bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fibre‐optic bronchoscopy in adults: a position paper of The Thoracic Society of Australia and New Zealand
Authors: Wood‐Baker R. , Burdon J. , McGregor A. , Robinson P. , Seal P. 
Published: March 2003

Abstract Fibre‐optic bronchoscopy in adults is a common procedure in clinical respiratory practice. Under controlled conditions it is safe, resulting in relatively few significant adverse events. The present position paper updates guidelines previously published by The Thoracic Society of Australia and New Zealand and is based on evidence obtained by searching the Medline and Embase databases. The level of evidence to support recommendations is indicated in the text. Where no evidence has been found, the guidelines reflect the opinions of the authors. Specific recommendations are made regarding sedation and anaesthesia, the cleaning of bronchoscopes and the training of bronchoscopists. (Intern Med J 2001; 31: 479–487)
Increasing relevance of pharmacogenetics of drug metabolism in clinical practice
Authors: Pillans P. I. 
Published: March 2003

Abstract Much of the individual variation in drug response is due to genetic drug metabolic polymorphisms. Clinically relevant examples include acetylator status; cytochrome P450 2D6, 2C9 and 2C19 polymorphisms; and thiopurine methyltransferase deficiency. It is important to be aware of which drugs are subject to pharmacogenetic variability. In the future, population‐based pharmacogenetic testing will allow more individualized drug treatment and will avoid the current empiricism. (Intern Med J 2001; 31: 476–478)
Hepatocellular carcinoma and chemoembolization
Authors: Harris M. , Gibbs P. , Cebon J. , Jones R. , Sewell R. , Schelleman T. , Angus P. 
Published: March 2003

Abstract Background: Chemoembolization is often used in the treatment of hepatocellular carcinoma; however, there are limited data on its efficacy in an Australian setting. Aims: To review retrospectively the experience of 21 patients with hepatocellular carcinoma who collectively had 36 chemoembolizations performed between October 1995 and February 1999 in a teaching hospital and liver transplant centre in Victoria. Methods: Selective catheterization of the right or left hepatic arteries was performed. A mixture of cis‐platin 50 mg, epirubicin 50 mg, mitomycin C 10 mg, Lipiodol and gelfoam was injected. Computed tomography (CT) scans were performed at baseline and at 1–3 months after chemoembolization. Outcome measures included response rates, toxicity, progression‐free and overall survival. Results: CT response rates: partial response 19% (n = 7), median duration 11 months (range 2+ to 37+); minor response 17% (n = 6), median duration 7 months (1+ to 12+); stable disease 42% (n = 15), median duration 3 months (1+ to 15 months); and progressive disease 22% (n = 8). Major toxicities included one case each of acute renal failure, contrast encephalopathy, gastric ulceration and hepatorenal failure. Median progression‐free survival was 3 months (range 0–37+). Median overall survival was 15 months (range 6–50+). Conclusion: Chemoembolization has a role in the palliative treatment of hepatocellular carcinoma. Our response rates and toxicity data are consistent with those in the published literature. However, new treatments are needed and prevention of disease by reduction in the prevalence of chronic hepatitis B and C will be required to significantly reduce mortality from this tumour. (Intern Med J 2001; 31: 517–522.
Bronchoscopic dilatation in the management of benign (non‐transplant) tracheobronchial stenosis
Authors: Chhajed P. N. , Malouf M. A. , Glanville A. R. 
Published: March 2003

