

The Red Cross War Memorial Children's Hospital, Cape Town, South Africa is the only dedicated children's hospital in sub‐Saharan Africa and, as such, is the referral hospital for complex procedures from this region.

Fifteen sets of conjoined twins have presented for separation from 1991 to 2002, and a total of 34 sets since 1964.

Anaesthesia for procedures on conjoined twins is a demanding, exacting and meticulous exercise, whether prior to or during separation. Anaesthesia forms part of the multidisciplinary management of the babies. Emphasis is laid on preoperative assessment, goal‐directed planning of theatre and the staff involved in the surgery, duplication of all equipment necessary for anaesthetizing and monitoring two infants in one operating room, and having plans in place to avoid overcrowding. Challenges encountered in anaesthesia for these twins include identifying anatomical conjunctions, airway management, acquiring vascular access, the potential for enormous blood loss, and maintaining normothermia. Planning for the postseparation period and the reconstruction and rehabilitation of the babies is essential from the time of their initial admission.

Meticulous attention to detail, monitoring and vigilance are mandatory. Successful management of conjoined twins relies on close communication and cooperation of all members of the multidisciplinary team.
Midnight reckonings: on a question of knowledge and nursing
Authors: Ceci Christine
Published: December 2004

Abstract The paper contrasts understandings of knowledge grounded in Enlightenment norms with the departures from those norms taken by some strands of feminism and hermeneutics, as well as the contributions made by the writing of Michel Foucault. A reading of Foucault's writings on knowledge, power and the discursive constitution of self and world is offered as a potentially useful frame within which to raise questions about nursing, nurses and knowledge.
The exclusion of the other: challenges to the ethics of closeness
Authors: Myhrvold Trine
Published: December 2004

Abstract  There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position?
Through pragmatic eyes: philosophy and the re‐sourcing of family nursing
Authors: Hartrick Doane Gweneth
Published: December 2004

Abstract  This paper explores the integral relationship between philosophy and nursing practice. The discussion begins by suggesting that philosophy is more than a set of abstract ideas or an intellectual activity; that it is a way of living and being in practice. The author contends that philosophical inquiry can improve the adequacy and relevance of family and nursing theories by promoting the examination and expansion of those theories in light of the experiences and intuitions of nurses. Offering a personal example the author exemplifies how philosophical activity can directly and experientially enhance everyday nursing practice.
Open‐mindedness: a virtue for professional practice
Authors: Sellman Derek
Published: December 2004

Abstract  This paper introduces the notion of open‐mindedness before proceeding to outline its value to the practical activity of nursing. An argument is constructed to point to the desirability of the development of a virtue of open‐mindedness in nurses in order to complement evidence‐based practice. Attention is drawn to two failures of open‐mindedness (the vices of closed‐mindedness and credulousness), which have the potential both to restrict autonomous practice and to cause harm.
Fuzzy logic and nursing
Authors: Im Eun‐Ok , Chee Wonshik
Published: December 2004

Abstract  In empiricism, there are only two answers for a question: black or white. Yet, subjective meanings of human behaviours and responses toward health and illness cannot be simply explained with black and white. Gray zones are needed because they are characterized by complexity and require a contextual understanding. In this paper, we present and suggest fuzzy logic as an example of theoretical bases that help transcend the conflicts between objectivity and subjectivity, respect gray zones between black and white answers for questions, and provide a contextual understanding of complex nursing phenomenon. A historical review of fuzzy logic is followed by a definition of fuzzy logic. Then, fuzzy logic is discussed in terms of its compatibility with nursing epistemological views and philosophical thoughts. Fuzzy logic agrees with three categories of epistemological views of nursing, including correspondence, coherence and pragmatism. Fuzzy logic also agrees with four major philosophical thoughts in nursing, including postempiricism, pragmatism, feminism, and postmodernism. Based on the discussion, we propose that fuzzy logic be further explored, used and developed in research and practice in the nursing areas/situations/phenomena that are characterized by complexity, ambiguousness, and vagueness.
Restorative nursing: toward a philosophy of postmodern punishment
Authors: Gadow Sally
Published: December 2004

