bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of acute and chronic alcohol intake on the clinical course and outcome in acetaminophen overdose
Authors: Schiødt F. V. , Lee W. M. , Bondesen S. , Ott P. , Christensen E.
Published: March 2003

Background:

Animal studies on acetaminophen toxicity suggest that chronic alcohol intake affects the outcome adversely, whereas acute alcohol intake seems protective. Few clinical data are available.

Methods:

We studied 209 consecutive patients with single‐dose acetaminophen overdose. The combined influence of independent variables (gender, age, dose, delay to antidote treatment, chronic and acute alcohol intake and nomogram risk group) on dependent variables (death, development of hepatic encephalopathy and biochemical liver markers) was studied using multiple or logistic regression analysis.

Results:

Fifty‐seven (27.3%) patients had chronic alcohol intake and 45 (21.5%) patients had acute alcohol intake. Forty‐four (21.1%) patients developed hepatic coma and 20 (43.5%) of these patients died. Chronic alcohol intake was significantly and independently associated with the development of hepatic coma, with a lower prothrombin index, lower platelet count, higher creatinine and higher bilirubin. The relative risks for hepatic coma and death were 5.3 (95% confidence interval, 2.2–12.4) and 1.4 (95% confidence interval, 0.5–3.9), respectively, in the chronic alcohol intake group compared with the no chronic alcohol intake group. Acute alcohol intake was not significantly associated with any of the dependent variables studied.

Conclusions:

Chronic alcohol intake enhances acetaminophen hepatotoxicity, whereas acute alcohol intake does not affect the clinical course.
Acute effect of clonidine on gastric emptying in patients with diabetic gastropathy and controls
Authors: Huilgol V. , Evans J. , Hellman R. S. , Soergel K. H.
Published: March 2003

Background:

The treatments available for diabetic gastropathy are frequently ineffective. Clinical observations suggest that clonidine, an a‐2 adrenergic agonist, may improve diabetic gastropathy symptoms.

Aims:

To establish whether a single oral dose of clonidine alters the gastric emptying of a solid meal in 10 patients with diabetic gastropathy and their matched controls. A secondary goal was to compare two methods of analysis of the data from gastric emptying studies.

Methods:

Clonidine, 0.3 mg, or a matched placebo were administered orally in a double‐blind fashion.

Results:

Only three of the 10 patients showed an increased gastric residual volume. Gastric emptying rates were comparable in patients and controls. Clonidine had no significant effect on gastric emptying in the controls but increased t1/2 values in the patient group. This effect just reached statistical significance only when calculated by the power exponential method (P=0.05 but not by the linear component model.

Conclusions:

Delayed gastric emptying is not an invariable characteristic of symptomatic diabetic gastropathy. Clonidine, given as a single dose of 0.3 mg orally, has no gastric prokinetic effects. It may act on gastric afferent innervation or, more likely, at a central site to reduce nausea and vomiting. The analysis of gastric emptying data by the power exponential and the two linear component methods yields equivalent results.
Osteoporosis in inflammatory bowel disease: effect of calcium and vitamin D with or without fluoride
Authors: Abitbol V. , Mary J. Y. , Roux C. , Soulé J. C. , Belaiche J. , Dupas J. ‐L. , Gendre J. P. , Lerebours E. , Chaussade S. ,   The Groupe D'etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID)
Published: March 2003

Background:

Previous data have indicated low bone formation as a mechanism of osteoporosis in inflammatory bowel disease. Fluoride can stimulate bone formation.

Aim:

To assess the effect of fluoride supplementation on lumbar spine bone mineral density in osteoporotic patients with inflammatory bowel disease treated in parallel with calcium and vitamin D.

Methods:

In this prospective, randomized, double‐blind, parallel and placebo‐controlled study, 94 patients with inflammatory bowel disease (lumbar spine T score below − 2 standard deviations, normal serum 25OH vitamin D), with a median age of 35 years, were included. Bone mineral density was measured by dual‐energy X‐ray absorptiometry. Patients were randomized to receive daily either sodium monofluorophosphate (150 mg, n=45) or placebo (n=49) for 1 year, and all received calcium (1 g) and vitamin D (800 IU). The relative change in bone mineral density from 0 to 12 months was tested in each group (fluoride or placebo) and compared between the groups.

Results:

Lumbar spine bone mineral density increased significantly in both groups after 1 year: 4.8 ± 5.6% (n=29) and 3.2 ± 3.8% (n=31) in the calcium–vitamin D–fluoride and calcium–vitamin D–placebo groups, respectively (P < 0.001 for each group). There was no difference between the groups (P=0.403). Similar results were observed according to corticosteroid intake or disease activity.

Conclusions:

Calcium and vitamin D seem to increase lumbar spine density in osteoporotic patients with inflammatory bowel disease; fluoride does not provide further benefit.
Effect of alosetron on left colonic motility in non‐constipated patients with irritable bowel syndrome and healthy volunteers
Authors: Clemens C. H. M. , Samsom M. , Van Berge Henegouwen G. P. , Fabri M. , Smout A. J. P. M.
Published: March 2003

Background:

Alosetron is a 5‐hydroxytryptamine‐3 receptor antagonist reducing symptoms in female patients with diarrhoea‐predominant irritable bowel syndrome, and is known to increase the colonic transit time.

Aim:

To study the effect of alosetron on left colonic phasic motility in ambulant non‐constipated patients with irritable bowel syndrome and healthy volunteers.

