bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicobacter pyloriinfection and gastric outlet obstruction — prevalence of the infection and role of antimicrobial treatment
Authors: Gisbert J. P. , Pajares J. M.
Published: March 2003

The prevalence of Helicobacter pylori infection in peptic ulcer disease complicated by gastric outlet obstruction seems to be, overall, lower than that reported in non‐complicated ulcer disease, with a mean value of 69%. However, H. pylori infection rates in various studies range from 33% to 91%, suggesting that differences in variables, such as the number and type of diagnostic methods used or the frequency of non‐steroidal anti‐inflammatory drug intake, may be responsible for the low prevalence reported in some studies.

The resolution of gastric outlet obstruction after the eradication of H. pylori has been demonstrated by several studies. It seems that the beneficial effect of H. pylori eradication on gastric outlet obstruction is observed early, just a few weeks after the administration of antimicrobial treatment. Furthermore, this favourable effect seems to remain during long‐term follow‐up. Nevertheless, gastric outlet obstruction does not always resolve after H. pylori eradication treatment and an explanation for the failures is not completely clear, non‐steroidal anti‐inflammatory drug intake perhaps playing a major role in these cases. Treatment should start pharmacologically with the eradication of H. pylori even when stenosis is considered to be fibrotic, or when there is some gastric stasis.

In summary, H. pylori eradication therapy should be considered as the first step in the treatment of duodenal or pyloric H. pylori‐positive stenosis, whereas dilation or surgery should be reserved for patients who do not respond to such medical therapy.
Helicobacter pylori ‘rescue’ regimen when proton pump inhibitor‐based triple therapies fail
Authors: Gisbert J. P. , Pajares J. M.
Published: March 2003

Even with the currently most effective treatment regimens, about 10–20% of patients will fail to obtain eradication of Helicobacter pylori infection. Therefore, in designing a treatment strategy, we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate.

The choice of second‐line treatment depends on which treatment was used initially, as re‐treatment with the same regimen is not recommended. Therefore, it is not necessary to perform culture after the first eradication failure. Assessment of the sensitivity of H. pylori to antibiotics only after failure of the second treatment is suggested in clinical practice.

Different possibilities of empirical treatment have been suggested. After failure of proton pump inhibitor–amoxicillin–clarithromycin, quadruple therapy has generally been used. More recently, replacement of the proton pump inhibitor and the bismuth compound by ranitidine bismuth citrate has also achieved good results. After proton pump inhibitor–amoxicillin–nitroimidazole failure, re‐treatment with proton pump inhibitor–amoxicillin–clarithromycin has been proven to be effective. Finally, first‐line treatment should not combine clarithromycin and metronidazole in the same regimen, because of the problem of resistance to both antibiotics.

Recently, rifabutin‐based rescue therapies have been shown to constitute an encouraging strategy for eradication failures, as they are effective against H. pylori strains resistant to antibiotics.
Genetic testing and counselling for hereditary colorectal cancer
Authors: Trimbath J. D. , Giardiello F. M.
Published: March 2003

Colorectal cancer is the second leading cause of cancer death, after lung cancer, in the USA. The great majority (80%) of patients with colorectal cancer have sporadic disease with no evidence of having inherited the disorder. In the remaining 20%, a potentially definable genetic component exists. With the discovery of gene mutations related to hereditary colorectal cancer, risk assessment based on genetic test results is now feasible. The following review focuses on the two well‐described colorectal cancer genetic syndromes—familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, the process of genetic counselling, currently available genetic tests, and indications for their use.
Treatment of Helicobacter pylori infection and factors influencing eradication
Authors: Qasim A. , O'Morain C. A.
Published: March 2003

Currently available Helicobacter pylori eradication therapies are considered very effective and safe. The most recent eradication guidelines proposed in the Maastricht 2‐2000 Consensus Report recommend the use of proton pump inhibitors (standard b.d.) along with clarithromycin (500 mg b.d.) and amoxycillin (1000 mg b.d.) or metronidazole (500 mg b.d.) for a minimum of 7 days. The combination of amoxycillin and clarithromycin is preferred because it may favour best results with a second‐line proton pump inhibitor quadruple therapy. The recommended second‐line therapy includes a combination of a proton pump inhibitor (standard b.d.) with bismuth salt (subsalicylate/subcitrate 120 mg q.d.s.), metronidazole (500 mg t.d.s.), and tetracycline (500 mg q.d.s.) for a minimum of 7 days. Extended proton pump inhibitor‐based triple therapy can be used if bismuth is not available. Specialists should manage subsequent failures. Based on direct and indirect evidence from well‐designed studies and clinical experience, eradication is recommended in gastric and duodenal ulcers, MALToma, atrophic gastritis, postgastric cancer resection, and in first‐degree relatives of gastric cancer patients. The most common reason for treatment failure is poor compliance with eradication guidelines. Antibiotic resistance may be a significant factor in certain geographical areas. Proton pump inhibitors are an integral part of the eradication regimens as proved by meta‐analyses of clinical trials. Novel agents used in secondary failure are few and depend on the use of new antibiotics. The role of H. pylori‐specific antibiotics, probiotics, and vaccines is not established as yet. Widespread acceptance of the eradication guidelines should be regarded as the single most important factor in eradication success.
Helicobacter pylori infection in peptic ulcer haemorrhage
Authors: Van Leerdam M. E. , Tytgat G. N. J.
Published: March 2003

