bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti–protein Z antibodies in women with pathologic pregnancies
Authors: Gris Jean-Christophe , Amadio Cécile , Mercier Eric , Lavigne-Lissalde Géraldine , Déchaud Hervé , Hoffet Médéric , Quéré Isabelle , Amiral Jean , Dauzat Michel , Marès Pierre
Published: March 2003

Protein Z deficiencies have recently been described in women with unexplained early fetal loss. Using a new, specifically elaborated, commercially available enzyme-linked immunosorbent assay (ELISA), we performed a case-control study on anti–protein Z immunoglobulin G (IgG) and IgM antibodies in 191 nonthrombotic, nonthrombophilic women with consecutive pathologic pregnancies. Levels of anti–protein Z antibodies were categorized in 3 strata (percentiles 1 through 74, 75 through 97, 98 through 100 among controls). The 2 upper levels of IgG and IgM anti–protein Z antibodies were associated with the risk of unexplained recurrent embryo loss or fetal death independently from habitual antiphospholipid/anticofactor antibodies, and a dose-effect relationship between antibody levels and the clinical risks was evidenced. In women, enhanced immune-complex formation with protein Z may play a role in unexplained embryo losses and, from the 10th week of gestation, may favor hypercoagulability in the maternal placenta side.
Severe telomere shortening in patients with paroxysmal nocturnal hemoglobinuria affects both GPI– and GPI+ hematopoiesis
Authors: Karadimitris Anastasios , Araten David J. , Luzzatto Lucio , Notaro Rosario
Published: March 2003

A most distinctive feature of paroxysmal nocturnal hemoglobinuria (PNH) is that in each patient glycosylphosphatidylinositol-negative (GPI–) and GPI+ hematopoietic stem cells (HSCs) coexist, and both contribute to hematopoiesis. Telomere size correlates inversely with the cell division history of HSCs. In 10 patients with hemolytic PNH the telomeres in sorted GPI– granulocytes were shorter than in sorted GPI+ granulocytes in 4 cases, comparable in 2 cases, and longer in the remaining 4 cases. Furthermore, the telomeres of both GPI– and GPI+ hematopoietic cells were markedly shortened compared with age-matched controls. The short telomeres in the GPI– cells probably reflect the large number of cell divisions required for the progeny of a single cell to contribute a large proportion of hematopoiesis. The short telomeres of the GPI+ cells indicate that the residual hematopoiesis contributed by these cells is not normal. This epigenetic change is an additional feature shared by PNH and aplastic anemia.
Cases with several and with no solutions of the initial value problem and the corresponding states of systems with friction-affected constraints
Authors: Klepp H J
Published: March 2003

Owing to the kinetic friction laws, the equations for the computation of the accelerations and reaction forces for given positions and velocities of systems with friction-affected constraints are non-linear. Therefore, cases without, with one or with several sets of solutions can occur. With the help of planar systems with sliding and hinge joints it is shown that several sets of solutions correspond to different modes of contact in the constraints. All sets of solutions can be assigned to physical unequivocal states of the system and can be interpreted as unique solutions of the initial value problem with specified configurations of the system. No solution means that the friction parameters are too large and exceed the values for which friction locking occurs.
Is the Time of Suicide a Random Choice? A New Statistical Perspective
Authors: Rocchi Marco B.L. , Perlini Chiara
Published: March 2003

Summary: The problem of the time distribution of suicide has aroused the interest of many authors, but their findings often appear uncertain and contradictory. These inconsistencies can be partially explained by both the choice of the sample and the statistical method used for the analysis. In this study, in order to reveal expected and unexpected periodicities in the time distribution of suicides, we analyzed a small but complete and very homogeneous sample of suicides which occurred in the Mountain District of the Metauro River Valley in Italy in the period 1960-1994. A recent circular statistics technique, the “maximization of mean vector length” was used. We found no significant weekly and lunar patterns, but significant seasonal and intraseasonal cycles, with peaks in March and at the beginning of each season. The superposition of these two significant cyclic trends was also studied.
Successful Model of Suicide Prevention in the Ukraine Military Environment
Authors: Rozanov Vsevolod A. , Mokhovikov .Alexander N. , Stiliha Richard
Published: March 2003

Summary: The article deals with the problem of suicidal behavior in the Ukraine military environment and gives an example of the successful prevention approach. The model of prevention is based on (1) education of the responsible officers, (2) training of the representatives of the most vulnerable risk groups, and (3) follow-up procedures based on distribution of pocket books for soldiers, educational booklets, and sets of helpful materials for officers. One of the main conclusions is that the prevention activity must be organized as a continuum of actions, seminars, consultations, and materials distribution.
Facial Skin Pallor Increases During Motion Sickness
Authors: Holmes Sharon R. , King Stuart , Rollin Scott J.R. , Clemes Stacy
Published: March 2003

