MB's Articles of Interest - April 2001

ARTICLE TITLE: Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.
COMMENTS: N Engl J Med. 2000 Oct 26; 343(17):1259-60/20486792
ARTICLE SOURCE: N Engl J Med (United States), Oct 26 2000, 343(17) p1206-9
AUTHOR(S): Valenzuela TD; Roe DJ; Nichol G; Clark LL; Spaite DW; Hardman RG
AUTHOR'S ADDRESS: Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson 85724-5057, USA. terry.aemrc.arizona.edu.
PUBLICATION TYPE: Evaluation Studies; Journal Article
ABSTRACT: BACKGROUND: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. METHODS: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. RESULTS: Automated external defibrillators were used, 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients 153 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attachment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to The arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes

ARTICLE TITLE: Use of automated external defibrillators by a U.S. airline.
COMMENTS: N Engl J Med. 2000 Oct 26; 343(17):1259-60/20486792
ARTICLE SOURCE: N Engl J Med (United States), Oct 26 2000, 343(17) p1210-6
AUTHOR(S): Page RL; Joglar JA; Kowal RC; Zagrodzky JD; Nelson LL; Ramaswamy K; Barbera SJ; Hamdan MH; McKenas DK
AUTHOR'S ADDRESS: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-9047, USA. rpage@parknet.pmh.org.
PUBLICATION TYPE: Evaluation Studies; Journal Article
ABSTRACT: METHODS: In 1997, a major U.S. airline began equipping its aircraft with automated external defibrillators. We analyzed data on all 200 instances in which the defibrillators were used between June 1, 1997, and July 15, 1999. RESULTS: Automated external defibrillators were used for 200 patients (191 on the aircraft and 9 in the terminal), including 99 with documented loss of consciousness. The rate of survival to discharge from the hospital after shock with the automated external defibrillator was 40 percent. A total of 36 patients either died or were resuscitated after cardiac arrest. No complications arose from use of the automated external defibrillator as a monitor in conscious passengers.

ARTICLE TITLE: Sudden death from cardiac arrest--improving the odds.
COMMENTS: N Engl J Med. 2000 Oct 26; 343(17):1206-9/20486784; : N Engl J Med. 2000 Oct 26; 343(17):1210-6/20486785
ARTICLE SOURCE: N Engl J Med (United States), Oct 26 2000, 343(17) p1259-60
AUTHOR(S): Robertson RM
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Effects of intrathecal morphine on the ventilatory response to hypoxia.
ARTICLE SOURCE: N Engl J Med (United States), Oct 26 2000, 343(17) p1228-34
AUTHOR(S): Bailey PL; Lu JK; Pace NL; Orr JA; White JL; Hamber EA; Slawson MH; Crouch DJ; Rollins DE
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Rochester, NY 14642, USA. peter_bailey@urmc.rochester.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Depression of the ventilatory response to hypoxia after the administration of intrathecal morphine is similar in magnitude to, but longer-lasting than, that after the administration of an equianalgesic dose of intravenous morphine.

ARTICLE TITLE: Conflict-of-interest policies for investigators in clinical trials.
COMMENTS: N Engl J Med. 2000 Nov 30; 343(22):1643-5/20527316
ARTICLE SOURCE: N Engl J Med (United States), Nov 30 2000, 343(22) p1616-20
AUTHOR(S): Lo B; Wolf LE; Berkeley A
AUTHOR'S ADDRESS: Medical Ethics, Center for AIDS Prevention Studies, University of California at San Francisco, USA. bernie@medicine.ucsf.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Policies governing conflicts of interest at leading medical schools in the United States vary widely. We suggest that university-based investigators and research staff be prohibited from holding stock, stock options, or decision-making positions in a company that may reasonably appear to be affected by the results of their clinical research. Of the 10 medical schools we studied, only 1 had a policy that was close to this standard.

ARTICLE TITLE: In whose best interest? Breaching the academic-industrial wall.
COMMENTS: N Engl J Med. 2000 Nov 30; 343(22):1643-5/20527316
ARTICLE SOURCE: N Engl J Med (United States), Nov 30 2000, 343(22) p1646-9
AUTHOR(S): Martin JB; Kasper DL
AUTHOR'S ADDRESS: Harvard Medical School, Boston, MA 02115, USA.
PUBLICATION TYPE: Historical Article; Journal Article

ARTICLE TITLE: The pharmaceutical industry--to whom is it accountable?
ARTICLE SOURCE: N Engl J Med (United States), Nov 9 2000, 343(19) p1415; discussion 1417
AUTHOR(S): Holmer AF
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Triggering of sudden death from cardiac causes by vigorous exertion.
COMMENTS: N Engl J Med. 2000 Nov 9; 343(19):1409-11/20505233
ARTICLE SOURCE: N Engl J Med (United States), Nov 9 2000, 343(19) p1355-61
AUTHOR(S): Albert CM; Mittleman MA; Chae CU; Lee IM; Hennekens CH; Manson JE
AUTHOR'S ADDRESS: Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215-1204, USA. calbert@partners.org.
MAJOR SUBJECT HEADING(S): Death, Sudden, Cardiac [etiology]; Exercise; Exertion
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These prospective data from a study of U.S. male physicians suggest that habitual vigorous exercise diminishes the risk of sudden death during vigorous exertion.
MB. Those prone to death following vigorous exercise had probably already died.

ARTICLE TITLE: The paradox of exercise.
COMMENTS: N Engl J Med. 2000 Nov 9; 343(19):1355-61/20505224
ARTICLE SOURCE: N Engl J Med (United States), Nov 9 2000, 343(19) p1409-11
AUTHOR(S): Maron BJ
PUBLICATION TYPE: Comment; Journal Article
MB. They are having to make up lots of ad hoc hypotheses to keep the popular fitness theory alive. The 'exercise is good' theory can't be correct. Exercise can be bad. It always seemed bad to me.

ARTICLE TITLE: Inhaled glucocorticoids in chronic obstructive pulmonary disease.
COMMENTS: N Engl J Med. 2000 Dec 28; 343(26):1902-9/21012239
ARTICLE SOURCE: N Engl J Med (United States), Dec 28 2000, 343(26) p1960-1
AUTHOR(S): Mapp CE
PUBLICATION TYPE: Comment; Editorial
MB. Useless.

ARTICLE TITLE: Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty.
ARTICLE SOURCE: N Engl J Med (United States), Dec 14 2000, 343(24) p1758-64
AUTHOR(S): White RH; Gettner S; Newman JM; Trauner KB; Romano PS
AUTHOR'S ADDRESS: Department of Medicine, University of California, Davis, Sacramento, USA. rhwhite@ucdavis.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Recent studies have shown that symptomatic venous thromboembolism after total hip arthroplasty most commonly develops after the patient is discharged from the hospital. Risk factors associated with these symptomatic thromboembolic events are not well defined. METHODS: Using administrative data from the California Medicare records for 1993 through 1996, we identified 297 patients 65 years of age or older who were rehospitalized for thromboembolism within three months after total hip arthroplasty. We compared demographic, surgical, and medical variables potentially associated with the development of thromboembolism in these patients and 592 unmatched controls. RESULTS: A total of 89.6 percent of patients with thromboembolism and 93.8 percent of control patients were treated with pneumatic compression, warfarin, enoxaparin, or unfractionated heparin, alone or in combination. In addition, 22.2 percent and 29.7 percent, respectively, received warfarin after discharge. A body-mass index (the weight in kilograms divided by the square of the height in meters) of 25 or greater was associated with rehospitalization for thromboembolism, with an odds ratio of 2.5 (95 percent confidence interval, 1.8 to 3.4). In a multivariate model, the only prophylactic regimens associated with a reduced risk of thromboembolism were pneumatic compression in patients with body-mass indexes of less than 25 (odds ratio, 0.3; 95 percent confidence interval, 0.2 to 0.6) and warfarin treatment after discharge (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 1.0). CONCLUSIONS: In patients who underwent total hip arthroplasty, a body-mass index of 25 or greater was associated with subsequent hospitalization for thromboembolism. Pneumatic compression in patients with a body-mass index of less than 25 and prophylaxis with warfarin after discharge were independently protective against thromboembolism.
MB. There is no mention of the anaesthetics in the abstract. Initially I thought that the study had not looked at the anaesthetic type but it was so unimportant that I had to scour the text to find it in a table of all the factors. There is less than 1% difference in the number of patients who had regional anaesthesia between the groups treated for venous thrombosis and those not. About three quarters of the anaesthetists were not influenced by the prevalent press in favour of regional anaesthesia for hip operations.

ARTICLE TITLE: Cost effectiveness of deep venous thrombosis prophylaxis after hip fracture.
ARTICLE SOURCE: Am J Orthop (United States), May 2000, 29(5) p397-9
AUTHOR(S): Wade WE; Chisholm MA
AUTHOR'S ADDRESS: College of Pharmacy, University of Georgia, Athens, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Patients undergoing hip fracture repair are at significant risk for deep vein thrombosis and pulmonary embolism in the postoperative period without appropriate prophylaxis. Agents available in the United States that have undergone clinical trials as pharmacoprophylaxis for this indication include warfarin, dalteparin, and danaparoid. Safety and efficacy data from these trials were used to determine the most cost-effective agent for routine deep vein thrombosis prophylaxis in patients with hip fractures. Incremental cost-effectiveness ratio calculations demonstrate that warfarin dosed to an international normalized ratio of 2-2.7 is currently the most cost-effective agent in these patients

ARTICLE TITLE: Blinded prospective study of the incidence of deep venous thrombosis following conventional or laparoscopic colorectal resection.
ARTICLE SOURCE: Br J Surg (England), Jan 2001, 88(1) p99-100
AUTHOR(S): Mall JW; Schwenk W; Rodiger O; Zippel K; Pollmann C; Muller JM
AUTHOR'S ADDRESS: Department of General, Vascular and Thoracic Surgery and Cardiology, Angiology and Pneumology, Medical Faculty of Humboldt University, Berlin, Charite, Berlin, Germany. julainmall@hotmail.com.
PUBLICATION TYPE: Clinical Trial; Journal Article ARTICLE TITLE: Conquering hepatitis C, step by step.
COMMENTS: N Engl J Med. 2000 Dec 7; 343(23):1666-72/20537432; : N Engl J Med. 2000 Dec 7; 343(23):1673-80/20537433
ARTICLE SOURCE: N Engl J Med (United States), Dec 7 2000, 343(23) p1723-4
AUTHOR(S): Schafer DF; Sorrell MF
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Lack of effect of induction of hypothermia after acute brain injury.
COMMENTS: N Engl J Med. 2001 Feb 22; 344(8):602-3/21079651
ARTICLE SOURCE: N Engl J Med (United States), Feb 22 2001, 344(8) p556-63
AUTHOR(S): Clifton GL; Miller ER; Choi SC; Levin HS; McCauley S; Smith KR; Muizelaar JP; Wagner FC; Marion DW; Luerssen TG; Chesnut RM; Schwartz M
AUTHOR'S ADDRESS: Vivian L Smith Center for Neurologic Research, Department of Neurosurgery, University of Texas-Houston Medical School, 77030, USA. guy.l.clifton@uth.tmc.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
The study subjects were 392 patients 16 to 65 years of age with coma after sustaining closed head injuries who were randomly assigned to be treated with hypothermia (body temperature, 33 degrees C), which was initiated within 6 hours after injury and maintained for 48 hours by means of surface cooling, or normothermia.. Mortality was 28 percent in the hypothermia group and 27 percent in the normothermia group (P=0.79). The patients in the hypothermia group had more hospital days with complications than the patients in the normothermia group. Fewer patients in the hypothermia group had high intracranial pressure than in the normothermia group. CONCLUSIONS: Treatment with hypothermia, with the body temperature reaching 33 degrees C within eight hours after injury, is not effective in improving outcomes in patients with severe brain injury.
MB. Well there we go ---the end of another 'good' theory which has been applied for a long time.

ARTICLE TITLE: Hypothermia for fulminant hepatic failure: a cool approach to a burning problem.
ARTICLE SOURCE: Liver Transpl (United States), Mar 2000, 6(2) p245-7
AUTHOR(S): Blei A
AUTHOR'S ADDRESS: Northwestern University Medical School Division of Gastroenterology and Hepatology Department of Medicine Galter Pavilion, Suite 17-250 Chicago, IL 60611-2923, USA.
PUBLICATION TYPE: Journal Article
MB. It's not good in head injuries.

ARTICLE TITLE: Hypothermia for traumatic brain injury--a good idea proved ineffective.
COMMENTS: N Engl J Med. 2001 Feb 22; 344(8):556-63/21079644
ARTICLE SOURCE: N Engl J Med (United States), Feb 22 2001, 344(8) p602-3
AUTHOR(S): Narayan RK
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Cellular telephones and brain tumors.
COMMENTS: N Engl J Med. 2001 Jan 11; 344(2):79-86/21019596
ARTICLE SOURCE: N Engl J Med (United States), Jan 11 2001, 344(2) p133-4
AUTHOR(S): Trichopoulos D; Adami HO
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Diastolic heart failure--no time to relax.
COMMENTS: N Engl J Med. 2001 Jan 4; 344(1):17-22/21012265
ARTICLE SOURCE: N Engl J Med (United States), Jan 4 2001, 344(1) p56-9
AUTHOR(S): Vasan RS; Benjamin EJ
PUBLICATION TYPE: Comment; Editorial
MB. Apparently it is difficult to diagnose. I can't work out what the definitions of what systolic & diastolic heart failure are.

ARTICLE TITLE: Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery. Effects on pulmonary mechanics.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2000, 44(9) p1071-6
AUTHOR(S): Tenling A; Joachimsson P-O; Tyden H; Hedenstierna G
AUTHOR'S ADDRESS: Departments of Cardiothoracic Anaesthesiology, University Hospital, Uppsala, Sweden. Arne.Tenling@KlinFys.uu.se.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: A lasting impairment of pulmonary function is common after cardiac surgery. Pain from the sternotomy may contribute to the impairment. Thoracic epidural analgesia (TEA) can efficiently relieve pain in the postoperative phase, but may also affect respiratory muscle function if local anaesthetics are used. We examined the effects of TEA on pulmonary function and ventilation at rest, before and after coronary artery bypass graft surgery (CABG). METHODS: Thirty patients scheduled for CABG were randomized to receive either general anaesthesia alone or general anaesthesia with TEA. Before and after the operation the patients were examined by respiratory inductive plethysmography and spirometric tests. RESULTS: Before the operation, TEA caused significant reductions in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), maximal inspiratory (PImax) and expiratory (PEmax) pressure. The rib cage contribution to tidal volume decreased significantly but the co-ordination of the thoracic and abdominal movements remained essentially unaffected. Minute volume and respiratory frequency did not change significantly. On the first postoperative day a decrease in maximal breathing efforts was found in both groups. No differences between the groups in FVC, FEV1 and PImax were found, but PEmax was significantly greater in the TEA group. Despite the impairment, breathing at rest was largely normal in both groups. CONCLUSIONS: A better pain-relief from TEA after CABG may improve the ability to cough by a greater expiratory muscle strength. FVC, FEV1, PImax and breathing at rest are not affected by TEA after cardiac surgery.
MB. Well that is pretty hopeless too

ARTICLE TITLE: Thoracic epidural anaesthesia and analgesia: United Kingdom practice.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2000, 44(9) p1087-92
AUTHOR(S): O'Higgins F; Tuckey JP
AUTHOR'S ADDRESS: Department of Anaesthesia, Royal United Hospital, Bath, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists. METHODS: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom. RESULTS: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia. CONCLUSION: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up.
MB. Even more hopeless

ARTICLE TITLE: Mixed venous oxygen saturation during mobilization after cardiac surgery: are reflectance oximetry catheters reliable?
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2000, 44(9) p1103-8
AUTHOR(S): Kirkeby-Garstad I; Skogvoll E; Sellevold FM
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, University Hospital of Trondheim, Norway. Idar.Kirkeby-Garstad@medisin.ntnu.no.
PUBLICATION TYPE: Clinical Trial; Evaluation Studies; Journal Article
CONCLUSION: The two methods are interchangeable for most clinical purposes. Catheter readings are, however, substantially lower than the corresponding haemoximetric measurements at low SvO2 values. Careful interpretation of the absolute values resulting from catheter measurements is recommended, especially when SvO2 readings are low.
MB. If it is low it is low. The exact lowness would be of marginal importance.

