bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tramadol for pain relief in children undergoing herniotomy: a comparison with ilioinguinal and iliohypogastric blocks
Authors: KHOSRAVI MOHAMMAD BAGHER , KHEZRI SASAN , AZEMATI SIMIN 
Published: November 2005

SummaryBackground:  Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Preoperative ilioinguinal and iliohypogastric nerve blocks have been widely used to provide analgesia in children undergoing herniorrhaphy. Tramadol is an analgesic with micro‐opioid and nonopioid activity. In this study we compared the usage of intravenous tramadol with ilioinguinal and iliohypogastric nerve blocks for control of postherniorrhaphy pain in children aged 2–7 years.Methods:  Sixty patients were randomly allocated to two groups of thirty. One group received tramadol 1.5 mg·kg−1 i.v. before induction of general anesthesia and the other had an ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine (0.25 ml·kg−1) before skin incision. We assessed pain using the Children's Hospital of Eastern Ontario Pain Scale and the Categorical Pain Scale.Results:  At 1, 4 and 24 h after surgery the two groups had identical pain scores. At 2 and 3 h after surgery the tramadol group experienced significantly less pain (P < 0.05). The rescue drug for residual pain, was used equally in the two groups. None of the 60 patients had respiratory depression but the tramadol group patients were found to have more episodes of nausea and vomiting (P < 0.05).Conclusions:  We concluded that tramadol can have at least the same analgesic effect as that of ilioinguinal and iliohypogastric nerve blocks for postherniorrhaphy pain in children, with even a superior effect at the time of maximal analgesia. We also highlight the troublesome side‐effect of nausea and vomiting which brings into question the benefits of using this opioid that seems to lack respiratory depression.
Use of BIS monitor in a child with congenital insensitivity to pain with anhidrosis
Authors: BRANDES IVO F. , STUTH ECKEHARD A. E. 
Published: November 2005

SummaryWe describe a case of a 14‐year‐old boy with congenital insensitivity to pain and anhidrosis (CIPA) who underwent tarsal tunnel release for tarsal tunnel syndrome. Because of abnormal pain perception, the patient's response to normally painful surgical stimuli is severely impaired and not adequately reflected in a corresponding rise in blood pressure or heart rate. This lack of autonomic feedback to pain stimuli may make it more difficult to assess whether anesthetic depth is adequate to prevent intraoperative awareness and thus to safely conduct anesthesia, especially if muscle paralysis is required for surgical indications. We describe for the first time the use of processed EEG monitoring with a BIS A‐2000 monitor to gauge anesthetic depth in a patient with CIPA. Initial forehead bispectral index (BIS) values prior to induction were normal (98) and then ranged between 23 and 79 during the whole surgical procedure. Propofol and lidocaine were used for induction and deep extubation; isoflurane was used as the sole anesthetic for maintenance with concentrations ranging from 0.21% to 0.92% to maintain a target BIS of 40–60. Volatile anesthetic requirements remained low throughout the procedure and no narcotics were necessary during surgery. The BIS monitor served as an adequate tool to help avoid excessive use of volatile anesthetic while assuring a processed EEG consistent with unconsciousness and amnesia. After the patient had recovered and was oriented to place and time in the recovery room, he was asked whether he remembered anything about the surgery and the presence of a breathing tube in his mouth. He denied any recall of such events.
Perception of pain following rectal administration of morphine in children: a comparison of a gel and a solution
Authors: LUNDEBERG STEFAN , HATAVA PIRKKO , LAGERKRANSER MICHAEL , OLSSON GUNNAR L. 
Published: November 2005

