bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of transrectal ultrasound guided prostate biopsy: Histopathological correlation to matched prostatectomy specimens
Authors: Cam Kamil , Yucel Selcuk , Turkeri Levent , Akdas Atif 
Published: March 2003

Abstract
Background:
The Gleason grading system is currently the world’s most commonly used histological system for prostate cancer. It provides significant information about the prognosis. Therefore, Gleason score is accepted as an important factor in therapeutic decision‐making for prostate cancer. This retrospective study assessed the correlation of transrectal ultrasound (TRUS) guided biopsy and radical prostatectomy specimens in terms of Gleason scores.
Methods:
We reviewed the records of 103 patients who underwent radical prostatectomy due to clinically localized prostate cancer. The Gleason scores of the TRUS biopsies were compared with the respective Gleason scores of surgical specimen.
Results:
In 28.7% of cases, the TRUS biopsy score was the same as that of the radical prostatectomy specimen. The most significant discordance was the upgrading of well‐differentiated tumors after surgery in 71.7% of cases. However, in 81.8% of cases with high Gleason score on TRUS, biopsy was correlated with poorly differentiated tumor after surgery.
Conclusions:
Well‐differentiated tumors on TRUS biopsy did not correlate with the grades of final pathology in the majority of cases; however, a high Gleason score on TRUS biopsy usually indicated a poorly differentiated tumor on prostatectomy specimen. Therefore, the treatment algorithms for particularly well‐differentiated tumors should not be deduced from biopsy histology alone.
Renal oncocytomatosis in a long‐term hemodialysis patient treated by laparoscopic surgery
Authors: Shiga Yoshiyuki , Suzuki Koichiro , Tsutsumi Masakazu , Ishikawa Satoru , Gotoh Michihiro , Shimokama Tatsuro , Hattori Kazunori 
Published: March 2003

AbstractA 50‐year‐old female, who had been on maintenance hemodialysis for 22 years, consulted our clinic because of a left renal mass detected incidentally by ultrasonography. Computed tomography (CT) demonstrated a solid hypervascular mass, suggesting a renal cell carcinoma (RCC), in the left atrophic kidney. Left hand‐assisted laparoscopic nephrectomy (HALN) was performed. The histopathological diagnosis was renal oncocytomatosis. Renal oncocytomatosis in a long‐term hemodialysis patient is extremely rare. We report the first case of renal oncocytomatosis in a long‐term hemodialysis patient treated with hand‐assisted laparoscopic nephrectomy.
Antecedents to hospital deaths
Authors: Hillman K. M. , Bristow P. J. , Chey T. , Daffurn K. , Jacques T. , Norman S. L. , Bishop G. F. , Simmons G. 
Published: March 2003

Abstract Background: Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals. Aim: This study aimed to document antecedent factors in hospital deaths in an attempt to identify potentially preventative factors. Methods: The study was conducted at three separate acute hospitals. Demographics of all deaths were recorded over a 6‐month period as well as antecedent factors present within 0–8 and 8–48 h of all deaths including vital sign abnormalities, cardiorespiratory arrests and admission to intensive care. Separate analysis was performed on ‘not for resuscitation’ deaths. Results: There were a total of 778 deaths, of which 549 (71%) were ‘not for resuscitation’. There were 171 (22%) deaths preceded by arrest and 160 (21%) preceded by admission to intensive care. Of the remaining deaths, 30% had severely abnormal physiological abnormalities documented. This incidence was 50% in the non‐do not resuscitate (DNR) subgroup. Concern about the patient’s condition was expressed in the patient’s notes by attending nursing staff and junior medical staff in approximately one‐third of non‐DNR deaths. Hypotension (30%) and tachypnoea (17%) were the most common antecedents in the non‐DNR deaths. Conclusion: There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention. (Intern Med J 2001; 31: 343–348)
Myocardial perfusion imaging in evaluation of undiagnosed acute chest pain
Authors: Knott J. C. , Better N. 
Published: March 2003

