bluuebunny/crossref_metadata_2025 huggingface dataset:
The politics and practices of intersectional prefiguration in social movements: The case of Sisters Uncut
Authors: Ishkanian Armine , Peña Saavedra Anita
Published: January 2019

Considering contemporary movements as sites of struggle between attempts at inclusiveness and enduring tendencies to exclude and reproduce power hierarchies, this article examines how movement actors confront and tackle inequalities within their organisational spaces. Drawing on an in-depth study, which relied on Participatory Action Research methods, of the intersectional feminist anti-austerity group Sisters Uncut, the article analyses how actors collectively define and translate intersectionality into practice and the challenges they face in enacting this form of politics, which the authors call intersectional prefiguration. The authors consider intersectional prefiguration as a form of radical democratic politics which acknowledges relations of domination and seeks to transform them within both movements and society. The article discusses how enacting intersectional prefiguration is predicated on actors developing a collective identity, embracing a commitment to organise intersectionally, and adopting specific methodologies through which to do so. The findings have relevance to scholars of social movements and intersectionality and can help advance our understandings of the ways in which movements, prefigurative and otherwise, drive social change and transformative politics and the challenges they face in this process.
From Evidence-based to Market-based mHealth: Itinerary of a Mobile (for) Development Project
Authors: Al Dahdah Marine
Published: January 2019

Information and communication technologies are increasingly used for development in the Global South, and mHealth (health assisted by mobile technologies) plays key role. This paper analyzes the particular relationship to science that characterizes a global maternal mHealth program deployed in Ghana and India. Using science and technology studies (STS), this research relies on qualitative interviews conducted between 2014 and 2016 with funders, implementers, and beneficiaries of this mHealth program. This story begins with a randomized controlled trial, a biomedical experiment with a strong positioning regarding science and the production of evidence. But rapidly the scientific stance disappears to give way to the testing and marketing of a product for the digital economy. From science to market, this paper offers to revisit a classical STS topic through the lens of mHealth. It shows how the various experimental forms taken by this project fundamentally diverge from scientific methods and evidence production and at the same time how it nurtures an ongoing instrumental relationship with science. Thus, from clinical research to product marketing, this paper highlights the tenuous link between evidence-based and market-based mHealth in the Global South.
Peripheral Vestibulopathy Presenting as Acute Vertigo and Spontaneous Nystagmus with Negative Video Head Impulse Test
Authors: Lee Jung‐Yup , Kim Chang‐Hee , Park Jin Su , Kim Min‐Beom
Published: January 2019

Objective

To analyze acute vertigo showing spontaneous nystagmus with negative video head impulse test (vHIT).

Study Design

Retrospective chart analysis.

Setting

Tertiary referral hospital.

Subjects and Methods

Over 16 months, 155 patients were identified with acute vertigo with spontaneous nystagmus. Of these 155, 30 (19.4%) were enrolled in this study because they did not show gain loss or catch‐up saccades in both sides of the horizontal vHIT. Results of vestibular function tests (videonystagmography, horizontal vHIT, caloric test, and cervical vestibular‐evoked myogenic potential [cVEMP]) and pure tone audiometry were analyzed. For all cases, magnetic resonance imaging with diffusion‐weighted imaging was checked.

Results

Patients consisted of 17 with Ménière's disease and 7 with sudden sensorineural hearing loss with vertigo (SSNHL_V), and only 3 patients were finally diagnosed as having acute vascular stroke. Except for the loss of hearing on the lesion side, the direction of nystagmus or cVEMP asymmetry showed very different results. All 7 patients with SSNHL_V did not have canal paresis in the caloric test, but cVEMP amplitude was smaller on the lesion side for 6 patients.

Conclusions

For patients with acute vertigo presenting spontaneous nystagmus with negative horizontal vHIT, it is important not only to focus on the diagnosis of acute vascular stroke but also to evaluate hearing because of the high possibility of Ménière's disease or SSNHL_V.
Implication of eruption of caseous calcification of mitral annulus
Authors: Enomoto Yoshinori , Sudo Yoshio , Hasegawa Hideomi
Published: January 2019

A 74-year-old female with caseous calcification of the mitral annulus and interstitial pneumonia was admitted with stroke due to calcific emboli. Computed tomography revealed an oval calcification with homogeneous density in and scattered calcification under the posterior mitral annulus, which was detected for the first time. Computed tomography performed during treatment for pneumonia and stroke showed changes in the shape and density of the caseous calcification; however, scattered calcification under the mitral annulus persisted. Operative findings were consistent with the signs on computed tomography: a white, soft, plaster-like content and similar scattered material around the chordae of the posterior leaflet.
Surgical management of esophageal perforation: role of primary closure
Authors: Huu Vinh Vu , Viet Dang Quang Nguyen , Van Khoi Nguyen
Published: January 2019

Objective

Esophageal perforation is a life-threatening condition associated with high mortality and morbidity. Ambiguous clinical presentation is one of the most common causes of delayed and difficult diagnosis of esophageal perforation. In this retrospective single-center study, we reviewed the outcome of primary closure in patients with esophageal perforation between 2009 and 2017.

