bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreased renal sympathetic activity in response to cardiac unloading with nitroglycerin in patients with heart failure*
Authors: Petersson Magnus , Friberg Peter , Lambert Gavin , Rundqvist Bengt 
Published: April 2005

AbstractAims:To examine changes in renal sympathetic outflow in response to cardiac unloading with nitroglycerin (GTN) in patients with chronic heart failure (CHF) and healthy subjects (HS).Methods and Results:Renal (RNAsp) and total body (TBNAsp) noradrenaline (NA) spillover were measured with radiotracer methods in 16 patients with CHF (50±3 years, LVEF 20±1%) and nine HS (57±2 years) during right heart and renal vein catheterisation. Low dose GTN decreased mean pulmonary artery pressure (PAm: CHF −7±2 mm Hg, HS −4±1 mm Hg, p<0.05 vs. baseline) but not mean arterial pressure (MAP: CHF −2±1 mm Hg, HS −2±1 mm Hg) and did not affect RNAsp in any of the study groups. High dose GTN lowered MAP (CHF −12±1 mm Hg, HS −12±2 mm Hg, p<0.05 vs. baseline) and PAm (CHF −13±2 mm Hg, HS −5±1 mm Hg, p<0.05 vs. baseline) and was accompanied by a significant reduction in RNAsp only in CHF (1.3±0.1 nmol/min baseline to 0.9±0.2 nmol/min, p<0.05), whereas RNAsp in HS remained unchanged.ConclusionsIn spite of a reduction in both arterial pressure and cardiac filling pressures, renal sympathetic activity decreased in CHF and did not increase in HS. These findings suggest that the altered loading conditions resulting from high‐dose GTN infusion have renal sympathoinhibitory effects.
Multi‐site‐frequency electromechanocardiography for the prediction of ejection fraction and stroke volume in heart failure
Authors: Skrabal Falko , Mayer Harald , Hopfgartner Elke , Gratze Gerfried , Haitchi Gerhard , Holler Albert 
Published: April 2005

AbstractBackground:Methods for stroke volume (SV) and ejection fraction (EF) measurements require the presence of qualified physicians and are not suited for continuous monitoring.Aim:To develop an automated non‐invasive method for the measurement and continuous monitoring of SV and EF.Methods:We have designed a method for the measurement of EF and SV using multiple‐site‐impedance (z0) measurements, applying multiple frequencies of 5, 40 and 200 kHz whereby various segments of the human body, including volume changes within these segments, could be defined electrically. The obtained variables were used to train neuronal nets and related by multiple regression analyses to cardiac output (CO) as measured by a partial rebreathing Fick method (COr‐fick) or EF as measured by echocardiography (EFecho), respectively. A total of 129 subjects (48 with normal heart function and 81 with CHF, NYHA I–IV) were investigated.Results:The multiply derived values of z0 and of change of impedance (dz/dt) were shown, by multiple regression analysis, to be significantly related to COr‐fick and to EFecho, (total r=0.77, n=35, p<0.001, and r=0.81, n=47, p<0.001, respectively.). By training a neuronal net with the electrical data of 67 (out of 94) subjects, EFecho could be predicted in the remaining 27 subjects which were unknown to the neuronal net with a combined r=0.71 (p<0.001,n=27). In contrast, conventional impedance cardiography (ICG) was unable to predict either COr‐fick or EFecho.Conclusion:The new method, which we call multi‐site‐frequency electromechanocardiography (msf‐ELMC) appears promising for the automated electrical measurement of the mechanical heart action in patients with normal and reduced cardiac function.
Inflammation and perturbation of the l‐carnitine system in heart failure
Authors: Vescovo Giorgio , Ravara Barbara , Gobbo Valerio , Libera Luciano Dalla 
Published: April 2005