Methods:

In a double‐blind, randomized, crossover design, 10 patients with irritable bowel syndrome and 12 sex‐ and age‐matched volunteers were treated for two 7‐day periods with alosetron, 4 mg b.d., or placebo b.d. On day 6 of each treatment period, a six‐channel solid‐state manometric catheter was positioned in the left colon and 24 h motility was studied on day 7. The periprandial phasic motility around dinnertime was evaluated in the descending and sigmoid colon. The high‐amplitude propagated contraction frequency and characteristics were calculated.

Results:

Alosetron appeared to increase the overall periprandial frequency in the sigmoid colon (P=0.043) and the mean amplitude of colonic contractions in the descending colon (P=0.007). The high‐amplitude propagated contraction frequency was higher on alosetron during the second half of the day for patients with irritable bowel syndrome (P=0.002), with increased mean propagation length of high‐amplitude propagated contractions (P=0.001). The stool frequency (P=0.024) and stool consistency score (P=0.002) were decreased by alosetron.

Conclusions:

The 5‐hydroxytryptamine‐3 receptor antagonist alosetron marginally increased left colonic periprandial phasic motility. Alosetron increased the number and propagation length of high‐amplitude propagated contractions, which were paradoxically accompanied by a decrease in stool frequency and a firming of stool consistency.
Long‐term cisapride treatment improves diabetic gastroparesis but not glycaemic control
Authors: Braden B. , Enghofer M. , Schaub M. , Usadel K.‐H. , Caspary W. F. , Lembcke B.
Published: March 2003

Background:

In patients with diabetic gastroparesis, delayed food delivery to the intestine may become a major obstacle to post‐prandial glycaemic control.

Aim:

To investigate whether cisapride accelerates gastric emptying in the long term or improves diabetes control in patients with diabetic gastroparesis.

Methods:

Eighty‐five patients with long‐standing insulin‐dependent diabetes mellitus (glycosylated haemoglobin (HbA1c) > 7.0%), dyspepsia and diabetic neuropathy were tested for impaired gastric emptying of solids by the 13C‐octanoate breath test. Nineteen of these patients with severe diabetic gastroparesis (i.e. t1/2 > 170 min) were randomly treated with 10 mg cisapride t.d.s. (n=9) or placebo (n=10) for 12 months. Thereafter, the breath test, dyspeptic symptoms and HbA1c values were reassessed.

Results:

Half emptying times in nine patients with diabetic gastroparesis were significantly shortened by cisapride (175 ± 46 min vs. 227 ± 40 min; P < 0.03). Half emptying times in the 10 patients taking placebo did not change (205 ± 37 min vs. 211 ± 36 min, P=0.54). Cisapride significantly reduced dyspepsia (score: 4.1 ± 1.6 vs. 2.0 ± 0.5, P=0.002). HbA1c values after 12 months of treatment were not different (cisapride: 7.7 ± 0.4% vs. 7.6 ± 0.9%, P=0.76; placebo: 7.5 ± 0.6% vs. 7.6 ± 1.5%, P=0.89).

Conclusions:

Prokinetic treatment with cisapride accelerates gastric emptying of solids and improves dyspeptic symptoms in diabetic gastroparesis. Glycaemic control, however, is not affected by cisapride.
A modification of the quininium resin test for assessing gastric acidity
Authors: Passaro D. J. , Hurwitz A. , Triadafilopoulos G. , Parsonnet J.
Published: March 2003

Background:

Gastric acid is an important defence against enteric infection. Studies investigating the relationship between hypochlorhydria and enteric infections or gastric malignancy have been limited by difficulties in the non‐invasive measurement of gastric acidity.

Aim:

To develop a blood test for hypochlorhydria based on the quininium resin test.

Methods:

Quininium resin dissociates to liberate free quinine at pH ≤ 3.5. Ten fasting adult volunteers ingested 100 mg/kg of quininium resin twice: once before (control) and once after acid suppression with rabeprazole (10 mg b.d. for 3 days). Blood and serum samples were collected at baseline and 45, 60, 75, 90 and 120 min after ingestion. Quinine levels were measured fluorometrically from 100 μL samples after simple extraction. Results obtained by the quininium resin test were compared with gastric juice pH measurements.

Results:

After quininium resin ingestion, mean quinine levels were lower in the acid‐suppressed than in the control condition at all times (P < 0.001). Optimized cut‐off values at 90 min post‐ingestion yielded 95% accuracy rates in both serum and blood. Quininium resin was well tolerated.

Conclusions:

Using blood or serum, the quininium resin test identifies hypochlorhydria accurately and non‐invasively. This test may be useful in screening for gastric atrophy and in studies investigating hypochlorhydria.
Oral beclometasone dipropionate in the treatment of active ulcerative colitis: a double‐blind placebo‐controlled study
Authors: Rizzello F. , Gionchetti P. , D'Arienzo A. , Manguso F. , Di Matteo G. , Annese V. , Valpiani D. , Casetti T. , Adamo S. , Prada A. , Castiglione G. N. , Varoli G. , Campieri M.
Published: March 2003

Aim : To evaluate efficacy and safety of oral beclometasone dipropionate (BDP) when added to 5‐ASA in the treatment of patients with active ulcerative colitis.