ARTICLE TITLE: Bispectral index, predicted and measured drug levels of target-controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy and emergence.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2000, 44(9) p1138-44
AUTHOR(S): Hoymork SC; Raeder J; Grimsmo B; Steen PA
AUTHOR'S ADDRESS: Department of Anaesthesia, Ullevaal Hospital, Oslo, Norway. sivcathrine.hoymork@ulleval.no.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSION: Present systems for Target-controlled infusions (TCI) of remifentanil and propofol result in large intra- and interindividual variations in measured drug levels, and measured levels differ from target. There may be possible interaction between the two anaesthetics at a pharmacokinetic level. Within the level of anaesthesia studied here bispectral index of EEG (BIS)was not an indicator of the actual drug levels. Women woke up significantly faster than men.
MB. Both these modalities have been/are being pushed like mad. There have been some quite nice meals

ARTICLE TITLE: Future anesthesiologists will be as much outside as inside operating theaters.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Sep 2000, 44(8) p906-9
AUTHOR(S): Lindahl SG
PUBLICATION TYPE: Editorial
MB. They are always saying this. A small minority of people for a small part of their time is the most likely future.

ARTICLE TITLE: Light-guided intubation via the intubating laryngeal mask using a prototype illuminated flexible catheter. Clinical experience in 400 patients.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Sep 2000, 44(8) p1002-6
AUTHOR(S): Dimitriou V; Voyagis GS
AUTHOR'S ADDRESS: Department of Anaesthesia, Gennimatas Hospital, Athens, Greece.
PUBLICATION TYPE: Clinical Trial; Evaluation Studies; Journal Article
CONCLUSION: We conclude that the use of the illuminated flexible catheter facilitates the intubation through the intubating laryngeal mask. The suggested light-guided intubating method proved to be a simple, safe and effective technique.

ARTICLE TITLE: Use of an EEG-bispectral closed-loop delivery system for administering propofol.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Sep 2000, 44(8) p1007-10
AUTHOR(S): Sakai T; Matsuki A; White PF; Giesecke AH
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Hirosaki School of Medicine, Japan.
PUBLICATION TYPE: Journal Article
ABSTRACT: Closed-loop control of propofol delivery was instituted in three patients who received a propofol infusion as part of: (Case 1) general "balanced" anesthesia, (Case 2) total intravenous anesthesia, and (Case 3) monitored anesthesia care. The bispectral index was the input variable used in a proportioned, integral and differential controller to determine the infusion rate of propofol required to maintain a stable level of hypnosis (Cases 1 and 2) or sedation (Case 3). This feedback control system provided intraoperative hemodynamic stability and a prompt recovery from the sedative-hypnotic effects of propofol.
MB. That's a good series----3. The editors must have a bias.

ARTICLE TITLE: Epidural abscess after epidural catheter for pain release during pancreatitis.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Sep 2000, 44(8) p1024-7
AUTHOR(S): Heller AR; Ragaller M; Koch T
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany. heller-a@rcs.urz.tu-dresden.de.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Despite knowledge about compromised host defence in the course of diabetes mellitus and pancreatitis, epidural analgesia (EA) is recommended for pain management during pancreatitis. CASE REPORT: We present the case of a diabetic patient with pancreatitis who developed an epidural abscess after 3 days with an epidural catheter. Natural killer and T-helper cell counts were distinctively reduced in the absence of HIV serology. Furthermore, a synthesis failure of the liver was observed and evidenced by low cholinesterase, low whole protein fraction and low antithrombin III in the peripheral blood. CONCLUSION: We suggest that the combination of pancreatitis, diabetes and compromised immunity might be a contraindication to epidural analgesia.

ARTICLE TITLE: Complications of common selective spinal injections: prevention and management.
ARTICLE SOURCE: Am J Orthop (United States), Oct 2000, 29(10) p759-70
AUTHOR(S): Windsor RE; Pinzon EG; Gore HC
AUTHOR'S ADDRESS: Emory University, Department of Physical Medicine & Rehabilitation, Georgia, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial .

ARTICLE TITLE: Bupivacaine for postoperative pain relief at the iliac crest bone graft harvest site.
ARTICLE SOURCE: Am J Orthop (United States), Jun 2000, 29(6) p443-6
AUTHOR(S): Puri R; Moskovich R; Gusmorino P; Shott S
AUTHOR'S ADDRESS: Hospital for Joint Diseases Orthopaedic Institute, New York, New York, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: An inevitable side effect of iliac crest bone graft harvesting is postoperative pain at the donor site. Bupivacaine hydrochloride is a long-acting local anesthetic that is clinically effective for approximately 8 hours. The present study was undertaken to assess postoperative pain relief with locally injected bupivacaine at the iliac crest bone graft harvest site. Pain relief with locally injected bupivacaine or saline at the iliac bone harvest site using an indwelling catheter was studied in 13 patients in a prospective, double-blind, crossover study. Twelve patients had cervical diskectomy and arthrodesis with autograft and one patient had a triple arthrodesis of the foot. There were no statistically significant differences between patients given bupivacaine and patients given saline with respect to pain relief ratings and hip-pain ratings at rest and motion during the first 24-hour postoperative period and the second 24-hour postoperative period (Mann-Whitney test). The single diabetic patient who had a triple arthrodesis developed a wound infection at the catheter placement site. The number of patients was too small to draw conclusions about the differences in pain-medication requirements between patients undergoing single versus multiple diskectomies and fusions. In view of the lack of improvement in pain relief and the risk of infection, local administration of bupivacaine at the iliac bone harvest site is not recommended in its present form for postoperative analgesia.
MB. It is silly to do statistics on such a small study. But the reality is that the bupivicaine was no better than saline. This is a pilot study but I don't think it would be worth while doing a big study. That would be common sense based medicine.

ARTICLE TITLE: Visual estimation of angles by orthopedic surgeons.
ARTICLE SOURCE: Am J Orthop (United States), May 2000, 29(5) p361-2; discussion 363
AUTHOR(S): Moran KM; Ness K; Finkbeiner AA
AUTHOR'S ADDRESS: Sadler Clinic, The Woodlands, Texas, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: A literature review indicates that the exactness of visual estimation of angles has not adequately been addressed. This study used a series of angles to examine how accurately and consistently practicing orthopedic surgeons were able to visually estimate angles. The data indicate that orthopedic surgeons were able to visually estimate angles to within 10 degrees 93.1% of the time and to within 5 degrees 64.6% of the time. Repeat measurements 6 weeks later were within 5 degrees of the initial responses 82.2% of the time and within 10 degrees of the initial responses 94.5% of the time. The number of years in practice or in training was irrelevant to the validity and reliability of the estimates. Acute angles of 31 degrees or less were consistently overestimated.
MB. Maybe they should get some protractors

ARTICLE TITLE: Can we achieve consensus on central venous catheter-related infections?
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Oct 2000, 28(5) p475-90
AUTHOR(S): Fraenkel DJ; Rickard C; Lipman J
AUTHOR'S ADDRESS: Royal Brisbane Hospital, Queensland.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
. The authors hope that this classification will enhance the interpretation of the literature and the planning of new investigations. Infection rates can be reduced by appropriate site selection, adequate skin preparation, sterile technique and appropriate dressings. Decreased manipulation of administration sets, with more careful technique and less frequent set replacement, may reduce hub contamination. Infection rates increase with the duration in situ of the catheter, however are not reduced by regular scheduled catheter replacement or guide-wire exchanges. A range of antimicrobial catheter materials and coatings are under investigation, some of which are effective in reducing the rate of catheter-related bacteraemia. Chorhexidine-silver sulphadiazine and rifampicin-minocycline are the best studied combinations to date. Further developments are expected, although none are likely to be as effective as not inserting or removing the central venous catheter when it is not required.
MB. We all live in hope

ARTICLE TITLE: Effect of pre-incision skin infiltration on post-hysterectomy pain--a double-blind randomized controlled trial.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Oct 2000, 28(5) p510-6
AUTHOR(S): Leung CC; Chan YM; Ngai SW; Ng KF; Tsui SL
AUTHOR'S ADDRESS: Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong, China.
We concluded that local anaesthetic infiltration is not effective in reducing pain after abdominal hysterectomy. Effective postoperative analgesia should aim to eliminate the visceral pain component.

ARTICLE TITLE: Acidosis associated with perioperative saline administration: dilution or delusion? [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1167-9
AUTHOR(S): Prough; White
PUBLICATION TYPE: MEDLINE RECORD IN PROCESS
JOURNAL ARTICLE

ARTICLE TITLE: Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1170-3
AUTHOR(S): Liskaser; Bellomo; Hayhoe; Story; Poustie; Smith; Letis; Bennett
AUTHOR'S ADDRESS: Departments of Anaesthesia and Intensive Care, Austin and Repatriation Medical Centre, Melbourne, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Cardiopulmonary bypass-induced metabolic acidosis appears to be iatrogenic in nature and derived from the effect of pump prime fluid on acid-base balance. The extent of such acidosis and its duration varies according to the type of pump prime.
MB. This is exactly what I would have expected to see.

ARTICLE TITLE: Acid-base changes caused by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution: A randomized prospective study
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1174-83
AUTHOR(S): Rehm; Orth; Scheingraber; Kreimeier; Brechtelsbauer; Finsterer
AUTHOR'S ADDRESS: Clinic of Anesthesiology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
PUBLICATION TYPE: MEDLINE RECORD IN PROCESS
JOURNAL ARTICLE
CONCLUSIONS: acute normovolemic hemodilution (ANH with 5% albumin or 6% hydroxyethyl starch solutions led to metabolic acidosis. A dilution of extracellular bicarbonate or changes in strong ion difference and albumin concentration offer explanations for this type of acidosis.

ARTICLE TITLE: Dilutional acidosis following hetastarch or albumin in healthy volunteers
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1184-7
AUTHOR(S): Waters; Bernstein
AUTHOR'S ADDRESS: Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, and the Department of Anesthesiology, University of California, Irvine Medical Center, Orange, California.
PUBLICATION TYPE JOURNAL ARTICLE
ABSTRACT: BACKGROUND: The intent of this study was to evaluate the impact of the commonly used colloids-hetastarch and albumin-on in vivo acid-base balance. From this evaluation, a better understanding of the mechanism of dilutional acidosis was expected. METHODS: In a prospective, randomized fashion, 11 healthy volunteers were administered 15 ml/kg hetastarch solution, 6%, or 15 ml/kg albumin, 5%, intravenously over 30 min. Four weeks later, the study subjects were administered the other colloid. Arterial blood gas and electrolyte parameters were measured at baseline and at 30, 60, 90, 120, 210, and 300 min after colloid administration. Pre- and postlaboratory values were compared within groups using a paired t test and a Wilcoxon signed rank test and between groups using repeated-measures analysis of variance and a Wilcoxon rank sum test. RESULTS: Thirty min after infusion, subjects who were administered hetastarch showed statistically significant changes (P < 0.05) in base excess (from 2.5 +/- 0.9 mEq/l to 0.7 +/- 1.1 mEq/l), HCO3- concentration (from 27 +/- 1.0 mEq/l to 25 +/- 1.3 mEq/l), Cl- concentration (from 108 +/- 2 mEq/l to 112 +/- 2 mEq/l), albumin concentration (from 4.4 +/- 0.2 g/dl to 3.5 +/- 0.5 g/dl), and arterial carbon dioxide tension (Paco2; from 40.8 +/- 2.3 mmHg to 39. 2 +/- 3.2 mmHg), whereas only the albumin concentration (from 4.4 +/- 0.2 g/dl to 4.8 +/- 0.6 g/dl) changed significantly in the albumin-treated group. CONCLUSIONS: Decreases in base excess were observed for 210 min after hetastarch administration but not after albumin. The mechanism for this difference is discussed.

ARTICLE TITLE: Low- and medium-molecular-weight hydroxyethyl starches: comparison of their effect on blood coagulation [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1231-7
AUTHOR(S): Jamnicki; Bombeli; Seifert; Zollinger; Camenzind; Pasch; Spahn
AUTHOR'S ADDRESS: Institute of Anesthesiology, University Hospital, Zurich, Switzerland.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Low-molecular-weight hydroxyethyl starch (70 kd) compromises blood coagulation slightly less than compared medium molecular weight HES (200 kd [HES200]), but it is unclear whether this is clinically relevant.
MB. If they are not clear about it why did the editors bother publishing it.

ARTICLE TITLE: Sex differences in morphine analgesia: An experimental study in healthy volunteers
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1245-54
AUTHOR(S): Sarton; Olofsen; Romberg; den Hartigh J; Kest; Nieuwenhuijs; Burm; Teppema; Dahan
AUTHOR'S ADDRESS: Departments of Anesthesiology, Clinical Pharmacy and Toxicology, and Physiology, Leiden University Medical Center, Leiden, The Netherlands, and the Department of Psychology and Program in Neuroscience, College of Staten Island-City Un.
PUBLICATION TYPE: MEDLINE RECORD IN PROCESS
JOURNAL ARTICLE
CONCLUSIONS: These data show sex differences in morphine analgesia, with greater morphine potency but slower speed of onset and offset in women. The data are in agreement with observations of sex differences in morphine-induced respiratory depression and may explain higher postoperative opioid consumption in men relative to women.

ARTICLE TITLE: Acute subdural hematoma following spinal anesthesia with a very small spinal needle [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1354-6
AUTHOR(S): Cantais; Behnamou; Petit; Palmier
AUTHOR'S ADDRESS: Military Teaching Hospital, Intensive Care Unit, Hopital d'Instruction des Armees Sainte Anne, Toulon-Naval, France.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: Intraoperative hemodialysis during emergency laparotomy [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2000, 93(5) p1356-7
AUTHOR(S): Cooper; Kurtz; Sawyer; Narr
AUTHOR'S ADDRESS: Mayo Clinic, Rochester, Minnesota.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: Cause-specific mortality risks of anesthesiologists: new evidence for the existence of old problems
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p919-21
AUTHOR(S): Berry; Fleisher
PUBLICATION TYPE JOURNAL ARTICLE
MB. 50% mortality of general population but higher suicide and drug related deaths than internists.

