bluuebunny/crossref_metadata_2025 huggingface dataset:
Inverse dynamic analysis of mechanical systems in joint coordinate space
Authors: Lee B H
Published: March 2003

An inverse dynamic analysis algorithm for spatial flexible mechanical systems with closed loops is developed in the relative joint coordinate space. System equations of motion and constraint acceleration equations are derived using the velocity transformation technique. An inverse velocity transformation operator, which transforms the Cartesian velocities to the relative velocities, is derived systematically, corresponding to the types of kinematic joint connecting the bodies. Using the resulting matrix, the joint reaction forces and moments are analysed in the Cartesian coordinate space. The joint coordinates and the deformation modal coordinates are used as the generalized coordinates of a flexible mechanical system. The algorithm is verified by means of two numerical examples.
Jerk distribution of a 6–3 Gough-Stewart platform
Authors: Gallardo-Alvarado J
Published: March 2003

This paper is devoted to forward and inverse jerk analyses, by means of screw theory, of a Gough-Stewart platform with special topology, namely type 6–3. Given a set of generalized coordinates, and their time derivatives, the reduced jerk state or, for brevity, the jerkor of the moving platform, with respect to the fixed platform, is easily obtained by taking advantage of the properties of the Klein form, a bilinear symmetric form of the Lie algebra, e(3). Finally, the joint rate jerks of the parallel manipulator are found, expressing in screw form the jerkor of the moving platform with respect to the fixed platform. A numerical example is provided.
The Communicative Aspect of Nonfatal Suicidal Behavior— Are There Gender Differences?
Authors: Hjelmeland Heidi , Knizek Birthe Loa , Nordvik Hilmar
Published: March 2003

Summary: Data from the Norwegian part of the WHO/EURO Multicenter Study on Suicidal Behavior were used to investigate gender differences in the communicative aspect of nonfatal suicidal behavior by means of analyzing precipitating factors, intentions involved in and effects of the suicidal act within the frame of Qvortrup's interpretation of speech-act theory. Eighty-nine patients (48 women and 41 men) were included in the analyses. Virtually no gender differences were found. Thus, in general, the results did not support the view that persons engaging in nonfatal suicidal behavior should receive different treatment or follow-up as a group based on their gender. The results gave some support to Qvortrup's speech-act theory and his four categories of suicidal behavior: emotional toward others, regulative toward others, emotional toward oneself and regulative toward oneself.
Do Event-Related Brain Potentials Reflect Mental (Cognitive) Operations?
Authors: Kotchoubey Boris
Published: March 2003

Abstract Most cognitive psychophysiological studies assume (1) that there is a chain of (partially overlapping) cognitive processes (processing stages, mechanisms, operators) leading from stimulus to response, and (2) that components of event-related brain potentials (ERPs) may be regarded as manifestations of these processing stages. What is usually discussed is which particular processing mechanisms are related to some particular component, but not whether such a relationship exists at all. Alternatively, from the point of view of noncognitive (e. g., “naturalistic”) theories of perception ERP components might be conceived of as correlates of extraction of the information from the experimental environment. In a series of experiments, the author attempted to separate these two accounts, i. e., internal variables like mental operations or cognitive parameters versus external variables like information content of stimulation. Whenever this separation could be performed, the latter factor proved to significantly affect ERP amplitudes, whereas the former did not. These data indicate that ERPs cannot be unequivocally linked to processing mechanisms postulated by cognitive models of perception. Therefore, they cannot be regarded as support for these models.
Salivary Testosterone and Cortisol Responses to Cycle Ergometry in Basketball Players with Different Training Volume
Authors: González-Bono E. , Moya-Albiol L. , Martínez-Sanchis S. , Salvador A.
Published: March 2003

Abstract This study analyzes the degree to which different amounts of training during a 4-month period affects salivary testosterone (Tsal), salivary cortisol (Csal) responses, and changes in the salivary testosterone/cortisol ratio (Tsal/Csal ratio) following acute physical effort. Two professional basketball teams with similar fitness levels carried out a maximal cycle ergometry at the beginning and in the middle of the sports season. In both sessions, saliva samples were collected to determine Tsal and Csal, and mood was assessed. Training was registered daily, total training volume being almost two-fold higher in Team 1 than in Team 2. No significant differences between the teams in anthropometric characteristics, mood, or cycle ergometer performance were found. The Tsal/Csal ratio response to ergometry decreased after training in Team 1 and increased in Team 2, whereas Tsal response did not change significantly and the Csal response to ergometry increased in Team 1 and decreased in Team 2. Results obtained are modulated by initial differences in the Csal values at baseline, with Team 1 showing higher levels than Team 2. In addition, the training volume applied was associated with the changes in the Csal and Tsal/Csal ratio responses to a maximal physical exercise in professional basketball players.
Inhibition-Related ERP Components: Variation with Modality, Age, and Time-on-Task
Authors: Falkenstein Michael , Hoormann Jörg , Hohnsbein Joachim
Published: March 2003

