bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunomodulation: an important concept in modern anaesthesia
Authors: McBRIDE W. T. , ARMSTRONG M. A. , McBRIDE S. J. 
Published: February 2007

SummaryThis review summarises evidence for immunomodulatory effect of drugs administered peri‐operatively. The clinical significance of the balance of pro‐ and anti‐inflammatory cytokines may be seen in certain disease states, for example, meningococcal meningitis and Lyme arthritis. This balance may be altered peri‐operatively. Traditionally, these changes are considered to be due to the stress response of surgery, the response to cardiopulmonary bypass, or endotoxaemia. This review presents in vitro evidence suggesting that drugs modulating this cytokine balance include non‐steroidal anti‐inflammatory agents, phosphodiesterase inhibitors and opioids, acting through effects on intracellular cyclic nucleotide messenger systems. An important consequence of the pro‐inflammatory cytokine activity is increased adhesion of neutrophils. Aspects of this process may be inhibited by avoiding low blood flow states, by reducing adhesion molecule expression (for example by use of pentoxifylline), or by use of negatively charged anions such as heparin. Neutrophil activity is generally depressed by intravenous anaesthetic induction agents, but is enhanced by opioids. Natural killer cell activity, which is involved in immunity against tumour cells and virally infected cells is transiently depressed by volatile anaesthetic agents and opioids. In contrast catecholamines enhance natural killer cell activity. Whereas decrease in immunoglobulin levels occur peri‐operatively, this is not thought to be as a result of drugs at clinically used concentrations but rather due to haemodilution.
Esmolol aids extubation in intensive care patient with ischaemic pulmonary oedema
Authors: Duane D. T. , Redwood S. R. , Grounds R. M. 
Published: February 2007

SummaryA 49‐year‐old man with a history of ischaemic heart disease failed successful tracheal extubation on four consecutive occasions following emergency surgery because of the development of acute pulmonary oedema. Attenuation of the cardiovascular responses to tracheal tube removal by pretreatment with an intravenous infusion of esmolol hydrochloride allowed successful extubation of the patient to be achieved.
Flumazenil: an unreliable antagonist in baclofen overdose
Authors: Byrnes S. M. A. , Watson G. W. , Hardy P. A. J. 
Published: February 2007

SummaryWe report a case of inadvertent overdose of baclofen given intrathecally resulting in coma. This was unresponsive to flumazenil and required supportive intensive therapy. With the increasing use of baclofen intrathecally for spasticity and its wide interpatient dose variability, there is a need to find a safe antagonist to baclofen for routine medical use.
Epidural morphine for postherpetic neuralgia
Authors: WATT J. W. G. , WILES J. R. , BOWSHER D. R. 
Published: February 2007

SummaryEleven patients with established postherpetic neuralgia, unresponsive to antidepressant therapy, entered this single‐blind, placebo‐controlled study to assess the effectiveness of epidural morphine in the control of the pain of postherpetic neuralgia. Two patients obtained a reduction in pain of greater than 50% following morphine 0.5 mg. The duration of this pain relief was 36 h in one patient and 72 h in the other. Repeated doses, however, were ineffective in one patient and resulted in intolerable side effects in the other. The other six patients who received morphine developed oploid‐related side effects without pain relief. Three patients did not receive morphine as they gained significant, long‐lasting pain relief from placebo. Two retained that benefit for more than 6 months. Epidural morphine is more likely to produce side effects than pain relief when administered to patients with postherpetic neuralgia.
Spontaneous movement after injection of propofol
Authors: CHAN A. , NICKOLL E. , THORNTON C. , DORÉ C. , NEWTON D. E. F. 
Published: February 2007

