bluuebunny/crossref_metadata_2025 huggingface dataset:
DIFFERENTIAL EFFECTS OF SEDIMENTS ON SURVIVAL AND GROWTH OF FUCUS SERRATUS EMBRYOS (FUCALES, PHAEOPHYCEAE)1
Authors: Chapman Annelise S. , Albrecht) A. S. , Fletcher Robert L.
Published: March 2003

Recruitment of seaweeds through small reproductive stages is limited on sediment inundated rocky shores and largely unsuccessful in soft sediment environments. Burial in sediment has several potentially negative effects for seaweed propagules, and these effects were differentiated in a laboratory experiment. We investigated how light deprivation, sediment type (grain size, organic content, and origin), and sediment chemistry (oxygen presence and toxicity through hydrogen sulfide) affected survivorship and growth of Fucus serratus L. embryos. Presence of hydrogen sulfide had overriding negative impacts on both survivorship and growth of Fucus embryos, independently of sediment type and light availability. In contrast, simple anaerobiosis generally did not impair survival or growth of the embryos. Fine sediments, 3 mm thick, significantly reduced embryo survivorship, presumably through accumulation of metabolic waste products in the immediate vicinity of the embryos as a consequence of constrained diffusion. This effect was equally pronounced in the presence of a 1‐mm layer of organically rich biodeposits. Irradiance levels did not affect survival of embryos but influenced growth. Decreasing thickness and increasing coarseness of sediments together represented a gradient of enhanced light penetration and diffusion. Growth of embryos increased along this gradient. In nature, soft sediment environments with organically enriched muds (e.g. tidal flats and salt marshes) represent habitats least favorable for colonization through small reproductive stages of seaweeds.
Patterns of Onset of Disability in Activities of Daily Living with Age
Authors: Jagger Carol , Arthur Antony J. , Spiers Nicola A. , Clarke Michael
Published: March 2003

OBJECTIVES: To investigate the order in which activities of daily living (ADLs) are lost and whether the order is invariant between the sexes and age groups.

DESIGN: Longitudinal data from the first five rounds of a routine health assessment by a nurse in participant's own home.

SETTING: One large UK general practice with a list size of 32,500.

PARTICIPANTS: Patients registered with the practice and age 75 and older.

MEASUREMENTS: Disability was measured by self‐report of performance in seven ADLs: mobility around the home, getting to and from the toilet, transfer from chair, transfer from bed, feeding, dressing, and bathing. Disability in each ADL was classified as being independent but having difficulty, using aids or help, or being unable to perform. Age at onset of disability in each ADL was calculated and analyzed using Kaplan‐Meier plots and Cox regression models. Subjects who had died or remained independent by their last assessment were not included.

RESULTS: The mean times between health assessments was approximately 20 months but with substantial variability both within and between individuals. A total of 1,344 people reported no difficulty in any ADL initially and 47.6% (640) subsequently reported disability. The order of activity restriction was bathing, mobility, toileting, dressing, transfers from bed and chair, and feeding. Women had a higher risk of disability in bathing (relative risk (RR) = 1.6, 95% confidence interval (CI) 1.3–1.9, P < .001) and toileting (RR = 1.7, 95% CI 1.2–2.5, P = .003), while for all ADLs there was a significant increase in the risk of disability with increasing age. The order of onset of disability for ADLs was invariant across sex and age groups.

CONCLUSION: Lower‐extremity strength (bathing, mobility, toileting) appears to be lost in older people before upper‐extremity strength (dressing, feeding). Further work is now needed to develop prevention strategies to delay the onset of these disabilities.
Physician Visits, Emergency Room Utilization, and Overnight Hospitalization in the Old‐Old in Israel: The Cross‐Sectional and Longitudinal Aging Study (CALAS)
Authors: Walter‐Ginzburg Adrian , Chetrit Angela , Medina Chaya , Blumstein Tzvia , Gindin Jacob , Modan Baruch
Published: March 2003

OBJECTIVES:The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework.

DESIGN:A random stratified sample of subjects age 75 to 94 was selected from the National Population Register (a complete listing of the Israeli population maintained by the Ministry of the Interior). The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5‐year age groups: 75–79, 80–84, 85–89, and 90–94), sex, and place of birth (Europe/America, Asia/Africa, and Israel).

SETTING:Community‐dwelling old‐old Jewish Israelis.

PARTICIPANTS:1,487 people living in the community at the time of the baseline interview.

MEASUREMENTS:The dependent variables were PM in the month before the interview and ERU and OH in the previous year. The independent variables were: predisposing variables (age, sex, place of birth, and education); enabling variables (income and the social network variables of marital status, living arrangements, and number of in‐person contacts per week with any child); and need variables (number of self‐reported chronic medical conditions, subjective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of physical robustness, and engaging in regular physical sportive activities).

RESULTS:The predisposing and enabling factors were only minimally associated with utilization rates in the old old in Israel, with the exception of lower rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old‐old population studied. Healthcare utilization was found to be associated primarily with health and functional status.

