bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis
Authors: Mikkelsen T. S. , Toft P.
Published: June 2005

Background:  (I) To investigate the kinetics of the myoglobin and creatine kinase (CK) in rhabdomyolysis. Especially to describe those patients in whom an isolated increase in the myoglobin or the CK occurred at a later stage. (II) To evaluate the sensitivity of the myoglobin and the CK as prognostic tools for the development of Acute renal failure (ARF). (III) To investigate the effect of continuous venovenous haemodiafiltration (CVVHDF) on the myoglobin elimination in ARF.

Patients and methods:  Prospective and retrospective cohort study carried out in an ICU of a university hospital. A total of 47 critically ill patients with rhabdomyolysis and a plasma myoglobin > 5000 µg l−1 were admitted between July 1998 and July 2003.

Results:  (I) The myoglobin peaked 0.66 ± 0.6 days before the CK. The elimination kinetics of the myoglobin was faster than for the CK. (II) Fifty percent developed ARF. Mortality in the ARF patients was 52% compared to 14% in the non‐ARF patients. The sensitivity and specificity of developing ARF were higher with the myoglobin in comparison to the CK. (III) In non‐ARF, t½ CK was 25.5 h and t½ myoglobin was 17 h (13–23). In those with ARF treated with CVVHDF, t½ CK was 24.8 and t½ myoglobin was 21 h (17–29).

Conclusion:  (I) The myoglobin peaked earlier than the CK. (II) The myoglobin was a better prognostic tool than the CK. However, the myoglobin also has a wide interindividual range. (III) Though the myoglobin is eliminated in ultrafiltration t½ myoglobin, it was not faster in patients with ARF treated with CVVHDF compared to non‐ARF patients.
Carbon monoxide production from desflurane and six types of carbon dioxide absorbents in a patient model
Authors: Keijzer C. , Perez R. S. G. M. , De Lange J. J.
Published: June 2005

Background:  Desflurane is known to produce high concentrations of carbon monoxide (CO) in desiccated sodalime or Baralyme® (Allied Healthcare Products, St. Louis, MO). Desiccated absorbents without strong bases like potassium hydroxide or sodium hydroxide are reported to produce less or no CO at all. The purpose of this study is to compare the concentration of CO in an anesthesia circuit for desflurane with six different types of completely desiccated CO2 absorbents with less strong bases than sodalime.

Methods:  A patient model was simulated using a circle anesthesia system connected to an artificial lung. Completely desiccated CO2 absorbent (950 g) was used in this system. A low flow anesthesia (500 ml min−1) was maintained using desflurane. For immediate quantification of CO production a portable gas chromatograph was used.

Results:  Peak concentrations of CO were very high in Medisorb® (Datex‐Ohmeda, Hoevelaken, The Netherlands) and Spherasorb®(Intersurgical, Uden, The Netherlands) (13317 and 9045 p.p.m., respectively). It was lower with Loflosorb® (Intersurgical, Uden, The Netherlands) and Superia® (Datex‐Ohmeda, Hoevelaken, The Netherlands) (524 and 31 p.p.m., respectively). Amsorb® (Armstrong, Coleraine, N. Ireland) and lithium hydroxide produced no CO at all.

Conclusion:  Medisorb® and Spherasorb® are capable of producing large concentrations of CO when desiccated. Loflosorb® and Superia® produce far less CO under the same conditions. Amsorb® and lithium hydroxide should be considered safe when desiccated.
Intrathecal picrotoxin minimally alters electro‐encephalographic responses to noxious stimulation during halothane and isoflurane anesthesia
Authors: Dominguez C. L. , Barter L. S. , Antognini J. F.
Published: June 2005

Background:  Isoflurane and halothane act in the spinal cord to blunt ascending transmission of impulses to the brain resulting from noxious stimulation. Because intrathecal picrotoxin (an antagonist at the gamma‐aminobutyric acid‐A receptor) partially reverses the immobilizing effect of isoflurane and halothane, we hypothesized that the electroencephalographic response to noxious stimulation would likewise be partially reversed by intrathecal picrotoxin.

Methods:  Rats were anesthetized with isoflurane (n = 8) or halothane (n = 8) and a laminectomy performed. Following determination of minimum alveolar concentration (MAC), the electroencephalogram (EEG) was recorded during separate applications of a hindpaw clamp, tail clamp and electrical current to the tail at 0.8 and 1.2 MAC. Picrotoxin was then applied to the exposed spinal cord and the EEG response to noxious stimulation again determined.

Results:  The EEG was more active during halothane anesthesia than isoflurane (spectral edge frequency for 95% power: 25.6 ± 2.1 Hz vs. 23.1 ± 1.6 Hz, P < 0.05). Noxious stimulation usually caused the EEG to shift to higher frequencies (e.g. for 0.8 MAC halothane, median edge frequency for 50% power: from 7.6 ± 3.1 Hz to 10.7 ± 2.6 Hz, P < 0.05). Picrotoxin minimally affected this response.

Conclusions:  Noxious stimulation evokes an EEG response that is minimally altered by intrathecal picrotoxin. This suggests that isoflurane and halothane do not have GABAergic actions in the spinal cord that indirectly suppress the EEG response.
Desflurane induces more cerebral vasodilation than isoflurane at the same A‐line® autoregressive index level
Authors: Holmström A. , Åkeson J.
Published: June 2005

Background:  Clinical use of desflurane in neuroanesthesia remains under debate. Comparison of dose‐dependent vasodilatory properties between desflurane and isoflurane, the more traditional volatile agent for clinical neuroanesthesia, requires equianesthetic dosing of the agents. Reproducible neurophysiological measurements of the level of anesthesia in an individual, e.g. the A‐line® autoregressive index (AAI), can be used for an equipotent dosage of two volatile agents in the same individual.

