bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing preoperative fasting policies: Impact of a national consensus
Authors: Fasting S. , SØReide E. , Ræder J. C. 
Published: January 2009

Background: Liberalisation of preoperative fasting rules has been discussed and recommended in the anaesthesia literature in recent years. In Norway, a national consensus on this issue was reached in 1993. The aim of the present study was to investigate whether a national consensus on fasting recommendations led to a change in fasting policies in Norwegian anaesthesia departments.Methods: A questionnaire on preoperative fasting routines was sent to all Norwegian anaesthesia departments in 1993 and repeated in 1996.Results: Written local guidelines for preoperative fasting were present in 85% of the institutions in both surveys. Of the hospitals, 69% had changed their local guidelines after the national consensus. In 1996 more hospitals allowed less than 6 h fasting for clear liquids in children (93% versus 71% in 1993; P<0.005). A similar tendency was noted in adults (79% versus 63% in 1993; P=0.1). In contradiction to the national guidelines, 31% of the departments reported that they allowed less than 6 h fasting after a light breakfast in the morning of surgery in 1996. The corresponding number for 1993 was 21% (ns).Conclusion: The new, consensus‐based national fasting guidelines have been associated with a change towards more liberal fasting policies in Norwegian departments of anaesthesia. However, as not all local changes were supported by the national consensus, other sources of information were used when local policies were decided.
Respiration during emergence from anaesthesia with desflurane/N2O vs. desflurane/air for gynaecological laparoscopy
Authors: Einarsson S. G. , Cerne A. , Bengtsson A. , Stenqvist O. , Bengtson J. P. 
Published: January 2009

Background: The complications related to anaesthesia usually occur in the early postoperative period. Hypercapnia and hypoxaemia may result from any persistent depression of the respiratory drive relative to the metabolic demand. The purpose of this study was to compare the respiratory effects of desflurane anaesthesia with or without nitrous oxide during the period of emergence.Methods: Twenty patients scheduled for a standardised surgical procedure, laparoscopic hysterectomy, were randomly allocated to anaesthesia with 1.3 MAC of desflurane/N2O (Group 1) or desflurane alone (Group 2), with 10 patients in each group. Times of resumption of spontaneous breathing and extubation were recorded and elimination rates of carbon dioxide, end‐tidal concentrations of desflurane and N2O, and blood gases were measured.Results: Spontaneous breathing was resumed in both groups when pH had decreased by about 0.07 and PaCO2 increased by about 1.4 kPa compared with the values at the end of 1.3 MAC anaesthesia with controlled normoventilation. There were no significant differences between the groups with regards to extubation time, 6 vs. 13 min, or total MAC value at extubation, 0.20 vs. 0.19 in Group 1 and 2, respectively. Neither did the groups differ in minute ventilation, end‐tidal carbon dioxide, oxygen concentrations, or blood gases. CO2 elimination decreased in both groups from about 220 ml 70 kg−1 min−1 at the end of anaesthesia to a lowest value of about 160 ml 70 kg−1 min−1.Conclusion: The respiratory profiles during recovery from gynaecological laparoscopy with either desflurane/N2O or desflurane anaesthesia were similar with fast resumption of spontaneous breathing, short time to extubation, and no signs of CO2 retention.
Puncture technique and postural postdural puncture headache. A randomised, double‐blind study comparing transverse and parallel puncture
Authors: Flaatten H. , Thorsen T. , Askeland B. , Finne M. , Rosland J. , Hansen T. , Rønhovde K. , Wisborg T. 
Published: January 2009

