bluuebunny/crossref_metadata_2025 huggingface dataset:
Airway changes in children with mucopolysaccharidoses: CT evaluation
Authors: S.-L. Shih , Y.-J. Lee , S.-P. Lin , C.-Y. Sheu , Blickman J.G.
Published: July 2004

Objective: To assess the CT findings of the airway in children with mucopolysaccharidoses (MPS).

Material and Methods: The study included 13 patients (9 boys, 4 girls; age range 2-17 years; mean age 9.2 years) with MPS: 6 with Hunter syndrome, 3 with Maroteaux-Lamy syndrome, 2 with Sanfilippo syndrome, 1 with Hurler/Scheie syndrome and 1 with Morquio syndrome. CT of the airways was done in the axial section with 3-mm collimation from the oropharynx at the level of C3 to the base of the lung. The shape of the vocal cords and trachea at the level of T1 was evaluated. The tracheal surface area (TSA) at the level of T1 was measured both in patients and in age-matched subjects.

Results: CT showed an abnormality of the vocal cords in 7 of the 13 patients. Six patients had an abnormal shape and 7 had an inhomogenous density. The abnormalities included elliptical (5 of 6) and star-shaped (1 of 6) cords. Eight of 13 tracheas were also abnormal, either U-shaped (6 of 8) or worm-shaped (2 of 8). The TSA was significantly smaller in patients (79.6±28.9 mm2) than in control subjects (138.1±50.1 mm2). The TSA of those ≤⃒9 years was 61.4±15.2 mm2 as compared with 99.9±23.5 mm2 for the control group. The TSA of patients ≥11 years was 107.1±25.3 mm2 as compared with 187.6±32.0 mm2 for the control group.

Conclusion: Significant changes in the shape of the vocal cords and trachea in patients with MPS were found. The most common abnormal configuration of trachea was the U-shape. The TSA was smaller in patients with MPS than in controls. The airway changes may be due to abnormal submucosal storage of substances such as keratan or dermatan sulfate.
Ultrasound-guided percutaneous thoracoabdominal biopsy: Efficacy, cost-effectiveness and safety
Authors: Ojalehto M. , Tikkakoski T. , Rissanen T. , Apaja-Sarkkinen M.
Published: July 2004

This review will discuss the benefits and disadvantages of ultrasound-guided percutaneous fine-needle aspiration and cutting needle biopsies. Clinical efficacy, cost-effectiveness, some controversies and safety will be reviewed.
Continuous ambulatory peritoneal dialysis: CT peritoneography findings and assessment of related clinical complications
Authors: Karahan O.I. , Taşkapan H. , Tokgöz B. , Coşkun A. , Utaş C. , Güleç M.
Published: July 2004

Purpose: To assess complications of continuous ambulatory peritoneal dialysis (CAPD) in uremic patients with and without clinical symptoms by CT peritoneography.

Material and Methods: A total of 64 patients with end-stage renal disease and on continuous CAPD were investigated. Twenty-eight had some clinical symptoms, which might be related to the complications of CAPD. Thirty-six patients had no complaints or symptoms due to the dialysis treatment.

Results: CT peritoneography revealed various complications including hernias (50%), dialysate leakage (46%), localized fluid collection (4%) and peritoneal adhesions (4%) in the patients who had clinical symptoms that might be related to the dialysis treatment. Moreover, similar complications were found in the asymptomatic patients at a lower rate: hernia (3%), dialysate leakage (17%), peritoneal adhesions (3%) and abdominal wall laxity (3%). Complication detection rate by CT peritoneography was 68% (n=19) in the symptomatic patients and 22% (n=8) in the asymptomatic patients. The number of complications found in each group was significant.

Conclusion: CT peritoneography was an effective modality in detecting complications from CAPD in patients with and without clinical symptoms.
Efficacy of sequential use of superparamagnetic iron oxide and gadolinium in liver MR imaging
Authors: Halavaara J. , Tervahartiala P. , Isoniemi H. , Höckerstedt K.
Published: July 2004

Purpose: To evaluate the efficacy of combined (double contrast) use of superparamagnetic iron particles (SPIOs) and gadolinium (Gd) in liver MR imaging.

Material and Methods: Unenhanced, Gd-enhanced, SPIO-enhanced, and both SPIO- and Gd-enhanced images were acquired at 1.5 T. Twenty patients with previously detected liver lesions were included. Fast SE-STIR, and breath-hold true FISP, fat-suppressed T1- and T2-weighted sequences were obtained with all techniques. Lesion count was assessed by consensus reading.

Results: Collective evaluation of all MR sequences revealed 61 lesions in 16 patients; SPIO-enhanced MR detected lesions with a sensitivity of 95% (n=58). The sensitivity of unenhanced MR imaging was 90% (n=55). There was no statistical difference between SPIO-enhanced and unenhanced MR images. From single sequences, the greatest number of lesions was detected with the SPIO-enhanced fast SE-STIR sequence (n=56, sensitivity 92%). By using the fat-suppressed T1-weighted sequence, Gd-enhanced and both SPIO- and Gd-enhanced MR images demonstrated sensitivities of 77% (n=47) and 80% (n=49), respectively. Despite the combined use of both contrast media, this sequence was significantly less sensitive in lesion detection when compared to SPIO-enhanced imaging.