In this overview, medical advice for routine clinical practice regarding peptic ulcer haemorrhage (PUH) is given, based on the extensive literature about Helicobacter pylori and the controversial results about the interaction of H. pylori infection and nonsteriodal anti‐inflammatory drug (NSAID) use. PUH remains an important emergency situation with an incidence between 32 and 51/100 000 persons per year. There is a high association between H. pylori infection and peptic ulcer disease. The association between H. pylori infection and PUH is less clear, but a strong argument for the aetiological role is the fact that eradication of H. pylori decreases recurrence of bleeding. NSAID use is another important risk factor for PUH. H. pylori infection and NSAID use seem to act independently, although some studies show a synergistic interaction while other studies report that H. pylori is protective against the development of PUH in NSAID users. All patients with PUH should be tested for H. pylori infection, regardless of the use of NSAIDs. Because invasive tests are less sensitive in PUH patients, negative tests in patients with no other risk factors should be confirmed by serology or urea breath test (UBT). Eradication therapy with a proton pump inhibitor or ranitidine bismuth citrate‐based triple therapy should be given to all H. pylori‐positive patients. Only for nonaspirin–NSAID users does the effect of eradication therapy on the healing of gastric ulcers remain controversial, but currently we also advise eradication of H. pylori in this subgroup. After eradication therapy, acid‐suppressant therapy is advised to heal the ulcer. The success of eradication should always be confirmed because of the risk of recurrence of peptic ulcer disease and bleeding in H. pylori‐infected patients.
Immunopathogenetic and therapeutic aspects of autoimmune hepatitis
Authors: Medina J. , García‐Buey L. , Moreno‐Otero R.
Published: March 2003

Autoimmune hepatitis is a chronic, progressive liver disease that responds well to immunosuppressive therapy, but has a poor prognosis if untreated. Possible triggering factors include viruses, other autoimmune disorders and drugs. The molecular mechanisms contributing to the pathogenesis include: reactions of autoantibodies against their corresponding autoantigens; aberrant expression of histocompatibility antigen class I and II molecules, cell adhesion molecules and cytokines; increased oxidative stress; and the occurrence of angiogenesis. The prevalence of the disease is highest in Caucasians, Europeans and women. The natural history of autoimmune hepatitis shows a poor prognosis, with frequent progression to cirrhosis and hepatic insufficiency in untreated patients. The occurrence of hepatocellular carcinoma is rare and is found only in long‐standing cirrhosis. Corticosteroids as monotherapy or in combination with azathioprine are the treatments of choice; different therapeutic schedules and particularities of treatment for pregnant women and children have been established. To avoid treatment‐associated adverse effects, alternative therapies have been proposed, including ciclosporin, budesonide, tacrolimus, mycophenolate mofetil, ursodeoxycholic acid, methotrexate, cyclophosphamide, mercaptopurine and free radical scavengers. Liver transplantation is indicated for patients refractory to or intolerant of immunosuppressive therapy.
Psychiatry, psychotherapy and gastroenterology — bringing it all together
Authors: Stern J. M.
Published: March 2003

In this review, some aspects of functional gastrointestinal disorders are described, with particular reference to psychiatric and psychological features. Seven syndromes or conditions, which may present not uncommonly in a gastroenterology clinic, are identified and clarified. Thereafter, the roles of a psychiatrist and other mental health professionals (psychotherapists, psychologists) within gastroenterology are described, with particular reference to what an integrated service may offer.
Effective intra‐oesophageal acid suppression in patients with gastro‐oesophageal reflux disease: lansoprazole vs. pantoprazole
Authors: Frazzoni M. , De Micheli E. , Grisendi A. , Savarino V.
Published: March 2003

Background : Effective intra‐oesophageal acid suppression is an important therapeutic goal in complicated and atypical gastro‐oesophageal reflux disease.

Aim : To compare the efficacy of lansoprazole and pantoprazole in normalizing oesophageal acid exposure.

Methods : Fifty patients with complicated or atypical gastro‐oesophageal reflux disease were randomly assigned to receive 30 mg lansoprazole (n = 26) or 40 mg pantoprazole (n = 24) once daily. Three to four weeks after the start of treatment, patients underwent 24‐h oesophageal pH monitoring whilst on therapy. If the results were improved but still abnormal, the dosage was doubled and pH monitoring was repeated. If oesophageal acid exposure was not improved, the patient was shifted to the alternative drug regimen.

Results : Oesophageal acid exposure was normalized in all 26 patients treated with lansoprazole (in 35% of cases with a double daily dosage), whereas in six of the 24 (25%) patients treated with pantoprazole it was neither normalized nor lowered (P = 0.008). Accordingly, the mean percentage acid reflux time was significantly lower for the lansoprazole group (2.1) than for the pantoprazole group (5.8) (P = 0.032).

Conclusions : Effective intra‐oesophageal acid suppression can be accomplished more reliably with lansoprazole than with pantoprazole in patients with complicated and atypical gastro‐oesophageal reflux disease.
Occurrence of peptic ulcer disease in connective tissue disease patients associated with xerostomia
Authors: Luo J.‐C. , Lin H.‐Y. , Chang F.‐Y. , Lu R.‐H. , Lu C.‐L. , Chen C.‐Y. , Lee S.‐D.
Published: March 2003

Background : Saliva plays a role in mucosal protection and ulcer healing.