CONCLUSION:In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic disease and disability is driven primarily by health needs, rather than by extraneous factors such as income and education. The study indicates that equity in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate estimates of future needs.
Highlights of Papers in Clinical Investigations Section: Factors Associated with Healthy Aging: The Cardiovascular Health Study
Authors: Burke GL , Arnold AM , Bild DE
Published: March 2003

In the Cardiovascular Health Study, 3,332 participants age 65 years and older who were free of chronic disease were followed for over 6.5 years. The vast majority of older adults remained healthy during the follow‐up period. Physical activity, not smoking, lack of obesity, lack of diabetes mellitus, high high‐density lipoprotein cholesterol, and lower blood pressure were associated with maintenance of good health in this population. Behavior and risk‐factor modification may be expected to enhance the number of years of healthy living in older people.
Highlights of Papers in Clinical Investigations Section: Depressive Disorder as a Predictor of Physical Disability in Old Age
Authors: Kivela S‐L , Kimmo P
Published: March 2003

In this longitudinal study with a 5‐year follow‐up, 786 subjects were assessed for the impact of depression on physical disability. Depression present at baseline did not predict lowering of functional abilities during the follow‐up period. However, new‐onset depression that was relapsing or long‐term in course was associated with increased risk for lowering functional abilities, even when age, sociodemographic factors, physical diseases, and baseline disabilities were controlled. Depressed older people should be placed on a program to maintain their functional abilities through physical exercise and training in activities of daily living and intermediate activities of daily living.
Colonization of Skilled‐Care Facility Residents with Antimicrobial‐Resistant Pathogens
Authors: Trick William E. , Weinstein Robert A. , DeMarais Patricia L. , Kuehnert Matthew J. , Tomaska Wanda , Nathan Catherine , Rice Thomas W. , McAllister Sigrid K. , Carson Loretta A. , Jarvis William R.
Published: March 2003

OBJECTIVES: To determine the frequency of and risk factors for colonization of skilled‐care unit residents by several antimicrobial‐resistant bacterial species, methicillin‐resistant Stuphylococcus aweus (MRSA), vancomycin‐resistant enterococcus (VRE), or extended‐spectrum‐B‐lactamase‐producing (ESBL‐producing) (ceftazidime resistant) Klebsiella pneumoniae or Escherichia coli.

DESIGN: Point‐prevalence survey and medical record review.

SETTING: The skilled‐care units in one healthcare facility.

PARTICIPANTS: 120 skilled‐care unit residents.

MEASUREMENTS: Colonization by each of the four antimicrobial‐resistant pathogens during a point‐prevalence survey, using rectal, nasal, gastrostomy‐tube site, wound, and axillary cultures, June 1–3, 1998; 117 (98%) had at least one swab collected and 1 14 (95%) had a rectal swab collected. Demographic and clinical characteristics were evaluated as risk factors for colonization. All isolates were strain typed by pulsed‐field gel electrophoresis of total genomic deoxyribonucleic acid.

RESULTS: Of 117 participants, 50 (43%) were culture positive for ≥1 antimicrobial‐resistant pathogen: MRSA (24%), ESBL‐producing K. pneumoniae (18%) or E. coli (15%), and VRE (3.5%). Of 50 residents culture positive for any of these four antimicrobial‐resistant species, 13 (26%) were colonized by more than one resistant species; only three (6%) were on contact‐isolation precautions at the time of the prevalence survey. Risk factors for colonization varied by pathogen: total dependence on healthcare workers (HCWs) for activities of daily living (ADLs) and antimicrobial receipt for MRSA, total dependence on HCWs for ADLs for ESBL‐producing K. pneumoniae, and antimicrobial receipt for VRE. No significant risk factors were identified for colonization by ESBL‐producing E. coli. Among colonized patients, there was a limited number of strain types for MRSA (24 patients, 4 strain types) and ESBL‐producing K. pneumoniae (21 patients, 3 strain types), and a high proportion of unique strain types for VRE (4 patients, 4 strain types) and ESBL‐producing E. coli (17 patients, 10 strain types).

CONCLUSION: A large unrecognized reservoir of skilledcare‐unit residents was colonized by antimicrobial‐resistant pathogens, and co‐colonization by more than one target species was common. To prevent transmission of antimicrobial‐resistant pathogens in long‐term care facilities in which residents have high rates of colonization, infection‐control strategies may need to he modified. Potential modifications include enhanced infection‐control strategies, such as universal gloving for all or high‐risk residents, or screening of high‐risk residents, such as those with total dependence on HCWs for ADLs or recent antimicrobial receipt, and initiation of contact‐isolation precautions for colonized residents.
Endothelial Function in Healthy Younger and Older Hyperhomocysteinemic Subjects
Authors: Hirsch Sandra , De La Maza Pía , Mendoza Laura , Petermann Margarita , Glasinovic Andrea , Paulinelli Paola , Barrera Gladys , Rosenberg Irwin H. , Bunout Daniel
Published: March 2003

OBJECTIVES: To compare endothelium‐dependent vasomotor response in healthy younger and older subjects without classic cardiovascular risk factors, with high and normal fasting homocysteine (tHcy) levels.

DESIGN: We compared endothelium‐dependent vasodilatation, using ultrasound, in healthy younger (aged 18–40) and older (≥70) people with normal (<13 μmol/L) and high (>15 μmol/L) tHcy levels. Exclusion criteria were smoking, personal history of cardiovascular disease, hypertension, chronic diseases, vitamin intake, obesity, abnormal serum lipids levels, and creatinine higher than 130 μmol/L.

