bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of intramuscular ketamine for endoscopy sedation in children
Authors: Law Albert K , Ng Daniel K , Chan Keung‐kit 
Published: May 2003

Abstract
Objective
: To report the experience of the use of intramuscular (IM) ketamine for endoscopy sedation in children.
Methodology
: Children over 6 months of age scheduled for elective endoscopy − esophagogastroduodenoscopy (EGD), bronchoscopy and nasopharyngolaryngoscopy (NPL) were enrolled for (2 mg/kg to 3 mg/kg) intramuscular ketamine sedation. A repeated dose of 2 mg/kg intramuscular ketamine was administered to those who failed the first sedation. Alternative sedation (intravenous midazolam and fentanyl) was given to children who failed ketamine sedation twice. Sedation was regarded as successful if the procedure was completed by endoscopist with a single dose of ketamine.
Results
: Sixty children were enrolled for the study. Overall success rate in our patients was 78.3%. Failure rate in infants was 50%, i.e. 4 out of 8. For children aged 1−7, the failure rate was 32%. Failure rate dropped markedly to 6.7% for those older than 7 years of age, and it showed significant difference when compared with the other two groups. Two cases of laryngospasm were experienced in the present study.
Conclusion
: Intramuscular ketamine is an effective medication for sedation in endoscopy undertaken in children over age 7 years, but it should be avoided with children under age 7 because of the high failure rate.
Mass screening for early detection of congenital kidney and urinary tract abnormalities in infancy
Authors: Yoshida Junko , Tsuchiya Masami , Tatsuma Noriko , Murakami Mutsumi 
Published: May 2003

Abstract
Background:
Recent widespread use of ultrasound has led to new efforts at screening for congenital kidney and urinary tract abnormalities. However, a standard screening methodology, criteria defining abnormalities, and follow‐up procedures remain to be established. In order to establish screening criteria for these abnor­malities, we performed a preliminary study in 800 1‐month‐old infants using provisional methods and criteria.
Methods:
Based on the results of preliminary study, we screened 2700 1‐month‐old infants in a prospective study using the criteria of renal size (longitudinal diameter ≤35 mm or ≥60 mm, or a difference between sides of ≥10 mm), and of pelvic dilatation (Society for Fetal Urology [SFU] grade 2 or higher) as positive at the first ultrasound screening. We used the SFU grading system instead of anteroposterior pelvic diameter measurements for pelvic dilatation.
Results:
One hundred and twelve (4.1%) of the 2700 infants had abnormalities at the first ultrasound screening, while 18 (0.67%) had congenital kidney and urinary tract abnormalities on further examination. Use of the SFU grading system enabled us to reduce the false‐positive rate at first screening, while maintaining a high diagnostic rate. The abnormalities consisted of ureteropelvic junction obstruction in seven infants, megaureter in two, hypoplastic kidney in four, vesicoureteral reflux in six (three were accompanied by hypoplastic kidneys or multicystic dysplastic kidney), multicystic dysplastic kidney in one, and horseshoe kidney in one.
Conclusion:
These results indicate that our screening methods and criteria are useful variables for detecting congenital kidney and urinary tract abnormalities.
Brain temperature in newborn piglets under selective head cooling with minimal systemic hypothermia
Authors: Iwata Osuke , Iwata Sachiko , Tamura Masanori , Nakamura Tomohiko , Sugiura Masatoshi , Ogiso Yoshifumi 
Published: May 2003

Abstract
Background:
Although selective brain hypothermia is expected to be a promising neuroprotective treatment, the thermal distribution under hypothermia is not fully investigated. We applied selective head cooling to seven newborn piglets under general anesthesia in order to investigate the mechanism of cooling.
Methods:
Seven healthy, large white piglets aged within 5 days after birth were studied. Temperatures were monitored at the superficial brain (0.5 cm), deep brain (2.0 cm), scalp skin, nasopharynx, tympanum, esophagus, and rectum. A radiant heater and a warmer blanket were used to maintain the normal rectal temperature (38.5−39°C). For the first piglet, the coolant temperature was widely changed from 15C to − 20C in order to define the practical range. Subsequently, the coolant temperature was set at 10C, 0C, and − 10C for the remaining six piglets. The target deep brain temperature was set at 35C, as the same reduction of brain temperature might provide moderate brain hypothermia in the human neonate.
Results:
With 0C coolant temperature, the deep brain temperature was cooled to 35C; however, the scalp skin attached to the cooling cap became broadly blotchy and injured in all animals. When we induced minimal systemic hypothermia by 1C for a cohort of three piglets, the deep brain temperature decreased in parallel with the rectal temperature, which enabled us to achieve the target temperature with 10°C coolant without injuring the scalp skin. The scalp skin and nasopharyngeal temperatures were good predictors of both superficial and deep‐brain temperatures throughout the experiment.
Conclusions:
Our results suggest that moderate brain hypothermia may be applied to newborn infants without inducing moderate systemic hypothermia.
Factor VIII levels in children with thrombosis
Authors: Kurekci A Emin , Gokce Hafize , Akar Nejat 
Published: May 2003

