bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case of pseudotumorous pancreatitis that presented unique pancreatoscopic findings with the peroral electronic pancreatoscope
Authors: KODAMA TADASHI , ABE MITSUMASA , SATO HIDEKI , IMAMURA YOICHI , KOSHITANI TATSUYA , KATO KEIMEI , UEHIRA HIROSHI , YAMANE YUKIO , HORII YOSHIYUKI , YAMAGISHI MARIKO , YAMAGISHI HISAKAZU 
Published: March 2003

Abstract  A 49‐year‐old man was admitted to Hospital of Kyoto Prefectural University of Medicine complaining of epigastralgia and jaundice. There was a tumor (approximately 30 mm) in the pancreatic head on ultrasound, computed tomography and magnetic resonance imaging. Endoscopic retrograde cholangiopancreatography revealed a stenosis of the main pancreatic duct in the head of the pancreas. Pancreatoscopy with the peroral electronic pancreatoscope (PEPS) was performed to differentiate between pseudotumorous pancreatitis (PTP) and pancreatic carcinoma. The PEPS showed non‐erosive erythematous mucosa around the stenosis and this unique finding was different from that of pancreatic carcinoma. Pylorus‐preserving pancreatoduodenectomy was performed under the possible diagnosis of carcinoma. As a result, the diagnosis of PTP was confirmed histopathologically. At present, the diagnosis of PTP is difficult because of similar findings with carcinoma in various imaging procedures. However, we consider that detailed observation and accurate morphologic assessment of the main pancreatic duct with the PEPS has the possibility of differentiating PTP from pancreatic carcinoma.© 2003 Blackwell Publishing Asia Pty Ltd
Impaired gallbladder mucosal function in aged gallstone patients suppresses gallstone recurrence after successful extracorporeal shockwave lithotripsy
Authors: TAZUMA SUSUMU , NISHIOKA TOMOJI , OCHI HIDENORI , HYOGO HIDEYUKI , SUNAMI YASUSHI , NAKAI KUNIHARU , TSUBOI KAZUHIKO , ASAMOTO YASUMASA , SAKOMOTO MINORU , NUMATA YOSHIHIRO , KANNO KEISHI , YAMAGUCHI ATSUSHI , KOBUKE TOSHIYA , KOMICHI DAISUKE , NONAKA YOSHIHIRO , CHAYAMA KAZUAKI 
Published: March 2003

AbstractBackground:  Absorption of water, as well as emptying of bile, are important functions of the gallbladder. We studied the changes of gallbladder function with age in gallstone patients and their influence on the outcome of extracorporeal shockwave lithotripsy (ESWL).Methods:  (i) A total of 123 consecutive patients with complete stone clearance by ESWL were examined. Gallbladder emptying was assessed before treatment using intravenous cholecystography. After stone clearance, the recurrence of gallstones was monitored by using ultrasonography. Cox regression analysis was used to determine the risk factors associated with stone recurrence. (ii) Gallbladder bile was sampled from 59 gallstone patients during surgery. Biliary cholesterol, phospholipids, and total bile acids were simultaneously quantified by using gas–liquid chromatography.Results:  Impaired gallbladder function, but not gallstone recurrence, was more frequently observed in older patients (≥65 years old) than in younger patients (<65 years old). Cox regression analysis revealed that poor gallbladder emptying was an independent predictor of stone recurrence after ESWL in the total study population, but not in the older patients (≥65 years old). Analysis of bile from surgically treated patients with cholesterol stones showed a significantly higher total lipid concentration and a shorter nucleation time in the younger group (<65 years old), but the cholesterol saturation index did not differ between the younger and older groups.Conclusions:  Our data suggest that the reduced concentrating function of the gallbladder in elderly gallstone patients helps to counteract stone recurrence despite their abnormal gallbladder motility. Therefore, aged gallstone patients may be preferentially treated by a non‐surgical strategy.
End tidal carbon monoxide concentration in childhood haemolytic disorders
Authors: CHAN GCF , LAU YL , YEUNG CY 
Published: March 2003