Conclusion: SPIO-enhanced MR imaging was the most sensitive method in lesion detection. The benefit of the combined use of SPIO and Gd was negligible.
A new liquid embolic material for liver tumors: An animal experimental study using Onyx
Authors: Komemushi A. , Tanigawa N. , Okuda Y. , Kojima H. , Fujii H. , Shomura Y. , Sougawa M. , Sawada S.
Published: July 2004

Purpose: To evaluate the feasibility of a new liquid embolic material, Onyx, for treating liver tumors.

Material and Methods: Onyx is a mixture of 6% (w/v) ethylene-vinyl-alcohol copolymer dissolved in anhydrous dimethyl sulfoxide (DMSO) with 28% (w/v) tantalum powder. In addition to 6% Onyx, we also tried 4%, 2% and 1% solutions, prepared by adjusting the amount of DMSO. We used 15 white rabbits with liver tumors created by percutaneous injection of VX2 tumor cells. In 4 groups with 3 rabbits in each, the liver arteries were embolized with 6%, 4%, 2% and 1% Onyx, respectively, and in 3 rabbits DMSO alone was injected. The injections were performed just proximal to the bifurcation of the proper hepatic artery, followed by celiac arteriography. Post mortem, the livers were examined by soft-tissue radiography, and liver-tissue section microscopy.

Results: The maximum number of arterial branching points passed by embolic material in either the right or left hepatic arteries was 11, 15 and 16, for 6%, 4% and 2% Onyx, respectively, but was non-measurable for 1% Onyx. Minimum diameters of arteries reached by 6%, 4%, 2% and 1% Onyx in tumorous areas were 40 μm, 35 μm, 20 μm and 10 μm, respectively, and in non-tumorous areas 35 μm, 5 μm, 5 μm and 5 μm, respectively.

Conclusion: This study suggests that Onyx may be feasible for treatment of hepatic tumors.
Peritoneal calcifications in a patient on continuous ambulatory peritoneal dialysis
Authors: Ramiro E. , Contreras J. , Miró C. , Acosta J. , Molinelli M.
Published: July 2004

Complications in a long-term ambulatory peritoneal dialysis patient are described.
CT angiography in the assessment of carotid artery atherosclerosis: A comparative analysis with MR angiography with reference to contrast angiography and intravascular ultrasound
Authors: Berg M.H. , Manninen H.I. , Räsänen H.T. , Vanninen R.L. , Jaakkola P.A.
Published: July 2004

Objective: The aim of the study was to evaluate the ability of CT angiography (CTA) to detect atherosclerosis of the carotid arteries in comparison with 3D time-of-flight MR angiography (3D TOF MRA), using contrast angiography and intravascular ultrasound (IVUS) as a reference.

Material and Methods: Contrast angiography and CTA were performed in 31 patients (mean age 65 years, range 45-79). The image quality was evaluated, atherosclerotic lesions were registered, and diameter stenosis degree was visually estimated from axial source images of CTA and 3D TOF MRA (21 patients), and results of interpretations were compared. The comparison of quantitative measurements was performed using IVUS as a reference.

Results: Contrast angiography detected 51 lesions (mean diameter stenosis 50%, range 10-100%), and CTA detected all same lesions. CTA provided better image quality and consistency of image interpretation than 3D TOF MRA. IVUS verified 29 atherosclerotic lesions with a mean diameter stenosis of 35%, (range 4-40%). CTA yielded a sensitivity of 96% to 100% (≤⃒10% or ≤⃒20% diameter stenosis regarded as normal) for the detection of lesions with reference to IVUS.

Conclusion: CTA seems feasible and accurate for the detection of atherosclerosis in carotid arteries.
Jejunojejunal intussusception secondary to lipoma in an adult
Authors: Çakirer S. , Şirvanci M. , Duran C.
Published: July 2004

Lipoma is a rare cause of adult intussusception. We present the CT findings of an adult patient with jejunojejunal intussusception secondary to submucosal lipoma as the lead point in this case report.
Dynamic contrast-enhanced MR imaging and histopathology in chronic achilles tendinosis: A longitudinal MR study of 15 patients
Authors: Shalabi A. , Kristoffersen-Wiberg M. , Papadogiannakis N. , Aspelin P. , Movin T.
Published: July 2004

Purpose: To evaluate the value of dynamic contrast-enhanced MR imaging (DEMRI) and its correlation to symptoms and histopathology in chronic Achilles tendinosis.

Material and Methods: Fifteen patients with severe symptoms underwent DEMRI preoperatively and 2 years postoperatively. US-guided core biopsies of tendinosis tissue were obtained preoperatively and the specimens were analyzed using a semiquantitative protocol. DEMRI was evaluated by calculating the area under curve (AUC) of signal alteration and the static MR by a semiquantitative grading scale. A questionnaire and clinical examination evaluated the clinical outcome.

Results: Early contrast enhancement (first 72 s) was seen in DEMRI at tendon lesions of the symptomatic Achilles tendons with a significant difference to asymptomatic contralateral tendon that revealed no or mild enhancement. Increased severity of tendon pathology (including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans) was correlated to both dynamic and static signal enhancement. Two years following surgical treatment, the signal alterations showed regression of early contrast enhancement (AUC decreased from 9 preoperatively to 2 postoperatively). The clinical outcome was as follows: 8 patients excellent, 4 good, 2 fair and 1 poor.

