bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula
Authors: Vas Lakshmi , Naregal Falguni , Nobre Subita , Dongre Hanspal 
Published: March 2003

SummaryThe anaesthetic management of a left pneumonectomy in a 18‐month‐old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. Pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.
Early tracheal extubation after paediatric cardiac surgery: the use of propofol to supplement low‐dose opioid anaesthesia
Authors: Cray Steven H. , Holtby Helen M. , Kartha Vyas M. , Cox Peter N. , Roy W. Lawrence 
Published: March 2003

Background: After institutional approval and parental consent, 103 children, aged 6 months to 18 years, who were undergoing repair of simple and complex congenital heart lesions using cardiopulmonary bypass (CPB) were studied and compared with a group of 135 children who had undergone similar surgery in our institution in the year before. Methods: Anaesthesia for study patients included fentanyl (< 20 μg·kg−1) and isoflurane. Infusions of propofol (median infusion rate 70 μg·kg−1·min−1) and morphine (median infusion rate 20 μg·kg−1·h−1) were started after weaning from CPB and continued postoperatively. Preestablished criteria were used in the intensive care unit (ICU) to assess readiness for tracheal extubation. Results: Median time from admission to ICU to tracheal extubation was 5 h. Fifty‐six children were extubated within 6 h and 73 within 9 h of ICU admission. Mean ICU stay for study patients was 1.7 days [95% confidence interval (CI) 1.2–2.2] and 2.6 days (95% CI 2.3–2.9) in the comparison group (P<0.005). Conclusions: We found the propofol regimen to be satisfactory with a shorted ICU stay for these patients.
Bispectral index monitoring in children undergoing mild hypothermic cardiopulmonary bypass
Authors: Laussen Peter C. , Murphy Julia A. , Zurakowski David , Sullivan Lorna J. , Mcgowan JR Francis X. , Demaso David Ray 
Published: March 2003

Background: In this prospective, cohort study of 15 children (median age 7.7 years, range 4.9–16.5 years) undergoing atrial septal defect repair, we evaluated changes in the Bispectral index (BIS) as a potential monitor of level of consciousness during cardiac anaesthesia. Methods: Identical cardiac surgery, cardiopulmonary bypass (CPB) and anaesthetic techniques were used, including mild hypothermia and an early extubation protocol. BIS, mean arterial pressure, heart rate and tympanic temperature were recorded at baseline postinduction (Tbaseline), skin incision (Tincis), sternotomy (Tsternot), aortic cannulation (Tcann), nadir temperature (Tnadir), rewarmed (Trewarmed), immediate post‐CPB (TpostCPB), chest drain insertion (Tdrains), sternal wires (Twire), skin closure (Tclosed) and spontaneous movement (Tmove). As a measure of stress response, serum lactate, glucose, norepinephrine and epinephrine levels were measured at Tbaseline, Tsternot, Tcann, Tnadir, Trewarmed and Tdrains. Explicit memory testing was undertaken prior to hospital discharge. Results: BIS increased significantly during the rewarming phase (Trewarmed versus Tbaseline and Tnadir, P<0.001). Lactate, epinephrine and glucose levels were also significantly elevated at Trewarmed. There were no correlations between BIS and the increase in epinephrine, lactate and glucose during rewarming, nor with changes in heart rate or mean arterial pressure during surgery. All patients had an uneventful recovery without evidence for explicit recall. Conclusions: The increase in BIS during the rewarming phase could reflect an increase in conscious level, and is consistent with the reported risk for awareness during this phase of cardiac surgery.
How to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S‐ketamine versus clonidine
Authors: De Negri Pasquale , Ivani Giorgio , Visconti Ciro , De Vivo Paolo 
Published: March 2003

Background: The aim of the study was to determine whether caudal S‐ketamine or clonidine prolonged analgesia together with ropivacaine. Methods: Sixty‐three boys, aged 1–5 years, who were undergoing minor surgery, were allocated in order to receive one of three solutions for caudal anaesthesia. Group R received 2 mg·kg–1 0.2% ropivacaine; group C, 2 mg·kg–1 0.2% ropivacaine + clonidine 2 μg·kg–1; and group K, 2 mg·kg–1 0.2% ropivacaine + S‐ketamine 0.5 mg·kg–1. Results: Postoperative analgesia assessed by CHEOPS lasted 701 min in group K (P < 0.05) compared with 492 min in group C and 291 min in group R. There were no significant differences between the groups for incidence of haemodynamic and respiratory alterations, motor block or sedation. Conclusions: This study demonstrates that S‐ketamine 0.5 mg·kg–1 when added to 0.2% caudal ropivacaine provides better postoperative analgesia than clonidine without any clinically significant side‐effect.
Difficult tracheal intubation induced by maxillary distraction devices in craniosynostosis syndromes
Authors: Roche John , Frawley Geoff , Heggie Andrew 
Published: March 2003

