bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical trial: renzapride therapy for constipation‐predominant irritable bowel syndrome – multicentre, randomized, placebo‐controlled, double‐blind study in primary healthcare setting
Authors: GEORGE A. M. , MEYERS N. L. , HICKLING R. I. 
Published: July 2010

SummaryBackground Relatively few pharmacological treatment options are available for treating patients with irritable bowel syndrome. New and effective medicines are urgently required.Aim To identify an appropriate dosage of renzapride (a 5‐HT4receptor full agonist/5‐HT3receptor antagonist) to treat abdominal pain/discomfort in patients with constipation‐predominant irritable bowel syndrome.Methods In this randomized, placebo‐controlled, phase IIb study in the primary care setting, men and women were randomized to placebo or renzapride (1, 2 or 4 mg/day) for 12 weeks. The primary outcome measure was patient self‐assessed relief of abdominal pain/discomfort during weeks 5–12. Secondary efficacy measures included patients’ assessment of their bowel habits, stool consistency and quality of life.Results Although there were no statistically significant differences between renzapride and placebo for relief from abdominal pain/discomfort, responder rates in the renzapride treatment groups increased dose dependently, with the 4 mg/day group being consistently numerically greater than placebo. Importantly, a larger numerical treatment difference vs. placebo was observed in women (8% and 12% respectively). Statistically significant improvements in bowel movement frequency and stool consistency were observed in the 4 mg/day group relative to placebo. Renzapride was well tolerated at all doses.Conclusions This study confirms the gastrointestinal prokinetic effects of renzparide. The data also suggested a potentially beneficial effect on abdominal pain/discomfort in women with constipation‐predominant irritable bowel syndrome.
Review article: nonalcoholic fatty liver disease and hepatitis C virus – partners in crime
Authors: BLONSKY J. J. , HARRISON S. A. 
Published: July 2010

SummaryBackground Both nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC) are frequent causes of chronic liver disease. In recent years, there have been significant revelations as regards the relationship between NAFLD and CHC.Aim To conduct a systematic, evidence‐based review of the epidemiology, pathophysiology and potential treatments of coexistent NAFLD and CHC.Methods The terms such as hepatitis C, fatty liver, NAFLD, nonalcoholic steatohepatitis and steatosis were searched on PubMed up to January 2008. References from selected articles and pertinent abstracts were also included.Results Hepatic steatosis affects up to 80% of patients with CHC and is dependent on both viral and host factors. While insulin resistance (IR) is associated with hepatic steatosis and hepatitis C virus, genotype‐specific pathogenic mechanisms have been identified and are currently the focus of intense investigation in the literature. Clinical implications of concurrent NAFLD, CHC and IR include increased disease progression, elevated risk of hepatocellular carcinoma, and decreased response to antiviral therapy.Conclusions NAFLD and IR are common in patients with CHC virus infection. IR is a driving force in the development of hepatic steatosis. Because of the clinical implications of hepatic steatosis and IR in the setting of CHC, further studies evaluating treatments, which may increase response to antiviral therapy, are needed.
The use of acid‐decreasing medication in veteran patients with gastro‐oesophageal reflux disorder with and without Barrett’s oesophagus
Authors: EL‐SERAG H. B. , WIEMAN M. , RICHARDSON P. 
Published: July 2010

SummaryAim  To examine use of acid‐decreasing medications, especially proton pump inhibitors (PPIs), in patients with gastro‐oesophageal reflux disorder (GERD) with and without Barrett’s oesophagus (BO) in a large‐scale study.Methods  We conducted a retrospective cohort study of patients with newly diagnosed BO (ICD‐9 code 5302) and patients with GERD and no BO (ICD‐9 53081, 5301) in Department of Veterans Affairs (VA) databases. Filled prescriptions for oral PPI and histamine2‐receptor antagonists (H2RA) were identified in the VA Pharmacy Benefit Management database during 365 days following diagnosis. Groups with or without PPI or H2RA were compared in unadjusted and adjusted regression analyses. Chart review was used to validate diagnoses in a subset of patients with and without BO.Results  We evaluated 7732 patients with BO and 13 457 with GERD and no BO diagnosed between 1/2000 and 12/2002. At least one PPI prescription was filled during the first year following diagnosis in 91.5% of BO and 61.4% of non‐BO patients (P < 0.0001), and one H2RA in 31.7% of BO and 59.4% of non‐BO patients (P < 0.0001), respectively. However, 6.1% of BO patients were prescribed neither. Median duration for PPI filled prescriptions was twice as long for BO (221.7 vs. 106.9 days) compared with non‐BO patients. The ratio of PPI or H2RA filled prescription days to available follow‐up days among BO subjects was 0.66 (122.8 days were not covered with prescription for either), and 0.55 in GERD patients with no BO (165.0 days on neither).Conclusions  Veterans Affairs patients with BO are 50% more likely to be prescribed a PPI than patients with GERD and no BO. However, on average, PPI prescriptions cover only 60% of follow‐up time for BO patients.
Gastro‐oesophageal reflux, medical resource utilization and upper gastrointestinal endoscopy in patients at risk of oesophageal adenocarcinoma
Authors: VAN SOEST E. M. , DIELEMAN J. P. , STURKENBOOM M. C. J. M. , SIERSEMA P. D. , KUIPERS E. J. 
Published: July 2010