Conclusion: Patients with chronic painful achillodynia showed an early contrast-agent enhancement corresponding to the tendon lesion. Increased enhancement correlated to increased severity of tendon histopathology and patient symptoms. Two years after surgical treatment the contrast-agent enhancement decreased.
MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity
Authors: Kiuru M.J. , Pihlajamaki H.K. , Hietanen H.J. , Ahovuo J.A.
Published: July 2004

Purpose: To compare MR imaging, radiography and bone scintigraphy in the diagnosis of stress injuries to bones of the pelvis and lower extremity.

Material and Methods: Fifty consecutive conscripts with clinical signs of a stress injury to bone underwent MR imaging and bone scintigraphy. Forty-three patients also had radiographs available. Bone scintigraphy served as a gold standard.

Results: Compared to the bone scintigraphy, the sensitivity of radiography was 56%, specificity 94%, accuracy 67%, positive predictive value (PPV) 95%, and negative predictive value (NPV) 48%. The kappa value for radiography and bone scintigraphy was fair (0.39). Correspondingly, the sensitivity of MR imaging was 100%, specificity 86%, accuracy 95%, PPV 93% and NPV 100%. The kappa value for MR imaging and bone scintigraphy was very good (0.89). MR imaging depicted 3 bone stress injuries that were not visible on bone scintigraphy. Positive findings obtained from radiography correlated with MR signs of fracture line or callus ( p<0.001).

Conclusion: MR imaging is more sensitive than two-phase bone scintigraphy, and MR imaging should be used as the gold standard in the assessment of stress injuries of bone. Radiography reveals mainly the late phases of bone stress injuries, such as stress fracture and callus.
Capsular distance in the hip of the healthy child – normal values with sonography and MR imaging
Authors: Laurell L. , Hochbergs P. , Rydholm U. , Wingstrand H.
Published: July 2004

Purpose: To determine the normal values of the anterior and posterior capsular distances of the hip joint in healthy children by means of US, using MR imaging as reference, and to evaluate any possible correlation between age, length, weight and anterior capsular distance (ACD).

Material and Methods: In our first study both hips in 14 healthy children (5-18 years old) were examined with US and MR to obtain measurements of the ACD and the posterior capsular distance (PCD). The distance from the anterior or posterior aspect of the femoral neck to the anterior or posterior aspect, respectively, of the outer limit of the capsule was determined. The distances were measured both with the hips in spontaneous external rotation of 10-15° and in internal rotation of 45°. In our second study, both hips in 28 healthy children (3-16 years old) were examined with US to determine the ACD. Age, length and weight were recorded.

Results: Study I: There was good correlation between the US and MR measurements in all positions. The ACD measured by US was significantly increased in inward rotation of the hip. Study II: There was no correlation between ACD and age, length or weight.

Conclusion: The PCD of the hip joint can be accurately measured by US with the hip in internal rotation of 45°. When compared with MR values, the ACD measured by US was dependent on the degree of rotation of the leg and increased significantly in internal rotation. Because the outer limit of the external layer of the joint capsule is sonographically more distinct, we suggest that the capsular distance should be measured from the outer limit of the joint capsule to the anterior or posterior aspect of the femoral neck. The measurement should be made perpendicular to the femoral neck, at the position where the greatest numerical value is obtained.
Behaviour of the 2.1-mm (14 G) automated biopsy needle in phantoms
Authors: Abdsaleh S. , Azavedo E. , Lindgren P.G.
Published: July 2004

Purpose: To study the behaviour of the 2.1-mm (14 G) core biopsy needle in targets of different consistencies and to correlate the needle behaviour to lengths of the samples.

Material and Methods: A series of butter blocks at temperatures of -5 °C, -2 °C, +1 °C, +4 °C, +7 °C, +10 °C, +13 °C, +16 °C and +19 °C simulating lesions of different hardness in human breast, were passed with needles (3 passes at each temperature). Inner needle behaviour was studied both with and without outer cannula effect.

Results: At +4 °C to +13 °C the needle had a curved course, deviated to the side of its tip. At +4 °C, the needle was most deviated (range 4, 8, 10 °) and the samples were largest (8, 12, 12 mm). At -5 °C to +1 °C the needle was bent, the cannula was not triggered and no sample was obtained. At +16 °C and +19 °C the needle had a straight course and the length of the sample was decreasing.

Conclusion: Behaviour of the inner needle as well as the cannula depends on the hardness of the target. Targets of intermediate hardness yield adequate samples when the inner needle takes a curved course deviated toward the tip and get restored by the cannula.
MR of a nasal glioma in a young infant: A case report
Authors: Jartti P.H. , Jartti A.E. , Karttunen A.I. , Pääkkö E.L. , Herva R.L.O. , Pirilä T.O.
Published: July 2004

We describe MR findings of a nasal glioma in a 5-week-old male infant with feeding difficulties and symptoms of respiratory distress. Endoscopic examination revealed a soft tissue mass in the nasal cavity. In T1- and T2-weighted images, the gyral structure of grey matter was visible. In T1-weighted images, a tissue component with a lower signal intensity equal to that of white matter was also well distinguishable. Edge enhancement of the tumour was due to the nasal mucosal epithelium covering the tumour. MR images were useful to rule out intracranial extension of the nasal cavity lesion and the brain, thus excluding the diagnosis of encephalocele. The lesion was excised and histologically characterized as heterotopic brain tissue.
Early postoperative tissue harmonic sonography of the thyroid gland
Authors: Saleh A. , Cupisti K. , Cohnen M. , Feldkamp J. , Fürst G. , Luckey P. , Mödder U.
Published: July 2004

Purpose: Fundamental gray-scale imaging (FGI) is known to be unuseful for thyroid imaging in the early postoperative setting. Thus, we evaluated the feasability of tissue harmonic imaging (THI) early after thyroid resection.

