bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and efficacy of patient controlled epidural analgesia following pediatric spine surgery
Authors: Saudan S , Von Ungern‐Sternberg B.S , Ceroni D , Meyer P.A. , Kaelin A , Habre W 
Published: May 2007

Background:  Patient controlled epidural analgesia (PCEA) is uncommon in paediatric anaesthesia particularly for extensive spinal surgery. Since PCEA has been shown to offer superior pain control compared with continuous epidural infusions in adults, we prospectively evaluated the analgesia efficacy and safety of PCEA in children and adolescents following extensive spinal surgery.Methods:  Following approval of the local Ethics Committee, 100 consecutive children [age median (range) 14 (6–19) years] undergoing spinal surgery were included, and 98 children benefited from PCEA. One or two epidural catheters were set in place by the surgeon under direct vision based on the number of vertebral segments operated. The epidural solution consisted of bupivacaine 0.0625%, fentanyl 1 μg·ml−1 and clonidine 0.6 μg·ml−1, delivered at a rate of 0.2 ml·kg−1·h‐1 and a bolus of 0.1 ml·kg−1·h‐1 (max 2 per h). On the 4th postoperative day, PCEA was stopped and analgesia was continued with patient controlled analgesia with morphine (PCA). After surgery, all patients were followed by the paediatric anaesthesia acute pain team for the duration of the administration of the PCEA (day 1–4) and PCA morphine (day 4–7). Pain was assessed at rest every 6 h and during mobilization every 24 h by the means of the Revised Facial Scale (RFS). All patients were continuously monitored with pulse oximetry, and every 6 h the respiratory frequency was assessed. The Bromage scale was used to evaluate motor blockade (0 = no paralysis; 1 = inability to lift the thigh; 2 = inability to flex the knee; 3 = inability to move any joint in the legs). The occurrence of postoperative nausea and vomiting (PONV), pruritus, cardiac and pulmonary complications were reported.Results:  During the PCEA regimen, the maximal scores of the revised facial scale were below four at rest with a very high satisfaction rate (>90%). Pain scores were higher during mobilization on the first postoperative day and when PCEA was switched to PCA (Table 1). The overall incidence of adverse events was low and consisted primarily in technical problems and postoperative nausea and vomiting (Table 2). Only two children experienced a complication requiring the discontinuation of the PCEA but there were no consequent adverse sequelae: One child with known childhood epilepsy presented with a focal epileptic episode and one child had a suspected leak of the anaesthetic solution into the spinal space. The switch from PCEA to PCA was associated with a significant increase in PONV values as well as a decrease in satisfaction rates from 98% to 83%.Conclusions:  The present study demonstrates that PCEA provides excellent pain relief following extensive spinal surgery and is associated with a low incidence of adverse events. Therefore, the use of PCEA should be encouraged in children and adolescents following extensive spine surgery.
Optimal spectral irradiance for laryngoscopy
Authors: Lewis E , Sheraton T.E. , Hampson M.A. , Wilkes A.R. , Gildersleve C. , Hall J.E. 
Published: May 2007

Introduction:  Changing the colour of light produced by laryngoscopes may improve the view at laryngoscopy and facilitate intubation. This could be crucial in children with anatomically difficult airways and in acute airway emergencies. Infra red light has been shown to be detrimental to optimal laryngoscopy (1). Anaesthetists have expressed a preference for blue/white light output to facilitate intubation (2). Blue light corresponds to peak haemoglobin absorption (415 nm) and therefore enhances the view of capillary vessels within the surface mucosa.(3) Green light defines deeper structures more clearly (3). Specific combinations of blue and green light spectra may provide the best conditions for intubation. Light Emitting Diodes (LEDs) have the advantage of producing light in a more appropriate part of the spectrum. LEDs are not currently used in laryngoscopes available in the UK. The aim of this study was to compare the spectral irradiance of the ProAct Miller 1 Paediatric blade laryngoscope (containing an incandescent bulb) with a custom‐made laryngoscope containing an LED.Methods:  The light spectral irradiance from the laryngoscope blades was measured under standardised conditions using the Bentham spectroradiometer. Blackout conditions were applied to eliminate background light. The tip of each laryngoscope blade was placed in contact with the sample port of the spectroradiometer. A mains voltage supply was set at 3 V for the Miller 1 blade (A) and 3.6 V for the blade with the LED (B), as specified by the manufacturers.Results:  The Miller 1 paediatric blade produced spectral irradiance mainly in the infrared region (>660 nm) in contrast with the LED which produced most irradiance in the blue/green region of the spectrum (400–550 nm).