Abstract In Go/Nogo tasks, the ERP after Nogo stimuli generally reveals a negativity (Nogo-)N2 and a subsequent positivity (Nogo-)P3 over fronto-central scalp regions. These components are probably related to different subprocesses serving response inhibition, namely, modality-specific and general inhibition, respectively. In the present study we investigate whether aging or prolonged work (“time-on-task”) have an effect on N2 and P3. Twelve young and 12 elderly subjects performed simple Go/Nogo tasks to visual or auditory letter stimuli. Reaction times were longer after visual than after auditory stimuli, and longer in the elderly than in the young. The ERP results reveal a slight impairment of modality-specific inhibition (N2) in the elderly after visual, but not after auditory, stimuli. General inhibition (P3) was delayed in the elderly for both modalities, as was Go-P3 and RT. Hence, it appears that the response slowing of the elderly is the result of a slowing of the decision process whether to respond or to inhibit. Moreover, age appears to affect both aspects of inhibition in a different manner. No effects of time-on-task were found, which suggests that the inhibitory processes are fairly robust against mental fatigue.
Life after Heart Transplantation
Authors: Savadori Lucia , Lotto Lorella , Rumiati Rino
Published: March 2003

Progress in surgical technology and in postoperative therapy has remarkably increased life expectation after heart transplantation. Nevertheless, patients still show a resistance to resume a normal life after transplantation, for example, to return to work. In this study we assume that after surgery patients become risk averse because they achieve a positive frame of reference. Because of this propensity toward risk aversion, they withhold from engaging in behavior that their physical condition would allow them in principle. Coherent with this assumption we found that compared to the medical team patients overestimate the degree of risk for routine activities. The study also showed that the representation of risk by the patients could be captured by a dreadfulness factor and a voluntariness factor. Patients' risk judgments were strongly and specifically predicted by the perceived degree of dreadfulness of the activity and, to a lesser extent, by the perceived knowledge of the consequences. Implications for patient-physician communication were explored.
Euro Illusion: Psychological Insights into Price Evaluations with a Unitary Currency
Authors: Gamble Amelie , Gärling Tommy , Charlton John , Ranyard Rob
Published: March 2003

The Euro illusion is a phenomenon related to the money illusion whereby people are biased toward the nominal representation of the Euro (the numbers printed on notes and coins) when evaluating prices in the new currency. In Study 1 the Euro illusion was demonstrated in telephone interviews of a Swedish population-based sample. However, no Euro illusion was found for British students in Study 2. An additional two studies employing student samples demonstrated the Euro illusion for fictitious unknown currencies in that prices of goods or services were evaluated as less expensive when the money unit was larger. An exception, however, was that prices were evaluated as more expensive when the money unit was very small (like the Italian Lira). Furthermore, the illusion was weaker or absent for low-price essential goods or services or for an induced negative attitude toward the currency change.
The Training of Doctoral Students of Psychology in the United States
Authors: Silvera David H. , Laeng Bruno , Dahl Tove I.
Published: March 2003

This article describes both formal and informal aspects of doctoral training of psychology students in the United States. We first describe admission procedures and the financial support of doctoral students and then discuss the various milestones in a typical doctoral program. There follows an overview of what is expected of doctoral students and a description of the working environment (e.g., faculty and fellow students) in doctoral programs. Finally, we provide a brief analysis of the doctoral training system in the United States. One question of particular importance is whether the close supervision associated with many doctoral programs prepares the student adequately for supervising researchers and developing a research program of his/her own after graduation.
Effects of Neem Azal T/S and other insecticides against the pistachio psyllid Agonoscena targionii (Licht.) (Homoptera, Psyllidae) under field conditions in Syria
Authors: Lababidi M. S.
Published: March 2003

Different concentrations of Neem Azal‐T/S, an insect growth regulator (IGR) (antiecdysone) and various other insecticides were tested against the pistachio psyllid (Agonoscena targionii) affecting pistachio (Pistacia vera L.), in northern Syria. From 1997 – 99, three applications were made annually, in April, May, June or July. Results revealed that Neem Azal‐T/S, at the rate of 0.5 and 0.7 %, Flufenoxuron, Teflubenzuron, and the antagonistic fungus Beauveria bassiana Bals. were highly effective against the psyllid especially on the 1st and 2nd nymph instars in the April application. The possibilities of using these pesticides in integrated management against pistachio psyllid in Syria are discussed.
Investigations on side‐effects of the mixed biocide GCSC‐BtA on different predators of Plutella xylostella (L.) (Lep., Plutellidae) in southeastern China
Authors: Liu B. , Sengonca C.
Published: March 2003

The present paper deals with laboratory studies on side‐effects of the mixed biocide GCSC‐BtA on Plutella xylostella (L.) (Lep., Plutellidae) and its predators, e. g. Amblyseius longispinosus (Evans) (Acari, Phytoseiidae), Erigonidium graminicola (Sundvall) (Araneae, Linyphiidae), Orius similis Zheng (Het., Anthocoridae) and Coccinella septempunctata L.(Col., Coccinellidae), in comparison to the commercial insecticides, e. g. Abamectin, Tebufenozide, Dichlorvos, Cartap and Lambda‐cyhalothrin.

