bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of the management of suspected giant cell arteritis in a large teaching hospital
Authors: Dalbeth N. , Lynch N. , McLean L. , McQueen F. , Zwi J. 
Published: March 2003

Abstract Background : The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high‐dose corticosteroids may be associated with significant morbidity, including osteo­porosis. Aim: To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital. Methods: We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteo­porosis prophylaxis. Results: The mean waiting time for biopsy for all patients was 5.6 days (range 0−42 days). This
time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate. Conclusions: There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis. (Intern Med J 2002; 32: 315−319)
Resource allocation and bioethics: the Patti Hearst dilemma
Authors: Duggan J. M. 
Published: March 2003

Abstract Medicine has entered an era of high technology, accompanied by expensive investigation and management. Simultaneously, there is increasing recognition of the gap between the costs of medical technology and society's willingness to pay. It is debatable whether medicine recognizes that it is a hostage in thrall to the medical‐industrial complex or whether it has wittingly entered the compact to pursue the high‐cost, high‐technology course. The situation is reminiscent of the events surrounding the kidnap of Patti Hearst − a wealthy heiress who was much later arrested with the gang of robbers. Whether she was hostage or willing accomplice still remains obscure. It is necessary that a body, such as the Cochrane Collaboration, pursues these issues in medicine. (Intern Med J 2003; 33: 127−130)
Unexpected difficult intubation in the patient with Morning Glory syndrome
Authors: Shevchenko Yuri , Rehman Mohamed , Dorsey Alfred T. , Schwartz Roy E. , Moseley Ralph 
Published: March 2003

SummaryMorning Glory syndrome is an uncommon congenital optic disc anomaly with occasional systemic associations. A case of unsuspected difficult intubation in a three‐year old patient is described in this case report.
Accidental hypothermia in a child
Authors: Balagna Roberto , Abbo Delia , Ferrero Federica , Valori Andrea , Peruzzi Licia 
Published: March 2003

SummaryWe report a case of severe accidental hypothermia (24.8°C) in a seven‐year‐old child due to prolonged exposure to low temperatures and temporary contact with river water. When the patient was seen in hospital, bradycardia (30·min−1), bradypnoea (5·min−1), scarcely reacting pupils, and Glasgow Coma Scale=3 were noted. For rewarming minimally invasive techniques (humidified warmed gases and intravenous solutions at 40°C) were employed with a very successful outcome.
Another complication of ribavirin therapy in a mechanically ventilated neonate
Authors: Dimond John 
Published: March 2003

SummaryA critical incident is reported in which ribavirin administered from a small particle aerosol generator (SPAG) into a ventilator circuit became deposited around the humidifier temperature probe with the consequence that it became thermally insulated. This caused overheating of the humidifier and the potential for thermal injury to the respiratory tract. The circuit for aerosolized ribavirin administration is described and modifications suggested to avoid crystal precipitation within the circuit.
High‐frequency jet ventilation using a helium–oxygen mixture
Authors: Tobias Joseph D. , Grueber Ryan E. 
Published: March 2003

SummaryThe physiological basis for the use of helium relates to the relationship described by Poiseuille. During turbulent gas flow, the factors determining the resistance to flow include the density of gas as well as the length and the radius of a tube. While it may not be possible to readily change the latter two, altering the density of the gas is possible by using helium instead of nitrogen. A helium–oxygen combination has been used most commonly to improve air exchange in patients with upper airway obstruction. Anecdotal reports also suggest the beneficial effects of helium during mechanical ventilation in patients with status asthmaticus, hyaline membrane disease, and other pulmonary parenchymal disorders. To date, the clinical reports have utilized helium only with conventional mechanical ventilation. We present a child whose progressive respiratory failure was treated by using high‐frequency jet ventilation with a combination of helium and oxygen. The techniques for the delivery of helium and oxygen through the jet ventilator are discussed.
Novel use of neonatal cuffed tracheal tube to occlude tracheo‐oesophageal fistula
Authors: Greemberg Lev , Fisher Allan , Katz Ana 
Published: March 2003

