bluuebunny/crossref_metadata_2025_split huggingface dataset:
The mind of a failing heart: a systematic review of the association between congestive heart failure and cognitive functioning
Authors: Almeida O. P. , Flicker L. 
Published: March 2003

Abstract Background: Congestive heart failure (CHF) is a frequent complication of most diseases of the heart. CHF is associated with impairment in several aspects of the quality of life of patients, including mood and cognitive performance. Early reports indicated that patients with CHF display deficits in memory and other intellectual abilities, although the clinical relevance of these findings remains unclear. Aim: We reviewed systematically the medical literature with the aim of clarifying the association between CHF and cognitive functioning. Methods: Systematic review of Medline database for studies published between 1966 and June 2000 using the following key words: congestive heart failure, cognition, cognitive disorders, memory, memory disorders, short‐term memory, attention. Results: Thirteen studies reported cognitive information on patients with CHF, but only five met inclusion criteria for systematic review. Three reports described attention (total number of subjects = 369 patients and 882 controls) and memory scores (total number of subjects = 247 patients and 748 controls), two studies reported measures of general cognitive functioning (total number of subjects = 203 patients and 704 controls) and one reported the rate of cognitive impairment (total number of subjects = 88 patients and 987 controls). Pooled analysis indicated that CHF is associated with a pattern of generalized cognitive impairment that includes memory and attention deficits. Conclusions: The results of the present review highlight the enormous paucity of systematic information about the association between CHF and cognitive functioning, with only five studies reporting data suitable for analysis. We expect that new case‐control and cohort studies will be designed to confirm the presence of cognitive impairment in patients with CHF and trust that this information will improve the management of CHF patients and our understanding of the mechanisms associated with cognitive decline in later life. (Intern Med J 2001; 31: 290–295)
Improving benzodiazepine prescribing for elderly hospital inpatients using audit and multidisciplinary feedback
Authors: Elliott R. A. , Woodward M. C. , Oborne C. A. 
Published: March 2003

Abstract Background: Benzodiazepines are commonly prescribed for older people. Inappropriate benzodiazepine prescribing may result in serious adverse effects, including confusion and falls. Aims: To determine the prevalence and appropriateness of benzodiazepine prescribing for elderly inpatients at nine public hospitals in Victoria, Australia, and to assess the impact of multidisciplinary feedback on quality of benzodiazepine prescribing. Methods: Clearance for the study was obtained from ethics committees of participating hospitals. Medication charts for 1301 patients aged 65 years and over were reviewed to identify patients prescribed a benzodiazepine. Using an evidence‐based indicator of prescribing appropriateness, cross‐sectional notes‐based audits were conducted at three time points (baseline, 4–8 weeks and 6 months). Feedback of baseline audit results was provided to medical, pharmacy and nursing staff at multidisciplinary meetings. Changes in benzodiazepine prescribing over the following 6 months were assessed. Results: At baseline, benzodiazepines were prescribed for 36% of patients, and 20% of prescriptions were appropriate. Four to six weeks after feedback, the proportion of patients prescribed a benzodiazepine had not changed significantly (31%, P = 0.125); however, more prescriptions were appropriate (44%, P < 0.0001). For patients who were using a benzodiazepine prior to admission and had a contraindication, there were more attempts to withdraw or reduce the dose (47%vs 21%, P = 0.002) and more prescriptions were for acceptable indications (7.4%vs 2.6%, P = 0.024). Six months after feedback, appropriateness of prescribing remained improved compared with baseline (50%, P = 0.002). Conclusions: Benzodiazepines were prescribed for approximately one in three elderly hospital inpatients and a large proportion was inappropriate. A multidisciplinary intervention based on audit and feedback improved prescribing and the impact of the intervention was still evident after 6 months. (Intern Med J 2001; 31: 529–535)
Surface‐active phospholipid: a Pandora’s box of clinical applications. Part II. Barrier and lubricating properties
Authors: Hills B. A. 
Published: March 2003

