bluuebunny/crossref_metadata_2025_split huggingface dataset:
The psychometric properties of Chinese pain intensity verbal rating scale
Authors: Liu J. Y. W. , Chung J. W. Y. , Wong T. K. S. 
Published: August 2003

Background:  This study investigates the validity and reliability of the Chinese pain intensity verbal rating scale (C‐PIVRS).Methods:  This is a correlational comparative study. Fifty Chinese adults were recruited by convenience. A pain source generator (precision pain source, PPS‐3) was used to produce four levels of mechanical pain stimuli (350, 550, 750 and 950 g). The pain stimuli were applied to subjects' interphalangeal joints in random sequences to stimulate sensation of pain. The subjects then rated their pain intensity using both the C‐PIVRS and the visual analog scale (VAS) for each stimulus. The pain scores obtained from the C‐PIVRS were compared with the VAS for satisfactory level of reliability and validity. Test and re‐test were applied to verify consistency between the two pain scales.Results:  The test/re‐test correlation coefficients between the two pain scales were r = 0.92 (P < 0.001) and r = 0.91 (P < 0.001), respectively. This showed a good positive correlation. The intra‐class correlation (ICC) ranged from 0.78 to 0.90, which indicated good reliability. In the factor analysis, a single factor emerged in each analysis. The first eigen values of each matrix were 3.42, 3.24, 3.17 and 3.29 for each level of pain stimulation. This indicated that both pain scales were assessing the same pain dimension.Conclusions:  The two pain scales have a comparable level of reliability and validity for assessing pain intensity in Chinese adults.
Sevoflurane: an ideal agent for adult day‐case anesthesia?
Authors: Ghatge S. , Lee J. , Smith I. 
Published: August 2003

Sevoflurane has several properties which make it potentially useful as a day case anaesthetic. Following induction of anaesthesia with propofol, awakening from sevoflurane is faster compared to isoflurane, faster or similar compared to propofol and comparable (in the majority of studies) to desflurane. Subsequent recovery and discharge is generally similar following all agents. Sevoflurane may also be used to induce anaesthesia, which is generally well‐received and causes less hypotension and apnoea compared to propofol.When used as a maintenance anaesthetic, the incidence of postoperative nausea and vomiting after sevoflurane is comparable to other inhaled anaesthetics, but this complication appears more common after inhaled inductions. The tolerability and low solubility of sevoflurane facilitate titration of anaesthesia and may reduce the need for opioid analgesia, which in turn may limit the occurrence of nausea and vomiting.
Effects of 0.5 and 1.0 MAC isoflurane, sevoflurane and desflurane on intracranial and cerebral perfusion pressures in children
Authors: Sponheim S. , Skraastad Ø. , Helseth E. , Due‐Tønnesen B. , Aamodt G. , Breivik H. 
Published: August 2003

Background:  Isoflurane has been a commonly used agent for neuroanesthesia, but newer agents, sevoflurane and desflurane, have a quicker onset and shorter emergence from anesthesia and are increasingly preferred for general pediatric anesthesia. But their effects on intracranial pressure (ICP) and cerebral perfusion pressure (CPP), especially in pediatric patients with already increased ICP, have not been well documented.Methods:  We studied 36 children scheduled for elective implantation of an intraparenchymal pressure device for 24 h monitoring for suspected elevated ICP. After a standardized intravenous anesthesia, the patients were moderately hyperventilated with 60% nitrous oxide (N2O) in oxygen. The patients were then randomized to receive 0.5 and 1.0 MAC of isoflurane (Group I, n = 12), sevoflurane (Group S, n = 12) or desflurane (Group D, n = 12) in 60% N2O in oxygen. Respiratory and hemodynamic variables, ICP and CPP were recorded at baseline and after exposure to a target level of test drug for 10 min or until CPP fell below 30 mmHg (recommended lower ICP level is 25 mmHg in neonates, rising to 40 mmHg in toddlers).Results:  When comparing baseline values with values at 1.0 MAC, mean arterial pressure (MAP) decreased (P < 0.001) in all groups, with no differences between the groups. ICP increased (P < 0.001) with all agents, mean +2, +5, and +6 mmHg in Group I, S and D, respectively, with no differences between the groups. Regression analyzes found no relationship between baseline ICP and the increases in ICP from baseline to 1.0 MAC for isoflurane or sevoflurane. However, increased baseline ICP tended to cause a higher ICP increase with 1.0 MAC desflurane; regression coefficient +0.759 (P = 0.077). The difference between regression coefficients for Group I and Group D were not significant (P = 0.055). CPP (MAP‐ICP) decreased (P < 0.001) in all groups, mean −18, −14 and −17 mmHg in Group I, S and D, respectively, with no significant difference between the groups.Conclusions:  0.5 and 1.0 MAC isoflurane, sevoflurane and desflurane in N2O all increased ICP and reduced MAP and CPP in a dose‐dependent and clinically similar manner. There were no baseline dependent increases in ICP from 0 to 1.0 MAC with isoflurane or sevoflurane, but ICP increased somewhat more, although statistically insignificant, with higher baseline values in patients given desflurane. The effect of MAP on CPP is 3–4 times higher than the effect of the increases in ICP on CPP and this makes MAP the most important factor in preserving CPP. In children with known increased ICP, intravenous anesthesia may be safer. However, maintaining MAP remains the most important determinant of a safe CPP.
Serious overdoses involving buprenorphine in Helsinki
Authors: Boyd J. , Randell T. , Luurila H. , Kuisma M. 
Published: August 2003