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[  Spectral irradiance from the Miller 1 blade (A) and the blade with the LED (B). ]Discussion and conclusions:  Paediatric laryngoscopes with LEDs may provide superior intubating conditions than that currently available with incandescent light sources. LEDs can be further modified to emit the optimal spectral irradiance required for laryngoscopy. This may prove invaluable when presented with a difficult airway.References  1 Crosby E, Cleland M. An assessment of the luminance and light field characteristics of used direct laryngoscopes. CanJ Anesth 1999; 46: 792–796.2 Scholz A, Farnum N, Wilkes AR et al. Minimum and optimum light output of Mackintosh size 3 laryngoscopy blades: a manikin study. Anaesthesia 2007; 62: 163–168.3 Watanabe A, Tsujie H, Taniguchi M, Hosokawa M, Fujita M, Sasaki S. Laryngoscopic detection of pharyngeal carcinoma in situ with narrow band imaging. Laryngoscope 2006; 116: 650–654.
Clonidine disposition in children: a population analysis
Authors: Potts AL , Larsson P , Eksborg S , Warman G , Lönnqvist P‐A , Anderson BJ 
Published: May 2007

Background:  There are few data describing clonidine population pharmacokinetics in children (0–15 years) despite common use. Current paediatric data, described in terms of elimination half‐life or Cmax and Tmax, poorly explain variability in drug responses among individuals representative of those in whom the drug will be used clinically.Methods:  Published data from four studies investigating clonidine PK after intravenous, rectal and epidural administration (n = 42) were combined with an open‐label study undertaken to examine the pharmacokinetics of IV clonidine 1–2 μg·kg−1 bolus in children after cardiac surgery (n = 30, EC approval granted). A population pharmacokinetic analysis of clonidine time‐concentration profiles (380 observations) was undertaken using nonlinear mixed effects modelling. Estimates were standardised to a 70 kg adult using allometric size models.Results:  Children had a mean age of four (SD 3.6 years, range 1 week–14 years) year and weight 17.8 (SD 12.6, range 2.8–60 kg). A two compartment disposition model with first order elimination was superior to a one compartment model. Population parameter estimates (between subject variability) were clearance (CL) 14 (CV 28.3%) 1 h–1·70 kg−1, central volume of distribution (V1) 56.7 (67.5%) l·70 kg−1, inter‐compartment clearance (Q) 143 (19.1%) l h–1 70 kg−1 and peripheral volume of distribution (V2) 123 (72.8%) l.70kg−1. Clearance at birth was 4.7 l·h–1·70kg−1 and matured with a half‐time of 25.5 weeks to reach 85% adult rate by 1 year of age. The volumes of distribution, but not clearance, were increased after cardiac surgery (V1 180%, V2 117%). There was a lag time of 2.6 (CV 64%) min before absorption began in the rectum. The absorption half‐life from the epidural space was slower than that from the rectum 1.04 (CV31%) h vs 0.28 (CV24%) h. The relative bioavailability of epidural and rectal clonidine was unity (F = 1).Conclusions:  Clearance in neonates is approximately one third that described in adults, consistent with immature clearance pathways. Maintenance dosing, which is a function of clearance, should be reduced in neonates and infants when using a target concentration approach.
Species abundance distributions over time
Authors: Magurran Anne E. 
Published: May 2007