Methods

The data of 65 patients attending our department of thoracic surgery (from 2009 to 2017) for esophageal perforation were reviewed. Primary repair was attempted in 63 patients irrespective of the site of perforation and time interval between injury and hospital admission. In intrathoracic lesions, continuous mediastinal and pleural irrigation was undertaken, whereas in cervical perforations, gauze packing and local irrigation were performed. Jejunotomy was carried out in patients with inadequate healing.

Results

Of the 65 patients, 63 underwent primary closure and 2 were left to heal spontaneously. The majority of patients ( n = 44) had an esophageal perforation at the thoracic level, and only one was admitted early (<24 h after injury). Among the 63 patients managed with primary closure, 55 had satisfactory healing with one surgery. Healing was delayed in the other 10 patients. No mortality was reported.

Conclusions

Esophageal perforation can be well managed by primary closure, irrespective of the time interval between injury and hospital admission and the site of perforation. Conservative management might lead to an increased rate of complications such as empyema or necrotizing mediastinitis, and increased morbidity and mortality.
Music teachers and their implementation of the new Music Curriculum Standards in China
Authors: Yu Zhuo , Leung Bo-Wah
Published: January 2019

The Ministry of Education of China issued a new document of Music Curriculum Standards in 2011 substituting the old version of 2001. This study aims to investigate how music teachers in China implement and respond to the Curriculum Standards through a questionnaire survey and semi-structured interviews with voluntary teachers. A total of 2206 music teachers from 15 regions/provinces responded to the survey in 2015. Findings reveal that, after a few years of implementation, most teachers found different constraints in implementing the new curriculum. Trained teachers, younger teachers and experienced teachers are more receptive and capable in implementing the curriculum, while rural schools are still in a disadvantaged situation. Most teachers do not understand the concept of music education as aesthetic education. In-service training is found to be insufficient, especially in rural schools. In sum, the current ‘knowledge-centered curriculum’ might need to be redirected to the directions of society-centered and student-centered in order to make a balance.
A genetic deletion of the serotonin transporter differentially influences the behavioural effects of MDMA
Authors: Pettie Michaela , Oakly Alana , Harper David N , Ellenbroek Bart A
Published: January 2019

Background:

While (±)-3,4-methylenedioxymethamphetamine (MDMA) primarily induces serotonin release, it also affects dopamine and noradrenaline transmission. It is, however, unclear what role each of these neurotransmitters play in the behavioural profile of MDMA.

Methods:

In this study we used the drug discrimination (DD) and the acoustic startle (ASR) paradigms to examine the behaviour of rats with and without a genetic deletion of the serotonin transporter SERT (SERT−/− and SERT+/+ rats). In DD, rats were trained to respond on different levers following an injection of 1.5 mg/kg MDMA, or saline. After acquisition, they were given a challenge dose of 0.5 mg/kg amphetamine (AMPH). In the ASR paradigm, SERT+/+ and SERT−/− rats were given 0, 5 or 10 mg/kg MDMA.

Results:

In DD, significantly fewer SERT−/− rats acquired MDMA discrimination. When the acquirers were challenged with AMPH, SERT+/+ showed partial, while SERT−/− rats showed full generalisation to MDMA. In the ASR paradigm, MDMA significantly reduced prepulse inhibition and startle habituation in SERT+/+ rats, while having no effect in SERT−/− rats.

Conclusion:

Together these data suggest that in wildtype rats the interoceptive cues of MDMA are primarily mediated by serotonin and to a lesser extent by dopamine and noradrenaline, while the effects in the startle paradigm are almost exclusively mediated via serotonin. Together, these data contribute to our understanding of the complex pharmacodynamics of MDMA.
Reliable Graphs for SLAM
Authors: Khosoussi Kasra , Giamou Matthew , Sukhatme Gaurav S , Huang Shoudong , Dissanayake Gamini , How Jonathan P
Published: January 2019

Estimation-over-graphs (EoG) is a class of estimation problems that admit a natural graphical representation. Several key problems in robotics and sensor networks, including sensor network localization, synchronization over a group, and simultaneous localization and mapping (SLAM) fall into this category. We pursue two main goals in this work. First, we aim to characterize the impact of the graphical structure of SLAM and related problems on estimation reliability. We draw connections between several notions of graph connectivity and various properties of the underlying estimation problem. In particular, we establish results on the impact of the weighted number of spanning trees on the D-optimality criterion in 2D SLAM. These results enable agents to evaluate estimation reliability based only on the graphical representation of the EoG problem. We then use our findings and study the problem of designing sparse SLAM problems that lead to reliable maximum likelihood estimates through the synthesis of sparse graphs with the maximum weighted tree connectivity. Characterizing graphs with the maximum number of spanning trees is an open problem in general. To tackle this problem, we establish several new theoretical results, including the monotone log-submodularity of the weighted number of spanning trees. We exploit these structures and design a complementary greedy–convex pair of efficient approximation algorithms with provable guarantees. The proposed synthesis framework is applied to various forms of the measurement selection problem in resource-constrained SLAM. Our algorithms and theoretical findings are validated using random graphs, existing and new synthetic SLAM benchmarks, and publicly available real pose-graph SLAM datasets.
Water Metabolism
Authors: Phillips P. J.
Published: January 2019

Total body water is finely regulated and controls of intake and output are maximally activated by small osmotic changes. Sensors in the hypothalamus invoke the fluid repletion or depletion reactions through changes in thirst, urine concentration and solute intake. Antidiuretic hormone controls urinary concentration and is released mainly in response to osmotic stimuli. However, the threshold and sensitivity of this response are affected by non osmotic stimuli. Urine concentration varies in response to antidiuretic hormone only if the distal tubule, collecting duct and hypertonic medullary interstitum are intact. The capacity to conserve or excrete water depends on the osmolar load and an efficient urinary concentrating or diluting mechanism.

