MB's Articles of Interest - February 2002

ARTICLE TITLE: Wireless replacement of the "lost" central venous line in children.
ARTICLE SOURCE: Am Surg (United States), Sep 2001, 67(9) p817-9; discussion 819-20
AUTHOR(S): Somme S; Gedalia U; Caceres M; Hill CB; Liu DC
AUTHOR'S ADDRESS: Division of Pediatric Surgery, Children's Hospital of New Orleans and Louisiana State University School of Medicine, USA.
PUBLICATION TYPE: Journal Article
Wireless replacement was successful in 120 of 125 cases (96.0%). Recannulization was successful in CVLs as new as 3 days old and those removed for as long as 24 hours. Of the five unsuccessful cases, however, two CVLs were >3 weeks old, but >6 hours had elapsed since removal. The remaining three cases were CVLs that were <3 days old. There were no intra- or postoperative complications, notably air embolism. We conclude that wireless CVL replacement in children can be performed safely and successfully in children who have lost central access not amenable to replacement via the traditional Seldinger technique. The often difficult chore of re-establishing central access at a new site in small children can thus be avoided.
MB: They pushed a catheter, lubricated with oil, through the same hole with no wire. It would probably work for adults too.

ARTICLE TITLE: The impact of business cards on physician recognition after general anesthesia
ARTICLE SOURCE: Anesth Analg (United States), Nov 2001, 93(5) p1262-4
AUTHOR(S): Jeske HC; Lederer W; Lorenz I; Kolbitsch C; Margreiter J; Kinzl J; Benzer A
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care Medicine and Department of PsychiatryThe Leopold Franzens University of Innsbruck, Innsbruck, Austria.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Anesthesiologists often remain anonymous in everyday clinical practice. Handing a business card to the patient during the preoperative visit increased the postoperative recall of the anesthesiolgist's name from 11% to 51%.
MB: The anonymity of anaesthetists is not an imposition of the specialty but an inherent trait of anaesthetists. I am far from anonymous to my patients. I have used the business card method for a long time. I don't think you'd require a randomised trial to adopt the practice.
The ANZ College of Anaesthetists employed a public relations firm to help us improve our image. Their rep suggested business cards as one method we could institute ourselves, as they could not fix us alone. I was already doing it. I must have lots of common sense. It's a pity it is so rare.

ARTICLE TITLE: Anaphylactoid reactions after cisatracurium administration in six patients
ARTICLE SOURCE: Anesth Analg (United States), Nov 2001, 93(5) p1257-9
AUTHOR(S): Krombach J; Hunzelmann N; Koster F; Bischoff A; Hoffmann-Menzel H; Buzello W
AUTHOR'S ADDRESS: Departments of Anesthesiology and Dermatology, University of Koln, Koln, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: We report six cases of anaphylactoid reaction after the administration of the muscle relaxant cisatracurium. They include two first-time documented anaphylactoid reactions after a precurarising dose. These incidents challenge existing views of a substantially reduced anaphylactoid potential of cisatracurium relative to other muscle relaxants.

ARTICLE TITLE: A simple apparatus for accelerating recovery from inhaled volatile anesthetics
ARTICLE SOURCE: Anesth Analg (United States), Nov 2001, 93(5) p1188-91
AUTHOR(S): Sasano H; Vesely AE; Iscoe S; Tesler JC; Fisher JA
AUTHOR'S ADDRESS: Department of Anesthesiology and Resuscitology, Nagoya City University Medical School, Nagoya, Japan.
PUBLICATION TYPE: Journal Article
MB: Just a self inflating resuscitation bag with 6% CO2.

ARTICLE TITLE: Induction of anesthesia in the elderly ambulatory patient: a double-blinded comparison of propofol and sevoflurane
ARTICLE SOURCE: Anesth Analg (United States), Nov 2001, 93(5) p1185-7
AUTHOR(S): Kirkbride DA; Parker JL; Williams GD; Buggy DJ
AUTHOR'S ADDRESS: Department of Anesthesia, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: Hypotension during induction of anesthesia is common and particularly undesirable in elderly patients. This study has shown that inhaled induction with sevoflurane is well tolerated by the elderly and is associated with higher mean arterial pressure than slow propofol induction.
MB: And you can get it [sevoflurane I think he means (JL, ed)] out too. The NSW Death associated with Anaesthesia Committee had to issue a warning about propofol hypotenstion which is more severe than with thiopentone.

ARTICLE TITLE: The influence of medical information on the perioperative course of stress in cardiac surgery patients [In Process Citation]
ARTICLE SOURCE: Anesth Analg (United States), Nov 2001, 93(5) p1093-9
AUTHOR(S): Bergmann P; Huber S; Machler H; Liebl E; Hinghofer-Szalkay H; Rehak P; Rigler B
AUTHOR'S ADDRESS: Divisions of Cardiac Surgery and Physiology, Karl-Franzens University Hospital, Graz, Austria.
PUBLICATION TYPE: Journal Article
Our data demonstrate a lack of effect of extensive oral medical information that was presented as part of clinical routine on the perioperative psychoendocrinologic course of stress. High levels of stress during transport to the operating room were detected.
IMPLICATIONS: The quantity of stress during transport to the operating room and the perioperative psychoendocrinologic course of stress in combination with two different methods of preoperative medical information are described in 60 consecutive patients awaiting cardiac surgery.
MB: It sounds as though the extensive chatting up could make the patients worse. The level of anxiety in patients for breast surgery seems to be higher now the patients have lots of choices too.

ARTICLE TITLE: The inability to detect expired carbon dioxide after endotracheal intubation as a result of one-way valve obstruction of the endotracheal tube.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p971-2, table of contents
AUTHOR(S): Zar HA; Wu WW
AUTHOR'S ADDRESS: Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA. haz1859@med.unc.edu.
ABSTRACT: IMPLICATIONS: Failure to tracheally intubate and ventilate the lungs is a major cause of anesthesia morbidity. Expired carbon dioxide monitoring has become a standard for assessing correct endotracheal tube placement. We present a case of failure to detect expired carbon dioxide after successful intubation resulting from a one-way valve obstruction of the endotracheal tube.
MB: A big lump of mucus in the tube.

ARTICLE TITLE: Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p947-53
AUTHOR(S): Eger EI
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0464, USA. egere@anesthesia.ucsf.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Two defining effects of inhaled anesthetics (immobility in the face of noxious stimulation, and absence of memory) correlate with the end-tidal concentrations of the anesthetics. Such defining effects are characterized as MAC (the concentration producing immobility in 50% of patients subjected to a noxious stimulus) and MAC-Awake (the concentration suppressing appropriate response to command in 50% of patients; memory is usually lost at MAC-Awake). If the concentrations are monitored and corrected for the effects of age and temperature, the concentrations may be displayed as multiples of MAC for a standard age, usually 40 yr. This article provides an algorithm that might be used to produce such a display, including provision of an estimate of the effect of nitrous oxide. IMPLICATIONS: Two defining effects of inhaled anesthetics (immobility in the face of noxious stimulation, and absence of memory) correlate with the end-tidal concentrations of the anesthetics. Thus, these defining effects may be monitored and the results displayed if the concentrations are known and corrected for the effects of age and temperature.
MB: Eger declares that MAC is altered by age & temperature making it even less useful to the individual patient. It was silly to use it for controlling clinical anaesthesia in the beginning. It's just as silly now.

ARTICLE TITLE: Hemostatic changes in pediatric neurosurgical patients as evaluated by thrombelastograph.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p887-92
AUTHOR(S): Goobie SM; Soriano SG; Zurakowski D; McGowan FX; Rockoff MA
AUTHOR'S ADDRESS: Department of Anesthesia, Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. sgoobie@cw.bc.ca.
PUBLICATION TYPE: Clinical Trial; Journal Article
IMPLICATIONS: Hypercoagulability in postoperative neurosurgical patients has been demonstrated in the adult population, but few studies have dealt with the pediatric population. We found that children undergoing craniotomy for focal resection, lobectomy, and hemispherectomy are hypercoagulable as detected by thrombelastograph coagulation analysis. Further studies are needed to determine whether this is clinically significant.
MB: I don't think such clinical information has been established for adults. As far as I can work out TEG results have self-referring criteria but are not correlated to clinical haemostatic phenemona.

ARTICLE TITLE: The optimal length of insertion of central venous catheters for pediatric patients.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p883-6
AUTHOR(S): Andropoulos DB; Bent ST; Skjonsby B; Stayer SA
AUTHOR'S ADDRESS: Division of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Houston, Texas 77030-2399, USA. dra@bcm.tmc.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article
IMPLICATIONS: This study assessed central venous catheter placement in 452 infants and children undergoing cardiac surgery. Simple, clinically useful guidelines based on height and weight were developed to prevent malposition of these catheters, which may cause serious complications such as perforation of the heart or great vessels.
MB: The formula does not take into account the distance from the puncture site to the SVC surface land marks on the chest. There are cm markings on catheters.