AbstractIn Part I, it was described how their configuration renders phospholipid molecules surface active and capable of acting at interfaces in addition to the ­liquid−air interface to which conventional theory has hitherto confined the study of ‘surfactant’ in the lung. Surface‐active phospholipid (SAPL) appears no different to comparable surfactants studied in the physical sciences for the highly desirable properties that their adsorption (reversible binding) can impart to solid surfaces.In Part II, these properties are considered in sites where there is no air. Highly desirable properties include boundary lubrication (lubricity), release (antistick) and the ability of the strongly adsorbed and strongly cohesive SAPL linings to act as barriers against abrasion, corrosion and, possibly, against invasion by microorganisms. As the ‘sealant’, it could be the true barrier rather than the cells providing its mechanical support. Evidence is reviewed for SAPL providing the gastric mucosal barrier to acid in the stomach and preventing the digestion of Helicobacter pylori until that barrier is broken by bile in the duo­denum, where H. pylori cause ulcers. The concept that SAPL provides effortless sliding of many tissues, including pleura, pericardium and peritoneum is reviewed. Particular attention is paid to the load‐bearing joints, where a deficiency has been associated with osteoarthritis. The ability of the same SAPL lining to perform multiple roles is discussed in relation to the peritoneum, where it could provide the lubricant/release agent preventing surgical adhesions, while imparting semipermeability to ‘the membrane’ vital for peritoneal dialysis. In each site, the prophyl­actic use of exogenous SAPL is discussed for its potential clinical applications. (Intern Med J 2002; 32: 242−251)
Communicating in a multicultural society II: Greek community attitudes towards cancer in Australia
Authors: Goldstein D. , Thewes B. , Butow P. 
Published: March 2003

Abstract Background: Open and full disclosure of information regarding diagnosis and prognosis is the prevailing approach to cancer patients. However, such a view appears contrary to the preferences of many ethnic groups in Australia. Aims: This study sought to examine the range of attitudes to cancer, its treatment and disclosure of information among unaffected Greek adults, as part of an ongoing project to develop culturally appropriate cancer care in Australia. Methods: Respondents were recruited from first generation Australian residents. Twenty‐nine men and 29 women, half over and half under the age of 60 years, participated. Eight focus groups were conducted by a bilingual facilitator and supplemented with eight individual face to face interviews. Results: Several areas of misunderstanding were identified concerning the causes and outcomes of cancer. Having a cancer was regarded as a source of shame. Disclosure of diagnosis, but less so prognosis, was favoured, and only to immediate family members. Family members translating for the doctor were reported to commonly alter or ‘soften’ the doctor’s message without the patient’s knowledge in order to protect the patient. Greek doctors were favoured, and open discussion of alternative medicines was sought. Conclusions: The Greek community is the most established migrant community in Australia, but clearly many of their attitudes to cancer are at variance with what is considered good practice by clinicians. An increased awareness of cultural differences is needed to achieve optimal health outcomes in the diverse communities that make up modern Australia. (Intern Med J 2002; 32: 289−296)
Metabolic and clinical responses to different types of premedication in children
Authors: Rautakorpi Pirkka , Manner Tuula , Kanto Jussi , Lertola Kalle 
Published: March 2003

SummaryThe metabolic and clinical responses to intravenously administered atropine+meperidine (pethidine), glycopyrrolate+meperidine, diazepam and placebo were examined in 76 healthy children. After atropine+meperidine and glycopyrrolate+meperidine administration, a significant antisialogogue effect, tachycardia and elevation in systolic blood pressure were observed. Diazepam decreased oxygen consumption (VO2) whereas atropine+meperidine increased both VO2 and energy expenditure (EE). The maximal effect of diazepam on VO2 was found 10 min after drug administration (mean difference from baseline –10.0%) and maximal effect of atropine+meperidine on VO2 and EE after 5 min (mean difference from baseline +6.0% and +3.3%, respectively). It is concluded that intravenous administration of meperidine with atropine or glycopyrrolate is followed by profound anticholinergic effects and such combinations do not appear to be suitable for clinical purposes. Although statistically significant, the alterations in VO2 and EE after diazepam and atropine+meperidine premedication can be considered clinically insignificant because they were of short duration and the measured changes represented only a fraction of fluctuation seen in normal values.
Fatal pulmonary haemorrhage during anaesthesia for bronchial artery embolization in cystic fibrosis
Authors: Mcdougall Robert J. , Sherrington Colin A. 
Published: March 2003

