bluuebunny/crossref_metadata_2025_split huggingface dataset:
Small bowel injuries in children
Authors: Holland A J A , Cass D T , Glasson M J , Pitkin J 
Published: March 2003

Objective: To determine the common features of small bowel injury (SBI) in childhood and the consequences of delayed diagnosis. Methodology: A retrospective case review was performed of children with traumatic SBI between January 1988 and November 1999. Results: Twenty‐eight patients were identified with SBI. Road trauma accounted for 71% of them. Tachycardia was present on admission in 82% of patients with SBI including all but one of the intestinal perforations. SBI was associated with a Chance fracture of the lumbar spine in three patients (11%). An abdominal computed tomography scan with intravenous contrast was abnormal in all patients with a perforation or mesenteric tear. Diagnosis was delayed in six patients, one of whom died as a result of sepsis from a small bowel perforation. Conclusions: Persistent tachycardia with an appropriate mechanism of injury following blunt abdominal trauma requires active exclusion of SBI. Delayed diagnosis is associated with significant morbidity and mortality.
Analysis of the breath hydrogen test for carbohydrate malabsorption: Validation of a pocket‐sized breath test analyser
Authors: Lee Ws , Davidson Gp , Moore Dj , Butler Rn 
Published: March 2003

Objective: To assess the validity and clinical application of a hand‐held breath hydrogen (H2) analyzer (BreatH2, Europa Scientific, Crewe, UK). Methodology: Breath samples of patients referred to the Gastroenterology Unit, Women’s and Children’s Hospital, North Adelaide, South Australia, for confirmation of the diagnosis of carbohydrate malabsorption were analysed with the Quintron microlyzer (Quintron Instrument Co., Milwaukee, USA) and the BreatH2 analyser, using the Quintron microlyzer as the gold standard. Results: Twenty‐nine breath H2 tests (BHT) were performed in 29 patients aged 2 months to 61 years. The sensitivity and specificity of the BreatH2 analyser in detecting a positive BHT using the Quintron microlyser as the gold standard were 0.90 and 0.95 with positive and negative predictive values of 0.90 and 0.95, respectively. There was one false positive and one false negative reading. Bland–Altman plots showed a high degree of agreement between the values obtained with two different methods. Conclusions: The diagnosis of carbohydrate malabsorption, using a portable breath H2 analyser (BreatH2), achieved an acceptable degree of sensitivity and specificity, enabling it to be used where no alternative is available.
Medium‐term outcomes are comparable with short‐term outcomes in children with attention deficit hyperactivity disorder treated with stimulant medication
Authors: Efron D , Jarman Fc , Barker Mj 
Published: March 2003

Objective: To compare the short‐ and medium‐term effects of psychostimulant medication in children with attention deficit hyperactivity disorder (ADHD). Methods: Seventy‐three children with ADHD participated in a double‐blind crossover study of dextroamphetamine (DEX) and methylphenidate (MPH; results previously reported). At the completion of this study, subjects continued to take the preferred stimulant. Subjects were restudied 6–9 months later. The principal outcome measures were the Revised Conners’ Parent and Teacher Rating Scales. Results: Fifty‐three families (73%) returned the follow‐up surveys. At 6–9 months, mean T scores were still significantly lower than the mean at baseline for all factors of both the CPRS‐R and CTRS‐R (P < 0.01). There were no statistically significant differences between scores at 6–9 months and scores at the completion of the corresponding medication period in the crossover trial. Conclusions: After 6–9 months treatment with stimulant medication, ratings remained significantly better than at baseline. This suggests that the early benefits of stimulants are sustained for at least 6 months.
Errors in the certification of neonatal death
Authors: Hunt R , Barr P 
Published: March 2003