Material and Methods: FGI and THI of the neck were perfomed in 48 consecutive patients 4 days after surgery. The examiner was blinded to patient diagnoses and types of surgery. FGI and THI examinations were stored on videotape and reviewed offline by two different readers who rated the quality of delineation of the organ borders and presence or absence of focal lesions. The results were compared to neck US performed 12 weeks after surgery.

Results: Delineation of the thyroid remnants in THI/FGI was rated to be excellent in 22/2, good in 11/9, poor in 3/16 and not visible at all in 4/13 patients. The correlation between THI-volumetry and control-volumetry was very high (r=0.81; p<0.0001). THI but not FGI depicted presence or absence of solid thyroid nodules with 100% accuracy.

Conclusion: THI is a feasible method for thyroid US in the early postoperative setting. It permits volumetry of the residual thyroid tissue and accurately depicts nodules within the thyroid remnant.
The African National Congress: from illegality to the corridors of power
Authors: Jordan Pallo
Published: July 2004

This article examines both the performance of the ANC in power and the requisites of power which have forced it to redefine itself, experiencing thereby a profound metamorphosis. It argues that radical policy shifts have from the party's birth in 1912, been part of its political reality so that heterodoxy has often become the new orthodoxy. This tradition of change has been accelerated by local and global realities since 1994 – an assumption of office with virtually no power over the civil service and upper reaches of the security forces and a post-Cold War environment which generated a demonised of state intervention. Being in office has also changed the character of the ANC with the party now attracting those seeking a career and the perks of office, a consequence of which has been repeated allegations of the misuse of state funds levelled against ANC representatives. Finally, the paper notes that the ANC's second term has been marked by growing tensions with the Communist Party and a foreign policy with, as its central pillar, the creating of space for Africa to define its own future.
Women's human rights & the feminisation of poverty in South Africa
Authors: Bentley Kristina
Published: July 2004

This article assesses the range of measures in place in South Africa to protect the human rights of women and establish their equality. The Constitution, the National Action Plan, ratified international law and domestic law all aim, or claim, to prioritise the ‘right’ treatment of women in South Africa. On paper then, there is a human rights ‘culture’ which is particularly nuanced to take account of gender difference and women's particular vulnerability to the effects of poverty, HIV/AIDS and violence. In practice however, women comprise the majority of the most marginalised, impoverished and least empowered sector of South African society. The paper assesses this marginalisation in the context of an enduring patriarchal culture. The retention of this ‘under-blanket’ of patriarchal power underlies the virtual exclusion of women from the mainstream of South African economic life.
The post-apartheid economy
Authors: Makgetla Neva Seidman
Published: July 2004

South Africa's post-apartheid economy has been characterised by low growth and investment, and a rise in unemployment (at 30%, higher than any other middle income country). Government economic policy has stressed the encouragement of investment through deregulation, privatisation and fiscal restraint. However, the failure of this strategy to promote growth and create jobs points to the need for a more interventionist strategy, one in which government must do more to stimulate equitable growth. This proposition is highly contested. Nonetheless, in response to the crisis within the economy, the government has adopted limited reforms involving increased spending on basic social services and housing, greater emphasis on job creation and equity, a renewed stress on planning and coordination and greater support for cooperatives. Yet these new initiatives do not constitute a systematic plan for transforming the economy and more integrated policies are required to overcome dualism and stimulate job-creating growth.

My thanks to Tanya van Meelis for comments.
South Africa's post-apartheid foreign policy: from reconciliation to ambiguity?1
Authors: Alden Chris , le Pere Garth
Published: July 2004

This article focuses on South Africa's rehabilitation from international pariah status during the apartheid years to its de facto status as leader of the African continent. Its ambitious foreign policy agenda and the pan-African revivalism of Mbeki are discussed in the context of the many constraints (the need to attract foreign investment, limited institutional capacity, ambiguities over the nature of South Africa's identity) that circumscribe its capacity to achieve these goals. While under Mandela South Africa is portrayed in foreign policy terms as an over-stretched state striving to meet the idealistic demands placed upon it by a fragile world, Mbeki's pragmatism and moderation has seen South Africa recast its role in a manner more commensurate with its size and resources. The primary aims of the Mbeki presidency are seen as a reshaping of current international norms, institutions and processes to further global justice for Africa and the South.

This paper draws on previous research, which has culminated in an Adelphi Paper of the London-based International Institute for Strategic Studies (IISS).
The ANC & black capitalism in South Africa
Authors: Southall Roger
Published: July 2004

The emphasis initially laid by the African National Congress (ANC) on national reconciliation after 1994 meant that its ideas about Black Economic Empowerment (BEE) were non-threatening to white interests. However, the government's recent strategy is more assertive, having the aim of creating a black capitalist class, which is both ‘patriotic’ and productive, as laid down in the ANC's guiding theory of the ‘National Democratic Revolution’. Corporate capital is responding with recognition of the inevitability and potential advantages of BEE. However, given the centrality of the state to the deliberate task of creating black capitalism, there are considerable dangers of the latter's lapse into Asian-style cronyism. The ‘patriotic’ nature of black capitalism is therefore in sharp contestation with its ‘parasitism’.
The arms deal scandal
Authors: Crawford-Browne Terry
Published: July 2004