ARTICLE TITLE: Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p853-8
AUTHOR(S): Beattie WS; Badner NH; Choi P
AUTHOR'S ADDRESS: Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada. scott.beattie@uhn.on.ca.
PUBLICATION TYPE: Journal Article; Meta-Analysis
IMPLICATIONS: Postoperative epidural analgesia, especially thoracic epidural analgesia, continued for more than 24 h reduces postoperative myocardial infarctions.
MB: This is not the first meta-analysis. They are just a starting point. Big prospective studies have failed to establish any benefit

ARTICLE TITLE: Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p817-22
AUTHOR(S): Waters JH; Gottlieb A; Schoenwald P; Popovich MJ; Sprung J; Nelson DR
AUTHOR'S ADDRESS: Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. watersj@ccf.org.
PUBLICATION TYPE: Journal Article
ABSTRACT: Metabolic acidosis and changes in serum osmolarity are consequences of 0.9% normal saline (NS) solution administration. We sought to determine if these physiologic changes influence patient outcome. Patients undergoing aortic reconstructive surgery were enrolled and were randomly assigned to receive lactated Ringer's (LR) solution (n = 33) or NS (n = 33) in a double-blinded fashion. Anesthetic and fluid management were standardized. Multiple measures of outcome were monitored. The NS patients developed a hyperchloremic acidosis and received more bicarbonate therapy (30 +/- 62 mL in the NS group versus 4 +/- 16 mL in the LR group; mean +/- SD), which was given if the base deficit was greater than -5 mEq/L. The NS patients also received a larger volume of platelet transfusion (478 +/- 302 mL in the NS group versus 223 +/- 24 mL in the LR group; mean +/- SD). When all blood products were summed, the NS group received significantly more blood products (P = 0.02). There were no differences in duration of mechanical ventilation, intensive care unit stay, hospital stay, and incidence of complications. When NS was used as the primary intraoperative solution, significantly more acidosis was seen on completion of surgery. This acidosis resulted in no apparent change in outcome but required larger amounts of bicarbonate to achieve predetermined measurements of base deficit and was associated with the use of larger amounts of blood products. These changes should be considered when choosing fluids for surgical procedures involving extensive blood loss and requiring extensive fluid administration. IMPLICATIONS: Predominant use of 0.9% saline solution in major surgery has little impact on outcome as assessed by duration of mechanical ventilation, intensive care unit stay, hospital stay, and postoperative complications, but it does appear to be associated with increased perioperative blood loss.
MB: We use practically no bank blood for the few open AAAs we still do. I have used 0.9% NaCl since we adopted Shires theory---3 ^rd space/sustained hydration in 1966. I used 0.9% NaCl because Prof D. Joseph fell for Shires' formula using x mls/kg/hr of Hartmann's solution. I won the common practice war at RPAH.
The difference in the median bank blood transfusion (ie 500+ ml v 700+ mls) is trivial. They mostly had FFP & platelets. I can't recall giving either of these in an elective AAA in 40 years.

ARTICLE TITLE: Lactate versus chloride: which is better?
COMMENTS: Anesth Analg. 2001 Oct; 93(4):811-6/21458193
ARTICLE SOURCE: Anesth Analg (United States), Oct 2001, 93(4) p809-10
AUTHOR(S): O'Connor MF; Roizen MF
PUBLICATION TYPE: Comment; Editorial
MB: Not about the preceeding article but another looking at the differences in acidosis and bemoaning that it was stopped because of worries about the acidosis due to 0.9% Na Cl. I would not have thought it was worth worrying about. I would not think the study was worth doing.

ARTICLE TITLE: Wine and your heart
ARTICLE SOURCE: Circulation (United States), Nov 27 2001, 104(22) pE130-0
AUTHOR(S): Folts JD; Keevil J; Stein JH
AUTHOR'S ADDRESS: Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin Medical School, Madison, WI. Division of Preventive Medicine and Nutrition, Columbia University, New York, NY.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization
ARTICLE SOURCE: Circulation (United States), Nov 27 2001, 104(22) p2746-53
AUTHOR(S): Yusuf S; Reddy S; Ounpuu S; Anand S
AUTHOR'S ADDRESS: Population Health Research Institute and Division of Cardiology (S.Y., S.O., S.A.), McMaster University, Hamilton, Ontario, Canada.
PUBLICATION TYPE: Journal Article
ABSTRACT: This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

ARTICLE TITLE: Sudden cardiac death in the United States, 1989 to 1998
ARTICLE SOURCE: Circulation (United States), Oct 30 2001, 104(18) p2158-63
AUTHOR(S): Zheng ZJ; Croft JB; Giles WH; Mensah GA
AUTHOR'S ADDRESS: Cardiovascular Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga.
PUBLICATION TYPE: Journal Article
MB: 74% of cardiac deaths in the US are sudden. I was nearly one. My cardiologist thinks that is too high but it may be that those which chronic cardiac failure go out suddenly & are included.

ARTICLE TITLE: AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology.
ARTICLE SOURCE: Circulation (United States), Sep 25 2001, 104(13) p1577-9
AUTHOR(S): Smith SC; Blair SN; Bonow RO; Brass LM; Cerqueira MD; Dracup K; Fuster V; Gotto A; Grundy SM; Miller NH; Jacobs A; Jones D; Krauss RM; Mosca L; Ockene I; Pasternak RC; Pearson T; Pfeffer MA; Starke RD; Taubert KA
PUBLICATION TYPE: Journal Article
MB: Many at risk don't get appropriate therapy.

ARTICLE TITLE: Aprotinin, blood loss, and renal dysfunction in deep hypothermic circulatory arrest.
ARTICLE SOURCE: Circulation (United States), Sep 18 2001, 104(12 Suppl 1) pI276-81
AUTHOR(S): Mora Mangano CT; Neville MJ; Hsu PH; Mignea I; King J; Miller DC
AUTHOR'S ADDRESS: Department of Anesthesia and Cardiothoracic Surgery, Stanford University, Stanford, California, USA. cmoraman@stanford.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These data suggest that the administration of aprotinin to patients treated with deep hypothermic circulatory arrest (DHCA) does not increase the risk of renal dysfunction. However, aprotinin may not ameliorate the problem of perioperative blood loss in DHCA. Patients with greater requirements for packed red blood cell transfusions or reduced urine production are more likely to have postoperative renal dysfunction. Dopamine may provide renal protection in the setting of DHCA.
MB: Not a ringing endorsement of aprotinin.

ARTICLE TITLE: Antecedents to hospital deaths
ARTICLE SOURCE: Intern Med J (Australia), Aug 2001, 31(6) p343-8
AUTHOR(S): Hillman KM; Bristow PJ; Chey T; Daffurn K; Jacques T; Norman SL; Bishop GF; Simmons G
AUTHOR'S ADDRESS: University of New South Wales, Liverpool Hospital, Australia. k.hillman@unsw.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSION: There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention.
MB: This is around here [RPAH].

ARTICLE TITLE: Antecedents to hospital deaths: all in good time
ARTICLE SOURCE: Intern Med J (Australia), Aug 2001, 31(6) p321
AUTHOR(S): Hart GK
PUBLICATION TYPE: Editorial
MB: Note that disaster start was noted in the notes maybe 48 hr before death but nothing was done. They hope that such system problems are fixed within a generation.

ARTICLE TITLE: Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Nov 2001, 83-A(11) p1622-9
AUTHOR(S): Katz JN; Losina E; Barrett J; Phillips CB; Mahomed NN; Lew RA; Guadagnoli E; Harris WH; Poss R; Baron JA
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total hip replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.
MB: It would be worrying if they found the opposite.

ARTICLE TITLE: Pain: friend or foe?
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Sep 2001, 83-A(9) p1424-5
AUTHOR(S): Whitesides TE
PUBLICATION TYPE: Journal Article
MB: A string of disasters due to obliterating pain. In some US states there are laws requiring obliteration of pain.

ARTICLE TITLE: Atropine prevents midazolam-induced core hypothermia in elderly patients
ARTICLE SOURCE: J Clin Anesth (United States), Nov 2001, 13(7) p504-8
AUTHOR(S): Matsukawa T; Ozaki M; Nishiyama T; Imamura M; Iwamoto R; Iijima T; Kumazawa T
AUTHOR'S ADDRESS: Department of Anesthesia, Yamanashi Medical University, Yamanashi, Japan.
PUBLICATION TYPE: Journal Article
ABSTRACT: Study Objective: To test the hypothesis that core temperature is well preserved when atropine and midazolam are combined.Design: Randomized, blinded study.Setting: Department of Anesthesia, Yamanashi Medical University.Patients: 40 elderly, ASA physical status I and II patients (aged more than 60 years).Interventions: Patients were randomly assigned (n = 10 per group) to premedication with: 1) saline control; 2) midazolam 0.05 mg/kg; 3) atropine 0.01 mg/kg; and 4) midazolam 0.05 mg/kg combined with atropine 0.01 mg/kg. All premedication was given on the ward at approximately 8:30 am, approximately 30 minutes before induction of anesthesia.Measurements and Main Results: Core temperatures were measured at the right tympanic membrane. Mean skin temperature was calculated as 0.3 x (T(chest) + T(arm)) + 0.2 x (T(thigh) + T(calf)). Fingertip perfusion was evaluated using forearm minus fingertip and calf minus toe, skin-surface temperature gradients. Temperatures were evaluated at the time of premedication and 30 minutes later, just before induction of anesthesia. Core temperature remained nearly constant in the control patients (0.1 +/- 0.2 degrees C; mean +/- SD), whereas it decreased significantly in the patients given midazolam alone (-0.3 +/- 0.1 degrees C). Atropine alone increased core temperature (0.3 +/- 0.2 degrees C), although the increase was not statistically significant. The combination of midazolam and atropine attenuated the hypothermia induced by midazolam alone (0.0 +/- 0.2 degrees C). Initial skin-temperature gradients exceeded 0 degrees C in all groups, indicating that the patients were vasoconstricted. The gradients were unchanged by premedication with saline or atropine. Midazolam significantly decreased the gradient (-1.8 +/- 1.1 degrees C), as did the combination of midazolam and atropine (-1.4 +/- 0.9 degrees C).Conclusions: The thermoregulatory effects of benzodiazepine receptor agonist and cholinergic inhibitors oppose each other, and the combination leaves core temperature unchanged.
MB: I can't think how this might happen.

ARTICLE TITLE: Air-oxygen mixtures in circle systems.
ARTICLE SOURCE: J Clin Anesth (United States), Sep 2001, 13(6) p461-4
AUTHOR(S): Hendrickx JF; De Cooman S; Vandeput DM; Van Alphen J; Coddens J; Deloof T; De Wolf AM
AUTHOR'S ADDRESS: Department of Anesthesiology, Intensive Care and Pain Therapy, Onze Lieve Vrouwziekenhuis, Aalst, Belgium.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: STUDY OBJECTIVE: To determine the effect of different air-O(2) mixtures and fresh gas flows (FGF) on the relationship between the delivered (F(Del)O(2)) and inspired O(2) fraction (FIO(2)) in a circle system. STUDY DESIGN: Randomized clinical study. SETTING: Large teaching hospital. PATIENTS: 160 ASA physical status I, II, and III patients undergoing a variety of cardiovascular procedures with general endotracheal anesthesia. INTERVENTIONS: 160 patients were randomly assigned to one of 20 groups (n = 8 each), depending on the combination of total FGF (0.5, 1, 2, 4, or 8 L/min) and air-O(2) mixture used (ratios of 4/1, 3/2, 2/3, or 1/4), corresponding to a F(Del)O(2) of 0.37, 0.53, 0.68, and 0.84. For each combination of FGF and air-O(2) mixture, FIO(2) after equilibration was compared with F(Del)O(2). MEASUREMENTS AND MAIN RESULTS: With any air-O(2) mixture with a FGF < or = 2 L/min, FIO(2) became lower than F(Del)O(2). Because FIO(2) decreased below 0.25 after 13 and 26 minutes in the first two patients of the 4/1 0.5 L/min air-O(2) group, this study limb was terminated. CONCLUSIONS: When using air-O(2) mixtures in a circle system, FIO(2) becomes lower than the F(Del)O(2) with FGF < or = 2 L/min. The relative proportion of O(2) in the FGF has to be increased accordingly.