Disorders of thirst are uncommon and often associated with abnormal antidiuretic hormone secretion. Disorders of urine concentration and dilution are common in illness and reflect abnormalities of antidiuretic hormone secretion or the renal mechanisms generating the osmotic gradient. When urine concentrating capacity is impaired ( true or nephrogenic diabetes insipidus) water depletion occurs only when thirst fails or access to water is denied. When urine diluting ability is impaired, water excess occurs when the osmolar load and minimum urinary osmolality generated are inadequate for the fluid intake.

Hyper-osmolality and hypo-osmolality are usually caused by abnormal water metabolism although they may be associated with abnormalities of solute metabolism. The various clinical syndromes are determined by the primary disease, and the associated fluid volume and osmolar abnormalities.
Potassium Metabolism
Authors: Stockigt J. R.
Published: January 2019

In man, mechanisms for potassium excretion are complex and highly developed, while potassium conservation is potentially inadequate. Potassium balance is regulated by alterations in excretion in the distal renal tubule, where mineralocorticoid hormones and Na-K A T Pase are the major regulating factors. The distribution of potassium across cell membranes is influenced by changes in acid-base status, by pancreatic hormones and by the autonomic nervous system. Potassium stimulates insulin and aldosterone secretion and increases Na-K AT Pase in the distal nephron, so promoting its own redistribution or excretion. Emergency management of hyperkalaemia is best effected by promoting cell-entry of potassium, rather than renal excretion. The speed of replacement of deficits is always limited by the small extracellular potassium pool.
Intra-Operative Fluid and Electrolyte Requirements
Authors: Davidson George M.
Published: January 2019

The intravenous administration of Hartmann's solution at a rate sufficient to maintain the hourly urine volume between 0.5 and 1.0 ml/ kg/ hr is recommended during major operations. Intra-operative extracellular volume expansion followed by the administration of sodium containing fluids for 48 hours postoperatively decreases the incidence of haemodynamic instability and acute renal failure and results in normal water and sodium excretion by the kidney throughout the peri-operative period. Abnormal extracellular volume may exist prior to induction of anaesthesia particularly in patients with pre-existing cardiovascular, renal and hepatic disease. In these patients the suggested fluid regime should be administered with care and may require diuretic therapy.

If the operative blood loss in adults is less than one litre, no blood may be necessary. If the loss is between one and 2 litres packed red cells may be sufficient, whereas with a greater loss, filtered whole blood, coagulation factors and platelet infusions may be required. When possible, transfusions of stored autologous blood is recommended for elective operations.
Hydrogen Ion Metabolism
Authors: Worthley L. I. G.
Published: January 2019

The renal and respiratory systems regulate acid base homeostasis by modifying the bicarbonate buffer pair HCO3- and CO2; other buffer systems adjust to alterations in this pair.

The pH change following addition of metabolic acid, or base, is modified initially by the body's buffers. Subsequent respiratory compensation, by retention or excretion of CO2, modifies further this change before renal corrective responses finally occur. A primary respiratory acid base change is modified initially by cellular buffers, with renal compensatory mechanisms adjusting slowly to this change. However correction of the respiratory pH disorder only occurs with correction of the primary disease process. The body's capacity, therefore, to adjust to a metabolic acid base defect, appears greater than that observed with a primary respiratory pH abnormality.

Treatment in all acid base disorders focuses initially upon the primary diseases process; thereafter therapeutic manipulation of the HCO3 -, CO2 buffer pair, to aid the body's compensatory processes, can be considered.
Calcium, Phosphorus and Magnesium Turnover
Authors: Thomas D. W.
Published: January 2019

The body content of calcium, phosphorus and magnesium is important, not only from the structural or supporting aspect, but also from the aspect of cellular function. Membrane integrity, nervous tissue conduction, neuromuscular excitability, muscle contraction, hormone secretion, intermediary metabolism and synthesis, to mention but a few activities, are all influenced by these elements.

The normal body content and turnover of calcium, phosphorus and magnesium are outlined, together with a brief description of their physiological roles, emphasizing intracellular functions rather than their predominance within the skeleton. Regulatory mechanisms, particularly for calcium, involving vitamin D and its metabolites, parathormone, and possibly calcitonin, are discussed within the context of maintaining normal body content and turnover. Homeostatic mechanisms maintaining plasma concentrations in health and disease, as far as they have been identified, are also outlined. Lastly, disorders of calcium, phosphorus and magnesium turnover are considered from the aspect of altered plasma concentrations of these substances.

