bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fascia Iliaca Compartment Blockade for Acute Pain Control in Hip Fracture Patients
Authors: Foss Nicolai B. , Kristensen Billy B. , Bundgaard Morten , Bak Mikkel , Heiring Christian , Virkelyst Christina , Hougaard Sine , Kehlet Henrik 
Published: March 2007

Background
Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup.

Methods
Forty-eight patients with suspected hip fracture were included immediately after arrival in the emergency department, before x-ray confirmation of their fracture. Included patients were randomly assigned to two groups of 24. In the FICB group, the patients received an FICB with 1.0% mepivacaine and a placebo intramuscular injection of isotonic saline. In the morphine group, the patients received a placebo FICB with 0.9% saline and an intramuscular injection of 0.1 mg/kg morphine. Patients received intravenous rescue morphine when necessary.

Results
Maximum pain relief was superior in the FICB group both at rest (P < 0.01) and on movement (P = 0.02). The median total morphine consumption was 0 mg (interquartile range, 0-0 mg) in the FICB group and 6 mg (interquartile range, 5-7 mg) in the morphine group (P < 0.01). More patients (P = 0.05) were sedated in the morphine group at 180 min after block placement as compared with the FICB group.

Conclusion
Pain relief was superior at all times and at all measurements in the FICB group. The study supports the use of FICB in acute management of hip fracture pain because it is an effective, easily learned procedure that also may reduce opioid side effects in this fragile, elderly group of patients.
Factor V Leiden Does Not Affect Bleeding in Aprotinin Recipients after Cardiopulmonary Bypass
Authors: Boehm Johannes , Grammer Joachim Burkhard , Lehnert Fabian , Dietrich Wulf , Wagenpfeil Stefan , Wildhirt Stephen Michael , Wottke Michael , Braun Siegmund , Lange Rüdiger , Bauernschmitt Robert 
Published: March 2007

Background
Carriers of the factor V Leiden mutation (FVL) are resistant to activated protein C proteolysis. Therefore, they are at increased risk of thromboembolic events. Aprotinin is an unspecific proteinase inhibitor frequently used during cardiac surgery procedures to reduce bleeding. However, aprotinin may cause thromboembolic complications after cardiopulmonary bypass (CPB). The primary endpoint of this study was the amount of blood loss after CPB in aprotinin recipients, and secondary endpoints were thromboembolic complications.

Methods
A total of 1,447 consecutive patients who underwent cardiac surgery with CPB were prospectively enrolled. All patients were screened for FVL by a fluorescence-based polymerase chain reaction method. Linear and logistic regression analyses were performed to assess associations of FVL on bleeding and thromboembolic complications.

Results
One hundred seven individuals (7.4%) were heterozygous FVL carriers. No difference was found between FVL carriers and noncarriers regarding age, sex, CPB, type of operation, EuroSCORE, antiplatelet treatment, and reoperation. FVL was not significantly associated with postoperative blood loss, whereas a significant influence was found for female sex (P < 0.0001), duration of CPB (P < 0.0001), reoperation (P = 0.001), and preoperative antiplatelet treatment (P < 0.002). Multiple linear regression analysis for total blood loss had an observed power of at least 99%. FVL carriers faced the same risk for postoperative transfusion (P = 0.391), reoperation (P = 0.675), myocardial infarction (P = 0.44), stroke (P = 0.701), and 30-day mortality (P = 0.4) as did noncarriers.

Conclusions
These data suggest that FVL carriers do not have reduced blood loss compared with noncarriers. Furthermore, the combination of aprotinin and FVL does not enhance the risk for thromboembolic complications.
Behavior of Entropy/Complexity Measures of the Electroencephalogram during Propofol-induced Sedation
Authors: Ferenets Rain , Vanluchene Ann , Lipping Tarmo , Heyse Björn , Struys Michel M. R. F. 
Published: March 2007

Background
Several new measures based on the regularity of the electroencephalogram signal for the assessment of depth of anesthesia/sedation have been proposed recently. In this study we analyze the influence of remifentanil and electroencephalogram frequency content of the performance of a set of such measures.