Abstract Background: Tracheobronchial stenosis in the adult patient is a recognized postoperative complication of sleeve resection or lung transplantation, but also occurs in medical conditions such as sarcoidosis, tuberculosis, postintubation/tracheostomy or postradiation. Aims: To assess the response of bronchoscopic dilatation in the management of benign (non‐transplant) tracheobronchial stenosis and the longevity of symptomatic relief. Methods: Eight patients underwent bronchoscopic dilatation for benign (non‐transplant) tracheobronchial stenosis. The indications were post‐tuberculous bronchostenosis (n = 3), post‐tracheostomy/endotracheal intubation strictures (n = 3), postradiation bronchostenosis (n = 1) and narrowing of the tracheal lumen following a muscle flap surgery for tracheoesophageal fistula (n = 1). Results: Dilatation alone was effective in the management of four patients (50%). Two patients had stent placement postdilatation, one patient had tracheal resection and primary anastomosis and one patient had laser ablation for restenosis followed by balloon dilatation. All patients had clinical improvement. One patient was successfully weaned off mechanical ventilation and extubated. There was no procedure‐related mortality and all patients were alive and well at the time of reporting, with a mean duration since procedure of 123 ± 105 (range 8–340) weeks. The complications observed were granuloma formation at the site of laser excision and restenosis, each in one patient. Conclusions: Bronchoscopic dilatation is a safe and effective modality in the initial assessment and management of benign tracheobronchial stenosis. Stent placement and Nd:YAG laser therapy complement a dilatation procedure in the combined bronchoscopic treatment of benign tracheobronchial stenosis. (Intern Med J 2001; 31: 512–516)
Sleep disorders: a potential role in New Zealand motor vehicle accidents
Authors: Yee B. , Campbell A. , Beasley R. , Neill A. 
Published: March 2003

Abstract Background: The potential role of sleep disorders in New Zealand motor vehicle accidents (MVA) has not been systematically studied. Aims: To trial a recruitment method and document the frequency of sleep disorders in drivers attending an emergency department with injury following MVA. Methods: Injured drivers admitted to Wellington Hospital Emergency Department were prospectively recruited by letter and follow‐up telephone call. Data from a traffic accident, health and sleep questionnaire and polysomnography were collected and analysed using the SPSS statistical package. Results: Of 120 eligible drivers, 40 (33%) completed the study protocol. The mean age of participants was 44 ± 17 years.
Non‐participants were younger (mean age 33 ± 14 years, P < 0.01) and more often of Asian or Pacific Island ethnicity (P < 0.01). Twenty‐seven (67%) felt unrefreshed on waking and 10 (25%) had an elevated Epworth Sleepiness Score (> 10/24). Six (15%) felt drowsy or fell asleep prior to the accident. Sleep disorders were common (40%): obstructive sleep apnoea 14 (35.9%), periodic limb movements of sleep three (7.7%), sleep restriction (< 6 h sleep on a regular basis) five (12.5%), and insomnia one (2.5%). Conclusions: Daytime somnolence and sleep disorders were commonly found in drivers attending the Emergency Department after accidents resulting in injury. Driver fatigue and sleep disorders should be considered as a potential contributing factor in New Zealand MVAs. Recruitment of drivers following a MVA via the Emergency Department is challenging. Strategies to improve recruitment are discussed. (Intern Med J 2002; 32: 297−304)
Advance care planning in Australia: overdue for improvement
Authors: Taylor D. McD. , Cameron P. A. 
Published: March 2003

Abstract As the population of Australia ages, the issue of advance care planning (ACP) to improve medical management towards life's end becomes more important. However, ACP appears poorly developed in Australia. This article discusses ACP and advance directives in the context of the Australian experience and compares this with the experience overseas. It highlights the need for an improvement in ACP and recommends specific areas for discussion and research. (Intern Med J 2002; 32: 475−480)
Prevention of autoimmune attack and disease progression in multiple sclerosis: current therapies and future prospects
Authors: Pender M. P. , Wolfe N. P. 
Published: March 2003

Abstract Multiple sclerosis (MS) is an important cause of progressive neurological disability, typically commencing in early adulthood. There is a need for safe and effective therapy to prevent the progressive central nervous system (CNS) damage and resultant dis­ability that characterize the disease course. Increasing evidence supports a chronic autoimmune basis for CNS damage in MS. In the present study, we review current concepts of autoimmune pathogenesis in MS, assess current therapies aimed at countering auto­immune attack and discuss potential thera­peutic strategies. Among currently available therapies, β‐interferon and glatiramer acetate have a modest effect on reducing relapses and slowing the accumulation of disability in relapsing−remitting MS. β‐­Interferon is of doubtful efficacy in secondary progressive MS and appears to aggravate primary progressive MS, poss­ibly by increasing antibody‐mediated CNS damage through inhibition of B‐cell apoptosis. Mitoxantrone may reduce relapses and slow disability progression in relapsing−remitting and secondary progressive MS, but its use is limited by the risk of cardio­myopathy. There are currently no effective treatments for primary progressive MS. Many therapies that are effective in the animal model, experimental auto­immune encephalomyelitis (EAE), are either ineffective in MS or − in the case of γ‐interferon, lenercept and altered peptide ligands − actually make MS worse. This discrepancy may be explained by the occurrence in MS of defects in immunoregulatory mechanisms, the integrity of which is essential for the efficacy of these treatments in EAE. It is likely that the development of safe, effective therapy for MS will depend on a better understanding of immunoregulatory defects in MS. (Intern Med J 2002; 32: 554−563)
Laboratory cross‐contamination of Mycobacterium tuberculosis: an investigation and analysis of causes and consequences
Authors: Poynten M. , Andresen D. N. , Gottlieb T. 
Published: March 2003

