bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of West Nile Fever in Older Adults
Authors: Berner Yitshal N. , Lang Ruth , Chowers Michal Y. 
Published: March 2003

OBJECTIVES: To determine the effect of clinical presentation and cognitive changes on the postdischarge outcome in older adult patients with West Nile fever (WNF).DESIGN: Retrospective, cohort analysis.SETTING: Meir Hospital located in the center of Israel in the Sharon region.PARTICIPANTS: Thirty‐two patients aged 65 and older hospitalized during a WNF outbreak.MEASUREMENTS: All patients' charts were analyzed retrospectively with special emphasis on their cognitive and functional state. A follow‐up examination of patients with functional decline at discharge was performed after 3 months.RESULTS: A change in consciousness, rather than in cognition, predicted the outcome. The death rate was 22% (7/32); all fatal cases were aged 78 and older. Similarly, the functional decline and residual damage appeared only in the older age group (≥75). Eighty‐eight percent of the survivors returned to their premorbid function. In contrast to other viral infections, chronic conditions in the subjects had no effect on the outcome.CONCLUSIONS: In older adults, WNF carries a high death rate, but the outcome is favorable for the survivors.
Sex Differences in Peripheral Arterial Disease: Leg Symptoms and Physical Functioning
Authors: McDermott Mary McGrae , Greenland Philip , Liu Kiang , Criqui Michael H. , Guralnik Jack M. , Celic Lillian , Chan Cheeling 
Published: March 2003

OBJECTIVES:LTo compare lower extremity functioning and leg symptoms between women and men with peripheral arterial disease (PAD). DESIGN:Cross‐sectional. SETTING:Three Chicago‐area medical centers. PARTICIPANTS:One hundred eighty‐seven women and 273 men with PAD identified consecutively in patients in the noninvasive vascular laboratories and a general medicine practice at the three medical centers. MEASUREMENTS:Walking speed, 6‐minute walk, accelerometer‐measured 7‐day physical activity, and a summary performance score. The summary performance score combines data on walking velocity, time for five repeated chair rises, and standing balance to achieve a score on a 0 to 12 scale (12 = best). RESULTS:Women with PAD were older and had a lower prevalence of prior leg revascularization, a higher prevalence of spinal stenosis, and a lower prevalence of other cardiovascular disease than men with PAD. Mean ankle brachial index (ABI) values ± standard deviation were similar in women and men with PAD (0.64 ± 0.15 vs 0.66 ± 0.14, P = .15). Women with PAD were significantly more likely than men with PAD to have exertional leg pain that sometimes begins at rest (27.8% vs 13.2%, P < .001). Women with PAD had slower walking speed (0.81 vs 0.92 m/s, P < .001), shorter 6‐minute walk distance (1,047 vs 1,182 feet, P < .001), and a poorer summary performance score (8.9 vs 9.8, P < .001) than men with PAD, adjusting for age, race, height, comorbid disease, and leg symptoms. After adjusting for leg strength, sex differences in 6‐minute walk performance and summary performance score were attenuated modestly (1,089 vs 1,177 feet for 6‐minute walk, P = .022 and 9.2 vs 9.8 for summary performance score, P = .027). CONCLUSION:Women with PAD had a higher prevalence of leg pain on exertion and rest, poorer functioning, and greater walking impairment from leg symptoms than men with PAD. A higher prevalence of spinal stenosis in women may explain the observed sex differences in leg symptoms. Poorer leg strength in women may contribute to poorer lower extremity functioning in women with PAD than in men with PAD. J Am Geriatr Soc 51:222–228, 2003.
Effect of End‐Stage Renal Disease on the Quality of Life of Older Patients
Authors: Loos Carole , Briançon Serge , Frimat Luc , Hanesse Bernadette , Kessler Michèle 
Published: March 2003

