bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health‐related quality of life of ileocecal rectal bladder compared with ileal conduit diversion: A questionnaire survey
Authors: Satoh Shigeru , Sato Kazunari , Habuchi Tomonori , Matsuo Shigeki , Sasaki Shuhei , Kato Tetsuro 
Published: March 2003

AbstractBackground : The ileocecal rectal bladder (IRB) after cystectomy has been devised, in which continence is controlled by the anal sphincter. To assess how this procedure influences postoperative health‐related quality of life (QOL), IRB patients were compared with ileal conduit (IC) patients using a questionnaire mail‐out.Methods : The questionnaire consisted of 35 questions. The questions were multiple choice and the answers were rated on a Linkert rank‐type four‐point scale. The IRB operation was performed on 29 patients between March 1990 and July 1998. The questionnaire was mailed to 21 of 29 IRB and 34 IC patients, who underwent either operation during the same period and had no persistent or recurrent tumor. Statistical analysis was performed by Mann–Whitney U‐test.Results : All 21 IRB patients (100%) and 24 IC patients (71%) responded to the questionnaire. The mean age and follow‐up time of both groups were not significantly different. The IRB group had better scores in many items, especially, in those of self‐care, turning over freely during sleep, and tension. However, 43% of IRB patients used pads for small amounts of incontinence (spotting) and worried about flatus.Conclusion : These findings show that many functional and symptomatic health‐related QOL sores are better after IRB and support the use of this procedure of urinary diversion for selected patients.
Potential benefits of combining cytosine deaminase/5‐fluorocytosine gene therapy and irradiation for prostate cancer: Experimental study
Authors: KATO HIROAKI , KOSHIDA KIYOSHI , YOKOYAMA KUNIHIKO , MIZOKAMI ATSUSHI , NAMIKI MIKIO 
Published: March 2003

AbstractBackground:  The purpose of this study was to investigate the potential of combining cytosine deaminase/5‐fluorocytosine (CD/5‐FC) gene therapy and radiation therapy (either external beam radiation or radioimmunotherapy [RIT]), for the treatment of prostate cancer.Methods: Tumor xenografts of CD‐transduced LNCaP cells grown in the testes of severe combined immunodeficiency (SCID) mice were used to evaluate antitumor effect. The mice were injected intraperitoneally with 500 mg/kg of 5‐FC, or with 5, 15 or 30 mg/kg of 5‐fluorouracil (5‐FU), for 9 days. The tumors were treated with fractionated radiation at a dose of 1 or 3 Gy/day for 3 days, or I‐131 labelled anti‐prostate specific antigen (anti‐PSA) monoclonal antibody (mAb) administration at a subtherapeutic dose of 20 or 80 µCi. Intratumoral and serum concentrations of 5‐FU were measured using high performance liquid chromatography.Results: Mice treated with CD/5‐FC gene therapy presented a significant tumor growth inhibition comparable to that obtained with 15 mg/kg, 5‐FU systemic administration without marked weight loss. Treatment with CD/5‐FC gene therapy resulted in higher tumor but lower serum concentrations of 5‐FU than treatment with systemic 5‐FU chemotherapy. An additive antitumor effect was obtained when CD/5‐FC therapy was combined with 1 Gy irradiation, which by itself did not produce a significant antitumor effect. However, the efficacy of CD/5‐FC therapy was not enhanced when combined with RIT, probably due to poor accumulation of the mAb as the tumor/blood ratio never exceeded 1.Conclusion: These findings indicate that CD/5‐FC gene therapy for prostate cancer may function with enhanced antitumor effect when combined with external beam radiation. However, combining CD/5‐FC gene therapy and RIT using an anti‐PSA mAb may not be effective because of insufficient accumulation of the mAb at the target tumors.
Feasibility and usefulness of laparoscopic radical prostatectomy: Kobe University experience
Authors: Hara Isao , Kawabata Gaku , Miyake Hideaki , Hara Shoji , Fujisawa Masato , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao 
Published: March 2003