Abstract A change in facial skin colour from a normal hue toward increasing pallor has been associated with the development of motion sickness. This paper describes an experiment which investigated the use of a white-light reflectance technique for the objective measurement of skin colour during exposure to nauseogenic motion. Twelve subjects participated in four counterbalanced motion conditions, one week apart, with skin colour measurements obtained in the two conditions most likely to result in motion sickness: 0.285 Hz lateral linear and swing oscillations at 2.5 ms-2 peak acceleration. Skin colour measurements, using the L*a*b* colour space, were taken from the forehead, and subjective ratings of sickness (on a 0-6 scale) were obtained during a 12-minute baseline period, a 40-minute (maximum) exposure period and for the first 5 minutes of recovery. There was a significant effect of subjective ratings of sickness on the change from baseline in the a* axis of the L*a*b* skin colour coordinates (P < .001). This was attributable to a reduction in red tone at rating 6 (“moderate nausea”) compared to ratings 0, 1, and 2 (“no symptoms” - “mild symptoms”, P < .05). This study showed an increase in skin pallor, as revealed by a decrease in the degree of red tone in the skin, with the development of moderate nausea during nauseogenic motion exposure. This implies increased sympathetic nervous system vasoconstriction of the superficial facial blood vessels. Skin colour readings using the reflectance meter were easy to obtain and analyse.
Effect of Instructed Extinction on Verbal and Autonomic Indices of Pavlovian Learning with Fear-Relevant and Fear-Irrelevant Conditional Stimuli
Authors: Lipp Ottmar V. , Edwards Mark S.
Published: March 2003

Abstract We investigated the effects of conditional stimulus fear-relevance and of instructed extinction on human Pavlovian conditioning as indexed by electrodermal responses and verbal ratings of conditional stimulus unpleasantness. Half of the participants (n = 64) were trained with pictures of snakes and spiders (fear-relevant) as conditional stimuli, whereas the others were trained with pictures of flowers and mushrooms (fear-irrelevant) in a differential aversive Pavlovian conditioning procedure. Half of the participants in each group were instructed after the completion of acquisition that no more unconditional stimuli were to be presented. Extinction of differential electrodermal responses required more trials after training with fear-relevant pictures. Moreover, there was some evidence that verbal instructions did not affect extinction of second interval electrodermal responses to fear-relevant pictures. However, neither fear-relevance nor instructions affected the changes in rated conditional stimulus pleasantness. This dissociation across measures is interpreted as reflecting renewal of Pavlovian learning.
Estimates of Ten Multiple Intelligences
Authors: Furnham Adrian , Li-Ping Tang Thomas , Lester David , O'Connor Rory , Montgomery Robert
Published: March 2003

A total of 253 British and 318 American students were asked to make various estimates of overall intelligence as well as Gardner's (1999a) new list of 10 multiple intelligences. They made these estimations (11 in all) for themselves, their partner, and for various well-known figures such as Prince Charles, Tony Blair, Bill Gates, and Bill Clinton. Following previous research there were various sex and nationality differences in self-estimated IQ: Males rated themselves higher on verbal, logical, spatial, and spiritual IQ compared to females. Females rated their male partner as having lower verbal and spiritual, but higher spatial IQ than was the case when males rated their female partners. Participants considered Bill Clinton (2 points) and Prince Charles (5 points) less intelligent than themselves, but Tony Blair (5 points) and Bill Gates (15 points) more intelligent than themselves. Multiple regressions indicated that the best predictors of one's overall IQ estimates were logical, verbal, existential, and spatial IQ. Factor analysis of the 10 and then 8 self-estimated scores did not confirm Gardner's classification of multiple intelligences. Results are discussed in terms of the growing literature in the self-estimates of intelligence, as well as limitations of that approach.
A Cross-Cultural Investigation of Social Support and Burnout
Authors: Pines Ayala Malach , Ben-Ari Adital , Utasi Agnes , Larson Dale
Published: March 2003

A large number of studies have been published in recent years concerning social support, and a large number of studies have been published on burnout. Very few studies, however, have addressed the relationship between the two—and those that did reported conflicting results. The current exploratory study examines the different functions of social support (rather than the people who provide them) and their relationship to burnout among Israeli, Israeli Arab, Hungarian, and North American social science students (to assure subject homogeneity). Respondents were asked to rate the importance of six support functions and to indicate the extent to which they are available to them in their lives. Their responses were correlated with their burnout scores. Results showed both universal and culture-specific effects. While respondents in all four countries viewed the six support functions as very important, burnout was correlated more with the availability of support than with its importance. Different functions had different importance and availability ratings and different correlations with burnout in the four countries. The results demonstrate the importance of a cross-cultural perspective to the study of social support and burnout.
Self-Estimated Intelligence
Authors: Rammstedt Beatrice , Rammsayer Thomas H.
Published: March 2003

A total of 121 male and 107 female students from various German universities and vocational colleges estimated their own intelligence scores and were tested by psychometric intelligence tests on each of Thurstone's (1938) seven primary mental abilities. The correlations between self-estimated and tested intelligence differed largely among the various intelligence domains. In accordance with former studies, gender differences in self-estimated mathematical and spatial intelligence, perceptual speed, and reasoning were found. When controlling for psychometric intelligence, only gender-related differences in self-estimated mathematical abilities could be markedly reduced. Besides gender, level of education was identified as another variable that significantly moderates self-estimates of specific aspects of intelligence. The theoretical implications of the results are discussed.
Discounting of Delayed and Probabilistic Losses of Different Amounts
Authors: Ostaszewski Pawel , Karzel Katarzyna
Published: March 2003

