bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful radiotherapy of facial angiosarcoma
Authors: Gkalpakiotis S. , Arenberger P. , Vohradnikova O. , Arenbergerova M. 
Published: August 2010

AbstractCutaneous angiosarcoma of the face and scalp is a rare malignant vascular tumor that affects mostly Caucasian elderly males. At present, connections concerning the etiology of this neoplasm with radiation therapy, exposure to environmental carcinogens and chronic lymphedema have been described. Due to the difficult histologic evaluation, high local recurrence and tendency to early metastasing, angiosarcoma poses generally a very poor prognosis. We report the case of an 80‐year‐old patient who experienced successful removal of large, exophytic growing angiosarcoma of the face achieved with radiotherapy with long‐term relapse‐free survival.
Chronic nonhealing ulcer in a finger of a toddler – a rare presentation of the hair thread tourniquet syndrome
Authors: Kumaravel S. 
Published: August 2010

AbstractBackground  Hair‐thread tourniquet syndrome is caused by a strand of hair or thread tightly wrapped around an appendage. Affected parts include toes, phallus, fingers, clitoris, labia and even uvula. This disorder can be quite serious if not promptly recognized and treated; permanent tissue damage or even loss of the appendage can occur.Material  A rare and delayed presentation of hair‐thread tourniquet syndrome as a non‐healing, discharging ulcer in a two‐year‐old child is presented.Results  Identification of the fiber with loupes, complete removal of the fiber, and a dorsal longitudinal incision made to ensure complete release of any fibrotic constriction bands were the components of successful management in this child.Conclusions  Successful treatment depends on prompt recognition of the problem and alleviation of constriction, be it simple removal of the offending agent or surgical exploration and release. Medical professionals caring for children and parents should be made aware of the signs and symptoms of this rare but dangerous condition to ensure early diagnosis and prompt appropriate management.
Intravenous fluids warming by mattress is simple and efficient during pediatric surgery
Authors: Serour F. , Weissenberg M. , Boaz M. , Ezri T. , Gorenstein A. 
Published: August 2010

Background/Aim: Temperature control is essential during pediatric surgery. The effectiveness of two methods of warming intravenous (i.v.) fluids to preserve normothermia was compared during abdominal surgery.Methods: Intraoperative core temperature (CT) was measured in 59 children, 8 years of age and younger. Patients were randomly allocated to two study groups according to the method of fluids warming. In Group M (n = 30), fluids were warmed by placing the i.v. tubing under a warming mattress, and in Group T (n = 29), by using an active i.v. fluid tube warming system. Observations of CT, infusion fluid temperature (IFT) at the entry to the patient and other relevant parameters were made at 30‐min intervals throughout the surgical procedure.Results: The two groups did not differ significantly by age, gender, body weight or length of surgical procedure. Although baseline IFT was significantly lower in Group M than in Group T (33.8 °C vs. 35.1 °C), it increased during the procedure by 1.2 °C in Group M compared to a 0.2 °C increase in Group T. Baseline CT was also lower by 0.5 °C in Group M compared to Group T (NS), but CT increased in Group M by 1.0 °C compared to 0.2 °C in Group T, resulting in similar final CTs.Conclusions: The increase in CT was more pronounced in patients where fluids were warmed under the warming mattress (Group M) than in those with fluids warmed by a coil warming device (Group T). The elevation in CT seen in Group M is associated with an increase in infusion fluid temperature at the line just before the i.v. cannula. Both methods of fluid warming (by placing the i.v. tubing under warming mattress and by using a fluid warming system) effectively preserved normothermia during abdominal surgery in children.
Reversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesia
Authors: Zhou T. J. , Chiu J. W. , White P. F. , Forestner J. E. , Murphy M. T. 
Published: August 2010