Objective: To examine the precision of the perinatal death certificate (PDC) and ascertain the possible sources of error in the certification of neonatal deaths. Methods: The ‘Main’ and ‘Other’ causes of death recorded on the PDC were obtained from the Registry of Births, Deaths and Marriages and compared with those from a clinicopathological summary (CPS) completed after all pending laboratory results and/or autopsy information were available. Results: There were 179 neonatal deaths during the 7 year period under review. The PDC and CPS main causes of death were concordant in 103 of 179 infants (58%) and discordant in the remaining 76 infants (42%). The PDC main cause of death was incorrectly classified in 61 of 76 infants (80%) with discordant findings and was incompletely classified in the remaining 15 infants (20%). The following discordancies were recorded for the 61 infants with an incorrect classification: (i) transposition of the ‘Main’ and ‘Other’ causes of death, resulting in a sequencing discordancy in 14 infants (23%); (ii) recording a non‐pathological condition as the main cause of death in 40 infants (66%); and (iii) recording an incorrect pathological condition as the main cause of death in seven infants (11%). Eight of the 61 (13%) incorrect classifications and four of the 15 (27%) incomplete classifications were associated with laboratory and/or autopsy data being unavailable when the PDC was completed. Conclusions: The concordancy between the PDC and CPS would have increased from 58 to 91% if the ‘Main’ and ‘Other’ causes of death had been sequenced correctly, if the main cause of death had been ascribed to a pathological disease rather than a non‐pathological condition and if corrective information from pending laboratory tests and/or autopsy examination had been made available to the Registry of Births, Deaths and Marriages.
The changing pattern of diagnosis of infantile cholestasis
Authors: Stormon MO , Dorney SFA , Kamath KR , O'Loughlin EV , Gaskin KJ 
Published: March 2003

Objective: Cholestatic liver disease in infancy is caused by a wide range of conditions. This study reviews the pattern of diagnosis of infants with cholestasis presenting to a tertiary referral paediatric hospital in Sydney, Australia, during a 12‐year period (1985–96). Methodology: Infants aged less than 6 months with cholestasis were identified retrospectively from hospital records and data retrieved from the medical records. Results: There were 205 infants identified as having cholestatic liver disease. The aetiology of the cholestasis was idiopathic in 25%, metabolic/genetic in 23%, and due to obstruction in 20%, parenteral nutrition in 20%, infection in 9% and bile duct hypoplasia in 3%. Conclusions: This study highlights the changing patterns of diagnosis of cholestatic liver disease in infants at a tertiary paediatric facility, demonstrating that up to 50% of cases are now due to genetic/metabolic diseases or parenteral nutrition, and a high proportion are due to idiopathic disease.
The child of uncertain sex: 17 years of experience
Authors: Al‐Agha AE , Thomsett MJ , Batch JA 
Published: March 2003

Objective: To review the common clinical presentations, investigations and final diagnosis of children presenting with genital ambiguity.Methodology: Retrospective search of the Royal Children’s Hospital, Brisbane, Australia, medical records and personal medical database of one of the authors (MJT) between 1982 and 1999.Results: Fifty‐one children aged 0.1–;14 (mean 3.9) years were identified. Twenty‐two cases had a 46XX karyotype, and commonly presented with an enlarged phallus (77.2%), urogenital sinus (63.6%) and labioscrotal fold(s) (40.9%). Congenital adrenal hyperplasia (CAH) was the most common final diagnosis (72.7%) . Twenty‐nine cases of genital ambiguity had a 46XY karyotype and commonly presented with palpable gonad(s) (75.8%), undescended testes (51.7%), penoscrotal hypospadias (51.7%) and a small phallus (41.3%). Androgen insensitivity and gonadal dysgenesis were the commonest final diagnosis both occurring at a frequency of 17.2%.Conclusions: The results emphasize the importance of CAH as the most common diagnosis in 46XX cases presenting with ambiguous genitalia. Those with 46XY had a wider range of diagnoses. Despite thorough investigation, 23.5% had no definite final diagnosis made.
Passive exposure to tobacco smoke and bacterial meningitis in children
Authors: Iles K , Poplawski NK , Couper RTL 
Published: March 2003

