bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units?
Authors: Xenitidis K. , Gratsa A. , Bouras N. , Hammond R. , Ditchfield H. , Holt G. , Martin J. , Brooks D. 
Published: December 2003

AbstractBackground  When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services.Method  All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area.Results  Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out‐of‐area residential placement.Conclusions  Specialist units are an effective care option for this group of people.
Genetic structure of Mycosphaerella fijiensis populations from Australia, Papua New Guinea and the Pacific Islands
Authors: Hayden H. L. , Carlier J. , E. A. B. Aitken  
Published: December 2003

Single‐copy restriction fragment length polymorphism (RFLP) markers were used to determine the genetic structure of Mycosphaerella fijiensis, the cause of black leaf streak (black Sigatoka) disease of banana and plantain, in the Torres Strait, Papua New Guinea (PNG), and the Pacific Islands. A moderate level of genetic variation was observed in all populations with genotypic diversity values of 60–78% of the theoretical maximum, and gene diversity (H) values between 0·269 and 0·336. All populations were at gametic equilibrium, and with the high level of genotypic diversity observed this indicated that sexual reproduction has a major role in the genetic structure of the M. fijiensis populations examined. Population differentiation was tested on several hierarchical scales. No evidence of population differentiation was observed between sites on Mer Island. A moderate level of population differentiation was observed within the Torres Strait, between Badu and Mer Islands (FST = 0·097). On a regional scale, the greatest differentiation was found between the populations of the Torres Strait and the Pacific. Populations from these regions were more closely related to the PNG population than to each other, suggesting they were founded in separate events from the same population.
Phytophthora species in oak ecosystems in Turkey and their association with declining oak trees
Authors: Balcì Y. , Halmschlager E. 
Published: December 2003

From 1999 to 2001, a survey on the occurrence of Phytophthora spp. in the rhizosphere soil of healthy and declining oak trees was conducted in 51 oak stands in Turkey. Seven Phytophthora spp. were recovered from six out of the nine oak species sampled: P. cinnamomi, P. citricola, P. cryptogea, P. gonapodyides, P. quercina, Phytophthora sp. 1 and Phytophthora sp. 2. The most frequently isolated species, P. quercina, was very common on slopes susceptible to drought. It occurred in four different climatic zones and on six Quercus spp., suggesting that it is native to oaks. The second most common species, P. citricola, was separated into three subgroups: type C was recovered only in Anatolia, whereas A and B occurred only in the European part of Turkey. Phytophthora cinnamomi was recovered at one site only, and may not be involved in oak decline in Turkey. The other four species were recovered sporadically. On affected sites there was a significant association between deteriorating crown status and the presence of Phytophthora spp., particularly P. quercina. The occurrence of Phytophthora species was significantly influenced by soil pH. Stem inoculation tests on oak seedlings revealed that Q. petraea was the most susceptible species.
Variation in susceptibility to pitch canker disease, caused byFusarium circinatum, in native stands ofPinus muricata
Authors: Schmale D. G. , Gordon T. R. 
Published: December 2003

Two hundredPinus muricatatrees, located within a native forest near Monterey, California, were inoculated with the pitch canker pathogen. Treated branches were removed 10–13 weeks following the initial inoculation, and the lengths of the lesions that developed at each of the inoculation sites were measured. Results indicated that bishop pine exhibits a wide range of variation in susceptibility to pitch canker disease. Of the trees that received only one inoculation, 27% showed almost no lesion development, indicating that they were relatively resistant to the pathogen, while others had significantly longer lesions and thus were more susceptible. Clonal propagation and seed collection from resistant individuals may offer useful strategies for disease management in the future.
Age‐related effects in the EEG during propofol anaesthesia
Authors: Schultz A. , Grouven U. , Zander I. , Beger F. A. , Siedenberg M. , Schultz B. 
Published: December 2003

Background:  Age‐related differences in the spectral composition of the EEG in induction and emergence times, and in drug consumption during propofol anaesthesia were investigated.Methods:  The EEGs of 60 female patients between 22 and 85 years of age were monitored continuously during standardized induction of anaesthesia with 2 mg of propofol kg−160 s−1. The EEGs were visually assessed in 20‐s epochs according to a scale from A (awake) to F (very deep hypnosis). Visual EEG classifications, spectral parameters, and induction times were compared between different age groups. Additionally, data of 546 patients included in a multicentre study with 4630 patients (EEG monitor Narcotrend®, MT MonitorTechnik, Bad Bramstedt, Germany) were analyzed with regard to age‐dependent changes of propofol consumption using target‐controlled infusion (TCI).Results:  During induction, patients older than 70 years reached significantly deeper EEG stages than younger patients, needed a longer time to reach the deepest EEG stage, and needed more time until a light EEG stage was regained. In patients aged 70 years and older, the total power, mainly in deep EEG stages, was significantly smaller due to a distinctly smaller absolute power of the delta frequency band. No single spectral parameter was able to reliably distinguish all EEG stages.During the steady state of anaesthesia, older patients needed less propofol for the maintenance of a defined stage of hypnosis than younger patients.Conclusion:  Older patients differ from younger ones regarding the hypnotic effect of propofol and the spectral patterns in the EEG. For an efficient automatic assessment of the EEG during anaesthesia a multivariable approach accounting for age‐effects is indispensable.
Reduction in the incidence of awareness using BIS monitoring
Authors: Ekman A. , Lindholm M‐L. , Lennmarken C. , Sandin R. 
Published: December 2003