Background: This clinical study was conducted in order to investigate the effect of two different orientations of the bevel during dural puncture on development of postural postdural puncture headache (PPDPH).Methods: Two hundred and eighteen patients aged 18 to 50 years scheduled lor minor non‐obstetric surgery using spinal anaesthesia (SA) were included in this randomised, double‐blind study. Dural puncture was performed using a 0.42 mm O.D. (27‐g) Quincke spinal needle with the orientation of the bevel parallel or transverse relative to the longitudinal axis of the dural cylinder. All patients were blinded with regard to the puncture technique, and so was the anaesthesiologist performing a telephone interview 5 to 7 days postoperatively. The occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non‐PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10.Results: Two hundred and twelve patients with a mean age of 35.3 years completed the study, 106 in each group. The two groups were comparable with regard to mean age, sex, local anaesthetics used and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 4/106 patients (3.8%) in the parallel group and 24/106 (22.6%) in the transverse group (P<0.0002). Postoperative backache occurred in 31 and 20 patients (parallel compared to transverse) (NS).Conclusions: Dural puncture with the bevel of the needle transverse to the longitudinal axis of the dural cylinder gave significantly more cases of PPDPH than puncture with the bevel parallel to this axis even when using a 27‐g Quincke needle. When using Quincke bevelled needles care must be taken to assure that the orientation of the bevel is parallel to the longitudinal axis of the dural sac.
How many parents should we let into the operating room?
Authors: KAIN ZEEV N. , MACLAREN JILL , WEINBERG MEGAN , HUSZTI HEATHER , ANDERSON CYNTHIA , MAYES LINDA 
Published: January 2009

SummaryObjective:  This study compared anxiety of children with one and two parents present at anesthesia induction.Methodology:  Baseline measures of parent and child anxiety were obtained; parents were randomly assigned to the two study groups. Validated and reliable tools were used to assess the outcomes of interest.Results:  We found that observed anxiety of children as well as compliance of children with the induction process was not different between the two study groups. Parent’s anxiety was also evaluated using two‐way anova with repeated measures. A group by time interaction was demonstrated and parents in the one‐parent group reported significantly higher anxiety than parents in the two‐parents group (M = 48.6, sd = 13.1 vs M = 39.7, sd = 11.5, P < 0.02).Conclusions:  We conclude that while allowing two parents into the operating rooms does not affect observed child anxiety, it does reduce parent self‐reported anxiety. As the presence of multiple parents during invasive medical procedures is in congruence with family centered‐care we recommend that institutions examine this modality.
Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed
Authors: HERSHMAN ELI , HALBERTHAL MICHAEL , GOLDSHER DORIT , GOLZ AVISHAI , BAR‐JOSEPH GAD 
Published: January 2009

SummaryObjective:  To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed.Design:  Case report.Setting:  A tertiary pediatric critical care unit.Patient:  A healthy 7‐year‐old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure.Interventions:  Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy.Conclusion:  In children, local anesthetic infiltration of the adenoid bed may cause life‐threatening medullary injury and its routine use should be re‐considered.
Sedation medication received and adverse events related to sedation for brain MRI in children with and without developmental disabilities
Authors: KANNIKESWARAN NIRUPAMA , MAHAJAN PRASHANT V. , SETHURAMAN USHA , GROEBE ANNA , CHEN XINGUANG 
Published: January 2009

SummaryBackground:  There are few studies on sedation medication requirements and sedation related adverse events in developmentally disabled children.Objectives:  The objectives of our study were to compare sedation medication received and sedation related adverse events for brain magnetic resonance imaging (MRI) between children with and without developmental disabilities. We hypothesized that developmentally disabled children would require increased doses of sedative medications and will have increased frequency of adverse events when compared with normal children.Methods:  We conducted a retrospective chart review on children 1–18 years, who required sedation for an elective brain MRI. Children were excluded if they required sedation for diagnostic imaging other than brain MRI, belonged to ASA category >3, or required general anesthesia. Data on developmental status, demographics and details of sedation medications received along with adverse events were collected.Results:  About 53.5% (260/486) of the patients were classified as developmentally disabled. Pentobarbital and fentanyl were the two most common medications used for sedation in children with and without developmental disability. There was no difference in the mean dosages of pentobarbital (3.02 mg·kg−1 vs 3.06 mg·kg−1; P = 0.2) and fentanyl (1.01 mcg·kg−1 vs 1.02 mcg·kg−1; P = 0.81) in the two groups. There was a threefold increased incidence of hypoxia noted in children with developmental disability (11.9% vs 4.9%; P < 0.01). Presence of developmental disability alone was significantly associated with sedation related hypoxia (OR = 3.2, 95% CI: 1.8, 6.94; P < 0.01).Conclusions:  Children with developmental disabilities have similar requirements for sedation medications but are three times more likely to experience hypoxia when compared with normal children.
Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial
Authors: GOLAN G. , TIGHE P. , DOBIJA N. , PEREL A. , KEIDAN I. 
Published: January 2009

