bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF COPPER ON ALGAL COMMUNITIES FROM OLIGOTROPHIC CALCAREOUS STREAMS1
Authors: Guasch Helena , Paulsson Maria , Sabater Sergi
Published: March 2003

Two sets of experiments were done to quantify the effects of chronic copper exposure on natural peri‐ phyton in a nonpolluted calcareous river. The results of short‐term (up to 6 h exposure) experiments corroborated the significance of pH on copper toxicity. Copper toxicity increased when pH was reduced from 8.6 to 7.7, and this was related to the effect of pH on copper speciation (free copper concentration increased from 0.2% to 2.3% of total copper). Longer term experiments demonstrated that periphyton communities exposed to copper under pH variation (8.2–8.6) were already affected at 10 μg·L−1 (20–80 ng·L−1 Cu2+) after 12 days of exposure. Copper exposure caused stronger effects on structural (algal biomass and community structure) than on functional (photosynthetic efficiency) parameters of peri‐ phyton. Changes in community composition included the enhancement of some taxa (Gomphonema gracile), the inhibition of others (Fragilaria capucina and Phormidium sp.), and the appearance of filament malformations (Mougeotia sp.). The results of our study demonstrated that several weeks of exposure to copper (10–20 μg·L−1) were sufficient to cause chronic changes in the periphyton of oligotrophic calcareous rivers. This degree of copper pollution can be commonly found in the Mediterranean region as a result of agricultural practices and farming activities.
A Note of Caution on Using Absolute Methanol Concentrations and Low Temperatures to Quantify Mycosporine‐Like Amino Acids in Algae
Authors: Sommaruga R. , Tartarotti B.
Published: March 2003

Mycosporine‐like amino acids (MAAs), a family of UV‐absorbing compounds, are widespread among many marine and freshwater organisms, however, no standard method to analyze these compounds is available. Consequently, protocols to extract MAAs largely differ, for example, in the type of solvent, concentrations, temperatures, and times used. In this study, we tested whether the concentrations of MAAs are affected by extraction at different temperatures and methanol (MeOH) concentrations. Natural assemblages of freshwater phytoplankton and the marine alga Porphyra sp. were used as test organisms. The MAAs shinorine, palythine, MAA 331, asterina‐330, and porphyra‐334 present in the organisms examined were generally best extracted at 45 °C in 25% aqueous MeOH. In Porphyra sp. and natural freshwater phytoplankton, the mean total MAA concentrations obtained with this protocol were, respectively, about 13 and 3 times higher than when extracted in 100% MeOH at 4 °C. Depending on the organism examined, both MeOH concentration and temperature affected extraction efficiency and final MAA concentration. Our results stress the need for a priori testing the influence of these variables to assure that the highest concentration is obtained without altering the qualitative MAA composition. Based on these results, direct comparison of MAA concentrations reported in the scientific literature should be done with caution.
Impact of a Cost‐Sharing Drug Insurance Plan on Drug Utilization Among Older People
Authors: Blais Lucie , Boucher Jean‐Marc , Couture Julie , Rahme Elham , LeLorier Jacques
Published: March 2003

OBJECTIVES: In August 1996, the Régie de l'assurance‐maladie du Québec (RAMQ), the government body responsible for medical insurance in the Canadian province of Quebec, introduced a cost‐sharing drug insurance plan. Before this plan, individuals age 65 years and older had to pay Canadian (CDN)$2 per prescription, with the remaining cost paid by the RAMQ. With the new plan, beneficiaries may have to pay an amount between CDN$200 and CDN$925 per year, depending on their income. Concerned that this financial constraint imposed on older people might have an impact on the use of medications, we investigated whether the consumption of four classes of medications, antihypertensive agents, anticoagulants, nitrates, and benzodiazepines, was affected by the drug plan implementation.

DESIGN: Time series models with pre/post comparison group.

SETTING: Administrative computerized databases of the RAMQ.

PARTICIPANTS: Random sample of Quebec residents age 65 years and older registered in the provincial drug plan between August 1992 and June 1997: 54,771 users of nitrates, 133,146 users of antihypertensive agents, 45,534 users of anti‐coagulants, and 26,165 users of benzodiazepines.

MEASUREMENTS: We modeled the monthly consumption of the medications under study between August 1992 and June 1996. Monthly drug consumptions predicted from the models were compared with those observed for the 13 months (August 1996 to August 1997) following the implementation of the new drug plan using 95% confidence intervals. The number of prescriptions dispensed served as an indicator for drug consumption.

RESULTS: During the study period we observed a nonstatistically significant decrease in number of prescriptions of 5.1% for nitrates, 1.1% for antihypertensive agents, and 0.8% for benzodiazepines, and a nonstatistically significant increase of 1.6% for anticoagulants.

CONCLUSION: Residents of Quebec age 65 years and older were not found to have reduced significantly their consumption of nitrates, antihypertensive agents, anticoagulants, and benzodiazepines during the 13 months that followed the implementation of a cost‐sharing drug insurance plan.
Vitamin E and Lipid Peroxide Plasma Levels Predict the Risk of Cardiovascular Events in a Group of Healthy Very Old People
Authors: Mezzetti Andrea , Zuliani Giovanni , Romano Ferdinando , Costantini Fabrizio , Pierdomenico Sante D. , Cuccurullo Franco , Fellin Renato , The Associazione Medica Sabin
Published: March 2003

OBJECTIVES: To assess whether systemic oxidative stress can predict the risk of first myocardial infarction, ischemic stroke, and congestive heart failure.