Background:  Explicit recall (ER) is evident in approximately 0.2% of patients given general anaesthesia including muscle relaxants. This prospective study was performed to evaluate if cerebral monitoring using BIS to guide the conduction of anaesthesia could reduce this incidence significantly.Patients and methods:  A prospective cohort of 4945 consecutive surgical patients requiring muscle relaxants and/or intubation were monitored with BIS and subsequently interviewed for ER on three occasions. BIS values between 40 and 60 were recommended. The results from the BIS‐monitored group of patients was compared with a historical group of 7826 similar cases in a previous study when no cerebral monitoring was used.Results:  Two patients in the BIS‐monitored group, 0.04%, had ER as compared with 0.18% in the control group (P < 0.038). Both BIS‐monitored patients with ER were aware during intubation when they had high BIS values (>60) for 4 min and more than 10 min, respectively. However, periods with high BIS = 4 min were also evident in other patients with no ER. Episodes with high BIS, 4 min or more, were found in 19% of the monitored patients during induction, and in 8% of cases during maintenance.Conclusions:  The use of BIS monitoring during general anaesthesia requiring endotracheal intubation and/or muscle relaxants was associated with a significantly reduced incidence of awareness as compared with a historical control population.
Pulmonary inflammatory mediators after sevoflurane and thiopentone anaesthesia in pigs
Authors: Takala R. S. K. , Soukka H. R. , Salo M. S. , Kirvelä O. A. , Kääpä P. O. , Rajamäki A. A. , Riutta A. , Aantaa R. E. 
Published: December 2003

Background:  Volatile anaesthetics have been shown to affect the release of pulmonary inflammatory mediators and exacerbate pulmonary injury after experimental aspiration. Thus, in theory, volatile anaesthetics may worsen inflammatory pulmonary injury and disease. We have previously described that no significant changes in alveolar ultrastructure are seen after sevoflurane anaesthesia. However, this does not exclude any possible physiological alterations. The aim of our study was to evaluate pulmonary inflammatory mediators in bronchoalveolar lavage (BAL) after sevoflurane and thiopentone anaesthesia in pigs with intact lungs.Methods:  Sixteen pigs were randomly selected to receive either a continuous thiopentone infusion (control group, n = 8) or sevoflurane (n = 8) at 4.0% inspiratory concentration (1.5 MAC) in air for 6 h. Bronchoalveolar lavage samples were collected at the end of the study to determine pulmonary inflammatory markers.Results:  Compared with thiopentone anaesthesia, significant increases in BAL leukotriene C4 (LTC4), NO3‐, and NO2‐ levels were observed after sevoflurane anaesthesia. In addition, there was a significant decrease in total blood leukocyte count in sevoflurane‐treated animals.Conclusion:  We conclude that sevoflurane increases pulmonary LTC4, NO3‐, and NO2‐ production in pigs, indicating an inflammatory response.
Direct myocardial depressant effect of naloxone: mechanical and electrophysiological actions in vitro
Authors: Kim Ki Jun , Chung Nam‐sik , Park Wyun Kon 
Published: December 2003

Background:  Naloxone, an opioid antagonist, has a cardiovascular pressor effect and has been used in various types of shock states. The aim was to determine the non‐opioid effect on direct cardiac muscle contractility and explore the mechanism using guinea pig right ventricular papillary muscles.Methods:  With institutional approval, isometric contractile force was measured in modified normal and 26 mM K+ Tyrode solution at various stimulation rates. The effects of naloxone on sarcoplasmic recticulum function were evaluated by measuring rested‐state contraction in low Na+ (25 mM) Tyrode solution and rapid cooling contracture in modified normal Tyrode solution. Normal and slow action potentials (APs) were measured using conventional microelectrode technique. Patch clamp study was performed to examine the direct effect on Ca2+ current in cardiac ventricular myocytes.Results:  Naloxone (50, 100, and 200 µM) caused a concentration‐dependent depression of peak force and maximal rate of force development. Modest depression, approximately 20%, was shown in rested‐state contraction in low Na+ Tyrode solution. Naloxone (100 µM) modestly depressed the rapid cooling contracture to 80 ± 3% of baseline, accompanied by prolongation of time to peak contracture by approximately 37%. In 26 mM K+ Tyrode solution, naloxone (100 µM) markedly and selectively depressed the late force development. While naloxone (100 µM) did not alter the amplitude and dV/dt‐max in normal and slow APs at 0.25 Hz, AP duration was prolonged significantly. In patch clamp experiment, naloxone (50 µM) depressed Ca2+ current by approximately 50%.Conclusions:  The direct myocardial depressant effect of naloxone appeared to be in part caused by depression of Ca2+ influx through cardiac membrane. Sarcoplasmic reticulum function appeared to be modestly depressed.
Fluid challenge in patients at risk for fluid loading‐induced pulmonary edema
Authors: Matejovic M. , Krouzecky A. , Rokyta R. , Novak I. 
Published: December 2003