OBJECTIVES: To assess the effect of chronic renal failure (CRF) on quality of life (QOL).DESIGN: Controlled cross‐sectional study.SETTING: All 13 dialysis units in the French Lorraine region and six departments of a Nancy hospital.PARTICIPANTS: One hundred sixty‐nine older patients with end‐stage renal disease (ESRD) who were starting first dialysis (mean age ± standard deviation = 76.2 ± 5.1) and 169 age‐ and sex‐matched non‐CRF controls.MEASUREMENTS: QOL was assessed using the short‐form health survey 36‐item (SF‐36) self‐administered questionnaire. Information on comorbid conditions, clinical symptoms and laboratory findings was obtained from medical records.RESULTS: Mean QOL scores ranged from 11.2 (role limitation due to physical function (RP) dimension) to 55.5 (social function) in the ESRD group, and from 22.0 (RP) to 54.3 (mental health) in the non‐CRF group. Among ESRD patients, factors related to QOL scores (physical function (PF) and vitality dimensions) were the conditions under which dialysis was initiated and comorbidity. Patients whose first dialysis was unplanned had 10.4 fewer points in the PF dimension than those in whom it was planned (P = .014).CONCLUSIONS: If dialysis initiation is planned, ESRD in older patients has no more effect on QOL than others diseases. However, patients whose dialysis is unplanned have severely impaired QOL. These results represent an argument for improving the predialysis care of older renal failure patients to optimize conditions at first dialysis.
Antinoceptive and motor‐blocking action of epidurally administered IQB‐9302 and bupivacaine in the dog. (La Paz University Hospital, Madrid, Spain) Reg Anesth Pain Med 2000;25:522–528.
Authors: De Segura Ignacio A. Gómez , Vazquez Isabel , De Miguel: Enrique 
Published: March 2003

This study aimed to compare the antinociceptive and motor‐blocking effects of epidurally administered IQB‐9302 and bupivacaine in the dog. Twelve adult female Beagle dogs were used. Each animal received 3 concentrations of either IQB‐9302 or bupivacaine by means of chronic epidural catheter. Epidurally administered IQB‐9302 caused a more potent nocifensive and motor‐blocking action than bupivacaine. The duration of complete nocifensive block was the longest with IQB‐9302, whereas the duration of dermatome nocifensive block was similar for both drugs. The nocifensive to motor block ratio was significantly higher with IQB‐9302. Conclude that IQB‐9302 produced an anesthetic action similar to that of bupivacaine, although the former drug induced slightly more potent nocifensive block. Nocifensive and motor block duration are very similar with IQB‐9302, whereas bupivacaine induces a more prolonged motor block without nocifensive block.Comment by James E. Heavner, D.V.M., Ph.D. IQB‐9302 (1‐methylcycloprophyl‐N‐(2,6‐dymethylphenyl)‐2 piperidinecarboxyamide) is a recently developed local anesthetic with physiochemical properties similar to those of bupivacaine. Therefore, it is not surprising that the two compounds produce very similar outcomes when motor and sensory block is evaluated following epidural administration to dogs. What distinguishes results from the two compounds is that the motor blocking and nociceptive blocking actions of IQB apparently are better matched than are the blocking actions of bupivacaine. Whether this compound will eventually reach clinical use will depend on at least two things: 1) if IQB offers advantage in terms of systemic toxicity relative to the systemic toxicity of bupivacaine; and 2) whether the relatively small difference between bupivacaine and IQB when used for epidural anesthesia exists in humans as it does in animals and the differences are considered to be clinically meaningful. The Holy Grail sought by developers of new local anesthetics is a local anesthetic that produces sensory, but no motor block. IQB clearly is not that Holy Grail.
Morphine tolerance increases [3H]MK‐801 binding affinity and constitutive neuronal nitric oxide synthase expression in rat spinal cord. (National Medical Defense Center, Taipei, Taiwan) Br J Anaesth 2000;85:587–591.
Authors: Wong Chih‐Shung , Hsu Ming‐Man , Chou Yen‐Yen , Tao Pao‐Luh , Tung: Che‐Se 
Published: March 2003

N‐Methyl‐D‐aspartate (NMDA) receptor antagonists and nitric oxide synthase (NOS) inhibitors inhibit morphine tolerance. In the present study, a lumbar subarachnoid polyethylene (PE10) catheter was implanted for drug administration to study alterations in NMDA receptor activity and NOS protein expression in a morphine‐tolerant rat spinal model. Antinociceptive tolerance induced by intrathecal morphine infusion (10 μg h−1) for 5 days. Co‐administered MK801 with morphine was used to inhibit the development of morphine tolerance. Lumbar spinal cord segments were removed and prepared for [3H]MK‐801 binding assays and NOS western blotting. The binding affinity of [3H]MK‐801 was higher in spinal cords of morphine‐related rats than in control rats. There was no difference in Bmax. Western blot analysis showed that constitutive expression of neuronal NOS protein in the morphine‐tolerant group was twice that in the control group. This up‐regulation was partially prevented by MK‐801. The results suggest that morphine tolerance affects NMDA receptor binding activity and increases nNOS expression in the rat spinal cord.Comment by Octavio Calvillo, M.D., Ph.D. Morphine tolerance may be due to receptor down‐regulation or receptor uncoupling; activation of the NMDA‐dependent pain‐facilitatory system may also play a role. It has been proposed that NMDA receptor activation may play a role in morphine tolerance. NMDA receptor antagonists and nitric oxide synthase [NOS] inhibitors may prevent morphine tolerance. Tolerance was induced in rats by intrathecal injection of morphine [10 ug/h] for 5 days, co‐administration of MK801 [NMDA antagonist] with morphine was used to prevent morphine tolerance. Lumbar spinal cord segments were removed and prepared for [H3]MK801 binding assays and NOS western blotting. The binding affinity of labeled MK801 was higher in spinal cords of morphine tolerant rats than in control rats. Western blot analysis showed that constitutive expression of neuronal NOS protein in the morphine tolerant rats was twice that in the control group, thus, up‐regulation was prevented by MK801. The results suggest that morphine tolerance affect NMDA receptor binding activity and increase neuronal protein expression in rat the spinal cord.
The role of central and peripheral Cannabinoid1 receptors in the antihyperalgesic activity of cannabinoids in a model of neuropathic pain. (Novartic Institute for Medical Sciences, London, United Kingdom) Pain. 2001;92:91–100.
Authors: Fox Alyson , Kesingland Adam , Gentry Clive , McNair Kara , Patel Sadhana , Urban Laszlo , James Iain 
Published: March 2003

This study examined the effects of cannabinoid agonists on hyperalgesia in a model of neuropathic pain in the rat and investigated the possible sites of action. The antihyperalgesic activity of the cannabinoids was compared with their ability to elicit behavioral effects characteristic of central cannabinoid activity. WIN55, 212‐2 (0.3–10 mg/kg−1), CP‐55, 940 (0.03–1 mg/kg−1), and HU‐210 (0.001–0.03 mg/kg−1) were all active in a “tetrad” of tests consisting of tail‐flick, catalepsy, rotarod, and hypothermia following subcutaneous administration, with a rank order of potency in each of HU‐210> CP‐55, 940> WIN55, 212‐2. The effects of WIN55, 212‐2 in each assay were blocked by the Cannabinoid1 (CB1) antagonist SR141716A. In the partial sciatic ligation model if neuropathic pain WIN55, 212‐2, CP‐55, 940, and HU‐210 produced complete reversal of mechanical hyperalgesia within 3 hours of subcutaneous administration with D50 values of 0.52, 0.08, and 0.005 mg/kg−1, respectively. In this model WIN55, 212‐2 was also effective against thermal hyperalgesia and mechanical allodynia. WIN55, 212‐2 produced pronounced reversal of mechanical hyperalgesia following intrathecal administration that was blocked by the CB1 antagonist SR141716A. Following intraplantar administration into the ipsilateral hindpaw, WIN55, 212‐2 produced up to 70% reversal of mechanical hyperalgesia, although activity was also observed at high doses following injection into contralateral paw. The antihyperalgesic effect of WIN55, 212‐2 injected into the ipsilateral paw was blocked by subcutaneously administered SR141716A, but was not affected by intrathecally administered SR141716A. Conclude that cannabinoids are highly potent and efficacious antihyperalgesic agents in a model of neuropathic pain. This activity is likely to be mediated via action in both the CNS and in the periphery.Comment by Leland Lou, M.D. Rat study that looked at the potential of cannabinoids in the management of neuropathic pain. The data seem to indicate the presence of peripheral cannabinoid receptors for suppression of neuropathic pain. Historically, a central mechanism of action for cannabinoid's analgesic and antihyperalgesic properties is thought to be responsible. Unfortunately, this report only confirms previous studies finding a peripheral mechanism of action.
Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases. 2001;32:1481–1486.
Authors: Schmader Kenneth 
Published: March 2003

Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged‐related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella‐zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age‐related, disease‐related, and drug‐related decline in cellular immunity to VZV. VZV‐induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients.Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy.The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio‐frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain.
Lumbar sympathetic block for pain relief in two patients with interstitial cystitis. (Shimane Medical University, Izumo, Japan) Reg Anesth Pain Med 2001;26:271–273.
Authors: Doi Katsushi , Saito Yoji , Nikai Tetsuro , Morimoto Noriko , Nakatani Toshihiko , Sakura Shinichi 
Published: March 2003

This case report discussed the effective treatment of interstitial cystitis (IC) with regard to a 63‐year‐old woman and a 78‐year‐old woman. Medical therapy with nonsteroidal anti‐inflammatory drugs, anticholinergics, and hydrodistention of the bladder failed to improve their symptoms. Subsequently, a continuous lumbar epidural block using 1% mepivacaine was used in these patients. A transient reduction of the symptoms in both patients was achieved. A lumbar sympathetic block with a neurolytic agent produced almost complete and long‐lasting relief of their symptoms. Conclude that lumbar sympathetic block using a neurolytic agent produced long‐lasting pain relief in 2 patients with IC.Comment by Pedro F. Bejarano, M.D. Chronic visceral pain association to the neurovegetative system and to sympathetically‐maintained mechanisms has been well documented nowadays. The multiple neural connections among different abdominal nerve plexus has also been described, and this anastomoses may account for the observed analgesic effects in this case obtained without specific blockade of the superior hypogastric plexus. Despite the reported good results, the use of the lumbar approach may be controversial in this cases, as the uncomfortable peripheral effects of a permanent lumbar sympathetic neurolytic block (i.e.: lower limb vasodilation) favors a more anatomically restricted (visceral) area like that obtained with a superior hypogastric approach.We must remark that the existence of Sympathetically mediated and/or maintained pain is not enough phenomenae to fit the diagnostic criteria of a RCPS, as suggested by the authors, but it is less so in the case of an evidently persistent, organic source of visceral nociception like in the Intersticial Cystitis disease.
Low retention of white cell fragments by polyester fiber white cell‐ reduction platelet filters
Authors: Ramos Ricardo R. , Curtis Brian R. , Duffy Brian F. , Chaplin H 
Published: March 2003

