bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behaviour of the 2.1-mm (14 G) automated biopsy needle in phantoms
Authors: Abdsaleh S. , Azavedo E. , Lindgren P.G. 
Published: July 2004

Purpose: To study the behaviour of the 2.1-mm (14 G) core biopsy needle in targets of different consistencies and to correlate the needle behaviour to lengths of the samples. Material and Methods: A series of butter blocks at temperatures of -5 °C, -2 °C, +1 °C, +4 °C, +7 °C, +10 °C, +13 °C, +16 °C and +19 °C simulating lesions of different hardness in human breast, were passed with needles (3 passes at each temperature). Inner needle behaviour was studied both with and without outer cannula effect. Results: At +4 °C to +13 °C the needle had a curved course, deviated to the side of its tip. At +4 °C, the needle was most deviated (range 4, 8, 10 °) and the samples were largest (8, 12, 12 mm). At -5 °C to +1 °C the needle was bent, the cannula was not triggered and no sample was obtained. At +16 °C and +19 °C the needle had a straight course and the length of the sample was decreasing. Conclusion: Behaviour of the inner needle as well as the cannula depends on the hardness of the target. Targets of intermediate hardness yield adequate samples when the inner needle takes a curved course deviated toward the tip and get restored by the cannula.
Early postoperative tissue harmonic sonography of the thyroid gland
Authors: Saleh A. , Cupisti K. , Cohnen M. , Feldkamp J. , Fürst G. , Luckey P. , Mödder U. 
Published: July 2004

Purpose: Fundamental gray-scale imaging (FGI) is known to be unuseful for thyroid imaging in the early postoperative setting. Thus, we evaluated the feasability of tissue harmonic imaging (THI) early after thyroid resection. Material and Methods: FGI and THI of the neck were perfomed in 48 consecutive patients 4 days after surgery. The examiner was blinded to patient diagnoses and types of surgery. FGI and THI examinations were stored on videotape and reviewed offline by two different readers who rated the quality of delineation of the organ borders and presence or absence of focal lesions. The results were compared to neck US performed 12 weeks after surgery. Results: Delineation of the thyroid remnants in THI/FGI was rated to be excellent in 22/2, good in 11/9, poor in 3/16 and not visible at all in 4/13 patients. The correlation between THI-volumetry and control-volumetry was very high (r=0.81; p&lt;0.0001). THI but not FGI depicted presence or absence of solid thyroid nodules with 100% accuracy. Conclusion: THI is a feasible method for thyroid US in the early postoperative setting. It permits volumetry of the residual thyroid tissue and accurately depicts nodules within the thyroid remnant.
The post-apartheid economy
Authors: Makgetla Neva Seidman 
Published: July 2004

South Africa's post-apartheid economy has been characterised by low growth and investment, and a rise in unemployment (at 30%, higher than any other middle income country). Government economic policy has stressed the encouragement of investment through deregulation, privatisation and fiscal restraint. However, the failure of this strategy to promote growth and create jobs points to the need for a more interventionist strategy, one in which government must do more to stimulate equitable growth. This proposition is highly contested. Nonetheless, in response to the crisis within the economy, the government has adopted limited reforms involving increased spending on basic social services and housing, greater emphasis on job creation and equity, a renewed stress on planning and coordination and greater support for cooperatives. Yet these new initiatives do not constitute a systematic plan for transforming the economy and more integrated policies are required to overcome dualism and stimulate job-creating growth.
My thanks to Tanya van Meelis for comments.
South Africa's post-apartheid foreign policy: from reconciliation to ambiguity?1
Authors: Alden Chris , le Pere Garth 
Published: July 2004

This article focuses on South Africa's rehabilitation from international pariah status during the apartheid years to its de facto status as leader of the African continent. Its ambitious foreign policy agenda and the pan-African revivalism of Mbeki are discussed in the context of the many constraints (the need to attract foreign investment, limited institutional capacity, ambiguities over the nature of South Africa's identity) that circumscribe its capacity to achieve these goals. While under Mandela South Africa is portrayed in foreign policy terms as an over-stretched state striving to meet the idealistic demands placed upon it by a fragile world, Mbeki's pragmatism and moderation has seen South Africa recast its role in a manner more commensurate with its size and resources. The primary aims of the Mbeki presidency are seen as a reshaping of current international norms, institutions and processes to further global justice for Africa and the South.
This paper draws on previous research, which has culminated in an Adelphi Paper of the London-based International Institute for Strategic Studies (IISS).
Anesthetic Requirement Is Increased in Redheads
Authors: Liem Edwin B. , Lin Chun-Ming , Suleman Mohammad-Irfan , Doufas Anthony G. , Gregg Ronald G. , Veauthier Jacqueline M. , Loyd Gary , Sessler Daniel I. 
Published: July 2004