SummaryBackground  Early identification of patients at risk of oesophageal adenocarcinoma (OAC) might improve survival.Aim  To assess the medical resource utilization in the 3 years before OAC diagnosis as potential markers for early identification and intervention.Methods  We identified 65 incident OAC within the Integrated Primary Care Information database. For comparison, we randomly selected 260 age‐ and gender‐matched population controls. We abstracted the use of gastric acid inhibitors, general practitioner (GP) and specialist care, and gastroscopies in the 3 years before the detection of OAC.Results  Approximately 20% of the cases used gastric acid inhibitors in the third and second year before OAC, which increased to almost 50% in the last year, compared to approximately 10% among controls. Only in the 6 months before OAC, the proportion of patients visiting a GP (97%) or specialist (41%) increased compared to controls. Of 13 gastroscopies performed in the 3 years, six (46%) were not suspect for a malignancy.Conclusions  Only a minority of all OAC patients used acid inhibitors before diagnosis. The use of medical care between cases and controls differed only in the final year before OAC diagnosis. Detection of early neoplastic changes proves to be difficult.
Review article: epidemiology, pathogenesis and potential treatments of paediatric non‐alcoholic fatty liver disease
Authors: BARSHOP N. J. , SIRLIN C. B. , SCHWIMMER J. B. , LAVINE J. E. 
Published: July 2010

SummaryBackground Non‐alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease. Similar to NAFLD in adults, NAFLD in children is associated with obesity and insulin resistance and requires liver histology for diagnosis and staging. However, significant histological differences exist between adult and paediatric NAFLD to warrant caution in extrapolation of adult data.Aim To review the available data on the epidemiology, pathogenesis, diagnosis and treatment of paediatric NAFLD.Methods Relevant articles were identified by Medline searches using the keywords: nonalcoholic fatty liver disease, steatohepatitis, obesity and children.Results The rise in childhood obesity has been accompanied by an increase in paediatric NAFLD. Age, gender and race/ethnicity are significant determinants of risk, and sex hormones, insulin sensitivity and adipocytokines are implicated in the pathogenesis of paediatric NAFLD. There is no consensus for treatment of NAFLD; however, data suggest that diet, exercise and some pharmacological therapies may be of benefit.Conclusions To evaluate and effectively treat paediatric NAFLD, the pathophysiology and natural history of the disease should be clarified and non‐invasive methods for screening, diagnosis, and longitudinal assessment developed. Randomized, controlled, double‐blind trials of pharmacological therapies in children with biopsy‐proven disease are necessary.
Health‐economic analysis: cost‐effectiveness of scheduled maintenance treatment with infliximab for Crohn’s disease – modelling outcomes in active luminal and fistulizing disease in adults
Authors: LINDSAY J. , PUNEKAR Y. S. , MORRIS J. , CHUNG‐FAYE G. 
Published: July 2010