DESIGN: A longitudinal study started in 1992 and completed in 1997.

SETTING: Community‐based, outpatient.

PARTICIPANTS: 102 apparently healthy, community‐dwelling subjects age 80 and older from the Vibrata valley, Teramo, Italy.

MEASUREMENTS: Plasma vitamin E, β‐carotene, vitamin C, fluorescent products of lipid peroxidation (FPLPs), and serum lipids were determined at enrollment.

RESULTS: Thirty‐two cardiovascular events were recorded in 47.4 months of follow‐up. The subjects with vitamin E levels in the highest quartile had a risk of cardiovascular events one‐sixth those with vitamin E levels in the lowest quartile (relative risk (RR) = 0.16; 95% confidence interval (CI) = 0.04–0.55). The subjects with FPLPs in the highest quartile had a risk seven times greater than those with FPLPs in the lowest quartile (RR = 7.61; 95% CI = 2.23–25.96). No association was observed for vitamin C, β‐carotene, or total cholesterol. Multivariate adjustment for known risk factors did not significantly change the results.

CONCLUSIONS: Our results suggest that in apparently healthy, community‐dwelling very old subjects, base‐line plasma concentration of vitamin E and FPLPs predicts the risk of future cardiovascular events. We confirm previous data showing that total cholesterol is not a predictor of cardiovascular disease in people age 80 and older.
Measuring Fitness in Healthy Older Adults: The Health ABC Long Distance Corridor Walk
Authors: Simonsick Eleanor M. , Montgomery Polly S. , Newman Anne B. , Bauer Douglas C. , Harris Tamara
Published: March 2003

OBJECTIVES: The Health ABC Long Distance Corridor Walk (LDCW) was designed to extend the testing range of self‐paced walking tests of fitness for older adults by including a warm‐up and timing performance over 400 meters. This study compares performance on the LDCW and 6‐minute walk to determine whether the LDCW encourages greater participant effort.

DESIGN: Subjects were administered the LDCW and 6‐minute walk during a single visit. Test order alternated between subjects, and a 15‐minute rest was given between tests.

SETTING: The Baltimore Veterans Affairs Medical Center.

PARTICIPANTS: Twenty volunteers age 70 to 78.

MEASUREMENTS: The LDCW, consisting of a 2‐minute warm‐up walk followed by a 400‐meter walk and a 6‐minute walk test were administered using a 20‐meter long course in an unobstructed hallway. Heart rate (HR) and blood pressure (BP) were recorded at rest and before and after all walks.

RESULTS: All 20 subjects walked a faster pace over 400 meters than for 6 minutes, in which the mean distance covered was 402 meters. From paired t‐tests, walking speed was faster (mean difference = 0.23 m/sec; P < .001), and ending HR (mean difference = 7.6 bpm; P < .001) and systolic BP (mean difference = 8.3 mmHg; P = .024) were greater for the 400‐meter walk than for the 6‐minute walk. Results were independent of test order and subject fitness level.

CONCLUSIONS: Providing a warm‐up walk and using a target distance instead of time encouraged subjects to work closer to their maximum capacity. This low‐cost alternative to treadmill testing can be used in research and clinical settings to assess fitness and help identify early functional decline in older adults.
Disability Outcomes of Older Medicare HMO Enrollees and Fee‐for‐Service Medicare Beneficiaries
Authors: Porell Frank W. , Miltiades Helen B.
Published: March 2003

OBJECTIVES: To investigate whether older Medicare beneficiaries enrolled in Medicare risk health maintenance organizations (HMOs) have different rates of disablement than fee‐for‐service (FFS) beneficiaries.

DESIGN: Secondary analysis of annual functional status transitions using the Medicare Current Beneficiary Survey, 1991 to 1996.

SETTING: Telephone interviews.

PARTICIPANTS: Forty‐four thousand seven hundred and sixty‐five person‐years of annual functional status transitions for noninstitutionalized older Medicare beneficiaries who were either risk HMO enrollees or FFS beneficiaries with or without private supplementary insurance.

MEASUREMENTS: Five multinomial logit models were estimated as single‐state transition models, with five functional states, death, and censored as outcomes. The probability of being in a certain functional state the following year was specified as a function of individual risk factors and HMO versus FFS supplementary insurance status.

RESULTS: Among functionally independent beneficiaries, the odds of becoming disabled in activities of daily living (ADLs) within a year were lower among FFS individuals with supplementary insurance (odds ratios (OR) = 0.67, P < .01) and HMO enrollees (OR = 0.58, P < .01). Among older people who were functionally impaired, neither HMO enrollment nor private supplementary insurance affected the risk of further functional decline or functional improvement. Supplementary insurance, but not HMO enrollment, was associated with lower mortality risk among beneficiaries with functional limitations (OR = 0.65, P < .05) or moderate ADL disability (OR = 0.72, P < .05).