Background: The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non‐depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium‐atropine during propofol‐ versus sevoflurane‐based anesthesia.Methods: Following induction of anesthesia with propofol (2–2.5 mg kg−1, iv) and fentanyl (1–2 μg kg−1 iv), rocuronium 0.6 mg kg−1 iv was administered to facilitate tracheal intubation. Patients were then randomized to receive either a propofol infusion (100 μg kg−1 min−1) or sevoflurane (1.0%, end‐tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular blockade was monitored using electromyography at the wrist, and reversed with edrophonium 1.0 mg kg−1 and atropine 0.015 mg kg−1 when the first twitch hight (T1) of the train‐of‐four (TOF) stimulation recovered to 25% of the baseline value. Anesthetic maintenance with propofol or sevoflurane was continued following reversal until a TOF ratio of 0.7 was attained.Results: The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol‐ (39.3±14.6 min) and sevoflurane‐based (48.1±19.7 min) anesthesia. However, the reversal time from 25% T1 to TOF ratio of 0.7 was significantly longer with sevoflurane [Median 2.8 (range 0.5–18.8) min] compared with propofol [1.5 (0.75–3) min] (P<0.05).Conclusions: We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg−1 iv, was similar during both propofol‐ and sevoflurane‐based anesthesia. However, the reversal of rocuronium‐induced residual blockade was slower and more variable in the presence of sevoflurane.
Comparison of the effect of ketamine added to bupivacaine and ropivacaine, on stress hormone levels and the duration of caudal analgesia
Authors: Akbas M. , Titiz T. A. , Ertugrul F. , Akbas H. , Melikoglu M. 
Published: August 2010

Background:  The aim of this study was to compare bupivacaine 0.25% and ropivacaine 0.2%, singly and in combination with ketamine, for caudal administration in children. Duration of analgesia, the need for other analgesics and the stress response were measured.Methods:  Eighty children were ramdomized into four groups of twenty. The bupivacaine group received bupivacaine 0.25% and the ketamine/bupivacaine group received bupivacaine 0.25% plus 0.5 mg/kg ketamine. The ropivacaine group received ropivacaine 0.2%, and the ketamine/ropivacaine group received ropivacaine 0.2% plus 0.5 mg/kg ketamine. The duration of analgesia and analgesic requirements were recorded for each group, as were peri‐operative and post‐operative concentrations of the stress hormones insulin, glucose and cortisol.Results:  Ketamine, added to either bupivacaine or ropivacaine for caudal analgesia, gave a longer duration of analgesia (P < 0.05) than bupivacaine or ropivacaine alone. In all groups, blood insulin concentration was increased, and cortisol concentration reduced. Glucose concentration was significantly increased in all groups (P < 0.05).Conclusions:  Ketamine can safely be added to ropivacaine 0.2% or bupivacaine 0.25% for caudal anesthesia in order to prolong duration of analgesia and reduce the need for additional analgesics. Stress hormone levels are partially attenuated.
Cerebral physiological responses to bolus injection of racemic,S(+)‐ orR(−)‐ketamine in the pig
Authors: Schmidt A. , Øye I. , Åkeson J. 
Published: August 2010

Background: Little is known about the influence of ketamine and its enantiomers on cerebral haemodynamics, and there are no direct comparison reports. This study was designed to evaluate cerebrovascular responses to bolus injections of racemic,S(+)‐ andR(−)‐ketamine in an established experimental model.Methods: Anaesthesia was induced with propofol in 14 pigs and maintained with fentanyl and vecuronium. The intra‐arterial xenon clearance technique was used to calculate the cerebral blood flow (CBF). Eight pigs (part I) were given three consecutive 60‐s intravenous (i.v.) bolus injections of 10 mg/kg of racemic ketamine (Ketalar®, Pfizer), and cerebral and systemic physiological responses were studied for 30 min after each injection. Following the determination of equipotent doses of the racemate and its enantiomers by recumbency tests, bolus injections of racemic ketamine (10 mg/kg),S‐ketamine (5 mg/kg) andR‐ketamine (20 mg/kg) were given in randomized sequence to another six pigs (part II) and evaluated at 1, 5, 10, 15, 25 and 40 min.Results: No statistically significant acute tolerance in the CBF response to racemic ketamine was found in part I of the study. In part II, the decreases in the mean arterial pressure (MAP) and CBF byS‐ketamine were significantly smaller than those by racemic andR‐ketamine (bothP < 0.001). No study drug had any significant effect on the cerebral arteriovenous oxygen content difference (Cavo2) over time, butS‐ketamine was associated with lowerCavo2than racemic ketamine (P = 0.008) andR‐ketamine (P = 0.016).Conclusions: Bolus injection ofS‐ketamine was associated with less cerebral and systemic haemodynamic depression than racemic orR‐ketamine in equipotent doses in this experimental model. These findings indicate possible advantages ofS‐ketamine over racemic ketamine.
Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine‐containing solutions of lidocaine produces profound hypotension
Authors: Yang J. J. , Li W. Y. , Jil Q. , Wang Z. Y. , Sun J. , Wang Q. P. , Li Z. Q. , Xu J. G. 
Published: August 2010

