bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polymorphisms in the sequences of Marteilia internal transcribed spacer region of the ribosomal RNA genes (ITS‐1) in Spain: genetic types are not related with bivalve hosts
Authors: Novoa B , Posada D , Figueras A 
Published: June 2005

Abstract Marteilia refringens is a protozoan parasite causing a disease notifiable to the Office International des Epizooties (OIE) and its distribution has implications for the transfer of live animals. The internal transcribed spacer‐1 (ITS‐1) from Marteilia clones contains polymorphism. Digestion with HhaI reveals two different restriction profiles, previously referred as ‘O’ (Marteilia from oyster or Marteilia refringens) and ‘M’ (Marteilia from mussels or Marteilia maurini). The aim of the present work was to determine whether the two previously described Marteilia molecular types (O and M) exist in the Iberian Peninsula and the strictness of the association with their bivalve host species. The sequence variability in the ITS‐1 of Marteilia species was studied in mussels, Mytilus galloprovincialis, and flat oysters, Ostrea edulis, from different geographical locations in Spain, to establish the existence and the distribution of different species or molecular types. Although there were two distinct evolutionary lineages that corresponded more or less strictly with the ‘M’ and ‘O’ types, it was evident from the estimated phylogeny that some ‘O’ types have switched to ‘M’ type, and vice versa. Moreover, ‘O’ types were found in mussels and ‘M’ types were found in oysters, which suggests that there have been several cross‐species transmissions of Marteilia between mussels and oysters.
Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis
Authors: Mikkelsen T. S. , Toft P. 
Published: June 2005

Background:  (I) To investigate the kinetics of the myoglobin and creatine kinase (CK) in rhabdomyolysis. Especially to describe those patients in whom an isolated increase in the myoglobin or the CK occurred at a later stage. (II) To evaluate the sensitivity of the myoglobin and the CK as prognostic tools for the development of Acute renal failure (ARF). (III) To investigate the effect of continuous venovenous haemodiafiltration (CVVHDF) on the myoglobin elimination in ARF.Patients and methods:  Prospective and retrospective cohort study carried out in an ICU of a university hospital. A total of 47 critically ill patients with rhabdomyolysis and a plasma myoglobin > 5000 µg l−1 were admitted between July 1998 and July 2003.Results:  (I) The myoglobin peaked 0.66 ± 0.6 days before the CK. The elimination kinetics of the myoglobin was faster than for the CK. (II) Fifty percent developed ARF. Mortality in the ARF patients was 52% compared to 14% in the non‐ARF patients. The sensitivity and specificity of developing ARF were higher with the myoglobin in comparison to the CK. (III) In non‐ARF, t½ CK was 25.5 h and t½ myoglobin was 17 h (13–23). In those with ARF treated with CVVHDF, t½ CK was 24.8 and t½ myoglobin was 21 h (17–29).Conclusion:  (I) The myoglobin peaked earlier than the CK. (II) The myoglobin was a better prognostic tool than the CK. However, the myoglobin also has a wide interindividual range. (III) Though the myoglobin is eliminated in ultrafiltration t½ myoglobin, it was not faster in patients with ARF treated with CVVHDF compared to non‐ARF patients.
Carbon monoxide production from desflurane and six types of carbon dioxide absorbents in a patient model
Authors: Keijzer C. , Perez R. S. G. M. , De Lange J. J. 
Published: June 2005

Background:  Desflurane is known to produce high concentrations of carbon monoxide (CO) in desiccated sodalime or Baralyme® (Allied Healthcare Products, St. Louis, MO). Desiccated absorbents without strong bases like potassium hydroxide or sodium hydroxide are reported to produce less or no CO at all. The purpose of this study is to compare the concentration of CO in an anesthesia circuit for desflurane with six different types of completely desiccated CO2 absorbents with less strong bases than sodalime.Methods:  A patient model was simulated using a circle anesthesia system connected to an artificial lung. Completely desiccated CO2 absorbent (950 g) was used in this system. A low flow anesthesia (500 ml min−1) was maintained using desflurane. For immediate quantification of CO production a portable gas chromatograph was used.Results:  Peak concentrations of CO were very high in Medisorb® (Datex‐Ohmeda, Hoevelaken, The Netherlands) and Spherasorb®(Intersurgical, Uden, The Netherlands) (13317 and 9045 p.p.m., respectively). It was lower with Loflosorb® (Intersurgical, Uden, The Netherlands) and Superia® (Datex‐Ohmeda, Hoevelaken, The Netherlands) (524 and 31 p.p.m., respectively). Amsorb® (Armstrong, Coleraine, N. Ireland) and lithium hydroxide produced no CO at all.Conclusion:  Medisorb® and Spherasorb® are capable of producing large concentrations of CO when desiccated. Loflosorb® and Superia® produce far less CO under the same conditions. Amsorb® and lithium hydroxide should be considered safe when desiccated.
Intrathecal picrotoxin minimally alters electro‐encephalographic responses to noxious stimulation during halothane and isoflurane anesthesia
Authors: Dominguez C. L. , Barter L. S. , Antognini J. F. 
Published: June 2005

