bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cyclooxygenase‐2 mRNA is up‐regulated in cirrhotic or chronic hepatitis liver adjacent to hepatocellular carcinoma
Authors: Morinaga Soichiro , Yamamoto Yuji , Noguchi Yoshikazu , Imada Toshio , Rino Yasushi , Akaike Makoto , Sugimasa Yukio , Takemiya Shoji , Kameda Yoichi , Takanashi Yoshinori 
Published: March 2003

AbstractBackground and Aim: Hepatocellular carcinoma (HCC) is unique in that its carcinogenesis is related to inflammatory changes and regenerative activities in the background liver. Although there are some data on cyclooxygenase (COX)‐2 expression in HCC by immunohistochemical studies, little is known about the possible role of COX‐2 in inducing hepatitis and/or carcinoma. To elucidate whether COX‐2 is involved in a part of these processes, we attempted to examine COX‐2 mRNA both in the adjacent non‐tumoral liver and in HCC.Methods: Twenty‐two matched sets of adjacent liver and HCC specimens were analyzed for COX‐2 mRNA expression using a real‐time quantitative reverse transcription polymerase chain reaction. Cyclooxygenase‐2 protein expression was also determined by immunohistochemistry.Results: Cyclooxygenase‐2 mRNA expression was significantly higher in the adjacent liver than in HCC (P = 0.016). Cyclooxygenase‐2 mRNA expression in adjacent liver tissues was positively correlated with the modified histological activity index scores (r = 0.575, P = 0.006), the serum alanine aminotransferase levels (r = 0.536, P = 0.010), and the Ki‐67 labeling indices (r = 0.698, P = 0.001). In contrast, COX‐2 mRNA expression in HCC was not correlated with any of the clinicopathological features.Conclusions: Cyclooxygenase‐2 is expressed at higher levels in the adjacent liver than in HCC, and it may be associated with high levels of necroinflammation and regeneration in the background liver. Conversely, COX‐2 may have a lesser role in the progression of HCC.
Role of the longitudinal smooth muscle coat in the ileal motile activity: Evidence of ileo–ileal inhibitory reflex
Authors: SHAFIK AHMED , SHAFIK ALI A , AHMED ISMAIL 
Published: March 2003

Abstract
Background
: All gut movements are claimed to be activated essentially by the concentric contraction of the circular muscle, moving the chyme aborally. The role of the longitudinal smooth muscle of the small intestine in gut motility is poorly understood; this point was investigated in the current study.
Methods
: The abdomens of 14 crossbreed dogs (eight dogs, six bitches) were opened. A segment of the small intestine was distended by a balloon in increments of 2 mL of saline, and the pressure and electrical activity were recorded proximally and distally to the balloon. The gut wall around the balloon was anesthetized and the test was repeated. The longitudinal muscle coat of the small intestine segment was then excised, and the pressure response and electrical activity were recorded on ileal distension.
Results
: Two milliliter ileal distension produced pressure decrease (P < 0.05) proximally and distally to the balloon and caused balloon movement. Four, 6 and 8 mL distension effected similar pressure response, while 10 mL showed no response. Electrical waves were recorded from the three electrodes applied to the ileal segment. Upon ileal distension, electrical activity increased over the distended area, with no activity proximally and distally to it. Balloon distension of the anesthetized ileal segment produced no pressure response or electrical activity. After longitudinal myectomy, no electrical activity was recorded at rest or upon ileal distension, and the balloon did not move.
Conclusion
: Ileal distension initiated circular muscle contraction only in the presence of the overlying longitudinal muscle, which appears to transmit the electrical activity to the circular muscle upon ileal distension. Ileal contraction is suggested to initiate ileal hypotonia in the proximal and distal ileal segments mediated through an ‘ileo–ileal inhibitory reflex’ that leads to aboral progress of the proximally and distally located chyme.© 2002 Blackwell Publishing Asia Pty Ltd
Lower esophagus in dyspeptic Iranian patients: A prospective study
Authors: NASSERI‐MOGHADDAM SIAVOSH , MALEKZADEH REZA , Sotoudeh MASOUD , TAVANGAR MOHAMMAD , AZIMI KOUROSH , SOHRABPOUR AMIR‐ALI , MOSTADJABI PARDIS , FATHI HOSNIEH , MINAPOOR MINA 
Published: March 2003