Abstract Myocardial perfusion imaging is a relatively new technique in the emergency department management of acute chest pain. With improved sensitivity and specificity compared to traditional methods of risk stratification, an abnormal scan rapidly identifies individuals with acute perfusion abnormalities and allows the appropriate utilization of limited resources. Conversely, a normal scan allows prompt hospital discharge and is associated with excellent outcomes both in the short and medium terms. Acute chest pain myocardial perfusion imaging has been demonstrated to alter patient management and disposition and its routine use results in decreased costs in the intermediate risk population. (Intern Med J 2001; 31: 544–546)
Difficult tracheal intubation following midface distraction surgery
Authors: Morris G.P. , Cooper M.G. 
Published: March 2003

SummaryA case of difficult intubation in a patient with Apert syndrome, who had recently undergone bilateral internal midface distraction, is described. The 14‐year‐old boy had no antecedent history of such difficulty, despite numerous previous anaesthetics. We suggest that trismus due to temporalis muscle fibrosis, and the altered relationships of the maxilla and mandible following midface advancement, were causal.
A comparison of rectal and intramuscular codeine phosphate in children following neurosurgery
Authors: McEwan A. , Sigston P.E. , Andrews K.A. , Hack H.A. , Jenkins A.M.C. , May L. , Llewelyn N. , Mackersie A. 
Published: March 2003

SummaryCodeine is frequently used for postoperative analgesia in children. Intramuscular injections are not ideal and the rectal route may be preferable. We compared rectal and intramuscular codeine administered following neurosurgery. 20 children (over 3 months) undergoing elective neurosurgical procedures, were randomized to receive either rectal or intramuscular codeine phospate (1 mg·kg−1) at the end of the procedure. Serum levels of codeine and morphine were assayed at intervals following administration (0, 30, 60, 120, 240 min). Fentanyl was the intraoperative analgesic and postoperative rescue analgesia was paracetamol, diclofenac and intramuscular codeine. The Children's Hospital of Eastern Ontario Pain Scale was used to assess analgesia. Peak codeine levels in both groups were observed at 30 min and morphine levels were consistently low. The plasma codeine levels were significantly greater at 30 and 60 min following intramuscular injection, and were associated with slightly better analgesia scores, but did not reach statistical significance. However, the peak plasma level occurred at similar times in both groups. Codeine is absorbed as rapidly via the rectal route compared with the intramuscular route but the peak levels are lower.
Recovery after paediatric daycase herniotomy performed under spinal anaesthesia
Authors: Kokki Hannu , Heikkinen Marja , Ahonen Riitta 
Published: March 2003

SummaryIn this prospective survey, recovery in hospital and at home was evaluated in 195 children aged 6 months to 10 years who had undergone herniotomy under spinal anaesthesia as a daycase procedure. Spinal anaesthesia was successful in most of the children, with only two patients being given general anaesthesia. Eighty‐three percent of the children had pain at home and 19% had moderate or severe pain. Eighty‐five percent of the children needed pain medication at home; the median dose of analgesics was 4 (1–9, 10th and 90th percentiles). Vomiting was noted in two of 195 children in hospital and in 10 of 192 children at home. Eleven children developed a mild position‐dependent headache. Most of the children (183/191) recovered their normal daily activities during the first three postoperative days. We conclude that spinal anaesthesia is a safe and effective technique for paediatric herniotomy. Moreover, pain is common following herniotomy and children should be given analgesics for the first two or three postoperative days.
Applications of intrathecal catheters in children
Authors: Tobias Joseph D. 
Published: March 2003

SummaryAccess to the intrathecal space may be required for sampling of cerebrospinal fluid for diagnostic purposes, for the administration of pharmacological agents, or for cerebrospinal fluid (CSF) drainage to lower intracranial pressure. The current report details five children in whom a percutaneously placed lumbar intrathecal catheter was used: (i) to provide intraoperative surgical anaesthesia instead of general anaesthesia (ii); to deliver intrathecal fentanyl to provide postoperative analgesia (iii); to provide chronic pain control during the terminal stages of metastatic malignancy; (iv) to allow repeated doses of intrathecal chemotherapy; and (v) to allow CSF drainage and prevent CSF leakage following frontal encephalocele repair. The indications and applications of intrathecal catheters in the paediatric aged patient are reviewed.
Increased levels of S‐100 protein after cardiac surgery with cardiopulmonary bypass and general surgery in children
Authors: Jensen Eva , Sandström Kerstin , Andréasson Svenerik , Nilsson Krister , Berggren Håkan , Larsson Lars E. 
Published: March 2003

