bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scaphotrapeziotrapezoid (STT)-Arthrodesis in Kienböck’s Disease
Authors: MEIER R. , VAN GRIENSVEN M. , KRIMMER H. 
Published: August 2004

This study reviews the results of 59 of 84 patients with severe Kienböck’s disease who were treated with STT fusion. The average follow-up period was 4 (ranges: 2–8) years. The average arc of wrist extension and flexion was 67° (60% of the contralateral side, 81% of pre-operative range) and that of ulnar and radial deviation was 31° (52% of the contralateral side, 56% of pre-operative range). Pre-operative pain values (VAS) were 56 (non-stress) and 87 (stress) and were significantly higher than the postoperative values of 12 (non-stress) and 41 (stress). Grip strength improved from 45 kPa pre-operatively to 52 kPa postoperatively. The mean modified Mayo wrist score was 63 points. The patients reported low disability in the DASH scores, with an average of 28 points. Our data show that STT fusion is a reliable and effective treatment for pain relief and offers a good functional result in advanced stages of Kienböck’s disease. However the long-term effect of this procedure on radioscaphoid and other intercarpal joints is yet to be determined.
Motion‐based tendon diagnosis using sequence processing of ultrasound images
Authors: Ofer Nir , Akselrod Solange , Nyska Meir , Werner Miriam , Glaser Ernesto , Shabat Shay 
Published: August 2004

AbstractDegenerative or pre‐degenerative processes in the tendon, which could lead to a spontaneous rupture, are well known problems, especially among athletes. Existing non‐invasive diagnostic methods are mainly based on subjective analysis of static images of the tendon, but in many cases the degeneration cannot be diagnosed in time. Combining a set of existing image processing techniques, a tool for tracking the in vivo motion of a tendon imaged with dynamic ultrasound was implemented.A group of subjects that had undergone a degenerative rupture of their Achilles tendon, one subject with a traumatic rupture, and a group of control subjects were all tested. Using the motion information that was obtained from both tendons of all subjects, we developed an automatic test that examines the symmetrical properties of the tendon's motion, and defined a negative asymmetry property that could be quantified as a score.This score was found to be significantly more enhanced in the post‐operative tendons (18.0 ± 19.0) than in the contra‐lateral healthy tendons of the same subjects (3.9 ± 4.6). In the single traumatic rupture subject, this effect was not found (0.0). This leads us to believe that the negative asymmetry of tendon motion may be associated with degenerative or pre‐degenerative processes in the tendon. Also, the mean degree of negative asymmetry in the healthy tendons of post‐operative subjects (3.9 ± 4.6) was found to be higher than that of healthy tendons of the control group (1.5 ± 1.8). This finding may be associated with the fact that tendons that are contra‐lateral to spontaneously ruptured tendons have a higher risk of developing degenerative processes. The method presented here is objective, low‐cost, non‐invasive and possibly more sensitive than existing non‐invasive techniques. © 2004 Orthopaedic Research Society. Published y Elsevier Ltd. All rights reserved.
Changes in mothers' basic beliefs following a child's bone marrow transplantation: The role of prior trauma and negative life events
Authors: Rini Christine , Manne Sharon , DuHamel Katherine N. , Austin Jane , Ostroff Jamie , Boulad Farid , Parsons Susan K. , Martini Richard , Williams Sharon , Mee Laura , Sexson Sandra , Redd William H. 
Published: August 2004

AbstractThis longitudinal study examined the relation between life stress and basic beliefs about self‐worth and the benevolence and meaningfulness of the world among mothers of children undergoing bone marrow transplantation (BMT). One hundred mothers completed study measures during the child's hospitalization for BMT and 1 year later. Prior trauma and recent negative events were associated with basic beliefs during hospitalization and also with changes in basic beliefs in the subsequent year, with distress mediating some of these relations. Findings also demonstrated relations between basic beliefs and physical and mental functioning. However, each basic belief exhibited different relations with study variables, suggesting the need to investigate them separately.
Residents lack knowledge and practical skills in handling the difficult airway
Authors: Rosenstock C. , Østergaard D. , Kristensen M. S. , Lippert A. , Ruhnau B. , Rasmussen L. S. 
Published: August 2004