AbstractBackground:Heart failure (HF) is accompanied by elevated levels of pro‐inflammatory cytokines. Skeletal muscle myopathy with atrophy of fibres, decreased oxidative metabolism and preferential synthesis of fast myosin heavy chains (MHCs) occurs, which contributes to the worsening of symptoms. l‐Carnitine has been shown to be protective against the apoptosis‐induced atrophy of fibres and fast MHCs shift.Aims:To investigate the interrelationship between TNFα and sphingosine (SPH), which induce muscle wastage, and plasma levels of l‐carnitine.Methods:We studied 18 heart failure patients and correlated NYHA class and ventricular function with the plasma concentration of these molecules.Results:TNFα and SPH levels were raised and correlated with the severity of HF. l‐Carnitine levels were increased in HF patients, but decreased according to the severity of cardiac decompensation.Conclusions:The increased levels of l‐carnitine are likely due to release from the damaged muscle, reduced urinary excretion, decreased dietary intake and liver synthesis (malnutrition). It is possible that the cytokine‐induced muscle wastage is not counterbalanced by the beneficial metabolic effects of l‐carnitine, the metabolism of which is profoundly perturbed in CHF. l‐Carnitine supplementation may produce positive effects on the skeletal muscle, as has been shown in animal models of HF.
Incidence of normal values of natriuretic peptides in patients with chronic heart failure and impact on survival: A direct comparison of N‐terminal atrial natriuretic peptide, N‐terminal brain natriuretic peptide and brain natriuretic peptide
Authors: Hülsmann Martin , Berger Rudolf , Mörtl Deddo , Gore Odette , Meyer Brigitte , Pacher Richard 
Published: April 2005

AimsN‐ANP, N‐BNP and BNP are proven to be excellent markers for diagnosis and the prediction of outcome in heart failure patients. Published studies on this subject differ in respect of their design and are therefore difficult to compare. The EuroHeart Failure Survey was undertaken to evaluate the drug prescription rate; the cohort of this survey best reflects clinical practice. The purpose of the present study was to compare the three hormones in clinical practice for the purpose of diagnosis and the prediction of outcome. Attention was focused on patients with normal values and the implications of these on survival.Methods and resultsOf 341 patients recruited in the Austrian centers of the survey, blood samples for the determination of N‐ANP, N‐BNP and BNP were taken from 112 patients. Mortality within the observation period was defined as the endpoint. Normal levels of the hormones were found in 5% of cases for N‐ANP, 25% for N‐BNP and 30% for BNP. The mortality of patients with normal values was low (0%, 3% and 6%, respectively) and occurred late (after more than 23 months). Above‐median levels of all three hormones resulted in a comparable mortality (51% survival for N‐ANP, 50% for BNP and 49% for N‐BNP).ConclusionsIn a clinical setting, the risk stratification for outcome is similar for N‐ANP, N‐BNP and BNP. More importantly, all hormones are reliable parameters to diagnose CHF using normal values as a cut‐point. However, N‐ANP appears to be more sensitve than BNP or N‐BNP.
Temperament and character in primary insomnia
Authors: de Saint Hilaire Zara , Straub Judith , Pelissolo Antoine 
Published: April 2005

AbstractRecent studies by Cloninger suggest that the temperament dimension of harm avoidance might be related to serotonergic activity. Since serotonergic mechanisms equally play a major role in sleep regulation, we decided to use Cloninger’s psychobiological model of temperament and character to assess whether there is a link between psychophysiologic insomnia and specific personality traits. Chronic insomnia is a common complaint in modern society, and it is still controversial whether insomniacs share specific personality traits. Thirty-two chronic insomniacs (<50 years) were studied. They underwent polysomnography for two consecutive nights and filled out the 226-item self-questionnaire of Temperament and Character Inventory as well as the Hospital Anxiety and Depression scale. (1) Harm avoidance for all subscores was significantly higher in insomniac patients when compared with controls; (2) self-directedness scores were lower in insomniacs; (3) sleep latency was positively correlated to harm avoidance; (4) HA1 (anticipatory worry) was negatively correlated to REM latency. Temperament and Character Inventory is a useful tool in the investigation of chronic insomnia. Serotonergic mechanisms might explain the high incidence of harm avoidance as personality trait in psychophysiologic insomniac patients. Further studies are needed to see whether harm avoidance could be a psychological vulnerability marker for primary insomnia and be used as predictor of SSRI treatment responders.
READING AND (RE)WRITING CLASS: ELIZABETH GASKELL'SWIVES AND DAUGHTERS
Authors: Boiko Karen 
Published: April 2005

His anatomy was philosophic, or transcendent, becausetranscendingthe vision of the eye, it had the vision of the mind, seeing what the eye alone could never see.—G. H. Lewes, “Life and Doctrine of Geoffroy St. Hilaire”Scientific material does not have clear boundaries once it enters literature.—Dame Gillian Beer,Open Fields
Trends and Contrasts
Authors: Niedermayer Oskar 
Published: April 2005