Aim : To study whether decreased salivary production leads to peptic ulcer disease in connective tissue disease patients associated with xerostomia.

Patients and methods : Two hundred and two connective tissue disease patients (90 with xerostomia and 112 without xerostomia) were enrolled. Their demographic data and use of medications were recorded. Peptic ulcer disease was confirmed by endoscopy. The stimulated salivary output and secretory epidermal growth factor level were measured.

Results : Compared with non‐xerostomic counterparts, xerostomic patients manifested a higher occurrence of peptic ulcer disease (31% vs. 12%, P = 0.001), lower stimulated salivary output (9.3 ± 4.1 vs. 22.9 ± 5.9 mL/15 min, P < 0.001) and lower stimulated salivary epidermal growth factor output (1.40 ± 0.77 vs. 3.00 ± 0.96 ng/min, P < 0.001). Multivariate analysis disclosed that an older age (≥ 60 years) (odds ratio, 4.71; P < 0.001), xerostomia with stimulated salivary output of ≤1 mL/min (odds ratio, 7.54; P = 0.014) and the use of non‐steroidal anti‐inflammatory drugs (odds ratio, 5.76; P = 0.031) were the risk factors leading to peptic ulcer disease. In addition, xerostomic connective tissue disease patients receiving non‐steroidal anti‐inflammatory drugs manifested an extremely high risk of development of peptic ulcer disease (odds ratio, 19.78; P < 0.001).

Conclusions : Ageing, the use of non‐steroidal anti‐inflammatory drugs and poor salivary function are potential risk factors for the development of peptic ulcer disease in patients with connective tissue disease. If these xerostomic subjects consume non‐steroidal anti‐inflammatory drugs, they will encounter an extremely high peptic ulcer disease risk.
Circadian pattern of intragastric acidity in patients with non‐erosive reflux disease (NERD)
Authors: Zentilin P. , Dulbecco P. , Bilardi C. , Gambaro C. , Iiritano E. , Biagini R. , Mela G. S. , Tessieri L. , Mele M. R. , Mansi C. , Pandolfo N. , Vigneri S. , Savarino V.
Published: March 2003

Background : Most patients with gastro‐oesophageal reflux disease have non‐erosive reflux disease. Proton pump inhibitors are less effective than expected in these patients, but no previous study has measured their 24‐h gastric pH values.

Aims : To evaluate whether there are differences in 24‐h intragastric acidity between reflux patients with and without oesophagitis and controls. The influence of Helicobacter pylori on the gastric pH of reflux patients was also assessed.

Methods : Sixty‐three consecutive patients with gastro‐oesophageal reflux disease symptoms who agreed to undergo endoscopy and 24‐h pH‐metry were recruited. Twenty‐five (39%) had erosive oesophagitis and 38 (61%) did not. H. pylori was diagnosed by CLO test, histology and 13C‐urea breath test. Gastric pH was also measured in 30 controls without digestive symptoms.

Results : H. pylori was found in seven of the 25 (28%) patients with oesophagitis and 14 of the 38 (37%) patients with non‐erosive reflux disease. Oesophageal pH‐metry was abnormal in 21 of the 25 (84%) patients with oesophagitis and in 32 of the 38 (84%) patients with non‐erosive reflux disease. The median gastric pH did not differ between patients with and without oesophagitis or between them and controls during the 24 h (P = 0.8) and other time intervals (P = 0.2–0.4). The gastric pH did not differ between infected and non‐infected patients with oesophagitis (P = 0.2–0.4) or non‐erosive reflux disease (P = 0.3–0.8).

Conclusions : The circadian pattern of intragastric acidity does not differ between patients with non‐erosive reflux disease and oesophagitis. Moreover, the study confirms that H. pylori infection does not affect the gastric pH in either group of reflux patients.
Moderate coffee consumption increases plasma glutathione but not homocysteine in healthy subjects
Authors: Esposito F. , Morisco F. , Verde V. , Ritieni A. , Alezio A. , Caporaso N. , Fogliano V.
Published: March 2003

Background : The consumption of unfiltered coffee, containing bioactive diterpenes, causes an increase in plasma homocysteine concentration. A slight increase in plasma homocysteine is also caused by large quantities of filtered coffee. Coffee terpenes also raise plasma glutathione in mice.

Aim : To verify the effect of Italian‐style coffee consumption on the plasma concentration of glutathione and homocysteine in healthy subjects.

Methods : Twenty‐two volunteers consumed five cups of coffee per day for 1 week and maintained their usual diet. Five subjects were enrolled as controls. The intervention trial was preceded and followed by seven coffee‐free days.

Results : Plasma glutathione increased by 16% (P < 0.05) on coffee consumption, and returned to the original concentration after the washout period. The increase in plasma homocysteine concentration (13% after 1 week of coffee intake) was not significant. No differences in glutathione or homocysteine concentration were observed in the control group. No variation of plasma hydroperoxide concentration was detectable.

Conclusions : A coffee intake regimen, representing the average consumption of coffee drinkers in Italy, increased the plasma concentration of glutathione, but no significant increase in the plasma homocysteine concentration was detected.
Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora
Authors: Kuisma J. , Mentula S. , Jarvinen H. , Kahri A. , Saxelin M. , Farkkila M.
Published: March 2003

Background : Preliminary trials of probiotics in preventing recurrent chronic pouchitis have been encouraging.