To people in South Africa and millions around the world who supported the struggle against apartheid, it is incomprehensible that the ANC government's first major decision was to buy warships and warplanes when there is no conceivable foreign military threat and when the real threat to the consolidation of democracy is poverty. Instead of houses, schools and clinics being built, instead of money to tackle AIDS, South Africa bought submarines.
Anesthetic Requirement Is Increased in Redheads
Authors: Liem Edwin B. , Lin Chun-Ming , Suleman Mohammad-Irfan , Doufas Anthony G. , Gregg Ronald G. , Veauthier Jacqueline M. , Loyd Gary , Sessler Daniel I.
Published: July 2004

Background

Age and body temperature alter inhalational anesthetic requirement; however, no human genotype is associated with inhalational anesthetic requirement. There is an anecdotal impression that anesthetic requirement is increased in redheads. Furthermore, red hair results from distinct mutations of the melanocortin-1 receptor. Therefore, the authors tested the hypothesis that the requirement for the volatile anesthetic desflurane is greater in natural redheaded than in dark-haired women.

Methods

The authors studied healthy women with bright red (n = 10) or dark (n = 10) hair. Blood was sampled for subsequent analyses of melanocortin-1 receptor alleles. Anesthesia was induced with sevoflurane and maintained with desflurane randomly set at an end-tidal concentration between 5.5 and 7.5%. After an equilibration period, a noxious electrical stimulation (100 Hz, 70 mA) was transmitted through bilateral intradermal needles. If the volunteer moved in response to stimulation, desflurane was increased by 0.5%; otherwise, it was decreased by 0.5%. This was continued until volunteers "crossed over" from movement to nonmovement (or vice versa) four times. Individual logistic regression curves were used to determine desflurane requirement (P50). Desflurane requirements in the two groups were compared using Mann-Whitney nonparametric two-sample test; P < 0.05 was considered statistically significant.

Results

The desflurane requirement in redheads (6.2 vol% [95% CI, 5.9-6.5]) was significantly greater than in dark-haired women (5.2 vol% [4.9-5.5]; P = 0.0004). Nine of 10 redheads were either homozygous or compound heterozygotes for mutations on the melanocortin-1 receptor gene.

Conclusions

Red hair seems to be a distinct phenotype linked to anesthetic requirement in humans that can also be traced to a specific genotype.
Effect of Clonidine on Cardiovascular Morbidity and Mortality after Noncardiac Surgery
Authors: Wallace Arthur W. , Galindez Daniel , Salahieh Ali , Layug Elizabeth L. , Lazo Eleanor A. , Haratonik Kathy A. , Boisvert Denis M. , Kardatzke David
Published: July 2004

Background

Perioperative myocardial ischemia occurs in 20-40% of patients at risk for cardiac morbidity and is associated with a ninefold increase in risk of cardiac morbidity.

Methods

In a prospective, double-blinded, clinical trial, we studied 190 patients with or at risk for coronary artery disease in two study groups with a 2:1 ratio (clonidine, n = 125 vs. placebo, n = 65) to test the hypothesis that prophylactic clonidine reduces the incidence of perioperative myocardial ischemia and postoperative death in patients undergoing noncardiac surgery. Clonidine (0.2 mg orally as well as a patch) or placebo (tablet and patch) was administered the night before surgery, and clonidine (0.2 mg orally) or placebo (tablet) was administered on the morning of surgery. The patch or placebo remained on the patient for 4 days and was then removed.

Results

The incidence of perioperative myocardial ischemia was significantly reduced with clonidine (intraoperative and postoperative, 18 of 125, 14% vs. placebo, 20 of 65, 31%; P = 0.01). Prophylactic clonidine administration had minimal hemodynamic effects. Clonidine reduced the incidence of postoperative mortality for up to 2 yr (clonidine, 19 of 125 [15%] vs. placebo, 19 of 65 [29%]; relative risk = 0.43 [confidence interval, 0.21-0.89]; P = 0.035).

Conclusions

Perioperative administration of clonidine for 4 days to patients at risk for coronary artery disease significantly reduces the incidence of perioperative myocardial ischemia and postoperative death.
Evaluation of the Alaris Auditory Evoked Potential Index as an Indicator of Anesthetic Depth in Preschool Children during Induction of Anesthesia with Sevoflurane and Remifentanil
Authors: Weber Frank , Bein Thomas , Hobbhahn Jonny , Taeger Kai
Published: July 2004

Background

Autoregressive modeling with exogenous input of middle latency auditory evoked potentials (A-Line autoregressive index [AAI]) has been proposed for monitoring depth of anesthesia in adults. The aim of this study was to evaluate the performance of the AAI during induction of anesthesia with sevoflurane and remifentanil in pediatric patients.

Methods

Twenty preschool children were anesthetized with sevoflurane and remifentanil. AAI, heart rate, and mean arterial pressure were compared for their ability to distinguish between different hypnotic states before inhalation induction and during sevoflurane anesthesia with and without remifentanil infusion. The prediction probability was calculated for discrimination between the predefined case milestones Awake, Spontaneous Eye Closure, and insertion of a laryngeal mask airway during general anesthesia (Laryngeal Mask Insertion).