CONCLUSION: Medicare risk HMO enrollment and FFS private supplementary insurance convey similar benefits of slowing functional decline and extending life span for nonseverely disabled older people. That no association was found between adverse functional status outcomes and risk HMO enrollment has favorable implications regarding the quality of care of managed care plans.
Does Advanced Age Affect the Immediate and Long‐Term Results of Direct‐Current External Cardioversion of Atrial Fibrillation?
Authors: Fumagalli Stefano , Boncinelli Lorenzo , Bondi Ernesta , Caleri Veronica , Gatto Silvia , Di Bari Mauro , Baldereschi Giorgio , Valoti Paolo , Masotti Giulio , Marchionni Niccolò
Published: March 2003

OBJECTIVES: To determine whether advanced age affects the immediate and long‐term results of direct‐current external cardioversion (ECV) of atrial fibrillation (AF), the sustained arrhythmia most commonly encountered in older patients.

DESIGN: Retrospective analysis of medical records.

SETTING: Intensive care unit.

PARTICIPANTS: Two hundred fifty consecutive patients (age 34–100) with AF who underwent ECV following a standardized protocol in an intensive care unit.

MEASUREMENTS: Immediate efficacy of ECV, defined as recovery of sinus rhythm, and maintenance of sinus rhythm over the follow‐up were study outcomes. The univariate and multivariate associations of immediate efficacy of ECV and long‐term results with clinical variables were analyzed.

RESULTS: At univariate analysis, immediate efficacy of ECV (overall, 91.2%) was lower in older patients and in those with chronic obstructive pulmonary disease, higher for a 3‐ to 90‐day pre‐ECV duration of AF than for a duration of 2 days or less or more than 90 days, and independent of underlying cardiac disease, hypertension, diabetes mellitus, previous AF, and left atrial dimension. However, pre‐ECV duration of AF was the only multivariate predictor of ECV immediate success. Major complications occurred in only three patients. Of 220 patients discharged in sinus rhythm, 211 were followed up for a mean period ± standard deviation of 34 ± 25 months. AF relapsed in 45.5% of them. At multivariate analysis, underlying cardiac disease was the only predictor of the relapse rate, and relapse rate was lower in coronary heart disease than in valvular heart disease, congestive heart failure, or lone AF.

CONCLUSION: Immediate and long‐term results of ECV of AF, an effective and safe procedure, are unaffected by age, at least after adjusting for several covariates.
Mood Symptoms and Cognitive Performance in Women Estrogen Users and Nonusers and Men
Authors: Miller Karen J. , Conney Janet C. , Rasgon Natalie L. , Fairbanks Lynn A. , Small Gary W.
Published: March 2003

OBJECTIVES: Previous studies have suggested sex differences in mood and cognition and that estrogen effects may partially explain such differences. In this study, we explore sex differences for a range of mood symptoms and for neuropsychological performance in men and postmenopausal women and assess the potential influence of estrogen on these measures.

DESIGN: Cross‐sectional study of men and women examining mood, neuropsychological test data, and estrogen replacement therapy (ERT) use.

SETTING: Outpatient study at an urban teaching hospital with subjects recruited from the community.

PARTICIPANTS: All subjects (N = 96) were between the ages of 57 and 75 and included 31 women using ERT, 16 non‐ERT users, and 49 men. Subjects did not have major depression and were nondemented.

MEASUREMENT: The three groups were compared according to profile of mood states and neuropsychological performance, and statistical analyses were controlled for socioeconomic status, age, and education level.

RESULTS: Female ERT users were less depressed and less angry and performed better on measures of verbal fluency and working memory than the other subject groups.

CONCLUSION: Postmenopausal estrogen use is associated with better mood and cognitive performance on tasks of fluency and working memory. These results suggest that estrogen should be examined as a potentially critical variable influencing late‐life sex differences in mood and cognition.
A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. (University of Michigan Medical Center, Ann Arbor, MI) Anesth Analg 2000;91:781–786.
Authors: Pandit Jaideep J. , Bree Stephen , Dillon Patrick , Elcock David , McLaren Ian D. , Crider: Bruce
Published: March 2003

Carotid endarterectomy may be preformed by using cervical plexus blockade with local anesthetic supplementation by the surgeon during surgery. Most practitioners use either a superficial cervical plexus block or a combined (superficial and deep) block, but it is unclear which offers the best operative conditions or greatest patient satisfaction. This study compared the 2 techniques in 40 patients undergoing carotid endarterectomy. The patient randomly received either a superficial or a combined cervical plexus block. Bupivacaine 0.375% to a total dose of 1.4 mg/kg was used. The main outcome measure was the amount of supplemental lidocaine 1% used by the surgeon. Subsidiary outcome measures were postoperative pain score, sedative and analgesic requirements before and during surgery, and postoperative analgesic requirements. Median supplemental lidocaine requirements were 100 mg in the superficial block group and 115 mg in the combined block group. These differences were not statistically significant. There was no significant difference in the number of patients needing postoperative analgesia between the groups in the 24 h after surgery. The median time to first analgesia in the superficial block group was 150 min. more than in the combined block group, but this difference, although large, was not statistically significant. No significant differences were found between the anesthetic techniques studied.