Objectives:Endogenous carbon monoxide (CO) is produced mainly by heme catabolism. As CO is excreted solely by the lung, a simple technique for measuring the end tidal carbon monoxide (ETCO) level was assessed as a method for screening for haemolytic disease in children.Methods:Two end expiratory breath samples were collected from normal children and from children with haemolytic disease using a one way valve connector between a mouth piece and an anaesthetic bag. The samples were analysed by gas chromatography for CO and carbon for dioxide (CO2). The CO2 value was used to normalise the CO value to an alveolar concentration. Carboxyhaemoglobin (HbCO) also was measured in the patient group for correlation analysis with ETCO.Results:A total of 21 children with β thalassaemia major, 15 children with other haemolytic diseases (hereditary spherocytosis n=8, haemoglobin H disease n=3 and thalassaemia intermedia n=4) and 23 normal children were studied. The mean ETCO concentrations in the three groups were 3.21 p.p.m., 7.41 p.p.m. and 0.69 p.p.m., respectively, which were significantly different from each other (P<0.0001). There was a significant correlation between ETCO and HbCO in the patient groups (r=0.85; P<0.0001).Conclusions:The end expiratory breath collection device is a simple and feasible sample collection method. The results confirm that ETCO can be used clinically to distinguish children with a variety of haemolytic disorders from normal subjects.
Predischarge screening of very low birthweight infants by click evoked otoacoustic emissions
Authors: GILL AW , GOSLING D , KELLY C , WALKER P , WOODERSON S 
Published: March 2003

Objective:To evaluate the role of transient evoked otoacoustic emission (TEOAE) in screening very low birthweight (VLBW) neonatal intensive care unit (NICU) graduates for hearing loss in comparison with visual reinforcement orientation audiology (VROA) at 10 months.Methodology:The study population was all VLBW neonatal survivors discharged from a single regional NICU at John Hunter Childrens Hospital (JHCH), Newcastle, New South Wales, Australia, between April 1994 and March 1996. A TEOAE screen was performed prior to discharge and repeated if necessary until a pass was obtained in at least one ear. Infants were further screened by VROA at their local Australian Hearing Services (AHS) office at 10 months corrected age. Repeated TEOAE failures were referred directly for an ENT opinion. Results: A total of 193 infants were eligible for enrolment during the study period. One hundred and forty‐four (75%) received TEOAE testing. The median age of first screen was 36 weeks gestational age. Ninety‐five (66%) of infants tested passed on a single screen. Of the remaining 49 infants, 26 passed on retesting (overall pass rate 84%). Twenty‐three (16%) were deemed to have failed the TEOAE screen. Of the 121 infants who passed TEOAE, only 67 (55%) completed VROA. Two of these infants have a high frequency sensorineural loss and one of them has been aided. In the 23 who failed TEOAE, nine have subsequently had normal VROA, another, though not tested is clinically normal. three have hearing loss with middle ear disease and eight have confirmed sensorineural deafness, all aided. One infant has died and an infant with Down’s syndrome has been adopted out of the area. It is of interest to note that the eight aided infants are all of less than 28 weeks gestation. If we restrict analysis to infants with completed VROA testing, the TEOAE has a 97% negative predictive value for sensorineural deafness and a 38% positive predictive value.Conclusions:This study has highlighted both the prevalence of hearing impairment in the very premature survivors and difficulties in compliance with a VROA based hearing screen. We see an advantage in directing resources towards an early screening test, such as TEOAE, that can be applied while the target population is still captive.
Do children need to be monitored after electric shocks?
Authors: WILSON CM , FATOVICH DM 
Published: March 2003

Objective:To determine whether cardiac monitoring is required in children sustaining electric shock at Australian household voltage.Methodology:Records of patients admitted via the Emergency Department of Princess Margaret Hospital for Children, Perth, Australia, for the period 1968–96 were retrospectively reviewed. The initial ECG findings of patients with an electric shock were recorded, and the development of any arrhythmia.Results:Forty‐four patients were identified, 40 of whom had sustained a household electrical injury. One patient had an abnormal ECG on admission, none developed an arrhythmia and all survived.Conclusions:Routine cardiac monitoring is not required after exposure to Australian household electricity supply if the child is asymptomatic and has a normal ECG on presentation.
Effect of nappy liners on temperature stability in very preterm infants
Authors: Monterosso L , Percival P , Cole J , Evans SF 
Published: March 2003