Throughout emphasis is given to common problems and their practical management. Metabolic bone disease and uncommon disorders of bone and bone mineral are not discussed specifically.
Post-Operative Respiratory Resistance
Authors: Morton A.
Published: January 2019

Respiratory resistance was studied pre-operatively and post-operatively in a group of patients undergoing abdominal surgery. Respiratory resistance was shown to be markedly increased post-operatively in patients with chronic bronchitis and slightly increased in nonbronchitic patients.
Blood Glucose Changes during Neurosurgery
Authors: Male Christopher G.
Published: January 2019

Blood glucose levels were studied prospectively in 40 patients undergoing elective major craniotomy. A significant (p < 0.01) hyperglycaemic response was noted after scalp infiltration with adrenaline and incision (0.5 mmol/l) and with continued surgery (0.9 mmol/l). Patients aged 50 years and under showed a significantly greater rise with adrenaline and incision than older patients (0.8 compared with 0.4 mmol/l p < 0.01). Preoperative high dose steroid therapy did not modify the response Blood glucose changes were unrelated to sex, obesity, a family history of diabetes, the duration of starvation, intraoperative body temperature, anaesthetic technique induced hypotension or blood loss.
Intradermal Testing in the Diagnosis of Acute Anaphylaxis during Anaesthesia — Results of Five Years Experience
Authors: Fisher M. McD.
Published: January 2019

Intradermal testing has been used in the diagnosis of acute anaphylactic reactions during anaesthesia in 51 patients.

Positive results occurred in 32 patients and confirmation was possible in 26. Only in one case did a combination of history and intradermal testing not give a diagnosis. Nine of the negative results were confirmed.

Intradermal testing is of no value in the diagnosis of reactions to local anaesthetics or colloids but has great value in determining the cause of reactions due to induction agents or muscle relaxants if performed under controlled conditions. It is safe, and requires no expertise in performance or interpretation.
Severe Bronchospasm in an Asthmatic Patient following Alcuronium and D-Tubocurarine
Authors: Yeung M. L. , Ng L. Y. , Koo Assumpta W. L.
Published: January 2019

An asthmatic patient developed intense bronchospasm immediately following the administration of alcuronium and d-tubocurarine in the same anaesthetic. Intradermal test was positive for both of these drugs but negative for thiopentone and suxamethonium, both of which were given prior to alcuronium. The differential diagnosis and the possible mechanism of the reaction are discussed.
Clinical Presentation of Haemolytic Transfusion Reactions
Authors: Webster B. H.
Published: January 2019

Haemolytic transfusion reactions can be defined as the occurrence after transfusion of measurably increased destruction of red cells, of donor or recipient, by alloantibodies. They may be acute (occurring within 24 hours of transfusion) or delayed (when signs of red cell destruction do not occur until 4 to 10 days after transfusion).

The severest signs and symptoms of acute reactions follow intravascular red cell lysis and progress to anaemia, fever, haemoglobinuria and jaundice. The subjective responses of pain, restlessness, nausea, skin flushing, dyspnoea and shock are mediated by cleavage products of complement (C3a, C5a) activated by red cell antigen-antibody reaction. The bleeding and renal failure complications that follow are multi-factoral in aetiology but also stem from the activation of intravascular clotting and from the vasomotor disturbances following histamine and kinin release.
Maximal Conservation and Minimal Usage of Blood Products in Open Heart Surgery
Authors: Newland P. E. , Pastoriza-Pinol J. , McMillan J. , Smith B. F. , Stirling G. R.
Published: January 2019

Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.
Accidental Intubation of the Oesophagus
Authors: Pollard B. J. , Junius F.
Published: January 2019

It is widely accepted and taught that the accidental placement of a tracheal tube in the oesophagus can be readily detected if it is looked for, though it is recognised that death from this cause occurs from time to time. Evidence is now presented of instances where anaesthetists have been misled by a range of tests which are commonly used to check the correct placement of a tracheal tube. An explanation is offered for this unexpected finding, and some recommendations are formulated to improve patient safety.
Post Carotid Endarterectomy Hypertension
Authors: Davies M. J. , Cronin K. D.
Published: January 2019

Blood pressure changes following carotid endarterectomy were studied in 39 patients undergoing 42 carotid endarterectomies, in order to establish the incidence of hypertension and to study the use of hydrallazine for its treatment.

Hypertension occurred in 28 cases (66%) and was treated with intravenous hydrallazine in a dose of 20 ±8 mg; this resulted in a systolic blood pressure fall of 46 ±22 mmHg, diastolic blood pressure fall of 24 ± 12 mmHg, mean blood pressure fall of 31 ± 15 mmHg, and a pulse rate increase of 7 ±9 beats per minute. Hydrallazine is a safe, effective drug for the treatment of intraoperative hypertension.
Unexplained Hepatitis following Halothane: Case Report
Authors: Pollard B. J. , Coombs J.
Published: January 2019

A 50-year-old woman suffered severe jaundice following a second anaesthetic, two weeks after an anaesthetic which had been followed by fever and malaise. An initial diagnosis of “probable halothane hepatitis” was made. This diagnosis is discussed, together with some implications.
Biplanar Angiography through Swan-Ganz Catheters
Authors: Thompson K. J. , Wattie W. J. , Hayes A. R.
Published: January 2019