Background:  Local anesthetic containing epinephrine is commonly used in many operations for the main purpose of hemostasis. A randomized, controlled, prospective clinical trial was designed to find out hemodynamic changes after local infiltration of different concentrations and/or different dosages of epinephrine during functional endoscopic sinus surgery (FESS) under general anesthesia.Methods:  One hundred and eight adult patients undergoing elective FESS under general anesthesia were randomly allocated into four groups. Group I received 2% lidocaine 2 ml with epinephrine (5 µg/ml); group II received 1% lidocaine 4 ml with epinephrine (2.5 µg/ml); group III received 1% lidocaine 4 ml with epinephrine (5 µg/ml); and group IV received 1% lidocaine 4 ml for local infiltration. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were monitored continuously in the radial artery and recorded in 6 min: before infiltration (baseline), 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, and 6 min after local infiltration. The lowest blood pressure (BP) in this period was also recorded.Results:  Significant hemodynamic changes, particularly a decrease in BP (P < 0.001) with a slight increase in HR (P < 0.001) at approximately 1.5 min and an increase in SBP at approximately 3 min (P < 0.01) after local infiltration, were observed in group I, group II and group III compared with the baseline, but not in group IV. No significant hemodynamic differences were observed between group I, group II and group III at the same time points (P > 0.05).Conclusion:  Local infiltration of low‐dose epinephrine causes temporary significant hemodynamic changes particularly a marked decrease in BP during FESS under general anesthesia.
Induced mild hypothermia reduces mortality during acute inflammation in rats
Authors: Huet O. , Kinirons B. , Dupic L. , Lajeunie E. , Mazoit J. X. , Benhamou D. , Vicaut E. , Duranteau J. 
Published: August 2010

Background:  Hypothermia has been proposed as a therapeutic possibility in brain trauma, cardiac arrest and hemorrhagic shock. Experimental studies have shown that hypothermia may act by modulating the inflammatory response during endotoxemia. This study was carried out to test whether hypothermia could protect rats from endotoxemic insult.Methods:  After general anesthesia and oro‐tracheal intubation, Sprague–Dawley rats were randomly assigned to either a hypothermic group or normothermic group. In each group, rats received intraperitoneal lipopolysaccharide (LPS) (10 or 20 mg/kg). Blood samples were taken prior to and 2 h after LPS injection to measure blood gases, liver enzymes, muscular enzymes, tumor necrosis factor‐α (TNF‐α) and interleukin‐10 (IL‐10) plasma levels. After 2 h of hypothermia, the rats were extubated and brought back to their cages. The mortality rate was observed for 7 days following endotoxemia. In a second set of experiments, hypothermia was induced 1 h after endotoxemia (10 mg/kg of intraperitoneal LPS) and the mortality rate was observed for the following 7 days.Results:  The survival rate was significantly increased in the hypothermic group relative to the normothermic group, regardless of LPS dose. This increased survival rate was also observed when hypothermia was induced 1 h after endotoxemia. In the hypothermic group, IL‐10 and the ΔIL‐10/ΔTNF‐α ratio were significantly increased relative to those in the normothermic group.Conclusion:  Induced mild hypothermia reduces mortality during endotoxemia in rats. The modulation of the inflammatory response, with an increase in anti‐inflammatory cytokines, may be involved in this protective effect.
Oxygenation and release of inflammatory mediators after off‐pump compared with after on‐pump coronary artery bypass surgery
Authors: Rasmussen B. S. , Laugesen H. , Sollid J. , Grønlund J. , Rees S. E. , Toft E. , Gjedsted J. , Dethlefsen C. , Tønnesen E. 
Published: August 2010