SummaryThe use of a cuffed tracheal tube is described to occlude the leak through a tracheo‐oesophageal fistula (TOF) in a neonate and prevent gastric dilatation during positive‐pressure lung ventilation.
Anaesthetic management of a patient with adrenocortical tumour
Authors: Vas Lakshmi , Pangam Shilpa Y. , Sanzgiri Savita M. 
Published: March 2003

SummaryAdrenocortical tumours in children are rare. They produce many changes in haemodynamics and blood chemistry due to hormones of the adrenal cortex. The details of perioperative management and the need for perioperative steroid supplementation are discussed.
Central venous catheter placement in children: evaluation of electrocardiography using J‐wire
Authors: Simon L. , Teboul A. , Gwinner N. , Boulay G. , Cerceau‐Delaporte S. , Hamza J. 
Published: March 2003

SummaryMisplacement of a central venous catheter may lead to myocardial perforation and dysrhythmia. Atrial electrocardiography (ECG) through a saline column is an effective but complex method to determine the accurate location of catheters. We evaluated a simplified variant of this technique using the guidewire as an internal electrode in 23 children (5–16 years old) undergoing spinal surgery. Catheters were placed using a Seldinger technique after jugular or subclavian venous puncture. Each time the operator recognized the atrial signal, the catheter was found to be correctly placed on the chest radiograph (20/23). In three patients, the atrial signal was not obtained. A technical error was responsible in one case whereas the two others were related to aberrant migrations of the catheter either into a subclavian vein or into the pleura. In this latter case, the complication was unrecognized on the first radiograph despite malposition having been predicted by atrial ECG. We conclude that a method using atrial ECG guidance is sensitive and specific, and may be an alternative to the classical chest radiograph to detect accurate placement of central venous catheters in children.
Duration of action of atracurium when given by infusion to critically ill children
Authors: Playfor S.D. , Thomas David A. , Choonara Imti 
Published: March 2003

SummaryThe aim of the study was to investigate the offset time of atracurium when given by continuous infusion on a paediatric intensive care unit and to look for evidence of tolerance. Over a period of 8 months, 20 mechanically ventilated children had a steady‐state infusion of atracurium discontinued to enable the assessment of their level of sedation. The offset time of atracurium was assessed by train‐of‐four (TOF) stimulation of the ulnar nerve. The initial TOF reading was documented as was the time taken to reach a TOF ratio of 0.9. Thirty‐five assessments were carried out. The mean offset time of atracurium was 28.7 min (SEM 1.76 min, range 8–56 min). There was no correlation between the dose of atracurium at discontinuation and the offset time of the infusion. The duration of infusion was negatively correlated with the offset time of atracurium, and this effect was most prominent in children who had received infusions for longer than 48 h. When given by continuous infusion, the offset time of atracurium is very variable between individual patients. Infusions administered for longer than 48 h are associated with a significant reduction in the offset time as a result of increasing tolerance.
Pharmacokinetics of ropivacaine following caudal analgesia in children
Authors: Habre Walid , Bergesio Riccardo , Johnson Chris , Hackett Peter , Joyce David , Sims Craig 
Published: March 2003

SummaryRopivacaine has a favourable toxicity profile for epidural anaesthesia in adults, so it may also be an appropriate agent for epidural analgesia in children. We therefore designed this study to determine the pharmacokinetic variables of ropivacaine relevant to the risk of toxicity, after caudal administration in children. We studied nine healthy children, aged 1–6 years who received 1 ml.kg−1 of ropivacaine 0.25% for caudal analgesia. Venous blood samples were collected at intervals for 12 h after injection. Total plasma concentration of ropivacaine was assayed by high performance liquid chromatography, and pharmacokinetic descriptors were estimated from the plasma concentration‐time data. The median peak venous plasma concentration was 799 μg·l−1[interquartile range (IQR) 707–1044 μg·l−1], and was reached at a median time of 1.5 h (IQR 0.5–2 h). The mean elimination half‐life was 3.9 h (95% CI 2.7–5.0 h), and the mean apparent clearance and volume of distribution were 7.6±1.6 ml·min−1·kg−1 (95% CI 6.1–9.1 ml·min−1·kg−1) and 2.4±0.6 l·kg−1 (95% CI 1.9–3.0 l.kg−1), respectively. Analgesia was satisfactory in all cases and no systemic ropivacaine toxicity was observed. Caudal administration of weight‐adjusted doses of ropivacaine to children resulted in systemic exposure similar to that reported for adults. No systemic toxicity was observed. The findings strengthen predictions that the relative systemic safety of epidural ropivacaine in adults will apply to children. However, the pharmacokinetics and safety of epidural ropivacaine need to be studied further in children with circumstances that affect drug disposition and systemic tolerance.
High frequency oscillatory ventilation during repair of neonatal congenital diaphragmatic hernia
Authors: Bouchut Jean‐Christophe , Dubois Remi , Moussa Martine , Godard Jean , Picaud Jean‐Charles , Di Maio Massimo , Claris Olivier , Bouletreau Paul 
Published: March 2003

