bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. (University of Michigan Medical Center, Ann Arbor, MI) Anesth Analg 2000;91:781–786.
Authors: Pandit Jaideep J. , Bree Stephen , Dillon Patrick , Elcock David , McLaren Ian D. , Crider: Bruce 
Published: March 2003

Carotid endarterectomy may be preformed by using cervical plexus blockade with local anesthetic supplementation by the surgeon during surgery. Most practitioners use either a superficial cervical plexus block or a combined (superficial and deep) block, but it is unclear which offers the best operative conditions or greatest patient satisfaction. This study compared the 2 techniques in 40 patients undergoing carotid endarterectomy. The patient randomly received either a superficial or a combined cervical plexus block. Bupivacaine 0.375% to a total dose of 1.4 mg/kg was used. The main outcome measure was the amount of supplemental lidocaine 1% used by the surgeon. Subsidiary outcome measures were postoperative pain score, sedative and analgesic requirements before and during surgery, and postoperative analgesic requirements. Median supplemental lidocaine requirements were 100 mg in the superficial block group and 115 mg in the combined block group. These differences were not statistically significant. There was no significant difference in the number of patients needing postoperative analgesia between the groups in the 24 h after surgery. The median time to first analgesia in the superficial block group was 150 min. more than in the combined block group, but this difference, although large, was not statistically significant. No significant differences were found between the anesthetic techniques studied.Comment by Alan Kaye, M.D. Carotid endarterectomy surgery can be performed with regional or general anesthesia. It is probable that a substantial majority of CEAs performed in North America are performed under general anesthesia. Debate over choice of regional versus general anesthesia persists because of various studies of risks and benefits. Each type of anesthesia has its own advantages and disadvantages, which must be considered when choosing the optimal anesthetic for patients. Regional anesthetic techniques available include local infiltration, superficial and deep cervical plexus block, a combination of these with or without contralateral superficial plexus, and cervical epidural anesthesia. This prospective, randomized, double‐blinded study compared superficial versus combined (superficial and deep) cervical plexus block in 40 patients. Outcomes were measured by supplemental local anesthetic used by the surgeon, postoperative pain scores, and sedative and analgesic requirements before, during, and postoperatively. The results showed no significant difference in either study group. Therefore, this small study suggests that superficial block should be preferred in as much that it is relatively easy to do and the potential side‐effects are far less than deep cervical block. Larger studies are warranted in this difficult population of patients.
Evaluation of the acute cervical spine: a management algorithm. (Department of Surgery, University of Kentucky, Lexington, KY) J Trauma 2000;49:450–456.
Authors: Banit Daxes M. , Grau Greg , Fisher: J. Rush 
Published: March 2003

A retrospective review was initiated of all trauma patients evaluated in a Level I trauma center the year before and after implementation of a new cervical spine protocol to determine the incidence of missed cervical injuries. An additional 6 months were reviewed to detect any missed injuries late in the study period. During the 2‐year study period, 4,460 patients presented to the emergency room with some form of cervical spine precautions. Blunt trauma comprised 90% of the study population. According to the protocol, approximately 45% required further cervical radiographs after presentation. In the preprotocol year, 77 of 2,217 (3.4%) patients were diagnosed with cervical spine injuries, 16 of 77 (21%) with multiple level injuries, and 25 of 77 (32%) with neurologic compromise. Three of 2,217 patient had missed cervical spine injuries on their initial evaluations. In the postprotocol year, 84 of 2,243 (3.4%) patients had cervical injuries, 25 of 84 (30%) with multiple levels of injuries and 28 of 84 (28%) with neurologic compromise. No patient evaluated during the protocol year was missed. All statistics between the two groups were not significant. Conclude the current protocol by risk stratifying patients on presentation is effective in assessing patients for cervical spine injuries.Comment by Gabor B. Racz, M.D. This is a retrospective review from a Level I trauma center a year before and after implantation of a cervical spine injury protocol. The comparison of outcomes before and after the protocol was rather similar in that the diagnosis of cervical spine injury in 77 of 2,217 patients, or 3.4% and 84 of 2,243 had cervical injuries again 3.4%. Prior to the initiation of the protocol, the first year had three cervical spine injuries missed, which were diagnosed later secondary to continued neck pain on reevaluation. There were no missed cases after the protocol. The evaluation and examination go hand in hand. More emphasis is placed on the clinical exam and plain multiple view x‐ray films and adherence to limiting the rigid collar to 6 h switching over to soft collar and developing more of a confidence in the clinical exam rather than to concentrate on the more expensive and time consuming radiological diagnostic procedures. The cervical algorithm does work and it is impressive that there were no missed injuries. It is recommended that physicians working in a Level I trauma center should go and review the algorithm in detail. The recommended practice is to rely on plain films first if there is persistent pain flexion and extension films and involvement of appropriate consultants in these patients who must be assumed to have cervical spine injury.
Left stellate ganglion block has only small effects on left ventricular function in awake dogs before and after induction of heart failure. (Institut für Klinische Anaesthesiologie, Heinrich‐Heine‐Universität, Düsseldorf, Germany) Anesth Analg 2000;91:787–792.
Authors: Mullenheim Jose , Preckel Benedikt , Obal Detlef , Heiderhoff Marc , Hoff Juliane , Thämer Volker , Schlack: Wolfgang 
Published: March 2003

