bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrograde tracheal intubation: beyond fibreoptic endotracheal intubation
Authors: Weksler N. , Klein M. , Weksler D. , Sidelnick C. , Chorni I. , Rozentsveig V. , Brill S. , Gurman G. M. , Ovadia L. 
Published: December 2004

Background:  Flexible fibreoptic laryngoscopy is the method of choice for coping with difficult tracheal intubations, a leading cause of catastrophic outcomes in anaesthesia. However, this technique is not always available or feasible. Retrograde intubation is a minimally invasive airway management technique with a flat learning curve and a high level of skill retention.Methods:  A retrospective review of the anaesthesia records of 24 patients who underwent retrograde intubation. The success rate and the incidence of complications were recorded.Results:  Retrograde tracheal intubation was successful in all 24 patients. In 21 patients it succeeded on the first attempt. In two patients it succeeded when the technique was changed from sliding over a guide wire to a pulling technique. The most common complication was a sore throat in almost 60% of the patients. Two patients had mild subcutaneous emphysema and one had minimal bleeding at the puncture site.Conclusions:  In these patients retrograde tracheal intubation was easy to perform, had a high success rate and a low incidence of complications. It is a reliable alternative when fibreoptic intubation is precluded, fails or is unavailable.
Effect of remifentanil on intracranial pressure and cerebral blood flow velocity in patients with head trauma
Authors: Engelhard K. , Reeker W. , Kochs E. , Werner C. 
Published: December 2004

Background:  Remifentanil, an ultra‐short‐acting opioid, is used as an on‐top analgesic in head trauma patients during transient painful procedures, e.g. endotracheal suctioning, physiotherapy, on the intensive care unit. However, previous studies have shown that opioids may increase intracranial pressure and decrease cerebral blood flow.Methods:  The present study investigates the effect of remifentanil on mean arterial blood pressure, intracranial pressure measured with intraparenchymal or epidural probes, and on cerebral blood flow velocity assessed by transcranial Doppler flowmetry in 20 head trauma patients sedated with propofol and sufentanil. Ventilation was adjusted for a target PaCO2 of 4.7–5.1 kPa. After baseline measurements a bolus of remifentanil (0.5 µg·kg−1 i.v.) was administrated followed by a continuous infusion of remifentanil (0.25 µg·kg−1·min−1 i.v.) for 20 min.Results:  There was no change in mean arterial blood pressure, intracranial pressure, and cerebral blood flow velocity in response to remifentanil infusion over time. Statistical analysis was performed using the Wilcoxon Signed Rank test.Conclusions:  These data suggest that remifentanil can be used for on‐top analgesia in head trauma patients without adverse effects on cerebrovascular haemodynamics, cerebral perfusion pressure or intracranial pressure.
Effect of aminophylline on bispectral index
Authors: Turan A. , Memiş D. , Karamanlỳoðlu B. , PamukÇu Z. , Süt N. 
Published: December 2004

Background:  The aim of the present study was to investigate the effects of aminophylline on BIS as well as clinical recovery in patients anesthetized with sevoflurane.Methods:  Sixty patients with status of ASA I–II scheduled for elective surgery were enrolled in this study. Anesthesia was induced by 2 mg kg−1 of propofol and 0.5 mg kg−1 of atracurium, maintained with 1:1 ratio of oxygen and nitrous oxide and 2–2.5% sevoflurane, keeping BIS values at 50 ± 5. During the last 30 min of the operation no muscle relaxant was given and anesthesia was continued without decreasing anesthetic concentration. After sevoflurane discontinuation, saline was given to Group P, and 5 mg kg−1 of aminophylline was given to Group A. Bispectral index values, heart rate, blood pressure and oxygen saturation were determined in all the patients before and every min after injection of the test drug for 15 min. The following variables were measured in both groups: eye opening, extubation time, response to command, Aldrete scores, and performing three simple arithmetic calculations.Results:  Between groups there was no statistically significant difference in mean arterial blood pressure, SpO2 and anesthesia time. Heart rate was found to be statistically higher (P < 0.001) at 2 to 6 min in Group A when compared with group P. Eye opening, verbal response, extubation and arithmetic calculation times were significantly shorter (P < 0.001) in Group A. Bispectral index scores were significantly higher in Group A at 1 to 12 min after aminophylline injection when compared with placebo (P < 0.001).Conclusion:  Recovery from sevoflurane anesthesia and BIS scores are improved in early period when aminophylline is given at emerging from anesthesia.
Outcome of the elderly critically ill after intensive care in an era of cost containment
Authors: Walther S M. , Jonasson U. 
Published: December 2004