Comment by Alan Kaye, M.D. Carotid endarterectomy surgery can be performed with regional or general anesthesia. It is probable that a substantial majority of CEAs performed in North America are performed under general anesthesia. Debate over choice of regional versus general anesthesia persists because of various studies of risks and benefits. Each type of anesthesia has its own advantages and disadvantages, which must be considered when choosing the optimal anesthetic for patients. Regional anesthetic techniques available include local infiltration, superficial and deep cervical plexus block, a combination of these with or without contralateral superficial plexus, and cervical epidural anesthesia. This prospective, randomized, double‐blinded study compared superficial versus combined (superficial and deep) cervical plexus block in 40 patients. Outcomes were measured by supplemental local anesthetic used by the surgeon, postoperative pain scores, and sedative and analgesic requirements before, during, and postoperatively. The results showed no significant difference in either study group. Therefore, this small study suggests that superficial block should be preferred in as much that it is relatively easy to do and the potential side‐effects are far less than deep cervical block. Larger studies are warranted in this difficult population of patients.
Factors that limit pain relief and increase. (Union Memorial Hospital, Baltimore, MD) Geriatrics 2000;55:46–54.
Authors: Glott F. Michael , Iii:
Published: March 2003

This article discusses chronic pain in individuals who are 65 years of age and older. The importance of achieving adequate pain management in geriatric patients is discussed. Factors that limit pain control are listed and explained. Emphasis is placed on what role depression, anxiety, and dementia have in the patient's perception of pain as well as the need to avoid adverse drug reactions in a population that can be complicated to treat for pain.
Evaluation of the acute cervical spine: a management algorithm. (Department of Surgery, University of Kentucky, Lexington, KY) J Trauma 2000;49:450–456.
Authors: Banit Daxes M. , Grau Greg , Fisher: J. Rush
Published: March 2003

A retrospective review was initiated of all trauma patients evaluated in a Level I trauma center the year before and after implementation of a new cervical spine protocol to determine the incidence of missed cervical injuries. An additional 6 months were reviewed to detect any missed injuries late in the study period. During the 2‐year study period, 4,460 patients presented to the emergency room with some form of cervical spine precautions. Blunt trauma comprised 90% of the study population. According to the protocol, approximately 45% required further cervical radiographs after presentation. In the preprotocol year, 77 of 2,217 (3.4%) patients were diagnosed with cervical spine injuries, 16 of 77 (21%) with multiple level injuries, and 25 of 77 (32%) with neurologic compromise. Three of 2,217 patient had missed cervical spine injuries on their initial evaluations. In the postprotocol year, 84 of 2,243 (3.4%) patients had cervical injuries, 25 of 84 (30%) with multiple levels of injuries and 28 of 84 (28%) with neurologic compromise. No patient evaluated during the protocol year was missed. All statistics between the two groups were not significant. Conclude the current protocol by risk stratifying patients on presentation is effective in assessing patients for cervical spine injuries.

Comment by Gabor B. Racz, M.D. This is a retrospective review from a Level I trauma center a year before and after implantation of a cervical spine injury protocol. The comparison of outcomes before and after the protocol was rather similar in that the diagnosis of cervical spine injury in 77 of 2,217 patients, or 3.4% and 84 of 2,243 had cervical injuries again 3.4%. Prior to the initiation of the protocol, the first year had three cervical spine injuries missed, which were diagnosed later secondary to continued neck pain on reevaluation. There were no missed cases after the protocol. The evaluation and examination go hand in hand. More emphasis is placed on the clinical exam and plain multiple view x‐ray films and adherence to limiting the rigid collar to 6 h switching over to soft collar and developing more of a confidence in the clinical exam rather than to concentrate on the more expensive and time consuming radiological diagnostic procedures. The cervical algorithm does work and it is impressive that there were no missed injuries. It is recommended that physicians working in a Level I trauma center should go and review the algorithm in detail. The recommended practice is to rely on plain films first if there is persistent pain flexion and extension films and involvement of appropriate consultants in these patients who must be assumed to have cervical spine injury.
Forensic Issues in Pain: Review of Current Practice
Authors: Kulich Ronald J. , Kreis Paul G. , Fishman Scott M. , Prescott John C. , Pelletier Nina J. , Bennett Pamela , Mehta Noshir R.
Published: March 2003

Abstract: Forensic activity in pain practice is reviewed with reference to the differing roles of the pain clinician and the independent expert. Ethical guidelines and recommendations for assessment, documentation, record review, and court testimony are discussed. Specific issues include the assessment of disability and impairment, malingering, and application of the Daubert standard in forensic pain practice. Examples of case law are reviewed for civil liability and CRPS, malpractice with opioid prescribing, and practice issues in a correctional setting.
Left stellate ganglion block has only small effects on left ventricular function in awake dogs before and after induction of heart failure. (Institut für Klinische Anaesthesiologie, Heinrich‐Heine‐Universität, Düsseldorf, Germany) Anesth Analg 2000;91:787–792.
Authors: Mullenheim Jose , Preckel Benedikt , Obal Detlef , Heiderhoff Marc , Hoff Juliane , Thämer Volker , Schlack: Wolfgang
Published: March 2003

This study investigated the effects of left stellate ganglion block (LSGB) in chronically instrumented awake dogs before and after the induction of pacing‐induced congestive heart failure. Twelve dogs were instrumented for measurement of global hemodynamics (LV pressure [LVP]), its first derivative, cardiac output (CO), and regional myocardial function (systolic posterobasal, segment length shortening, mean velocity [SLmv]). Before the induction of heart failure, LSGB did not affect CO and SLmv, but slightly reduced LVP. Conclude that even during heart failure the hemodynamic changes after LSGB are small, confirming a broad margin of safety.