Objective: To determine whether absorbent liners used in posturally supportive cloth nappies influence temperature stability in infants < 31 weeks gestation. Methodology: Randomized cross‐over trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Twenty‐three infants nursed in incubators on Infant Servo Control were randomly assigned to wear cloth postural support nappies alternately with or without absorbent liners for 24‐h periods over 4 days. Measurements of skin and incubator temperatures were recorded hourly. Times of all nappy changes and infant handling procedures were also recorded. Results: There was no change in any temperature measurement over time, between days, or between day/night periods. Infants nursed with the liner demonstrated a higher skin temperature (0.04°C), and a lower incubator temperature (1.05°C). A drop in skin temperature of 0.02°C and an increase in incubator temperature of 0.28°C occurred following handling of infants. There was no effect due to sex, gestational age, or actual age of the infants. Conclusion: Use of an absorbent liner within a cloth postural support nappy promotes better temperature regulation in infants < 31 weeks gestation, by reducing incubator temperature and increasing skin temperature.
Immunization coverage of Australian‐born children of Arabic‐speaking background in Central Sydney
Authors: Karr M , Mira M , Alperstein G , Labib S 
Published: March 2003

Objectives: To examine the immunization coverage rates of 12–36‐month‐old Australian‐born children from an Arabic‐speaking background in Central Sydney as determined by parental report and documentary evidence. Methodology: Eligible children were identified by examination of the records of five hospitals. Eligibility criteria were that the mother gave an Arabic speaking country of birth and a Central Sydney post code (as her place of residence) and the child was born between 1 May 1994 and 30 April 1996. Parents of all eligible children were invited to participate, either by a special appointment to answer a structured questionnaire, or by telephone survey. Of the 1157 eligible children identified from hospital birth records, only 641 could be contacted, of whom 584 (91.1%) agreed to participate. Full information on age appropriate immunization rates, as reported by parents and documented in records, could be assessed for 403 children. Results: Parents reported that 97.6% of children were fully immunized. When the child’s immunization status could be verified from either the child’s personal health record and/or the service provider, the rate of full, age‐appropriate immunization was 94.3% (95% confidence intervals 92.0–96.6) compared to a parent‐reported rate of 98.0%. General practitioners provided 76.2% of immunizations. Conclusion: While a substantial proportion of children identified from birth records could not be contacted, comparisons with census data and other analyses indicate that this sample is likely to be representative of the general population of 12–36‐month‐old Australian‐born children from an Arabic‐speaking background. This group appeared to be highly immunized. Further studies examining why the rates for this ethnic group are high in Central Sydney may determine strategies which will enhance immunization rates in other communities.
Risk of hepatitis C virus infection in multiply transfused premature neonates
Authors: Beeby PJ , Spencer JD , Cossart YE 
Published: March 2003

Background: Reports from around the world indicate that multiply transfused patients are at increased risk of hepatitis C virus (HCV) infection, with reported rates of between 4% and 44%. Such reports are mostly of haematological and renal patients. As recipients of blood products in the newborn period, premature infants share this risk, but there is little information regarding their risk. Aim: To assess the risk of HCV infection in children who, as premature neonates, received multiple blood products prior to the introduction of screening of donated blood for HCV. Methods: Premature infants born between January 1985 and January 1990 who had attended our high‐risk follow‐up clinic were selected on the basis of the number of transfusions of blood, platelets or fresh frozen plasma they received in the newborn period. Ethical approval to offer HCV testing to parents was obtained from the Central Sydney Area Health Service Ethics Review Committee. Parents of infants who received three or more transfusions were then contacted by mail with the approved letter explaining the study, and offered HCV testing. Detection of anti‐HCV antibodies was undertaken using second, and later third generation enzyme immunoassay kits. Samples which were found to be ‘indeterminate’ were tested using a Wellcozyme HCV western blot assay (Murex Diagnostics Ltd, Datford, UK). Hepatitis C virus–ribonucleic acid (RNA) was detected using an ‘in‐house’ polymerase chain reaction (PCR) assay. Alanine transaminase (ALT) was also measured, with values above 55 U/L considered abnormal. Results: Consent was obtained for 45 children (25 males, 20 females). The mean (± SEM) gestational age and weight of the children at birth was 26.7 ± 0.2 weeks and 938 ± 27 g, respectively. The children received 198 transfusions of blood products, an average of 4.4 U per child. All of the infants except for one were negative for anti‐HCV antibodies. One infant was ‘indeterminate’ (low positive on third generation test but negative on second generation test), but proved negative subsequently on both western blot and PCR testing. HCV–RNA was not detected in any of the infants on PCR testing. All of the samples had normal ALT values, the mean being 16 U/L (range 8–52). Conclusion: None of the children consenting to this study had evidence of current HCV infection. Because of the sample size, we were not able to estimate the true risk of infection from this study, except that the upper limit for the risk is about 1/200 per transfused blood sample.
Abolishing the bag: A quality assurance project on urine collection
Authors: Greaves J , Buckmaster A 
Published: March 2003