Previous research has shown that the value of a larger future reward is discounted less steeply than the value of a smaller future reward. The value of probabilistic reward has been shown to have either an opposite effect on discounting (when a smaller reward is not certain its value was discounted less steeply than the value of a larger reward) or no effect on the rate of discounting at all. The present article shows the results for delayed and probabilistic losses: The same hyperbola-like functions describe temporal and probabilistic discounting of both rewards and losses. In the case of losses, larger delayed amounts are discounted less steeply than smaller delayed amounts (as in the case of delayed rewards). No relationship was found between the amount of probabilistic losses and the rate of discounting of their value. In summary, the results show that the description of the discounting process and the effect of amount on the rate of discounting are basically the same in case of both rewards and losses.
Doctoral Training in Psychology in Italy
Authors: Cimino Guido , Ferreri Antonio M.
Published: March 2003

Both formal and informal issues of doctoral training in psychology in Italy are discussed. We describe, from a formal point of view, PhD entrance procedures, selection of candidates, obligations and rights, financial support, and duration of the courses. We also list the main PhD courses. Finally, we focus our attention on some critical remarks about the present state of doctoral training in Italy and point to some possible improvements.
Doctoral Training of Psychology Students in France
Authors: Roland-Lévy Christine
Published: March 2003

Abstract: The aim of doctoral programs in psychology is to help students become competent psychologists, capable of conducting research and of finding suitable employment. Starting with a brief description of the basic organization of the French university system, this paper presents an overview of how the psychology doctoral training is organized in France. Since October 2000, the requisites and the training of PhD students are the same in all French universities, but what now differs is the openness to other disciplines according to the size and location of the university. Three main groups of doctoral programs are distinguished in this paper. The first group refers to small universities in which the Doctoral Schools are constructed around multidisciplinary seminars that combine various themes, sometimes rather distant from psychology. The second group covers larger universities, with a PhD program that includes psychology as well as other social sciences. The third group contains a few major universities that have doctoral programs that are clearly centered on psychology (clinical, social, and/or cognitive psychology). These descriptions are followed by comments on how PhD programs are presently structured and organized. In the third section, I suggest some concrete ways of improving this doctoral training in order to give French psychologists a more European dimension.
A UK PhD in Psychology: The British Psychological Society Guidelines
Authors: Foster Jonathan K. , Foster Jonathan K.
Published: March 2003

This paper first presents the author's impressions of the UK PhD in psychology, with respect to the author's experience of 9 years' teaching at the Universities of Oxford (1987-1989) and Manchester (1992-1999). In the second section of the paper, he discusses the Guidelines for the Assessment of the PhD in Psychology and Related Disciplines, endorsed by the British Psychological Society. Reference is also made to the Australian and North-American PhD systems, based on the author's experience working at the University of Toronto (1990-1992) and the University of Western Australia (2000-present). Several current trends are identified for the UK PhD in psychology, including the tendency for the UK PhD to become more programmatic, better regulated, and more formalized. A final point concerns the development of the international “market” in PhD graduates, facilitated via media such as the internet. The author agrees with the majority of the recommendations made by the BPS PhD Guidelines. However, based on his recent UK teaching experience, he is somewhat sceptical concerning whether these Guidelines will—realistically—be implemented within the current political and managerial climate existing in the UK higher education sector.
A 12‐week, placebo‐controlled study of the efficacy and safety of ebastine, 10 and 20 mg once daily, in the treatment of perennial allergic rhinitis
Authors: Bousquet J , Gaudaño Em , Palma Carlos Ag , Staudinger H ,   and the Multicentre Study Group.
Published: March 2003

This double‐blind, placebo‐controlled, multicentre study investigated the ability of ebastine, 10 and 20 mg once daily, to control symptoms of perennial allergic rhinitis (PAR) over a 12‐week period, and assessed additional benefits of the 20‐mg dose. Following a 2‐week baseline period, patients (12–63 years) were randomized to treatment with ebastine 10 mg (n=88) or 20 mg (n=102), or placebo (n=100). Patients scored symptom severity (0–3) twice daily, and mean changes from baseline scores showed ebastine to be significantly effective in week 1. Control of symptoms persisted over the 12 weeks, the average daily total nasal symptom score for nasal stuffiness plus nasal discharge plus sneezing plus itchy nose being reduced by both doses, with statistical significance at 20 mg (P=0.015 vs placebo) despite decreased usage of sodium cromoglycate rescue medications. Patient and clinician final opinions of treatment also significantly favoured ebastine, both 10 and 20 mg, over placebo. No serious adverse events occurred, and study treatments were well tolerated with a low incidence of central nervous system‐related adverse events and headache. In conclusion, ebastine 10 or 20 mg once daily was rapidly effective in relieving symptoms of PAR in adult and adolescent patients; additional benefits of the 20‐mg dose became apparent in the longer term.
Urinary leukotriene E4, eosinophil protein X, and nasal eosinophil cationic protein are not associated with respiratory symptoms in 1‐year‐old children
Authors: Wojnarowski C. , Halmerbauer G. , Mayatepek E. , Gartner C. , Frischer T. , Forster J. , Kuehr J. ,   the Collaborative SPACE Team
Published: March 2003

Background: Eosinophilic airways inflammation forms the pathophysiologic basis for a proportion of children at risk of developing recurrent wheezing. Early preventive measures and/or anti‐inflammatory treatment may be guided by the identification of such children. We aimed to study the relationship between respiratory symptoms and indirect markers of airway inflammation.

