bluuebunny/crossref_metadata_2025 huggingface dataset:
Peri‐operative outcome for day‐case laparoscopic and open inguinal hernia repair
Authors: RUDKIN G. E. , MADDERN G. J.
Published: September 2007

This study documents the results obtained in 30 day patients undergoing open hernia repair under local infiltration block with patient‐controlled sedation (group A) and 29 day patients undergoing laparoscopic hernia repair under general anaesthesia (group B). The mean operating time was less in group A (44.8min) compared with group B (66.6min) (p < 0.0001). Similarly, stage 1 recovery room times were longer in group B (98.1 min) than group A (45.1 min) (p < 0.0001). Time to discharge for group A (139.1 min) was significantly shorter than group B (224.2 min) (p < 0.002), with more peri‐operative complications occurring in group B and greater analgesic requirements. An open inguinal hernia repair under local infiltration block is the optimal approach for unilateral non‐recurrent herniae as a day surgical procedure. These results have important cost and efficiency implications.
Leukotriene B4 as a marker of cerebral dysfunction
Authors: KENDALL A. P. , LIN E. S. , OH T. E.
Published: September 2007

It has been postulated that leukotriene B4 is involved in the pathogenesis of postisehaemie cerebral oedema. We set out to determine if a relationship exists between jugular bulb leukotriene B4 and other indicators of cerebral ischaemia. No association could be demonstrated for either intracranial pressure, jugular bulb blood oxygen saturation or lactate oxygen index. Our results provide insufficient evidence to suggest that measurement of leukotriene B4 has any place in the management of head‐injured patients.
No effect of circulating drug upon isolated forearm block
Authors: HOOD J. R. , CAMPKIN N. T. A. , FELDMAN S. A.
Published: September 2007

Controversy exists as to whether the recovery of isolated arm blockade is primarily determined by resultant plasma drug concentrations, or by the affinity of the drug for the biophase. We have investigated the effect of the circulating drug produced by the isolated forearm experiment upon its recovery profile. Paralysis from retrograde spread of drug after the intravenous injection of 20 ml saline containing vecuronium 0.3 mg into a forearm isolated from the circulation was achieved in three groups of five experiments. Group 1 were used as controls, the tourniquet being released after 3–4 min and the recovery of block observed. In group 2 the tourniquet was similarly released but a repeat dose of vecuronium 0.3 mg was administered into the systemic circulation at 10% recovery. In group 3 the tourniquet was released at 50% twitch depression and the repeat dose of vecuronium 0.3 mg given when the twitch height had recovered to that level. The mean (SD) 25% to 75% recovery indices of groups 1, 2 and 3 were: 9.2 (2.4), 8.7 (1.2) and 9.9 (1.9) min. There was no noticeable effect on the recovery slope of any of the traces when the second dose of myoneural blocker was given systemically in groups 2 and 3. The findings indicate that the main determinant of recovery of the isolated forearm experiment is not its plasma drug concentration but a mechanism which maintains the drug in the effect compartment.
The Hayek Oscillator
Authors: PETROS A. J. , FERNANDO S. S. D. , SHENOY V. S. , AL‐SAADY N. M.
Published: September 2007

The Hayek Oscillator is a recent development in external high frequency ventilation and is a useful mode of ventilatory support during anaesthesia, in chronic respiratory failure and weaning in intensive care. The Hayek Oscillator is new and its application is growing, as are the number of patients who have benefited from its use. However, there are no clear guidelines on how best to adjust the oscillator to achieve optimum ventilation. A simple method of predicting changes in tidal volume and minute ventilation following adjustment would make the oscillator more useful. We present nomograms for tidal volume, minute ventilation and effective alveolar ventilation when the three variables, oscillator frequency, mean chamber pressure and peak‐to‐trough pressure span were adjusted. The frequency‐tidal volume relationship was unaffected by a mean chamber pressure of0, – 5, –10 cmH20, but altered with changes in peak‐to‐trough pressure span. We have also determined the effect of increasing negative extrathoracic pressure on functional residual capacity. The relationship between tidal volume and frequency was non‐linear and related to the peak‐to‐trough pressure span. Mean functional residual capacity significantly increased from 2.251 (SEM 0.10) without the cuirass at rest to 2.611 (SEM 0.14) at ‐ 10 cmH20 (p < 0.05; n = 5) and 2.47 (SEM 0.12) at ‐ 20 cmH20 of mean chamber pressure. Vital capacity was unchanged by increasing extrathoracic pressure as was total lung capacity.
The use of a portable refractometer to measure desflurane
Authors: CHEAM E. W. S. , LOCKWOOD G. G.
Published: September 2007

The measurement of volatile anaesthetic agents by infrared absorption is liable to interference by other gases which absorb infrared light. In particular, nitrous oxide may, in principle, interfere with the measurement of desflurane. On the other hand, the refractometer shouldbe immune to such effects. We demonstrated that interactions may occur between desflurane and nitrous oxide with some gas analysers and that the refractometer remains a useful instrument.
A combined high frequency oscillator and intermittent positive pressure ventilator
Authors: RAPHAEL J. H. , ATKINSON I. , BEXTON M. D. R.
Published: September 2007

A high frequency oscillator and its interface with the Siemens 900C ventilator form a combined high frequency oscillator and intermittent positive pressure ventilator. This combined high frequency ventilator is designed for use in selected cases of refractory hypoxaemia.
Anaesthesia and cystic fibrosis
Authors: WALSH T. S. , YOUNG C. H.
Published: September 2007