Background: Difficult intubation occurred during anaesthesia for removal of maxillary distraction devices in five of seven children with syndromal craniosynostoses (four with Apert, two with Pfeiffer and one with Crouzon syndrome).Methods: Intubation was assessed in terms of laryngeal view and an established intubation difficulty score and had been straightforward before device insertion. Difficulty was induced by trismus due to device insertion and by increased maxillary prominence. This was compounded by preexisting mandibular hypoplasia. Cephalometric analysis, with each child acting as their own control, demonstrated anterior displacement of the maxilla and increased maxillary vertical height, as well as increased protuberance of the maxillary incisors.Results: All five difficult tracheal intubations were associated with preoperative Mallampati scores of 3 or 4 and the nine straightforward intubations with scores of 1 or 2. Maximal interincisor distance was less than the lower 95% confidence limit for age in all five children who were difficult to intubate at the time of device removal. No child had a failed intubation, but all had significantly increased intubation difficulty.Conclusions: In view of the risks of trauma, hypoxia and aspiration associated with difficult direct laryngoscopy, we recommend elective fibreoptic intubation at anaesthesia for removal of maxillary distraction osteogenesis devices in these children.
Spinal versus peripheral effects of adjunct clonidine: comparison of the analgesic effect of a ropivacaine–clonidine mixture when administered as a caudal or ilioinguinal–iliohypogastric nerve blockade for inguinal surgery in children
Authors: Ivani G. , Conio A. , De Negri P. , Eksborg S. , Lönnqvist P.A. 
Published: March 2003

Summary Background: The adjunctive use of clonidine to local anaesthetics has been reported to enhance analgesia both after spinal and peripheral administration. However, no attempt has been made to compare spinal and peripheral application of clonidine in the same surgical context in order to further explore the mechanism for the analgesic action of clonidine when administered together with local anaesthetics. Methods: Using a prospective, randomized, observer‐blinded study design, 40 patients, aged 1–7 years, who were undergoing elective surgery for inguinal hernia repair or orchidopexy, were randomly allocated to receive either a caudal block (group C: n = 20; ropivacaine 0.2%, 1 ml·kg−1 + clonidine 2 µg·kg−1) or an ilioinguinal–iliohypogastric nerve block (group I: n = 20; ropivacaine 0.2%, 0.4 ml·kg−1 + clonidine 2 µg·kg−1) following the induction of a standardized sevoflurane based anaesthetic. Postoperative analgesia [maximum Objective Pain Scale (OPS) score and requirement for supplemental analgesia] and sedation (three‐point scale) were assessed at predetermined intervals during the first 24 h postoperatively. Results: Fourteen children in group I and nine children in group C did not require rescue analgesia (P = 0.17). No difference in maximum OPS scores could be detected between the two study groups. The mean time to full recovery regarding sedation was 149 min and 153 min in groups C and I, respectively. Conclusions: This pilot study demonstrates a trend for better postoperative analgesia following peripheral administration of clonidine compared with central application. However, the main mechanism for the adjunct analgesic effect of clonidine when administered together with local anaesthetics requires further study.
Infusion technology: a cause for alarm
Authors: Hee Hwan‐Ing , Lim Suan‐Ling , Tan Shani Sian‐Wei 
Published: March 2003

Summary Background: Volumetric infusion pumps are widely used in paediatric practice. Tissue extravasation is a hazard. The occlusion pressure limit alarm, although not intended to detect extravasation, is the only warning sign present to indicate flow faults in the infusion systems. Methods: Extravasations were created in the subcutaneous plane of 20 limbs of five piglets with normal saline via an infusion pump. Five flow rates were used with each piglet allocated to one: 100 ml·h−1, 200 ml·h−1, 300 ml·h−1, 400 ml·h−1, 500 ml·h−1. The occlusion pressure limit was first set at low and adjusted to medium, then to high, upon alarm activation. Line pressure at 5‐min intervals and upon alarm activation and volume of infusate given were measured. Limb diameters before and after infusion were measured. Results: Six out of 20 cases failed to activate any alarm. The low, medium and high occlusion pressure limit alarms were activated in 14, 1 and 0 instances, respectively. The incidence of alarm activation is higher in the forelimb compared with the hindlimb (P=0.001). The tissue compliance and volume infused at alarm activation are significantly lower in the former (P < 0.05). Line pressure increases with increase in flow rates for the same limb (P=0.013 Fore, P=0.005 Hind). Conclusions: Occlusion pressure limit alarm cannot reliably detect extravasation especially at sites with high compliance, low flow rates, even at low occlusion limit. Line pressure depends on interplay of site (compliance) and flow rate and is independent of volume extravasated. Users must be aware of the set occlusion pressure limit. Repeated clinical assessment remains vital.
Sedation and neuromuscular blockade in paediatric intensive care: a review of current practice in the UK
Authors: Playfor Stephen D. , Thomas David A. , Choonara Imti 
Published: March 2003