SETTING: Research laboratory.

MEASUREMENTS: In addition to tHcy levels, serum folate and vitamin B12 levels were measured.

RESULTS: We studied 17 younger and 12 older hyperhomocysteinemic subjects and respective aged‐matched normohocysteinemic subjects. Endothelium‐dependent vasodilatation was lower in the hyperhomocysteinemic older people (P < .01) than in all younger subjects and in normohomocysteinemic older people. Serum vitamin B12 levels were higher in younger and older normal controls. Folic acid levels were higher in younger controls and in both older groups.

CONCLUSIONS: This study shows an effect of high circulating tHcy on vascular reactivity in older people. Because serum levels of tHcy are associated with nutritional status of vitamin B12 and folic acid, prospective studies are necessary to demonstrate the effects of a long‐term nutritional supplementation with vitamins on vascular function and global cardiovascular risk.
Waist Circumference, Body Mass Index, and Risk for Stroke in Older People
Authors: Dey Debashish K. , Rothenberg Elisabet , Sundh Valter , Bosaeus Ingvar , Steen Bertil
Published: March 2003

OBJECTIVES:To investigate waist circumference (WC) and body mass index (BMI) at age 70 as risk factors for stroke.

DESIGN:Cohort study of 70‐year‐olds with 15‐year follow‐up.

SETTING:Geriatric Medicine Department, Göteborg University, Sweden.

PARTICIPANTS:Two thousand two hundred eighty‐seven (1,045 men; 1,242 women) 70‐year‐olds examined between 1971 and 1981 in Göteborg, Sweden.

MEASUREMENTS:Cox regression model was used to calculate relative risk (RR) and 95% confidence interval (CI) for first‐ever stroke (fatal and nonfatal) in reference to the lowest quartiles of WC and BMI. Tests for trend were performed fitting WC and BMI in their original continuous form.

RESULTS:In men and women, RRs for stroke, in the highest WC quartile were 1.65 (95% CI = 1.08–2.51) and 1.31 (95% CI = 0.88–1.92), respectively, after adjustment for cohorts, smoking habit, coronary heart disease (CHD), diabetes mellitus, total cholesterol (TC), systolic blood pressure (SBP), and height at age 70. In men, RR for stroke in the highest BMI quartile (≥28 kg/m2) was 1.68 (95% CI = 1.12–2.53) after adjustment for cohorts, smoking habits, CHD, diabetes mellitus, TC, and SBP at age 70. In women, adjusted RRs for stroke across the BMI quartiles were not significantly different. In men, population attributable fractions of stroke were 24.8% and 25.2% for the highest quartiles of WC and BMI, respectively.

CONCLUSIONS:High WC (≥99 cm) and BMI (≥28 kg/m2) are risks for stroke in older men but not in older women.
Preoperative Electrocardiogram Abnormalities Do Not Predict Postoperative Cardiac Complications in Geriatric Surgical Patients
Authors: Liu Linda L. , Dzankic Samir , Leung Jacqueline M.
Published: March 2003

OBJECTIVES: IPreoperative electrocardiograms (ECGs) are routinely performed on older patients before surgery. Whether patients with abnormalities on preoperative ECGs have an increased likelihood of developing postoperative cardiac complications is unknown. This study was designed to determine whether abnormalities on preoperative ECGs were predictive of postoperative cardiac complications.

DESIGN: Prospective observational study.

SETTING: One of the teaching hospitals of the University of California, San Francisco, Medical Center.

PARTICIPANTS: Five hundred thirteen patients aged 70 and older undergoing noncardiac surgery.

MEASUREMENTS: Preoperative ECGs were analyzed using the Minnesota Codes. Predefined preoperative risk factors and in‐hospital postoperative cardiac complications were measured. The association between ECG abnormalities and postoperative cardiac complications was determined by multivariate logistic regression after controlling for clinical covariates. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.

RESULTS: Three hundred eighty‐six of 513 patients (75.2%) had at least one abnormality on their preoperative ECGs. On multivariate analysis, the predictors of postoperative cardiac complications included American Society of Anesthesiologists physical status classification of 3 or greater (OR = 2.5, 95% CI = 1.28–4.89, P = .007) and a history of congestive heart failure (OR = 2.1, 95% CI = 1.1–5.1, P = .034). The presence of abnormalities on preoperative ECGs was not associated with an increased risk of postoperative cardiac complications (OR = 0.63, 95% CI = 0.28–1.40, P = .26).

