bluuebunny/crossref_metadata_2025_split huggingface dataset:
The spinal muscular atrophy gene product regulates neurite outgrowth: importance of the C terminus
Authors: van Bergeijk Jeroen , Rydel‐Könecke Katharina , Grothe Claudia , Claus Peter 
Published: February 2007

ABSTRACTSpinal muscular atrophy is a neurodegenerative disease accompanied by a loss of motoneurons. Either mutations or deletions in the survival of motoneuron (SMN) gene are responsible for this defect. SMN is an assembly protein for RNA‐protein complexes in the nucleus and is also found in axons of neurons. However, it is unclear which dysfunctions of SMN are important for disease progression. In this study we analyzed the contributions of different SMN regions for localization and neuronal differentiation associated with outgrowth of neurites. Suppression of endogenous SMN protein levels significantly decreased the growth of neurites. Down‐regulation of the interacting protein gemin2 had the opposite effect. Surprisingly, selective overexpression of the SMN C‐terminal domain promoted neurite outgrowth similar to full‐length protein and could rescue the SMN knock‐down effects. The knock‐down led to a significant change in the G‐/F‐actin ratio, indicating a role for SMN in actin dynamics. Therefore, our data suggest a functional role for SMN in microfilament metabolism in axons of motoneurons.—van Bergeijk, J., Rydel‐Könecke, K., Grothe, C., Claus, P. The spinal muscular atrophy gene product regulates neurite outgrowth: importance of the C terminus. FASEB J. 21, 1492–1502 (2007)
Anaesthesia in the Guillain‐Barré syndrome
Authors: PEREL A. , RECHES A. , DAVIDSON J. T. 
Published: February 2007

SummaryA large proportion of patients with the Guillain‐Barre syndrome show signs of involvement of the autonomic nervous system beside the better known motor and sensory features of this disease. These patients present a substantial anaesthetic risk because of autonomic dysfunction. We present here an illustrative case in which the administration of a low subarachnoid block resulted in cardiac arrest and offer suggestions for the anaesthetic management of such cases.
Failure of epidural morphine to relieve pain in labour
Authors: HUSEMEYER R.P. , O'CONNOR M.C. , DAVENPORT H.T. 
Published: February 2007

SummaryLumbar epidural injections of 2 mg preservative‐free morphine were given to 10 subjects in established labour. Assessment of pain using a visual analogue scoring system revealed no appreciable relief of pain 30 min after morphine injection. Analgesia was subsequently provided by epidural injection of 8 ml bupivacaine 0·375%. Failure of epidural morphine 2 mg to provide analgesia in labour is in contrast to the reported efficacy of epidural morphine 2 mg in the treatment of severe pain other than labour. Possible explanations for this discrepancy are discussed.
Suxamethonium apnoea associated with plasmaphoresis
Authors: EVANS R.T. , MACDONALD ROSEMARY , ROBINSON ANGELA 
Published: February 2007

SummaryA patient is reported who developed suxamethonium apnoea as a result of reduction in serum cholinesterase activity secondary to both pregnancy and plasmaphoresis. Had the enzyme studies been carried out before operation, regional rather than general, anaesthesia would have been used. In order to avoid the problems associated with prolonged paralysis we recommend the measurement of cholinesterase activity in all patients who have undergone plasmaphoresis and in whom anaesthesia involving the use of suxamethonium is contemplated.
Epidural anaesthesia with chloroprocaine
Authors: CONKLIN KENNETH A. , VAN DER WAL CALVIN 
Published: February 2007

SummaryA case report of continuous lumbar epidural anaesthesia with chloroprocaine is described in which delayed onset, extensive and delayed spread, and prolonged duration were observed. Although placement of neither the needle nor the catheter was confirmed radiographically, the anaesthetic course may be consistent with extra‐arachnoid subdural injection of the local anaesthetic solution. Other reported cases, with similar features and which may be explained in the same way, are also discussed.
Midazolam: a water‐soluble benzodiazepine
Authors: DUNDEE J.W. , SAMUEL I.O. , TONER W. , HOWARD P.J. 
Published: February 2007

