bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change
Authors: GRALNEK I. M. , DEFRANCHIS R. , SEIDMAN E. , LEIGHTON J. A. , LEGNANI P. , LEWIS B. S. 
Published: July 2010

SummaryBackground Capsule endoscopy can identify small bowel mucosal inflammatory change. However, there has been no validated index for capsule endoscopy findings. This manuscript documents the development of such an index.Aim To develop a capsule endoscopy scoring index for small bowel mucosal inflammatory change.Methods The index was created in four separate steps. First, parameters and descriptors of inflammatory change were identified. Secondly, blinded readers prospectively graded the presence or absence of each parameter on de‐identified videos and graded a perceived global assessment of overall severity. Thirdly, the individual parameters and descriptors were ranked in order of severity. Fourthly, values for each parameter were created using the descent gradient methodology. The premise was to assure that the final numerical score reflected the global assessment and that the global assessment agreed with the ranking of finding severity. Results were compiled for the three categories: no or clinically insignificant change, mild change, and moderate or severe change. Thresholds were determined.Results The final index includes three parameters: villous oedema, ulcer and stenosis. A score <135 is designated normal or clinically insignificant mucosal inflammatory change, a score between 135 and 790 is mild, and a score ≥790 is moderate to severe.Conclusion This capsule endoscopy score provides a common language to quantify small bowel inflammatory changes.
Can biological markers act as non‐invasive, sensitive indicators of radiation‐induced effects in the gastrointestinal mucosa?
Authors: WEDLAKE L. , McGOUGH C. , HACKETT C. , THOMAS K. , BLAKE P. , HARRINGTON K. , TAIT D. , KHOO V. , DEARNALEY D. , ANDREYEV H. J. N. 
Published: July 2010

SummaryBackground  Reliable, non‐invasive biological markers of the severity of radiotherapy‐induced damage to the gastrointestinal tract are not available. Clinicians continue to use symptom scores as surrogate indicators of toxicity.Aim  To determine whether levels of potential biochemical markers of mucosal toxicity change during pelvic radiotherapy.Methods  Fifty‐nine patients (30:29 males:females) with mixed pelvic malignancies, receiving 45–70 Gy were recruited. At baseline and weeks 4 or 5 of radiotherapy, blood samples for citrulline, C‐reactive protein, eosinophil cationic protein and stool samples for faecal calprotectin were obtained. Symptoms were measured using the Inflammatory Bowel Disease Questionnaire – Bowel Subset, Radiation Therapy Oncology Group and Vaizey Incontinence Questionnaires. Paired t‐tests of change in marker values were calculated.Results  Citrulline (P = 0.02) and faecal calprotectin (P = 0.01) values changed significantly between baseline and 4/5 weeks. Inflammatory Bowel Disease Questionnaire – Bowel Subset fell significantly (mean fall = 10 points, s.d.: 8.9). Changes in markers did not correlate with symptoms.Conclusions  Some biochemical markers of mucosal toxicity change significantly during treatment. Further studies must investigate the timing of changes of these biochemical markers, their relationship to gastrointestinal physiological change and the radiotherapy dose delivered to the gastrointestinal tract and whether changes in markers acutely can predict the degree of long‐term gastrointestinal dysfunction.
Review article: current management of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis
Authors: YOUNOSSI Z. M. 
Published: July 2010

SummaryBackground Non‐alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome.Aim To assess the epidemiological impact and the current management of patients with NAFLD.Methods Published peer‐reviewed literature and abstracts concerning NAFLD and non‐alcoholic steatohepatitis (NASH) were reviewed. Articles specifically related to epidemiology, diagnosis and current treatment strategies for NAFLD and NASH are summarized.Results NAFLD is strongly associated with the epidemic of obesity and type‐2 diabetes mellitus, and is estimated to affect about 20–30% of the population in the US. From the spectrum of NAFLD, only patients with biopsy‐proven NASH (estimated prevalence in the US population is about 3–5%) have been convincingly shown to progress to cirrhosis, liver failure and hepatocellular carcinoma. The clinical manifestation of NAFLD is usually absent or subtle, with abnormal aminotransferases or incidental radiographic findings of fatty liver. The pathogenesis of NAFLD is attributed to a multi‐hit process involving insulin resistance, oxidative stress, apoptotic pathways, and adipocytokines. In 2008, there is no established treatment for NAFLD. Weight loss and treatment for each component of metabolic syndrome. Nevertheless, a large number of agents are being considered in clinical trials of patients with NASH.Conclusions Awareness of the tremendous impact of NAFLD as an important cause of chronic liver disease is increasing along with a great deal of information about its pathogenesis. Future, well‐designed clinical trials that target specific pathways involved in the pathogenesis of NASH are urgently needed.
Peri‐operative endocrine effects of etomidate
Authors: MOORE R. A. , ALLEN M. C. , WOOD P. J. , REES L. H. , SEAR J. W. 
Published: July 2010