CONCLUSION: Abnormalities on preoperative ECGs are common but are of limited value in predicting postoperative cardiac complications in older patients undergoing noncardiac surgery. These results suggest that obtaining preoperative ECGs based on an age cutoff alone may not be indicated, because ECG abnormalities in older people are prevalent but nonspecific and less useful than the presence and severity of comorbidities in predicting postoperative cardiac complications.
Oral therapy for migraine: Comparisons between rizatriptan and sumatriptan. A review of 4 randomized, double‐blinded clinical trials. (University of Copenhagen, Glostrup, Denmark) Neurology 2000;55:S19–S24.
Authors: Tfelt‐Hansen Per , Ryan: Robert E.
Published: March 2003

Four comparative, placebo‐controlled, randomized clinical trials of oral rizatriptan versus oral sumatriptan including one Phase II trial and three Phase III trials were reported in this study. Forty mg rizatriptan was found to be more effective than 100 mg sumatriptan, but was associated with a high incidence of adverse effects. Five mg rizatriptan was comparable to 50 mg sumatriptan. In two trials, rizatriptan 10 mg, the recommended dose in most countries, had a more rapid onset of action than 50 mg and 100 mg of sumatriptan. In addition, 10 mg of rizatriptan resulted in more patients being pain‐free after 2 h than 100 mg of sumatriptan, and resulted in fewer drug‐related adverse events than sumatriptan.
Chronic neuropathic pain: mechanisms and treatment. (Hôspital Ambroise Paré, Paris, France) Clin J Pain 2000; 16:S118–S130.
Authors: Attal: Nadine
Published: March 2003

This report presents a brief overview of the mechanisms of peripheral neuropathic pain, which are largely detailed elsewhere, and reviews the current pharmacologic approach to the treatment of neuropathic pain. Nonpharmacologic treatment of neuropathic pain is not addressed in this report.
Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. (Wessex Neurological Centre, Southampton, United Kingdom) Neurology 2000;69:816–819.
Authors: Duffill J. , Sparrow O. C. , Millar J. , Barker: C. S.
Published: March 2003

The presentation, investigation, and management of 4 patients with spontaneous spinal epidural haematoma is presented. In each case, the diagnosis was made by MRI. At the time of the diagnosis spontaneous recovery had started in each patient and; therefore, they were all treated conservatively. In each case follow up, MRI confirmed rapid reduction in the size of the haematoma and no underlying cause was demonstrated. The presentation, diagnosis, and rationale for treatment are discussed. Conservative treatment is safe in some cases of spinal epidural haematoma if early neurological recovery has started.
Hypogonadism in patients treated with intrathecal morphine. (Perth Pain Medicine Center, South Perth, Western Australia) Clin J Pain 2000;16:251–254.
Authors: Finch Philip M. , Roberts Lindy J. , Price Leanne , Hadlow Narelle C. , Pullman: Peter T.
Published: March 2003

This study investigated the hypothalamic‐pituitary‐gonadal response to intrathecal opioids. Thirty patients receiving intrathecal morphine for chronic nonmalignant pain were studied for clinical and biochemical evidence of hypogonadism. Ten men and 10 postmenopausal women with chronic pain of similar duration but were not receiving any form of opioid therapy acted as control subjects. Men and both premenopausal and postmenopausal women had evidence of hypogonadism with low levels of serum testosterone or estrogen coupled with low levels of pituitary gonadotrophins. Control subjects had hormone levels in the expected range for their sex and age. Two men demonstrated recovery after ceasing intrathecal opioid therapy. Conclude that hypogonadotrophic hypogonadism is a common complication of intrathecal opioid therapy in both men and women.
Spinal Cord Stimulation in Peripheral Vascular Disease: A Retrospective Analysis of 95 Cases
Authors: Reig E. , Abejón D. , Del Pozo C. , Wojcikiewicz R.
Published: March 2003

Abstract: Spinal Cord Stimulation is one of the interventionist treatments used for treating diverse chronic pain syndromes.

This study analyses retrospectively 95 patients diagnosed as suffering from grave peripheral arteriopathy in Fontaine state III (36 patients) and Fontaine state IV (56 patients). Eight patients required a minor amputation and 29 a major amputation. Those patients diagnosed as suffering from diabetes (diabetic arteriopathy) had a higher rate of amputation, above all those diagnosed as Fontaine group III. The most frequent complication was incorrect stimulation (22 cases), which necessitated the repositioning of the electrode.
Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction? (Vanderbilt University Medical Center, Nashville, TN) American Journal of Sports Medicine 2001;29:327–332.
Authors: McCarthy Eric C. , Spindler Kurt P. , Tingstad Ed , Shyr Yu , Higgins Michael
Published: March 2003

In a prospective, randomized, double‐blinded manner, the authors of this study compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty‐two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the 2 groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. A comparison of the visual analog pain scale scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block. No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc analysis revealed that the study power reached 87% with a significance level of 5%. Conclude that the postoperative femoral nerve block was effective and intraarticular morphine provided no additional benefit.