AbstractBefore one can embark on an analysis of the factors which affect public support for European Community integration, one must take a high‐level view of the main trends in such support. This is the primary purpose of this chapter. It also examines some of the macro‐level hypotheses which have been put forward to explain variations in public opinion between countries. It concludes with a discussion of the impact on public opinion of one particularly salient event: the signing of the Maastricht Treaty.
Trust and Sense of Community
Authors: Niedermayer Oskar 
Published: April 2005

AbstractThis chapter begins with an explication of mutual trust as an element in Deutsch's concept of ‘sense of community’, and then examines how far it applies to the context of individual citizens’ perceptions of the European Community. It first presents an aggregate‐level analysis of the average level of trust in the people of other member countries of the EC, the salience of these other people, and the uniformity or diversity with which they are evaluated. This part of the analysis focuses on whether it is possible to speak of a sense of community within the EC and whether this sense is increasing over time. Secondly, it presents an individual‐level analysis examining the average level of trust which individuals in a particular country have in the peoples of the other member states taken as a whole, the salience of these other peoples, and the uniformity or diversity of these evaluations. This part focuses on the factors which influence individual levels of trust in the other peoples of the EC, and attempts to identify the groups which are fostering the development of a sense of community.
NATO, the European Community, and the United Nations
Authors: Everts Philip 
Published: April 2005

AbstractThe analysis of public attitudes towards NATO, the EC, and the UN throws light on two key questions concerning public opinion and internationalized governance: first, whether public support for an agency of internationalized governance can withstand fundamental contextual change, amounting even to changes in the very mission of the agency; second, whether there exists a single continuum of internationalized governance, corresponding to the degree of authority transferred to the agency, or whether attitudes and orientations are multi dimensional, depending on the issues involved. This chapter examines whether attitudes towards NATO, the EC, and the UN belong to one and the same dimension of attitudes towards internationalized governance, or represent distinct and separate dimensions.
Nitrite‐induced methaemoglobinaemia – aetiology, diagnosis and treatment
Authors: Chui J. S. W. , Poon W. T. , Chan K. C. , Chan A. Y. W. , Buckley T. A. 
Published: April 2005

SummaryA 41‐year‐old woman presented with the clinical features of methaemoglobinaemia after drinking Chinese herbal medicine. A life threatening methaemoglobin level of 68% was measured. Both clinical and laboratory diagnostic difficulties were encountered. The pitfalls of pulse oximeter, blood gas analysis and co‐oximeter interpretation during diagnosis and after methylene blue administration are discussed.
Effect of low dose inhaled anaesthetic agents on the ventilatory response to carbon dioxide in humans: a quantitative review
Authors: Pandit J. J. 
Published: April 2005

SummaryThis paper reviews published studies (identified by a Medline‐assisted search) on the effect of ≤ 0.2 minimum alveolar concentration inhaled anaesthetic agents on the hypercapnic ventilatory response in healthy subjects. Each article was examined for the anaesthetic agent used, whether CO2 was administered using a rebreathing or a steady state (step hypercapnia) technique, and subject arousal (by audiovisual stimulation or by pain). Analysis of variance was used to assess the influence of each of these factors on the standardised hypercapnic response (the hypercapnic ventilatory response in l.min−1.kPa−1 in the presence of anaesthetic, expressed as a fraction of the response without anaesthetic). There were 21 separate studies embedded within 14 published articles. When considered together, the effect of anaesthetics on the hypercapnic ventilatory response was not significant (p = 0.089). Furthermore, when each agent was considered separately, no agent alone had a significant effect on the hypercapnic response. Neither subject arousal (p = 0.396) nor the method used to induce hypercapnia (p = 0.625) had any significant influence on the response. This suggests that the hypercapnic response is more resistant to the effects of anaesthetics than the hypoxic ventilatory response. These results indicate areas for future work. It would seem important to identify the cellular mechanisms which might underlie the difference in hypercapnic and hypoxic responses, and possible ways in which subject arousal might interact in the brain with the chemoreflexes.
Appropriate cuff volumes of the Laryngeal Tube
Authors: Asai T. , Shingu K. 
Published: April 2005