SummaryMidazolam, a new water‐soluble benzodiazepine, was given intravenously in 5 and 10 mg doses to nine volunteers and plasma levels estimated at intervals for 24 hours. Recovery was also studied. The drug was easy and painless to inject and venous thrombosis was not found in this series. While there was a great individual variation in response to the drug this was not related to the weight of the subjects. Plasma levels declined rapidly and there was no ‘second peak’ effect. The half‐life was between 60 and 90 min. Recovery was much more rapid than after comparable doses of diazepam.
Personality characteristics of a sample of anaesthetists
Authors: REEVE PETER E. 
Published: February 2007

SummaryNo published information on the personality characteristics of a significant proportion of any specialty of the medical profession has been available to date. The author presents the results from the application of a personality questionnaire (Cattell's 16 PF Form C) to a sample of anaesthetists (n = 231). These show that this sample of anaesthetists differs from the general population in a number of dimensions. They are more reserved, intelligent, assertive, serious, conscientious, self‐sufficient and tense and less socially bold and self‐assured. They also differ from a sample of general practitioners. Within the sample of anaesthetists, there are significant differences on a cluster of factors relating to stability. Evidence is quoted, from part of the sample, of a significant relationship between personality profiles and behaviour and performance. The author puts forward a descriptive picture of the ‘good’ anaesthetist and the obverse and the possible implications for the assessment and selection of applicants for this shortage specialty.
Self‐administered intravenous and intramuscular pethidine
Authors: ROBINSON J.O. , ROSEN M. , EVANS J.M. , REVILL SUSAN I. , DAVID H. , REES G.A.D. 
Published: February 2007

SummaryIn a randomised controlled trial of mothers in labour intramuscular pethidine 150 mg, repeated if necessary, was compared with self‐administered intravenous pethidine (0·25 mg/kg available at 10‐min‐intervals). Each mother agreed to have either method of pain relief and could opt for epidural block. The intramuscular group had significantly more pethidine than the intravenous group (mean differences, primipara 29 mg; multipara 16 mg). Ratings by mothers of the pain of 1st, 2nd stage and overall (analogue scores and gradings) were consistently better for the intravenous group although not significantly different. There were no differences in mean Apgar scores between the babies in the groups. In mothers who do not choose epidural block, similar pain relief is afforded by adequate intramuscular pethidine or self‐demand intravenous pethidine; however, intravenous self‐administration is more efficient since the pain relief is achieved with a lower dose of pethidine.
Retirement of anaesthetists
Authors: SMITH W.D.A. 
Published: February 2007

SummaryThe tenure of posts by consultant anaesthetists is compared with that by consultants in other specialties. Populations studied were not strictly comparable: however, due mainly to early retirement for reasons unknown, only 70–80% of anaesthetists who might have been expected to retire at 65 years of age actually did so. Provisional plans for a study of Occupational health are described. Results of a questionnaire on attitudes to retirement are reported. Comments elicited refer to: financial and family considerations: a belief in longevity associated with early retirement: effects of ageing upon health, ability and response to ‘stress’: lack of self‐pacing and of job adjustment for age and health: professional and administrative ‘stresses’: recruitment, manpower and workload: health hazards: and a wish to pursue other interests. Forty per cent of responders anticipated retiring before the age of 61 years. Possible relevance of early appointment as consultant is mentioned.
Air embolism in hip surgery
Authors: MICHEL ROSALIND 
Published: February 2007

SummaryThe hearts of 49 patients undergoing hip‐replacement surgery were auscultated and the characteristic sounds of air emboli were heard in 15 of them—30% of the total. This finding was confirmed in the later patients by the use of an ultrasonic transducer to detect air emboli.Routine auscultation of the heart during the insertion of acrylic bone cement and prosthesis is recommended.
Respiratory depression after intrathecal narcotics
Authors: DAVIES G.K. , TOLHURST‐CLEAVER C.L. , JAMES T.L. 
Published: February 2007

SummaryThree out of six patients who had received 1 mg of morphine and 0·22 ml plain bupivacaine 0·5%/segment as a subarachnoid spinal anaesthetic developed serious and delayed respiratory depression on several occasions. This was reversed by intravenous naloxone. It is postulated that the morphine had diffused to the level of the cisterna magnum and thence through brain tissue around the fourth ventricle. Naloxone did not reverse the analgesia.
Control of heparinisation during cardiopulmonary bypass
Authors: KAMATH B.S.K. , FOZARD J.R. 
Published: February 2007