Comment by Alan David Kaye, M.D., Ph.D., and Erin Bayer, M.D. This prospective, randomized, double blinded study compared the effects of preoperative intraarticular injection of morphine or a placebo along with postoperative femoral “three‐in‐one” block on postoperative pain. 62 patients underwent arthroscopic ACL reconstruction under general anesthesia. After induction of anesthesia, patients were injected with either morphine 5 mg or placebo along with local anesthetics intraarticularly. Femoral nerve blocks were performed in the recovery room with a total of 3 mg/kg bupivacaine. The VAS of pain was assessed immediately postoperatively and at six time points afterward up to 24 hours. This study concluded that there were no statistical differences between the two groups comparing VAS. Also no significant difference was observed in postoperative narcotic use in the recovery room or at home. The study included antiemetics; however, the results did not include if the morphine group had a larger incidence of nausea or vomiting postoperatively. Finally, the authors suggest that there are no advantages to use of intraarticular morphine with a femoral nerve block post‐operatively. A future study employing preoperative femoral nerve block with or without use of intraarticular morphine might be interesting to see on arthroscopic ACL repairs to obtain adequate analgesia as the authors suggested.
Subdural hematoma after dural puncture headache treated by epidural blood patch. (St. Thomas Hospital, London, United Kingdom) British J Anesth. 2001;86:720–723.
Authors: Davies J. M. , Murphy A. , Smith M. , O'Sullivan G.
Published: March 2003

This case study discussed an accidental dural puncture in a 39‐year‐old patient during the siting of an epidural catheter for pain relief in labor. Twenty hours after the puncture, the mother developed a typical postdural headache, which increased in severity over the subsequent 24‐hour period. An epidural blood patch was performed at 48 hours, and this initially relieved the headache. After discharge from the hospital, and 14 days after the dural puncture, the headache recurred, together with expressive dysphasia, poor coordination, and sensory loss in the right arm. A magnetic resonance imaging scan demonstrated a left‐sided subdural hematoma, which drained successfully with complete recovery.
An in vivo rat model to study calcitonin gene related peptide release following activation of the trigeminal vascular system. (Department of Neurology, University of Essen, Essen, Germany) Pain. 2001;92:101–106.
Authors: Limmroth Volker , Katsarava Zaza , Liedert Bernd , Guehring Hans , Schmitz Kerstin , Diener Hans‐Christoph , Michel Martin C.
Published: March 2003

This report described a new rat model, which allowed the study of calcitonin gene related peptide (CGRP) release from the meninges into venous blood following activation of the trigeminal vascular system. The effects of classical and new antimigraine drugs as acetylsalicylic acid (ASA), sumatriptan and the new high efficacy 5‐HT1B/1D agonist donitriptan (4‐[4‐[2‐(2‐aminoethyl)‐1H‐indol‐5‐yloxyl]acetyl]piperazinyl‐1‐yl] benzonitrile) were evaluated in comparison with the established model of neurogenic inflammation in the meninges. Sumatriptan and donitriptan inhibited CGRP release as well as neurogenic inflammation. ASA, however, attenuated neurogenic inflammation, but not CGRP release, confirming the concept of prejunctional inhibition of CGRP release by 5‐HT1B/1D receptors. This new model allows the further study of prejunctional pharmacology and mechanisms of neuropeptide release in the trigeminal vascular system, which might be crucial for the further development of potent, more effective anti‐migraine drugs.

Comment by Leland Lou Basic migraine headache research report with the goal of establishing trigeminal stimulation in rats as an equivalent substitute for the cat model and superior sagittal sinus stimulation is discussed. The 5‐HT receptor agonists appeared to be more efficacious than inflammation suppression with NSAIDs alone. Within the 5‐HT receptor agonists group, donitriptan had a statistical benefit greater than sumitriptan. In summary the rat model results are similar to the cat migraine model with an increase in calcitonin gene related peptide levels and neurogenic inflammation.
Axillary brachial plexus block with patient controlled analgesia for complex regional pain syndrome type I: a case report. (National Cheng Kung University, Tainan, Taiwan) Reg Anesth Pain Med 2001;26:68–71.
Authors: Wang Li‐Kai , Chen Han‐Ping , Chang Pei‐Jung , Kang Fu‐Chi , Tsai Yu‐Chuan
Published: March 2003

A 32‐year‐old man who suffered from complex regional pain syndrome type I (CRPS I) of the right upper limb after surgical release of carpal tunnel syndrome of the right hand is the subject of this case report. Symptoms and signs over the right hand were alleviated under rehabilitation and conventional pharmacological management, but severe painful swelling of the right wrist persisted. Axillary brachial plexus block (BPB) with patient controlled analgesia (PCA) was performed on the 32nd postoperative day, which soon resulted in significant reduction of pain with gradual improvement of function of the right wrist. Conclude that axillary BPB with PCA may provide patients with CRPS I of the upper limb a feasible and effective treatment.
Obtaining informed consent for clinical pain research: patients' concerns and informational needs. (University of Pennsylvania Center for Bioethics, Philadelphia, PA) Pain. 2001;92:71–79.
Authors: Casarett David , Karlawish Jason , Sankar Pamela , Hirschman Karen B. , Asch David A.
Published: March 2003

Investigators who conduct pain research are required to obtain voluntary informed consent from patients. However, little is known about what information patients expect when they decide whether to enroll in such studies. It is important that the investigators understand the need for information so that they can effectively and clearly describe the research risks and potential benefits that matter to the potential subjects. This study was designed to define information needs that patients have when they decide whether to participate in clinical pain research and identified clinical and demographic variables associate with specific needs.
Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. (Medical School Hannover, Hannover, Germany) Neurosurgery. 2001;48:1269–1275.
Authors: Samii Madjid , Bear‐Henney Steffani , Lüdemann Wolf , Tatagiba Marcos , Blömer Ulrike
Published: March 2003

Forty‐seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years. Immediately after surgery, 75% of the patients experienced significant pain reduction; this value was reduced to 63% during long‐term follow‐up monitoring. Nine patients experienced major complications including subdural hematomas and motor weakness of the lower limb. Improved coagulation electrodes with thermistors that could produce smaller and more accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. Conclude that long‐term follow‐up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long‐lasting satisfactory relief is possible for the majority of individuals with acceptable morbidity rates.