ARTICLE TITLE: Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p959-63
AUTHOR(S): Olympio; Youngblood; James
AUTHOR'S ADDRESS: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
PUBLICATION TYPE JOURNAL ARTICLE
CONCLUSIONS: Prone emergence and extubation is associated with less hemodynamic stimulation, less coughing, and less disruption of monitors, without specifically observed adverse effects, when compared with conventional supine techniques.

ARTICLE TITLE: Electrocardiographic ST-segment changes during acute, severe isovolemic hemodilution in humans [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p1004-10
AUTHOR(S): Leung; Weiskopf; Feiner; Hopf; Kelley; Viele; Lieberman; Watson; Noorani; Pastor; Yeap; Ho; Toy
PUBLICATION TYPE JOURNAL ARTICLE
CONCLUSION: With acute reduction of hemoglobin concentration to 5 g/dl, ECG ST-segment changes developed in 3 of 55 healthy conscious adults and were suggestive of, but not conclusive for, myocardial ischemia. The higher heart rates that developed during hemodilution may have contributed to the development of an imbalance between myocardial supply and demand resulting in ECG evidence of myocardial ischemia. However, these ECG changes appear to be benign because they were reversible and not accompanied by symptoms.
MB. It would be worse in high risk patients.

ARTICLE TITLE: Cardiovascular and metabolic response to acute normovolemic anemia: effects of anesthesia [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p1011-6
AUTHOR(S): Ickx; Rigolet; Van Der Linden PJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Erasme University Hospital, Brussels, Belgium.
PUBLICATION TYPE JOURNAL ARTICLE
CONCLUSIONS: Anesthesia significantly reduces the cardiac output response associated with acute normovolemic hemodilution (ANH). This could be related to the effects of the anesthetic drugs on the autonomic and the cardiovascular systems.
MB. Why do it then?

ARTICLE TITLE: Systematic overview of the evidence supporting the use of cerebrospinal fluid drainage in thoracoabdominal aneurysm surgery for prevention of paraplegia
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p1115-22
AUTHOR(S): Ling; Arellano
AUTHOR'S ADDRESS: McMaster University, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada, and University of Toronto, The Toronto Hospital, Toronto, Ontario, Canada.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: Preemptive analgesia
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p1138-43
AUTHOR(S): Kissin
AUTHOR'S ADDRESS: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussets.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: Can epidural fentanyl induce selective spinal hyperalgesia? [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Oct 2000, 93(4) p1153
AUTHOR(S): Cooper; Bernards
PUBLICATION TYPE JOURNAL ARTICLE
MB. What a disappointment!

ARTICLE TITLE: The National Liver Transplantation audit: an overview of patients presenting for liver transplantation from 1994 to 1998. On behalf of the Steering Group of the UK Liver Transplantation Audit.
ARTICLE SOURCE: Br J Surg (England), Jan 2001, 88(1) p52-8
AUTHOR(S): Hartley P; Petruckevitch A; Reeves B; Rolles K
AUTHOR'S ADDRESS: Clinical Effectiveness Unit, The Royal College of Surgeons and University Department of Surgery, Royal Free Hospital, London, UK.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: BACKGROUND: The aim of this study was to describe current clinical practice in liver transplantation in the UK and Ireland, to provide overall 1-year graft and patient survival rates, and to study some preoperative risk factors. METHODS: All patients receiving a liver transplant in the UK or Ireland between 1 March 1994 and 30 September 1998 were included. Data were collected on patients at the time of transplantation, 3 months after grafting and annually thereafter until the patient's death. The main outcome measures were graft and patient survival at 1 year. RESULTS: A total of 3102 liver transplants were carried out, of which 87 per cent were first transplants. The mean age at first transplantation was 42 (range 0-76) years. The most common indications for transplantation were primary biliary cirrhosis, alcoholic cirrhosis and posthepatitis C cirrhosis, but variations existed between sexes and centres. Risk factors associated with lower graft and patient survival were the presence of acute disease, being transplanted from hospital, and the need for renal and/or ventilatory support before operation. CONCLUSION: Donor and recipient demographics are consistent with data held by the European Liver Transplant Registry, as are 1-year graft and patient survival rates. Variation across centres in factors such as the primary indication for liver transplantation, population demographics, the clinical status of each patient, incidence of retransplantation and other risk factors contributes to the problem of adjusting for case mix.

ARTICLE TITLE: Pre-emptive analgesia: importance of timing. [In Process Citation]
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 2001, 48(2) p105-14
AUTHOR(S): Katz J
PUBLICATION TYPE Editorial

ARTICLE TITLE: The role of anesthesiologists in Canadian undergraduate medical education
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 2001, 48(2) p147-52
AUTHOR(S): Brull R; Bradley JW
AUTHOR'S ADDRESS: Department of Anesthesia, Faculty of Medicine, University of Toronto, Ontario, Canada.
PUBLICATION TYPE: MEDLINE RECORD IN PROCESS
Journal Article
CONCLUSION: A very small proportion of faculty anesthesiologists participate in Canadian UME at the pre-clerkship level. Considerable variation exists in the amount and format of teaching by anesthesiologists among the Canadian undergraduate curricula, particularly at the pre-clerkship level. However, our results indicate that anesthesiologists are assuming a more important teaching role during clerkship. Our findings may suggest that Canadian medical schools are overlooking the advantages that anesthesiologists offer to Canadian undergraduate medical education (UME) at the pre-clerkship level, or that many anesthesiologists are reluctant to assume pre-clerkship teaching responsibilities.

ARTICLE TITLE: Why should we teach medical students?
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 2001, 48(2) p115-20
AUTHOR(S): Yang H; Wilson-Yang K; Raymer K
PUBLICATION TYPE: MEDLINE RECORD IN PROCESS
Editorial

ARTICLE TITLE: Impact of the initial doses of rocuronium and pancuronium on subsequent maintenance for neuromuscular block.
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 2001, 48(2) p129-32
AUTHOR(S): Kern SE; Fragen RJ; Fitzgerald PC; van Zeeland M; Johnson JO
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City 84132, USA. skern@remi.med.utah.edu.
PUBLICATION TYPE Journal Article
CONCLUSIONS: For combinations of rocuronium and pancuronium, the duration of twitch suppression after a maintenance dose is only dependent on the first agent given for the first two maintenance doses administered.
MB. It is probably better not to mix drugs.

ARTICLE TITLE: [L'anesthesie loco-regionale neuraxiale et la chirurgie vasculaire: les benefices.]
ARTICLE SOURCE: Can J Anaesth (Canada), Jan 2001, 48(1) p65-71
AUTHOR(S): Drolet P; Girard M
AUTHOR'S ADDRESS: Departement d'anesthesie-reanimation, H pital Maisonneuve-Rosement, Montreal, Quebec, Canada. pdrolet@aei.ca.
PUBLICATION TYPE: MEDLINE RECORD IN PROCESS
Journal Article
ABSTRACT: PURPOSE: To assess the advantages of neuraxial blockade (NB) during and after vascular surgery and to confront them with the risk of epidural or spinal hematoma. MAIN FINDINGS: NB may reduce the risk of thrombotic occlusion following lower extremity vascular reconstruction. This effect of NB may be attributed to reduced hypercoagulability, decreased peripheral resistance and increased graft flow. In patients under general anesthesia, only those authors using an aggressive perioperative management (pulmonary artery catheter monitoring, intensive care unit admission) were able to report grafts patency rates similar to those obtained with NB. NB facilitates the modulation of the hemodynamic and hormonal stress responses during the perioperative period. It also produces superior postoperative analgesia. Still, the impact of NB on cardiac morbidity following aortic reconstructive surgery remains open to debate. Only very few cases of epidural hematomas associated to NB following vascular surgery have been reported. They implicated patients who received either fibrinolytic medication, continuous heparin infusion, or both. Low molecular weight heparins may increase the risk or epidural hematoma and, should their administration become more frequent during vascular surgery, the safety of NB would then have to be reassessed. CONCLUSION: NB during vascular surgery is a safe and well-established practice. It offers many theoretical and demonstrated advantages. NB is particularly beneficial and economical for lower extremity vascular reconstruction. Still, NB may not be the best approach if the administration of fibrinolityc medication or prolonged heparin infusion is contemplated.
MB. Equivocal.

ARTICLE TITLE: [L'anesthesie loco-regionale neuraxiale ne devrait plus etre utilisee en chirurgie vasculaire.]
ARTICLE SOURCE: Can J Anaesth (Canada), Jan 2001, 48(1) p72-7
AUTHOR(S): Samama CM; Baillard C
AUTHOR'S ADDRESS: Departement d'anesthesie-reanimation, H pital Avicenne, France. cmsamama@invivo.edu.
PUBLICATION TYPE Journal Article
ABSTRACT: OBJECTIVES: Neuraxial blockade (spinal or epidural anesthesia) is still widely used in patients undergoing vascular surgery. However, the combined administration of anticoagulants and antiplatelet agents may compromise the safety of this technique with regards to the potential occurrence of a spinal or of an epidural hematoma. We review the benefits and risks of neuraxial blockade in light of the evolution of anticoagulation for vascular surgery. MAIN FINDINGS: Vascular surgery generally requires a high level of intraoperative anticoagulation. An increasing number of patients are also treated pre and post-operatively with antiplatelet agents. Their administration cannot be interrupted without serious risks to the patients' cardiovascular system and, further their continued use during surgery may improve graft permeability. Recent reports have emphasized the danger of neuraxial anesthesia in patients receiving low dose anticoagulation. So, high doses of heparins should carry an ever higher risk of serious complications in patients undergoing neuraxial blockade. Furthermore, no published data has ever demonstrated convincingly the benefit of either epidural or spinal anesthesia over general anesthesia. No differences have ever been documented in terms of cardio-vascular morbidity, graft patency, and mortality. CONCLUSION: Routine neuraxial blockade cannot be recommended in patients undergoing vascular surgery. The decision to perform a neuraxial block in such a patient may only be taken on a case by case basis, after careful consideration of expected benefits and potential risks.
MB The one before this is equivical and this one is realistic. The conclusions would be, "Don't do it."

ARTICLE TITLE: Patient assessment of efficacy of pain management: the fallacy of management by opinion poll.
COMMENTS: Can J Anaesth. 2000 Dec; 47(12):1166-70/21018787
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 2000, 47(12) p1161-5
AUTHOR(S): Buckley DN
PUBLICATION TYPE: Comment; Editorial
MB. There is not much connection between satisfaction and pain rating.

ARTICLE TITLE: Intraoperative vs postoperative morphine improves analgesia without increasing PONV on emergence from ambulatory surgery.
ARTICLE SOURCE: Can J Anaesth (Canada), Nov 2000, 47(11) p1090-3
AUTHOR(S): Wong J; Ritchie E; Chung F; Marshall S; McHardy F; Fortier J
AUTHOR'S ADDRESS: Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Administration of 0.1 mg x kg(-1) morphine iv intraoperatively improves postoperative analgesia upon emergence from painful ambulatory surgical procedures without increasing the incidence of PONV There was no increase in PONV when morphine was administered intraoperatively rather than postoperatively.
MB. There was no subjective difference so why not wait till the pateint is awake. Sometimes slow recovery is due to narcotics.

ARTICLE TITLE: Pain management in patients who undergo outpatient arthroscopic surgery of the knee. [In Process Citation]
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Dec 2000, 82-A(12) p1754-66
AUTHOR(S): Reuben; Sklar
AUTHOR'S ADDRESS: Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA. scott.reuben@bhs.org.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Ondansetron hydrochloride for the treatment of delirium after coronary artery surgery.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Jan 2001, 121(1) p176-7
AUTHOR(S): Bayindir O; Guden M; Akpinar B; Sanisoglu I; Sagbas E
AUTHOR'S ADDRESS: Departments of Anesthesia and Cardiovascular Surgery, Kadir Has University Medical Faculty, Florence Nightingale Hospital, Si&scedil; li-Istanbul, Turkey.
PUBLICATION TYPE: Evaluation Studies; Journal Article

ARTICLE TITLE: Nocturnal blood pressure and 24-hour pulse pressure are potent indicators of mortality in hemodialysis patients.
ARTICLE SOURCE: Kidney Int (United States), Jun 2000, 57(6) p2485-91
AUTHOR(S): Amar J; Vernier I; Rossignol E; Bongard V; Arnaud C; Conte JJ; Salvador M; Chamontin B
AUTHOR'S ADDRESS: Service de Medecine Interne et d'Hypertension Arterielle and Service de Nephrologie et d'Hemodialyse, CHU Purpan; and Departement d'Epidemiologie, d'Economie de la Sante et de Sante Communautaire, Toulouse, France.
PUBLICATION TYPE: Journal Article
CONCLUSION: This study demonstrates that nocturnal BP and 24-hour PP are independent predictors of CV mortality in treated hypertensive hemodialysis patients. Randomized trials are needed to investigate whether nocturnal BP and 24-hour PP are superior to office BP as targets for antihypertensive therapy in this high-risk group.

ARTICLE TITLE: Therapy of heart failure.
ARTICLE SOURCE: Kidney Int (United States), Apr 2000, 57(4) p1418-25
AUTHOR(S): Schrier RW; Abdallah JG; Weinberger HH; Abraham WT
AUTHOR'S ADDRESS: Department of Medicine, University of Colorado School of Medicine, Denver, CO 80262 USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: The incidence and prevalence of heart failure is on the rise. It has become the single most expensive health care item in the United States and the number one discharge diagnosis in the elderly. The goals of therapy include both prevention and treatment of heart failure. In recent years research studies and randomized clinical trials have revolutionized the understanding of the pathophysiology and treatment of this disease. This article focuses on the medical management of chronic systolic heart failure based on the pathophysiology of the disease. Systolic heart failure is characterized by a decrease in left ventricular function and cardiac output, which results in activation of several neurohormonal compensatory systems. The long term effects of this neurohormonal activation leads to further deterioration of cardiac function. The use of hydralazine and nitrates to reduce the systemic vascular resistance was the first to show an improvement in mortality and morbidity. Then angiotensin converting enzyme inhibitors, by inhibiting the renin angiotensin system, demonstrated a greater improvement in mortality and morbidity. More recently the inhibition of the sympathetic stimulation with beta-blockers has been shown to have an additive effect on morbidity and mortality in combination with angiotensin-converting enzyme inhibitors. Digoxin and diuretics remain important for improving symptoms and decreasing hospitalizations but have not been shown to decrease mortality. The most recent advance in the treatment of cardiac failure is the demonstration that the aldosterone antagonists, spironolactone decreases morbidity and mortality.