This study investigated the effects of left stellate ganglion block (LSGB) in chronically instrumented awake dogs before and after the induction of pacing‐induced congestive heart failure. Twelve dogs were instrumented for measurement of global hemodynamics (LV pressure [LVP]), its first derivative, cardiac output (CO), and regional myocardial function (systolic posterobasal, segment length shortening, mean velocity [SLmv]). Before the induction of heart failure, LSGB did not affect CO and SLmv, but slightly reduced LVP. Conclude that even during heart failure the hemodynamic changes after LSGB are small, confirming a broad margin of safety.Comment by James E. Heavner, D.V.M., Ph.D. The outcomes of this very nice animal study should provide some comfort to clinicians that perform stellate ganglion blocks on patients with a history of heart failure. In chronically instrumented animals, left stellate ganglion block had minimal affect on cardiac function either before or after heart failure had been induced. However, caution should always be exercised in extrapolating animal data to humans. In this regard, the investigators point out that in healthy humans, an impairment of left ventricular relaxation can be seen after left stellate ganglion block. They further caution that patients with acute heart failure in whom the response to changes in sympathetic tone is maintained, may be more susceptible to the adverse effects of left stellate ganglion block on cardiac dynamics.
Epinephrine increases the neurotoxic potential of intrathecally administered lidocaine in the rat. (Department of Anesthesia and Preoperative Care, University of California, San Francisco, CA) Anesthesiology. 2001;94:876–881.
Authors: Hashimoto Keishi , Hampl Karl F. , Nakamura Yuji , Bollen Andrew W. , Feiner John , Drasner Kenneth 
Published: March 2003

This study investigated whether adding epinephrine increases functional impairment or histologic damage induced by spinal administration of lidocaine in the rat. Eighty rats were divided into 4 groups to receive an intrathecal injection of normal saline containing 5% lidocaine, 5% lidocaine with 0.2 mg/mL of epinephrine, 0.2 mg/mL of epinephrine, or normal saline alone. Animals were assessed for persistent sensory impairment using the tail‐flick test administered 4 to 7 days after infusion. Animals were then killed, and the spinal cord and nerve roots were prepared for neuropathologic evaluation. Rats given 5% lidocaine developed persistent sensory impairment and histologic damage, and the addition of epinephrine resulted in a further significant increase in injury. Sensory function in animals given epinephrine without anesthetic was similar to baseline and did not differ from saline. Histologic changes in animals treated with epinephrine alone did not differ significantly from saline controls. Conclude the neurotoxicity of intrathecally administered lidocaine is increased by the addition of epinephrine. When making clinical recommendations for maximum safe intrathecal dose of this anesthetic, one may need to consider whether the solution contains epinephrine.Comment by Octavio Calvillo, M.D., Ph.D. The authors studied the neurotoxicity of epinephrine added to lidocaine injected intrathecally in rats. The animals were allocated to four groups of 20 rats each, receiving: normal saline alone, normal saline and 5% lidocaine, 5% lidocaine with epinephrine [0.2 mg/ml] in saline or epinephrine 0.2 mgml in saline. The animals were assessed for sensory deficits 4 and 7 days after infusion and then sacrificed. The spinal cords and nerve roots were prepared for neuropathological evaluation. Sections obtained from animals treated with lidocaine, lidocaine with epinephrine. Rats given 5% lidocaine developed persistent sensory impairment and histological evidence of damage, the addition of epinephrine, resulted in further damage. Histological changes in animals treated with epinephrine alone did not differ significantly from saline controls. The authors concluded that the neurotoxicity of intrathecally‐administered lidocaine is increased by the addition of epinephrine. They raised the possibility that the neurotoxicity of commercially available epinephrine may be due to the bisulfite contained therein, this chemical has been associated with neurotoxicity.
Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long‐term results in a series of 44 patients. (University of Lyon, Lyon, France) Pain. 2001;92:159–171.
Authors: Sindou M , Mertens P. , Wael M. 
Published: March 2003