 The results showed that GCSC‐BtA was highly toxic to the 3rd instar of P. xylostella with 91.18 % mortality, followed by Cartap with 84.38 %, Abamectin with 78.00 %, Tebufenozide with 75.57 %, Lambda‐cyhalothrin with 63.75 % and Dichlorvos with 50.86 % mortality. On the other hand, GCSC‐BtA was found to be comparatively less toxic to the predators, causing 31.11 %, 13.33 %, 11.54 % and 6.00 % mortalities in A. longispinosus, E. graminicola, O. similis and C. septempunctata, respectively. For comparison, the mortalities recorded for Abamectin, Tebufenozide, Dichlorvos, Cartap, Lambda‐cyhalothrin were 72.94 %, 55.55 %, 70.00 %, 53.26 % and 98.85 % in A. longispinosus, 46.51 %, 55.10 %, 60.00 %, 46.00 % and 73.68 % in E. graminicola, 22.00 %, 16.00 %, 35.71 %, 26.78 % and 81.03 % in O. similis, 15.55 %, 19.64 %, 28.00 %, 16.66 % and 41.79 % in C. septempunctata, respectively.

 Cluster analysis was introduced to group the mortalities caused by the treatments into three toxicity groups with the distance of D = 4.1. The 1st group consisted of GCSC‐BtA characterized with low toxicity to all the predators tested with 15.49 % mortality on average (highest 31.11 % and lowest 6.00 %). The 2nd group consisted of Abamectin, Tebufenozide, Dichlorvos and Cartap with moderate toxicity to the predators with 39.96 % mortality on average. The 3rd group included Lambda‐cyhalothrin with high toxicity to the predators with 73.83 % mortality on average (highest 98.85 % and lowest 41.70 %). The susceptibility of the pest and its predators to GCSC‐BtA and the insecticides is discussed. GCSC‐BtA as a biological control agent is recommended for use in the integrated pests control programs in the vegetable fields.
Activity of heterorhabditid nematodes at high temperature and in combination with cytoplasmic polyhedrosis virus
Authors: Salama H.S. , Abd‐Elgawad M.
Published: March 2003

Percentage survival in aqueous suspensions and infectivity of six Egyptian entomopathogenic nematode isolates from the genus Heterorhabditis varied during the hot period of the year with daily temperature range from 18 to 24 °C. The isolate designated as AS1 had the highest mean of survival (87 %) and infectivity to Galleria mellonella larvae (90 %) after 10 days. When the nematodes coexisted with cytoplasmic polyhedrosis virus of 100 × 106 polyhedra inclusion bodies/ml, which was reproduced within and killed Rhynchophorus ferrugineus larvae, the nematode survival was adversely and progressively affected by the increase in the viral suspension. Among tested concentrations, a viral suspension equal to one‐fifth size of the nematode and virus suspension is the best for nematode activity in integrated control against the red palm weevil.
Zur Lebensweise der Hausratte (Rattus rattus L.). Langjährige Beobachtungen in einer Getreidemühle bei Magdeburg
Authors: Mielke U.
Published: March 2003

A large flour mill near Magdeburg was built in 1912 and has since been infested with house rats (Rattus rattus L.). Observations made over the past decades by personnel interested were acquired, and recorded together with own findings, in the course of which well‐known facts of the habits of house rats were confirmed and thought‐provoking shades added. Reference is made in this paper to varied issues including degree of infestation, skin colours, food, reproduction, as well as behavioural patterns and the problem area of control and extermination.
The development of mice and voles in an oak forest with a surplus of acorns
Authors: Margaletic J. , Glavaš M. , Bäumler W.
Published: March 2003

130 kg of acorns of Common Oak (Quercus robur L.) were distributed on an area of 1.44 ha in an oak forest near Zagreb (Croatia), where acorns were lacking. The influence of this surplus of food on the development of mice and voles was observed from September 1999 till February 2000 on the experimental plot and on an untreated control area before and after offering the acorns. The Redbacked Vole Clethrionomys glareolus was the most abundant and dominant species in both observed areas. After distribution of the acorns, all species of mice, e. g. the Yellownecked Fieldmouse Apodemus flavicollis, the Longtailed Fieldmouse A. sylvaticus, and the Striped Field Mouse A. agrarius, increased up to 4 times in number on the area treated with a surplus of acorns. On the same area, however, all species of voles, e. g. the Redbacked Vole C. glareolus, the Field Vole Microtus agrestis, and the Common Vole M. arvalis, decreased. The numbers of captured and recaptured rodents before and after offering acorns on the treated and the untreated control area were compared by statistical analysis (Chi2‐test). The results show how food can influence the competitive relations between mice and voles.
Zur Schädlingsvertilgung einiger Singvogelarten in einem Schwarzkiefern/Eichen‐Mischbestand im Beynamer Wald bei Ankara*
Authors: Kiziroğlu Ilhami , Turan Levend , Erdoğan Ali , Adizel Özdemir , Pamukoğlu Nahit
Published: March 2003

Analysis of nestling food in four species of Parus and one species of Ficedula using the ‘Halsringmethode’ showed a high quota of adults and caterpillars of the important forest pests: Tortrix viridana, Euproctis chrysorrhoea, Diprion pini, and Lymantria dispar. These four major pest species amounted in the nestling food of Parus major to 50 %, P. coeruleus to 52.6 %, P. ater to 40.9 %, and Ficedula hypoleuca to 30.2 %.
Adult morphology and life cycle under constant temperatures of the predator Rhyzobius lophanthae Blaisdell (Col., Coccinellidae)
Authors: Stathas G. J. , Eliopoulos P. A. , Kontodimas D. C. , Siamos D. Th.
Published: March 2003

