bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of surface retrieved cloud optical properties with in situ measurements at the Atmospheric Radiation Measurement Program (ARM) South Great Plains site
Authors: Min Q.‐L. , Duan M. , Marchand R.
Published: September 2003

Cloud optical properties inferred from a multifilter rotating shadowband radiometer have been validated against in situ measurements during the second ARM Enhanced Shortwave Experiment (ARESE II) field campaign at the ARM South Great Plains (SGP) site. On the basis of eight aircraft in situ vertical profiles (constructed from measurements), Forward Spectra Scattering Probe (FSSP), we find that our retrieved cloud effective radii for single‐layer warm water clouds agree well with in situ measurements, within 5.5%. A sensitivity study also illustrates that (for this case) a 13% uncertainty in observed liquid water path (LWP, 20 g/m2) results in 1.5% difference in retrieved cloud optical depth and 12.7% difference in inferred cloud effective radius, on average. The uncertainty of the LWP measured by the microwave radiometer (MWR) is the major contributor to the uncertainty of retrieved cloud effective radius. Further, we conclude that the uncertainty of our inferred cloud optical properties is better than 5% for warm water clouds based on a surface closure study, in which cloud optical properties inferred from narrowband irradiances are applied to a shortwave model and the modeled broadband fluxes are compared to a surface pyranometer.
Factors affecting short‐ and long‐term changes of spectral UV irradiance at two European stations
Authors: Arola A. , Lakkala K. , Bais A. , Kaurola J. , Meleti C. , Taalas P.
Published: September 2003

There have been relatively few studies that have attempted to separate the effects of the different factors affecting the short‐ and long‐term changes of UV radiation. The effect of ozone is fairly easily represented, but that of other factors (surface albedo, aerosols, clouds) is more complex. In this paper, we present a methodology that can account for the other effects as well. We have used this methodology to study what part of the short‐ and long‐term variability of measured spectral UV data from Sodankylä, Finland (67°N), and Thessaloniki, Greece (40°N), is explained by each factor. It was found that the effect of ozone on the short‐term variability of monthly mean irradiance can be almost as high as 100%, whereas on average it is about 35%. The corresponding impacts by clouds are typically smaller, 40% and 12%, respectively. During May the albedo‐related effect is strongest at Sodankylä, being 21% at its maximum and 7% on average at monthly levels. The amplitude of the variability caused by ozone is much stronger at Sodankylä than at Thessaloniki, so a longer time series at the former place is needed to detect any possible long‐term trend. In the Thessaloniki time series there is no significant ozone‐related increase. In the summer data from Thessaloniki, however, there is a long‐term increase, which is mainly caused by cloudiness. It was found that it is crucial to check the spectral data for any possible wavelength shift, if the long‐term variability at a single wavelength is studied. Moreover, it was demonstrated that if the irradiance measurements of a given solar zenith angle (SZA) range are selected, the use of even the rather narrow band of 2° can introduce an effect that hampers trend detection. In other words, it is important to remove the effect of SZA and normalize all the measurements to some constant SZA value.
Heterogeneous nucleation as a potential sulphate‐coating mechanism of atmospheric mineral dust particles and implications of coated dust on new particle formation
Authors: Korhonen H. , Napari I. , Timmreck C. , Vehkamäki H. , Pirjola L. , Lehtinen K. E. J. , Lauri A. , Kulmala M.
Published: September 2003

The plausibility of heterogeneous conucleation of water, sulphuric acid, and ammonia as a pathway leading to soluble coating of atmospheric mineral dust is investigated. In addition, the effect of such sulphate‐coated dust on the formation and growth of atmospheric aerosol particles is addressed. The simulated new particle formation mechanism is ternary nucleation of water, sulphuric acid, and ammonia vapors, while in the condensational growth process the effect of condensable organic vapor is also studied. The results indicate that soluble coating of dust by heterogeneous nucleation can occur at atmospheric sulphuric acid concentrations. In addition, the simulations show that homogeneous ternary nucleation and subsequent growth are decoupled. Although observed (or even higher) dust concentrations are unable to inhibit new particle formation, coated dust particles acting as condensation and coagulation sinks can prevent the growth of newly formed particles to detectable sizes. This is particularly true in desert areas, where organic vapor concentrations are low.
Stream temperature‐equilibrium temperature relationship
Authors: Bogan Travis , Mohseni Omid , Stefan Heinz G.
Published: September 2003

Equilibrium temperature is the water temperature at which the sum of all heat fluxes through the water surface is zero. It can be calculated from weather data. Mean weekly stream temperature was found to be linearly related to mean weekly equilibrium temperature above 0°C. The slopes and intercepts of the linear relationship were used to identify effects of shading, sheltering, cold water inputs (groundwater, meltwater, and deep reservoir releases) and warm water inputs (wastewater, cooling water, and lake surface water). The linearity hypothesis was confirmed for data from 596 U.S. Geological Survey stream gaging stations in the eastern and central United States. For approximately 15% (89 of 596, NSC ≥ 0.90) of stream gaging stations, weekly equilibrium temperature was a good estimator of weekly stream temperature with zero wind sheltering and sun shading. With sheltering and shading the number rose to 26% (156 of 596). For these streams the heat exchange through the water surface has the most controlling effect on stream temperatures. For the remaining 74% of streams the relationship between weekly stream temperature and weekly equilibrium temperature was also linear, but its slope was significantly less than 1.0 (even after calibration for shading and sheltering), indicating that processes other than surface heat exchange have an influence. Cold water inflows were dominant for 8% (46 of 596) of stream gaging sites. Less than 5% of all stream gaging stations showed evidence of unnatural heat inputs. Fitting an equilibrium temperature linearly to recorded stream temperatures, e.g., at a weekly timescale, can be of use to project stream temperatures under different weather‐climate scenarios or to identify both natural and anthropogenic heat and hydrologic inputs to streams.
To tell or not to tell: barriers and facilitators in family communication about genetic risk
Authors: Forrest K , Simpson SA , Wilson BJ , Van Teijlingen ER , McKee L , Haites N , Matthews E
Published: September 2003