Objective: To determine whether an association exists between passive exposure to tobacco smoke and bacterial meningitis in childhood, in an Australian population. Methodology: A retrospective, case‐controlled telephone survey of the parents of 71 children admitted to the Women’s and Children’s Hospital, North Adelaide, with bacterial meningitis between 1990 and 1999. Results: The annual incidence of Haemophilus influenzae type b (Hib) meningitis decreased significantly during the study period (11.0 cases per year 1991–;93 and 1.5 cases per year 1994–;99, Fisher’s exact test; P < 0.001) whilst pneumococcal cases significantly increased (2.3 cases per year 1991–;93 and 4.9 cases per year 1994–;99, Fisher’s exact test; P < 0.001). Although comparable numbers of cases and controls came from smoking families (41%vs 45%), more cases came from bi‐parental smoking households (17%vs 8%; odds ratio (OR) = 2.20, 95% confidence interval (CI) 0.77–;6.24) and cases were more likely to live in households where parents smoked inside (27%vs 13%; OR 2.51, 95% CI 1.05–;6.03). In households where parents smoked, children who had had meningitis were significantly more likely to have parents who smoked inside the house, than children who had not had meningitis (66%vs 28%, Fisher’s exact test; P = 0.005). Conclusion: This study suggests there may be an association between high levels of passive exposure to tobacco smoke and bacterial meningitis in Australian children. A study with larger numbers of affected children which quantifies passive exposure to tobacco smoke is needed to determine the strength of this association.
Functional status of school‐aged children with Down syndrome
Authors: Leonard S , Msall M , Bower C , Tremont M , Leonard H 
Published: March 2003

Objective: To field test, in questionnaire format, the Functional Independence Measure for Children (WeeFIM, a schedule usually administered by interview) on parents of a cohort of school‐aged children with Down syndrome. Methods: The parents of 211 Western Australian children with Down syndrome participated in the present study, representing 79.9% of all children with Down syndrome in the State. Subjects were identified using two sources: (i) the Birth Defects Registry; and (ii) the Disability Services Commission. Results: The total WeeFIM score was 106.2 ± 17.0 (mean ±
SD) out of a possible 126. Girls scored higher than boys (108.6 vs 103.6;
P = 0.05). Scores increased across all age groups (P < 0.0001), even relative to normative data. Performance was strongest in the transfer and locomotion domains and weakest in social cognition. Conclusion: We found that severe functional limitations are rare in school‐aged children with Down syndrome. Some support and supervision are required for complex self‐care, communication and social skill tasks. This study demonstrates the feasibility of using the WeeFIM for collecting population survey data in children with developmental disability. This may be useful for the longitudinal tracking of such populations, as well as the monitoring of response to interventions.
Tracheobronchography and angiocardiography of paediatric cardiac patients with airway disorders
Authors: Cheung YF , Lee SL , Leung MP , Yung TC , Chau AKT , Hui HKY 
Published: March 2003

Objective:  We report our experience in combining tracheobronchography and angiocardiography in the assessment of a selected cohort of paediatric cardiac patients with problematic airway disorders.Methodology:  The clinical records of 11 patients who underwent 17 studies at a median age of 5.5 months (range 3 months to 10.8 years) were reviewed. Tracheobronchography and angiocardiography were performed under general anaesthesia using a non‐ionic contrast agent. The findings were compared with those of flexible bronchoscopy and magnetic resonance imaging (MRI).Results:  Seven patients had cardiac lesions associated with vascular anomalies potentially compressing the airway, while four had no identifiable aberrant or enlarged vessels. All examinations but one were performed without complications. Tracheobronchography demonstrated extrinsic vascular compression with secondary airway malacia in three (27%), intrinsic tracheobronchial stenosis in five (45%), and airway malacia in three patients (27%). Precise measurement of the airway calibre and real‐time fluoroscopic monitoring facilitated transcatheter tracheobronchial interventions (six balloon dilations, three stent implantations) in four patients. In conjunction with angiocardiography, cine‐tracheobronchography provided detailed information on the spatial relationship between vascular and airway structures in all patients; allowed dynamic assessment of airway malacia; and facilitated preoperative planning in six patients. In contrast, bronchoscopy failed to differentiate malacia from extrinsic compression in four patients (36%), while MRI, performed in six patients, was unsatisfactory in one due to a motion artefact and failed to diagnose airway malacia and extrinsic compression in three patients.Conclusions:  Tracheobronchography is relatively safe in paediatric cardiac patients. Combined tracheobronchography and angiocardiography, a less operator‐dependent imaging modality compared to bronchoscopy and MRI, delineated the airway and vascular anatomy in detail; facilitated preoperative planning; and permitted transcatheter tracheo‐bronchial interventions. The dynamic capability of tracheobronchography supplements that of flexible bronchoscopy and MRI in the diagnosis of airway malacia.
Effect of low versus normal birthweight on menarche in 14‐year‐old Polish girls
Authors: Koziel S , Jankowska EA 
Published: March 2003