This article reported on the long‐term results of the microsurgical approach to the dorsal root entry zone (DREZotomy) in a series of 44 patients suffering from unbearable neuropathic pain secondary to spine injury. The follow‐up ranged from 1 to 20 years. The series included 25 cases with conus medullaris, 12 with thoracic cord, 4 with cauda equina and 3 with cervical cord injuries. Surgery was performed in 37 cases at the pathological spinal cord levels that corresponded to the territory of the so‐called “segmental pain,” and in 7 cases, on the spinal cord levels below the lesion for “infralesional pain,” syndromes. Regarding pain characteristics, a good result was obtained in 88% of the cases with predominately paroxysmal pain as compared with 26% with continuous pain. There were no perioperative mortalities. Morbidity included cerebrospinal fluid leak (3 patients), wound infection (2 patients), subcutaneous hematoma (1 patient), and bacteremia (1 patient). Conclude that the inclusion of DREZ‐lesioning surgery in the neurosurgical armamentarium for treating “segmental” pain due to spinal cord injuries is justified.Comment by Ron Pawl, M.D., FAC This is a seminal report, because it provides long‐term (greater than 1 year, 71 months average) outcome from the dorsal root entry zone lesioning, at the site of and one level above and below the site of injury, for pain after spinal cord injury. This procedure was performed using a microsurgical open technique. Results were good (greater than 75% relief) in patients with regional pain syndromes, in the body segments related to the site of cord injury, that was paroxysmal pain, and after conus medullaris lesions, which were the greatest number of cases treated. Continuous pain, burning pain, and infralesional pain syndromes, below the site of the cord injury, were not significantly benefited. Unfortunately, the authors did not report on the psychological make‐up of the patients, which might provide some insight into good versus bad outcome.
Platelet storage. Effects of leachable materials on morphology and function
Authors: Labow R. S. , Tocchi M. , Rock G. 
Published: March 2003

A polyolefin plastic (PL 732) bag formulated without liquid plasticizer allows storage of platelets for 5 and, now, up to 7 days. In order to assess the leaching of compounds from this new plastic, extracts of the supernatant from platelet concentrates stored in these bags were analyzed by high‐performance liquid chromatography, mass spectrometry, and gas‐liquid chromatography. A leachable material was detected and identified as di(2‐ethylhexyl) phthalate (DEHP). During the sterilization process, migration of the DEHP occurs from the polyvinylchloride (PVC) bags into the PL 732 plastic bag. The level of DEHP was 12‐fold less in the extracts of PC supernatant stored in the PL 732 bag than those in the polyvinyl chloride (PL 146) plastic bags which were used previously for platelet storage.Platelets stored in low DEHP concentrations in the PL 732 bags were composed of 10 to 35 percent of unclassifiable shapes. These shape changes were not observed in higher concentrations of plasticizer, although the morphology scores decreased during storage in PL 146 as well. This effect on morphology was not related directly to the dose of DEHP. When platelet membranes were isolated from platelets stored in the presence of radiolabeled DEHP, the amount of bound 14C‐DEHP was found to be directly proportional to the concentration of DEHP in the plasma supernatant. However, while there was a linear relationship between the protein concentration in the membrane fraction and the amount of bound DEHP, no specific DEHP binding site could be identified by electrophoresis of the solubilized platelet membranes.
Lack of effect on platelet increments of granulocyte‐macrophage‐colony‐ stimulating factor following autologous bone marrow transplantation for malignant lymphoma
Authors: Chambers L.A. , Garcia L.W. 
Published: March 2003