AbstractBackground: Gastroesophageal junction cancer has increased over time in Western countries. Gastroesophageal reflux disease (GERD) is considered to be a major risk factor. We prospectively studied the prevalence of clinical, histological and endoscopic GERD, and premalignant changes among dyspeptic Iranian patients referred for upper gastrointestinal endoscopy (UGIE).Methods: Consenting patients referred for UGIE to our clinic were enrolled. Their symptoms were recorded, UGIE was conducted, and biopsies from all suspicious lesions and across the Z‐line were taken.Results: Of the 344 enrolled patients, 269 (135 women, 134 men; mean age: 41.6 years) were evaluated. One major GERD symptom (heart burn, acid regurgitation, dysphagia and chest pain) was seen in 209 (77.6%) patients, and 207 patients (76.1%) had endoscopic esophagitis. Thirteen patients (5%) had specialized intestinal metaplasia at the gastrointestinal junction (SIM‐GEJ), and three had glandular dysplasia (two low‐grade, one high‐grade). No symptom could predict the presence of histological or endoscopic findings. Patients with dysplasia had more advanced degrees of endoscopic esophagitis.Conclusion: Gastroesophageal reflux disease is common among Iranian patients referred for diagnostic endoscopy. The prevalence of SIM‐GEJ among this population was comparable to that reported in Western countries.
Is breast feeding in bed always a safe practice?
Authors: BYARD RW 
Published: March 2003

Objectives:To examine whether infants who are being breast fed in their mother’s bed are at increased risk of accidental suffocation.Materials and methods:Review of all cases of unexpected infant death occurring in South Australia, Australia during 1996 was undertaken to ascertain whether any cases of sudden infant death had occurred in association with breast feeding in the parental bed. All infants had death scene examinations, history reviews and full autopsies performed.Results:Three of a total of 28 cases of unexpected infant death were identified where accidental asphyxia associated with breast feeding‐related cosleeping was considered a likely cause of death. Maternal fatigue was a factor in each of the three cases. There were nine SIDS cases and 16 other cases which included non‐accidental injury, accidental asphyxia, congenital cardiovascular disease and sepsis.Conclusions:Accidental asphyxia is a rare but possible outcome if mothers fall asleep in bed with their infants while breast feeding. Nursing mothers should be made aware of the potential dangers of fatigue and sedation in such circumstances. Breast feeding out of bed, or in the company of a second person who can ensure the safety of the infant if breast feeding is occurring in bed may prevent these unfortunate fatalities.
A novel approach to monitoring adherence to preventive therapy for tuberculosis in adolescence
Authors: Starr M , Sawyer SM , Carlin JB , Powell CVE , Newman RG , Johnson PDR 
Published: March 2003

Objectives: To evaluate the usefulness of a microelectronic tablet‐dispenser for monitoring adherence to preventive therapy for tuberculosis infection in adolescents. Methodology: Twenty‐one patients with positive Mantoux tests were treated with isoniazid (INH), dispensed in a microelectronic tablet‐dispenser that recorded the date, time and duration that the container was opened. Other measures of adherence included attendance at clinic, patient self‐report, tablet count, and measurement of urinary INH metabolites. Results: The mean adherence rates were: 83% using attendance at clinic, 91% using tablet counts, 79% using urine assays, and 66% using the electronic tablet‐dispenser. Self‐reporting appeared to over‐estimate adherence. Conclusions: Adherence to 6 months of INH calculated using different measures is higher in this study than in previous reports. Microelectronic tablet‐dispensers are an effective method to objectively measure adherence on a daily basis. Other measures are less helpful.
A quality assurance review of outpatient care of children with life‐threatening asthma exacerbations
Authors: Dakin CJ , Wales S , Field P , Henry R , Morton J 
Published: March 2003