Background:  Economical constraints have, in many countries, led to a reduction in provision of health care services, including care of the critically ill, after decades of expansion. We hypothesized that elderly critically ill patients may be particularly vulnerable to these changes. The purpose of the present study was to examine survival of patients ≥75 years between 1993 and 1999 when overall staff and ICU/HDU‐beds were stepwise reduced, but the nurse/bed ratio increased.Methods:  Patient demographics, reason for admission, APACHE II and TISS scores were retrieved from a prospectively collected clinical database, and 180‐day mortality was secured from a national database. Multivariate logistic regression was used to determine the role of year of admission on outcome.Results:  The annual number of elderly admissions (mean 656, range 611–702) and their APACHE II‐derived probability of death (mean 0.25, range 0.24–0.26) did not alter significantly during the period. For patients admitted after anesthesia and surgery, length of stay was significantly shorter (P<0.001) and TISS points per admission were fewer (P<0.05) at the end of the period, whereas 180‐day survival remained unchanged (mean 27.5%, range 25.3–29.3%). Year of admission had no explanatory power with an odds ratio of 1.0 (95% CI 0.9–1.1) per year.Conclusion:  Reduction of intensive care services led to shorter stay and lower TISS allocation for elderly critically ill without any significant increase in 180‐day mortality.
Desflurane results in higher cerebral blood flow than sevoflurane or isoflurane at hypocapnia in pigs
Authors: Holmström A. , Rosén I. , Åkeson J. 
Published: December 2004

Background:  In clinical neuroanaesthesia, the increase in cerebral blood flow (CBF) and intracranial pressure caused by the cerebral vasodilative effects of an inhalational anaesthetic agent is counteracted by the cerebral vasoconstriction induced by hypocapnia. Desflurane and sevoflurane may have advantages over the more traditionally used isoflurane in neuroanaesthesia but their dose‐dependent vasodilative effects at hypocapnia have not been compared in the same model using truly equipotent minimal alveolar concentrations (MACs).Method:  Desflurane, sevoflurane and isoflurane were administered in a randomized order to six pigs at 0.5 and 1.0 MAC. The intra‐arterial xenon clearance technique was used to calculate CBF. Blood pressure was invasively monitored. Cerebral and systemic physiological variables were recorded first at normocapnia (PaCO2 5.6 kPa) and then at hypocapnia (PaCO2 3.5 kPa). Electroencephalographic (EEG) activity was continuously recorded.Results:  None of the three agents abolished cerebrovascular reactivity to hyperventilation, and at 0.5 MAC all had similar effects on CBF at hypocapnia. Desflurane at 1.0 MAC was associated with 16% higher CBF (P = 0.027) at hypocapnia than isoflurane, and with 24% higher CBF (P = 0.020) than sevoflurane. There was no seizure activity in the EEG.Conclusion:  More cerebral vasodilation at hypocapnia with high doses of desflurane than with sevoflurane or isoflurane indicates that desflurane might be less suitable for neuroanaesthesia than sevoflurane and isoflurane.
Increased spillover of norepinephrine to the portal vein during CO2‐pneumoperitoneum in pigs
Authors: Myre K. , Rostrup M. , Eriksen M. , Buanes T. , Ræder J. , Stokland O. 
Published: December 2004

