bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury
Authors: Wang J. , Abu‐Zidan F. M. , Walther S. M.
Published: March 2003

Background: Chlorine gas may induce severe acute lung injury. Improvement of pulmonary gas exchange in patients and animals with acute lung injury nursed in the prone position was observed in recent years. The purpose of this study was to evaluate the effects of prone and supine positions on pulmonary and cardiovascular functions following experimental chlorine gas lung injury.

Methods: Twenty anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 p.p.m. in air) for 20 min in the supine position, then assigned randomly to ventilation in the supine or prone positions (n=10 in each group). Hemodynamics, gas exchange, lung mechanics and oxygen transport were evaluated for 5 h.

Results: All animals showed severe pulmonary dysfunction immediately after chlorine gassing with a threefold increase in pulmonary vascular resistance index, a drop in arterial oxygenation (12.3±1.3 kPa to 5.4±0.7 kPa) and a fall in lung‐thorax compliance (22±1 ml cmH2O−1 to 8±2 ml cmH2O−1). Venous admixture (Qs/Qt) improved in animals in the prone position while there was no change in the supine position (prone 32±11% vs. supine 42±9% at 5 h,P<0.05). Lung‐thorax compliance improved significantly with time in the prone group only (P<0.01). Oxygen delivery increased significantly in prone animals compared with animals nursed in the supine posture (P<0.001).

Conclusion: Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport.
Acceleromyography of the orbicularis oculi muscle I: significance of the electrode position
Authors: Gätke M. R. , Larsen P. B. , Engbæk J. , Fredensborg B. B. , Berg H. , Viby‐Mogensen J.
Published: March 2003

Background: This study aimed to establish the best position of the stimulating electrodes for facial nerve stimulation during acceleromyographic monitoring from the orbital part of the orbicularis oculi muscle.

Methods: In 59 anaesthetised patients, an acceleration transducer was positioned over the middle of the eyebrow. In 47 patients, supramaximal train‐of‐four (TOF) stimulation was established for four electrode pairs with different positions along the facial nerve and behind the ear. The electrode pair with the lowest, the intermediate, and the highest supramaximal stimulating current based on first response (T1) in TOF was found in each patient. A possible response from direct muscle stimulation was evaluated during complete vecuronium block. In 12 patients, supramaximal stimulation was established using a stimulation sequence different from the one used in the first part of the study.

Results: The best positions for the stimulating electrodes were either with both electrodes just lateral to the eye, or with one electrode lateral to the eye and one in front of the ear. In most patients, supramaximal stimulation was obtained at these positions at 20–60 mA. However, in 10–21% of the patients, supramaximal stimulation could not be obtained. During complete block, 1–4 responses with a twitch height of 3–11% were recorded in 80% of the patients.

Conclusion: The best placements of the stimulation electrodes are either just lateral to the eye or along the zygomatic arch. However, supramaximal stimulation may often not be obtainable, and activation of other facial muscles may be a confounding factor that may impede correct evaluation of the degree of neuromuscular block.
Acceleromyography of the orbicularis oculi muscle II: comparing the orbicularis oculi and adductor pollicis muscles
Authors: Larsen P. B. , Gätke M. R. , Fredensborg B. B. , Berg H. , Engbæk J. , Viby‐Mogensen J.
Published: March 2003

Background: The orbicularis oculi (OO) muscle has been recommended for neuromuscular monitoring when the adductor pollicis (AP) muscle is not available. We investigated whether neuromuscular block could be measured reliably from the orbital part of the OO muscle by the use of acceleromyography.

Methods: During propofol, fentanyl, and alfentanil anaesthesia two TOF‐Guards® (Organon Teknika NV, Boxtel, the Netherlands) with acceleration transducers placed on the distal phalanx of the thumb and over the middle of the eyebrow, respectively, were used to measure neuromuscular block simultaneously in 23 patients during vecuronium‐induced and neostigmine‐antagonized neuromuscular block.

For both muscles, the simultaneously recorded first response (T1) in the train‐of‐four (TOF) and TOF‐ratio were measured both during onset and recovery of the block. Furthermore, both the AP muscle T1 and TOF‐ratio responses were plotted against 10% intervals of the OO muscle responses during onset and recovery, respectively.

Results: The orbicularis oculi muscle had a shorter latency and a faster recovery to TOF‐ratio 0.80 compared with the AP muscle. During onset and recovery, pronounced variations of the AP muscle T1 and TOF‐ratio responses were observed when compared with the OO muscle.

Conclusion: A significant clinical disagreement exists between the degree of paralysis measured at the OO and the AP muscles. It is impossible to obtain a reasonable estimate of the degree of block at the AP muscle when the block is measured from the OO muscle with acceleromyography. If used, there is substantial risk of overlooking a residual block, and adequate recovery of the block should be confirmed by a final AP muscle measurement.
Reproducibility of in vitro contracture test results in patients tested for malignant hyperthermia susceptibility
Authors: Islander G. , Örding H. , Bendixen D. , Ranklev Twetman E.
Published: March 2003

Background: The in vitro contracture test (IVCT) is the golden standard to diagnose malignant hyperthermia susceptibility (MHS). A high reproducibility is important for a high validity of a test.