Methods:  Desflurane and isoflurane, in randomized order, were titrated to a stable AAI level of 15–20 in 18 ASA I or II patients. The mean flow velocity (Vmca) and pulsatility index (PI) in the middle cerebral artery were then measured with transcranial Doppler at an end‐tidal CO2 concentration of 4.4%.

Results:  For desflurane Vmca was 11% higher [95% confidence interval (CI), 5–18%; P = 0.0020] and PI was 13% lower (95% CI, 3–23%; P  = 0.0083) than for isoflurane. The mean arterial blood pressure did not differ between the agents. The fraction of MAC necessary for the intended AAI level was 35% lower (95% CI, 20–49%; P = 0.00016) with desflurane than with isoflurane.

Conclusion:  Desflurane was associated with more cerebral vasodilation than isoflurane at the same depth of anesthesia, as indicated by the AAI. This attributes further reason for caution in the use of desflurane in clinical neuroanesthesia. The difference between desflurane and isoflurane in the MAC fractions required for the same AAI level confirms the limitations of MAC in defining the level of anesthesia.
Relationship between arterial and end‐tidal carbon dioxide pressures during anesthesia using a laryngeal tube
Authors: Lee J. S. , Nam S. B. , Chang C. H. , Han D. W. , Lee Y. W. , Shin C. S.
Published: June 2005

Background:  The Laryngeal Tube® (LT), (VBM Medizintechnik, Sulz, Germany) is a relatively new supraglottic device for controlling the airway. Arterial carbon dioxide tension (PaCO2) can be estimated by monitoring the end‐tidal tension of carbon dioxide (PETCO2). The relationship between PETCO2 and PaCO2 during controlled ventilation via the LT has not been reported.

Methods:  During general anesthesia, 45 patients were mechanically ventilated using an LT. PETCO2 and PaCO2 were measured once PETCO2 had reached a steady state. The LT was then removed and the trachea intubated using an endotracheal tube (ETT), and the identical ventilatory variables were resumed. Following stabilization, PETCO2 was again determined and PaCO2 estimated.

Results:  The mean PETCO2 and PaCO2 values were 4.43 ± 0.26 kPa and 4.67 ± 0.32 kPa, respectively, during LT ventilation, and 4.36 ± 0.23 kPa and 4.61 ± 0.26 kPa, respectively, during ETT ventilation. Analysis of differences between the PETCO2 and PaCO2 values using the Bland and Altman method revealed a bias ± precision of 0.24 ± 0.15 kPa for LT and 0.27 ± 0.15 kPa for ETT. The root mean square error was 0.28 for the LT and 0.30 for the ETT.

Conclusion:  This study suggests that for healthy adult patients mechanically ventilated via the LT, the PETCO2 value reflects the PaCO2 value as closely as when patients are ETT ventilated, allowing capnometry to be used to evaluate the adequacy of ventilation.
Propofol attenuates responses of the auditory cortex to acoustic stimulation in a dose‐dependent manner: A FMRI study
Authors: Dueck M. H. , Petzke F. , Gerbershagen H. J. , Paul M. , Heßelmann V. , Girnus R. , Krug B. , Sorger B. , Goebel R. , Lehrke R. , Sturm V. , Boerner U.
Published: June 2005

Background:  Functional magnetic resonance imaging (fMRI) using blood‐oxygen‐level‐dependent (BOLD) contrasts is a common method for studying sensory or cognitive brain functions. The aim of the present study was to assess the effect of the intravenous anaesthetic propofol on auditory‐induced brain activation using BOLD contrast fMRI.

Methods:  In eight neurosurgical patients, musical stimuli were presented binaurally in a block design. Imaging was performed under five conditions: no propofol (or wakefulness) and propofol plasma target concentrations of 0.5, 1.0, 1.5, and 2.0 µg ml−1.

Results:  During wakefulness we found activations in the superior temporal gyrus (STG) corresponding to the primary and secondary auditory cortex as well as in regions of higher functions of auditory information processing. The BOLD response decreased with increasing concentrations of propofol but remained partially preserved in areas of basic auditory processing in the STG during propofol 2.0 µg ml−1.

Conclusions:  Our results suggest a dose‐dependent impairment of central processing of auditory information after propofol administration. These results are consistent with electrophysiological findings measuring neuronal activity directly, thus suggesting a dose‐dependent impairment of central processing of auditory information after propofol administration. However, propofol did not totally blunt primary cortical responses to acoustic stimulation, indicating that patients may process auditory information under general anaesthesia.
Positive end‐expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum
Authors: Meininger D. , Byhahn C. , Mierdl S. , Westphal K. , Zwissler B.
Published: June 2005

Background:  Laparoscopic surgery usually requires the use of a pneumoperitoneum by insufflating gas in the peritoneal space. The gas most commonly used for insufflation is carbon dioxide. Increased intra‐abdominal pressure causes cephalad displacement of the diaphragm resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. The aim of this prospective study was to investigate the effect of prolonged intraperitoneal gas insufflation on arterial oxygenation and hemodynamics during mechanical ventilation with and without positive end‐expiratory pressure (PEEP).

Methods:  Twenty patients undergoing totally endoscopic robot‐assisted radical prostatectomy were randomly allocated to one of two groups. In the PEEP group (n = 10) a constant PEEP of 5 cmH2O was used, whereas in the ZPEEP group (n = 10) no PEEP was used.