Cystic fibrosis occurs in I in 2000 children and the majority now reach adulthood. The disease is a complex multisystem disorder which is likely to challenge anaesthetists with increasing frequency. In this review the presentation and genetics of the disease are briefly described, followed by a detailed account of the pathophysiology relevant to anaesthesia. The pre‐operative assessment and conduct of anaesthesia are discussed and some suggestions made regarding management.
Continuous axillary brachial plexus blockade for reflex sympathetic dystrophy
Authors: Murray P. , Floor K. , Atkinson R. E.
Published: September 2007

Reflex sympathetic dystrophy is one of the commoner neurogenic pain syndromes; the typical onset follows peripheral trauma and is characterised by diffuse burning pain and hyperalgesia, accompanied by variable vasomotor and dystrophic changes. Successful treatment of an established reflex sympathetic dystrophy may be difficult. A case is reported describing the successful use of a series of continuous axillary brachial plexus blocks for the treatment of this syndrome.
Use of the laryngeal mask airway for respiratory distress in the intensive care unit
Authors: Arosio E. M. , Conci F.
Published: September 2007

Two patients with respiratory distress are described in which the laryngeal mask airway and continuous positive airway pressure were used with good effect. The laryngeal mask airway may be useful in some cases of respiratory distress occurring in the intensive care unit when a patient is unable to tolerate a tracheal tube.
Fatal subclavian artery haemorrhage
Authors: Mercer‐Jones M. A. , Wenstone R. , Hershman M. J.
Published: September 2007

Subclavian artery puncture occurred during attempted subclavian vein catheterisation. Although initially stable, the patient became shocked one day later and died from massive local haemorrhage. This case emphasises the need for continued vigilance following accidental arterial puncture.
Unexpected brainstem compression following routine surgery in a child with oto‐palato‐digital syndrome
Authors: Clark J. R. , Smith L. J. , Kendall B. E. , Tasker R. C. , Wilkinson K. A.
Published: September 2007

Oto‐palato‐digital syndrome type 1 is a rare condition with several features of concern to the anaesthetist. We report a patient who developed respiratory depression 5 h after general anaesthesia. This was subsequently found to be due to brainstem compression secondary to congenital deformities of the skull base and cervical vertebrae.
Comparison of propofol and fentanyl anaesthesia in coronary artery versus valve surgery
Authors: Bell J. , Sartain J. , Wilkinson G. A. L. , Sherry K. M.
Published: September 2007

Total intravenous anaesthesia with propofol and fentanyl was used in 23 patients undergoing coronary artery and 16 patients undergoing valve surgery and the haemodynamic effects in the two groups were compared. Baseline values showed that the valve surgery group had a higher mean heart rate, pulmonary artery wedge pressure and pulmonary artery pressure and smaller mean stroke volume than the coronary artery surgery group. In both groups, heart rate, arterial pressure, pulmonary artery wedge pressure, pulmonary artery pressure and cardiac index decreased during surgery. In the valve surgery group there were greater percentage decreases in heart rate, mean arterial pressure and diastolic arterial pressure. Overall, propofol and moderate‐dose fentanyl anaesthesia was no more detrimental to the haemodynamics in patients undergoing valve surgery when compared to those undergoing coronary artery surgery.
Attitudes to the Association of Anaesthetists recommendations for standards of monitoring during anaesthesia and recovery
Authors: Pearsall F.J. , Davidson J.A. , Asbury A.J.
Published: September 2007

A questionnaire was sent to 293 anaesthetists in the West of Scotland to assess their attitudes to the recommendations for standards of monitoring during anaesthesia and recovery published by the Association of Anaesthetists of Great Britain and Ireland. Such standards are considered achievable and affordable in terms of costs and allow the early detection of events occurring during anaesthesia, which might lead to injury to the patient. The survey shows that there is wide acceptance of the recommendations by anaesthetists of all grades, with resultant improvements in the quality of patients care.
A comparison of droperidol and cyclizine in the prevention of postoperative nausea and vomiting associated with patient‐controlled analgesia
Authors: Walder A. D. , Aitkenhead A. R.
Published: September 2007

Fifty ASA 1 or 2 patients scheduled to undergo major gynaecological surgery were allocated randomly to one of two groups. All patients received a standard anaesthetic regimen. Patients in group 1 received droperidol 1.25 mg given intravenously 20min prior to the end of surgery and a patient‐controlled analgesia infusion containing morphine 1 mg.ml‐1 and droperidol 0.05 mg.ml‐1. Patients in group 2 received cyclizine 50 mg by slow intravenous injection 20 min prior to the end of surgery and a patient‐controlled analgesia infusion containing morphine 1 mg.ml‐1 and cyclizine 2 mg. ml‐1. Fifteen of 25 patients (60%) in group 1 and 18 (72%) of 25 in group 2 suffered no nausea or vomiting postoperatively. Two patients (8%) in group 1 and three (12%) in group 2 suffered severe postoperative nausea or vomiting. We conclude that cyclizine is as effective as droperidol in the prevention of postoperative nausea and vomiting when included in a patient‐controlled analgesia infusion using morphine.
Hypertension, admission blood pressure and perioperative cardiovascular risk
Authors: HOWELL S. J. , SEAR Y. M. , YEATES D. , GOLDACRE M. , SEAR J. W. , FOËX P.
Published: September 2007