Background:  Elevated intra abdominal pressure (IAP) during CO2‐insufflation has been associated with increased catecholamine concentrations in plasma. We have previously indicated that this may be due to a regional increased spillover from the abdominal region. In this experimental study we investigated catecholamine spillover from the drainage area of the portal vein during CO2‐pneumoperitoneum.Methods:  Eight pigs under general anesthesia were investigated before and after CO2‐pneumoperitoneum with an IAP of 15 mmHg. Regional spillover of catecholamines was determined by measuring plasma catecholamine concentrations and flow simultaneously. Plasma concentrations of catecholamines were measured from the portal and femoral veins, the pulmonary and carotid arteries. Flow data were collected with laser‐Doppler transit time flow probes around the portal and femoral veins. Cardiac output was measured by the thermo‐dilution technique. Estimated spillover was calculated by the veno‐arterial difference multiplied by flow.Results:  We found a significant increase in estimated spillover of norepinephrine from the drainage area of the portal vein from 10 (−1.2, 78) ng·min−1 to 27 (1.8, 475) ng·min−1[median (range)] (P = 0.05), but no change in estimated spillover of norepinephrine from the drainage area of the femoral vein. Plasma concentrations of norepinephrine increased in central venous and arterial blood. There was no significant change in epinephrine concentrations in arterial blood.Conclusion:  Estimated norepinephrine spillover from the drainage area of the portal vein increased during CO2‐pneumoperitoneum in pigs. This may indicate that the increased norepinephrine concentrations found in arterial plasma reflects a local activation of sympathetic nerves in the region of the portal drainage area.
Respiratory changes during prolonged increased intra‐abdominal pressure in pigs
Authors: Gudmundsson F. F. , Heltne J. K. 
Published: December 2004

Background:  Increased intra‐abdominal pressure (IAP) elevates thoracic pressure and airway pressures and reduces lung compliance in humans and laboratory animals. We studied respiratory alterations and arterial blood gas changes in pigs with IAP maintained at 20 mmHg or 30 mmHg for 3 h.Methods:  Domestic pigs of both sexes weighing 30.0 ± 5.1 kg (mean ± SD) (n = 21) were divided into three groups. The animals were anesthetized and kept at 20 mmHg IAP (n = 7) or 30 mmHg IAP (n = 7) for 3 h. The third group (n = 7) served as control without an elevated IAP. We recorded respiratory alterations and changes in acid‐based parameters at baseline and after 90 min and 180 min of increased IAP.Results:  No significant hypoxia or hypercarbia was found in animals with an IAP of 20 mmHg IAP. At an IAP of 30 mmHg, pO2 decreased to an average 19.6 kPa and pCO2 increased to about 6 kPa, and the animals were slightly acidotic. Airway pressure increased significantly and lung compliance decreased in both groups of elevated IAP.Conclusion:  In our porcine model, an IAP of 20 mmHg or higher for 3 h is harmful for the respiratory function of the animals due to deterioration of respiratory parameters, increased airway pressure and decreased lung compliance.
The role of the extrinsic thoracic limb muscles in equine locomotion
Authors: Payne R. C. , Veenman P. , Wilson A. M. 
Published: December 2004

AbstractMuscles have two major roles in locomotion: to generate force and to absorb/generate power (do work). Economical force generation is achieved by short‐fibred pennate muscle while the maximum power output of a muscle is architecture independent. In this study we tested the hypothesis that there is an anatomical and structural separation between the force‐generating anti‐gravity muscles and the propulsive (limb/trunk moving) muscles of the equine forelimb. Muscle mass and fascicle length measurements were made on the thoracic limb extrinsic muscles of six fresh horse cadavers. Physiological cross‐sectional area and maximum isometric force were then estimated. Maximum power was estimated from muscle volume and published contraction velocity data. The majority of extrinsic forelimb muscles were large with long fascicles arranged in parallel to the long axis of the muscle. Muscles arranged in this way are optimised for doing work. The architecture of serratus ventralis thoracis (SVT) was unique. It had short (48 ± 17 mm) fascicles, arranged at about 45° to the long axis of the muscle, which would suggest a force‐generating, anti‐gravity role. The muscle belly of SVT was sandwiched between two broad, thick sheets of aponeurosis. Hence, SVT could make a significant contribution to the overall elastic properties of the thoracic limb.
Transmitter receptors and functional anatomy of the cerebral cortex
Authors: Zilles Karl , Palomero‐Gallagher Nicola , Schleicher Axel 
Published: December 2004