Methods: We measured eosinophil protein X (EPX) and leukotriene E4 (LTE4) in urine, as well as eosinophil cationic protein (ECP) in nasal lavages, in a random sample of 1‐year‐old children with a family history of atopy who participated in an international multicenter study on the prevention of allergy in Europe. For urine analyses, 10 children with upper respiratory illness and 19 healthy children without a family history of atopy were also enrolled. Endogenous urinary LTE4 was separated by HPLC and determined by enzyme immunoassay with a specific antibody. The concentrations of nasal ECP and urinary EPX were determined by RIA analysis.

Results: One hundred and ten children (mean age: 1.05±0.1 years) were enrolled. Prolonged coughing during the first year of life was reported in 29 children, wheezy breathing in 17 children, and dry skin in 33 children. A doctor's diagnosis of wheezy bronchitis was given to 17 children. Sensitization to dust mites (specific IgE ≥1.43 ML/units) was detected in two children. Children with a doctor's diagnosis of atopic dermatitis within the first 12 months of life (n=6) had significantly higher urinary EPX than children without this (66.7 vs 30.1 µg/mmol creatinine, P=0.01). Urinary excretion of EPX and LTE4 showed a weak correlation (r=0.22, P=0.02). There were no significant differences in urinary excretion of EPX and LTE4 or nasal ECP between children with and without respiratory symptoms (P>0.1).

Conclusions: At the age of 1 year, urinary EPX is increased in children with atopic dermatitis. With regard to respiratory symptoms, urinary and nasal inflammatory parameters are not helpful in characterizing the phenotype of a single patient.
Definition of the flight period of Lasioderma serricorne (F.) in stored tobacco
Authors: Papadopoulou S.Ch. , Buchelos C.Th.
Published: March 2003

A 4‐year (1996 – 99) survey of the biology of L. serricorne (F) (Coleoptera, Anobiidae) on stored tobacco has taken place in Thessaloniki, northern Greece. For the trapping of the adults, pheromone (‘New Serrico’ and ‘Black Stripe Moth’) as well as electric (black light) traps were used. The first generation adults emerging from larvae hibernating inside the tobacco bales appeared flying on the 17/5, 16/5, 28/4, and 30/4 of the years 1996, 1997, 1998, and 1999, respectively. In parallel observations, adults inside the bales were found on the 14/5, 12/5, 23/4, and 26/4 of the above‐mentioned years, respectively. Termination of flights, in all the years concerned, took place during October or November, while the last flights of November were recorded in temperatures of about 13 °C.
New parasitoids of Paraphytomyza populi (Kltb.) (Diptera, Agromyzidae)  in Bulgaria
Authors: Georgiev G.Ts. , Boyadzhiev P.
Published: March 2003

The parasitoid complex of Paraphytomyza populi (Kltb.) (Diptera: Agromyzidae) was studied in Sofia, Bulgaria in 1997. Poplar leaves with P. populi larvae and pupae were collected from poplar stump shoots and examined in a laboratory. As a result, eleven parasitoid species were established: Chorebus albipes (Haliday) (Hymenoptera, Braconidae), Pediobius metallicus (Nees), Danuviella subplana Erdos, Chrysocharis nephereus (Walker), Chrysocharis pubicornis (Zetterstedt), Diglyphus crassinervis Erdos, Diglyphus isaea (Walker), Diglyphus albiscapus Erdos, Cirrospilus diallus Walker, Cirrospilus pictus (Nees) (Hymenoptera, Eulophidae) and Elasmus sp. (Hymenoptera, Elasmidae). Six species (D. crassinervis, D. isaea, D. albiscapus, C. diallus, C. pictus and Elasmus sp.) have been recorded as new parasitoids of P. populi. The genus Danuviella was found for the first time in Bulgaria. Five species (C. albipes, P. metallicus, D. subplana, D. crassinervis and D. albiscapus) are new records for the fauna of the country. The total mortality of P. populi caused by parasitoids was 19.1 % and 49.0 % for the overwintering and the summer generations, respectively. P. metallicus was the most important in reducing the pest number.
Pymetrozine: Selectivity spectrum to beneficial arthropods and fitness for integrated pest management
Authors: Sechser B. , Reber B. , Bourgeois F.
Published: March 2003

Pymetrozine is the first and only substance from the group of azomethine pyridines, a novel class of insecticides. The spectrum of activity covers sucking pests such as aphids, whiteflies and planthoppers.

 Tests were carried out in the laboratory and under field conditions to evaluate its impact on beneficial arthropods.

 In laboratory tests it demonstrated full selectivity against predaceous Coleoptera, Heteroptera, Neuroptera and the predatory mite Typhlodromus pyri. Following a single application at 250/200 g a.i./ha on cotton in Egypt and in the USA, the regular sampling of predators over a period of three weeks revealed a similar population development in the pymetrozine and the untreated control plots. On okra, a vegetable crop in Egypt, it suppressed populations of Aphis gossypii with two sprays at 100 g a.i./ha for the whole observation period of 23 days. It also allowed the survival of predators.