Twenty-eight patients had biplanar angiography performed through wedged Swan-Ganz Catheters. In only five cases were the catheter tips symmetrically placed within the vessels in both AP and lateral views. The value of performing angiography immediately after placement of a Swan-Ganz catheter is discussed.
Anaphylaxis to Muscle Relaxants: Cross Sensitivity between Relaxants
Authors: Fisher M. McD.
Published: January 2019

Two patients are described who had clinical anaphylaxis due to muscle relaxants. One patient had systemic hypersensitivity and positive intradermal tests to d-tubocurarine and alcuronium. The second had systemic hypersensitivity to d-tubocurarine and positive intradermal tests to d-tubocurarine, alcuronium, and pancuronium. It is suggested that positive intradermal tests to more than one relaxant may mean allergy to more than one relaxant rather than false positive test. Cross sensitivity between alcuronium and d-tubocurarine occurs and a similar situation may exist for suxamethonium and gallamine. When intradermal testing is carried out after anaesthetic reactions all relaxants should be tested.
Hyperosmolar Non-Ketotic Diabetic Coma — Less Sodium in Therapy?
Authors: To Luen Bik , Phillips P. J.
Published: January 2019

Eighteen patients with hyperosmolar non-ketotic diabetic coma were studied retrospectively to identify factors affecting prognosis and to review treatment. This condition affected older women two-thirds of whom were unrecognised diabetics. Eight (44%) died. Mortality correlated with age above 60, uraemia and hyperosmolarity, but not with the degree or rate of fall of hyperglycaemia. Hyperglycaemia responded to rehydration and insulin, but in all patients serum osmolarity remained high for several days. In 14 patients (78%) the serum sodium concentration initially increased and in four (22 %) serum osmolarity increased. This persistence or worsening of the hyperosmolar state can be avoided without the risk of cerebal oedema by replacing the fluid and electrolyte deficits over 48 hours and using 5% dextrose for the water deficit.
The pH and Titratable Acidity of Stored CPD Blood
Authors: Gaudry P. L. , Duffy C. , Joseph D.
Published: January 2019

Blood stored in citrate-phosphate-dextrose (CPD) solution for periods up to 20 days had a mean pH 6.71. The mean metabolic hydrogen ion excess was 32 mmol/litre and the mean respiratory hydrogen ion excess was 80 mmol/litre. These results for CPD blood are compared with those obtained on acid-citrate-dextrose blood.

A prediction is made that clinically, only small variations in metabolic and respiratory acid-base balance would be produced directly due to the acid and base loads in transfused blood.
Effect of Halothane and Enflurane Anaesthesia on the Level of Reduced Glutathione in Human Red Blood Cells
Authors: Agar N. S. , Lewis G. B. H.
Published: January 2019

No significant changes were found in packed cell volume, haemoglobin concentration and red cell glutathione levels in patients before and after anaesthesia with halothane or enflurane. These results, though unable to explain the mechanism, support the earlier suggestion that glutathione plays little, if any, role in protecting liver against toxic effects of these anaesthetic agents or their metabolites.
The Period of Nasotracheal Intubation in Acute Epiglottitis
Authors: Phelan P. D. , Mullins G. C. , Laundau L. I. , Duncan A. W.
Published: January 2019

Experience during the last three years with nasotracheal intubation in children with acute epiglottitis indicates that a period of intubation of 8–12 hours after the institution of appropriate antibiotic therapy is satisfactory in most patients. Shortening the period of intubation should have benefits to the patient. A shorter period of intubation should provide less opportunity for complications to develop and allow earlier discharge.
Comparison of Thiopentone and Methohexitone as Induction Agents for Caesarean Section
Authors: Morgan M. , Holdcroft A. , Whitwam J. G.
Published: January 2019

Anaesthesia was induced with equipotent doses of either thiopentone or methohexitone in 127 women undergoing Caesarean section. They divided into three groups: those having normal placental function, those with an undefinable degree of placental insufficiency, and emergencies. There was no clinical or biochemical difference in the neonates following induction of anaesthesia with either thiopentone or methohexitone. The clinical condition of neonates born of mothers with normal placental function was superior to the other two groups.
Acute Intracranial Hypertension occurring during Infusion of Stable Plasma Protein Solution
Authors: Duncan A. W. , Gleeson M. T.
Published: January 2019

A case of traumatic cerebral oedema is reported in which the infusion of small volumes of stable plasma protein solution (SPPS) resulted in acute and massive increases in intracranial pressure. The batch of SPPS responsible was found to have high levels of prekallikrein activator which is thought to be the cause of the systemic hypotension previously described with plasma proteins solutions. A second batch of SPPS with low levels of prekallikrein activator generated much smaller increases in intracranial pressure. The mechanism of this phenomenon is discussed and a recommendation made for the cautious use of SPPS when intracranial hypertension is present or suspected.
Etomidate: A foreshortened clinical trial
Authors: Yelavich P. M. , Holmes C. McK.
Published: January 2019

A clinical evaluation of etomidate for outpatient cystoscopy was embarked upon. Unpremedicated patients were given fentanyl 1 $mUg/kg followed by etomidate 0.3 mg/kg. Anaesthesia was maintained with intermittent etomidate in 2–4 mg doses. Patients were interviewed personally later the same day, and by questionnaire three to four weeks later.