Background:  Full‐scale simulators have been developed in anaesthesia. We aimed at assessing Danish anaesthesia residents' knowledge and management of a standardized difficult airway situation in an advanced airway simulator. The reliability of the assessment was also determined.Methods:  Thirty‐six residents answered a questionnaire testing their knowledge on difficult airway management and practice patterns. Secondly, all residents attempted management of a standardized ‘cannot ventilate, cannot intubate’ airway scenario. Three observers independently assessed a video recording of the performance.Results:  Only 17% of the residents passed the written test. Ninety‐seven per cent stated that they had difficulties recalling the American Society of Anesthesiologists'(ASA) difficult airway algorithm and 53% did not know how to oxygenate through the cricothyroid membrane. Seventeen per cent had previously been involved in emergency situations with severe complications due to insufficient airway management. In the scenario 75% of the residents established ventilation using a laryngeal mask airway. After establishing ventilation, 26% would continue with surgery without a definitive airway, despite the risk of aspiration. Analysis of the interobserver agreement showed good (Κ = 0.63) to excellent (Κ = 0.78) consistency for objective parameters in the scoring scheme. Inter‐observer reliability was satisfactory (R = 0.43) for trained Crisis Resource Management evaluators.Conclusions:  Theoretical and practical education in difficult airway management needs to be improved among Danish anaesthesia residents. Simulator assessment should only be performed using well‐defined objective parameters and trained assessors.
Acute acalculous cholecystitis in critically ill patients
Authors: Laurila J. , Syrjälä H. , Laurila P. A. , Saarnio J. , Ala‐Kokko T. I. 
Published: August 2004

Background:  Acute acalculous cholecystitis (AAC) is a serious complication of critical illness. We evaluated the underlying diseases, clinical and diagnostic features, severity of associated organ failures, and outcome of operatively treated AAC in a mixed ICU patient population.Methods:  The data of all ICU patients who had operatively confirmed AAC during their ICU stay between 1 January 2000 and 31 December 2001 were collected from the hospital records and the intensive care unit's data management system for predetermined variables.Results:  Thirty‐nine (1%) out of 3984 patients underwent open cholecystectomy for AAC during the two‐year period. Infection was the most common admission diagnosis, followed by cardiovascular surgery. The mean APACHE II score on admission was 25, and 64% of the patients had three or more failing organs on the day of cholecystectomy. The mean length of ICU stay before cholecystectomy was 8 days, and the mean total length of ICU stay was 19 days. Most patients (85%) received norepinephrine infusion, and 90% suffered respiratory failure before cholecystectomy. Hospital mortality was 44%. The non‐survivors had higher Sequential Organ Failure Assessment (SOFA) scores on the day of cholecystectomy compared to the survivors (12.9 vs. 9.5, P = 0.007).Conclusion:  Acute acalculous cholecystitis was associated with severe illness, infection, long ICU stay, and multiple organ failure. Mortality was related to the degree of organ failure. Prompt diagnosis and active treatment of AAC can be life‐saving in these patients.
Dobutamine compensates deleterious hemodynamic and metabolic effects of vasopressin in the splanchnic region in endotoxin shock
Authors: Martikainen T. J. , Uusaro A. , Tenhunen J. J. , Ruokonen E. 
Published: August 2004

Background:  Vasopressin is a potent vasopressor in septic shock, but it may impair splanchnic perfusion. We compared the effects of vasopressin alone and in combination with dobutamine on systemic and splanchnic circulation and metabolism in porcine endotoxin shock.Methods:  Twelve pigs were randomized to receive either vasopressin (VASO, n = 6) or vasopressin in combination with dobutamine (DOBU, n = 6) during endotoxin shock (E. coli endotoxin infusion). Endotoxin infusion rate was increased to induce hypotension after which vasoactive drugs were started. We aimed to keep systemic mean arterial pressure (MAP) >70 mmHg by vasopressin; the goal of dobutamine infusion was to prevent decrease in cardiac output often associated with vasopressin infusion. Regional blood flows, oxygen delivery and consumption, arterial and regional lactate concentrations were measured.Results:  Mean arterial pressure >70 mmHg was achieved in both the VASO and DOBU groups. After the primary decrease of cardiac output by vasopressin, systemic blood flow remained stable in vasopressin‐treated animals. However, vasopressin as a monotherapy decreased portal venous blood flow. This was prevented by dobutamine. Vasopressin also induced splanchnic lactate release and arterial hyperlactatemia, which were not observed when dobutamine was combined with vasopressin.Conclusion:  Dobutamine prevents adverse hemodynamic and metabolic effects of vasopressin in septic shock.
Effect of cardiopulmonary bypass on pulmonary clearance of adrenomedullin in humans
Authors: Kamei M. , Hayashi Y. , Kikumoto K. , Kawai Y. , Kangawa K. , Kuro M. , Minaminoals N. 
Published: August 2004

