bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single institution outcomes of treatment of severe aplastic anaemia
Authors: Mollee P. , Woodward N. , Durrant S. , Lockwood L. , Gillett E. A. , Morton J. , Rowell J. 
Published: March 2003

Abstract Background: In severe aplastic anaemia, the treatment of choice for young patients with a human leucocyte antigen‐matched sibling is now established as allogeneic bone marrow transplantation (BMT). In older patients and in those without a matched sibling donor, immunosuppressive therapy is the usual first option. ‘Alternative’ marrow donors are emerging as an option for those without a matched sibling donor. Aims: To review 10 years of local experience in treating severe aplastic anaemia with BMT and immunosuppressive therapy with emphasis on long‐term outcomes. Methods: A retrospective analysis was performed of all patients with severe aplastic anaemia presenting to the Royal Brisbane and Royal Children’s Hos‐ pitals between 1989 and 1999. Data were abstracted regarding patient demographics, pretreatment characteristics and outcome measures, including response rates, overall survival and long‐term complications. Results: Twenty‐seven consecutive patients were identified, 12 treated with immunosuppression alone and 15 with BMT. In these two groups, transfusion independence was attained in 25% and 100%, respectively, with overall survival being 36% and 100%, respectively. Those treated with immunosuppression were significantly older (median 41.5 versus 22 years, P = 0.008). Long‐term survivors of either treatment had extremely low morbidity. Three patients carried pregnancies to term post‐transplant. Three patients received alternative donor BMT with correspondingly excellent survival. Conclusions: Patients treated with allogeneic BMT for severe aplastic anaemia enjoyed extremely good long‐term survival and minimal morbidity. Patients treated with immunosuppressive therapy had a poorer outcome reflecting their older age and different usage of therapies over the past decade. Optimal treatment strategies for severe aplastic anaemia remain to be determined. (Intern Med J 2001; 31: 337–342)
Sentinel lymph node biopsy in patients with melanoma and breast cancer
Authors: Uren R. F. , Thompson J. F. , Howman‐Giles R. 
Published: March 2003

Abstract Sentinel lymph node biopsy (SNLB) is a new method for staging regional node fields in patients with cancers that have a propensity to metastasise to lymph nodes. The majority of early experience has been obtained in patients with melanoma and breast cancer.The technique requires the close cooperation of nuclear medicine physicians, surgical oncologists and histopathologists to achieve the desired accuracy. It involves: (i) identification of all lymph nodes that directly drain a primary tumour site (the sentinel nodes) by the use of pre‐operative lymphoscintigraphy, (ii) selective excision of these nodes by the surgeon, guided by pre‐operative blue dye injection and a gamma detecting probe intra‐operatively and (iii) careful histological examination of the sentinel nodes by the histopathologist using serial sections and immunohistochemical stains.If the nodes are normal it can be inferred with a high degree of accuracy that all nodes in the node field are normal. This means that radical dissections of draining node fields can be avoided in patients with normal lymph nodes.A further advantage of lyamphatic mapping is that drainage to sentinel nodes in unusual locations is identified, leading to more accurate nodal staging than could be achieved with routine dissection of the closest node field. (Intern Med J 2001; 31: 547–553)
Stem cells in cardiovascular disease: from cell biology to clinical therapy
Authors: Semsarian C. 
Published: March 2003

AbstractHuman life begins as a single fertilized cell. As adult human beings we are profoundly complex. This journey from single cell to complex being is attributable to the role of stem cells (i.e. cells that produce all the different types of cells and tissues that make up the human body). Recent interest has focused on the development of stem cells as a therapeutic option in the treatment of disease. Due to their ability both to replace and/or repair damaged tissue, stem cell therapy provides an ideal means to improve therapy for cardiac disorders associated with heart muscle injury. In particular, pre‐clinical studies in animal models of acute myocardial infarction have shown great promise for both repairing damaged cardiac muscle and generating new blood vessel formation in the infarcted area. Stem‐cell research therefore holds great therapeutic potential and is relevant, not only to basic science researchers, but also to clinicians (who may need to consider such cell‐based therapy in the future) and to their patients. (Intern Med J 2002; 32: 259−265)
Knowledge, attitudes and experience associated with testing for prostate cancer: a comparison between male doctors and men in the community
Authors: Livingston P. , Cohen P. , Frydenberg M. , Borland R. , Reading D. , Clarke V. , Hill D. 
Published: March 2003

