bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracic epidural catheter in the management of a child with an anterior mediastinal mass: a case report and literature review
Authors: SOLIMAN LORAN M. , MOSSAD EMAD B. 
Published: November 2005

SummaryWe describe a case of an anterior mediastinal mass compressing the right main bronchus that required a biopsy through a thoracotomy incision. The anesthetic management of these patients is associated with several risks and challenges, including potential airway compression and cardiovascular collapse. Inhalation induction and maintenance of spontaneous respiration is recommended to preserve normal transpulmonary pressure gradient and improve flow through conducting airways. We placed a thoracic epidural catheter under general anesthesia as the main analgesic technique in order to maintain spontaneous breathing. The use of regional anesthesia, especially continuous epidurals in pediatric cardiothoracic anesthesia have many theoretical advantages including attenuation of the neuroendocrine response, facilitation of rapid extubation and improved ventilatory mechanics secondary to decreased narcotic requirements. The absolute risk of nerve injury and epidural hematoma for this procedure is unknown and hard to define in this patient population. We reviewed multiple studies and case reports addressing its safety and reported side effects. Finally, we emphasize that a thoracic epidural anesthesia is a reasonable choice that can be applied carefully in special situations even for children under general anesthesia.
Subcutaneous emphysema after dental treatment: a case report
Authors: TORGAY ADNAN , AYDIN ERDINC , CILASUN ULKEM , DURMAZ LALE , ARSLAN GULNAZ 
Published: November 2005

SummarySubcutaneous emphysema is the condition in which air or other gases penetrate the skin and submucosa causing soft‐tissue distention. This type of emphysema may be traumatic, iatrogenic or may occur spontaneously. This report describes the youngest case of subcutaneous emphysema related to dental treatment that has been documented to date. In addition to the patient's age, the case is of interest because subcutaneous emphysema is a rare complication of dental therapy.
The efficacy of morphine and Entonox analgesia during chest drain removal in children
Authors: BRUCE ELIZABETH , FRANCK LINDA , HOWARD RICHARD F. 
Published: November 2005

SummaryBackground:  Morphine is commonly used for chest drain removal pain, although a few studies in adults suggest that inhalation agents may be effective for this procedure. Little is known about chest drain removal pain and its management in children.Methods:  Three separate studies were carried out at a large tertiary pediatric hospital to examine the characteristics and management of chest drain removal pain in children. Study 1 examined the prevalence and clinical characteristics of pain and analgesic practices in 135 nonventilated children aged 1 week to 18 years having chest drains removed. Study 2 was an observation study to determine the efficacy and safety of self‐administered Entonox (50% nitrous oxide and oxygen) for chest drain removal pain in 30 children aged 7–18 years. Study 3 was a pilot randomized controlled trial comparing intravenous morphine and continuous flow Entonox for chest drain removal pain in 14 children aged 3.5 months to 2.75 years.Results:  In study 1, the prevalence of moderate to severe pain during chest drain removal was 76%. Morphine was commonly given preprocedure, but the dose varied considerably. In study 2, children experienced a significant increase in pain during the procedure compared with preprocedure pain at rest, despite receiving Entonox, morphine and/or diclofenac. However, procedure pain was no worse than preprocedure pain during movement or deep breathing. A few minor side effects occurred, which resolved spontaneously. In study 3, no differences were found in pain between the two treatment groups. Children experienced moderate to severe pain during the procedure, despite receiving Entonox or morphine.Conclusions:  Morphine or Entonox alone are unlikely to provide adequate analgesia for chest drain removal pain in children. More research is needed to determine the most effective interventions for this procedure.
Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients
Authors: BORTONE LUCIANO , INGELMO PABLO M. , NINNO GESÙ DE , TOSI MICHELA , CAFFINI LAURA , TRENCHI JUNA , MERGONI MARIO , MARTORANA FABIO 
Published: November 2005