The external and internal morphological characteristics of the predator Rhyzobius lophanthae Blaisdell (Coleoptera, Coccinellidae) were studied. The head, antenna, thorax elytra, hind wings, legs and abdomen are described. The adult has an average length of about 2.5 mm and width of 1.8 mm. The flagellum of the antenna consists of 9 segments. The whole surface of thorax and elytra is covered by setae. The tarsus of the 3 legs is 3‐segmented. An external morphological difference between male and female is the outline of the 5th sternite. The alimentary canal, the central nervous system, and the reproductive system of both male and female are also described. The testes consist of 10 follicles and the ovaries of 10 ovarioles. The life cycle of R. lophanthae was studied by rearing the predator on the diaspidid Chrysomphalus aonidum (Linnaeus). The duration of the development of the embryo, 1st, 2nd, 3rd, 4th larval instars, pupa and preoviposition period of adults were measured at 15, 20, 25 and 30 °C.
Patient‐controlled analgesia with oxycodone in the treatment of postcraniotomy pain
Authors: Tanskanen P. , Kyttä J. , Randell T.
Published: March 2003

Background: Moderate to severe pain occurs after craniotomy in 60% of patients. We evaluated the feasibility and safety of patient‐controlled analgesia (PCA) with oxycodone in neurosurgical patients, and compared the efficacy of paracetamol with ketoprofen.

Methods: In the study there were 45 patients, who received either paracetamol 1000 mg or ketoprofen 100 mg three times a day. Oxycodone‐boluses 0.03 mg/kg were given by PCA‐device maximally three times an hour, lock‐out time 10 min. The amount of oxycodone used, pain scores and side‐effects were recorded.

Results: The ketoprofen group required less oxycodone than the paracetamol group (medians 37.1 mg vs 19.6 mg, P<0.05). The VAS scores were comparable between the groups at the beginning of the study, during the first postoperative evening and the next morning, but the paracetamol group had a higher score at the conclusion of the study (P<0.05). The patients in both groups were equally satisfied with the pain relief. There were no differences in side‐effects between the groups.

Conclusions: PCA with oxycodone is a suitable method for pain control after craniotomy. No progressive hypoventilation, desaturation or excessive sedation were encountered. Ketoprofen appeared to be more effective than paracetamol.
Alterations of bacterial clearance induced by propofol
Authors: Kelbel I. , Koch T. , Weber A. , Schiefer H. G. , Van Ackern K. , Neuhof H.
Published: March 2003

Background: The purpose of the study was to investigate the potential influence of the anaesthetic agent propofol on immune function in terms of systemic clearance and organ distribution of injected Escherichia coli in a rabbit model.

Methods: Defined numbers of E. coli (1.3×108 colony‐forming units, CFU) were injected intravenously 1 h after starting a 4‐h infusion of the anaesthetic propofol (2 ml · kg−1 · h−1, Disoprivan® 1%; n=6)) or after saline application (n=6). As propofol is formulated in a 10% lipid emulsion, the lipid vehicle Intralipid® (2 ml · kg−1 · h−1; n=6) alone was investigated in a separate group. Parameters monitored were arterial pressure and rates of bacterial elimination from the blood. Three hours after bacterial injection, the animals were killed, and tissue samples of liver, spleen, lung, and kidney were collected for microbiological examinations.

Results: Compared to saline‐treated animals, infusion of propofol induced increased accumulation of E. coli in lung and spleen, thus reflecting reticuloendothelial system dysfunction.

Conclusion: As the lipid emulsion by itself induced the same effects, the impaired immune function due to propofol is thought to be attributed to its solvent Intralipid®.
Heat stress produces an early phase of protection against oxidative damage in human muscle
Authors: Naito J. , Hartung E. , Schramm E. , Inselmann G.
Published: March 2003

Background: It has been rarely reported that heat stress induces an early phase of protection against oxidative damage, whereas a delayed phase of protection is shown in heat stress. To explore the early effect of heat stress against oxidative damage, we evaluated the changes in contractility, lipid peroxidation, and ultrastructure induced by hydrogen peroxide (H2O2) with or without heat stress (HS) in human skeleton muscle.

Methods: Thirty‐two muscle samples were obtained from the vastus lateralis muscle of 7 subjects. These specimens were divided into three groups based on form of treatment: HS (n=13), non HS (n=14), and control group (n=5). The control group was performed under identical conditions without H2O2. Specimens in the HS group were incubated at 42°C for 20 min, while those in the non‐HS and control groups were maintained at 37°C.

Results: The control group showed no significant change in contractile force. Although contractile force significantly decreased 30 min after H2O2 administration in both the HS and non‐HS groups, only the HS group showed apparent recovery of contractile force 60 min after H2O2 administration. Lipid peroxidation was lower in the HS group than in the non‐HS group. Ultrastructural examination revealed less mitochondrial damage in the HS group compared with the non‐HS group.

Conclusion: We found that human skeleton muscle escaped cellular damage induced by H2O2 in the early phase after heat stress. These data suggest evidence for an early effect of heat stress against ischemia/reperfusion injury in human muscle.
Clinical application of diadenosine tetraphosphate(Ap4A:F‐1500) for controlled hypotension
Authors: Kikuta Y. , Ohiwa E. , Okada K. , Watanabe A. , Haruki S.
Published: March 2003

Background: In our animal study, it was revealed that diadenosine tetraphosphate (Ap4A:F‐1500) has a dose‐dependent hypotension effect of up to 60% decrease in mean arterial pressure compared to control value. Furthermore, in healthy male volunteers, the safety of Ap4A up to 4 mg · min−1 was confirmed. In patients who require surgical procedures under general anesthesia together with controlled hypotension, hypotension was induced by Ap4A in order to examine its hypotensive effect and modulating action on the blood pressure.