We performed a retrospective case‐control study to investigate hypertension and admission blood pressure as risk factors for postoperative cardiovascular death. We identified records of 76 patients who had died of a cardiovascular cause within 30 days of anaesthesia and elective surgery and 76 matched controls. From the records of each patient (case and control) we recorded the admission blood pressure and details of any history of hypertension. A pre‐operative history of hypertension was strongly associated with perioperative cardiovascular death (p < 0.001 with one degree of freedom: odds ratio 4.14, 95% confidence intervals 1.63–11.69). There was no association between systolic or diastolic pressure at admission for operation and perioperative cardiovascular death. The mean admission systolic pressure of the cases was 145.5 mmHg (range 90–250 mmHg) and that of the controls was 146.5 mmHg (range 100–200 mmHg). The mean admission diastolic pressure of the cases was 83.2 mmHg (range 60–130 mmHg), and that of the controls was 84.5 mmHg (range 60–110 mmHg).
Pre‐operative parental anxiety
Authors: THOMPSON N. , IRWIN M. G. , GUNAWARDENE W. M. S. , CHAN L.
Published: September 2007

This study attempts to identify the incidence and specific sources of anxiety in the parents of children admitted to hospital for elective surgery, to isolate factors associated with increased anxiety and to identify useful ameliorative measures. One hundred parents were interviewed and completed a questionnaire before their child's surgery. Parental anxiety levels were measured using the Leeds scale for self‐assessment of anxiety. Anxiety‐related illness was identified in 47% of parents, who were significantly more concerned than others about all aspects of their children's hospitalisation. No factors were identified which could predict which parents were at high risk of developing an anxiety state. When questioned about educational and interventional measures which they felt would be reassuring, the same factors were identified by ‘anxious’ and ‘non‐anxious’ parents. As all parents agree on useful ameliorative factors, a general advice and education programme would be appropriate.
Premature failure of battery‐powered syringe pumps
Authors: TATMAN A. , BRUNNER H. , STOKES M.
Published: September 2007

Failure of battery‐powered equipment during the interhospital transfer of patients is potentially life threatening. The time to failure of 60 fully‐charged identical syringe pumps (20 from each batch purchased in 1992, 1994 and 1995) was measured. Older pumps were associated with less predictable charge capacity, with 40% of the 1992 pumps failing within 60 min. The premature failure of these pumps is most likely due to poor battery care. It is unsafe to assume that a fully‐charged, battery‐powered pump will continue to function throughout a long transfer. The routine carriage of spare pumps or a backup power supply is recommended.
Anaesthetic management of a quadriplegic patient with severe respiratory insufficiency undergoing Caesarean section
Authors: Ahmed A. B. , Bogod D. G.
Published: September 2007

The anaesthetic management of a 30‐year‐old pregnant quadriplegic patient with severe respiratory insufficiency undergoing Caesarean section is described. Quadriplegia and respiratory insufficiency pose potential problems for anaesthetists and these are discussed. In particular autonomic hyperreflexia may occur and this may be mistaken for pre‐eclampsia.
Acute stridor as a presentation of bilateral abductor vocal cord paralysis
Authors: Strauss A. , Finder M. , Lipman J. , Conidaris M.
Published: September 2007

We report the case of a 48‐year‐old woman, referred to the Intensive Care Unit with community‐acquired pneumonia, who was noted to have stridor of acute onset. Subsequent indirect laryngoscopy revealed bilateral abductor vocal cord paralysis, secondary to unsuspected carcinoma of the oesophagus, requiring immediate tracheostomy. We highlight the importance of visualisation of the vocal cords in cases of stridor of uncertain aetiology.
Compartment syndrome as a complication of the prolonged use of the Lloyd‐Davies position
Authors: Goldsmith A. L. , McCallum M. I. D.
Published: September 2007

Compartment syndrome in the legs is a rare complication of the prolonged use of the lithotomy position. We report two cases of compartment syndrome developing as a complication of the prolonged use of the Lloyd‐Davies position. Both patients received combined general and epidural anaesthesia and postoperative epidural analgesia. The diagnosis was delayed in the first case, resulting in the avoidable complications of renal failure and permanent neuromuscular dysfunction.
Comparison of sufentanil/propofol versus isoflurane/nitrous oxide anaesthesia on mesenteric artery blood flow
Authors: Zwijsen J. H. M. J. , Bovill J. G. , Geelkerken R. H. , Delahunt T. A. , Van Bockel J. H. , Hermans J.
Published: September 2007

Duplex sonography was used to determine the changes in mesenteric arterial blood flow occurring in patients undergoing aortic surgery, anaesthetised either by total intravenous anaesthesia with propofol and sufentanil (group A) or inhalational anaesthesia with isoflurane and nitrous oxide (group B). Sixteen patients were studied. Measurements were performed immediately before and 15 min after induction of anaesthesia, before surgery. There was a 38% decrease (p = 0.015) in the superior mesenteric artery end diastolic velocity in group A and a 23% decrease (p = 0.033) in the superior mesenteric artery peak systolic velocity in group B. There were no changes in any of the other sonography parameters in either group. We conclude that neither total intravenous anaesthesia with propofol and sufentanil nor inhalational anaesthesia with isoflurane and nitrous oxide have any clinically significant influence on mesenteric blood flow in the absence of surgical stimulation.
The analgesic efficacy of tenoxicam versus placebo in day case laparoscopy: a randomised parallel double‐blind trial
Authors: Windsor A. , McDonald P. , Mumtaz T. , Millar J. M.
Published: September 2007