Background:  Isoflurane and halothane act in the spinal cord to blunt ascending transmission of impulses to the brain resulting from noxious stimulation. Because intrathecal picrotoxin (an antagonist at the gamma‐aminobutyric acid‐A receptor) partially reverses the immobilizing effect of isoflurane and halothane, we hypothesized that the electroencephalographic response to noxious stimulation would likewise be partially reversed by intrathecal picrotoxin.Methods:  Rats were anesthetized with isoflurane (n = 8) or halothane (n = 8) and a laminectomy performed. Following determination of minimum alveolar concentration (MAC), the electroencephalogram (EEG) was recorded during separate applications of a hindpaw clamp, tail clamp and electrical current to the tail at 0.8 and 1.2 MAC. Picrotoxin was then applied to the exposed spinal cord and the EEG response to noxious stimulation again determined.Results:  The EEG was more active during halothane anesthesia than isoflurane (spectral edge frequency for 95% power: 25.6 ± 2.1 Hz vs. 23.1 ± 1.6 Hz, P < 0.05). Noxious stimulation usually caused the EEG to shift to higher frequencies (e.g. for 0.8 MAC halothane, median edge frequency for 50% power: from 7.6 ± 3.1 Hz to 10.7 ± 2.6 Hz, P < 0.05). Picrotoxin minimally affected this response.Conclusions:  Noxious stimulation evokes an EEG response that is minimally altered by intrathecal picrotoxin. This suggests that isoflurane and halothane do not have GABAergic actions in the spinal cord that indirectly suppress the EEG response.
Desflurane induces more cerebral vasodilation than isoflurane at the same A‐line® autoregressive index level
Authors: Holmström A. , Åkeson J. 
Published: June 2005

Background:  Clinical use of desflurane in neuroanesthesia remains under debate. Comparison of dose‐dependent vasodilatory properties between desflurane and isoflurane, the more traditional volatile agent for clinical neuroanesthesia, requires equianesthetic dosing of the agents. Reproducible neurophysiological measurements of the level of anesthesia in an individual, e.g. the A‐line® autoregressive index (AAI), can be used for an equipotent dosage of two volatile agents in the same individual.Methods:  Desflurane and isoflurane, in randomized order, were titrated to a stable AAI level of 15–20 in 18 ASA I or II patients. The mean flow velocity (Vmca) and pulsatility index (PI) in the middle cerebral artery were then measured with transcranial Doppler at an end‐tidal CO2 concentration of 4.4%.Results:  For desflurane Vmca was 11% higher [95% confidence interval (CI), 5–18%; P = 0.0020] and PI was 13% lower (95% CI, 3–23%; P  = 0.0083) than for isoflurane. The mean arterial blood pressure did not differ between the agents. The fraction of MAC necessary for the intended AAI level was 35% lower (95% CI, 20–49%; P = 0.00016) with desflurane than with isoflurane.Conclusion:  Desflurane was associated with more cerebral vasodilation than isoflurane at the same depth of anesthesia, as indicated by the AAI. This attributes further reason for caution in the use of desflurane in clinical neuroanesthesia. The difference between desflurane and isoflurane in the MAC fractions required for the same AAI level confirms the limitations of MAC in defining the level of anesthesia.
Relationship between arterial and end‐tidal carbon dioxide pressures during anesthesia using a laryngeal tube
Authors: Lee J. S. , Nam S. B. , Chang C. H. , Han D. W. , Lee Y. W. , Shin C. S. 
Published: June 2005

