bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurodevelopmental outcome of infants with birth asphyxia treated with magnesium sulfate
Authors: ICHIBA HIROYUKI , YOKOI TOSHIAKI , TAMAI HIROSHI , UEDA TORU , KIM TAE‐JANG , YAMANO TSUNEKAZU 
Published: February 2006

AbstractBackground:A neuroprotective effect of MgSO4has been shown in some animal models of perinatal hypoxic–ischemic brain damage. The aim of the present paper was to determine whether postnatal MgSO4infusion (250 mg/kg per day i.v. for 3 days, in combination with dopamine) is safe in infants with severe birth asphyxia, and also observe effects on neurodevelopmental outcome at 18 months.Methods:Inclusion criteria were clinical history consistent with perinatal asphyxia; gestational age at least 37 weeks; 5 min Apgar score ≤6; failure to initiate spontaneous respiration within 10 min after birth; and symptoms of encephalopathy. On each day MgSO4was infused over 1 h in combination with dopamine (5 μg/kg per min). Changes in vital signs, clinical course of encephalopathy, laboratory variables, and adverse events were monitored. Infants were followed for 18 months.Results:Thirty infants were studied. Mean birthweight was 2878 g; mean gestational age, 39.6 weeks, and median 5 min Apgar score, 3. All required endotracheal intubation for resuscitation. Median age at MgSO4initiation was 5 h. All infants had moderate or severe hypoxic–ischemic encephalopathy. Mean serum Mg2+concentration remained at least 1.3 mmol/L. MgSO4caused no change in physiological variables including mean arterial pressure. Two infants died as neonates, while six of 28 survivors had severe neurodevelopmental disability at 18 months; the remaining 22 had no neurodevelopmental disability.Conclusion:Postnatal infusion of MgSO4with dopamine caused no change in physiological variables. Deaths and severe sequelae were less frequent than in reported cases with the same grade of hypoxic–ischemic encephalopathy severity, and this treatment may improve neurodevelopmental outcome in infants with severe birth asphyxia.
Ability of preschool children to use dry powder inhalers as evaluated by In‐Check Meter
Authors: ADACHI YOKO S , ADACHI YUICHI , ITAZAWA TOSHIKO , YAMAMOTO JUNKO , MURAKAMI GYOKEI , MIYAWAKI TOSHIO 
Published: February 2006

AbstractBackground: Although current guidelines recommend the pressurized metered‐dose inhaler with a spacer for preschool children with asthma, dry powder inhalers (DPI) may be a valuable treatment alternative.Methods: To evaluate the ability of preschool children to inhale through DPI, peak inspiratory flow rates (PIFR) of 57 healthy children aged 3–6 years were measured with In‐Check Meter after practising with an instructor. Two different calibrated resistances were attached to the Meter to mimic the internal resistance of each inhaler; Diskus and Turbuhaler.Results: The ability of children to generate adequate inspiratory flow increased with age. The percentages of the 3‐, 4‐, 5‐, and 6‐year‐old children who were able to inhale reliably through the devices were 30% (3/10), 79.0% (15/19), 100% (16/16), and 100% (12/12), respectively. In these children, 100%, 93.3%, 100%, and 100% achieved an adequate PIFR for the Diskus (30 L/min). In contrast, 66.7%, 66.7%, 62.5%, and 91.7% generated an adequate PIFR for the Turbuhaler (60 L/min).Conclusions: The In‐Check Meter is a useful device to assess the ability of preschool children to generate adequate PIFR for each inhaler. Most children aged ≥5 years could use DPI.
Three novel and six common mutations in 11 patients with methylmalonic acidemia
Authors: KOBAYASHI AZUSA , KAKINUMA HIROAKI , TAKAHASHI HIROAKI 
Published: February 2006