Methods : In a 4‐week, placebo‐controlled, double‐blind study, patients with extensive or left‐sided mild to moderate active ulcerative colitis were randomized to receive oral 5‐ASA (3.2 g/day) plus BDP (5 mg/day) or placebo. Clinical, endoscopic and histologic features, and haematochemical parameters were recorded at baseline and at the end of the study.

Results : One hundred and nineteen patients were enrolled and randomly treated with BDP plus 5‐ASA (n = 58) or placebo plus 5‐ASA (n = 61). Both treatment groups showed a statistically significant decrease of disease activity index (DAI) and histology score at the end of treatment (P = 0.001, each). DAI score was lower in the BDP group than in the placebo group (P = 0.014), with more patients in clinical remission in the BDP group (58.6% vs. 34.4%, P = 0.008). Serum cortisol levels significantly decreased in BDP group vs. baseline (P = 0.002), but without signs of pituitary‐adrenal function depletion. A low incidence of adverse events was observed in both groups.

Conclusions : Oral BDP in combination with oral 5‐ASA is significantly more effective than 5‐ASA alone in the treatment of patients with extensive or left‐sided active ulcerative colitis.
Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading
Authors: Rugge M. , Correa P. , Dixon M. F. , Fiocca R. , Hattori T. , Lechago J. , Leandro G. , Price A. B. , Sipponen P. , Solcia E. , Watanabe H. , Genta R. M.
Published: March 2003

Background and aims : Considerable difficulties persist amongst pathologists in agreeing on the presence and severity of gastric atrophy. An international group of pathologists pursued the following aims: (i) to generate an acceptable definition and a simple reproducible classification of gastric atrophy; and (ii) to develop guidelines for the recognition of atrophy useful for increasing agreement among observers.

Methods : After redefining atrophy as the ‘loss of appropriate glands’ and examining histological samples from different gastric compartments, three categories were identified: (i) negative; (ii) indefinite; (iii) atrophy, with and without intestinalization. Atrophy was graded on a three‐level scale. Interobserver reproducibility of the classification was tested by κ statistics (general and weighted) in a series of 48 cases.

Results : The medians of the general agreement and weighted κ values were 0.78 and 0.73, respectively. The weighted κ coefficients, obtained by cross‐tabulating the evaluation of each pathologist against all others, were, with only one exception, > 0.4 (moderate to excellent agreement).

Conclusions : By using the definition of atrophy as the loss of appropriate glands and distinguishing the two main morphological entities of metaplastic and non‐metaplastic types, a high level of agreement was achieved by a group of gastrointestinal pathologists trained in different cultural contexts.
Naloxone treatment for irritable bowel syndrome — a randomized controlled trial with an oral formulation
Authors: Hawkes N. D. , Rhodes J. , Evans B. K. , Rhodes P. , Hawthorne A. B. , Thomas G. A. O.
Published: March 2003

Background : Opioids change gut motility and secretion, causing delayed intestinal transit and constipation. Endorphins play a role in the constipation troubling some patients with irritable bowel syndrome; hence naloxone, an opioid antagonist, may have a therapeutic role.

Aim : To assess the efficacy and safety of an oral formulation of naloxone in irritable bowel syndrome patients with constipation.

Methods : A randomized, double‐blind, placebo‐controlled trial was performed. Patients fulfilling the Rome II criteria for irritable bowel syndrome (constipation‐predominant and alternating types) were randomized to receive 8 weeks of treatment with naloxone capsules, 10 mg twice daily, or identical placebo.

Results : Twenty‐eight patients entered the study, which was completed by 25. ‘Adequate symptomatic relief’ was recorded in six of 14 on naloxone and three of 11 on placebo. Whilst the differences were not significant, improvements in severity gradings and mean symptom scores for pain, bloating, straining and urgency to defecate were greater with naloxone than placebo for all parameters. In addition, quality of life assessments improved to a greater extent in patients taking naloxone.

Conclusions : Preliminary results suggest that naloxone is well tolerated and beneficial in patients with irritable bowel syndrome and constipation. A larger clinical trial is needed to provide sufficient statistical power to assess efficacy.
Eradication rates of clarithromycin‐resistant Helicobacter pylori using either rabeprazole or lansoprazole plus amoxicillin and clarithromycin
Authors: Murakami K. , Sato R. , Okimoto T. , Nasu M. , Fujioka T. , Kodama M. , Kagawa J. , Sato S. , Abe H. , Arita T.
Published: March 2003

Background : The resistance of Helicobacter pylori to clarithromycin has become one of the primary reasons for eradication failure.

Aim : To compare the eradication rates of triple therapy using amoxicillin (A), clarithromycin (C) and rabeprazole (R) or lansoprazole (L) against clarithromycin‐sensitive and clarithromycin‐resistant strains.

Methods : Two hundred and ninety‐five patients were randomly divided into four groups and treated for 1 week: 147 cases were treated with RAC, i.e. 49 cases with R20C400 (10 mg R + 750 mg A + 200 mg C, twice daily), 48 cases with R40C400 (20 mg R + 750 mg A + 200 mg C, twice daily) and 50 cases with R40C800 (20 mg R + 750 mg A + 400 mg C, twice daily); 148 cases with treated with LAC (30 mg L + 750 mg A + 200 mg C, twice daily).