SummaryThe aim of this study was to evaluate changes in concentrations of the neurospecific protein S‐100 in relation to cardiac surgery with cardiopulmonary bypass (CPB) and noncardiac general surgery in children below 3 years of age. Seventeen children underwent surgery for congenital heart disease and all survived without clinical signs of neurological complications. Samples for plasma concentrations of S‐100 in these patients were taken on three occasions in connection with surgery: before the start of surgery, after CPB and finally 16–20 h after CPB. In the noncardiac group of 31 children, S‐100 concentrations were measured on two occasions: before surgery and during surgery. In both groups, a significant increase in S‐100 concentrations was observed during surgery, although the increase in the CPB group was significantly higher than in the noncardiac group. The CPB group included four children with Down's syndrome who had higher mean S‐100 concentrations on all sampling occasions compared to the remaining patients. The peak S‐100 concentrations after cardiac surgery were related to the duration of CPB, the time from the termination of CPB to the first post‐CPB sample, as well as mean arterial pressure and cerebral arteriovenous lactate difference during rewarming. All the children studied (Down's patients excluded) had age‐dependent plasma concentrations of S‐100 measured before surgery. It can be concluded that CPB initiates a marked but transient release of S‐100 into the systemic circulation during open heart surgery in children who are not developing clinical signs of neurological sequelae.
An audit of perioperative management of autistic children
Authors: Van Der Walt J. H. , Moran C. 
Published: March 2003

Background: Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. Methods: We have developed a unique management program for autistic children admitted for medical and surgical procedures requiring a general anaesthetic. Details of each patient managed according to this program have been prospectively entered into an Autistic Register. Results: An audit of this database shows that we have administered anaesthesia on 87 occasions for 59 autistic children over 4 years. Conclusions: There is great variation in the severity of autism and hospital needs of these children. The focus is on early communication with the patient’s families, flexibility to individualize the admission process and anaesthetic plan with admission and early discharge on the day of surgery whenever possible. Oral midazolam is an effective premedication for the milder cases and oral ketamine is the most reliable for moderate and severe cases. Comparison of oral midazolam and ketamine shows no significant different postoperative recovery and hospital discharge times. Routine intravenous fluids and antiemesis prophylaxis with removal of the i.v. cannula before return to the ward are also seen as important steps to decrease stress and smooth the postoperative phase. This program has also successfully been extended to the management of problem children due to other causes.
Is the sitting or the prone position best for surgery for posterior fossa tumours in children?
Authors: Orliaguet Gilles A. , Hanafi Mohamed , Meyer Philippe G. , Blanot Stéphane , Jarreau Marie‐Madeleine , Bresson Damien , Zerah Michel , Carli Pierre A. 
Published: March 2003

Background: The aim of this study was to compare complications in children operated for posterior fossa tumours in the sitting position with those in the prone position. Methods: We retrospectively assessed the perioperative course of posterior fossa tumour (PFT) surgery according to the operating position. Sixty children were operated in the sitting position (SP) and 19 in the prone position (PP). Preoperative data were not different between groups. Results: Patients in the PP group received a larger median (95% confidence interval) volume of intraoperative blood transfusion than patients in the SP group [200 (20–325) versus 0 (0–80) ml, P=0.04]. Intraoperative complications, as well as severe perioperative complications were more frequent in the PP group (P=0.01). The median duration of tracheal intubation [20 (18–24) versus 36 (18–72) h, P=0.037], of ICU stay [2 (2–3) versus 4 (2–5) days, P=0.02] and of hospital stay [11 (9–12) versus 14 (10–20) days, P=0.02] was longer in the PP group compared with the SP group. Conclusions: PFT surgery in the sitting position in children is not associated with an increased number or severity of perioperative complications, while the postoperative course appears better in this position.
Respiratory complications during anaesthesia in Apert syndrome
Authors: Elwood Thomas , Sarathy Priya V. , Geiduschek Jeremy M. , Ulma George A. , Karl Helen W. 
Published: March 2003