Results:  Application of PEEP (5 cmH2O) resulted in significantly higher PaO2 levels after 3 h (182 ± 49 vs. 224 ± 35 mmHg) and 4 h (179 ± 48 vs. 229 ± 29 mmHg) of pneumoperitoneum; after desufflation, PaO2 values decreased significantly below preinsufflation values. While there were no significant differences in heart rate, central venous pressure (CVP) and mean arterial blood pressure (MAP) during pneumoperitoneum between both groups, baseline values in CVP and MAP differed significantly between both groups with higher levels in the ZPEEP group.

Conclusion:  The application of a constant positive airway pressure of 5 cmH2O preserves arterial oxygenation during prolonged pneumoperitoneum.
Auditory‐evoked potentials in general anesthesia monitoring: baseline study of availability in relation to hearing function in awake status
Authors: De Siena L. , Pallavicino F. , Lacilla M. , Canale A. , Longobardo A. , Pecorari G. , Albera R.
Published: June 2005

Background:  It has been confirmed that middle latency auditory‐evoked potentials are good indicators of the hypnotic level in patients undergoing general anesthesia. The focal point for the evocation of auditory‐evoked potentials is the presence of a serviceable hearing function. The aim of the study was to evaluate the limit of hearing loss above which the test could not be applied.

Methods:  To determine the limit of applicability of the technique, 100 subjects were studied. Twenty of them were normally hearing and 80 were affected by sensorineural hearing loss of various degrees. Each subject was submitted to pure tone audiometry, to determine hearing threshold, and then, in awake status, to auditory‐evoked potentials recording using acoustic stimuli of 85 dB HL.

Results:  All the 20 normally hearing subjects showed a reliable auditory‐evoked potentials. Among the 80 subjects affected by hearing loss, only five had no potentials. These five subjects presented a pure tone audiometry threshold greater than 85 dB HL.

Conclusion:  The study demonstrated that middle latency auditory‐evoked potentials recorded using an A‐Line® (software version 1.4) AEP monitor (Danmeter, Odense, Denmark) can be carried out even in presence of hearing loss if the pure tone threshold is less than 85 dB HL.
Nociceptin system does not affect MAC of volatile anaesthetics
Authors: Himukashi S. , Miyazaki Y. , Takeshima H. , Koyanagi S. , Mukaida K. , Shichino T. , Uga H. , Fukuda K.
Published: June 2005

Background:  Nociceptin is the endogenous agonist of the opioid receptor‐like (ORL) 1 receptor (NOP), and both nociceptin and NOP are widely expressed in the brain and spinal cord, which are target organs of general anaesthetics. As nociceptin has been reported to be involved in modulating pain mechanisms and stress responses, it is possible that the activity of the nociceptin system affects the anaesthetic potency of general anaesthetics. To address this possibility, we investigated the minimum alveolar concentrations (MACs) of various volatile anaesthetics in nociceptin receptor knockout mice (NOP–/–) and wild‐type mice (NOP+/+).

Methods:  We used male NOP–/– mice and NOP+/+ mice. MACs for halothane, isoflurane and sevoflurane were determined by the tail‐clamp method.

Results:  MACs for halothane, isoflurane and sevoflurane in NOP–/– mice were 1.60 (SD 0.06), 1.68 (0.08) and 3.36 (0.07)%, respectively. In NOP+/+ mice, MACs for halothane, isoflurane and sevoflurane were 1.59 (SD 0.07), 1.72 (0.07) and 3.38 (0.09)%, respectively.

Conclusion:  MACs in NOP–/– mice did not significantly differ from those in NOP+/+ mice for halothane, isoflurane and sevoflurane. This result suggests that the nociceptin system does not affect the anaesthetic potency of volatile anaesthetics.
Emotional and interpersonal factors are most important for patient satisfaction with anaesthesia
Authors: Capuzzo M. , Landi F. , Bassani A. , Grassi L. , Volta C. A. , Alvisi R.
Published: June 2005

Background:  Questionnaires to evaluate patient satisfaction with anaesthesia mainly consider physiological aspects. This study was performed to identify the items of value for patients having anaesthesia (pilot phase) and to validate the questionnaire built on these findings in a new group of inpatients.

Methods:  In the pilot phase, 100 surgical patients were interviewed and asked whether each of the 23 items selected by a panel of providers was relevant (score 1) and to rank these from 1 (additional score 6) to 5 (additional score 2). The resulting 10‐item final instrument was administered to 219 consecutive inpatients by interview, after recent anaesthesia, asking them how much of each item they received (item received) and the level of satisfaction with the same item, using Numerical Rating Scales (range 0–10).

Results:  In the pilot phase, gender, age, education and surgery did not influence the score enough to change the first 10 rank‐ordered items. The 219 patients subsequently studied did not differ from those missing the questionnaire administration. The patients aged less than 55 years showed lower satisfaction scores than those aged 55 years or more (P = 0.019). In all items, except ‘feeling anxious/frightened’, the item received was significantly associated with the satisfaction reported. ‘Kindness/regard of caregivers’ together with ‘information given by anaesthetist’ and ‘feeling safe’ predicted 47% of the variance in total patient satisfaction.

Conclusions:  Inpatients value highly those elements of care that pertain to emotional and interpersonal relationships.
Safety of mixture of morphine with ketamine for postoperative patient‐controlled analgesia: an audit with 1026 patients
Authors: Sveticic G. , Eichenberger U. , Curatolo M.
Published: June 2005

Background:  Adding ketamine to morphine for patient‐controlled analgesia (PCA) may be useful. However, data on this drug combination have been collected on small sample sizes. In order to evaluate the safety of the combination morphine– ketamine, we conducted a prospective study on a large patient population.

Methods:  Patient‐controlled analgesia was performed with 1026 patients using morphine and ketamine in a dose ratio of 1:1. All patients were treated in the ward. Prospectively collected data included incidence of complications and side‐effects, verbal pain scores at rest and during mobilization (0 = no pain to 4 = very strong pain), consumption of morphine and ketamine and patient satisfaction (0 = very unsatisfied to 3 = very satisfied).

Results:  The study included 462 women and 564 men who underwent, on average, 71.8 h (±56.1) of PCA. There were 698 orthopaedic, 160 abdominal, 96 thoracic, 20 vascular, 16 plastic, 15 neurosurgical, 11 urologic and 10 other surgical procedures. No complication was observed. Incidence of side‐effects was: 1.2% respiratory depression, 23.5% nausea, 6.2% vivid dreams and/or hallucinations, 21.4% sedation and 10.3% pruritus. Reasons for discontinuing the PCA were side‐effects (7.0%) and other (0.5%). Mean pain scores over the whole period were 0.44 (±0.54) at rest and 1.36 (±0.62) during mobilization. Mean satisfaction score was 2.52 (±0.69).

Conclusion:  Patient‐controlled analgesia with morphine and ketamine is safe. It produces side‐effects which, however, are infrequently a reason for discontinuing the regimen. It is also associated with low pain scores and high patient satisfaction.
Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure
Authors: Manser T. , Staender S.
Published: June 2005

An important element of how adverse events are handled is effective communication between health care providers and patients and their families. This review addresses the main questions: What do patients expect in the aftermath of an adverse event? What is known about the practice of open disclosure? How can organizations support health care providers in the aftermath of an adverse event, both professionally and personally?

Patients clearly expect open disclosure to include an explanation of what happened, an apology for harm done, that appropriate remedial action will be taken and an explanation of what will be done to learn from the event and to prevent recurrence.

Research has found that open disclosure is not very common although the ethical duty to disclose is widely acknowledged. Barriers to open disclosure include discomfort and a lack of training how to disclose, a fear of litigation, a culture of infallibility among health professionals, and inadequate systems for analysis, discussion and learning from mistakes.

Significant commitment is required from health care organizations and managers to develop frameworks for open disclosure to occur, to assure its quality and to support health care providers in this process. Organizations also need to address the emotional needs of health care professionals in the aftermath of an adverse event. Last but not least, adequate systems for debriefing and incident analysis need to be in place to learn from adverse events and to avoid recurrence.
Aspergillus fumigatus peritonitis in ambulatory peritoneal dialysis: A case report and notes on the therapeutic approach (Case Report)
Authors: BONFANTE LUCIANA , NALESSO FEDERICO , CARA MARILENA , ANTONELLO AUGUSTO , MALAGOLI ANDREA , PASTORI GIORDANO , GUIZZO MARTA , D’ANGELO ANGELA , GAMBARO GIOVANNI
Published: June 2005

SUMMARY:  Aspergillus peritonitis is a rare disease in continuous peritoneal dialysis. It is a severe form of peritonitis, which is frequently lethal. We report a case of Aspergillus fumigatus peritonitis in a female patient on automated peritoneal dialysis (APD), who was successfully treated with intravenous amphotericin B and the removal of the peritoneal catheter. As delayed treatment has an increased mortality rate, it is mandatory to remove the catheter and to start intravenous treatment with amphotericin B empirically.
Adult stem cells in renal injury and repair (Review Article)
Authors: RICARDO SHARON D , DEANE JAMES A
Published: June 2005

SUMMARY:  There has been considerable focus on the ability of bone marrow‐derived cells to differentiate into non‐haematopoietic cells of various tissue lineages, including cells of the kidney. This growing evidence has led to a reconsideration of the source of cells contributing to renal repair following injury. The kidney has an inherent ability for recovery and regeneration following acute damage. It is thought that dedifferentiation of glomerular and tubular cells to a more embryonic/mesenchymal phenotype represent key processes for recovery in response to damage. However, there has been much contention as to the source of regenerating renal cells. The present review focuses on new aspects of the plasticity of intrinsic renal cells and their role in renal remodelling and scarring. Growing support also suggests that bone marrow‐derived cells have the ability to contribute to structural and functional repair following acute renal failure. Evidence for bone marrow cell engraftment in the repairing kidney leading to incorporation into a variety of tissue types is discussed. Because cell death and fibrosis is a common end‐point in a variety of acute and chronic renal nephropathies, the paradigm of stem cell plasticity may have important implications in the cellular and pathological mechanisms of renal injury and repair. A better understanding of the processes controlling extra‐renal cell engraftment and intrinsic renal cell differentiation may provide important clues for the development of new cell‐based therapies in the field of renal reparative medicine.
Prospects for urinary proteomics: Exosomes as a source of urinary biomarkers (Review Article)
Authors: HOORN EWOUT J , PISITKUN TRAIRAK , ZIETSE ROBERT , GROSS PETER , FROKIAER JOERGEN , WANG NAM SUN , GONZALES PATRICIA A , STAR ROBERT A , KNEPPER MARK A
Published: June 2005