The trial was discontinued after 20 cases because of an unacceptable incidence of side effects. Venous pain occurred in 68% of patients and 50% had redness, pain or swelling related to the injection site, in some cases lasting up to three weeks after anaesthesia. Skeletal movements occurred in 50% of patients; 30% experienced respiratory upset, one sufficiently severe to necessitate abandoning the technique. Nausea and vomiting occurred in 40% and 25% had disturbing emergence psychoses.
A Controlled Trial of Pain on Skin Infiltration with Local Anaesthetics
Authors: Morris R. W. , Whish D. K. M.
Published: January 2019

A double-blind, randomised controlled trial was performed to compare the pain experienced on intradermal and subcutaneous injection of lignocaine 1% with adrenaline 1:100,000, lignocaine 1%, procaine 1% and normal saline. A linear analogue pain scale was used to assess pain. Lignocaine with adrenaline caused the most pain and was more painful than lignocaine 1%, which in turn was more painful than procaine or normal saline. These differences were significant at p < 0.05 or greater for all comparisons except procaine 1% and normal saline. In conclusion, procaine 1% appears to be the local anaesthetic of choice from among those tested for intradermal and subcutaneous injection.
Epidural Pethidine for Relief of Episiotomy Pain
Authors: Duffy Brian L. , Read M. D.
Published: January 2019

Epidural pethidine was compared with epidural saline for relief of pain from episiotomy wounds. Pethidine 25 mg administered by the lumbar epidural route produced significant analgesia. However, the incidence and severity of episiotomy pain are so variable that routine use of the technique is not recommended.
Haemotherapy for Acute Haemorrhage
Authors: Isbister James P.
Published: January 2019

In this review blood component therapy for acute haemorrhage is summarised. As the haemotherapy is frequently the cornerstone of a successful outcome of haemorrhagic shock, attention to details in relation to the indications, safety and efficiency is essential. Massive blood transfusion brings with it many potential complications which may jeopardise a successful outcome for the patient after skilful medical and surgical care has controlled the basic problem.
Blood Conservation in Elective Surgery
Authors: Davies Michael J. , Cronin Keith D.
Published: January 2019

Blood conservation for elective surgery involves both the reduction of blood loss and the reduction of homologous blood transfusion. Methods of reducing blood loss such as the use of tourniquets, vasoconstrictor drugs, regional anaesthetic supplements and hypotensive anaesthesia are considered briefly. Preoperative and intraoperative techniques of autotransfusion and haemodilution are considered in detail, including a technique of scavenging and reinfusing blood aspirated from the surgical site.
Autotransfusion: An Impossible Dream?
Authors: Isbister James P.
Published: January 2019

Despite the many critics of autologous blood transfusion, there is virtually no literature to support such an attitude in relation to any form of premeditated autologous blood transfusion. It is only in relation to intraoperative blood scavenging that there have been complications. In contrast, there is considerable literature supporting the theoretical and practical advantages of autologous transfusion and haemodilution and a wealth of evidence pointing to the immediate and delayed complications of homologous transfusions.

In this paper autologous blood transfusion is reviewed with particular emphasis on the factors responsible for its failure to achieve a widely accepted place in clinical medicine despite its theoretical, practical and economic advantages.
The Provision of Blood for Elective Surgery
Authors: Dodds A. J. , Pun A.
Published: January 2019

The improvement in efficiency of blood use within a hospital is a major responsibility of the hospital blood bank. Such an improvement can be brought about by introducing a group and antibody screen system or by limiting the amount of blood routinely cross-matched for any procedure. Data to justify this can be best provided with the use of a blood bank microcomputer. Although autologous blood transfusion is the ideal it is difficult to implement in many situations and so homologous blood is used. The use of red cell concentrates in elective surgery has not been shown to be inferior to whole blood in most procedures.
Alterations in Blood Components during Storage and their Clinical Significance
Authors: Lovric V. A.
Published: January 2019

Storage-dependent changes in blood and components as affecting a patient with acute haemorrhage are described. With currently used preservatives and additives blood qualifies as “fresh” for two weeks after collection. Modified red cell concentrates are the optimal form of initial haemotherapy, with the possible exception of massive blood transfusion. Availability of platelet concentrates and other haemostatic blood components as routinely issued by a modern blood bank should meet almost all requirements for an acutely bleeding patient.
Central Venous and Pulmonary Artery Occlusion Pressures following Air Embolism in Upright Sheep
Authors: Pfitzner J. , McLean A. G.
Published: January 2019

A study on five upright (head above thorax) anaesthetised sheep demonstrated a statistically significant increase in central venous pressure and decrease in pulmonary artery occlusion pressure, following the injection of air 2 ml per kg into the pulmonary artery. In two out of the five sheep after air embolism, right-sided pressures equalled or exceeded those on the left, confirming their potential susceptibility to paradoxical air embolism.
Spinal Anaesthesia Revisited: An Evaluation of Subarachnoid Block in Obstetrics
Authors: Brownridge P.
Published: January 2019

A series of 442 women receiving subarachnoid block for various obstetrical procedures is described. These included caesarean section, instrumental delivery, manual removal of placenta, insertion of cervical suture and miscellaneous procedures. General anaesthesia was required in ten patients because subarachnoid block proved to be unsatisfactory.

