bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sedation for children with metachromatic leukodystrophy undergoing MRI
Authors: MATTIOLI CRISTINA , GEMMA MARCO , BALDOLI CRISTINA , SESSA MARIA , ALBERTIN ANDREA , BERETTA LUIGI 
Published: June 2006

SummaryBackground:  Metachromatic leukodystrophy (MLD) is a lysosomal storage disease with infantile and juvenile onset with a poor prognosis and magnetic resonance imaging (MRI) plays a fundamental role in its diagnosis. Procedural sedation is needed to carry out MRI on children. Very few case reports have been published on anesthesia or sedation for MLD patients.Methods:  We prospectively studied 18 MLD patients undergoing sedation for brain MRI. Twenty consecutive similar‐aged ASA I children undergoing MRI during the same time span for suspected seizures and exhibiting no MRI brain alteration healthy (HLT) patients were also studied for comparison. In patients up to 3 years of age (T_MLD and T_HLT groups), sedation was induced with thiopental 5 mg·kg−1 i.v. and further 2.5 mg·kg−1 i.v. rescue boluses were given if the sedation level was inadequate. In patients over 3 years of age (P_MLD and P_HLT groups), sedation was induced with propofol 1–1.5 mg·kg−1 i.v. and maintained with 0.1–0.15 mg·kg−1·min−1 continuous i.v. infusion, which was increased if the sedation level was inadequate. We recorded complications, if any, caused by sedation (hypoxia, vomiting, bradycardia, other major arrhythmias, convulsions, MRI artifact movements with increasing sedation, prolonged recovery).Results:  No sedation complications occurred. The mean dose of thiopental required to warrant patient immobility was 0.227 ± 0.053 mg·kg−1·min−1 of procedure in T_MLD patients and 0.119 ± 0.061 mg·kg−1·min−1 of procedure in T_HLT patients (difference not significant). The mean dose of propofol required for immobility was 0.119 ± 0.054 mg·kg−1·min−1 of procedure in T_MLD patients and 0.115 ± 0.043 mg·kg−1·min−1 of procedure in T_HLT patients (difference not significant).Conclusions:  Our protocol for sedation in the MRI setting proved safe and effective in children with MLD, who do not require different doses of sedatives compared with healthy children.
Intravenous paracetamol for postoperative analgesia in a 4‐day‐old term neonate
Authors: AGRAWAL SHRUTI , FITZSIMONS JOHN J , HORN VENETIA , PETROS ANDY 
Published: June 2006

SummaryThere are only a few clinical reports on the use of intravenous (i.v.) paracetamol in term neonates. This case report illustrates that when routes for administration of analgesics are restricted to i.v. only and when opioids are not indicated then i.v. paracetamol may be used. In our 4‐day‐old term infant, despite i.v. paracetamol for 48 h, the trough level during therapy was almost undetectable indicating rapid clearance. Although i.v. paracetamol is not licensed in this age group, it can prove very helpful when the only route of administration is intravenous.
Can Bispectral Index aid laryngeal mask placement in children?
Authors: LIM SOO IM , CHAMBERS NEIL A. , SOMERVILLE NICOLA S. 
Published: June 2006

SummaryBackground:  Laryngeal mask airway (LMA) placement requires an adequate depth of anesthesia to prevent patient movement and adverse airway responses. Patient movement, coughing, stridor or laryngospasm at LMA placement may result in transient hypoxia, injury to the patient and prolong time spent in the anesthetic room. The Bispectral Index Score (BIS) is a relatively new tool that has not yet established its place in routine clinical pediatric anesthesia practice. One potential use may be to predict an adequate depth of anesthesia for successful intraoperative interventions such as LMA placement in children.Methods:  A total of 116 children aged between 1 and 16 years due to have an LMA placed under general anesthesia were enrolled into this prospective, blinded observational study. Complication or success of LMA placement was then analyzed in relation to the BIS value at the time of placement. Other clinical variables were also considered.Results:  The difference in BIS values in children with complicated compared with successful LMA placement was small and BIS therefore appears not to be a reliable predictor for either. Inexperience of the anesthetist and a history of recent upper respiratory tract infection (URTI) may be better indicators for complications.Conclusions:  Bispectral Index Score appears, from this study, not to be a useful tool to help predict complications of LMA placement or to help reduce airway complications during LMA placement. Other markers may be more useful predictors of adverse airway events.
Diminished Blalock‐Taussig shunt flow detected by cerebral oximetry
Authors: ROSSI MICHAEL , TIROTTA CHRISTOPHER F. , LAGUERUELA RICHARD G. , MADRIL DANIELLE 
Published: June 2006