ARTICLE TITLE: Michelangelo: art, anatomy, and the kidney.
ARTICLE SOURCE: Kidney Int (United States), Mar 2000, 57(3) p1190-201
AUTHOR(S): Eknoyan G
AUTHOR'S ADDRESS: Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. geknoyan@bcm.tmc.edu.
PUBLICATION TYPE: Biography; Historical Article; Journal Article; Review; Review, Tutorial
ABSTRACT: Michelangelo (1475-1564) had a life-long interest in anatomy that began with his participation in public dissections in his early teens, when he joined the court of Lorenzo de' Medici and was exposed to its physician-philosopher members. By the age of 18, he began to perform his own dissections. His early anatomic interests were revived later in life when he aspired to publish a book on anatomy for artists and to collaborate in the illustration of a medical anatomy text that was being prepared by the Paduan anatomist Realdo Colombo (1516-1559). His relationship with Colombo likely began when Colombo diagnosed and treated him for nephrolithiasis in 1549. He seems to have developed gouty arthritis in 1555, making the possibility of uric acid stones a distinct probability. Recurrent urinary stones until the end of his life are well documented in his correspondence, and available documents imply that he may have suffered from nephrolithiasis earlier in life. His terminal illness with symptoms of fluid overload suggests that he may have sustained obstructive nephropathy. That this may account for his interest in kidney function is evident in his poetry and drawings. Most impressive in this regard is the mantle of the Creator in his painting of the Separation of Land and Water in the Sistine Ceiling, which is in the shape of a bisected right kidney. His use of the renal outline in a scene representing the separation of solids (Land) from liquid (Water) suggests that Michelangelo was likely familiar with the anatomy and function of the kidney as it was understood at the time.

ARTICLE TITLE: Effects of bicarbonate- and lactate-buffered replacement fluids on cardiovascular outcome in continuous venovenous hemofiltration (CVVH) patients
ARTICLE SOURCE: Kidney Int (United States), Oct 2000, 58(4) p1751-7
AUTHOR(S): Barenbrock; Hausberg; Matzkies; De La Motte S; Schaefer
AUTHOR'S ADDRESS: Department of Medicine D, University of Munster, Munster, and Statistical Institute, Harrison Clinical Research,Munich, Germany.
PUBLICATION TYPE JOURNAL ARTICLE
CONCLUSIONS: The results show that the administration of RF-bic solution was superior to lactate-buffered replacement fluid (RF-lac) in normalizing acidosis of patients without the risk of alkalosis. The data also suggest that the use of : bicarbonate-buffered replacement fluid (RF-bic)during CVVH reduces cardiovascular events in critically ill patients with acute renal failure, particularly those with previous cardiovascular disease or heart failure.

ARTICLE TITLE: Delayed graft function influences renal function, but not survival.
ARTICLE SOURCE: Kidney Int (United States), Aug 2000, 58(2) p859-66
AUTHOR(S): Boom H; Mallat MJ; de Fijter JW; Zwinderman AH; Paul LC
AUTHOR'S ADDRESS: Departments of Nephrology and Medical Statistics, Leiden University Medical Center, The Netherlands. hboom@nephrology.azl.nl.
PUBLICATION TYPE: Journal Article
CONCLUSION: Several risk factors for delayed graft function (DGF) were identified, of which a low recipient pretransplant mean arterial blood pressure, the transplantation of kidneys from female donors to male recipients, and a prolonged cold ischemia time are potentially avoidable. Although DGF is one of the several risk factors of acute rejection and suboptimal function at one year, it is not independently associated with an increased rate of graft loss.

ARTICLE TITLE: Living unrelated donor kidney transplantation.
ARTICLE SOURCE: Kidney Int (United States), Aug 2000, 58(2) p491-9
AUTHOR(S): Gjertson DW; Cecka JM
AUTHOR'S ADDRESS: UCLA Immunogenetics Center, Department of Pathology, Los Angeles, CA 90095, USA. gjertson@ucla.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Living unrelated kidney donors represent the fastest growing donor source in the United States and provide excellent long-term results. Encouraging spouses to donate could remove nearly 15% of the patients from the UNOS waiting list, effectively increasing the number of available cadaveric organs.

ARTICLE TITLE: Why we block angiotensin II.
COMMENTS: Kidney Int. 2000 Jul; 58(1):144-52
ARTICLE SOURCE: Kidney Int (United States), Jul 2000, 58(1) p458-9
AUTHOR(S): Meyer TW
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Is smoking a risk factor for progression of chronic renal failure?
ARTICLE SOURCE: Kidney Int (United States), Dec 2000, 58(6) p2597
AUTHOR(S): Samuelsson; Attman
AUTHOR'S ADDRESS: Goteborg, Sweden.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: Laparoscopic versus open donor nephrectomy
ARTICLE SOURCE: Kidney Int (United States), Dec 2000, 58(6) p2596
AUTHOR(S): Morrissey; Madras; Gohh; Monaco
AUTHOR'S ADDRESS: Providence, Rhode Island, USA.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: A comparison of the results of renal transplantation from non-heart-beating, conventional cadaveric, and living donors [In Process Citation]
ARTICLE SOURCE: Kidney Int (United States), Dec 2000, 58(6) p2585-91
AUTHOR(S): Nicholson; Metcalfe; White; Waller; Doughman; Horsburgh; Feehally; Carr; Veitch
AUTHOR'S ADDRESS: Departments of Surgery and Nephrology, University of Leicester, Leicester General Hospital, Leicester, England,United Kingdom.
PUBLICATION TYPE JOURNAL ARTICLE
CONCLUSIONS: Despite being associated with poor initial graft function, the long-term allograft survival of non-heart-beating donor (NHBD) kidneys does not differ significantly from the results of heart-beating cadaveric (HBD) and Living D transplants.

ARTICLE TITLE: Effect of early arterialization of the porcine liver allograft on reperfusion injury, hepatocellular injury, and endothelial cell dysfunction.
ARTICLE SOURCE: Liver Transpl (United States), Jan 2001, 7(1) p32-7
AUTHOR(S): van As AB; Lotz Z; Tyler M; Kahn D
AUTHOR'S ADDRESS: Department of Surgery, Liver Research Centre, University of Cape Town, Cape Town, South Africa. abvanas@pawc.wcape.gov.za.
PUBLICATION TYPE: Journal Article
ABSTRACT: The conventional technique of liver transplantation involves the initial perfusion of the graft with portal blood. However, recent evidence suggests that initial arterialization of the graft may be better. The aim of this study is to evaluate the timing of arterialization on reperfusion injury, hepatocellular injury, and endothelial cell function after liver transplantation. Large white X Landrace pigs (n = 24) were subjected to orthotopic liver transplantation. The animals were randomly assigned to 4 groups, ranging from late arterialization (60 minutes after portal reperfusion) to early rearterialization (20 minutes before portal reperfusion). Aspartate aminotransferase levels continued to increase 4 hours posttransplantation in group 1 (late arterialization), but remained stable after 1 hour posttransplantation in group 4 (early rearterialization). Levels of malondialdehyde doubled in all groups after portal reperfusion with the exception of group 4, in which the liver received arterial blood before portal reperfusion. Vitamin A levels decreased in all groups after revascularization, but the decrease was more pronounced and prolonged in groups 1 and 2 (late arterialization) compared with groups 3 and 4 (early rearterialization). Hyaluronic acid levels continued to increase in all groups until 1 hour posttransplantation except in group 4, in which the level decreased from 20 minutes posttransplantation. Results of this study show that early rearterialization is associated with less hepatocellular damage, less reperfusion injury, and improved liver endothelial cell function. In conclusion, our results indicate that early rearterialization of the graft is beneficial to the transplanted liver.
MB. WE used to do this in humans via a temporary shunt from an iliac artery to portal vein.

ARTICLE TITLE: Coronary artery disease and liver transplantation: the state of the art.
ARTICLE SOURCE: Liver Transpl (United States), Jul 2000, 6(4 Suppl 1) pS53-6
AUTHOR(S): Plotkin JS; Johnson LB; Rustgi V; Kuo PC
AUTHOR'S ADDRESS: Georgetown Transplant Institute, Georgetown University Medical Center, Washington, DC 20007, USA. plotkinj@gunet.georgetown.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Critical care issues in liver transplantation.
ARTICLE SOURCE: Liver Transpl (United States), Jul 2000, 6(4 Suppl 1) pS2-4
AUTHOR(S): Plevak DJ; Findlay JY
AUTHOR'S ADDRESS: Department of Anesthesiology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. plevak.david@mayo.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Whither living donor liver transplantation?
COMMENTS: Liver Transpl Surg. 1999 Nov; 5(6):536-8
ARTICLE SOURCE: Liver Transpl (United States), May 2000, 6(3) p387
AUTHOR(S): Lee KH; Tan KC
PUBLICATION TYPE: Comment; Letter

ARTICLE TITLE: Do continuing professional development models promote one-dimensional learning?
ARTICLE SOURCE: Med Educ (England), Jan 2001, 35(1) p8-11
AUTHOR(S): Eraut M
AUTHOR'S ADDRESS: University of Sussex Institute of Education, Brighton, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Sexual harassment during medical training: the perceptions of medical students at a university medical school in Australia.
ARTICLE SOURCE: Med Educ (England), Dec 2000, 34(12) p980-6
AUTHOR(S): White GE
AUTHOR'S ADDRESS: School of Health Sciences, Massey University, Auckland, New Zealand.
PUBLICATION TYPE: Journal Article
ABSTRACT: CONTEXT: A survey of medical students' experiences of sexual harassment during medical training. OBJECTIVE: To assess the prevalence and nature of workplace sexual harassment as perceived by undergraduate medical students in order to address their learning needs concerning setting and maintaining sexual boundaries. DESIGN: A questionnaire involving both quantitative and qualitative descriptions. SETTING: A university medical school in Australia. PARTICIPANTS: The medical student population. MAIN OUTCOME MEASURES: Estimated prevalence of sexual harassment according to gender and year of training; frequency of sexual harassment reported by category of behaviour, year of training and gender; type of sexual harassment and alleged harasser reported by gender; frequency of sexual harassment reported by category of behaviour and alleged harasser. RESULTS: Female students encountered an unacceptable amount of sexual harassment in medical training from fellow students, patients, faculty and doctors they worked with, which was perceived as affecting learning opportunities. CONCLUSION: Genderized sexual harassment exists in medical training. While both male and female students report episodes perceived as sexual harassment a difference in interpretation results in greater vulnerability for female students. Medical educators need to address issues of gender, sexual harassment, and the setting and maintaining of sexual boundaries in order to avoid a hostile learning environment.

ARTICLE TITLE: Undergraduate medical students' views on the value of dissecting [In Process Citation]
ARTICLE SOURCE: Med Educ (England), Nov 2000, 34(11) p961
AUTHOR(S): Charlton; Smith
AUTHOR'S ADDRESS: Senior Lecturer, Centre For Primary Health Care Warwick University, UK; Research Assistant The Surgery, Hampton-in-Arden West Midlands, UK.
PUBLICATION TYPE JOURNAL ARTICLE

ARTICLE TITLE: Assumptions underlying self-directed learning may be false.
COMMENTS: Med Educ. 2000 Apr; 34(4):299-306
ARTICLE SOURCE: Med Educ (England), Apr 2000, 34(4) p243-5
AUTHOR(S): Schmidt HG
AUTHOR'S ADDRESS: Deartment of Psychology, Maastricht University, Maastricht, The Netherlands.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Defining moments in medicine. Anaesthesia. [In Process Citation]
ARTICLE SOURCE: Med J Aust (Australia), Jan 1 2001, 174(1) p17-8
AUTHOR(S): Phillips GD
AUTHOR'S ADDRESS: Flinders Medical Centre, Adelaide, SA.
PUBLICATION TYPE Journal Article

ARTICLE TITLE: Getting to grips with heroin and other opioid use.
COMMENTS: Med J Aust. 2000 Nov 20; 173(10):524-7/21032741; : Med J Aust. 2000 Nov 20; 173(10):528-31/21032742
ARTICLE SOURCE: Med J Aust (Australia), Nov 20 2000, 173(10) p509-10
AUTHOR(S): Saunders JB; Richards AH
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: How many dependent heroin users are there in Australia?
COMMENTS: Med J Aust. 2000 Nov 20; 173(10):509-10/21032736
ARTICLE SOURCE: Med J Aust (Australia), Nov 20 2000, 173(10) p528-31
AUTHOR(S): Hall WD; Ross JE; Lynskey MT; Law MG; Degenhardt LJ
AUTHOR'S ADDRESS: National Drug and Alcohol Research Centre, University of New South Wales, Sydney.
PUBLICATION TYPE: Journal Article
RESULTS: The best estimates of the number of dependent heroin users in Australia in 1997-1998 from the three methods of estimation were between 67 000 and 92 000 and the median estimate was 74 000. The population prevalence was 6.9 per 1000 adults aged 15-54 years. The prevalence of heroin dependence in Australia is the same as that in Britain (7 per 1000) and within the range of recently derived estimates in the European Union (3-8 per 1000 adults aged 15-54 years). CONCLUSIONS: Although the exact figures need to be interpreted with caution, our estimates suggest that Australia has a substantial public health problem with dependent heroin use that is of a magnitude similar to that in comparable European societies.

ARTICLE TITLE: Depression: dispirited or spiritually deprived?
ARTICLE SOURCE: Med J Aust (Australia), Nov 20 2000, 173(10) p545-7
AUTHOR(S): Hassed CS
AUTHOR'S ADDRESS: Department of Community Medicine and General Practice, Monash University, East Bentleigh, VIC. craig.hassed@med.monash.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: The 20th century has seen a widespread decline in mental health in Western society. One important factor may be the lack of meaning and spiritual fulfilment that is part of our increasingly secular and materialistic society. In medical education and practice, religious issues are often marginalised or 'pathologised", despite consistent evidence from the literature of the protective effect of "religiosity" or "spirituality" on mental and physical health.

ARTICLE TITLE: Depressed Australians: should we worry?
COMMENTS: Med J Aust. 2000 Nov 6; 173(9):458-61/21024074
ARTICLE SOURCE: Med J Aust (Australia), Nov 6 2000, 173(9) p453-5
AUTHOR(S): Parker GB
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Recent trends in the use of antidepressant drugs in Australia, 1990-1998.
COMMENTS: Med J Aust. 2000 Nov 6; 173(9):453-5/21024071
ARTICLE SOURCE: Med J Aust (Australia), Nov 6 2000, 173(9) p458-61
AUTHOR(S): McManus P; Mant A; Mitchell PB; Montgomery WS; Marley J; Auland ME
AUTHOR'S ADDRESS: Department of Health and Aged Care, Canberra, ACT. peter.mcmanus@health.gov.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: As in most developed countries, antidepressant use increased between 1990 and 1998. The rapid market uptake of the new antidepressants, particularly serotonin reuptake inhibitors (SSRIs), is likely to have been driven by increased awareness of depression, together with availability and promotion of new therapies.

ARTICLE TITLE: Erectile dysfunction.
ARTICLE SOURCE: Med J Aust (Australia), Nov 6 2000, 173(9) p492-7
AUTHOR(S): McMahon CG
AUTHOR'S ADDRESS: North Shore Private Hospital, Sydney, NSW. cmcmahon@mail.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: Erectile dysfunction (ED) is a common condition and can usually be managed pharmacologically, with drugs delivered by intracavernosal injection (ICI), transurethrally or orally. The cardiovascular status of the patient and his overall fitness for renewed sexual activity must be assessed before treatment for ED is initiated. The efficacy of sildenafil is related to the extent and severity of ED, and is significantly reduced in patients with severe vasculogenic ED, ED associated with diabetes and after radical prostatectomy. Alprostadil (prostaglandin E1) is the drug of first choice in patients treated with ICI; it is effective in 72.6% of men with ED and is associated with a low risk of priapism and cavernosal fibrosis. Transurethral alprostadil is significantly less effective than alprostadil ICI, producing improved erections in 30%-40%, but rigid erections in only 10%, of men with ED. There is Level II evidence that: alprostadil ICI is an effective treatment for ED papaverine ICI is associated with a high risk of cavernosal fibrosis and priapism papaverine ICI should be restricted to informed patients refractory to treatment with alprostadil ICI transurethral alprostadil is less effective than alprostadil ICI sildenafil is an effective treatment for ED.