Abstract Background:  Debate about testing for prostate cancer using prostate‐specific antigen (PSA) and digital rectal examination (DRE) continues. The evidence of benefit from screening for prostate cancer using PSA tests is inconclusive, and it is unclear how PSA can be used most effectively in the detection of prostate cancer. Given the lack of consensus, it is important that consumers understand the issues in a way that will permit them to decide whether or not to have a test and, if symptomatic, how their condition is managed. Aims:  To compare prostate cancer knowledge, attitudes and testing experiences reported by male doctors and men in the community, despite the lack of evidence of a benefit. Methods : The primary method for ascertaining the attitudes of male doctors (MD) was a telephone survey, with some doctors electing to complete a written survey. Each MD was selected, at random, from a register of male practitioners aged ≥ 49 years of age. A total of 266 MD participated in the survey. The community sample (CS) was accessed using a telephone survey. Five hundred male Victorian residents aged ≥ 49 years of age participated in the study. Results:  Knowledge − Overall, 55% of the CS indicated ­correctly that prostate disease is sometimes cancer, compared to 83% of MD.  Attitudes − Fifty‐five per cent of MD believed men should be tested for prostate disease at least every 2 years, compared to 68% of men in the CS.  Testing experience − Forty‐five per cent of MD had been tested for prostate cancer in the past, and 92% of those tests were reported as negative. In the CS, 56% had been tested for prostate cancer in the past, and 78% of the results were reported as negative. The ­significant independent predictors of having had a prostate test among MD were: (i) age (≥ 60 years; odds ratio (OR): 1.59; 95% confidence intervals (CI): 1.30−1.88) and (ii) positive attitudes towards regular testing for prostate cancer (OR: 2.27; 95% CI: 1.98−2.56). The significant independent predictors for the CS were: (i) age (≥ 60 years; OR: 1.65; 95% CI: 1.40−1.89), (ii) being married (OR: 1.30; 95% CI: 1.00−1.60), (iii) knowledge that prostate disease was sometimes cancer (OR: 1.46; 95% CI: 1.26−1.66) and (iv) positive attitudes towards regular testing for prostate cancer (OR: 2.12; 95% CI: 1.90−2.34). Conclusions: The results highlight that testing for prostate cancer is widespread in the community and in the medical profession. Further research should be undertaken to identify how to help men make fully informed decisions about prostate cancer testing. (Intern Med J 2002; 32: 215−223)
Medications taken by 26‐year‐olds
Authors: Thomson W. M. , Poulton R. 
Published: March 2003

Abstract Background: Most descriptive pharmacoepidemiological reports are from studies of older people, and little is known about medication use by younger adults. Aims: The aim of the present study was to examine the prevalence of medication usage in the previous 2 weeks among young adults. Methods: Detailed information was collected on medications taken by 26‐year‐old participants in the longstanding Dunedin Multidisciplinary Health and Development Study. Results: At age 26, 980 (96.2%) of the surviving cohort participated; medication data were available for 978 individuals,of whom 78.1% had taken one or more prescribed or over‐the‐counter medi­cations. Medication use was higher among females.The most prevalent drug categories were analgesics (taken by 22.8% of the sample), hormonal contraceptives (21.9%; 44.7% offemales), nutrient supplements (17.6%) and anti‐asthma drugs (11.1%). Conclusions: The prevalence and pattern of medi­cation use among younger adults differ from those reported for older age groups. Asthma appears to be the most prevalent chronic medical condition requiring pharmacological intervention (and for which medical care has been sought) among younger adults. The low rates of use of antidepressants and anxiolytics suggest that common psychiatric disorders may currently go unrecognized or untreated among young adults, and the high prevalence of ‘third generation’ oral contraceptive use among females is of particular concern. (Intern Med J 2002; 32: 305−310)
Upper gastrointestinal endoscopic ultrasound and its impact on patient management: 1990−2000
Authors: Kaffes A. J. , Mishra A. , Simpson S. B. , Jones D. B. 
Published: March 2003