Summary Background: Our aim was to investigate the current practice of sedation and neuromuscular blockade in critically ill children in paediatric intensive care units (PICUs) in the UK. Methods: A postal questionnaire was sent to all PICUs in the UK. Results: The most commonly used sedative agents were midazolam in combination with morphine. Written clinical guidelines for the sedation of critically ill children were available in 45% of units. Sedation is formally assessed in 40% of units. Vecuronium is the most commonly used neuromuscular blocking agent. In the UK, 31% of critically ill children are likely to receive neuromuscular blocking agents. Depth of neuromuscular blockade is routinely assessed in 16% of patients. Conclusions: Relatively few units possess clinical guidelines for the sedation of critically ill children, and only a minority formally assess sedation levels. Where neuromuscular blocking agents are administered, sedation is frequently inadequately assessed and the depth of neuromuscular blockade is rarely estimated.
Results of ophthalmologic screening examinations of German Pinschers in Finland – a retrospective study
Authors: Leppänen Minna , Mårtenson Jerker , Mäki Katariina 
Published: March 2003

AbstractObjective To retrospectively review ophthalmologic findings in German Pinschers in Finland.Animals studied One hundred and twenty‐two German Pinschers that had ophthalmologic examination performed according to the Finnish Kennel Club’s Eye Scheme before June 15, 1999.Procedures A total of 154 eye examination reports of 122 dogs were analysed and all described findings were reported.Results Persistent hyperplastic tunica vasculosa lentis (PHTVL) was diagnosed in 8.4% of all cases, and hereditary cataract (HC) in 6.5%. Even higher numbers of similar changes were reported by ophthalmologists; some of the dogs, however, were officially diagnosed as ‘free of symptoms’ of inherited ocular diseases. A relatively high number (4.5%) of dogs had reported changes in Y sutures. A pedigree analysis suggests recessive inheritance for both diseases. Because of missing information about many dogs in the pedigree, an autosomal incomplete inheritance pattern cannot be ruled out in either case.Conclusions Both HC and PHTVL are inherited diseases in German Pinschers. Further studies are needed to determine the importance of the changes found in Y sutures. Discrepancies between the official diagnosis and described changes are probably partially due to the lack of familiarity with the published literature concerning this breed. Further studies are needed to ascertain the inheritance pattern for both diseases. So far breeding with affected animals should be avoided.
Fluorouracil as a treatment for corneal papilloma in a Malayan tapir
Authors: Karpinski Lorraine G. , Miller Christine L. 
Published: March 2003

AbstractA 26‐year‐old, wild caught, male Malayan tapir at the Miami Metrozoo with bilateral corneal papillomas was serially immobilized and given subconjunctival injections of fluorouracil. Over the course of 17 weeks five bilateral injections of 25 mg fluorouracil were given. This treatment caused regression of the corneal lesions as evidenced by decreased lesion diameter, decreased corneal vascularity, increased corneal clarity, and improved visual function. No adverse drug effects were observed.
Correction of eyelid coloboma in four cats using subdermal collagen and a modified Stades technique
Authors: Wolfer J. C. 
Published: March 2003

AbstractFour feline cases of bilateral eyelid coloboma were treated with injectable subdermal collagen and a modified Stades technique. This new technique was found to be easy to perform and the long‐term results appear to be similar to other published reports.
The changing epidemiology of HIV infection in injecting drug users in Dublin, Ireland
Authors: Clarke S , Keenan E , Bergin C , Lyons F , Hopkins S , Mulcahy F 
Published: March 2003