SummaryNear‐infrared spectroscopy is a noninvasive optical technique used to monitor brain tissue oxygenation. Measurement of cerebral oxygenation is a more sensitive monitor of oxygen delivery to the brain than other available monitors. Prolonged cerebral desaturation is correlated with poor neurological outcomes. We report a case where the cerebral oximeter alerted us to diminished blood flow in a preexisting Blalock‐Taussig (subclavian artery to pulmonary artery) shunt.
Short course preoperative radiotherapy is the single most important risk factor for perineal wound complications after abdominoperineal excision of the rectum
Authors: Chadwick M. A. , Vieten D. , Pettitt E. , Dixon A. R. , Roe A. M. 
Published: June 2006

AbstractAim  To determine factors associated with perineal wound complications following abdominoperineal excision of the rectum (APER) for rectal adenocarcinoma and their effects on time to healing.Patients and methods  We studied all cases of APER performed in our unit by four consultants over 7 years. Seven out of nine factors considered important in wound healing were analysed using logistic regression and a multivariate model was built to examine interactions. Wound persistence was calculated using the Kaplan–Meier method.Results  Data were available for 94 of 96 patients [male:female, 3:2, median age 72.5 (IQR: 64–78)]. Thirty‐nine (41%) patients had 25 Gray, 3‐portal, fractionated 5‐day short course preoperative radiotherapy (SCPRT). Dukes stages were A (34%), B (26%), C (40%). Perineal wound complications occurred in 44 (47%), 16% of these requiring return to theatre. Local recurrences occurred in 13 (15%). There was no evidence to suggest that either patient gender, age, smoking status, preoperative albumin or haemoglobin level, or T stage were associated with the development of wound complications. The odds of wound complications for a patient who had SCPRT was over 10 times that for a patient who did not have preoperative radiotherapy (odds ratio 10.15, 95% CI: 3.80–27.05, n = 94). Seventy‐four per cent of SCPRT and 96% of non‐SCPRT wounds had healed by 1 year. Estimated failed wound healing rates at 30 and 90 days were 64% (95% CI: 46–78) and 48% (95% CI: 30–64) in SCPRT patients compared with 23% (95% CI: 12–35) and 9% (95% CI: 3–20) in non‐SCPRT patients (log rank test P < 0.0001).Conclusion  Patients who have an APER are over 10 times more likely to have a perineal wound complication if they have SCPRT than not. Two‐thirds of these will not have healed by 1 month, half by 3 months and over a quarter will still remain unhealed at 1 year. This has important implications for patient management decisions. Large prospective studies are needed to evaluate the effects of a selective policy for radiotherapy administered to patients requiring APER.
Vascular resistance in the prostate evaluated by colour Doppler ultrasonography: is benign prostatic hyperplasia a vascular disease?
Authors: BERGER ANDREAS P. , HORNINGER WOLFGANG , BEKTIC JASMIN , PELZER ALEXANDRE , SPRANGER ROBERT , BARTSCH GEORGE , FRAUSCHER FERDINAND 
Published: June 2006

There is a wide variety of topics in this section of the Journal this month. The papers come from Austria, Israel, Scotland, Denmark, England and Australia. I am, as ever, pleased that the Journal continues to receive papers from so many countries, and that the high standard of these papers help us to maintain a quality product of great general interest to the reader.OBJECTIVETo evaluate prostatic vascular resistance by measuring the resistive index (RI), and flow velocity using colour Doppler ultrasonography (CDUS), in normal prostates and in patients with benign prostatic hyperplasia (BPH) or prostate cancer, as BPH is considered to be a result of urogenital ageing and studies suggest that hyperplasia in the stromal and glandular compartments might be induced by stromal growth secondary to hypoxia, which in turn results from abnormal blood flow patterns.PATIENTS, SUBJECTS AND METHODSNinety‐two men (22 with normal prostates, 45 with BPH and 25 with prostate cancer; mean age 56 years) were prospectively evaluated by CDUS. The RI values for the peripheral, central and transition zones were assessed by one investigator. The diagnosis of BPH and prostate cancer was established from histological findings.RESULTSThe mean (sd) RI in the transition zone was significantly higher only in patients with BPH, at 0.77 (0.05), vs 0.65 (0.05) in the other two groups. In the peripheral and central zones there was no significant difference in the RI among the three groups. Arterial CDUS flow velocity was increased in the transition zone of patients with BPH, but not in the peripheral and central zones.CONCLUSIONSThe present results support the hypothesis that an age‐related impairment of blood supply to the lower urinary tract might have a role in the development of BPH. Although prostate cancer cannot be excluded by measuring RI, high RI values (>0.75) in the transition zone are indicative of BPH.
Radical cystectomy with ileal conduit diversion: early prospective evaluation of the impact of robotic assistance
Authors: Rhee Jonathan J. , Lebeau Sam , Smolkin Mark , Theodorescu Dan 
Published: June 2006