 These positive features make pymetrozine an ideal component in situations where sucking pests have to be controlled and natural enemies can play a substantial role as complementary control tools.
Peroperative treatment with i.v. ketoprofen reduces pain and vomiting in children after strabismus surgery
Authors: Kokki H. , Homan E. , Tuovinen K. , Purhonen S.
Published: March 2003

Background: Strabismus surgery is associated with both pain and vomiting. Ketoprofen is widely used in adults to treat acute pain, but there are only few reports of its use in children. This randomised, double‐blind, placebo‐controlled, parallel group study was designed to investigate the analgesic effect of i.v. ketoprofen and its effect on the incidence of vomiting in children after day‐case strabismus surgery.

Methods: Fifty‐nine ASA 1 children, aged 1–12 years, entered the study. After premedication with diazepam and glycopyrronium, anaesthesia was induced with fentanyl and propofol and maintained with isoflurane. After induction the children in the ketoprofen group received 1 mg kg−1 ketoprofen followed by an infusion of 1 mg kg−1 ketoprofen over 2 h. In the placebo group, children received 0.9% saline. The postoperative pain was assessed by the Maunuksela pain score (0=no pain, 10=worst possible pain). All children received fentanyl as a rescue analgesic if the Maunuksela score was ≥3.

Results: In the ketoprofen group the number of fentanyl doses was smaller compared to the placebo group (median 1, quartiles (0–2) vs. 2 (1–3), P=0.047). The children in the ketoprofen group had less pain at 30 min (P=0.02) and the worst pain observed in the post anaesthesia care unit was lower (3 (0–6) vs. 5 (3–8), P=0.035). The incidence of vomiting was less in the ketoprofen group compared to the placebo group (17% vs. 41%, P=0.036). No serious adverse reactions occurred.

Conclusion: We concluded that ketoprofen administered i.v. during the operation produced analgesia and reduced opioid consumption and the incidence of vomiting in children after strabismus surgery.
Pain on injection of propofol: The mitigating influence of metoclopramide using different techniques
Authors: Liaw W.‐J. , Pang W.‐W. , Chang D.‐P. , Hwang M.‐H.
Published: March 2003

Background: Metoclopramide administered intravenously (iv) immediately before injection of propofol, after mixing with propofol, or after a rubber tourniquet for 1 min before propofol injection will reduce pain induced by propofol injection. In this study, these three different techniques in reducing propofol injection pain with metoclopramide were compared with lidocaine or saline to evaluate the most effective method in reducing propofol injection pain.

Methods: In a randomized, semi‐double‐blind treatment, 175 patients were included into this study. Patients in group A were pretreated with metoclopramide 10 mg iv before propofol (2 mg/kg) induction. Patients in group B were induced with a mixture of propofol and metoclopramide. Patients in group C were pretreated with metoclopramide iv with a rubber tourniquet on the arm for 1 min followed by propofol administration. Groups D and E were identical to group C except for the replacement of pretreatment with either lidocaine (40 mg) or saline, respectively.

Results: Groups A, C and D (with active pain prophylaxis) showed a significantly less incidence of pain than the saline control group (E) as propofol was injected. There was no significance difference between metoclopramide and lidocaine in reducing propofol injection pain using a tourniquet technique. The intensity of the propofol injection pain (verbal pain score) was stronger with saline as compared with the other groups.

Conclusions: We conclude that iv retention of metoclopramide with tourniquet is as good as lidocaine and may be a useful alternative for reducing pain on propofol injection.
Intact proprioception and control of labour painduring epidural analgesia
Authors: Abrahams M. , Higgins P. , Whyte P. , Breen P. , Muttu S. , Gardiner J.
Published: March 2003

Background: Accurate proprioception is critical while walking, yet an ambulatory epidural regimen that provides adequate analgesia for labour while simultaneously preserving proprioceptive input has not been described.

Methods: Sixty primigravidae in established labour received bupivacaine 15 mg (15 ml of 0.1% w/v) and fentanyl 100 μg through a lumbar epidural catheter. Clinical assessment of dorsal column sensory function included: vibration sense, distal proprioception and the Romberg test, and were all performed before catheter insertion and 30 min after the study bolus. Sensory modalities were also tested compared to an unblocked dermatome. Pain was scored on a 0–10 cm visual analogue scale (VAS) before and 30 min after induction. Intensity of the motor block was tested using a modified Bromage score (grade 1–6).

Results: The study bolus provided reliable analgesia with 43 parturients attaining a VAS pain score of zero. Mean duration of analgesia was 67.5 min (SD 22.85). All parturients retained the ability to perform a partial knee bend while standing (grade 6). No mothers exhibited impaired distal proprioception, altered vibration sense or a positive Romberg sign.

Conclusion: This study confirms that the addition of lumbar epidural fentanyl 100 μg to 15 mg of epidural bupivacaine provides good control of labour pain with no motor block and establishes that this combination preserves dorsal column sensory function.
Effects of adenosine infusion on gastric emptying in healthy volunteers
Authors: Forsberg C. , Sollevi A. , Thörn S.‐E. , Segerdahl M.
Published: March 2003

Background: A low dose of systemic adenosine infusion has been shown to induce antinociception in clinical experimental studies as well as in patients. There is no clinical information about the effect of adenosine on the motility of the gastrointestinal tract. The aim of this study was therefore to evaluate the effect of exogenous adenosine administration on gastric emptying in man.