SummaryBackground  Infliximab has been shown to be efficacious in moderate‐to‐severe Crohn’s disease (CD).Aim  To evaluate the cost‐effectiveness of scheduled maintenance treatment with infliximab in luminal and fistulizing CD patients.Methods  Markov models were constructed to simulate the progression of adult CD patients with and without fistulae during treatment with infliximab (5 mg/kg). Transitions were estimated from published clinical trials of infliximab. Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. An average weight of 60 kg was used to estimate the dose of infliximab. The costs and outcomes were discounted at 3.5% over 5 years. The primary effectiveness measurement was quality‐adjusted life years (QALYs) estimated using EQ‐5D. One‐way and probabilistic sensitivity analyses were performed by varying the infliximab efficacy estimates, costs and utilities.Results  The incremental cost per QALY gained was £26 128 in luminal CD and £29 752 in fistulizing CD at 5 years. Results were robust and remained in the range of £23 752–£38 848 for luminal CD and £27 047–£44 206 for fistulizing CD. Patient body weight was the most important factor affecting cost‐effectiveness.Conclusion  Eight‐week scheduled maintenance treatment with infliximab is a cost‐effective treatment for adult patients suffering from active luminal or fistulizing CD.
Pre‐operative intramuscular ranitidine and cimetidine
Authors: WILLIAMS J. G. , STRUNIN L. 
Published: July 2010

SummaryA controlled trial was carried out on 120 healthy patients presenting for elective surgery. The patients were divided randomly into three groups, which received respectively, 50 mg ranitidine, 100 mg ranitidine, or 300 mg cimetidine intramuscularly at least 45 minutes before operation. Following induction of anaesthesia, a nasogastric tube was passed, the stomach contents aspirated and analysed for volume and pH. Thirteen per cent of cimetidine‐treated patients had a gastric pH of 2.5 or less, compared to 8% of those given ranitidine 50 mg and 3% of those given ranitidine 100 mg; however, these differences were not statistically significant. No side effects attributable to the administration of either drug were observed. It is concluded that intramuscular administration of ranitidine or cimetidine is an effective method of reducing the number of patients at risk of acid aspiration during anaesthesia. However, neither drug eliminates the risk of acid aspiration in all patients. and thus careful anaesthetic technique to protect the airway remains essential.
Potential hazard of East‐Radcliffe ventilator
Authors: MYERSON K. R. 
Published: July 2010

SummaryReports of two hypoxic episodes which occurred during the use of the East Radcliffe PNA 1 ventilator in the ‘complete rebreathing’ mode led to the study of the efficiency of the emergency air entrainment system. The inability of this system to maintain adequate oxygen concentrations during interruption of the fresh gas supply results in the development of a hypoxic gas mixture despite potency of the entrainment valve. The reasons for this, and their clinical implications during intermittent positive pressure ventilation in the ‘complete rebreathing’ mode, are discussed.
Allergy, plasma IgE level and anaphylactoid response: a hypothesis
Authors: WATKINS J. , WILD G. , CLARKE R.S.J. 
Published: July 2010

SummaryAny simple test predictive of immediate hypersensitivity‐like (anaphylactoid) response to anaesthetic agents would be clinically useful. Possession of the traits of allergy or atopy, and of raised plasma IgE levels, all easily established, have previously been reported as predisposing factors. The usefulness of such observations has been limited by the fact that many reactions are not immune and do not involve IgE antibodies. This hypothesis suggests how IgE levels may be widely predictive of other reaction mechanisms and partially explains some of the divergent views on the mechanisms of anaphylactoid response which occur in the literature.
Review of domiciliary consultations for pain relief
Authors: Casale F.F. , Thorogood A. 
Published: July 2010

SummaryThree hundred consecutive requests for a domiciliary visit for pain relief were reviewed to assess the type of case referred by general practitioners and what treatment was instituted. Two hundred and thirty one (77%) were requested for lumbago/sciatica. In total 179 caudal epidurals and 49 other injections were performed in the patient's home. The safety of the procedures are discussed emphasising careful history taking, physical examination and meticulous attention to injection techniques as 12 patients (7%) were wrongly diagnosed as suffering from lumbago and sciatica from the 231 referred with that diagnosis.
Nitrous oxide solubility in halothane and its effect on the output of vaporizers
Authors: PALAYIWA E. , HAHN C. E. W. , SUGG B. R. 
Published: July 2010

SummaryThe absorption of nitrous oxide in halothane was studied by bubbling nitrous oxide and nitrous oxide/oxygen gas mixtures through a halothane bottle, using 100% oxygen as a control. The gas volume emerging from the halothane bottle was measured each minute, over a period of up to 15 minutes. When oxygen was used as a control gas, the averaged flow rate dropped slightly over the experimental period, due to the cooling of the halothane. However, in the presence of nitrous oxide, the initial flow rate of the gas emerging from the halothane bottle was greatly diminished, but then accelerated rapidly to reach that obtained with oxygen. The results suggested that nitrous oxide dissolved in large quantities in halothane, and the data are consistent with an Ostwald coefficient in excess of 4.0.
Effect of premedication with controlled‐release oral morphine on postoperative pain
Authors: SLOWEY H. F. , REYNOLDS A. D. , MAPLESON W. W. , VICKERS M. D. 
Published: July 2010