SummaryBackground:  The laryngeal tube (LT) is a supraglottic ventilatory device used in adults. However, there is limited information about LT use in pediatric patients. This randomized controlled study compares LT with laryngeal mask (LMA) for airway management during spontaneous or assisted ventilation and during fiberoptic laryngoscopy in children.Methods:  Thirty children under 10‐years old, ASA I–II, scheduled for minor general surgery, Mallampati score I–II, fasted and premedicated were included. Patients with upper respiratory infection, craniofacial malformation, intracranial hypertension, emergency surgery were excluded. The primary outcome measure was the proportion of patients in whom effective spontaneous or assisted ventilation [Vt ≥ 4 ml·kg−1, SpO2 ≥ 95% with FiO2 0.4, PECO2≤7.2 kPa (55 mmHg)] was achieved after 3 min of LT or LMA cuff inflation. The secondary endpoint was the proportion of patients in whom fiberoptic laryngoscopy resulted in identification of the vocal cords.Results:  Eleven children with LMA and two children in LT group had adequate spontaneous or assisted ventilation after initial positioning (P < 0.01). After head extension or device repositioning 15 of 15 patients in LMA group had adequate ventilation compared with 11 of 15 patients in LT group (P < 0.05). The vocal cords could be observed with fiberoptic laryngoscopy in 11 LMA group patients compared with no patients in the LT group (P < 0.001).Conclusions:  The LT is less effective than the LMA to allow adequate spontaneous or assisted ventilation and for fiberoptic evaluation of the airway in children under 10 years old.
Futility and inappropriate care in pediatric intensive care: a cross‐sectional survey
Authors: VEMURI GOPI , PLAYFOR STEPHEN DEREK 
Published: November 2005

SummaryBackground : Over recent years, there have been increasing concerns regarding an increase in the number of futile and inappropriate admissions to pediatric intensive care units (PICUs) in the United Kingdom (UK).Methods : A prospective cross‐sectional survey was carried out using a data collection form distributed by mail to the directors of all PICUs in the UK. Respondents were asked to give details of all patients on their unit on a specific day including age, reason for admission and any preexisting medical conditions. An assessment was made by respondents of whether the care being provided in each case was, in their opinion, appropriate, futile or inappropriate according to standard definitions.Results : We received responses from 21 units (68%) who reported the details of 111 patients. Care was felt to be appropriate in 88 of these cases (79%), futile in nine cases (8%) and inappropriate in 14 cases (13%). Futile cases were most commonly admitted with respiratory failure and all had preexisting medical conditions, most commonly developmental delay. Where care was felt to be inappropriate, respiratory failure was again the most common reason for admission and all had a preexisting medical condition, most commonly cardiovascular disease.Conclusions : The care being provided in 21% of the PICU cases, described in this study, was felt to be either futile or inappropriate by the directors of those units. There is an urgent need to, accurately, establish the resource consumption associated with these patients and to establish a standard approach to futility and inappropriate care in PICU in the UK.
The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment
Authors: MALVIYA SHOBHA , VOEPEL‐LEWIS TERRI , BURKE CONSTANCE , MERKEL SANDRA , TAIT ALAN R. 
Published: November 2005

SummaryBackground:  Difficulty with pain assessment in individuals who cannot self‐report their pain poses a significant barrier to effective pain management. However, available assessment tools lack consistent reliability as pain measures in children with cognitive impairment (CI). This study evaluated the validity and reliability of the revised and individualized Face Legs Activity Cry and Consolability (FLACC) behavioral pain assessment tool in children with CI.Methods:  Children with CI scheduled for elective surgery were studied. The FLACC was revised to include specific descriptors and parent‐identified, unique behaviors for individual children. The child's ability to self‐report pain was evaluated. Postoperatively, two nurses scored pain using the revised FLACC scale before and after analgesic administration, and, children self‐reported a pain score, if able. Observations were videotaped and later viewed by experienced nurses blinded to analgesic administration.Results:  Eighty observations were recorded in 52 children aged 4–19 years. Twenty‐one parents added individualized pain behaviors to the revised FLACC. Interrater reliability was supported by excellent intraclass correlation coefficients (ICC, ranging from 0.76 to 0.90) and adequate κ statistics (0.44–0.57). Criterion validity was supported by the correlations between FLACC, parent, and child scores (ρ = 0.65–0.87; P < 0.001). Construct validity was demonstrated by the decrease in FLACC scores following analgesic administration (6.1 ± 2.6 vs 1.9 ± 2.7; P < 0.001).Conclusions:  Findings support the reliability and validity of the FLACC as a measure of pain in children with CI.
Propofol anesthesia in spontaneously breathing children undergoing magnetic resonance imaging: comparison of two propofol emulsions
Authors: GUTMANN ANTON , PESSENBACHER KLAUS , GSCHANES ANDREA , EGGENREICH UDO , WARGENAU MANFRED , TOLLER WOLFGANG 
Published: November 2005