Introduction Injecting drug users (IDUs) represent 41.6% of the total cohort of HIV‐infected patients in Ireland. Between January 1999 and December 2000, referrals to the largest tertiary centre for HIV infection in Dublin have increased dramatically. This has occurred on a background of a reduction in the overall incidence of HIV infection in Ireland between 1990 and 1998. Here we describe the changing epidemiology of HIV disease in IDUs and explore potential aetiological factors.Methods This is a retrospective study, collecting all data relating to new HIV diagnoses occurring in IDUs, referred to the GenitoUrinary Medicine and Infectious Diseases (GUIDE) clinic between 1987 and 2000. We calculated 6‐month incidence rates of new HIV diagnoses in IDUs referred to the GUIDE clinic and performed a more detailed analysis of those patients diagnosed between January 1999 and December 2000, documenting age, sex, time and place of diagnosis, drug use history and primary drug of misuse, needle sharing history, attendance at a drug treatment clinic, prior HIV testing history, hepatitis B and hepatitis C status, and CD4 cell counts and HIV RNA levels at diagnosis.Results The number of new HIV diagnoses in IDUs increased fivefold between 1995 and 2000. Moreover, 40% of patients diagnosed since then have been under 22 years old. There has also been a significant reversal of the initial male to female ratio seen in the initial epidemic of the 1980s.Conclusion There has been a significant increase in the incidence of HIV infection in IDUs between 1995 and 2000. Similar trends have been described recently in other risk groups. The aetiology of these trends is multifactorial, and a multidisciplinary, rejuvenated approach is required to focus on improving health education to reduce both sexual and needle sharing practices.
Long‐term efficacy and safety of ritonavir/indinavir at 400/400 mg twice a day in combination with two nucleoside reverse transcriptase inhibitors as first line antiretroviral therapy
Authors: Lichterfeld M , Nischalke HD , Bergmann F , Wiesel W , Rieke A , Theisen A , Fätkenheuer G , Oette M , Carls H , Fenske S , Nadler M , Knechten H , Wasmuth J‐C , Rockstroh JK 
Published: March 2003

Objective To determine the long‐term antiretroviral efficacy and tolerability of dual protease inhibitor (PI) therapy with indinavir (IDV)/ritonavir (RTV) at 400/400 mg twice a day (BID) in combination with two nucleoside reverse trancriptase inhibitors (NRTIs).Design and methods In an open‐label, uncontrolled multicentre clinical trial, antiretroviral therapy naive patients (n = 93) with a high median baseline HIV‐1 RNA level of 210 000 copies/mL (range 17 000–2 943 000) and a median CD4 cell count of 195 copies/µL (range 4–656 copies/µL) were started on a regimen of either zidovudine (ZDV)/lamivudine (3TC) (49%), stavudine (d4T)/3TC (38%) or d4T/didanosine (ddI) (14%) plus RTV and IDV, each at 400 mg BID. CD4 cell counts and HIV RNA were determined at 4‐week intervals for a duration of 72 weeks. Statistical analysis was performed on treatment as well as by intent to treat, where missing values were counted as failures.Results HIV RNA levels below the limit of detection were achieved in 59.5% (< 80 copies/mL) and 63% (< 500 copies/mL) of patients according to the intent to treat analysis at week 72. In the on treatment analysis, the proportion of patients reaching an undetectable viral load was 94.5% (< 80 copies/mL) and 100% (< 500 copies/mL), respectively. Apart from diarrhoea and nausea, serum lipid abnormalities were identified as the most prominent adverse reaction. No cases of nephrotoxicity occurred during the entire observation period of 72 weeks.Conclusions Our results demonstrate that quadruple therapy with RTV/IDV and two NRTIs induces potent, durable and safe HIV suppression and might be particularly beneficial as a first line therapy for patients with a high baseline viral load.
Thymic activity in late‐stage HIV‐1 infected individuals receiving highly active antiretroviral therapy: potential effect of steroid therapy
Authors: Pido‐Lopez J , Pires A , Nelson M , O'Moore E , Fisher M , Gazzard B , Aspinall R , Gotch F , Imami N 
Published: March 2003