Methods: Ten patients who required controlled hypotension and who were scheduled for elective surgery under general anesthesia were studied. Anesthesia was maintained with isoflurane (n=7) or sevoflurane (n=3) in oxygen‐nitrous oxide. Controlled hypotension was induced by Ap4A administered at a rate of 10–20 μg · kg−1 · min−1. The dose was adjusted at a maximum rate of 80 μg · kg−1 · min−1 until the target blood pressure was achieved. Arterial blood pressure and heart rate were monitored. Arterial samples were drawn at 4 separate time points to measure the concentration of Ap4A in the plasma.

Results: The time required for attaining the target blood pressure after initiation of Ap4A infusion was about 16 min, and the time lapse between withdrawal of infusion to recovery of blood pressure was about 18 min. No reflex tachycardia was observed during infusion of Ap4A and no rebound hypertension was evident after withdrawal. The plasma Ap4A concentration increased in response to the acceleration rate of Ap4A administration with a tendency of augmented hypotensive effect.

Conclusion: As it produces an excellent hypotensive effect together with a modulating action on blood pressure, Ap4A was assessed as useful in producing controlled hypotension.
Finland’s first anaesthesia revealed by newspapers
Authors: Tammisto T. , Tammisto CH.
Published: March 2003

Background: According to the literature on the history of anaesthesia, Finland’s first anaesthesia was given on March 8, 1847 for a ligature of an aneurysm of the subclavian artery. It has, however, not been possible to verify the date with certainty. We therefore wanted to find out whether newspapers might give additional information and how this exceptionally important medical invention had been received by the Finnish newspapers.

Methods: Microfilms of the 10 newspapers which appeared in Finland in 1847 were studied at the Helsinki University library.

Results: The first report which made reference to English newspapers was published on February 10 by “Borgå Tidning”. On March 6, “Helsingfors Tidningar” wrote that two anaesthesias had already been given in Helsinki; the first of them for a difficult varicose veins operation and the second for an exarticulation of a shoulder. But there was no information regarding the dates of the operations. Fortunately, both operations had been recorded in the patient diary of the clinic, although without any information about the anaesthesia. According to the diary, Johan August Örn was operated for varicose veins on February 16 and Anders Gustaf Henrikson had his right arm exarticulated on March 3. Both patients recovered. In total, only six pieces of news on anaesthesia were found.

Conclusions: Finland’s first anaesthesia was given on February 16, 1847, which is three weeks earlier than had been previously assumed.
Angiotropic large B‐cell lymphoma misdiagnosed as urosepsis with multiple organ dysfunction syndrome
Authors: Deusch E. , Mayr A. , Hobisch‐Hagen P. , Fend F. , Mutz N. , Bangerl I. , Hasibeder W.
Published: March 2003

A 53‐year‐old woman with a history of cervical carcinoma 14 years ago, treated with hysterectomy and radiation therapy, was admitted to the intensive care unit with severe SIRS (systemic inflammatory response syndrome) progressing to shock, multiple organ failure and death within 5 d. Bilateral hydronephrosis diagnosed by sonography and an enlarged left kidney with suspected abscesses verified in a CT‐scan suggested the diagnosis of urosepsis. However, multiple microbiological examinations remained sterile. Despite surgical treatment and aggressive intensive care, she died in unresponsive shock. Pathohistologically, an angiotropic large B‐cell lymphoma, a rare diffuse intravascular neoplasm of lymphoid origin, was diagnosed. The patient’s history of abdominal radiation therapy 14 years earlier as well as multiple negative microbiological specimens in a patient with suspected urosepsis should have initiated the search for a non‐infectious cause of the disease.
Airway obstruction due to arytenoid prolapse in a child
Authors: Reber A. , Paganoni R. , Frei F. J.
Published: March 2003

In paediatric patients, obstruction of the upper airway is still a common problem during general anaesthesia. This case report documents the susceptibility of arytenoids to prolapse in paediatric patients during halothane anaesthesia. The use of video endoscopy provides an excellent tool for visualizing this type of airway obstruction; and continuous positive airway pressure is an effective treatment for clearing the airway.
Non‐invasive evaluation of left ventricular function by means of impedance cardiography
Authors: Van Der Meer B. J. M. , Vonk Noordegraaf A. , Bax J. J. , Kamp O. , De Vries P. M. J. M.
Published: March 2003

Background: Simple, accurate, continuous non‐invasive cardiac monitoring during the peri‐ and postoperative periods for patients at risk of cardiac failure would be very useful. Electrical impedance cardiography (EIC) has been proposed as an accurate method for non‐invasive measurement of cardiac function. However, in recent years the accuracy of EIC in stroke volume (SV) measurement has been questioned and this prevented global acceptance of the method. Beside SV, EIC is capable of measuring several other left ventricular contractility indices, which are measured directly from the impedance signal. The aim of this study was to compare these variables with the echocardiographically derived left ventricular wall motion score (WMS) as the reference method.

