bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inhibitory effect of clotrimazole on angiogenesis associated with bladder epithelium proliferation in rats
Authors: TAKEI SHUNSAKU , ISEDA TOKUHIRO , YOKOYAMA MASAYOSHI 
Published: March 2003

Abstract
Background:
Up‐regulation of epithelial vascular endothelial growth factor (VEGF) expression was recently reported at an early stage of bladder carcinogenesis in rats. Subsequently, clotrimazole (CLT) was reported to exert an inhibitory effect on the in vitro proliferation of vascular endothelial cells stimulated by VEGF. The present study was performed to evaluate the effect of CLT on the initial stage of N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine (BBN)‐induced carcinogenesis of the urinary bladder in rats.
Methods:
Seven‐week‐old‐female Wistar rats were divided into both a control group and the other four groups that were allowed free access to drinking water containing 0.05%BBN. Two groups of rats (10‐CLT and 20‐CLT) received CLT (100 mg/kg per day) once daily by gavage for 10 and 20 weeks, respectively. The other two groups of rats (10‐BBN and 20‐BBN) were maintained on the same BBN‐containing drinking water for 10 and 20 weeks, respectively, without receiving CLT. After removing the urinary bladder of each rat, expression of VEGF and VEGF receptor FLT1, and new capillaries were examined by immunohistochemical staining. VEGF mRNA was detected by the reverse transcription polymerase chain reaction.
Results:
The ratio of VEGF‐positive cells and the expression of VEGF mRNA were lower in the 20‐CLT group than in the 10‐BBN group. Newly formed capillaries in the 20‐CLT group were significantly decreased compared with those in the 10‐BBN group.
Conclusion:
These quantitative data suggested that CLT can inhibit VEGF expression in vivo and hence inhibit angiogenesis in the early stages of bladder carcinoma.
Survival on long‐term oxygen therapy in chronic airflow limitation: from evidence to outcomes in the routine clinical setting
Authors: Crockett A. J. , Cranston J. M. , Moss J. R. , Alpers J. H. 
Published: March 2003

Abstract Background: Two previous randomized controlled trials (RCT) demonstrated that the administration of long‐term oxygen therapy (LTOT) improved survival in selected patients with hypoxic chronic obstructive pulmonary disease (COPD) or chronic airflow limitation (CAL). Aims: The aim of the present study was to investigate whether the survival of CAL patients prescribed LTOT at Flinders Medical Centre (FMC) was gender and age related, and equivalent to that of the previous RCT. Methods: A list of patients prescribed domiciliary oxygen therapy for CAL at FMC was generated from Respiratory Unit records and hospital financial records for the supply of this therapy. Survival was compared with that reported for the original RCT, and for Swedish and Belgian COPD patients. Factors influencing survival were studied. Results: Five hundred and five (249 males, 256 females) patients were prescribed LTOT for CAL at FMC during the study period and included in the survival analysis. The patients were elderly with multiple comorbidities. Survival was less than for the control arms of the previous RCT (apart from the Medical Research Council Working Party (MRC) female group) but comparable with recent overseas data. Overall crude survival was 75.1%, 51.3%, 18.9% and 1.1% at 1, 2, 5 and 10 years respectively. Females experienced longer survival than males. Multivariate analysis indicated that age, forced expiratory volume in 1 s, body mass index (BMI) and the number of comorbidities were prognostic indicators for females; BMI was a prognostic indicator for males. A survival advantage existed for females using at least 19 h concentrator oxygen per day. Conclusions: In routine practice, survival of unselected CAL patients with multiple comorbidities is less than that reported in the original RCT. (Intern Med J 2001; 31: 448–454)
Pharmaceutical industry‐sponsored meetings: good value or just a free meal?
Authors: Carney S. L. , Nair K. R. , Sales M. A. , Walsh J. 
Published: March 2003