Methods
Forty-five patients with American Society of Anesthesiologists physical status I were randomly allocated to one of three groups according to the received dose of predicted effect compartment-controlled remifentanil (0, 2, and 4 ng/ml). All 45 patients received stepwise increased effect site concentration-controlled dose of propofol. At every step of propofol increase, the Observer's Assessment of Alertness/Sedation score was assessed. The following measures were calculated from the electroencephalographic signal: spectral entropy, approximate entropy, Higuchi fractal dimension, Lempel-Ziv complexity, relative beta ratio, and SyncFastSlow measure.

Results
The behavior of the electroencephalogram-based measures is highly sensitive to the frequency content of the signal and the dose of remifentanil. The prediction probability with respect to the Observer's Assessment of Alertness/Sedation score of the most discriminative measure, the Higuchi fractal dimension, dropped from 0.90 (electroencephalographic frequency band 6-47 Hz, no remifentanil) to 0.55 when the frequency band was changed to 0.5-19 Hz and to 0.83 when remifentanil concentration was increased to 4 ng/ml. The coeffect of remifentanil on electroencephalographic regularity is bimodal depending on the frequency band of the signal.

Conclusions
Cutting off high frequencies from the electroencephalogram and increased remifentanil concentration deteriorate the performance of the electroencephalogram-based entropy/complexity measures as indicators of the depth of propofol sedation.
A Prospective Assessment of Food and Nutrient Intake in a Population of Malawian Children at Risk for Kwashiorkor
Authors: Lin Carol A , Boslaugh Sarah , Ciliberto Heather M , Maleta Kenneth , Ashorn Per , Briend André , Manary Mark J 
Published: March 2007

ABSTRACTObjective:To determine what foods, nutrients, and dietary patterns are associated with development of kwashiorkor in populations of vulnerable 1‐ to 3‐year‐old Malawian children.Patients and Methods:This was a prospective observational study conducted in 8 rural villages. Upon enrollment, demographic, anthropometric, and dietary intake data were collected. Children were studied every 2 weeks for 10 weeks to determine whether they developed kwashiorkor. Dietary intake was assessed on enrollment using a food frequency questionnaire, which included all possible foods in the child's diet. Food frequency data were used to estimate energy, protein, vitamins C and A, niacin, thiamin, zinc, and iron intake using food composition and serving size data. Dietary diversity was assessed with a 7‐point score. Regression modeling was used to determine whether the consumption of any food or nutrient was associated with the development of kwashiorkor.Results:A total of 43 (2.6%) of the 1651 healthy children ages 1 to 3 years enrolled developed kwashiorkor. Children who developed kwashiorkor were younger and had more nutritional wasting than those who did not. Thirty children (70%) who developed kwashiorkor were breast‐fed. In the combined regression model no foods or nutrients were found to be associated with the development of kwashiorkor. There were no differences in the dietary diversity between children who developed kwashiorkor and those who did not.Conclusions:No association between the development of kwashiorkor and the consumption of any food or nutrient was found.
Prospective Controlled Long‐term Follow‐up for Functional Outcome After Anoplasty in Boys With Perineal Fistula
Authors: Pakarinen Mikko P , Koivusalo Antti , Lindahl Harry , Rintala Risto J 
Published: March 2007

ABSTRACTBackground:Functional outcomes after treatment of low anorectal anomalies remain controversial. To address this, we conducted a controlled, prospective single‐center long‐term follow‐up study of functional outcome in boys treated for perineal fistula with anoplasty.Patients and Methods:Twenty‐four consecutive boys treated exclusively for perineal fistula from 1992 to 2001 underwent prospective follow‐up after completion of toilet training. All of the patients had identical surgical treatment. Functional outcome was assessed according to a previously validated bowel function score (7 questions, maximum score of 20). Daytime and nighttime wetting, as well as the age at toilet training, were also recorded. Thirty‐seven age‐matched boys served as healthy controls. An independent nurse specialist interviewed caregivers.Results:Age of the patients (9.1 ± 2.6 years) and controls (9.0 ± 2.9 years) were similar. Seven patients (32%) had bowel function scores below the 10th percentile (17.2) of the controls, which was chosen as a lower limit of normality. The overall mean bowel function score was significantly lower (P < 0.01) among the patients (17.9 ± 1.9) compared with the controls (19.1 ± 1.2). The difference was attributed mainly to significantly lower scores (0–3) among patients in questions assessing constipation (2.4 ± 0.8 vs 2.9 ± 0.3; P < 0.05) and soiling (2.5 ± 0.5 vs 2.8 ± 0.4; P = 0.05). Constipation and soiling were significantly more common (P < 0.05) among patients (41% and 55%, respectively) compared with controls (8% and 24%, respectively).Conclusions:Overall long‐term bowel function is impaired in one third of boys with perineal fistula. The main reasons for impaired functional outcome are constipation and soiling, which affect as many as half the patients.
Fecal Lactoferrin Is a Sensitive and Specific Marker of Disease Activity in Children and Young Adults With Inflammatory Bowel Disease
Authors: Walker Thomas R , Land Michelle L , Kartashov Alex , Saslowsky Tracee M , Lyerly David M , Boone James H , Rufo Paul A 
Published: March 2007

ABSTRACTBackground and Aims:Fecal lactoferrin (FLA) is a neutrophil‐derived surrogate marker of intestinal inflammation that is elevated in patients with inflammatory bowel disease. However, the correlation between FLA levels and serological markers of disease activity has not been previously reported, to our knowledge. In the present study we evaluated the ability of FLA levels to reflect disease activity in pediatric patients with inflammatory bowel disease. We further assessed the relationship between FLA levels and customary laboratory and clinical measures of inflammation.Patients and Methods:Fecal specimens were collected from 148 consecutive pediatric patients (79 with Crohn disease, 62 with ulcerative colitis, and 7 with irritable bowel syndrome) and 22 healthy control individuals. Lactoferrin was measured by enzyme‐linked immunosorbent assay (IBD‐SCAN, TECHLAB, Inc). Disease activity was assessed at the time of sample provision by laboratory measures (including erythrocyte sedimentation rate [ESR] and albumin) and previously validated disease activity indices (Pediatric Crohn Disease Activity Index, Kozarek, Harvey Bradshaw Activity Index).Results:Lactoferrin levels were significantly higher in patients with ulcerative colitis (1880 ± 565 μg/mL) (mean ± SE) or Crohn disease (1701 ± 382 μg/mL) than in healthy control individuals under 21 years of age (1.17 ± 0.47 μg/mL, P < 0.001). Lactoferrin levels correlated significantly with ESR, hematocrit, albumin, and platelet count (P < 0.001). Receiver operating characteristic curve analysis revealed that FLA levels were comparable to ESR in detecting patients with clinically active disease (P < 0.001). Patients who experienced a clinical flare within 2 months of specimen collection displayed higher lactoferrin levels (845 ± 452 μg/mL) than did those who remained in clinical remission (190 ± 90 μg/mL, P = 0.003).Conclusions:Data presented here demonstrate that FLA is a sensitive and specific biochemical marker of inflammation for use in the diagnosis and interval assessment of pediatric patients with IBD, and its level correlates well with both clinical disease activity indices and ESR. Elevated levels of FLA may also identify patients at greater risk for the development of subsequent clinical flares.
Dose requirements of ICI 35,868 (Propofol, ‘Diprivan’) in a new formulation for induction of anaesthesia
Authors: CUMMINGS G. C. , DIXON J. , KAY N. H. , WINDSOR J. P. W. , MAJOR E. , MORGAN M. , SEAR J. W. , SPENCE A. A. , STEPHENSON D. K. 
Published: March 2007

SummaryIn order to avoid Cremophor‐related reactions and reduce the incidence of pain on injection, di‐isopropylphenol (ICI 35,868; propofol) has been reformulated as an emulsion. One hundred and fifteen patients received an induction dose of propofol in the new formulation. The dose required to induce anaesthesia in 95% of healthy, unpremedicated patients was 2.5 mg/kg. Induction was associated with a degree of cardiovascular and respiratory depression. There were no adverse reactions although there were a number of minor side‐effects. The incidence of pain on injection was low (3%) and the overall quality of induction was assessed as good or adequate in 92% of patients.
Intramuscular midazolam
Authors: McATEER E. J. , DIXON J. , WHITWAM J. G. 
Published: March 2007

SummaryMidazolam, administered intramuscularly was compared with papaveretum and hyoscine for premedication in patients undergoing gynaecological surgery. Midazolam proved to be a satisfactory agent for premedication compared with papaveretum and hyoscine, producing a similar degree of sedation and anxiolysis, but causing significantly more anterograde amnesia.
Acid‐base control during hypothermia Acid‐base contrnl in children during hypothermia without temperature correction of pH and P CO2
Authors: MATTHEWS A. J. , STEAD A. L. , ABBOTT T. R. 
Published: March 2007

SummaryIn 28 children undergoing cardiopulmonary bypass with deep hypothermia for open heart surgery, an attempt was made to maintain pH at 7.4 not corrected for temperature by varying the CO2 concentration supplied to the oxygenator so that the PaCO2 was 5.33 kPa, not corrected for temperature. One to two percent CO2 gave satisfactory results. Five percent CO2 had previously been given. No adverse clinical side effects were noted, and the acid‐base status remainpd stable for 24 hours in 16 patients. There are strong theoretical reasons for maintaining a pH of 7.4, uncorrected for temperature, during hypothermia and a clinical impression was gained of better myocardial function and improved systemic and cerebral perfusion.
The relative prognostic value of lactate and haemodynamic measurements in early shock
Authors: COWAN B. N. , BURNS H. J. G. , BOYLE P. , LEDINGHAM I. McA. 
Published: March 2007

SummaryA prospective study was completed of 30 shocked patients admitted consecutively to an intensive therapy unit; the majority of the patients had shock of septic origin. Measurements were made of whole blood lactate together with mean arterial pressure, hourly urine volume and core: peripheral temperature difference at the start of treatment and 3 and 24 hours later. Serial lactate measurements were better at predicting outcome than single measurements. However, lactate measurements were much less valuable than serial measurements of the simple haemodynamic variables.
Reversal of neuromuscular block
Authors: HARPER K. W. , BALI I. M. , GIBSON F. M. , CARLISLE R. , BLACK I. H. C. , GRAINGER D. J. , DUNDEE J. W. 
Published: March 2007

SummaryThe effect on heart rate of different rates of injection (10 seconds, 1, 3 und 5 minutes) of a fixed dose (neostigmine 2.5 mg and atropine 1.2 mg) and a weight‐related dose (neostigmine 50 μg/kg and atropine 25 μg/kg) of neostigmine‐atropine mixture given for the reversal of residual competitive neuromuscular block was studied in 196 healthy adult patients. In both series slow injection lessened and delayed the initial rise in heart rate. The subsequent fall in heart rate was less when the drugs were injected over 3 min compared with the 10 seconds and 1 minute injection groups but when given over 5 minutes there was a steady fall in heart rate, more so with the weight‐related dose. It is recommended that a neostigmine and atropine mixture should be administered over 3 min.
Mortality amongst multiple trauma patients admitted to an intensive therapy unit
Authors: Watt I. , Ledingham I. McA. 
Published: March 2007

SummaryA retrospective review of 428 severely injured patients admitted to an intensive therapy unit between 1969 and 1982 was performed. The patients' primary injuries were assessed using the injury severity score (ISS), and subsequent complications using the complications impact index and sepsis score. Between 1969 and 1980 mortality fluctuated between 19% and 29% but rose to 47% (p < 0.05) during 1981–82 in spite of an unchanged ISS. The increased mortality was confined to ventilated patients surviving more than 5 days from injury and was associated with multiple organ failure and severe infection. The rapid and sustained increase in mortality could not be explained by any obvious change in severity of injury or referral pattern. The only deliberate change in management related to the combination of analgesic sedative drugs used in ventilated patients. During 1979 to 1982 mortality was 28% in patients given morphine with or without benzodiazepines and 77% in those given morphine and etomidate (p < 0.0005). After discontinuation of the latter regimen (May 1983) and resumption of the former analgesic/sedative combination, mortality fell to 25% (p < 0.005). Possible mechanisms leading to increased mortality include adrenocortical insufficiency or depth of anaesthesia.
Intrathecal ketamine for war surgery. A preliminary study under field conditions
Authors: Bion J. F. 
Published: March 2007