Results

The AAI (mean +/- SD) in Awake children was 79 +/- 10, declining to 59 +/- 22 at Spontaneous Eye Closure and 34 +/- 13 when anesthetized. AAI values significantly overlapped between anesthetic states. For the AAI, the prediction probabilities regarding the ability to discriminate the hypnotic state at the case milestones Awake versus Spontaneous Eye Closure and Awake versus Laryngeal Mask Insertion were 0.77 and 0.99, respectively. In terms of prediction probability values, heart rate and mean arterial pressure were not indicative for anesthetic states. Remifentanil did not influence the AAI.

Conclusion

During induction of pediatric patients with sevoflurane, the AAI is of higher value in predicting anesthetic states than hemodynamic variables and reliably differentiates between the awake and anesthetized states. However, individual AAI values demonstrate significant variability and overlap between different clinical conditions.
Cardioprotective Properties of Sevoflurane in Patients Undergoing Coronary Surgery with Cardiopulmonary Bypass Are Related to the Modalities of Its Administration
Authors: De Hert Stefan G. , Van der Linden Philippe J. , Cromheecke Stefanie , Meeus Roel , Nelis Anne , Van Reeth Veronique , ten Broecke Pieter W. , De Blier Ivo G. , Stockman Bernard A. , Rodrigus Inez E.
Published: July 2004

Background

Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion. In clinical studies, the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period. The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration.

Methods

Elective coronary surgery patients were randomly assigned to four different anesthetic protocols (n = 50 each). In a first group, patients received a propofol based intravenous regimen (propofol group). In a second group, propofol was replaced by sevoflurane from sternotomy until the start of cardiopulmonary bypass (SEVO pre group). In a third group, propofol was replaced by sevoflurane after completion of the coronary anastomoses (SEVO post group). In a fourth group, propofol was administered until sternotomy and then replaced by sevoflurane for the remaining of the operation (SEVO all group). Postoperative concentrations of cardiac troponin I were followed during 48 h. Cardiac function was assessed perioperatively and during 24 h postoperatively.

Results

Postoperative troponin I concentrations in the SEVO all group were lower than in the propofol group. Stroke volume decreased transiently after cardiopulmonary bypass in the propofol group but remained unchanged throughout in the SEVO all group. In the SEVO pre and SEVO post groups, stroke volume also decreased after cardiopulmonary bypass but returned earlier to baseline values than in the propofol group. Duration of stay in the intensive care unit was lower in the SEVO all group than in the propofol group.

Conclusion

In patients undergoing coronary artery surgery with cardiopulmonary bypass, the cardioprotective effects of sevoflurane were clinically most apparent when it was administered throughout the operation.
Effects of Bispectral Index Monitoring on Ambulatory Anesthesia
Authors: Liu Spencer S.
Published: July 2004

Background

Ambulatory surgery is growing in popularity worldwide. For example, 50-70% of surgical procedures in North America are performed on an ambulatory basis. Use of Bispectral Index (BIS) monitoring for titration of general anesthesia may allow use of less anesthetics, reduction in side effects, and faster patient recovery.

Methods

MEDLINE and other databases were searched for randomized controlled trials examining the use of BIS monitoring versus standard practice in ambulatory surgery patients. Outcomes were extracted from these articles, and a meta-analysis was performed.

Results

One thousand three hundred eighty subjects from 11 trials were included in the meta-analysis. The use of BIS monitoring significantly reduced anesthetic consumption by 19%, reduced the incidence of nausea/vomiting (32% vs. 38%; odds ratio, 0.77), and reduced time in the recovery room by 4 min. However, these benefits did not result in significant reduction in time until patient discharge from the ambulatory surgery unit. Cost analysis using pooled costs to reflect North America, Europe, and Asia indicated that use of BIS monitoring increased the cost per patient by 5.55 US dollars because of the cost of BIS electrodes.

Conclusions

The use of BIS monitoring modestly reduced anesthetic consumption, risk of nausea and vomiting, and recovery room time. These benefits did not reduce time spent in the ambulatory surgery unit, and cost of the BIS electrode exceeded any cost savings.
A Randomized Controlled Trial Comparing the ProSeal™ Laryngeal Mask Airway with the Laryngeal Tube Suction in Mechanically Ventilated Patients
Authors: Gaitini Luis A. , Vaida Sonia J. , Somri Mostafa , Yanovski Boris , Ben-David Bruce , Hagberg Carin A.
Published: July 2004

Background

The ProSeal Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) is a new laryngeal mask with a modified cuff designed to improve its seal and a drain tube for gastric tube placement. Similarly, the Laryngeal Tube Suction (LTS) (VBM Medizintechnik Gmbh, Sulz a.N, Germany) is a new laryngeal tube that also has an additional channel for gastric tube placement. This study compared the placement and functions of these two devices.

Methods

One hundred fifty patients undergoing general anesthesia for elective surgery were randomly allocated to the PLMA (n = 75) or LTS (n = 75). Oxygenation and ventilation, ease of insertion, fiberoptic view, oropharyngeal leak pressure, ventilatory data, ease of gastric tube insertion, and postoperative airway morbidity were determined.

Results

After successful insertion of the devices in 96% of patients with the PLMA and in 94.4% with the LTS it was possible to maintain oxygenation, ventilation, and respiratory mechanics during the entire duration of surgery. Successful first and second attempt insertion rates were 57 patients (76%) and 15 patients (20%), respectively, for the PLMA and 60 patients (80%) and 11 patients (14.6%), respectively, for the LTS. Airway placement was unsuccessful with the PLMA in three patients and with the LTS in four patients. Time to achieve an effective airway was 36 +/- 24 s with the PLMA versus 34 +/- 25 s with the LTS. Gastric tube insertion was possible in 97.3% of patients with the PLMA and in 96% with the LTS.