Objective:  The relationship between intrauterine growth retardation and sexual maturation has not been completely established. The aim of the present study was to compare menarche in 14‐year‐old Polish girls of low and normal birthweight, along with an evaluation of the impact of socio‐economic status and body mass index (BMI).Methods:  We studied 1060 girls (177 pre‐ and 883 post‐menarche) aged 13.5−14.5 years. These girls attended the 7th grade of randomly selected primary schools in Wroclaw, Poland. The BMI was used as a measurement of general adiposity. The cut‐off value of the 10th percentile of birthweight for gestational age was used to differentiate between girls born small for gestational age (SGA) and girls with a birthweight appropriate to gestational age (AGA). Parental education level and other measures were used to assess socio‐economic status (SES).Results:  Birthweight (OR = 2.54; 95% CI 1.22−5.28) and BMI at the age of 14 years (OR = 7.93; 95%CI 4.67−13.48) were factors affecting the onset of menarche among the 14‐year‐old girls.Conclusion:  Polish girls born small for gestational age are more likely to have experienced menarche by the age of 14 years, compared with their peers of normal weight at birth. These findings seem to be consistent with the hypothesis that the age of menarche is, to some extent, set by patterns of gonadotropin release, established prior to birth. Additionally, the age of menarche varies depending on levels of fat accumulation during childhood and adolescence.
Rebreathing potential of infant mattresses and bedcovers
Authors: Colditz PB , Joy GJ , Dunster KR 
Published: March 2003

Objective: To establish the CO2 dispersion and retention properties of some mattresses and bed coverings commercially available in Australia. Methods: Five mattresses were studied in (i) an in vivo model in
which an infant’s head was covered by a headbox, rebreathing was allowed to
occur, and the final steady state CO2 concentration was measured; and
(ii) an in vitro model in which 5% CO2 in a headbox was
allowed to disperse, and the time taken for the concentration to reach 1%
was measured. Five types of bedcover were studied in (i) an in vivo model
in which an infant’s head was covered by a bedcover and the final steady state
CO2 concentration was measured; and (ii) an in vitro model in which
5% CO2 under a bedcover was allowed to disperse, and the time taken for the concentration to reach 1% was measured. Results: The steady state CO2 concentrations ranged from 0.6%
to 3.0% for the mattresses (P < 0.05). The time for CO2
to disperse ranged from 5.5 min to 30.4 min (P < 0.05). Steady state CO2
concentrations ranged from 2.5% to 3.6% for the bedcoverings (P
> 0.05). The time for CO2 to disperse ranged from 5.4 min to 7.7 min
(P > 0.05). Conclusions: Some commercial cot mattresses and bedcoverings allow high
concentrations of CO2 to accumulate in rebreathing environments. Some
mattress types studied were more diffusive to CO2, whereas there was no difference between the bedcovers studied. This may have implications for vulnerable infants at risk of sudden infant death syndrome.
Idiopathic pulmonary haemosiderosis: An Oriental experience
Authors: Yao T‐C , Hung I‐J , Wong K‐S , Huang J‐L , Niu C‐K 
Published: March 2003

Objectives:  Idiopathic pulmonary haemosiderosis (IPH) is a rare but potentially lethal disorder. A retrospective analysis of documented cases of IPH in our hospital was conducted in order to study the clinical spectrum and radiographic features, and to explore therapeutic strategies.Methods:  A retrospective chart review was carried out, collecting medical records of patients with pulmonary haemo­siderosis at Chang Gung Children's Hospital (CGCH), a tertiary children's hospital in northern Taiwan. Secondary causes of pulmonary haemosiderosis were excluded.Results:  Five patients were diagnosed as having IPH over a 25‐year period. The classical triad of IPH was found at initial presentation in only 2/5 patients. One patient had well‐established pulmonary fibrosis, but no pulmonary symptoms. The clinical course of IPH was exceedingly variable, with a mean delay of 9 months before diagnosis was made. Bronchoalveolar lavage (BAL) confirmed IPH in 3/5 patients. Immunological abnormalities were noted in two patients, without progression to immune disorders during follow up. While using corticosteroids alone, 4/5 patients continued to have recurrent bleeding episodes. All five patients required immunosuppressive therapy for maintenance of a symptom‐free period, but survived to a mean follow up of 2 years.Conclusions:  Early definitive diagnosis and aggressive immunosuppressive therapy of IPH are imperative in order to avoid pulmonary fibrosis and mortality in IPH. A chest radiograph should be included in a serial work‐up of unexplained anaemia in children. An examination using BAL can confirm IPH and high‐resolution thoracic computed tomography scans are useful for early detection of pulmonary fibrosis.
Dryland lakes1
Authors: Williams William D. 
Published: March 2003