SummarySpontaneous movement following injection of propofol at induction was studied in 303 patients. Two hundred patients were Caucasians and 103 were Asians. In a pilot study carried out prior to the main study, 26% of the Asians moved at induction as compared with 6% of the Caucasians. The patients were studied in relation to a number of variables; age, sex, weight, height, race, smoker/non smoker, vegetarian/non vegetarian, alcohol consumption, premedication, use of fentanyl at induction and dose of propofol. When race was included as the sole variable there was a marginal but not significant difference between the two groups in terms of movement (p = 0.06). However, when the other recorded variables were taken into account, race was not included as a predictor of whether or not the patient moved. The best model for predicting whether the patients moved or not combines the variables weight and dose of propofol. Patients were more likely to move if they were lighter and the dose of propofol used at induction was higher.
Lung aeration
Authors: REBER A. , ENGBERG G. , WEGENIUS G. , HEDENSTIERNA G. 
Published: February 2007

SummaryWe have investigated the effect of pre‐oxygenation and hyperoxygenation (an increase in inspired oxygen fraction from 0.4 to 1.0 after induction of general anaesthesia) on aeration and atelectasis formation in the lungs during total intravenous anaesthesia. Twenty‐seven consecutive patients were randomly allocated to group I (with pre‐oxygenation), group 2 (without pre‐oxygenation), or group 3 (hyperoxygenation). Lung aeration was investigated by means of spiral computed tomography. The aeration of lung regions identified by computed tomography scans was divided into five categories: over‐aeration, normal aeration, reduced aeration, poor aeration, and atelectasis formation. In group I larger areas of atelectasis were found in the basal parts of the lungs compared to group 2. In group 3 a significant increase in atelectatic areas with a corresponding reduction in areas with reduced aeration occurred at the bases of the lungs. The considerable increase in atelectasis associated with pre‐oxygenation and its rapid appearance during hyperoxygenation suggest that these procedures should be used with caution.
Emergency transtracheal ventilation: assessment of breathing systems chosen by anaesthetists
Authors: RYDER I. G. , PAOLONI C. C. E. , HARLE C. C. 
Published: February 2007

SummaryThe choice of equipment for emergency transtracheal ventilation and the time taken to assemble it were surveyed in 39 anaesthetists. Thirty seven (95%) assembled a system in a median time of 104s (interquartile range 54s to 120s). Systems specially constructed from oxygen tubing and connectors took longest to put together (p < 0.05). Consultants and senior registrars performed no better than senior house officers and registrars (p > 0.05). In the second part of the study we tested four anaesthetic systems which the survey revealed might be chosen for emergency transtracheal ventilation. These were: a simple length of oxygen tubing; a T‐piece system; a Bain system; a jet injector. All had the appropriate connectors. The oxygen flow was measured through a 14 G venous‘transtracheal’cannula on depression of the oxygen flush device on a standard Boyle's M anaesthetic machine. The jet injector was connected to the high pressure outlet. This device delivered the highest flow, 43 l.min‐1 and was the only system capable of ventilating a trachea/lung model. The T‐piece system, and the one constructed from oxygen tubing, delivered flows of 12.7 and 12.0 l.min ‐1, respectively, whereas the Bain system delivered only 4.7 1.min ‐1. We conclude that, except for jet ventilation, none of the systems chosen, using equipment available in the anaesthetic room, would be likely to achieve effective CO2 elimination; at best they would provide oxygenation.
Postoperative analgesia in dental day case surgery
Authors: Wakeling H. G. , Barry P. Creagh , Butler P. J. 
Published: February 2007

SummaryA randomised, double‐blind placebo‐controlled trial was conducted to compare the analgesic efficacy of piroxicam as Feldene‘Melt’with diclofenac suppositories following day case wisdom tooth extraction. Piroxicam was found to be equivalent to diclofenac in speed of onset and efficacy when given 1 h prior to surgery with no significant adverse effects. It is therefore possible to confer the benefits of postoperative analgesia from a non‐steroidal anti‐inflammatory drug whilst avoiding the inconvenience of the rectal route of administration.
Anaesthesia for cardioversion
Authors: STONEHAM M. D. 
Published: February 2007