ARTICLE TITLE: Suppression of cough during emergence from general anesthesia: laryngotracheal lidocaine through a modified endotracheal tube.
ARTICLE SOURCE: J Clin Anesth (United States), Sep 2001, 13(6) p447-51
AUTHOR(S): Diachun CA; Tunink BP; Brock-Utne JG
AUTHOR'S ADDRESS: Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA. Carol_Diachun@urmc.rochester.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: The technique of laryngotracheal topical lidocaine administered by the laryngotracheal instillation of topical anesthesia (LITA) tube can, in most cases, provide a smooth emergence from general anesthesia without coughing.
MB: I want the patient to give a really big cough on extubation.

ARTICLE TITLE: Influenza Vaccine Effectiveness in Preventing Hospitalizations and Deaths in Persons 65 Years or Older in Minnesota, New York, and Oregon: Data from 3 Health Plans [In Process Citation]
ARTICLE SOURCE: J Infect Dis (United States), Sep 15 2001, 184(6) p665-70
AUTHOR(S): Nordin J; Mullooly J; Poblete S; Strikas R; Petrucci R; Wei F; Rush B; Safirstein B; Wheeler D; Nichol KL
AUTHOR'S ADDRESS: HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA.
PUBLICATION TYPE: Journal Article
The virus-vaccine match was excellent for year 1 and fair for year 2. Both years, during peak and total periods, vaccination reduced all causes of death and hospitalization for pneumonia and influenza: hospitalizations were reduced by 19%-20% and 18%-24% for years 1 and 2, respectively, and deaths were reduced by 60%-61% and 35%-39% for the same periods. These results show that all elderly persons should be immunized annually for influenza

ARTICLE TITLE: Antibiotic treatment in acute Otitis Media promotes superinfection with resistant Streptococcus pneumoniae carried before initiation of treatment.
ARTICLE SOURCE: J Infect Dis (United States), Mar 15 2001, 183(6) p880-6
AUTHOR(S): Dagan R; Leibovitz E; Cheletz G; Leiberman A; Porat N
AUTHOR'S ADDRESS: Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel. rdagan@bgumail.bgu.ac.il.
PUBLICATION TYPE: Clinical Trial; Journal Article

ARTICLE TITLE: The effectiveness of active head restraint in preventing whiplash
ARTICLE SOURCE: J Trauma (United States), Nov 2001, 51(5) p959-69
AUTHOR(S): Viano DC; Olsen S
AUTHOR'S ADDRESS: General Motors R&D Center (D.C.V.), Warren, Michigan, and Saab Automobile AB (D.V.C., S.O.), Trollhattan, Sweden.
PUBLICATION TYPE: Journal Article
CONCLUSION: A Self-Aligning Head Restraint (SAHR) is effective in reducing whiplash injury in rear crashes and is a passive public-health approach that works irrespective of manual head-restraint adjustment.

ARTICLE TITLE: Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma [In Process Citation]
ARTICLE SOURCE: J Trauma (United States), Nov 2001, 51(5) p835-42
AUTHOR(S): Nast-Kolb D; Aufmkolk M; Rucholtz S; Obertacke U; Waydhas C
AUTHOR'S ADDRESS: Department of Trauma Surgery, Universitatsklinikum Essen, Essen, Germany.
PUBLICATION TYPE: Journal Article
CONCLUSION: Although multiple organ failure (MOF) incidence remains unchanged, there is a significant fall in MOF-related mortality in patients with severe trauma, and death from single organ failure is virtually absent. Severe brain injury is now the leading cause of death in patients with severe multiple injuries admitted to the ICU.

ARTICLE TITLE: Intramuscular ketamine for the rapid tranquilization of the uncontrollable, violent, and dangerous adult patient [In Process Citation]
ARTICLE SOURCE: J Trauma (United States), Nov 2001, 51(5) p1008-10
AUTHOR(S): Roberts JR; Geeting GK
AUTHOR'S ADDRESS: Department of Emergency Medicine, Mercy Health Systems and the Medical College of Pennsylvania/Hahnemann University, Philadelphia, Pennsylvania.
PUBLICATION TYPE: Journal Article
MB: Paraldehyde was quite good.

ARTICLE TITLE: Pain relief in major trauma patients: an Israeli perspective.
ARTICLE SOURCE: J Trauma (United States), Oct 2001, 51(4) p767-72
AUTHOR(S): Zohar Z; Eitan A; Halperin P; Stolero J; Hadid S; Shemer J; Zveibel FR
AUTHOR'S ADDRESS: Department of Emergency Medicine, Western Galilee Medical Center, Nahariya, Israel. zoharyz@netvision.net.il.
PUBLICATION TYPE: Journal Article; Multicenter Study
METHODS: Current status was evaluated from questionnaires filled by trauma unit personnel of nine medical centers. In one, a pain management protocol was introduced. Staff and patients evaluated pain management before and after the protocol was instituted. RESULTS: About 80% of staff respondents from various centers were not aware of guidelines for pain management in trauma. The belief that pain assists diagnosis was the main reason (78.6%) for withholding analgesia. Large variability existed on what contraindicates analgesia, with the majority withholding analgesia in abdominal and multiple injuries. When administered, analgesia was delayed, and most commonly intramuscular meperidine was given. After the protocol's implementation, the personnel's awareness of analgesia increased, and consequently it was administered earlier and to more patients, mostly as intravenous morphine. Patients appreciated the timely analgesia (38% after vs. 14% before, p = 0.01), with fewer receiving none. Analgesia was considered beneficial by more patients (70% after vs. 23% before, p < 0.001), and enhanced cooperativity with personnel (p < 0.001). This was reflected in increased overall satisfaction with pain relief during the entire hospitalization. CONCLUSION: The importance of pain management protocols in major trauma was demonstrated by the response of personnel and patients.

ARTICLE TITLE: A review of the adrenal cortex and severe inflammation: quest of the "eucorticoid" state.
ARTICLE SOURCE: J Trauma (United States), Oct 2001, 51(4) p800-14
AUTHOR(S): Burchard K
AUTHOR'S ADDRESS: Department of Surgery, Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA. kenneth.w.burchard@hitchcock.org.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Beyond the major trauma outcome study: benchmarking performance using a national contemporary, population-based trauma registry.
COMMENTS: J Trauma. 2001 Oct; 51(4):717-24
ARTICLE SOURCE: J Trauma (United States), Oct 2001, 51(4) p725-7
AUTHOR(S): Glance LG; Osler T
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. laurent_glance@urmc.rochester.edu.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Low-impact falls: demands on a system of trauma management, prediction of outcome, and influence of comorbidities.
COMMENTS: J Trauma. 2001 Oct; 51(4):725-7/21470073
ARTICLE SOURCE: J Trauma (United States), Oct 2001, 51(4) p717-24
AUTHOR(S): Kennedy RL; Grant PT; Blackwell D
AUTHOR'S ADDRESS: Department of Medicine, University of Sunderland, City Hospitals Sunderland, United Kingdom. lee.kennedy1@sunderland.ac.uk.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSION: Patients with low falls make considerable demands on a system of trauma care. TRISS methodology performs less well in this group than with other types of injury. Chronic medical conditions are associated with increased mortality and more prolonged stay after a low fall. Between-institutional variation in length of stay was considerable and this, along with the poor performance of predictive models derived from routinely collected clinical data, make it unlikely that length of stay could be used as a measure of institutional performance. More robust audit measures for patients with low falls are required.
MB: The patients fell over.

ARTICLE TITLE: The 15-year evolution of an urban trauma center: what does the future hold for the trauma surgeon?
ARTICLE SOURCE: J Trauma (United States), Oct 2001, 51(4) p633-7; discussion 637-8
AUTHOR(S): Engelhardt S; Hoyt D; Coimbra R; Fortlage D; Holbrook T
AUTHOR'S ADDRESS: Southern California Kaiser Permanente Medical Group, San Diego Medical Center, California, USA.

ARTICLE TITLE: Recombinant activated factor VII for adjunctive hemorrhage control in trauma.
ARTICLE SOURCE: J Trauma (United States), Sep 2001, 51(3) p431-8; discussion 438-9
AUTHOR(S): Martinowitz U; Kenet G; Segal E; Luboshitz J; Lubetsky A; Ingerslev J; Lynn M
AUTHOR'S ADDRESS: National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. hemophil@trendline.co.il.
PUBLICATION TYPE: Journal Article
CONCLUSION: The results of this report suggest that in trauma patients recombinant activated factor VII (rFVIIa) may play a role as an adjunctive hemostatic measure, in addition to surgical hemostatic techniques, and provides the motivation for controlled animal and clinical trials.
MB: I think this was the people who presented as seminars in Sydney & Melbourne associated with the Nov 2001 World ICU Congress in Sydney.

ARTICLE TITLE: Adrenal crisis after traumatic bilateral adrenal hemorrhage.
ARTICLE SOURCE: J Trauma (United States), Sep 2001, 51(3) p597-600
AUTHOR(S): Udobi KF; Childs EW
AUTHOR'S ADDRESS: Department of Surgery, Kansas University School of Medicine, 4002 Murphy Building, 3901 Rainbow Blvd., Kansas City, KS 66160, USA. kudobi@kumc.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Outcome of adolescent trauma admitted to an adult surgical intensive care unit versus a pediatric intensive care unit.
ARTICLE SOURCE: J Trauma (United States), Sep 2001, 51(3) p478-80
AUTHOR(S): Sanchez JL; Lucas J; Feustel PJ
AUTHOR'S ADDRESS: Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA. javierluis@aol.com.
MAJOR SUBJECT HEADING(S): Intensive Care Units, Pediatric; Intensive Care Units; Wounds and Injuries [classification]
MINOR SUBJECT HEADING(S): Adolescence; Adult; Glasgow Coma Scale; Injury Severity Score; Length of Stay; Retrospective Studies; Treatment Outcome; Wounds and Injuries [epidemiology] [therapy]
INDEXING CHECK TAG(S): Comparative Study; Human
PUBLICATION TYPE: Journal Article
CONCLUSION: Adolescent trauma patients admitted to the pediatric intensive care unit (PICU) were less likely to be intubated or have a Swan-Ganz catheter placed. They had decreased length of stay (LOS) and days of mechanical ventilation. There was no difference in outcome measurements.
MB: It applies only to their ICUs.

