bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of radiographic landmarks and the echocardiographic SVC/RA junction in the positioning of long‐term central venous catheters
Authors: Hsu J.‐H. , Wang C.‐K. , Chu K.‐S. , Cheng K.‐I. , Chuang H.‐Y. , Jaw T.‐S. , Wu J.‐R. 
Published: June 2006

Background:  When implanting a permanent central venous catheter, the usual aim is to place the tip at the superior vena cava/right atrial (SVC/RA) junction. However, data validating radiographic landmarks of the SVC/RA junction are limited. This investigation was undertaken to compare the radiographic landmarks with the SVC/RA junction as determined by transesophageal echocardiography (TEE).Methods:  In 20 adult oncologic patients undergoing implantation of a permanent subcutaneous central venous catheter, the catheter tip was placed in the SVC/RA junction under TEE guidance. The position of the catheter tip on chest X‐ray, which represented the echocardiographic SVC/RA junction, was then compared with a standard radiographic landmark of the SVC/RA junction and with thoracic vertebral levels.Results:  In all but two patients radiographic SVC/RA junctions were identified. The echocardiographic SVC/RA junction ranged from 0.6 cm above to 2.8 cm below the radiographic SVC/RA junction. There was a significant difference between the distance from the carina to the radiographic SVC/RA junction and the distance from the carina to the echocardiographic SVC/RA junction. The thoracic vertebral body correlating with the echocardiographic SVC/RA junction ranged from the sixth to the ninth level.Conclusion:  Both the radiographic SVC/RA junction and the thoracic vertebral bodies are not reliable landmarks for the SVC/RA junction defined by TEE. Physicians should be aware that using the radiographic SVC/RA junction to confirm proper positioning of permanent central venous catheters risks placing the catheter tip in the upper SVC, with subsequent potential long‐term complications. More reliable radiographic landmarks for the SVC/RA junction should be investigated.
Cerebral state index response to incision: a clinical study in day‐surgical patients
Authors: Anderson R. E. , Jakobsson J. G. 
Published: June 2006

Background:  Inadequate anaesthesia, with somatic/autonomic response or awareness, is often revealed at intubation and surgical incision. Anaesthetic depth monitors should be able to prevent this risk. This explorative study examined the ability of the cerebral state monitor to predict autonomic/somatic responses to incision.Methods:  Forty‐two ASA I–II day‐surgical patients [19 men and 23 females; mean age 52 (29–79) years, mean weight 77 (50–118) kg] were induced clinically with fentanyl/propofol with sevoflurane after placement of the laryngeal mask airway. The cerebral state index (CSI™) was blindly recorded 4 min prior to and 4 min after incision.Results:  During the 4 min prior to incision, the mean CSI™ was 45 (16–62) and increased by 9 (–13–40) when the mean value for the first 4 min after incision was subtracted from the value prior to incision, corresponding to a relative change of 21% (–21–118). The change in CSI™ did not show any consistent relation to the value before incision. Five patients showed minor movements after incision and six patients had > 25% increase in blood pressure. Neither CSI™ nor the change in index differed between patients who did or did not respond somatically or autonomically to incision. The last CSI™ value just prior to incision was 44 for non‐responders and 40 and 42 for somatic and autonomic responders, respectively.Conclusion:  The CSI™ in the majority of patients was within acceptable ranges during clinically adjusted anaesthesia prior to incision but seems not to be able to reliably predict an autonomic or somatic response to incision.
Portable ultrasound in pre‐hospital emergencies: a feasibility study
Authors: Busch M. 
Published: June 2006