SummaryBackground:  This study evaluated a propofol‐based anesthesia regimen with spontaneous breathing in pediatric patients scheduled for magnetic resonance imaging (MRI).Methods:  In this prospective, randomized, double‐blind study propofol formulated with long‐chain triglycerides (LCT) and mixed medium‐chain/long‐chain triglycerides (MCT/LCT) were used. Ninety patients aged 2.4 months to 7.3 years were premedicated with intravenous midazolam. Lidocaine was injected prior to propofol to reduce injection pain. Anesthesia was induced and maintained by propofol. Glycopyrronium bromide was administered for saliva reduction. Hemodynamics, blood oxygen saturation and endtidal capnography were continuously monitored. All patients received additional oxygen. The aggregated propofol dose for induction and maintenance of anesthesia was analyzed for therapeutic equivalence. Incidence of injection pain, laboratory safety values, vital signs, and the adverse event profile were analyzed to compare tolerability and safety.Results:  Propofol anesthesia was safe and successful in all children. Both propofol formulations were equivalent regarding dose requirements (mean induction and maintenance doses for anesthesia 2.0–4.0 mg·kg−1 and 6.0–8.8 mg·kg−1·h−1 respectively; aggregated doses 8–13.26 mg·kg−1). There were no differences in drug safety such as hemodynamics, spontaneous breathing, injection pain, and laboratory values. Duration of induction and of recovery from anesthesia were short and all examinations were completed with minimal interruption.Conclusions:  Propofol‐based short‐term anesthesia was well suited for anesthesia during MRI procedures in the studied pediatric patients. There were no clinically relevant differences between the two propofol formulations.
Evaluation of knowledge and anxiety level of patients visiting the colorectal pelvic floor clinic
Authors: Coolen J. C. G. , Florisson J. M. G. , Bissett I. P. , Parry B. R. 
Published: November 2005

AbstractObjective  Discussing defaecating disorders is difficult for patients and many view anal physiology investigations (ultrasound, manometry, electromyography and pudendal nerve studies) as distasteful. This pilot study sought to assess whether present information sheets supplied to patients and the visit to the colorectal Pelvic Floor Clinic itself influenced patients' knowledge and anxiety.Patients and methods  Thirty Pelvic Floor Clinic patients from Auckland City Hospital were included. Each patient filled in a questionnaire before and after the clinic. This included objective questions about their knowledge of the structure and function of the pelvic floor and satisfaction with and understanding of the information sheet. Both visual analogue scale (VAS) and multiple choice questions (MCQ) were used. Their subjective and objective knowledge were compared. Anxiety was assessed on a visual analogue anxiety scale (VAAS). Results were expressed as VAS scores or percentage correct and relationships were tested using Fisher's Exact test and paired T‐test.Results  Subjective knowledge increased in 93% of the patients. The doctor's explanation led to a greater increase in subjective knowledge than the information sheet (35/100 mm, P < 0.001 and 10/100 mm, P = 0.01, respectively). Subjective improvement in knowledge did not however, translate into an increase in objective knowledge (P = 0.63). The information sheet was read by 87% of the patients. The information sheet had reduced anxiety only in 23% of the patients and increased in 10%. Anxiety levels were not significantly influenced by the information sheet, but reduced significantly by the clinic visit in 87% of patients (P < 0.001). The mean anxiety level reduced from 44/100 to 12/100 after the clinic visit.Conclusion  Anxiety levels are high in those visiting the Pelvic Floor Clinic. It appears that it is the interaction with the doctor that has a profound influence on anxiety levels and subjective knowledge rather than written information.
Aetiology and surgical management of toxic megacolon
Authors: Ausch C. , Madoff R. D. , Gnant M. , Rosen H. R. , Garcia‐Aguilar J. , Hölbling N. , Herbst F. , Buxhofer V. , Holzer B. , Rothenberger D. A. , Schiessel R. 
Published: November 2005