SummaryBackground:  Rectal administration of morphine is one possible route of delivery in children. The aim of this study was to determine the pain experience during rectal administration of two different morphine preparations.Methods:  The acceptance of the pain of rectal administration of morphine for premedication was studied in 120 children. Children were randomized to receive either morphine solution in saline (0.2 mg·kg−1, 1 mg·ml−1) or morphine gel (0.2 mg·kg−1, 1 mg·ml−1) with an adjusted pH for rectal use in a double‐blind fashion. Children were stratified into three groups according to age (1–2, 3–6, and 7–10 years). Pain was assessed with the Children's Hospital of Eastern Ontario Pain Scale, the McGrath Facial Affective Scale, or the visual analogue scale, depending on the age group.Results:  The overall pain scores in all age groups were low. Children aged 1–2 years (P < 0.01) and 3–6 years (P < 0.05) had significantly less pain when morphine was administered as a gel than a solution. The difference in pain experience between the two forms was not significant in the age group of 7–10 years.Conclusion:  The results indicate that most of the children tolerated rectal administration of morphine well in terms of pain experience, in both gel and solution form. The morphine gel, intended for rectal use appears to be the preparation of choice in children aged 1–6 years.
The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate
Authors: XUE F.S. , ZHANG G.H. , LI P. , SUN H.T. , LI C.W. , LIU K.P. , TONG S.Y. , LIAO X. , ZHANG Y.M. 
Published: November 2005

SummaryBackground:  The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities.Methods:  A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1–6 months group, 6–12 months group and 1–3 years group.Results:  The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1–6 months group, 2.90% in 6–12 months group, and 3.13% in 1–3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively.Conclusions:  Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections – anesthetic implications and literature review
Authors: SADHASIVAM SENTHILKUMAR , LITMAN RONALD S. 
Published: November 2005

SummaryPediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are rare neurobehavioral disorders in children. Affected children may have a diverse array of perioperative manifestations including compulsive behavior, agitation, and abnormal movements. Perioperative management might be more challenging for anesthesiologists. Series of therapeutic plasmapheresis in these children may complicate their anesthesia management. We describe the first case of a patient with PANDAS and its anesthesia implications.
Transient loss of motor‐evoked responses associated with caudal injection of morphine in a patient with spondylolisthesis undergoing spinal fusion
Authors: GIBSON PETER R.J. , FCA(SA) SARAH JOHNSTON , LAGOPOULOS JIM , CUMMINE JOHN L. 
Published: November 2005

SummaryA 7‐year‐old girl having posterior spinal fusion for Grade 3 anterior spondylolisthesis at the L5/S1 level was administered 2.5 mg of morphine in 10 ml saline via the caudal epidural route before surgery. Motor‐evoked responses were markedly diminished in her lower limbs for 1 h following this but returned spontaneously. She suffered no neurological injury. The cause for this is postulated to be transient cauda equina compression from the volume of injectate. This complication of caudal injection has not been reported before. The possible mechanisms for this are discussed. We believe that significant L5/S1 spondylolisthesis should be considered a contraindication to the use of caudal epidural injections.
Human factors in pediatric anesthesia incidents
Authors: MARCUS R. 
Published: November 2005

SummaryBackground:  Anesthesia and the operating theater environment is a complex system involving man–machine and human–human interactions. Although we strive for an error free system, we are humans and errors and mistakes will occur. The aim of this study was to investigate the human factors behind events and incidents in pediatric anesthesia at our institution.Methods:  This study consisted of a retrospective review and analysis of all contemporaneously reported anesthetic incidents between April 1, 2002 and March 31, 2004 at Birmingham Children's Hospital. Where there were anesthetic human factors involved in the event these were classified.Results:  There were 668 incidents reported, giving a rate of 2.4% of the 28 023 anesthetics recorded. Airway and respiratory incidents were the most common representing 52.2% of all incidents. A total of 284 anesthetic human factors could be identified and classified. Of these the most common were errors in judgment 43%, failure to check 17.8%, technical failures of skill 9.2%, inexperience 7.7%, inattention/distraction 5.6% and communication issues 5.6%.Conclusions:  In our institution anesthetic human factors occur in 42.5% of in‐theater incidents in pediatric anesthesia. Knowledge of these is necessary so that changes can be made in practice both by individuals and departments of anesthesia, to make anesthesia as safe as possible.
Changes in vasoconstrictor and vasodilator neurotransmitters in nerves supplying arterioles in developing colorectal polyps
Authors: Chamary V. L. , Loizidou M. , Boulos P. B. , Taylor I. , Burnstock G. 
Published: November 2005