Methods: We have therefore analyzed IVCT in 838 patients, investigated in two laboratories. Each halothane and caffeine test was performed in two muscle strips. The test results were analyzed with respect to reproducibility of abnormal outcomes within pairs of tested muscle strips and size of contractures, thresholds and quality criteria. The patients were tested according to the European Malignant Hyperthermia Group protocol (EMHG). To fulfill quality criteria in the EMHG protocol the twitch height should be 10 mN (1 g) or more. For the caffeine test a minimum contracture of 50 mN (5 g) or more at 32 mmol l−1 caffeine could be used as an alternative quality criterion

Results: There was better reproducibility with larger contractures. The correlation between size of contractures and fraction of muscle strips with abnormal contractures was 0.77 or larger. Contractures < 5 mN (0.5 g) were reproducible in less than half of the tests. There was no difference in reproducibility or size of contractures between tests fulfillling all quality criteria and those not fulfillling these criteria.

Conclusions: IVCT responses close to cut off limits, i.e. <5 mN (0.5 g) in the EMHG protocol, are less reproducible and must scientifically be considered as less reliable. The clinical cut off limits must remain unchanged for reasons of clinical safety. The outcome of quality measurements does not influence the test results.
Cardiac failure and multiple organ dysfunction syndrome in a patient with endocrine adenomatosis
Authors: Dünser M. W. , Mayr A. J. , Gasser R. , Rieger M. , Friesenecker B. , Hasibeder W. R.
Published: March 2003

In this case report, we present the successful therapy of severe cardiac failure in pituitary adrenal insufficiency. A previously healthy 56‐year‐old‐man in pituitary coma due to an atypical variant of multiple endocrine adenomatosis (pituitary adenoma and pheochromocytoma) suffered from cardiac failure resistant to catecholamine and standard hydrocortisone therapy. After two bolus injections of dexamethasone (2 × 24 mg) mean arterial pressure and cardiac function dramatically improved, probably due to restoration of permissive effects on catecholamine action and reversal of pathophysiological mechanisms of cardiac failure. We conclude that in patients with severe cardiovascular failure in pituitary coma the administration of potent glucocorticoids may be more effective in reversing cardiovascular failure than standard dosages of hydrocortisone.
Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study
Authors: Veien M. , Sørensen J. V. , Madsen F. , Juelsgaard P.
Published: March 2003

Background: Extensive blood loss in total knee replacement (TKR) surgery is well known and is associated with a high transfusion rate of allogenic blood. Tranexamic acid (TXA) has been shown to reduce blood loss by 50% in this patient group, but only in cases with a perioperative loss of 1400–1800 ml. This study was performed to see if TXA offers any advantages in knee replacement surgery with blood loss at 800 ml.

Methods: Thirty consecutive patients scheduled for TKR in spinal anesthesia with the use of a tourniquet, were randomized to TXA or non‐TXA. Tranexamic acid 10 mg kg−1 was given at conclusion of surgery and again 3 h later. Blood loss was registered.

Results: Total blood loss was at all times significantly lower in the TXA group compared to the non‐TXA group (409.7±174.9 ml vs. 761.7±313.1 ml; P<0.001). There were no differences in coagulation parameters. No patients in the TXA group had a blood transfusion vs. 13% in the non‐TXA group (NS). No complications were registered in the two groups.

Conclusion: We conclude that TXA significantly reduces blood loss after total knee replacement surgery.
Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia
Authors: Bach F. , Grundmann U. , Bauer M. , Buchinger H. , Soltész S. , Graeter T. , Larsen R. , Silomon M.
Published: March 2003

Background:Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. Microcirculation‐dependent alteration of the gut mucosal barrier with subsequent translocation of endotoxins is a postulated mechanism for this inflammatory response. This study was designed to elucidate whether two different approaches to modulate splanchnic perfusion may influence systemic inflammation to CPB.

Methods:We examined 40 patients scheduled for elective coronary bypass surgery in a prospective, randomized study. One group (DPX) received dopexamine (1 µg · kg−1 · min−1) continuously after induction of anesthesia until 18 h after CPB. The control group (CON) received equal volumes of NaCl 0.9% in a time‐matched fashion. In a third group (EPI) a continuous epidural infusion of bupivacaine 0.25% [(body height (cm) – 100) · 10−1=ml·h−1] was administered for the whole study period. Procalcitonin (PCT), tumor necrosis factor (TNF‐α), soluble TNF receptor, human soluble intercellular adhesion molecule‐1, C‐reactive protein (CRP) and leukocyte count were measured as parameters of inflammation.

Results:All parameters significantly increased following CPB. Increases of PCT, TNF‐α and leukocyte count were significantly attenuated in the DPX and EPI groups at different time points. However, neither splanchnic blood flow nor oxygen delivery and consumption were different when compared with the CON‐group.

Conclusion:These results do suggest that mechanisms other than an improved splanchnic blood flow by DPX and EPI treatment have to be considered for the anti‐inflammatory effects.
Cerebrospinal fluid concentrations of atracurium, laudanosine and vecuronium following clinical subarachnoid hemorrhage
Authors: Tassonyi E. , Fathi M. , Hughes G. J. , Chiodini F. , Bertrand D. , Muller D. , Fuchs‐Buder T.
Published: March 2003

Background: Neuromuscular blocking agents may exert central nervous system effects when they reach the brain. This study assessed the concentrations and the time course of passage of vecuronium, atracurium, and its metabolite laudanosine in the cerebrospinal fluid (CSF) of patients undergoing intracranial aneurysm clipping.