Communication about genetic risk in families is an important issue for genetic counsellors. The objective of this study was to explore the barriers and facilitators in family communication about genetic risk. Semi‐structured interviews were undertaken with patients in the Northeast of Scotland who had attended genetic counselling for risk of hereditary breast and ovarian cancer and Huntington's disease, and with some spouses/partners. The interviews confirmed that the issue of disclosure was a problem for some, and that there were generic communication issues common to both groups. Telling family members about genetic risk was generally seen as a family responsibility and family structures, dynamics and ‘rules’ influenced disclosure decisions. A sense of responsibility towards younger generations was also important. The level of certainty felt by a person in relation to his or her own risk estimate also influenced what he or she could tell other family members. Communication within a family about genetic risk is a complex issue and is influenced by both pre‐existing familial and cultural factors and individuals' responses to risk information. If genetic counsellors understood how these factors operate in individual families they might be able to identify effective strategies to promote considered decisions and prevent unnecessary emotional distress.
Ring chromosome 17: phenotype variation by deletion size
Authors: Shashi V , White JR , Pettenati MJ , Root SK , Bell WL
Published: September 2003

Ring chromosome 17 is a rare cytogenetic abnormality, with 12 previous reports in the literature. Some have a relatively mild phenotype characterized by seizures, mental retardation, skin changes and short stature. Other patients have Miller–Dieker syndrome (MDS), which includes lissencephaly, multiple dysmorphic features, severe mental retardation and shortened life expectancy.

We describe two new cases of ring chromosome 17 and review the literature. Our cases and the other reports of patients without a deletion encompassing the Miller–Dieker region, delineate a fairly distinctive subgroup of individuals with ring 17, whose phenotype consists of growth and mental retardation, seizures, minor dysmorphic features, café‐au‐lait spots and retinal flecks. This classification of ring 17 into two distinct groups based on the size of the deletion and the phenotypic manifestations should facilitate clinical suspicion of this rare chromosomal abnormality.
Design of peptide mimetics of HIV‐1 gp120 for prevention and therapy of HIV disease
Authors: Veljkovic N. , Branch D.R. , Metlas R. , Prljic J , Vlahovicek K. , Pongor S. , Veljkovic V.
Published: September 2003

Abstract: It has been reported that the C‐terminus of the second conserved region (C2) of the envelope glycoprotein gp120, encompassing peptide RSANFTDNAKTIIVQLNESVEIN (NTM), is important for infectivity and neutralization of the human immunodeficiency virus type 1 (HIV‐1). It was also demonstrated that human natural anti‐vasoactive intestinal peptide (VIP) antibodies reactive with this gp120 region play an important role in control of HIV disease progression. The bioinformatic analysis based on the time‐frequency signal processing revealed non‐obvious similarities between NTM and VIP. When tested against a battery of sera from 46 AIDS patients, these peptides, in spite of a significant difference in their primary structures, showed a similar reactivity profiles (r = 0.83). Presented results point out that similarity in the periodical pattern of some physicochemical properties in primary structures of peptides plays a significant role in determination of their immunological crossreactivity. Based on these findings, we propose this bioinformatic criterion be used for design of VIP/NTM peptide mimetics for prevention and treatment of HIV disease.
Combinations of turns in proteins
Authors: Guruprasad K. , Rao M. J. , Adindla S. , Guruprasad L.
Published: September 2003

We observed that β‐ and γ‐turns in protein structure may be associated as peptides representing combinations of turns that span between nine and 26 amino acid residues along the polypeptide backbone chain and often correspond to loops in the protein structure. Around 475 peptides resulted from the analysis of a non‐redundant data set corresponding to 248 protein crystal structures selected from the Protein Data Bank. Nearly 40% protein chains are associated with two or more peptides and the peptides with nine and 10 amino acid residues are more frequent. A maximum of four distinct peptides varying in number of amino acid residues were observed in at least 10 proteins along the same protein chain. Nearly 80% peptides comprise type IV β‐turns that are associated with irregular dihedral angle values suggesting this may be important for the conformational diversity associated with the loops in proteins. In general, predominant interactions that possibly stabilize these peptides involve main‐chain and side‐chain interactions with solvent, in addition to hydrogen bond, salt‐bridge and non‐bonded interactions. Majority of the peptides were observed in hydrolase, oxidoreductase, transferase, serine proteinase/inhibitor complex, electron transport/electron transfer and lyase proteins.
Seizure duration with remifentanil/methohexital vs. methohexital alone in middle‐aged patients undergoing electroconvulsive therapy
Authors: Smith D. L. , Angst M. S. , Brock‐Utne J. G. , DeBattista C.
Published: September 2003

Background:  The object of this study was to test whether substituting part of the methohexital dose with the short‐acting opioid remifentanil would prolong seizure duration in middle‐aged patients while providing a similar depth of anesthesia as with methohexital alone. This has been reported for the combined use of methohexital and remifentanil in elderly patients, but has not been investigated in middle‐aged patients likely to require a higher total dose of methohexital for inducing anesthesia.