SummaryThis study investigated the effects of etomidate on endocrine responses to anaesthesia and surgery. Patients undergoing abdominal hysterectomy received standard anaesthetics of either etomidate for induction with etomidate infusion, or thiopentone and halo thane. Etomidate suppressed the secretion of cortisol and aldosterone for between 8 and 22 hours after the end of the etomidate infusion; 11‐deoxycortisol secretion was not suppressed during the etomidate infusion, but rose postoperatively; 17α‐hydroxyprogesterone suppression also lasted only as long as the etomidate infiion. There were no effects on plasma oestradiol, A CTH, or prolactin, but growth hormone concentrations were elevated in the etomidate group. Etomidate was concluded to have influenced adrenocortical function only, where it probably inhibits 11 β‐hydroxylation, 17 α‐hydroxylation and other intramitochondrial hydroxylation reactions. There were no clinical sequelae attributable to adrenocortical suppression. The relationship of chemical structure of etomidate and other phenylated imidazoles to inhibition of steroidogenesis is discussed.
Anaesthetic management of glucagonoma
Authors: NICOLL J. M. V. , CATLING S. J. 
Published: July 2010

SummaryAlpha cell tumours of the pancreatic islets of Langerhans are rare. The glucagonoma syndrome is caused by excess glucagon secretion from such a tumour. Physiologically, glucagon is important in the control of the homeostasis of glucose and certain amino acids. Pharmacologically, it has been used to treat heart failure. Problems with both glucose homeostasis and myocardial function could, therefore, theoretically be anticipated following resection of a glucagonoma. This paper describes the peri‐operative management of such a case, where, despite measured changes in glucagon, no problems of this nature were encountered.
Treatment of acute total atelectasis
Authors: MURRAY J.F. 
Published: July 2010

SummaryThree cases are described of complete collapse of a lung in the absence of bronchial obstruction. The condition was treated by the application of a sustained high pressure (6 kPa) to the aflected lung through one limb of a double lumen bronchial tube whilst intermittent positive pressure ventilation was continued through the other limb.
Severe hypercalcaemia due to a parathyroid‐type hormone‐secreting tumour of the liver treated by hepatic transplantation
Authors: SEALEY M. M. 
Published: July 2010

SummaryIt is very rare for a patient to have to be submitted for surgery and anaesthesia with severe hypercalcaemia unresponsive to medical treatment. Problems which may be anticipated are hypertension, hypotension, cardiac dysrhythmias and renal failure. Anaesthesia for liver transplantation also requires a full appreciation of the biochemical, haematological and haemodynamic problems involved. In the present report a patient scheduled for hepatic transplantation had a consistently raised serum calcium level (4 mmol/litre) due to the secretion of a parathyroid‐type hormone by hepatic tumour cells. The pre‐operative management of hypercalcaemia and intra‐ and postoperative management of liver transplantation in this patient are presented and discussed.
A rate pressure product meter A new module for use with the Simonsen & Weel System 8000 monitors
Authors: LAWLER P. G. , ROYALL R. A. , BURNISTON M. T. 
Published: July 2010

SummaryA prototype rate pressure product module has been constructed for use with Simonsen and Weel Series 8000 monitors. The importance of method of display of rate pressure product is stressed.
Isoflurane: effect on the encephalogram during carotid endarterectomy
Authors: Campkin T.V. , Honigsberger L. , Smith I.S. 
Published: July 2010

SummaryThe effect of isoflurane on the electroencephalogram was studied in patients monitored during carotid endarterectomy. Increasing concentrations of this agent cause changes, but did not affect the ability to detect the onset of cerebral ischaemia consequent upon temporary occlusion of the internal carotid artery. At 1.0% and 1.5% concentration isopurane caused signijcant decreases in mean arterial pressure which is undesirable in patients undergoing vascular surgery.
Disposable double‐lumen bronchial tubes. A cost‐effectiveness survey
Authors: Linter S.P.K. 
Published: July 2010