Background:  Buprenorphine is used as maintenance therapy for opioid‐dependent patients. In comparison with other opioids it is thought to be safer because it is less likely to cause serious respiratory depression. However, concomitant use of psychotropics, especially benzodiazepines, and intravenous injection of dissolved buprenorphine tablets increase the risk of a serious overdose.Methods:  As part of a larger retrospective study of opioid overdoses in Helsinki, the emergency medical services (EMS) records from January 1995 to April 2002 were reviewed for overdoses involving buprenorphine. Hospital records were reviewed when available.Results:  We report 11 overdoses in which buprenorphine was involved. The classic symptoms and signs of an opioid overdose (respiratory depression, miosis and central nervous system depression) were present in most of the cases. At least eight of the patients had an overdose that was potentially fatal. One of the patients had a heroin overdose and was reportedly ‘treated’ by his friends with intravenously administered buprenorphine.Conclusion:  The high‐dosage formulation of buprenorphine used for opioid‐dependent patients might have caused several dangerous and potentially fatal overdoses in Helsinki. However, it does cause considerably less serious overdoses than heroin. Drug abusers might be intravenously administering buprenorphine themselves to treat heroin overdoses.
A lung recruitment maneuver immediately before rescue surfactant therapy does not affect the lung mechanical response in immature lambs with respiratory distress syndrome
Authors: Ingimarsson J. , Björklund L. J. , Curstedt T. , Larsson A. , Robertson B. , Werner O. 
Published: August 2003

Background:  In animals with acquired surfactant‐deficiency, a recruitment maneuver by increased tidal volumes enhances the effect of exogenous surfactant. In contrast, in the preterm lamb model, hyperinflation early after birth impairs the effect of surfactant prophylaxis. Here we examined whether a lung recruitment maneuver just before surfactant would affect the response to rescue treatment in immature lambs with established respiratory distress syndrome (RDS).Methods:  Five pairs of preterm twin lambs with gestational age 127 days were delivered by cesarean section and supported by pressure‐limited mechanical ventilation for 4 h. At 30 min of age, when all the lambs were in severe respiratory failure, they were treated with porcine surfactant, 200 mg kg−1. One lamb in each pair was subjected to a lung recruitment maneuver consisting of five sustained inflations of 20 ml kg−1 just before surfactant instillation.Results:  At 10 min after surfactant treatment, all the lambs showed a large improvement in oxygenation and an increase in inspiratory capacity and static compliance. Except for a transiently better oxygenation after surfactant therapy in the recruitment group (P < 0.05), there was no significant between‐group differences in gas exchange or lung mechanics at any time point during the study. There was no difference in post mortem intrapulmonary air volume or alveolar expansion in histologic lung sections between groups.Conclusion:  This small study does not show any positive or negative effect of a lung recruitment maneuver on the response to rescue surfactant therapy in immature animals with RDS.
Computerized quality assurance of decisions to transfuse blood components to critically ill patients
Authors: Pentti J. , Syrjälä M. , Pettilä V. 
Published: August 2003