Background: Clinical experience with anaesthesia for a series of patients with Apert syndrome (craniosynostosis, midface hypoplasia and syndactyly) has not been reported previously. Methods: In this review, 10 years of experience was examined at our hospital. There were 145 anaesthetics administered to 18 individuals. Results: There were 16 complications (15 were perioperative wheezing) which occurred in seven patients. In four cases, surgery was cancelled due to intractable wheezing. Conclusions: We could not demonstrate any benefit from preoperative administration of nebulized albuterol. Paediatric anaesthetists should be aware of this high incidence of respiratory complications in Apert syndrome.
Motion sickness and postoperative vomiting in children
Authors: BUSONI PAOLO , SARTI ARMANDO , CRESCIOLI MASSIMO , AGOSTINO MARIA ROSARIA , SESTINI GIUSEPPINA , BANTI SILVIA 
Published: March 2003

Background: Motion sickness is considered an important risk factor for postoperative nausea and vomiting in children. The aim of this study was to verify the impact of motion sickness on the incidence of vomiting after routine surgery in children, and to compare the incidence of vomiting, after combined regional/general anaesthesia, using either halothane or sevoflurane.Methods: We prospectively studied 420 children (369 males and 51 females) who received general anaesthesia and inguinal field block for common paediatric surgery. The children were randomly allocated into one of two groups (halothane or sevoflurane). In the 200 children in the first group (H), general anaesthesia was induced and maintained with halothane, whereas in the 220 children in the second group (S), anaesthesia was induced and maintained with sevoflurane.Results: There were 79 children with a prior history of motion sickness (MS+) and 341 without such a history (MS–). In the MS+ population, the incidence of vomiting was similar in both H and S groups, being around 33%. However, repeated episodes of vomiting in MS+ children were more frequent when halothane was used. In the MS– group, the incidence of vomiting was significantly greater in the H group (19%) than in the S group (8%).Conclusions: In the postoperative period, we found that MS+ children vomit more than MS– children, regardless of the inhalation anaesthetic used. However, MS– children displayed a higher incidence of vomiting when halothane was used rather than sevoflurane.
Noninvasive intraoperative monitoring of carbon dioxide in children: endtidal versus transcutaneous techniques
Authors: NOSOVITCH MACE A , JOHNSON JOEL O , TOBIAS JOSEPH D 
Published: March 2003

Background: The current study prospectively compares the accuracy of the intraoperative use of transcutaneous (Tc) and endtidal (PE) CO2 monitoring during surgical procedures in 30 paediatric patients, ranging in age from 6 months to 15 years (6.15 ± 4.35 years) and in weight from 4.7 to 73 kg (24.9 ± 18.2 kg). Methods: Following calibration and an equilibration time for the TcCO2 monitor, arterial blood gas samples were obtained as clinically indicated. A total of 64 sample sets (PaCO2, PECO2 and TcCO2) were obtained from the 30 patients. Results: The PECO2 to PaCO2 difference was 0.6–0.9 kPa (4.4 ± 7.1 mmHg) while the TcCO2 to PaCO2 difference was 0.36–0.38 kPa (2.8 ± 2.9 mmHg) (P=NS). The difference between the PaCO2 and PECO2 was 0.4 kPa (3 mmHg) or less in 37 of 64 sample sets while the difference between the PaCO2 and TcCO2 was 0.4 kPa (3 mmHg) or less in 49 of 64 sample sets (P=0.038). Linear regression analysis of PECO2 vs. PaCO2 revealed a slope of 0.434, r=0.8761, r2=0.7676. Linear regression analysis of TcCO2 vs. PaCO2 revealed a slope of 0.914, r=0.9472, r2=0.8972. Conclusions: Although in most circumstances, both noninvasive monitors of PCO2 provided a clinically acceptable estimate of PaCO2, TCCO2 provided a slightly more accurate estimate of PaCO2 during intraoperative anaesthetic care in children.
The efficacy of caudal ropivacaine 1, 2 and 3 mg·ml−1 for postoperative analgesia in children
Authors: BOSENBERG A , THOMAS J , LOPEZ T , LYBECK A , HUIZAR KARIN , LARSSON L.E 
Published: March 2003