SummaryWe evaluated the use of high frequency oscillatory ventilation (HFOV) during congenital diaphragmatic hernia repair. After preoperative stabilization, 22 newborn infants were ventilated with HFOV during surgery. Ventilatory settings, blood gas values and oxygenation index were recorded before, during and after surgical repair. No differences were noted for these variables. No complications related to ventilation were recorded. According to the surgeon, diaphragmatic repair during HFOV is facilitated. This study confirms that CDH can be safely repaired using HFOV during anaesthesia.
A randomized controlled trial of the antiemetic effect of three doses of ondansetron after strabismus surgery in children
Authors: Bowhay A.R. , May H.A. , Rudnicka A.R. , Booker P.D. 
Published: March 2003

Methods: One hundred and thirty‐one healthy children, aged 31–152 months, undergoing strabismus surgery under general anaesthesia, were randomly allocated to one of four groups: group A received 0.04 mg·kg−1(≡ 1 mg·m−2) of ondansetron, group B 0.1 mg·kg−1(≡ 2.5 mg·m−2), group C 0.2 mg·kg−1(≡ 5 mg·m−2) and group D placebo, given intravenously following induction of anaesthesia. Morphine 0.15 mg·kg−1was given intravenously, intraoperatively, to provide postoperative analgesia. Hourly records of emetic episodes were made for 24 h.Results: A considerably higher proportion of children suffered emesis in the placebo group compared to the active treatment groups taken together, during the first 8 h of postoperative care (76% vs. 45%,P=0.002). During the first 8 h, only 25% of those in treatment group C suffered emesis, the number‐needed‐to‐treat was 3. There was a statistically significant decrease in the chance of vomiting with increasing dose of ondansetron (P=0.03). By 24 h, the difference in the rate of emesis was less marked but still statistically significant (90% vs. 69%,P=0.03).Conclusions: Overall, children given ondansetron had less than one‐half the risk of vomiting compared to those given placebo (hazard ratio 0.46, 95% confidence interval 0.29–0.74). The mean number of emetic episodes declined from 2.73 in the placebo group to 1.92 in treatment group C. There was no difference in the incidence of side‐effects between groups.
Unlicensed and off label analgesic use in paediatric pain management
Authors: Conroy Sharon , Peden Vanessa 
Published: March 2003

Background: The management of pain in children has advanced enormously in recent years. Pharmacological treatment of pain is complicated however, by the widespread use of unlicensed and off label medicines in the paediatric population, leading to everyday practical problems. This study aimed to document the incidence and nature of unlicensed and off label analgesic agents in children. Methods: Data regarding analgesic use were collected prospectively over a 4‐week period from two wards. The data were analysed to determine whether the drug use was licensed, unlicensed or off label. Results: Seven hundred and fifteen prescription episodes were analysed. Some 480 of these (67%) were licensed; 235 were licensed medicines used in an off label manner (33%). No medicines were unlicensed. Paracetamol was the most common analgesic used. Conclusions: Issues regarding the use of off label drugs in children at risk of pain are discussed. Suggestions are made regarding the way forward for the future.
Severe head trauma in children: cranial computer tomography and clinical consequences
Authors: HIRSCH WOLFGANG , SCHOBEß AXEL , EICHLER GERBURG , ZUMKELLER WALTHER , TEICHLER HEIKE , SCHLÜTER ANDREAS 
Published: March 2003