SummaryThirty five patients presenting for elective total hip replacement were randomly allocated to receive a premedication of 60 or 90 mg controlled‐release oral morphine or 15 mg intramuscular morphine. Postoperative analgesia was assessed using on‐demand intravenous pethidine supplementation requirements. In 15 patients free plasma morphine concentrations were measured. Both 60 and 90 mg controlled‐release oral morphine led to a reduced pethidine requirement compared to the intramuscular group but the reduction was not statistically different.
The management of anaesthesia for patients with cystic fibrosis
Authors: LAMBERTY J. M. , RUBIN B. K. 
Published: July 2010

SummaryThe clinical problems of patients with cystic fibrosis who require anaesthesia are reviewed. The management and the complications of anaesthesia in 77 patients over a 3‐year period are presented. The long term effects of anaesthesia are analysed by a study of the lung function tests of these patients. The results suggest that even multiple procedures, as for instance nasal polypectomy, are not harmful. A method for safe peroperative management is presented.
Evaluation of the Datex ‘Normac’ anaesthetic agent monitor
Authors: LUFF N. P. , WHITE D. C. 
Published: July 2010

SummaryThe Datex ‘Normac’ infrared anaesthetic agent monitor has been evaluated for accuracy of calibration, stability and speed of response. Accuracy was assessed by comparing with a gas chromatograph calibrated using volumetric standards and was found to be very good for isopurane and enflurane but was slightly less accurate for halothane, due to a low signal: noise ratio. The stability of the instrument was found to be exceptionally good. The response time is dependent on the sampling rate and we found that, in practice, the instrument would record the end expired anaesthetic concentration on patients breathing up to 15 breaths/minute. The instrument is compact and convenient for use in operating theatres.
Fibreoptic bronchoscopic nasotracheal intubation of a neonate with Pierre Robin syndrome
Authors: HOWARDY‐HANSEN P. , BERTHELSEN P. 
Published: July 2010

SummaryA case of nasotracheal intubation using a fibreoptic bronchoscope and the Seldinger technique is described. A guide wire was passed through the suction channel of the fibrescope after the epiglottis and the vocal cords were seen; the fibrescope was removed and a nasotracheal tube passed over the wire into the trachea.
Intrathecal buprenorphine for postoperative analgesia in the elderly patient
Authors: CAPOGNA G. , CELLENO D. , TAGARIELLO V. , LOFFREDA‐MANCINELLI C. 
Published: July 2010

SummaryNinety patients aged 56–85 years scheduled for suprapubic prostatectomy, randomly received intrathecally either bupivacaine 30 mg (group A, n = 30), bupivacaine 30 mg plus buprenorphine 0.03 mg (group B, n = 30) or bupivacaine 30 mg plus buprenorphine 0.045 mg (group C, n = 30). Prolongea postoperative analgesia, minimal disturbance of consciousness and comfortable breathing were common to the groups that received buprenorphine. The higher concentration of buprenorphine improved the quality and duration of analgesia. The only side effects found in the buprenorphine groups were nausea and vomiting in 11 and 14 patients, respectively, in groups B and C. Our study shows that buprenorphine is an effective analgesic, suitable for the management of postoperative pain in elderly patients.
HELLP syndrome and the anaesthetist
Authors: DUFFY B. L. 
Published: July 2010

SummaryFour pregnant patients are described who had varying signs of pre‐eclampsia plus haemolysis, elevated liver enzymes and a low platelet count. Two of the patients presented without hypertension and all posed considerable diagnostic difficulties, with problems in clinical management. Pregnancy induced hypertension is only one manifestation of a much more diverse pathophysiological process. Anaesthetists need to be aware of these other pregnancy related disorders in order to avoid diagnostic pitfalls and to enable them to provide safely the appropriate general and regional anaesthetic techniques.
Technical advantages of the paramedian approach for lumbar epidural puncture and catheter introduction
Authors: BLOMBERG R. G. 
Published: July 2010