SummaryThe use of red rubber double‐lumen‐bronchial tubes was studied in the Regional Cardiothoracic Centre and three large District General Hospitals to assess whether the use of disposable polyvinylchloride tubes was a viable cost‐effective alternative. In the Regional Cardiothoracic Centre red rubber tubes were used frequently throughout their predicted lifespan and were cost eflective. In the district hospitals red rubber tubes were unlikely to be used sufficiently to justify their cost. Many district general hospitals could reduce capital expenditure and annual costs by changing from red rubber to disposable polyvinyl chloride double lumen tubes.
Ventilation, dynamic compliance and ventilatory response to CO2
Authors: OLSSON A.‐K. , LINDAHL S. G. E. 
Published: July 2010

SummaryAge dependent variations in minute ventilation (V̇E), tidal volume (Vr), respiratory rate and dynamic compliance (Cdyn) as well as ventilatory response to inhalation of carbon dixoide (CO2) were investigated in 20 spontaneously breathing intubated infants and children during halothane anaesthesia. Ages ranged from 6 days to 5 years. Seven patients were younger than 6 months of age. Ventilation volumes were measured by pneumotachography and end tidal carbon dioxide concentration by an in‐line capnograph. Fluid‐filled oesophageal catheters were used for pressure recordings. Measurements were made before surgery (with and without 2.22 and 3.71% of CO2 in inspired gas) and during surgery. Regression analysis of the relationship between V̇E and body weight revealed no direct proportionality. On a weight basis, V̇E was significantly higher in younger than in older patients. Tidal volume was directly proportional to body weight. The mean (SEW value of tidal volume was 4.3 (0.2) ml/kg. Dynamic compliance showed a direct proportionality with weight. The mean (SEM) value of Cdyn was 10 (1.1) ml/kPa/kg. There was no ventilatory response in any patient to inhalation of 2.22% CO2. In the older group of children (>6 months of age) V̇E increased by 34% during inhalation of 3.71% CO2 (p < 0.025). In the younger patients (<6 months of age) no ventilatory response to inhalation of 3.71% of CO2 was found, indicating a more pronounced depression of ventilation in these infants.
Plasma ionized calcium during open‐heart surgery
Authors: HEINING M. P. D. , LINTON R. A. F. , BAND D. M. 
Published: July 2010

SummaryPlasma ionized calcium has been measured in eighteen patients undergoing open heart surgery. No change in ionized calcium concentration was found during the period of cardiopulmonary bypass. In the early postbypass period, a wide range of ionized calcium concentrations was found, but this did not obviously affect myocardial performance. Factors influencing the ionized calcium concentration under these circumstances are discussed.
Disruption of colonic anastomosis during continuous epidural analgesia
Authors: BIGLER D. , HJORTSØ N‐C , KEHLET H. 
Published: July 2010

SummaryThe clinical presentation is described of partial rupture of a colonic anastomosis two hours after surgery during epidural analgesia. The unusually early presentation of this complication is possibly due to removal of normal intestinal sympathetic activity by epidural analgesia resulting in normal or increased colonic motility. It is not known whether epidural analgesia may precipitate anastomotic breakdown due to increased contractions and strain on the anastomosis, or lead to an earlier presentation of a disruption caused by failure of surgical technique or other factors.
The evacuated canister method of personal sampling
Authors: GRAY W. M. , BURNSIDE G. W. 
Published: July 2010

SummaryAlthough there is a recognised need for routine monitoring of the exposure of operating theatre staff to waste anaesthetic gases, there is as yet no standard method for carrying out such measurements. We have assessed a commercial version of one proposed sampling system—the evacuated canister—by testing it in the laboratory and also using it to carry out pilot surveys in operating theatres. We encountered many difficulties in using the system; some of these were caused by design faults in the commercial equipment, but others are inherent in the concept of using an evacuated canister for personal sampling.
Drug dilution in anaesthetic practice
Authors: Wright M. , Grant I. S. , MacLeod T. M. 
Published: July 2010