AbstractObjective  To examine the changes that occur in the immunohistochemistry of vasoconstrictor and vasodilator transmitters in nerves supplying early and advanced colorectal polyps.Subjects and methods  We studied the perivascular innervation of submucosal arterioles of colorectal polyps (n = 18) and the innervation of the epithelial layer of polyps compared to normal controls (n = 8), using immunohistochemical markers for the neurotransmitters; noradrenaline (NA) (marker used; tyrosine hydroxylase (TH)), neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), substance P (SP), and calcitonin gene‐related polypeptide (CGRP). (Advanced polyps; villous adenomas > 1.5 cm, polyps with severe dysplasia or partial carcinoma).Results  In submucosal arterioles there was a progressive decrease from controls through early polyps to advanced polyps in TH and NPY perivascular immunoreactivity (P < 0.015 for both). VIP and SP immunoreactivity was higher in early polyps compared to controls, but markedly reduced in advanced polyps (P < 0.05 for VIP). Sparse CGRP immunoreactivity was present in polyps only. Neural VIP and SP immunoreactivity in the lamina propria of polyp mucosa was more intense than in controls.Conclusion  There is a decrease in vasoconstrictor neurotransmitters NPY and NA (shown by TH) around submucosal arterioles of both early and advanced polyps, but an increase in the vasodilator neurotransmitters, particularly VIP, in early colorectal polyps. These results suggest a predominantly vasodilatory neural influence in early polyps, perhaps indicating a mechanism that maintains polyp growth.
Ileal pouch anal anastomosis for ulcerative colitis is feasible for septuagenarians
Authors: Ho Kok Sun , Chang C. C. , Baig M. K. , Börjesson L. , Nogueras J. J. , Efron J. , Weiss E. G. , Sands D. , Vernava A. M. , Wexner S. D. 
Published: November 2005

AbstractObjective  Proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the standard surgery for patients with mucosal ulcerative colitis (MUC). Although there is no absolute age limitation, there are concerns as to its use in elderly patients due to the risks of potential complications and poor function. The aim of this study was to assess the complications and outcome of patients over the age of 70 years with MUC who underwent IPAA. Results in these patients were compared to the results in a group of patients aged less than 70 years who had IPAA.Methods  After Institutional Review Board approval, a retrospective review of the medical records of patients with MUC who underwent IPAA was undertaken. These patients were divided into four age groups: < 30 years of age, 30–49 years, 50–69 years, ≥ 70 years.Results  From 1989 to 2001, 330 patients underwent IPAA for preoperative clinical and histopathological and postoperative histopathologically confirmed MUC; 17 were aged ≥ 70 years. The mean hospital stay was 5.8 (SEM 0.7) days in the patients aged < 70 years and 6.0 (SEM 0.4) days in the patients aged ≥ 70 years (P = 0.911). Postoperative complications occurred in 39% of patients ≥ 70 years and in 40% in the < 70 years group (P = 0.08). Pouch failure occurred in two (11.8%) patients ≥ 70 years and in 6 (1.9%) < 70 (P = 0.2).Conclusion  IPAA is a safe and feasible option in MUC patients over the age of 70 with functional results similar to results seen in younger patients.
Diagnostic accuracy of body coil MRI in describing the characteristics of perianal fistulas
Authors: Mahjoubi B. , Haizadch Kharazi H. , Mirzaei R. , Moghimi A. , Changizi A. 
Published: November 2005