Background:  Ultrasound plays a central role in the evaluation of both trauma and medical emergencies. The development of portable sonography devices could extent its application into the pre‐hospital arena. The aim of our study was to evaluate feasibility of pre‐hospital ultrasound in the Norwegian Air Rescue setting.Material and methods:  During a 3‐month period, we conducted a prospective study using sonography in pre‐hospital patient management. All examinations were carried out by the same ultrasound‐certified physician using a Primedic™ Handyscan in a standardized focused protocol for abdominal and lung sonography and a subcostal 2‐chamber long axis view. Inclusion criteria were abdominal/thoracic and obstetric trauma, circulatory/respiratory compromise, pulseless electric activity (PEA) in cardiac arrest, acute abdomen and monitoring during transport. Allowed examination time was restricted to 3 min on the scene. The patient’s gender, age, symptoms, trauma mechanism, quality of visualization and diagnose made were recorded. Pre‐hospital results were compared with in‐hospital findings.Results:  Thirty‐eight patients were entered into the study. Three patients had to be excluded due to technical difficulties. Nineteen medical, 15 traumas and 1 obstetric patient were included. Good visualization was obtained in 74% (n= 26), moderate in 26% (n= 9). Median examination time was 2.5 min (range 1–3 min). Nine patients (26%) showed positive sonography findings. Sensitivity was 90%, specificity 96%. Diagnostic usefulness was high in undetermined cardiac arrest and hypotension and massive hematoperitoneum.Conclusion:  Pre‐hospital ultrasound when applied by an proficient examiner using a goal‐directed, time sensitive protocol is feasible, does not delay patient management and provides diagnostic and therapeutic benefit. Further studies are warranted to identify the exact indications and role of pre‐hospital sonography.
Beneficial outcome after prostaglandin‐induced post‐partum cardiac arrest using levosimendan and extracorporeal membrane oxygenation
Authors: Krumnikl J. J. , Toller W. G. , Prenner G. , Metzler H. 
Published: June 2006

Background:  Administration of high doses of prostaglandins is a frequently performed and effective method for the treatment of atonic uterine haemorrhage in order to increase uterine muscle tone. Rarely, however, these drugs may cause life‐threatening complications including bronchospasm, acute pulmonary oedema and myocardial infarction caused by coronary spasms.Methods:  We discuss the management of a patient suffering post‐partum atonic uterine bleeding, catecholamine‐resistant cardiac arrest and fulminant pulmonary failure due to deleterious side‐effects of treatment with prostaglandins.Results:  During therapy resistant cardiopulmonary resuscitation, the addition of levosimendan to standard medications resulted in a prompt stabilization of haemodynamics. Subsequent treatment of pulmonary failure was successfully managed with ECMO.Conclusion:  Although levosimendan is not approved for pharmacological treatment of cardiopulmonary arrest, the beneficial effects in this patient suggest an important role of calcium sensitization and vasodilation during prostaglandin‐induced cardiac arrest.
Being a young and inexperienced trainee anesthetist: a phenomenological study on tough working conditions
Authors: Larsson J. , Rosenqvist U. , Holmström I. 
Published: June 2006

Background:  Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.Methods:  Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.Results:  All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.Conclusions:  This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.
Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trial
Authors: Petersen M. K. , Madsen C. , Andersen N. T. , Søballe K. 
Published: June 2006

Background:  The aim of this trial was to assess the effects of optimization of mobilization and nutrition on patients undergoing primary total hip replacement (THR).Methods:  Seventy‐nine patients undergoing elective primary THR were recruited prospectively. After randomization, one group received optimized pre‐operative information and enforced mobilization and nutrition, another group received conventional peri‐operative care. Epidural anaesthesia and post‐operative epidural analgesia with local anaesthetics and opioids were used in all cases. Outcome related to length of stay, complications, pain, mobilization, energy intake, and physical activities of daily living (PADL).Results:  Although mobilization and nutrition were highly significantly increased in the intervention group, the reduction in length of stay was moderate (7.0 vs. 8.0 days P= 0.019). We found no differences between groups in relation to complications or pain. In the intervention group, the median day of independence in PADL was the third post‐operative day (2 : 6 day) and the fourth post‐operative day (2 : 7 day) in the control group. The difference was not significant.Conclusion:  Compared with conventional care, optimal and aggressive nutrition and mobilization resulted in a very moderate reduction in length of stay. There were no differences regarding pain, complications or time until independence in PADL.
Excess mortality in winter in Finnish intensive care
Authors: Reinikainen M. , Uusaro A. , Ruokonen E. , Niskanen M. 
Published: June 2006