Background:  The Laryngeal Tube® (LT), (VBM Medizintechnik, Sulz, Germany) is a relatively new supraglottic device for controlling the airway. Arterial carbon dioxide tension (PaCO2) can be estimated by monitoring the end‐tidal tension of carbon dioxide (PETCO2). The relationship between PETCO2 and PaCO2 during controlled ventilation via the LT has not been reported.Methods:  During general anesthesia, 45 patients were mechanically ventilated using an LT. PETCO2 and PaCO2 were measured once PETCO2 had reached a steady state. The LT was then removed and the trachea intubated using an endotracheal tube (ETT), and the identical ventilatory variables were resumed. Following stabilization, PETCO2 was again determined and PaCO2 estimated.Results:  The mean PETCO2 and PaCO2 values were 4.43 ± 0.26 kPa and 4.67 ± 0.32 kPa, respectively, during LT ventilation, and 4.36 ± 0.23 kPa and 4.61 ± 0.26 kPa, respectively, during ETT ventilation. Analysis of differences between the PETCO2 and PaCO2 values using the Bland and Altman method revealed a bias ± precision of 0.24 ± 0.15 kPa for LT and 0.27 ± 0.15 kPa for ETT. The root mean square error was 0.28 for the LT and 0.30 for the ETT.Conclusion:  This study suggests that for healthy adult patients mechanically ventilated via the LT, the PETCO2 value reflects the PaCO2 value as closely as when patients are ETT ventilated, allowing capnometry to be used to evaluate the adequacy of ventilation.
Propofol attenuates responses of the auditory cortex to acoustic stimulation in a dose‐dependent manner: A FMRI study
Authors: Dueck M. H. , Petzke F. , Gerbershagen H. J. , Paul M. , Heßelmann V. , Girnus R. , Krug B. , Sorger B. , Goebel R. , Lehrke R. , Sturm V. , Boerner U. 
Published: June 2005

Background:  Functional magnetic resonance imaging (fMRI) using blood‐oxygen‐level‐dependent (BOLD) contrasts is a common method for studying sensory or cognitive brain functions. The aim of the present study was to assess the effect of the intravenous anaesthetic propofol on auditory‐induced brain activation using BOLD contrast fMRI.Methods:  In eight neurosurgical patients, musical stimuli were presented binaurally in a block design. Imaging was performed under five conditions: no propofol (or wakefulness) and propofol plasma target concentrations of 0.5, 1.0, 1.5, and 2.0 µg ml−1.Results:  During wakefulness we found activations in the superior temporal gyrus (STG) corresponding to the primary and secondary auditory cortex as well as in regions of higher functions of auditory information processing. The BOLD response decreased with increasing concentrations of propofol but remained partially preserved in areas of basic auditory processing in the STG during propofol 2.0 µg ml−1.Conclusions:  Our results suggest a dose‐dependent impairment of central processing of auditory information after propofol administration. These results are consistent with electrophysiological findings measuring neuronal activity directly, thus suggesting a dose‐dependent impairment of central processing of auditory information after propofol administration. However, propofol did not totally blunt primary cortical responses to acoustic stimulation, indicating that patients may process auditory information under general anaesthesia.
Positive end‐expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum
Authors: Meininger D. , Byhahn C. , Mierdl S. , Westphal K. , Zwissler B. 
Published: June 2005

Background:  Laparoscopic surgery usually requires the use of a pneumoperitoneum by insufflating gas in the peritoneal space. The gas most commonly used for insufflation is carbon dioxide. Increased intra‐abdominal pressure causes cephalad displacement of the diaphragm resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. The aim of this prospective study was to investigate the effect of prolonged intraperitoneal gas insufflation on arterial oxygenation and hemodynamics during mechanical ventilation with and without positive end‐expiratory pressure (PEEP).Methods:  Twenty patients undergoing totally endoscopic robot‐assisted radical prostatectomy were randomly allocated to one of two groups. In the PEEP group (n = 10) a constant PEEP of 5 cmH2O was used, whereas in the ZPEEP group (n = 10) no PEEP was used.Results:  Application of PEEP (5 cmH2O) resulted in significantly higher PaO2 levels after 3 h (182 ± 49 vs. 224 ± 35 mmHg) and 4 h (179 ± 48 vs. 229 ± 29 mmHg) of pneumoperitoneum; after desufflation, PaO2 values decreased significantly below preinsufflation values. While there were no significant differences in heart rate, central venous pressure (CVP) and mean arterial blood pressure (MAP) during pneumoperitoneum between both groups, baseline values in CVP and MAP differed significantly between both groups with higher levels in the ZPEEP group.Conclusion:  The application of a constant positive airway pressure of 5 cmH2O preserves arterial oxygenation during prolonged pneumoperitoneum.
Auditory‐evoked potentials in general anesthesia monitoring: baseline study of availability in relation to hearing function in awake status
Authors: De Siena L. , Pallavicino F. , Lacilla M. , Canale A. , Longobardo A. , Pecorari G. , Albera R. 
Published: June 2005