Background:  In critically ill patients optimal transfusion therapy for most clinical settings has not been determined. The objective of this study was to evaluate the impact of a computerized audit on transfusion decisions of red blood cells (RBC), fresh frozen plasma (FFP), and platelets among critically ill patients.Methods:  Two hundred and ninety consecutive patients admitted to nine‐bed medical‐surgical intensive care unit at a university hospital were included in this prospective study. Prior to the study, the criteria for transfusions of RBCs, FFP and platelets were established. Phase I, the first 3‐month period served as a control period. During phase II the fulfilment of these criteria was prospectively monitored by an audit software belonging to the computerized blood request program. If the predefined transfusion criteria were not met the audit software was automatically activated. The last 3‐month period, phase III, was to assess if possible effects on transfusion decisions were permanent.Results:  The proportion of RBC transfusions administered according to predefined trigger during the study phases I, II, and III were 55.9%, 75.1% and 67.9%, respectively (P < 0.001). The proportion of FFP and platelet transfusions according to a predefined trigger did not differ statistically significantly between the study phases. Logistic multiple regression analysis revealed an independent effect of the audit phase on the decision to transfuse RBCs and FFP.Conclusions:  The data suggests that a computerized prospective transfusion audit has impact on the realisation of predefined transfusion decisions.
Pharmacological modulation of experimental phasic and tonic muscle pain by morphine, alfentanil and ketamine in healthy volunteers
Authors: Schulte H. , Graven‐Nielsen T. , Sollevi A. , Jansson Y. , Arendt‐Nielsen L. , Segerdahl M. 
Published: August 2003

Background:  Muscle pain is a major clinical problem but the underlying mechanisms and its pharmacological modulation need further investigation. This study on 15 volunteers evaluates if two experimental muscle pain models are sensitive to µ‐receptor agonists and to an N‐methyl‐D‐aspartate (NMDA)‐receptor antagonist.Methods:  In the left tibialis anterior, intramuscular electrical (IMES) pain thresholds were determined for single (SPTmuscle) and five (RPTmuscle) repeated stimuli. Also pain to suprathreshold stimulation at 150% of RPTmuscle, 10 s, was assessed on a visual analog scale (VAS) as AUCimes (area under the VAS curve). In the right TA muscle, pain intensity on infusion of 0.5 ml of hypertonic saline, 5% (AUCsaline) and pain distribution indicated as local and referred were evaluated. Pain variables were assessed before, during and after intravenous infusions of morphine (10 µg kg−1 min−1, 10 min), alfentanil (target‐controlled infusion, plasma concentration; 60 ng ml−1, 60 min) and ketamine (10 µg kg−1 min−1, 60 min). All data were normalized to baseline pain values (before drug infusions were initiated) and compared with placebo (midazolam, 2 µg kg−1 min−1, 10 min).Results:  SPTmuscle increased (log mean values  ±  SD, mA) with morphine (0.11 ± 0.17, P < 0.05), alfentanil (0.28  ±  0.24, P < 0.001) and ketamine (0.19  ±  0.18, P < 0.01) as compared with placebo (−0.03  ±  0.12). Alfentanil and ketamine also increased RPTmuscle (0.25  ±  0.21, P < 0.01 and 0.21  ±  0.19, P < 0.05, respectively) as compared with placebo (0.00  ±  0.17). Pain to IMES (AUCimes) was reduced (median values [25th−75th percentiles], cm × s) by alfentanil and ketamine (−19.7 [−14.6 – −29.6] and−12.8 [−8.3 – −27.8], P < 0.05, respectively) vs. placebo (−0.8 [1.6 – −12.3]). Similar drug effects were seen when pain to infusion of hypertonic saline (AUCsaline) was assessed (alfentanil:−388 [−99 – −677] and ketamine:−326 [−227 – −573], P < 0.05 compared with placebo: 150 [449–−240]). Ketamine also reduced the size of the local pain area (−58.4 [−21.2 – −176.1],  < 0.05) as compared with placebo (−0.4 [70.6 – −13.4]). The frequency of referred pain was also lower when ketamine was given (3/13, P < 0.05) vs. placebo (9/14).Conclusion:  The study demonstrates that experimental muscle pain induced in humans by electrical stimulation and infusion of hypertonic saline is sensitive to pharmacological modulation similar to preclinical animal tests and clinical trials. The data suggest that these models can be valuable tools in analgesic drug development.
A study on the microheterogeneity of alpha‐fetoproteins produced by yolk sac and germ cell tumors
Authors: Yamamoto Ritsu , Ohkouchi Toshihiro , Wakui Yukio , Minobe Shinichiro , Watari Hidemichi , Shimizu Kayoko , Satomura Shinji , Sakuragi Noriaki 
Published: August 2003