Abstract Background: Endoscopic ultrasound (EUS) is a relatively new method used in the investigation and staging of upper gastrointestinal tract (UGIT) disease. Aims: To review practice and outcomes of EUS in an Australian university teaching hospital. Methods: The first part of the study was a retrospective review of indications, safety, referral patterns and tech­nical difficulties of all EUS procedures performed at Concord Hospital, New South Wales, Australia, over a 10‐year period from 1990 to 2000. The second part of the study examined the impact of EUS on the management of 225 consecutive cases, as determined by a ­questionnaire completed by each of the referring doctors. Results: A total of 537 EUS examinations was performed over the 10‐year period. Indications for EUS included: (i) assessment of oesophageal lesions (241), (ii) assessment of gastric lesions (184) and (iii) assessment of pancreaticobiliary (112) disease. Cancer staging was performed in 46.7% of oesoph­ageal and 31.4% of gastric cases. Sedation was achieved using intravenous midazolam (5.3 ± 1.3 mg; mean ± SD) and 52% of cases required additional intravenous pethidine (48.5 ± 10.0 mg; mean ± SD). Technical difficulties were encountered in 11% of cases and these were mainly related to non‐­traversable luminal stricturing. Of the 537 referrals, 48.2% were from within Central Sydney Area Health Services, and the remainder were from other Sydney hospitals, New South Wales regional centres and interstate. Of 225 questionnaires sent to referring doctors, 146 questionnaires were completed and returned for analysis. EUS aided staging of malignant disease, and confirmed or established a diagnosis in 86% of cases. The diagnostic accuracy of EUS was 76% when confirmed histologically. EUS avoided further diagnostic investigations in the majority of cases and in 25% of cases surgery was avoided. Fine‐needle aspiration biopsy (FNAB) during EUS would have been useful in 30% of cases. Overall, clinical decision‐making and management were changed in one‐third of cases. Conclusions: Endoscopic ultrasound is an accurate, safe and useful imaging method in UGIT disease. The increasing demand for EUS and EUS‐guided FNAB suggests an expanding future for EUS in Australia. (Intern Med J 2002; 32: 372−378)
Utility of a weight‐based heparin nomogram for patients with acute coronary syndromes
Authors: Zimmermann A. T. , Jeffries W. S. , McElroy H. , Horowitz J. D 
Published: March 2003

Abstract Background:  Unfractionated heparin has been pivotal in the management of acute coronary syndromes (ACS), and continues to be used widely despite the emerging role of low molecular weight heparins (LMWH). The apparent superiority of LMWH over unfractionated heparin may, at least partially, reside in its more predictable achievement of therapeutic effect, with high rates of non‐therapeutic activated partial thromboplastin time (APTT) results being observed in the intravenous heparin treatment groups.Aim:  To evaluate the impact of introduction of a weight‐based heparin nomogram developed for use in patients with ACS on frequency of ‘therapeutic’ APTT results.Methods:  The effectiveness of an existing non‐weight‐based heparin nomogram in achieving a therapeutic APTT was compared sequentially with that of a weight‐based heparin nomogram in 89 and 84 consecutive patients admitted with a diagnosis of ACS.Results:  Patients in whom heparin dosage adjustment was weight based rapidly achieved therapeutic APTT. The median time to achieve an APTT within the target range was 8.75 h in the weight‐based group versus >24 h in the non‐weight‐based group. Utilization of a weight‐based nomogram was associated with markedly increased proportions of readings within the therapeutic APTT range at 6 h and at 24 h (51%vs. 26% and 72%vs. 36%, respectively).Conclusions:  The current study confirms the marked superiority of the weight‐based heparin regimen for treatment of patients with ACS. The nomogram dramatically facilitated the attainment of therapeutic APTT, and may represent the optimal method for titration of heparin dosage to individual heparin requirements in patients with ACS. (Intern Med J 2003; 33: 18−25)
The use of propofol infusions in paediatric anaesthesia: a practical guide
Authors: McFarlan Charles S. , Anderson Brian J. , Short Timothy G. 
Published: March 2003