Method:  Seven patients (42±10 years; mean ±SD) receiving electroconvulsive therapy (ECT) were anesthetized with methohexital (1.25 mg kg−1) or with methohexital (0.625 mg kg−1) plus remifentanil (1 µg kg−1) in this randomized, double blind, crossover study. Additional methohexital was given as needed until loss of eyelash reflex was observed. Suxamethonium (1 mg kg−1) was used for muscular paralysis.

Results:  Motor and EEG seizure durations were significantly longer after induction with methohexital plus remifentanil (45±14 and 58±15 s) than with methohexital alone (31±11 and 42±18 s). A methohexital dose of 1.2±0.3 and 1.9±0.3 mg was necessary to achieve loss of eyelash reflex if methohexital was used with and without remifentanil. Peak heart rate after ECT was significantly higher if remifentanil was coadministered with methohexital (148±12 vs. 126±24 b.p.m).

Conclusion:  Substituting part of the methohexital dose with remifentanil is a useful anesthetic technique to prolong seizure duration in middle‐aged patients requiring a 1.5‐fold higher induction dose of methohexital than elderly patients, the only population studied to date for the combined use of methohexital and remifentanil in ECT.
Intrathecal midazolam added to bupivacaine improves the duration and quality of spinal anaesthesia
Authors: Bharti N. , Madan R. , Mohanty P. R. , Kaul H. L.
Published: September 2003

Background:  The antinociceptive action of intrathecal midazolam is well documented. In this prospective study, we investigated the addition of midazolam to intrathecal bupivacaine on the duration and quality of spinal blockade.

Methods:  Forty ASA I or II adult patients undergoing lower abdominal surgery were selected for the study. The patients were randomly allocated to receive 3 ml of 0.5% hyperbaric bupivacaine intrathecally either alone or with 1 mg of midazolam using a combined spinal epidural technique. The duration and quality of sensory and motor block, perioperative analgesia, haemodynamic changes, and sedation levels were assessed.

Results:  The duration of sensory block (i.e. time to regression to the S2 segment) was significantly longer in the midazolam group than the control group (218 min vs. 165 min; P < 0.001). The duration of motor block was also prolonged in the midazolam group as compared with the control group (P < 0.01). In 90% of the patients in the midazolam group, the quality of block was adequate during the intra‐operative period as compared with only 65% of the patients in the control group (P < 0.05). The duration of effective analgesia was longer in the midazolam group than in the control group (199 vs. 103 min; P < 0.001). Blood pressure, heart rate, oxygen saturation and sedation scores were comparable in both groups. No neurological deficit or other significant adverse effects were recorded.

Conclusion:  The addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anaesthesia and provides prolonged perioperative analgesia without significant side‐effects.
Experience with albumin dialysis in five patients with severe overdoses of paracetamol
Authors: Koivusalo A.‐M. , Yildirim Y. , Vakkuri A. , Lindgren L. , Höckerstedt K. , Isoniemi H.
Published: September 2003

Five patients in whom the serum paracetamol levels or the amount of ingested paracetamol was high enough to cause severe liver injury were treated with N‐acetyl‐cysteine (NAC) and a molecular absorbant recirculating system (MARS). MARS treatment was started as early as possible in order to prevent or retard the development of hepatocyte necrosis. Four of our five patients survived without liver transplantation, and one died due to brain oedema. The early commencement with NAC and MARS treatments in paracetamol intoxication might give enough time for the liver to regenerate and thus avoid liver transplantation.
Continuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double‐blind clinical trial
Authors: Debreceni G. , Molnár Z. , Szélig L. , Molnár T. F.
Published: September 2003

Background:  Pain following thoracotomy is frequently associated with clinically important abnormalities of pulmonary function. The aim of the current study was to compare the efficacy of continuous thoracic epidural analgesia (EDA) to continuous intercostal (IC) block for postoperative pain and pulmonary function in a prospective, randomized, double‐blinded clinical trial.

Methods:  Fifty patients undergoing lung lobectomy for malignancies were randomized into two groups (25/group). Respiratory function (forced vital capacity, forced expiratory volume per 1 s/forced vital capacity, maximum midexpiratory flow rate, peak expiratory flow rate) were evaluated preoperatively, within 4 h after the operation and on the first postoperative day. Visual analog scale (VAS: 0–10) scores were evaluated four‐hourly for 20 h.

Results:  The VAS scores were significantly lower in the EDA versus IC group at the 4th, 8th, and 12th h of observation (mean ± SD) 5.5 ± 2.9 vs. 7.3 ± 2.2 P = 0.04; 4.1 ± 2.1 vs. 5.1 ± 2.9 P = 0.02; 3.6 ± 1.9 vs. 5.2 ± 2.4 P = 0.01, respectively. Respiratory function parameters deteriorated significantly in both groups (P < 0.001) with no significant difference between the groups. Only one major adverse effect was detected: one patient suffered from rib osteomyelitis after intercostal cannulation and healed following surgical repair.