Aim : To investigate the efficacy of Lactobacillus GG supplementation as primary therapy for ileal pouch inflammation, and its effect on the microbial flora.

Methods : Twenty patients, with a previous history of pouchitis and endoscopic inflammation, were recruited for a prospective, randomized, double‐blind, placebo‐controlled trial of Lactobacillus GG supplementation (10 LGG, 10 placebo) in two gelatine capsules [(0.5–1) × 1010 colony‐forming units/capsule] b.d. for 3 months. Quantitative bacterial culture of fresh faecal samples and biopsies taken from the pouch and afferent limb was performed before and after supplementation.

Results : Lactobacillus GG supplementation changed the pouch intestinal flora by increasing the ratio of total faecal lactobacilli to total faecal anaerobes (P = 0.03) and enhancing the frequency of lactobacilli‐positive cultures in the pouch and afferent limb mucosal biopsy samples. However, only 40% of patients were colonized with Lactobacillus GG. No differences were observed between the groups with regard to the mean pouchitis disease activity index or the total anaerobes or aerobes of faecal or tissue biopsy samples.

Conclusions : A single‐strain probiotic bacterium supplement of Lactobacillus GG changed the pouch intestinal bacterial flora, but was ineffective as primary therapy for a clinical or endoscopic response. More clinical trials are needed to evaluate the right placement and dosage of probiotics within a treatment regimen for pouchitis.
Esomeprazole — enhanced bio‐availability, specificity for the proton pump and inhibition of acid secretion
Authors: Lindberg P. , Keeling D. , Fryklund J. , Andersson T. , Lundborg P. , Carlsson E.
Published: March 2003

Esomeprazole, the S‐isomer of omeprazole, is the first proton pump inhibitor available for clinical use as a single isomer. It demonstrates pharmacological and clinical benefits beyond those seen with the racemic omeprazole.

Esomeprazole has higher and more consistent bio‐availability than omeprazole, which results in a greater area under the plasma concentration–time curve. It is the area under the plasma concentration–time curve of omeprazole and esomeprazole that determines how much of each reaches the parietal cell, and thus the control of gastric acid secretion that is achieved. Esomeprazole, like other proton pump inhibitors, has a high specificity for the acidic environment of the parietal cell, where it is accumulated, activated and covalently inhibits the proton pump. Proton pumps elsewhere in the body do not achieve the level of acidity needed for accumulation and activation.

Esomeprazole, 40 mg once daily, provides more effective control of gastric acid secretion than omeprazole, 20 or 40 mg once daily, and all other proton pump inhibitors given at their standard doses. This translates into greater clinical effect compared with omeprazole, 20 mg once daily, and lansoprazole, 30 mg once daily, in the management of reflux disease. Esomeprazole therapy is well tolerated, with a low adverse events profile, similar to that seen with omeprazole.
Cerebral infarct following central venous cannulation
Authors: Zaidi N. A. , Khan M. , Naqvi H. I. , Kamal R. S.
Published: March 2003

Inadvertent carotid artery puncture is a well‐known complication of internal jugular vein cannulation. A case of cerebral infarct subsequent to carotid artery puncture during internal jugular vein cannulation is reported.
Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm
Authors: Tschaikowsky K. , Hemmerling T.
Published: March 2003

In 54 patients who were to undergo surgery of the upper extremity in plexus block anaesthesia the effect of 5 g EMLA (group E) on tourniquet pain was examined and compared with the effect of a semicircular subcutaneous anaesthesia using 10 ml 0.25% bupivacaine (group B) or 10 ml 1% mepivacaine (group M). Among the patients with satisfactory brachial plexus analgesia allowing for surgery (n = 51), the incidence of tourniquet pain was not significantly different between groups E, M and B. Notably, there was no significant difference in the time of tourniquet application. We conclude that topical application of EMLA is as effective as a semicircular subcutaneous anaesthesia with mepivacaine or bupivacaine in the prevention of tourniquet pain during brachial plexus anaesthesia.
The influence of neck position on ventilation using the Combitube airway
Authors: Mercer M. H. , Gabbott D. A.
Published: March 2003

A Combitube airway was inserted into 40 patients undergoing general anaesthesia. A rigid cervical collar was then used to immobilise the neck of each patient. In all 40 subjects adequate ventilation of the lungs was possible in this position as assessed by chest movement and auscultation, measurement of expired tidal volume and maintenance of satisfactory arterial oxygen saturation. In 18/40 patients (45%), blood was present on the Combitube after removal. Reducing the volume of air injected into the proximal balloon of the Combitube appeared to reduce the incidence of airway trauma during insertion.
Reporting of ‘hypotension’ after epidural analgesia during labour
Authors: Kinsella S. M. , Black A. M. S.
Published: March 2003

We studied 20 women in labour to see how reporting ‘hypotension’ after obstetric epidural analgesia is affected by position of the blood pressure cuff and baseline definition. Blood pressure was recorded from both arms simultaneously while the woman was semirecumbent and then in the left lateral position. Three readings were then taken after epidural bupivacaine, one left lateral and the remainder right lateral. Before the epidural, blood pressure in the dependent arm in the lateral position was similar to blood pressure in either arm in the semirecumbent position and an average of 10 mmHg (systolic) and 14 mmHg (diastolic) higher than blood pressure in the uppermost arm (p ≤ 0.00005). This difference persisted in both lateral positions as epidural analgesia became established. Choosing different definitions of hypotension, baselines and arm to measure blood pressure resulted in ‘hypotension rates’ between 0% and 75%. For blood pressure measurement in the lateral position, the blood pressure cuff should be placed on the dependent arm.
Anaesthesia and the QT intervalEffects of isoflurane and halothane in unpremedicated children
Authors: Michaloudis D. , Fraidakis O. , Petrou A. , Gigourtsi C. , Parthenakis F.
Published: March 2003