Methods: Twenty‐five patients with subarachnoid hemorrhage were randomly allocated to receive an intravenous infusion of vecuronium (n=13) or atracurium (n=12). Arterial blood and lumbar CSF were sampled before and 1, 2, 3, 4 and 8 h after the start of the relaxant infusion. The samples were analyzed by liquid chromatography‐electrospray ionization mass spectrometry (vecuronium) and high‐pressure liquid chromatography (atracurium and laudanosine).

Results: The data of 20 patients (10 in both groups) were analyzed. In 11 CSF samples from five patients atracurium was detected in concentrations from 10 to 50 ng/ml. Laudanosine was retrieved in all CSF samples at 1, 2, 3, 4 and 8 h; the highest CSF concentration of laudanosine occurred at 3 h [38 (18–63) ng/ml: median (range)]. Vecuronium was not found in any CSF sample.

Conclusion: Significant concentrations of atracurium and laudanosine but not of vecuronium were detected in the CSF of patients during and immediately after intracranial aneurysm surgery.
Intravenous sedation and general anesthesia for a patient with Gilles de la Tourette's syndrome undergoing dental treatment
Authors: Yoshikawa F. , Takagi T. , Fukayama H. , Miwa Z. , Umino M.
Published: March 2003

Patients with Gilles de la Tourette's syndrome develop symptoms during childhood. Repetitive various motor tics or speech tics that are spontaneous, aimless, and involuntary are characteristic of the syndrome (1). Patients with the syndrome have been considered to have an aggressive, impulsive, and obsessive character (2) (3). Suicide is one of the mental symptoms of the syndrome. Routine dental treatment with this syndrome can be difficult.
Two propofol formulations are equivalent in small children aged 1 month to 3 years
Authors: Pessenbacher K. , Gutmann A. , Eggenreich U. , Gschanes A. , Rehak P. , List W. F.
Published: March 2003

Background: Propofol has been widely used in general anesthesia. Although it is also often used in pediatric anesthesia, there has been only limited scientific evidence on the use of propofol in children up to 3 years.

Methods: A prospective, randomized, double‐blind, therapeutic equivalence study comparing two propofol 1% emulsions (Propofol 1% Fresenius vs. Diprivan 1%) was performed in 60 patients scheduled for routine surgery or for diagnostic laparoscopic procedures requiring anesthesia. To guarantee comparability of age distribution between the two groups, a stratified randomization with patients younger than 12 months of age in a low age group and with patients aged 12 months to 3 years in a high age group was used. The average propofol induction dose and the average propofol infusion dose were analyzed to prove equivalence. The side‐effects profile was analyzed to compare the safety profiles of the two propofol formulations in this study.

Results: There were no differences in baseline characteristics between the two treatment groups of high and low age. Medications used for induction and maintenance of anesthesia, and side‐effects profiles were comparable, as were the average propofol dose for induction of anesthesia (range of the mean dose 4.0–4.2 mg/kg) and for maintenance of anesthesia (range of the mean dose in the first hour 8.74–9.42 mg·kg−1·h−1).

Conclusions: The two 1% propofol formulations were equally effective in our patient population of infants and young children between 1 month and 3 years of age. No differences between the two propofol formulations were found with regard to the circulatory reaction, lipid metabolism, dosages, and recovery profile in the studied age groups.
Effect of rewarming speed during hypothermic cardiopulmonary bypass on cerebral pressure–flow relation
Authors: Diephuis J. C. , Balt J. , Van Dijk D. , Moons K. G. M. , Knape J. T. A.
Published: March 2003

Background: Cerebral blood flow is less dependent on arterial blood pressure during hypothermic cardiopulmonary bypass (CPB) compared to warm CPB. Fast rewarming has a more pronounced effect on cognitive performance in the elderly and causes an increased arterio‐jugular oxygen content difference. We studied the effect of rewarming and rewarming speed on cerebral pressure–flow relation in adult patients undergoing elective coronary artery bypass surgery with mild hypothermic CPB.

Methods: Fifty patients were randomly assigned to either a slow rewarming strategy (0.24 °C/min) or a fast rewarming strategy (0.5 °C/min). Cerebral pressure–flow relation was assessed by a transcranial Doppler derived index for cerebral pressure–flow relation (Pressure–flow Index, PFI). The effect of rewarming speed on cerebral pressure–flow relation was assessed by comparing the absolute PFI value after rewarming between the two treatment groups.

Results The mean PFI decreased significantly from 0.73 (standard deviation: 0.28) before rewarming to 0.54 (0.35) after rewarming in the slow rewarming group and from 0.63 (0.29) to 0.48 (0.30) in the fast rewarming group. Absolute PFI after rewarming was not significantly different (mean PFI difference = 0.06; 95% CI = − 0.13; 0.26) between both rewarming strategies.

Conclusion: Rewarming from mild hypothermic CPB might result in pressure‐dependent cerebral blood flow velocity but rewarming speed did not aggravate the effect of rewarming on pressure–flow dependency.
Changes in intrathoracic blood volume associated with pneumoperitoneum and positioning
Authors: Hofer C. K. , Zalunardo M. P. , Klaghofer R. , Spahr T. , Pasch T. , Zollinger A.
Published: March 2003

Background: It is still controversial whether elevated cardiac filling pressures after the onset of pneumoperitoneum are the consequence of increased intrathoracic pressure or of increased venous return. The aim of this study was to assess the effects of pneumoperitoneum and body positioning on intrathoracic blood volume (ITBV).