SummaryThree children with cystic fibrosis (CF) had significant pulmonary haemorrhage during anaesthetic induction prior to bronchial artery embolization (BAE). Haemorrhage was associated with rapid clinical deterioration and subsequent early death. We believe that the stresses associated with intermittent positive pressure ventilation (IPPV) were the most likely precipitant to rebleeding and that the inability to clear blood through coughing was also an important factor leading to deterioration. Intermittent positive pressure ventilation should be avoided when possible in children with CF with recent significant pulmonary haemorrhage.
Observation of the correlation of postanaesthesia recovery scores with early postoperative hypoxaemia in children
Authors: XUE F. S. , TONG S. Y. , LIAO X. , LIU J. H. , ZHANG R. J. , AN G. , LUO L. K. 
Published: March 2003

SummaryTo observe the correlation of the postanaesthesia recovery score (PARS) with the incidence, and severity of early postoperative hypoxaemia in children, 1213 infants and children, ASA physical status I, aged three months to 14 years, scheduled for elective plastic surgery were included in this study. Arterial oxygen saturation (SpO
2) levels were recorded while children were breathing room air shortly after arrival in the recovery room (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120 and 180 min thereafter. The PARS was also determined on all patients when SpO
2 levels were recorded in the recovery room. On the basis of different PARS, children were divided into the three groups: Group 1 – children having the PARS of ≤6; Group 2 – children having the PARS of 7–9; and Group 3 – children having a PARS of 10. The results showed that during the early postoperative period, the incidence and severity of hypoxaemia correlated closely with the PARS. The lower the children's PARS, the higher the incidences of hypoxaemia (SpO
2=86–90%) and severe hypoxaemia (SpO
2≤85%). The incidences of hypoxaemia and severe hypoxaemia were 12.9% and 15.8%, respectively, in Group 1, 20.9% and 2.9% in Group 2, 0.8% and 0% in Group 3. There were significant differences among the three groups. Of the 91 children who required O2 supplementation in the recovery room because of low measured SpO
2, 69 had the PARS of ≤6, and 22 had the PARS of 7–8. It is concluded that if a patient has a PARS of 10, the patient will not need routine oxygen supplement because hypoxaemia will not occur.
Pulmonary artery catheter placement under transoesophageal echocardiography guidance
Authors: RIMENSBERGER PETER C. , BEGHETTI MAURICE 
Published: March 2003

SummaryDespite correct positioning pulmonary artery catheters may be displaced accidentally. Repositioning may prove to be difficult, especially when high pulmonary artery pressures are present. After failure of usual placement methods, transoesophageal echocardiography was used to guide repositioning of a displaced Swan‐Ganz catheter in the early postoperative course after cardiac surgery in a child. This technique proved to be useful in visualizing intracardiac catheter orientation and facilitating pulmonary artery catheter placement at bedside, avoiding transportation of a haemodynamically unstable patient.
Preoperative anxiety and volume and acidity of gastric fluid in children
Authors: Kawana Shin , Uzuki Mitsuru , Nakae Yuri , Namiki Akiyoshi 
Published: March 2003

SummaryForty‐three patients aged 3–6 years, undergoing minor surgery were studied. Parents staying with their children were asked to evaluate the anxiety of their children and themselves by a visual–analogue scale the night before surgery (VAS‐N) and just before premedication in the morning (VAS‐M). After induction, gastric fluid was collected and the volume and pH were measured. Patients with a VAS‐M lower than 5 were considered the low‐anxiety group ( L‐group; n=24) and the remainder comprised the high‐anxiety group (H‐group; n=19). The gastric volume of the H‐group was significantly lower than that of the
L‐group. No difference was found in pH. A significant overall correlation of VAS‐N was found between patients and their parents. These results suggest that the low level anxiety of children and their parents could not reduce the volume and acidity of gastric fluid and consequently the risk of aspiration pneumonia.
Anaesthesia and juvenile Huntington's disease
Authors: Gupta Kalpna , Leng Christopher P. 
Published: March 2003

SummaryJuvenile Huntington's Disease (JHD) is an involuntary movement disorder that comprises both neurological and psychiatric symptoms. Whilst it has many similarities to Huntington's Disease, it is regarded as a separate clinical entity. The anaesthetic plan should be based on careful assessment of the important issues, including the risk of regurgitation and pulmonary aspiration, possible associated autonomic neuropathy, poor respiratory function and the avoidance of precipitating convulsions and clonic spasms. We describe the management of a 12‐year‐old girl with JHD scheduled for gastroscopy under general anaesthesia necessitating the use of suxamethonium. We suggest an alternative mechanism for the delayed recovery seen in our patient and in other adult case reports.
An assessment of desflurane for use during cardiac electrophysiological study and radiofrequency ablation of supraventricular dysrhythmias in children
Authors: Schaffer Michael S. , Snyder Andrew M. , Morrison John E. 
Published: March 2003