ARTICLE TITLE: Practical utility of the D-dimer assay for excluding thromboembolism in severely injured trauma patients.
ARTICLE SOURCE: J Trauma (United States), Sep 2001, 51(3) p425-9; discussion 429-30
AUTHOR(S): Owings JT; Gosselin RC; Anderson JT; Battistella FD; Bagley M; Larkin EC
AUTHOR'S ADDRESS: Trauma Division, University of California-Davis, 23155 Stockton Blvd., Sacramento, CA 95817, USA. jtowings@ucdavis.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: These data serve to validate D-dimer as a means of excluding thromboembolism, specifically in patients with severe injury (100% negative predictive value). Before 48 hours after injury, however, the vast majority of these patients without thromboembolism had positive D-dimer assays. Because of the high false-positive rate early after severe injury, the D-dimer assay may be of little value before postinjury hour 48.
MB: I would have thought more specific methods would be more sensible.

ARTICLE TITLE: Effective antibiotic-resistance control strategies.
COMMENTS: Lancet. 2001 Apr 28; 357(9265):1325-8
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1307-8
AUTHOR(S): Cunha BA
AUTHOR'S ADDRESS: Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. llusardi@winthrop.org.
PUBLICATION TYPE: Comment; Journal Article
MB: Attacking some common theories of antibiotic resistance.

ARTICLE TITLE: Understanding the experience of pain in terminally ill patients.
COMMENTS: Lancet. 2001 Apr 28; 357(9265):1304-5/21242951
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1311-5
AUTHOR(S): Weiss SC; Emanuel LL; Fairclough DL; Emanuel EJ
AUTHOR'S ADDRESS: Department of Clinical Bioethics, Warren G Magnuson Clinical Center, National Institutes of Health, Building 10, Room 1C118, Bethesda, MD 20892, USA. sweiss@nih.gov.
PUBLICATION TYPE: Journal Article
INTERPRETATION: Although half of terminally ill patients experienced moderate to severe pain, only 30% of them wanted additional pain treatment from their primary-care physician. The number of patients experiencing pain remains too high. However, the number is not as large as perceived. Additionally, most are willing to tolerate pain. Furthermore, the experience of pain is constant across major terminal diseases.
MB: Things aren't bad as have been made out.

ARTICLE TITLE: Should endarterectomy decisions be based on non-invasive imaging?
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1343
AUTHOR(S): Larkin M
PUBLICATION TYPE: News
MB: Many sougeons do but the answer was NO.

ARTICLE TITLE: Death rate of Aborigines in prison is increasing.
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1348
AUTHOR(S): Loff B; Cordner S
PUBLICATION TYPE: News
MB: 3 times as many as before the Royal Commission

ARTICLE TITLE: US state given go ahead to reduce drug prices for uninsured people.
ARTICLE SOURCE: Lancet (England), May 26 2001, 357(9269) p1683
AUTHOR(S): Ashraf H
PUBLICATION TYPE: News
MB: Maine wants to be able to negotiate lower prices for drugs from a federally funded scheme & have been allowed to.

ARTICLE TITLE: Unsatisfactory redefinition of myocardial infarction.
ARTICLE SOURCE: Lancet (England), May 26 2001, 357(9269) p1635-6
AUTHOR(S): Richards AM; Lainchbury JG; Nicholls MG
AUTHOR'S ADDRESS: Christchurch Cardioendocrine Research Group. Christchurch School of Medicine, University of Otago, Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
PUBLICATION TYPE: Journal Article
MB: Possibility of too much emphasis on new enzymes.

ARTICLE TITLE: Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial.
COMMENTS: Lancet. 2001 May 19; 357(9268):1549-50
ARTICLE SOURCE: Lancet (England), May 19 2001, 357(9268) p1583-5
AUTHOR(S): Bottiger BW; Bode C; Kern S; Gries A; Gust R; Glatzer R; Bauer H; Motsch J; Martin E
AUTHOR'S ADDRESS: Departments of Anaesthesiology, University of Heidelberg, D-69120, Heidelberg, Germany. bernd_boettiger@med.uni-heidelberg.de.
PUBLICATION TYPE: Clinical Trial; Controlled Clinical Trial; Journal Article
ABSTRACT: BACKGROUND: During cardiopulmonary resuscitation (CPR), thrombolysis can help to stabilise patients with pulmonary embolism and myocardial infarction. Moreover, thrombolysis during CPR has beneficial effects on cerebral reperfusion after cardiac arrest. We investigated this new therapeutic approach in patients in whom conventional CPR had been unsuccessful. METHODS: We assessed, in a prospective study, patients undergoing CPR after out-of-hospital cardiac arrest for cardiological reasons in whom return of spontaneous circulation was not achieved within 15 min. According to the Ustein criteria, our control group consisted of patients who were assessed during 1 year. After this year patients were treated with a bolus of 5000 U of heparin and 50mg, over 2 min, of tissue-type plasminogen activator (rt-PA treated group). This intervention was repeated if return of spontaneous circulation was not achieved within the following 30 min. For controls only CPR was given. FINDINGS: Overall, 90 patients were included; heparin and rt-PA were given to 40 patients. There were no bleeding complications related to the CPR procedures. Of the rt-PA group, 68% (27) had return of spontaneous circulation and 58% (23) were admitted to a cardiac intensive care unit, compared with 44% (22; p=0.026) and 30% (15; p=0.009) of the controls, respectively. At 24 h after cardiac arrest a larger proportion of the rt-PA group than of the controls was alive (35% [14] vs 22% [11], p=0.171), and 15% (six) of rt-PA-treated patients and 8% (four) of controls could be discharged from hospital. INTERPRETATION: After initially unsuccessful out-of-hospital CPR, thrombolytic therapy combined with heparin is safe and might improve patient outcome. On the basis of our data a randomised controlled trial might be regarded as ethical.
MB: I took 20 minutes.

ARTICLE TITLE: Thrombolytic therapy during cardiopulmonary resuscitation.
COMMENTS: Lancet. 2001 May 19; 357(9268):1583-5/21272985
ARTICLE SOURCE: Lancet (England), May 19 2001, 357(9268) p1549-50
AUTHOR(S): Kern KB
AUTHOR'S ADDRESS: Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA. kernk@u.arizona.edu.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial.
COMMENTS: Lancet. 2001 May 12; 357(9267):1461-2
ARTICLE SOURCE: Lancet (England), May 12 2001, 357(9267) p1485-9
AUTHOR(S): Scurr JH; Machin SJ; Bailey-King S; Mackie IJ; McDonald S; Smith PD
AUTHOR'S ADDRESS: Department of Surgery, Royal Free and University College Medical School, London, UK. medleg@mailbox.co.uk.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
INTERPRETATION: We conclude that symptomless DVT might occur in up to 10% of long-haul airline travellers. Wearing of elastic compression stockings during long-haul air travel is associated with a reduction in symptomless DVT.
MB: I did not wait for this study. My prophylactic regimen is sleep in a bed before the flight, don't sleep during the flight, elastic stockings, aspirin, business class, aisle seat & frequent walks.

ARTICLE TITLE: Venous thromboembolism after long flights: are airlines to blame?
COMMENTS: Lancet. 2001 May 12; 357(9267):1485-9
ARTICLE SOURCE: Lancet (England), May 12 2001, 357(9267) p1461-2
AUTHOR(S): Hirsh J; O'Donnell MJ
AUTHOR'S ADDRESS: Hamilton Civic Hospitals Research Centre, McMaster University, Ontario L8V 1C3, Hamilton, Canada. jhirsh@thrombosis.hhscr.org.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Detention of asylum seekers: assault on health, human rights, and social development.
ARTICLE SOURCE: Lancet (England), May 5 2001, 357(9266) p1436-7
AUTHOR(S): Silove D; Steel Z; Mollica R
AUTHOR'S ADDRESS: Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW 2107, Sydney, Australia. d.silove@unsw.edu.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial.
ARTICLE SOURCE: Lancet (England), May 5 2001, 357(9266) p1385-90
AUTHOR(S): Dargie HJ
AUTHOR'S ADDRESS: Department of Cardiology, Western Infirmary, G11 2NT, Glasgow, UK. H.Dargie@bio.gla.ac.uk.
INTERPRETATION: In patients treated long-term after an acute myocardial infarction complicated by left-ventricular systolic dysfunction, carvedilol reduced the frequency of all-cause and cardiovascular mortality, and recurrent, non-fatal myocardial infarctions. These beneficial effects are additional to those of evidence-based treatments for acute myocardial infarction including ACE inhibitors.

ARTICLE TITLE: Breast self examination does more harm than good, says task force.
ARTICLE SOURCE: Lancet (England), Jun 30 2001, 357(9274) p2109
AUTHOR(S): Larkin M
PUBLICATION TYPE: News
MB: Well that is news.

ARTICLE TITLE: AIDS: unbeatable 20 years on.
ARTICLE SOURCE: Lancet (England), Jun 30 2001, 357(9274) p2073-4
AUTHOR(S): Weiss R
AUTHOR'S ADDRESS: Department of Viral Oncology, Immunology, and Molecular Pathology, University College London, W1T 4JF, London, UK. r.weiss@ucl.ac.uk.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Canadian epidemiologists examine elective surgery.
ARTICLE SOURCE: Lancet (England), Jun 9 2001, 357(9271) p1861
AUTHOR(S): Kondro W
PUBLICATION TYPE: News
MB: The average results of many non-life preserving operations is often not good.