SUMMARY:  Recent progress in biotechnology offers the promise of better medical care at lower costs. Among the techniques that show the greatest promise is mass spectrometry of proteins, which can identify proteins present in body fluids and tissue specimens at a large scale. Because urine can be collected in large amounts in a non‐invasive fashion, the potential exists to use mass spectrometry to discover urinary biomarkers that are early predictors of renal disease, or useful in making therapeutic choices. Recently, the authors demonstrated that both membrane proteins and cytosolic proteins from renal epithelia are highly enriched in low‐density urinary structures identified as exosomes. Exosomes were found to contain many disease‐associated proteins including aquaporin‐2, polycystin‐1, podocin, non‐muscle myosin II, angiotensin‐converting enzyme, Na+K+2Cl‐ cotransporter (NKCC2), thiazide‐sensitive Na‐Cl cotransporter (NCC), and epithelial sodium channel (ENaC). Potentially, other disease biomarkers could be discovered by mass spectrometry‐based proteomic studies in well‐defined patient populations. Herein is described the advantages of using urinary exosomes as a starting material for biomarker discovery. In addition, the purpose of this review is to present an overall strategy for biomarker discovery in urine using exosomes and for developing cost‐effective clinical assays for these biomarkers, which can potentially be used for early detection of disease, as a means of differential diagnosis, or as a means of guiding therapy. Finally, potential barriers that need to be overcome before urinary proteomics can be applied clinically, are emphasized.
Hypersensitivity reactions to the polysorbate contained in recombinant erythropoietin and darbepoietin (Case Report)
Authors: STEELE RICHARD H , LIMAYE SANDHYA , CLELAND BRUCE , CHOW JOSEPHINE , SURANYI MICHAEL G
Published: June 2005

SUMMARY:  The following case reports are of two patients who have developed hypersensitivity reactions to the red cell growth hormones, darbepoietin and erythropoietin. The subsequent skin testing and clinical course suggested that the cause of these reactions was due to the excipient polysorbate 80. This finding might have implications in the recent increase in the incidence of pure red cell aplasia.
History of home haemodialysis in Australia (Review Article)
Authors: GEORGE CHARLES RP
Published: June 2005

SUMMARY: Australia has had an active and slowly expanding home haemodialysis programme; however, this has failed to expand as rapidly as some other methods of treatment of end‐stage kidney disease. The technique in Australia has always been a derivative from overseas experience, rather than innovative. It received some minor initial support from the report issued in 1968 by an ad‐hoc Committee of the National Health and Medical Research Council on Rationalization of Facilities for Organ Transplantation and Renal Dialysis, but was ultimately disadvantaged because the report promoted transplantation over dialysis to an extent that proved markedly disproportionate to the number of patients who, in succeeding decades, would need maintenance dialysis treatment rather than transplantation. Nevertheless, each state in Australia established home haemodialysis facilities, but major interstate variations occurred in the uptake of the modality. The subsequent development of continuous ambulatory peritoneal dialysis and limited care dialysis centres appeared to have an important negative impact on home haemodialysis, although the recent introduction of daily dialysis is likely to have a positive influence in the future.
Clinical risk factors associated with bleeding after native kidney biopsy
Authors: SHIDHAM GANESH B , SIDDIQI NAUMAN , BERES JOSEPH A , LOGAN BRENT , NAGARAJA HN , SHIDHAM SHUBHANGI G , PIERING WALTER F
Published: June 2005

Purpose:  To determine the effect of various risk factors on postbiopsy bleeding (PBB).

Procedure:  A retrospective review of 645 native kidney biopsies carried out from 1981 to 2001 was conducted. Data regarding age, gender, race, prebiopsy blood pressure, history of hypertension, pre‐ and postbiopsy haemoglobin/haematocrit, serum creatinine and blood urea nitrogen (BUN) were collected.

Findings:  The overall PBB complication rate was 6.2%. High blood pressure was associated with a high risk of bleeding (test for trend, P < 0.05). It increased when systolic blood pressure (SBP) was >160 mm of Hg, diastolic blood pressure (DBP) was >100 mm of Hg, or mean arterial pressure (MAP) was ≥120 mm of Hg. In patients with a history of hypertension, the risk of PBB was 3.74 times higher (P = 0.0001) than patients with no history of hypertension, irrespective of blood pressure at the time of biopsy. For patients with creatinine >2 mg/dL, the risk ratio for PBB was 5.89 when compared with patients with creatinine ≤2 mg/dL. Logistic regression analysis showed that a history of hypertension was associated with PBB, with an odds ratio of 1.89 (confidence interval, 1.10–3.26, P < 0.03), and serum creatinine of >2.0 mg/dL was associated with an odds ratio of 2.56 (confidence interval, 1.48–4.42, P = 0.001) for PBB.

Conclusions:  The risk of PBB increases with high SBP, DBP or MAP. A history of hypertension and high serum creatinine are significant independent risk factors for PBB.
Bad and good growth factors in the peritoneal cavity (Review Article)
Authors: FAULL RANDALL J
Published: June 2005

SUMMARY:  Progressive peritoneal membrane fibrosis, and associated loss of ultrafiltration and dialysis capacity, is an increasingly limiting problem with time on peritoneal dialysis. The primary culprit is the composition of the peritoneal dialysate, although episodes of peritonitis can hasten the process. At a molecular level, there is increasing evidence that several growth factors play key roles in the development of peritoneal membrane fibrosis. Transforming growth factor (TGF)‐β is widely implicated in pathological fibrosis, and a considerable body of evidence favours a similar role in the peritoneal membrane. Connective tissue growth factor (CTGF), a downstream mediator of TGF‐β‐induced fibrosis, has more recently been implicated in peritoneal membrane scarring. In contrast to the pleiotropic effects of TGF‐β, CTGF more specifically targets the fibrosis pathway, and so is an attractive candidate for inhibiting the damage to the membrane. Heparin‐binding epidermal growth factor‐like growth factor (HB‐EGF) has also been found in the peritoneal cavity, but its effect on peritoneal mesothelial cells suggests that it has a positive role in guiding membrane repair and avoiding pathological fibrosis. In the future, it is hoped that changes in peritoneal dialysis technology will create a better balance between the bad and good effects of these growth factors, which in turn will lead to more successful long‐term outcomes for this major renal replacement therapy.
Immunohistochemical detection of immunoglobulins and complements in formaldehyde‐fixed and paraffin‐embedded renal biopsy tissues; an adjunct for diagnosis of glomerulonephritis
Authors: CHOWDHURY AKM ROWNAK HOSSAIN , EHARA TAKASHI , HIGUCHI MAKOTO , HORA KAZUHIKO , SHIGEMATSU HIDEKAZU
Published: June 2005

Background:  The present study was undertaken to demonstrate the deposition of immunoglobulins or complements in formaldehyde‐fixed and paraffin‐embedded renal biopsy tissues through the unmasking of antigens with microwave treatment plus protease digestion or trypsin digestion.