Background:  It has been confirmed that middle latency auditory‐evoked potentials are good indicators of the hypnotic level in patients undergoing general anesthesia. The focal point for the evocation of auditory‐evoked potentials is the presence of a serviceable hearing function. The aim of the study was to evaluate the limit of hearing loss above which the test could not be applied.Methods:  To determine the limit of applicability of the technique, 100 subjects were studied. Twenty of them were normally hearing and 80 were affected by sensorineural hearing loss of various degrees. Each subject was submitted to pure tone audiometry, to determine hearing threshold, and then, in awake status, to auditory‐evoked potentials recording using acoustic stimuli of 85 dB HL.Results:  All the 20 normally hearing subjects showed a reliable auditory‐evoked potentials. Among the 80 subjects affected by hearing loss, only five had no potentials. These five subjects presented a pure tone audiometry threshold greater than 85 dB HL.Conclusion:  The study demonstrated that middle latency auditory‐evoked potentials recorded using an A‐Line® (software version 1.4) AEP monitor (Danmeter, Odense, Denmark) can be carried out even in presence of hearing loss if the pure tone threshold is less than 85 dB HL.
Nociceptin system does not affect MAC of volatile anaesthetics
Authors: Himukashi S. , Miyazaki Y. , Takeshima H. , Koyanagi S. , Mukaida K. , Shichino T. , Uga H. , Fukuda K. 
Published: June 2005

Background:  Nociceptin is the endogenous agonist of the opioid receptor‐like (ORL) 1 receptor (NOP), and both nociceptin and NOP are widely expressed in the brain and spinal cord, which are target organs of general anaesthetics. As nociceptin has been reported to be involved in modulating pain mechanisms and stress responses, it is possible that the activity of the nociceptin system affects the anaesthetic potency of general anaesthetics. To address this possibility, we investigated the minimum alveolar concentrations (MACs) of various volatile anaesthetics in nociceptin receptor knockout mice (NOP–/–) and wild‐type mice (NOP+/+).Methods:  We used male NOP–/– mice and NOP+/+ mice. MACs for halothane, isoflurane and sevoflurane were determined by the tail‐clamp method.Results:  MACs for halothane, isoflurane and sevoflurane in NOP–/– mice were 1.60 (SD 0.06), 1.68 (0.08) and 3.36 (0.07)%, respectively. In NOP+/+ mice, MACs for halothane, isoflurane and sevoflurane were 1.59 (SD 0.07), 1.72 (0.07) and 3.38 (0.09)%, respectively.Conclusion:  MACs in NOP–/– mice did not significantly differ from those in NOP+/+ mice for halothane, isoflurane and sevoflurane. This result suggests that the nociceptin system does not affect the anaesthetic potency of volatile anaesthetics.
Emotional and interpersonal factors are most important for patient satisfaction with anaesthesia
Authors: Capuzzo M. , Landi F. , Bassani A. , Grassi L. , Volta C. A. , Alvisi R. 
Published: June 2005

Background:  Questionnaires to evaluate patient satisfaction with anaesthesia mainly consider physiological aspects. This study was performed to identify the items of value for patients having anaesthesia (pilot phase) and to validate the questionnaire built on these findings in a new group of inpatients.Methods:  In the pilot phase, 100 surgical patients were interviewed and asked whether each of the 23 items selected by a panel of providers was relevant (score 1) and to rank these from 1 (additional score 6) to 5 (additional score 2). The resulting 10‐item final instrument was administered to 219 consecutive inpatients by interview, after recent anaesthesia, asking them how much of each item they received (item received) and the level of satisfaction with the same item, using Numerical Rating Scales (range 0–10).Results:  In the pilot phase, gender, age, education and surgery did not influence the score enough to change the first 10 rank‐ordered items. The 219 patients subsequently studied did not differ from those missing the questionnaire administration. The patients aged less than 55 years showed lower satisfaction scores than those aged 55 years or more (P = 0.019). In all items, except ‘feeling anxious/frightened’, the item received was significantly associated with the satisfaction reported. ‘Kindness/regard of caregivers’ together with ‘information given by anaesthetist’ and ‘feeling safe’ predicted 47% of the variance in total patient satisfaction.Conclusions:  Inpatients value highly those elements of care that pertain to emotional and interpersonal relationships.
Safety of mixture of morphine with ketamine for postoperative patient‐controlled analgesia: an audit with 1026 patients
Authors: Sveticic G. , Eichenberger U. , Curatolo M. 
Published: June 2005