Background:  Adrenomedullin is a potent vasodilatory peptide and its plasma concentration increases after cardiopulmonary bypass. We analyzed the contribution of the lung to the disposition of adrenomedullin before and after cardiopulmonary bypass in humans.Methods:  Thirty‐five patients undergoing cardiac surgery with cardiopulmonary bypass were studied. Bloods were sampled from the pulmonary artery and left atrium at the following times: prior to systemic heparinization, during pulmonary reperfusion and after cardiopulmonary bypass. Plasma concentrations of total and mature adrenomedullin were measured using an immunoradiometric assay kit specific for human adrenomedullin. Intermediate adrenomedullin was calculated as the difference between total adrenomedullin and mature adrenomedullin.Results:  Before cardiopulmonary bypass, mature and intermediate adrenomedullin concentrations were reduced by the pulmonary circulation by approximately 30% and 20%, respectively. However, these effects were not observed during pulmonary reperfusion. Mature, but not intermediate, adrenomedullin was reduced after cardiopulmonary bypass. Furthermore, pulmonary clearance quantity of mature adrenomedullin was significantly enhanced after cardiopulmonary bypass.Conclusion:  These results indicate that cardiopulmonary bypass temporally impairs the pulmonary clearance of mature and intermediate adrenomedullin, but clearance of mature, not intermediate adrenomedullin is enhanced after cardiopulmonary bypass.
Chromosome instability in T‐cells cultured in the presence of pancuronium or fentanyl
Authors: Delogu G. , Antonelli A. , Signore M. , Marcucci L. , Petrinelli P. , Tellan G. , Antonucci A. , Elli R. 
Published: August 2004

Background:  Genomic instability is recognized as a cause of cellular apoptosis and certain drugs that exhibit a proapoptotic effect are also able to induce chromosome damage. Since we found in recent experiments that drugs such as pancuronium and fentanyl exerted an apoptogenic effect on T cells, we studied the capacity of those agents to promote chromosome instability, i.e. chromosome aberrations (CA) and telomeric associations (tas) in peripheral blood lymphocytes.Methods:  Lymphocytes from healthy donors were cultured with pancuronium or fentanyl, using two different concentrations for each drug: 20 and 200 ng/ml for pancuronium and 10 and 30 ng/ml for fentanyl, respectively. Cells were exposed to each concentration of these drugs either for 24 or 48 h. The higher concentration chosen was the same at which we detected the proapoptotic effect in our previous works. Cytogenetic analysis was performed by means of a standard technique and chromosome aberrations or telomeric associations were blindly evaluated by two independent observers.Results:  The chromosome aberrations we observed in treated cells were not significantly different from control lymphocytes. However, an unusual rate of telomeric associations (P < 0.001) was detected in cells exposed to both pancuronium and fentanyl, at each concentration tested and at each exposure time of the study.Conclusions:  Fentanyl and pancuronium do not have a direct clastogenic effect on T cultures, but at the same concentrations at which we demonstrated their apoptogenic power, these drugs are able to increase genomic instability through inducing an elevated rate of telomeric associations. Such a capacity could exploit in peripheral T cells the same mitochondrion‐mediated signal pathway of apoptosis death.
Primary sepsis in a university hospital in northern Sweden: A retrospective study
Authors: Jacobson S. , Johansson G. , Winsö O. 
Published: August 2004

Background:  Severe sepsis and septic shock are associated with high mortality rates. Data on sepsis outcome from Scandinavian countries are sparse. The aim of this study was to examine the length of stay (LOS) in the ICU, ICU mortality and costs of care for adult patients with primary sepsis in a university hospital in northern Sweden.Methods:  We performed a retrospective data analysis of records of 92 patients admitted over a 3‐year period, under the diagnosis of sepsis or urosepsis. Demographic data, admission category, APACHE II score, aetiology and severity of sepsis, ICU LOS, mortality and TISS were analyzed.Results:  Eighty‐one adult patients were identified by standard definitions as suffering from sepsis. The median ICU length of stay was 4.2 days, 6 days for survivors and 2.1 days for non‐survivors. Thirteen out of 20 deaths occurred within the first 3 days after admission. Overall ICU mortality rate was 24.7% while the ICU mortality for patients with septic shock was 57.7%. The mean costs of care for patients with sepsis were 3139 Euros day−1 and the cost of care per patient surviving sepsis was 38 494 Euros.Conclusion:  The incidence of primary sepsis in our ICU was low. Previous reports on high mortality in association with severe sepsis and septic shock are valid also at our hospital. The ICU‐LOS was shorter than previously reported, while our costs of care were in the same range as stated by others. This retrospective analysis is valid for interpretation of the applicability of currently available sepsis therapies.
Hyperoxic ventilation at the critical hematocrit: Effects on myocardial perfusion and function
Authors: Kemming G. I. , Meisner F. G. , Meier J. , Tillmanns J. , Thein E. , Eriskat J. , Habler O. P. 
Published: August 2004

Background:  Hemodilution reduces hematocrit (Hct) and blood oxygen content. Tissue oxygenation is mainly preserved by increased cardiac output. As myocardial O2‐demands increase, coronary vasodilatation becomes necessary to increase myocardial blood flow. Myocardial ischemia occurs at a critical Hct‐value (Hctcrit), with accompanying exhaustion of coronary reserve. Hyperoxic ventilation is known to both reverse peripheral tissue hypoxia at Hctcrit and also to induce coronary vasoconstriction. This study aimed to determine whether hyperoxic ventilation at Hctcrit further exacerbates myocardial ischemia and dysfunction.Methods:  Nine anesthetized pigs ventilated on room air were hemodiluted by 1 : 1 exchange of blood with pentastarch (6%HES) to Hctcrit , defined as onset of myocardial ischemia (ECG changes). At Hctcrit , hyperoxic ventilation was started. Measurements were performed at baseline, at Hctcrit, and after 15 min of hyperoxic ventilation. We determined myocardial blood flow (microsphere method), arterial O2‐content, subendocardial O2‐delivery and myocardial function (left ventricular pressure increase).Results:  At Hctcrit 7 (6;8)%, O2‐content was reduced [3.7 (3.1;3.9) ml dl−1]. Despite a compensatory increase of myocardial blood flow [531 (449;573), ml min−1100 g−1], all pigs displayed myocardial ischemia and compromised myocardial function (P < 0.05). Hyperoxic ventilation produced increased coronary vascular resistance secondary to vasoconstriction, and reduced myocardial blood flow [426 (404;464), ml min−1100 g−1; P < 0.05]. Myocardial oxygenation was found to be maintained by increased O2‐content [4.4 (4.2;4.8), ml dl−1; P < 0.05], the contribution of dissolved O2 to subendocardial O2‐delivery increased (32 vs. 8%; P < 0.05), which preserved myocardial function.Conclusion:  Hyperoxic ventilation at Hctcrit is followed by coronary vasoconstriction and reduction of coronary blood flow. However, myocardial oxygenation and function is maintained, as increased O2‐content (in particular dissolved O2) preserves myocardial oxygenation.
Comparative analysis of in vitro contracture tests with ryanodine and a combination of ryanodine with either halothane or caffeine: a comparative investigation in malignant hyperthermia
Authors: Bendahan D. , Guis S. , Monnier N. , Kozak‐Ribbens G. , Lunardi J. , Ghattas B. , Mattei J‐P. , Cozzone P. J. 
Published: August 2004