Methods:  Biopsy samples from patients with IgA nephritis (n = 7), lupus nephritis (7), membranous nephropathy (7) and mesangiocapillary glomerulonephritis (3) were used. Antigen unmasking was performed with (i) microwave treatment plus protease digestion for 10, 30 or 60 min, or (ii) digestion with 0.25% trypsin for 60 or 120 min.

Results:  Microwave treatment plus protease digestion for 30 or 60 min and trypsin digestion for 120 min provided good results for the unmasking of immunoglobulins in glomeruli with structural preservation. The IgA deposits in IgA nephritis and IgG deposits in lupus nephritis and membranous nephropathy were clearly revealed in more than 80% of cases by both pretreatments. Microwave treatment plus protease digestion for 30 min revealed the deposition of C3 in all cases of mesangiocapillary glomerulonephritis and lupus nephritis and was superior to trypsin digestion. Characteristic patterns of C3 deposition were observed for these forms of glomerulonephritis, although C3 deposits in membranous nephropathy were detected in only 50% of cases. It was not possible to unmask all of the antigens in the glomeruli, especially those with weak immunofluorescence.

Conclusion:  Microwave treatment plus protease digestion is effective for the unmasking of antigens in paraffin sections and as useful for the diagnosis of immune‐mediated glomerulonephritis as trypsin digestion.
Expression of Fas, Bcl‐2 and p53 molecules in glomerulonephritis and their correlations with clinical and laboratory findings*
Authors: UĞUZ AYSUN , GÖNLÜŞEN GÜLFILIZ , ERGIN MELEK , TUNCER İLHAN
Published: June 2005

Background and Aim:  Apoptosis plays a crucial role in glomerulonephritis (GN) as a regulatory mechanism and is controlled by various molecules including Fas antigen, Bcl‐2 and p53 oncoproteins. The aim of the present study is to evaluate the correlation between the expression of these molecules and clinical and laboratory data in different types of GN.

Results:  The expression of Fas antigen, Bcl‐2 and p53 protein in five normal human kidney specimens and 55 tissues from patients with several types of GN were examined by immunohistochemistry and correlated with clinical and laboratory findings. The number of Fas‐positive intraglomerular cells was significantly increased in proliferative GN when compared with non‐proliferative cases. Numbers of Bcl‐2‐ and p53‐positive cells in proliferative GN were not different from the non‐proliferative cases and there was no correlation between the changes in Fas, Bcl‐2 and p53 themselves. Significant correlation of expression of these molecules with clinical and laboratory findings was not found, except between p53 and blood urea nitrogen levels.

Conclusion:  Apoptosis is a complex molecular process and the results of the present study should be supported with other methods to understand whether apoptosis contributes to progression or resolution of GN. Increased glomerular expression of Fas, Bcl‐2 and p53 molecules in all types of GN might contribute new therapeutic approaches by modulating the expression of these molecules.
Nocturnal haemodialysis in Australia and New Zealand (Review Article)
Authors: AGAR JOHN WM
Published: June 2005

SUMMARY:  Although early experience in Australia and New Zealand confirmed home haemodialysis to be well tolerated, effective and with lower morbidity and mortality compared with centre‐based haemodialysis, the advent of ambulatory peritoneal dialysis and ‘satellite’ haemodialysis has led to a steadily declining home haemodialysis population. However, the emergence of nocturnal haemodialysis, as a safe and highly effective therapy, has added to the modality choices now available and offers a new, highly attractive home‐based option with many advantages over centre‐based dialysis. For the patient, nocturnal haemodialysis means fluid and dietary freedom, less antihypertensive medication, the abolition of phosphate binders, the return of daytime freedom and the capacity for full‐time employment. Potential biochemical benefits include normalization of the blood urea, serum creatinine, albumin, β2 microglobulin, homocysteine and triglyceride levels and other nutritional markers. Improved quality of life and sleep patterns and a resolution of sleep apnoea have been shown. Left ventricular function has also shown marked improvement. For the provider, nocturnal home haemodialysis offers clear cost advantages by avoiding high‐cost nursing and infrastructure expenditure. Although consumable and equipment costs are higher, the savings on wage and infrastructure far outweigh this added expenditure. These combined factors make nocturnal haemodialysis an irresistible addition to comprehensive dialysis services, both from a clinical outcome and fiscal perspective.
Encapsulating peritoneal sclerosis (Review Article)
Authors: KAWANISHI HIDEKI
Published: June 2005