SummaryObjective:  To determine if specially trained professional clowns allayed preoperative anxiety and resulted in a smooth anesthetic induction compared to the use of midazolam or no intervention.Methods:  This was a randomized, controlled, and blinded study conducted with children 3–8 years of age undergoing general anesthesia and elective outpatient surgery. Patients were assigned to one of three groups: Group 1 did not receive midazolam or clown presence; group 2 received 0.5 mg·kg−1 oral midazolam 30 min before surgery up to a maximum of 15 mg; and group 3 had two specially trained clowns present upon arrival to the preoperative holding area and throughout operating room (OR) entrance and mask application for inhalation induction of anesthesia. The children were videotaped for later grading.Results:  The clown group had a statistically significant lower modified‐Yale Preoperative Anxiety Scale score in the preoperative holding area compared to the control and midazolam group. The clowns’ effect on anxiety reduction continued when the children entered the OR but was equal at this point to the midazolam group. Upon application of the anesthesia mask no significant differences were detected between the groups.Conclusions:  This study found that the use of preoperative medically trained clowns for children undergoing surgery can significantly alleviate preoperative anxiety. However, clowns do not have any effect once the anesthesia mask is introduced.
THROUGH A DIFFERENT LENS: RETHINKING THE ROLE OF SEXUAL DIFFERENCE IN THE THEOLOGY OF HANS URS VON BALTHASAR
Authors: SAIN BARBARA K. 
Published: January 2009

AbstractSexual difference plays a pivotal role in Balthasar's thought, as an analogy for the Trinity and as an analogy for the relation between Christ and the church. This essay examines the influence of the analogy of being on his interpretations of these analogies, his understanding of created masculinity, and his use of the language of sexual difference for the Holy Spirit. Ultimately many of Balthasar's best insights about human love as an analogy for divine love can be retained without connecting femininity uniquely with creation, and his trinitarian theology provides the best interpretive key for doing so.
“BE NOT OVERCOME BY EVIL, BUT OVERCOME EVIL WITH GOOD”—AN ORIENTATIONAL APPROACH TO SUFFERING AND EVIL
Authors: GOCKEL MATTHIAS 
Published: January 2009

AbstractI discuss two recent books by Ingolf U. Dalferth, which consider the problem of suffering and evil. Dalferth argues that evil is defined by events where someone experiences ills, not by an act of the will or an evil intention, as Kant thought. Suffering is seen in relation to evil, evil in relation to God, and God in relation to the history of Jesus Christ, in whom God created new life through the overcoming of evil. Christianity shall proclaim the end of evil, not the end of suffering. Dalferth contends that nothing connects human beings as strongly as the common experience of evil. Unfortunately, he does not elaborate on the problem of sin, especially in relation to God.
Short incubation with methyl aminolevulinate for photodynamic therapy of actinic keratoses
Authors: Braathen LR , Paredes BE , Saksela O , Fritsch C , Gardlo K , Morken T , Frølich KW , Warloe T , Solér AM , Ros A‐M 
Published: January 2009