Background
Age and body temperature alter inhalational anesthetic requirement; however, no human genotype is associated with inhalational anesthetic requirement. There is an anecdotal impression that anesthetic requirement is increased in redheads. Furthermore, red hair results from distinct mutations of the melanocortin-1 receptor. Therefore, the authors tested the hypothesis that the requirement for the volatile anesthetic desflurane is greater in natural redheaded than in dark-haired women.

Methods
The authors studied healthy women with bright red (n = 10) or dark (n = 10) hair. Blood was sampled for subsequent analyses of melanocortin-1 receptor alleles. Anesthesia was induced with sevoflurane and maintained with desflurane randomly set at an end-tidal concentration between 5.5 and 7.5%. After an equilibration period, a noxious electrical stimulation (100 Hz, 70 mA) was transmitted through bilateral intradermal needles. If the volunteer moved in response to stimulation, desflurane was increased by 0.5%; otherwise, it was decreased by 0.5%. This was continued until volunteers "crossed over" from movement to nonmovement (or vice versa) four times. Individual logistic regression curves were used to determine desflurane requirement (P50). Desflurane requirements in the two groups were compared using Mann-Whitney nonparametric two-sample test; P < 0.05 was considered statistically significant.

Results
The desflurane requirement in redheads (6.2 vol% [95% CI, 5.9-6.5]) was significantly greater than in dark-haired women (5.2 vol% [4.9-5.5]; P = 0.0004). Nine of 10 redheads were either homozygous or compound heterozygotes for mutations on the melanocortin-1 receptor gene.

Conclusions
Red hair seems to be a distinct phenotype linked to anesthetic requirement in humans that can also be traced to a specific genotype.
Effect of Clonidine on Cardiovascular Morbidity and Mortality after Noncardiac Surgery
Authors: Wallace Arthur W. , Galindez Daniel , Salahieh Ali , Layug Elizabeth L. , Lazo Eleanor A. , Haratonik Kathy A. , Boisvert Denis M. , Kardatzke David 
Published: July 2004

Background
Perioperative myocardial ischemia occurs in 20-40% of patients at risk for cardiac morbidity and is associated with a ninefold increase in risk of cardiac morbidity.

Methods
In a prospective, double-blinded, clinical trial, we studied 190 patients with or at risk for coronary artery disease in two study groups with a 2:1 ratio (clonidine, n = 125 vs. placebo, n = 65) to test the hypothesis that prophylactic clonidine reduces the incidence of perioperative myocardial ischemia and postoperative death in patients undergoing noncardiac surgery. Clonidine (0.2 mg orally as well as a patch) or placebo (tablet and patch) was administered the night before surgery, and clonidine (0.2 mg orally) or placebo (tablet) was administered on the morning of surgery. The patch or placebo remained on the patient for 4 days and was then removed.

Results
The incidence of perioperative myocardial ischemia was significantly reduced with clonidine (intraoperative and postoperative, 18 of 125, 14% vs. placebo, 20 of 65, 31%; P = 0.01). Prophylactic clonidine administration had minimal hemodynamic effects. Clonidine reduced the incidence of postoperative mortality for up to 2 yr (clonidine, 19 of 125 [15%] vs. placebo, 19 of 65 [29%]; relative risk = 0.43 [confidence interval, 0.21-0.89]; P = 0.035).

Conclusions
Perioperative administration of clonidine for 4 days to patients at risk for coronary artery disease significantly reduces the incidence of perioperative myocardial ischemia and postoperative death.
Evaluation of the Alaris Auditory Evoked Potential Index as an Indicator of Anesthetic Depth in Preschool Children during Induction of Anesthesia with Sevoflurane and Remifentanil
Authors: Weber Frank , Bein Thomas , Hobbhahn Jonny , Taeger Kai 
Published: July 2004

Background
Autoregressive modeling with exogenous input of middle latency auditory evoked potentials (A-Line autoregressive index [AAI]) has been proposed for monitoring depth of anesthesia in adults. The aim of this study was to evaluate the performance of the AAI during induction of anesthesia with sevoflurane and remifentanil in pediatric patients.

Methods
Twenty preschool children were anesthetized with sevoflurane and remifentanil. AAI, heart rate, and mean arterial pressure were compared for their ability to distinguish between different hypnotic states before inhalation induction and during sevoflurane anesthesia with and without remifentanil infusion. The prediction probability was calculated for discrimination between the predefined case milestones Awake, Spontaneous Eye Closure, and insertion of a laryngeal mask airway during general anesthesia (Laryngeal Mask Insertion).

Results
The AAI (mean +/- SD) in Awake children was 79 +/- 10, declining to 59 +/- 22 at Spontaneous Eye Closure and 34 +/- 13 when anesthetized. AAI values significantly overlapped between anesthetic states. For the AAI, the prediction probabilities regarding the ability to discriminate the hypnotic state at the case milestones Awake versus Spontaneous Eye Closure and Awake versus Laryngeal Mask Insertion were 0.77 and 0.99, respectively. In terms of prediction probability values, heart rate and mean arterial pressure were not indicative for anesthetic states. Remifentanil did not influence the AAI.

Conclusion
During induction of pediatric patients with sevoflurane, the AAI is of higher value in predicting anesthetic states than hemodynamic variables and reliably differentiates between the awake and anesthetized states. However, individual AAI values demonstrate significant variability and overlap between different clinical conditions.
Cardioprotective Properties of Sevoflurane in Patients Undergoing Coronary Surgery with Cardiopulmonary Bypass Are Related to the Modalities of Its Administration
Authors: De Hert Stefan G. , Van der Linden Philippe J. , Cromheecke Stefanie , Meeus Roel , Nelis Anne , Van Reeth Veronique , ten Broecke Pieter W. , De Blier Ivo G. , Stockman Bernard A. , Rodrigus Inez E. 
Published: July 2004

Background
Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion. In clinical studies, the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period. The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration.

Methods
Elective coronary surgery patients were randomly assigned to four different anesthetic protocols (n = 50 each). In a first group, patients received a propofol based intravenous regimen (propofol group). In a second group, propofol was replaced by sevoflurane from sternotomy until the start of cardiopulmonary bypass (SEVO pre group). In a third group, propofol was replaced by sevoflurane after completion of the coronary anastomoses (SEVO post group). In a fourth group, propofol was administered until sternotomy and then replaced by sevoflurane for the remaining of the operation (SEVO all group). Postoperative concentrations of cardiac troponin I were followed during 48 h. Cardiac function was assessed perioperatively and during 24 h postoperatively.

Results
Postoperative troponin I concentrations in the SEVO all group were lower than in the propofol group. Stroke volume decreased transiently after cardiopulmonary bypass in the propofol group but remained unchanged throughout in the SEVO all group. In the SEVO pre and SEVO post groups, stroke volume also decreased after cardiopulmonary bypass but returned earlier to baseline values than in the propofol group. Duration of stay in the intensive care unit was lower in the SEVO all group than in the propofol group.

Conclusion
In patients undergoing coronary artery surgery with cardiopulmonary bypass, the cardioprotective effects of sevoflurane were clinically most apparent when it was administered throughout the operation.
Effects of Bispectral Index Monitoring on Ambulatory Anesthesia
Authors: Liu Spencer S. 
Published: July 2004

Background
Ambulatory surgery is growing in popularity worldwide. For example, 50-70% of surgical procedures in North America are performed on an ambulatory basis. Use of Bispectral Index (BIS) monitoring for titration of general anesthesia may allow use of less anesthetics, reduction in side effects, and faster patient recovery.

Methods
MEDLINE and other databases were searched for randomized controlled trials examining the use of BIS monitoring versus standard practice in ambulatory surgery patients. Outcomes were extracted from these articles, and a meta-analysis was performed.