The effects of isoflurane and halothane on the QT interval were investigated during induction of anaesthesia. Fifty‐one unpremedicated, ASA grade 1 children were studied. Anaesthesia was induced with either isoflurane (n = 25) or halothane (n = 26) and was maintained to the end of the study with end‐tidal concentrations of between 2.5% and 3%. Recordings of the electrocardiograph, heart rate and systolic arterial pressure were obtained at the following times: before induction of anaesthesia; 1 min and 3 min after stable end‐tidal concentrations of anaesthetic agent had been reached; 1 min and 3 min following vecuronium administration; at the time of tracheal intubation and 1 min and 3 min later. Isoflurane significantly prolonged the QT interval (p < 0.001), in contrast to halothane which shortened it (p < 0.01). Heart rate remained largely unchanged during isoflurane anaesthesia but it decreased in the presence of halothane (p < 0.001). In both groups, systolic arterial pressure decreased significantly after induction of anaesthesia (p < 0.001) and remained so to the end of the study. In the isoflurane group, 12 children developed ECG repolarisation abnormalities and in one child an arrhythmia was noticed. In the halothane group, one child developed repolarisation changes while arrhythmias were observed in 10 children. There were no adverse sequelae. It is concluded that halothane may be a better anaesthetic agent than isoflurane for use in children with a prolonged QT interval.
Pneumopericardium: an unusual cause for cardiac arrest
Authors: Djaiani G. , Major E.
Published: March 2003

A 1‐year‐old boy breathing via a T‐piece system and recovering from meningococcal septicaemia in the intensive care unit suffered a severe bout of coughing and developed bilateral pneumothoraces and tension pneumopericardium resulting in electromechanical dissociation and asystole. Conventional cardiopulmonary resuscitation and adrenaline boluses were unsuccessful. Administration of 20 ml.kg−1 of colloid and 3 mmol.kg−1 of sodium bicarbonate solutions produced instantaneous return of cardiac output. The deleterious effects of cardiac tamponade appeared to decrease with increasing cardiac filling pressures. The patient was managed conservatively and he made a full recovery with no signs of residual neurological deficit.
The intubating laryngeal maskClinical appraisal of ventilation and blind tracheal intubation in 110 patients
Authors: Agrò F. , Brimacombe J. , Carassiti M. , Marchionni L. , Morelli A. , Cataldo R.
Published: March 2003

This study assesses the efficacy of the intubating laryngeal mask as a ventilation device and blind intubation guide. Following induction of anaesthesia with propofol, the device was successfully inserted at the first attempt in 110/110 (100%) patients. Placement took less than 10 s in all patients. Size selection was based on nose–chin distance. Adequate ventilation was achieved in 104/110 (95%) patients. Blind tracheal intubation using an 8‐mm internal diameter straight silicone cuffed tracheal tube was attempted 3 min after the administration of vecuronium. Passage of a lighted stylet through the intubating laryngeal mask was used to determine the position of the intubating laryngeal mask cuff before blind intubation. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used, based on the depth at which resistance occurred. Tracheal intubation was possible in 104/104 (100%) patients. In 42 (40%) patients, no resistance was encountered and the trachea was intubated at the first attempt. Sixty‐two (60%) patients required one adjusting manoeuvre. The mean (range) time taken to successful intubation, i.e. the time from disconnection of the intubating laryngeal mask from the breathing system to successful tracheal intubation, was 79 (12–315) s. Six patients with potential or known intubation problems were included in the study. The tracheas of all six patients were successfully intubated. We conclude that the intubating laryngeal mask is an effective ventilation device and intubation guide with potential for use in patients who may present difficulty in tracheal intubation.
Revised checklist for anaesthetic machines
Authors: Kendell J. , Barthram C.
Published: March 2003

A revised edition of the guidelines of the Association of Anaesthetists of Great Britain and Ireland, for the pre‐operative check of anaesthetic machines, was published in March 1997. A checklist based on the revised guidelines was used for the routine pre‐operative checks of anaesthetic machines over a 6‐week period in a district general hospital. One hundred and thirty‐two checklists were completed. These were analysed for the time taken to complete the check and for the faults found in the anaesthetic machines. The mean time taken to complete a check was 6.8 min and the mean time taken to complete two consecutive checks, in the anaesthetic room and operating theatre, was 12.7 min. Carbon dioxide cylinders were present on the machines in 99 checks (75%), contrary to Association guidelines. Other faults were found in 40 checks (30.3%). The most frequent cause of faults was the oxygen analyser, faults being found in 15 checks. Other frequent faults were due to empty vaporisers or spare gas cylinders and the emergency oxygen bypass control.
The effect of the addition of adrenaline to pethidine for patient‐controlled epidural analgesia after Caesarean section
Authors: Ngan Kee W. D. , Khaw K. S. , Ma M. L.
Published: March 2003