ARTICLE TITLE: What's in a name? The labelling of back pain.
COMMENTS: Med J Aust. 2000 Oct 16; 173(8):419-22
ARTICLE SOURCE: Med J Aust (Australia), Oct 16 2000, 173(8) p400-1
AUTHOR(S): Bogduk N
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: An uncommon cause of postoperative confusion.
ARTICLE SOURCE: Med J Aust (Australia), Oct 16 2000, 173(8) p440-1
AUTHOR(S): Foot CL; Barnett RJ
AUTHOR'S ADDRESS: Princess Alexandra Hospital, Wooloongabba, QLD. carolelf@powerup.com.au.
PUBLICATION TYPE: Journal Article
MB. Methaemoglobinaemia.

ARTICLE TITLE: Abdominal aortic aneurysm: endovascular repair.
ARTICLE SOURCE: Med J Aust (Australia), Oct 2 2000, 173(7) p340-1
AUTHOR(S): May J
PUBLICATION TYPE: Editorial
MB. From our unit. J

ARTICLE TITLE: Costs, charges and revenues of elective coronary angioplasty and stenting: the public versus the private system.
COMMENTS: Med J Aust. 2000 Sep 18; 173(6):285-6
ARTICLE SOURCE: Med J Aust (Australia), Sep 18 2000, 173(6) p296-300
AUTHOR(S): Harper RW; Sampson KD; See PL; Kealey JL; Meredith IT
AUTHOR'S ADDRESS: Centre for Heart and Chest Research, Monash University and Monash Medical Centre, Melbourne, VIC. richard.harper@med.monash.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Despite similar treatments and similar treatment costs, coronary angioplasty and stenting (CAS) in the private system, as a consequence of the charges levied, is more than twice as expensive as in the public system, with government costs similar for both systems. These data (together with data from other studies showing that CAS is performed more frequently in private patients) suggest that encouraging more people to take out private health insurance will, paradoxically, increase government costs for CAS as well as increasing overall health expenditure.

ARTICLE TITLE: Coronary angiography and coronary artery revascularisation rates in public and private hospital patients after acute myocardial infarction.
COMMENTS: Med J Aust. 2000 Sep 18; 173(6):285-6
ARTICLE SOURCE: Med J Aust (Australia), Sep 18 2000, 173(6) p291-5
AUTHOR(S): Robertson IK; Richardson JR
AUTHOR'S ADDRESS: Health Economics Unit, Monash University, Melbourne, VIC. iain.robertson@buseco.monash.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In Victoria, management of patients with acute myocardial infarction is influenced by the public or private status of the patient, and by whether management occurs in private or public hospitals. Patients are more likely to undergo coronary angiography and coronary artery revascularisation procedures in private hospitals.

ARTICLE TITLE: Coronary revascularisation in the private and public sectors. Does the Australian healthcare system deliver value for money?
COMMENTS: Med J Aust. 2000 Sep 18; 173(6):291-5; : Med J Aust. 2000 Sep 18; 173(6):296-300
ARTICLE SOURCE: Med J Aust (Australia), Sep 18 2000, 173(6) p285-6
AUTHOR(S): Bett N
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Evidence-based management of melanoma. Clinical practice guidelines are now available for managing this cancer which occurs in relatively young people and is a particular problem in Australia.
ARTICLE SOURCE: Med J Aust (Australia), Sep 18 2000, 173(6) p286-7
AUTHOR(S): McCarthy WH
MAJOR SUBJECT HEADING(S): Evidence-Based Medicine; Melanoma [surgery]; Skin Neoplasms [surgery]
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Blood transfusion practice: mayhem or monitoring? [In Process Citation]
ARTICLE SOURCE: Med J Aust (Australia), Sep 2000, 173(5) p230-1
AUTHOR(S): Street; Cole-Sinclair
PUBLICATION TYPE Editorial
MB. Trying to make sure donated blood is well used.

ARTICLE TITLE: Alcohol: the good, the bad and the ugly. [In Process Citation]
ARTICLE SOURCE: Med J Aust (Australia), Sep 2000, 173(5) p231-2
AUTHOR(S): Whelan; Gijsbers
PUBLICATION TYPE Editorial

ARTICLE TITLE: Non-cardiac chest pain: squeezing the life out of the Australian healthcare system? [In Process Citation]
ARTICLE SOURCE: Med J Aust (Australia), Sep 2000, 173(5) p233-4
AUTHOR(S): Eslick; Talley
PUBLICATION TYPE Editorial

ARTICLE TITLE: Circumstances leading to a change to prone sleeping in sudden infant death syndrome victims [In Process Citation]
ARTICLE SOURCE: Pediatrics (United States), Dec 2000, 106(6) pE86
AUTHOR(S): Cote; Gerez; Brouillette; Laplante
AUTHOR'S ADDRESS: Jeremy Rill Centre for SIDS, Division of Respiratory Medicine, Department of Pediatrics.
PUBLICATION TYPE: JOURNAL ARTICLE
Conclusions. Ongoing campaigns to decrease the risk of sudden infant death syndrome (SIDS) should emphasize the risk of unaccustomed prone sleeping to both parents and secondary caretakers.

ARTICLE TITLE: Adverse sedation events in pediatrics: analysis of medications used for sedation
ARTICLE SOURCE: Pediatrics (United States), Oct 2000, 106(4) p633-44
AUTHOR(S): Cote; Karl; Notterman; Weinberg; McCloskey
AUTHOR'S ADDRESS: Department of Pediatric Anesthesiology, Children's Memorial Hospital, Northwestern University School of Medicine, Chicago, Illinois.
PUBLICATION TYPE JOURNAL ARTICLE
Conclusions. Adverse sedation events were frequently associated with drug overdoses and drug interactions, particularly when 3 or more drugs were used. Adverse outcome was associated with all routes of drug administration and all classes of medication, even those (such as chloral hydrate) thought to have minimal effect on respiration. Patients receiving medications with long plasma half-lives may benefit from a prolonged period of postsedation observation. Adverse events occurred when sedative medications were administered outside the safety net of medical supervision. Uniform monitoring and training standards should be instituted regardless of the subspecialty or venue of practice. Standards of care, scope of practice, resource management, and reimbursement for sedation should be based on the depth of sedation achieved (ie, the degree of vigilance and resuscitation skills required) rather than on the drug class, route of drug administration, practitioner, or venue.

ARTICLE TITLE: Pediatric analgesia and sedation for the management of orthopedic conditions.
ARTICLE SOURCE: Am J Orthop (United States), Sep 2000, 29(9) p665-72
AUTHOR(S): Cameron ML; Sponseller PD; Rossberg MI
AUTHOR'S ADDRESS: Johns Hopkins Medical Institution, Outpatient Center, Baltimore, Maryland, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Orthopedic injuries are common in the emergency department; this is especially true in children. The orthopedist must often supervise sedation and analgesia for the injured child. While the techniques of conscious sedation have improved, the therapeutic index between adequate and excessive sedation is much narrower in children than adults, especially for painful procedures. The purpose of this review is to outline a reasonable approach to sedation and analgesia in the pediatric patient. In addition, current monitoring guidelines are reviewed, as well as the basic pharmacology of the most commonly used drugs.

ARTICLE TITLE: Cost effectiveness of deep venous thrombosis prophylaxis after hip fracture.
ARTICLE SOURCE: Am J Orthop (United States), May 2000, 29(5) p397-9
AUTHOR(S): Wade WE; Chisholm MA
AUTHOR'S ADDRESS: College of Pharmacy, University of Georgia, Athens, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Patients undergoing hip fracture repair are at significant risk for deep vein thrombosis and pulmonary embolism in the postoperative period without appropriate prophylaxis. Agents available in the United States that have undergone clinical trials as pharmacoprophylaxis for this indication include warfarin, dalteparin, and danaparoid. Safety and efficacy data from these trials were used to determine the most cost-effective agent for routine deep vein thrombosis prophylaxis in patients with hip fractures. Incremental cost-effectiveness ratio calculations demonstrate that warfarin dosed to an international normalized ratio of 2-2.7 is currently the most cost-effective agent in these patients.

ARTICLE TITLE: Recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2000, 28(4) p431-3
AUTHOR(S): Harris RJ; Benveniste G
AUTHOR'S ADDRESS: Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, South Australia.
PUBLICATION TYPE: Journal Article
ABSTRACT: We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.
MB. How could coughing cause a haematoma if haemostasis was complete.

ARTICLE TITLE: Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2000, 28(4) p408-13
AUTHOR(S): Bennett MH; Isert PR; Cumming RG
AUTHOR'S ADDRESS: Division of Anaesthesia, Prince of Wales Hospital, Sydney, New South Wales.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. <snip> The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied
MB. What a silly experiment.

ARTICLE TITLE: Effect of bolus dose of remifentanil on haemodynamic response to tracheal intubation.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2000, 28(4) p403-7
AUTHOR(S): Barclay K; Kluger MT
AUTHOR'S ADDRESS: Department of Anaesthesia, North Shore Hospital, Takapuna, Auckland, New Zealand.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: A randomized placebo-controlled double-blinded study was conducted in 40 ASA 1 and 2 patients to determine the dose response of remifentanil in attenuating the haemodynamic response to tracheal intubation. Patients were allocated to one of four groups: placebo, remifentanil 1 microgram.kg-1, remifentanil 2 micrograms.kg-1 and remifentanil 4 micrograms.kg-1. A propofol target-controlled infusion was started at 4 micrograms.ml-1 and incrementally titrated to loss of verbal contact. Muscle relaxation was provided by cisatracurium. The study drug was given three minutes later over 30 seconds, and 90 seconds later the patient's trachea was intubated under direct laryngoscopy. Baseline noninvasive blood pressure and heart rate recordings were made prior to starting target-controlled infusion, then at one-minute intervals after loss of verbal contact for the duration of the study. Demographic data and target-controlled infusion rate at intubation was similar for the groups. Following intubation, heart rate increased by 15% in the placebo group, 10% in 1 microgram.kg-1 group, with no changes in 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Systolic blood pressure following intubation increased by 30% in the placebo group, 10% in the 1 microgram.kg-1 group and remained unchanged in the 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Remifentanil 1 microgram.kg-1 attenuated the rise in heart rate and systolic blood pressure. Remifentanil 2 micrograms.kg-1 blocked the haemodynamic response completely: no further benefit was shown from increasing the dose to 4 micrograms.kg-1.

ARTICLE TITLE: Agreement between two plasma bicarbonate assays in critically ill patients.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2000, 28(4) p399-402
AUTHOR(S): Story DA; Poustie S
AUTHOR'S ADDRESS: Department of Anaesthesia, Austin and Repatriation Medical Centre, Heidelberg, Victoria.
PUBLICATION TYPE: Journal Article
ABSTRACT: Previous studies have suggested that measurement of plasma bicarbonate concentration using the Henderson-Hasselbalch equation may be unreliable, particularly in critically ill patients. We examined the agreement between two plasma bicarbonate concentration assays in critically ill patients. Data were collected from records of routine daily blood samples. Paired samples were taken at the same time from arterial lines. A Bland-Altman analysis was used to compare two bicarbonate assays in clinical use. The first used the Henderson-Hasselbalch equation for blood-gas machine calculations. The second used a spectrophotometric enzymatic technique. Comparing the enzymatic method to the calculated method (enzymatic minus calculated) the bias was -1.6 mmol/l (95% CI: -1.2 to -2.0 mmol/l). The limits of agreement were -5.85 mmol/l to 2.65 mmol/l. This study found poor agreement between the two bicarbonate assays. This poor agreement is clinically important but the causes are unclear. We suggest further investigation of the reliability of bicarbonate assays.
MB. I would suggest that they just went and played golf.

ARTICLE TITLE: Pre-emptive analgesia with epidural morphine or morphine and bupivacaine.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2000, 28(4) p392-8
AUTHOR(S): Subramaniam B; Pawar DK; Kashyap L
AUTHOR'S ADDRESS: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: Studies of preemptive analgesia in humans have shown conflicting results. The study design, patient population and the duration of assessment of postoperative pain are important in the evaluation of preemptive analgesia. We carried out a prospective, randomized, double-blind controlled study in 80 patients of physical status ASA 1-3 undergoing upper abdominal and thoracic surgery. Patients received two epidural injections, one 20 minutes before induction and the other at the end of surgery. Study solution was either morphine (50 micrograms/kg), with or without 0.1% bupivacaine in 10 ml of normal saline, or normal saline alone. The study groups (Pre M, Pre MB) were given either morphine or morphine-bupivacaine before induction and saline at the end of surgery. The control groups (Post M, Post MB) were given saline before induction and morphine or morphine-bupivacaine at the end of surgery. Postoperative pain was assessed with a Visual Analogue Scale (VAS) during coughing and deep breathing at six-hourly intervals for five days. Epidural morphine was given if the VAS exceeded 4. Pre MB compared to Post MB had a significantly increased interval between the analgesic top-ups (P < 0.01) and decreased total postoperative morphine requirements (P < 0.0001) and number of top-ups (P < 0.001). Pre M and Post M were comparable. Pre MB compared to Pre M had significantly decreased total postoperative morphine requirements (P < 0.0001) and number of top-ups (P < 0.0001). Epidural morphine plus bupivacaine is effective as a preemptive analgesic. Morphine plus bupivacaine has better efficacy than morphine given alone before the induction of anaesthesia.

ARTICLE TITLE: Tramadol--present and future.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2000, 28(4) p363-74
AUTHOR(S): Shipton EA
AUTHOR'S ADDRESS: Department of Anaesthesiology and Pain Management, CH Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Cardiovascular and pulmonary effects of epidural anaesthesia.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2000, 28(6) p620-35
AUTHOR(S): Veering BT; Cousins MJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
MAJOR SUBJECT HEADING(S): Anesthesia, Epidural; Hemodynamics [drug effects]; Respiratory Mechanics [drug effects]
INDEXING CHECK TAG(S): Animal; Human
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: Epidural anaesthesia has been used since the early 1900s. Consequently the general characteristics of these procedures have been well defined. More studies have provided a better understanding of the cardiopulmonary changes produced by epidural anaesthesia. The cardiovascular effects observed with epidural anaesthesia are complex and variable, depending on a multitude of factors. The extent of sympathetic denervation, balance of sympathetic and parasympathetic activity, the pharmacological effect of systemically absorbed local anaesthetic agents, inclusion of adrenaline in the anaesthetic solution, the distribution of blood in relation to cardiac filling and cardiovascular function of the patient must be taken into account when considering the circulatory effects of epidural anaesthesia. Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block. Epidural anaesthesia that is restricted to the level of the low thoracic and lumbar region (T5-L4) results in a "peripheral" sympathetic blockade with vascular dilatation in the pelvis and lower limbs. High thoracic epidural anaesthesia, from the first to fifth thoracic, blocks the cardiac afferent and efferent sympathetic fibres with loss of chronotropic and inotropic drive to the myocardium. Thoracic epidural anaesthesia appears to at least partly reverse the diaphragmatic dysfunction that is a major determinant of the decrease in lung volumes observed after upper abdominal surgery. This article summarizes cardiovascular and pulmonary responses to epidural anaesthesia. Details of clinical management are not included in the review.

ARTICLE TITLE: Unwashed shed blood infusion causes deterioration in right ventricular function after coronary artery surgery.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2000, 28(6) p642-5
AUTHOR(S): Kitano T; Hattori S; Miyakawa H; Yoshitake S; Iwasaka H; Noguchi T
AUTHOR'S ADDRESS: Department of Anesthesiology, Oita Medical University, Oita-gun, Oita, Japan.
PUBLICATION TYPE: Clinical Trial; Journal Article
ABSTRACT: We investigated right ventricular function after infusion of unwashed shed blood collected from mediastinal and chest tube drainage. Changes in thromboxane B2 (TXB2) and 6-keto-PGF1 alpha, which are stable metabolites of thromboxane A2 (TXA2) and prostacyclin respectively, were also investigated. The amount of infused shed blood was 484 +/- 76 ml (mean +/- SD). Right ventricular ejection fraction decreased rapidly after the infusion and did not return to its original level until 120 minutes later (P < 0.05). Mean pulmonary artery pressure rose after infusion of the shed blood (P < 0.05). The TXB2 level in the unwashed shed blood was about 20,000 times higher than the preoperative plasma level. The plasma TXB2 level at 30 minutes after the infusion was significantly elevated (P < 0.05), and at 120 minutes it had returned to the original level. Unwashed shed blood may contain vasoactive substances that induce the release of TXA2 and increase right ventricular afterload.

ARTICLE TITLE: Relative cost of autologous red cell salvage versus allogeneic red cell transfusion during abdominal aortic aneurysm repair.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2000, 28(6) p646-9
AUTHOR(S): Gardner A; Gibbs N; Evans C; Bell R
AUTHOR'S ADDRESS: Departments of Anaesthesia and Vascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia.
These findings indicate that, compared with the use of allogeneic packed red cells, red cell salvage during emergency abdominal aortic aneurysm repair can be justified on an economic basis alone.

ARTICLE TITLE: Supraclavicular regional anaesthesia revisited--the bent needle technique.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2000, 28(6) p676-9
AUTHOR(S): Cornish PB
AUTHOR'S ADDRESS: Department of Anaesthesia, Wellington Hospital, Wellington, New Zealand.
PUBLICATION TYPE: Clinical Trial; Journal Article
ABSTRACT: A new technique for achieving brachial plexus anaesthesia through the supraclavicular fossa is described. Its objectives are to minimize risk to the lung and provide for continuous as well as single-shot options. The plexus is approached through the lateral aspect of the supraclavicular fossa, and a bend in the shaft of the needle permits the tip of the needle to be directed tangential to the chest wall. An audit of 572 cases associated with the development of this technique is presented.
MB. Why do people persist in poking needles near the pleura. I changed to other methods in 1962.

ARTICLE TITLE: Vale supraclavicular brachial plexus block?
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2000, 28(6) p708-9
AUTHOR(S): Berry FR
PUBLICATION TYPE: Letter

ARTICLE TITLE: Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial [In Process Citation]
ARTICLE SOURCE: Ann Surg (United States), Mar 2001, 233(3) p438-44
AUTHOR(S): McLeod RS; Geerts WH; Sniderman KW; Greenwood C; Gregoire RC; Taylor BM; Silverman RE; Atkinson KG; Burnstein M; Marshall JC; Burul CJ; Anderson DR; Ross T; Wilson SR; Barton P
AUTHOR'S ADDRESS: Department of Surgery, University of Toronto, Toronto, Ontario, Canada. rmcleod@mtsinai.on.ca; Collective Name: Canadian Colorectal Surgery DVT Prophylaxis Trial investigators.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Both heparin 5,000 units subcutaneously every 8 hours and enoxaparin 40 mg subcutaneously once daily provide highly effective and safe prophylaxis for patients undergoing colorectal surgery. However, given the current differences in cost, prophylaxis with low-dose heparin remains the preferred method at present.

ARTICLE TITLE: Central and peripheral adverse hemodynamic changes during laparoscopic surgery and their reversal with a novel intermittent sequential pneumatic compression device.
ARTICLE SOURCE: Ann Surg (United States), Feb 2001, 233(2) p176-82
AUTHOR(S): Alishahi S; Francis N; Crofts S; Duncan L; Bickel A; Cuschieri A
AUTHOR'S ADDRESS: Departments of Surgery & Molecular Oncology and Anaesthesia, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Significant and individually variable central and peripheral hemodynamic changes are encountered during laparoscopic surgery with PPPn and the head-up tilt position. These are reversed by intermittent sequential pneumatic compression using Lympha-press.

ARTICLE TITLE: The internal jugular vein maintains its regional anatomy and patency after carotid endarterectomy: a prospective study.
ARTICLE SOURCE: Ann Surg (United States), Feb 2001, 233(2) p282-6
AUTHOR(S): Khatri VP; Wagner-Sevy S; Espinosa MH; Fisher JB
AUTHOR'S ADDRESS: Department of Surgery at University of California-Davis, Sacramento, California, USA. vijay.khatri@ucdmc.ucdavis.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Duplex imaging validated the accuracy of the surface landmarks for IJV cannulation and documented the adverse effects of neck rotation. IJV anatomy is not altered after CEA.
MB. You should check the patency of IJV before attacking it.

ARTICLE TITLE: The surgeon as a prognostic factor.
ARTICLE SOURCE: Ann Surg (United States), Dec 2000, 232(6) p729-32
AUTHOR(S): Lerut T
AUTHOR'S ADDRESS: Department of Thoracic Surgery, U.Z. Gasthuisgerg, Herestraat 49, 3000 Leuven, Belgium. Toni.Lerut@us.kuleuven.ac.be.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Surgical anatomy of the left lateral segment as applied to living-donor and split-liver transplantation: a clinicopathologic study.
ARTICLE SOURCE: Ann Surg (United States), Nov 2000, 232(5) p658-64
AUTHOR(S): Reichert PR; Renz JF; D'Albuquerque LA; Rosenthal P; Lim RC; Roberts JP; Ascher NL; Emond JC
AUTHOR'S ADDRESS: Department of Anatomy, Universidade de Passo Fundo, and the Disciplina de Cirurgia do Aparelho Digestivo da Universidade de Sao Paulo, Sao Paulo, Brazil.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Although highly variable, the biliary and hepatic venous anatomy of the LLS can be broadly categorized into distinct patterns. The identification of the LLS duct origin lateral to the umbilical fissure in segment 4 in 50% of cast specimens is significant in the performance of split-liver and living-donor transplantation, because dissection of the graft pedicle at the level of the round ligament will result in separate ducts from segments 2 and 3 in most patients, with the further possibility of an anterior segment 4 duct. A connective tissue bile duct plate, which can be clinically identified, is described to guide dissection of the segment 2 and 3 biliary radicles.

ARTICLE TITLE: Will endovascular repair replace open surgery for abdominal aortic aneurysm repair?
ARTICLE SOURCE: Ann Surg (United States), Oct 2000, 232(4) p501-7
AUTHOR(S): Zarins CK; Wolf YG; Lee WA; Hill BB; Olcott CIV; Harris EJ; Dalman RL; Fogarty TJ
AUTHOR'S ADDRESS: Division of Vascular Surgery, Stanford University Hospital, Stanford, California 94305-5642, USA. zarins@stanford.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Endovascular repair appears to have augmented treatment options rather than replaced open surgical repair for patients with AAA. Patients who previously were not candidates for repair because of medical comorbidity may now be safely treated with endovascular repair.
MB. It has almost replaced open operation here.

ARTICLE TITLE: Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials (Br J Surg 2000; 87: 854-9) and Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials (Br J Surg 2000; 87: 860-7) [In Process Citation]
ARTICLE SOURCE: Br J Surg (England), Mar 2001, 88(3) p469-72
AUTHOR(S): Slater GH; Hopkins G; Bailey M
AUTHOR'S ADDRESS: Minimal Access Therapy Training Unit; Royal Surrey County Hospital; Egerton Road; Guildford GU2 5XX; UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence.
ARTICLE SOURCE: Br J Surg (England), Feb 2001, 88(2) p267-72
AUTHOR(S): van de Watering LM; Brand A; Houbiers JG; Klein Kranenbarg WM; Hermans J; van de Velde C
AUTHOR'S ADDRESS: Sanquin Blood Bank Leiden-Haaglanden, Leiden University Medical Centre, Leiden University, Leiden, The Netherlands. L.M.G.van_de_Watering@LUMC.nl; Collective Name: Cancer Recurrence and Blood transfusion study group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Leucocyte depletion of perioperative transfused blood has no effect on long-term survival and/or cancer recurrence. Perioperative blood transfusions are associated with impaired survival, but not with cancer recurrence. The slight increase in local recurrence rate in transfused patients appears to be related to complicated, in particular rectal, surgery.
MB. I assumed that this would be the explanation when the association of transfusion and worse survival was first noted.

ARTICLE TITLE: Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit.
ARTICLE SOURCE: Br J Surg (England), Feb 2001, 88(2) p273-7
AUTHOR(S): Smedh K; Olsson L; Johansson H; Aberg C; Andersson M
AUTHOR'S ADDRESS: Colorectal Unit, Department of Surgery, Central Hospital, Vasteras, Sweden. kennet.smedh@ltvastmanland.se.
PUBLICATION TYPE: Journal Article
CONCLUSION: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.
MB. How surprising. ;-)

ARTICLE TITLE: Vascular access for haemodialysis.
ARTICLE SOURCE: Br J Surg (England), Oct 2000, 87(10) p1300-15
AUTHOR(S): Murphy GJ; White SA; Nicholson ML
AUTHOR'S ADDRESS: University Department of Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
PUBLICATION TYPE: Journal Article; Review; Review Literature
CONCLUSION: The introduction of strategies to improve access patency rates will change vascular access surgical practice away from the construction of new fistulas towards an increase in outpatient percutaneous intervention and surgical revisional procedures. The role of surgical interventions requires clearer definition.
MB. I think that is already the practice.

ARTICLE TITLE: Some personal thoughts on plagiarism.
ARTICLE SOURCE: Br J Surg (England), Sep 2000, 87(9) p1251
AUTHOR(S): Schein M
PUBLICATION TYPE: Letter

ARTICLE TITLE: Enteral versus parenteral nutrition.
ARTICLE SOURCE: Br J Surg (England), Sep 2000, 87(9) p1121-2
AUTHOR(S): MacFie J
AUTHOR'S ADDRESS: Scarborough Hospital, Woodlands Drive, Scarborough YO12 6QL, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Successful pharyngeal pulse oximetry in low perfusion states.
ARTICLE SOURCE: Can J Anaesth (Canada), Sep 2000, 47(9) p907-9
AUTHOR(S): Brimacombe J; Keller C
AUTHOR'S ADDRESS: University of Queensland, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Australia. 100236,2343@compuserve.com.
ABSTRACT: PURPOSE: We describe pharyngeal oximetry with the laryngeal mask airway in two patients with low perfusion states where finger oximetry failed. CLINICAL FEATURES: One patient was a 47-yr-old man with septic shock and the other a 64-yr-old man with multiorgan failure. In both patients, a # 4 laryngeal mask airway with a pediatric pulse oximeter probe was inserted behind the tracheal tube. A good waveform was obtained and oxygen saturation was 0-2% lower than arterial samples. CONCLUSION: Pharyngeal oximetry with the laryngeal mask airway is feasible in low perfusion states when finger oximetry fails.

ARTICLE TITLE: Adult learning principles: you can teach an old dog new tricks.
COMMENTS: Can J Anaesth. 2000 Sep; 47(9):849-53
ARTICLE SOURCE: Can J Anaesth (Canada), Sep 2000, 47(9) p837-42
AUTHOR(S): Shysh AJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Predicting difficult intubation: a multivariable analysis.
COMMENTS: Can J Anaesth. 2000 Aug; 47(8):721-4
ARTICLE SOURCE: Can J Anaesth (Canada), Aug 2000, 47(8) p730-9
AUTHOR(S): Karkouti K; Rose DK; Wigglesworth D; Cohen MM
AUTHOR'S ADDRESS: Department of Anaesthesia, Toronto General Hospital, University Health Network, Ontario, Canada. keyvan.karkouti@uhn.on.ca.
PUBLICATION TYPE: Journal Article
CONCLUSION: A simple and accurate multivariable model, consisting of three airway tests, is produced for predicting difficult laryngoscopic tracheal intubation. Additional studies will be required to determine the accuracy and feasibility of this model when applied to a large sample of new patients by multiple anesthesiologists.
MB. It would have been a good idea if they had tried it out first

ARTICLE TITLE: Predictions and clinical decisions: a fine balance.
COMMENTS: Can J Anaesth. 2000 Aug; 47(8):730-9
ARTICLE SOURCE: Can J Anaesth (Canada), Aug 2000, 47(8) p721-4
AUTHOR(S): Hung O; Mills J
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children [In Process Citation]
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Mar 2001, 83-A(3) p323-7
AUTHOR(S): Mehlman CT; Strub WM; Roy DR; Wall EJ; Crawford AH
AUTHOR'S ADDRESS: Division of Pediatric Orthopaedic Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio 45229-3039, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: We were unable to identify any significant difference, with regard to perioperative complication rates, between early and delayed treatment of displaced supracondylar humeral fractures. Within the parameters outlined in our study, we think that the timing of surgical intervention can be either early or delayed as deemed appropriate by the surgeon.

ARTICLE TITLE: Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. Enoxaparin Clinical Trial Group [In Process Citation]
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Mar 2001, 83-A(3) p336-45
AUTHOR(S): Comp PC; Spiro TE; Friedman RJ; Whitsett TL; Johnson GJ; Gardiner GA; Landon GC; Jove M
AUTHOR'S ADDRESS: Department of Medicine, The University Hospitals, Oklahoma City, OK 73126, USA. philip-comp@uokhsc.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Prolonging enoxaparin thromboprophylaxis following hip replacement for a total of four weeks provided therapeutic benefit, by reducing the prevalence of venous thromboembolism, without compromising safety. A similar benefit was not observed in patients treated with knee replacement.

ARTICLE TITLE: Repetitive stress injury: diagnosis or self-fulfilling prophecy?
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Sep 2000, 82(9) p1314-22
AUTHOR(S): Szabo RM; King KJ
AUTHOR'S ADDRESS: Department of Orthopaedics, University of California, Davis, School of Medicine, Sacramento 95817, USA. rmszabo@ucdavis.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: * The vague definitions of so-called repetitive stress injuries are indicative of the fact that scientific studies have failed to show that repetitive motion causes injury. * Given the uncertainty about causation, work-related musculoskeletal disorders (WRMSDs) is a more readily accepted term to describe these phenomena. * There is little doubt that most ergonomic interventions increase comfort in the work environment, which is of great benefit to the worker. Many proponents of ergonomics assert that the elimination of certain risk factors related to force, repetition, and posture can prevent or even cure work-related musculoskeletal disorders of the upper extremity. However, there is little scientific support for this position. * Undue reliance on ergonomics to treat musculoskeletal disorders, to the exclusion of proper diagnosis and attention to medical and health risk factors, can have adverse consequences for the patient. * Science rather than politics and public policy should determine what causes injury and disease. * The failure of numerous plaintiffs in litigation regarding repetitive stress injury due to use of computer keyboards is important because, when judges and lay jurors were presented with both sides of the issue, they rejected these claims in a forum (the judicial system) that traditionally compensates individuals bringing so-called mass-tort cases.