Results
One thousand three hundred eighty subjects from 11 trials were included in the meta-analysis. The use of BIS monitoring significantly reduced anesthetic consumption by 19%, reduced the incidence of nausea/vomiting (32% vs. 38%; odds ratio, 0.77), and reduced time in the recovery room by 4 min. However, these benefits did not result in significant reduction in time until patient discharge from the ambulatory surgery unit. Cost analysis using pooled costs to reflect North America, Europe, and Asia indicated that use of BIS monitoring increased the cost per patient by 5.55 US dollars because of the cost of BIS electrodes.

Conclusions
The use of BIS monitoring modestly reduced anesthetic consumption, risk of nausea and vomiting, and recovery room time. These benefits did not reduce time spent in the ambulatory surgery unit, and cost of the BIS electrode exceeded any cost savings.
A Randomized Controlled Trial Comparing the ProSeal™ Laryngeal Mask Airway with the Laryngeal Tube Suction in Mechanically Ventilated Patients
Authors: Gaitini Luis A. , Vaida Sonia J. , Somri Mostafa , Yanovski Boris , Ben-David Bruce , Hagberg Carin A. 
Published: July 2004

Background
The ProSeal Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) is a new laryngeal mask with a modified cuff designed to improve its seal and a drain tube for gastric tube placement. Similarly, the Laryngeal Tube Suction (LTS) (VBM Medizintechnik Gmbh, Sulz a.N, Germany) is a new laryngeal tube that also has an additional channel for gastric tube placement. This study compared the placement and functions of these two devices.

Methods
One hundred fifty patients undergoing general anesthesia for elective surgery were randomly allocated to the PLMA (n = 75) or LTS (n = 75). Oxygenation and ventilation, ease of insertion, fiberoptic view, oropharyngeal leak pressure, ventilatory data, ease of gastric tube insertion, and postoperative airway morbidity were determined.

Results
After successful insertion of the devices in 96% of patients with the PLMA and in 94.4% with the LTS it was possible to maintain oxygenation, ventilation, and respiratory mechanics during the entire duration of surgery. Successful first and second attempt insertion rates were 57 patients (76%) and 15 patients (20%), respectively, for the PLMA and 60 patients (80%) and 11 patients (14.6%), respectively, for the LTS. Airway placement was unsuccessful with the PLMA in three patients and with the LTS in four patients. Time to achieve an effective airway was 36 +/- 24 s with the PLMA versus 34 +/- 25 s with the LTS. Gastric tube insertion was possible in 97.3% of patients with the PLMA and in 96% with the LTS.

Conclusions
With respect to both physiologic and clinical function, the PLMA and LTS are similar and either device can be used to establish a safe and effective airway in mechanically ventilated anesthetized adult patients.
Signal Verification of Middle Latency Auditory Evoked Potentials by Automated Detection of the Brainstem Response
Authors: Schneider Gerhard , Kochs Eberhard F. , Arenbeck Henry , Gallinat Michael , Stockmanns Gudrun 
Published: July 2004

Background
The midlatency components of auditory evoked potentials (AEPs) are gradually suppressed with increasing concentrations of anesthetics. Thus, they have been proposed as a monitor of anesthetic depth. However, undetected malfunction or disconnection of headphones and undetected hearing loss also result in suppressed midlatency AEPs that in turn may be misinterpreted as signs of deep anesthesia. As the brainstem component of the AEP is minimally influenced by anesthetics, its presence or absence can be used to verify that the recorded signal is a true AEP rather than an artifact. In this study, an online-capable procedure for detection of the brainstem component of the AEP was developed.

Methods
One hundred and ninety perioperatively recorded AEPs (binaural stimuli, 500 sweeps) were selected from a database with electroencephalographic and concomitant AEP stimulus information. Identical electroencephalogram regions were used to produce nonstimulus synchronized averaged signals (500 sweeps, "non-AEP"). The 190 AEPs and 190 "non-AEPs" were used to develop a detector of the brainstem component of AEPs. AEPs and "non-AEPs" were wavelet transformed (discrete wavelet decomposition, biorthogonal 2.2 mother-wavelet), and the coefficient with the best separation of the two classes of signals was selected. Receiver operating characteristic curve analysis was performed to determine the optimum threshold value for this coefficient.

Results
The third coefficient of the third level was selected. In AEP signals, retransform of this coefficient produces a peak that resembles peak V of the brainstem response. The developed detector of the brainstem component of AEP had a sensitivity of 97.90% and a specificity of 99.48%.