SummaryCardioversion is a minor procedure requiring sedation and analgesia. However, it is often performed out‐of‐hours in remote sites by inexperienced anaesthetists. An understanding is required both of the pathophysiology underlying cardiac arrhythmias and of the technical side of defibrillation equipment, including electrical safety. Patients should have their coagulation status and electrolyte balance checked prior to the procedure to reduce the likelihood of complications. Almost all the available anaesthetic agents have been used for cardioversion in the past, with varying degrees of success. The anaesthetic agent chosen for patients undergoing cardioversion must provide analgesia and sedation, cause the least cardiovascular compromise possible and still enable rapid recovery. Propofol may be the closest anaesthetic agent to this ideal currently available, although careful titration of any agent chosen is also important. Cardioversion may be performed as an emergency, including in the pregnant patient, providing safe anaesthetic practice is followed.
Anaesthetic management in maple syrup urine disease
Authors: Kahraman S. , Ercan M. , Akkuş Ö. , Erçelen Ö. , Erdem K. , Coşkun T. 
Published: February 2007

SummaryTwo children with maple syrup urine disease undergoing emergency and elective surgery are reported. The administration of ketamine to a 12‐month‐old boy without neurological problems and propofol infusion to a 5‐year‐old girl with a history of convulsions, was uneventful. We believe that a, full knowledge of the pathophysiology of maple syrup urine disease and potential peri‐operative problems associated with the disease are essential, so that patients are not subjected to unnecessary risks.
Use of liposome‐associated bupivacaine in a cancer pain syndrome
Authors: Lafont N. D. , Legros F. J. , Boogaerts J. G. 
Published: February 2007

Summary Bupivacaine. 0.25% encapsulated by multilamellar liposomes was administered epidurally to a patient suffering pain associated with lung cancer and the effect compared with a plain bupivacaine solution of the same concentration. Complete analgesia was produced for 4 h with the plain solution and 11 h with the liposomal formulation. No motor blockade or haemodynamic instability was observed with the liposome‐associated bupivacaine.
Laryngoscopy using the McCoy laryngoscope after application of a cervical collar
Authors: GABBOTT D. A. 
Published: February 2007

Summary A rigid cervical collar was applied to 102 patients under general anaesthesia. Laryngoscopy was performed using a McCoy laryngoscope blade (size 3) initially in the standard Macintosh configuration followed by activation of the distal hinged tip. The two views obtained at laryngoscopy were graded according to standard guidelines. In 46/102 (45.1%) patients the laryngoscopic view was improved by one or more grades. In 10/102 (9.8%) the view was improved by two grades. Difficult laryngoscopy (grade 3 or 4) was encountered in 26/102 patients using the McCoy laryngoscope in the unactivated position (Macintosh configuration). Of these 26 patients, 24 (92.3%) had glottic structures identified (grade 1 or 2) when the distal tip of the laryngoscope blade was activated (p < 0.001). The McCoy laryngoscope significantly improves the view at laryngoscopy in the patient whose neck is immobilised in a rigid cervical collar.
Osteogenesis imperfecta and malignant hyperthermia
Authors: Porsborg P. , Astrup G. , Bendixen D. , Lund A. M. , Ørding H. 
Published: February 2007

Summary We describe a patient with osteogenesis imperfecta who developed tachycardia, metabolic and respiratory acidosis (pH 7.14, Pco2 8.4 kPa, BE 8.5 mmol.l‐1) and hyperthermia up to 40°C during anaesthesia with barbiturates, fentanyl, pancuronium, and nitrous oxide. Malignant hyperthermia was suspected and the patient treated accordingly. Two years later the in‐vitro contracture test for malignant hyperthermia was completely normal. We conclude that hypermetabolism in patients with osteogenesis imperfecta is due to unknown mechanisms other than malignant hyperthermia.
Antiemetic efficacy of ondansetron with patient‐controlled analgesia
Authors: Davies P. R. F. , Warwick P. , O'Connor M. 
Published: February 2007