AbstractThe currently available architectonic maps of the human cerebral cortex do not match the high degree of cortical segregation as shown by functional imaging. Such functional imaging studies have demonstrated a considerable number of functionally specialized areas not displayed in the architectonic maps. We therefore analysed the regional and laminar distribution of various transmitter receptors in the human cerebral cortex, because these signalling molecules play a crucial role in cortical functions. They may provide a novel and functionally more relevant insight into the regional organization of the cortex, which cannot be achieved by architectonic observations in cell body‐ or myelin‐stained sections. Serial cryostat sections through whole human hemispheres were used for quantitative receptor autoradiography. The regional and laminar densities of numerous receptors of classic transmitter systems were analysed. Alternating sections were stained for comparisons based on cyto‐ or myeloarchitectonic criteria. Our results demonstrate that the regional distribution of transmitter receptors reflects well‐established cyto‐ and myeloarchitectonically defined borders of cortical areas, but in addition enables the identification of more cortical areas than previously demonstrated. Moreover, the laminar distribution patterns of a given receptor type in different cortical areas as well as those of different receptor types in the same cortical area reveal novel and functionally relevant data concerning the intracortical organization in the human cerebral cortex.
‘Cheaper than a newcomer’: on the social production of IVF policy in Israel
Authors: Birenbaum‐Carmeli Daphna 
Published: December 2004

AbstractThis paper explores the shaping of health policy in terms of power relations and group interests, as enacted in Israel's IVF policy. A comparison with the principles of IVF provision in other countries (UK, Canada, USA) shows Israel's policy to be substantially more ‘liberal’. In order to explain this exception, the policy is initially located within the context of the state's pro‐natalist reproductive policy, women's impaired equality and a complex system of healthcare provision. A Parliament Committee discussion on the subject is then analysed in greater detail, revealing three narratives that are used to account for the state's IVF policy: a nationalised narrative of reproductive medicine as a source of international acclaim, a personalised narrative of compassion for anguished women, and a medicalised narrative of experts as being best capable of regulating IVF. All three narratives have merged within the local IVF discourse, enabling the creation and maintenance of consensus among the participating politicians, physicians, consumers and women activists. Of significance is the muted argument regarding the state's interest in enlarging its Jewish population, which dominated other discussions on this topic. I argue that it is the demographic interest which crucially underlies the state's willingness to sustain its costly IVF policy, and that it is this interest which has enabled the various participants – who all shared an interest in unlimited IVF provision – to present a unanimous agreement. State representatives then used this consensus as a firm civil ground for the development and maintenance of Israel's exceptional IVF policy. The paper concludes with several implications regarding women's health and wellbeing.
Use of methoxamine in the resuscitation of epinephrine resistant electromechanical dissociation
Authors: Harban F. M. J. 
Published: December 2004

Dr McBrien et al. describe three interesting cases of electromechanical dissociation (EMD) resistant to epinephrine treatment (McBrien et al. Anaesthesia 2001; 56: 1085–9). In these cases, an␣α adrenergic agonist (methoxamine) proved to be lifesaving. However, to ‘consider an α agonist for any case of cardiac arrest secondary to electromechanical dissociation which is unresponsive to epinephrine’ may not be appropriate. These cases involved a specific situation where the likely cause of hypotension was a fall in the systemic vascular resistance (SVR). This occurred as a result of proven type 1 hypersensitivity in two cases and direct action of methylmethacrylate cement in the other. Clearly in this case, an α agonist is a logical choice. The Advanced Life Support guidelines are designed to cover a wide range of differing conditions for use by practitioners of differing experience who may or may not be aware of the originating event. Indeed, hypotension causing EMD may be as a result of cardiac tamponade, tension pneumothorax or hypovolaemia. It is unlikely that the use of α agonists would be helpful in these situations. It would seem prudent to continue to use epinephrine as the first line treatment for an EMD cardiac arrest and to advise using an α agonist in cases of hypotension where reduced SVR is suspected as the cause when epinephrine may not be effective in restoring the blood pressure. However, as methoxamine has now been withdrawn from clinical use, other α agonists such as metaraminol or phenylephrine may be more readily available.
Sources of variability in nicotine and cotinine levels with use of nicotine nasal spray, transdermal nicotine, and cigarette smoking
Authors: Benowitz N.L. , Zevin S. , Jacob P. 
Published: December 2004