Objective: To audit practice in diagnosis of urinary tract infection (UTI) and implement a protocol to reduce the number of falsely diagnosed or missed UTI in febrile children. Methodology: Data were obtained from the microbiology database on the number of urine samples collected for culture, the methods of collection and the culture results over a 3 month period. Using these data and published evidence, a protocol was developed for the collection of urine in febrile children. An education program was instituted which included the adoption of the protocol. Further data were collected and compared with those obtained before the program. Results: Total urine samples sent for culture decreased from 219 in 1998 to 143 in 1999. The percentage collected by bag fell from 60% (n = 132) to 14% (n = 20). The number of definite UTI diagnosed was 15 in both time periods. The number of children given antibiotics before an appropriate sample could be collected fell from nine to two for the respective 3‐month periods. Conclusions: Through the development of a new protocol, its introduction and an education program, a change in management was effected and a reduction in the chance of missed or mistaken diagnosis of UTI occurred.
Clinical correlates of response to pneumococcal immunization
Authors: Akikusa JD , Kemp AS 
Published: March 2003

Objective: The inability to form antibodies to polysaccharide antigens may occur as a part of a more significant immunodeficiency or as an isolated defect. The latter has been reported in some children with recurrent upper and lower respiratory tract infections and evaluation of the responsiveness of such patients to polysaccharide antigens is indicated as part of their assessment. The present study evaluated the pattern of antibody responses of patients immunized with pneumococcal vaccine as part of the investigation of recurrent upper and lower respiratory tract infections to determine if any correlation exists between these responses and clinical presentation. Methodology: An analysis was performed of antibody responses to pneumococcal serotypes 3, 4 and 6 following immunization with a 23‐valent vaccine in 42 children with normal IgG levels who were evaluated for recurrent infections. Antibody responses were assessed in relation to clinical features and the results of other immunological investigations. Results: Of the 42 patients evaluated, 25 (59%) were responders to all serotypes tested. Failure to respond to serotype 3 alone was the least common pattern of non‐response. Recurrent pneumonia, but not otitis media with discharge or chronic productive cough, was significantly associated with a lack of response to two or three serotypes. Failure to respond to serotype 3 alone or in combination with other serotypes was associated with more significant immune abnormalities. Conclusion: In a selected population of children with recurrent bacterial infections, pneumococcal serotype 3 is a strong immunogen. In this clinical group recurrent pneumonia is associated with a defect in response to multiple pneumococcal serotypes.
Chest physiotherapy and porencephalic brain lesions in very preterm infants
Authors: Knight DB , Bevan CJ , Harding JE , Teele RL , Kuschel CA , Battin MR , Rowley RSH 
Published: March 2003