We have investigated the addition of adrenaline to pethidine for patient‐controlled epidural analgesia after elective Caesarean section. In a randomised, double‐blind study, patients received patient‐controlled epidural analgesia for 24 h using pethidine 5 mgml−1 with adrenaline 5 μgml−1 (adrenaline group, n = 40) or pethidine 5 mgml−1 without adrenaline (plain group, n = 38). Visual analogue scale pain scores at rest and on coughing measured 2 h, 6 h and 24 h after surgery were similar between the two groups. There was a trend towards lower mean total consumption of pethidine in the adrenaline group (231.5 mg; SD 140.5 mg) compared with the plain group (289.5 mg; SD 139.5 mg; p = 0.071). Patients in the adrenaline group had higher visual analogue scale scores for nausea at 2 h and 24 h and higher scores for pruritus at 2 h compared with the plain group. Addition of adrenaline to pethidine for patient‐controlled epidural analgesia does not appear to have significant clinical advantages.
Mucosal host defence response to hysterectomy assessed by saliva analyses: a comparison of propofol and isoflurane anaesthesia
Authors: Lähteenmäki M. , Salo M. , Tenovuo J.
Published: March 2003

We compared the effects of propofol‐based (n = 15) and isoflurane‐based anaesthesia (n = 15) on mucous host defences by measuring the salivary flow and the concentrations/activities of salivary total protein and amylase, and of salivary immunological (IgA, IgG and IgM) and nonimmunoglobulin defence factors (lysozyme, myeloperoxidase, total salivary peroxidase and thiocyanate) in patients undergoing elective abdominal hysterectomy. The saliva samples were collected pre‐operatively and on the first and fourth postoperative days. The concentrations of salivary protein and amylase as well as those of immunological and nonimmunological defence factors were significantly increased on the first postoperative day. The secretion rate of total protein, amylase, lysozyme, total peroxidase, thiocyanate and IgG, however, decreased owing to a marked decrease in the salivary flow, but no alterations were found in the secretion rate of myeloperoxidase, IgA and IgM. The changes were similar in both groups. These findings show that nonimmunological oral mucous host defences are altered after major surgery, but immunoglobulin responses are better maintained. Both types of anaesthesia induce marked short‐term hyposalivation.
Low‐dose intra‐articular ketorolac for pain relief following arthroscopy of the knee joint
Authors: Convery P. N. , Milligan K. R. , Quinn P. , Scott K. , Clarke R. C. N.
Published: March 2003

The systemic administration of nonsteroidal anti‐inflammatory agents has been shown to improve analgesia following arthroscopy of the knee joint. Ketorolac 60 mg, when given intra‐articularly, provides better postoperative analgesia than an identical dose administered systemically. We compared the postoperative analgesic effect of ketorolac 10 mg given intravenously with 5 mg intra‐articularly in 60 patients undergoing arthroscopy of the knee joint under general anaesthesia. Patients were randomly allocated in a double‐blind manner to receive 0.25% bupivacaine 20 ml and ketorolac 5 mg intra‐articularly (n = 27) or intravenous ketorolac 10 mg followed by 0.25% bupivicaine 20 ml (n = 30) at the end of surgery. There were no differences between the groups in terms of their physical characteristics or in the nature of procedure performed. There was no statistical difference between the two groups in time to first analgesia or postoperative visual analogue pain scores at 1, 2 and 4 h (p = 0.6). The median consumption of a standard analgesic was reduced in the intra‐articular group in the second 24‐h period but this did not achieve statistical significance (p = 0.08). Only five patients in total needed postoperative morphine. A reduced amount of locally applied ketorolac (5 mg) provides similar analgesia to a higher systemic dose (10 mg) following knee arthroscopy.
Comparison of 0.75% levobupivacaine with 0.75% racemic bupivacaine for peribulbar anaesthesia
Authors: McLure H. A. , Rubin A. P.
Published: March 2003

In a single centre, randomised, double‐blind study 50 patients scheduled for intra‐ocular surgery received 0.75% levobupivacaine or 0.75% racemic bupivacaine for peribulbar anaesthesia. There were no significant differences in the mean (SD) volume of levobupivacaine (11 (2.7) ml) or racemic bupivacaine (10 (2.6) ml) required, time to satisfactory block (levobupivacaine — 13 (5.6) min; racemic bupivacaine — 11 (4.4) min), peri‐operative pain scores or frequency of adverse events between levobupivacaine and racemic bupivacaine. The safer side‐effect profile of levobupivacaine may offer significant advantages in the elderly population undergoing cataract extraction in whom intercurrent disease is common.
Classification treesA possible method for iso‐resource grouping in intensive care
Authors: Ridley S. , Jones S. , Shahani A. , Brampton W. , Nielsen M. , Rowan K.
Published: March 2003

Classification and grouping of clinical data into defined categories or hierarchies is difficult in intensive care practice. Diagnosis‐related groups are used to categorise patients on the basis of diagnosis. However, this approach may not be applicable to intensive care where there is wide heterogeneity within diagnostic groups. Classification tree analysis uses selected independent variables to group patients according to a dependent variable in a way that reduces variation. In this study, the influence of three easily identified patient attributes on their length of intensive care unit stay was explored using classification analysis. Two thousand five hundred and forty‐five critically ill patients from three hospitals were classified into groups so that the variation in length of stay within each group was minimised. In 23 out of 39 terminal groups, the interquartile range of the length of stay was ≤ 3 days.
Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS)
Authors: Kluger M. T. , Short T. G.
Published: March 2003