SummaryChildren require higher infusion rates of propofol than adults to maintain clinical anaesthesia. We aimed to produce a manual infusion regimen capable of maintaining a steady‐state blood concentration of 3 μg ml−1 in children aged 3–11 years. Pharmacokinetic parameter estimates were taken from published studies of infusion data in children and used in a pharmacokinetic simulation programme to predict likely propofol blood concentrations during infusions. A variability of 5% was allowed about the target concentration of 3 μg ml−1. A loading dose of 2.5 mg·kg−1 followed by an infusion rate of 15 mg·kg−1·h−1 for the first 15 min, 13 mg·kg−1·h−1 from 15 to 30 min, 11 mg·kg−1·h−1 from 30 to 60 min, 10 mg·kg−1·h−1 from 1 to 2 h and 9 mg·kg−1·h−1 from 2 to 4 h resulted in a pseudo‐steady state target concentration of 3 μg·ml−1 in children 3–11 years. We were unable to predict similar rates by applying size models to adult data. The context sensitive half‐time in children was longer than in adults, rising from 10.4 min at 1 h to 19.6 min at 4 h compared to adult estimates of 6.7 min and 9.5 min, respectively. Children require higher infusion rates than adults to maintain steady state concentrations of 3 μg·ml−1 and have longer context sensitive half‐times than adults. These differences can be attributed to altered pharmacokinetics in this age group.
Hemifacial microsomia: anatomical prediction of difficult intubation
Authors: Nargozian Charles , Ririe Douglas G. , Bennun Ricardo D. , Mulliken John B. 
Published: March 2003

SummaryHemifacial microsomia (HFM) is associated with a difficult airway. We hypothesized that a difficult intubation would be predicted by radiographic evaluation of the severity of mandibular hypoplasia. A retrospective review of anaesthetic and surgical records of 102 children with HFM from 1986 to 1996 was conducted for radiographic classification of mandibular hypoplasia and degree of difficulty with intubation. Intubation was classified as Grade A—easy, Grade B—difficult, or Grade C—very difficult. The mandibular anatomy was categorized as Type I—‘mini‐mandible’, Type II—abnormal condylar size and shape, or Type III—absent ramus, condyle, and temporomandibular joint. In the 82 patients with HFM, 70% were classified as Grade A, 21% had Grade B and 9% had Grade C airways. No patients with Type I mandible had Grade C airway, while 25% of the patients with Type III mandible had Grade C airway. The correlation of the degree of airway difficulty with mandibular type was significant (P=0.001). In 20 patients with bilateral mandibular hypoplasia, 30% had Grade A, 35% had Grade B, and 35% had Grade C airways. We conclude that radiographic classification of mandibular deformity is a useful adjunct for preoperative prediction of airway difficulty in the management of children with unilateral HFM.
Complications of emergency tracheal intubation in severely head‐injured children
Authors: Meyer ;philippe G. , Orliaguet Gilles , Blanot Stéphane , Jarreau Marie‐Madeleine , Charron Brigitte , De Sauverzac Rodolphe , Carli Pierre 
Published: March 2003