Results : According to intention‐to‐treat and per protocol analyses, the eradication rates were 88% and 91% with RAC and 78% and 81% with LAC; the eradication rates with R20C400, R40C400 and R40C800 were 94%, 81% and 86%, respectively, in the intention‐to‐treat analysis. In addition, the eradication rates for clarithromycin‐sensitive strains with RAC and LAC were 98% and 89%, respectively, and for clarithromycin‐resistant strains with RAC and LAC were 8.1% and 0%, respectively.

Conclusions : The eradication rate was significantly higher with RAC than LAC. The eradication rate for clarithromycin‐resistant strains was low in both groups, and an improved eradication rate could not be achieved by changing the dose of clarithromycin or proton pump inhibitor.
Arthritis treatment in Hong Kong — cost analysis of celecoxib versus conventional NSAIDS, with or without gastroprotective agents
Authors: You J. H. S. , Lee K. K. C. , Chan T. Y. K. , Lau W. H. , Chan F. K. L.
Published: March 2003

Background : Selective cyclo‐oxygenase‐2 inhibitors have been reported to cause fewer gastrointestinal complications when compared with conventional, non‐selective, non‐steroidal anti‐inflammatory drugs (NSAIDs).

Aim : To analyse the cost of celecoxib (selective cyclo‐oxygenase‐2 inhibitor) and conventional NSAID regimens for the treatment of osteoarthritis and rheumatoid arthritis from the perspective of a public health organization in Hong Kong.

Methods : A decision tree was used to analyse the cost of celecoxib, NSAID alone, NSAID plus histamine2‐receptor antagonist, NSAID plus misoprostol and NSAID plus proton pump inhibitor over 6 months. Model outcomes were no gastrointestinal toxicity, gastrointestinal discomfort, symptomatic ulcer, anaemia with occult bleeding and serious gastrointestinal complications. The clinical probabilities were estimated from clinical trials. Resource utilization for gastrointestinal events was determined locally. Sensitivity analysis was performed.

Results : The 6‐month costs per base‐case analysis were as follows: NSAID plus histamine2‐receptor antagonist, HK$1404 (1US$=7.8HK$); celecoxib, HK$1545; NSAID alone, HK$1610; NSAID plus misoprostol, HK$2213; NSAID plus proton pump inhibitor, HK$2857. The model was sensitive to the patients' underlying gastrointestinal risk scores, daily cost of NSAID regimen, risk ratio of NSAID plus histamine2‐receptor antagonist for symptomatic ulcer, daily cost of celecoxib and daily cost of histamine2‐receptor antagonist.

Conclusions : Celecoxib appeared to be the least costly alternative in patients with intermediate to high gastrointestinal risk for the treatment of osteoarthritis and rheumatoid arthritis in Hong Kong.
Serotonergic modulators in the treatment of irritable bowel syndrome — influence on psychiatric and gastrointestinal symptoms
Authors: Kilkens T. O. C. , Honig A. , Rozendaal N. , Van Nieuwenhoven M. A. , Brummer R.‐J. M.
Published: March 2003

Background : Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.

Aim : To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.

Methods : A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points).

Results : Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.

Conclusions : The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.
Oral antioxidant supplementation for fatigue associated with primary biliary cirrhosis: results of a multicentre, randomized, placebo‐controlled, cross‐over trial
Authors: Prince M. I. , Mitchison H. C. , Ashley D. , Burke D. A. , Edwards N. , Bramble M. G. , James O. F. W. , Jones D. E. J.
Published: March 2003

Background : We have previously reported, in an uncontrolled trial, an improvement in fatigue scores in patients with primary biliary cirrhosis given oral antioxidant supplementation. We now present data from a controlled trial.

Patients and methods : Sixty‐one patients with primary biliary cirrhosis‐associated fatigue were randomized into a double‐blind, placebo‐controlled, cross‐over trial. Participants received 12 weeks each of placebo and antioxidant supplementation (vitamins A, C and E, selenium, methionine and ubiquinone) in random order, separated by a 4‐week washout period. The primary trial outcome (fatigue) was assessed using the Fisk scale. Other symptoms of primary biliary cirrhosis were measured using Likert and visual analogue scales.

Results : Forty‐four patients completed both arms of the trial. No significant changes in fatigue were recorded in the active phase of treatment (median improvement in Fisk score, 1; P = 0.61). Small improvements in Fisk scores were recorded during placebo therapy (median improvement, 4; P = 0.03). Neither medication was associated with improvement in any other symptoms related to primary biliary cirrhosis. Adverse effects were more common during active therapy and were mild and self‐limiting. One patient died from unrelated causes during active treatment.

Conclusions : Although oral antioxidant supplementation appears to be safe, we could not find any evidence for a beneficial effect on fatigue or other liver‐related symptoms.
Helicobacter pylori and reflux disease
Authors: Sharma P. , Vakil N.
Published: March 2003