Conclusions
This detector of the AEP brainstem component can be used to verify that the signal reflects the response to an auditory stimulus. An alternative approach, used in the Danmeter AEP monitor, is based on the signal-to-noise ratio of the midlatency components of the AEP. Because the midlatency components of AEP are suppressed by anesthesia, a false alarm "low AEP/no AEP" is generated during deep anesthesia. This, in turn, may suggest disconnection of headphones or technical problems whenever anesthesia is deep. This disadvantage has been overcome by our detector, which is based on the identification of the brainstem component of AEP.
A Comparison of Sex- and Weight-based ProSeal™ Laryngeal Mask Size Selection Criteria
Authors: Kihara Shinichi , Brimacombe Joseph R. , Yaguchi Yuichi , Taguchi Noriko , Watanabe Seiji 
Published: July 2004

Background
The authors compared the manufacturer's weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50-70 kg, and size 5 for weight > 70 kg) with a sex-based formula (size 4 for women and size 5 for men) for selecting the appropriate size of ProSeal laryngeal mask airway.

Methods
Two hundred thirty-seven healthy, anesthetized, paralyzed adult patients (American Society of Anesthesiologists physical status I or II; age, 18-80 yr) were randomly allocated for weight- or sex-based size selection. An experienced user inserted the ProSeal laryngeal mask airway with the digital technique. The following were compared: ease of insertion, oropharyngeal leak pressure, ease of ventilation, gas exchange, location of gas leak, anatomic position, mucosal injury, and postoperative pharyngolaryngeal problems. Intraoperative and postoperative data collection were unblinded and blinded, respectively.

Results
Ease of insertion, anatomic position, gas exchange, mucosal injury, and postoperative pharyngolaryngeal problems were similar between groups. For the sex-based group, larger ProSeal laryngeal mask airways were selected more frequently (P < 0.0001), oropharyngeal leak pressure (P = 0.02) was higher, leak volume (P = 0.004) and leak fraction (P = 0.007) were lower, and oropharyngeal leaks (P = 0.03) were detected less frequently.

Conclusion
Size selection for the ProSeal laryngeal mask airway is equally effective using the manufacturer's weight-based formula or the sex-based formula in healthy, anesthetized, paralyzed adult patients, but leakage of small volumes of air from the mouth occurs less frequently with the sex-based formula.
Mitochondrial Complex I Function Affects Halothane Sensitivity in Caenorhabditis elegans
Authors: Kayser Ernst-Bernhard , Morgan Phil G. , Sedensky Margaret M. 
Published: July 2004

Background
: The gene gas-1 encodes a subunit of complex I of the mitochondrial electron transport chain in Caenorhabditis elegans. A mutation in gas-1 profoundly increases sensitivity of C. elegans to volatile anesthetics. It is unclear which aspects of mitochondrial function account for the hypersensitivity of the mutant.

Methods
: Oxidative phosphorylation was determined by measuring mitochondrial oxygen consumption using electron donors specific for either complex I or complex II. Adenosine triphosphate concentrations were determined by measuring luciferase activity. Oxidative damage to mitochondrial proteins was identified using specific antibodies.

Results
: Halothane inhibited oxidative phosphorylation in isolated wild-type mitochondria within a concentration range that immobilizes intact worms. At equal halothane concentrations, complex I activity but not complex II activity was lower in mitochondria from mutant (gas-1) animals than from wild-type (N2) animals. The halothane concentrations needed to immobilize 50% of N2 or gas-1 animals, respectively, did not reduce oxidative phosphorylation to identical rates in the two strains. In air, adenosine triphosphate concentrations were similar for N2 and gas-1 but were decreased in the presence of halothane only in gas-1 animals. Oxygen tension changed the sensitivity of both strains to halothane. When nematodes were raised in room air, oxidative damage to mitochondrial proteins was increased in the mutant animal compared with the wild type.

Conclusions
: Rates of oxidative phosphorylation and changes in adenosine triphosphate concentrations by themselves do not control anesthetic-induced immobility of wild-type C. elegans. However, they may contribute to the increased sensitivity to volatile anesthetics of the gas-1 mutant. Oxidative damage to proteins may be an important contributor to sensitivity to volatile anesthetics in C. elegans.