AbstractBackground  Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first‐line treatment for actinic keratoses. A reduced incubation period may have practical advantages.Objective  This study aims to evaluate the effect of incubation time (1 vs. 3 h), MAL concentration (160 mg/g vs. 80 mg/g) and lesion preparation in the setting of MAL‐PDT for treatment of actinic keratosis (AK).Design  Open, randomized, parallel‐group multicentre study.Setting  Outpatient dermatology clinics.Subjects  One hundred and twelve patients with 384 previously untreated AK. Most lesions (87%) were located on the face and scalp and were thin (55%) or moderately thick (34%).Methods  Lesions were debrided, and MAL cream (160 mg/g or 80 mg/g) was applied before illumination with red light (570–670 nm; light dose, 75 J/cm2). Patients were followed up at 2 and 3 months. Sixty patients (54%) were re‐treated and assessed at 6 months.Main outcome  Complete lesion response rates 3 and 12 months after last treatment.Results  For lesions on the face/scalp, lesion complete response rates were 78% for thin AK and 74% for moderately thick AK lesions after 1 h vs. 96% and 87% after 3 h incubation with MAL 160 mg/g. Lesion recurrence rates at 12 months after two treatments were similar [19% (3 of 16) with 1 h vs. 17% (3 of 18) with 3 h 160 mg/kg MAL‐PDT] and lower than for 80 mg/g MAL‐PDT (44–45%).Conclusion  MAL‐PDT using a 1‐h incubation may be sufficient for successful treatment of selected AK lesions.Conflicts of interestLasse R Braathen consults for Photocure and has received speaker honoraria from Photocure and Galderma. Trond Warloe is a co‐inventor of the corresponding patent and is a minor share holder of Photocure ASA. Tore Morken has been paid as a chairman of a Photocure‐sponsored symposium. Bruno E Paredes, Olli Saksela, Clemens Fritsch, Kerstin Gardlo, Karin W Frölich, Ana M Solér and Ann‐Marie Ros do not have any relevant conflict of interest, financial or otherwise.
Endothelial CD200 is heterogeneously distributed, regulated and involved in immune cell–endothelium interactions
Authors: Ko Ya‐Chen , Chien Hsiung‐Fei , Jiang‐Shieh Ya‐Fen , Chang Chiu‐Yun , Pai Man‐Hui , Huang Jian‐Pei , Chen Hui‐Min , Wu Ching‐Hsiang 
Published: January 2009

AbstractCD200 is a highly glycosylated cell surface protein containing two immunoglobulin superfamily domains in the extracellular region and performs immunosuppressive activities. It is widely distributed in various tissues including the vascular endothelium. We report here the distribution of CD200 in rat endothelia from different vascular beds. Endothelial CD200 immunoreactivity was weakly expressed in most arteries but was intensely expressed in the arterioles, most veins and venules, as well as continuous and fenestrated capillaries. The distribution of CD200 in the sinusoidal and lymphatic endothelia was variable. Immunoelectron microscopic studies revealed that endothelial CD200 varied considerably not only in different microvasculatures but also in the membrane domains at the subcellular level. Endothelial CD200 expression was differentially regulated by lipopolysaccharide in cell types both in vivo and in vitro. Functional assessments of endothelial CD200 suggested that the physical binding between CD200 and CD200 receptor (CD200R) was involved in T‐cell adhesion to the endothelium but not in macrophage–endothelium interaction. In the latter, however, CD200 agonist, a synthetic peptide from complementarity‐determining region 3 of mouse CD200, may trigger CD200R signaling in macrophages to suppress their adhesion to the endothelium. Our findings demonstrate that the distribution, subcellular localization, and lipopolysaccharide‐regulation of endothelial CD200 are heterogeneous, and provide evidence elucidating the functional roles of endothelial CD200 during tissue inflammation.
Cytoskeletal proteins in thymic epithelial cells of the Australian lungfish Neoceratodus forsteri
Authors: Mohammad Mohammad G. , Raftos David A. , Joss Jean 
Published: January 2009

AbstractThe vertebrate thymus consists of distinctive subpopulations of epithelial cells that contain a diverse repertoire of cytoskeletal proteins. In this study of the thymus in the Australian lungfish, Neoceratodus forsteri, immunohistochemistry was used to distinguish the cytoskeletal proteins present in each class of thymic epithelial cell. A panel of antibodies (Abs), each specific for a different cytoskeletal polypeptide (keratins, vimentin, desmin, actin and tubulins), was used on paraffin and ultrathin resin sections of thymus. Ab AE I (reactive against human type I cytokeratins (CK) 14, 16 and 19) selectively stained the cytoplasm of capsular, trabecular and the outermost epithelial cells of Hassall's corpuscles. Anti‐CK 10 Abs strongly labelled the capsular epithelial cells and less than 20% of cortical and medullary epithelial cells. The anti‐50‐kDa desmin Ab did not react with any thymic cells, whereas the anti‐53‐kDa desmin Ab labelled some capsular, cortical and medullary thymic epithelial cells. The anti‐vimentin Ab stained most of the capsular and ~60% of the cortical epithelium. Thymic nurse cells and Hassall's corpuscles were found to be devoid of actin, which was strongly detected in medullary and perivascular epithelium. Both α and β tubulins were detected in all thymic cells. This study extends the concept of thymic epithelial heterogeneity. The complexity of thymic epithelium in N. forsteri may indicate a relationship between thymic epithelial subpopulations and the thymic microenvironment. These data identify anti‐keratin Abs as a valuable tool for studying differentiation and ontogeny of the thymic epithelium in N. forsteri.
Comparative microanatomy of the orbicularis oris muscle between chimpanzees and humans: evolutionary divergence of lip function
Authors: Rogers Carolyn R. , Mooney Mark P. , Smith Timothy D. , Weinberg Seth M. , Waller Bridget M. , Parr Lisa A. , Docherty Beth A. , Bonar Christopher J. , Reinholt Lauren E. , Deleyiannis Frederic W.‐B. , Siegel Michael I. , Marazita Mary L. , Burrows Anne M. 
Published: January 2009