SUMMARY:  Since the first peritoneal dialysis (PD) patients with encapsulating peritoneal sclerosis (EPS) were reported in 1980, EPS has been considered primarily a fatal complication. The incidence of EPS in PD patients has been reported to be from 0.7% to 7.3%, and the rate appears to be higher in patients receiving long‐term treatment. Most data from Japan has shown an overall incidence of 2.5% with an evident negative effect of increasing duration of PD, which also augments mortality. Since EPS occurred after withdrawal from PD in more than half of the patients, strict monitoring is necessary when a long‐term PD patient is withdrawn from PD. Maintaining patients on standard PD for more than 8 years using conventional solutions is associated with a substantial risk for development of EPS. Appropriate treatment according to the disease stage is most important in EPS treatment. Therefore, when examining a PD patient complaining of gastrointestinal symptoms, the possibility of EPS has to be kept in mind. Basic therapeutic tactics for EPS include appropriate use of steroids. If the state of bowel obstruction persists, laparotomy and enterolysis should be performed to obtain a complete cure. It is now recognized that EPS is not a fatal complication of PD.
Use of CobraPLATM for airway management in a neonate with Desbuquois syndrome. Case report and anesthetic implications
Authors: SZMUK PETER , MATUSZCZEAK MARIA , CARLSON RICHARD F. , DAVID WARTERS R. , RABB MARY F. , EZRI TIBERIU
Published: June 2005

We present the anesthetic management of an infant with Desbuquois syndrome (a rare form of micromelic dwarfism) with a possible difficult airway. The anesthetic implications of this syndrome are presented. The airway was managed with a new supraglottic device – the CobraPLA. Although intubation through this device was not possible in this instance, CobraPLA provided a satisfactory supraglottic airway. It was easy to insert and provided satisfactory conditions for positive pressure ventilation. The CobraPLA provides another option for airway management.
A survey of the use of capnography for the confirmation of correct placement of tracheal tubes in pediatric intensive care units in the UK
Authors: CUMMING CRAIG , McFADZEAN JILLIAN
Published: June 2005

Background : The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland recommend the use of capnography to ensure correct tracheal tube placement in the theater environment. Correct tracheal tube placement is essential in the care of ventilated patient, even more vital if the patient is critically ill, if serious morbidity and mortality is to be avoided. This survey examined the availability and use of capnography to confirm correct tracheal tube placement in the pediatric intensive care unit (PICU) in the UK.

Methods : A questionnaire concerning the use of capnography to confirm tracheal tube placement were sent to the lead clinicians of every PICU in the UK.

Results : A total of 19 replies were received from 26 (73%) consultants. One unit did not have a capnograph, 13 units (68%) had one capnograph for several beds and five units (26%) had one capnograph for each bed. Two units (11%) used capnography for every intubation and in 10 units (52%) the use of capnography was dependent on individual physician preference. Eight consultants (42%) felt that confirming tracheal tube placement by capnography should be mandatory after every intubation whether in the ward, A & E, or PICU. A total of 89% of PICUs have trainees with <1 year anesthetic experience compared with 65% of adult ICUs.

Conclusions : The use of capnography to confirm tracheal tube placement may be even more important in the PICU than in adult ICU.
Acute quadriplegic myopathy in a 16‐month‐old child
Authors: IODICE FRANCESCA , SALZANO MARCO , PROSPERI MONICA , D’ AMICO ADELE , LAURI ALDO , BERTINI ENRICO
Published: June 2005

We present a case of a 16‐month old previously healthy child who was hospitalized because of an acute respiratory insufficiency most likely caused by a viral infection and who then developed a severe acute quadriplegic myopathy (AQM). Initial clinical symptoms were respiratory acidosis, dypnea, intense wheezing, and deterioration of the level of consciousness, which required orotracheal intubation and mechanical ventilation. We administered neuromuscular blocking agents, corticosteroids, and antibiotics. After 9 days the clinical picture improved. An attempt to wean from the ventilator failed. We diagnosed AQM. This paper discusses AQM and its clinical importance.
Clonidine administered as adjuvant for bupivacaine in ilioinguinal–iliohypogastric nerve block does not prolong postoperative analgesia
Authors: KAABACHI OLFA , ZERELLI ZIED , METHAMEM MEHDI , ABDELAZIZ AHMED BEN , MONCER KHALED , TOUMI MOHSEN
Published: June 2005

Background : Coadministration of clonidine with local anesthetics is associated with improvement of the quality of peripheral nerve block and significant prolongation of postoperative analgesia. Better analgesia has been reported with clonidine in ilioinguinal nerve block compared with caudal use. The object of this study was to determine whether adding of 1 μg·kg−1 clonidine to bupivacaine 0.25% in ilioinguinal–iliohypogastric nerve block prolongs postoperative analgesia in children.

Methods : Ninety‐eight children ASA I–II aged between 1 and 12 years, scheduled for elective outpatient herniorrhaphy or orchidopexy were randomly allocated to receive an ilioinguinal–iliohypogastric nerve block either with 0.3 ml·kg−1 bupivacaine 0.25% plus 1 μg·kg−1 clonidine or only bupivacaine. Postoperative analgesic needs, time to the first analgesic supplementation and sedation score were assessed in hospital for 6 h postoperatively and at home by telephone call.

Results : Demographic data were similar in both groups. There was no statistical difference in the rate of rescue analgesia between the two groups during the first six postoperative hours (20.4% group clonidine vs 30.6% group no clonidine) (P = 0.17). A slight decrease in systolic blood pressure during surgery was reported in the clonidine group. There was no difference in the scores of sedation between the two groups. At home, 10 patients in the clonidine group and nine patients in the nonclonidine group received analgesic medication. There was no difference between the two groups regarding the number of patients receiving analgesic rescue during the first 24 h (log rank = 0.39). Parental satisfaction was high in both groups.

Conclusions : Our study failed to demonstrate any advantage in addition of 1 μg·kg−1 clonidine to 0.25% bupivacaine for ilioinguinal–iliohypogastric nerve block compared with bupivacaine 0.25% alone.
Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia
Authors: TANDER BURAK , BARIS SIBEL , KARAKAYA DENIZ , ARITURK ENDER , RIZALAR RIZA , BERNAY FERIT
Published: June 2005

Background : The factors affecting the thermal status in neonates and infants undergoing general anesthesia are not yet investigated in detail. We evaluated the factors leading to intraoperative hypothermia in 60 neonates and infants.