Conclusions:  The results of the present study show that following thoracotomy in the early postoperative period continuous EDA is a better pain relieving method than continuous IC block, as indicated by the VAS scores.
Pancuronium bromide, a non‐depolarizing muscle relaxant which promotes apoptosis of blood lymphocytes in vitro
Authors: Delogu G. , Moretti S. , Marcellini S. , Antonucci A. , Tellan G. , Marandola M. , Signore M. , Famularo G.
Published: September 2003

Background:  Several compounds used in anesthesia practice have demonstrated to impair immune function and to influence the process of apoptotic death in T cell population following surgical trauma. We designed this study to test in vitro the impact of neuromuscular blocker, such as pancuronium, at clinically relevant concentration on lymphocyte apoptosis, death factor expression and mitochondrial function.

Methods:  Following isolation, lymphocytes were incubated with pancuronium bromide at a clinically relevant concentration (0.136 µmol l−1) for 3 h at 37 C in a 5% carbon‐dioxide‐humidified atmosphere and the frequency of apoptotic lymphocytes was then measured. We also investigated crucial steps in the apoptotic process, including Fas/Fas ligand (FasL) phenotype, intracellular expression of the interleukin‐1β‐converting enzyme (ICE) p20, mitochondrial membrane potential (ΔΨm), generation of mitochondrial reactive oxygen species, and glutathione (GSH) levels. Control experiments were performed incubating cells in the complete culture medium added with the dilution medium of the drug without addition of the drug.

Results:  Expression of Fas, FasL and ICEp20 was six‐fold, four‐fold, and five‐fold increased, respectively, among pancuronium‐treated lymphocytes with respect to control cultures (P = 0.0001). The percentage of cells exhibiting either dissipation of mitochondrial membrane potential or increased production of reactive oxygen species was seven‐fold increased following exposure to pancuronium compared with untreated lymphocytes (P = 0.0001). These findings were associated with a decrease in GSH level. In addition, the frequency of apoptotic cells was 10‐fold greater among lymphocytes cultured in the presence of the drug with respect to control cultures. (P = 0.0001).

Conclusion:  Our data suggest an apoptogenic effect of pancuronium in vitro at clinically relevant concentration on peripheral blood lymphocytes. This could be implicated in the transient immune suppression following a surgical operation.
Epinephrine added to a lumbar epidural infusion of a small‐dose ropivacaine‐fentanyl mixture after arterial bypass surgery of the lower extremities
Authors: Förster J. G. , Niemi T. T. , Aromaa U. , Neuvonen P. J. , Seppälä T. A. , Rosenberg P. H.
Published: September 2003

Background:  The addition of epinephrine (2 µg·ml−1) to a thoracic epidural infusion of an opioid‐local anesthetic mixture improves analgesia. Here, we studied whether epinephrine could improve analgesia also at lumbar level, when added to an epidural infusion of a low‐dose ropivacaine‐fentanyl mixture after arterial bypass surgery of the legs.

Methods:  Patients in group RFE (n = 21) received a postoperative epidural infusion containing ropivacaine (1 mg·ml−1), fentanyl (2 µg·ml−1), and epinephrine (2 µg·ml−1). Patients in group RF (n = 25) received a similar infusion without epinephrine. The infusion speed was 1 ml·10 kg−1 · h−1. The infusion was scheduled for 48 h.

Results:  Epinephrine did not reduce the need for rescue pain medication. Visual analog scale scores (VAS) for pain at rest were low and similar in the groups. Pain intensity was stronger during leg movement [mean VAS 1.5–2.6 (range 0–9)], but it was not affected by the coadministration of epinephrine. The groups did not differ concerning frequency and severity of side‐effects. Epinephrine did not reduce fentanyl plasma concentrations. Ropivacaine concentrations were slightly lower in group RFE only in the samples 6 h from the start of the infusion, but not anymore on the first and second postoperative day.

Conclusion:  In the dosage used here, epinephrine did not improve epidural lumbar analgesia. Different distances from the epidural application site to the α2‐adrenergic receptors of the spinal cord, and differing epinephrine dose requirements may explain why epinephrine as an additive improves epidural analgesia at thoracic, but not at lumbar level.
Antinociception of intrathecal cholinesterase inhibitors and cholinergic receptors in rats
Authors: Yoon M. H. , Choi J. I. , Jeong S. W.
Published: September 2003

Background:  Intrathecal cholinesterase inhibitors have been shown to have an antinociceptive effect which is mediated through the spinal cholinergic receptors, mainly muscarinic receptor. Spinal nicotinic receptor also has been involved in the control of nociception. Authors characterized the respective role of muscarinic or nicotinic receptor for the antinociception of cholinesterase inhibitors and further determined the antinociceptive potency of them.

Methods:  Rats were prepared with intrathecal catheters. Formalin‐induced flinching response was regarded as a nociceptive behavior.

Results:  Intrathecal neostigmine, physostigmine and edrophonium produced a dose‐dependent suppression of flinching in both phases. Atropine and the M1 selective antagonist attenuated the effect of them, while the M2 selective antagonist did not affect. M3, M4 selective, and nicotinic receptor antagonists reversed the antinociception induced by edrophonium, but by neither neostigmine nor physostigmine. The ordering of potency was neostigmine > physostigmine > > edrophonium.