The falling prevalence of Helicobacter pylori infection and related diseases (peptic ulcer disease, gastric cancer) in developed countries has been paralleled by an increased recognition of gastro‐oesophageal reflux and its complications. These epidemiological data do not support a role for H. pylori in the pathogenesis of reflux disease, but suggest a negative association with the increasing incidence of oesophageal diseases. This has led some investigators to propose a ‘protective’ role of H. pylori infection against the development of oesophageal diseases. In these patients, pre‐existing lower oesophageal sphincter dysfunction, susceptibility to reflux, unmasking of latent reflux and the patterns and severity of gastritis are probably important factors contributing to the development of oesophageal diseases. The most likely mechanism by which H. pylori infection may protect against reflux is by decreasing the potency of the gastric refluxate in patients with corpus‐predominant gastritis. The prevalence of H. pylori infection in patients with reflux disease is probably no greater than that in those without reflux, and there are conflicting data indicating that reflux symptoms or erosive oesophagitis develop after H. pylori eradication. It is also unclear whether H. pylori augments the antisecretory effects of proton pump inhibitors or accelerates the development of atrophic gastritis.
6‐Thioguanine — efficacy and safety in chronic active Crohn's disease
Authors: Herrlinger K. R. , Kreisel W. , Schwab M. , Schoelmerich J. , Fleig W. E. , Ruhl A. , Reinshagen M. , Deibert P. , Fellermann K. , Greinwald R. , Stange E. F.
Published: March 2003

Background : Azathioprine and mercaptopurine are commonly used in chronic active Crohn's disease. They share the disadvantage of a delayed onset of action and potentially serious side‐effects, and are metabolized to thioguanine nucleotides which are thought to be the active metabolites. The direct use of 6‐thioguanine may offer a more rapid and safer alternative. We conducted an open prospective study to investigate the efficacy and safety of 6‐thioguanine in chronic active Crohn's disease.

Methods : Thirty‐seven patients with chronic active Crohn's disease and a Crohn's disease activity index of > 150 were enrolled in this study. Inclusion criteria were steroid dependence (n = 19), steroid refractoriness (n = 9) and/or intolerance (n = 16) or refractoriness (n = 6) to azathioprine. Patients were treated with 40 mg/day of 6‐thioguanine for 24 weeks; a dose escalation to 80 mg was allowed at week 12. Remission was defined as a Crohn's disease activity index of < 150 associated with a decrease of > 70 points; response was defined as a decrease of > 70 points in the Crohn's disease activity index.

Results : In the intention‐to‐treat analysis, 13 of 37 patients achieved remission (35%). Twelve of these 13 patients achieved remission after 4 weeks. Fifty‐seven per cent of patients (21/37) achieved a response. The mean Crohn's disease activity index decreased from 284 ± 74 to 153 ± 101. 6‐Thioguanine was more effective in azathioprine‐intolerant than in azathioprine‐refractory patients. Twelve of 16 patients intolerant to azathioprine tolerated 6‐thioguanine. Adverse events included phototoxicity, pancreatitis, headache, nausea, alopecia, arthralgia, minor infections and reversible elevation of transaminases. Six patients required discontinuation of medication, two because of leucopenia.

Conclusions : In this patient group with chronic active Crohn's disease, 6‐thioguanine appeared to be effective with acceptable short‐term toxicity, but long‐term controlled trials are clearly needed to further define its role.
Oral desensitizing treatment in food allergy: clinical and immunological results
Authors: Patriarca G. , Nucera E. , Roncallo C. , Pollastrini E. , Bartolozzi F. , De Pasquale T. , Buonomo A. , Gasbarrini G. , Di Campli C. , Schiavino D.
Published: March 2003

Background : The possibility of inducing oral desensitization in patients with food allergy is still controversial and no standardized programmes are yet available.

Aim : To evaluate the safety and efficacy of oral desensitization in patients with allergy induced by the most common food allergens.

Methods : Fifty‐nine patients with food allergy underwent an oral desensitizing treatment according to standardized protocols. The control group consisted of age‐ and sex‐matched subjects, who followed a strict elimination diet. Specific immunoglobulin E and immunoglobulin G4 were assessed at baseline and after 6, 12 and 18 months.

Results : The majority of patients (83.3%) successfully completed the treatment. During treatment, 51.1% of subjects experienced some mild side‐effects, easily controlled by the oral administration of antihistamines or sodium cromolyn. Specific immunoglobulin E showed a significant decrease, whilst specific immunoglobulin G4 showed a significant increase in all patients.

Conclusions : The immunological findings induced by oral desensitization in food allergy allow us to hypothesize that oral tolerance may be mediated by the same mechanisms as those involved in traditional desensitizing treatments for respiratory allergies. Moreover, the proposed standardized oral desensitization protocols may represent an effective alternative approach in the management of food‐allergic patients.
Regional anaesthesia with a subarachnoid microcatheter for Caesarean section in a parturient with aortic stenosis
Authors: Pittard A. , Vucevic M.
Published: March 2003

We present a woman in her first pregnancy, with known aortic stenosis prior to conception, who successfully underwent regional anaesthesia for an elective Caesarean section using a subarachnoid microcatheter. The anaesthetic management of patients with aortic stenosis requiring noncardiac surgery is a complex and contentious matter, particularly when the situation is compounded by the physiological changes accompanying pregnancy and delivery. This is the first reported use of a subarachnoid microcatheter in such a patient. The choice of technique is discussed and compared with other options for providing anaesthesia.
Requirements for muscle relaxation in Friedreich's ataxia
Authors: Mouloudi H. , Katsanoulas C. , Frantzeskos G.
Published: March 2003

Friedreich's ataxia is an inherited disorder of the nervous system, requiring special care during anaesthesia, because of increased sensitivity to muscle relaxants. We report a case of Friedreich's ataxia in a 31‐year‐old woman, anaesthetised on two occasions, for tendinoplasty and pes cavus repair. Atracurium was used for neuromuscular blockade and monitored by a train‐of‐four twitch technique. The patient's response was normal. She returned to adequate spontaneous breathing within 20 min of the last dose of the muscle relaxant without need for anticholinesterase administration. When neuromuscular function is monitored, normal doses of muscle relaxant can safely be used in these patients.
The effect of music on anaesthetists' psychomotor performance
Authors: Hawksworth C. R. E. , Sivalingam P. , Asbury A. J.
Published: March 2003