Comment by James E. Heavner, D.V.M., Ph.D. The outcomes of this very nice animal study should provide some comfort to clinicians that perform stellate ganglion blocks on patients with a history of heart failure. In chronically instrumented animals, left stellate ganglion block had minimal affect on cardiac function either before or after heart failure had been induced. However, caution should always be exercised in extrapolating animal data to humans. In this regard, the investigators point out that in healthy humans, an impairment of left ventricular relaxation can be seen after left stellate ganglion block. They further caution that patients with acute heart failure in whom the response to changes in sympathetic tone is maintained, may be more susceptible to the adverse effects of left stellate ganglion block on cardiac dynamics.
Randomized crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic noncancer pain. (University of Alberta, Alberta, Canada) British J Anesh. 2001;322:1154–1158.
Authors: Allan Laurie , Hays Helen , Jensen Niels‐Henrik , Le Polain de Waroux Bernard , Bolt Michiel , Donald Royden , Kalso Eija
Published: March 2003

This study involved 256 patients with chronic noncancer pain who had been treated with opioids. Of 212 patients, 138 (65%) preferred transdermal fentanyl, whereas 59 (28%) preferred sustained release oral morphine and 15 (7%) expressed no preference. Better pain relief was the main preference for fentanyl given by 35% of the patients. These results were reflected in both the patients, and the investigators' opinions on the global efficacy of transdermal fentanyl. The incidence of adverse events was similar in both treatment groups; however, more patients experienced constipation with morphine than with fentanyl. Overall, 41% of the patients experienced mild or moderate cutaneous problems associated with wearing the transdermal fentanyl patch, and more patients withdrew because of adverse events during treatment with fentanyl than with morphine. Conclude that transdermal fentanyl was preferred to sustained release oral morphine by patients with chronic noncancer pain previously treated with opioids with the main reason being better pain relief.
Epinephrine increases the neurotoxic potential of intrathecally administered lidocaine in the rat. (Department of Anesthesia and Preoperative Care, University of California, San Francisco, CA) Anesthesiology. 2001;94:876–881.
Authors: Hashimoto Keishi , Hampl Karl F. , Nakamura Yuji , Bollen Andrew W. , Feiner John , Drasner Kenneth
Published: March 2003

This study investigated whether adding epinephrine increases functional impairment or histologic damage induced by spinal administration of lidocaine in the rat. Eighty rats were divided into 4 groups to receive an intrathecal injection of normal saline containing 5% lidocaine, 5% lidocaine with 0.2 mg/mL of epinephrine, 0.2 mg/mL of epinephrine, or normal saline alone. Animals were assessed for persistent sensory impairment using the tail‐flick test administered 4 to 7 days after infusion. Animals were then killed, and the spinal cord and nerve roots were prepared for neuropathologic evaluation. Rats given 5% lidocaine developed persistent sensory impairment and histologic damage, and the addition of epinephrine resulted in a further significant increase in injury. Sensory function in animals given epinephrine without anesthetic was similar to baseline and did not differ from saline. Histologic changes in animals treated with epinephrine alone did not differ significantly from saline controls. Conclude the neurotoxicity of intrathecally administered lidocaine is increased by the addition of epinephrine. When making clinical recommendations for maximum safe intrathecal dose of this anesthetic, one may need to consider whether the solution contains epinephrine.

Comment by Octavio Calvillo, M.D., Ph.D. The authors studied the neurotoxicity of epinephrine added to lidocaine injected intrathecally in rats. The animals were allocated to four groups of 20 rats each, receiving: normal saline alone, normal saline and 5% lidocaine, 5% lidocaine with epinephrine [0.2 mg/ml] in saline or epinephrine 0.2 mgml in saline. The animals were assessed for sensory deficits 4 and 7 days after infusion and then sacrificed. The spinal cords and nerve roots were prepared for neuropathological evaluation. Sections obtained from animals treated with lidocaine, lidocaine with epinephrine. Rats given 5% lidocaine developed persistent sensory impairment and histological evidence of damage, the addition of epinephrine, resulted in further damage. Histological changes in animals treated with epinephrine alone did not differ significantly from saline controls. The authors concluded that the neurotoxicity of intrathecally‐administered lidocaine is increased by the addition of epinephrine. They raised the possibility that the neurotoxicity of commercially available epinephrine may be due to the bisulfite contained therein, this chemical has been associated with neurotoxicity.
Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long‐term results in a series of 44 patients. (University of Lyon, Lyon, France) Pain. 2001;92:159–171.
Authors: Sindou M , Mertens P. , Wael M.
Published: March 2003

This article reported on the long‐term results of the microsurgical approach to the dorsal root entry zone (DREZotomy) in a series of 44 patients suffering from unbearable neuropathic pain secondary to spine injury. The follow‐up ranged from 1 to 20 years. The series included 25 cases with conus medullaris, 12 with thoracic cord, 4 with cauda equina and 3 with cervical cord injuries. Surgery was performed in 37 cases at the pathological spinal cord levels that corresponded to the territory of the so‐called “segmental pain,” and in 7 cases, on the spinal cord levels below the lesion for “infralesional pain,” syndromes. Regarding pain characteristics, a good result was obtained in 88% of the cases with predominately paroxysmal pain as compared with 26% with continuous pain. There were no perioperative mortalities. Morbidity included cerebrospinal fluid leak (3 patients), wound infection (2 patients), subcutaneous hematoma (1 patient), and bacteremia (1 patient). Conclude that the inclusion of DREZ‐lesioning surgery in the neurosurgical armamentarium for treating “segmental” pain due to spinal cord injuries is justified.