Conclusion:  These data indicate that the nicotinic receptor may be involved, at least in part, in the antinociceptive action of cholinesterase inhibitor at the spinal level, and M1 receptor subtype may be a common pharmacologic site of action. Moreover, neostigmine is more potent than physostigmine and edrophonium.
Neither vasopressin nor amiodarone improve CPR outcome in an animal model of hypothermic cardiac arrest
Authors: Schwarz B. , Mair P. , Wagner‐Berger H. , Stadlbauer K. H. , Girg S. , Wenzel V. , Lindner K. H.
Published: September 2003

Background:  Aim of this experimental animal study was to investigate the influence of vasopressin and amiodarone on cardiopulmonary resuscitation (CPR) outcome in a pig model of hypothermic cardiac arrest.

Methods:  After surface cooling to a core temperature of 26°C, ventricular fibrillation was induced in 14 12–16‐week‐old domestic pigs. After 15 min of untreated cardiac arrest, a manual closed chest CPR was started and pigs were randomly assigned to two treatment groups: Group 1 pigs (n = 7) received vasopressin 0.4 U kg−1 as initial drug therapy, followed by a combination vasopressin (0.4 U kg−1) and amiodarone (4 mg kg−1) as subsequent drug therapy. Subsequent drug therapy was administered in animals without permanent restoration of spontaneous circulation after a first series of electrical countershocks 10 min after drug administration. Group 2 pigs (n = 7) received saline placebo as initial drug therapy and saline placebo and amiodarone (4 mg kg−1) as subsequent drug therapy.

Results:  Vasopressin significantly increased coronary perfusion pressure and defibrillation success (successful defibrillation in five of seven Group 1 vs. none of seven Group 2 pigs, P = 0.02). Due to refibrillation within 30–150 s, the 60‐min survival rate was not improved by vasopressin. Subsequent drug therapy with amiodarone had no further effect on defibrillation success or the refibrillation rate.

Conclusions:  Data from this experimental animal model suggest that vasopressin and amiodarone may not be beneficial for treatment of ventricular fibrillation associated with severe hypothermia when concomitant measures at core rewarming are not applied.
Management of unexpected coronary artery spasm in an asymptomatic patient during anaesthesia
Authors: Adachi N. , Miyamoto Y. , Hodono S. , Yorozuya T. , Arai T.
Published: September 2003

We report a case of life‐threatening arrhythmia that was not predicted before surgery. Pulse‐less ventricular tachycardia and ventricular fibrillation occurred during surgery without any changes in heart rate and blood pressure, and cardiac massage was required to maintain circulation. Although no organic stenosis was found in either the right or left coronary arteries, post‐surgical angiographic examination revealed severe vasospastic angina induced by intra‐luminal administration of acetylcholine. Anaesthesia with a high dose of fentanyl and vasodilators prevented the recurrence of life‐threatening arrhythmia. Vasospastic angina attacks are difficult to predict with the preoperative examination routinely employed.
Unusual foreign body in the esophagus: A challenge for the anesthesiologist
Authors: Abrão J. , Khabbaz K. M. , Abrão J. M. , Coutinho D. J. , Juliano E. A. C.
Published: September 2003

A foreign body in the esophagus is usually removed by endoscopy. An elder man entered the emergency room dyspneic and dysphagic. A chest X‐ray showed that he had a table fork stuck in the upper esophagus. An endoscopist tried to remove it without success. After bilateral block of the superior laryngeal nerve, transtracheal injection, topical anesthesia of the mouth, and sedation, an awake laryngoscopy was carried out. Pushing the laryngoscope into the opening of the esophagus the fork was seen and extracted by the anesthesiologist. This case focuses on the role of the anesthesiologist in the removal of esophageal foreign bodies.
Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol – the role of cardiac output
Authors: Ezri T. , Szmuk P. , Warters R. D. , Gebhard R. E. , Pivalizza E. G. , Katz J.
Published: September 2003

Background:  We investigated the hypothesis that manipulation of cardiac output (CO) with esmolol (Es) or ephedrine (E) affects the onset time of rocuronium.

Methods:  Following anesthesia induction, 33 patients received E (70 µg kg−1), Es (500 µg kg−1) or placebo (P) 30 s before rocuronium (0.6 mg kg−1) administration. Cardiac output was measured non‐invasively after intubation every 3 min. The interval from the end of rocuronium administration to the disappearance of all twitches was considered to be the onset time.

Results:  Onset time was shorter after E (52.2 ± 16.5 s) and longer after Es (114.3 ± 11.1 s) compared with P (87.4 ± 7.3 s) (P < 0.0001). Cardiac output increased (P < 0.05) in group E for 15 min after rocuronium. In group Es, CO decreased (P < 0.05) at 3 and 6 min. Cardiac output was higher in group E vs. group Es, 3–6 min post administration of rocuronium (P=0.015).

Conclusion:  Pretreatment with E or Es appears to affect the onset time of rocuronium by altering CO as measured with the NICOTM (Non‐Invasive Cardiac Output) monitor (Novametrix Medical Systems Inc., Willingford, CO).
Regionally differentiated fibrinolytic responses during volume‐resuscitated acute endotoxemia in pigs
Authors: Nyberg A. , Seeman‐Lodding H. , Ahlqvist M. , Fagerberg A. , Jern C. , Åneman A.
Published: September 2003

Background:  Microcirculatory dysfunction and formation of microthrombi are common in sepsis as a result of a procoagulant state. A profibrinolytic change has however, been reported in early sepsis. This study investigates systemic and regional (pulmonary, preportal, hepatic, renal) fibrinolytic capacity as mirrored by fluxes of tissue‐type plasminogen activator (t‐PA) in response to acute endotoxemia and volume resuscitation.

