MB's Articles of Interest - March 2002

ARTICLE TITLE: Pharmacologic stress testing for coronary disease diagnosis: A meta-analysis
ARTICLE SOURCE: Am Heart J (United States), Dec 2001, 142(6) p934-44
AUTHOR(S): Kim C; Kwok YS; Heagerty P; Redberg R
AUTHOR'S ADDRESS: Robert Wood Johnson Clinical Scholars Program and the Department of Biostatistics, University of Washington, Seattle, WA, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The findings of our study can be used to guide the selection of the optimal pharmacologic stress test for each patient. Maximum sensitivity can be attained by use of a vasodilator combined with single-photon emission computed tomography (SPECT) imaging. Maximum specificity can be attained by use of a vasodilator with echocardiography. The highest combination of sensitivity and specificity can be attained with dobutamine echocardiography.

ARTICLE TITLE: Effect of early treatment with captopril and metoprolol singly and together on postinfarction left ventricular remodeling ARTICLE SOURCE: Am Heart J (United States), Oct 2001, 142(4) pE5
AUTHOR(S): Ricci R; Coletta C; Ceci V; