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1.J Pediatr Surg. 2005

1.j pediatr surg. 2005 aug;40(8):125868. atresia of the colon. etensel b, temir g, karkiner a, melek m, edirne y, karaca i, mir e
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1.J Pediatr Surg. 2005 Aug;40(8):125868.
Atresia of the colon.
Etensel B, Temir G, Karkiner A, Melek M, Edirne Y, Karaca I, Mir E.
METHODS: We reviewed the charts of CA cases treated in our center
between 1992 and 2002. We aimed to collect all reported cases in
Medline, and personal communications with the authors of published
series were used to reach the missing data. RESULTS: The chart review
revealed 9 newborns with CA treated in our center (6 cases of type
III, 2 cases of type II, and 1 case of type IV). These accounted for
3.7% of all gastrointestinal atresias managed in our center. Of the CA
cases, 3 were isolated and 6 had at least one or more associated
congenital anomalies. The preferred surgical technique at the initial
treatment of CA was performing a proximal stoma and distal mucous
fistula in an average of postnatal 59.4 hours. The literature survey
enabled us to reach 224 cases of CA, including our cases.
2.Arq Gastroenterol. 2004 JulSep;41(3):1626. Epub 2005 Jan 21.
Oxygen desaturation of patients submitted to endoscopic retrograde
cholangiopancreatography under conscious sedation.
Muller S, Prolla JC, Maguilnik I, Breyer HP.
PATIENTS AND METHODS: A total of 186 patients were monitored with
continuous pulse oximetry. Poisson regression was used to measure the
independent effect of each factor adjusted for effects of each of the
other factors. The variables studied were: age, gender, hematocrit and
hemoglobin levels, scopolamine use, diagnostic or therapeutic exam,
American Society of Anesthesiologists Scores (ASA), duration time of
exam, sedative used midazolam in the average of 0.07 mg/kg and
analgesic drug meperidine in the average of 0.7 mg/kg that was
titrated according patients reaction. RESULTS: No desaturation was
found in 113 (60.8%) patients, mild desaturation (SpO2 60 years old and ASA score
III. The duration of exam was barely significant for desaturation.
3. J Clin Microbiol. 2005 Aug;43(8):363641.
 Etiology of diarrhea in young children in denmark.
Olesen B, Neimann J, Bottiger B, Ethelberg S, Schiellerup P, Jensen C,
Helms M, Scheutz F, Olsen KE, Krogfelt K, Petersen E, Molbak K,
GernerSmidt P.
Infectious gastroenteritis is one of the most common diseases in young
children. To clarify the infectious etiology of diarrhea in Danish
children less than 5 years of age, we conducted a 2year prospective
casecontrol study. Stools from 424 children with diarrhea and 870
asymptomatic agematched controls were examined, and their parents
were interviewed concerning symptoms. Rotavirus, adenovirus, and
astrovirus were detected by enzymelinked immunosorbent assay, and
norovirus and sapovirus were detected by PCR. Salmonella,
thermotolerant Campylobacter, Yersinia, Shigella, and Vibrio spp. were
detected by standard methods. Shiga toxinproducing (STEC),
attachingandeffacing (A/EEC), enteropathogenic (EPEC),
enterotoxigenic, enteroinvasive, and enteroaggregative Escherichia
coli were detected by using colony hybridization with virulence gene
probes and serotyping. Parasites were detected by microscopy. Overall,
a potential pathogen was found in 54% of cases. More cases than
controls were infected with rotavirus, Salmonella, norovirus,
adenovirus, Campylobacter, sapovirus, STEC, classical EPEC, Yersinia,
and Cryptosporidium strains, whereas A/EEC, although common, was not
associated with illness. The single most important cause of diarrhea
was rotavirus, which points toward the need for a childhood vaccine
for this pathogen, but norovirus, adenovirus, and sapovirus were also
major etiologies. Salmonella sp. was the most common bacterial
pathogen, followed by Campylobacter, STEC, Yersinia, and classical
EPEC strains. A/EEC not belonging to the classical EPEC serotypes was
not associated with diarrhea, underscoring the importance of
serotyping for the definition of EPEC.
4. Eur J Epidemiol. 2005;20(5):4119.
Factors of noncompliance with the therapeutic regimen among
hypertensive men and women.
Baune BT, Aljeesh Y, Bender R.
Strip among 112 patients, who had been hospitalized for acute stroke
and history of hypertension, and 224 controls with history of
hypertension. Conditional logistic regression models show significant
associations between stroke and medication not taking as prescribed
(OR 6.07; 95% CI: 1.53, 24.07), using excessive salt at meals (OR
4.51; 95% CI: 2.05, 9.90), eating diet high in fat (OR 4.67; 95% CI:
2.09, 10.40), and high level of stress (OR 2.77; 95% CI: 1.43,
5.38). No significant association between smoking and the development
of stroke (OR 2.12; 95% CI: 0.82, 5.51) was found. Regular physical
exercise was a protective factor (OR0.26; 95% CI: 0.12, 0.57). Using
excessive salt at meals was a significant risk factor (OR 16.61; 95%
CI: 4.40, 62.80) in people having low level of stress, whereas it was
not significant in people having high level of stress. (OR 1.76; 95%
CI: 0.58, 5.33). Smoking in combination with low level of stress was a
significant risk factor for stroke (OR 9.88; 95% CI: 2.52, 38.78),
but a nonsignificant protective factor in combination with high level
of stress (OR0.52; 95% CI: 0.14, 1.99). An increase in compliance
with the pharmacological and nonpharmacological therapeutic regimen
might be a key to a reduction of stroke incidence and prevalence among
hypertensive patients.
5. J Rheumatol. 2005 Aug;32(8):158993.
Ibuprofen may abrogate the benefits of aspirin when used for secondary
prevention of myocardial infarction.
Hudson M, Baron M, Rahme E, Pilote L.
METHODS: In this population based, retrospective cohort study using
governmental databases, patients >/ 66 years of age, hospitalized for
an index acute myocardial infarction (AMI) between January 1992 and
March 1999 and taking ASA throughout the period of followup were
identified. The main exposure was the concomitant use of ibuprofen and
ASA after the index AMI. The outcome of interest was recurrent AMI.
Subjects were followed to one year after the index AMI. RESULTS: A
total of 18,503 patients met the study entry criteria. Of these, 372
patients were dispensed a prescription for ibuprofen (exposed) and
14,424 patients were not dispensed a prescription for any nonsteroidal
antiinflammatory drug (NSAID) (unexposed). Patients dispensed
prescriptions for any NSAID (n 4079), naproxen (n 1239), and
diclofenac (n 1474) were analyzed separately. There was a trend to
an increase in the rate of recurrent AMI in patients taking ibuprofen
and ASA compared to those taking ASA alone as the duration of exposure
increased [hazard ratios for ever, >/ 30 days, and >/ 60 days
exposed were 1.01 (95% CI 0.581.76), 1.13 (95% CI 0.542.39), and
1.83 (95% CI 0.764.42), respectively]. In contrast, subjects taking
prolonged naproxen and ASA had a trend toward a lower rate of
recurrent AMI compared to those taking ASA alone. CONCLUSION: The
results are consistent with data that suggest that regular, but not
intermittent, ibuprofen may abrogate the benefits of aspirin when used
for the secondary prevention of AMI. There may be differences in the
risk of heart disease with various NSAID.
6. Prev Med. 2005 Aug 1; [Epub ahead of print]
 Influence of lifestyle, health, and work environment on smoking
cessation among Danish nurses followed over 6 years.
Sanderson DM, Ekholm O, Hundrup YA, Rasmussen NK.
METHODS.: Data derive from the Danish Nurse Cohort Study; a
prospective cohort established in 1993 when all Danish female nurses
45+ years old and members of the Danish Nurses Association were mailed
a questionnaire. The cohort was followed up 6 years later in 1999. In
total, 12,980 responded to questions concerning smoking status in both
the 1993 and 1999 surveys. This study deals with the 4713 women (36%)
who reported smoking at baseline. Smoking cessation was based on
selfreport. RESULTS.: At followup in 1999, 24% reported that they no
longer smoked. Low prior tobacco consumption at baseline, high fresh
fruit consumption, high blood pressure, working day shifts, having low
physical job strain, perceiving influence on one's own work, and
partner's socioeconomic status (as measured by most recent
occupation) were associated with successful smoking cessation.
CONCLUSION.: The findings from this study highlight the importance of
various factors, including lifestyle, health status, and aspects of
one's work environment, on successful efforts at smoking cessation.
7. Clin Cancer Res. 2005 Apr 1;11(7):264450.
 A biologic study of thrombopoietin and granulocyte colonystimulating
factor in children receiving ifosfamide, carboplatin, and etoposide
chemotherapy for recurrent or refractory solid tumors: a Children's
Oncology Group experience.
Angiolillo AL, Davenport V, Bonilla MA, van de Ven C, Ayello J,
Militano O, Miller LL, Krailo M, Reaman G, Cairo MS; Children's
Oncology Group.
EXPERIMENTAL DESIGN: Children received ifosfamide 1,800 mg/m2 on days
0 to 4, carboplatin 400 mg/m2 on days 0 to 1, and etoposide 100 mg/m2
on days 0 to 4. rhTPO was administered i.v. on days +4, +6, +8, +10,
and +12 at 1.2, 2.4, or 3.6 microg/kg per dose.RESULTS: rhTPO was well
tolerated and maximum tolerated dose was not reached. Median time to
platelet recovery > or 100,000/microL of rhTPO at 1.2, 2.4, and 3.6
microg/kg/d was 24 days (2224 d), 25 days (2329 d), and 22 days
(1637 d), respectively. Patients required a median of 2 days of
platelet transfusions (07 days). Mean (+/ SD) rhTPO maximum serum
concentrations were 63.3 +/ 9.7 and 89.3 +/ 15.7 ng/mL and terminal
halflives were 47 +/ 13 and 64 +/ 42 hours after 2.4 and 3.6
microg/kg/d, respectively. There was a significant increase in
colonyforming unit megakaryocyte upon WBC count recovery.
CONCLUSIONS: rhTPO was well tolerated. Time to hematologic recovery
and median number of platelet transfusions seem to be improved
compared with historical controls receiving ICE + granulocyte
colonystimulating factor.
8. N Engl J Med. 2000 Jul 13;343(2):1005.
Indications for computed tomography in patients with minor head
injury.
Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM.
METHODS: In the first phase of the study, we recorded clinical
findings in 520 consecutive patients with minor head injury who had a
normal score on the Glasgow Coma Scale and normal findings on a brief
neurologic examination; the patients then underwent CT. Using
recursive partitioning, we derived a set of criteria to identify all
patients who had abnormalities on CT scanning. In the second phase,
the sensitivity and specificity of the criteria for predicting a
positive scan were evaluated in a group of 909 patients. RESULTS: Of
the 520 patients in the first phase, 36 (6.9 percent) had positive
scans. All patients with positive CT scans had one or more of seven
findings: headache, vomiting, an age over 60 years, drug or alcohol
intoxication, deficits in shortterm memory, physical evidence of
trauma above the clavicles, and seizure. Among the 909 patients in the
second phase, 57 (6.3 percent) had positive scans. In this group of
patients, the sensitivity of the seven findings combined was 100
percent (95 percent confidence interval, 95 to 100 percent). All
patients with
positive CT scans had at least one of the findings. CONCLUSIONS: For
the evaluation of patients with minor head injury, the use of CT can
be safely limited to those who have certain clinical findings.
09. J Clin Oncol. 2005 Jun 20;23(18):40318. Epub 2005 Mar 14.
Granulocyte colonystimulating factor support in children and
adolescents with advancedstage nonrhabdomyosarcomatous soft tissue
sarcomas: a Pediatric Oncology Group Study.
Pappo AS, Devidas M, Jenkins J, Rao B, Marcus R, Thomas P, Gebhardt M,
Pratt C,
PATIENTS AND METHODS: Between September 1996 and June 2000, 39
eligible patients received vincristine (1.5 mg/m(2) weekly for 13
doses), ifosfamide (3 g/m(2) daily for 3 days every 3 weeks for seven
cycles), doxorubicin (30 mg/m(2) daily for 2 days for six cycles), and
mesna (750 mg/m(2) for four doses after ifosfamide). Granulocyte
colonystimulating factor was administered daily (5 mug/kg) after each
cycle of chemotherapy. Radiotherapy was administered from weeks 7
through 12. RESULTS: The median patient age at diagnosis was 11.7
years; the most common primary tumor site was lower extremity (36%);
and synovial sarcoma was the predominant histology. More than three
fourths of all tumors were 5 cm or greater at their largest diameters.
The overall objective combined partialand complete response rate was
41% (95% CI, 25.7% to 56.7%). The estimated 3year overall survival
and progressionfree survival rates (+/ standard deviation) for
eligible patients were 59% +/ 8.2% and 43.6% +/ 7%, respectively.
Patients with clinical group III disease had significantly better
3year and progressionfree survival rates compared with patients who
presented with metastatic disease. CONCLUSION: The vincristine,
ifosfamide, and doxorubicin regimen was moderately active against
pediatric NRSTS. Patients with synovial sarcoma had higher response
rates than other patients, and patients with unresected disease had
improved outcomes. Patients with metastatic disease continue to fare
poorly, and newer approaches are indicated for these patients.
10. Blood. 1993 May 15;81(10):2496502.
 Recombinant human granulocyte colonystimulating factor (filgrastim)
for treatment of severe chronic neutropenia.
Dale DC, Bonilla MA, Davis MW, Nakanishi AM, Hammond WP, Kurtzberg J,
Wang W, Jakubowski A, Winton E, Lalezari P, et al.
Patients with idiopathic, cyclic, and congenital neutropenia have
recurrent severe bacterial infections. One hundred twentythree
patients with recurrent infections and severe chronic neutropenia
(absolute neutrophil count or 1.5 x 10(9)/L.
Examination of BM aspirates showed increased proportions of maturing
neutrophils. Infectionrelated events were significantly decreased (P
0.70 in identifying primary endpoint pneumonia; 13
out of 20 readers had a kappa index of > 0.6 compared with the
reference reading. For the 92 radiographs deemed to be interpretable
among the 100 images used for intraobserver variability, 19 out of 20
readers had a kappa index of > 0.6. CONCLUSION: Using standardized
definitions and training, it is possible to achieve agreement in
identifying radiological pneumonia, thus facilitating the comparison
of results of epidemiological studies that use radiological pneumonia
as an outcome.
18. Curr Med Res Opin. 2004 Nov;20(11):177783.
Migraine treatment strategies: the global Migraine And Zolmitriptan
Evaluation (MAZE) survey.
MacGregor EA, Brandes J, Gendolla A, Giammarco R.
OBJECTIVE: To determine which medications UK migraineurs have access
to and assess the usage of these products in a 'reallife' setting.
RESEARCH DESIGN AND METHODS: Data were collected using an online
questionnaire, which subjects were directed to by advertisements in
pharmacies, a UK national newspaper, on the internet and information
on the Migraine Action Association website and newsletters.
Respondents were eligible for inclusion if attacks fulfilled
International Headache Society criteria for migraine and/or if
previously diagnosed by a physician as having migraine. MAIN OUTCOME
MEASURES: Respondents were asked to specify which products had been
prescribed or purchased for migraine treatment. The pattern of use of
these products was determined, including the reasons why respondents
chose particular products to treat attacks. RESULTS: Of 3072 eligible
respondents, the majority had purchased a variety of overthecounter
(OTC) medicines for treatment of attacks. Eightyseven per cent had
been diagnosed by a physician and were prescribed multiple products
(average 1.68); 45% received triptans, but 26% were still prescribed
products that were also available OTC. Over half (52%) of respondents
initially used an OTC medicine to treat the last migraine attack.
However, 73% required a second dose/product, mainly as a result of
lack of efficacy of the first dose/product. Respondents using triptans
were less likely to require a second dose/product than those not using
triptans (52% vs. 78%, respectively). The two main reasons for
choosing a triptan to treat an attack were the need for quick control
and the severity of the attack. Satisfaction with regard to migraine
medication was higher among triptanusers than nontriptan users.
CONCLUSIONS: Medicines that are available OTC are often used as
firstline therapy for migraine despite many migraineurs having access
to prescription therapies such as triptans. Many migraineurs require a
second dose/product, possibly indicating suboptimal treatment
efficacy. Physicians should consider the range of migrainespecific
treatments available, including triptans, in order to develop a
treatment plan that is based on the patient's needs and preferences.
 
19. Ren Fail. 2005;27(4):38592.
Torsemide versus furosemide after continuous renal replacement therapy
due to acute renal failure in cardiac surgery patients.
Vargas Hein O, Staegemann M, Wagner D, von Heymann C, Martin M,
Morgera S, Spies C.
Diuretic therapy in ARF (acute renal failure) is mainly done with loop
diuretics, first of all furosemide. Torsemide has a longer duration of
action and does not accumulate in renal failure. In chronic and acute
renal failure, both diuretics have been effectively applied, with a
more pronounced diuretic effect for torsemide. In this study, the
effects of torsemide versus furosemide on renal function in cardiac
surgery patients recovering from ARF after continuous renal
replacement therapy (CRRT) were studied. Twentynine critically ill
patients admitted to an intensive care unit at a university teaching
hospital after cardiac surgery recovering from ARF after CRRT were
included in this prospective, controlled, singlecenter, openlabeled,
randomized clinical trial. Inclusion criteria were urine output >0.5
mL/kg/h over 6 h under CRRT. Torsemide and furosemide dosages were
adjusted with the target urine output being 0.81.5 mL/kg/h.
Hemodynamic data, urine output, volume balance, serum creatinine
clearance, electrolytes, blood urea nitrogen, serum creatinine, renin,
and aldosterone concentrations were measured. Fourteen patients were
included in the furosemide group and 15 patients in the torsemide
group. Dosages of 29 (0160) mg torsemide and a dosage of 60 (0240)
mg furosemide were given every 6 h in each group, respectively. The
dosage given at the end of the study decreased significantly in
furosemide and torsemide treated patients. Urine output, 24 h balance,
and serum creatinine clearance did not differ significantly between
groups. Urine output decreased in both groups, mostly dosedependent
in the torsemide group. The intragroup comparison of the first
timeinterval after inclusion with the last timeinterval showed a
significant increase in serum creatinine and blood urea nitrogen in
the furosemide group. Renin and aldosterone concentrations did not
show significant differences. In conclusion, torsemide and furosemide
were effective in increasing urine output. Torsemide might show a
better dosedependent diuretic effect in ARF patients after CRRT
treatment. Serum creatinine and blood urea nitrogen elimination were
less pronounced in the furosemide group.
20. Am J Sports Med. 2005 May;33(5):699704. Epub 2005 Feb 16.
The diagnostic value of intracompartmental pressure measurement,
magnetic resonance imaging, and nearinfrared spectroscopy in chronic
exertional compartment syndrome: a study in 50 patients.
van den Brand JG, Nelson T, Verleisdonk EJ, van der Werken C.
HYPOTHESIS: Magnetic resonance imaging and nearinfrared spectroscopy
can be used to diagnose chronic exertional compartment syndrome. STUDY
DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS:
Patients were enrolled if there was clinical suspicion of chronic
exertional compartment syndrome, and a fasciotomy was performed based
on this suspicion. Before fasciotomy, intracompartmental pressure,
nearinfrared spectroscopy, and magnetic resonance imaging data were
collected during and after exercise on a treadmill. Nearinfrared
spectroscopy and intracompartmental pressure values were recorded in
the same manner after fasciotomy. Retrospective proof that diagnosis
of the syndrome had been correct was the absence of exertional
complaints from the preoperative examination during exercise at
postfasciotomy visit. RESULTS: Fifty patients (100 legs) participated
in the prefasciotomy visit; 3 refused fasciotomy; 2 were lost to
followup. Of 45 patients who completed the postfasciotomy visit, the
diagnosis of chronic exertional compartment syndrome was
retrospectively confirmed in 42 patients and discarded in 3 patients.
The sensitivity for intracompartmental pressure (cutoff point, 35
mmHg) found in this study was 77% (67%86%, exact 95% confidence
interval), lower than estimates from the literature (93%). The
sensitivity (previously defined cutoff) for nearinfrared spectroscopy
was 85% (76%92%, exact 95% confidence interval), validating the
estimate found in the literature (85%). Sensitivity of magnetic
resonance imaging was comparable to that of intracompartmental
pressure and nearinfrared spectroscopy; associated specificity at a
given sensitivity appeared to be lower with magnetic resonance
imaging. CONCLUSION: This study validates the sensitivity of
nearinfrared spectroscopy and provides estimates for the sensitivity
and specificity of magnetic resonance imaging in chronic exertional
compartment syndrome in a large group of patients. The sensitivity of
noninvasive nearinfrared spectroscopy is clinically equivalent to
that of invasive intracompartmental pressure measurements.

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