Abstract
Objectives: The objective of this study was to present the clinical outcomes of 26 patients who underwent laparoscopic radical prostatectomy at our institution.
Methods: We performed laparoscopic prostatectomy on patients who were clinical stage T1 or T2. The mean age was 70 years old (range: 52–76). The mean level of pre‐treatment prostate‐specific antigen (PSA) was 8.7 ng/mL (range: 3.3–45). The Gleason score of the needle biopsy was < 7 in 21 patients and ≥ 7 in five patients. Clinical stage was T1c in 17 patients, T2a in 6 patients and T2b in 3 patients. Operative techniques followed those of the French groups. Five trocars were introduced into the peritoneal cavity. The vas deferens and seminal vesicles were dissected to reach the posterior wall of the prostate and the retroperitoneal space was dissected around the urinary bladder. Incision of endopelvic fascia and dorsal vein complex (DVC) ligation were performed. The bladder neck and prostate were divided, then the distal urethra was cut. The lateral pedicles of the prostate were cut and the entire prostate was removed. Vesico‐urethral anastomosis was performed at eight points.
Results: Mean operation time was 7 h 30 min. Mean bleeding volume (including urine volume) was 850 mL (range: 32–3135). All patients underwent autologous blood transfusion. Only one patient required further blood transfusion. Gleason scores of resected specimens were < 7 in 10 patients, and ≥ 7 in 16 patients. Pathological stage was T0 in 1 patient, T2a in 6 patients, T2b in 13 patients, T3a in 5 patients and T3b in 1 patient. The PSA value was undetectable in all patients one month after surgery. Ten patients who survived for 6 months after surgery had complete urinary continence without a pad. In 7 of the 12 patients who were potent before surgery, neurovascular bundles were preserved, and 5 of them (71%) achieved complete or incomplete erection 3 months after surgery. However, only one patient (14%) could have sexual intercourse.
Conclusion: Although longer follow‐up is necessary to evaluate this surgical technique, laparoscopic prostatectomy seems to be a reasonable option in the treatment of organ‐confined prostate cancer.
Advanced renal cell carcinoma in which a combination of IFN‐α and meloxicam was thought to be effective
Authors: YOSHINO SHUJI , OKABE TADASHI 
Published: March 2003

AbstractAn 83‐year‐old man with left renal cell carcinoma (RCC; pT4N0M0) was treated with postoperative combined subcutaneous injection therapy of alpha interferon (IFN‐α) and IFN gamma‐1a (IFN‐γ‐1a). Metastasis to the pleura occurred 3 months after surgery. The metastatic lesion grew while the treatment was changed to intramuscular injection of IFN‐α‐2b due to the presence of severe general malaise, which seemed to be caused by IFN‐α and IFN‐γ therapy. As melosalgia associated with sciatica was also severe, treatment with meloxicam, which is known as a potent cyclooxigenase‐2 inhibitor among commercially available non‐steroidal anti‐inflammatory drugs, was combined, resulting in significant improvement in activity of daily life, 43.2% decrease in the size of the pleural metastasis and complete regression of retroperitoneal residual tumor.
Cyclooxygenase inhibitors: any reservations?
Authors: Penglis P. S. , James M. J. , Cleland L. G. 
Published: March 2003

AbstractThe discovery of two cyclooxygenase isozymes, constitutive COX‐1 and inducible COX‐2, has resulted in the rapid development of selective inhibitors of COX‐2, such as celecoxib and rofecoxib. Compared with traditional non‐steroidal anti‐inflammatory drug agents, use of COX‐2 selective inhibitors is associated with decreased incidence of adverse gastric events as a result of minimal inhibition of gastroprotective COX‐1, but with equivalent anti‐inflammatory benefit through inhibition of COX‐2. However, there is evidence to suggest that the ‘COX‐1 = constitutive, COX‐2 = inflammatory’ paradigm is less distinct than originally proposed. Futhermore, selective COX‐2 inhibitors may have other consequences as a result of the change in the eicosanoid profile. Thus, despite the relatively safe gastrointestinal profile, vigilant post‐marketing surveillance for other adverse effects is required. (Intern Med J 2001; 31: 37–41.
Checking the scoreboard: the impact of cancer genetics on clinical practice
Authors: Ward R. L. , Hawkins N. J. 
Published: March 2003

AbstractImprovements in cancer care have historically been predicated on significant scientific and technological advances, such as antisepsis in surgery, and the discovery of the therapeutic benefits of radiation and chemotherapeutic drugs. The past 30 years have seen an exponential increase in our knowledge of the biology and genetics of cancer, built on a massive and sustained research effort worldwide. Yet over the same period, significant changes in cancer outcomes have occurred largely as a result of public health measures and through incremental advances in existing technologies. The present paper examines the extent to which the new knowledge of cancer genetics has impacted on current patient care. It considers some of the issues that may have served to lessen this impact, as well as some of the reasons for this apparent imbalance between action and outcome. (Intern Med J 2001; 31: 249–253)
The oratory of addiction: a 30‐year perspective on alcohol and drug misuse
Authors: Mackay I. R. 
Published: March 2003