Abstract Although the role of the pharmaceutical industry in continuing medical education (CME) has been debated for many years, industry CME funding continues to increase. Because of concern about the educational quality of industry CME, the Hunter Postgraduate Medical Institute (HPMI), an independent Newcastle and Hunter Valley CME provider, evaluated the use and quality of industry CME as reported by rural and urban general practitioners, physicians and psychiatrists. Furthermore, clinicians were asked if they supported increased industry‐funded independent CME. Sixty‐two per cent of general practitioners and 71% of psychiatrists attended at least three industry‐organized meetings each year, compared with 24% of physicians. Twenty‐five per cent of general practitioners attended five or more such meetings. Industry meetings were judged to be of good to excellent quality by 81% of generalists, 79% of physicians and 87% of psychiatrists. All clinical groups ranked the topic and then speaker as the most important reason for attending, with CME points, venue and the sponsor ranked lowest. Eighty to 90% of doctors supported a greater role of industry‐funded independent CME. Despite the absence of current data on the use and perceived benefits of industry CME, these preliminary results suggest that industry CME is playing an increasingly important role in clinician education. However, many clinicians and industry representatives support a greater role by independent postgraduate organizations in industry‐sponsored CME. (Intern Med J 2001; 31: 488–491)
Cost comparison of at‐home treatment of deep venous thrombosis with low molecular weight heparin to inpatient treatment with unfractionated heparin
Authors: Smith B. J. , Weekley J. S. , Pilotto L. , Howe T. , Beven R. 
Published: March 2003

Abstract Aims: Low molecular weight heparins (LMWH) permit safe and effective treatment of uncomplicated deep venous thrombosis (DVT) at home. The aim of this study was to evaluate the cost minimization, cost shifting and patient satisfaction associated with at‐home DVT treatment using the LMWH enoxaparin, compared to standard inpatient care in an Australian health‐care setting. Methods: Subjects presenting with a principal diagnosis of uncomplicated DVT to the Emergency Department at The Queen Elizabeth Hospital, Adelaide, were recruited over 1997–1999. Costs to the hospital, to Federal funding (Medicare) and to patients were tracked prospectively, and satisfaction was also measured. Subjects were matched to historical controls (1994–1997) for age, gender and level of comorbidity (same or lower) by two medical officers who were blinded to costs. Control costs were obtained using the clinical costing system Trendstar®, and adjusted for consumer price index. Results: Twenty‐eight subjects participated in the at‐home programme. Of these, 26 were discharged without any inpatient admission (including one who agreed to self‐injection) and two were admitted briefly. Audit demonstrated that only 29% of eligible subjects were managed at home. Mean (SEM) total treatment cost was $756 (76) per patient for at‐home, and $2208 (146) for controls. Minimal cost shifts to patients and to Medicare occurred, and satisfaction was high. Conclusions: At‐home treatment of uncomplicated DVT using enoxaparin in an Australian metropolitan setting provides effective cost minimization, with little cost‐shifting. Our cost minimisation estimates are conservative as most at‐home subjects received enoxaparin twice daily (now used once per day) and controls had at least as high comorbidity. However, uptake of the at‐home programme was limited. (Intern Med J 2002; 32: 29–34)
Why is quality assurance so difficult? A review of issues in quality assurance over the last decade
Authors: Brown R. W. 
Published: March 2003

Abstract The quality assurance movement has been unable to produce major improvements in the realm of clinical practice because of an inability to make satisfactory measurements of process and/or outcome, together with the intrinsic difficulties associated with producing change. Progress in both these areas is likely to be slow. Improvements in the quality of care occurring as a result of the introduction of information technology into clinical practice may be seen more quickly. (Intern Med J 2002; 32: 331−337)
Video‐assisted thoracoscopic thymectomy for myasthenia gravis
Authors: Wright G. M. , Barnett S. , Clarke C. P. 
Published: March 2003

Abstract Background: Thymectomy is an effective, but radical therapy for myasthenia. Video‐assisted thoracic surgery (VATS) may allow a minimally invasive altern­ative to the standard sternotomy approach. Aims: To audit prospectively the outcome of VATS thymectomy for myasthenia gravis in a unit specializing in advanced VATS techniques. Methods: Twenty‐six patients underwent VATS thymectomy between 1997 and 2001. Most underwent preoperative plasma exchange therapy. Seventeen women and nine men with a median age of 36 years (range 17−71 years) had a right‐sided VATS approach to remove all anterior mediastinal fat and thymic tissue. Results: There was no perioperative mortality and all procedures were concluded successfully, with one patient requiring sternotomy. Twenty‐five patients were extubated in theatre and one patient required 17 h of assisted ventilation. The other significant complication was a diathermy injury to the phrenic nerve, which recovered. Median postoperative stay was 4 days (range 2−6 days), with median postoper­ative chest drainage for 2 days (range 1−3 days). Three patients had progression of disease postoperatively. The remainder were asymptomatic (7), improved (14) or stable (2). Conclusion: In a dedicated unit with neurological and intensive care support, VATS thymectomy is a safe, effective method of obtaining remission or improvement in myasthenia gravis (MG). While achieving the same surgical goal, this approach offers advantages of improved cosmesis, shorter recovery time and minimal chest wall disruption over the gold standard of sternotomy. Better patient acceptance of this minimally invasive technique may result in wider application of the benefits of thymectomy in MG. (Intern Med J 2002; 32: 367−371)
Multiple sclerosis is more prevalent in northern New Zealand than previously reported
Authors: Chancellor A. M. , Addidle M. , Dawson K. 
Published: March 2003