SummaryThe lumbar epidural space of 14 autopsy subjects was examined by epiduroscopy. The aim was to compare the midline and paramedian approaches of locating the space, the estimated risk of accidental dural puncture, the course taken by the epidural catheter after introduction and with special attention to the influence of the dorsomedian connective tissue band. The paramedian needle passed a greater distance within the epidural space before contact with the dura mater and demonstrated a low risk of accidental dural puncture. The catheter passed by the paramedian approach did not cause any tenting of the dura and took a straight cephalad direction in all 14 cases. The midline catheter caused tenting of the dura in all 14 cases and the direction of travel was variable. Differences were statistically significant. Influence of the dorsomedian connective tissue band was greatest on the behaviour of the midline needle and catheter.
Lignocaine 2% with adrenaline for epidural Caesarean section
Authors: NORTON A. C. , DAVIS A. G. , SPICER R. J. 
Published: July 2010

SummaryA randomised double blind controlled trial of freshly prepared 2% lignocaine with 1/200 000 adrenaline and 0.5% plain bupivacaine was conducted on 60 women undergoing elective Caesarean section. The use of the former enabled epidural blockade to above the T6 dermatome to be established in a significantly shorter time than with bupivacaine (p < 0.005). The quality of sensory blockade and incidence of complications was similar in the two groups. The solutions were of similar potency as measured by the volume required per segment blocked. Motor blockade was more intense with 2% lignocaine with adrenaline (p < 0.03). More neonates had moderately depressed Apgar scores (5–7) at one minute in the lignocaine group but this difference was not statistically significant, and there was no difference in the distribution of Apgar scores at 3 minutes. Lignocaine with 1/200 000 adrenaline is a useful alternative to 0.5% plain bupivacaine when it is desired to establish rapidly epidural blockade for Caesarean section.
Spina bifida occulta and epidural anaesthesia
Authors: McGRADY E. M. , DAVIS A. G. 
Published: July 2010

SummarySpina bifida occulta occurs in 5–10% of the population, not all of whom display superficial signs. Attempted epidural puncture at the level of the lesion will almost certainly result in a dural tap. We report a patient who developed a postural headache after Caesarean section under epidural anaesthesia, in whom radiography of the spine later demonstrated spina bifida occulta. This problem has not been described previously, although it is unlikely to be an isolated case.
Systemic air embolism during laser bronchoscopy
Authors: PEACHEY T. , EASON J. , MOXHAM J. , JARVIS D. , DRIVER M. 
Published: July 2010

SummaryWe report a case of massive, fatal, systemic gas embolism which occurred during the course of laser bronchoscopic resection of a bronchial carcinoma. The clinical features of systemic air embolism are discussed.
Costs of replacement of anaesthetic equipment. Projected expenditure for clinical anaesthetic equipment in a teaching health district
Authors: Schofield N. McC. 
Published: July 2010

SummaryA study was made of all the anaesthetic equipment in clinical use to substantiate estimates of the cost of its replacement on four hospital sites. The years during which replacement was likely to become necessary were estimated from the list compiled and an existing full inventory, together with costs at 1986 prices. The predicted costs for each year until 2000AD were derived. To these were added sums required to make good existing shortfalls and to introduce a moderate amount of equipment incorporating newer technology. The totals showed that the capital currently available in the health district is sufficient only for anaesthetic equipment and requires a substantial increase to replace medical apparatus belonging to all specialties already in routine clinical use. Health authorities must be given detailed projections of these costs.
‘Fruit‐flavoured’ mask for isoflurane induction in children
Authors: Lewis R. P. , Jones M. J. , Eastley R. J. , Wandless J. G. 
Published: July 2010

SummaryThe effect of disguising the odour of isoflurane with fruit flavouring, upon the quality of inhalational induction, was studied in 41 children aged 3–10 years in a double‐blind, randomised trial. Facemasks were either lightly coated with fruit extract or moistened with water so that their appearance was identical to children, anaesthetist and observer. Children allocated to receive fruit flavouring were significantly quieter than the placebo group, but their degree of movement during induction was unchanged. The incidence of respiratory complications including breath‐holding, laryngospasm and coughing was similar in both groups. Overall impression of the quality of induction as assessed by the anaesthetist showed no difference between the groups. This simple, cheap modification of inhalational induction warrants further appraisal while the case for disguising the odour of isoflurane remains unproven.