Objectives: A hospital admission for asthma represents an opportunity to address and improve asthma control. The aims of this study were to compare the ambulatory care of children admitted to the intensive care unit (ICU) following a life‐threatening asthma exacerbation with published guidelines of asthma management and to identify areas that could be targeted for change. Methods: A retrospective review of case notes of children admitted to the ICU with asthma over a 6‐month period. Variables recorded were: demographic; asthma history (including prior pattern of asthma, hospital admissions, interval treatment and managing doctor); admission details (consultation of respiratory team and asthma educator); and discharge management. Results: There were 40 admissions of 38 children (24 males) with mean age 5.7 years (range 1.1–14 years). The majority (58%) had previous admissions for asthma (55 admissions in 22 children), with 23% of these to ICU. Sixty three per cent of those with previous admissions had persistent asthma, but only 29% were on inhaled corticosteroid (ICS). Most (60%) were managed by their local medical officer (LMO). Use of ICS was more likely if managed by a paediatrician. A respiratory subspecialist was consulted in 42% and the asthma educator in 70% of ICU admissions. Discharge medication included ICS in 74%, with no interval treatment in 18% of admissions. Follow up was by a respiratory subspecialist in 25% of cases. Conclusion: Asthma management before and after admission with life‐threatening asthma did not conform to available guidelines. Persistent asthma was under‐treated. Paediatricians were more likely to use interval treatment than LMO. We identified areas in which quality of care and outcome could be improved in this vulnerable group of asthmatics.
Persistent or severe back pain and stiffness are ominous symptoms requiring prompt attention
Authors: Grattan‐Smith P J , Ryan M M , Procopis P G 
Published: March 2003

Background: Children with severe or persistent back pain and stiffness often have an underlying organic cause but there is a large differential diagnosis, examination may be difficult and the problem is relatively rare in general paediatric practice. These difficulties appeared to lead to delays in diagnosis and management of children with this problem. Objectives: To provide an approach to the diagnosis and management children with severe or persistent back pain or stiffness based on our clinical experience and the literature. Methodology: The case histories of 10 children with severe back pain seen by the authors over a 5‐year period were reviewed. They were chosen as illustrative examples of the diagnostic and management problems and did not represent a systematic review of all cases seen by the authors over that time. Results: Underlying causes included infection, inflammation, neoplasm, trauma and vascular malformation. Four of the children had spinal cord compression which required urgent decompression. There was one child with a conversion disorder but three children with organic disease were initially felt to have a conversion disorder. Investigations generally proceeded relatively slowly and the problem was not regarded as a semi‐urgent situation carrying the risk of permanent paraplegia. Magnetic resonance imaging (MRI) scan of the spine was the investigation of choice. Conclusion: Children with severe or persistent back pain and stiffness have a wide variety of underlying causes. The possibility of underlying spinal cord compression should always be considered in children with this presentation. If the diagnosis is not obvious, MRI scan of the spine should be arranged without delay.
The drug epidemic: Effects on newborn infants and health resource consumption at a tertiary perinatal centre
Authors: Kelly J J , Davis P G , Henschke P N 
Published: March 2003

Objectives: Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre. Methodology: An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women’s Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital’s obstetric database. Results: Ninety‐six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty‐three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P < 0.01). Conclusions: Infants born to drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources.
A 7‐year review of deaths on the general paediatric wards at John Hunter Children’s Hospital, 1991–97
Authors: Mallinson J , Jones P D 
Published: March 2003