Music is frequently played in operating theatres, but may prove distracting to anaesthetists. We undertook a laboratory‐based study of the effects of music on the psychomotor performance of 12 anaesthetic trainees. Using part of the computer‐based PsychE psychomotor evaluation programme, we were unable to demonstrate any effect of self‐chosen music, silence, white noise or classical music on their performance in these tests.
Rescue from neutropenic fever and a bamboo pole
Authors: Yi C. Y. , Tan I. K. S.
Published: March 2003

We describe a patient admitted to the intensive care unit following a penetrating head injury. This patient developed agranulocytosis and subsequently pancytopenia secondary to an idiosyncratic drug reaction. The possible causative drugs are phenytoin, cloxacillin, ceftriaxone and ceftazidime. The patient was treated with recombinant human granulocyte colony‐stimulating factor.
Evaluation of five oxygen delivery devices in spontaneously breathing subjects by oxygraphy
Authors: Waldau T. , Larsen V. H. , Bonde J.
Published: March 2003

Oxygen supply systems may be divided into constant and variable performance systems. As the variable performance systems are widely used, it is relevant to investigate the variation in performance between devices and the influence of oxygen supply on the inspired oxygen fraction. Data were collected from 10 healthy volunteers during the use of one constant performance system and four variable performance systems at different gas flows and inspired oxygen fractions. A thin sampling catheter was placed in the nasopharynx to allow the measurement of the end‐tidal oxygen fraction. When oxygen was supplied to variable performance systems, end‐tidal oxygen fraction values measured in this way varied less and were more easily quantifiable than inspired oxygen fraction. End‐tidal oxygen fraction was used to calculate inspired oxygen fraction. With the variable performance systems, inspired oxygen fraction varied considerably between subjects whereas a constant and equal rise was found for each subject with the fixed performance system. A large nasal catheter was capable of delivering the highest inspired oxygen fraction, whereas the Venturi mask delivered the most precise inspired oxygen fraction. We found oxygraphy useful in the interpretation of measurements made in patients receiving unknown inspired fractions of oxygen.
The effect of increasing degrees of spinal flexion on cerebrospinal fluid pressure
Authors: Dinsmore J. , Bacon R. C. , Hollway T. E.
Published: March 2003

The effects of increasing degrees of flexion on cerebrospinal fluid pressure were investigated in 12 neurosurgical patients requiring lumbar subarachnoid drains. Cerebrospinal fluid pressure and central venous pressure were measured in three positions: fully flexed (‘chin on chest’), flexed at ninety degrees and straight. There was a significant increase in cerebrospinal fluid pressure on moving from the fully flexed to the flexed position (p < 0.0001), but not from the flexed to the straight position. These results were mirrored by smaller changes in central venous pressure. In patients without intracranial pathology these increases in cerebrospinal fluid pressure are probably unimportant. However, intracranial pathology may result in low cerebral perfusion pressures and any increase in cerebrospinal fluid pressure in this group may be harmful. The fully flexed position should be avoided when inserting lumbar drains in at risk patients.
Early postoperative emergencies requiring an intensive care team interventionThe role of ASA physical status and after‐hours surgery
Authors: Lee A. , Lum M. E. , O'Regan W. J. , Hillman K. M.
Published: March 2003

To examine the risk factors of early postoperative emergencies that required an intensive care team intervention, a matched nested case‐control study (34 cases and 126 controls) was conducted. Over a 17‐month period, the incidence of early postoperative emergencies occurring within 48 h of surgery was 0.21% (95% confidence intervals (CI): 0.14%‐0.30%). The intensive care team treated two cardiac arrests and three respiratory arrests. The major physiological changes which led to ward staff summoning an intensive care team were hypotension (13 cases) and a decreased level of consciousness (nine cases). Significant associations with early postoperative emergencies were high ASA (≥ IV) physical status grades (odds ratio: 4.51, 95% CI: 1.24–16.40) and surgery performed outside normal working hours (odds ratio: 4.40, 95% CI: 1.41–13.69). High‐risk patients may benefit from a visit by a postoperative care team during the early postoperative period but this requires further evaluation.
Anaesthesia for Caesarean section in a patient with Charcot–Marie‐Tooth disease
Authors: Reah G. , Lyons G. R. , Wilson R. C.
Published: March 2003

We describe the management of a 25‐year‐old primigravida with severe respiratory insufficiency secondary to Charcot‐Marie‐Tooth disease type I scheduled for Caesarean section. Incremental subarachnoid anaesthesia via a microcatheter was utilised. Mother and baby made an uneventful recovery and were discharged home on the tenth postoperative day.
Postoperative nausea and vomiting in arthroscopic day‐case surgery: a comparison between desflurane and isoflurane
Authors: Hough M. B. , Sweeney B.
Published: March 2003

We compared the postoperative effects, in particular nausea and vomiting, of two commonly used anaesthetic agents, isoflurane and desflurane, in patients undergoing day‐case arthroscopic surgery. We found a significantly higher incidence of postoperative nausea and vomiting in those patients receiving desflurane. In our study, desflurane was associated with a higher incidence of peroperative respiratory complications, including airway irritability and coughing.
The effect of lead time bias on severity of illness scoring, mortality prediction and standardised mortality ratio in intensive care — a pilot study
Authors: Tunnell R. D. , Millar B. W. , Smith G. B.
Published: March 2003