Background: We investigated the prognostic and therapeutic implications of cranial computerized tomography (CCT) examinations after severe head trauma in children. Materials and methods: The CCT scans from 248 children (aged 0.1–14 years) during the course of treatment after severe head trauma were assessed. The initial CCT findings, the frequency of CCT examinations and the schedule as well as duration of treatment were registered. The neurological outcome was examined both 1 month and 1 year after the trauma. Results: Approximately one‐third (29%) of the children who suffered from severe head trauma showed no changes in the CCT. Furthermore, 40.3% of the children showed a singular finding in the CCT, whereas 30.6% of all children had a combined injury pattern. One year after trauma, we found no impairment of consciousness in children without pathological CCT findings, as well as in cases with isolated epidural and subdural haemorrhage. Children with massive generalized brain oedema had the poorest prognosis (37% died, 25% had impairment of consciousness). The outcome of children with parenchymal and ventricular bleeding was also unfavourable (23.1% and 33.3% neurological findings). Patients with focal oedema likewise had impairment of consciousness. An average number of 3.0 CCT per child was performed but numbers in single cases varied greatly (1–13 scans per individual). Conclusions: The initial CCT was of importance regarding further therapy, especially for children in need of surgical treatment. In the other cases, there was no direct impact from CCT findings on treatment procedures in the paediatric intensive care unit. The initial CCT was related to the prognosis, which can be poor even if there are only minimal changes in CCT, such as focal oedema or isolated ventricular bleeding.
Perioperative management of tetralogy of Fallot with absent pulmonary valve
Authors: Stayer Stephen A. , Shetty Shakunthala , Andropoulos Dean B. 
Published: March 2003

Summary Background: Tetralogy of Fallot with absent pulmonary valve is a rare form of congenital heart disease. The records of patients with this lesion were reviewed over a 6½ year period, and the perioperative management of 13 patients is described. Methods: We found that our patients could be divided into two groups by age. The younger group failed medical management and was referred for surgery at less than 1 year of age. This group of patients had considerable respiratory disease at the time of surgery, greater ventilatory problems during surgery and prolonged recovery. Most patients in this group have residual respiratory disease. Results: There were significant differences in postoperative outcome between younger versus older patients: days of ventilation 37 ± 41 versus 1 ± 0.6 days, length of ICU stay 28 ± 31 versus 3 ± 1 days and length of hospital stay 64 ± 48 versus 9 ± 5 days.
Anaesthesia with sevoflurane in children: nitrous oxide does not increase postoperative vomiting
Authors: Bortone Luciano , Picetti Edoardo , Mergoni Mario 
Published: March 2003

Summary Background: Nitrous oxide (N2O) has been associated with postoperative nausea and vomiting (PONV), but some studies show conflicting data. The aim of this study was to assess whether the combination of N2O/sevoflurane, in paediatric general anaesthesia, increases the incidence of vomiting in the 24 h following surgery compared with sevoflurane alone. Methods: One hundred and fourteen children, aged 1–10 years, who underwent testicle and inguinal hernia surgery, were randomized to receive one of the following two anaesthetic regimens: sevoflurane with 70% N2O (group A) or sevoflurane alone (group B). Results: No significant differences were observed in the incidence of postoperative vomiting between the two groups. The overall incidence of postoperative vomiting was 14.9%; 14.3% in group A and 15.5% in group B (P=0.9). Conclusions: Nitrous oxide used in combination with sevoflurane is not associated with an increase in the incidence of emesis in children who undergo testicle and inguinal hernia procedures.
Intravenous anaesthesia for laser surgery of the airway in children with recurrent laryngeal papillomatosis.
Authors: Kailey J. , Cranston A. , Moriarty A. 
Published: March 2003