Methods: In a group of eight coronary artery disease patients we performed a pharmacologically (dobutamine) induced stress test. Echocardiographic and impedance cardiographic recordings were performed simultaneously during four levels of dobutamine infusion. WMS was derived from the simultaneously displayed four‐stage echocardiographic image.

Results: Analysis of variance showed that the majority of indices changed significantly during the test. Direct correlation with the wall motion score gave very satisfactory results over all stages with the RZ time (r=0.75, P<0.001) and Heather index (r=−0.78, P<0.001). Other correlations were substantially lower.

Conclusion: The Heather index has to be preferred as indicator of the left ventricular performance. Since EIC is capable of giving continuous information of the left ventricular performance, it might be a valuable method for peri‐ and postoperative monitoring.
Implementation of percutaneous dilation tracheotomy – value of preincisional ultrasonic examination?
Authors: Bonde J. , Nørgaard N. , Antonsen K. , Faber T.
Published: March 2003

Background: In this observational study we have evaluated the implementation of percutaneous dilation tracheotomy (PDT), using the foreceps dilation technique (Portex) in a multidicsiplinary ICU.

Methods: We included a preincisional ultrasonic evaluation of the neck in order to visualise the isthmus glandula thyroidea and major vessels. The observational period comprised one year. PDT was performed in 28 patients.

Results: Implementation of PDT was uneventful. Duration of insertion was 10 min (4–40 min). Total time of tracheostomy was 8 days (1–65 days). In nine cases, the proximal end of the isthmus was overlying the space between the 1st and 2nd tracheal ring, which was considered the optimal insertion site. This resulted in seven cases of insertion between the cricoidea and the 1st tracheal ring and in two cases in a more distal insertion. Nineteen tracheotomies were performed in the interstice between the 1st and 2nd tracheal ring. In nine patients, major vessels were overlying the trachea. In none of the patients did this information result in an altered insertion site. Two cases of minor bleeding were observed; both stopped upon compression. In two patients the primary tube size (8.0) was too big and a smaller tube had to be inserted. In one patient the tube was maladapted to the stoma and had to be interchanged with an ordinary tracheostomial tube on the 5th day of tracheostomy.

Conclusion: Based on the experience gathered in this study and information from the literature, we have abandoned the routine use of ultrasonic examination of the neck prior to PDT. In order to achieve and maintain routine, we suggest that the procedure is performed by a restricted number of doctors.
In‐hospital cardiopulmonary resuscitation
Authors: Skogvoll E. , Isern E. , Sangolt G. K. , Gisvold S. E.
Published: March 2003

Background: Direct comparison of survival rates from in‐hospital cardiopulmonary resuscitation (CPR) remains difficult. The objective of this study was to report outcome according to the Utstein template for in‐hospital cardiac arrest and to evaluate the Utstein template itself as applied to a retrospective material.

Methods: The hospital (900 beds, 37 000 annual admissions) has no established do‐not‐resuscitate (DNR) order policy. CPR outside the Intensive‐ or Coronary Care Units (ICU/CCU) is performed by an emergency medical team consisting of an anaesthesiologist, a medical resident and a nurse anaesthetist. CPR attempts during 5 years (1990–1994) were analysed retrospectively. Patient survival, cerebral and overall performance category (CPC/OPC) score of the survivors was determined. The Utstein template was evaluated in terms of clinical relevance and data availability.

Results: During 5 years, 4927 patients died as in‐patients. CPR outside the CCU/ICU was attempted 244 times. CPR was primarily successful on 83 occasions (34%), and 42 patients (17%) were finally discharged with CPC 1 or 2. Survival from primary ventricular fibrillation (VF) or ventricular tachycardia was 40%, pulseless electrical activity 3%, asystole 11% and of rhythm undetermined 6%. Age or sex effects were not observed.

Conclusion: More than 90% of in‐hospital deaths in this hospital are handled without CPR being initiated. Overall survival was 17%, and almost all survivors made a favourable outcome. The Utstein template for in‐hospital cardiac arrest performed acceptably as a framework for reporting outcome in this retrospective study.
Postoperative nausea and vomiting in childrenusing patient‐controlled analgesia:the effect of prophylactic intravenous dixyrazine
Authors: Kokinsky E. , Thornberg E. , Nilsson K. , Larsson L. E.
Published: March 2003

Background: Although patient‐controlled analgesia (PCA) with morphine provides a high degree of satisfactory postoperative analgesia in children, it is often associated with a high incidence of postoperative nausea and vomiting (PONV). Our aim in this study was to evaluate the prophylactic effect of dixyrazine, a phenothiazine with proven anti‐emetic properties.

Methods: The incidence of nausea and vomiting was studied in 60 children using PCA after major surgery. The patients were randomised to receive either dixyrazine 0.25 mg kg−1 or placebo on the induction of anaesthesia in a double‐blind, placebo‐controlled design. The anaesthetic technique was standardised. The PCA pump was programmed to deliver bolus doses of morphine of 20 μg kg−1 with a continuous background infusion of 8–10 μg kg−1 h−1. Nausea, vomiting, sedation and pain scores were noted every 3 h for a period of 24 h.

Results: The morphine consumption of morphine was the same in both groups. During the stay in the recovery room the incidence of vomiting was 3% in the dixyrazine group compared to 30% in the placebo group (P<0.05). On the ward, 57% versus 83% of the children vomited (P<0.05). Rescue antiemetics were significantly lower, 30%, in the dixyrazine group compared to 60% in the placebo group (P<0.05). Higher sedation scores were recorded for the dixyrazine group in the recovery room. No other adverse effects were found.