The analgesic efficacy and duration of action of tenoxicam, an injectable non‐steroidal analgesic with a long elimination half‐life, were studied in day case laparoscopy in a double‐blind randomised prospective parallel placebo‐controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. Outcome measures were time to first analgesia, pain levels at 2, 4 and 24 h plus postoperative analgesic consumption in hospital and at home. The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20mg intravenously immediately pre‐operatively cannot be recommended for day case surgery on the basis of this study.
Intra‐ocular pressure changes during gynaecological laparoscopy
Authors: LENTSCHENER C. , BENHAMOU D. , NIESSEN F. , MERCIER F. J. , FERNANDEZ H.
Published: September 2007

Laparoscopic surgery carried out under general anaesthesia is associated with physiological changes, which also determine changes in intra‐ocular pressure. We measured intra‐ocular pressure at each phase of gynaecological laparoscopy, carried out under propofol‐alfentanil‐isoflurane general anaesthesia, in young women of ASA 1 status, with no pre‐existing eye disease. Measurements were made with a Perkins applanation tonometer. Mean arterial pressure and end‐tidal CO, tension were kept constant throughout the study. Intra‐ocular pressure decreased significantly after induction of anaesthesia, remained unchanged after a pneumoperitoneum of up to an intraperitoneal pressure of 15 mmHg had been created, increased significantly with head down tilt, but did not increase significantly above pre‐induction values. Adequate depth of anaesthesia compensated for the intra‐ocular pressure increase caused by head down position. Plateau airway pressure, considered as reflecting intrathoracic pressure, increased with intraperitoneal pressure elevation. However, such changes did not correlate with intra‐ocular pressure changes.
Blood flow in the lower limbs in the knee‐chest position: Ultrasonographic study in unanaesthetised volunteers
Authors: LAAKSO E. , AHOVUO J. , ROSENBERG P. H.
Published: September 2007

The knee‐chest position for lumbar spine surgery is favoured because decreased filling of the epidural veins is associated with reduced peroperative bleeding. However, the position may be unfavourable from a circulatory point of view. In the present study, non‐invasive assessment of circulation in the lower limbs was performed in 21 unanaesthetised, healthy volunteers who were placed in the surgical knee‐chest position. Measurements included blood flow velocity (colour Doppler ultrasonography), oscillotonometric arterial blood pressure from upper and lower limbs and pulse oximetry from a toe. There was a statistically significant reduction in the posterior tibial artery flow velocity, maximally 31.6%, when the subject was moved from the prone to the knee‐chest position. An enlargement of the trunk‐femoral angle at the hip did not improve arterial flow. In 10 of the 21 volunteers, no flow in the posterior tibial vein was detected in the knee‐chest position. In spite of the deteriorated blood flow, pulse oximetry indicated sufficient capillary flow in the very periphery of the lower limb. The change from prone to knee‐chest position resulted in an increase in arterial blood pressure of the upper limb; the increase in diastolic arterial pressure was statistically significant (p < 0.001). It is concluded that the surgical knee‐chest position involves deterioration of both the arterial and venous flow of the lower limbs. This should be considered in patients undergoing surgery in this position and, in particular, in those at risk of developing cardiovascular complications.
Respiratory effects of spinal anaesthesia for Caesarean section
Authors: Kelly M. C. , Fitzpatrick K. T. J. , HILL D. A.
Published: September 2007

We report the changes observed in a number of pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow, forced expiratory volume in one second, forced vital capacity, forced expiratory volume in one second to forced vital capacity ratio and the maximal mid‐expiratory flow. Significant changes occurred that are consistent with a restrictive ventilatory defect. These changes persisted for four hours after the induction of spinal anaesthesia. Administration of 35% oxygen by facemask failed to change significantly fetal umbilical vein pH or partial pressure of oxygen.
A ventilation‐exchange bougie for fibreoptic intubations with the laryngeal mask airway
Authors: ATHERTON D. P. L. , O'SULLIVAN E. , LOWE D. , CHARTERS P.
Published: September 2007

The ventilation‐exchange bougie is a new airway device which can be mounted on a fibreoptic laryngoscope for passage through the larynx into the trachea via a laryngeal mask airway. Subsequent removal of the fibreoptic laryngoscope and laryngeal mask airway allows a tracheal tube to be railroaded into position over the ventilation‐exchange bougie. This study described the use of this technique for elective tracheal intubation in two groups of 12 subjects in whom difficulty with intubation was not expected. All the subjects were successfully intubated by one of two anaesthetists, one experienced and the other inexperienced with fibreoptic intubation techniques. Neither had had prior experience with the ventilation‐exchange bougie. Because ventilation was maintained throughout the procedure, intubation did not need to be hurried. Cusum analysis confirmed the impression of a learning curve and the technique could be considered learnt after four and six intubations for the experienced and inexperienced fibreoptic larvngoscopists respectively. No difficulty was found either in intubating the larynx with the fibreoptic laryngoscope and ventilation‐exchange bougie or when railroading the tracheal tube over the ventilation‐exchange bougie. It is suggested that this new device could have an important role in teaching fibreoptic techniques, management of the difficult airway and failed intubations.
Pruritus—itching for a cause and relief?
Authors: KAM P. C. A. , TAN K. H.
Published: September 2007

The mechanisms of pruritus, an unpleasant irritation on the skin that provokes an urge to scratch, are reviewed. Whilst symptomatic treatment is only partially effective, antihistamines remain the first choice of treatment. However, recent novel treatment using opiate antagonists, propofol (subhypnotic doses) and serotonin antagonists offer attractive alternatives.
Sciatic nerve palsy following childbirth
Authors: Silva M. , Mallinson C. , Reynolds F.
Published: September 2007