The effect of lead time bias on severity of illness scoring, mortality prediction and standardised mortality ratios was examined in a pilot study of 76 intensive care (ICU) patients using APACHE II, APACHE III and SAPS II scoring systems. The inclusion of data collected in the period prior to ICU admission increased severity of illness scores and estimated risk of hospital mortality significantly for all three scoring systems (p < 0.01) by up to 14 points and 42.7% (APACHE II), 50 points and 26.3% (APACHE III) and 23 points and 33.4% (SAPS II), respectively. Standardised mortality ratios fell from 0.99 to 0.79 (APACHE II), 0.96 to 0.84 (APACHE III) and 0.75 to 0.64 (SAPS II), but these changes failed to reach statistical significance. Lead time bias had most effect in medical patients and on emergency admissions, and least effect in patients admitted from the operating theatre. These trends suggest that mortality ratios may not necessarily reflect intensive care unit performance and indicate that a larger study of the effect of lead time bias, case mix, pre‐ICU care or post‐ICU management on standardised mortality ratios is indicated.
Use and safety of percutaneous tracheostomy in intensive careReport of a postal survey of ICU practice
Authors: Cooper R. M.
Published: March 2003

A brief questionnaire was sent to 231 clinical directors of intensive care units in England and Wales to investigate the use of percutaneous tracheostomy. There was a 76% response rate. Percutaneous tracheostomies were in use in 78.4% of units. The Ciaglia technique was the most commonly used, with 31.3% routinely using fibreoscopy as part of their technique. Only 12% of units routinely provided long‐term follow up of their percutaneous tracheostomies. Overall, 78.4% thought that percutaneous tracheostomy was safe and 66.7% considered percutaneous tracheostomy to be the technique of choice for Intensive Care patients. Percutaneous tracheostomy is now a well‐established technique. However, the limited use of fibreoscopy and the lack of long‐term follow‐up are areas of concern.
General anaesthesia for thyroplasty
Authors: Griffin M. , Russell J. , Chambers F.
Published: March 2003

A new anaesthetic technique is described for thyroplasty. Thyroplasty was performed to restore the voice in unilateral vocal cord paralysis. After skin incision and dissection down to the larynx, a window was cut in the thyroid ala and a silastic wedge used to displace the vocal cord medially. The required size of this wedge was determined by pre‐operative computerized tomography scanning of the larynx. At this point the patient had to be awake and cooperative to allow repeated phonation to facilitate correct displacement of the vocal cord.
Awake intubation of the difficult airway with the intubating laryngeal mask airway
Authors: Shung J. , Avidan M. S. , Ing R. , Klein D. C. , Pott L.
Published: March 2003

The intubating laryngeal mask airway is a new device that facilitates intubation of the trachea. We assessed its use in 15 awake patients in whom we anticipated difficulty with tracheal intubation; we would otherwise have secured the patients' airways using a fibreoptic bronchoscope. All patients were sedated and had their airways anaesthetised with local anaesthetic. The tracheas of all 15 patients were successfully intubated. The mean time from start of sedation to successful intubation was 10.8 min. The mean time from completion of sedation and airway local anaesthesia to tracheal intubation was 2.8 min. Patients remained haemodynamically stable throughout, peripheral oxygen saturation was maintained and there were no obvious cases of pulmonary aspiration. Most patients complained of sore throat and hoarseness. We have demonstrated through this descriptive study that the intubating laryngeal mask airway may, in certain circumstances, be used as an alternative to the fibreoptic bronchoscope.
The use of remifentanil in general anaesthesia for Caesarean section in a patient with mitral valve disease
Authors: Scott H. , Bateman C. , Price M.
Published: March 2003

We report the use of remifentanil as part of a general anaesthetic technique for a patient with mixed mitral valve disease, asthma and pre‐eclampsia presenting for an emergency Caesarean section. The use of remifentanil was associated with stable haemodynamic variables during general anaesthesia. No clinically significant respiratory depression was noted in the neonate.
Analgesic and adverse effects of a low dose of intrathecally administered hyperbaric neostigmine alone or combined with morphine in patients submitted to spinal anaesthesia: pilot studies
Authors: Klamt J. G. , Garcia L. V. , Prado W. A.
Published: March 2003

We report the analgesic and adverse effects of intrathecally administered hyperbaric neostigmine, alone or combined with morphine, in two patients suffering from severe lower limb ischaemic pain (group 1), five patients undergoing Caesarean section (group 2) and 19 patients scheduled for orthopaedic surgery (group 3) under spinal anaesthesia. These patients were enrolled in three pilot studies undertaken before the initiation of the planned controlled studies. Hyperbaric neostigmine (50 μg in glucose 8%) produced analgesia lasting more than 6 h in patients of group 1, but the effect was accompanied by episodes of vomiting. A lower dose of hyperbaric neostigmine (25 μg), alone (two patients) or combined with morphine (50 μg) (one patient) produced no discernible analgesic effect but was followed by severe nausea and vomiting within 15 min of intrathecal injection in patients of group 2. Two patients who received hyperbaric morphine (100 μg) had analgesia for more than 24 h and exhibited mild pruritus. In patients of group 3, hyperbaric neostigmine alone (25 μg) produced analgesia of shorter duration than neostigmine (25 μg) plus morphine (50 μg) or morphine (100 μg). Neostigmine alone or combined with morphine was associated with adverse events, mainly nausea and vomiting that lasted up to 9–12 h in some patients. Other adverse events observed included anxiety, somnolence and involuntary defaecation. Most patients who received the combination of neostigmine and morphine exhibited more severe nausea, vomiting and somnolence. The low clinical efficacy of intrathecally administered neostigmine alone or in combination with morphine impairs the design of a double‐blind protocol and might restrict the clinical usefulness of the drug combination.
The effect of ionised magnesium on coagulation using thromboelastography
Authors: Ames W. A. , McDonnell N. , Potter D.
Published: March 2003