ARTICLE TITLE: Results of the arterial switch operation in neonates with transposed great arteries.
COMMENTS: Lancet. 2001 Jun 9; 357(9271):1814/21303936
ARTICLE SOURCE: Lancet (England), Jun 9 2001, 357(9271) p1826-30
AUTHOR(S): Pretre R; Tamisier D; Bonhoeffer P; Mauriat P; Pouard P; Sidi D; Vouhe P
AUTHOR'S ADDRESS: Department of Cardiovascular Surgery, Hopital Laennec-Necker, 75743 Cedex 15, Paris, France.
PUBLICATION TYPE: Evaluation Studies; Journal Article
INTERPRETATION: The arterial switch operation in neonates achieves excellent results mid-term. Obstruction of the translocated coronary arteries is responsible for most deaths and a substantial number of reoperations. Although confirmation is needed, these results allow anticipation of a favourable long-term prognosis.
MB: The Bristol operation.

ARTICLE TITLE: Lessons from the arterial-switch operation.
COMMENTS: Lancet. 2001 Jun 9; 357(9271):1826-30/21303944
ARTICLE SOURCE: Lancet (England), Jun 9 2001, 357(9271) p1814
AUTHOR(S): de Leval MR
AUTHOR'S ADDRESS: Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust and the Institute of Child Health, WC1N 3JH, London, UK. delevm@gosh.nhs.uk.
PUBLICATION TYPE: Comment; Journal Article
MB: Discusses some of the ethical dilemmas inherent in complex congenital cardiac surgery.

ARTICLE TITLE: Comparison of UK paediatric cardiac surgical performance by analysis of routinely collected data 1984-96: was Bristol an outlier?
ARTICLE SOURCE: Lancet (England), Jul 21 2001, 358(9277) p181-7
AUTHOR(S): Aylin P; Alves B; Best N; Cook A; Elliott P; Evans SJ; Lawrence AE; Murray GD; Pollock J; Spiegelhalter D
AUTHOR'S ADDRESS: Division of Primary Care and Population Health Sciences, Imperial College School of Medicine, London, UK. p.aylin@ic.ac.uk.
PUBLICATION TYPE: Journal Article; Multicenter Study
INTERPRETATION: Our results suggest that Bristol was an outlier, and we do not believe that statistical variation, systematic bias in data collection, case-mix, or data quality can explain a divergence in performance of this size.
MB: Outliers are the ones which should be investigated to find out what is going wrong. The average result will not be the best possible at the beginning at least

ARTICLE TITLE: Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.
COMMENTS: Lancet. 2001 Jun 2; 357(9270):1722-3
ARTICLE SOURCE: Lancet (England), Jun 2 2001, 357(9270) p1729-37
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
INTERPRETATION: Endovascular treatment had similar major risks and effectiveness at prevention of stroke during 3 years compared with carotid surgery, but with wide confidence intervals. Endovascular treatment had the advantage of avoiding minor complications.
MB: Some Melbourne & Perth hospitals included. Only 7% had regional anaesthesia.

ARTICLE TITLE: Endarterectomy or angioplasty for treatment of carotid stenosis?
COMMENTS: Lancet. 2001 Jun 2; 357(9270):1729-37
ARTICLE SOURCE: Lancet (England), Jun 2 2001, 357(9270) p1722-3
AUTHOR(S): Spence D; Eliasziw M
AUTHOR'S ADDRESS: Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Ontario N6G 2V2, London, Canada. dspence@rri.on.ca.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Reducing likelihood of instrumental delivery with epidural anaesthesia.
COMMENTS: Lancet. 2001 Jul 7; 358(9275):19-23ARTICLE SOURCE: Lancet (England), Jul 7 2001, 358(9275) p2
AUTHOR(S): Thornton JG; Capogna G
AUTHOR'S ADDRESS: Academic Unit of Paediatrics, Obstetrics and Gynaecology, University of Leeds, Leeds General Infirmary, LS2 9NS, Leeds, UK. j.g.thornton@leeds.ac.uk.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial.
COMMENTS: Lancet. 2001 Jul 7; 358(9275):2/21348358
ARTICLE SOURCE: Lancet (England), Jul 7 2001, 358(9275) p19-23
AUTHOR'S ADDRESS: Collective Name: Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
INTERPRETATION: The use of low-dose epidural techniques for labour analgesia has benefits for delivery outcome. Continued routine use of traditional epidurals might not be justified.

ARTICLE TITLE: Protecting patient privacy: striking a balance.
ARTICLE SOURCE: Lancet (England), Aug 25 2001, 358(9282) p597
PUBLICATION TYPE: Editorial
MB: It won't will it? (It's about a new US law .) We have a new law too. I can't imagine it being much good ie effective and not harmful

ARTICLE TITLE: 1966 and all that-when is a literature search done?
ARTICLE SOURCE: Lancet (England), Aug 25 2001, 358(9282) p646
AUTHOR(S): McLellan F
PUBLICATION TYPE: News
MB: They killed a volunteer at John Hophins from a side effect of hexamethonium and are blaming it on the that relevant references are pre 1966 so are not on ordinary Medline.

ARTICLE TITLE: Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study.
COMMENTS: Lancet. 2001 Aug 25; 358(9282):599-601ARTICLE SOURCE: Lancet (England), Aug 25 2001, 358(9282) p629-35
AUTHOR(S): Salmeron S; Liard R; Elkharrat D; Muir J; Neukirch F; Ellrodt A
AUTHOR'S ADDRESS: Unite de Pneumologie, Service de Medecine Interne, Hopital Universitaire Bicetre, 78 Rue du General Leclerc, 94275 Cedex, Kremlin Bicetre, France. sergio.salmeron@bct.ap-hop-paris.fr.
PUBLICATION TYPE: Journal Article; Multicenter Study
INTERPRETATION: Acute asthma exacerbations are often life-threatening in patients who attend accident and emergency departments, and management of patients is not ideal, mainly because of underuse of corticosteroids and inappropriate admission rates according to severity.
MB: They must think that more than 54% should have been admitted. That could make it worse. The mortality has been getting worse since I have been watching (1965+) but the treatment have been getting better. Could it be iatrogenic? I am still waiting for the blind trials of the use of steroids in asthma.

ARTICLE TITLE: Exacerbations of asthma--still room for improvement.
COMMENTS: Lancet. 2001 Aug 25; 358(9282):629-35
ARTICLE SOURCE: Lancet (England), Aug 25 2001, 358(9282) p599-601
AUTHOR(S): Tattersfield AE; Harrison TW
AUTHOR'S ADDRESS: Division of Respiratory Medicine, City Hospital, NG5 1PB, Nottingham, UK. anne.tattersfield@nottingham.ac.uk.
PUBLICATION TYPE: Comment; Journal Article
MB: They don't seem to be getting anywhere fast.

ARTICLE TITLE: Clinical decisions: from art to science and back again.
COMMENTS: Lancet. 2001 Aug 18; 358(9281):571-4
ARTICLE SOURCE: Lancet (England), Aug 18 2001, 358(9281) p523-4
AUTHOR(S): Naylor CD
AUTHOR'S ADDRESS: Faculty of Medicine, University of Toronto, ON M5S 1AB, Toronto, Canada. david.naylor@utoronto.ca.
PUBLICATION TYPE: Comment; Journal Article
MB: This is muddled. There is a desperate need for professional philosophers to help us sort out our muddled minds.

ARTICLE TITLE: Decision analysis in patient care.
COMMENTS: Lancet. 2001 Aug 18; 358(9281):523-4/21412186
ARTICLE SOURCE: Lancet (England), Aug 18 2001, 358(9281) p571-4
AUTHOR(S): Elwyn G; Edwards A; Eccles M; Rovner D
AUTHOR'S ADDRESS: Department of General Practice, University of Wales College of Medicine, Canolfan Iechyd Llanedeyrn Health Centre, CF23 9PN, Cardiff, UK. elwyng@cardiff.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: To help patients to fully participate in shared decision making is becoming an important goal in clinical practice and one which is receiving increasing attention in terms of the requisite skills and technological development. We discuss the potential application of decision analysis-a specific technology that has been introduced into clinical practice but to date only within research contexts-and examine the usefulness and feasibility of the technique for patients, particularly in settings where clinical presentations are diverse and characterised by uncertainty.
MB: This also illustrates that we have not got the process explicitly

ARTICLE TITLE: Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study.
COMMENTS: Lancet. 2001 Aug 11; 358(9280):432-4
ARTICLE SOURCE: Lancet (England), Aug 11 2001, 358(9280) p439-44
AUTHOR(S): Davies M; Hobbs F; Davis R; Kenkre J; Roalfe AK; Hare R; Wosornu D; Lancashire RJ
AUTHOR'S ADDRESS: Department of Cardiology, Selly Oak Hospital, Raddlebarn Road, Selly Oak, West Midlands, UK.
PUBLICATION TYPE: Journal Article
INTERPRETATION: Heart failure is often misdiagnosed or underdiagnosed in primary care. Our results suggest that assessment of left-ventricular function in patients with suspected heart failure could lead to more effective diagnosis and treatment of this disorder.

ARTICLE TITLE: Changes in notions about heart failure.
COMMENTS: Lancet. 2001 Aug 11; 358(9280):439-44/21405924
ARTICLE SOURCE: Lancet (England), Aug 11 2001, 358(9280) p432-4
AUTHOR(S): Petrie M; McMurray J
AUTHOR'S ADDRESS: Clinical Research Initiative in Heart Failure, University of Glasgow, G12 8QQ, Glasgow, UK.
PUBLICATION TYPE: Comment; Journal Article
MB: This is related to the preceding article. The comment discusses some of the changes occurring in the concept of heart failure. It appears that the traditional definitions have broken down. We understand less but the results are getting better.

ARTICLE TITLE: Origins of the desire for euthanasia and assisted suicide in people with HIV-1 or AIDS: a qualitative study.
COMMENTS: Lancet. 2001 Aug 4; 358(9279):344-5
ARTICLE SOURCE: Lancet (England), Aug 4 2001, 358(9279) p362-7
AUTHOR(S): Lavery JV; Boyle J; Dickens BM; Maclean H; Singer PA
AUTHOR'S ADDRESS: University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada. laveryj@mail.nih.gov.
PUBLICATION TYPE: Journal Article
INTERPRETATION: These determinants of desire for euthanasia or assisted suicide in people with HIV-1 or AIDS have implications for the debate on these practices, and development of policies to regulate them.
MB: They mean for people with other diseases.