Abstract Background:  The misdiagnosis of Mycobacterium tuberculosis infection has many ramifications. These include medical and psychological implications for patients and their families and financial and public health implications for health‐care institutions. Microbiology laboratory procedures should minimize the possibility of laboratory cross‐contamination of specimens and maximize the ability to recognize a cluster of false‐positive cultures. Newer molecular typing methods provide rapid, accurate and effective means of identifying false‐positive M. tuberculosis­cultures.Aims:  To investigate a cluster of patients with positive M. tuberculosis cultures that were processed in the mycobacteriology laboratory on the same day.Methods:  Five patients’ medical records and radiology results were reviewed to determine whether the cases were epidemiologically linked and whether there was clinical suspicion of tuberculosis. Restriction fragment length polymorphism (DNA fingerprinting) was performed using repetitive elements IS6110 and pTBN12. Laboratory processing procedures were analysed.Results:  On the basis of DNA fingerprinting using IS6110, the isolates from all five patients were identical. Molecular typing using pTBN12 was performed on four of the five isolates. All four had identical patterns. There was no epidemiological link between the patients. At least three (and probably four) of the five patients were misdiagnosed with tuberculosis.Conclusion:  Microbiology laboratories should ensure that appropriate methodologies are in place to avoid cross‐contamination of specimens. Clinicians need to critically interpret any positive laboratory result, especially in an unlikely clinical setting. (Intern Med J 2002; 32: 512−519)
Dementia: an update to refresh your memory
Authors: Logiudice D. 
Published: March 2003

Abstract The number of people with dementia and cognitive impairment is predicted to rise exponentially in the future. The increasing awareness of dementia in the community has led to a better understanding of the impact of this condition on individuals, their families and their carers. There is burgeoning research in the pathogenesis of dementia, and advances have been made in pharmacological treatments for the management of symptoms, including behavioural and ­psychological disturbances. However, the mainstay of management rests in comprehensive clinical assessment, education, counselling and provision of support for those affected and their families. The present paper provides a clinical update on recent advances in diagnosis and management of the most common forms of dementia. (Intern Med J 2002; 32: 535−540)
Endoscopic ultrasound: diagnostic and therapeutic applications
Authors: Norton I. D. , Jones D. B. 
Published: March 2003

Abstract Endoscopic ultrasound (EUS) comprises several techniques of performing high‐frequency ultrasound via an endoscope placed in the gastrointestinal tract (oesophagus, stomach, duodenum and pancreaticobiliary tree and rectum). It has rapidly become an important tool in the investigation of a variety of lumenal disorders as well as locoregional staging of gastrointestinal malignancies. Needle biopsy of peri‐intestinal structures, such as lymph nodes and pancreatic masses, can also be performed under real‐time ultrasound control. To date, the utilization of this technology in Australia has been limited by cost constraints and a paucity of training opportunities.EUS continues to be a rapidly growing area in clinical gastroenterology. Recent studies continue to define its role, particularly in the loco‐regional staging of a variety of malignancies. In addition, new instruments permit tissue sampling and a variety of therapeutic manoeuvres under direct ultrasound guidance. (Intern Med J 2003; 33; 26−32)
Propanil‐resistant barnyardgrass [Echinochloa crus‐galli (L.) Beauv.] in Sri Lanka: Seedling growth under different temperatures and control
Authors: MARAMBE B. , AMARASINGHE L. 
Published: March 2003