SummaryThe manufacturer of the Laryngeal Tube (VBM, Germany) states that the cuffs should be inflated until the intracuff pressure reaches 60 cmH2O or with a certain volume of air (60 ml for the size 3 and 80 ml for size 4). We studied 100 patients to investigate this. In addition, we examined whether the patient's height or weight could be a predictor of the required volume. Following insertion of a laryngeal tube, the cuff volume at the intracuff pressure 60 cmH2O was measured. The mean (SD) volume was 62 (7.2) ml for size 3 and 84 (11.2) ml for size 4. There was a correlation between the height of the patient and the cuff volume (correlation coefficient = 0.64; p < 0.01; volume (ml) = −86.5 + 1.02 height (cm)), and between the patient's weight and the cuff volume (correlation coefficient = 0.37; p < 0.01; volume (ml) = 45.3 + 0.558 weight (kg)). The required volume for size 3 was < 60 ml in nine of 27 patients (33%), and for size, 4 < 80 ml in 20 of 73 patients (27%). Our results support the manufacturer's recommended cuff volumes, but if the cuff is inflated with these fixed volumes (60 ml and 80 ml), the cuff would be overinflated in one‐third of patients, increasing the theoretical risk of ischaemic changes to the oropharynx. Since the cuff volume is correlated with the patient's height or weight, the cuff volume should be adjusted to the patients' stature.
Paradoxical embolism through a patent foramen ovale: an unexpected complication of tracheal extubation
Authors: Turley A. J. , Thambyrajah J. , Clarke F. L. , Stewart M. J. 
Published: April 2005

SummaryA 41‐year‐old male with insulin‐dependent diabetes mellitus was admitted for an elective arthroscopic release of adhesive capsulitis of his left shoulder. At the end of the surgical procedure, he appeared to regain consciousness but then became unresponsive at the time of tracheal extubation after a violent bout of coughing, developing bilateral up‐going plantar responses, decorticate posturing and abnormal pupillary reflexes. He was transferred to the intensive care unit. The following day, the patient made a full neurological recovery. Contrast echocardiography, performed using agitated saline delivered through a femoral venous line, revealed a large patent foramen ovale with evidence of right to left shunting. In the absence of risk factors for air embolism, the clinical diagnosis was one of paradoxical embolism of venous thrombus resulting in brain stem ischaemia. The patient was commenced on life‐long aspirin to minimise future embolic risk.
A comparison of direct laryngoscopy and jaw thrust to aid fibreoptic intubation*
Authors: Stacey M. R. , Rassam S. , Sivasankar R. , Hall J. E. , Latto I. P. 
Published: April 2005

SummaryWe compared two manoeuvres, jaw thrust and laryngoscopy, to open the airway during fibreoptic intubation in 50 patients after induction of anaesthesia in a crossover study. Patients were randomly allocated to receive either jaw thrust or conventional Macintosh laryngoscopy first. Airway clearance was assessed at both the soft palate and the epiglottis. Direct laryngoscopy provided significantly better airway clearance at the level of the soft palate than jaw thrust (44 (88%) vs 31 (62%), respectively; p = 0.002). At the level of the larynx, airway clearance was equally good in both groups (45 (90%) vs 46 (92%), respectively; p = 0.56). The times to view the larynx (median (interquartile range [range]) 4 (3–5 [2–35]) s vs 3 (3–4 [2–8]) s, respectively) and intubation time (20 (17–23 [11–83]) s vs 18 (15–20 [11–28]) s, respectively) were also similar.
The effect of high altitude commercial air travel on oxygen saturation
Authors: Humphreys S. , Deyermond R. , Bali I. , Stevenson M. , Fee J. P. H. 
Published: April 2005

SummaryAir travel has increased steadily over the last decade, and its effect on the health of passengers has been the subject of much debate. There is a paucity of evidence on the effects of air travel on oxygen saturation in general populations. The peripheral oxygen saturation and pulse rate of 84 passengers, aged 1–78 years, were measured by pulse oximetry at round level and altitude during air travel. There was a statistically significant reduction in oxygen saturation in all passengers travelling long haul and short haul flights (p < 0.05). The mean [range] (SD) SpO2 for all flights at ground level was 97% [93–100] (1.33) and at cruising altitude 93% [85–98] (2.33). Fifty‐four per cent of passengers had SpO2 values of 94% or less at cruising altitude. This is a value which may prompt physicians to administer supplemental oxygen in hospital patients.
Mortality from percutaneous dilatational tracheostomy. A report of three cases*
Authors: McCormick B. , Manara A. R. 
Published: April 2005

SummaryWe report three deaths following percutaneous dilatational tracheostomy in a series of 1187 procedures undertaken in a single intensive care unit over a 13‐year period. All deaths were due to severe haemorrhage. The first patient died during the procedure from uncontrollable haemorrhage from the innominate vein. Delayed haemorrhage in the other two patients was caused by the tracheostomy tube eroding into the aorta in one patient and into the innominate vein in the other. In both these patients, the tracheal stoma was found at postmortem to be sited unexpectedly low. Fatal haemorrhage is a rare complication of percutaneous tracheostomy (0.25% in this series), but is probably under‐reported. While bronchoscopy is now used routinely during percutaneous tracheostomy insertion in most units, we speculate that ultrasound examination of the neck is more likely to identify major vascular structures at risk. However, whilst intuitive, there is little evidence that either bronchoscopy or ultrasound scanning reduces the incidence of complications. Magnetic resonance images of normal subjects are presented to demonstrate the anatomical relations of the trachea to major vascular structures and their variability.
Role of electrophysiological study and ablation in the management of recurrent atrial flutter associated with haemodynamic compromise in a critically ill patient
Authors: Kojodjojo P. , Kanagaratnam P. , Davies D. W. , Peters N. S. , Markides V. 
Published: April 2005

SummaryAtrial flutter is a common arrhythmia. In the critical care setting, the arrhythmia may present in any patient, but it is most commonly seen in patients with impaired ventricular function, valvular disease, atrial dilatation or after cardiac surgery. We present a 68‐year‐old lady with recurrent poorly tolerated atrial flutter that was resistant to multiple pharmacological interventions and complicated by cardiogenic shock following direct current cardioversion. The flutter was successfully cured with radiofrequency ablation and was followed by an immediate improvement in her haemodynamic status. We review the management of acute atrial flutter and discuss the role of electrophysiologically guided ablation.
Management of subarachnoid haemorrhage in a non‐neurosurgical centre
Authors: Wilson S. R. , Hirsch N. P. , Appleby I. 
Published: April 2005

SummarySubarachnoid haemorrhage is a common neurological emergency, which carries a high morbidity and mortality. It is usually caused by rupture of an intracerebral aneurysm or, less commonly, an arteriovenous malformation. Although most patients present to a non‐neurosurgical hospital, they often require urgent neurosurgical or neuroradiological intervention. Whilst awaiting transfer to a neurological centre, active management of the patient must be instituted. This should include confirmation of the diagnosis with CT imaging, lumbar puncture or both, and recognition of the complications of subarachnoid haemorrhage, which include hydrocephalus, further haemorrhage and cerebral vasospasm. Medical management is directed towards maintaining adequate cerebral perfusion pressure whilst avoiding large increases in arterial blood pressure. Nimodipine therapy must be started early in an attempt to prevent cerebral vasospasm. The treatment options available at the neurological centre include surgical treatment or endovascular obliteration of the aneurysm or arteriovenous malformation.
Evaluation of a non‐invasive method of assessing opioid induced respiratory depression
Authors: Pattinson K. T. S. , Bowes M. , Wise R G. , Parkes M. J. , Morrell M. J. 
Published: April 2005

SummaryOpioid induced respiratory depression is potentially fatal. The aim of this study was to validate a monitoring system that could be used to assess respiratory depression in postoperative patients. The hypercapnic ventilatory response was estimated non‐invasively in 12 volunteers. In two steps, we tested a system which delivered carbon dioxide (CO2) challenges through a venturi mask, measuring changes in ventilation with an uncalibrated respiratory inductance plethysmograph (RIP). RIP and pneumotachograph measurements of ventilation, taken at the same time during a CO2 challenge, were similar; group mean (SD), pneumotachograph 13.9 (3.5) l.min−1.kPa−1, RIP 14.3 (2.9) l.min−1.kPa−1. Bland–Altmann analysis showed the variation between these two methods was ± 5 l.min−1.kPa−1 (2 SD). Second, we confirmed that the venturi mask is suitable for delivering CO2 challenges. Despite the variability in RIP measurements, a simple multimodal respiratory monitoring system could be developed that incorporates clinical observation and non‐invasive measurement of the ventilatory response to CO2.