Method: Ten healthy male volunteers (22–45 yrs) were included in a placebo‐controlled, double‐blind, randomised, cross‐over study, where the experiments were separated by at least one week. During one session the volunteers received a continuous intravenous infusion of adenosine (50 μg · kg−1 · min−1) initiated 15 min prior to the test of gastric emptying (a standard test meal, followed by oral acetaminophen, 2 g) and lasting throughout the experiment (2 h). During the other experimental session an infusion of saline was given. Acetaminophen absorption test was used as an indirect measure of the rate of gastric emptying. Venous acetaminophen concentration curves were produced and the maximum acetaminophen concentration (Cmax), the time to reach the maximum concentration (Tmax), and the area under the serum acetaminophen concentration time curve from 0 to 60 min (AUC60) were calculated.

Results: There was no difference between placebo and adenosine in Cmax (197 vs. 199 μmol · L−1, P=0.80), Tmax (23 vs. 45 min, P=0.14), AUC60 (9633 vs. 9111 min · μmol · L−1, P=0.28).

Conclusion: The results demonstrate that adenosine in a clinically antinociceptive dose of 50 μg · kg−1 · min−1 does not affect the rate of gastric emptying in healthy volunteers.
Malignant hyperthermia and neuroleptic malignant syndrome in a patient during treatment for acute asthma
Authors: Portel L. , Hilbert G. , Gruson D. , Favier J.‐C. , Gbikpi‐Benissan G. , Cardinaud J.‐P.
Published: March 2003

Acute asthma is well known to provoke complications. We report the case of a patient who needed intubation and mechanical ventilation for acute asthma. Despite a treatment with corticosteroids, bronchodilators, neuromuscular blocking drugs and magnesium sulfate, the situation remained uncontrolled and as a last resort, halothane became necessary. The patient then developed an episode of malignant hyperthermia with fever at 40°C and rhabdomyolysis. At this time, halothane could be stopped and all the symptoms disappeared without modifying the rest of the treatment. Eight days later, he presented with a neuroleptic malignant syndrome following an injection of droperidol. Temperature rose to 42°C, associated with muscle rigidity, sweating, tachycardia and severe circulatatory collapse. The use of dantrolene in association with a symptomatic treatment of the collapse led to a favourable outcome in. Unfortunately, in vitro contracture test could not be performed in this case.

The links between malignant hyperthermia and neuroleptic malignant syndrome remain unclear. Although these two pathologies share the same physiopathology, symptomatology and treatment, they are clearly individualized. This case seems to be the first description of their occurrence in the same patient.
Signs of massive intraoperative pulmonary embolism with extensive invasive monitoring
Authors: Toivonen H. J. , Sipponen J. , Heikkilä L.
Published: March 2003

A 71‐year‐old patient suffered a massive pulmonary tumor embolism during removal of a renal carcinoma. He had extensive invasive monitoring, and the data were stored for later analysis. This shows that most of the known signs of pulmonary embolism were present in the tracings. It is discussed how none of them alone was sufficient for clinical diagnosis, but the comparison of several simultaneous variables together may be of great help. This report shows also the importance of the data‐storing devices in the anesthesia monitors to make these comparisons possible in quickly changing emergency situations.
Combined effects of high‐frequency ventilation and surfactant treatment in experimental meconium aspiration syndrome
Authors: Calkovska A. , Sun B. , Curstedt T. , Renheim G. , Robertson B.
Published: March 2003

Background: Deterioration of lung function in meconium aspiration syndrome may in part be due to inactivation of endogenous surfactant. We evaluated the efficacy of high‐frequency ventilation (HFV) and the combination of HFV and surfactant therapy in the management of respiratory failure induced by experimental meconium aspiration in adult rats.

Methods: Animals were anesthetized and tracheotomized, and received via the tracheal cannula a suspension of human meconium (25 mg/ml, dose 4 or 5 ml/kg). After 30 min of conventional ventilation (CV) with 100% oxygen, animals were in respiratory failure as indicated by a decrease in lung‐thorax compliance of ≥30% and PaO2 <10 kPa. They were then ventilated for an additional 3 h with either CV (frequency 40/min, inspiration time 50%) or HFV (frequency 15 Hz, inspiration time 50%) using comparable mean airway pressures (about 20 cmH2O) and variable FiO2. Subgroups of animals were treated with Curosurf (80 mg/ml, dose 200 mg/kg) 30 min after meconium aspiration; no additional material was instilled in controls.