BACKGROUND: There is intense interest in the potential of current white cell (WBC)‐reduction filters to prevent the alloimmunization of patients by the residual donor WBCs in filtered blood components transfused to them. Little attention has been paid to the capacity of current synthetic fiber filters to remove WBC membrane fragments bearing detectable leukocyte antigens.STUDY DESIGN AND METHODS: Fluorescein isothiocyanate‐conjugated monoclonal antibody to a universal WBC membrane antigen (CD45) and high‐speed centrifugation coupled with ficoll‐hypaque differential sedimentation were used to quantitate low‐density WBC fragments in single‐donor platelet components before and after filtration to determine if a polyester fiber filter retained WBC fragments.RESULTS: Prefiltration measurements in 25 single‐donor platelet components indicated that WBC fragments increased with length of storage up to 5 days at room temperature (p < 0.0001). When fragments in eight components were measured before and after filtration, absolute values for differences were insignificant (p = 0.15). CONCLUSION: WBC fragments were poorly retained by these polyester fiber WBC‐reduction filters. The antigenicity of WBC fragments could contribute to the WBC alloimmunization of some recipients of WBC‐reduced blood components.
Platelet concentrates stored for 5 days in a reduced volume of plasma maintain hemostatic function and viability
Authors: Ali A.M. , Warkentin T.E. , Bardossy L. , Goldsmith C.H. , Blajchman MA 
Published: March 2003

BACKGROUND: Platelet concentrates prepared from whole blood are generally suspended in a standard volume of 50 to 60 mL of plasma and can be stored thus at 20 to 24 degrees C for up to 5 days. In vitro studies suggested that this plasma volume could be reduced to 30 to 35 mL without impairing platelet function.STUDY DESIGN AND METHODS: This study evaluated whether platelets stored for 5 days in a reduced volume (30‐35 mL) of plasma maintained their in vivo viability, hemostatic function, and recovery in recipients. Paired autologous platelet survival studies were done in 20 adult volunteers to assess platelet viability. A rabbit ear bleeding‐time model was used to compare the hemostatic effectiveness of human platelet concentrates stored for 5 days in the standard or reduced volume of plasma. Platelet recovery was compared in thrombocytopenic hospital patients.RESULTS: Paired platelet survival studies indicated no significant difference between the values in platelet concentrates stored for 5 days in the reduced volume of plasma and the values in those stored in the standard volume. In the animal model, there was no significant difference in the bleeding times achieved by either set of platelet concentrates. The platelet count increments in thrombocytopenic patients were measured. The platelet count increments in patients who received reduced‐volume platelet concentrates were as good as the increments achieved in patients given standard‐volume concentrates.CONCLUSION: The in vivo viability, recovery, and hemostatic function of platelets collected in polyvinylchloride plastic containers and stored in 30 to 35 mL of plasma for 5 days are maintained as well as those of platelets stored in 50 to 60 mL of plasma.
Protective effect of blood transfusions on postoperative recurrence of Crohn's disease in parous women
Authors: Silvis R. , Steup W.H. , Brand A. , Zwinderman K.A. , Lamers C.B. , Griffioen G. , Gooszen H.G. 
Published: March 2003

Background: Perioperative blood transfusion (BT) appeared to have adverse effects on survival after surgery for malignant tumors while pretransplantation BT suppressed allograft rejection. Interest grew in the effect of BT on postoperative recurrence of Crohn's disease.Study Design and methods: To determine the effect of perioperative BT on the recurrence of Crohn's disease after primary surgery, the medical histories of 148 patients with Crohn's disease, 62 males and 86 females (49 nonparous and 37 parous), were reviewed. Eighty‐seven patients received perioperative BT.Results: Overall, perioperative BT showed no effect on recurrence. Patients with Crohn's disease limited to the ileum had a better prognosis with regard to recurrence than did patients with Crohn's disease located in the colon or located in both ileum and colon, but the difference was not significant. Perioperative transfusion seemed to protect against recurrent disease after colon resection, which might be explained by the fact that colon resections, which often necessitate perioperative BT, generally result in a shorter bowel segment at risk for recurrent disease. Overall, parous women showed a worse prognosis than nonparous females and men (p = 0.022). Transfusions had a beneficial effect in parous women (p = 0.068) and, after correction for type of operation, this beneficial effect was significant (p = 0.026). After perioperative BT, parous women had a similar prognosis with respect to recurrent Crohn's disease as nonparous females and men.Conclusion: Perioperative BT has a beneficial effect on the postoperative recurrence of Crohn's disease in parous women.