Objective: To study the palliative management of children dying on the wards of a tertiary referral centre. In particular to identify areas of difficulty and discuss ways in which these can be improved. Methodology: All children between the ages 1 and 19 years dying on the general paediatric wards of the John Hunter Children’s Hospital (JHCH) (a tertiary referral centre in New South Wales Hunter Valley) between 1991 and 1998 were included in the study. The main outcome measures were the duration of ‘terminal care only’ treatment; time spent in hospital in the previous year; analgesia used, dose and route of administration; adjuvant medications; quality of life in the final 24 h. Results: Eighteen children (aged between 1 and 19 years) died on the general paediatric wards at JHCH between 1991 and 1998. The most common diagnosis was malignancy (five patients), with cystic fibrosis, cerebral palsy and a degenerative neurological disorder each accounting for four patients, and one child had herpes simplex encephalitis. In all children the terminal nature of their condition was recognized and in all but three patients there was documentation of ‘not for resuscitation’ (NFR) orders following discussion with the child’s parents. The mainstay of analgesia was an intravenous narcotic infusion with 11 (61%) children needing a morphine infusion. Fifteen patients (83%) required other medications including antiemetics, anticonvulsants and corticosteroids. Twelve (66%) children were semiconscious or unconscious on the day of death. Three children were uncomfortable and distressed, one alert and symptom free and in two cases the level of consciousness was not recorded. Three children continued to have seizures until their death. Conclusion: The majority of terminally ill children were managed well with intravenous narcotics and adjuvant medications. There may be scope for such children to be managed successfully at home with appropriate support for the general practitioner by paediatric and palliative care specialists. Some cases in which palliation is difficult do remain in hospital and additional measures need to be employed to ensure a symptom free death for these children.
Prevalence and pattern of childhood abdominal pain in an Australian general practice
Authors: Huang Rc , Palmer Lj , Forbes Da 
Published: March 2003

Objective: Abdominal pain is a common problem in childhood and accounts for a significant workload in general practice. The aim of this study was assess the nature of abdominal pain in a sample of Australian children attending a Western Australian general practice for any reason, and to determine factors associated with the reporting of such pain.Methodology: A prospective study of children and their families attending a rural general practice was undertaken using a parental survey to assess the frequency and nature of abdominal pain, demographic features, physical and behavioural characteristics.Results: Abdominal pain was common in this population; 44% (70 of 164) of parents reported that the index child had experienced abdominal pain in the past 12 months. The average age of children who experienced recent abdominal pain was 9 years and 9 months. Multivariate analysis suggested that children experiencing abdominal pain in the preceding 12 months were more likely to be anxious (odds ratio (OR) = 3.74,P= 0.01), to have a family history of similar problems in siblings (OR = 4.26,P= 0.01) and to experience sleep disturbance (OR = 3.90,P= 0.02) than children without abdominal pain. Consumption of three or more serves of wholemeal bread or cereals per day had a significant protective effect on reported abdominal pain in children (OR = 0.12,P= 0.03). The majority of families (66%) dealt with the pain without resorting to medical care.Conclusions: Abdominal pain remains a common problem of children attending an Australian general practice, and was associated with features suggesting that it is related to anxiety and coping ability. Abdominal pain is not usually associated with disease; most families recognize this and cope with abdominal pain without medical consultation.
Is acid base determination an accurate predictor of pyloric stenosis?
Authors: Oakley E A , Barnett P L J 
Published: March 2003