Methods:  Eight anaesthetized, ventilated pigs (24–29 kg) were instrumented for systemic and regional haemodynamic monitoring. Aortic, pulmonary arterial, portal, hepatic and renal venous blood samples were collected. Following baseline stabilisation, Escherichia coli endotoxin was infused for 120 min. During the last 30 min of infusion, volume resuscitation was initiated targeting baseline cardiac output, and animals were observed for 3 h. Total tPA was analyzed by ELISA calibrated for porcine tPA. Net organ tPA fluxes were calculated based on in/outflowing plasma concentrations and regional blood flows.

Results:  Preportal release and hepatic extraction of tPA was observed at baseline. Pulmonary and renal net fluxes of tPA were not significantly different from zero. Endotoxemia increased plasma tPA levels in all investigated vascular beds. Preportal tPA release increased approximately 10‐fold and hepatic extraction increased approximately 12‐fold in non‐resuscitated acute endotoxemia. No significant changes in pulmonary or renal tPA fluxes were observed. Volume resuscitation restored net fluxes to baseline values while plasma levels remained elevated approximately twofold compared with baseline.

Conclusion:  Acute endotoxemia induces a prompt, marked and regionally differentiated pro‐fibrinolytic response that cannot be discerned based on systemic levels of circulating tPA and that was normalized during volume resuscitation.
Equivalence of hydroxyethyl starch HES 130/0. 4 and HES 200/0. 5 for perioperative volume replacement in major gynaecological surgery
Authors: Sander O. , Reinhart K. , Meier‐Hellmann A.
Published: September 2003

Background:  Hydroxyethyl starch solutions (HES) are increasingly used for the compensation of surgical blood loss. The objective of this clinical trial was to compare a novel 6% HES 130/0.4 solution with a favourable pharmacological profile and a standard 6% HES 200/0.5 solution for maintenance of haemodynamic stability in major gynaecological surgery.

Methods:  Sixty female patients aged 18–80 years undergoing major gynaecological surgery with indication for perioperative colloidal volume replacement were enrolled in this prospective, randomized double‐blinded clinical study. The administration of study medication was dependent on individual requirements to maintain haemodynamic stability. The amount of study medication required from induction of anaesthesia until 6 h postoperatively served as the primary investigative parameter.

Results:  The two one‐sided test procedure by Westlake demonstrated equivalence of mean infused volumes between HES 130/0.4 and HES 200/0.5 during the study period (1224 ± 544 ml and 1389 ± 610 ml, respectively, P < 0.05). Perioperatively, haemodynamics did not differ significantly between treatment groups. While none of the mean values of coagulation parameters shifted outside the normal range, the degree of haemodilution revealed reduced haematocrit values in HES 200/0.5 treated patients at 6 h postoperatively (P < 0.05). Moreover, prothrombin time (PT) was higher and consequently international normalized ratio (INR) was lower at the same time point for patients who received HES 130/0.4 (P < 0.05).

Conclusion:  This clinical trial demonstrated therapeutic equivalence of this novel low‐substituted HES 130/0.4 solution and a standard HES 200/0.5 solution for perioperative volume replacement. Moreover, both HES preparations were equally well‐tolerated and safe.
Xenon incorporated in a lipid emulsion inhibits NMDA receptor channels
Authors: Weigt H. U. , Georgieff M. , Beyer C. , Wachter U. , Föhr K. J.
Published: September 2003

Background:  Over the past decade hyperpolarized (129)xenon incorporated in lipid emulsions has been studied for the purpose of imaging enhancement in radiology. Xenon (Xe), a NMDA (N‐methyl‐D‐aspartate)‐receptor antagonist, has neuroprotective properties even at subanesthetic concentrations. Thus, its intravenous administration for this purpose deserves further evaluation. In this study, we investigated in an in vitro model the effect of Xe, incorporated in a lipid emulsion (Lipofundin MCT® 20%), on the NMDA receptor channel of cortical neurons of the mouse.

Methods:  Pulses of 50 µM of NMDA solution were extracellularly applied to the cells for 10 s, and the elicited membrane currents (I) were recorded while the membrane potential (V) was clamped at −80 mV. Either Lipofundin MCT® 20% or aqueous solution was loaded with Xe and applied simultaneously with the NMDA pulses by means of a multibarreled pipette attached to a battery of infusion‐pumps.

Results:  Xenon equilibrated in Lipofundin® caused a concentration‐dependent and reversible inhibition of NMDA‐induced currents (maximal Xe content [Xemax]: 190 µl ml−1). The inhibitory effect was equivalent compared with the effect of Xe dissolved in aqueous solution (Xemax: 89 µl ml−1) even though the Xe content of the lipid solution was almost doubled. Further enhancement of the Xe content by saturating both the lipid emulsion and the aqueous solutions with Xe (Xemax: 256 µl ml−1) did not increase the inhibitory action on NMDA‐receptors.