Associate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani Menon, USAOBJECTIVETo compare the performance of radical cystectomy with ileal conduit diversion by standard methods with that using the assistance of the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA).PATIENTS AND METHODSFrom November 2003 to August 2005, we performed 30 radical cystectomies with ileal conduit urinary diversions on patients with bladder cancer. Seven patients (one woman) had a cystectomy with the daVinci system and 23 (nine women) had a standard cystectomy. Data were collected prospectively, including estimated blood loss (EBL), transfusion requirement, operative duration, hospital stay and body mass index (BMI), and compared.RESULTSThe mean EBL and transfusion requirements for standard and daVinci‐assisted cases was 1109 and 479 mL (P = 0.002) and 2.7 and 1.6 units (P = 0.14), respectively. Four of seven patients received a transfusion in the robotic group, and 20 of 23 in the standard group (P = 0.084). The mean operative duration was 638 and 507 min (P = 0.005) for the daVinci and standard group, respectively, with respective mean hospital stays of 11 and 13 days (P = 0.52). There was no difference in patient BMI between the groups (P = 0.22).CONCLUSIONThe daVinci‐assisted cystectomy appears to offer some advantages over standard cystectomy. Larger randomized studies are needed to confirm these findings.
A phase II trial of imatinib mesylate in patients with biochemical relapse of prostate cancer after definitive local therapy
Authors: Lin Amy M. , Rini Brian I. , Weinberg Vivian , Fong Kristen , Ryan Charles J. , Rosenberg Jonathan E. , Fong Lawrence , Small Eric J. 
Published: June 2006

OBJECTIVETo determine the biological effects of imatinib mesylate (STI‐571, Gleevec®; Novartis Pharmaceuticals, Inc., East Hanover, NJ, USA), as measured by prostate‐specific antigen (PSA) kinetics in men with biochemical relapse of prostate cancer after definitive local therapy.PATIENTS AND METHODSMen with prostate cancer, who had had definitive local therapy, with nonmetastatic recurrent disease as manifested by a rising PSA level, were enrolled on this phase II trial. Men received 400 mg of imatinib mesylate orally twice daily and continuously until disease progression or unacceptable toxicity. The PSA level was measured monthly.RESULTSIn all, 20 men with biochemically relapsed prostate cancer were treated. The median pretreatment PSA level was 5.4 ng/mL. Of the 19 evaluable men, one achieved a ≥ 50% reduction in PSA level and two had decreases of <50%. For the 16 men in whom the on‐treatment PSA doubling time (PSADT) could be calculated (those with increasing PSA level) the median PSADT did not increase significantly (5.8 vs 7.2 months, P = 0.64). Eleven of 20 men discontinued therapy due to toxicity and the trial was stopped early due to toxicity.CONCLUSIONSBased on the lack of PSA modulation and pronounced toxicities leading to early closure of this trial, further study of single‐agent imatinib mesylate at this dose (400 mg twice daily) cannot be recommended in this patient population.
Intimal media thickness, glucose intolerance and metabolic syndrome in Asian Indians—the Chennai Urban Rural Epidemiology Study (CURES −22)
Authors: Mohan V. , Gokulakrishnan K. , Sandeep S. , Srivastava B. K. , Ravikumar R. , Deepa R. 
Published: June 2006