Background:  In a previous study, we showed that oxygenation was impaired for up to 5 day after conventional coronary artery bypass grafting (CABG). As cardiopulmonary bypass (CPB) may have a detrimental effect on pulmonary function, we hypothesized that coronary revascularization grafting without the use of CPB (OPCAB) would affect post‐operative oxygenation and release of inflammatory mediators less compared with CABG.Methods:  Low‐risk patients scheduled for elective coronary revascularization were randomly assigned to one of two groups (CABG, n = 17 or OPCAB, n = 18). Two parameters of oxygenation, shunt (%) and ventilation‐perfusions mismatch, described as ΔPO2 (kPa), were estimated for up to 5 days post‐operatively. Systemic release of interleukin (IL)‐6, ‐8 and ‐10, C‐reactive protein (CRP) and neutrophils were measured in peripheral blood samples for up to 3 days post‐operatively. The lungs participation in the cytokine response was evaluated from mixed venous blood samples taken within the first 16 h post‐operatively.Results:  OPCAB was followed by a higher shunt (P = 0.047), with no difference (P = 0.47) in the deterioration of ΔPO2 between the groups. OPCAB was followed by an attenuated systemic release of IL‐8 (P = 0.041) and IL‐10 (P = 0.006), while the release of IL‐6 (P = 0.94), CRP (P = 0.121) and neutrophils (P = 0.078) did not differ between the groups. Indications of an uptake of cytokines in the lungs were found after OPCAB.Conclusions:  When comparing OPCAB with CABG, oxygenation was more affected and only part of the systemic inflammatory response was attenuated.
Mortality after discharge from the intensive care unit during the early weekend period: a population‐based cohort study in Denmark
Authors: Obel N , Schierbeck J , Pedersen L , Storgaard M , Pedersen C , Sørensen H. T. , Hansen B 
Published: August 2010

Background:  As a result of a shortage of intensive care capacity, patients may be discharged prematurely early during weekends which may lead to an increased mortality and risk of readmission to intensive care units (ICU). We examined whether discharge from the ICU during the first part of the weekend was associated with an increased mortality and readmission to the ICU.Methods:  The study was conducted at a university clinic of internal medicine and included all patients admitted for the first time to the ICU, and discharged alive in the period 1 January 2001 to 31 December 2005. Patients were divided in those discharged between 00.00 h Friday and 24.00 h Saturday (weekend group) and those discharged Sunday to Thursday (non‐weekend group). The main outcome was time from discharge from the ICU to the combined endpoint death or re‐admission to ICU which ever came first. We used Kaplan–Meier analysis and Cox’s proportional‐hazards regression to compute survival curves and risk ratio estimates.Results:  There were 228 patients in the weekend group and 555 patients in the non‐weekend group. Crude and adjusted 28‐day risk ratio of the combined endpoint was 1.50 [95% confidence interval (CI): 1.15–1.97] and 1.43 (1.09–1.87) in the weekend group. Although an increased risk of death was observed in the weekend group immediately after discharge from the ICU, the difference in mortality between the two groups had disappeared after 2 years.Conclusion:  Medical patients discharged from the ICU early in the weekends seem to have an increased mortality and risk of readmission to the ICU.
Effect of ropivacaine on endothelium‐dependent phenylephrine‐induced contraction in guinea pig aorta
Authors: Lin P. L. , Huang H. H. , Fan S. Z. , Tsai M. C. , Lin C. H. , Huang C. H. 
Published: August 2010

Background:  Previous studies have shown that ropivacaine has biphasic vascular effects, causing vasoconstriction at low concentrations and vasorelaxation at high concentrations. This study was designed to examine the role of the endothelium during accidental intravascular absorption of ropivacaine, and to elucidate the mechanisms responsible.Methods:  Isolated guinea pig aortic rings were suspended for isometric tension recording. The effects of ropivacaine on endothelium‐intact and endothelium‐denuded aortic rings were assessed. Endothelium‐intact aortic rings were pre‐contracted with phenylephrine before being exposed to ropivacaine and acetylcholine, in order to generate and compare concentration–response curves. In the absence and presence of yohimbine, propranolol, atropine, indometacin, NG‐nitro‐l‐arginine methyl ester (l‐NAME), 1H‐[1,2,4]oxadiazolo[4,3‐a]quinoxalin‐1‐one (ODQ) or methylene blue, the contractile response induced by ropivacaine was assessed on endothelium‐intact aortic rings pre‐contracted with phenylephrine.Results:  Ropivacaine (3 × 10−4 to 10−2 mol/l) produced vasoconstriction in endothelium‐denuded aortic rings, whereas no such response was observed in aortic rings with intact endothelium. In phenylephrine pre‐contracted intact aortic rings, ropivacaine induced a greater degree of vasorelaxation than did acetylcholine. Yohimbine, propranolol and atropine all failed to affect the relaxation responses induced by ropivacaine. However, pre‐treatment with indometacin (cyclo‐oxygenase inhibitor), l‐NAME (nitric oxide synthase inhibitor), methylene blue (soluble guanylyl cyclase inhibitor) or ODQ (soluble guanylyl cyclase inhibitor), significantly decreased the ropivacaine‐induced relaxation of endothelium‐intact aortic rings (3 × 10−4 to 10−2 mol/l).Conclusions:  Ropivacaine elicits an endothelium‐dependent vasorelaxation in phenylephrine pre‐contracted aortic rings via the nitric oxide–cyclic guanosine 3′,5′‐monophosphate pathway and the prostaglandin system.
Administration of fentanyl before remifentanil‐based anaesthesia has no influence on post‐operative pain or analgesic consumption
Authors: LENZ H. , RAEDER J. , HOYMORK S. C. 
Published: August 2010