SummaryA rational approach to the control of heparinisation during open heart surgery is advocated. Some of the possible and potential shortcomings of the time‐based heparin protocols in current use are presented.The use of a recent, simple automated device ‘Hemochron’ to estimate the Activated Clotting Time is described and it is found to be an economical and efficient method to monitor heparinisation during cardiopulmonary bypass.
Transcutaneous nerve stimulation in labour
Authors: Jones C.M.H. Miller 
Published: February 2007

SummaryTranscutaneous nerve stimulation was assessed as a method of relieving pain in labour in 51 patients.The majority of patients found it sufficiently helpful to want to use it again in any subsequent labour, and it reduced the overall pethidine requirement compared with controls. It did not have an effect on Apgar neonatal scores or length of labour.
Temazepam as premedication in day surgery
Authors: BEECHEY A.P.G. , ELTRINGHAM R.J. , STUDD C. 
Published: February 2007

SummarySixty patients scheduled for day case surgery were allocated into two groups in a double‐blind study. One group received temazepam 20 mg or 30 mg orally 1 hour before surgery whilst the second group receiiled a placebo of identical appearance.The use of temazepam was followed by a greater frequency of sedation and anxiolysis and with fewer problems at induction. The time to awaken, the level of postoperative sedation and the ability to walk unaided were similar in both groups. Postoperative sequelae were less frequent in the temazepam group. Temazepam is advocated as a suitable drug for premedication in day case surgery.
Acute onset facial oedema
Authors: CONACHER I.D. 
Published: February 2007

SummaryA case of sudden onset facial swelling which occurred in association with extubation is presented. Factors are suggested that may have made this patient—a known sufferer from chronic liver disease—more susceptible to the development of such a reaction, but the principle cause is thought to have been the changes in capillary hydrostatic pressure induced by the patient ‘fighting’on the tracheal tube whilst regaining consciousness after an anaesthetic for the injection of her oesophageal varices.
Epidural morphine in terminal care
Authors: HOWARD R.P. , MILNE L.A. , WILLIAMS N.E. 
Published: February 2007

SummaryCase histories of three patients with intractable pain, all of whom responded to epidural morphine, are presented. Drug tolerance appeared to develop in two patients who survivied longer than 10 days. Nevertheless this method of pain relief may be a useful adjunct to terminal care and in certain circumstances may allow for easier management in the patient's own home.
A survey of anaesthetic misadventures
Authors: CRAIG JANET , WILSON M.E. 
Published: February 2007

SummaryReports of anaesthetic misadventures were regularly collected in the Anaesthetic Department of a district general hospital, to identify recurring problems. Eighty‐one misadventures, none of which had serious outcome, were reported during a 6‐month period, in which 8312 anaesthetics were administered. Human error was more frequently responsible than equipment failure, and failure to perform a normal check was the factor most frequently associated. Local hazard warnings were circulated when necessary to members of the Department, and the reports formed the basis of departmental discussion and teaching.
Postoperative analgesia in major orthopaedic surgery
Authors: BARRON DAVID W. , STRONG JOHN E. 
Published: February 2007

SummarySixty‐two patients were given morphine 2 mg and 69 patients were given diamorphine 0·5 mg by either the epidural or intrathecal route. All had undergone either total hip replacement or spinal disc surgery. Forty‐nine out of 131 patients required no further analgesia. Diamorphine was superior to morphine and the intrathecal route more effective than the epidural. Headache, pruritus, urinary retention and nausea and vomiting were recorded, the incidence of the latter being unacceptably high, particularly when the drugs were administered by the intrathecal route: one patient required resuscitation. It is suggested that previously reported respiratory depression using these techniques is associated with the administration of other analgesics co‐temporaneously; that dosage should be limited to one‐fifth of the estimated intramuscular dose; and that patients should be observed in a recovery ward for 24 hours.
Test of delayed memory recall suitable for assessing postoperative amnesia
Authors: BETHUNE D.W. 
Published: February 2007