AbstractThe annual Leonard Ball Orations illustrate changing perspectives in Australia over 30 years on medical and social effects of misuse of alcohol and other substances. The first oration, in 1968, examined causal factors in the context of ‘agent’, ‘purveyor’ and ‘host’ and provided themes for subsequent orators. In regard to the agent (alcohol), it was proposed that availability (and cost) determined not only overall consumption within the community, but also numbers of users at hazardous levels. This principle seemed applicable to substance misuse and addictive behaviours overall. The influence of purveyors (and advertisers) was discussed with expectedly different perspectives from the liquor industry and social and health‐care providers. The role of host was examined in terms of genetic predisposition, foreshadowing current experimental applications of gene transfer and disruption technologies in mice to substance misuse and the promise of the Human Genome Project in clarifying inheritance of substance misuse. Individual successes in harm reduction were described in the context of alcohol and road trauma, smoking prevention and heroin addiction. Government intervention was introduced with the 1987 National Campaign Against Drug Abuse. The focus shifted during the 1980s from alcohol to addictive drugs, in line with community concerns. The 1996 oration on the aborted Canberra trial of supervised heroin administration illustrated the need for, and problems associated with, such studies. The prescience and achievements of the Ball orators provide optimism and direction for efforts in the future. (Intern Med J 2001; 31: 357–363)
Anaesthetic management of a patient with erythropoietic protoporphyria for ventricular septal defect closure
Authors: Asokumar Buvanendran , Kierney Catherine , James Timothy W. , Amato Joseph , Tumanmd Kenneth J. 
Published: March 2003

SummaryErythropoietic protoporphyria (EPP) is due to a deficiency in ferrochelatase required for haem synthesis. We describe the anaesthetic management of a seven‐year‐old with EPP undergoing closure of a haemodynamically significant ventricular septal defect. Photosensitivity in EPP patients is triggered at wavelengths near 400 nm and light‐excited porphyrins generate free radicals and singlet oxygen that lead to erythrocyte deformity and haemolysis. Stimuli that could trigger a porphyric crisis during anaesthesia and surgery were reduced by avoiding exposure to the sensitive 400 nm spectrum and using light sources covered with yellow acrylate filters in the operating room. Anaesthetic agents not previously associated with porphyric crisis were chosen. Whole blood priming of the extracorporeal circuit was performed to ensure adequate haemoglobin concentrations during the perioperative period.
Spinal anaesthesia and meningitis in former preterm infants: cause–effect?
Authors: Luz G , Büchele H , Innerhofer P , Maurer H 
Published: March 2003

SummaryMeningitis associated with spinal anaesthesia is a rare but well‐known complication. We report on a case of fatal bacterial meningitis following spinal anaesthesia in a former preterm infant. The aetiology of this meningitis could not be established. Former preterm infants represent a high‐risk population because of their susceptibility to group B streptococcal meningitis at this age as documented in a second case. Therefore we discuss whether meningitis was consequential or coincidental with spinal anaesthesia and could have been prevented by more comprehensive preoperative laboratory screening or prophylactic antibiotics.
Guillain–Barré Syndrome: delayed diagnosis following anaesthesia
Authors: Jones Gareth D. , Wilmshurst Jo M. , Sykes Kim , Murdoch Ian A. 
Published: March 2003

SummaryGuillain–Barré syndrome following anaesthesia or surgery is rare. Diagnosis is often delayed, which may lead to an increase in morbidity. There is now good evidence that early diagnosis and treatment reduces this morbidity. The two cases highlight the difficulties with diagnosis in the perioperative period and further discuss the aetiology, diagnostic features and complications of childhood Guillain–Barré syndrome.
Propofol‐nitrous oxideversussevoflurane‐nitrous oxide for strabismus surgery in children
Authors: Gürkan Yavuz , Kiliçkan Levent , Toker Kamíl 
Published: March 2003