Methods: Thirty anesthetized patients were randomly assigned to have CO2‐pneumoperitoneum (13 mmHg) either in a supine, in a 15° head‐up tilt or in a 15° head‐down tilt position. Measurements of ITBV and hemodynamics by the double indicator method were recorded after induction of anesthesia and application of a fluid bolus (Lactated Ringer's solution 10 ml/kg), after positioning and after induction of pneumoperitoneum.

Results: Intrathoracic blood volume index (ITBVI) increased significantly after induction of pneumoperitoneum in all body positions (supine: from 18.5 ± 3.3 –20.2  ± 5.2 ml/kg (+6%) head‐up from 16.7 ± 3.8 – 17.4 ± 3.7 ml/kg (+16%) and head‐down: from 19.8 ± 5.6 – 20.5 ± 5.9 ml/kg (+14%)). Heart rate did not change significantly in any of the groups. Cardiac index showed a statistically significant change in the head‐down position with pneumoperitoneum (−11%). A good correlation was found for stroke volume (SV) with ITBV (r = 0.79), but not with central venous pressure (r = 0.26). Systemic vascular resistance index increased significantly in all three groups (supine +6%, head‐up +16%, head‐down position +14%).

Conclusion: The present study indicates that the onset of pneumoperitoneum, even with moderate intra‐abdominal pressures, is associated with an increased intrathoracic blood volume in ASA I/II patients.
Comparison of the opioid‐sparing efficacy of diclofenac and ketoprofen for 3 days after knee arthroplasty
Authors: Silvanto M. , Lappi M. , Rosenberg P. H.
Published: March 2003

Background: Comparative postoperative non‐steroidal anti‐inflammatory drug (NSAID) studies in orthopedic patients have usually been restricted in time to the first postoperative day. The opioid‐sparing effect of NSAIDs may be beneficial postoperatively as long as pain otherwise restricts ambulation and rehabilitation. We therefore compared the analgesic efficacy of the maximum recommended doses of diclofenac and ketoprofen for 3 days after knee arthroplasty.

Methods: We studied 64 knee arthroplasty patients, operated on under spinal anesthesia. In a randomized, double‐blind and placebo‐controlled fashion, the patients received either i.v. diclofenac 75 mg (n = 24), ketoprofen 100 mg (n = 24) or saline (n = 16) in the recovery room, followed by oral diclofenac 150 mg/day, ketoprofen 300 mg/day or placebo, respectively, for 3 days, supplemented by patient‐controlled analgesia (PCA) with i.v. oxycodone.

Results: The mean consumption of oxycodone during the first, second and third study days was 45.3, 22.3 and 15.2 mg in the diclofenac group, 43.5, 37.5 and 21.8 mg in the ketoprofen group, and 61.2, 45.9 and 36.1 mg, respectively, in the placebo group. Oxycodone consumption was significantly lower (P < 0.05) in the ketoprofen group than in the placebo group in the postoperative period 13–24 h and 61–72 h. Diclofenac was superior to placebo in the postoperative period 25–48 h (P < 0.01), 49–60 h (P < 0.05) and to ketoprofen at 49–60 h (P < 0.05). During administration of diclofenac on days 1–3 and ketoprofen on day 2, the mean pain scores (VAS) were lower than in the placebo group (P < 0.05). Six patients had difficulties in operating the PCA device. There were no differences in blood loss.

Conclusion: We conclude that in the first day after knee arthroplasty (13–24 h), ketoprofen exerted an opioid‐sparing effect. After day 1 (25–60 h), with the doses used, diclofenac proved to be better than placebo, whereas ketoprofen was not.
Continuous spinal analgesia for labor and delivery in a parturient with hypertrophic obstructive cardiomyopathy
Authors: Okutomi T. , Kikuchi S. , Amano K. , Okamoto H. , Hoka S.
Published: March 2003

Induction of labor under analgesia was planned for a 30‐year‐old‐primiparous patient with hypertrophic obstructive cardiomyopathy (HOCM), as her fetal evaluation revealed intrauterine growth restriction at 38 weeks' gestation. However, regional analgesia during labor may present a potential risk for hemodynamic instability in patients with HOCM due to the possibility of a sympathetic block, as a result of vasodilation associated with the administration of local anesthesia. This case report demonstrates the successful management of the patient with analgesia provided by a continuous spinal catheter dosed with a continuous infusion of fentanyl and supplemental meperidine. Fetal surveillance monitoring included fetal pulse oximetry in addition to conventional cardiotocography, on the basis of which cesarean section was avoided.
One‐lung ventilation of a preterm newborn during esophageal atresia and tracheoesophageal fistula repair
Authors: Tercan E. , Sungun M. B. , Boyaci A. , Kücükaydin M.
Published: March 2003

In this paper, we assessed the anesthesia management of a male, a 34‐week gestation age newborn, weighing 1500 g, who has esophageal atresia and tracheoesophageal fistula localized just above the carina. Endotracheal intubation and intermittent positive pressure ventilation caused air leakage through the fistula into the stomach, causing abdominal distention. One‐lung ventilation by left main bronchus intubation eliminated this problem.
Fatal amniotic fluid embolism diagnosed histologically
Authors: Aguilera L. G. , Fernandez C. , Plaza A. , Gracia J. , Gomar C.
Published: March 2003

Although the mortality of amniotic fluid embolism remains very high, there are more and more reports of patients surviving after prompt and aggressive therapy. However its pathogenesis is controversial, and, in some cases, an anaphylactic reaction to the amniotic fluid rather than the hemodynamic changes following mechanical obstruction by an embolus has been proposed as the underlying pathophysiological mechanism.