Two cases are reported of sciatic nerve palsy after delivery by Caesarean section in primigravidae. One mother was slender and had an emergency Caesarean section for failure to progress with a breech presentation. Epidural analgesia during labour was extended for operative delivery. The other mother was obese, mildly hypertensive, had a large baby with a high head and was delivered by elective Caesarean section under epidural anaesthesia. She experienced severe intrapartum hypotension. Both patients suffered right sided sciatic nerve palsy. The aetiologies of obstetric palsies and those following regional block are reviewed and the importance of careful diagnosis and of avoiding peripheral nerve compression during regional block are emphasised.
Epidural anaesthesia, ephedrine and phenylephrine in a patient taking moclobemide, a new monoamine oxidase inhibitor
Authors: Martyr J. W. , Orlikowski C. E. P.
Published: September 2007

We report a case of low thoracic epidural and general anaesthesia in a patient receiving moclobemide, a new selective inhibitor of monoamine oxidase A. Intra‐operative hypotension was initially treated with phenylephrine and then with ephedrine. The short half‐life of moclobemide and its modest interaction with direct and indirect acting sympathomimetic drugs permit the use of epidural anaesthesia, since any associated hypotension can be safely treated.
Acquired laryngomalacia as a cause of airway obstruction immediately after unilateral mouth floor surgery
Authors: Mima H. , Ishida H. , Yamazaki K.
Published: September 2007

We report a case of acquired laryngomalacia in which airway obstruction due to prolapse of the epiglottis during inspiration was observed immediately after a unilateral mouth floor resection. Suggested causes are resection of unilateral elevator muscles of the hyoid bone, epiglottic oedema and transient loss of pharyngeal motor control due to surgical intervention and high‐dose radiation.
Lithium toxicity
Authors: Vipond A. J. , Bakewell S. , Telford R. , Nicholls A. J.
Published: September 2007

We report a case of severe lithium toxicity precipitated by a thiazide diuretic and compounded by an angiotensin converting enzyme inhibitor. There was severe vasodilatation refractory to noradrenaline.
Spinal anaesthesia and spina‐bifida occulta
Authors: Davies P. R. F. , Loach A. B.
Published: September 2007

We describe a patient with unexpected spina bifida who underwent spinal anaesthesia for trans‐urethral resection of prostate and developed serious neurological signs. An unexpected spinal tumour was removed two weeks later. This report demonstrates that not all neurological problems associated with spinal anaesthesia should be blamed on the technique.
Tissue expander causing iatrogenic difficult intubation
Authors: Chadha I. A. , Multani S. T. , Chadha A.
Published: September 2007

Difficulty during tracheal intubation may occur due to a number of anatomical factors and pathological conditions. These factors may be influenced by earlier surgical manoeuvres, so that dificulty may occasionally be encountered at subsequent operation. One such case of‘iatrogenic’dificulty, where a tissue expander beneath the anterolateral skin of the neck caused transient intubation problems, is reported.
A comparison of prophylactic ondansetron and metoclopramide administration in patients undergoing major neurosurgical procedures
Authors: Pugh S. C. , Jones N. C. , Barsoum L. Z.
Published: September 2007

In a prospective, randomised, double‐blind trial, we assessed the relative efficacy of prophylactic ondansetron and metoclopramide administration in the reduction of postoperative nausea and vomiting in 60 patients undergoing routine major neurosurgical procedures. The patients were randomly allocated into one of two groups. Both groups received a standardised anaesthetic. When the dura mater was closed, patients in group A received an intravenous injection of metoclopramide 10 mg whilst group B received ondansetron 8 mg intravenously. Patients who received metoclopramide experienced less postoperative nausea and vomiting than those who received ondansetron in the 48 h following surgery (17 (56%) versus 9 (30%) p = 0.038). In the light of these findings, we believe that ondansetron is an inappropriate agent for the prevention of postoperative nausea and vomiting in the neurosurgical population.
The incidence of post dural puncture headache in children
Authors: Wee L. H. , Lam F. , Cranston A. J.
Published: September 2007

One hundred and five children with malignant disease attended for lumbar puncture which was performed under general anaesthesia. A questionnaire was answered over the next three days to determine the incidence of post dural puncture headache. Ninety‐seven questionnaires were returned and the results show that no child aged under ten years developed a headache. Of the children aged 10–12 years, two out of seventeen developed a headache (11.8%). In children aged 13–18 years, five out of ten developed a headache (50%).
Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask
Authors: Drage M. P. , Nunez J. , Vaughan R. S. , Asai T.
Published: September 2007

We have studied the efficacy of the loss of response to jaw thrust as a clinical test to assess adequate depth of anaesthesia for insertion of the laryngeal mask in 60 patients. After induction of anaesthesia with propofol (infused using a syringe driver), the patients were randomly allocated to one of two groups. In one group, insertion of the laryngeal mask was attempted immediately after the loss of verbal contact and in the other group, after the loss of motor response to a jaw thrust. Conditions for insertion of the laryngeal mask were assessed. The mean dose of propofol required to obtain loss of verbal contact was 1.94 mg. kg−1(SD 0.39, 95% confidence intervals (CI) 1.79–2.08 mg. kg−1) and that for the loss of response to jaw thrust was 2.55mg. kg−1(SD 0.46, 95% CI 2.38–2.72 mg. kg−1). When depth of anaesthesia was assessed using jaw thrusting, it was always possible to insert the mask and the conditions were optimal in 87% (95% CI 72–95%) of patients. Neither coughing nor gagging occurred. In contrast, conditions were almost always less than optimal when insertion was attempted after the loss of verbal contact. Conditions were significantly better when jaw thrust was used as a clinical test compared with loss of verbal contact (p = 0.001). No marked haemodynamic depression occurred in any patient. Thus, jaw thrust is a reliable clinical test to assess the adequate depth of anaesthesia for uncomplicated insertion of the laryngeal mask after induction of anaesthesia with propofol.
The optimal dose of ketamine for caudal epidural blockade in children
Authors: Semple D. , Findlow D. , Aldridge L. M. , Doyle E.
Published: September 2007

Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml. kg−1 of 0.25% bupivacaine with 0.25 mg. kg−1of preservative‐free ketamine, group B received 1 ml. kg−1 of 0.25% bupivacaine with ketamine 0.5mg. kg−1 and group C received 1 ml. kg−1 of 0.25% bupivacaine with 1 mg. kg−1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 7.9h in group A, 11 h in group B and 16.5 h in group C. There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.
Pre‐operative oral administration of morphine in day‐case gynaecological laparoscopy
Authors: Rasanayagam R. , Harrison G.
Published: September 2007

The analgesic effect of morphine sulphate 10 mg by mouth given pre‐operatively on pain after gynaecological laparoscopy was studied in a randomised, prospective, double‐blind, placebo‐controlled comparison. Two groups of 56 patients were studied, one group undergoing diagnostic laparoscopy and the other laparoscopic sterilisation. All patients received a standard anaesthetic after premedication with morphine or placebo 1 h before the operation. Morphine premedication did not significantly influence postoperative pain as assessed on a visual analogue scale in either group and postoperative opioid consumption was unaffected. Premedication with morphine Wmg orally does not significantly decrease pain after day‐case gynaecological laparoscopy.
Identification of PML as novel PAX5 fusion partner in childhood acute lymphoblastic leukaemia
Authors: Nebral Karin , König Margit , Harder Lana , Siebert Reiner , Haas Oskar A. , Strehl Sabine
Published: September 2007

PAX5 encodes the B‐cell lineage specific activator protein (BSAP) and is required for B‐cell development and maintenance. In B‐cell precursor acute lymphoblastic leukaemia (ALL), PAX5 is involved in several chromosome translocations that fuse the N‐terminal paired DNA‐binding domain of PAX5 with the C‐terminal regulatory sequences of ETV6, FOXP1, ZNF521 or ELN. Herein, we describe the identification of a novel recurrent t(9;15)(p13;q24) in two cases of childhood ALL, which results in an in‐frame fusion of PAX5 to the promyelocytic leukaemia (PML) gene. The putative PAX5‐PML fusion gene encodes a chimaeric protein that retains the paired domain, the octapeptid and the partial homeodomain of PAX5, and virtually the whole PML protein. The steadily increasing number of PAX5 rearrangements suggests that PAX5 is not only crucial for B‐cell lymphopoiesis but also for the development of B‐cell malignancies.
In vitro expansion of gamma delta T cells with anti‐myeloma cell activity by Phosphostim and IL‐2 in patients with multiple myeloma
Authors: Burjanadzé Maka , Condomines Maud , Reme Thierry , Quittet Philippe , Latry Pascal , Lugagne Cécile , Romagne François , Morel Yanis , Rossi Jean François , Klein Bernard , Lu Zhao Yang
Published: September 2007

T‐cell‐mediated immunotherapy is a promising therapeutic option for multiple myeloma (MM). Gamma‐delta T cells (γδ T cells) recognize phosphoantigens and display strong anti‐tumour cytotoxicity. The synthetic agonist Phosphostim (bromohydrin pyrophosphate, BrHPP) has been shown to selectively activate Vγ9Vδ2 T cells. This study aimed to evaluate the expansion capacity and anti‐myeloma cell cytotoxicity of circulating γδ T cells from MM patients at different time points throughout the disease, using Phosphostim and interleukin 2 (IL‐2). Circulating γδ T cell counts in patients with newly diagnosed MM or in relapse did not differ from those in healthy donors. A 14‐d culture of peripheral blood mononuclear cells with Phosphostim and IL‐2 triggered a 100‐fold expansion of γδ T cells in 78% of newly diagnosed patients. γδ T cells harvested at the time of haematopoietic progenitor collection or in relapsing patients expanded less efficiently. Expanded γδ T cells killed 13/14 myeloma cell lines as well as primary myeloma cells, but not normal CD34 cells. Their killing efficiency was not affected by 2‐d IL‐2 starvation. This study demonstrated the ability of Phosphostim and IL‐2 to expand γδ T cells from MM patients, and the efficient and stable killing of human myeloma cells by gd T cells.
M4 and M5 acute myeloid leukaemias display a high sensitivity to Bortezomib‐mediated apoptosis
Authors: Riccioni Roberta , Senese Mara , Diverio Daniela , Riti Viviana , Buffolino Sonia , Mariani Gualtiero , Boe Alessandra , Cedrone Michele , Lo‐Coco Francesco , Foà Robin , Peschle Cesare , Testa Ugo
Published: September 2007