Comment by Ron Pawl, M.D., FAC This is a seminal report, because it provides long‐term (greater than 1 year, 71 months average) outcome from the dorsal root entry zone lesioning, at the site of and one level above and below the site of injury, for pain after spinal cord injury. This procedure was performed using a microsurgical open technique. Results were good (greater than 75% relief) in patients with regional pain syndromes, in the body segments related to the site of cord injury, that was paroxysmal pain, and after conus medullaris lesions, which were the greatest number of cases treated. Continuous pain, burning pain, and infralesional pain syndromes, below the site of the cord injury, were not significantly benefited. Unfortunately, the authors did not report on the psychological make‐up of the patients, which might provide some insight into good versus bad outcome.
Chronic lateral epicondylitis of the elbow: a prospective study of low‐energy shockwave therapy and low‐energy shockwave therapy plus manual therapy of the cervical spine. (Johannes Gutenberg University School of Medicine, Mainz, Germany). Arch Phys Med Rehabil. 2001;82:578–582.
Authors: Rompe J. D. , Riedel C. , Betz U. , Fink C.
Published: March 2003

This prospective, matched single‐blinded control trial compared the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction were studied. Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of 0.16J/mm2 at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (Group I). For each patient, a control matched by age and gender at first conservative treatment was drawn at random from 127 patients who had undergone low‐energy shockwave therapy in the same unit in the past 3 years (Group II). Follow‐up examinations took place at 12 weeks and at 12 months. Neither group differed statistically before the study, with a poor rating for all patients. At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in Group I and 60% in Group II. Each group showed significant improvement compared with the respective prestudy evaluation. Conclude ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.
Precautions During Epidural Neuroplasty
Authors: Erdine Serdar , K.Talu Gül
Published: March 2003

Abstract: Scar formation in the epidural space due to previous operations or presence of inflammation in and around the nerve roots or spinal nerves in patients with back pain or radiculopathy have been documented in patients suffering from spinal pain. Several methods targeting the scar formation and inflammation have been used. Epidural neuroplasty is one of the recently used methods. The goals of neuroplasty are to break down fibrous adhesions that may prevent free movement of structures in the intervertebral foramen and in the bony vertebral canal. However, epidural neuroplasty is not free of complications. During epidural neuroplasty, unintended dural puncture, administration of hypertonic saline to the subarachnoid/subdural space, catheter shear, infection, and haemodynamic instability during the application are the most commonly observed complications. The most commonly seen complications of epidural neuroplasty are due to the procedure or the drugs administered. Complications relating to the procedure are usually seen immediately, while complications relating to drug administration are typically seen later. In this article, we discuss not only the possible complications during epidural neuroplasty, but their prevention and management as well.
A “new” phenotype confirming a relationship between Cra and Tca
Authors: LEVENE C. , HAKEI N. , LAVIE G. , GKEENBEKG S. , LAIRD‐FRYER B. , DANIELS G.L.
Published: March 2003

The red cells of two sisters had very weak Cra and Tca antigens and reacted only weakly with the antibody of the Cr(a‐) Tc(a‐)person, Inab. Both sisters had an antibody, named anti‐Dra, to a high frequency antigen absent from their own cells and Inab cells but present on Cr(a‐) Tc(a+) and on Cr(a+) Tc(a‐) cells. This is the third example in which both Cra and Tca antigens are either absent or show weakened expression on the red cells, but the first case in which the unusual phenotype is shown to be inherited.
Donor reaction to hydroxyethyl starch during granulocytap heresis
Authors: DUTCHER J.P. , AISNER J. , HOGGE D. E. , SCHIFFER C.A.
Published: March 2003

Granulocyte transfusion therapy has become relatively routine in centers treating patients with hematologic malignancies. The yield of granulocytes has been improved with newer leukapheresis techniques, premedication with corticosteroids, and the use of sedimenting agents, usually hydroxyethyl starch. Despite the relative safety of these techniques, there are risks to participating donors. A case of a donor reaction related to hydroxyethyl starch is presented. This report is a reminder that leukapheresis must be performed with careful consideration of therapeutic benefit‐to‐risk ratios.
Plateletapheresis program. I. Donor recruitment and commitment
Authors: Meyer DM , Hillman RS , Slichter SJ
Published: March 2003

A dedicated cytapheresis donor program was developed to meet the need for granulocytes and single‐donor platelets. A study was undertaken to determine the most effective way to recruit a panel of 500 HLA‐typed committed volunteer cytapheresis donors. Factors analyzed included ease of donor recruitment, information necessary to assure donor commitment, rate and reasons for donor attrition, and donor reaction to participation in the program. Audiovisual educational materials were tested as a part of the recruitment process in terms of both motivating volunteer donors and guaranteeing their continued participation. Over a 16‐month interval, 793 repeat donors of whole blood expressed an interest in joining the program. A simple brochure was enough to stimulate the majority of these donors (661 or 83%) to consider participation. Overall, 481 (61%) joined the program and were HLA typed. Of these, 311 (65%) required no additional information other than a brief phone exchange to answer questions. The remaining 170 (35%), at their request, received further structured education prior to enrollment. Actual participation in cytapheresis procedures was the major factor that maintained donor enthusiasm. Only 66 (16%) of the donors left the program during the first year; the majority were unable to participate because of circumstances beyond their control.
On the safety of using stored bank blood for chronic hemodialysis patients
Authors: Fogh‐Andersen N. , Mogensen F.
Published: March 2003