Experiments were conducted to (i) evaluate the efficacy of propanil formulations available in Sri Lanka in controlling Echinochloa crus‐galli; (ii) study the seedling growth of propanil‐resistant (R) and ‐susceptible (S) biotypes of the weed under different temperatures; (iii) quantify the level of resistance in R biotypes and; (iv) to suggest alternative control measures for R biotypes. Field studies showed that retail propanil formulations (36% a.i., EC) applied at 2.7 kg a.i. ha−1 gave less than 30% control of E. crus‐galli collected from several locations of the north dry zone of Sri Lanka. Chemical analysis revealed that there was no adulteration of propanil formulations at the retailer level. Growth studies conducted in controlled environments indicated that per cent germination and seedling growth of R and S biotypes were similar at the day/night temperature regimes imposed. However, per cent germination for plants grown under a 34/31°C (day/night) regime was 27–29% higher compared to those grown at 28/24°C. At the higher temperature regime, R and S biotypes reached the 2–3 leaf stage five days earlier, and the 4–5 leaf stage seven days earlier.The ED50 values from the dose–response experiments indicated that the R biotype was four times more resistant to propanil than susceptible ones. The resistance index (RI) did not vary significantly under different temperature regimes. Quinclorac (25% a.i., SC) applied at 200 g a.i. ha−1 and bispyribac‐sodium (10% a.i., SC) applied at 30 g a.i. ha−1 (recommended dosages) successfully controlled propanil‐resistant biotypes of E. crus‐galli. Conversely, oxadiazon and propanil (8% and 23% a.i., EC, respectively) applied at 280 + 805 g a.i. ha−1 did not result in satisfactory control.
Retracted: Combination of granisetron and droperidol for the prevention of vomiting after paediatric strabismus surgery
Authors: Fujii Yoshitaka , Saitoh Yuhji , Tanaka Hiroyoshi , Toyooka Hidenori 
Published: March 2003

SummaryThis study was undertaken to compare the efficacy of granisetron plus droperidol with each antiemetic alone for the prevention of vomiting after paediatric strabismus surgery. In a prospective, randomized, double‐blinded trial, 120 ASA physical status I children, aged 4–10 years, received granisetron 40 μg.kg− 1, droperidol 50 μg.kg− 1, granisetron 40 μg.kg− 1 plus droperidol 50 μg.kg− 1 (n=40 of each) intravenously after an inhalation induction of anaesthesia. A complete response, defined as no vomiting, no retching and no need for another rescue antiemetic medication, during 0–3 h after anaesthesia was 80% with granisetron, 45% with droperidol and 98% with granisetron plus droperidol, respectively; the corresponding incidence during 3–24 h after anaesthesia was 78%, 38% and 98% (P< 0.05; overall chi‐squared test with Yates continuity correction). No clinically important adverse events were observed in any of the groups. In conclusion, a combination of granisetron and droperidol was more effective than granisetron or droperidol as a sole antiemetic for the prevention of postoperative vomiting in children undergoing strabismus repair.
Prediction of difficult airway in school‐aged patients with microtia
Authors: Uezono Shoichi , Holzman Robert S. , Goto Takahisa , Nakata Yoshinori , Nagata Satoru , Morita Shigeho 
Published: March 2003

Background: Because the ear and mandible develop from the first and second branchial arches and first branchial cleft, abnormalities of the ear may be a sign that intubation will be difficult. We hypothesized that children with microtia would have a greater incidence of difficult laryngeal visualization with conventional rigid laryngoscopy compared to those with normal facial anatomy. Methods: We enrolled 93 consecutive school‐aged patients with microtia undergoing the first stage of total reconstruction of the auricle. Age‐matched patients with normal facial anatomy served as controls. Each patient was examined for the presence or absence of the five dysmorphic features of hemifacial microsomia: orbital asymmetry, mandibular hypoplasia, ear deformity, nerve involvement, soft tissue deficiency (OMENS classification). After a standardized induction of anaesthesia, the laryngeal view during rigid laryngoscopy was graded. Results: The incidence of difficult laryngeal view was 42% in the patients with bilateral microtia, 2% in those with unilateral microtia and 0% in the controls. Conclusions: There was a strong positive correlation between the number of involved abnormal anatomical components according to the OMENS classification and the degree of difficult visualization of the larynx in patients with both bilateral and unilateral microtia (Spearman rank order correlation coefficient=0.85 and 0.88, respectively).
Pain management in children with and without cognitive impairment following spine fusion surgery
Authors: Malviya Shobha , Voepel‐Lewis Terri , Tait Alan R. , Merkel Sandra , Lauer Anthony , Munro Hamish , Farley Frances 
Published: March 2003