Background: The aim of this double blind, randomized, comparative study was to assess the analgesic efficacy and incidence of motor block after caudal block using three different concentrations of ropivacaine, 1, 2 and 3 mg·ml–1, in children 4–12‐year‐old. Methods: One hundred and ten children ASA I–II, scheduled for inguinal surgery, were included in the study. After induction of a standardized general anaesthetic technique, all patients received 1 ml·kg–1 of the ropivacaine solution for a caudal block and were assessed for 8 h after the injection. Results: The ropivacaine was well tolerated in all patients. Median time to treatment with analgesics was 3.3, 4.5 and 4.2 h in the 1, 2 and 3 mg·ml–1 groups, respectively. During the first 4 h, the pain scores for both a 6‐graded faces scale and a 4‐graded observer scale were higher in the 1 mg·ml–1 group than the 3 mg·ml–1 group. The median sensory block reached T12 in all groups 1 h after the caudal block. Thereafter, the speed of regression was correlated with the ropivacaine concentration. In the patients with a sensory block from T12 and above, the median time to treatment with analgesics was longer than in the children with a sensory block below T12. The incidence of motor block was 28% in the 3 mg·ml–1 group in comparison with 0 and 13% in the 1 and 2 mg·ml–1 groups. Conclusions: It was concluded that 1 ml·kg–1 of ropivacaine 2 mg·ml–1 for caudal block provided satisfactory postoperative pain relief after inguinal surgery in 4–12‐year‐old children. Ropivacaine 1 mg·ml–1 showed less efficacy while the use of ropivacaine 3 mg·ml–1 was associated with a higher incidence of motor block with minimal improvement in postoperative pain relief.
Extrapolation of cardiac index from analysis of the left ventricular outflow velocities in children: implication of the relationship between aortic size and body surface area
Authors: Wodey Eric , Senhadji Lotfi , Carre François , Ecoffey Claude 
Published: March 2003

Background: It has recently been reported in critically ill patients that a linear relationship exists between cardiac index (CI) measured with thermodilution and mean aortic blood flow velocity (MAFV). This hypothesis can be validated mathematically only if the aortic area (AA index) indexed to body surface area (BSA) remains constant and if the relationship between aortic diameter (ØAo) and BSA is nonlinear. However, several other equations have described the relationship between BSA and, respectively, ØAo and aortic area (AA) in children. The aim of this study was to determine if the relationships calculated between BSA and aortic size in children (without left ventricular outflow tract abnormality) could validate the hypothesis that MAFV and CI are well linked linearly, leading to its use to determine CI.Methods: Two hundred and thirty‐two measurements performed in 126 children and infants were retrospectively analysed. ØAo was measured in the long axis view at the annulus using two‐dimensional mode echocardiography with a 5‐MHz transducer. Various linear and nonlinear relationships between BSA and, respectively, ØAo, ØAoindex, AA and AAindex were determined based on a nonlinear regression method with a model as follows: y=a(xc) + b. The comparisons between regressions were conducted based on the estimation error.Results: The relationships between ØAo and BSA appeared nonlinear and was well described by: ØAo=2.96(BSA1/4) – 1.31 with a non‐zero y‐intercept and ØAo=1.64(BSA1/2) with a zero y‐intercept. In contrast, the relationships between AA and BSA were linear. The AAindex was not linked to BSA and can be considered as constant. The coefficient a of the equation appeared similar to those obtained mathematically with the relationship previously described between MAFV and CI.Conclusions: The hypothesis that CI can be extrapolated to the measurement of MAFV appears valid as regards the relationships calculated between aortic size and BSA in children without left ventricular outflow tract abnormality.
The rotational technique with a partially inflated laryngeal mask airway improves the ease of insertion in children
Authors: NAKAYAMA SHIN , OSAKA YOSHIKO , YAMASHITA MASAO 
Published: March 2003

Background: This study compared the ease of insertion of the laryngeal mask airway (LMA™) with a partially inflated cuff using the standard `nonrotational' technique versus the rotational technique. Methods: One hundred and forty‐five children undergoing anaesthesia using the LMA were randomly assigned to either method. The cuff was partially inflated in both groups. The ease of insertion was assessed by the time taken to complete the LMA insertion, the number of attempts before successful placement and the occurrence of complications. Results: The success rate of insertion at the first attempt was higher in the rotational technique group (99% versus 79%, P < 0.05). All patients in the rotational group had the mask inserted within two attempts. On the other hand, three patients had the mask inserted on the first attempt with the rotational technique after three unsuccessful attempts by an anaesthesiologist with the standard `nonrotational' technique. Insertion technique made no difference on insertion time. Conclusions: The rotational technique was associated with a higher success rate for insertion and a lower incidence of complications in children. Using the rotational technique with a partially inflated cuff could be the first‐choice approach in paediatric patients.