In this paper we describe a case of amniotic fluid embolism with florid clinical features and a difficult and delayed diagnosis. On autopsy, clear‐cut histological changes of amniotic fluid embolism were found.
Oral clonidine premedication preserves heart rate variability for patients undergoing larparoscopic cholecystectomy
Authors: Yu H.‐P. , Hseu S.‐S. , Yien H.‐W. , Teng Y.‐H. , Chan K.‐H.
Published: March 2003

Background: Clonidine has been shown to reduce perioperative circulatory instability. This postoperative analgesic effect of clonidine was also known in previous studies. The aim of the study was to investigate the clinical efficiency of oral clonidine premedication in anesthesia and analgesia in patients undergoing laparoscopic cholecystectomy.

Methods: Thirty‐two patients scheduled for elective laparoscopic cholecystectomy were recruited for a prospective, randomized, double‐blinded comparative study. They were allotted randomly to two groups: placebo or clonidine. Patients in the placebo group (n = 16) were premedicated with oral antacid (alugel hydroxide 300 mg), while those in the clonidine group (n = 16) were premedicated with oral clonidine 150 µg before anesthesia. Analysis of heart rate variability was used to quantify the control of heart rate at baseline, and during the pneumoperitoneum and recovery periods. Time of the first request for postoperative analgesic and cumulative analgesic requirements in 24 h were recorded. Data are expressed as mean ± SD.

Results: Heart rate variability was reduced in the pneumoperitoneum and postoperative period in the placebo group. Clonidine resulted in a greater perioperative (pneumoperitoneum period) power at all frequency ranges compared with placebo (671.5 ± 470.5 vs. 55.1 ± 51.6 ms2/Hz for total power variability, 170.1 ± 94.4 vs. 16.9 ± 21.1 ms2/Hz for low‐frequency variability and 206.1 ± 95.7 vs. 16.4 ± 15.1 ms2/Hz for high‐frequency variability, P < 0.05). The postoperative analgesic requirement was less (2.3 ± 0.8 vs. 3.2 ± 1.2 dose, P < 0.05) in comparison with the placebo group.

Conclusion: Clonidine preserves heart rate control in pneumoperitoneum and recovery periods. Oral clonidine premedication also reduces the requirement for postoperative analgesia.
Anesthesiologists in prehospital care make a difference to certain groups of patients
Authors: Christenszen E. F. , Melchiorsen H. , Kilsmark J. , Foldspang A. , Søgaard J.
Published: March 2003

Background: Knowledge of the population using prehospital emergency services is scarce except for selected subgroups. Interventions are often made without evaluation. The aim of this study was (1) to describe mortality, hospitalization and the diagnostic pattern among emergency ambulance users and (2) to evaluate the impact of one mobile emergency care unit (MECU) staffed by an anesthesiologist.

Design and methods: A descriptive and quasi‐experimental study of consecutive emergency ambulance users during two 3‐month periods: before the MECU (Period 1) and after (Period 2). Hospitalization, diagnostic and 0–180‐day mortality data were requested from national registers. Diagnoses were according to the International Classification of Diseases (ICD).

Results: Periods 1 and 2 included 2950 and 2869 users, respectively. The MECU attended 27.7% in Period 2. Fewer users were brought to hospital in Period 2 (87.9% vs. 93.8%, P < 0.0001), especially MECU users (76.5% MECU users vs. 92.3% other users; P < 0.001). Diagnoses included all main ICD‐groups. Overall mortality of all users was 10.2%; no difference between the periods. Cardiovascular and respiratory diseases were among the most frequent and were associated with high mortality. In Period 2 mortality was lower in subgroups: acute myocardial infarction (AMI; n = 177, day 0–180, 13.3% vs. 40.5%, P < 0.001); and respiratory diseases, only short‐term mortality (n = 388, day 0–1 mortality, 0.0% vs. 2.4%, P < 0.05).

Conclusion: The diagnostic pattern among emergency ambulance users included all main groups of diseases. After the MECU fewer were brought to hospital. The overall mortality for all ambulance users was not influenced by the MECU. For the subgroups, especially AMI, mortality was lower after the introduction of the MECU.
Effects of human cathelicidin antimicrobial peptide LL‐37 on lipopolysaccharide‐induced nitric oxide release from rat aorta in vitro
Authors: Ciornei C. D. , Egesten A. , Bodelsson M.
Published: March 2003

Background: Lipopolysaccharides (LPS), released by Gram‐negative bacteria, cause vascular expression of inducible nitric oxide synthase (iNOS) leading to nitric oxide (NO) production and septic shock. Human cathelicidin antimicrobial peptide (LL‐37) can bind and neutralize LPS. We wanted to study whether LL‐37 affects LPS or interleukin‐1β (IL‐1β)‐induced production, release and function of NO in intact rat aorta rings and cultured rat aorta smooth muscle cells.

Methods: Isolated segments of thoracic aorta and cultured cells were incubated in the presence of LPS, LL‐37, LPS + IL‐37, IL‐1β, IL‐1β + IL‐37 or in medium alone. Smooth muscle contraction in response to phenylephrine and accumulation of the sdegradation products of NO, nitrate and nitrite, were measured on aorta segments. Levels of iNOS were assessed by Western blot and cytotoxic effects were detected by measurement of DNA fragmentation in cultured cells. Number of viable cells were determined after Trypan blue treatment.