Nursing practice in correctional settings is ethically unique. Its premise is the contradiction between causing harm (the purpose of imprisonment) and acting for patients’ good (the purpose of health care). I describe three ethical regions in which correctional nurses can practise, based on different philosophies: punishment as retribution, as rationality, and as paradox. Retribution and rationality resolve the ethical contradiction by relegating offenders to intractable otherness. Restorative nursing based on paradox is an oppositional practice that preserves the contradiction, making engagement possible between prisoner and nurse. Endorsement by nursing of one of the three philosophies of punishment could redefine care for the entire profession.
European withdrawal of appetite suppressants
Authors: Kinnell H. G.
Published: December 2004

The temporary delicensing of the centrally acting appetite suppressants (first in April 2000, then in May 2001) by the European Commission's Committee on Proprietary Medical Products was premature and possibly unjustified. While their ultimate fate is awaited, the European Drugs Evaluation Agency declined to release the information on which its withdrawal advice was based.
Should we recommend low‐fat diets for obesity?
Authors: Pirozzo S. , Summerbell C. , Cameron C. , Glasziou P.
Published: December 2004

Dietary fat intake has been blamed for the increase in adiposity and has led to a worldwide effort to decrease the amount of fat in the diet. However, the comparative efficacy of this approach is debatable. Whilst short‐term dietary intervention studies show that low‐fat diets lead to weight loss in both healthy and overweight individuals, it is less clear if a reduction in fat intake is more efficacious than other dietary restrictions in the long term. The purpose of this systematic review was to determine the effectiveness of low‐fat diets in achieving sustained weight loss when used for the express purpose of weight loss in obese or overweight people. A comprehensive search identified six studies that fulfilled our criteria for inclusion (randomized controlled trial, participants either overweight or obese, comparison of a low‐fat diet with another type of weight‐reducing diet, follow‐up period that was at least 6 months in duration and inclusion of participants 18 years or older without serious disease). There were a total of 594 participants in the six trials. The duration of the intervention varied from 3 to 18 months with follow‐up from 6 to 18 months. There were no significant differences between low‐fat diets and other weight‐reducing diets in terms of sustained weight loss. Furthermore, the overall weight loss at the 12–18‐month follow‐up in all studies was very small (2–4 kg). In overweight or obese individuals who are dieting for the purpose of weight reduction, low‐fat diets are as efficacious as other weight‐reducing diets for achieving sustained weight loss, but not more so.
Dusting off the epidemiological triad: could it work with obesity?
Authors: Egger G. , Swinburn B. , Rossner S.
Published: December 2004

The search for effective ways of dealing with obesity has centred on biological research and clinical management. However, obesity needs to be conceptualized more broadly if the modern pandemic is to be arrested. The epidemiological triad (hosts, agent/vectors and environments) has served us well in dealing with epidemics in the past, and may be worth re‐evaluating to this end. Education, behaviour change and clinical practices deal predominantly with the host, although multidisciplinary practices such as shared‐care might also be expected to impact on other corners of the triad. Technology deals best with the agent of obesity (energy imbalance) and it's vectors (excessive energy intake and/or inadequate energy expenditure), and policy and social change are needed to cope with the environment. The value of a broad model like this, rather than specific isolated approaches, is that the key players such as legislators, health professionals, governments and industry can see their roles in attenuating and eventually reversing the epidemic. It also highlights the need to intervene at all levels in obesity control and reduces the relevance of arguments about nature vs. nurture.
Hyperpigmentation mimicking Laugier syndrome, levodopa therapy and Addison's disease
Authors: Vega Gutiérrez J , Miranda Romero A , Martínez G , Torrero MV , López de Juan M
Published: December 2004