Conclusions

With respect to both physiologic and clinical function, the PLMA and LTS are similar and either device can be used to establish a safe and effective airway in mechanically ventilated anesthetized adult patients.
Signal Verification of Middle Latency Auditory Evoked Potentials by Automated Detection of the Brainstem Response
Authors: Schneider Gerhard , Kochs Eberhard F. , Arenbeck Henry , Gallinat Michael , Stockmanns Gudrun
Published: July 2004

Background

The midlatency components of auditory evoked potentials (AEPs) are gradually suppressed with increasing concentrations of anesthetics. Thus, they have been proposed as a monitor of anesthetic depth. However, undetected malfunction or disconnection of headphones and undetected hearing loss also result in suppressed midlatency AEPs that in turn may be misinterpreted as signs of deep anesthesia. As the brainstem component of the AEP is minimally influenced by anesthetics, its presence or absence can be used to verify that the recorded signal is a true AEP rather than an artifact. In this study, an online-capable procedure for detection of the brainstem component of the AEP was developed.

Methods

One hundred and ninety perioperatively recorded AEPs (binaural stimuli, 500 sweeps) were selected from a database with electroencephalographic and concomitant AEP stimulus information. Identical electroencephalogram regions were used to produce nonstimulus synchronized averaged signals (500 sweeps, "non-AEP"). The 190 AEPs and 190 "non-AEPs" were used to develop a detector of the brainstem component of AEPs. AEPs and "non-AEPs" were wavelet transformed (discrete wavelet decomposition, biorthogonal 2.2 mother-wavelet), and the coefficient with the best separation of the two classes of signals was selected. Receiver operating characteristic curve analysis was performed to determine the optimum threshold value for this coefficient.

Results

The third coefficient of the third level was selected. In AEP signals, retransform of this coefficient produces a peak that resembles peak V of the brainstem response. The developed detector of the brainstem component of AEP had a sensitivity of 97.90% and a specificity of 99.48%.

Conclusions

This detector of the AEP brainstem component can be used to verify that the signal reflects the response to an auditory stimulus. An alternative approach, used in the Danmeter AEP monitor, is based on the signal-to-noise ratio of the midlatency components of the AEP. Because the midlatency components of AEP are suppressed by anesthesia, a false alarm "low AEP/no AEP" is generated during deep anesthesia. This, in turn, may suggest disconnection of headphones or technical problems whenever anesthesia is deep. This disadvantage has been overcome by our detector, which is based on the identification of the brainstem component of AEP.
A Comparison of Sex- and Weight-based ProSeal™ Laryngeal Mask Size Selection Criteria
Authors: Kihara Shinichi , Brimacombe Joseph R. , Yaguchi Yuichi , Taguchi Noriko , Watanabe Seiji
Published: July 2004

Background

The authors compared the manufacturer's weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50-70 kg, and size 5 for weight > 70 kg) with a sex-based formula (size 4 for women and size 5 for men) for selecting the appropriate size of ProSeal laryngeal mask airway.

Methods

Two hundred thirty-seven healthy, anesthetized, paralyzed adult patients (American Society of Anesthesiologists physical status I or II; age, 18-80 yr) were randomly allocated for weight- or sex-based size selection. An experienced user inserted the ProSeal laryngeal mask airway with the digital technique. The following were compared: ease of insertion, oropharyngeal leak pressure, ease of ventilation, gas exchange, location of gas leak, anatomic position, mucosal injury, and postoperative pharyngolaryngeal problems. Intraoperative and postoperative data collection were unblinded and blinded, respectively.

Results

Ease of insertion, anatomic position, gas exchange, mucosal injury, and postoperative pharyngolaryngeal problems were similar between groups. For the sex-based group, larger ProSeal laryngeal mask airways were selected more frequently (P < 0.0001), oropharyngeal leak pressure (P = 0.02) was higher, leak volume (P = 0.004) and leak fraction (P = 0.007) were lower, and oropharyngeal leaks (P = 0.03) were detected less frequently.

Conclusion

Size selection for the ProSeal laryngeal mask airway is equally effective using the manufacturer's weight-based formula or the sex-based formula in healthy, anesthetized, paralyzed adult patients, but leakage of small volumes of air from the mouth occurs less frequently with the sex-based formula.
Mitochondrial Complex I Function Affects Halothane Sensitivity in Caenorhabditis elegans
Authors: Kayser Ernst-Bernhard , Morgan Phil G. , Sedensky Margaret M.
Published: July 2004

Background

: The gene gas-1 encodes a subunit of complex I of the mitochondrial electron transport chain in Caenorhabditis elegans. A mutation in gas-1 profoundly increases sensitivity of C. elegans to volatile anesthetics. It is unclear which aspects of mitochondrial function account for the hypersensitivity of the mutant.

Methods

: Oxidative phosphorylation was determined by measuring mitochondrial oxygen consumption using electron donors specific for either complex I or complex II. Adenosine triphosphate concentrations were determined by measuring luciferase activity. Oxidative damage to mitochondrial proteins was identified using specific antibodies.