Background:  In the general population, mortality from acute myocardial infarctions, strokes and respiratory causes is increased in winter. The winter climate in Finland is harsh. The aim of this study was to find out whether there are seasonal variations in mortality rates in Finnish intensive care units (ICUs).Methods:  We analysed data on 31,040 patients treated in 18 Finnish ICUs. We measured severity of illness with acute physiology and chronic health evaluation II (APACHE II) scores and intensity of care with therapeutic intervention scoring system (TISS) scores. We assessed mortality rates in different months and seasons and used logistic regression analysis to test the independent effect of various seasons on hospital mortality. We defined ‘winter’ as the period from December to February, inclusive.Results:  The crude hospital mortality rate was 17.9% in winter and 16.4% in non‐winter, P= 0.003. Even after adjustment for case mix, winter season was an independent risk factor for increased hospital mortality (adjusted odds ratio 1.13, 95% confidence interval 1.04–1.22, P= 0.005). In particular, the risk of respiratory failure was increased in winter. Crude hospital mortality was increased during the main holiday season in July. However, the severity of illness‐adjusted risk of death was not higher in July than in other months. An increase in the mean daily TISS score was an independent predictor of increased hospital mortality.Conclusion:  Severity of illness‐adjusted hospital mortality for Finnish ICU patients is higher in winter than in other seasons.
Oscillometric brachial mean artery pressures are higher than intra‐radial mean artery pressures in intensive care unit patients receiving norepinephrine
Authors: Pytte M. , Dybwik K. , Sexton J. , Straume B. , Nielsen E. Waage 
Published: June 2006

Background:  Norepinephrine is frequently used in intensive care unit (ICU) patients to raise and maintain an adequate mean arterial pressure (MAP). Conflict arises as to which MAP should guide vasopressor dose, as oscillometric MAP in the brachial artery often diverges from intra‐radial MAP. We wanted to estimate the magnitude of this difference in ICU patients receiving norepinephrine, and to see whether the patient age, norepinephrine dose, age of radial catheter, ventilation treatment or severity of illness influenced the difference.Methods:  Prospective observational study comparing oscillometric MAP and intra‐radial MAP performed in a central hospital‐based surgical ICU during the period from February 2002 through to October 2003. Sixty‐eight consecutive patients who received a norepinephrine infusion to maintain MAP above 70 mmHg were included. The mean arterial blood pressure was measured both oscillometrically and in the ipsilateral radial artery.Results:  Oscillometric MAP was on average 6.6 mmHg higher (95% CI 5.3–7.9) than intra‐radial MAP in the 134 sets of measurements (P < 0.001). The patient’s age (P = 0.319), norepinephrine dosage (P = 0.959) the age of the radial catheter (P = 0.992) were not significant. The difference in MAP was marginally greater in ventilated patients (P = 0.061) and significantly greater as the simplified acute physiology score (SAPS) score increased (P = 0.022).Conclusions:  MAP measured oscillometrically over the brachial artery directly in the radial artery gave different results in an ICU population receiving norepinephrine. In more than one of four patients this difference is so large, and increases with illness severity, that the selection of any one method would influence treatment.
Coloured chlorhexidine cotton pads may help to identify cerebrospinal fluid during epidural or spinal anaesthesia
Authors: Knudsen K. 
Published: June 2006