AbstractIt has been known for 50 years that the time period over which data are collected affects the shape of empirical species abundance distributions. However, despite a recent resurgence of interest in characterizing and explaining these patterns the temporal component of species abundance distributions has been largely ignored. I argue that it is essential to take account of time, and not only because sampling duration can have a profound influence on the perceived shape of the distribution. Partitions of species abundance distributions based on temporal occurrence in the record will facilitate tests of both biological and neutral models and may lead to a better understanding of rarity. These temporal partitions also have interesting, but as yet barely explored, parallels with spatial ones such as the core‐satellite division. Moreover, changes in abundance distributions across all three of Preston's temporal scales (sampling time, ecological time and evolutionary time) present rich opportunities for ecological research.
Biased data reduce efficiency and effectiveness of conservation reserve networks
Authors: Grand Joanna , Cummings Michael P. , Rebelo Tony G. , Ricketts Taylor H. , Neel Maile C. 
Published: May 2007

AbstractComplementarity‐based reserve selection algorithms efficiently prioritize sites for biodiversity conservation, but they are data‐intensive and most regions lack accurate distribution maps for the majority of species. We explored implications of basing conservation planning decisions on incomplete and biased data using occurrence records of the plant family Proteaceae in South Africa. Treating this high‐quality database as ‘complete’, we introduced three realistic sampling biases characteristic of biodiversity databases: a detectability sampling bias and two forms of roads sampling bias. We then compared reserve networks constructed using complete, biased, and randomly sampled data. All forms of biased sampling performed worse than both the complete data set and equal‐effort random sampling. Biased sampling failed to detect a median of 1–5% of species, and resulted in reserve networks that were 9–17% larger than those designed with complete data. Spatial congruence and the correlation of irreplaceability scores between reserve networks selected with biased and complete data were low. Thus, reserve networks based on biased data require more area to protect fewer species and identify different locations than those selected with randomly sampled or complete data.
Four decades of opposing natural and human‐induced artificial selection acting on Windermere pike (Esox lucius)
Authors: Carlson Stephanie M. , Edeline Eric , Asbjørn Vøllestad L. , Haugen Thrond. O. , Winfield Ian J. , Fletcher Janice M. , Ben James J. , Stenseth Nils Chr. 
Published: May 2007

AbstractThe ability of natural selection to drive local adaptation has been appreciated ever since Darwin. Whether human impacts can impede the adaptive process has received less attention. We tested this hypothesis by quantifying natural selection and harvest selection acting on a freshwater fish (pike) over four decades. Across the time series, directional natural selection tended to favour large individuals whereas the fishery targeted large individuals. Moreover, non‐linear natural selection tended to favour intermediate sized fish whereas the fishery targeted intermediate sized fish because the smallest and largest individuals were often not captured. Thus, our results unequivocally demonstrate that natural selection and fishery selection often acted in opposite directions within this natural system. Moreover, the two selective factors combined to produce reduced fitness overall and stronger stabilizing selection relative to natural selection acting alone. The long‐term ramifications of such human‐induced modifications to adaptive landscapes are currently unknown and certainly warrant further investigation.
Real‐time elastography for detecting prostate cancer: preliminary experience
Authors: Pallwein Leo , Mitterberger Michael , Struve Peter , Pinggera Germar , Horninger Wolfgang , Bartsch Georg , Aigner Friedrich , Lorenz Andreas , Pedross Florian , Frauscher Ferdinand 
Published: May 2007