SummaryThe accuracy of dilution by anaesthetists of commonly used drug preparations was assessed by ultra violet spectrophotometric assay of the diluted drugs. Percentage deviation from target concentrations was then calculated. Of a total of 358 drug dilutions carried out by 28 anaesthetists only 58% were within 10% of the target concentration while 6% lay outside 50% of the target concentration.
Isoflurane in paediatric anaesthesia
Authors: WREN W. S. , MCSHANE A. J. , MCCARTHY J. G. , LAMONT B. J. , CASEY W. F. , HANNON V. M. 
Published: July 2010

SummaryThe characteristics of induction with and recovery from isoflurane anaesthesia were studied in 248 children. The mean time to loss of consciousness was 1.5 min (SD 0.5). Tracheal intubation, without interruption of spontaneous ventilation, was accomplished in a mean time of 4.2 min (SD 54 seconds). Movement and excitement, of 20–30 seconds duration, occurred in 23.9% children and 22 patients coughed during induction; 15 (12.6%) during the first 124 inductions; 7 (5.6%) subsequently. The mean haw‐times of reduction of alveolar isoflurane concentrations in 28 children whose lungs were ventilated with isoflurane and in 13 children who breathed isoflurane spontaneously during anaesthesia were: 45 sec after exposure for one hour, 70 sec after exposure of 2–3 hours and 110 second following exposures of 4–8 hours. The mean recovery times of the three groups were 6.5, 9.5 and 11.5 min respectively. In two further groups of nine children the mean hay times of elimination of halothane and isoflurane were 220 secondr and 54 secondr respectively; recovery from isoflurane was markedly faster.Isoflurane is well accepted by children; induction is more rapid than with halothane, and the marked flexibility in the control of its effects are due to its relative insolubility. It has wide application in paediatric anaesthesia.
A comparison of triazolam and diazepam as premedication agents for minor gynaecological surgery
Authors: PINNOCK C. A. , FELL D. , HUNT P. C. W. , MILLER R. , SMITH G. 
Published: July 2010

SummaryTriazolam 0.25 mg, diazepam 10 mg and placebo were compared in a randomized double‐blind trial of oral premedication in 90 patients undergoing minor gynaecological surgery. Both triazolam and diazepam produced a significant sedative effect as measured by patient serf assessment linear analogue scales but only diazepam was more anxiolytic than placebo. Psychomotor performance assessed by the letter‐search test at 3 and 6 hours after awakening showed a decrement in performance in patients receiving triazolam at 3 hours compared with the two other groups. Triazolam was shown to have a pronounced amnesic effect and whilst it might be used for premedication, its lack of anxiolysis coupled with a significant impairment of psychomotor performance at 3 hours after awakening, render the drug unsuitable for premedication in the short stay patient.
Anaphylactoid reactions during anaesthesia
Authors: GALLETLY D. C. , TREUREN B. C. 
Published: July 2010

SummarySixty one patients who had suffered intra‐operative anaphylactoid reactions were studied. Intradermal testing identified the causative agent in 84% of cases and, in 75% of these, muscle relaxants were responsible. Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy. The incidence of previous exposure was considerably higher than that reported in the literature. Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction.
Temazepam in fast dispensing dosage form as a premedication for children
Authors: Smith Gary B. , Hughes David G. , Kumar Viney 
Published: July 2010

SummaryForty‐seven children aged between four and 11 years received temazepam 0.5 mg/kg in a novel fast dispensing dosage form. The preparation was well accepted and associated with few side‐effects. Satisfactory sedation and anxiolysis was obtained in over 93% of patients. The relative merits of a variety of routes of administration of premedicant drugs for children are discussed and the advantages of buccally administered formulations for this age group are presented.
Plasma bupivacaine levels associated with extradural anaesthesia for Caesarean section
Authors: THOMPSON E. M. , WILSON C. M. , MOORE J. , McClean E. 
Published: July 2010

SummaryPlasma bupivacaine levels were measured in 47 women undergoing extradural Caesarean delivery. They were divided into four groups according to the following dose regimens using 0.5% bupivacaine. Group A were given a bolus of 20 ml with increment after 20 minutes. Groups B and C were given 10 ml initially with further increments if required at 10 minutes (group B) and 20 minutes (group C); Group D consisted of patients who had an extradural block extended for emergency Caesarean delivery. In the elective groups the highest and most rapidly achieved values were associated with groyo A and the lowest levels found in group C. The highest levels of all were found in the emergency group. The investigation indicates that slow controlled induction of extradural anaesthesia for Caesarean section greatly reduces the risk of local anaesthetic toxicity.
Cardiovascular and cerebral complications during glossopharyngeal nerve thermocoagulation
Authors: ORI C. , SALAR G. , GIRON G. P. 
Published: July 2010