SummaryThe application of a test of delayed memory recall to determine the extent of postoperative (anterograde) amnesia is described. Results from studies following the application of different anaesthetic techniques to patients undergoing minor surgery suggests that a period of anterograde amnesia is inevitable following general anaesthesia.The anterograde amnesia persists after apparent full clinical recovery and the possibility of clinical and medico‐legal problems from this cause must be recognised in the overall management of the patient.
Fixed performance oxygen masks
Authors: COX DOMINIC , GILLBE CHARLES 
Published: February 2007

SummaryFour recently introduced low‐capacity fixed performance oxygen therapy masks have been compared with the established Ventimask design. Under conditions of varying peak inspiratory flow rate the low‐capacity devices all permit a variable amount of air admixture with a consequent fall in the inspired oxygen concentration. It is concluded that low‐capacity venturi masks are not true fixed performance devices under all circumstances. The Ventimasks satisfy their specifications under all test conditions. A case is made for more rigorous assessment of new so‐called ‘fixed performance’ oxygen therapy devices before marketing is permitted.
Treatment of stress response to laryngoscopy and intubation with fentanyl
Authors: DAHLGREN N. , MESSETER K. 
Published: February 2007

SummaryThe cardiovascular response to laryngoscopy and intubation was investigated in lightly anaesthetised patients admitted to hospital for elective intracranial surgery. One group of patients was given fentanyl 5 μg/kg body weight before induction with thiopentone and suxamethonium. The other group served as controls. Fentanyl treatment caused a significant attenuation of the blood pressure and pulse response to laryngoscopy and intubation.Different techniques for induction of anaesthesia are discussed in relation to the demands of neuroanaesthesia.
Tolerance to rectal ketamine in paediatric anaesthesia
Authors: STEVENS R.W. , HAIN W.R. 
Published: February 2007

SummaryThe use of rectal ketamine as the sole anaesthetic for short, minor procedures in young children is discussed. A case in which 18 anaesthetics were administered by this route, to facilitate radiotherapy, is reported and the subsequent development of tolerance and its possible mechanisms are discussed.
Cardiovascular changes during controlled blood loss and replacement
Authors: Kirwan T. , Scurr C.F. , Smith G. Brindle 
Published: February 2007

SummaryChanges in central venous pressure, systolic arterial pressure and pulse rate were recorded in 31 patients undergoing surgery involving withdrawal of 1 litre of blood and subsequent transfusion. Central venous pressure gave immediate and consistent indications of blood loss and replacement but blood volume changes could not be correlated numerically with central venous pressure. No difference was found between patients anaesthetised using spontaneous ventilation with halothane and intermittent positive pressure ventilation.
Anticonvulsant drugs used in the treatment of lancinating pain. A comparison
Authors: Swerdlow Mark , Cundill J.G. 
Published: February 2007

SummaryThe value of anticonvulsant drugs in the treatment of some cases of lancinating pain is now established. The results in 170 consecutive cases in an ongoing series are reported with special reference to the efficacy of four anticonvulsants–carbamazepine, clonazepam, phenytoin and valproate. The findings are discussed.
The prevention of hypertension at intubation
Authors: DAVIES MICHAEL J. , CRONIN KEITH D. , COWIE ROBERT W. 
Published: February 2007

SummaryArterial blood pressure and pulse rate changes following tracheal intubation were studied in 20 patients undergoing intracranial surgery who received a thiopentone/suxamethonium anaesthetic induction sequence. Ten of the patients were pretreated with 0.4 mg/kg of hydrallazine and 10 with saline to determine whether hydrallazine prevents intubation hypertension. The results show that the incidence of intubation hypertension can be reduced using this dose of hydrallazine. Hydrallazine pretreatment is therefore recommended in patients at risk from hypertension following tracheal intubation.
Ketamine for induction and intubation in Treacher‐Collins syndrome
Authors: MACLENNAN FIONA M. , ROBERTSON GEORGE S. 
Published: February 2007

SummaryA patient with the Treacher‐Collins syndrome is described, in whom intubation of the trachea was achieved using ketamine as the sole anaesthetic agent. Intubation was aided by blind location of the glottis with a gum‐elastic stylet.
The oesophageal obturator airway
Authors: MERRIFIELD A.J. , KING S.J. 
Published: February 2007