SummaryIntrathecal ketamine, which has not previously been described in man, has been administered to 16 patients with war injuries of the lower limbs. The first five received varying doses from 5 to 50 mg in a volume of 3 ml of 5% dextrose, to determine a dose‐response curve (Group 1). The optimal dose was then administered to a further 11 patients who received ketamine 50 mg in a volume of 3 ml in 5% dextrose with the addition of adrenaline 0.1 mg (Group 2). A distinct sensory level was obtained in all patients. In Group 2, nine of the eleven patients obtained satisfactory surgical analgesia and two required supplementation with local anaesthetic. Central effects (drowsiness, dizziness, and nystagmus) also occurred in nine patients, but they remained conscious throughout; one patient experienced no central effects, and one patient developed dissociative anaesthesia. Central effects were more intense the higher the level of block. There were no significant changes in mean systolic arterial blood pressure, pulse, or respiratory rates. Surgical analgesia for the blocked dermatomes lasted for a mean of 58 minutes (range 45–90), and recovery was complete and uncomplicated; mild generalised analgesia persisted for a further one to three hours following return of sensation. Ketamine alone did not produce motor block, but addition of adrenaline resulted in complete motor block, and may have intensified sensory blockade. Motor loss persisted for the same duration as surgical analgesia. Adrenaline neither delayed the onset of central effects, nor reduced their intensity. The absence of hypotension or respiratory depression is of obvious benefit in anaesthesia for trauma, but central effects and short duration of surgical analgesia would appear to limit this application of ketamine.
Genesis of the ‘true’ negative pressure in the lumbar epidural space
Authors: ZARZUR E. 
Published: March 2007

SummaryA hypothesis is suggested that the initial or ‘true’ negative pressure encountered when a needle first enters the epidural space is due to initial bulging of the ligamentum flavum in front of the advancing needle followed by its rapid return to the resting position once the needle has perforated the ligament. The bulging has been confirmed to occur in fresh cadavers, and pressure studies carried out during performance of epidural blocks in patients lend weight to this hypothesis.
Perception of risk of adverse drug reactions by medical students: influence of a 1 year pharmacological course
Authors: Durrieu G. , Hurault C. , Bongard V. , Damase‐Michel C. , Montastruc J. L. 
Published: March 2007

What is already known about this subject • Previous studies have pointed out the question of effective training and information for health professionals on adverse drug reactions (ADRs).• This lack of training is known to induce inadequate use of drugs and noncompliance of patients. What this study adds • Our study was the first to evaluate the perceived risk of ADRs among young medical students and to investigate the impact of university pharmacology courses on their perception of this risk.• The aim of our study was not to assess a definite level of perception of risk for the different drug classes but to determine whether the perceived risk of ADRs differs after attending pharmacology courses.• Our results show that the pharmacological training allows young medical students to be aware of potentially serious ADRs, especially related to drugs considered as relatively safe, such as NSAIDs and aspirin.AimsTo investigate how adverse drug reactions (ADRs) to several classes of drugs are perceived by young medical students before and after a 1 year pharmacology course.MethodsThe whole cohort of 92 medical students (63 females and 29 males) was questioned during their third year. A visual analogue scale was used to define a score (ranging from 0 to 10) of perceived risk of ADRs associated with each drug class before and at the end of the pharmacological training period.ResultsBefore the pharmacology course, hypnotics were ranked as the most dangerous drugs by the medical students, followed by antidepressants and anticoagulants. Contraceptive pills were listed in the last position. After pharmacological training, antidepressants moved into the first position, followed by anticoagulants and hypnotics. When all different drug classes were taken as a whole, the mean (±SD) of median scores of the perceived risk were 4.8 (±1.3) before and 5.8 (±1.5) at the end of the pharmacology course (P < 0.0001). Except for antidiabetics, antihypertensive drugs, tranquillizers, corticosteroids and hypnotics, the perceived risk significantly increased after the pharmacology course for the other drugs. The highest increases were observed for contraceptive pills (+104%, P < 0.01), NSAIDs (+86%, P < 0.01) and aspirin (+56%, P < 0.01).ConclusionsPharmacological training allows young medical students to be aware of potentially serious ADRs associated with drugs, in particular with drugs considered relatively safe (such as NSAIDs and aspirin) by nonhealth professionals.