Abstract Background: There have been no studies of multiple sclerosis (MS) prevalence from New Zealand (NZ) in the past two decades, and only one in a northern NZ district. Our impression was that the local prevalence of MS was higher than previously published data would suggest. There is limited access to new treatments for MS in NZ.Aims: The present paper aims to: (i) measure the prevalence of definite and probable MS in the Bay of Plenty (BOP), a North Island province, (ii) compare this with previous NZ studies, (iii) study the profile of disability in this population‐based group and (iv) determine the proportion of MS patients who receive government funding for modern drug treatment (β‐interferons).Methods:  Patients were identified from a geograph­ically and demographically defined area of the North Island of NZ, using multiple sources of case ascertainment and modern diagnostic criteria. All clinical records were reviewed and data were supported by a telephone interview. All patients’ eligibility for ­government‐funded treatment with β‐interferon was considered.Results:  Eighty‐six patients were identified as residents in BOP, NZ, on 15 January 2001. Excluding ‘possible’ cases, this represented a prevalence of 50/105 (95% confidence interval 40−62/105). Half of the population‐based cohort had a disability defined as ‘moderate to severe’ (i.e. aids needed to walk, unable to take more than a few steps, or worse). Eleven patients (13%) had a primarily progressive form of MS. Eleven patients (13%) had the relapsing−­remitting form of the disease and qualified for ­government‐funded treatment with β‐­interferon.Conclusion:  The prevalence of MS in the defined region was twice as high as that reported from an adjacent area, the Waikato, 20 years previous. Our data will help to update NZ prevalence statistics and are of direct relevance to current funding issues for modern treatments which, in NZ, are presently limited to a proportion of patients with relapsing− remitting disease. (Intern Med J 2003; 33: 79−83)
Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from The Horn of Africa
Authors: Skull S. A. , Ngeow J. Y. Y. , Biggs B. A. , Street A. , Ebeling P. R. 
Published: March 2003

Abstract The prevalence of and risk factors for vitamin D deficiency were examined for recent adult immigrants from East Africa living in Melbourne. Demographic data were collected via a face‐to‐face questionnaire and risk factors predicting deficiency were examined. Suboptimal levels <25 nmol/L were found in 61 patients (53%; 74% of women; 20% of men). Lower levels were more likely in: (i) patients with a longer duration of residence in Australia, (ii) patients who were mostly covered when outdoors and (iii) women. Routine assessment for vitamin D deficiency should be considered for male and female immigrants from East Africa. (Intern Med J 2003; 33: 47−51)
Postoperative extradural infusions in children: preliminary data from a comparison of bupivacaine/diamorphine with plain ropivacaine
Authors: Moriarty A. 
Published: March 2003

SummaryTo try to decrease the incidence of side‐effects associated with postoperative extradural infusions of local anaesthetics in combination with opioids, we have used plain ropivacaine solutions in 200 children. The first 72 children received an infusion of bupivacaine 0.125%+ diamorphine 20 μg·ml−1, then 200 children received plain ropivacaine solutions. The children who received ropivacaine were found to have lower incidences of nausea, pruritus, urinary retention, and were less sedated, despite comparable analgesia. The management of plain ropivacaine for extradural analgesia is discussed.
Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children
Authors: López Gil M. , Brimacombe J. , Clar B. 
Published: March 2003