Aims Nicotine nasal spray and transdermal nicotine are effective aids to smoking cessation, and are being evaluated for treatment of other medical diseases. Wide variation in levels of nicotine and its metabolite, cotinine, have been observed with such therapies. This study aimed primarily to assess sources of individual variability in nicotine and metabolite plasma levels from these dosing systems and from cigarette smoking. Methods Twelve cigarette smokers, studied on a clinical research ward, received four treatments of 5 days duration each, including (1) cigarette smoking, 16 cigarettes/day; (2) transdermal nicotine, 15 mg/day; (3) nicotine nasal spray, 24–1 mg doses/day; (4) placebo nicotine nasal spray, 24 doses/day. On a different occasion, the disposition kinetics of nicotine and cotinine were determined via infusion of deuterium‐labeled nicotine and cotinine. Plasma levels of nicotine, cotinine, and 3′‐hydroxycotinine and daily intake of nicotine during various treatments were examined, as well as pharmacokinetic factors that determined plasma nicotine and cotinine levels. Results There was considerable individual variation in plasma nicotine and cotinine levels and in the daily dose of nicotine absorbed from various delivery systems, with most variability with nicotine nasal spray (fivefold) and least for transdermal nicotine (two‐to threefold). Plasma nicotine levels were determined most strongly by nicotine clearance. Cotinine levels were determined most strongly by dose of nicotine and, to a lesser extent, the clearance of cotinine and fractional conversion of nicotine to cotinine. Conclusions Plasma levels of nicotine and cotinine produced by nicotine therapies are highly variable, due to both wide variability in individual pharmacokinetics and in dose delivery from the products. To compensate for individual differences in clearance, individualization of nicotine dosing based on therapeutic drug monitoring with comparison to nicotine or cotinine levels during cigarette smoking prior to treatment may be necessary to optimize nicotine therapy. This study also validates a recently proposed method for estimating absolute bioavailability of a drug using drug and metabolite pharmacokinetic data, and presents novel data on plasma levels of the metabolite trans‐3′‐hydroxycotinine in people.
Frequency and characteristics of hospital admissions associated with drug‐related problems in paediatrics
Authors: Easton Kylie L. , Chapman Colin B. , Brien Jo‐anne E. 
Published: December 2004

AimTo determine the frequency of paediatric hospital admissions associated with drug‐related problems (DRPs) at two Australian hospitals.MethodsThe investigator and ward pharmacists prospectively screened eligible patients. A multidisciplinary panel reviewed data and established causality, preventability and clinical significance classifications.ResultsOver 22 weeks of data collection, a total of 11 564 patients were admitted, 2933 met eligibility criteria. Of those eligible, 127 [4.3%, 95% confidence interval (CI) 3.6, 5.0] were judged to have hospital admissions associated with DRPs. Direct costs associated with DRPs identified totalled £100 707. Of the 81 cases assessed for preventability, 46.9% were deemed preventable.ConclusionsThis research has provided information on the nature and characteristics of paediatric DRPs associated with hospital admissions.
Novel FLT3 point mutations within exon 14 found in patients with acute myeloid leukaemia
Authors: Stirewalt Derek L. , Meshinchi Soheil , Kussick Steven J. , Sheets Kayla M. , Pogosova‐Agadjanyan Era , Willman Cheryl L. , Radich Jerald P. 
Published: December 2004

SummaryInternal tandem duplications in FLT3 are the most common mutation in acute myeloid leukaemia (AML), with agarose gel electrophoresis of polymerase chain reaction products (PCR/agarose) being the screening method of choice for these mutations. As PCR/agarose screening does not detect small mutations, single‐stranded conformational polymorphism analyses (PCR/SSCP) were used in an attempt to identify previously unrecognized point mutations in FLT3 exons 14 and 15 of 140 AML patients, using newly designed primers that anneal within intron sequences. Novel missense point mutations were found in exon 14, suggesting additional investigations should be performed in AML and other haematopoietic malignancies, using this sensitive technique.
Percutaneous vertebroplasty for acute vertebral body fracture and deformity in multiple myeloma: a short report
Authors: Diamond Terrence H. , Hartwell Tabitha , Clarke William , Manoharan Arumugam 
Published: December 2004

SummaryWe describe seven patients with multiple myeloma who were treated for acute vertebral body fractures with percutaneous vertebroplasty to a total of 14 vertebrae. Six of the seven patients had at least a 50% decrease in their pain scores at 24 h following vertebroplasty. There were no procedure‐related complications. These encouraging results prompt us to suggest further large‐scale evaluation of this procedure in myeloma patients.