AbstractObjective  The purpose of this article is to review the surgical management and outcome of toxic megacolon and to update the aetiology of toxic megacolon.Patients and method  A retrospective chart review of three academic colorectal surgery units was undertaken. Over a period of 20 years, 70 patients with surgically managed toxic megacolon were identified: 32 men and 38 women, median age 63 years (range, 23–87 years).Results  In 33 (48%) patients the main cause of toxic megacolon was inflammatory bowel disease. Thirty‐seven (52%) patients had toxic megacolon of different aetiology. Sixty‐three patients underwent colonic resection: 49 (70%) subtotal colectomies and 14 (20%) total colectomies, including 4 (6%) proctocolectomies. Seven (10%) patients had decompression (n = 3) or faecal diversion (n = 4) only. Forty‐four of the resected patients underwent a Hartmann's procedure and an ileostomy; 13 (19%) patients had primary anastomoses, 11 (16%) ileorectal anastomoses (IRA) and 2 (3%) patients had ileal pouch‐anal anastomosis (IPAA). Twenty‐six (37%) patients subsequently had continuity restored. Total surgical complication rate was 19% (n = 13), 8% (n = 4) in patients treated with subtotal colectomy, 21% (n = 3) in patients treated with total proctocolectomy and 86% (n = 6) in patients treated with either decompression or diversion. The total mortality rate was 16% (n = 11).Conclusions  Toxic colitis complicated by toxic megacolon can occur after various diseases of the colon and remains a life‐threatening disorder associated with a significant risk of postoperative complications. Subtotal colectomy with ileostomy remains the procedure of choice. Surgical colonic decompression with faecal diversion alone is associated with a high rate of complications.
Ultrastructure of the spermatozoon of Apus apus (Linnaeus 1758), the common swift (Aves; Apodiformes; Apodidae), with phylogenetic implications
Authors: Jamieson Barrie G. M. , Tripepi Sandro 
Published: November 2005

AbstractThe spermatozoon of Apus apus is typical of non‐passerines in many respects. Features shared with palaeognaths and the Galloanserae are the conical acrosome, shorter than the nucleus; the presence of a proximal as well as distal centriole; the elongate midpiece with mitochondria grouped around an elongate distal centriole; and the presence of a fibrous or amorphous sheath around the principal piece of the axoneme. The perforatorium and endonuclear canal are lost in A. apus as in some other non‐passerines. All non‐passerines differ from palaeognaths in that the latter have a transversely ribbed fibrous sheath whereas in non‐passerines it is amorphous, as in Apus, or absent. The absence of an annulus is an apomorphic but homoplastic feature of swift, psittaciform, gruiform and passerine spermatozoa. The long distal centriole, penetrating the entire midpiece, is a remarkably plesiomorphic feature of the swift spermatozoa, known elsewhere only in palaeognaths. The long centriole of Apus, if not a reversal, would be inconsistent with the former placement of the Apodiformes above the Psittaciformes from DNA–DNA hybridization. In contrast to passerines, in A. apus the microtubules in the spermatid are restricted to a transient single row encircling the cell. The form of the spermatozoon fully justifies the exclusion of swifts from the passerine family Hirundinidae.
Morpho‐anatomical differences of the Early Cambrian Chengjiang and Recent lingulids and their implications
Authors: Zhang Zhifei , Shu Degan , Han Jian , Liu Jianni 
Published: November 2005

AbstractSince the publication of Darwin's theory of evolution in 1859, lingulids have probably been the most widely quoted examples of arrested evolution. This, to some degree, may be because few anatomical features are impressed either on or inside valves so these may not adequately reflect the extent of change incurred during lingulid evolution. Two lingulid brachiopods, Lingulella chengjiangensis and Lingulellotreta malongensis, from the Early Cambrian Chengjiang Lagerstätte (Yunnan, South China) show preservation of a series of soft parts, notably the lophophores, setae mantle canals and perfectly impressed visceral region, which are vital to understanding the evolution and lifestyle of brachiopods. Analysis of the valve interiors favours the claim that an epifaunal mode of life could be a plesiomorphic state in contrast to the infaunal one of modern lingulids. Based on these fossils, the three‐pseudosiphon formation of setae found in Recent lingulids is proposed to be an apomorphy derived as an adaptation to an infaunal lifestyle. Comparison between the interior of the fossils with that of modern lingulids does little to support the widespread notion that the morphology of this lineage has remained remarkably constant since at least the early Palaeozoic.
Gonadal morphology and reproductive traits of the Amazonian fish Arapaima gigas (Schinz, 1822)
Authors: Godinho Hugo P. , Santos José E. , Formagio Paulo S. , Guimarães‐Cruz Rodrigo J. 
Published: November 2005