Conclusion:  The data demonstrate that Xe dissolved in Lipofundin MCT® 20% inhibits NMDA‐receptors. Lipid emulsions enriched with Xe may serve as a carrier and a reservoir for Xe.
Differences among forced‐air warming systems with upper body blankets are small. A randomized trial for heat transfer in volunteers
Authors: Perl T. , Bräuer A. , Timmermann A. , Mielck F. , Weyland W. , Braun U.
Published: September 2003

Background:  Forced‐air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Significant differences have been described between forced‐air warming systems in combination with full body blankets. We investigated four forced‐air warming systems in combination with upper body blankets for existing differences in heat transfer.

Methods:  After approval of the local Ethics Committee and written informed consent, four forced‐air warming systems combined with upper body blankets were investigated in a randomized cross‐over trial on six healthy volunteers: (1) BairHugger™ 505 and Upper Body Blanket 520, Augustine Medical; (2) ThermaCare™ TC 3003, Gaymar™ and Optisan™ Upper Body Blanket, Brinkhaus; (3) WarmAir™ 134 and FilteredFlow™ Upper Body Blanket, CSZ; and (4) WarmTouch™ 5800 and CareDrape™ Upper Body Blanket, Mallinckrodt. Heat transfer from the blanket to the body surface was measured with 11 calibrated heat flux transducers (HFTs) with integrated thermistors on the upper body. Additionally, the blanket temperature was measured 1 cm above the HFT. After a preparation time of 60 min measurements were started for 20 min. Mean values were calculated over 20 min. The t‐test for matched pairs with Bonferroni‐Holm‐correcture for multiple testing was used for statistical evaluation at a P‐level of 0.05. The values are presented as mean±SD.

Results:  The WarmTouch™ blower with the CareDrape™ blanket obtained the best heat flux (17.0±3.5 W). The BairHugger™ system gave the lowest heat transfer (8.1±1.1 W). The heat transfer of the ThermaCare™ system and WarmAir™ systems were intermediate with 14.3±2.1 W and 11.3±1.0 W.

Conclusions:  Based on an estimated heat loss from the covered area of 38 W the heat balance is changed by 46.1 W to 55 W by forced‐air warming systems with upper body blankets. Although the differences in heat transfer are significant, the clinical relevance of this difference is small.
Modest protection of early hydrocortisone treatment in a rat model of volume‐controlled haemorrhage
Authors: Gundersen Y. , Vaagenes P. , Reistad T. , Opstad P. K.
Published: September 2003

Background:  Major insults may trigger generalized inflammatory responses that contribute to progressive multiple organ dysfunction. The present study was performed to test the potential of early hydrocortisone treatment to influence these responses as well as organ function following an episode of rapid and profound blood loss.

Methods:  In isoflurane anaesthesia, 35 spontaneously breathing male Sprague‐Dawley rats were bled 2.5 ml 100 g−1 body weight over 10 min. Immediately following withdrawal of blood, one group (n = 17) was given 2 mg of hydrocortisone, and the other (n = 18) had the same amount of normal saline. Seventy‐five minutes after initiation of bleeding, two‐thirds of the blood was retransfused, together with a new injection of hydrocortisone or saline. Thereafter the rats were observed for 2 h. Key mediators of systemic inflammation and plasma markers of organ function and integrity were measured. Internal organs were weighed and scored for visible pathology. Leukocyte infiltration of the liver was counted in a light microscope.

Results:  Hydrocortisone reduced the plasma levels of IL‐6 (P < 0.05); non‐significant reductions of TNF‐α (P = 0.12) and IL‐10 (P = 0.44) were noted. The synthesis of reactive oxygen species in peritoneal cells was unaffected. Relative organ weights and organ injury scores tended to be reduced, but only wet organ weight for the lungs reached statistical significance. Leukocyte infiltration of the liver was equal in both groups. Plasma levels of ALT, AST, α‐GST and creatinine did not differ significantly between groups. Two of the hydrocortisone treated rats died compared with four controls.

Conclusion:  Early treatment with hydrocortisone had a limited organ protective effect in this model of controlled haemorrhagic shock. Although a general tendency for better outcome in the hydrocortisone group was noted, clear‐cut and significant advantages of the treatment were not obtained.
Brain death: an important paradigm shift in the 20th century
Authors: Settergren G.
Published: September 2003

The description of death in medical or pathophysiological terms changed during the last century. The focus of attention shifted from the condition of the heart to the state of the brain. The current paper investigates the time period from 1866, when the effects of an increased intracranial pressure (ICP) were studied experimentally, to 1967, when the first heart transplantation was performed. Between 1894 and 1965 four neurosurgeons: Horsley in England, Cushing in USA, Wertheimer in France and Frykholm in Sweden made important contributions. Documented discussions, if ventilator treatment should be stopped in patients with a dead brain and a beating heart, began in 1959. However, already during the latter part of the 19th century it was shown that the heart could continue to beat if artificial ventilation was performed, when spontaneous respiration had ceased due to a high ICP. Furthermore, brain death was by chance implemented in clinical practice in heart surgery with cardiopulmonary bypass (CPB) some years before the expressions ‘death of the nervous system’ and ‘brain death’ were coined.
Effects of propofol on bronchoconstriction and bradycardia induced by vagal nerve stimulation
Authors: Hashiba E. , Hirota K. , Suzuki K. , Matsuki A.
Published: September 2003

Background:  Vagolysis has been considered as a mechanism by which propofol produces bronchodilation. However, it has also been suggested that propofol‐induced bradycardia may result from increased vagal tone. In this study, we have determined whether propofol has vagolytic effects on both the airway and cardiovascular system.