Objective Our objective was to monitor the effect of steroid therapy on the thymic output and function of late‐stage HIV‐1‐infected patients undergoing highly active antiretroviral therapy (HAART).Design The indirect measurement of T cells that have recently emigrated from the thymus as a means of quantifying thymic output, and therefore thymic function, was achieved through use of the polymerase chain reaction‐based signal joint T cell receptor rearrangement excision circles (sjTREC) assay. Proliferative capacity and interleukin (IL)‐2 and IL‐4 production by T cells after antigenic, mitogenic and IL‐2 stimulation were also analysed.Method Measurements were made of sjTREC levels in peripheral blood mononuclear cell DNA samples from five HIV‐1 infected patients (one on steroid therapy prior to and at the time of sample extraction) receiving HAART. IL‐2 and IL‐4 production and proliferative capacity were also measured in three patients, including the patient receiving steroids.Result The sjTREC assay gave an extremely weak result for the patient on steroids but, under the same assay conditions, provided clear, positive readings for the four patients not on steroids. Comparison of the patients' cytokine profiles revealed that IL‐2 production was generally low or absent in all three patients tested but that IL‐4 production was significantly higher in the patient given steroids. Functional potential as revealed by proliferation assays showed very low or absent cellular proliferation.Conclusion The thymic contribution to the restoration of T lymphocyte numbers, particularly during the treatment of HIV‐1 infection, may become compromised if thymic inhibitory factors such as steroids are used. Furthermore, the use of steroids may also favour the development of a T helper 2 response, which could prove particularly undesirable during HIV‐1 infection.
Resistance to fungal pathogens triggered by the Cf9‐Avr9 response in tomato and oilseed rape in the absence of hypersensitive cell death
Authors: Hennin Caroline , Diederichsen Elke , Höfte Monica 
Published: March 2003

summaryIn tomato and related species, the Cf9 resistance gene induces hypersensitive cell death and activates downstream defence pathways upon recognition of the Avr9 elicitor. We investigated whether the Cf9‐Avr9 response without hypersensitive cell death symptoms increases resistance to several fungi. A low Avr9 dose that does not cause hypersensitive cell death was injected in Cf9 tomato and transgenic Cf9 oilseed rape plants. Subsequently, the injected leaves were infected with different fungal pathogens. The disease development of Botrytis cinerea was delayed in Cf9 tomato when the pathogen was inoculated on, or around, the Avr9 injection site. Disease development of Leptosphaeria maculans and Sclerotinia sclerotiorum was delayed on Cf9 oilseed rape plant parts located around the Avr9 injection site. Disease development of Oidium lycopersicum in Cf9 tomato or Erysiphe polygoni in Cf9 oilseed rape was not restricted on leaves injected with Avr9. The Avr9 injection induced systemic resistance to L. maculans and E. polygoni in Cf9 oilseed rape. F1(Cf9×Avr9) oilseed rape plants, obtained from crosses of transgenic Cf9× transgenic Avr9 oilseed rape, exhibited higher levels of resistance to L. maculans and E. polygoni but not to S. sclerotiorum, than wild‐type plants. F1(Cf9×Avr9) plants treated with benzothiadiazole (BTH) did not show elevated levels of expression of some pathogenesis‐related genes but developed higher levels of resistance to L. maculans than BTH‐treated wild‐type plants. This report demonstrates that the hypersensitive cell death which is associated with the Cf9‐Avr9 response is not required for quantitative disease resistance.
Molecular evidence that Verticillium ablo‐atrum Grp 2 isolates are distinct from V. albo‐atrum Grp 1 and V. tricorpus
Authors: Mahuku George S. , Platt H. W. 
Published: March 2003

summary Verticillium species‐specific primers were used in a polymerase chain reaction to differentiate between Verticillium albo‐atrum groups and V. tricorpus. Amplification with species‐specific primers identified 21 isolates from the 64 V. albo‐atrum isolates tested as Grp2. Genome analysis using RAPDs and restriction fragment length polymorphism (RFLP) of the intergenic (IGS) region of the rDNA showed that V. albo‐atrum Grp2 isolate were genetically distinct from either V. albo‐atrum Grp1 or V. tricorpus, demonstrating a significant differentiation between these species. The sizes of the amplified IGS fragment were different, with Grp1 isolates having a smaller fragment (≈ 2.1 kb) than either Grp2 (≈ 2.3 kb) or V. tricorpus (≈ 2.7 kb). Based on RAPD analysis, the average similarity coefficients between Grp1 and Grp2 were 35% and 34% between Grp2 and V. tricorpus. Multiple correspondence analysis separated the isolates into three major groups corresponding to Grp1, Grp2 and V. tricorpus. Surprisingly, isolates collected from Pisum sativa were distinct from other Grp1 V. albo‐atrum isolates. The observed low levels of genetic similarity, the differences in sizes of IGS fragments, IGS‐RFLP profiles and the RAPD patterns point to the possibility of Grp2 isolates comprising a different species of Verticillium than those occupied by either V. albo‐atrum Grp1 isolates or V. tricorpus.