Two‐hundred and forty incidents of vomiting/regurgitation and aspiration were reported to the Anaesthetic Incident Monitoring Study database consisting of 5000 reports. Of these, 133 cases of aspiration were recorded. Passive regurgitation occurred three times more commonly than active vomiting. Aspiration was reported twice as often in elective compared with emergency surgery, with 56% of incidents taking place during induction of anaesthesia. Anti‐aspiration prophylaxis was prescribed in 14% of patients who subsequently aspirated; however, the majority of cases had at least one predisposing factor for regurgitation, vomiting or aspiration evident peri‐operatively. While a major immediate physiological disturbance was common, long‐term morbidity was not. Death ensued in five cases, all of whom had significant co‐morbidities. Factors reported as contributing to the incident included error of judgement and fault of technique, while clinical experience and anaesthetic assistance tended to minimise the incident. Aspiration remains an important anaesthetic‐related morbidity. The application of simple guidelines may have prevented the incident in 60% of all cases of aspiration. Ensuring airway security may be as important as chemoprophylaxis in its prevention.
Anaesthesia for daycase gynaecological laparoscopy: a survey of clinical practice in the United Kingdom
Authors: Simpson R. B. , Russell D.
Published: March 2003

Gynaecological laparoscopy is a daycase procedure that can be associated with significant morbidity and patients may require admission to hospital for overnight stay. Following a decision to administer intraperitoneal bupivacaine routinely to such patients in our day surgery unit, we wished to establish whether this was routine practice elsewhere. We therefore carried out a postal survey of consultant anaesthetists in the UK who regularly anaesthetise patients undergoing daycase gynaecological laparoscopy, addressing a number of clinical issues. The results of the survey are presented, discussed and compared with published advice.
Urine colour as an index of hydration in critically ill patients
Authors: Fletcher S. J. , Slaymaker A. E. , Bodenham A. R. , Vucevic M.
Published: March 2003

In order to test the hypothesis that urine colour can be used as an index of hydration in critically ill patients, we selected 40 intensive care and high‐dependency patients and correlated urine colour (scored on an eight‐point scale) with various indices of hydration: urine:plasma sodium, osmolality and urea ratios, urine output and central venous pressure. In addition, we compared the colour‐chart score with scores made by intensive care nurses (without the benefit of a colour chart) in order to test subjective assessment of urine colour. There were weak but statistically significant correlations between urine colour and urine output (Spearman's r = − 0.555) and between urine colour and urine:plasma sodium ratio (Spearman's r = − 0.459). Subjective assessment of urine colour appeared to be reliable. Thus, although urine colour does vary with hydration in the critically ill, assessment of urine colour adds little to the overall assessment of hydration in this group of patients.
Propofol auto‐co‐induction as an alternative to midazolam co‐induction for ambulatory surgery
Authors: Djaiani G. , Ribes‐Pastor M. P.
Published: March 2003

We propose the use of an intravenous propofol/propofol auto‐co‐induction technique as an alternative to propofol/midazolam for induction of anaesthesia. We have studied 54 unpremedicated ASA 1 or 2 patients undergoing day‐stay anaesthesia for minor orthopaedic surgery. All received 10 μg.kg−1 of alfentanil before induction, followed by either midazolam 0.05 mg.kg−1, propofol 0.4 mg.kg−1 or saline, and 2 min later, a propofol infusion at a rate of 50 mg.kg−1.h−1 until loss of eyelash reflex. We compared pre‐ and postinduction haemodynamic changes, complications at insertion of a laryngeal mask airway and recovery from anaesthesia in the three groups. Both co‐induction techniques showed less postinduction hypotension and significant reduction of the total induction dose of propofol when compared to the control group. In the propofol/propofol group there was a decreased incidence of apnoea during induction of anaesthesia. These patients were discharged from hospital 2 h after the end of anaesthesia whereas patients in the midazolam/propofol group were discharged after 2½ h (p < 0.001).
A comparison of transoesophageal echocardiographic Doppler across the aortic valve and the thermodilution technique for estimating cardiac output
Authors: Poelaert J. , Schmidt C. , Van Aken H. , Hinder F. , Mollhoff T. , Loick H. M.
Published: March 2003

This study was undertaken in order to elucidate the differences between various planes of measurement and Doppler techniques (pulsed‐ vs. continuous‐wave Doppler) across the aortic valve to estimate cardiac output. In 45 coronary artery bypass patients, cardiac output was measured each time using four different Doppler techniques (transverse and longitudinal plane, pulsed‐ and continuous‐wave Doppler) and compared with the thermodilution technique. Measurements were performed after induction of anaesthesia and shortly after arrival in the intensive care unit. Optimal imaging was obtained in 91% of the patients, in whom a total of 82 measurements of cardiac output were performed. The respective mean (SD) areas of the aortic valve were 3.77 (0.71) cm2 in the transverse plane and 3.86 (0.89) cm2 in the longitudinal plane. A correlation of 0.87 was found between pulsed‐wave Doppler cardiac output and the thermodilution technique in either transverse or longitudinal plane. Correlation coefficients of 0.82 and 0.84 were found between thermodilution cardiac output and transverse and longitudinal continuous‐wave Doppler cardiac output, respectively. Although thermodilution cardiac output is a widely accepted clinical standard, transoesophageal Doppler echocardiography across the aortic valve offers adequate estimations of cardiac output. In particular, pulsed‐wave Doppler cardiac output in both the transverse and longitudinal plane provides useful data.
Influence of induction of anaesthesia on intubating conditions one minute after rocuronium administration: comparison of ketamine and thiopentone
Authors: Hans P. , Brichant J. F. , Hubert B. , Dewandre P. Y. , Lamy M.
Published: March 2003