The Laugier–Hunziker syndrome is an acquired, idiopathic, benign mucocutaneous hypermelanosis that usually occurs on the lips and oral mucosa, although it may appear at other sites. Nails are frequently involved, mainly forming longitudinal hyperpigmented bands. We report the case of a patient that presented a typical picture of this entity, nearly 1 year after the beginning of treatment with levodopa. Two years after the first lesions occurred, she developed Addison's disease. The patient suffered from a diffuse discrete hyperpigmentation (it was more remarkable on exposed areas) and an intensification of the melanotic macules that were previously noticeable before in oral and genital mucosa, fingers, toes and nails. Hormonal replacement treatment enabled the control of laboratory and general manifestations and to decrease the degree of mucocutaneous hyperpigmentation considerably, despite initial hyperpigmented lesions persisting in described areas.
Cytotoxic γ/δ subcutaneous panniculitis‐like T‐cell lymphoma: report of a case with pulmonary involvement unresponsive to therapy
Authors: Guizzardi M , Hendrickx IAG , Mancini LL , Monti M
Published: December 2004

Peripheral subcutaneous panniculitis‐like T‐cell lymphoma (PSPTCL) is a rare form of cutaneous lymphoma recently proposed as a distinct clinicopathological entity. It usually presents with multiple indurated subcutaneous plaques or tumours, most commonly located on the extremities and trunk and clinically mimicking lobular panniculitis. Associated constitutional symptoms due to haemophagocytic syndrome may advance or, more often, complicate the clinical course in about 40–70% of cases. Finding of TIA‐1+ and perforin + cytolytic granules in atypical pleomorphic lymphocytes suggests PSPTCL origin from granular cells of T‐cell or natural killer cell phenotype. Cells have a CD3+ CD4+ CD8– or CD3+ CD4– CD8+ T‐cell phenotype. Moreover, these lymphomas can express natural killer cell associated antigens, such as CD56, especially in γ/δ variants. PSPTCL following an indolent clinical course with recurrent self‐healing lesions have been described. The prognosis of most PSPTCL is poor even when treated with aggressive chemotherapy. This paper reports a case of PCTCL in a young woman with T‐cytotoxic differentiation, with rapid progression unresponsive to several treatments.
Indolent systemic mast cell disease: immunophenotypic characterization of bone marrow mast cells by flow cytometry
Authors: Bodni RA , Sapia S , Galeano A , Kaminsky A
Published: December 2004

Background Mast cell disease has a low prevalence and is difficult to diagnose in the absence of the characteristic skin lesions that usually accompany the condition. Extracutaneous involvement is not easy to assess. There are reports in the recent literature on the use of tryptase as a reliable immunohistochemical marker as well as on the study of the immunophenotype of bone marrow mast cells. The latter is of great help for the diagnosis of systemic involvement as, after the skin, the bone marrow is the organ most commonly affected by the disease.

Objective We describe two cases of indolent systemic mast cell disease (SMCD) where flow cytometry was used to identify immunophenotypical characteristics of bone marrow mast cells. Recent advances in the application of this technique prove it can be a good diagnostic tool for assessing systemic involvement of the disease.

Patients and methods Two adult subjects with indolent SMCD had multiple clinical symptoms. Cutaneous lesions were the clue to the diagnosis but, subsequently, in the presence of disturbing symptoms, involvement of other organ systems was confirmed. In both cases, the authors used flow cytometry techniques, as described by Escribano et al. (1998) to define the immunophenotype of bone marrow mast cells.

Results Both patients were diagnosed with indolent SMCD with cutaneous and bone marrow involvement. Also, they presented visible clues to the presumptive bone, cardiovascular and nervous system involvement. Gastrointestinal manifestations were documented in one case.

Conclusions The use of flow cytometry on bone marrow samples from patients with mastocytosis reveals immunophenotypic differences that can serve to allow classification of these subjects in the category of indolent SMCD even though involvement of another organ system may not be thoroughly confirmed.
Bullous scleroderma‐like changes in chronic graft‐versus‐host disease
Authors: Moreno JC , Valverde F , Martinez F , Vélez A , Torres A , Fanego J , Ocaña MS
Published: December 2004

Cutaneous graft‐versus‐host disease (GVHD) is the most common clinical setting for GVHD after bone marrow transplantation. Chronic cutaneous GVHD is categorized according to the type of skin lesions into lichenoid and sclerodermoid variants, but bullous scleroderma‐like changes are exceptional. Recently, we studied a patient with these alterations. This is the second case described in the literature.
Polydactylous Bowen's disease
Authors: Koch A , Schönlebe J , Haroske G , Köstler E , Wollina U
Published: December 2004