Results: From 30 min onwards, values for PaO2/FiO2 were significantly higher in animals ventilated with HFV without receiving surfactant than in control animals subjected to CV alone (at 120 min: 18±7.3 vs. 7.4±0.8 kPa, P<0.05). Additional improvement in oxygenation was seen in HFV‐treated animals receiving Curosurf (at 120 min: 39±16 kPa: P vs. HFV alone <0.01). Relative lung volumes at a deflation pressure of 10 cmH2O, expressed as percent of maximum volume, were larger in animals ventilated with HFV than in those undergoing CV (41±12 vs. 33±10%; P<0.05), and were further increased in the groups of animals treated with surfactant and ventilated with HFV (55±9.9%; P vs. animals ventilated with HFV not receiving surfactant <0.01) or CV (49±9.6%; P vs. animals ventilated with CV without receiving surfactant <0.05). Hyaline membranes, granulocytes in cytospin preparations from lung lavage fluid, and vascular‐to‐alveolar leak of albumin were less prominent in the HFV than in the CV group, particularly in animals treated with surfactant.

Conclusion: Our data indicate that HFV, especially in combination with surfactant therapy, may be superior to CV for treatment of respiratory failure in this animal model of meconium aspiration syndrome.
Diminished interleukin‐6 and C‐reactive protein responses to laparoscopic versus open cholecystectomy
Authors: Kristiansson M. , Saraste L. , Soop M. , Sundqvist K. G. , Thörne A.
Published: March 2003

Background: Cytokines and their inhibitors are thought to be involved in many of the pathophysiological changes associated with trauma and infection. The magnitude of the trauma and the degree of tissue damage have an impact on the trauma response. The purpose of the study was to examine cytokine and hormonal responses to elective cholecystectomy and the extent to which these responses are influenced by the surgical procedure employed.

Methods: Sixteen patients, ASA grades I and II, were studied: 8 of them underwent laparoscopic cholecystectomy while the remaining 8 were operated on using the open technique. Systemic concentrations of tumour necrosis factor α (TNF), interleukin‐1 β (IL‐1), interleukin‐6 (IL‐6), cortisol, epinephrine and norepinephrine were measured before and during the operation and subsequently for up to 48 h postoperatively. The degree of pain and fatigue were recorded during the study period.

Results: The preoperative levels of cytokines and hormones were all similar in the groups. Concentrations of TNF and IL‐1 were detected only sporadically. The rise in plasma IL‐6 was less marked following laparoscopic than after open cholecystectomy. However, the hormonal response was quite similar in the two groups. Pain and fatigue scores were lower (P<0.05–0.01) in the laparoscopic group than in the open surgery group.

Conclusion: In summary, cholecystectomy, irrespective of whether it was performed using the laparoscopic or open technique, was followed by a trauma response and increased pain and fatigue. However, the magnitude of stress, pain and fatigue was less pronounced in laparoscopic cholecystectomy patients. Concentrations of IL‐6 seem to be more sensitive when it comes to delineating the trauma response than systemic norepinephrine and epinephrine levels.
The potential for increased risk of infection due to the reuse of convective air‐warming/cooling coverlets
Authors: Sigg D. C. , Houlton A. J. , Iaizzo P. A.
Published: March 2003

Background: The use of convective air warming and/or cooling for the prevention of hypothermia or to induce hypothermia is growing rapidly. To date, there is no information available as to the potential risks for infection associated with either the postsurgical reuse or the repositioning of coverlets closer to the wound. We hypothesized that use of coverlets either intra‐ or postoperatively leads to increased contamination.

Methods: The bacterial contamination of commercially available coverlets before (control group, n=10) and after patient application (n=18) was investigated. From 3 predetermined sites, 1 cm×2 cm pieces of coverlet were removed and analyzed for bacterial contamination.

Results: Even prior to use, coverlet samplings provided identifiable contamination (3 out of 30 sites, 10%), but this could be within our study’s sampling error. Nevertheless, following clinical use the frequency of contamination was considerably increased; 17 out of 57 sampled sites (31.5%) elicited contamination (P<0.05, Fisher’s exact test).

Conclusion: This study demonstrates that the use of the coverlets, intra‐ or postoperatively, can lead to significant bacterial contamination. It is concluded that it is not advisable to reuse coverlets for multiple clinical applications.
In vitro effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastograph technique
Authors: Kohro S. , Yamakage M. , Omote T. , Namiki A.
Published: March 2003

Background: To investigate the in vitro effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastograph (TEG) technique.

Methods: The blood samples, obtained from 14 healthy volunteers, were divided into two groups: propofol (n=7) and intralipid (n=7), and 360 μl volumes of whole blood were incubated with 2 μl of 1% propofol and with its solvent intralipid, respectively. The incubated sample was then used for TEG measurements.

Results: The maximum amplitude (MA), which reflects coagulability, in the intralipid group significantly increased by about 7% and 16% compared to the control and propofol groups, respectively (P<0.05), whereas the MA in the propofol group did not change. The fibrinolytic rate (FR) in the propofol group significantly increased by about 170% and 210% compared to the control and intralipid groups, respectively (P<0.05), whereas the FR in the intralipid group did not change.