Results

: Halothane inhibited oxidative phosphorylation in isolated wild-type mitochondria within a concentration range that immobilizes intact worms. At equal halothane concentrations, complex I activity but not complex II activity was lower in mitochondria from mutant (gas-1) animals than from wild-type (N2) animals. The halothane concentrations needed to immobilize 50% of N2 or gas-1 animals, respectively, did not reduce oxidative phosphorylation to identical rates in the two strains. In air, adenosine triphosphate concentrations were similar for N2 and gas-1 but were decreased in the presence of halothane only in gas-1 animals. Oxygen tension changed the sensitivity of both strains to halothane. When nematodes were raised in room air, oxidative damage to mitochondrial proteins was increased in the mutant animal compared with the wild type.

Conclusions

: Rates of oxidative phosphorylation and changes in adenosine triphosphate concentrations by themselves do not control anesthetic-induced immobility of wild-type C. elegans. However, they may contribute to the increased sensitivity to volatile anesthetics of the gas-1 mutant. Oxidative damage to proteins may be an important contributor to sensitivity to volatile anesthetics in C. elegans.
Effects of Volatile Anesthetics on Store-operated Ca2+Influx in Airway Smooth Muscle
Authors: Pabelick Christina M. , Ay Binnaz , Prakash Yedatore S. , Sieck Gary C.
Published: July 2004

Background

In airway smooth muscle (ASM), volatile anesthetics deplete sarcoplasmic reticulum (SR) Ca(2+) stores by increasing Ca(2+) "leak." Accordingly, SR replenishment becomes dependent on Ca(2+) influx. Depletion of SR Ca(2+) stores triggers Ca(2+) influx via specific plasma membrane channels, store-operated Ca(2+) channels (SOCC). We hypothesized that anesthetics inhibit SOCC triggered by increased SR Ca(2+) "leak," preventing SR replenishment and enhancing ASM relaxation.

Methods

In porcine ASM cells, SR Ca was depleted by cyclopiazonic acid or caffeine in 0 extracellular Ca(2+), nifedipine and KCl (preventing Ca(2+) influx through L-type and SOCC channels). Extracellular Ca(2+) was rapidly introduced to selectively activate SOCC. After SOCC activation, SR was replenished and the protocol repeated in the presence of 1 or 2 minimum alveolar concentration halothane, isoflurane, or sevoflurane. In other cells, characteristics of SOCC and interactions between acetylcholine (Ach) and volatile anesthetics were examined.

Results

Cyclopiazonic acid produced slow SR leak, whereas the caffeine response was transient in ASM cells. Reintroduction of extracellular Ca(2+) rapidly increased [Ca(2+)]i. This influx was insensitive to nifedipine, SKF-96365, and KBR-7943, inhibited by Ni and blockade of inositol 1,4,5-triphosphate-induced SR Ca(2+) release, and enhanced by ACh. Preexposure to 1 or 2 minimum alveolar concentration halothane completely inhibited Ca(2+) influx when extracellular Ca(2+) was reintroduced, whereas isoflurane and sevoflurane produced less inhibition. Only halothane and isoflurane inhibited ACh-induced augmentation of Ca(2+) influx.

Conclusion

Volatile anesthetics inhibit a Ni/La-sensitive store-operated Ca(2+) influx mechanism in porcine ASM cells, which likely helps maintain anesthetic-induced bronchodilation.
Protein Kinase C-ε Primes the Cardiac Sarcolemmal Adenosine Triphosphate–sensitive Potassium Channel to Modulation by Isoflurane
Authors: Aizawa Kei , Turner Lawrence A. , Weihrauch Dorothee , Bosnjak Zeljko J. , Kwok Wai-Meng
Published: July 2004

Background

Cardioprotection by volatile anesthetic-induced preconditioning is known to involve intracellular signaling pathways. Recent studies have shown that protein kinase C (PKC) plays an important role in anesthetic-induced preconditioning. In this study, the effects of the activation of specific isozymes of PKC, specifically PKC-epsilon and -delta, on the modulation of the sarcolemmal adenosine triphosphate-sensitive potassium (sarcKATP) channel by isoflurane were investigated.

Methods

The sarcKATP current was measured in ventricular myocytes isolated from guinea pig hearts using the whole cell configuration of the patch clamp technique. Peptides that induced the translocation of specific PKC isozymes were used to activate PKC-epsilon and PKC-delta.

Results

Under whole cell conditions, isoflurane alone was unable to elicit the opening of the sarcKATP channel. Pretreatment with the specific PKC-epsilon activator, PP106, primed the sarcKATP channel to open in the presence of isoflurane. The resulting sarcKATP current densities in the presence of 0.88 mm isoflurane were 6.5 +/- 6.0 pA/pF (n = 7) and 40.4 +/- 18.2 pA/pF (n = 7) after pretreatment with 100 and 200 nm PP106, respectively. The PKC-epsilon antagonist PP93 abolished this effect. A scrambled peptide of the PKC-epsilon activator PP105 did not prime the sarcKATP channel. The PKC-delta activator PP114 was significantly less effective in priming the sarcKATP channel. 5-Hydroxydecanoate significantly attenuated the effect of the PKC-epdsilon activator on the sarcKATP channel. In addition, immunohistochemical analysis showed that the PKC-epsilon isoform translocated to both the mitochondria and sarcolemma after anesthetic-induced preconditioning, whereas the PKC-delta isoform translocated to the mitochondria.

Conclusion

The PKC-epsilon isozyme primed the sarcKATP channel to open in the presence of isoflurane. The PKC-delta isozyme was significantly less effective in modulating the isoflurane effect on this channel.