Abstract
Background
: A number of coagulation defects have been implicated as risk factors in thrombo‐embolic disease. Of these, high levels of clotting factor VIII have been shown to be associated with a five‐ to six‐fold increased risk of thrombosis, compared to levels < 100 IU/dL in adults. The objective of this study was to investigate the prevalence of elevated plasma levels of factor VIII in a pediatric population with thrombo‐embolism (TE).
Methods:
Forty‐two children (17 female, 25 male) with TE and 165 healthy controls without familial history of thrombosis or stroke were included in the present study. Doppler ultrasonography with or without angiography, computed tomography, magnetic resonance imaging or echocardiography was utilized to establish the diagnosis. One‐stage clotting assay with factor VIII‐deficient plasma for measurement of factor VIII and immunoturbidometric assay for von Willebrand factor (vWF) levels were utilized. All measurements were performed in duplicate. Plasma levels of factor VIII were assessed in parents of nine patients to establish whether high levels of factor VIII were genetically determined.
Results
: The median age at onset of TE was 7 years (range 0−17 years). Among patients with TE compared to controls, the prevalence of high factor VIII levels was 59.5% versus 12.1% (odds ratio 10.6, 95% CI: 4.9−23.1). The prevalence of high factor VIII levels was detected in at least one of nine families.
Conclusion:
The data in the present study provide evidence that elevated plasma factor VIII levels are associated with increased risk of thrombosis in children: thus, plasma concentration of factor VIII should be measured in all children with TE.
Inducible and endothelial constitutive nitric oxide synthase gene polymorphisms in Kawasaki disease
Authors: Khajoee Vahid , Kariyazono Hidehiko , Ohno Takuro , Ihara Kenji , Mizuno Yumi , Kusuhara Koichi , Hara Toshiro 
Published: May 2003

Abstract
Background
: Nitric oxide (NO) is secreted by immune and vascular endothelial cells, and appears to play important roles in the pathophysiology of Kawasaki disease (KD). Thus, genetic variations in NO synthase (NOS) genes may be involved in the development of coronary artery lesions (CAL) in KD.
Methods
: The present study investigated the association of endothelial constitutive NOS (ecNOS) and inducible NOS (iNOS) gene polymorphisms with the development of CAL in KD in a Japanese population.
Results
: The genotype distributions of 27‐bp tandem repeat polymorphism within intron 4 of ecNOS gene did not show any significant difference between controls and KD patients with or without CAL. In addition, there was no significant association between whole‐allele distribution of iNOS gene promoter (penta‐repeat CCTTT) polymorphism and KD with or without CAL.
Conclusion
: These results did not support any association of ecNOS and iNOS gene polymorphisms to the development of CAL in KD patients in a Japanese population.
Effect of Trp64Arg mutation of the β3‐adrenergic receptor gene and C161T substitution of the peroxisome proliferator activated receptor γ gene on obesity in Japanese children
Authors: Arashiro Rina , Katsuren Keisuke , Fukuyama Shigeru , Ohta Takao 
Published: May 2003