There were no serious complications. The overall headache rate, ascertained by daily direct questioning during hospital admission, was 26.2%. Clinical features of dural puncture headache (DPH) were present in 8.6% and equivocally so in a further 3.4%. A significantly higher incidence of DPH was recorded among patients receiving a cervical suture. Among the thirty-eight patients who developed DPH, a 25 or 26 SWG spinal needle had invariably been used and in most instances the procedure was described as being uneventful. There were no consistent technical features among the patients who developed DPH, although operator experience may have been a factor. DPH was graded as ‘severe’ in ten patients (2.3%) and an epidural blood patch was rapidly curative in each of these cases. One patient required a repeat patch.

Subarachnoid block proved to be a satisfactory technique for the procedures outlined in the survey. It proved to be particularly valuable when anaesthesia was required urgently in the delivery suite and may even be regarded as the anaesthetic of choice in these circumstances.
The Airway of Patients with a Lipid Storage Disease
Authors: Wark H. , Gold P. , Overton J.
Published: January 2019

There have been no previous reports in the anaesthetic literature regarding the airway management during anaesthesia of patients with a lipid storage disease. In a 40-year period (1942-1982) at a busy paediatric hospital 15 patients with a lipid storage disease were anaesthetised on 19 occasions. Eight patients were intubated, three of them twice. No difficulties in airway management during anaesthesia were documented.
Epidermolysis Bullosa — a Review of 15 Years’ Experience, including Experience with Combined General and Regional Anaesthetic Techniques
Authors: Boughton R. , Crawford M. R. , Vonwiller J. B.
Published: January 2019

Eight patients with epidermolysis bullosa received a total of 60 anaesthetics for 67 procedures over the fifteen-year period 1972 to 1986. On twenty-three occasions patients were intubated. On thirteen occasions general anaesthesia was supplemented by regional blockade, involving a total of thirty-four local anaesthetic blocks. Complications from intubation were minimal and none were seen related to regional blockade.
Infusion Thrombophlebitis: A Prospective Comparison of 645 Vialon® and Teflon® Cannulae in Anaesthetic and Postoperative Use
Authors: Gaukroger P. B. , Roberts J. G. , Manners T. A.
Published: January 2019

A prospective study of the incidence and severity of infusion thrombophlebitis in peripheral intravenous infusions used for anaesthetic and postoperative purposes in 645 patients was conducted over a four-month period. Conditions of insertion were carefully controlled while ward management was according to standard practice. A total of 330 polyurethane Vialon® and 315 FEP-A Teflon® cannulae were used. The results show that the nature of the cannula was the single most important factor in the incidence and severity of infusion thrombophlebitis, Vialon® cannulae being associated with a 46% lower incidence than the Teflon® type. Less important but significant factors included intravenous antibiotics, duration of infusion, cannula tip damage and caesarean section. Factors not associated with infusion thrombophlebitis included potassium therapy, blood transfusion or site of insertion in the upper limb. Heparinisation increased duration of infusion without affecting the incidence of infusion thrombophlebitis.
Cardiovascular Changes during Deep Halothane Anaesthesia in Infants and Children
Authors: Tibballs J. , Malbezin S.
Published: January 2019

Cardiac output, blood pressure and heart rate were measured with noninvasive techniques before, during and after induction of anaesthesia with halothane and after intubation in unpremedicated infants and in diazepam-atropine premedicated children presenting for elective surgery. Cardiac output was measured with pulsed doppler echocardiography. Left ventricular shortening fraction was estimated with M-mode echocardiography during induction. Induction with halothane in infants caused significant decrements in blood pressure, cardiac index, stroke volume index and significant depression of left ventricular shortening fraction. Induction with halothane in diazepam-atropine premedicated children caused a significant increase in heart rate but significant decreases in blood pressure, stroke volume index and left ventricular shortening fraction while cardiac index decreased slightly. Intubation in infants caused a mild increase in heart rate compared with pre-induction values but blood pressure, cardiac index and stroke volume index remained below pre-induction values. Intubation in diazepam-atropine premedicated children caused significant increases in heart rate and cardiac index, and a nonsignificant increase in blood pressure but stroke volume index remained significantly below pre-induction values. Healthy infants and children tolerate induction of anaesthesia with halothane to a depth to permit intubation but large reductions in cardiac output and myocardial contractility are expected with subsequent reductions in blood pressure.
Anaesthesia for Extracorporeal Shockwave Lithotripsy at the Victorian Lithotripsy Service — the First 300 Patients
Authors: Silbert B. S. , Kluger R. , Dixon G. C. E. , Berg J.
Published: January 2019

A prospective survey was undertaken of the anaesthesia for the first 300 patients at the Victorian Lithotripsy Service. The majority (71.7%) were not hospitalised on site, including four quadriplegics and two ASA grade IV patients. Two hundred and eighty-three (94.3%) patients received continuous lumbar epidural anaesthesia, sixteen (5.3%) received general anaesthesia and one received a spinal anaesthetic. Eighty-two patients (27.3%) underwent ancillary procedures at the time of extracorporeal Shockwave lithotripsy. The most common intraoperative complications were hypotension (72 patients, 25.4%) and shivering (39 patients, 13.8%). Arrhythmias occurred in nine (3%) patients. There was a 90% patient follow-up rate and the most common postoperative complication was backache (101 patients, 37.4%). The problems of anaesthesia for extracorporeal Shockwave lithotripsy are discussed. Epidural anaesthesia offers a number of advantages for this procedure and proved very suitable for the majority of patients.
Anaesthesia for Closed Embolisation of Cerebral Arteriovenous Malformations
Authors: O'Mahony B. J. , Bolsin S. N. C.
Published: January 2019