Background.  It is generally believed that the lower the grade of differentiation of glycoprotein‐producing cells, the more often modification by bisecting N‐acetylglucosamine (GlcNAc) or fucose (Fuc) at the sugar chain of the glycoprotein or increase in branching of side chains occurs. We examined the characteristics of the alpha‐fetoprotein (AFP) sugar chain stored in amniotic and exocoelomic fluid during 5–9 weeks of gestation and analyzed serum‐derived AFP of patients with germ cell tumors.Methods.  Total AFP concentrations in embryonic fluid at 5–9 weeks of gestation (n = 11) and serum of patients with germ cell tumors (n = 7) were measured using a radioimmunoassay (RIA) method. The percentages of AFPs reactive with Lens culinaris agglutinin (LCA), concanavalin A (Con A), erythroagglutinating phytohemagglutinin‐E4 (E‐PHA) and Ricinus communis agglutinin‐120 (RCA 120) were obtained by lectin‐affinity electrophoresis coupled with antibody‐affinity blotting.Results.  It was revealed that at 5–9 weeks of gestation, AFP variants that had been modified by the Fuc residue, which bound to the GlcNAc residue at the reducing end of the sugar chain, and bisecting GlcNAc residues gradually decreased as pregnancy advanced; however, the presence of N‐acetylneuraminic acid (Neu5Ac) at the nonreducing ends changed little.Conclusions.  It appears very likely that the changes in the relative amounts of AFP variants in the embryonic fluid during early pregnancy were due to differentiation of the yolk sac. The grade of differentiation of yolk sac tumors was very similar to that of the normal yolk sac at around 6 weeks of gestation.
Effect of combined oral estrogen/progestogen preparation (Kliogest®) on bone mineral density, plasma lipids and postmenopausal symptoms in HRT‐naïve Thai women
Authors: Jirapinyo Mayuree , Theppisai Urusa , Manonai Jittima , Suchartwatnachai Charnchai , Jorgensen Lars Nelleman 
Published: August 2003

Background.  Kliogest® is commonly prescribed for the relief of acute postmenopausal symptoms and prevention of postmenopausal bone loss. However, there have been few data on its effect in Asian women.Methods.  This 1‐year, single‐center, randomized, double‐blind and placebo‐controlled study evaluated the efficacy and safety of Kliogest® in hormone replacement therapy (HRT)‐naïve Thai women. The subjects were 120 healthy Thai women aged between 45 and 65 years, with intact uterus, and who had been amenorrheic for at least 1 year.Results.  Kliogest® increased spine (+ 6%, p < 0.01) and hip (+2%, p < 0.01) bone mineral density (BMD), and lowered plasma total cholesterol (TC) (−16%, p < 0.05) and low density lipoprotein cholesterol (LDL‐C) (−16%, p < 0.05) concentrations. However, Kliogest® also resulted in a decrease in high density lipoprotein cholesterol (HDL‐C) concentration (−18%, p < 0.05). Compared to placebo, the reduction in menopausal symptoms by Kliogest® was not statistically significant. The frequency and severity of treatment‐related uterine bleeding decreased with the duration of Kliogest® treatment. Furthermore, there was a fairly strong relationship between the change in serum estrone concentration and the average monthly weighted bleeding scores over the first 6 months (Spearman's correlation r = 0.54; p < 0.001), which became weaker over the entire treatment period (Spearman's correlation r = 0.27; p < 0.01). Although there was a small to moderate relationship between baseline estrone concentration and both lumbar (r = 0.23, p < 0.02) and hip (r = 0.20, p < 0.05) BMD, there was no significant relationship between Kliogest®‐induced change in estrone concentration and change in lumbar and hip BMD.Conclusions.  Continuous treatment with Kliogest® for 1 year reversed the potential postmenopausal bone loss in HRT‐naïve Thai postmenopausal women. However, its effect on cardiovascular risk is uncertain. Furthermore, Kliogest® is safe but appears to have no significant effect on climacteric symptoms in the patients in the present study.
Experiences with fetomaternal alloimmune thrombocytopenia at a Swedish hospital over a 10‐year period
Authors: Tiblad Eleonor , Olsson Ingeborg , Petersson Karin , Shanwell Agneta , Winiarski Jacek , Wolff Kerstin , Westgren Magnus 
Published: August 2003