Malignant nail tumours are rare. We report on a 52‐year‐old patient with chronic verrucous lesions of the nail bed of fingers and toes. Nail biopsy revealed polydactylous Bowen's disease. This is the first case reported with hand and foot lesions.
Cutaneous extranasal NK/T‐cell lymphoma
Authors: Ruiz Villaverde R , Blasco Melguizo J , Juez Martel I , Linares Solano J , Naranjo Sintes R
Published: December 2004

Malignant neoplasm from natural killer (NK) cells are characterized by their positivty for CD56 and absence of monoclonal TCR gene rearrangement. We present the case of a 54‐year‐old man with a fungous mass in his left flank whose histological examination was consistent with cutaneous extranasal T/NK cell lymphoma. We review the literature and also discuss the prognose and treatment of this variety of lymphoma.
Late onset Blueberry Muffin Syndrome following congenital rubella
Authors: Vozza A , Tolone C , Carrano Em , Di Girolamo F , Santinelli R , Ascierto Pa , Toraldo R , Nacca L , Vozza G
Published: December 2004

The authors report a case of congenital rubella in a 7‐month‐old female infant presenting a Blueberry Muffin Rash. Blueberry Muffin Syndrome is a cutaneous manifestation characterized by widespread maculo papular lesions of a reddish‐blue or magenta colour, due to persistent dermal erythropoiesis in patients with congenital viral infections.
Kaposi's sarcoma: aetiopathogenesis, histology and clinical features
Authors: Buonaguro FM , Tornesello ML , Buonaguro L , Satriano RA , Ruocco E , Castello G , Ruocco V
Published: December 2004

Kaposi's sarcoma (KS) represents today one of the most common skin cancers in transplanted Mediterranean subjects and, since the epidemic of human immunodeficiency virus/acquired immune deficiency syndrome, in young unmarried single men. The disease has been associated with the recent identified human herpesvirus (HHV)‐8 or KS herpesvirus and its incidence in the general population shows a north to south gradient that parallels the HHV‐8 increasing prevalence from Nordic countries to sub‐Saharan regions. The identification of the aetiopathogenetic mechanisms (viral agents and immunodeficiency) involved in the pathogenesis of KS, are relevant for identifying susceptible subjects (HHV‐8 seropositive subjects), monitoring the immune levels in iatrogenic immune suppressed patients, and developing new therapeutic approaches based on antiviral and immune modulators.

Learning objective This article should enable the reader: (i) to learn about the clinical and molecular aspects of KS in order to have a multidisciplinary approach to a tumour that shows unique features; (ii) to consider the role of viral agents and immunity; and (iii) to recognize properties of an opportunistic neoplasm. The identification of the HHV‐8 role in KS pathogenesis should establish a relevant tool in the clinical management of KS patients.
Apoptosis in HIV‐1 infection
Authors: Bell DJ , Dockrell DH
Published: December 2004

Apoptosis is a key event in biologic homeostasis with particular importance to the immune system. It is an active energy‐dependent process that is tightly regulated and controlled by a variety of signal transduction pathways. Apoptosis modulation plays a part in the pathogenesis of many human diseases, including HIV infection. Although multiple mechanisms may contribute to the decline in CD4 T‐lymphocyte numbers observed, apoptosis is a significant factor. Alterations in levels of apoptosis are observed in both directly infected and uninfected bystander cells and a variety of pathways of apoptosis induction have been implicated. Apoptosis induction is related to death receptor and mitochondrial‐induced pathways in specific circumstances. These events have been linked to individual HIV proteins and have been demonstrated to be altered by antiretroviral therapy.
Evaluation of emergency dermatological consultations in a tertiary care centre in North India
Authors: Gupta S , Sandhu K , Kumar B
Published: December 2004

Introduction The nature of dermatological consultations in an emergency setting has not been studied in detail.

Aim To evaluate the reasons and the nature of emergency dermatological consultations at a tertiary care centre in India.