Background:  During complicated technical conditions in epidural or spinal anaesthesia, it may be difficult to safely identify the epidural space. The confirmation or exclusion of the presence of cerebrospinal fluid (CSF) during the procedure of regional anaesthesia is helpful to determine the position of the epidural needle in order to proceed with the anaesthetic block.Methods:  We have examined how CSF and different anaesthetic solutions change the colour of yellowish phenol red absorbed in cotton pads.Results:  Sodium chloride and local anaesthetic agents do not change the colour of yellowish phenol red. However, CSF immediately changes the colour from yellow to pink or red. Letting a drop of fluid from the epidural/spinal needle fall on to the cleaning pads filled with phenol red will enable the anaesthesiologist to immediately confirm the presence or absence of CSF. The higher pH of CSF relative to that of sodium chloride and local anaesthetic agents explains the different colour reaction.Conclusion:  This colour reaction quickly identifies the presence of CSF and thus the intradural space during the procedure of spinal or epidural anaesthesia.
Can remifentanil be a better choice than propofol for colonoscopy during monitored anesthesia care?
Authors: Akcaboy Z. N. , Akcaboy E. Y. , Albayrak D. , Altinoren B. , Dikmen B. , Gogus N. 
Published: June 2006

Background and objective:  This prospective, randomized trial was designed to test the hypothesis that continuous infusion of low‐dose remifentanil can provide effective analgesia, sedation, amnesia, patient comfort and stable recovery profile without respiratory depression when compared with propofol infusion during colonoscopy.Methods:  One hundred patients were randomly assigned to receive either remifentanil (group R, 0.5 μg/kg followed by 0.05 μg/kg/min, n= 50) or propofol (group P, 0.5 mg/kg followed by 50 μg/kg/min, n= 50). Supplemental doses of remifentanil 12.5 μg in group R and propofol 10 mg in group P were given to treat complaints of moderate to severe pain and discomfort. Hemodynamic and respiratory data, pain, discomfort and sedation scores, patient and gastroenterologist satisfaction and recovery profiles were recorded.Results:  The duration of colonoscopy was longer in group P. The mean arterial pressure, heart rate and end‐tidal CO2 remained stable during the procedure and were comparable between the groups. After bolus injection of the study drugs, the respiratory rate and oxygen saturation values were lower in group R than in group P. Only one patient in group R required airway support. Pain and discomfort scores were better in group R than in group P. Sedation levels were higher in group P than in group R. Group P needed more supplemental doses than group R. The time to reach an Aldrete score of nine or more was shorter in group R, but discharge times were similar in the two groups. Amnesia was better in group P. Nausea and vomiting were more frequent in group R during the recovery phase.Conclusion:  Low‐dose remifentanil infusion with intermittent bolus injections can provide adequate sedation, amnesia and better analgesia than propofol infusion during colonoscopy. However, remifentanil‐induced nausea and vomiting may be a problem during the recovery phase.
Reproductive tradeoffs and yolk steroids in female leopard geckos, Eublepharis macularius
Authors: Rhen T. , Crews D. , Fivizzani A. , Elf P. 
Published: June 2006

Abstract
Life history theory predicts tradeoffs among reproductive traits, but the physiological mechanisms underlying such tradeoffs remain unclear. Here we examine reproductive tradeoffs and their association with yolk steroids in an oviparous lizard. Female leopard geckos lay two eggs in a clutch, produce multiple clutches in a breeding season, and reproduce for several years. We detected a significant tradeoff between egg size and the number of clutches laid by females during their first two breeding seasons. Total reproductive effort was strongly condition-dependent in the first season, but much less so in the second season. Although these and other tradeoffs were unmistakable, they were not associated with levels of androstenedione, oestradiol, or testosterone in egg yolk. Female condition and egg size, however, were inversely related to dihydrotestosterone (DHT) levels in egg yolk. Finally, steroid levels in egg yolk were not directly related to steroid levels in the maternal circulation when follicles were developing, indicating that steroid transfer to eggs is regulated. These findings suggest that maternal allocation of DHT could mitigate tradeoffs that lead to poor offspring quality (i.e. poor female condition) and small offspring size (i.e. small egg size).
Ecological significance of microsatellite variation in western North American populations of Bromus tectorum
Authors: RAMAKRISHNAN ALISA P. , MEYER SUSAN E. , FAIRBANKS DANIEL J. , COLEMAN CRAIG E. 
Published: June 2006