Abstract
Objective:
Obesity is a multifactorial syndrome influenced by both genetic and behavioral factors. Trp64Arg mutation of the β3‐adrenergic receptor (AR) gene and C161T substitution of the peroxisome proliferator‐activated receptor (PPAR) γ gene have been reported to be associated with obesity or lipid metabolism in adults. However, the effects of these mutations on children have not yet been clarified. For this reason, we studied the effects of Trp64Arg mutation of the β3‐AR gene and C161T substitution of the PPARγ gene on obesity in Japanese children.
Subjects and Methods:
In order to determine the effects of Trp64Arg mutation of the β3‐AR gene and C161T substitution of the PPARγ gene on obesity in children, 105 obese Japanese children were screened by the polymerase chain reaction and restriction fragment‐length polymorphism analysis. Plasma lipid, apolipo­protein (apo), glucose, insulin and leptin levels were also determined.
Results:
Obese boys with Trp64Arg showed a higher obesity index and lower plasma levels of high‐density lipoprotein cholesterol (HDL‐C), apoA‐I and apoA‐II than those of them without the mutation. Obese boys with both mutations showed a higher plasma leptin level than those with only the β3‐AR gene mutation or PPARγ gene mutation. No significant effect of these mutations was found in obese girls.
Conclusion:
All of these data suggest that Trp64Arg mutation of the β3‐AR gene might affect obesity and HDL metabolism in obese boys. In contrast, C161T mutation of the PPARγ gene, by itself, is unlikely to influence obesity, lipid metabolism or plasma leptin levels.
Body fat ratios in urban Chinese children
Authors: Iwata Fujihiko , Hara Mitsuhiko , Okada Tomoo , Harada Kensuke , Li Shilian 
Published: May 2003

Abstract
Objective
: As obesity has been increasing in China, the present study examined the body composition of children to assess their fatness.
Study design
: A total of 532 healthy schoolchildren who lived in central Beijing were examined. Skinfold thicknesses, hip and waist circumferences, and body fat percentage were measured, as well as height and weight.
Results
: The prevalence of overweight (Body Mass Index (BMI) ≥ 95% for age and sex of Chinese children) was 27.7% in boys and 14.2% in girls (chi‐squared; P = 0.0001). The percentages of body fat (BF%), waist/hip ratios and skinfold thicknesses ratios (subscapular/triceps) in overweight children were significantly higher than those in non‐overweight children (Mann−Whitney U‐test). The BF% of non‐overweight boys was significantly higher than that of non‐overweight girls.
Conclusion
: Urban Chinese overweight children have high BF% with adverse fat distribution. They may have high risk of atherogeniety. Boys in the non‐overweight category may have higher fat accumulation than predicted by BMI. The establishment of an intervention program for childhood obesity is strongly recommended.
Effects of childhood bronchiectasis on cardiac functions
Authors: Akalin Figen , Koroglu Tolga F , Bakac Serap , Dagli Elif 
Published: May 2003

Abstract
Background
: Bronchiectasis is still a widespread disease in developing countries. It is an important cause of mortality and morbidity. The information on cardiac involvement in bronchiectasis is limited. However, cor pulmonale is common in patients with chronic lung disease, such as cystic fibrosis.
Methods:
We utilized echocardiography and exercise tests, along with clinical scoring, chest radiograph scoring, and pulmonary function tests in 21 patients to determine whether detectable changes in cardiac functions were present, and the nature of their relationship to the underlying disease severity.
Results:
The ventricular systolic functions were preserved in all patients. Some of the patients had changes in left ventricular diastolic function indices, characterized by abnormal Ewave/Awave (E/A) ratios or isovolumetric relaxation time values. Isovolumetric relaxation time but not E/A ratios was found to have a significant negative correlation with the clinical score. In addition, exercise capacity was decreased in bronchiectatic children. Most of the patients stopped the exercise test due to exhaustion before reaching maximum heart rate.
Conclusion
: Left ventricular diastolic functions are affected in bronchiectasis, and the performance of patients is dependent on their pulmonary status. This is the first study demonstrating the cardiac effects of bronchiectasis according to our survey of the published literature.
Associated features of conversion disorder in Turkish adolescents
Authors: Ercan Eyüp S , Varan Azmi , Veznedaroğlu Baybars 
Published: May 2003