Background: Recombinant growth factors are used increasingly often to stimulate bone marrow recovery after intensive chemotherapy and bone marrow transplantation. Their effects on the requirements for and responsiveness to coincident therapies, including transfusion, should be defined.Study Design and Methods: To determine whether treatment with recombinant granulocyte‐macrophage‐colony‐stimulating factor (GM‐ CSF) affects platelet transfusion responsiveness, the clinical and blood bank records were examined for 16 adult patients (8 controls, 8 receiving GM‐CSF) participating in a double‐blind study of GM‐CSF administration (250 μg/m2 × 21 days) following autologous bone marrow transplantation for lymphoma. For each platelet transfusion, a corrected count increment was calculated, and note was made of the presence or absence of selected additional factors thought to decrease platelet responsiveness: fever, amphotericin treatment, HLA antibodies, platelet ABO incompatibility, and febrile transfusion reactions.Results: The total number of platelet transfusions (GM‐CSF patients, 145; controls, 145) and the mean number of transfusions per patient (GM‐ CSF, 18.3; controls, 18.0) were comparable in the two groups. GM‐CSF patients received significantly more platelets that were ABO incompatible, that were given during a febrile period, or that were given while the patient was on amphotericin. Nevertheless, the corrected count increments in patients who received GM‐CSF were at least as good as those in controls: for GM‐CSF patients: mean was 8,574 ± 5,868, median was 7,818, 49 percent were < 7,500 and 66 percent were < 10,000; for controls; mean was 7,618 ± 7,536, median was 6,100, 59 percent were < 7,500, and 73 percent were < 10,000.Conclusion: In this group of patients, GM‐CSF did not adversely affect the required number of, increments to, or incidence of refractoriness to platelet transfusions.
Development of a carbohydrate antigen during storage of red cells
Authors: Krugluger W. , Koller M. , Hopmeier P. 
Published: March 2003

Background: Changes in surface antigens during the aging of red cells led to the expression of epitopes that can induce an immune response. Recently, irregular antibodies detected in the sera of two patients agglutinated in vitro aged red cells.Study Design and Methods: The aging of red cells during storage was examined by flow cytometric analysis using fluorescein isothiocyanate‐labeled lectins, fluorescein isothiocyanate‐labeled anti‐human IgG, and fluorescein isothiocyanate‐ labeled IgM.Results: Red cells stored for 1 day and 21 days exhibited no difference in the binding of wheat germ agglutinin, Ulex europaeus agglutinin, or concanavalin A. Only soybean agglutinin showed increased binding to old red cells. IgM antibodies present in the sera of two patients induced strong agglutination of stored red cells, but not of fresh red cells of the same or compatible ABO blood groups. The binding of these antibodies did not involve known red cell antigens and could be significantly inhibited by galactose and mannose in a dose‐dependent manner. Staining of red cells with sera from both patients indicated that the antibodies recognized the same structure on stored red cells. The number of binding sites on red cells stored for 21 days was between 7,000 and 10,000 per cell.Conclusion: These results demonstrate that, during storage of red cells, gradual expression of galactosyl residues on the red cell membrane occurs.
Serologic evidence that factor IX inhibitor in the plasma of hemophilia B patients detects factor IX on normal red cells
Authors: Swanson J. L. , Moertel C. L. , Stroncek D. F. , Key N. S. 
Published: March 2003