AbstractAims  The aim of the present study was to assess carotid intimal media thickness (IMT) in different grades of glucose intolerance and the metabolic syndrome (MS) in Asian Indians, a high‐risk group for diabetes and coronary artery disease.Methods  Subjects with normal glucose tolerance (NGT) (n = 1600), impaired glucose tolerance (IGT) (n = 330), newly diagnosed diabetes (NDD) (n = 330) and known diabetes (KD) (n = 1170) were recruited from the Chennai Urban Rural Epidemiology Study (CURES), an ongoing study on a representative population of Chennai (formerly Madras), in southern India. Assessment of carotid IMT was performed using high‐resolution B‐mode ultrasonography. MS was defined using modified adult treatment parel (ATP) III guidelines. Subjects with self‐reported diabetes, hypertension and dyslipidaemia were excluded from the analysis on MS.Results  Subjects with glucose intolerance had significantly higher mean carotid IMT values compared with subjects with normal glucose tolerance (NGT 0.69 ± 0.12 mm, IGT 0.75 ± 0.16 mm, NDD 0.79 ± 0.19 mm and KD 0.87 ± 0.24 mm, P < 0.001). Regression analysis showed that there was a linear increase in mean IMT values with increasing severity of glucose intolerance, even after adjusting for age and gender. Mean IMT values were higher in those with MS and increased with increase in number of metabolic abnormalities (subjects without any metabolic abnormality 0.66 ± 0.12 mm, one abnormality 0.67 ± 0.13 mm, two 0.70 ± 0.12 mm, three 0.72 ± 0.12 mm, four 0.77 ± 0.15 mm, five 0.76 ± 0.13 mm). Regression models showed MS to be associated with IMT, even after adjusting for age, gender and presence of diabetes (P = 0.021).Conclusio  In Asian Indians, carotid IMT increases progressively with increasing severity of glucose intolerance and is also associated with the metabolic syndrome, independent of age, gender and presence of diabetes.
Quality of care in diabetic patients attending routine primary care clinics compared with those attending GP specialist clinics
Authors: Ismail H. , Wright J. , Rhodes P. , Scally A. 
Published: June 2006

AbstractAim  To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics.Methods  Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics.Results  Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001).Conclusions  This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.
Structured patient education: the Diabetes X‐PERT Programme makes a difference
Authors: Deakin T. A. , Cade J. E. , Williams R. , Greenwood D. C. 
Published: June 2006

AbstractAims  To develop a patient‐centred, group‐based self‐management programme (X‐PERT), based on theories of empowerment and discovery learning, and to assess the effectiveness of the programme on clinical, lifestyle and psychosocial outcomes.Methods  Adults with Type 2 diabetes (n = 314), living in Burnley, Pendle or Rossendale, Lancashire, UK were randomized to either individual appointments (control group) (n = 157) or the X‐PERT Programme (n = 157). X‐PERT patients were invited to attend six 2‐h group sessions of self‐management education. Outcomes were assessed at baseline, 4 and 14 months.Results  One hundred and forty‐nine participants (95%) attended the X‐PERT Programme, with 128 (82%) attending four or more sessions. By 14 months the X‐PERT group compared with the control group showed significant improvements in the mean HbA1c (− 0.6% vs. + 0.1%, repeated measures anova, P < 0.001). The number needed to treat (NNT) for preventing diabetes medication increase was 4 [95% confidence interval (CI) 3, 7] and NNT for reducing diabetes medication was 7 (95% CI 5, 11). Statistically significant improvements were also shown in the X‐PERT patients compared with the control patients for body weight, body mass index (BMI), waist circumference, total cholesterol, self‐empowerment, diabetes knowledge, physical activity levels, foot care, fruit and vegetable intake, enjoyment of food and treatment satisfaction.Conclusions  Participation in the X‐PERT Programme by adults with Type 2 diabetes was shown at 14 months to have led to improved glycaemic control, reduced total cholesterol level, body weight, BMI and waist circumference, reduced requirement for diabetes medication, increased consumption of fruit and vegetables, enjoyment of food, knowledge of diabetes, self‐empowerment, self‐management skills and treatment satisfaction.
Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes
Authors: Lawton J. , Ahmad N. , Hanna L. , Douglas M. , Hallowell N. 
Published: June 2006

AbstractAims  To explore Pakistani and Indian patients’ experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.Design  Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews.Results  Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health‐care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly.Conclusions  Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health‐care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients’ need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability.
Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999
Authors:   The DIAMOND Project Group
Published: June 2006

AbstractAims  To examine incidence and trends of Type 1 diabetes worldwide for the period 1990–1999.Methods  The incidence of Type 1 diabetes (per 100 000/year) was analysed in children aged ≤ 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset.Results  A total of 43 013 cases were diagnosed in the study populations of 84 million children. The age‐adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100 000/year in China and Venezuela to 40.9 per 100 000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4–3.2%). During the years 1990–1994, this increase was 2.4% (95% CI 1.3–3.4%) and during the second study period of 1995–1999 it was slightly higher at 3.4% (95% CI 2.7–4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age.Conclusions  The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies.