bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma amino‐terminal pro‐brain natriuretic peptide levels in subjects presenting to the Emergency Department with suspected acute coronary syndrome: possible role in selecting patients for follow up?
Authors: Campbell D. J. , Munir V. , Hennessy O. F. , Dent A. W. 
Published: March 2003

Abstract Background: Plasma amino‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level is a sensitive and specific indicator of cardiac dysfunction. Aim: To determine whether plasma NT‐proBNP level is elevated at the time of presentation with acute coronary syndrome (ACS) and whether it may assist in the diagnosis of heart failure and myocardial ischaemia in the Emergency Department. Methods: Plasma NT‐proBNP levels were measured prospectively in 201 unselected presentations to the Emergency Department with suspected ACS where cardiac injury markers were requested by clinicians as part of routine assessment. NT‐proBNP levels were correlated with clinical, electrocardiogram (ECG), biochemical and radiological findings. Results: Elevated NT‐proBNP level detected heart failure with high sensitivity (95–96%). Among patients without heart failure, NT‐proBNP levels were increased more frequently in patients with previously diagnosed ischaemic heart disease. Elevated NT‐proBNP level predicted cardiomegaly and a cardiac cause of presentation. However, the NT‐proBNP level was not associated with ECG or biochemical markers of myocardial ischaemia, and only one‐third of patients with ACS showed an increase of 40% or more in NT‐proBNP level at repeat measurement of cardiac injury markers 5 h after presentation. Conclusions: Although elevated NT‐proBNP level detected heart failure with high sensitivity, NT‐proBNP level did not assist in the diagnosis of acute myocardial ischaemia. These findings indicate that the major determinant of elevated NT‐proBNP level on presentation with suspected ACS was underlying cardiac dysfunction rather than acute myocardial ischaemia. This suggests that NT‐proBNP measurement in patients with a suspected cardiac reason for presentation to the Emergency Department may identify a previously unrecognized group of patients without acute ischaemia who may nevertheless benefit from further investigation of cardiac function. (Intern Med J 2001; 31: 211–219)
Outcomes research: what is it and why does it matter?
Authors: Jefford M. , Stockler M. R. , Tattersall M. H. N. 
Published: March 2003

Abstract Outcomes research is a broad umbrella term without a consistent definition. However it tends to describe research that is concerned with the effectiveness of public‐health interventions and health services; that is, the outcomes of these services. Attention is frequently focused on the affected individual − with measures such as quality of life and preferences − but outcomes research may also refer to effectiveness of health‐care delivery, with measures such as cost‐effectiveness, health status and disease burden. The present review details the historical background of outcomes research to reveal the origins of its diversity. The value and relevance of outcomes research, commonly employed research techniques and examples of recent publications in the area are also discussed. (Intern Med J 2003; 33: 110−118)
Evaluation of dosage adjustment in patients with renal impairment
Authors: Pillans P. I. , Landsberg P. G. , Fleming A.‐M. , Fanning M. , Sturtevant J. M. 
Published: March 2003

Abstract Aims: To determine whether appropriate dosage adjust­ments are made in patients with significant renal impairment for drugs with a high fractional renal clearance.Methods:  Evaluation of dosage adjustment was performed in patients who were admitted to a 480‐bed metropolitan hospital (Princess Alexandra Hospital, Brisbane, Australia) with an estimated creatinine clearance of ≤40 mL/min. All drugs had a high fractional renal excretion. A prescribed dose within 30% of the calculated dose was considered appropriate.Results:  Doses were found to be inappropriately high in 105 (42.2%) of 249 admission prescriptions of the targeted drugs. Doses were appropriately reduced in hospital in 32 patients (30.4%). Seventy‐three (29.3%) prescriptions were continued with excessive doses. Only 34 prescriptions for the target drugs were initiated in hospital, of which 88.2% were appropriately dosed.Conclusions:  A significant percentage of patients with renal impairment are admitted to hospital on inappro­priately high doses of drugs, with a high fractional renal excretion and low therapeutic index. Doses are appropriately reduced in hospital in some patients but there is still room for improvement. (Intern Med J 2003; 33: 10−13)
Use of computed tomography pulmonary angiography in the diagnosis of pulmonary embolismin patients with an intermediate probability ventilation/perfusion scan
Authors: Stone E. , Roach P. , Bernard E. , Briggs G. , Havryk A. , Faulder K. , Dennis C. 
Published: March 2003

Abstract Background:  Computed tomography pulmonary ­angiography (CTPA) plays an increasingly important role in the diagnosis of pulmonary embolism (PE). Although accurate in the detection of large PE, its accuracy in other patient groups is yet to be defined.Aim:  To compare CTPA with pulmonary angiog­raphy as a second‐line investigation in patients with a ventilation/perfusion (VQ) scan indicating an intermediate probability of PE.Methods:  We recruited 25 patients over a 17‐month period. Subjects were eligible if they: (i) had clinically suspected PE, (ii) had a VQ scan indicating an intermediate probability of PE and (iii) were referred for pulmonary angiography. Subjects underwent CTPA within 36 h of the VQ scan. CTPA was interpreted without knowledge of the results of the pulmonary angiogram by two of the authors.Results:  PE was prevalent (i.e. embolus detected at pulmonary angiography) in seven of 25 subjects (28%). The sensitivity of CTPA was 57% and the specificity was 94%.Conclusions:  In the setting of intermediate‐probability VQ scanning, CTPA may be used to clarify the diagnosis of PE. However, a negative CTPA cannot ­definitely exclude PE. Conventional pulmonary angiography may be necessary to determine the presence of PE if CTPA is negative. (Intern Med J 2003; 33: 74−78)
Incidence and therapy of midazolam induced hiccups in paediatric anaesthesia
Authors: Marhofer Peter , Glaser Christian , Krenn Claus G. , Grabner Claudia M. , Semsroth Margot 
Published: March 2003

SummaryA prospective, randomized and double blind study was undertaken to determine the incidence and a possible dose‐ or age‐dependence of hiccups in children premedicated with rectal midazolam and to investigate the treatment of hiccups by intranasal ethyl chloride spray application. Two hundred ASA physical status 1 and 2 children, weighing 3.0 to 15.0 kg, scheduled for minor surgery, were randomly assigned to be given either 0.5 mg·kg−1 midazolam(n=100) or 1.0 mg·kg−1 midazolam (n=100) administered rectally. If hiccups were observed during a period of 20 min after premedication with midazolam, these children were treated after 3 min of hiccups with two short intranasal applications of ethyl chloride spray. Hiccups occurred in 22% of children in the 0.5 mg·kg−1 group and 26% in the 1.0 mg·kg−1 group (n.s.). The intranasal application with ethyl chloride was successful in 100% in both groups. The mean age levels between children with or without hiccups were 5±9 months vs 21±19 months (P<0.01) in the 0.5 mg·kg−1 group and 6±7 months vs 20±14 months (P<0.01) in the 1.0 mg·kg−1 group. Intranasal application of ethyl chloride spray seems to be an effective therapy for midazolam induced hiccups in paediatric anaesthesia. The incidence of these hiccups is highly age significant, but not dose dependent.
Haemodynamic depression by halothane is age‐related in paediatric patients
Authors: Friesen Robert H. , Wurl Jonathan L. , Charlton Gareth A. 
Published: March 2003

SummaryThe hypothesis that young infants are more sensitive to the haemodynamic depressant effects of halothane compared with older children was tested. One hundred and sixty unpremedicated, ASA physical status I or II paediatric patients without cardiac or pulmonary disease were divided into five age groups: term neonates, 1–6 months, 6–24 months, 2–6 years and 6–12 years. Anaesthetic induction was achieved with halothane in oxygen and air via mask. Vecuronium 0.1 mg·kg−1 was administered intravenously. During normocapnic manual ventilation by mask, endtidal halothane concentration was maintained at either 2×age‐specific MAC (Method I) or 1.7% (Method II) in 20 patients in each age group for 10 min. In both Method I and Method II, systolic and mean blood pressure of term neonates and infants aged 1–6 months decreased significantly (P < 0.01) compared with other age groups. The results of this study demonstrate that neonates and young infants are more susceptible to haemodynamic depression during halothane anaesthesia than are older children, confirming clinical experience.
Age‐dependent variations in white adipose tissue glycerol and lactate production after surgery measured by microdialysis in neonates and children
Authors: Hildingsson Ulf , Lönnqvist Per‐Arne , Selldén Hans , Eksborg Staffan , Ungerstedt Urban , Marcus Claude 
Published: March 2003

SummaryIn previous studies, we observed that lactate concentrations in interstitial white adipose tissue are higher in small infants than in adults. Moreover, no lipolysis following catecholamine challenge has been reported in neonates and small infants. Our aim was to determine with microdialysis whether the above mentioned age‐dependent changes could be detected in situ after surgery. A microdialysis catheter was introduced into the abdominal subcutaneous tissue in 13 neonates and 12 children undergoing surgery. Interstitial concentrations of glucose, lactate and glycerol were measured hourly during the first 20 postoperative hours. The concentrations of lactate in interstitial white adipose tissue were consistently higher in neonates compared to older children, with a significant difference during the 9–18 h postoperative period (P < 0.05). A significant difference in the lactate:glucose ratio was observed at 1–2, 8–10, 15 and 18 h postoperatively (P < 0.05). No significant differences were observed between the two groups with respect to glycerol and glucose concentrations. Interstitial lactate concentrations in white adipose tissue were higher in neonates compared with children in the early postoperative period. No age‐dependent difference in postoperative lipolysis, measured as interstitial glycerol concentrations, was observed. Thus, an age‐dependent difference in interstitial lactate production, but not lipolysis, was detected in the early postoperative period.
Preoperative coagulation tests in former preterm infants undergoing spinal anaesthesia
Authors: DE SAINT BLANQUAT L. , SIMON L. , LAPLACE C. , EGU J.F. , HAMZA J. 
Published: March 2003

Background: Clinical history is insufficient to detect disorders of haemostasis in infants aged less than 1 year and laboratory coagulation testing is recommended in infants before perimedullar anaesthesia. Methods: We designed a retrospective study to assess the preoperative coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time, platelet count] performed in 141 former preterm infants who underwent spinal anaesthesia for elective inguinal hernia repair. All the infants had recovered from any significant medical event (necrotizing enterocolitis, intracranial haemorrhages, transfusions of blood products, sepsis, etc.) when they were scheduled for surgery. Results: Mean values for aPTT were frequently abnormal (60.4%) in infants with a postconceptional age of less than 45 weeks. No complication related to the puncture or abnormal perioperative bleeding was detected. Conclusions: Other coagulation tests should be evaluated to assess the coagulation status in infants with a postconceptional age of less than 45 weeks.
Caudal block with 4 mg·kg−1 (1.6 ml·kg−1) of bupivacaine 0.25% in children undergoing surgical correction of congenital pyloric stenosis
Authors: MOYAO‐GARCÍA DIANA , GARZA‐LEYVA MERCEDES , VELÁZQUEZ‐ARMENTA ELVIA Y. , NAVA‐OCAMPO ALEJANDRO A. 
Published: March 2003

Background: Since 1970, bupivacaine 0.25% in a dose of 4 mg·kg−1 (1.6 ml·kg−1) has been used at the Hospital Infantil de México for caudal block in children undergoing surgical correction of congenital pyloric stenosis (CPS). Although this dose is considered unsafe, in our experience, it has been associated with a high success rate and a low incidence of adverse events. This experience has not been previously documented. Methods: A retrospective cohort of patients undergoing surgical correction of CPS was studied. Nineteen patients received general anaesthesia while 223 received caudal block. The latter were then grouped according to the sedation technique. The rate of successful caudal blocks and complications were considered the major outcomes of the study, whereas the postsurgical fasting period and hospital stay were considered secondary outcomes. Results: The rate of success of caudal block was 96%. Anaesthetic complications related to bupivacaine were present in 1.3%. Mortality occurred in the postoperatory period in one septic patient who also was suffering from gastroschisis that required general anaesthesia. Postoperatory fasting period and hospital stay tended to be higher with general anaesthesia than caudal block. However, of the 19 patients receiving general anaesthesia, five suffered serious comorbidity and nine were failed caudal blocks. Conclusions: Caudal block with bupivacaine 0.25% (4 mg·kg−1) was associated with a low rate of anaesthetic complications. Further prospective studies to clarify the risks and benefits are required.
Analgesia for paediatric tonsillectomy and adenoidectomy with intramuscular clonidine
Authors: Freeman Katherine O. , Connelly Neil Roy , Schwartz Donald , Jacobs Barry R. , Schreibstein Jerry M. , Gibson Charles 
Published: March 2003

Summary Background: After undergoing tonsillectomy and adenoidectomy (T&A), children may experience significant pain. Clonidine, an α2 agonist, exhibits significant analgesic properties. The current investigation sought to determine whether intramuscular (I.M.) clonidine would decrease pain in paediatric patients undergoing T&A. Methods: Thirty‐nine children undergoing elective T&A were studied. Following inhalational anaesthetic induction, fentanyl (2 μg·kg−1) was given intravenously, acetaminophen (paracetamol) (30 mg·kg−1) was given rectally and the children then randomly received an i.m. injection of either normal saline or clonidine (2μg·kg−1). Perioperative analgesic requirements in the postanaesthesia care unit and at home following hospital discharge were evaluated. Results: There were no significant demographic, analgesic consumption, haemodynamic or pain score differences between the groups. Conclusions: We do not recommend adding i.m. clonidine (2 μg·kg−1) to the analgesic regimen of children undergoing tonsillectomy and adenoidectomy.
Effect of route of buprenorphine on recovery and postoperative analgesic requirement in paediatric patients
Authors: Khan Fauzia Anis , Memon Ghulam Asghar , Kamal Rehana S. 
Published: March 2003

Summary Background: We compared the effects of extradural with intravenous (i.v.) buprenorphine on postoperative pain and recovery characteristics. Methods: Thirty patients, aged 11–13 years, who were undergoing inguinal hernia repair with or without orchidopexy, were randomly allocated to receive either caudal 0.5% bupivacaine alone (group A) or were additionally given i.v. buprenorphine 2.5 µg·kg−1 (group B) or caudal buprenorphine in the same dose (group C). Patients were followed for 8 h after the end of surgery. Results: All patients remained haemodynamically stable during the study period and no clinical respiratory depression was seen. Nausea, vomiting, urinary retention and pruritus were more common in the extradural buprenorphine group. Three patients in group A, five in group B and eight in group C did not require any additional analgesia during the study period. The incidence of vomiting was 20%, 50% and 80% in groups A, B and C, respectively. Four patients in group C had urinary retention compared with one each in the other two groups. Conclusions: Administration of buprenorphine resulted in a higher incidence of side‐effects.
Aqueous misdirection and ciliary block (malignant) glaucoma after cataract removal in a llama
Authors: C. Powell Cynthia , Nuhsbaum Tanja M. , Gionfriddo Juliet R. 
Published: March 2003

AbstractCiliary block (malignant) glaucoma is caused by the posterior flow of aqueous humor into or behind the vitreous. It is a rare complication of anterior segment surgery in humans. This is a report of ciliary block glaucoma occurring as a postoperative complication of cataract surgery in a llama. Medical management was ineffective in lowering intraocular pressure (IOP). Posterior capsulotomy and anterior hyaloid disruption with a 22‐gauge needle, in addition to medical management maintained IOP in the normal range until anterior vitrectomy could be performed. After vitrectomy, glaucoma resolved and medical treatment was no longer necessary.
Unilateral exophthalmia in a European hedgehog (Erinaceus europaeus) caused by a lacrimal ductal carcinoma
Authors: Kuonen Vanessa J. , Wilkie David A. , Morreale Raymond J. , Oglesbee Barbara , Barrett‐Rephun Kelly 
Published: March 2003

AbstractA 5‐year‐old European hedgehog was examined because of exophthalmos of the left eye. A retrobulbar mass in the ventromedial orbit was suspected and confirmed by a computed tomography scan. Exophthalmos progressed despite systemic broad‐spectrum antibiotic therapy. The left orbit was exenterated and the mass was partially removed. The histopathologic diagnosis was lacrimal ductal carcinoma. Lacrimal ductal carcinoma is rare in humans and animals. The long‐term prognosis is guarded to poor.
Bilateral eyelid agenesis repair in a captive Texas cougar
Authors: Cutler Tim J. 
Published: March 2003

AbstractBilateral eyelid agenesis was presented with multiple ocular anomalies in a captive Texas cougar (Felis concolor). Corneal exposure resulted in substantial keratoconjunctivitis and blepharospasm. Bilateral inferopapillary fundic colobomas, persistent pupillary membranes, and an atypical iris coloboma OD were present. Surgical repair with a rotational pedicle flap resulted in functionally effective eyelids. Trichiasis was later treated with cryotherapy. Eyelid agenesis is reported infrequently in domestic cats and among large felids has only been reported in the snow leopard.
Phylogeny and classification of the Conochilidae (Rotifera, Monogononta, Flosculariacea)
Authors: Segers Hendrik H. , Wallace Robert L. 
Published: March 2003

To resolve several taxonomic problems within the family Conochilidae (Rotifera, Monogononta, Flosculariacea), we initiated a comparative study of the morphology in this and related taxa using samples collected from widely separated geographical regions. As part of this study, we paid special attention to trophal morphology using scanning electron microscopy. We also constructed and analysed a data matrix comprising 19 morphological characters of 11 taxa using cladistic methods to uncover all most‐parsimonious trees. The results indicate that Conochilidae share a body form with Flosculariidae, but they possess a trophal structure which clearly differentiates them from all other Flosculariacea; thus, the diagnosis of the family Conochilidae is amended to incorporate morphological characters of the trophi. The analysis of our data matrix yielded a single, most‐parsimonious tree. From the topology of that tree and our scanning electron microscopy observations, we propose the following: (1) the status of Conochilidae as a separate suborder of Flosculariacea is rejected; (2) taxonomic separation ofConochilusandConochiloidesas subgenera ofConochilusis confirmed; and (3)Lacinularia causeyaeVidrine, Mclaughlin & Willis, 1985 is reallocated to a new genus within the family Conochilide,Conochilopsisgen. nov., asConochilopsis causeyae(Vidrineet al.) comb. nov.
Geographic patterns of genetic and morphological divergence amongst populations of a river crab (Decapoda, Potamonautidae) with the description of a new species from mountain streams in the Western Cape, South Africa
Authors: Daniels Savel R. , Stewart Barbara A. , Burmeister Lisa 
Published: March 2003

Recent systematic research has revealed that Potamonautes brincki comprises two genetically and morphologically distinct population groups. The systematic affinities between these population groups have remained uncertain. In the present study, the relationship between the population groups was examined. Eleven populations were collected from high mountain streams in the Western Cape, South Africa and used in the genetic and morphological analyses. Allozyme electrophoresis of 13 protein coding loci separated two main population groups: group A (Cape Peninsular groups) and group B (Hottentot’s Holland) at I = 0.73. Two additional genetic groups were evident, with group B being conspecific to group A, and group D being conspecific to group C. Morphological examination of pleopod 1 and the terminal segment of the mandibular palp showed considerable differences between the two main population groups, with groups A and B being similar and groups C and D being similar. The morphometric data for the four main groups were examined using discriminant functions analysis and the two main groups were compared using analyses of covariance. Discriminant functions analysis showed a moderate degree of overlap between the groups. Additional morphometric data showed a clear discrimination between the two main population groups. The genetic and morphometric data sets exhibited congruent patterns of variation and the data showed the presence of a species boundary. A new freshwater crab species, P. parvicorpus sp. n., is described. The results of the present study are discussed in the light of historical and contemporary factors that are likely to have contributed to speciation.
Non‐host resistance of barley is associated with a hydrogen peroxide burst at sites of attempted penetration by wheat powdery mildew fungus
Authors: Hückelhoven Ralph , Dechert Cornelia , Kogel Karl‐Heinz 
Published: March 2003

SummaryIn barley, non‐host resistance against the wheat powdery mildew fungus (Blumeria graminis f.sp. tritici, Bgt) is associated with the formation of cell wall appositions and a hypersensitive reaction in which epidermal cells die rapidly in response to fungal attack. In the interaction of barley with the pathogenic barley powdery mildew fungus (Blumeria graminis f.sp. hordei, Bgh), these defence reactions are also associated with accumulation of H2O2. To elucidate the mechanism of non‐host resistance, the accumulation of H2O2 in response to Bgt was studied in situ by histochemical staining with diaminobenzidine. H2O2 accumulation was found in cell wall appositions under appressoria from Bgt and in cells undergoing a hypersensitive reaction. A mutation (mlo5) at the barley Mlo locus, that confers broad spectrum resistance to Bgh, did not influence the barley defence phenotype to Bgt. Significantly, Bgt triggered cell death on mlo5‐barley while Bgh did not.