Objective: National Women’s Hospital is one of two hospitals to report a destructive brain lesion, namely encephaloclastic porencephaly (ECPE), in extremely preterm infants. It has been associated with non‐cephalic presentation, early hypotension and the number of chest physiotherapy treatments in the first month. The aim of the present study was to determine the temporal relationship between ECPE and chest physiotherapy use in very low‐birth weight (VLBW) infants in our unit. Methodology: Cerebral ultrasound scan reports, post‐mortem reports, clinical and physiotherapy records and, if indicated, original ultrasound films were reviewed for all VLBW babies admitted between 1985 and 1998. Results: Over the 14 year period in question, 2219 babies with a birth weight ≤ 1500 g were admitted. Encephaloclastic porencephaly was found in only the 13 previously reported babies born between 1992 and 1994. Encephaloclastic porencephaly was excluded in 1564 (70%) babies. In 621 (28%) babies who did not have late ultrasound scans, ECPE was thought to be unlikely either because the babies never had any chest physiotherapy (n = 479) or because they had chest physiotherapy but were known to be neurodevelopmentally normal on follow up (n = 142). Data were incomplete for 21 babies (0.9%). The number of chest physiotherapy treatments per baby decreased from a median of 95 prior to 1989 to 38 and the age of starting treatment increased from 5 to 8 days after 1990. The use of chest physiotherapy ceased in 1995. Conclusions: Encephaloclastic porencephaly emerged as a problem at a time when the use of chest physiotherapy had decreased. The cluster of cases seen between 1992 and 1994, although associated with the number of chest physiotherapy treatments given, began to appear because of some other factor.
Introduction of a conjugate meningococcal type C vaccine programme in the UK
Authors: Salisbury D 
Published: March 2003

Objective: The purpose of the UK initiative was to accelerate the development and introduction of new conjugate meningococcal C vaccine into the routine immunisation programme, and to implement a catch‐up campaign based on the disease epidemiology. Methodology: Collaboration between Government supported institutions and the vaccine industry lead to a collaborative programme of research designed to answer policy specific questions and to accelerate the availability of new vaccines. Results: Three new conjugate meningococcal C vaccines were developed and licensed for use in the UK after satisfactory data on safety and immunogenicity had been generated. A nationwide campaign was designed to offer vaccine to all infants at the same time as their three doses of primary immunisations, two doses were offered to children over 4 months and under 1 year old; all those over 1 and under 18 years old were offered a single dose of vaccine. The programme was on course for completion within approximately twelve months, with around 15 million immunisations being offered. The programme was implemented simultaneously through school and primary care services. Conclusions: A safe and effective new vaccine, against group C meningococcal disease, has been introduced into the UK immunisation programme after just a 5 year development to implementation process. Early indications point to high coverage and impacts on disease are already apparent in the groups that have been immunised. These vaccines may play an equally important role in other countries where there is a significant burden from Group C meningococcal disease.
Regional and urban Victorian diabetic youth: Clinical and quality‐of‐life outcomes
Authors: Cameron FJ , Clarke C , Hesketh K , White EL , Boyce DF , Dalton VL , Cross J , Brown M , Thies NH , Pallas G , Goss PW , Werther GA 
Published: March 2003

Objectives:  To compare groups of urban and regional Victorian diabetic children and assess their quality of life, diabetes knowledge, access to services and metabolic control.Methods:  Forty‐seven children from three regional Victorian communities (Horsham, Warrnambool and Sale; n = 16, 18 and 13, respectively) were compared with 120 age‐, sex‐ and duration of diabetes‐matched children attending the Royal Children's Hospital (RCH) diabetes clinic in Melbourne. Quality of life, diabetes knowledge, use of services, and metabolic control were assessed using the child health questionnaire (CHQ PF‐50/CF‐80); a diabetes‐knowledge questionnaire; access to a diabetes nurse educator (DNE), dietitian and complication screening; and indices of mean HbA1C (values are taken every 3 months in the ‘yearly HbA1C’), respectively.Results:  Comparisons of CHQ data showed that regional diabetic youth scored significantly lower on most subscales. The greatest deficits were seen in areas of mental health, self‐esteem, parent impact (emotional) and family cohesion. Diabetes knowledge and median yearly HbA1C for patients were not significantly different between the regional and urban centres (8.1%, 8.9%, 8.4% and 8.6% at RCH, Horsham, Warrnambool and Sale, respectively). Patients in regional centres had reportedly less access to team‐based diabetes care.Conclusions:  Regional youth in Victoria, with similar levels of metabolic control and diabetes knowledge as their urban counterparts, have a markedly lower quality of life, implying a negative synergy between diabetes and the demands of regional lifestyles.