SummaryVentilation of cadaver lungs using a Pneupac ventilator through oesophageal obturator airways (EOA), oesophageal gastric tube airways (EGTA), and tracheal tubes was studied in 23 subjects. The mean tidal volume obtained through tracheal tubes was 381 ml compared with a mean tidal volume of 156 ml obtained through the EOA and a mean tidal volume of 237 ml through the EGTA. Considerable leakage occurred at the pressure relief valve of the ventilator and at the face mask. With the pressure relief valve occluded and better mask fit achieved by observation of maximum possible tidal volume, the mean tidal volume obtained through obturator gastric airways was 606 ml compared with 906 ml obtained through tracheal tubes. This represents adequate ventilation in these very stiff lungs. Subject to modification of the device and prevention of leakage the oesophageal gastric tube airway is a useful alternative to tracheal intubation in certain adverse conditions.
Intubation problem in a case of cystic hygroma complicated by a laryngotracheal haemangioma
Authors: EVANS P. 
Published: February 2007

SummaryIn dealing with this case of cystic hygroma a non‐routine intubation was expected and some of the possible problems anticipated. However, the unusual nature of the difficulty encountered was not initially apparent and presented special problems, both with initial and subsequent management of the patient.The presence of a primary laryngeal condition in this case presented another life‐threatening feature. Not only was the airway narrowed, but intubation could not be easily achieved and the possibility of haemorrhage into the respiratory tract existed.The outcome of the case reflects the high mortality associated with this essentially benign condition.1,2,8
Total intravenous anaesthesia with low dose ketamine and Althesin Assessment of a technique for minor surgery in difficult situations
Authors: Keith Ian , Shenoy B. J. 
Published: February 2007

SummaryIn 38 patients subjected to minor surgery, totally intravenous anaesthesia with low dose ketamine and Althesin produced adequate operating conditions in 92% of patients with minimal cardiorespiratory disturbance. Problems arose from muscular hyper tonus, spontaneous movement and occasionally salivation. Initial recovery was quicker and the incidence of side‐effects lower, than those reported when ketamine was used as the sole agent. The technique could be useful in difficult situations as an alternative to inhalation anaesthesia or other intravenous techniques.
Epidural space pressures during pregnancy
Authors: MESSIH MORAD N.A. 
Published: February 2007

SummaryThe epidural space pressure in the lumbar region was monitored and recorded in 21 full term pregnant patients, before and during labour and 6–12 hours postpartum, in different positions. The pre‐labour epidural pressure was found to be above atmospheric in all patients, being highest when supine, and lowest in the lateral position. Three patients with twin pregnancy showed a greater rise in epidural space pressure in the supine position even with the use of lateral tilt, compared with patients with single fetus pregnancy. It is suggested that the epidural space pressure in the full term pregnant patient is closely related to the degree of inferior vena caval obstruction imposed by the gravid uterus. It is also suggested that when the patient is aware of a uterine contraction, the synchronous rise of the epidural space pressure with the contraction is a result of reflex increase in abdominal muscle tone. With established epidural block, and the parturient unaware of a contraction, such a rise was minimal, and was replaced by a drop in pressure in patients with a single fetus who developed loss of muscle power. The magnitude of the drop in the epidural space pressure immediately after delivery was found to be related to the duration of labour and to the mode of delivery. Epidural pressures measured 6–12 hours after delivery were comparable in all patients.
Control of ventilation by continuous infusion of pancuronium bromide
Authors: CLYBURN P.A. , MARSHALL R.D. 
Published: February 2007

SummaryCertain groups of patients who require prolonged intermittent positive pressure ventilation in the Intensive Therapy Unit are difficult to manage with conventional sedative and narcotic drugs, and require muscle paralysis. In such cases, the authors have preferred a continuous infusion of a long‐acting muscle relaxant using a syringe pump rather than intermittent injections. The technique and apparatus employed in the Intensive Therapy Unit at Northampton General Hospital are described.
Postoperative pain control with intrathecal morphine
Authors: GJESSING JON , TOMLIN PETER J. 
Published: February 2007

SummaryA clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. When combined with a relaxant technique of anaesthesia some persistent curarisation was seen.The only complication to emerge from the study was respiratory depression which could be very delayed in its onset. The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.