AbstractAn account of gonadal morphology and reproductive traits of the Amazonian arapaimatid, Arapaima gigas (Schinz 1822), is given. The only functional ovary (left) was foliaceous in shape having the ventral surface without an ovarian capsule. The absence of the ovarian capsule ventral portion, absence of oviduct and funnel‐shaped coelomic cavity are features that imply that oocytes are freed in the coelomic cavity before being shed to the aquatic environment through a genital papilla. The only functional testis (left) was cord‐like with a maximum diameter of 1–1.5 cm and was connected to the genital papilla through a spermatic duct. Size at sexual maturity was 145–154 cm and 115–124 cm, total length class, for females and males, respectively.
A predictive tool for the self‐management of diabetes (Librae): evaluation using a continuous glucose monitoring system
Authors: Franklin V. L. , Wilson A. W. , Butler R. A. , Greene S. A. 
Published: November 2005

AbstractAims  Diabetes self‐management involves a difficult balancing act between insulin, food and exercise. The challenge is to develop innovative, validated algorithms to aid patient decision‐making and optimize glycaemic control. ‘Librae’ is a computerized diabetes simulator in diary format, developed as an educational predictive tool for patients, reducing ‘trial and error’ by allowing patients to simulate and experiment with dietary or insulin adjustments on a ‘body double’. We have evaluated the predictive ability of Librae using continuous blood glucose monitoring (CGMS).Methods  Patients with Type 1 Diabetes attending the Paediatric Clinic were invited to use ‘Librae’ for 1 week and were then fitted with a CGMS for 72 h. The predictive ability of ‘Librae’ was compared with concurrent data obtained from the CGMS.Results  Seven thousand nine hundred and sixty paired blood glucose values were obtained from the 11 patients who completed the study. ‘Librae’ underestimated the measured CGMS values, the error having a positive mean of 0.35 mmol/l (95% confidence interval 0.22–0.48 mmol/l). However, Librae tended to overestimate at low levels of blood glucose readings, and underestimate at high levels of blood glucose readings.Conclusion  The modelled values of ‘Librae’ correlated well with the CGMS data, but clinically unacceptable errors occurred at extremes of blood glucose levels. Concurrent CGMS recordings have provided a large data set to modify and improve the existing Librae model and patient feedback has led to improvements in its usability. Librae may provide a useful tool to improve diabetes self‐management education and optimize glycaemic control.
Improving Ecological Impact Assessment by Statistical Data Synthesis Using Process-Based Models
Authors: Demyanov V. , Wood S. N. , Kedwards T. J. 
Published: November 2005

Summary
Population dynamic modelling often entails parameterizing quite sophisticated biological and ecological mechanisms. For models of moderate mechanistic complexity, this has traditionally been done in an ad hoc manner, with different parameters being estimated independently. The point estimates so obtained are then used for model simulation, perhaps with some further ad hoc adjustment based on comparison with any available data on population dynamics. Quantitative assessments of model adequacy and prediction uncertainty are not easily made using this approach. As an alternative, the paper investigates the practical feasibility of fitting a moderately complex population dynamic model directly and simultaneously to all the data available for parameterization of the model, and to all available data on the population dynamics of the target animal. This alternative approach allows us to combine all available quantitative information on the target species, to assess the viability of the model, the mutual consistency of model and different sources of data and to estimate the uncertainties that are associated with model-based predictions. The target organism in this study is the freshwater amphipod Gammarus pulex (L.), which we model using a stage-structured population dynamic model, implemented via a set of delay differential equations describing the basic demography of the population. Target data include population dynamic data from two sites, information on basic physiological relationships and environmental temperature data. Fitting is performed by using a non-linear least squares approach supplemented with a bootstrapping method for avoiding small scale local minima in the least squares objective function. Variance estimation is performed by further bootstrapping. Interest in Gammarus pulex population dynamics in this case is primarily related to likely population level responses to chemical stressors, and for this we examine predicted ‘recovery times’ following exposure to a known toxicant.