SummaryWe compared patient outcomes for propofol vs sevoflurane with the laryngeal mask airway (LMA) using either spontaneous breathing (SB) or pressure controlled ventilation (PCV). One hundred and twenty children undergoing minor surgery below the umbilicus were randomly assigned to receive either (1) propofol 3 mg·kg−1 followed by a maintenance infusion of 5 mg·kg−1·h−1, or (2) induction with sevoflurane 7% followed by maintenance with 1.7%. Following LMA insertion, patients were given atracurium and underwent PCV if surgery was expected to last ≥30 min. The following assessments were made: time to LMA insertion/removal, airway problems, cardiorespiratory effects and recovery characteristics. The first time insertion success rates were similar, but insertion time was shorter with sevoflurane (115±67 s vs 252±107 s, P < 0.0001). One patient coughed during placement, but there were no other problems during any phase of anaesthesia in any group. Heart rate was higher in the sevoflurane group following insertion, during maintenance and emergence (all P < 0.03). There were no differences in blood pressure and oxygen saturation among groups PECO2 in the SB group was unaffected by the agent used. Emergence was more rapid (232±104 s vs 348±127 s, P < 0.0001) and postoperative agitation more common (15%vs 0%, P=0.02) with sevoflurane. There were no differences in the Aldrete scores among groups. Patient outcome was similar for the SB and PCV groups. We concluded that the techniques described here using propofol and sevoflurane are equally suitable for induction and maintenance of anaesthesia with the LMA in children undergoing minor surgery below the umbilicus. Emergence is more rapid, but postoperative agitation more common with sevoflurane.
Can gastric intramucosal pH (pHi) predict outcome of paediatric cardiac surgery?
Authors: BICHEL THIERRY , KALANGOS AFKSENDIYOS , ROUGE JEAN‐CLAUDE 
Published: March 2003

SummaryIn forty‐two children undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), a gastric tonometer was used intraoperatively to estimate pHi, reflection of splanchnic perfusion. PHi monitoring was used to predict early postoperative complications. Intramucosal acidosis appeared after removal of the aortic clamp and remained after weaning of CPB. Fifteen children (group C) developed early postoperative life‐threatening complications. Twenty‐seven children (group NC) had no major complications. Retrospective data analysis showed a decrease of pHi during hypothermic CPB in the two groups but at completion of surgery, pHi was significantly lower in the group C (7.13??0.04 vs 7.31??0.001, P<0.001). Bypass and aortic clamp times were also longer in group C and intraoperative core temperature lower. Continuous automated tonometer gas analysis appeared more acurate for the monitoring of acute haemodynamic and respiratory changes and should probably improve the predictive value of tonometry in the future. Tonometry is highly sensitive and represents an interesting and minimally invasive monitoring for critically ill children.
The adult Bullard laryngoscope as an alternative to the Wis‐Hipple 1½ in paediatric patients
Authors: Shulman Brent , Connelly Neil Roy 
Published: March 2003

SummaryThis prospective, randomized study was undertaken to compare the adult Bullard laryngoscope (BL) with the Wis‐Hipple laryngoscope (WhL) in paediatric patients with regards to laryngeal view and time to intubation, and whether its efficacy was related to age or weight. Fifty patients scheduled for general anaesthesia between the ages of 1 and 5 years were examined. Patients were randomized into two groups: one group had an initial laryngoscopy via the WhL and then had a laryngoscopy and intubation using the BL; the second group had an initial laryngoscopy with the BL and then had a laryngoscopy and intubation using the WhL. The laryngeal view, attempts at intubation, time to intubation and the reason for any difficulty with intubation were recorded. Correlation was then sought relating attempts and time to intubation with age, and weight. Mean time to intubation was 20 ± 6 s in the WhL group and 26 ± 9 s in the BL group (P < 0.02). The majority of the patients had similar laryngeal views in both groups; three patients had a superior view with the BL. Failed intubations occurred in two BL patients; the tracheas were both intubated with the WhL. In one patient, intubation was not possible with the WhL but it was successful with the BL. Multiple passes of the tube off the BL most frequently occurred because of right aryepiglottic fold contact or anterior vocal cord contact. The latter appears to be more problematic when the adult BL is used in the paediatric population. No relationship was found between the time to intubation and age or weight. In an occasional child, the BL provides a superior laryngeal view and provides a means for a successful intubation when a failure with the WhL occurs. Although intubation of children aged 1–5 years takes longer with a BL than a WhL, the adult BL complemented the WhL laryngoscope in paediatric patients.
Retracted: Pretreatment with oral clonidine attenuates cardiovascular responses to tracheal extubation in children
Authors: Fujii Yoshitaka , Saitoh Yuhji , Tanaka Hiroyoshi , Toyooka Hidenori 
Published: March 2003