Material and methods One hundred consecutive emergency calls received over a period of four months from the emergency outpatient department were included in the analysis. The details of all the patients along with their clinical diagnosis were recorded in a proforma. In order to evaluate the reasons for emergency calls they were divided into four categories; Category I comprised of primarily dermatological disorders without any systemic involvement, Category II included III consisted of primarily systemic disorders with related cutaneous lesions and in Category IV systemic diseases with unrelated cutaneous findings were included.

Results Out of 100 patients, 63 were males and 37 were females. The number of calls in categories I–IV was 57, 9, 7 and 27 respectively. Infections (32) constituted the most common dermatological presentations, followed by drug reactions (27). Only 21 were true dermatological emergencies.

Conclusion Diagnosis and management of common skin diseases should be stressed during the training of physicians in emergency medicine.
Digital imaging in clinical dermatology across the UK in the year 2001
Authors: Strauss RM , Goodfield MJD
Published: December 2004

Colour photography is an important tool in the daily practice of dermatologists. Digital photography promises quicker acquisition and handling of clinical images. Despite increasing availability and falling costs, dermatologists have been slow in adopting this new technique. To establish to what degree digital photography has found its way into routine practice in dermatology departments in the UK during the year 2001, we conducted a postal survey of all dermatology departments in the UK about usage of digital cameras. A total of 65.4% of the questionnaires were returned. The responses indicated that 71% of departments in teaching hospitals vs. 56% of departments in district general hospitals (DGH) had access to a digital camera. Reasons for not having a digital camera were satisfaction with conventional photography and lack of resources. In 48% of the departments of teaching hospitals or DGH with access to a digital camera, less than 10% of all photos were taken digitally. However, 24% of departments in DGH and 22% in teaching hospitals took more than 80% of their clinical photos digitally, indicating that in many departments digital photography is still in an early phase and only occasionally used, whilst in others a change from conventional photography towards digital photography as the mainly used technique has already taken place. Overall, the main drawbacks of digital photography were poorer resolution in comparison with conventional photography, problems with storage and filing images and time required for downloading and storing images.
Psoriasis, vasculitis and methotrexate
Authors: Moreno JC , Vélez A , Medina I , Valverde F , Fernández‐Roldán JC , Ocaña MS , Espinosa M , Aljama P
Published: December 2004

Report on the association of the psoriasis and vasculitis are a very infrequent in the literature. Such an association as been described in extensive psoriasis and arthropathy psoriasis. In this paper we described two cases in which psoriasis, vasculitis and nephropathy are present together. In both cases the association might be produced by methotrexate. In both cases methotrexate is possible uleashing.
Clinical aspects of epidermodysplasia verruciformis
Authors: De Oliveira WRP , Festa Neto C , Rady PL , Tyring SK
Published: December 2004

Thirteen patients with epidermodysplasia verruciformis (EV) were studied over a period of 7 years. EV is a rare genodermatosis characterized by a generalized infection with a specific group of human papilloma virus (HPV) and a propensity for developing skin malignant tumours in 30%−50% of patients. The diagnosis of EV was confirmed by histopathological and immunohistochemical findings. Three of our patients had the benign form of EV, which is characterized by monomorphous lesions and no malignant changes, whereas 10 had the malignant form, which is characterized by polymorphic lesions and development of cutaneous malignant tumours. All EV patients with the malignant form developed multiple skin tumours (77%). They started to appear at age 20, predominantly on the forehead (50%). Most were squamous cell carcinoma, extremely aggressive and invasive, which provoked metastasis and death in two patients.
Erythema annulare centrifugum‐type psoriasis: a particular variant of acute‐eruptive psoriasis
Authors: Vocks E , Worret W‐I , Ring J
Published: December 2004

A case of erythema annulare centrifugum‐type psoriasis in a 58‐year‐old white woman with a history of chronic plaque psoriasis is described. Initial failure of antipsoriatic treatments and an untypical histology complicated the diagnosis. After several trials acitretin at a low maintenance dose combined with oral fish oil and topical calcitriol led to sustained long‐term remission. The spectrum of clinical differentiation of this rare disease, the histological characteristics and its nosological classification are discussed. It is suggested that this dermatosis represents a variant of acute psoriasis, rather than a variant of pustular psoriasis.