OBJECTIVETo assess the use of real‐time elastography (RTE) for detecting prostate cancer in patients scheduled for radical prostatectomy (RP), as most solid tumours differ in their consistency from the deriving tissue, and RTE might offer a new tool for cancer detection.PATIENTS AND METHODSWe examined 15 patients (mean age 56 years, sd 6.2, range 46–71) with RTE, using an ultrasonography (US) system with a 7.5‐MHz transrectal probe as a transducer. RTE is capable of visualizing displacements between pairs of US images of tissues when placed under axial compression. The stiffness of the lesion was displayed from blue (soft) to black (hard). Hard lesions with a diameter of ≥ 5 mm were considered as malignant. All patients had the diagnosis of prostate cancer confirmed by biopsy and had a mean (range) prostate specific antigen (PSA) level of 4.6 (1.4–16.1) ng/mL; all were scheduled for RP. US was performed by two investigators and interpreted by consensus. Cancer location and size was determined in the RTE mode only. One pathologist classified tumour location, grade and stage. The RTE findings were compared with the pathological findings.RESULTSThere were no major complications during RP in any patient; all had a pT2 tumour on histopathological examination, the Gleason score was 5–9 and the mean (range) tumour size 1.1 (0.6–2.5) cm. Thirty‐five foci of prostate cancer were present at the pathological evaluation; multiple foci were found in 11 of the 15 glands. RTE detected 28 of 35 cancer foci (sensitivity 80%). The per‐patient analysis showed that RTE detected at least one cancer area in each of the 15 patients. Only four sites with false‐positive findings on RTE and no histopathological correlation were detected; these findings were obtained in the first five patients (period of learning).CONCLUSIONSRTE can be used to visualize differences in tissue elasticity. Our results show that RTE allows the detection of prostate cancer and estimation of tumour location and size. RTE of the prostate is a new imaging method with great potential for detecting prostate cancer.
The reliability of the frequency‐volume chart in assessing lower urinary tract symptoms
Authors: Yap Tet L. , Cromwell David A. , Brown Christian , Emberton Mark , Van Der Meulen Jan 
Published: May 2007

OBJECTIVETo assess the test‐retest reliability of a 1‐day frequency‐volume chart (FVC) in men with lower urinary tract symptoms (LUTS).PATIENTS AND METHODSMen with uncomplicated LUTS presenting to a urology clinic were asked to complete FVCs on three consecutive days. Standard measures of voiding frequency and volume were derived using International Continence Society definitions. Test‐retest reliability of 1‐day voiding behaviour was evaluated with an intraclass correlation coefficient (ICC). We also derived 95% confidence intervals (CI) for each measure, thereby indicating the precision of the measurements produced by a 1‐day chart.RESULTSOf 140 patients with LUTS enrolled, 96 patients (69%) completed three 1‐day FVCs. The frequency and volume measures typically had ICCs of 0.7–0.8; the ‘number of urgent voids’ had the highest ICC. Nocturnal frequency and nocturnal volume were less reliable, with ICCs of 0.59 and 0.60, respectively. However, the 95% CIs around patient measurements tended to be wide. For 24‐h voiding frequency, the true value for a patient might be up to ± three voids away from the observed value for 95% of patients.CONCLUSIONThe measures of voiding behaviour derived from 1‐day FVCs had sufficient test‐retest reliability to differentiate between high and low levels of voiding symptoms. However, individual measurements could be imprecise, suggesting that, in men with LUTS, a 1‐day FVC cannot be used for diagnosis, or monitoring changes in symptom scores after treatment.
Laparoscopic radical cystectomy for cancer: oncological outcomes at up to 5 years
Authors: Haber Georges‐Pascal , Gill Inderbir S. 
Published: May 2007

Associate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani Menon, USAOBJECTIVETo report the oncological outcomes at ≤ 5 years after laparoscopic radical cystectomy (LRC), as open RC is the reference standard treatment for muscle‐invasive bladder cancer, but interest in LRC is increasing at selected centres worldwide and as yet there are no long‐term follow‐up data.PATIENTS AND METHODSBetween December 1999 and January 2005, 37 patients (mean age 66 years) had LRC with urinary diversion for invasive bladder cancer; 26 patients (70%) also had an extended pelvic lymphadenectomy. Overall and cancer‐specific survival data were obtained from patient charts, radiographic reports, telephone contact, and a check of the Social Security Death Index.RESULTSMost tumours were transitional cell carcinoma (32, 86%), high‐grade (grade III in 29, 78%) and high‐stage (≥pT2 in 26, 70%). Two patients had a positive surgical margin. The median (range) number of lymph nodes excised was 14 (2–24); seven patients (17%) had node‐positive disease (pN1). Follow‐up data were available for 35 patients (95%); eight (22%) completed ≥ 5 years of follow‐up, and the mean (range) follow‐up was 31  (1–66) months. At the last follow‐up, 24 patients (65%) were alive with no evidence of disease and 11 (30%) were dead, two (5%) from metastasis and nine (24%) from unrelated causes. The 5‐year actuarial overall, cancer‐specific and recurrence‐free survival was 63%, 92% and 92%, respectively.CONCLUSIONTo our knowledge, this is the first report of ≤ 5‐year follow‐up after LRC; the data suggest that LRC provides oncological outcomes comparable to contemporary series of open RC.
Penile‐preserving surgery for male distal urethral carcinoma
Authors: Smith Yuko , Hadway Paul , Ahmed Shwan , Perry Matthew J. , Corbishley Catherine M. , Watkin Nicholas A. 
Published: May 2007