AbstractDry regions of the world, that is, hyper‐arid to subhumid regions that are mostly warm to hot and so‐called ‘drylands’, cover almost 50% of the total land area. They are inhabited by human populations that are approaching one billion worldwide. Despite low rainfall levels, dry regions have some of the world’s largest lakes and reservoirs. They also have the widest variety of standing water types that include permanent freshwater lakes and reservoirs, temporary freshwater lakes, and permanent and temporary saline lakes. Many characteristics of these waters are different from waters in temperate, better‐watered areas, upon which most limnological knowledge is based. Notwithstanding many economic, scientific, ecological and other values, lakes in drylands are subject to extensive and intensive anthropogenic impacts. Included are almost all those affecting lakes in temperate, tropical and subtropical regions, as well as some impacts more or less confined to dryland lakes, especially salinization. These anthropogenic impacts and their importance have not been fully recognized at national and international levels.
Refilling, ageing and water quality management of Brucher Reservoir
Authors: Scharf Wilfried 
Published: March 2003

AbstractRefilling of the formerly oligo‐mesotrophic, softwater Brucher Reservoir commenced in April 1993 and took 11 months to completely fill. A severe ‘trophic upsurge’ in the sense of nutrient enrichment (phosphorus, dissolved organic material) as a result of the decomposition of the inundated vegetation occurred. However, algal crop and phosphorus utilization efficiency, expressed as chlorophyll concentrations per unit of total phosphorus, remained very low. In the absence of any fish stock, a single species, Daphnia galeata, monopolized the resources. Sustained by the detritus food chain, daphnids exerted a severe‚‘top‐down’ control upon phytoplankton, thereby preventing any net algal growth. In 1994, artificial mixing prevented the occurrence of anoxic water conditions and internal nutrient enrichment of the lake. Although the decay of the inundated vegetation was still of importance, phosphorus concentrations in the water column approached equilibrium with the external input while dissolved organic material concentrations clearly declined. That year, the reservoir became stocked with minnows, sun bleak (Leucaspius delineatus) and trout. As food limitation, as a result of reduced heterotrophic production, became more severe in the face of an increasing predation pressure, the daphnid population density declined, resulting in a decreasing but still adequate community filtering rate providing pronounced ‘clear‐water phases’ of up to 10 m that were features of the period 1995–1997. Although D. galeata defended its key position in the food web, its life‐history traits (e.g. body size) changed. Submerged macrophytes, which since 1995 gradually colonized suitable areas of the reservoir, provided a favourable refuge for minnows from trout predation that resulted in reduced predation pressure upon pelagic daphnids. However, in 1998, ungrazeable algae became prominent, adversely affecting transparency. That year, the significant inverse relationship between chlorophyll : total phosphorus ratios and daphnids became uncoupled during the summer (July–August) by indigestible chlorococcalean algae. Nevertheless, the fishery management that was implemented was successful in sustaining not only the lowest yield of algae at the given nutrient concentration but also the most favourable species composition with respect to water quality.
Screening of Azolla strains for tolerance to ammonium
Authors: Shiomi Nobuyuki , Kitoh Shunji 
Published: March 2003

AbstractSixty‐seven strains of seven species of Azolla were screened for tolerance to ammonium ion on the basis of their growth on the medium with or without 20 mmol/L ammonium. Azolla nilotica was the most sensitive species followed by Azolla rubra. Azolla pinnata var. pinnata was the most tolerant species. Twelve tolerant strains in Azolla mexicana, Azolla caroliniana, Azolla microphylla and A. pinnata var. pinnata were selected. No tolerant strain was found in Azolla filiculoides containing native strains in Japan.