Conclusions: Propofol, per se, has at the concentration of 55.6 μg · ml−1 an in vitro accelerative effect on blood fibrinolysis detected by TEG.
Pituitary apoplexy after cardiac surgery presenting as deep coma with dilated pupils
Authors: Wiesmann M. , Gliemroth J. , Kehler U. , Missler U.
Published: March 2003

Acute clinical deterioration due to infarction or haemorrhage of an existing, often previously unrecognized, pituitary tumour is a rare but well‐described complication. It can occur spontaneously or may be caused e.g. by mechanical ventilation, infection or surgical procedures. We report on a case of pituitary apoplexy occurring in a 64‐year‐old patient 3 weeks after cardiac surgery. The patient presented with deep coma and dilated pupils. Magnetic resonance imaging revealed a haemorrhagic pituitary tumour. After prompt endocrinologic replacement therapy with levothyroxine and hydrocortisone the patient regained consciousness. Neurological examination revealed right oculomotor nerve palsy and bilateral cranial nerve VI palsy. Subsequent trans‐sphenoidal removal of a nonfunctional macroadenoma with large necrotic areas was performed. The patient recovered completely. To our knowledge, pituitary tumours presenting with a combination of deep coma and dilated pupils must be considered exceedingly rare. Possible pathophysiologic mechanisms are discussed. As our case illustrates, even in severe cases complete recovery is possible if the diagnosis is suspected, and diagnostic and therapeutic measures are initiated in time.
Paracetamol 1 g given rectally at the end of minor gynaecological surgery is not efficacious in reducing postoperative pain
Authors: Hein A. , Jakobsson J. , Ryberg G.
Published: March 2003

Background: We studied the analgesic effects of 1 g paracetamol given rectally at the end of surgery in a prospective, randomised, double‐blind study.

Methods: One hundred and forty ASA I–II women scheduled for elective termination of pregnancy under general anaesthesia were randomly allocated to receive paracetamol or placebo. All patients had standardised anaesthesia with propofol, fentanyl and oxygen in nitrous oxide. Postoperative pain was assessed by VAS score.

Results: We could find no difference regarding postoperative pain, need for analgesics or time to discharge between the groups.

Conclusion: The routine use of 1 g paracetamol given rectally at the end of surgery after termination of pregnancy seems not to be justified.
Intra‐articular morphine for pain relief after knee arthroscopy
Authors: Rosseland L. A. , Stubhaug A. , Skoglund A. , Breivik H.
Published: March 2003

Background: Peripheral opioid analgesia is well documented. But the clinical usefulness of intra‐articular morphine after surgery is uncertain. The aim of the present study was to evaluate the analgesic effects of intra‐articular morphine after knee arthroscopy.

Methods: In this parallel‐group, double‐blind study, 90 patients were randomised to receive either morphine 1 mg, morphine 2 mg or placebo in 5 ml saline intra‐articularly at the end of arthroscopic knee surgery. Anaesthetic technique was local infiltration and intra‐articular injection of lidocaine. Analgesic efficacy was evaluated by a global pain score, pain intensity (visual analogue scale), and analgesic requirements (paracetamol) during the first 48 h postoperatively.

Results: No significant differences between the groups were found for any of the efficacy variables. A majority of the patients had mild pain throughout the study, thus possibly compromising study sensitivity. In a subgroup with more intense pain early after arthroscopy, intra‐articular morphine 2 mg reduced pain intensity (P<0.05) and analgesic requirements (P<0.05) compared with placebo.

Conclusion: Postoperative analgesic effect of intra‐articular morphine was found only in a subgroup of patients with higher pain intensity in the immediate postanaesthetic period. Possible reasons for our overall negative findings include low study sensitivity due to weak pain stimulus, lack of inflammation that may be a prerequisite for peripheral opioid analgesia, and the local anaesthetic, which impedes local inflammatory reaction and expression of peripheral opioid receptors. These factors may also explain the conflicting results in other studies.
Irrigating fluid absorption during percutaneous nephrolithotripsy
Authors: Gehring H. , Nahm W. , Zimmermann K. , Fornara P. , Ocklitz E. , Schmucker P.
Published: March 2003

Background: The most common complication during percutaneous nephrolithotripsy (PNL) is the destruction of organ structures with extravasation of the irrigation fluid into the retroperitoneal space. Consequently, there is an increased risk of a urosepsis and a complicated therapeutic course. In this study we aimed to show that extravascular absorption could be differentiated from intravascular absorption due to their unique absorption characteristics, and that these characteristics enable a prediction of possible post‐operative complications.

Methods: In a prospective study of 31 patients with PNL, ethanol was added to the irrigating fluid and blood ethanol concentration (BEC) was measured by gas chromatography during the endoscopic procedure and in the recovery room. Following the guidelines of Hahn, patients were divided into two groups: group EVA, in whom extravasation had occurred with subsequent absorption; group IVA, those with intravascular absorption. Patients’ post‐operative progress along with diagnoses of renal perforations or bleeding, or signs of infection or sepsis, were comprehensively listed.

Results: EVA was diagnosed in 19 cases, and IVA in 12 cases. Maximum BEC levels were achieved after 20 min (median) in the IVA group, and 75 min in the EVA group (P<0.05). Apart from their significantly higher demand for opioids (P<0.05), EVA patients had been hospitalised for a substantially and significantly longer period of time (P<0.01). Although without statistical significance, there was a higher rate of peri‐operatively confirmed complications and prolonged intensive therapeutic treatment in the extravasation group.

Conclusion: Retroperitoneal extravasation can be identified by using ethanol monitoring during and after PNL. Afflicted patients require considerably longer hospitalisation, probably because of the additional injury to surrounding organ structures.