Results: Both LPS and IL‐1β reduced contractility in response to phenylephrine and increased NO production as well as iNOS expression. LL‐37 inhibited the LPS depression of vascular contractility induced only by LPS. LL‐37 reduced both the LPS‐ and IL‐1β‐induced NO production and iNOS expression. LL‐37 at high concentrations induced DNA fragmentation and decreased the number of living cells.

Conclusion: IL‐37 reduces NO production induced by LPS and IL‐1β. The reduction does not seem to result only from neutralization of LPS but also from a cytotoxic effect, possibly via induction of apoptosis.
New and active role of the interstitium in control of interstitial fluid pressure: potential therapeutic consequences
Authors: Wiig H. , Rubin K. , Reed R. K.
Published: March 2003

Here we present recent data indicating that the present view of the interstitium as a passive fluid reservoir has to be revised. The connective tissue cells and extracellular matrix have a role in the control of Pif and a fundamental role in the rapid development of edema in burns and in the initial swelling in inflammation by generating a lowering of interstitial fluid pressure. In this process, the β1‐integrin system seems to provide a common pathway by which the cells can lower as well as raise Pif. Inflammatory swelling can be reversed by endo‐ and exogenous substances, thereby suggesting that the connective tissue can serve as a novel target for pharmacological intervention. Furthermore, the new knowledge in interstitial physiology on means to reduce interstitial fluid pressure may be of importance for drug delivery into solid tumors, where a high Pif limits the uptake of therapeutic agents.
Effects of high‐dose propofol on succinylcholine‐induced fasciculations and myalgia
Authors: Kararmaz A. , Kaya S. , Turhanoglu S. , Ozyilmaz M. A.
Published: March 2003

Background: The purpose of this prospective study was to determine the effects of high‐dose propofol on the incidence of fasciculations and myalgia, and to evaluate changes in creatine kinase levels following the administration of succinylcholine in 90 women who underwent laparoscopy.

Methods: Patients were randomly assigned to one of three groups. Induction of anesthesia was performed with thiopentone 5 mg kg−1 in Group I (n = 30), propofol 2 mg kg−1 in Group II (n = 30), and propofol 3.5 mg kg−1 in Group III (n = 30). Then succinylcholine 1 mg kg−1 was administered to the patients for intubation.

Results: Fasciculation was absent in 20% of Group III patients, and no vigorous fasciculation occurred in this group. Furthermore, the severity of fasciculation in Group III was significantly lower than in the other two groups (P = 0.01). Seventy per cent of patients had no myalgia in Group III, 39.2% in Group II and 37% in Group I (P = 0.007). Severity of myalgia was also significantly lower in Group III compared with the other two groups (P = 0.011). Post‐operative creatine kinase levels were significantly higher than their baseline values in Groups I and II (P < 0.0001).

Conclusion: Administration of propofol 3.5 mg kg−1 is effective in reducing fasciculations and myalgia after succinylcholine.
Low‐dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine
Authors: Gupta A. , Axelsson K. , Thörn S. E. , Matthiessen P. , Larsson L. G. , Holmström B. , Wattwil M.
Published: March 2003

Background: Inguinal herniorrhaphy is commonly performed as an outpatient procedure. Spinal anesthesia offers some advantages over general anesthesia in this setting.

Methods: Forty patients were randomly divided into two groups according to a double‐blind protocol: Group L had spinal anesthesia with bupivacaine 6.0 mg and Group H with bupivacaine 7.5 mg; in both groups, fentanyl 25 µg was added to the spinal anesthetic. The sensory block was measured by ‘pin‐prick’ and the motor block was evaluated by a modified Bromage scale.

Results: No differences were seen in the spread, duration and regression of sensory block between the groups on the operated side. A greater number of patients required analgesics during the operation in Group L (6) compared with Group H (1) (P<0.05). The return of the modified Bromage scale to grade 0 was earlier in Group L than in Group H (P<0.05) but the time to mobilization and discharge was similar. Seven patients (17%) needed to be catheterized and two had the catheter retained overnight. Times to home discharge (median) were 350 and 445 min, respectively, in Groups L and H. Postoperatively and during the first week, visual analog pain scores, analgesic requirements and side‐effects were similar between the groups. In Group H, 95% of the patients and in Group L 85% would have the same anesthetic again if operated upon for a similar procedure.

Conclusions: Spinal anesthesia with bupivacaine 7.5 mg and fentanyl offers an alternative to general or local anesthesia for ambulatory inguinal herniorrhaphy. However, the long discharge times and risk for urinary retention restrict its routine use in all patients.
Remifentanil‐propofol vs. sufentanil‐propofol: optimal combinations in clinical anesthesia
Authors: Lentschener C. , Ghimouz A. , Bonnichon P. , Pépion C. , Gomola A. , Ozier Y.
Published: March 2003

Background: Two opioid regimens, computer‐simulated to provide optimal general anesthesia in combination with propofol, were compared using clinical criteria.

Methods: Fifty patients undergoing thyroid surgery were blindly, prospectively and randomly allocated to receive either (a) i.v. remifentanil (1.5 µg kg−1, followed by 0.2 µg kg−1 min−1) or (b) i.v. sufentanil (0.2 µg kg−1 followed by 0.2 µg kg−1 h−1). Remifentanil infusion was stopped at the last skin suture. Sufentanil infusion was stopped 30 min before the end of surgery. Intravenous propofol was titrated to keep BIS at 50±5. Remifentanil and sufentanil groups were compared with regards to (a) propofol delivery, (b) hemodynamic and recovery variables, and (c) effect‐site propofol levels during a steady‐state period for effect‐site remifentanil and sufentanil levels. P<0.05 was significant.