Comment by Ron Pawl, M.D. This paper is important for several reasons. It provides a long‐term follow‐up on patients suffering intractable pain after cervical nerve root avulsion from the cord, and results of dorsal root entry zone lesioning using the thermocoagulation technique, where lesions are made at 1 mm intervals covering the length of the cord and one level above and one below the levels of the roots involved. Thirty‐nine of 47 patients had 63% reduction of pain in follow‐up of 2 to 18 years (14 year average). The authors also reported that 9 patients experienced major complications including subdural hematomas and lower extremity weakness, which they attribute to the electrodes used to make the lesions prior to 1989. Using an improved electrode since that time, they report fewer complications. Also, the authors note no correlation between the duration of the pain, the time between the trauma and the surgery, and the time of onset of the pain after trauma with the outcome of the surgery, indicating the procedure is effective, even when carried out years after the onset of the pain. This last concept puts a damper on the idea of centralized pain memory as the mechanism for the chronic pain.
Complementary therapies in palliative cancer care. (University of Exeter, Exeter, United Kingdom) Cancer. 2001;91:2181–2185.
Authors: Ernst Edzard
Published: March 2003

In this article several complementary therapies were identified as particularly relevant to palliative cancer care. Exemplary studies were discussed. Although it was found that some promising results for treatment existed, the article concluded that there is a great deal of potential for complementary medicine in palliative care. The article also discussed the need for more rigorous research into the value of such treatments in palliative and supportive cancer care.
Unsubstituted hydrolyzed waxy maize as a potential agent for centrifugal leukacytapheresis
Authors: Studebaker JF , DeBroy JA
Published: March 2003

In order to determine whether newer, possibly safer erythrocyte sedimenting agents could be used during centrifugal leukacytapheresis, we tested seven varieties of plant starch. Only waxy maize prepared by partial acid hydrolysis appeared suitable, and it was tested extensively on an analytical device developed especially for testing erythrocyte sedimentation under the conditions of residence time, force, and sedimenting agent concentration used in a cell separator. This species of waxy maize, however, was not quite as effective a sedimenting agent when compared to hydroxyethyl starch (HES 450/0.70) under the test conditions used. Although chromatographic analysis showed the average molecular weights of the unsubstituted waxy maize were considerably higher than those of HES 450/0.70, degradation of waxy maize to smaller molecular weight fragments occurred more rapidly. The rapid degradation of this material may offer significant advantages during centrifugal leukacytapheresis procedures, but additional studies of its storage stability are needed.
The effect of platelets and red cells on granulocytes stored at 22 degrees C
Authors: Glasser L , Fiederlein RL
Published: March 2003

Granulocyte concentrates contain varying numbers of platelets and red cells depending upon the method of collection. Either platelet or red cell concentrations may be as high as 2.0 × 10(12) per I. Studies were done on unwashed and washed granulocyte concentrates and on pure granulocyte suspensions with known numbers of platelets or red cells added. These suspensions or concentrates were stored for 72 hours at 22 degrees C. In both experiments, the following were measured: leukocyte and absolute granulocyte counts, dye exclusion, chemotaxis, plasma glucose, plasma pH, and osmolality. Red cell contamination did not adversely effect granulocyte storage. Platelets, however, did contribute to the functional deterioration of stored granulocytes. In the presence of high concentrations of platelets, both granulocyte dye exclusion and chemotaxis were adversely affected at 48 hours of storage. In another experiment, fresh autologous granulocytes incubated for 18 hours in hydroxyethyl starch‐citrated‐plasma obtained from stored granulocyte concentrates showed a progressive decrease in chemotaxis related to the age of the stored plasma. Glucose supplementation of the spent plasma maintained chemotactic activity. Contamination of granulocyte concentrates with other cells and the availability of glucose to granulocytes are variables affecting the short‐term liquid storage of granulocytes at 22 degrees C.
Does Cohn‐fractionated Rh immune globulin transmit viral hepatitis?
Authors: Iwarson S. , Steen Y. , Rybo G. , Hermodsson S. , Antonsson I. , Vietorisz A.
Published: March 2003

In light of recently raised doubts about the safety of Cohn fraction II globulins, a prospective study on the risk of transmission of viral hepatitis with a Cohn‐fractionated Rh immune globulin (Rhesonativ, KabiVitrum AB, Stockholm, Sweden) was performed in 47 newly delivered mothers. The women were followed regularly for 6 months after the injection of the Rh immune globulin for biochemical, serological, and clinical signs of viral hepatitis.

No clinical signs of acute hepatitis were noted during the study, nor were HBsAg or anti‐HBc found in any patient. A slight and transient rise in alanine aminotransferase (ALT) levels was seen in three women, but these never reached 2.5 times the upper normal limit as is the currently used lower limit for a diagnosis of non‐A, non‐B hepatitis. One woman had positive tests for anti‐HBs at 5 and 5.5 months, respectively, after the injection, but serum samples taken before and after this period were all anti‐HBs negative. Nonspecific reactions in the method used probably explained this finding.