Background:  This study evaluated the effects of protocol‐guided fluid loading on extravascular lung water (EVLW) and hemodynamics in a group of patients at high risk for volume expansion‐induced pulmonary and systemic edema.Methods:  Nine acutely admitted septic patients with acute lung injury (ALI) were prospectively studied. In addition to sepsis and ALI, the following criteria indicating increased risk for edema formation had to be fulfilled: increased vascular permeability defined as microalbuminuria greater than fivefold normal and hypoalbuminemia <30 g l−1. Two hundred‐ml boluses of a 10% hydroxyethyl starch (HES) was titrated to obtain best filling pressure/stroke volume relation. Extravascular lung water and intrathoracic blood volume (ITBV) were measured using a transpulmonary double‐indicator dilution technique. Baseline data were compared with data at the end of fluid loading and 3 h postchallenge.Results:  At study entry the mean EVLW was 13 ml kg−1, and the mean EVLW/ITBV ratio (indicator of pulmonary permeability) was 0.72 (normal range 0.20–0.30). To attain optimal preload/stroke volume relation 633 ± 240 ml of HES was needed. Fluid loading significantly increased preload (CVP, PAOP and ITBV), and stroke volume. Effective pulmonary capillary pressure (Pcap) rose only slightly. As a result, the Pcap–PAOP gradient decreased. Despite increased cardiac output, EVLW did not change by plasma expansion.Conclusion:  In this selected group of at‐risk patients, the optimization of cardiac output guided by the concept of best individual filling pressure/stroke volume relationship did not worsen permeability pulmonary edema.
Chronic pain following Caesarean section
Authors: Nikolajsen L. , Sørensen H.C. , Jensen T.S. , Kehlet H. 
Published: December 2003

Background:  Chronic postoperative pain is a well‐recognized problem after various types of surgery such as amputation, thoracotomy, mastectomy, gallbladder surgery and inguinal hernia repair. However, little is known about chronic pain after gynaecologic surgery. Therefore, the aim was to study the incidence of chronic pain after Caesarean section.Methods:  A questionnaire was sent in February/March 2003 to 244 consecutive patients who underwent Caesarean section in a one‐year period from 1 October 2001 to 30 September 2002. Patients were asked about duration of postoperative abdominal scar pain, and if pain was still present to describe the frequency and intensity of pain and its impact on daily life. The questionnaire also included questions about the Caesarean section and about pain problems elsewhere.Results:  A total of 220 patients (90.2%) answered the questionnaire. The mean follow‐up time was 10.2 months (range 6–17.6). Postoperative pain resolved in most patients within 3 months but 27 patients (12.3%) still had pain at the time of the interview. No patients had constant pain, but in 13 of 27 patients (5.9%) pain was present daily or almost daily. Patients with persistent pain (n = 27) had more often undergone general than spinal anaesthesia for the Caesarean section. Frequencies of pain problems elsewhere and recalls of severe acute postoperative pain were also higher among patients with persistent pain.Conclusion:  Chronic pain after Caesarean section seems to be a significant problem in at least 5.9% of patients.
The effect of carbon dioxide, respiratory rate and tidal volume on human heart rate variability
Authors: Pöyhönen M. , Syväoja S. , Hartikainen J. , Ruokonen E. , Takala J. 
Published: December 2003