AbstractBackground: Patients with a defect in methylmalonyl‐coenzyme A mutase (MCM) are classified as having methylmalonic acidemia, which is divided into two subclasses: mut0 and mut−. Fifty‐five disease‐causing mutations have been identified. Although most are private mutations, only three (E117X, G717V, and N219Y) are reportedly common in Japanese, Black, and Caucasian populations, respectively. Here we identified mutations in 11 Japanese patients with MCM deficiency.Methods: Mutational analysis was performed in 11 unrelated Japanese patients with MCM deficiency using polymerase chain reaction and direct sequencing.Results: Three novel (L494X, R727X, and 449_461del) and six previously reported (R93H, E117X, N219Y, R369H, G648D and IVS2 + 5G>A) mutations were identified. The L494X mutation was found in three unrelated patients, and the R93H, E117X, R369H, G648D, and IVS2 + 5G>A mutations occurred more than once. Two of the patients were classified as mut− phenotype because of residual [14C]‐propionate incorporation in the presence of a high concentration of hydroxocobalamin. The two mut− patients were heterozygous for the G648D mutation and presented with lethargy and metabolic acidosis after 2 years of life. Their psychomotor development has been documented as normal. The patients with the R727X or 449_461del mutations clinically exhibited mut0 phenotype. Two patients with mut0 phenotype died in infancy. One presented early in the neonatal period; the other was symptomatic in the late infantile period.Conclusions: The L494X, R93H, E117X, R369H, G648D, and IVS2 + 5G>A mutations are found in more than two unrelated families in the Japanese population. The short‐term outcome was generally poor in patients with mut0, and therefore alternative treatments should be considered.
CHANGES IN THE MANAGEMENT OF DUCTAL CARCINOMA IN SITU BEFORE THE RELEASE OF CLINICAL PRACTICE RECOMMENDATIONS IN AUSTRALIA: THE CASE IN VICTORIA
Authors: White Victoria , Pruden Myee , Giles Graham , Kitchen Paul , Collins John , Inglis Graeme , Hill David 
Published: February 2006

Background:  This study examines changes in the management of ductal carcinoma in situ between 1995 and 1999 in the Australian State of Victoria. This period was before the release of Australian treatment recommendations.Methods:  All new cases of ductal carcinoma in situ diagnosed between 1 April and 30 September in 1995 and 1999 were identified from the population cancer registry. Treating surgeons completed a questionnaire on the presentation and management of each case. In 1995, 64 out of 70 surgeons returned questionnaires for 137 cases (case response, 94%). In 1999, 68 surgeons treated 159 registered cases and 141 completed surveys were returned (case response, 89%).Results:  More cases underwent an image‐guided biopsy in 1999 (54%) than in 1995 (34%). Breast‐conserving surgery (BCS) was used to treat 69% of cases in 1999 and 63% in 1995. The use of axillary procedures (clearance or sampling) for women treated by mastectomy decreased from 61% in 1995 to 30% in 1999. More patients treated with BCS had margins simply described as ‘clear’ in 1995 (49%) than in 1999 (21%). In 1995, only 7% of cases treated with BCS had radiotherapy, and this was 25% in 1999.Conclusion:  In both 1999 and 1995, the majority of patients were treated by BCS, but only a minority received radiotherapy.
INDOCYANINE GREEN ELIMINATION: A COMPARISON OF THE LiMON AND SERIAL BLOOD SAMPLING METHODS
Authors: Purcell Roslyn , Kruger Peter , Jones Mark 
Published: February 2006

Background:  Indocyanine green (ICG) elimination is a test widely used to evaluate hepatic functional reserve in patients being assessed for hepatic resection. This study compares a non‐invasive liver function monitoring system, the LiMON (Pulsion Medical Systems, Munich, Germany), with serial blood sampling methods.Methods:  ICG elimination was measured by the LiMON, spectrophotometry and high‐performance liquid chromatography (HPLC) in 20 patients with hepatocellular carcinoma and cirrhosis as part of their preoperative work‐up.Results:  The ICG 15‐min retention rates obtained by spectrophotometry and HPLC correlated well (correlation coefficient = 0.91), and there was good agreement between the tests (mean bias = 2.93, 95% confidence interval (CI) = 1.59–4.28). There was a reasonably strong correlation between results obtained with the LiMON and spectrophotometry (correlation coefficient = 0.81), and again there was good agreement between the tests (mean bias = 2.71, 95% CI = 0.19–5.22). On average, 15‐min retention rates measured by the LiMON were 2.71 lower than those measured with spectrophotometry.Conclusion:  In patients being assessed for suitability of hepatic resection, the LiMON provides results similar to those obtained by serial blood sampling methods. This is important as techniques of carrying out ICG elimination vary widely between institutions and results are frequently incorporated into scoring systems that are used to determine surgical decisions.
COST, DEMOGRAPHICS AND INJURY PROFILE OF ADULT PEDESTRIAN TRAUMA IN INNER SYDNEY
Authors: Small Timothy J. , Sheedy Joanne M. , Grabs Anthony J. 
Published: February 2006