ARTICLE TITLE: Desire for physician-assisted suicide: requests for a better death?
COMMENTS: Lancet. 2001 Aug 4; 358(9279):362-7
ARTICLE SOURCE: Lancet (England), Aug 4 2001, 358(9279) p344-5
AUTHOR(S): Back AL; Pearlman RA
AUTHOR'S ADDRESS: Vaterans Affairs Puget Sound Health Care System, University of Washington, Seattle WA 98108, USA. tonyback@u.washington.edu.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: The art of anaesthesia.
ARTICLE SOURCE: Lancet (England), Sep 29 2001, 358(9287) p1110
AUTHOR(S): Nadaraja S
PUBLICATION TYPE: Journal Article
MB: Quite funny----but not very profound. The author sometimes harbours nasty critical thoughts about those around him but he reamins silent. I usually tell them. They then think I am in a worse mood than usual.

ARTICLE TITLE: When to initiate dialysis: effect of proposed US guidelines on survival.
ARTICLE SOURCE: Lancet (England), Sep 29 2001, 358(9287) p1046-50
AUTHOR(S): Korevaar JC; Jansen MA; Dekker FW; Jager KJ; Boeschoten EW; Krediet RT; Bossuyt PM
AUTHOR'S ADDRESS: Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, Netherlands. j.korevaar@amc.uva.nl; Collective Name: Netherlands Cooperative Study on the Adequacy of Dialysis Study Group.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Recent guidelines from the US National Kidney Foundation Dialysis Outcomes Quality Initiative recommend an earlier start of dialysis treatment than has been common practice. Their implementation would have a substantial effect on patients' daily lives and would increase costs. The guidelines are largely opinion-based, because evidence is still lacking. METHODS: As part of a prospective multicentre study in the Netherlands, we included, between January, 1997, and May, 1999, all new patients with end-stage renal disease, for whom data were available on residual renal function 0-4 weeks before the start of dialysis. We recorded date of death or censoring until August, 2000. FINDINGS: 94 (37%) of 253 patients started dialysis treatment later than recommended by the US guideline. There was an increased mortality risk for these patients compared with those who started dialysis on time, although it was not significant (adjusted hazard ratio 1.66 [95% CI 0.95-2.89]). The adjusted difference in estimated survival time after 3 years on dialysis treatment was 2.5 months (1.1-4.0) in favour of timely starters. Conversely, the average delay in dialysis initiation for late starters, the extra time free of dialysis, was at least 4.1 months. INTERPRETATION: Although we observed a gain in survival time with a timely start of dialysis, it is probably a reflection of initiating dialysis earlier in the disease. We question the benefit of putting this guideline into daily practice, given the current clinical evidence and the effects it would have on patients and dialysis resources.
MB: They do not seem to take into account that it would make a patient more able to function. I think there is an age limit on the use of dialysis in the NHS.

ARTICLE TITLE: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack.
COMMENTS: Lancet. 2001 Sep 29; 358(9287):1026-7
ARTICLE SOURCE: Lancet (England), Sep 29 2001, 358(9287) p1033-41
AUTHOR'S ADDRESS: Collective Name: PROGRESS Collaborative Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
INTERPRETATION: This blood-pressure-lowering regimen reduced the risk of stroke among both hypertensive and non-hypertensive individuals with a history of stroke or transient ischaemic attack. Combination therapy with perindopril and indapamide produced larger blood pressure reductions and larger risk reductions than did single drug therapy with perindopril alone. Treatment with these two agents should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure. -

ARTICLE TITLE: Blood-pressure lowering for the secondary prevention of stroke.
COMMENTS: Lancet. 2001 Sep 29; 358(9287):1033-41
ARTICLE SOURCE: Lancet (England), Sep 29 2001, 358(9287) p1026-7
AUTHOR(S): Staessen JA; Wang J
AUTHOR'S ADDRESS: Study Coordinating Centre, Laboratory of Hypertension, Department of Molecular and Cardiovascular Research, University of Leuven, B-3000, Leuven, Belgium. jan.staessen@med.kuleuven.ac.be.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Health economics without tears.
COMMENTS: Lancet. 2001 Sep 22; 358(9286):993-8/21468358
ARTICLE SOURCE: Lancet (England), Sep 22 2001, 358(9286) p950
AUTHOR(S): Sharp D
AUTHOR'S ADDRESS: c/o The Lancet, WC1X 8RR, London, UK.
PUBLICATION TYPE: Comment; Journal Article
MB: A plug for the following 5 papers. They are of variable value. They need to be read completely so I will cut out the abstracts

ARTICLE TITLE: Introduction to health economics for physicians.
COMMENTS: Lancet. 2001 Sep 22; 358(9286):950
ARTICLE SOURCE: Lancet (England), Sep 22 2001, 358(9286) p993-8
AUTHOR(S): Meltzer MI
AUTHOR'S ADDRESS: National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop D-59, 1600 Clifton Road, Atlanta, GA 30333, USA. MMeltzer@cdc.gov.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Economics of surgery.
ARTICLE SOURCE: Lancet (England), Sep 29 2001, 358(9287) p1077-81
AUTHOR(S): Brazier JE; Johnson AG
AUTHOR'S ADDRESS: Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, UK. jbrazier@sheff.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Importance of perspective in economic analyses of cancer screening decisions.
ARTICLE SOURCE: Lancet (England), Oct 6 2001, 358(9288) p1169-73
AUTHOR(S): Mansley EC; McKenna MT
AUTHOR'S ADDRESS: US Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, USA. edward_mansley@merck.com.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Economics of drug treatment: for which patients is it costeffective to lower cholesterol?
ARTICLE SOURCE: Lancet (England), Oct 13 2001, 358(9289) p1251-6
AUTHOR(S): Jonsson B
AUTHOR'S ADDRESS: Centre for Health Economics, Stockholm School of Economics, Box 6501, S-113 83, Stockholm, Sweden. hebj@hhs.se.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Costeffectiveness of diagnostic tests
ARTICLE SOURCE: Lancet (England), Oct 20 2001, 358(9290) p1353-5
AUTHOR(S): Mushlin AI; Ruchlin HS; Callahan MA
AUTHOR'S ADDRESS: Department of Public Health, Weill Medical College of Cornell University, NY, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial.
ARTICLE SOURCE: Lancet (England), Sep 15 2001, 358(9285) p876-80
AUTHOR(S): Melling AC; Ali B; Scott EM; Leaper DJ
AUTHOR'S ADDRESS: Professorial Unit of Surgery, North Tees & Hartlepool NHS Trust, University Hospital of North Tees, TS19 8PE, Stockton-on-Tees, UK. andymelling@pop.compuserve.com.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: Wound infection after clean surgery is an expensive and often underestimated cause of patient morbidity, and the benefits of using prophylactic antibiotics have not been proven. Warming patients during colorectal surgery has been shown to reduce infection rates. We aimed to assess whether warming patients before short duration, clean surgery would have the same effect. METHODS: 421 patients having clean (breast, varicose vein, or hernia) surgery were randomly assigned to either a non-warmed (standard) group or one of two warmed groups (local and systemic). We applied warming for at least 30 min before surgery. Patients were followed up and masked outcome assessments made at 2 and 6 weeks. FINDINGS: Analysis was done on an intention-to-treat basis. We identified 19 wound infections in 139 non-warmed patients (14%) but only 13 in 277 who received warming (5%; p=0.001). Wound scores were also significantly lower (p=0.007) in warmed patients. There was no significant difference in the development of haematomas or seromas after surgery but the non-warmed group were prescribed significantly more postoperative antibiotics (p=0.002). INTERPRETATION: Warming patients before clean surgery seems to aid the prevention of postoperative wound infection. If applied according to the manufacturers guidelines these therapies have no known side-effects and might, with the support of further studies, provide an alternative to prophylactic antibiotics in this type of surgery.
MB: I have advocated adequate insulation ie blankets preoperatively for 30+ years. It is not as sexy as external heating. They say that the systemic temperatures are higher but not how much higher. I am sure that adequate covering would be much cheaper.

ARTICLE TITLE: Cochrane review on screening for breast cancer with mammography
ARTICLE SOURCE: Lancet (England), Oct 20 2001, 358(9290) p1340-2
AUTHOR(S): Olsen O; Gotzsche PC
AUTHOR'S ADDRESS: Nordic Cochrane Centre, Rigshospitalet Dept 7112, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
PUBLICATION TYPE: Journal Article
ABSTRACT: In 2000, we reported that there is no reliable evidence that screening for breast cancer reduces mortality. As we discuss here, a Cochrane review has now confirmed and strengthened our previous findings. The review also shows that breast-cancer mortality is a misleading outcome measure. Finally, we use data supplemental to those in the Cochrane review to show that screening leads to more aggressive treatment.
MB: This whole affair is hopeless.

ARTICLE TITLE: Screening mammography-an overview revisited
ARTICLE SOURCE: Lancet (England), Oct 20 2001, 358(9290) p1284-5
AUTHOR(S): Horton R
AUTHOR'S ADDRESS: The Lancet, WC1X 8RR, London, UK.
PUBLICATION TYPE: Journal Article
MB: Worth looking at as it shows that there can be bias in self-styled sanctimonious censors.

ARTICLE TITLE: Cardiovascular protection and blood pressure reduction: a meta-analysis
ARTICLE SOURCE: Lancet (England), Oct 20 2001, 358(9290) p1305-15
AUTHOR(S): Staessen JA; Wang JG; Thijs L
AUTHOR'S ADDRESS: Studiecoordinatiecentrum, Hypertensie en Cardiovasculaire Revalidatie Eenheid, Departement Moleculair en Cardiovasculair Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium.
PUBLICATION TYPE: Journal Article
ABSTRACT: Interpretation Our findings emphasise that blood pressure control is important. All antihypertensive drugs have similar long-term efficacy and safety. Calcium-channel blockers might be especially effective in stroke prevention. We did not find that converting-enzyme inhibitors or a-blockers affect cardiovascular prognosis beyond their antihypertensive effects.

ARTICLE TITLE: What progress with artificial livers
ARTICLE SOURCE: Lancet (England), Oct 20 2001, 358(9290) p1286-7
AUTHOR(S): Hayes PC; Lee A
AUTHOR'S ADDRESS: Department of Medicine and Anaesthetics, Royal Infirmary, EH3 9YW, Edinburgh, UK.
PUBLICATION TYPE: Journal Article
MB: It seems to be none. We have done quite a few.