Objective: To determine if acid base status predicts which vomiting patients have pyloric stenosis. Design: Retrospective chart review. Setting: Tertiary paediatric hospital. Methodology: We compared the clinical and biochemical parameters of 100 patients with a discharge diagnosis of pyloric stenosis and 84 patients of a similar age who presented to the emergency department with vomiting and who had an acid base determination. Patients were included from January 1995 to January 1997. Clinical correlates consisted of age, duration of vomiting, weight loss, gestation, and family history of pyloric stenosis. Biochemical correlates were pH, bicarbonate, base excess (BE), chloride, potassium, and sodium. Results: Independent variables of significance were pH, BE, chloride, bicarbonate, potassium, weight loss (all of which had a P value < 0.0001), and sex (P = 0.006). Each variable was placed in a logistic regression equation with pyloric stenosis being the dominant variable. Variables of significance were pH (P = 0.0001), BE (P = 0.0001), and chloride (P = 0.009). A model for predicting pyloric stenosis using these variables was then created with pH > 7.45, chloride < 98, and BE > +3, with a positive predictive value of 88%. Conclusion: Acid base determination is a useful screening tool when considering pyloric stenosis. This model now needs to be validated on a prospective series of patients with vomiting.
Echocardiographic evaluation of cardiac functions and left ventricular mass in children with malnutrition
Authors: Öcal B , Ünal S , Zorlu P , Tezic HT , Oğuz D 
Published: March 2003

Objective: This study was undertaken to assess the left ventricular mass (LV Mass) and systolic and diastolic functions of the left ventricle in children with protein energy malnutrition (PEM). Methodology: Thirty children, aged between 2 months and 2 years with PEM (four kwashiorkor, seven marasmic– kwashiorkor, 19 marasmus), and 17 healthy, age‐matched children, using Doppler echocardiography were studied. Results: The mean LV Mass in the patients was lower than that in the controls (14.5 ± 5.2 vs 19.8 ± 4.7 g, P < 0.05). However, the LV Mass/body surface area was not different in the patients with PEM and in the control group (52 ± 9.2 vs 53.9 ± 8.2g/m2, P > 0.05), indicating that LV Mass was reduced in proportion to decrease in body size in malnutrition. Left ventricular septal and posterior wall thickness in PEM were also lower than that in the controls, and the most significant reduction in the LV Mass, septal and posterior wall thickness were found in the kwashiorkor group. Cardiac output was reduced in proportion to decrease in body size in the patient group (1.6 ± 0.5 vs 2.1 ± 0.8 L/min, P < 0.05), therefore cardiac index was not significantly different between the patients and the control subjects (5.9 ± 1.4 vs 5.7 ± 1.6 L/min/m2, P > 0.05). Systolic function indices including ejection fraction, fractional shortening, and diastolic function indices were not significantly different in the groups. Conclusions: We demonstrated that LV Mass and cardiac output were reduced in proportion to decrease in body size in patients with PEM, and LV systolic and diastolic functions were preserved in atrophic hearts.
Quantifying pulmonary hypertension in ventilated infants with bronchiolitis: A pilot study
Authors: Fitzgerald D , Davis GM , Rohlicek C , Gottesman R 
Published: March 2003

Objective: To determine whether previously well infants ventilated for bronchiolitis have sufficiently elevated pulmonary artery pressures (PAP) to warrant a trial of inhaled nitric oxide (iNO) therapy. Methods: Consecutive infants mechanically ventilated for bronchiolitis were offered Doppler echocardiography between 24 and 72 h after intubation. Patients were divided into those with normal PAP, mild, moderate or severe pulmonary hypertension. Patients with at least moderate pulmonary hypertension (systolic PAP > 30 mmHg and > 50% of systemic systolic arterial pressure) were offered a 60 min trial of iNO therapy at a concentration of 20 ppm and repeat echocardiography. Results: Six infants (four preterm, two term) were studied at a mean corrected age of 13 weeks (4, 24). Respiratory syncytial virus was confirmed on immunofluorescence of nasal secretions in five of six subjects (84%). Echocardiography was performed (mean, 5.5 days) (95%CI 3.8–7.3) after the onset of symptoms. All patients had structurally normal hearts. Four patients had mild pulmonary artery hypertension and two had normal pulmonary artery pressures. None of the patients qualified for iNO therapy. The mean (range) duration of intubation was 14 days (9–19) and the duration of hospitalization was 28 days (14–42). All patients recovered. Conclusion: Significant pulmonary hypertension should not be presumed in previously well preterm and term infants ventilated for bronchiolitis.