Cerebral arteriovenous malformation embolisation is a therapeutic, neuroradiological procedure involving injection of bucrylate glue into the nidus of the A V malformation to obliterate the abnormal vascular network. These procedures may involve significant risks, are often long and thereby necessitate the need for some form of sedation and for adequate monitoring of the cerebral, cardiovascular and respiratory systems.

The anaesthetic management of a series of twenty patients undergoing embolisation of a cerebral arteriovenous malformation is outlined, seven general and nineteen neurolept anaesthetics being administered. Neurolept anaesthesia is the preferred technique as neurological assessment during the procedure is possible and complications may be diagnosed immediately. Systemic arterial hypotension may facilitate the embolisation process and various agents, including glyceryl trinitrate and sodium nitroprusside, have been employed for this purpose.
Effect of Continuously Warmed Irrigating Solution during Transurethral Resection
Authors: Harioka T. , Murakawa M. , Noda J. , Mori K.
Published: January 2019

The effects of a continuously warmed irrigating solution on body temperature during transurethral resection of the prostate and of bladder tumours were studied in forty patients. Anaesthesia was spinal and deep body temperatures of the forehead and lower abdomen were measured, using a deep body thermometry system. Both forehead and lower abdominal deep body temperatures decreased significantly in the patients who underwent transurethral resection of the prostate with an irrigating solution at operating room temperature, but did not decrease in the patients who received a continuously warmed irrigating solution. The same results were obtained for the patients who underwent transurethral resection of bladder tumour. Our results indicate that a continuously warmed irrigating solution could prevent the fall in body temperature during transurethral resection, especially prostate resection, under spinal anaesthesia.
Central Venous Catheter Stiffness and its Relation to Vascular Perforation
Authors: Bersten A. D. , Williams D. R. G. , Phillips G. D.
Published: January 2019

Delayed central venous perforation is an uncommon but serious complication of central venous catheter insertion. An increase in catheter stiffness may have been responsible for our association of venous perforation with use of a guidewire insertion technique. A bench model was used to investigate the stiffness characteristics of thirty-four different types of catheters. The initial stiffness is poorly described by material or catheter gauge. A large range of values is seen between apparently similar catheters — the 16 gauge polyethylene catheter associated with two perforations at our institution had an initial stiffness value 7.5 Nm 2 X 10 -5 at 37°C in comparison with our previous standard—the 16 gauge Deseret Intracath with an initial stiffness of 2 Nm2 X 10 -5. Multilumen catheters had a similar range of stiffness to single lumen catheters, while paediatric catheters in general were less stiff. Dialysis catheters were up to five times as stiff as the stiffest central venous catheter. Stiffness decayed at a rate and to an extent which differed from catheter to catheter. Absorption of water by the catheter appears to be one factor involved in stress relaxation.
A Continuous High Flow Intermittent Mandatory Ventilation System Incorporating a Downs Venturi Device and a Modified Nuffield Series 200 Ventilator
Authors: Breen D. P. , Spiers A. D. , Stokes J. W.
Published: January 2019

Systems for respiratory support are becoming increasingly expensive and complex. Many systems suffer inadequacies when used for spontaneous ventilation. Some modes on newer ventilators are rarely used because of the complex controls and settings. There is no truly universal ventilator that satisfies every intensivist's wishes. CPAP/IMV is becoming accepted as the standard management of many patients with acute respiratory failure and there would be few intensive care units where CPAP/IMV is not used for part of a patient's respiratory support. We describe a cost-effective system that may be used for respiratory support in the spontaneously breathing mode. This system combines a high flow venturi, an efficient humidifier and an inexpensive reliable ventilator that can be used for adult and paediatric patients. The system, primarily for use in patients breathing spontaneously, functions well in patients requiring full ventilation.
Experience with the Preoperative Invasive Measurement of Haemodynamic, Respiratory and Renal Function in 100 Elderly Patients Scheduled for Major Abdominal Surgery
Authors: Older P. , Smith R.
Published: January 2019

The extent of physiological disturbance in a preoperative population of 100 elderly patients scheduled for elective major surgery was measured. Haemodynamic, respiratory and renal function were evaluated preoperatively in the intensive care unit. Of these patients 13% had serious problems requiring either postponement of the operation (7%) or its cancellation (6%). Cardiac index was 2.2 l/min/m2 or less in 11% of patients; creatinine clearance 50 ml/min or less in 19% of patients; mean blood pressure was equal to or exceeded 120 mmHg in 15% of patients and intrapulmonary shunt equalled or exceeded 15% in 10% of patients. The mean duration of stay in the intensive care unit was four days, including the preoperative day. The logistics of preoperative admission were implemented without undue difficulty.