ARTICLE TITLE: Peripheral arterial disease.
ARTICLE SOURCE: Lancet (England), Oct 13 2001, 358(9289) p1257-64
AUTHOR(S): Ouriel K
AUTHOR'S ADDRESS: Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. ouurielk@ccf.org.
MINOR SUBJECT HEADING(S): Adult; Age Distribution; Aged; Algorithms; Exercise; Intermittent Claudication [diagnosis] [epidemiology] [physiopathology] [surgery] [therapy]; Life Style; Middle Age; Randomized Controlled Trials; Risk Factors
INDEXING CHECK TAG(S): Female; Human; Male
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: A summary of vascular surgery, I think.

ARTICLE TITLE: How (not) to improve a health service.
ARTICLE SOURCE: Lancet (England), Oct 6 2001, 358(9288) p1111
PUBLICATION TYPE: Editorial
MB: They have set up a 'Commission for Health Improvement' which is apparently hopeless. I hear that they are going to get a similar body for our Area Health Service.

ARTICLE TITLE: Adverse events of premixed nitrous oxide and oxygen for procedural sedation in children
ARTICLE SOURCE: Lancet (England), Nov 3 2001, 358(9292) p1514-5
AUTHOR(S): Gall O; Annequin D; Benoit G; Glabeke E; Vrancea F; Murat I
AUTHOR'S ADDRESS: Service d'Anesthesie-Reanimation, Hopital d'Enfants Armand Trousseau, 75571, Cedex 12, Paris, France.
PUBLICATION TYPE: Journal Article
ABSTRACT: In France, administration of premixed 50% nitrous oxide and oxygen for procedural sedation is under close supervision by the French Drug Agency before final approval for use. We have examined the frequency of adverse events in children sedated with 50% nitrous oxide and oxygen over a broad range of non-specialised facilities. A mean of 0.33% (SD 0.10) children had major adverse events. Thus, premixed 50% nitrous oxide and oxygen seems to be a safe option for procedural sedation in children.
MB: They don't say what the adverse effect were.

ARTICLE TITLE: Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial
ARTICLE SOURCE: Lancet (England), Nov 3 2001, 358(9292) p1487-92
AUTHOR(S): Bozzetti F; Braga M; Gianotti L; Gavazzi C; Mariani L
AUTHOR'S ADDRESS: The Italian Society for Parenteral and Enteral Nutrition, Milan, Italy.
PUBLICATION TYPE: Journal Article
Analysis was by intention to treat.Findings Postoperative complications occurred in 54 (34%) patients fed enterally versus 78 (49%) fed parenterally (relative risk 0.69, 95% CI 0.53-0.90, p=0.005). Length of postoperative stay was 13.4 days and 15.0 days in the enteral nutrition and parenteral nutrition groups, respectively (p=0.009). Adverse effects occurred in 56 (35%) patients fed enterally versus 22 (14%) patients fed parenterally (2.50, 1.61-3.86, p<0.0001). 14 (9%) patients on enteral nutrition had to switch to parenteral nutrition, whereas none of those fed parenterally crossed over to enteral feeding.Interpretation We conclude that early enteral nutrition significantly reduces the complication rate and duration of postoperative stay compared with parenteral nutrition, although parenteral nutrition is better tolerated than enteral nutrition.

ARTICLE TITLE: Appropriateness ratings: overuse, underuse, or misuse?
ARTICLE SOURCE: Lancet (England), Nov 3 2001, 358(9292) p1475-6
AUTHOR(S): Anderson GM; Brown AD
AUTHOR'S ADDRESS: Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, M5S 1A8, Ontario, Canada.
PUBLICATION TYPE: Journal Article
MB: They have a long way to go to establish the appropriateness of the ratings.

ARTICLE TITLE: Controversies in the diagnosis of ventilator-acquired pneumonia
ARTICLE SOURCE: Med Clin North Am (United States), Nov 2001, 85(6) p1565-81
AUTHOR(S): Waterer GW; Wunderink RG
AUTHOR'S ADDRESS: Department of Medicine, University of Western Australia, Royal Perth Hospital, Western Australia. tcross@lsuhsc.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Radiology of pneumonia
ARTICLE SOURCE: Med Clin North Am (United States), Nov 2001, 85(6) p1461-91, x
AUTHOR(S): Gharib AM; Stern EJ
AUTHOR'S ADDRESS: Department of Radiology, University of Louisville, Louisville, Kentucky, USA.
This article discusses the clinical and radiographic features of the most common causes of pneumonia, primarily in the adult population of the United States.

ARTICLE TITLE: Steroids and the surgical patient.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1311-7
AUTHOR(S): Jabbour SA
AUTHOR'S ADDRESS: Department of Medicine, Division of Endocrinology, Diabetes, and Metabolic Diseases, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. serge.jabbour@mail.tju.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: In patients undergoing surgery, a thorough history is important to obtain, including use of any steroid therapy within the previous year. If there is a history of steroid use, and if time permits, testing of the HPA axis should be performed. If adrenal unresponsiveness is documented or if clinical suspicion of [table: see text] adrenal insufficiency is high (without testing), a stress dose of steroids should be administered during the perioperative period to prevent an adrenal crisis.
MB: Giving steroids perioperatively is probably unnecessary except in Addison's disease, those currently having steroids & in transplantation.

ARTICLE TITLE: Abnormal coagulation in the postoperative period contributing to excessive bleeding.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1277-310, viii
AUTHOR(S): McKenna R
AUTHOR'S ADDRESS: Department of Medicine, Division of Hematology, Hemophilia Center, Special Hematology and Hemostasis Laboratory, Cardeza Foundation for Hematologic Research, Thomas Jefferson University Hospital and Medical Center, Philadelphia, Pennsylvania, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: This article deals primarily with acquired disorders that disrupt normal hemostasis and cause excessive bleeding in the postoperative period because of the coagulopathy itself or because of drugs needed to treat the hemostatic disorder.

ARTICLE TITLE: Postoperative renal insufficiency.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1241-54
AUTHOR(S): Edwards BF
AUTHOR'S ADDRESS: Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA. bfedwar@emory.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: The poor clinical outcomes associated with postoperative HARI necessitate increased vigilance for HARI detection and intervention to minimize the progression to dialysis dependency. Patient survival significantly worsens if HARI requires the initiation of dialysis. Postoperative changes, including intravascular volume expansion, SIRS, and reduced lean body mass, frequently confound the detection of HARI. Serum creatinine levels frequently do not reflect the decreased renal function because creatinine production rate is decreased with reduced lean body mass, and the serum creatinine concentration is reduced by increased intravascular volume expansion and increased volume of distribution associated with anasarca. Additional indices of renal function must be used postoperatively, including urine output, net volume status, urinalysis with microscopic examination of the spun pellet, and corrected estimations of creatinine clearance. Few therapeutic interventions currently exist to reverse HARI other than optimization of renal perfusion and limitation of nephrotoxin exposure. Dialysis remains a cornerstone of maintenance therapy for refractory and severe HARI. Selection of dialysis modality continues to be based on modality availability and patient stability.

ARTICLE TITLE: Postoperative delirium.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1229-39
AUTHOR(S): Winawer N
AUTHOR'S ADDRESS: Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. nwinawe@emory.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Postoperative management of the diabetic patient.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1213-28
AUTHOR(S): Hoogwerf BJ
AUTHOR'S ADDRESS: Department of Endocrinology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. hoogweb@ccf.org.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Stopping and restarting medications in the perioperative period.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1117-28
AUTHOR(S): Spell NO
AUTHOR'S ADDRESS: Department of Medicine, Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Nathan_Spell@Emory.org.
PUBLICATION TYPE: Journal Article
MB: I thing generally you should continue necessary therapy.

ARTICLE TITLE: Postoperative pulmonary complications.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1129-39
AUTHOR(S): Trayner E; Celli BR
AUTHOR'S ADDRESS: Department of Medicine, Division of Pulmonary and Critical Care Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. etrayner@chcs.org.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Duration of deep vein thrombosis and pulmonary embolism prophylaxis after joint arthroplasty.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2001, 85(5) p1101-7, v
AUTHOR(S): Merli GJ
AUTHOR'S ADDRESS: Department of Medicine, Thomas Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Sexual selection. Are ducks impressed by drakes' display?
ARTICLE SOURCE: Nature (England), Sep 13 2001, 413(6852) p128
AUTHOR(S): McCracken KG; Wilson RE; McCracken PJ; Johnson KP
AUTHOR'S ADDRESS: Institute of Arctic Biology and Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, Alaska 99775, USA. fnkgm@uaf.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Surprisingly few birds have penises, but among those that do, the Argentine lake duck (Oxyura vittata) tops the bill - the penis of this small stifftail duck from South America is shaped like a corkscrew and, at almost half a metre long, is the largest of any bird measured so far. Factors responsible for the evolution of this remarkable organ could include runaway selection, whereby drakes with longer penises gain dominance and copulate with more females, or preference by females for drakes with longer and more decorated penises.

ARTICLE TITLE: ACOG Committee Opinion No. 261, November 2001. Medical futility
ARTICLE SOURCE: Obstet Gynecol (United States), Nov 2001, 98(5 Pt 1) p889-92
AUTHOR'S ADDRESS: Collective Name: American College of Obstetricians and Gynecologists, Committee on Ethics.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: ACOG Committee Opinion. Circumcision. Number 260, October 2001.
ARTICLE SOURCE: Obstet Gynecol (United States), Oct 2001, 98(4) p707-8
AUTHOR'S ADDRESS: Collective Name: American College of Obstetricians and Gynecologists. Committee on Obstetric Practice.
PUBLICATION TYPE: Journal Article
ABSTRACT: The American College of Obstetricians and Gynecologists supports the current position of the American Academy of Pediatrics that finds the existing evidence insufficient to recommend routine neonatal circumcision. Given this circumstance, parents should be given accurate and impartial information to help them make an informed decision. There is ample evidence that newborns circumcised without analgesia experience pain and stress. If circumcision is performed, analgesia should be provided.
MB: The penultimate statement is correct but the final statement does not follow from it although it could be correct too.

ARTICLE TITLE: ACOG Committee Opinion. Number 258, September 2001. Fetal pulse oximetry.
ARTICLE SOURCE: Obstet Gynecol (United States), Sep 2001, 98(3) p523-4
AUTHOR'S ADDRESS: Collective Name: The American College of Obstetricians and Gynecologists Committee on Obstetric Practice.
PUBLICATION TYPE: Journal Article
ABSTRACT: The U.S. Food and Drug Administration recently approved the marketing of the Nellcor N-400 Fetal Oxygen Saturation Monitoring System, a fetal pulse oximeter. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice cannot endorse the adoption of this device in clinical practice at this time because of concerns that its introduction could further escalate the cost of medical care without necessarily improving clinical outcome. The committee recommends that prospective randomized clinical trials be conducted to evaluate the clinical use of this new technology in conjunction with fetal well-being assessment.