Results: Groups were similar in demographic data; types and durations of surgery; total propofol consumption; and response, extubation and emergence times. During the steady‐state period for the opioid delivery, the remifentanil and sufentanil effect‐site levels were 5.3 ng ml−1 and 0.18 ng ml−1, respectively (potency ratio=30). In both opioid groups, in accordance with previous computer‐simulations, the effect‐site propofol concentrations remained (a) within a narrow range unaffected by surgical stimuli, (b) significantly smaller in the remifentanil group than in the sufentanil group, but (c) smaller than expected from previous computer‐simulations. More patients required ephedrine following induction of anesthesia in the remifentanil compared with the sufentanil group.

Conclusions: The present clinical trial conducted in thyroid surgery is consistent with previous computer‐simulated opioid‐propofol combinations with respect to intraoperative and recovery variables. Effect‐site propofol ranges were, however, lower than expected.
Subarachnoid anesthesia in a patient with type I Gaucher disease
Authors: GarcÍa Collada J. C. , Pereda MarÍn R. M. , MartÍnez A. I. Garrote , Miralles Serrano E. M. , Pacheco López J. F.
Published: March 2003

Gaucher's disease is a rare genetic disorder characterized by lack or functional insufficiency of glucocerebrosidase, an enzyme accountable for intracellular hydrolysis of glucosyl ceramide and other glycosphingolipids, which results in macrophage storage in the mononuclear‐macrophage system. The severity of Gaucher's disease is correlated with the extent to which the central nervous system is involved. It is associated with the so‐called Gaucher's cells in the bone marrow, but is specifically diagnosed by showing enzyme acid beta‐glucosidase activity in a sample of blood leukocyte or cultured macrophages from skin biopsy. In the last 10 years, an enzyme replacement therapy (alglucerase) for the disease has been available, which has significantly changed approaches to its treatment.

Here we report the case of a 56‐year‐old female patient with type I Gaucher's disease who underwent surgery for subcapital hip fracture with subarachnoid anesthesia. Type I Gaucher's disease clinical and pathophysiologic aspects relevant to anesthetic management are discussed. As very few similar cases have been reported in the anesthesiology literature, it is our belief that the present case may help to elucidate some controversial issues relating to the perioperative anesthetic management of patients with type I Gaucher's disease.
Quality of life and seeking help in women with urinary incontinence
Authors: Hägglund Doris , Walker‐Engström Marie‐Louise , Larsson Gregor , Leppert Jerzy
Published: March 2003

Background. The aims of this population‐based study were to compare the quality of life (QoL) in; (a) women with urinary incontinence (UI) and women without urinary incontinence (wUI) in relation to age, (b) women with stress incontinence and women with urge incontinence, and (c) women who had vs. women who had not consulted a health care service because of UI.

Methods. Totally, 787 women who reported symptoms of UI and 787 women who did not report symptoms of UI, aged 18–72 years, were mailed the Short Form‐36 QoL questionnaire (SF‐36) and a question concerning professional consultation. They were also mailed the Detrusor Instability Score questionnaire, which was used to clarify the women as being stress vs. urge incontinent.

Results. Women with UI had significantly lower scores on all eight dimensions of the SF‐36. There were low correlations between age and the QoL scores in women with or without UI. Both women with stress incontinence and women with urge incontinence had significantly lower scores on all eight QoL dimensions compared with the women without UI. However, the absolute difference was smaller for women with stress incontinence. Women with urge incontinence consult health care service more often than women with stress incontinence. Women with UI who had consulted health care had significantly lower QoL scores than women with UI who had not consulted health care in seven out of eight dimensions.

Conclusions. The QoL, in this female general population, is more affected by women with urge incontinence than women with stress incontinence. Help seeking is associated with substantially lower QoL scores and with urge incontinence.
Transplantation of allogenic anterior lens capsule to the subretinal space in pigs
Authors: Folke Kiilgaard Jens , Katrine Wiencke Anne ,   Erik Scherfig, Ulrik Prause Jan , La Cour Morten
Published: March 2003

Purpose:  To investigate the consequences of transplantation of a new basement membrane to the subretinal space (SRS) as a substitution of Bruch's membrane.

Methods: Porcine anterior lens capsules (ALC) were transplanted to the subretinal space of 20 eyes from 19 young Danish landrace pigs. All pigs underwent a three port localized pars plana vitrectomy. Seventeen eyes received naked ALC. In three experiments the ALC was embedded in gelatine, in order to prevent curling of the ALC. The observation period varied between zero and 49 days. The pigs were examined by ophthalmoscopy and fundus photography. Histopathological examination of enucleated eyes was performed at the end of the experiment.

Results: ALCs transplanted to the subretinal space were well‐tolerated and caused no inflammation when Bruch's membrane was left undamaged. After 11 days host RPE and glial cells started to cover the ALC in a competitive fashion. When Bruch's membrane was damaged, ingrowths of choroidal vessels and fibroblasts was prominent. The use of gelatine to flatten the ALC did not prevent curling, and gelatine caused pronounced inflammation.

Conclusions: It is possible to transplant porcine ALC to the SRS of the pig. ALCs are well‐tolerated in the SRS and are covered with well‐differentiated monolayers of host RPE‐cells, if Bruch's membrane is left intact.
A comparison of risk factors for habitual violence in pre‐trial subjects
Authors: Kaliski S. Z.
Published: March 2003

Objective: Pre‐trial referrals to the Valkenberg Hospital forensic unit over a 6‐month period were studied. Habitually violent offenders were compared with those with no history of violence.