Background: Remifentanil's short‐acting analgesic effect and the potential of producing hyperalgesia is a challenge to post‐operative pain control. This study investigated whether pre‐treating the patients with fentanyl before remifentanil‐based anaesthesia could reduce post‐operative pain or analgesic consumption.Methods: One‐hundred patients admitted for anterior cruciate ligament repair were included in a double‐blind study. Propofol and remifentanil were used for general anaesthesia. Group Pre received fentanyl 1.5 μg/kg intravenously (IV) and Group Post placebo before the remifentanil infusion. At the end of surgery, Group Pre received 1.5 μg/kg and Group Post received 3.0 μg/kg. Patient‐controlled analgesia with fentanyl was used as analgesic rescue medication during the first 4 h post‐operatively. Oxycodone 5 mg orally was taken as needed during the subsequent 4–24‐h period.Results: A mean dose of remifentanil 0.43 μg/kg/min was used for 90 min during surgery in both groups. There were no differences in the verbal rate scale (VRS) score or need of rescue analgesic medication between the groups during the first 4 h. Group Post had significantly less pain in the 4–24‐h period after surgery, with a median VRS score of ‘slight pain’ vs. ‘moderate pain’ in Group Pre (P<0.05). The oxycodone consumption was similar in both groups.Conclusion: Pre‐treatment with fentanyl 1.5 μg/kg IV yielded no reduction in post‐operative pain or analgesic consumption after 90 min of remifentanil‐based anaesthesia with 0.43 μg/kg/min of remifentanil.
Chronic AT1‐receptor blockade does not alter cerebral oxygen supply/demand ratio during cardiopulmonary bypass in hypertensive patients
Authors: KOTTENBERG‐ASSENMACHER E. , MASSOUDY P. , JAKOB H. , PHILIPP T. , PETERS J. 
Published: August 2010

Background: The angiotensin II receptor type 1 antagonist candesartan has been hypothesized to alter vasopressor requirements and brain–blood flow by changing cerebrovascular autoregulation. Therefore, we assessed the effects of a pre‐anaesthetic treatment course with candesartan on cerebral arterial‐jugular bulb oxygen content difference, middle cerebral artery blood velocity, and vasopressor requirements in hypertensive patients undergoing elective on‐pump coronary artery bypass graft surgery.Methods: In a randomized, double‐blind, placebo‐controlled study, we evaluated the effects of candesartan (8 mg po/d, given for 6–8 days before surgery) in 35 hypertensive patients. The mean arterial pressure was maintained above 60 mmHg by bolus administration of phenylephrine, if required, and dosages were recorded.Results: Candesartan did not significantly alter oxygen content difference across the cerebral circulation, mean middle cerebral artery blood velocity during cardiopulmonary bypass, or phenylephrine requirements either before (0.0067 μg/kg/min±0.0042 vs. 0.0056 μg/kg/min±0.0049, P=0.48) or during cardiopulmonary bypass (0.0240 μg/kg/min±0.0240 vs. 0.0250 μg/kg/min±0.0190, P=0.97) compared with placebo.Conclusion: Thus, a 6–8‐day treatment course with candesartan does not alter global cerebral perfusion and oxygen supply/demand ratio during cardiopulmonary bypass, or vasopressor requirements in hypertensive patients undergoing on‐pump coronary artery bypass graft surgery, and no deleterious consequences of AT1‐receptor blockade were detected.