SummaryDesflurane has several properties making it a desirable agent for use in electrophysiological studies (EPS) for diagnosis and treatment of cardiac dysrhythmias. We studied 47 children, mean age 12.8±4.6 years, mean weight 52.9±24.0 kg, with clinical history of supra‐ ventricular tachycardia (SVT) during EPS using desflurane in a crossover comparison with fentanyl. The patients served as their own controls. All received oral premedication with lorazepam, and intravenous induction with thiopentone, rocuronium, and oxygen. Group 1 (n=24) were administered fentanyl 10 μg·kg−1 bolus i.v. with an infusion of 3 μg·kg−1·h−1 during initial EPS. Fentanyl was discontinued and desflurane, 6% endtidal, was administered and the EPS repeated. Group 2 (n=23) were initially administered 6% desflurane after induction, and following EPS the desflurane was discontinued and the patients administered fentanyl 3 μg·kg−1 bolus and EPS repeated (explanations of EPS abbreviations are provided). Desflurane reduced the mean arterial pressure (MAP) in all patients. In Group 1, desflurane shortened the sinus cycle length (SCL), i.e. increasing the heart rate, and atrial effective refractory period (AERP) while Group 2 demonstrated no such effect on AERP. There were no other significant differences between fentanyl or desflurane techniques in terms of EPS measurements. SVT was inducible with both agents in both groups. Desflurane seems an acceptable agent for use during EPS procedures.
The perioperative management of children with phaeochromocytoma
Authors: Hack H.A. 
Published: March 2003

SummaryThe safe anaesthetic management of a child with a phaeochromocytoma requires an understanding of the pathophysiology of the disease, together with a thorough knowledge of its pharmacology, in order to avoid or minimize the potentially harmful cardiovascular changes that may occur during anaesthesia. Although there is a considerable amount of information on the management of the adult with phaeochromocytoma, much less has been written concerning children with the disease. Children differ significantly from adults in the incidence, location, presentation and management of this condition and these differences are discussed here together with some of the more controversial issues of management.
Local and systemic immune response to surgery under balanced anaesthesia in children
Authors: Mattila‐Vuori Armi , Salo Matti , Iisalo Eila , Pajulo Olli , Viljanto Jouko 
Published: March 2003

SummaryWe studied perioperative changes in the immune response and compared changes in the peripheral blood with those in the wound in 20 boys (0.5–3 years) during elective inguinal surgery under balanced anaesthesia. Blood samples were drawn before premedication, immediately, and 4 or 24 h after anaesthesia. Cells from the wound were harvested with the Cellstick device, removed from the wound 4 (n=10) or 24 h (n=10) after anaesthesia. We found decreased lymphocyte counts in the peripheral blood, increased percentages of activated T lymphocytes and B lymphocytes, and decreased percentages of total T lymphocytes, T helper cells and T cytotoxic cells. The percentages of T helper cells and B lymphocytes were lower in the wound than in blood. Mitogen‐induced lymphocyte proliferative responses decreased. This study demonstrates perioperative changes in the immune response in children and, as a new finding, that immune effector cells in the blood and in the wound are in a dynamic balance.
Acid–base, electrolyte and metabolite concentrations in packed red blood cells for major transfusion in infants
Authors: Sümpelmann R. , Schürholz T. , Thorns E. , Hausdörfer J. 
Published: March 2003

Methods: Acid–base, electrolyte and metabolite concentrations were determined in 100 U of packed red blood cells (RBC) preserved in extended‐storage media to be used for major transfusion in paediatric and cardiac surgery. Results: In fresh RBC, low pH, bicarbonate (cHCO3−), base excess (BE) and high glucose values were observed all outside the physiological range. With lengthening storage duration, values of pH, cHCO3−, BE, sodium and glucose decreased and carbon dioxide, potassium and lactic acid concentrations increased [mean ± SD (range): storage duration 6.7 ± 3.8 (1–17) days, pH 6.79 ± 0.1 (6.53–6.99); mmol·l–1: cHCO3− 11.1 ± 1.5 (6.2–14.5), BE − 29.2 ± 4.1 ([−39.4] − [−20.9]), potassium 20.5 ± 7.8 (4.2–43.6), glucose 24.1 ± 6.1 (16.7–29.2), lactic acid 9.4 ± 4 (4.3–21.4)]. Conclusions: Massive and rapid transfusion of RBC may lead to a severe burden of hydrogen ions, carbon dioxide, potassium, glucose and lactic acid and this can be avoided by cell saver blood processing, when autologous erythrocytes from the operative field are saved and substrate load and storage lesions from packed red blood cells are minimized in one step by washing.
A novel thermoregulatory system maintains perioperative normothermia in children undergoing elective surgery
Authors: Nesher Nahum , Wolf Tamir , Uretzky Gideon , Oppenheim‐Eden Arieh , Yussim Elliott , Kushnir Igal , Shoshany Gideon , Rosenberg Benno , Berant Moshe 
Published: March 2003