Summary A double‐blind, randomised, placebo‐controlled study was performed to assess the antiemetic efficacy of ondansetron in women receiving morphine from a patient‐controlled analgesia system after total abdominal hysterectomy. Sixty‐six ASA grade 1 or 2 patients scheduled for total abdominal hysterectomy were randomly allocated into one of two groups. All patients received a standardised anaesthetic and postoperative patient‐controlled analgesia regimen. Group 1 received ondansetron 4 mg at induction of anaesthesia, repeated 8 h later. Group 2 received saline as a placebo at the same times. Pain scores, nausea scores, episodes of vomiting, use of rescue antiemetics and recollection of nausea and vomiting were not different between the groups. Only 15% of patients who received ondansetron and 30% of patients who received the placebo recorded no nausea or vomiting in the first 24 h. We conclude that ondansetron, in the dose studied, does not reduce nausea and vomiting in women receiving morphine from a patient‐controlled analgesia system after total abdominal hysterectomy.
Attitudes to pain and pain relief in adult surgical patients
Authors: Brydon C.W. , Asbury A.J. 
Published: February 2007

SummaryPain relief after surgery is. frequently inadequate. In the last few years much research has been devoted to improving the situation. Unfortunately, very little work has been undertaken to explore the patients' contribution to pain management. The beliefs and attitudes held by patients when they enter the hospital environment may be responsible in some instances for their not achieving optimal pain relief from the available techniques. We have studied some of these attitudes with a survey of 180 adult patients admitted for elective surgery. We found that most patients still expect pain. following surgery. However, they are not afraid to ask for analgesics when in pain and do not attribute pain to their own wrong doing. There are, however, some patients who appear to have deviant’ pain beliefs that could hinder their appropriate use of analgesics. Sadly, it is impossible to identify these patients according to age, gender, socio‐economic group or previous experience of pain or surgery.
PIF3 regulates anthocyanin biosynthesis in an HY5‐dependent manner with both factors directly binding anthocyanin biosynthetic gene promoters in Arabidopsis
Authors: Shin Jieun , Park Eunae , Choi Giltsu 
Published: February 2007

SummaryPhytochromes are red/far‐red light receptors that regulate various light responses by initiating the transcriptional cascades responsible for changing the expression patterns of 10–30% of the entire plant transcriptome. Several transcription factors that are thought to participate in this process have been identified, but the functional relationships among them have not yet been fully elucidated. Here we investigated the functional relationship between two such transcription factors, PIF3 and HY5, and their effects on anthocyanin biosynthesis. Our results revealed that PIF3 and HY5 do not regulate each other at either the transcriptional or the protein levels in continuous light conditions, suggesting that they are not directly linked within phytochrome‐mediated signaling. We found that both PIF3 and HY5 positively regulate anthocyanin biosynthesis by activating the transcription of the same anthocyanin biosynthetic genes, but the positive effects of PIF3 required functional HY5. Chromatin immunoprecipitation analyses indicated that both PIF3 and HY5 regulate anthocyanin biosynthetic gene expression by directly binding to different regions of the gene promoters in vivo. Additional experiments revealed that PIF3 bound the promoters regardless of light and HY5. Collectively, these data show that PIF3 and HY5 regulate anthocyanin biosynthesis by simultaneously binding anthocyanin biosynthetic gene promoters at separate sequence elements.
A plastid‐localized glycogen synthase kinase 3 modulates stress tolerance and carbohydrate metabolism
Authors: Kempa Stefan , Rozhon Wilfried , Šamaj Jozef , Erban Alexander , Baluška František , Becker Thomas , Haselmayer Joachim , Schleiff Enrico , Kopka Joachim , Hirt Heribert , Jonak Claudia 
Published: February 2007

SummaryGlycogen synthase kinase 3 (GSK‐3) was originally identified as a regulator of glycogen synthesis in mammals. Like starch in plants, glycogen is a polymer of glucose, and serves as an energy and carbon store. Starch is the main carbohydrate store in plants. Regulation of starch metabolism, in particular in response to environmental cues, is of primary importance for carbon and energy flow in plants but is still obscure. Here, we provide evidence that MsK4, a novel Medicago sativa GSK‐3‐like kinase, connects stress signalling with carbon metabolism. MsK4 was found to be a plastid‐localized protein kinase that is associated with starch granules. High‐salt stress rapidly induced the in vivo kinase activity of MsK4. Metabolic profiling of MsK4 over‐expressor lines revealed changes in sugar metabolism, including increased amounts of maltose, the main degradation product of starch in leaves. Plants over‐expressing MsK4 showed improved tolerance to salt stress. Moreover, under high‐salinity conditions, MsK4‐over‐expressing plants accumulated significantly more starch and showed modified carbohydrate content compared with wild‐type plants. Overall, these data indicate that MsK4 is an important regulator that adjusts carbohydrate metabolism to environmental stress.
English in the linguistic transformation of Hawaii: literacy, languages and discourse
Authors: BUCK ELIZABETH 
Published: February 2007