SummaryThis study was designed to evaluate the effects of diazepam and clonidine orally given preoperatively on cardiovascular responses to tracheal extubation in children. Fifty children, ASA physical status I, aged 4–10 years, undergoing minor elective surgery (inguinal hernia, phimosis) received orally, in a randomized, double‐blind manner, diazepam 0.4 mg·kg−1 or clonidine 4 μg·kg−1 (n=25 of each). These drugs were administered 105 min before an inhalational induction of anaesthesia. The same standard general anaesthetic technique was employed throughout. The maximum changes in heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were less in patients who had received clonidine than in those who had received diazepam (HR, 12 vs 24; SBP, 14 vs 26; DBP, 9 vs 16; mean, P < 0.05). In conclusion, compared to diazepam given orally, pretreatment with oral clonidine attenuates haemodynamic changes associated with tracheal extubation in children.
Acute Horner syndrome due to thoracic epidural analgesia in a paediatric patient
Authors: Aronson Lori A. , Parker Gwenevere C. , Valley Robert , Norfleet Edward A. 
Published: March 2003

SummaryA 4‐year‐old boy with coarctation of the aorta underwent surgical aortic arch repair with general anaesthesia and thoracic epidural analgesia. In the immediate postoperative period, the child developed a unilateral Horner syndrome which appeared to be related to the epidural infusion rate. Management of this patient as well as alternate aetiologies of Horner syndrome are described. Horner syndrome is a rare complication of epidural catheters and is often unrecognized, especially in children.
Prolonged somatosensory evoked potential depression following a brief exposure to low concentrations of inhalation anaesthetic in a 3‐year‐old child
Authors: Gillerman Richard , Duncan John , Bolton James 
Published: March 2003

SummaryA 3‐year‐old child was brought to the operating room for removal of a brainstem juvenile pilocytic astrocytoma. Following inhalation induction and intubation, he was maintained on 0.5% isoflurane. Somatosensory evoked potentials (SSEPs) were recorded but unobtainable initially and up to 90 min after all inhalation agents were discontinued. The operation was cancelled and the patient was transported to the paediatric intensive care unit (PICU). Subsequent PICU testing revealed a depression of amplitude with propofol and absence of potentials with 0.5% isoflurane. He returned to the operating room, was induced with propofol, and maintained with a propofol: nitrous oxide:fentanyl technique. This anaesthetic technique allowed adequate tumour resection with appropriate monitoring of SSEPs. These findings suggest that a total intravenous anaesthetic technique may be preferable for resection of spinal cord tumours where SSEPs are monitored.
Aspiration and regurgitation prophylaxis in paediatric anaesthesia
Authors: Engelhardt T. , Strachan L. , Johnston G. 
Published: March 2003

Background: Surveys of aspiration prophylaxis in paediatric anaesthesia do not exist. Methods: A postal survey was sent out to all UK members of the Association of Paediatric Anaesthetists (APA) to assess current practice. We asked about minimum fasting times for liquids and solids/milk, their routine acid aspiration prophylaxis and perceived risk factors for emergency and elective surgery in children those less than 1 year old and those aged 1–14 years. We also asked if the APA member had more than 10 years experience in paediatric anaesthesia. Results: One hundred and two (55.1%) APA members replied out of a total of 185 questionnaires sent. Eighty‐eight (88/102) were considered valid. Fasting in emergencies is approximately 4 h for solids/milk and 2 h for clear liquids. Fasting for elective surgery is between 5 and 6 h for solids/milk and 2 h for clear liquids. Pharmacological methods to reduce the risk of aspiration are not used. Mechanical methods vary from 40–50% for cricoid pressure and 20–30% for nasogastric aspiration if a tube is present. The presence of a hiatus hernia is perceived by over 80% as a risk factor, previous aspiration by over 60%, difficult intubation, cerebral palsy and sepsis by 20–30%. Conclusions: Perceived risk factors vary with ‘experience’: hiatus hernia, difficult intubation and cerebral palsy are less important whereas previous aspiration and renal failure appear to be more important for paediatric anaesthetists with less than 10 years in paediatric anaesthetic practice.