This prospective study supports the contention that Rhesonativ, a Cohn‐fractionated Rh immune globulin, does not transmit viral hepatitis.
A randomized study comparing leukocyte‐depleted versus packed red cell transfusions in prospective cadaver renal allograft recipients
Authors: Sanfilippo Fred P. , Bollinger R. Randal , MacQueen J. Marilyn , Brooks B. J. , Koepke John A.
Published: March 2003

A prospective randomized study at a single renal transplant center between 1980 and 1982 compared the influence of leukocyte‐depleted versus packed red cell pretransplantation blood transfusions on patient sensitization to leukocyte (HLA) antigens, likelihood of receiving a graft, and eventual transplantation results. All consenting potential cadaver renal transplant recipients (n = 107) were randomly assigned to receive transfusions at 6‐week intervals with either packed red cells (Group 1) or leukocyte‐poor red cells (Group 2) until they were transplanted. Actuarial graft and patient survival were identical for graft recipients in both groups. Although the likelihood of receiving a graft was associated with the level of pretransplant sensitization to leukocyte (HLA) antigens (p less than 0.02) as measured by the percent of panel reactive antibody (PRA), it was not associated with the type of blood used. The highest mean peak reactive PRA level for all patients showed a low but significant increase (29 +/− 4 versus 43 +/− 5%; p less than 0.0005) following entry into the transfusion protocol, but the rate of increase was the same for patients in both treatment groups. The likelihood of receiving a transplant was primarily associated with a history of prior graft rejection (p less than 0.05), and patients with prior graft loss had the greatest increase in sensitization following entry into the transfusion protocol. These findings indicate that using leukocyte‐poor red cells for pretransplant transfusions provided no added benefit when compared with packed red cells in terms of patient sensitization, the likelihood of receiving a transplant, or eventual graft survival.
Blood banking in the United States—1981
Authors: Polesky H. F.
Published: March 2003

Combined data from the American Association of Blood Banks, American National Red Cross, and Community Council of Blood Centers for 1981 compared to similar data for 1980 show an increase in the collection and use of blood and components. In 1981, a greater percent of donor units was converted to multiple components. Use of blood resources was more efficient in 1981 than in 1980.
A clinically significant anti‐N in a patient whose red cells were negative for N and U antigens
Authors: Ballas S. K. , Dignam C. , Harris M. , Marcolina M. J.
Published: March 2003

A patient with sickle cell anemia had M+N‐S‐s‐U‐phenotype and developed anti‐E, anti‐U, and anti‐N after multiple transfusions. The anti‐N was IgG, showed positive red cell mononuclear phagocyte assay, caused shortened survival of51Cr‐labeled N+ red cells, and incited a delayed hemolytic transfusion reaction. The anti‐U also caused decreased survival of U+ cells. The serological findings indicated that the anti‐ N recognized both N and ‘N’ antigens.
Perfluorochemical blood substitutes differentially alter human monocyte procoagulant generation and oxidative metabolism
Authors: Janco R. L. , Virmani R. , Morris P. J. , Gunter K.
Published: March 2003

Human blood mononuclear leukocytes exposed in vitro to perfluorochemical blood substitutes (Fluosol‐DA and FC‐43) generated increased procoagulant activity that was time dependent. Mononuclear leukocytes incubated with 10 percent Fluosol‐DA for 4 hours generated 3.43‐fold more procoagulant activity than control cells. At 24 hours of incubation with 10 percent Fluosol‐DA, cells generated 10.49‐fold more procoagulant than control. Cells incubated with 10 or 20 percent FC‐43 generated 2.5‐ or 3.4‐fold greater procoagulant than controls, respectively. The perfluorochemical emulsifier (Pluronic F68) also stimulated 3.4‐fold more activity than control cells. Stimulated oxidative metabolism (superoxide anion generation) was significantly impaired by Fluosol‐DA but not by FC‐43 or Pluronic F68. No significant perfluorochemical‐induced cytotoxicity was measured by trypan blue dye exclusion or lactate dehydrogenase release. Electron microscopic analysis showed progressive uptake of the perfluorochemicals by monocytes but not by lymphocytes. Thus, perfluorochemicals may differentially activate cellular initiators of coagulation while impairing other metabolic responses of mononuclear phagocytes. Patients receiving perfluorochemical preparations should be monitored for abnormalities of hemostasis and for disorders of the mononuclear phagocyte system.
Effects of intensive granulocyte donation on donors and yields
Authors: Strauss R. G. , Goeken J. A. , Eckermann I. , McEntegart C. M. , Hulse J. D.
Published: March 2003