Background: Body heat loss during anaesthesia may result in increased morbidity, particularly in high‐risk populations such as children. To avoid hypothermia, a novel thermoregulatory system (Allon) was devised. We tested the safety and efficacy of this system in maintaining normothermia in children undergoing routine surgical procedures. Methods: The system consists of a computerized body, which receives continuous afferent data, i.e. core (rectal) temperature. These data are then compared with a preset temperature (37°C) and a microprocessor heating/cooling unit warms/cools the temperature of circulating water in a garment that is specially designed to allow maximal coverage of body surface area, without impingement on the surgical field. Water temperature to the garment was limited to a maximum of 39.5°C. Continuous perioperative monitoring of skin and rectal temperature, heart rate and blood pressure was performed. Postoperative shivering and adverse effects were also assessed. Results: The Allon system was used in 38 patients aged 3 months to 14 years undergoing surgery under general anaesthesia lasting more than 30 min. Fifty to 80% body surface area was covered by the garment. Mean operative and postoperative core temperatures were 36.9 ± 0.5°C and 36.7 ± 0.5°C, respectively. Intraoperative skin temperatures were maintained at 34.4 ± 2.7°C. The average core‐ to‐periphery intraoperative gradient was 2.9 ± 4.9°C. Postoperative shivering was absent in 36 cases and mild in two cases. No device‐related adverse effects were observed. Conclusions: Perioperative thermoregulation using the Allon system is safe and effective in maintaining body temperature within a narrow range in children undergoing brief surgical procedures.
Start‐up delays of infusion syringe pumps
Authors: Neff T , Fischer J , Fehr S , Baenziger O , Weiss M 
Published: March 2003

Background: We performed a bench experiment to investigate the extent of start‐up delays in fluid delivery for four different syringe pumps after initially placing the infusion syringe in the syringe pump. Methods: Pump performance was determined at an infusion rate of 1 ml·h−1 with and without a fluid bolus delivered by the infusion pump prior to connecting the infusion line to the simulated patient. Results: The time (mean ± SD) from starting the pump up to first fluid delivery (t1) differed considerably between pumps (from 6.75 ± 4.4 to 57.2 ± 28.6 min) as did the time to steady state fluid delivery (t2) (from 19.6 ± 9.3 to 76.3 ± 29.0 min). Applying an initial bolus of 2 ml before connecting the line to the simulated patient practically eliminated the delay in fluid delivery (t1 ranging from 0.3 ± 0.1 to 1.1 ± 0.8 min). This manoeuvre also reduced the time to steady flow delivery (t2 from 6.0 ± 3.1 to 11.1 ± 4.3 min, P<0.001) and minimized the differences between syringe pumps. Conclusions: Syringe pump design affects start‐up delay times because of free play of the syringe. These delays can be eliminated by a start‐up bolus of 2 ml prior to connecting the infusion line to the patient.
Combined corneal lipid and calcium degeneration in a dog with hyperadrenocorticism: a case report
Authors: Laus José L. , Santos Cristiane dos , Talieri Ivia C. , Oriá Arianne P. , Bechara Gervásio H. 
Published: March 2003

AbstractCorneal degeneration may occur with a deposition of lipids or calcium, or both. Calcareous and lipid degeneration may be either primary or secondary, associated with systemic diseases such as primary hyperlipidemia, hyperlipidemia associated with hyperadrenocorticism, and hypothyroidism. The authors report a case of bilateral corneal lipid and calcium degeneration in a 7‐year‐old female Poodle with hyperadrenocorticism. The condition worsened with Lysodren® therapy but responded to surgical excision.