Juvenile laryngeal papillomatosis is a recurrent condition that presents a number of challenges to the anaesthetist: varying degrees of airway obstruction, the child's airway is shared and safe use of a laser is required. As well as the usual considerations of laser use, the child's larynx should move as little as possible.At present the treatment of choice is laser vapourisation of the papillomata. Several anaesthetic techniques have been described, including jet ventilation, intermittent intubation, apnoeic techniques and insufflation of volatile gases with or without spontaneous ventilation (1). Endotracheal intubation has been associated with seeding of the papillomata into the distal airway.The technique at the Birmingham Children's Hospital for the past 5 years is described; it is based upon deep intravenous anaesthesia with spontaneous ventilation, supplemented by topical lignocaine. Children with significant stridor at rest are induced with volatile/oxygen mixture, otherwise the method of induction is determined by child and anaesthetist. Once the child is deeply anaesthetised the larynx of the child is sprayed with lignocaine (4 mg·kg−1). The volatile agent is then discontinued and anaesthesia is provided by an intravenous infusion of propofol and alfentanil running at 10–20 mg·kg−1·hr−1 and 20–30 mcg·kg−1·hr−1 respectively. Oxygen enriched air is delivered into the pharynx via a nasopharyngeal airway. The oxygen saturation of the child is maintained at 95–97% in order to reduce the risk of ignition of the inspired oxygen by the laser. The larynx of the child is placed in suspension to produce an open airway. Depth of anaesthesia is determined primarily by the child's ventilatory pattern (adrenaline is used topically by the surgeon for haemostasis and interferes with the child's heart rate and blood pressure). End tidal CO2 concentration was measured intermittently for the first few cases, but was always found to be in the normal range. After completion of surgery (usually 15–90 min) the child is placed in the recovery position and allowed to recover.Over the past 5 years at our hospital 11 children have undergone 112 procedures. There have been no airway complications. Recovery is not prolonged (time to spontaneous eye opening about 10–15 min). This simple technique allows excellent surgical operating conditions with unimpeded visualisation of the barely mobile larynx. There is no pollution of the operating theatre or surgeon by volatile agents. The technique is now routinely used for all microlaryngeal surgery.
Preservation of canine and feline corneoscleral tissue in Optisol® GS
Authors: Arndt Carmen , Reese Sven , Köstlin Roberto 
Published: March 2003

AbstractObjective The objective of the research was to determine whether preservation of corneal tissue of dogs and cats in Optisol® GS (OGS, Bausch & Lomb Surgical, Irvine, CA, USA) is feasible for subsequent use in penetrating keratoplasty.Animals The study subjects were 33 dogs and 31 cats with no gross corneal pathology, which had been euthanised by pentobarbital overdose for reasons unrelated to this project.Procedure One cornea of each pair was evaluated immediately and the other was evaluated after storage in Optisol® GS for either 5, 10, 15 or 20 days. The most important criterion was the preservation of the endothelial cell layer.Results Corneoscleral tissue of cats survived longer, when preserved in Optisol® GS at 4 °C, than that of dogs. Light and scanning electron microscopy revealed good preservation of the endothelial cell layer for up to 10 days in dogs and up to 15 days in cats.
Excitotoxicity can be mediated through an interaction within the optic nerve; activation of cell body NMDA receptors is not required
Authors: Vorwerk Christian K. , Naskar Rita , Schuettauf Frank , Zurakowski David , McDermott Luann M. , Quinto Kristine M. , Dreyer Evan B. 
Published: March 2003

AbstractAxonal trauma leads to a series of pathologic events that can culminate in neuronal death. Although the precise mechanisms of retinal ganglion cell death after optic nerve crush in the rat model have not been elucidated, glutamate antagonists can protect retinal ganglion cells after optic nerve axotomy. We therefore explored whether a glutamate congener was toxic if applied directly within the optic nerve, or if toxicity depended upon an interaction at the cell body level. NMDA reduced retinal ganglion cell survival when applied directly into the rat optic nerve. Glutamate can be toxic if administered within the optic nerve; a direct effect at the cell body is not necessary. Future work will help to additionally unravel the steps by which axotomy induces excitotoxic damage to ganglion cells, and perhaps indicate protective interventions.