Methods : The initial body temperatures and the core temperatures at the 10th, 30th, 60th and 90th minute of anesthesia, as well as at the end of the operation were recorded. The patients were divided into the groups according to the age, type of surgery (minor vs major), operating room (OR) temperatures (low ‘<23°C’ vs high ‘>23°C’) and the initial core temperature of the patients.

Results : In 31 neonates and 29 infants, the mean core temperatures decreased 10 min after anesthesia induction. In all neonates and in infants with ‘low OR temperature’ (<23°C), these decreases continued to the end of the surgery. Except infants undergoing minor surgery, in all patients, the core temperatures at the end of surgery were lower than the baseline temperature. The greatest decrease in core temperatures occurred in neonates undergoing major surgery and with low OR temperature. In low OR temperature, the decrease of core temperature is higher in patients with major surgery. In patients undergoing minor surgery, the decrease of core temperature is more in neonates than infants. Major surgery increased the chance of decrease of the core temperature by 2.66 times and operating room temperature less than 23°C by 1.96 times.

Conclusion : The type of surgery and the OR temperature are the main factors for decrease of the core temperature in neonates and infants. In neonates, the core temperatures are less stable, regardless of OR temperature and type of surgery. In high OR temperature, infants can stabilize their core temperature better than neonates.
Comparison of the effects of clonidine and ketamine added to ropivacaine on stress hormone levels and the duration of caudal analgesia
Authors: AKBAS MERT , AKBAS HALIDE , YEGIN ARIF , SAHIN NURSEL , TITIZ TULIN AYDOGDU
Published: June 2005

Background : The purpose of this study was to compare the analgesic quality and duration of ropivacaine 0.2% with the addition of clonidine (1 μg·kg−1) with that of ropivacaine 0.2% and the addition of ketamine (0.5 mg·kg−1) to that of ropivacaine 0.2% and also compare the postoperative cortisol, insulin and glucose concentrations, sampled after induction and 1 h later following caudal administration in children.

Methods : According to the randomization, patients in the ropivacaine group (R; n = 25) received ropivacaine 0.2%, 0.75 ml·kg−1; those in the clonidine group (RC; n = 25) received ropivacaine 0.2% 0.75 ml·kg−1 plus clonidine 1 μg·kg−1 and those in the ketamine/ropivacaine group (RK; n = 25) ropivacaine 0.2% 0.75 ml·kg−1 plus ketamine 0.5 mg·kg−1 (10 mg·ml−1 concentration). Drugs were diluted in 0.9% saline (0.75 ml·kg−1) and prepared by a staff anesthesiologist not otherwise involved in the study. In all groups, the duration of analgesia, analgesic requirements, sedation and insulin, glucose, cortisol concentrations were recorded and statistically compared.

Results : There were no significant differences among the three study groups with respect to age, weight or duration of surgery. Caudal administration of clonidine 1 μg·kg−1 or ketamine 0.5 mg·kg−1 induced a longer duration of analgesia (P < 0.05) compared with ropivacaine alone. Insulin levels were increased and cortisol reduced in all groups. Glucose concentration was increased in all groups and statistically significant (P < 0.05).

Conclusions : Addition of ketamine and clonidine to ropivacaine 0.2% 0.75 ml·kg−1, when administered caudally in children, prolongs the duration of postoperative analgesia. The need for subsequent postoperative analgesic is also reduced. Caudal analgesia attenuates or allows partial changes to postoperative cortisol, insulin or blood glucose responses to surgery.
Marked variation in oxycodone pharmacokinetics in infants
Authors: POKELA MARJA‐LEENA , ANTTILA EIJA , SEPPÄLÄ TIMO , OLKKOLA KLAUS T.
Published: June 2005

Background : The pharmacokinetics of oxycodone (13‐hydroxy‐7,8‐dihydrocodeinone) has been studied in adults and in children who are older than 6 months but there is no information on the disposition of oxycodone in neonates and young infants. The aim of this study was to study the pharmacokinetics of oxycodone in infants varying in age from 0 to 6 months.

Methods : Twenty‐two infants undergoing surgery were given postoperatively an intravenous bolus of 0.1 mg·kg−1 of oxycodone hydrochloride. Ten of the patients were younger than 1 week (group 1), six from 1 week to 2 months (group 2) and six from 2 to 6 months (group 3). Plasma samples were collected for the analysis of oxycodone concentrations up to 24 h. Pharmacokinetics were characterized by noncompartmental methods.

Results : The median (range) values for the clearance (Cl) were 9.9 (2.3–17.2), 20.1 (3.7–40.4) and 15.4 (14.8–80.2) ml·min−1·kg−1 in the above three groups. The values for volume of distribution at steady‐state were 3.3 (1.9–4.7), 5.6 (1.3–8.5) and 3.2 (1.8–6.0) l·kg−1 and for elimination half‐life (t1/2) 4.4 (2.4–14.1), 3.6 (1.6–11.6) and 2.0 (0.8–3.9) h, respectively. Both Cl (r = 0.46) and half‐life (r = −0.46) were correlated to the age of the patient (P < 0.05). There were 13 patients who were on mechanical ventilation at the time of oxycodone administration. None of the spontaneously breathing infants had hypoventilation which required assistance during the study.

Conclusions : The values for Cl and t1/2 varied greatly between the subjects. This variability was most pronounced in the two youngest groups. Routine dosing of oxycodone in young infants may be dangerous. The dose of oxycodone must be titrated individually.