We compared the effect of thiopentone and ketamine on intubating conditions after rocuronium 0.6 mgkg−1 in two groups of patients (n = 16 each), aged 21–44 years, undergoing elective surgery. Premedication consisted of alprazolam 1 mg by mouth 1 h before surgery. All patients received midazolam 2 mg intravenously 2 min before intravenous administration of thiopentone 5 mgkg−1 or ketamine 2.5 mgkg−1. Muscle relaxation was provided by rocuronium 0.6 mgkg−1. One minute after rocuronium administration, tracheal intubation was performed within 15 s by a skilled anaesthetist blinded to the treatment group assignment. Intubating conditions were graded as excellent, good, fair or poor on the basis of jaw relaxation, position of vocal cords and diaphragmatic response. Neuromuscular transmission was assessed at the adductor pollicis muscle using a TOF‐GUARD™ monitor. Excellent and good intubating conditions were obtained in 100% of patients in the ketamine group and in 50% of patients in the thiopentone group (p = 0.002). Jaw relaxation was similar in both groups but vocal cord conditions were better and the diaphragmatic response less marked in the ketamine group compared with the thiopentone group (p = 0.002). The degree of neuromuscular block [% decrease of T1, mean (SD)] at the time of intubation was similar: 51.8 (25)% (ketamine group) and 54.3 (23.1)% (thiopentone group). We conclude that ketamine 2.5  mgkg−1 provides better intubating conditions than thiopentone 5 mgkg−1 1 min after administration of rocuronium 0.6 mgkg−1.
A comparison of the effects of dopexamine and prostacyclin in systemic inflammatory response syndrome
Authors: Blunt M. , Young P. , Ridley S.
Published: March 2003

Forty critically ill patients fulfilling the definitions of systemic inflammatory response syndrome were enrolled in a double‐blind cross‐over interventional study assessing the effects of dopexamine and prostacyclin on splanchnic perfusion, cardiovascular function and oxygen flux. The cross‐over design involved either dopexamine (1.25 μg.kg−1.min−1) or prostacyclin (0.5 ng.kg−1.min−1) being infused for 6 h followed by a 12‐h washout period prior to an identical infusion sequence using the other agent. Preliminary analysis revealed a significant period effect, so data from the second infusion period were excluded from further analysis. Dopexamine caused a significant increase in heart rate (116 vs. 106 beat.min−1), and urine output (103 vs. 69 ml.h−1). Dopexamine produced a significant increase in oxygen delivery (infusion 548 ml O2.min−1.m−2; no infusion 492 ml O2.min−1.m−2) while prostacyclin caused a decrease (infusion 460 ml O2.min−1.m−2; no infusion 547 ml O2.min−1.m−2). The results indicate that dopexamine improves oxygen delivery and urine output more effectively than prostacyclin.
Continuous propofol administration for suxamethonium‐induced postoperative myalgia
Authors: Manataki A. D. , Arnaoutoglou H. M. , Tefa L. K. , Glatzounis G. K. , Papadopoulos G. S.
Published: March 2003

The effect of continuous propofol administration on creatine kinase and suxamethonium‐induced postoperative myalgia was evaluated in 50 patients randomised into two groups of 25 patients each. Induction of anaesthesia was identical in all patients. Anaesthesia was maintained with 66% nitrous oxide in oxygen supplemented by either isoflurane 1% or continuous propofol. Creatine kinase was measured before and after operation. Myalgia was evaluated postoperatively by a blinded observer. The median level of myalgia was reduced significantly in the continuous propofol group (p = 0.011). The median creatine kinase value increased significantly in the isoflurane group (from 90 to 160 IU, p = 0.001).
Aspiration in severe trauma: a prospective study
Authors: Lockey D. J. , Coats T. , Parr M. J. A.
Published: March 2003

The incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway.
Physiological values and procedures in the 24 h before ICU admission from the ward
Authors: Goldhill D. R. , White S. A. , Sumner A.
Published: March 2003

Physiological values and interventions in the 24 h before entry to intensive care were collected for admissions from hospital wards. In a 13‐month period, there were 79 admissions in 76 patients who had been in hospital for at least 24 h and had not undergone surgery within 24 h of admission to intensive care. Thirty‐four per cent of patients underwent cardiopulmonary resuscitation before intensive care admission. Using Acute Physiology and Chronic Health Evaluation II scoring to quantify abnormal physiology in the group as a whole, a significant deterioration in respiratory function before admission was found. During the 6‐h period immediately before intensive care admission, 75% of patients received oxygen, 37% underwent arterial blood gas sampling, and oxygen saturation was measured in 61% of patients, 63% of whom had an oxygen saturation of less than 90%. Overall hospital mortality in the study group was 58%. Information collected on the wards identified seriously ill patients who may have benefited from earlier expert treatment.