Background:  Pedestrian accidents are associated with substantial morbidity, mortality and cost; however, there has been very little published work on this topic in Australasia over recent years. The objective of this study was to examine the demographics, injury profile, outcomes and cost of pedestrian versus motor vehicle accidents in a central city hospital in Sydney.Methods:  Consecutive pedestrians injured by motor vehicles and admitted as inpatients during the years 2002–2004 were identified from our prospective trauma registry. A retrospective review included patient profiles (age, sex, time of injury and blood alcohol), injury pattern, cost, morbidity and mortality.Results:  A total of 180 patients (64% men and 36% women) with a mean age of 46 and mean injury severity score of 14.1 were identified. Two peak injury periods were observed: one between 17.00 and 18.00 hours (P < 0.01) and the other between 20.00 and 22.00 hours (P < 0.01). Significantly more injuries occurred on Friday (P < 0.01) and during autumn months (P < 0.05). Musculoskeletal (34.3%), head (31.8%) and external (20.2%) injuries predominated. Forty‐nine per cent of patients tested positive for consuming alcohol, with an average blood alcohol concentration (BAC) of 0.22%. Alcohol consumption was associated with a worse outcome in terms of hospital and intensive care unit stay, morbidity and mortality. The average length of stay was 13.4 days costing $A16320 per admission. Sixteen patients died (mortality rate of 8.9%), with the highest rate in the elderly group (22.7%) (P < 0.001).Conclusions:  Pedestrian accidents in inner Sydney are common with injuries predominating in intoxicated adult males. Mortality was higher in the elderly group. Injuries to the head and lower extremities predominate. Hospital stays are lengthy, resulting in a high cost for each admission.
GOVERNANCE AND INNOVATION: EXPERIENCE WITH A POLICY ON THE INTRODUCTION OF NEW INTERVENTIONAL PROCEDURES
Authors: Spigelman Allan D. 
Published: February 2006

Background:  Changing consumer expectations, particularly in the area of informed consent, coupled with a history of an unanticipated rise in adverse events following the introduction of some new interventional procedures, have produced a need for the more formal evaluation of such procedures before their introduction into a health‐care facility. Moreover, a need exists to ensure that the outcomes of such procedures are monitored. Descriptions of such formal evaluation processes were lacking before 2000. The experience of a large regional health service with the implementation of a brief but comprehensive evaluation process for the introduction of new interventional procedures is described.Methods:  A policy outlining the approval and monitoring processes, including a simple, 15‐point checklist, was developed in consultation with clinicians and managers and was implemented in 2000. The experience with this policy between January 2001 and December 2004 (inclusive) is described.Results:  Twenty‐nine applications for the introduction of new procedures, from a range of clinical disciplines, were submitted and approved. Some required significant modification, particularly in the areas of clinical risk description and other data required to facilitate the provision of informed consent.Conclusions:  Innovation can be protected and encouraged by processes that allow for appropriate scrutiny of the benefits and requirements for the successful introduction of new interventional procedures. The approach described has since been used as the basis for the New South Wales Health Department statewide policy on this matter and as a model policy by the Royal Australasian College of Surgeons.
PALLIATIVE GASTRECTOMY IN ADVANCED GASTRIC CANCER: IS IT WORTHWHILE?
Authors: Samarasam Inian , Chandran B. Sudhakar , Sitaram V , Perakath Benjamin , Nair Aravindan , Mathew George 
Published: February 2006