ARTICLE TITLE: Statewide reporting of coronary artery surgery results: A view from California [In Process Citation]
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Mar 2001, 121(3) p409-17
AUTHOR(S): Harlan BJ
AUTHOR'S ADDRESS: Sutter Memorial Hospital, Sacramento, Calif.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation [In Process Citation]
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Mar 2001, 121(3) p561-9
AUTHOR(S): Chaney MA; Durazo-Arvizu RA; Nikolov MP; Blakeman BP; Bakhos M
AUTHOR'S ADDRESS: Department of Anesthesia and Critical Care, University of Chicago, Chicago, Ill, USA. mchaney@airway2.uchicago.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Methylprednisolone, as used in this investigation, offers no clinical benefits to patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass and may in fact be detrimental by initiating postoperative hyperglycemia and possibly hindering early postoperative tracheal extubation for undetermined reasons.
MB. I wonder how this hare-brained study was approved

ARTICLE TITLE: pH-stat strategy and hypothermia of 25 degrees C alone should protect the central nervous system consistently from 75 minutes of circulatory arrest [In Process Citation]
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Mar 2001, 121(3) p597
AUTHOR(S): Miyamoto TA; Miyamoto KJ
AUTHOR'S ADDRESS: Research Department, Kokura Memorial Hospital, 1-1 Kifune-cho, Kokura-kitaku, Kitakyushu-shi 802-8555, Japan.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Optimal pH strategy for hypothermic circulatory arrest.
COMMENTS: J Thorac Cardiovasc Surg. 2001 Feb; 121(2):336-43/21104891
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Feb 2001, 121(2) p204-5
AUTHOR(S): Jonas RA
INDEXING CHECK TAG(S): Animal
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs.
COMMENTS: J Thorac Cardiovasc Surg. 2001 Feb; 121(2):204-5/21104875
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Feb 2001, 121(2) p336-43
AUTHOR(S): Priestley MA; Golden JA; O'Hara IB; McCann J; Kurth CD
AUTHOR'S ADDRESS: Brain Research Laboratory, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104, USA. Priestley@email.chop.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: Deep hypothermic circulatory arrest for neonatal heart surgery poses the risk of brain damage. Several studies suggest that pH-stat management during cardiopulmonary bypass improves neurologic outcome compared with alpha-stat management. CONCLUSIONS: pH-stat cardiopulmonary bypass management improves neurologic outcome with deep hypothermic circulatory arrest compared with alpha-stat bypass. The mechanism of protection is not related to hemodynamics, hematocrit, glucose, or brain temperature.

ARTICLE TITLE: Echocardiography-assisted surgery in transaortic endovascular stent grafting: role of transesophageal echocardiography.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Oct 2000, 120(4) p672-8
AUTHOR(S): Orihashi K; Matsuura Y; Sueda T; Watari M; Okada K; Sugawara Y; Ishii O
AUTHOR'S ADDRESS: First Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan. kaori@mcai.med.hiroshima-u.ac.jp.
PUBLICATION TYPE: Journal Article
.CONCLUSION: Transesophageal echocardiography enables echocardiography-assisted operations with secure step-by-step endoluminal procedures and immediate intraoperative assessment, which is predictive of the postoperative results.
MB. WE have been doing this for thoracic aneurysms.

ARTICLE TITLE: Neurocognitive dysfunction after coronary artery bypass surgery: a systematic review.
COMMENTS: J Thorac Cardiovasc Surg. 2000 Oct; 120(4):629-31
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Oct 2000, 120(4) p632-9
AUTHOR(S): van Dijk D; Keizer AM; Diephuis JC; Durand C; Vos LJ; Hijman R
AUTHOR'S ADDRESS: Department of Anesthesiology, Utrecht University Hospital, Utrecht, The Netherlands. d.vandijk@anest.azu.nl.
PUBLICATION TYPE: Journal Article; Review; Review, Academic

ARTICLE TITLE: Neurologic injury from cardiac surgery-an important but enormously complex phenomenon.
COMMENTS: J Thorac Cardiovasc Surg. 2000 Oct; 120(4):632-9
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Oct 2000, 120(4) p629-31
AUTHOR(S): Blackstone EH
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Attitudes towards transferable skills in medical undergraduates [In Process Citation]
ARTICLE SOURCE: Med Educ (England), Feb 2001, 35(2) p148-53
AUTHOR(S): Whittle SR; Eaton DG
AUTHOR'S ADDRESS: School of Biochemistry & Molecular Biology, University of Leeds, Leeds LS2 9JT, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: CONTEXT: Changes to the style of medical teaching will place a greater responsibility on individual medical students to manage their own learning, highlighting the need for students to develop good so-called 'transferable' skills at an early stage in their undergraduate career. OBJECTIVES: To assess the attitudes of first year undergraduates towards transferable skills, and investigate the gender difference in these attitudes. To assess the contribution of their first year course to skills development. SUBJECTS: First year students, enrolled on a traditional-style course. METHOD: A questionnaire asking the students to consider: (a) the importance of named transferable skills for medicine; (b) their own ability in these areas; and (c) the influence of their first year course. RESULTS: All students, irrespective of gender, regarded transferable skills as very important to medicine, rating organizational skills and self-learning skills as most important. Overall, students have a high level of confidence in their own skills. Male students rated their overall level of skills more highly than women. In particular they rated their information handling, managing self-learning and technical skills more highly. Students feel that their first year course has enhanced their skills in most areas. CONCLUSIONS: Our results suggest that students will feel equipped to succeed in a learning system which places the onus on them to take responsibility for their own learning. They clearly believe that they have the necessary skills for independent learning. The study highlights the need to enhance students' self-evaluation skills.
MB. I can't imagine 1 ^st year undergraduates having an attitude about what they ought to be able to do.

ARTICLE TITLE: Does studying for an objective structured clinical examination make a difference?
ARTICLE SOURCE: Med Educ (England), Oct 2000, 34(10) p808-12
AUTHOR(S): Mavis BE
AUTHOR'S ADDRESS: Office of Medical Education Research and Development, A202 East Fee Hall, Michigan State University, East Lansing, Michigan 48824-1316, USA.
MAJOR SUBJECT HEADING(S): Education, Medical, Undergraduate [methods]; Educational Measurement; Learning; Students, Medical [psychology]
MINOR SUBJECT HEADING(S): Adult; Educational Status
INDEXING CHECK TAG(S): Female; Human; Male
PUBLICATION TYPE: Journal Article
DISCUSSION: The students whose performance was above average seemed to be the talented students whose records indicated a history of academic success. The amount of time they reported for OSCE preparation was comparable to that reported by students with below average performance. It appears that prior academic performance rather than preparatory studying time is a better predictor of OSCE outcomes.
MB. The ones who are good at exams do well at exams. I think that they would be well advised to get rid of that Office.

ARTICLE TITLE: Marks, scores and grades: scaling and aggregating student assessment outcomes.
ARTICLE SOURCE: Med Educ (England), Oct 2000, 34(10) p788-97
AUTHOR(S): McLachlan JC; Whiten SC
AUTHOR'S ADDRESS: School of Biomedical Sciences, University of St Andrews, Scotland, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: The term marks conflates the concepts of scores (raw test performance) and grades (level of performance). Neither scores nor grades represent interval scales, and therefore properly speaking arithmetic means should not be calculated during aggregation. The distributions of scores from a variety of kinds of assessment are considered, and ways of converting scores to grades are discussed. Methods of aggregation are also considered, and several strategies for implementing these via spreadsheets are made available. It is recommended that: 1 Scores should always be converted to grades before aggregation. The process of converting scores to grades requires both subject-specific skills, and familiarity with educational principles. 2 Whatever grade scale is used, it should be readily distinguishable from scores. 3 The median should be calculated as the measure of overall performance, not the arithmetic mean. 4 The interquartile range should be calculated as the measure of dispersion. 5 Students should be informed of both their score and grade for each assessment. 6 Where possible, assessment should report performance by individual assessment, not by a single aggregated mark. 7 When aggregation takes place, it should be possible to aggregate student performance by type of assessment as well as by academic subject. 8 Students who perform inconsistently should receive particular scrutiny during assessment.
MB. Sounds like gobbledegook to me

ARTICLE TITLE: Combining marks, scores and grades. Reviewing common practices reveals some bad habits.
ARTICLE SOURCE: Med Educ (England), Oct 2000, 34(10) p785-6
AUTHOR(S): Fowell S; Jolly B
AUTHOR'S ADDRESS: Department of Health Care Education, Faculty of Medicine, Liverpool, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Changes to the Pharmaceutical Benefits Advisory Committee.
ARTICLE SOURCE: Med J Aust (Australia), Mar 5 2001, 174(5) p209-10
AUTHOR(S): Henry DA; Birkett DJ
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Awareness during general anaesthesia: is it worth worrying about?
ARTICLE SOURCE: Med J Aust (Australia), Mar 5 2001, 174(5) p212-3
AUTHOR(S): Leslie K; Myles PS
PUBLICATION TYPE: Editorial
MB. This got into the news. It is about an incomplete study. It should have been an article when completed.

ARTICLE TITLE: Trichloroethylene and cancer: a carcinogen on trial.
ARTICLE SOURCE: Med J Aust (Australia), Mar 5 2001, 174(5) p244-7
AUTHOR(S): Stewart BW
AUTHOR'S ADDRESS: South Eastern Sydney Public Health Unit, Randwick, NSW. stewartb@sesahs.nsw.gov.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: The organic solvent trichloroethylene has been used in dry cleaning, as an industrial degreasing agent and as a solvent for oils and resins; large numbers of workers have been exposed to trichloroethylene, mainly by inhalation. Trichloroethylene has been categorised as a Group 2A carcinogen (probably carcinogenic to humans) by the International Agency for Research on Cancer (World Health Organization) and a Category 2 carcinogen (to be regarded as carcinogenic to humans) by the Australian National Industrial Chemicals Notification and Assessment Scheme. The Administrative Appeals Tribunal was asked to determine the validity of classifying trichloroethylene as a Category 2 rather than a Category 3 (data inadequate for making a satisfactory assessment) carcinogen. In the AAT's determination, relevant epidemiological evidence was not taken into account because such evidence concerned tumour sites apart from the kidney (the site of tumour induction by trichloroethylene in rats). This mode of evaluation is fundamentally different from that used by the International Agency for Research on Cancer. The precedent set by the consideration of carcinogenicity data in this case could have significant implications for classification of other putative carcinogens.
MB. Some of us oldies used it as an anaesthetic---before halothane. I think I used it once or twice after we got a Tritec.

ARTICLE TITLE: Bed availability and transfer of critically ill patients.
COMMENTS: Med J Aust. 2001 Feb 5; 174(3):122-5/21141083
ARTICLE SOURCE: Med J Aust (Australia), Feb 5 2001, 174(3) p114-5
AUTHOR(S): Dobb GJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Outcome of critically ill patients undergoing interhospital transfer.
COMMENTS: Med J Aust. 2001 Feb 5; 174(3):114-5/21141080
ARTICLE SOURCE: Med J Aust (Australia), Feb 5 2001, 174(3) p122-5
AUTHOR(S): Duke GJ; Green JV
AUTHOR'S ADDRESS: Intensive Care Department, The Northern Hospital, Melbourne, VIC. graeme.duke@nh.org.au.
PUBLICATION TYPE: Journal Article
CONCLUSION: Acute interhospital transfer is associated with a delay in ICU admission and a longer stay in ICU and hospital, but no statistically significant difference in mortality. A study of over 300 patient transfers would be required to clarify the morbidity and mortality risk of acute interhospital transfer.

ARTICLE TITLE: What are appropriate rates of invasive procedures following acute myocardial infarction? A systematic review.
ARTICLE SOURCE: Med J Aust (Australia), Feb 5 2001, 174(3) p130-6
AUTHOR(S): Scott IA; Harden H; Coory M
AUTHOR'S ADDRESS: Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, QLD. ian_scott@health.qld.gov.au.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Do doctors know best? Comments on a failed trial.
ARTICLE SOURCE: Med J Aust (Australia), Feb 5 2001, 174(3) p144-6
AUTHOR(S): Hunt CJ; Shepherd LM; Andrews G
AUTHOR'S ADDRESS: School of Psychiatry, University of New South Wales, Sydney. caroline@psych.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: A randomised controlled trial was planned to compare two different treatment strategies--structured problem solving and selective serotonin reuptake inhibitor (SSRI) medication--for patients with mild to moderate major depression. The trial was to be conducted in the primary care setting with all treatment given by general practitioners. When no patients had been recruited into the study after six months, we performed an audit of all patients with depressive symptoms attending the doctors' practices over three weeks. Exclusion criteria were changed to ease entry into the trial, but still no patients were recruited over the following six months. What went wrong?
MB. That's a classic.

ARTICLE TITLE: Herbal medicines for menopause: do they work and are they safe?
COMMENTS: Med J Aust. 2001 Jan 15; 174(2):68-71/21139125
ARTICLE SOURCE: Med J Aust (Australia), Jan 15 2001, 174(2) p63-4
AUTHOR(S): Eden JA
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The effects of Chinese medicinal herbs on postmenopausal vasomotor symptoms of Australian women. A randomised controlled trial.
COMMENTS: Med J Aust. 2001 Jan 15; 174(2):63-4/21139122
ARTICLE SOURCE: Med J Aust (Australia), Jan 15 2001, 174(2) p68-71
AUTHOR(S): Davis SR; Briganti EM; Chen RQ; Dalais FS; Bailey M; Burger HG
AUTHOR'S ADDRESS: The Jean Hailes Foundation, Melbourne, VIC. suedavis@netlink.com.au.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: The defined formula of Chinese medicinal herbs (CMH) was no more effective than placebo in reducing vasomotor episodes in Australian postmenopausal women, or in improving any of the four symptom domains in the the Menopause Specific Quality of Life (MENQOL) Questionnaire. Three of the MENQOL Questionnaire domains were modified by prior use of natural therapies. This finding has implications for future studies.

ARTICLE TITLE: The moving of St Vincent's: a tale in two cities.
ARTICLE SOURCE: Med J Aust (Australia), Jan 15 2001, 174(2) p93-6
AUTHOR(S): Haas MR; Hall JP; Chinchen LA
AUTHOR'S ADDRESS: Centre for Health Economics Research and Evaluation, Sydney, NSW. marionh@chere.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: In Australia, demographic changes have seen the population of large cities move away from the inner city. This, combined with changes in healthcare delivery and the ageing of many tertiary teaching hospitals, has led governments to attempt to close, relocate or redefine the role of some institutions. Tracing the media coverage of two such events--the attempts to move St Vincent's hospitals in Sydney and Melbourne--provides some interesting insights into the challenges of resource allocation facing policymakers within the healthcare sector. Both hospitals were long-established, much-loved fixtures on inner-city sites with powerful connections to government and business. In Sydney, where the attempt was part of a larger plan to reallocate resources to the western suburbs, the announcement was met with 10 days of intense media coverage and scrutiny by lobby groups and the general public. By contrast, in Melbourne, no such announcement was made and the low-key reporting of support and opposition to the move occurred over two months. Both attempts failed. No matter how the debate is handled, radical changes involving long-established hospitals, powerful provider groups and loyal communities are very difficult to accomplish.
MB. Shows how hopeless our 'health manager' & politicians are and how Centres like the above are ineffective.