Red cells stored either for 3 days or 2 weeks were equally susceptible to lysis during in vitro dialysis. Furthermore, the small increases in plasma hemoglobin during hemodialysis of 10 patients were independent of transfusion. We examined the patients during three separate hemodialyses: one without transfusion, one with transfusion of three units of red cells stored for less than 5 days, and one with transfusion of red cells stored for 2 weeks. The mean concentration of hemoglobin in plasma increased from 0.7 to 3.6 mumol per l (p less than 0.01), and it was normal again after 2 days. No significant changes occurred in the mean concentration of haptoglobin in plasma. The results indicate that red cells stored for 2 weeks are not more prone to lysis than those stored for less than 5 days. Consequently, we recommend a storage interval of less than 2 weeks, instead of 5 days, for blood transfused to chronic hemodialysis patients.
An unusual Donath‐Landsteiner antibody detectable at 37°C by the antiglobulin test
Authors: Lindgren Sally , Zimmerman Sherry , Gibbs Frankie , Garratty George
Published: March 2003

A 14‐year‐old boy with no history of transfusion experienced a hemolytic crisis attributed to paroxysmal cold hemoglobinuria. The Donath‐Landsteiner test was positive. The IgG autoantibody had anti‐P specificity but was unique in that it also reacted strongly by indirect antiglobulin test at 37 degrees C.
Platelet storage. Effects of leachable materials on morphology and function
Authors: Labow R. S. , Tocchi M. , Rock G.
Published: March 2003

A polyolefin plastic (PL 732) bag formulated without liquid plasticizer allows storage of platelets for 5 and, now, up to 7 days. In order to assess the leaching of compounds from this new plastic, extracts of the supernatant from platelet concentrates stored in these bags were analyzed by high‐performance liquid chromatography, mass spectrometry, and gas‐liquid chromatography. A leachable material was detected and identified as di(2‐ethylhexyl) phthalate (DEHP). During the sterilization process, migration of the DEHP occurs from the polyvinylchloride (PVC) bags into the PL 732 plastic bag. The level of DEHP was 12‐fold less in the extracts of PC supernatant stored in the PL 732 bag than those in the polyvinyl chloride (PL 146) plastic bags which were used previously for platelet storage.

Platelets stored in low DEHP concentrations in the PL 732 bags were composed of 10 to 35 percent of unclassifiable shapes. These shape changes were not observed in higher concentrations of plasticizer, although the morphology scores decreased during storage in PL 146 as well. This effect on morphology was not related directly to the dose of DEHP. When platelet membranes were isolated from platelets stored in the presence of radiolabeled DEHP, the amount of bound 14C‐DEHP was found to be directly proportional to the concentration of DEHP in the plasma supernatant. However, while there was a linear relationship between the protein concentration in the membrane fraction and the amount of bound DEHP, no specific DEHP binding site could be identified by electrophoresis of the solubilized platelet membranes.
Acquired secretion defect in platelets after cryopreservation in dimethyl sulfoxide
Authors: Van Prooijen H. C. , Van Heugten J. G. , Mommersteeg M. E. , Akkerman J. W. N.
Published: March 2003

Despite the use of preservatives, platelets are severely damaged during cryopreservation and, following freezing, function poorly in a number of in vitro tests. We report here that cryopreserved platelets show diminished aggregation in response to collagen. This may be a consequence of a secretion defect as evidenced by a 20 to 30 percent loss of dense‐ and α‐granule content (p < 0.05) and an impaired secretion mechanism. Analysis of adenine nucleotides confirmed the defect in dense granule adenosine triphosphate (ATP) and adenosine diphosphate (ADP) content (storage pool), but in addition revealed a 50 percent fall in cytosolic ATP (metabolic pool). In contrast, the adenylate energy charge, (ATP + 1/2 ADP)/(ATP + ADP + adenosine monophosphate), was normal. We concluded that platelet cryopreservation leads to a secretion defect, probably as a result of activation during freezing and thawing procedures.
Fatal Salmonella septicemia after platelet transfusion
Authors: Heal J.M. , Jones M.E. , Forey J. , Chaudhry A. , Stricof R.L.
Published: March 2003

A thrombocytopenic, leukopenic patient with multiple myeloma who was given 7 units of platelets died 6 days later from complications of Salmonella heidelberg septicemia. A platelet donor who was asymptomatic at the time of donation had group B Salmonella on stool culture. His clinical history and the results of serologic studies and stool culture were consistent with a mild Salmonella gastroenteritis 5 days before donation. Antibiotic sensitivity patterns and plasmid profiles indicated that the organism (S. heidelberg) isolated from the donor's stool was identical to that isolated from the patient's blood and from the platelet bags. It is believed that low‐grade, asymptomatic bacteremia in the donor was the source of infection in the recipient. Food and Drug Administration records contain reports of six septic deaths due to platelet transfusions since 1979, compared with none in the preceding 4 years. Increased use of platelet products and the standard practice of storage at room temperature may contribute to the risk of sepsis after platelet transfusion, particularly in immunocompromised patients.
Hepatitis B core antibody (anti‐HBc) in blood donors in the United States: implications for surrogate testing programs
Authors: KLINE W.E. , BOWMAN R.J. , MCCURDY K.K. ENNIS , O'MALLEY J.P. , SANDLER S.G.
Published: March 2003