Conclusion: A significant number of children using PCA with morphine after major surgery experience PONV. Although prophylactic dixyrazine reduces the incidence and severity of vomiting, the incidence still remains high.
Sepsis attenuates the intensity of the neuromuscular blocking effect of d‐tubocurarine and the antagonistic actions of neostigmine and edrophonium accompanying depression of muscle contractility of the diaphragm
Authors: Narimatsu E. , Nakayama Y. , Sumita S. , Iwasaki H. , Fujimura N. , Satoh K. , Namiki A.
Published: March 2003

Background: Prolonged effects of non‐depolarizing muscle relaxants in septic patients have been reported, although the influence of sepsis on neuromuscular transmission has not yet been clarified satisfactorily. These studies were intended to elucidate the influence of sepsis on neuromuscular transmission and on the action of drugs being utilized for regulation of muscle tone (a neuromuscular blocker and anti‐cholinesterase (anti‐ChE) drugs).

Methods: The effect of d‐tubocurarine (dTc) on neuromuscular transmission and the antagonistic action of anti‐ChE drugs (neostigmine and edrophonium) on dTc‐induced twitch depression were estimated using sham control and septic rat nerve‐hemidiaphragm preparations in vitro. Isometric twitch tension elicited by indirect (phrenic nerve) or direct (muscle) stimulation at 0.1 Hz was evaluated.

Results: Sepsis induced by panperitonitis attenuated the twitch tension elicited by indirect or direct stimulation (P<0.01) without obvious morphological inflammatory damage to the diaphragm. dTc dose‐dependently decreased twitch tension elicited by indirect stimulation (P<0.01) less intensely in the septic group than in the sham group (P<0.01). The antagonistic actions of the anti‐ChE drugs on dTc (1 μM)‐induced twitch depression were less intense in the septic group (P<0.01 or 0.05).

Conclusion: These results demonstrate that sepsis in the acute phase attenuates the effects of a neuromuscular blocker and anti‐ChE drugs and depresses muscle contractility simultaneously.
The effect of ketamine on clinical endpoints of hypnosis and EEG variables during propofol infusion
Authors: Sakai T. , Singh H. , Mi W. D. , Kudo T. , Matsuki A.
Published: March 2003

Background: We studied the effect of variable doses of ketamine on the endpoints of hypnosis, e.g., unresponsiveness to verbal commands (UVC), loss of eyelash reflex (LER), and inhibition of body movement response with or without sneezing to nasal membrane stimulation (INBMR), and processed EEG variables, e.g., bispectral index (BIS), 95% spectral edge frequency (SEF) and median frequency (MF) during propofol infusion.

Methods: Forty‐eight patients received either propofol infusion, 30 mg · kg−1 · h−1 (Group P; n=12) or ketamine bolus, 0.25, 0.5 or 0.75 mg i.v., followed by propofol infusion, 30 mg · kg−1 · h−1+variable dose ketamine infusion, 0.25, 0.5 or 0.75 mg · kg−1 · h−1 (Groups PK0.25, PK0.5 and PK0.75; n=12 each) until UVC, LER and INBMR. BIS, 95% SEF and MF values were monitored and recorded at the endpoints of hypnosis. Propofol and ketamine concentrations were measured at INBMR.

Results: Propofol infusion, 30 mg · kg−1 · h−1, induced UVC, LER and INBMR at BIS: 65±2, 63±9 and 33±7; 95% SEF: 17±3, 17±4 and 14±3; and MF values of 5±2, 5±3 and 3±2, respectively. With adjunctive ketamine (Groups PK0.5 and PK0.75), the hypnotic endpoints were achieved at higher BIS and 95% SEF values and lower propofol doses and concentrations as compared to Groups P and PK0.25 (9.9±5.8 and 9.4±3.4 vs. 13.4±4.5 and 14±5.8 μg · ml−1).

Conclusions: Our results suggest additive interaction between propofol and ketamine (Groups PK0.5 and PK0.75) for achieving the hypnotic endpoints; however, ketamine did not depress the EEG variables in proportion to its hypnotic effect. The paradoxically higher BIS and 95% SEF values at the hypnotic endpoints may be due to lower propofol concentrations and/or no effect of ketamine on the EEG variables.
Lack of pre‐emptive analgesic effect of (R)‐ketamine in laparoscopic cholecystectomy
Authors: Mathisen L. C. , Aasbø V. , Ræder J.
Published: March 2003

Aim: This study evaluated the pre‐emptive analgesic effect of intravenous (i.v.) (R)‐ketamine in laparoscopic cholecystectomy. (R)‐ketamine was used due to the lower incidence of side‐effects.

Methods: Sixty patients who underwent surgery under general anesthesia were randomly allocated to 3 groups and studied in a double‐blind manner. Two i.v. injections were administered: one after induction of anesthesia, approximately 3 min before surgery, and one after surgery. The placebo group (PLA, n=20) received saline in both injections. The preoperative group (PRE, n=20) received (R)‐ketamine 1 mg/kg and then saline. The postoperative group (POST, n=20) received saline and then (R)‐ketamine 1 mg/kg. Postoperatively, the patients used a patient‐controlled analgesia (PCA) pump. Pain was evaluated with a visual analog scale (VAS) at 30 min and every hour for 4 h and with a verbal rating scale (VRS) at 24 h and after 7 days.