Abstract
Background
: Conversion disorder in adolescents has not been studied extensively. A limited number of studies have focused on the features related to conversion disorder in adolescents. However, most of these studies used either retrospective data or did not have a control group that would allow comparison with the index cases.
Methods
: Fifty‐two Turkish adolescent patients diagnosed with conversion disorder were compared with a control group of 52 adolescents diagnosed with psychiatric disorders other than conversion disorder. The data were collected from the adolescent subjects and their mothers by various questionnaires, inventories, and psychiatric interviews.
Results
: In the present study, pseudoseizures were the most common subtype of conversion disorder, followed by motor symptoms or deficits. Coming from a rural area, having a broken family, long‐term separation from parents, problems related to communication and expression of emotions in the family, higher anxiety scores, conversion disorder in the proximal environment, and conversion disorder or other psychiatric disorders in the mother were significantly associated with conversion disorder in adolescents.
Conclusions
: The findings of the present study are in accordance with existing findings, and amplify the importance of problems in family functioning in the etiology of conversion disorder.
Prevention of methicillin‐resistant Staphylococcus aureus infections in neonates
Authors: Kitajima Hiroyuki 
Published: May 2003

Abstract Reports of methicillin‐resistant Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICU) and normal newborn nurseries in Japan were investigated, and various methods of preventing transmission were evaluated.In the late 1980s, MRSA which had spread in adult wards also invaded NICU. Very low birthweight or premature infants had become the targets of MRSA infection and this has now become a serious problem. Recent reports have revealed that 87% of major NICU in Japan have suffered from MRSA infections. However, we have found that preventive measures can greatly reduce the risk of a newborn being infected by a carrier, while also controlling the disease caused by MRSA infection. Recently, MRSA infections in normal newborn nurseries have also become a serious problem in pediatric departments. Methicillin‐resistant Staphylococcus aureus which can colonize in the newborn baby just after birth, is passed on to the newborn by carrier medical staff. It was found to be of great importance that infant's mothers hold and nurse their babies immediately after birth, and start breast‐feeding while still in the delivery room. Furthermore, the most appropriate and ideal newborn nursery is one where mother and child are roomed together and there is little intervention by the hospital. In neonatal care, it is of utmost importance to treat carriers of MRSA bacteria, and to inhibit the spread of the bacterium in babies by taking standard precautionary measures.
Genetic basis of neonatal methicillin‐resistant Staphylococcus aureus in Japan
Authors: Kikuchi Ken 
Published: May 2003

Abstract Methicillin‐resistant Staphylococcus aureus (MRSA) is still one of major problems of drug‐resistant microorganisms and healthcare‐acquired infections. Methicillin‐resistant Staphylococcus aureus is highly prevalent in patients in neonatal intensive care units (NICU) in Japan. The most predominant MRSA in NICU is multidrug resistant and produces superantigenic exotoxin, toxic shock syndrome toxin−1 (TSST−1) and staphylococcal enterotoxin C (SEC). These predominant MRSA strains belong to coagulase type II, SCCmec type II, mecA‐Tn554 polymorph type I‐A and show closely related pulse field gel electrophoresis types. The dissemination of MRSA is wide, and there is a pandemic distribution of a single MRSA clone in the NICU of Japan. Since 1992, the nationwide spread of this clone has also led to the development of a new neonatal disease known as neonatal toxic shock‐like exanthematous disease (NTED), which is caused by overactivation of vβ2+ T cells induced by TSST−1.The spread of MRSA in NICU in Japan has been attributed to overcrowding, high rates of extremely low birthweight babies, understaffing, low control measures of infection and overuse of antibiotics. The environment of NICU and infection control intervention should be improved and a new strategy for control like vaccination or probiotics is required.
Examination of severe, hospital acquired infections affecting extremely low birthweight (ELBW) infants
Authors: Usukura Yukihiro , Igarashi Takeyasu 
Published: May 2003