BACKGROUND: Patients with hemophilia B lack factor IX (F IX). These patients may become alloimmunized after the transfusion of F IX concentrates and may develop F IX inhibitors, which have been characterized as polyclonal IgG4 alloantibodies. Two cases in which F IX inhibitors caused difficulty in compatibility testing and antibody identification were encountered. It was hypothesized that, because F IX is present in normal plasma, it might be adsorbed by red cells in vivo and then be detected during antibody screening tests with serum containing F IX inhibitors.CASE REPORT: Sera from two African American half‐brothers with hemophilia B were incompatible with all common and rare red cell phenotypes tested in the anti‐human globulin test, but did not react with each other's red cells. The brothers' red cell antibodies were neutralized with both normal plasma and a commercially available F IX concentrate, which indicated that the red cell incompatibility was most probably caused by their F IX inhibitors. Red cells from an unrelated patient with hemophilia B and a very low titer of F IX inhibitor were tested against the half‐brothers' sera and did not react. The compatible red cells from one of the half‐brothers and the unrelated patient with hemophilia B adsorbed F IX from normal plasma or F IX concentrate after 37 degrees C incubation; this rendered them incompatible with the plasma containing F IX inhibitor from the other half‐brother.CONCLUSION: F IX appears to be present on normal red cells and may be detected during compatibility and antibody identification procedures when serum or plasma containing F IX inhibitors is tested.
Invasive line placement in critically ill patients: do hemostatic defects matter?
Authors: DeLoughery T.G. , Liebler J.M. , Simonds V. , Goodnight S.H. 
Published: March 2003

Background: Blood components are often given prophylactically before the placement of invasive lines in patients with coagulation defects. Little, however, is known about the epidemiology of defects in these patients. The purpose of this study is to ascertain what proportion of intensive care patients who receive invasive lines have hemostatic defects, what actions are taken by physicians to correct these abnormalities before invasive line insertion, and what the incidence is of bleeding complications after invasive line placement. Study Design and Methods: Charts were retrospectively reviewed for 490 intensive care patients in whom 938 arterial, pulmonary artery, and central venous lines were placed. Results: At least one defect in hemostasis was documented for 388 patients (41%) before line placement, with 253 (27%) of these patients evidencing severe abnormalities. Seventeen percent of patients had no preprocedure laboratory evaluation. Trauma patients showed the highest numbers of abnormalities in hemostatic testing, but medical patients had more‐severe defects. The occurrence of isolated abnormal laboratory values did not predict bleeding, but a score derived from a consideration of multiple defects did. Correction of the abnormalities was attempted in 37 percent of patients with hemostatic defects. Sixteen patients had bleeding complications, but only two had complications that were life‐threatening. None of the complications were fatal. Conclusion: Invasive lines are used frequently in patients with hemostatic defects, often without any attempt to correct the abnormalities. Nevertheless, rates of hemorrhage are low and appear to be closely related to the level of experience of the physician rather than to defects in hemostasis. These findings suggest that the use of blood components for preprocedure correction of hemostatic defects is not necessary, except in those patients who have the most severe hemostatic abnormalities.
Investigation of the survival of paroxysmal nocturnal hemoglobinuria red cells through the immunophenotyping of reticulocytes
Authors: Navenot J. M. , Muller J. Y. , Blanchard D. 
Published: March 2003

BACKGROUND: Complement‐mediated lysis of red cells (RBCs) is a classic feature of paroxysmal nocturnal hemoglobinuria (PNH) that is traditionally studied with a combination of radiolabeling of RBCs and in vitro hemolysis tests. Phenotyping of reticulocytes was used as an alternative method for the evaluation of the relative life span of normal RBCs (PNH I) and RBCs that were partially (PNH II) or completely (PNH III) deficient in CD59.STUDY DESIGN AND METHODS: Murine monoclonal antibodies CD55, CD58, and CD59 and thiazole orange were used to phenotype reticulocytes by two‐color flow cytometry in nine PNH patients. RBC survival could be calculated from the ratio of CD59‐ or CD59low mature RBCs to CD59‐ or CD59low reticulocytes obtained from these patients who had not received a transfusion.RESULTS: The life span of PNH III RBCs varied from about 17 to 60 days. PNH II reticulocytes were found in the four patients with PNH II RBCs. The life span of PNH II RBCs varied with their residual expression of CD59, and cells with 15 to 20 percent of the normal amount of CD59 were protected against in vivo hemolysis.CONCLUSION: Phenotyping of reticulocytes is a convenient and reliable tool for evaluating the relative survival of normal and PNH RBCs. PNH II and PNH III reticulocytes are phenotypically distinct, and some PNH II RBCs may be sensitive to complement‐mediated lysis in vitro, but normally they are complement‐resistant in vivo.