Thirteen HLA‐identical bone marrow donors served as the sole source of daily granulocyte transfusions for respective marrow recipients during the period of severe neutropenia between transplantation and engraftment. They experienced 12 to 29 (median, 17) daily, continuous flow centrifugation leukapheresis procedures using hydroxyethyl starch, but no corticosteroids, with little serious difficulty. No immediate clinical reactions occurred in 90 percent of 228 procedures. Mild citrate reactions were noted in 9 percent, and only two procedures (0.8%) were discontinued due to severe reactions. Ten donors (77%) answered a questionnaire mailed weeks later, and six reported transient, late clinical adverse effects. Five had moderate dermatologic problems; one had minimal hypertension requiring no therapy. Donors were monitored daily for laboratory abnormalities while donating granulocytes. Hemoglobin concentration and platelet counts remained stable (autologous red cell transfusions had been given). Blood leukocyte counts gradually fell (p < 0.05), particularly after 10 or more daily granulocyte donations, and this fall was associated with a decrease of about 33 percent in leukocyte yields. No attempts were made to improve yields by giving higher doses of hydroxyethyl starch or by corticosteroid stimulation. With primary emphasis on donor safety, it seems feasible for a few compatible donors to provide prolonged granulocyte transfusion support for designated patients. However, diminishing leukocyte yields may result from intensive, repeated leukapheresis.
Blood group incidence and Escherichia coli bacterial sepsis
Authors: Wittels E. G. , Lichtman H. C.
Published: March 2003

Many strains of Escherichia coli possess an antigen that reacts with naturally occurring antibodies to human red cell B antigens. The authors tested the hypothesis that the presence of naturally occurring anti‐B isoagglutinins afford protection against the development of E. coli septicemia. The blood groups found in 115 patients with E. coli septicemia were compared with those found in three “control” populations: 138 patients with septicemia due to other organisms, 23,135 hospitalized patients, and 40,038 normal blood donors. The relative incidence of B and AB blood groups (not containing anti‐B antibodies) was significantly higher than A and O blood groups (containing anti‐B antibodies) in the group with E. coli septicemia. This finding supports the hypothesis.
A second discriminator for biological false positive results in enzyme‐ linked immunosorbent assays for antibodies to human immunodeficiency virus (HTLV‐III/LAV)
Authors: WARTICK MARY G. , MCCARROLL DAVID R. , WILTBANK THOMAS B.
Published: March 2003

ABSTRACT: Two commercially available enzyme‐linked immunosorbent assays (ELISA) were compared in screening a large population of volunteer blood donors. One ELISA utilized the human T‐lymphotropic virus, Type III (HTLV‐III) grown on National Institutes of Health T‐lymphocyte cell line, H‐9, as antigen source; the second used lymphadenopathy associated virus (LAV) grown on Pasteur Institutes' T‐lymphocyte cell line, CEM‐F. Biological false positives (BFP) occurred at a rate of approximately 0.5 percent using each antigen source. However, distinct populations of BFP donors were detected when the two antigen sources were compared. Results indicate that at least two separate sets of antigens are recognized in ELISA by our normal population and result in BFP. Sequential utilization of tests using these distinct sources adds a second discriminator to identification of BFP, with the potential for decreasing the requirement for Western blot analysis.
Effective leukocyte removal from platelet preparations by centrifugation in a new pooling bag
Authors: Patten Ethel , Reilly James , Patel Sarala , Schiffer Charles A.
Published: March 2003

A pooling bag (Leukotrap, Cutter Laboratories, Berkeley, CA) with a protruding pocket at the bottom into which heavier cellular elements are collected after centrifugation at 390 × g for 10 minutes, was studied. The tab is clamped before transfusion. Varying numbers of platelet concentrates (PC) that had been stored for different durations were pooled and centrifuged in the bags. When 4 or more units of PC were studied, the results were independent of the number of units and the duration of storage. Approximately 90 percent of the contaminating leukocytes (WBC) were removed with a platelet loss of less than 10 percent. Similar results were obtained with single‐donor platelets (WBCs decreased 93%; range, 77–99%; n = 12). Posttransfusion increments were similar to those with unmodified platelets; in four patients, febrile platelet transfusion reactions were eliminated by the WBC removal. Thus, the bags represent a simple, reproducible, and effective means of reducing WBC and red cell contamination of platelet preparations with acceptable platelet losses.
Studies on granulocyte preservation
Authors: Sasakawa S. , Miyamoto M.
Published: March 2003

The effect of agitation on granulocyte storage was examined. Granulocyte concentrates were obtained as buffy coats from fresh blood by centrifugation and stored for up to 48 hours at 22 degrees C with or without horizontal agitation (80 rpm). The cell counts, mean cell volumes, morphologic changes, phagocytosis, and bactericidal activity of the stored granulocytes did not differ significantly. However, chemotaxis was maintained better in granulocytes that were agitated. At 48 hours, the ability of unagitated cells to adhere to both immunoglobulin‐coated and uncoated glass surfaces increased, and clumps were observed on the surfaces. These results seem to be related to the decrease in chemotaxis. The pH of unagitated sedimented cells was more acid. To avoid the decrease of this local pH, stored granulocytes need gentle agitation.
Prospective‐concurrent audits and medical consultation for platelet transfusions
Authors: Simpson M. B.
Published: March 2003

Prospective‐concurrent audits and medical consultation were associated with a 56 percent decrease in the use of platelet concentrates at a tertiary care medical center. This study documents that mandatory pretransfusion review of component requests can alter hospital transfusion practices.