Background:  The diagnosis of susceptibility to malignant hyperthermia (MH) is currently performed on muscle biopsies subjected to halothane‐caffeine in vitro contracture tests (IVCTs). There is a consensus on our need to improve the diagnostic potential of IVCTs if we are to maximize the information available for research and diagnosis in MH. This study was designed as a pilot comparative study and we aimed at comparing the ryanodine test and new tests using a combination of ryanodine, halothane and caffeine.Methods:  One hundred and thirty‐two subjects (52 MHS and 80 MHN) were included in this study and new IVCTs were performed in additional muscle biopsy specimens. The contracture time‐course was compared considering the onset time of contracture (OT) and the time to reach a 10 mN contracture (10T). Cut‐off values were determined using ROC analyses.Results:  For the ryanodine test, sensitivity and specificity calculated for OT were 84.6% and 90.4%, respectively, and were better than those obtained using 10T. Combined tests using either caffeine and ryanodine or halothane and ryanodine did provide higher sensitivities (from 85.3 to 93.9%). A better specificity was only observed for the IVC tests combining halothane (cumulated) and caffeine both with ryanodine (93.9% for both). The largest sensitivity was observed when halothane was used as a bolus and combined with ryanodine. The specificity was always larger with the combined tests as compared to the test using ryanodine alone (from 79.1 to 90.9%). This superiority was confirmed, at least in part, when comparing genetic investigations and the results of new tests in a subgroup of subjects.Conclusions:  This pilot study showed a clear diagnostic potential for new IVC tests combining halothane, the triggering agent of MH, and ryanodine acting at the calcium release channel, and should be considered as a first step in the investigation of combined tests.
Is the ARX index a more sensitive indicator of anesthetic depth than the bispectral index during sevoflurane/nitrous oxide anesthesia?
Authors: Nishiyama T. , Matsukawa T. , Hanaoka K. 
Published: August 2004

Background:  During general anesthesia, hypnotic components have been monitored with electroencephalogram. The bispectral index is derived from a cortical electroencephalogram, but the A‐line ARX index is the electroencephalographic response to auditory stimuli. The purpose of this study was to compare the changes of the A‐line ARX index and the bispectral index during sevoflurane – nitrous oxide anesthesia.Methods:  One hundred females aged 30–60 years, and scheduled for partial mastectomy, were divided into two groups. Anesthesia was induced with sevoflurane 5% and nitrous oxide in oxygen for 3 min. A laryngeal mask airway was inserted, and anesthesia was maintained with sevoflurane 1–2% and nitrous oxide in oxygen. During surgery, the sevoflurane end‐tidal concentration was kept at 0.5%, 1%, or 2% for 5 min before each measurement. Blood pressure, heart rate, and the A‐line ARX index (n = 50), and the bispectral index (n = 50) were measured.Results:  Blood pressure and heart rate increased following laryngeal mask airway insertion and blood pressure decreased at 2% sevoflurane in both groups similarly. The A‐line ARX index, but not the bispectral index, increased significantly by laryngeal mask airway insertion and skin incision. The A‐line ARX index decreased at 2% sevoflurane compared with 0.5%, while the bispectral index remained unchanged.Conclusion:  During sevoflurane‐nitrous oxide anesthesia, the A‐line ARX index might be a more sensitive indicator of anesthetic depth than the bispectral index.
Changes in visual and auditory response time during conscious sedation with propofol
Authors: Kim K. M. , Jeon W. J. , Lee D. H. , Kang W. C. , Kim J. H. , Noh G. J. 
Published: August 2004

Background:  Using a push‐button device, we investigated whether visual or auditory response time would increase with increasing sedation, and assessed the responsiveness score of the Observer's Assessment of Alertness/Sedation (OAA/S) scale at the point of first loss of response to visual or auditory stimulation.Methods:  In experiment 1 we applied visual and auditory stimulation to 19 patients as the propofol target plasma concentration (CPT) was increased to determine whether the visual or auditory response would be lost first. Thirty patients were each then infused with propofol, starting at a CPT of 0.3 µg ml−1 and increasing by increments of 0.2 µg ml−1, during which visual (experiment 2) or auditory (experiment 3) stimulation was applied when the effect‐site concentration (CE) of propofol reached CPT. Visual response time (VRT), auditory response time (ART), CE and total amounts of propofol, and OAA/S score at the first loss of visual/auditory response were measured.Results:  Visual response disappeared earlier than auditory response in 84.2% of the patients. Visual response time and ART were linearly prolonged as the CE of propofol increased. The CE and total amounts of propofol at the first loss of visual response were 1.2 ± 0.4 µg ml−1 and 57.9 ± 16.7 mg, compared with 1.4 ± 0.5 µg ml−1 and 71.6 ± 26.1 mg, respectively, at the first loss of auditory response. The median (range) OAA/S scores at the first loss of visual and auditory response were 4 (3–4) and 3 (2–4), respectively.Conclusion:  VRT and ART were linearly prolonged with increasing sedation. Visual response may be useful in monitoring conscious sedation.