Background: We compared pain assessment and management practices in children with and without cognitive impairment (CI) undergoing spine fusion surgery. Methods: The medical records of 42 children (19 with CI and 23 without) were reviewed and data related to demographics, surgery, pain assessment and management, and side‐effects were recorded. Results: Fewer children with CI were assessed for pain on postoperative days (POD) 0–4 compared to those without CI (P < 0.002). Self‐report was used for 81% of pain assessments in children without CI, while a behavioural tool was used for 75% of assessments in cognitively impaired children. Children with CI received smaller total opioid doses on POD 1–3 compared to those without CI (P ≤ 0.02). Furthermore, children without CI received patient/nurse‐controlled analgesia for more postoperative days than children with CI (P=0.02). Conclusions: Our data demonstrate a discrepancy in pain management practices in children with and without CI following spine fusion.
Side‐effects after inhalational anaesthesia for paediatric cerebral magnetic resonance imaging
Authors: SANDNER‐KIESLING ANDREAS , SCHWARZ GERHARD , VICENZI MARTIN , FALL ASTRID , JAMES ROBERT L. , EBNER FRANZ , LIST WERNER F. 
Published: March 2003

Background: The aim of this study was to evaluate the type, incidence and duration of postprocedure side‐effects in 168 children within the first 72 h after inhalational anaesthesia for magnetic resonance imaging (MRI).Methods: Premedication and induction followed standardized routines. Maintenance of anaesthesia was performed with inhalational anaesthetics solely: isoflurane (n=60 of 112; 53%), sevoflurane (n=32 of 112; 29%), desflurane (n=12 of 112; 11%) or halothane (n= 8 of 112; 7%) using a strapped on face mask (FiO2=0.4; flow 5 l·min–1). When indicated, gadolinium was administered (n=45; OF 112; 40%).Results: One hundred and twelve of 168 parents (67%) responded to questionnaires. In these 112 children, pathological MR findings were found supratentorially (n=31; 28%), infratentorially (n=9; 8%), extracerebrally (n=12; 11%) or combined (n=9; 8%). In 56 of these 112 children (50%), 14 different side‐effects were reported. One hour after anaesthesia, 55 children suffered between one and four side‐effects. Neurological side‐effects were associated with age ≥ 5 years (P < 0.01) or infratentorial pathophysiology (P < 0.01) and abdominal side‐effects (P < 0.02), especially nausea (P < 0.001) with age ≥ 5 years.Conclusions: Our findings indicate the need to inform parents of the incidence and variability of side‐effects after inhalational anaesthesia for minimally invasive, diagnostic procedures, such as MRI.
Unconscious sedation in children: a prospective multi‐arm clinical trial
Authors: Bauman Loren A. , Cannon Michael L. , McCloskey John , Allen Sharon , James Robert L. , Tobin Joseph R. , Politis George D. 
Published: March 2003

Summary Background: We report the evaluation of six sedative‐hypnotic and analgesic combinations administered to children undergoing brief periods of unconscious (or deep) sedation for painful procedures. Methods: In a prospective, open‐label, randomized, controlled study of six groups of 27–30 children each, patients were randomly assigned to receive propofol or methohexital for sedation‐hypnosis, and one of three incremental doses of fentanyl or remifentanil, respectively. Results: An infusion of methohexital (10 mg·ml−1) combined with remifentanil (6.67 µg·ml−1) provided significantly shorter geometric mean times to initial emergence, to eye‐opening and to discharge, and required airway interventions that were not significantly more frequent than all groups sedated with propofol and fentanyl. Conclusions: The combination of methohexital and remifentanil appears to be a satisfactory method for unconcious sedation for short painful procedures in children.