Background: Heart rate variability (HRV) has been used for assessment of depth of anesthesia. Alterations in respiratory rate and tidal volume modulate the sympatovagal neural drive to the heart. The changes in PaCO2that accompany changes in breathing pattern may, through chemoreceptors in the brainstem, independently influence the autonomic control of the heart and modulate HRV.Methods: We measured the effects of PaCO2, tidal volume and respiratory rate on HRV during spontaneous and mechanical ventilation in 22 healthy volunteers and in 25 mechanically ventilated anesthetized patients.Results: Adding CO2to the inspiratory gas increased high frequency (HF) and low frequency (LF) components of HRV in awake volunteers both during spontaneous and mechanical ventilation, while this effect of CO2was abolished in patients during anesthesia. Increase of tidal volume increased HF component of HRV only in volunteers during spontaneous ventilation. On the other hand, when respiratory rate was reduced, the balance of HF and LF power moved toward LF power in all study groups. Breathing frequency altered HRV independent on PaCO2, tidal volume and the level of consciousness. In contrast, the effect of PaCO2appeared to be related to normal level of consciousness, suggesting that a cortical modulation of the autonomic nervous activity contributes to the effects of PaCO2on HRV.Conclusions: PaCO2, tidal volume and respiratory rate should be controlled when HRV power spectrum is measured in conscious patients or volunteers, while in anesthetized patients small changes in end‐tidal CO2or tidal volume do not modulate HRV if respiratory rate remains unchanged.
Complement activation, endothelin‐1 and neuropeptide Y in relation to the cardiovascular response to endotoxin‐induced systemic inflammation in healthy volunteers
Authors: Soop A. , Albert J. , Weitzberg E. , Bengtsson A. , Lundberg J. O. N. , Sollevi A. 
Published: December 2003

Background:  Endotoxin is a major stimulus for triggering the host response in septicaemia. The pathophysiology of sepsis involves activation of the vascular endothelium and leukocytes, resulting in the release of various mediators, e.g. cytokines, nitric oxide (NO), endothelin (ET‐1) and complement factors. We evaluated the blood levels of complement activation, ET‐1 and neuropeptide Y (NPY) in parallel with the haemodynamic and oxygen transport response during human experimental endotoxemia.Methods:  Eleven healthy men had venous, arterial and pulmonary arterial catheters placed for continuous haemodynamic measuring. After 30 min rest endotoxin (E. Coli 4 ng kg−1, Lot G1) was intravenously administered. Blood samples from pulmonary and arterial catheters were collected hourly over 4 h.Results:  Body temperature augmented significantly from baseline values (36.7 ± 0.7 °C, mean ± SEM) with a maximum after 3.5 h (39.1 ± 0.3 °C, P < 0.001). Cardiac output increased by 100%, systemic vascular resistance decreased by 50%, the oxygen consumption and the tissue oxygen transport increased. Activation of the complement system was indicated by an increase in SC5b‐9. Endothelin‐1‐like immunoreactivity (ET‐1‐LI) increased over time in arterial blood. NPY‐like immunoreactivity (NPY‐LI) did not change over time.Conclusion:  A dose of endotoxin associated with reproducible systemic vasodilation and fever in healthy subjects causes complement activation and increased systemic levels of ET‐1‐LI, illustrating that the model is a useful tool for inducing moderate systemic inflammation where several mediator systems are activated.
Ventriculo‐arterial coupling and mechanical efficiency with remifentanil in patients with coronary artery disease
Authors: Pittarello D. , Bonato R. , Marcassa A. , Pasini L. , Falasco G. , Giron G. P. 
Published: December 2003

Background:  Optimum transfer of energy from the left ventricle to the arterial circulation requires appropriate matching of these mechanical systems. Left ventricular‐arterial coupling describes this relationship between the ventricular elastance (Ees) and arterial elastance (Ea). The ratio of these elastances defines the efficiency of myocardium and provides in our study a useful technique for assessment of the actions of remifentanil. The purpose of this study was to evaluate the effects of remifentanil on ventriculo‐arterial coupling in cardiac surgery in patients with coronary artery disease.Methods:  Fourteen patients with coronary artery disease, submitted intraoperatively to cardiac anesthesia for myocardial revascularization, were examined prospectively. With the use of transesophageal echocardiography (TEE) and different dicrotic arterial pressures, we determined the ventricle elastance (Ees), the arterial elastance (Ea) and myocardial efficiency before and after administration of a slow‐bolus of remifentanil (1 µ kg−1).Results:  Remifentanil decreases significantly the ventricular elastance (from 6.09 mmHg ml−1 m−2 to 4.88) (P < 0.05), with a less, but however, significant decrease of arterial elastance (from 3.68 mmHg ml−1 m−2 to 3.13) (P < 0.05). Despite causing simultaneous declines, maintains a good myocardial efficiency (0.64–0.68) with no significant difference.Conclusion:  Although remifentanil depresses ventricular and arterial elastance, preserves a good left ventricular‐arterial coupling and mechanical efficiency, despite a little increase of coupling. However, these effects are maintained only during a slow intravenous infusion and are dose‐dependent with impairment of coupling, that may contribute to decline in overall cardiovascular performance, at higher anesthetic dose and rapid infusion in patients with a severe myocardial dysfunction.
Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient
Authors: Schulz‐Stübner S. 
Published: December 2003

Background:  Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient.Methods:  A 48‐year‐old women with a history of depression, fibro‐myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks.Conclusion:  Pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. Pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present.