Abstract Bromus tectorum (cheatgrass or downy brome) is an exotic annual weed that is abundant in western USA. We examined variation in six microsatellite loci for 17 populations representing a range of habitats in Utah, Idaho, Nevada and Colorado (USA) and then intensively sampled four representative populations, for a total sample size of approximately 1000 individuals. All loci were homozygous, indicating that the species is strongly selfing. Populations consisted of a few common genotypes and variable numbers of rare genotypes. Small sample sizes (n = 10 individuals) were adequate for distinguishing among populations, but larger sample sizes were needed to characterize more diverse populations, particularly in terms of genotype. Large populations contained more genetic diversity than small populations in terms of both number of alleles per locus and number of genotypes. Genetic distance among survey populations was much more strongly correlated with ecological distance (habitat) than with geographical distance, and was also strongly correlated with a suite of adaptively significant seed germination traits. This suggests that similar habitats across the range of B. tectorum in western USA select for specific self‐pollinating lines from an array of widely distributed genotypes. Because all traits are effectively linked in this selfing organism, the distribution of adaptively significant genetic variation can be successfully inferred from an examination of microsatellite marker variation.
Reproductive biology and pollination ecology of the rare Yellowstone Park endemicAbronia ammophila(Nyctaginaceae)
Authors: SAUNDERS N. ELIZABETH , SIPES SEDONIA D. 
Published: June 2006

AbstractWe examined the breeding system, reproductive output and pollination ecology ofAbronia ammophilaGreene, a rare and highly restricted endemic of Yellowstone National Park, Wyoming, USA. Floral morphology permits the automatic deposition of self‐pollen on the stigma of individual flowers, and male and female reproductive functions temporally overlap. In controlled hand‐pollination treatments, we found no significant difference among pollination treatments (unmanipulated, self‐pollinated or cross‐pollination). The species maintains a long reproductive season with high reproductive output (natural seed set ranged from 59 to 84%). Our results, along with pollinator observations, suggest thatA. ammophilaexhibits a mixed‐mating system: the species can produce seed without pollinators (via either autogamy or agamospermy), but is also visited by an array of pollinating insects that included moths, butterflies and bumblebees. However, noctuid moths were the most abundant pollinators. In contrast, otherAbroniaspecies are obligate outcrossers. The mixed‐mating system ofA. ammophilamay have evolved as a consequence of ecological pressures such as scarcity of mates or pollinators.
Reproductive biology of two Cattleya (Orchidaceae) species endemic to north‐eastern Brazil
Authors: SMIDT ERIC CAMARGO , SILVA‐PEREIRA VIVIANE , BORBA EDUARDO LEITE 
Published: June 2006

AbstractThe reproductive biology of the endemic Cattleya elongata and the endemic and critically endangered Cattleya tenuis (Orchidaceae) was studied in areas of ‘campo rupestre’ and ‘caatinga’ vegetation, respectively, in the Chapada Diamantina, north‐eastern Brazil. Floral visitors and their behavior were recorded, and experimental pollinations were carried out to determine the breeding systems of these species. The species have similar flower morphology, flower in synchrony and both are pollinated by queens of Bombus (Fervidobombus) brevivillus (Apidae, Bombina). Flowers of both species do not present nectar despite the presence of a nectary‐like cuniculus. Cattleya tenuis presented low natural fruit set (10%), while C. elongata presented a higher fruit set (25%). Both species are self‐compatible, and only C. tenuis presented inbreeding depression, expressed as reduced seed viability in self‐pollinations compared with cross‐pollinations. The species have a parapatric distribution and differences in their habitats probably act as the principal barriers to the formation of natural hybrids.