Background:  Gastric cancer remains one of the leading causes of cancer‐related deaths. Many patients present late, and therefore, resections are often palliative in nature. The aim of this study was to assess the feasibility of resectional operation and the survival advantage of surgical resection in advanced gastric cancer. The effectiveness of palliation and the quality of life following operation for gastric cancer were assessed.Methods:  One hundred and fifty‐one patients who underwent operation for gastric cancer at a tertiary centre in South India during a 5‐year period between 1999 and 2003, were included in this study. Four sites of tumour spread were used as indicators of incurability in these patients. These were unresectable primary tumour or macroscopic residual primary tumour (T+), unresectable lymph nodal metastasis (L+), unresectable liver metastasis (H+) and peritoneal metastasis (P+). The resectability rate and survival were assessed in relation to these four factors.Results:  The resectability rate decreased as the number of sites of tumour spread increased. The overall survival was significantly better in the subgroup of patients who had a resectional operation (total gastrectomy or subtotal gastrectomy), as opposed to the subgroup who had non‐resectional operation (exploratory laparotomy or laparotomy with gastrojejunostomy) (P = 0.0003). This survival advantage of resectional operation disappeared when more than two sites of tumour spread were present. The quality of life was significantly better when a resection operation was carried out.Conclusion:  In advanced gastric cancer, palliative resection has a survival advantage if the tumour spread is restricted to two or less sites. Patients who undergo resectional operation have better palliation of symptoms and their postoperative quality of life is significantly better.
THE READABILITY OF ORIGINAL ARTICLES IN SURGICAL JOURNALS
Authors: Hall John C. 
Published: February 2006

Background:  Readability indices have been developed based on sentence length and the use of long words. One such measure is the Reading Ease Scale developed by Rudolf Flesch. Texts that are easy to read have high scores: texts with scores below 30 are similar to legal contracts. This study uses Flesch scores to evaluate the readability of surgical journals.Methods:  Flesch scores were calculated for articles published in the Archives of Surgery, the British Journal of Surgery, and the ANZ Journal of Surgery. The first 30 original articles published in each journal in 2005 were selected for study. Excluded from study were editorials, reviews and case reports.Results:  The overall median score was 15.1 (0.0–29.1). The median scores for each of the journals were 12.4 (Archives of Surgery), 14.4 (British Journal of Surgery), and 18.6 (ANZ Journal of Surgery). There was only a minor link between Flesch scores and the use of surgical terms.Conclusion:  Original articles published in surgical journals contain too many long sentences and complex words. Readability indices are useful tools because they promote the use of simple English. It is realistic for authors to aim for Flesch scores above 30 when creating manuscripts.
PARTIAL ORCHIDECTOMY FOR MALIGNANCY WITH CONSIDERATION OF CARCINOMA IN SITU
Authors: Hughes Peter D. 
Published: February 2006

Background:  This article reports partial orchidectomy for malignant tumour in a solitary testis and discusses the common occurrence of carcinoma in situ (CIS) in the non‐tumour part of a testis containing malignant tumour, or in 5% of the contralateral testis when malignant tumour is found in one testis.Method:  Ultrasound of the testis gave the appearance of a 21‐mm germ cell tumour in the lower pole of a solitary testis in a 20‐year‐old man. Chest X‐ray was clear, and blood testis tumour markers were negative. Semen was collected and stored under liquid nitrogen freezing. The testis was explored through a groin incision and then the palpable tumour together with a margin of normal‐looking testis was excised.Results:  Histology showed embryonal carcinoma with no CIS in the adjacent normal testis tissue that had been excised with the tumour. At 93 months postoperatively, computed tomography scans of the chest and abdomen were negative, as were blood testis tumour markers, and the patient is potent. Ultrasound shows a testis of normal size and consistency.Conclusion:  Partial orchidectomy was practical in this case, but CIS is common in the non‐tumour part of any testis containing germ cell tumour and should be searched for histologically. In a man with two testes, one containing a germ cell tumour, CIS is found in 5% of the contralateral testes. Testis CIS leads to invasive carcinoma within 5 years in 50% of cases. When CIS is present, local radiation therapy is recommended by Heidenreich et al.; this retains potency but destroys fertility. Some are treating with chemotherapy CIS or germ cell primary tumours other than teratoma, in an attempt to preserve both potency and fertility.
T‐stress solutions for two‐dimensional crack problems in anisotropic elasticity using the boundary element method
Authors: SHAH P. D. , TAN C. L. , WANG X. 
Published: February 2006

ABSTRACTThe importance of a two‐parameter approach in the fracture mechanics analysis of many cracked components is increasingly being recognized in engineering industry. In addition to the stress intensity factor, the T stress is the second parameter considered in fracture assessments. In this paper, the path‐independent mutual M‐integral method to evaluate the T stress is extended to treat plane, generally anisotropic cracked bodies. It is implemented into the boundary element method for two‐dimensional elasticity. Examples are presented to demonstrate the veracity of the formulations developed and its applicability. The numerical solutions obtained show that material anisotropy can have a significant effect on the T stress for a given cracked geometry.
Acute pancreatitis after anesthesia with propofol in a child with glycogen storage disease type IA
Authors: BUSTAMANTE SERGIO E. , APPACHI ELUMALAI 
Published: February 2006