OBJECTIVETo evaluate medium‐term outcome data from patients with distal urethral cancers treated with penile‐preserving surgery.PATIENTS AND METHODSWe analysed prospectively 18 consecutive men referred for the management of urethral carcinoma. All had a specialist review in a supra‐regional multidisciplinary team meeting, where the histology findings were reviewed by one pathology consultant. Tumours were staged according to the Tumour‐Node‐Metastasis classification and the patients offered penile‐preserving surgery when tumours were limited to the glanular or penile urethra.RESULTSAll 18 patients were suitable for penile‐preserving surgery; the procedures were: three hypospadias formation with or without topical chemotherapy; four buccal mucosa urethroplasty; three glansectomy and reconstruction; six glansectomy, distal corporectomy, reconstruction and hypospadias formation; two urethrectomy with or with no excision of adjacent tunica albuginea. The mean (median, range) follow‐up was 26 (20.5, 9–58) months. There were no local recurrences; four patients with regional nodal disease progressed and of these, two died from metastatic disease, and one died from an unrelated condition.CONCLUSIONMedium‐term data show that penile‐preserving surgery is a feasible treatment for men with distal urethral carcinoma, providing excellent local control without prejudicing survival; a longer follow‐up is needed.
The utility of lactate dehydrogenase in the follow‐up of testicular germ cell tumours
Authors: Venkitaraman Ramachandran , Johnson Bernadette , Huddart Robert A. , Parker Chris C. , Horwich Alan , Dearnaley David P. 
Published: May 2007

OBJECTIVETo evaluate the utility of lactate dehydrogenase (LDH), a tumour marker that is frequently elevated at diagnosis and relapse of testicular germ cell tumours (TGCTs), in the follow‐up of TGCTs for detecting tumour relapse, as it has role as a prognostic factor but its role in follow‐up is less certain.PATIENTS AND METHODSWe retrospectively reviewed 499 patients with TGCT who were followed from 1 January 2004 to 31 December 2005, with no clinical evidence of disease after a complete response to treatment or on surveillance for stage I disease.RESULTSOf patients attending for follow‐up or surveillance, in 26 of 1777 (1.4%) ‘patient‐visits’ there was a high LDH level related to disease, and in 137 of 1777 (7.7%) such visits there was a high LDH from unrelated causes. Of the 499 patients who were followed, 15 relapsed; the LDH level was high in six of 15 who relapsed, with LDH being one of the first elevated markers in four and the only elevated marker in one (seminoma). Of the 449 patients, 41 (9.1%) had a persistent false‐positive increase in LDH. The sensitivity of LDH was 40%, the specificity 90.5% and the positive predictive value 12.8% to detect relapse of disease during the follow‐up of TGCTs. When the series of 116 relapsed patients from 1992 to 2005 was analysed, an increase in LDH facilitated the detection of relapse in 2% of non‐seminomatous GCTs and 11% of seminomas, independent of other markers.CONCLUSIONLDH has limited sensitivity, specificity and positive predictive value for detecting relapse of TGCT and false‐positive increases are common. An elevated LDH level contributed to the detection in six of 15 relapses, suggesting that its value in the follow‐up of TGCT might be useful if interpreted cautiously. High LDH levels during the follow‐up might require repeat serial LDH estimates to confirm the elevation, and imaging to detect a relapse.