SummaryVomiting is a common problem following strabismus surgery. We compared the effects of propofol‐N2O and sevoflurane‐N2O on the incidence of oculocardiac reflex and postoperative nausea and vomiting. Forty unpremedicated children, aged 3–15 years were randomly assigned to two groups of 20 patients. In group 1, anaesthesia was induced and maintained with propofol infusion(173 ± 41 μg·kg−1·min−1). In group 2, anaesthesia was induced with N2O (66%) in O2and incremental sevoflurane via face mask and maintained with sevoflurane. Both groups received 66% N2O in O2throughout surgery. The overall incidence of vomiting and antiemetic requirement in the first 24 h was significantly higher in sevoflurane‐N2O group than propofol‐N2O group (P< 0.05). The propofol‐N2O group had significantly more episodes of oculocardiac reflex than sevoflurane‐N2O group (P< 0.05). Propofol‐N2O anaesthesia results in a significantly lower incidence of postoperative vomiting, yet a significantly higher incidence of oculocardiac reflex.
Anaesthetic implications of thoracoscopic surgery in children
Authors: TOBIAS JOSEPH D. 
Published: March 2003

SummaryAs the equipment and technique have improved, minimally invasive surgery is being applied to younger and younger children. With the advent of this valuable surgical technique, there are also specific modifications necessary in the anaesthetic technique. When considering the anaesthetic implications of these patients, one must account for both the patient's underlying status as well as physiological derangements induced by the surgical procedure. The following article attempts to address and review the specific anaesthetic implications of thoracoscopic procedures in neonates, infants, and children including the preoperative evaluation, intraoperative care and monitoring, and postoperative issues including analgesia. The techniques of one‐lung anaesthesia, commonly required for thoracoscopy, are reviewed as well as consideration of the adverse effects which can occur during thoracoscopy including inadvertent intravascular CO2 embolism.
Preoperative hypoglycaemia, propranolol and the Jervell and Lange‐Nielsen syndrome
Authors: BAINES DAVID B. , MURRELL DAVID 
Published: March 2003

SummaryThe Jervell and Lange‐Nielsen syndrome is an autosomal recessive trait characterized by deafness and electrocardiographic changes. These changes include prolongation of the QT interval and T‐wave inversion. Treatment may include the use of β‐blockers to prevent the development of malignant ventricular arrhythmias and sudden death. We report a patient with this syndrome, who was receiving propranolol orally and who became hypoglycaemic during the preoperative fasting period prior to cochlear implantation.
The efficacy of pre‐ versus postsurgical axillary block on postoperative pain in paediatric patients
Authors: Altintas Fatiş , Bozkurt Pervin , İpek Neval , Yücel Akin , Kaya Güner 
Published: March 2003

SummaryWe compared the effects of pre‐ and postsurgical axillary block on pain after hand and forearm surgery in 55 children in a double‐blind randomized study. The successful blocks are reported here (n=49). Children aged 1–11 years and ASA I or II were allocated randomly to receive axillary block with 2 mg.kg−1 of 0.25% bupivacaine, either after induction but before the surgery (presurgical group, n=25) or immediately after surgery, before the end of anaesthesia (postsurgical, n=24). In all patients, a standard general anaesthesia technique was used. The Faces Pain Scale (FPS) and analgesic requirements were recorded for 24 h at various times after operation. Eight patients (32%) in the presurgical group and 20 patients (83.33%) in the postsurgical group did not require additional analgesic within the first 24 h after operation (P< 0.05). In patients who had pain during the observation period, the pain started 13.66±2.61 h in the presurgical group and 13.14±2.34 h in the postsurgical group after performing block (P> 0.05). The FPS scores were similar in both groups during the first 8 h in the postoperative period (P> 0.05). There was a significant difference at 10 h after surgery (P< 0.05). Cumulative FPS score was higher in the presurgical group (10.50±1.06) than in the postsurgical group (9.45±1.28) (P< 0.05), but both groups had effective analgesia overall, the mean FPS score being less than 2. Additional analgesic consumption was similar in these patients in both groups. A lower isoflurane concentration was used in the presurgical group (0.68%vs 1.72%, P< 0.001). We did not demonstrate the superiority of preemptive analgesia, but our results indicate that presurgical axillary block with 0.25% bupivacaine allows the use of inhalational anaesthetics at lower concentrations while providing a reasonably painless postoperative period.
Propofol as a sole agent for paediatric day care diagnostic ophthalmic procedures: comparison with halothane anaesthesia
Authors: Madan Rashmi , Kapoor Indu , Balachander S. , Kathirvel S. , Kaul H. L. 
Published: March 2003