The present study explored the sensitivity of leukaemic blasts derived from 30 acute myeloid leukaemia (AML) patients to Bortezomib. Bortezomib induced apoptosis of primary AML blasts: 18/30 AMLs were clearly sensitive to the proapoptotic effects of Bortezomib, while the remaining cases were moderately sensitive to this molecule. The addition of tumour necrosis factor‐related‐apoptosis‐inducing ligand, when used alone, did not induce apoptosis of AML blasts and further potentiated the cytotoxic effects of Bortezomib. The majority of AMLs sensitive to Bortezomib showed immunophenotypic features of the M4 and M5 French–American–British classification subtypes and displayed myelomonocytic features. All AMLs with mutated FLT3 were in the Bortezomib‐sensitive group. Biochemical studies showed that: (i) Bortezomib activated caspase‐8 and caspase‐3 and decreased cellular FLICE [Fas‐associated death domain (FADD)‐like interleukin‐1β‐converting enzyme]‐inhibitory protein (c‐FLIP) levels in AML blasts; (ii) high c‐FLIP levels in AML blasts were associated with low Bortezomib sensitivity. Finally, analysis of the effects of Bortezomib on leukaemic cells displaying high aldehyde dehydrogenase activity suggested that this drug induced in vitro killing of leukaemic stem cells. The findings of the present study, further support the development of Bortezomib as an anti‐leukaemic drug and provide simple tools to predict the sensitivity of AML cells to this drug.
Circulating DNA: a potential marker of sickle cell crisis
Authors: Vasavda Nisha , Ulug Pinar , Kondaveeti Sheila , Ramasamy Karthik , Sugai Taku , Cheung Gordon , Rees David C. , Awogbade Moji , Bannister Sybil , Cunningham Juliette , Menzel Stephan , Thein Swee Lay
Published: September 2007

Free circulating DNA is present in the plasma of healthy subjects, and is elevated in conditions characterized by increased cell death, such as cancer and physical trauma. Analysis of circulating DNA in plasma could provide a useful biomarker in sickle cell disease (SCD) in view of the increased cell turnover through chronic ongoing haemolysis, recurrent vaso‐occlusion and inflammation. Plasma DNA was determined by real‐time quantitative polymerase chain reaction (PCR) amplification of the β‐globin gene (HBB) in 154 patients with SCD [105 haemoglobin (Hb)SS, 46 HbSC and three HbS/β0 thalassaemia] and 53 ethnically matched controls. Blood samples were obtained from all patients in steady state; 21 of the 154 patients were also sampled during admission to hospital for acute pain. Median concentration of circulating plasma DNA in acute pain was more than 10‐fold that in steady state and in controls – 10070 vs. 841 and 10070 vs. 933 genome equivalents/ml respectively (P < 0·0001, in both cases). During steady state, patients had plasma DNA levels similar to controls. Plasma DNA levels in SCD correlated with C‐reactive protein levels (P < 0·005) and total white cell counts (P < 0·05) in steady state. The study shows that plasma DNA concentration may have potential as a biomarker in sickle cell patients.
Picogram doses of lipopolysaccharide exacerbate antibody‐mediated thrombocytopenia and reduce the therapeutic efficacy of intravenous immunoglobulin in mice
Authors: Tremblay Tony , Aubin Éric , Lemieux Réal , Bazin Renée
Published: September 2007

Exacerbation of antibody‐mediated thrombocytopenia following infection with viruses has recently been demonstrated in a mouse model of the disease. The phenomenon was caused by an increased activation of phagocytes through gamma‐interferon secretion in response to infection. Endotoxins from Gram‐negative bacteria are also known to be potent activators of phagocytic cells. The objective of the present work was to determine whether lipopolysaccharide (LPS) could exacerbate antibody‐mediated thrombocytopenia in vivo and so alter the therapeutic efficacy of intravenous immunoglobulin (IVIg), using a mouse model of thrombocytopenia. Very low doses of LPS (picogram range) and of anti‐platelet antibodies (nanogram range), which did not induce thrombocytopenia individually, could synergize in vivo, resulting in significant decreases in platelet counts. The therapeutic efficacy of IVIg in antibody‐mediated thrombocytopenia was significantly reduced in presence of LPS. These in vivo observations further support a role for bacterial infections in the aetiology of immune thrombocytopenic purpura (ITP) and may contribute to better understand the recognized lack of efficacy of IVIg in a significant proportion of patients with ITP.
Loss of expression of LyGDI (ARHGDIB), a rho GDP‐dissociation inhibitor, in Hodgkin lymphoma*
Authors: Ma Liya , Xu Gaixiang , Sotnikova Anna , Szczepanowski Monika , Giefing Maciej , Krause Kristina , Krams Matthias , Siebert Reiner , Jin Jie , Klapper Wolfram
Published: September 2007

The guanosine triphosphatase (GTPase) inhibitor LyGDI (ARHGDIB, Ly/D4‐GDI, RhoGDIb or RhoGDI 2) is abundantly expressed in haematopoetic cells and possibly plays a role in the onset of apoptosis. Gene expression profiling of Hodgkin cell lines revealed that LyGDI expression was downregulated in these cell lines. The present study evaluated the expression of LyGDI in Hodgkin cells in vivo and studied the function of LyGDI in Hodgkin cell lines in vitro. Our results showed that virtually all Hodgkin and Reed‐Sternberg cells in classical Hodgkin lymphoma lacked LyGDI protein expression. On the other hand, almost all non‐Hodgkin lymphomas, except for anaplastic large cell lymphomas, expressed LyGDI protein. Transfection of the classical Hodgkin cell line L428 with a vector containing full‐length LyGDI‐induced apoptosis in a subset of cells. However, the majority of Hodgkin cells with transgenic expression of LyGDI escaped apoptosis. Our data show that lack of LyGDI expression is a frequent feature of cHL but that it is not of vital importance for the growth and survival of these cells.
Unbalanced protein S deficiency due to warfarin treatment as a possible cause for thrombosis
Authors: Haran Michal Z. , Lichman Inna , Berebbi Alain , Weinmann Eran , Rosenberg Nurit
Published: September 2007