SummaryGlycogen storage disorder type 1A (GSD 1A) is an inherited disorder of glycogen metabolism characterized by fasting hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. These children have a higher risk of developing pancreatitis because of hypertriglyceridemia. Drug‐induced pancreatitis accounts for a small proportion of cases of pancreatitis. The mechanism of drug‐induced pancreatitis include hypersensitivity, direct toxic injury or indirectly by inducing hypertriglyceridemia. Propofol is often the drug of choice for induction of anesthesia in ambulatory surgical procedures. There are various reports in the literature describing pancreatitis induced by propofol. We present a 4‐year‐old girl with GSD 1A, who required tonsillectomy and adenoidectomy under general anesthesia. She developed acute pancreatitis in the postoperative period. Propofol was used as a general anesthetic and the postoperative incidence of pancreatitis is discussed.
Use of the Esophageal Doppler Machine to help guide the intraoperative management of two children with pheochromocytoma
Authors: HACK HENRIK 
Published: February 2006

SummaryThe anesthetic management of pheochromocytoma has been based upon the intraoperative control of blood pressure and fluid balance following adequate preoperative preparation. This can be difficult, especially in the presence of significant comorbidity such as cardiac or renal dysfunction. Two cases of children with pheochromocytoma are reported where the introperative management of fluid balance and blood pressure control were guided by measurement of changes in descending aortic blood flow using an esophageal Doppler probe. The advantages of such a technique compared with more invasive monitors are discussed.
Pharmacokinetic–pharmacodynamic relationship of rocuronium under stable nitrous oxide–fentanyl or nitrous oxide–sevoflurane anesthesia in children
Authors: WOLOSZCZUK‐GEBICKA BOGUMILA , WYSKA ELZBIETA , GRABOWSKI TOMASZ , ŚWIERCZEWSKA ANNA , SAWICKA RENATA 
Published: February 2006

SummaryBackground:  The aim of this study was to compare pharmacokinetics and pharmacokinetic–pharmacodynamic (PK–PD) relationship of rocuronium in children anesthetized with nitrous oxide (N2O) and fentanyl or with N2O and sevoflurane.Methods:  Twenty‐four children (3–11 years old, ASA PS I or II) were randomized to receive N2O/O2–fentanyl or N2O/O2–sevoflurane (one MAC) anesthesia. Neuromuscular transmission was monitored electromyographically. Initial bolus dose of rocuronium, 0.6 mg·kg−1 was followed by continuous infusion, targeting at steady‐state 95% T1 depression. Neuromuscular transmission was allowed to recover spontaneously. Plasma samples were collected at the moment of discontinuation of infusion, and 10, 20, 30, 50, 60 and 75 min afterwards. Concentrations of rocuronium were measured using high‐performance liquid chromatography with electrochemical detection (HPLC‐EC). Rocuronium PK was described by a two‐compartment model and PD parameters were estimated using effect compartment and sigmoidal Emax models.Results:  No differences in rocuronium PK parameters were observed between study groups. Clearance was 3.91 ± 2.07 and 3.62 ± 0.80 ml·min−1·kg−1 in sevoflurane and fentanyl groups, respectively (P < 0.65). Effect compartment concentrations corresponding to 50% inhibition of T1 (EC50) were 1.41 ± 0.45 and 2.32 ± 1.00 μg·ml−1 (P < 0.02), and rate constants for equilibration between plasma and effect compartment (ke0) values were 0.10 ± 0.04 and 0.24 ± 0.14 min−1 (P < 0.009) in sevoflurane and fentanyl groups, respectively.Conclusions:  Disposition of rocuronium was similar under stable N2O–fentanyl and N2O–sevoflurane anesthesia. Sevoflurane reduced rocuronium requirements as well as decreased EC50 relevant to inhibition of T1 and rocuronium transfer to effect compartment. Therefore, the potentiating effect of sevoflurane seems to be mainly of PD origin, probably due to an increased sensitivity of the neuromuscular junction.