Methods:  Mongrel dogs were anesthetized with pentobarbital. Bronchoconstriction was assessed by measuring changes in a bronchial cross‐sectional area (BCA) using a bronchoscopic method. Heart rate (HR) and direct arterial blood pressure were also monitored. Vagal nerve stimulation (VNS) was performed for 60 s to produce both bronchoconstriction and bradycardia. To determine the effect of propofol on VNS‐induced bronchoconstriction and bradycardia (n = 7), 0 (saline), 2.0 and 20 mg/kg propofol were administered intravenously at 20‐min intervals with VNS commenced 5 min later. In addition, to determine if propofol‐induced bradycardia is due to a vagomimetic action, two groups of six dogs were given 20 mg/kg propofol with or without 0.2 mg/kg atropine pre‐treatment. HR was measured before and 5 min after propofol.

Results:  Propofol 20 mg/kg significantly inhibited VNS‐induced bronchoconstriction. Although propofol per se significantly reduced HR (24%) and blood pressure (37%), the reduction in HR produced by VNS after 20 mg/kg propofol did not differ from that after saline or the lower dose of propofol (2 mg/kg). As atropine pre‐treatment did not attenuate propofol‐induced bradycardia, this response is unlikely to be simply due to vagomimetic actions.

Conclusion:  Propofol has vagolytic effects on the airway but does not worsen bradycardia produced by parasympathetic stimulation.
Does lidocaine provoke clinically significant vasospasm?
Authors: Azma T. , Okida M.
Published: September 2003

Two cases with peripheral vasoconstriction possibly caused by topical application of lidocaine were reported. A potential risk of vasospasm provoked by lidocaine may be a pitfall for anesthesiologists because lidocaine is commonly considered a vasodilator.
Intensive care unit acquired infection: a prevalence and impact on morbidity and mortality
Authors: Vosylius S. , Sipylaite J. , Ivaskevicius J.
Published: September 2003

Background:  Severe infection is a common reason for intensive care and contributes to increased morbidity and mortality. The aim of the study was to determine the prevalence of infection among intensive care unit (ICU) patients and to evaluate the consequences of ICU‐acquired infection on morbidity and mortality.

Methods:  A total of 812 patients consecutively admitted for more than 48 h to the ICU at Vilnius University Emergency Hospital, Lithuania, were included in the prospective observational study. Organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) system.

Results:  Thirty‐seven per cent of patients were identified who developed at least one ICU‐acquired infection. Respiratory, bloodstream and urinary tract infections were the most common. The main isolates were coagulase‐negative Staphylococcus, S. aureus, Acinetobacter and Pseudomonas species. More severe degree of organ dysfunction, prolonged stay in the ICU and higher hospital mortality rate were more common among patients who acquired infection in the ICU than that of non‐infected patients.

Conclusion:  The prevalence of infection in the ICU was similar to other studies in European countries. The occurrence of ICU‐acquired infection was significantly related to the increase in morbidity and mortality. The findings are useful for the comparison of the prevalence rate of infection and implementation of strict infection control policy.
Which administration route of fentanyl better enhances the spread of spinal anaesthesia: intravenous, intrathecal or both?
Authors: Kararmaz A. , Kaya S. , Turhanoglu S. , Ozyilmaz M. A.
Published: September 2003

Background:  To enhance the spread of spinal anaesthesia, fentanyl may be administered intrathecally (i.t.) or intravenously (i.v.). The purpose of this prospective study was to investigate the effects of fentanyl administered i.v., i.t. or concurrently by both i.v. and spinal routes on the spread of spinal anaesthesia.

Methods:  Sixty patients were randomly assigned to one of three groups. In Groups I and II, spinal anaesthesia was performed with plain bupivacaine 10 mg plus 20 µg fentanyl and in Group III with 10 mg of plain bupivacaine. The level of first peak sensory block was marked. In addition, fentanyl 50 µg was administered i.v. in Groups II and III or by saline in Group I after the sensory blockade reached the highest dermatomal level. Ten minutes after i.v. administration, the level of the second peak sensory block was marked. The distance between the first‐ and second‐highest levels of sensory block was measured.

Results:  The distance between the first‐ and second‐highest level of sensory block was significantly different for the three groups: Group II (5.8 ± 2.6 cm) > Group III (2.9 ± 2.1 cm)  > Group I (−0.15 ± 1.7 cm). The peak dermatomal level of spinal block was significantly higher in Group II [T4 (T3–T7)] than in Group I [T6 (T4–T9)] and Group III [T6 (T4‐T8)]. In Groups I and II the sensory block regressed to S2 for a longer period of time than it did in Group III.

Conclusion:  Both the spinal and systemic administration of fentanyl enhanced the spread of spinal anaesthesia. The co‐administration of spinal and i.v. fentanyl produced a greater increase in the cephalad spread of spinal block.
An international study of the interobserver variation between interpretations of vaginal smear criteria of bacterial vaginosis
Authors: FORSUM U. , JAKOBSSON T. , LARSSON P. G. , SCHMIDT H. , BEVERLY A. , BJØRNEREM A. , CARLSSON B. , CSANGO P. , DONDERS G. , HAY P. , ISON C. , KEANE F. , McDONALD H. , MOI H. , PLATZ‐CHRISTENSEN J.‐J. , SCHWEBKE J.
Published: September 2003

An international workshop on vaginal smear‐based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.