The prothrombin time/International Normalized Ratio is an accurate parameter for following most warfarin‐treated patients. However, it reflects mostly factor VII levels, and significant disproportionate alterations in other vitamin K‐dependent factors may not be reflected properly. We report a rare case of a woman who developed arterial thrombosis whilst receiving therapeutic doses of warfarin, and was found to have a significant and unbalanced protein S deficiency. Discontinuation of warfarin resulted in complete normalization of coagulation factors, and no further thrombotic events under treatment with enoxaparin, with a follow‐up of 2.5 years.
Effect of standardization and normalization on imprecision of calibrated automated thrombography: an international multicentre study
Authors: Dargaud Yesim , Luddington Rodger , Gray Elaine , Negrier Claude , Lecompte Thomas , Petros Sirak , Hogwood John , Bordet Jean‐Claude , Regnault Veronique , Siegemund Annelie , Baglin Trevor
Published: September 2007

Calibrated automated thrombography (CAT) enables continuous measurement of thrombin generation (TG). Initial clinical studies using the CAT method showed large variability of normal values, indicating the necessity for a standardized CAT protocol. This international study assessed the intra‐ and inter‐assay imprecision of CAT as well as the inter‐centre variability of results in five European centres using locally available reagents and conditions (study 1) and a standardized protocol in which results were normalized (study 2). Samples with and without corn trypsin inhibitor from six healthy volunteers, two haemophilia patients and one protein C deficient patient were assayed. Study 1 confirmed that the use of different sources and concentrations of tissue factor (TF) and different phospholipid (PL) mixtures produced large variability in results. The second study demonstrated that, using the same source and concentration of TF, PL and the same test procedure, this variability could be significantly reduced. Normalization of results improved the inter‐centre variability. The benefit of contact factor inhibition prior to TG measurement was confirmed. These results demonstrated that standardization of CAT reduces the variability of results to acceptable limits. Standardization and normalization should be considered in future clinical studies which apply TG testing to clinical decision making.
Mesenchymal content of fresh bone marrow: a proposed quality control method for cell therapy
Authors: Veyrat‐Masson Richard , Boiret‐Dupré Nathalie , Rapatel Chantal , Descamps Stéphane , Guillouard Laurent , Guérin Jean‐Jacques , Pigeon Pascale , Boisgard Stéphane , Chassagne Jacques , Berger Marc G.
Published: September 2007

The scarcity of mesenchymal stem cells (MSC) in bone marrow (BM) has justified their ex vivo expansion before therapeutic use, but a method to evaluate the quality of initial mesenchymal content and track the modifications induced by graft processing has not yet been proposed. The aim of this study was to establish such a procedure. Flow cytometric and functional assay methods were modified to count CD45− CD14−/CD73+ subsets containing all MSC and used them to study BM from spongy bone (SB) and iliac crest aspirate (ICA). These methods detected the target subsets in all BM suspensions derived from SB (n = 154) and ICA, (n = 44) with a satisfactory correlation between immuno‐phenotyping and functional tests by low‐density plating. We noted a higher overall MSC frequency in SB cell suspensions but a lower plating efficiency of CD45− CD14−/CD73+ SB cells under standard culture conditions.

We propose a cell quality control on un‐manipulated BM cell suspensions to quantify the mesenchymal compartment with regard to varying donor factors, such as age and sampling site, that influence expansion and define a therapeutic threshold value. Furthermore, we were able to confirm differences in plating efficiency and proliferative capacity between two BM origins.
Functional regulation of D‐type cyclins by insulin‐like growth factor‐I and serum in multiple myeloma cells
Authors: Glassford Janet , Rabin Neil , Lam Eric W.‐F. , Yong Kwee L.
Published: September 2007

D‐type cyclin genes are universally dysregulated in multiple myeloma (MM), but the functional consequences are unclear as D‐type cyclin gene expression does not correlate with proliferation or disease progression. We examined the protein expression and regulation of D‐type cyclins and other cell cycle regulators in human myeloma cell lines and primary CD138+ plasma cells (PCs). Cyclin D1, cyclin D2, cyclin dependent kinase (CDK) 4, CDK6, p27Kip1 p18INK4C and retinoblastoma protein (pRb) were absent in normal PCs, heterogeneously expressed in primary MM cells and positively correlated with disease activity/progression. Cyclins D1 and D2 complexed with both CDK4 and CDK6, suggesting that both phosphorylate pRb in MM. Furthermore, cyclin D2 expressed via either t(14;16) or t(4;14) IgH translocations was functionally upregulated by fetal calf serum or insulin‐like growth factor‐I, leading to pRb phosphorylation and cell cycle entry/progression, and in some cases inversely correlated with p27Kip1. However, pRb phosphorylation and cell cycle progression mediated by cyclin D1 expressed via t(11;14) was less dependent on exogenous stimuli. These data suggest that the presence or absence of specific IgH translocations underlying aberrant D‐type cyclin expression may influence their response to mitogens in the bone marrow microenvironment. We showed for the first time that D‐type cyclins are functionally regulated in MM, differentially responsive to exogenous growth factors and upregulated with disease progression.