Results: There were no occurence of side‐effects from (R)‐ketamine. VAS and VRS at 1, 2, 3, and 4 h postoperatively showed no statistical differences. In the POST group, extubation was delayed and pain score (VAS) at 30 min postoperatively was significantly lower (P<0.05) than the two other groups. There were no statistical differences in meperidine consumption during the first 4 h postoperatively and no differences in consumption of analgesics at 24 h and 7 days.

Conclusion: In this study a 1 mg/kg dose of (R)‐ketamine given at the end of surgery exerted a short‐lasting hypnotic and analgesic effect. The same dose given preoperatively did not show postoperative analgesic effect or pre‐emptive effect.
Paraplegia after thoracotomy – not caused by the epidural catheter
Authors: Løvstad R. Z. , Steen P. A. , Forsman M.
Published: March 2003

Background: Paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used.

Case report: A 56‐yr‐old woman, with Bechterev disease but otherwise healthy, was operated with left‐sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid‐thoracic area before general anaesthesia was started. Bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 μg/ml fentanyl and 2 μg/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. Laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later.

Conclusions: This case shows – once again – that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.
Paraplegia, a severe complication to epidural analgesia
Authors: Bülow P. M. , Biering‐Sørensen F.
Published: March 2003

We report four cases where continuous epidural analgesia resulted in epidural abscesses (EA) causing spinal cord damage and paraplegia. The first symptom of EA was intense back pain, which developed 0–20 days after removal of the epidural catheter. The diagnosis of EA was not made prior to the development of severe neurologic disturbances in any of the patients. In all cases there was a timelag of 2–4 days between the first symptoms and institution of the appropriate treatment.
A simplified method for separate measurements of lung and chest wall mechanics in ventilator‐treated patients
Authors: Kárason S. , Karlsen K. L. , Lundin S. , Stenqvist O.
Published: March 2003

Background: Airway pressure measurements above the endotracheal tube will be distorted because of endotracheal tube resistance. To separate lung and chest wall compliance, esophageal pressure is conventionally measured with an air‐filled balloon catheter, which is difficult to insert in unconscious patients. We have developed a methodology with fluid‐filled catheters for intratracheal and esophageal pressure measurements.

Methods: Twelve anesthetized patients were studied. Tidal volumes were measured by side‐stream spirometry. Airway pressures were measured at the Y‐piece and in the trachea with fluid‐filled pressure lines. Esophageal pressure was measured via the narrow lumen in a fluid‐filled SalemTM double‐lumen stomach tube, which was slowly retracted from the stomach up through the esophagus until maximal respiratory pressure readings and minimal cardiac artifacts were obtained. Lung mechanics were measured at different tidal volumes (TV) and positive end‐expiratory pressure (PEEP).

Results: There was a significant difference between airway pressures at the Y‐piece and in the trachea. Total compliance significantly increased with increasing TV and decreased with increasing PEEP. Chest wall compliance increased significantly with increasing TV, while lung compliance did not change significantly. Two patients showed repeatedly marked increase in lung compliance at one specific ventilatory setting, an increase the proportion of which was not reflected by changes in total compliance.

Conclusions: Y‐piece pressures are not representative of intratracheal pressures, which can be measured by inserting a fluid‐filled pressure line through the tube. Esophageal pressure is easily recorded with a fluid‐filled SalemTM double‐lumen catheter. Large changes in lung compliance may pass unnoticed when only total compliance is monitored. Monitoring of lung compliance may offer an improved basis for decisions about ventilator settings.
The effect on intraocular pressure of endotracheal intubation or laryngeal mask use during TIVA withoutthe use of muscle relaxants
Authors: Kiliçkan L. , Baykara N. , Gürkan Y. , Toker K.
Published: March 2003

Background: Depolarizing and non‐depolarizing muscle relaxants possess many untoward side effects. In most patients endotracheal intubation may be performed with a propofol and alfentanil combination. The purpose of this study was to compare the effect on intraocular pressure (IOP) and haemodynamics of endotracheal (ET) intubation or laryngeal mask (LMA) insertion during total intravenous anaesthesia (TIVA) without the use of muscle relaxants.

Methods: In a randomised study, 20 patients scheduled for elective orthopaedic surgery were assigned to two groups of 10 patients. Anaesthesia was induced with i.v. alfentanil 40 μg/kg and propofol 2.5 mg/kg. LMA insertion or ET intubation was achieved by the same anaesthesiologist. Airway score, insertion score, patient response and haemodynamics were recorded. IOP measurements were recorded before and after induction, 1 and 2 min after ET intubation or LMA insertion, and 1 and 2 min after extubation.

Results: Mean arterial pressure and heart rate after insertion of the airway management devices was significantly higher than induction values in the ET group (P<0.05), while during 2–3 min no significant changes were observed in LMA group. In all patients following propofol and alfentanil induction, IOP was significantly lower than preinduction values (P<0.001). IOP following extubation was significantly higher than preinduction values in the ET group, but not in the LMA group (P<0.001).

Conclusion: During TIVA without the use of muscle relaxants neither LMA insertion nor ET intubation increased the IOP, but ET extubation did.