AbstractObjective  The purpose of this study was to determine the accuracy of synergic body coil MRI using SPIR technique without contrast, in the determination of fistula characteristics in patients with clinically positive signs.Method and subjects  This was a case‐series prospective study including 29 consecutive patients with clinically suspected fistulas‐in‐ano. The standard synergic body coil was used and all patients had T2‐weighted SPIR sequences. One radiologist, without prior knowledge of the clinical examination, analysed images and noted the presence of the fistula, its classification and the presence and number of any collections or extensions. The surgeon noted the MRI findings and looked for lesions suggested on MRI. The results of the MRI and surgical assessments were then compared. Results of surgical exploration while the surgeon was aware of MRI results were considered as the gold standard of surgical anatomy.Results  Twenty‐three (79.31%) of 29 fistula tracks were seen on MRI which correctly determined the type of all fistulas. In the six cases where the fistula was not seen on MRI, five were low trans‐sphincteric and one was rectovaginal. MRI identified 8 of 10 collections.Conclusion  The synergic body coil MRI with SPIR sequencing without endoanal coils had a high accuracy in the diagnosis of high fistulas collections, complex fistulas and extensions.
Patients' expectations of colorectal surgery for cancer
Authors: Holzer B. , Gyasi A. , Schiessel R. , Rosen H. R. 
Published: November 2005

AbstractObjective  The primary objectives of surgery for colorectal cancer are to achieve radical resection of the tumour and to ensure a satisfactory quality of life for the patient. But what is satisfactory quality of life for the patients? What do patients desire? The goal of our exploratory investigation was to evaluate prospectively the patient pre‐operative expectations as objectively as possible and to analyse results in relation to age, gender and socio‐economic status.Methods  In the period from 1998 to 2001, 167 patients were given a questionnaire consisting of 15 questions prior to surgery. The questionnaire included various aspects that were thought to influence the patient's quality of life. Moreover the patients were given the opportunity to rate the questions they considered most important.Results  The following five points were considered most important by the total group of patients: Complete cure of the disease was rated most important (95%); it was the prime expectation of the patients. This was followed by the avoidance of a stoma (81%), a reliable control of defaecation (52%), normal digestion (44%) and little pain (26%).Conclusion  Age, gender and education influence the pre‐operative expectations of patients undergoing surgery for colorectal cancer. In addition to the surgical standard, the care of the individual patient must be given due consideration in the treatment strategy.
Ultrastructure of the reproductive system of the black swamp snake (Seminatrix pygaea). V. The temporal germ cell development strategy of the testis
Authors: Gribbins Kevin M. , Happ Carrie S. , Sever David M. 
Published: November 2005

AbstractThe germ cell development strategy during spermatogenesis was investigated in the black swamp snake (Seminatrix pygaea). Testicular tissues were collected, embedded in plastic, sectioned by ultramicrotome, and stained with methylene blue and basic fuchsin. Black swamp snakes have a postnuptial pattern of development, where spermatogenesis occurs from May to July and spermiation is completed by October. Though spatial relationships are seen between germ cells within the seminiferous epithelium during specific months, accumulation of spermatogonia and spermatocytes early in spermatogenesis and the depletion of spermatocytes and accumulation of spermatids late in spermatogenesis prevent consistent cellular associations. This temporal germ cell development within an amniotic testis is consistent with that seen in other recently studied temperate reptiles (slider turtle and wall lizard). These reptiles’ temporal development is more similar to the developmental strategy found in anamniotes than the spatial germ cell development that characterizes birds and mammals. Our findings also imply that a third germ cell development strategy may exist in temperate breeding reptiles. Because of the phylogenetic position of reptiles between anamniotes and other terrestrial amniotes, this common germ cell development strategy shared by temperate reptiles representing different orders may have significant implications as far as the evolution of sperm development within vertebrates.
Structure of adhesive organ of the mountain‐stream catfish, Pseudocheneis sulcatus (Teleostei: Sisoridae)
Authors: Das Debasish , Nag Tapas Chandra 
Published: November 2005