SummaryA high incidence of unsuccessful attempts and complications has been reported when emergency tracheal intubation (ETI) is performed outside the hospital in severely injured children. The aim of this prospective series was to analyse the incidence and related risk factors of complications of emergency tracheal intubation. The time to complete successful ETI and occurrence of incidents, e.g. cough reflex, hypoxia or spasm were related to the experience of the physician performing intubation and the use of drugs to facilitate ETI. The incidence of hypoxia, hypercarbia, postintubation complications such as extubation stridor and long‐term sequelae were noted. Of the 188 children, 78% were successfully intubated at the site of the accident, 10% upon arrival at a local hospital from where they were secondarily transferred and 12% upon admission to our trauma centre. The most severely injured children were intubated in the field in 98% of cases without failure, nor life‐threatening complications related to ETI. The experience of the operator influenced the number of attempts and the time to complete successful intubation. Immediate incidents were noted in 25% of children, e.g. cough in 18%. The regimen of drugs, but not level of consciousness, influenced the incidence of immediate incidents; without drugs, more than 67% experienced incidents. Early tracheal intubation and controlled ventilation resulted in adequate ventilation upon arrival (mean PaO2 of 35.8±24 kPa, mean PaCO2 of 4.35±1 kPa). Long‐term complications, including transient stridor upon extubation in 33% of the cases, and laryngeal granuloma or tracheal stenosis, were comparable to those in other series. ETI in shocked patients and pulmonary infection in hospital, but not the technique of ETI, increased the risks of long‐term complications. Emergency tracheal intubation can be performed safely in the field, and results in adequate ventilation during transportation of severely injured children, provided that it can be performed by trained physicians using adequate drugs to facilitate intubation.
Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases
Authors: Lejus Corinne , Surbled Marielle , Schwoerer Didier , Renaudin Mariette , Guillaud Christian , Berard Luc , Pinaud Michel 
Published: March 2003

Background: The objective of this prospective study was the evaluation of the analgesia provided by an epidural infusion of bupivacaine and fentanyl after different types of surgery in children. Methods: Data were collected from 348 epidural analgesia in 87 children below 2 years of age, in 80 children between 2 and 6 years and 181 above 6 years of age, for a median duration of 43 postoperative hours. Bupivacaine (mean concentration 0.185%) and fentanyl (5 μg·kg−1·day−1) were administered on the surgical ward. Results: Pain control was considered excellent in 86% of the 11 072 pain hourly assessments. Analgesia was found to be better for children older than 2 years, and the overall quality of their night’s sleep was better than that of older children. Higher pain scores were noted for Nissen fundoplication surgery and club foot repairs. Early discontinuation rarely occurred, and only because of technical problems with the epidural catheter (4%) or insufficient analgesia (6%). Complications were minor (nausea/vomiting 14%, pruritus 0.6%, urinary retention 17%) and easily reversed. Conclusions: This combination of bupivacaine–fentanyl provides safe analgesia after major surgery in children with frequent clinical monitoring. Regular pain assessments of intensity and duration are useful to improve the quality of postoperative analgesia.
A study of epidural pressures in infants
Authors: Vas Lakshmi , Raghavendran Shreekrishna , Hosalkar Hetal , Patil Bharati 
Published: March 2003

Background: The pressures exerted on fragile structures in the infant during epidural injections have never been studied previously. Methods: We measured the pressure changes in the epidural space of 20 infants during injection of local anaesthetic solutions. The pressures developed during passage of the epidural needle through the ligaments of spine and in the epidural space during the injection of 1 ml at two rates of injection, over 1 and 2 min and the residual pressure 1 and 2 min after each injection were studied. Results: The mean pressure while the needle was being advanced through the ligamentum flavum was 69.14 ± 36.95 mmHg. The epidural pressure after needle had just penetrated the ligament without eliciting the loss of resistance was 1 ± 9.759 mmHg. A distinct pulsatile waveform identical to the pulse waveform was observed as soon as the epidural space was entered. The pressure rise varied according to the rate of injection. The pressures were 27.79 mmHg when the rate of injection was 1 ml·min–1, with a residual pressure after 1 min of 12 ± 5.53 mmHg and 10.14 ± 5.53 mmHg after 2 min of injection. When the rate of injection was 1 ml·2 min–1, the pressures were 15.66 ± 9.48 mmHg with a residual pressure after 1 min of 14.79 ± 5.15 mmHg and 12.93 ± 5.46 mmHg after 2 min of injection. Conclusions: The residual pressures seem to vary more with the volume injected than the rate of injection or the pressures developed during the injection. The relationship between the rate of injection and pressures is significant when compared with adults where the pressures have been measured after an injection rate of 1 ml·s–1 and 1 ml·5 s–1. This is a very fast rate compared with our rates of injection of 1 ml over 1 and 2 min. Based on the findings of this study, we recommend a rate of 1 ml·2 min–1 in infants. In neonates, a slower rate of injection would be preferable.