AbstractThe orbicularis oris muscle plays a role in the production of primate facial expressions and vocalizations, nutrient intake, and in some non‐human primates it is used as a prehensile, manipulative tool. As the chimpanzee (Pan troglodytes) is the closest living relative of humans, a comparison of the orbicularis oris muscle between these species may increase our understanding of the morphological specializations related to the differing functional demands of their lips and the factors responsible for their divergent evolution. To this end, this study compares the microanatomy of the mid‐line upper fibers of the orbicularis oris muscle between chimpanzees and humans. A mid‐line portion of the orbicularis oris muscle was harvested from the upper lips of three chimpanzee and five human cadavers. The sampled blocks included the area between the lateral borders of the nasal alar cartilages in both species. Each sample was processed for paraffin histology, sectioned and stained with a variety of protocols. Sections were examined for fiber direction and relative thickness of muscle layers. Ratios of cross‐sectional connective tissue area vs. cross‐sectional muscle tissue area, muscle fiber diameter and relative dermal thickness were calculated for each species. In both species, a clear pars marginalis layer was recognized, contrary to previous reports that only humans possess this layer. In chimpanzees, the relative fiber diameter and relative amount of muscle tissue (i.e. based on ratio of connective tissue area : muscle tissue area) were significantly (P < 0.05) greater than in humans. In contrast, measurements of relative dermal thickness showed that humans have a greater average dermal thickness of the upper lip than chimpanzees. Taken together, these results suggest that both human and chimpanzee orbicularis oris muscle upper fibers meet the specific functional demands associated with their divergent vocal and facial display repertoires, the development of human speech, and the use of the upper lip as a prehensile tool in chimpanzees.
Pelvic and thigh musculature in frogs (Anura) and origin of anuran jumping locomotion
Authors: Přikryl Tomáš , Aerts Peter , Havelková Pavla , Herrel Anthony , Roček Zbyněk 
Published: January 2009

AbstractComparative analysis of the anuran pelvic and thigh musculoskeletal system revealed that the thigh extensors, responsible for the initial phase of jump, the propulsive stroke in swimming and, if used asynchronously, also for walking, are least affected by the transformations observed between anurans and their temnospondyl ancestors (as reflected in contemporary caudates). The iliac shaft and urostyle, two of the most important anuran apomorphies, represent skeletal support for muscles that are mostly protractors of the femur or are important in attaining a crouching position, a necessary prerequisite for rapid escape. All of these muscles originate or insert on the iliac shaft. As the orientation of the pubis, ischium and ilium is the same in anurans, caudates and by inference also in their temnospondyl ancestors, it is probable that the pelvis was shifted from the sacral vertebra posteriorly along the reduced and stiffened tail (urostyle) by the elongation of the illiac shaft. Thus, the original vertical orientation of the ilium was maintained (which is also demonstrated by stable origins of the glutaeus maximus, iliofemoralis and iliofibularis on the tuber superius) and the shaft itself is a new structure. A review of functional analysis of anuran locomotion suggests some clear differences from that in caudates, suggesting that terrestrial jumping may have been a primary locomotor activity, from which other types of anuran locomotion are derived.