AbstractThe structure and ultrastructure of the adhesive organ (AO) in the catfish, Pseudocheneis sulcatus (Sisoridae), an inhabitant of the sub‐Himalayan streams of India, is described. The surface of the AO is thrown into folds, the ridges of which bear curved spines. The AO epidermis consists of 10–12 tiers of filament‐rich cells, of which the outer tier cells project spines lined with a thick plasma membrane and bear bundles of tonofilaments (TF). Their cytoplasm contains TF and large mucus‐like granules, but no obvious organelles. A second tier of living cells with spines is present beneath the outer tier and seems to replace the latter when its spines are damaged or shed. The outer tier cells react positively with antibody to cytokeratin. Actin labelling is clearly absent from the outer tier, indicating that keratinization of the outer tier occurs in the absence of actin filaments. In the cells of the third to fifth tiers, the cytoplasm possesses abundant small mucous granules (0.1–0.3 µm), and fewer TF compared to the cytoplasm in the spines. The cells of the innermost tiers and the basal layer possess few TF bundles, but no mucous granules. The potential of AO filament cells to produce both mucous granules and keratin filaments is noteworthy. The observations provide evidence that specific regions of fish epidermis can actually undergo a true process of keratinization.
Morphological variation and sexual dimorphism of the cephalic scales in Lacerta bilineata
Authors: Bruner Emiliano , Costantini David , Fanfani Alberto , Dell’Omo Giacomo 
Published: November 2005

AbstractThe Western green lizard (Lacerta bilineata) is a lacertid distributed throughout Mediterranean and Central Europe. Little is known about the morphological variability and sexual shape differences in this species. In this paper, the variation of the cephalic scales in L. bilineata is analysed by means of a geometric morphometric approach. A main structural pattern is characterized by negative allometry of the frontal and interparietal areas, and positive allometry of the parietal and frontoparietal scales. Sexual differences are described both in size and shape. In males, the scales are generally larger, with relative shortening of the frontal area, frontoparietal enlargement, occipital lengthening and bulging of the parietal scales, which compresses and narrows the interparietal and occipital areas midsagittally. This pattern is based on a shared allometric trajectory, with males displaying a peramorphic morphotype. However, males show some shape differences in the occipital area that are not size‐related, and cannot be interpreted in terms of general head enlargement. This structural trajectory can be related to the development of the skull, but the role of soft tissues (temporal, nuchal and masticatory muscles) must also be considered. The development of the jaw and nuchal muscles involved in intra‐ and intersexual behaviours could have played a pivotal role in the evolution of this pattern.
Ultrastructure of sperm development in the free‐living marine nematode Metachromadora itoi (Chromadoria, Desmodorida)
Authors: Yushin Vladimir V. , Coomans August 
Published: November 2005

AbstractThe spermatogenesis of the free‐living marine nematode Metachromadora itoi was studied with electron microscopy. Spermatocytes and early spermatids have no cytoplasmic components specific for nematodes, i.e. membranous organelles (MO) and fibrous bodies (FB). The late spermatids are subdivided into the residual body and the main cell body with a centrally located nucleus devoid of a nuclear envelope. A pair of 9 × 2 centrioles is associated with the nuclei of spermatids and spermatozoa. The nucleus of the mature spermatid is surrounded by a thick mass of radially arranged FB delimited externally by a discontinuous layer of mitochondria, which underlie a thin ectoplasm. Sperm development is accompanied by transfer of FB matter through the mitochondrion layer into the ectoplasm. The immature spermatozoa from the testis have the centrally located nucleus surrounded by a transparent halo with remnants of FB. The halo is delimited by a sphere of mitochondria that underlie the thick fibrous ectoplasm, a derivative of the FB. In the mature spermatozoa the ectoplasm is transformed into the prominent unpolarized pseudopod. The central nucleus is surrounded by a transparent halo and a sphere of mitochondria, which underlie the pseudopod. MO were not found throughout spermatogenesis. In general, spermatogenesis in M. itoi differs from that observed in many nematodes but resembles in some details the sperm development in some chromadorid and tylenchomorph nematodes. The phylogenetic importance of this sperm development is discussed.