Background.  This is a descriptive study of the management and outcome of 18 cases of fetomaternal alloimmune thrombocytopenia (FMAIT) treated from 1991 to 2001.Material and methods.  Management of the disease changed over the years from cordocentesis in the 20–24th week of gestation, platelet transfusions and immunoglobulin to a less invasive management consisting of only blind administration of immunoglobulin and predelivery cordocentesis.Results.  Three of the fetuses were treated with intrauterine platelet transfusions. Two of these were delivered by emergency cesarean section due to failed transfusions and the third fetus died as a result of the procedure. Nine mothers were treated with immunoglobulin intravenously. Four of these delivered thrombocytopenic children. Three women did not want to undergo any treatment, and all newborns had low platelet counts. Two fetuses died, one in conjunction with a platelet transfusion and the other in utero before treatment was commenced. All the other children did well despite the fact that some of them were severely thrombocytopenic at birth.Conclusions.  Due to the limited number of patients, the present material does not allow any far reaching conclusions. Our experience is that a non‐invasive management can be practiced in cases of FMAIT. The value of performing cordocentesis and platelet transfusions in the second trimester is doubtful in view of the risk for the fetus and the limited amount of information it provides for management of the individual case.
Elective cesarean section vs. spontaneous delivery: a comparative study of birth experience
Authors: Schindl Monika , Birner Peter , Reingrabner Michaela , Joura Elmar A. , Husslein Peter , Langer Martin 
Published: August 2003

Background.  To investigate birth experience and medical outcome in women with elective cesarean section (CS) compared with women with intended vaginal delivery.Methods.  A total of 1050 pregnant women were included in this prospective trial. Psychological factors, pain levels and birth experience were investigated using a self‐designed questionnaire and three established psychological tests in gestational week 38, and 3 days and 4 months postpartum. In addition, medical data were evaluated from the records.Results.  Out of 903 women with planned vaginal birth, in 484 women (53.6%) minimal perineal surgery had to be performed after birth, 41 women (4.5%) had vacuum deliveries, and in 93 cases (10.3%) emergency CS had to be performed. In the 147 elective CS (103 based on medical and 44 on psychological factors), a significantly lower rate of maternal and fetal complications was observed when compared with vaginal birth (5.4% vs. 19.3%; p < 0.0001). Birth experience (Salmon test) was significantly better in elective CS compared with vaginal delivery, but worse in women with emergency CS and worst in those with vacuum delivery. We found that 83.5% of women with vaginal delivery would choose the same mode of birth again, 74.3% of women with CS on demand, and 66% of women with medically necessary CS. Only 30.1% of women with emergency CS wanted to receive CS at the next birth.Conclusions.  Elective CS is a safe and psychologically well tolerated procedure. The results are comparable with uncomplicated vaginal delivery and far superior to secondary intervention such as vacuum delivery or emergency CS.
Comparison of the response to ovarian stimulation between women with one ovary and those with two ovaries, in a program of ICSI/ET
Authors: Al‐Hasani Safaa , Asimakopoulos Byron , Nikolettos Nikos , Diedrich Klaus 
Published: August 2003

Background.  Women with a single ovary form a group of special interest in assisted reproduction. The aim of this study was to compare the outcome of intracytoplasmic sperm injection cycles between women with one and two ovaries. To our knowledge, this is the first study reporting the outcome of intracytoplasmic sperm injection cycles with women with a single ovary.Methods.  Sixty‐three intracytoplasmic sperm injection cycles in 24 women with a single ovary were compared with 191 intracytoplasmic sperm injection cycles in 109 women with both ovaries. All cycles were stimulated with triptorelin‐long protocol.Results.  Statistically significant differences were found in the following parameters between women with a single ovary and women with two ovaries: total number of administrated gonadotropins (63.22 ± 45.03 vs. 44.72 ± 21.92), number of follicles (8.29 ± 5.02 vs. 14.45 ± 7.94), estradiol peak levels (1695.05 ± 1177.34 vs. 2728.51 ± 1852.67), number of retrieved metaphase II oocytes (6.95 ± 3.78 vs. 11.72 ± 6.11) and number of 2 PN oocytes (4.07 ± 2.85 vs. 6.53 ± 4.14). There were no differences in duration of stimulation, number of transferred embryos, and cumulative embryo score. In the group of women with a single ovary 14 pregnancies were achieved (22.2%), whereas 33 pregnancies were achieved in the group of women with two ovaries (17.28%).Conclusions.  Women with a single ovary have a decreased response to external ovarian stimulation than women with both ovaries, but they present a higher, although not statistically significant, pregnancy rate.