SummaryThe cardiovascular and cerebral complications observed during percutaneous radiofrequency thermocoagulation of the glossopharyngeal nerve are described. The value of such symptoms in anticipating a lesion of the vagus nerve is discussed.
The influence of age on the onset of anaesthesia with midazolam
Authors: DUNDEE J. W. , HALLIDAY N. J. , LOUGHRAN P. G. , HARPER K. W. 
Published: July 2010

SummaryThere was a considerable individual variation in response to a standard induction dose of 0.3 mg/kg midazolam in unpremedicated patients. This is shown by variations in time to onset of sleep and the fact that about one quarter of subjects did not lose consciousness in 3 minutes. In 166 fit patients a good negative correlation was demonstrated between the age of the patients and time to loss of consciousness. Patients over 50 years differed from younger patients in a greater reliability of effect and significantly shorter induction time. In elderly patients midazolam is a more reliable induction agent than in the young.
Tracheal tube cuff pressures
Authors: RAEDER J. C. , BORCHGREVINK P. C. , SELLEVOLD O. M. 
Published: July 2010

SummaryChanges in cuff pressure and volume of tracheal tubes were studied in 60 patients undergoing lower abdominal surgery under generol anaesthesia with nitrous oxide and oxygen as the anaesthetic gas mixture. The cuffs were inflated with either anaesthetic gas mixture or air. Three different brands of tubes were used. The pressure in the air filled cuffs increased steadily throughout the procedure and reached level high enough to impede microcirculation in the tracheal mucosa within one hour. We conclude that filling the cuffs with anaesthetic gas mixture is a simple and reliable way to achieve stable cuff pressure during anaesthesia.
Automatic blood pressure monitors A clinical evaluation of five models in adults
Authors: JOHNSON C. J. H. , KERR J. H. 
Published: July 2010

SummaryFive automatic blood pressure monitors were evaluated by comparing their values with almost simultaneous blood pressure readings from radial artery catheters. A total of 583 comparisons were made on 48 patients. Statistical analysis was performed on the pooled comparisons of systolic and diastolic pressure for each monitor. Agreement between the pressure measurements was variable between both patients and machines. For systolic pressure, two machines (Copal and Sentron) had correlation coefficients of over 0.9 while for the other machines (Dinamap 845XT, Narco and Vitastat 9001S) the values lay between 0.7 and 0.8. The steepest regression lines were also found with the Copal (0.93) and Sentron (0.86) data, but the other machines had considerably flatter slopes (0.55 to 0.67). The intercepts on the y axes ranged from + 14.1 (Copa) to + 50.1 (Dinamap). In clinical use, popularity of the different machines rejected the degree to which the machine reproduced the behaviour of the direct pressure measurement.
Meptazinol as an analgesic adjunct to total intravenous anaesthesia in cystoscopy patients
Authors: Hargreaves J. , Kay B. , Healy T.E.J. 
Published: July 2010

SummarySixty‐four unpremedicated patients undergoing cystoscopy received either intravenous meptazinol 2 mg/kg or saline in equivalent volume in a randomised, double‐blind manner immediately before induction of anaesthesia with Althesin. Inclusion of meptazinol reduced the total dose of anaesthetic required, allowed a more rapid recovery and was associated with less movement in response to surgery. The patients in the control group tended to hyperventilate, and had lower end‐tidal CO2 tension (p < 0.001), and also higher pulse rates during surgery (p < 0.01) than the meptazinol group. However, the patients who received meptazinol had a more frequent incidence of complications during induction and recovery (p < 0.05).
Contamination of internal jugular cannulae
Authors: CLAYTON D. G. , SHANAHAN E. C. , ORDMAN A. J. , SIMPSON J. C. 
Published: July 2010

Summary137 internal jugular vein cannulae from 113 patients undergoing open heart surgery were cultured using standard broth culture and a semiquantitative culture technique. 60 of the cannulae were placed using an aseptic technique and 77 using a standard non sterile technique. Significant contamination was found in 18.3% of the cannulae in the aseptic group and 15.6% in the standard group. The contaminating organism was Staphylococcus epidermidis in 87.1% of cases. No advantage in using an aseptic technique of cannula insertion was demonstrated. It was concluded that the major source of contamination was elsewhere.