ARTICLE TITLE: Maternal epidural use and neonatal sepsis evaluation in afebrile mothers
ARTICLE SOURCE: Pediatrics (United States), Nov 2001, 108(5) p1099-102
AUTHOR(S): Goetzl L; Cohen A; Frigoletto F; Ringer SA; Lang JM; Lieberman E
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas;
PUBLICATION TYPE: Journal Article
RESULTS: Infants of afebrile women with epidural analgesia were more likely to be evaluated for sepsis than infants of women without epidural (20.4% vs 8.9%), although not more likely to have neonatal sepsis. An increased risk of sepsis evaluation persisted in regression analysis (odds ratio: 3.1; 95% confidence interval: 2.0, 4.7) after controlling for confounders and was not explained by longer labors with epidural. Women with epidural were significantly more likely to have major and minor criteria for sepsis evaluation, including fetal tachycardia (4.4% vs 0.4%), rupture of membranes for >24 hours (6.2% vs 3.4%), low-grade fever of 99.6 degrees F to 100.4 degrees F (24.3% vs 5.2%), and rupture of membranes for 12 to 24 hours (21.4% vs 5.2%) than women without epidural. CONCLUSIONS: Epidural analgesia is associated with increased rates of major and minor criteria for neonatal sepsis evaluations in afebrile women.
MB: I have never heard this suggested before.

ARTICLE TITLE: A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age
ARTICLE SOURCE: Pediatrics (United States), Nov 2001, 108(5) p1072-9
AUTHOR(S): Charpak N; Ruiz-Pelaez JG; Figueroa De CZ; Charpak Y
AUTHOR'S ADDRESS: Fundacion Canguro, Santa Fe de Bogota, Colombia;
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To assess the effectiveness and safety of Kangaroo Mother Care (KMC) for infants of low birth weight. METHODS: An open, randomized, controlled trial of a Colombian social security referral hospital was conducted. A total of 1084 consecutive infants who were born at </=2000 g were followed, and 746 newborns were randomized when eligible for minimal care, with 382 to KMC and 364 to "traditional" care. Information on vital status was available for 693 infants (93%) at 12 months of corrected age. KMC consisted of skin-to-skin contact on the mother's chest 24 hours/day, nearly exclusive breastfeeding, and early discharge, with close ambulatory monitoring. Control infants remained in incubators until the usual discharge criteria were met. Both groups were followed at term and at 3, 6, 9, and 12 months of corrected age. The main outcomes measured were morbidity, mortality, growth, development, breastfeeding, hospital stay, and sequelae. RESULTS: Baseline variables were evenly distributed, except for weight at recruitment (KMC: 1678 g; control participants: 1713 g). The risk for death was lower among infants who were given KMC, although the difference was not significant (KMC: 11 [3.1%] of 339; control participants: 19 [5.5%] of 324; relative risk: 0.57; 95% confidence interval: 0.17-1.18). The growth index of head circumference was statistically significantly greater in the group given KMC, but the developmental indices of the 2 groups were similar. Infants who weighed </=1500 g at birth and were given KMC spent less time in the hospital than those who were given standard care. The number of infections was similar in the 2 groups, but the severity was less among infants who received KMC. More of these infants were breastfed until 3 months of corrected age. CONCLUSION: These results support earlier findings of the beneficial effects of KMC on mortality and growth. Use of this technique would humanize the practice of neonatology, promote breastfeeding, and shorten the neonatal hospital stay without compromising survival, growth, or development.
MB: Wow.

ARTICLE TITLE: Should we be teaching residents how to bill for their outpatient services?
ARTICLE SOURCE: Pediatrics (United States), Oct 2001, 108(4) p999
AUTHOR(S): Young PC
AUTHOR'S ADDRESS: Salt Lake City, UT 84132.
PUBLICATION TYPE: Journal Article
MB: They seem to find out quickly enough

ARTICLE TITLE: What if pediatric residents could bill for their outpatient services?
ARTICLE SOURCE: Pediatrics (United States), Oct 2001, 108(4) p827-34
AUTHOR(S): Ng M; Lawless ST
AUTHOR'S ADDRESS: Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania.
PUBLICATION TYPE: Journal Article
Conclusion. When pediatric residents are not trained adequately in proper coding practices, the potential for billing discrepancies is high and potential reimbursement differences may be substantial. Discussion of financial issues should be considered in curriculum development.
MB: That is very important.

ARTICLE TITLE: Sedation, risk, and safety: do we really have data at last?
ARTICLE SOURCE: Pediatrics (United States), Oct 2001, 108(4) p1006-8
AUTHOR(S): Polaner DM; Houck CS; Rockoff MA; Mancuso TJ; Finley GA; Maxwell LG; Cravero J; Kain ZN; Bell C; Bosenberg A; Zwass M; Valley R; Agarwal R; Savarese A; Rice LJ; Cote CJ; Davidson PJ; Ferrari LR; Davis PJ
AUTHOR'S ADDRESS: Denver, CO 80218.
PUBLICATION TYPE: Journal Article
MB: Letter attacking article in Pediatrics 2001, 108,178 which claims hypoxia during EEGs with chloral hydrate sedation is alright.

ARTICLE TITLE: Oranges and Apples: Sedation and Analgesia.
COMMENTS: Pediatrics. 2000 Apr; 105(4 Pt 1):805-14/20209530
ARTICLE SOURCE: Pediatrics (United States), Sep 2001, 108(3) p824
AUTHOR(S): Malviya S; Tait AR; Voepel-Lewis T; Maxwell LG
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: Comment; Letter
MB: Similar to previous letter.

ARTICLE TITLE: The assessment and management of acute pain in infants, children, and adolescents.
ARTICLE SOURCE: Pediatrics (United States), Sep 2001, 108(3) p793-7
AUTHOR'S ADDRESS: Collective Name: American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health; Collective Name: Task Force on Pain in Infants, Children, and Adolescents.
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline

ARTICLE TITLE: Early postnatal dexamethasone therapy for the prevention of chronic lung disease.
ARTICLE SOURCE: Pediatrics (United States), Sep 2001, 108(3) p741-8
AUTHOR'S ADDRESS: Collective Name: The Vermont Oxford Network Steroid Study Group..
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: A 12-day course of early postnatal steroid therapy given to extremely low birth weight infants did not decrease the risk of or chronic lung disease (CLD) or death at 36 weeks postmenstrual age and was associated with an increased risk of complications and poor weight gain.

ARTICLE TITLE: Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study
ARTICLE SOURCE: Ann Surg (United States), Oct 2001, 234(4) p560-9; discussion 569-71
AUTHOR(S): Park WY; Thompson JS; Lee KK
AUTHOR'S ADDRESS: Department of Anesthesia, Veterans Affairs Medical Center, Washington, DC.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The effect of anesthetic and postoperative analgesic techniques on perioperative outcome varies with the type of operation performed. Overall, epidural analgesia provides better postoperative pain relief. Epidural anesthesia and epidural analgesia improve the overall outcome and shorten the intubation time and intensive care stay in patients undergoing abdominal aortic operations.
MB: I doubt that they have established causation.
JL: [That's right - I'm weighing in on this one as well] It is impossible to get anything out of this paper without reading the whole thing, including the tables. That is because the authors wrote a rather misleading abstract. They stated that deaths (lumped with other complications) were reduced in the aortic surgery group with epidurals. In fact, they found NO such difference in deaths when you examine the data. Moreover, the complication reduction for aortic surgery was mainly respiratory and there were many more patients in the non-epidural group with COPD. Nearly all our elective aortic surgery is now endoluminal anyway. In summary, this large randomised study (n=1,021), like the only other large randomised study (MASTER) I understand, has found essentially no significant benefit of epidural analgesia in terms of reduction of major complications. MORE people died in the epidural group in both studies! This, I think, puts paid to the alleged benefits touted in all the recent meta-analyses.

ARTICLE TITLE: Endoluminal Graft Repair for Abdominal Aortic Aneurysms in High-Risk Patients and Octogenarians: Is it Better Than Open Repair?
ARTICLE SOURCE: Ann Surg (United States), Oct 2001, 234(4) p427-37
AUTHOR(S): Sicard GA; Rubin BG; Sanchez LA; Keller CA; Flye MW; Picus D; Hovsepian D; Choi ET; Geraghty PJ; Thompson RW
AUTHOR'S ADDRESS: Department of Surgery, Section of Vascular Surgery, the Department of Radiology, Section of Vascular Interventional Radiology, and the Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri.
PUBLICATION TYPE: Journal Article
CONCLUSION: The short-term and midterm results of of abdominal aortic aneurysms (AAA) repair by Conventional open repair (COR) or endoluminal graft (ELG) are similar. The death rate associated with this new technique is low and comparable, whereas the complication rate associated with COR in all patients and those 80 years or older in particular is greater and more serious than ELG repair. Long-term results will establish the role of ELG repair of AAA, especially in elderly and high-risk patients.
MB: Why are they in doubt?

ARTICLE TITLE: Serious injuries from airbags
ARTICLE SOURCE: ANZ J Surg (Australia), Sep 2001, 71(9) p507-8
AUTHOR(S): Danne P
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Spirituality in medicine: what is to be done?
ARTICLE SOURCE: J R Soc Med (England), Oct 2001, 94(10) p529-33
AUTHOR(S): Yawar A
AUTHOR'S ADDRESS: John Radcliffe Hospital, Oxford OX3 9DU, UK.
PUBLICATION TYPE: Journal Article
MB: I am not sure what is supposed to happen

ARTICLE TITLE: Medical ethics in a multicultural society
ARTICLE SOURCE: J R Soc Med (England), Nov 2001, 94(11) p592-4
AUTHOR(S): Turner L
AUTHOR'S ADDRESS: Biomedical Ethics Unit, Department of Social Studies of Medicine, Faculty of Medicine, McGill University, 3690 Peel Street, Montreal, Quebec, Canada.
PUBLICATION TYPE: Journal Article