Background: Our aim was to study the feasibility of total intravenous anaesthesia with propofol in spontaneously breathing children undergoing ophthalmic procedures.Methods: Fifty‐five children (aged 6 months to 5 years) were randomly allocated to receive either propofol bolus (until loss of eyelash reflex) followed by infusion [group P (n=29)] or halothane 3–4% for induction, followed by 1–2% in 70% nitrous oxide and oxygen via face mask [group H (n=28)]. Dose for induction and maintenance, intraoperative adverse events, time to recovery (on an Observer’s Assessment of Alertness/Sedation Scale, 5 at each level) and duration of procedure were recorded. All children in both groups, were anaesthetized successfully.Results: 4.0 ± 0.7 mg·kg–1and 5.1 ± 1.0 mg·kg–1of propofol were required for loss of eyelash reflex and tolerance of the ophthalmic speculum, respectively. An infusion rate of 8.3 ± 1.7 mg·kg–1·h–1was needed for maintenance of anaesthesia; 3.4 ± 0.5%, 3.6 ± 0.4% and 1.4 ± 0.4% halothane was needed for induction, tolerance of the eye speculum and maintenance of anaesthesia, respectively. Induction and recovery were significantly faster with halothane compared with propofol [induction – 38.3 ± 6.6 s (group H)/60.9 ± 15.2 s (group P) (P < 0.001); recovery 12.8 ± 4.6 min (group H)/27.0 ± 23.3 min (group P) (P < 0.001)]. Apnoea, coughing and breath‐holding were seen only in group H. Group P had significantly higher incidence of involuntary movements (minor degree) (n=6) (P < 0.01).Conclusions: Propofol is a feasible option for paediatric diagnostic ophthalmic procedures with the advantage over halothane of providing complete access to the eye.
Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine
Authors: Sharpe P. , Klein J.R. , Thompson J.P. , Rushman S.C. , Sherwin J. , Wandless J.G. , Fell D. 
Published: March 2003

Background: Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain. Methods: We compared the effect of clonidine, 1 and 2 μg·kg–1, added to bupivacaine (1.25 mg·kg–1) with that of bupivacaine alone in 75 male children undergoing elective circumcision. Results: There was a trend towards increasing duration of analgesia with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min, C1 (bupivacaine + clonidine 1 μg·kg–1) 327.8 (188.3) min and C2 (bupivacaine + clonidine 2 μg·kg–1) 382.0 (200.6) min], although this difference was not statistically significant. Mean time to arousal from anaesthesia was significantly prolonged with clonidine 2 μg kg–1 (group C2 21.3 (13–36) min, group C1 14.0 (6–25) min and group B 14.4 (2–32) min. Supplementary analgesic requirements and incidence of adverse effects were low, with no differences between the groups. Conclusions: For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 μg·kg–1 to low volume (0.5 ml·kg–1) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.
The analgesic efficacy of preoperative high dose (40 mg·kg–1) oral acetaminophen after bilateral myringotomy and tube insertion in children
Authors: BOLTON PHILLIP , BRIDGE HILARY S , MONTGOMERY CAROLYNE J , MERRICK PAMELA M 
Published: March 2003

Background: The purpose of this study was to measure the plasma levels and analgesic effectiveness of a dose of 40 mg·kg–1 of preoperative oral acetaminophen. Methods: Thirty children aged 55 (17–72) months undergoing bilateral myringotomy and tube insertion (BMT) received acetaminophen 40 mg·kg–1 p.o. preoperatively. Plasma levels were measured, at 29 (10–51) min and at 60 min in the postanaesthesia care unit (PACU). Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), for all subjects and the Poker Chip Tool (PCT) a self‐report scale for subjects aged > 4 years, were used. After discharge, 24‐h analgesic efficacy was evaluated using an observer Visual Analogue Scale (VAS) score and further acetaminophen use was recorded. Results: Plasma concentrations were 259 (60–391) μmol·l–1 and 250 (135–450) μmol·l–1, respectively. All 60 min plasma concentrations were ≥ 70 μmol·l–1 (ED50 for adenotonsillectomy) and less than 800 μmol·l–1 (associated with toxicity). Twenty‐six subjects (87%) had adequate analgesia (CHEOPS ≤ 8). The PCT was only understood in the PACU by 13 of the 21 children > 4 years (62%). The median worst 24‐h observer VAS was 0.5 (0–5.5) (27 subjects). No further analgesic was required after discharge in 16/28 (57%). A higher plasma level was associated with fewer doses of acetaminophen after discharge (r=–0.36, P=0.05). Conclusions: No relationship was evident between age, the 60 min plasma acetaminophen level and the CHEOPS carried out at the same time. Acetaminophen 40 mg·kg–1 p.o. results in 60 min plasma levels of 250 (135–450) μmol·l–1. The in‐hospital analgesic efficacy was 87% (CHEOPS < 9, no further analgesics) and the 24‐h efficacy was 57% (need for further acetaminophen).