ARTICLE TITLE: Epidural analgesia and fetal head malposition at vaginal delivery(1) [In Process Citation]
ARTICLE SOURCE: Obstet Gynecol (United States), Apr 2001, 97(4) p608-12
AUTHOR(S): Yancey MK; Zhang J; Schweitzer DL; Schwarz J; Klebanoff MA
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii, USA.
PUBLICATION TYPE: Journal Article
Conclusion: Providing on-request labor epidural analgesia to nulliparas in spontaneous labor did not result in a clinically significant increase in the frequency of fetal head malpositioning at vaginal delivery. (Obstet Gynecol 2001; 97:608-12.).
MEDLINE INDEXING DATE: 200103
ISSN: 0029-7844
LANGUAGE: English

ARTICLE TITLE: Mode of delivery and risk of respiratory diseases in newborns [In Process Citation]
ARTICLE SOURCE: Obstet Gynecol (United States), Mar 2001, 97(3) p439-42
AUTHOR(S): Levine EM; Ghai V; Barton JJ; Strom CM
AUTHOR'S ADDRESS: Department of Obstetrics & Gynecology, Illinois Masonic Medical Center, Chicago, Illinois, USA.
PUBLICATION TYPE: Journal Article
The incidence of persistent pulmonary hypertension of the newborn was approximately 0.37% among neonates delivered by elective cesarean, almost fivefold higher than those delivered vaginally. The findings have implications for informed consent before cesarean and increased surveillance of neonates after cesarean.
MB. I thought that elective caesarians were often on demand because there was less incontinence later.

ARTICLE TITLE: Adverse effects of oral corticosteroids in relation to dose in patients with lung disease [In Process Citation]
ARTICLE SOURCE: Thorax (England), Apr 2001, 56(4) p279-84
AUTHOR(S): Walsh LJ; Wong CA; Oborne J; Cooper S; Lewis SA; Pringle M; Hubbard R; Tattersfield AE
AUTHOR'S ADDRESS: Division of Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: By quantifying the morbidity associated with the use of oral corticosteroids, this study should help to rationalise their long term use.
MB. Is there no absorption with inhaled steroids?

ARTICLE TITLE: Herbal medicines for asthma: a systematic review.
ARTICLE SOURCE: Thorax (England), Nov 2000, 55(11) p925-9
AUTHOR(S): Huntley A; Ernst E
AUTHOR'S ADDRESS: Department of Complementary Medicine, School of Postgraduate Medicine and Health Studies, University of Exeter, Exeter EX2 4NT, UK. A.Huntley@ex.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
CONCLUSIONS: No definitive evidence for any of the herbal preparations emerged.

ARTICLE TITLE: Postoperative tracheal extubation after orthotopic liver transplantation [In Process Citation]
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Mar 2001, 45(3) p333-9
AUTHOR(S): Glanemann M; Langrehr J; Kaisers U; Schenk R; Muller A; Stange B; Neumann U; Bechstein WO; Falke K; Neuhaus P
AUTHOR'S ADDRESS: Department of General, Visceral & Transplantation Surgery, Charite, Humboldt University Berlin, Germany. matthias.glanemann@charite.de.
PUBLICATION TYPE: Journal Article
RESULTS: Immediate tracheal extubation in the operating theater was achieved in 18.7% of patients, and prolonged mechanical ventilation was required by 11.2% of patients. CONCLUSIONS: Immediate tracheal extubation was safe and well tolerated. The incidence of reintubation was not increased when compared to patients in whom extubation succeeded later.
MB. It can't have been too safe if only done in 19%.

ARTICLE TITLE: A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions, and methodological issues.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 2001, 45(1) p4-13
AUTHOR(S): Tramer MR
AUTHOR'S ADDRESS: Department APSIC, University Hospitals, Geneva, Switzerland. martin.tramer@hcuge.ch.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Measuring patient satisfaction with anaesthesia: perioperative questionnaire versus standardised face-to-face interview.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 2001, 45(1) p65-72
AUTHOR(S): Bauer M; Bohrer H; Aichele G; Bach A; Martin E
AUTHOR'S ADDRESS: Department of Anesthesia, University of Heidelberg, Germany. martin_bauer@med.uni-heidelberg.de.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS: The standardised interview may be more suited to determine patient satisfaction than a questionnaire. Quality improvements are possible for emergence from anaesthesia, postoperative pain therapy, and the treatment of postoperative nausea and vomiting.

ARTICLE TITLE: Study of the "sniffing position" by magnetic resonance imaging [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Jan 2001, 94(1) p83-6
AUTHOR(S): Adnet F; Borron SW; Dumas JL; Lapostolle F; Cupa M; Lapandry C
AUTHOR'S ADDRESS: Service d'Aide Medicale d'Urgence and the Departments of Anesthesiology and Radiology, Hopital Avicenne, University Paris 13, Bobigny, France, and the Department of Emergency Medicine, George Washington University, Washington, DC.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The sniffing position does not achieve alignment of the three important axes (MA, PA, and LA) in awake patients with normal airway anatomy.
MB. I don't think that it was supposed to. It was to allow a curved tube to start at the nose & arrive at the larynx.

ARTICLE TITLE: Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Dec 2000, 93(6) p1541-4
AUTHOR(S): Benumof JL
AUTHOR'S ADDRESS: Department of Anesthesiology, University of California-San Diego Medical Center, 92104, USA. jbenumof@ucsd.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Endoluminal grafting for abdominal aortic aneurysms: where will the buck stop?
ARTICLE SOURCE: Aust N Z J Surg (Australia), Nov 2000, 70(11) p767-8
AUTHOR(S): Myers AK
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Effectiveness of forced air warming after pediatric cardiac surgery employing hypothermic circulatory arrest without cardiopulmonary bypass.
ARTICLE SOURCE: J Clin Anesth (United States), Nov 2000, 12(7) p519-24
AUTHOR(S): Guvakov DV; Cheung AT; Weiss SJ; Kalinin NB; Fedorenko NO; Shunkin AV; Lomivorotov VN; Karaskov AM
AUTHOR'S ADDRESS: Department of Anesthesiology, Novosibirsk Institute of Circulatory Pathology, Russia. dmitrig@mail.med.upenn.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Both forced-air and radiant heat were effective for rewarming moderately hypothermic pediatric patients. When core temperature was less than 33 degrees C, the instantaneous rewarming rate by forced air was 21% faster than by radiant heat.
MB. Radient heat is a bit dangerous.

ARTICLE TITLE: Doctor does not know best: why in the new century physicians must stop trying to benefit patients [In Process Citation]
ARTICLE SOURCE: J Med Philos (Netherlands), Dec 2000, 25(6) p701-21
AUTHOR(S): Veatch RM
AUTHOR'S ADDRESS: Kennedy Institute of Ethics, Washington, District of Columbia, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: While twentieth-century medical ethics has focused on the duty of physicians to benefit their patients, the next century will see that duty challenged in three ways. First, we will increasingly recognize that it is unrealistic to expect physicians to be able to determine what will benefit their patients. Either they limit their attention to medical well-being when total well-being is the proper end of the patient or they strive for total well-being, which takes them beyond their expertise. Even within the medical sphere, they have no basis for choosing among the proper medical goals for medicine. Also, there are many plausible strategies for relating predicted benefits to harms, and physicians cannot be expert in picking among these strategies. Second, increasingly plausible ethical systems recognize that in some cases, patient benefit must be sacrificed to protect patient rights including the right to the truth, to have promises kept, to have autonomy respected, and to not be killed. Third, ethics of the next century will increasingly recognize that some patient benefits must be sacrificed to fulfill duties to others - either the duty to serve the interests of others or other duties such as keeping promises, telling the truth, and, particularly, promoting justice. Physicians in the twenty-first century will be seen as having a new, more limited duty to assist the patient in pursuing the patient's understanding of the patient's interest within the constraints of deontological ethical principles and externally imposed duties to promote justice. The result will be a duty to be loyal to the consumer of health care with the recognition that often this will mean that the physician is not permitted to pursue the physician's understanding of the patient's well-being.

ARTICLE TITLE: Expanding the organ donor pool: The Spanish Model [In Process Citation]
ARTICLE SOURCE: Kidney Int (United States), Apr 2001, 59(4) p1594
AUTHOR(S): Matesanz R; Miranda B
AUTHOR'S ADDRESS: Madrid, Spain.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Posttransplantation dialysis-associated infections: Morbidity and impact on outcome in liver transplant recipients [In Process Citation]
ARTICLE SOURCE: Liver Transpl (United States), Feb 2001, 7(2) p100-5
AUTHOR(S): Singh N; Gayowski T; Wagener MM
AUTHOR'S ADDRESS: Veterans Affairs Medical Center and University of Pittsburgh, Thomas E. Starzl Transplantation Institute, Pittsburgh, PA.
PUBLICATION TYPE: Journal Article
ABSTRACT: The aim of this study is to assess the predictors, impact on infectious morbidity, and outcome of posttransplantation dialysis in liver transplant recipients and to compare the results with data from patients who did not require dialysis after transplantation. The study sample included 176 consecutive patients undergoing liver transplantation; the median follow-up was 4.3 years. All patients were administered tacrolimus as primary immunosuppression. Overall, 16% (28 of 176 patients) of the patients required dialysis after transplantation. Patients requiring dialysis had significantly greater pretransplantation creatinine levels (2.4 v 1.2 mg/dL; P =.009), were more likely to require pretransplantation dialysis (21% v 1%; P =.0001), and had a greater rate of biopsy-proven rejection episodes (50%, 14 of 28 episodes v 20%, 30 of 148 episodes; P =.0009) and longer posttransplantation intensive care unit lengths of stay (P =.0001). The incidence of infections (91% v 41%; P =.0001) and episodes of infection per patient (2.4 v 0.7 episodes; P =.0001) were significantly greater in patients undergoing dialysis compared with those not undergoing dialysis. There was no difference in the frequency of cytomegalovirus (CMV) infection or disease; however, bacterial infections (87% v 31%; P =.0001) and invasive fungal infections (39% v 7%; P =.0001) were significantly more likely to occur in patients requiring dialysis. In logistic regression, dialysis (P =.0006) and CMV infection (P =.007) were independent significant predictors of major infections. Overall survival (assessed by Kaplan-Meier probability) was less in patients undergoing dialysis compared with those not undergoing dialysis (P =.0001). Among dialyzed patients, only 10% of those who survived had an invasive fungal infection compared with 46% of those who died (P =.08); 5 of 6 patients died within 1 month of the fungal infection. The need for dialysis portended a grave outcome in liver transplant recipients and identified a subgroup of patients at a significantly greater risk for major infections, particularly fungal infections, after liver transplantation.
MB. Our dialysis rate is much less than 16%. The only article on dopamine in surgical patients was in liver transplants. It had an upper teen% dialysis rate for dopamine and 60+% without dopamine.

ARTICLE TITLE: Cardiac arrest can be less of a gamble.
ARTICLE SOURCE: Nature (England), Nov 16 2000, 408(6810) p302
AUTHOR(S): Lincoln T
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors.
ARTICLE SOURCE: N Engl J Med (United States), Mar 8 2001, 344(10) p726-31
AUTHOR(S): Mange KC; Joffe MM; Feldman HI
AUTHOR'S ADDRESS: Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA. kmange@cceb.med.upenn.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Preemptive transplantation of kidneys from living donors without the previous initiation of dialysis is associated with longer allograft survival than transplantation performed after the initiation of dialysis.

ARTICLE TITLE: Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization.
COMMENTS: N Engl J Med. 2001 Mar 1; 344(9):645-54/21083465; : N Engl J Med. 2001 Mar 1; 344(9):645-54/21083465; : N Engl J Med. 2001 Mar 1; 344(9):677-8/21083471
ARTICLE SOURCE: N Engl J Med (United States), Mar 1 2001, 344(9) p645-54
AUTHOR(S): Hemingway H; Crook AM; Feder G; Banerjee S; Dawson JR; Magee P; Philpott S; Sanders J; Wood A; Timmis AD
AUTHOR'S ADDRESS: Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London, United Kingdom. harry.hemingway@ha.kcw-ha.nthames.nhs.uk.
PUBLICATION TYPE: Comment; Journal Article
ABSTRACT: BACKGROUND: Ratings by an expert panel of the appropriateness of treatments may offer better guidance for clinical practice than the variable decisions of individual clinicians, yet there have been no prospective studies of clinical outcomes. We compared the clinical outcomes of patients treated medically after angiography with those of patients who underwent revascularization, within groups defined by ratings of the degree of appropriateness of revascularization in varying clinical circumstances. METHODS: This was a prospective study of consecutive patients undergoing coronary angiography at three London hospitals. Before patients were recruited, a nine-member expert panel rated the appropriateness of percutaneous transluminal coronary angioplasty (PTCA) and coronary-artery bypass grafting (CABG) on a nine-point scale (with 1 denoting highly inappropriate and 9 denoting highly appropriate) for specific clinical indications. These ratings were then applied to a population of patients with coronary artery disease. However, the patients were treated without regard to the ratings. A total of 2552 patients were followed for a median of 30 months after angiography. RESULTS: Of 908 patients with indications for which PTCA was rated appropriate (score, 7 to 9), 34 percent were treated medically; these patients were more likely to have angina at follow-up than those who underwent PTCA (odds ratio, 1.97; 95 percent confidence interval, 1.29 to 3.00). Of 1353 patients with indications for which CABG was considered appropriate, 26 percent were treated medically; they were more likely than those who underwent CABG to die or have a nonfatal myocardial infarction--the composite primary outcome (hazard ratio, 4.08; 95 percent confidence interval, 2.82 to 5.93)--and to have angina (odds ratio, 3.03; 95 percent confidence interval, 2.08 to 4.42). Furthermore, there was a graded relation between rating and outcome over the entire scale of appropriateness (P for linear trend=0.002). CONCLUSIONS: On the basis of the ratings of the expert panel, we identified substantial underuse of coronary revascularization among patients who were considered appropriate candidates for these procedures. Underuse was associated with adverse clinical outcomes.

ARTICLE TITLE: Are appropriateness criteria ready for use in clinical practice?
COMMENTS: N Engl J Med. 2001 Mar 1; 344(9):645-54/21083465
ARTICLE SOURCE: N Engl J Med (United States), Mar 1 2001, 344(9) p677-8
AUTHOR(S): Shekelle PG
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Who's teaching neonatal resuscitation to housestaff? Results of a national survey [In Process Citation]
ARTICLE SOURCE: Pediatrics (United States), Feb 2001, 107(2) p249-55
AUTHOR(S): Halamek LP; Kaegi DM
AUTHOR'S ADDRESS: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. halamek@leland.stanford.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Because those in training collectively provide much of the supervision and teaching of neonatal resuscitation, vigilance is required so that appropriate resuscitation skills are developed and maintained. Objective performance markers may be useful in assessing competency in caring for sick newborns.neonatal resuscitation, delivery room, Neonatal Resuscitation Program, Pediatric Advanced Life Support, Advanced Cardiac Life Support.
MB. That means that there is no one in control.