Abstract
Purpose
: A nationwide questionnaire survey was carried out in 77 major neonatal intensive care unit (NICU) facilities in Japan. The survey investigated severe, hospital acquired infections occurring in extremely low birthweight (ELBW) infants at each institution.
Methods
: The nationwide questionnaire survey involved 77 major NICU facilities and ELBW infants born in 1996. The actual status of severe infection in these infants was investigated.
Results
: Replies were obtained from 57 of the 77 facilities that were sent a questionnaire (74% recovery). During the survey period, the total number of patients hospitalized in 57 facilities was 13 697, of which there were 836 ELBW infants. During this period, severe infection occurred in 126 of the ELBW infants. Of those, 98 who developed delayed infection (72 h or more after birth) on the basis of the date of onset were investigated. Methicillin‐resistant staphylococcus aureus (MRSA) was the most common organism found, (38 infants, 38.8%), followed by Pseudomonas (10 infants, 10.2%) and Candida (8 infants, 8.2%). Septicemia was present in 67 patients (68.4%), while pneumonia and gastrointestinal complications were found in 15 patients (15.3%). With respect to therapy, the selection of antibiotics varied between facilities. Vancomycin (VCM) was used in 31 cases (31.6%) because MRSA was the most common organism. VCM was used from the early stage of treatment in as many as 20 infants (20.4%). Fifty‐eight infants survived (59.2%), 28 infants died (28.6%), and 12 subsequentally had obvious complications (12.2%).
Conclusion
: It was confirmed that severe, hospital acquired infections caused by MRSA are still a significant problem in many institutions. Despite active prevention and treatment, the incidence of severe, hospital acquired infection has not decreased and the prognosis has not improved. Considering the inadequacy of the medical care environment in Japan, it seems impossible to solve these problems at present.
The influence of bladder filling on anorectal function
Authors: Crosbie J. J. , Eguare E. , McGovern B. , Keane F. B. V. 
Published: May 2003

AbstractObjective  The aim of this study was to develop a technique to simultaneously evaluate bladder and anorectal function. In particular, this study was designed to determine if anal sphincter resting pressure, anal sphincter squeeze pressure and rectal sensation change with bladder filling.Patient and methods  A pilot study of ten female patients who presented to the pelvic physiology unit for assessment of urinary symptoms was performed. All patients completed a symptom questionnaire and quality of life assessment form. Following informed consent a baseline urodynamic test was performed with the bladder empty and subsequently followed by an anorectal manometric test. Changes in anal sphincter resting pressure, squeeze pressure and rectal pressure were recorded over a ten‐minute period. With the patient lying in the left lateral position, the bladder was then filled with isotonic saline at room temperature at a constant rate of 30ml/min. A continuous assessment of changes in anal sphincter resting pressure during bladder filling was made. Anal sphincter squeeze pressure and rectal sensation were measured at fixed intervals during bladder filling (50, 100, 150 ml etc.) and at fixed intervals relative to bladder capacity (25, 50, 75 and 100% capacity) by stopping bladder filling at the appropriate level.Results   There was no significant change in anal sphincter resting pressure (Mean difference(s.d.) between bladder full and empty = 2.7(5.6) P = 0.92*), squeeze pressure (Mean(s.d.) difference = 9.5(26.3) P = 0.86*) and rectal sensation (Mean difference(s.d.) first sensation 10(15.2) P = 0.958; Mean difference(s.d.) urgency = 10(17.8) P = 0.07*) on bladder filling.Conclusion   Under normal physiological circumstances, bladder filling does not influence anorectal function.*Stastistical analysis: Wilcoxon signed rank sum test. P < 0.05 considered significant. Units = mmHg
Efficacy and tolerance of a new gentamicin collagen fleece (Septocoll®) after surgical treatment of a pilonidal sinus
Authors: Holzer B. , Grüßner U. , Brückner B. , Houf M. , Kiffner E. , Schildberg F. W. , Vogel P. , Rosen H. R. ,   the EMD study group
Published: May 2003

AbstractObjective  Pilonidal sinus is common. It causes substantial loss of working hours. The major disadvantage of open wound treatment is the long time required for healing. Primary wound closure is on the other hand often followed by infection. A controlled, multicentre trial was carried out to evaluate the efficacy of a new gentamicin collagen fleece (Septocoll®) combined with primary closure.Patients and methods  One hundred and three patients (88 men, 15 women, median age 30 years) were included. Fifty‐one were randomised to gentamicin fleece plus primary closure (Genta Group), and 52 patients to open treatment alone (Open Group).Results  The median interval to wound healing was 17 days in the Genta group and 68 days in the Open group (P = 0.0001, log‐rank test). Two patients in Group 1 developed infection within the first two weeks, requiring reopening of the wound, with primary wound healing occurring in 73%. Failure of primary healing (27%) was usually due to seroma or spontaneous dehiscence which subsequently healed.Conclusion  The combination of gentamicin collagen fleece (Septocoll®) with primary closure resulted in a shorter period to healing than the open technique without unwanted effects.