Abstract: The event of contact with the West has always been for the Other a moment of violence, rupture and discontinuity. As a colonized Other, Hawaii was not just modernized and modified, but transformed and reformed. The interactive forces that had constituted the dynamic of Hawaiian history before Cook were suddenly and radically skewed, eliminated and replaced by Western forces of power—not the least of these being language. What had been the totality of the world for the Hawaiians was suddenly only a part, a small part, of a global system containing other cultures, other languages, and other epistemes of knowledge and discourse. In this paper I will focus on language and the linguistic transformation of Hawaii, viewing language as socially constitutive, as creative and recreative, as consciousness that is saturated by and that saturates all social activity. Working within this constitutive view of language, the linguistic intrusion of the West takes on a significance, as significance, that is integral to every aspect of the Western penetration of Hawaii. Three fundamental changes in language were initiated with Western contact: (1) the radical shift from orality to literacy, (2) the displacement of Hawaiian by English as the dominant language of discourse, and (3) the repositioning and redefinition of Hawaii, the Hawaiians and their material and symbolizing practices by discourses informed by English, particularly ideologies embedded in American English. The first two involved fundamental changes in cognitive processes and social consciousness; all three reconstituted social relationships. Forms and practices of symbolic representation, including the most basic one of language itself, are never exterior to material forces. They are part of ideological social practices that are inscribed by history and embedded in social praxis. The English language and practices of that language, were integral to the social restructuring of the Hawaiian islands by Western capitalism, the dispossession and alienation of the Hawaiians, and the ultimate redistribution of power.What, then, is truth? A mobile army of metaphors, metonyms, and anthropomorphisms—in short, a sum of human relations, which have been enhanced, transposed, and embellished poetically and rhetorically, and which after long use seem firm, canonical, and obligatory to a people: truths are illusions about which one has forgotten that this is what they are; metaphors which are worn out and without sensuous power; coins which have lost their pictures and now matter only as metal, no longer as coins (Nietzsche, 1968: 46–47).
Immune Evasion by Helicobacter pylori: Gastric Spiral Bacteria Lack Surface Immunoglobulin Deposition and Reactivity with Homologous Antibodies
Authors: Darwin Peter E. , Sztein Marcelo B. , Zheng Qiao‐Xi , James Stephen P. , Fantry George T. 
Published: February 2007

ABSTRACT Background.
Helicobacter pylori infection persists in the presence of potent serum and gastric mucosal anti‐body responses against bacterial antigens. The aim of this article is to report on a study determine whether there is antibody deposition on H. pylori in vivo in the stomach of infected patients and whether gastric and cultured forms of H. pylori differ in their antibody reactivity. Materials and Methods.Serum, gastric biopsies, and antral brushings were obtained from 10 patients having endoscopy. H. pylori was cultured from gastric biopsies. Bacterial samples were stained directly for immunoglobulin deposition and indirectly using rabbit antiurease serum or patient serum. Samples were examined by immunofluorescence microscopy and flow cytometry. Results.Although spiral bacteria could be identified easily by acridine orange staining and antiurease staining of gastric brushings from H. pylori infected patients, gastric bacteria did not have detectable IgG or IgA present, and only one of five samples could be stained for IgG and IgA indirectly using patient serum. In contrast, cultured bacteria could be stained readily with homologous serum for IgG and IgA in the majority of cases. Low pH inhibited immunoglobulin reactivity with cultured H. pylori. Conclusions.Gastric H. pylori may evade humoral defense owing to poor deposition of immunoglobulin in the gastric environment or failure to express surface antigens that are present on cultured forms of H. pylori.