Magnesium is an ionised mineral with therapeutic uses. There is laboratory evidence that it may have an anticoagulant activity although recent research has been to the contrary. The clinical implications of the effect of a therapeutic dose of magnesium on coagulation have yet to be resolved conclusively. In our study, 10 healthy volunteers were given 4 g of magnesium sulphate intravenously. Thromboelastographs were recorded and blood analysed for haematological indices, before and after the infusion. All variables associated with coagulation remained unchanged except the alpha angle on the thromboelastograph which increased significantly. We conclude that in our in vivo study, the effect of magnesium sulphate on coagulation is not clinically significant.
The development of a method for comparative costing of individual intensive care units
Authors: Edbrooke D. , Hibbert C. , Ridley S. , Long T. , Dickie H. ,   The Intensive Care Working Group on Costing
Published: March 2003

Intensive care is one of the most costly areas of hospital care. Unfortunately, because of the diversity of case mix, costing intensive care is difficult. Many described costing methods previously are limited by being cumbersome, laborious to apply and expensive. The aim of this study was to develop a method for costing intensive care which can be applied with ease but facilitate meaningful cost comparisons between intensive care units. The method developed was based on cost blocks where the major components were identified and costed in a ‘top‐down’ manner. Using strict definitions, the cost blocks attempted to measure the costs of equipment, estates, nonclinical support services (such as hospital management costs), clinical support services (such as physiotherapy, laboratory services), consumables (such as drugs, fluids and disposables) and staff. The study found that clinical support services, consumables and staff costs accounted for approximately 85% of the total costs.
Conditions for laryngeal mask insertionA comparison of propofol versus sevoflurane with or without alfentanil
Authors: Sivalingam P. , Kandasamy R. , Madhavan G. , Dhakshinamoorthi P.
Published: March 2003

One hundred unpremedicated ASA 1 or 2 patients scheduled for elective surgery were divided equally into four groups and recruited into this prospective, randomised parallel groups study. Induction was with propofol 2.5 mgkg−1 or vital‐capacity breath induction with sevoflurane (> 7% in the inspiratory gas) in 65% nitrous oxide and oxygen, or gaseous induction with sevoflurane plus alfentanil 5 μgkg−1 or propofol 2.5 mgkg−1 and alfentanil 5 μgkg−1. The conditions for laryngeal mask insertion were assessed and graded on a three‐point scale using six variables. The overall condition for laryngeal mask insertion was assessed as excellent, satisfactory or poor on the basis of total score in each group. Excellent or satisfactory conditions were observed in 25 (100%) patients in the sevoflurane–alfentanil group, 22 (88%) in the propofol–alfentanil group and 16 (64%) patients each in the propofol and sevoflurane groups (p < 0.001). A sevoflurane–alfentanil combination provides better conditions for laryngeal mask insertion when compared with sevoflurane alone, or a propofol–alfentanil combination.
The impact of percutaneous tracheostomy on intensive care unit practice and training
Authors: Simpson T. P. , Day C. J. E. , Jewkes C. F. , Manara A. R.
Published: March 2003

We studied the impact of introducing percutaneous tracheostomy to our intensive care unit on the incidence and timing of tracheostomy and on the implications for surgical training. The proportion of patients receiving intensive care who underwent tracheostomy doubled from a median of 8.5% to 16.8% (p < 0.01) following the introduction of the percutaneous technique with the procedure being undertaken significantly earlier during the intensive care stay. The opportunity for surgical trainees to gain experience in open surgical tracheostomy has been virtually lost. The increase in tracheostomy rate may reflect a previous under‐utilisation caused by the logistic problems of transferring a critically ill patient to theatre, or alternatively a relaxation of the indications for tracheostomy caused by a perceived benefit for the patient. An increased workload may also have contributed to the rise. Surgical trainees should be encouraged to learn percutaneous techniques and training opportunities in open surgical techniques should be maximised.
Spinal haematoma following epidural anaesthesia in a patient with eclampsia
Authors: Yuen T. S. T. , Kua J. S. W. , Tan I. K. S.
Published: March 2003

A patient with a twin pregnancy required a Caesarean section for severe pre‐eclampsia. Her platelet count was 71 × 109.l−1. Epidural anaesthesia was performed after platelet transfusion. A spinal epidural haematoma was diagnosed postoperatively. A generalised tonic–clonic seizure sparing the lower limbs enabled early diagnosis to be made. The patient recovered with no permanent neurological damage after laminectomy and clot removal. The risks and benefits of regional techniques require careful consideration, and postoperative monitoring for recovery of neural blockade is essential.