Background:  Adding ketamine to morphine for patient‐controlled analgesia (PCA) may be useful. However, data on this drug combination have been collected on small sample sizes. In order to evaluate the safety of the combination morphine– ketamine, we conducted a prospective study on a large patient population.Methods:  Patient‐controlled analgesia was performed with 1026 patients using morphine and ketamine in a dose ratio of 1:1. All patients were treated in the ward. Prospectively collected data included incidence of complications and side‐effects, verbal pain scores at rest and during mobilization (0 = no pain to 4 = very strong pain), consumption of morphine and ketamine and patient satisfaction (0 = very unsatisfied to 3 = very satisfied).Results:  The study included 462 women and 564 men who underwent, on average, 71.8 h (±56.1) of PCA. There were 698 orthopaedic, 160 abdominal, 96 thoracic, 20 vascular, 16 plastic, 15 neurosurgical, 11 urologic and 10 other surgical procedures. No complication was observed. Incidence of side‐effects was: 1.2% respiratory depression, 23.5% nausea, 6.2% vivid dreams and/or hallucinations, 21.4% sedation and 10.3% pruritus. Reasons for discontinuing the PCA were side‐effects (7.0%) and other (0.5%). Mean pain scores over the whole period were 0.44 (±0.54) at rest and 1.36 (±0.62) during mobilization. Mean satisfaction score was 2.52 (±0.69).Conclusion:  Patient‐controlled analgesia with morphine and ketamine is safe. It produces side‐effects which, however, are infrequently a reason for discontinuing the regimen. It is also associated with low pain scores and high patient satisfaction.
Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure
Authors: Manser T. , Staender S. 
Published: June 2005

An important element of how adverse events are handled is effective communication between health care providers and patients and their families. This review addresses the main questions: What do patients expect in the aftermath of an adverse event? What is known about the practice of open disclosure? How can organizations support health care providers in the aftermath of an adverse event, both professionally and personally?Patients clearly expect open disclosure to include an explanation of what happened, an apology for harm done, that appropriate remedial action will be taken and an explanation of what will be done to learn from the event and to prevent recurrence.Research has found that open disclosure is not very common although the ethical duty to disclose is widely acknowledged. Barriers to open disclosure include discomfort and a lack of training how to disclose, a fear of litigation, a culture of infallibility among health professionals, and inadequate systems for analysis, discussion and learning from mistakes.Significant commitment is required from health care organizations and managers to develop frameworks for open disclosure to occur, to assure its quality and to support health care providers in this process. Organizations also need to address the emotional needs of health care professionals in the aftermath of an adverse event. Last but not least, adequate systems for debriefing and incident analysis need to be in place to learn from adverse events and to avoid recurrence.
Clinical risk factors associated with bleeding after native kidney biopsy
Authors: SHIDHAM GANESH B , SIDDIQI NAUMAN , BERES JOSEPH A , LOGAN BRENT , NAGARAJA HN , SHIDHAM SHUBHANGI G , PIERING WALTER F 
Published: June 2005

SUMMARY:Purpose:  To determine the effect of various risk factors on postbiopsy bleeding (PBB).Procedure:  A retrospective review of 645 native kidney biopsies carried out from 1981 to 2001 was conducted. Data regarding age, gender, race, prebiopsy blood pressure, history of hypertension, pre‐ and postbiopsy haemoglobin/haematocrit, serum creatinine and blood urea nitrogen (BUN) were collected.Findings:  The overall PBB complication rate was 6.2%. High blood pressure was associated with a high risk of bleeding (test for trend, P < 0.05). It increased when systolic blood pressure (SBP) was >160 mm of Hg, diastolic blood pressure (DBP) was >100 mm of Hg, or mean arterial pressure (MAP) was ≥120 mm of Hg. In patients with a history of hypertension, the risk of PBB was 3.74 times higher (P = 0.0001) than patients with no history of hypertension, irrespective of blood pressure at the time of biopsy. For patients with creatinine >2 mg/dL, the risk ratio for PBB was 5.89 when compared with patients with creatinine ≤2 mg/dL. Logistic regression analysis showed that a history of hypertension was associated with PBB, with an odds ratio of 1.89 (confidence interval, 1.10–3.26, P < 0.03), and serum creatinine of >2.0 mg/dL was associated with an odds ratio of 2.56 (confidence interval, 1.48–4.42, P = 0.001) for PBB.Conclusions:  The risk of PBB increases with high SBP, DBP or MAP. A history of hypertension and high serum creatinine are significant independent risk factors for PBB.