Methods:  Risk factors known to be associated with violent behaviour were elicited, i.e. demographics, behaviour during index offence (such as impulsivity, identity of victim, use of weapon, accomplices, intoxication, psychotic symptoms), psychiatric and family histories, history of suicide attempts, past child abuse, head injury, criminal record, psychiatric diagnosis and presence of medical disorders. EEG's, Barratt's Impulsivity, Zuckerman's Sensation Seeking and Mini‐Mental Scales were administered. Behaviour in the ward during the 30 days was also appraised. Logistic regression models were used to determine relative risks.

Results:  There were 155 subjects; 89.7% were male, 71.6% were single and 58.7% were unemployed. For 44.5% the index offence was violent, and 9.7% had committed sexual offences; 61.9% had histories of habitual violence. A psychotic disorder was diagnosed in 32.3% and a personality disorder in 48.4%. Habitually violent subjects were distin‐ guished by a history of issuing threats (OR=3.68; CI=3.19–4.16; P= 0.000), delusions of persecution (OR=3.43; CI=2.67–4.17; P=0.001), history of conduct disorder (OR=1.95; CI=1.70–2.19; P=0.006), alcohol/substance abuse (OR=2.08; CI=1.53–2.61; P=0.008) and violent index offence (OR=1.66; CI=1.54–2.61; P=0.035).

Conclusion: This seems to confirm the relationship between threats, feeling threatened, psychosis, a history of antisocial behaviour and alcohol abuse.
Criminal behavior of forensic and general psychiatric patients with schizophrenia: are they different?
Authors: Tengström A. , Hodgins S.
Published: March 2003

Objective: This study was designed to compare the rate of past criminal behavior among male patients being discharged from forensic and general psychiatric hospitals in four countries.

Method: Discharged consecutive patients from eight sites, four general and four forensic psychiatric, were included and asked for participation. Transcripts of past criminal behavior were available for this study. Analyses were limited to men with schizophrenia.

Results:One in five of the general psychiatric patients had a criminal record. The criminal histories of the offenders in the general and forensic hospitals were similar, except that all patients who had killed were treated in forensic hospitals.

Conclusion:The results point to the need to assess the risk of violent behavior among general psychiatric patients in order to provide them with appropriate treatments designed to prevent criminal recidivism.
Relapse in violent crime in relation to cerebrospinal fluid monoamine metabolites (5‐HIAA, HVA and HMPG) in male forensic psychiatric patients convicted of murder: a 16‐year follow‐up
Authors: Dåderman A. M. , Lidberg L.
Published: March 2003

Objective:  Our purpose was to investigate if low levels of cerebrospinal fluid (CSF) monoamine metabolites of 5‐HIAA, HVA and HMPG predict relapse in violent crimes.

Method:  Relapse in crime and level of CSF monoamine metabolites (5‐HIAA, HVA and HMPG) was studied in a group of 29 murderers. The follow‐up was 16 years.

Results:  Fourteen of the 29 murderers were convicted of crime; nine of them committed violent crimes; one was convicted of a new murder. The differences in mean CSF monoamine metabolites were lower in subjects who relapsed into any type of crime, but only the difference in mean CSF HVA was statistically significant.

Conclusion:  The risk to commit new murder is very small in males who earlier have been convicted of murder. Low levels of CSF HVA is associated with an increased risk for relapse in any type of crime.
A public‐health perspective on violence
Authors: Melinder K.
Published: March 2003

Objective:  To describe how specific theories and methods used in public health, especially regarding injuries, are related to violence.

Method:  Theories and preventive work in injury research (above accidents) are presented and related to violence.

Results: Registration of injuries and an interest in the environment are seen as specific for injuries. In prevention there is a focus on community work and the concept of ‘a safe community’ has been developed. Haddon's matrix offers a foundation for theoretical injury research. It is formed by cross‐tabulating the trichotomy of host‐agent‐environment against a time dimension.

Conclusion:  One practical and one theoretical model on how violence might be seen as an injury have been demonstrated. No clear evaluation has been made of the practical model up to now. The theoretical model has the advantage that the model makes it easier to get a more comprehensive picture of how different factors influence violence.
Adult psychopathy and violent behavior in males with early neglect and abuse
Authors: Lang S. , Af Klinteberg B. , Alm P.‐O.
Published: March 2003

Objective:  Within a Swedish longitudinal project, possible implications of childhood neglect and/or abuse on adult psychopathy checklist (PCL) scores and violent offending were studied.

Method:  The subjects were males (n=199), recruited from a socially high‐risk neighborhood and grouped on an index variable of victimization, yielding high (n=110) and low victimization (n=89) groups. To highlight a possible comorbidity of all three problems in the same persons, a combined dimensional and categorical (configural frequency analysis, CFA) approach was applied.

Results:  The high victimization subjects exerted significantly more violence, as did subjects with high PCL scores. Furthermore, in the CFA two significant ‘types’ were found: one type indicating that ‘high’ victimization in childhood is closely linked to later ‘extensive’ violence and ‘high’ PCL scores at adult age in the same individuals; the other supporting a frequent co‐occurring of ‘low’ victimization in childhood, ‘none or minor’ later indications of violence and ‘low’ adult PCL scores.

Conclusion:  The results point to possible underlying mechanisms linked to all three problems characterizing the affected subjects.