ABSTRACT: In order to evaluate the operational implications of excluding donated blood with antibody to hepatitis B core antigen (anti‐HBc), the American Red Cross tested 107,473 voluntary blood donations for anti‐ HBc in 72 test sites during a 1‐week period. The system‐wide prevalence of anti‐HBc was 2.60 percent, with a range of 0.55 to 6.38 percent, depending on geographic region. For the American Red Cross, which collects approximately one‐half of the blood supply in the United States, excluding donated blood with anti‐HBc would result in a loss of approximately 159,500 units during the first year.
An effective method for the preparation of leukocyte‐poor platelets
Authors: Kalmin N. D. , Orrell J. E. , Villarreal I. G.
Published: March 2003

Febrile transfusion reactions are encountered occasionally in patients receiving platelet concentrates that contain contaminating leukocytes. To remove heavier cellular elements, a 400‐ml platelet pooling bg with tapered sides and a pouch at the base was designed to trap these cells after centrifugation. Two versions of this bag were tested: the initial prototype with a 3‐ml pouch and a modified version with a 4‐ml pouch. Platelet concentrates were pooled in batches of 6 per bag and, after sampling, were centrifuged between 186 and 600 × g for 7 to 10 minutes. The pouch on each bag was then clamped off, and samples from the primary bag were withdrawn so tht the percentage of cellular elements remaining could be determined. At optimal centrifugation conditions (390 × g for 10 minutes) with the initial prototype of the bag, average cellular decreases were: leukocytes, 75.9 percent; red cells, 84.1 percent; and platelets, 9.8 percent. Twenty‐two components prepared in this manner were infused into 12 patients with histories of febrile transfusion reactions. Febrile reactions were markedly reduced or absent in ten patients, a strong febrile reaction due to incorrect component preparation occurred in one, and a marked allergic reaction occurred in one. The 4‐ml pouch gave much better production results with greater than 95 percent leukocyte removal and less than 5 percent platelet loss. This system removes sufficient leukocytes from platelet concentrates that the risk of febrile transfusion reactions is reduced significantly.
The para‐Bombay phenotype in Chinese persons
Authors: Lin‐Chu M. , Broadberry R.E. , Tsai S.J. , Chiou P.W.
Published: March 2003

The para‐Bombay phenotype occurs more frequently in Oriental than in white populations. This report describes the immunohematologic findings in 20 cases of the para‐Bombay phenotype detected over a period of about 15 months in the Chinese population of Taiwan.
Red cell tolerance of admixture with heated saline
Authors: Wilson E.B. , Knauf M.A. , Iserson K.V.
Published: March 2003

Red cell stability in the face of thermal stress has been evaluated only in the setting of prolonged incubation. This study was conducted to determine red cell tolerance of rapid mixture with heated saline, which exposes red cells to heat only until thermal equilibration, which is a matter of seconds. Half‐units of 35‐day‐old red cells stored in CPDA‐1 were mixed at 6 to 10 degrees C in the blood container with an equal weight of 60, 70, or 80 degrees C saline. This resulted in mean mixture temperatures of 30.9, 37.5, and 42.6 degrees C, respectively. Controls consisted of the same mixture, but with 6 to 10 degrees C saline. The red cells in the mixtures were assessed for osmotic fragility, and the supernatant was examined for plasma hemoglobin and potassium. Neither osmotic fragility curves nor supernatant hemoglobin or potassium changed significantly with saline temperatures of 60 or 70 degrees C. When 80 degrees C saline was used, osmotic fragility, supernatant hemoglobin, and potassium all increased significantly (p less than 0.01) over control values. Red cells tolerate rapid mixture with 70 degrees C saline without hemolysis or change in osmotic fragility.
The global distribution of human immunodeficiency virus type 2 (HIV‐2) infection
Authors: Horsburgh C. Robert , Holmberg Scott D.
Published: March 2003

We reviewed published reports of infection with human immunodeficiency virus type 2 (HIV‐2) to provide a picture of its geographic distribution, pathogenicity, modes of transmission, and risk to the blood supply. Since the first reports in 1986, 627 HIV‐2‐seropositive persons have been reported; 604 of these were in natives of West Africa. Acquired immunodeficiency syndrome (AIDS) had developed in 42 patients, while 8 patients had AIDS‐related complex. Transmission by sexual intercourse was the usual reported mode of spread. The modes of transmission of HIV‐2 are thought to be the same as those for HIV‐1, but perinatal transmission and transmission by sharing of needles among intravenous drug abusers have not yet been reported. The virus has not been identified in blood donors in the United States or West Germany, but two HIV‐2‐infected blood donors were reported in France. Further epidemiologic studies are needed to define the spectrum of disease, modes of transmission, and risk of HIV‐2 to the blood supply.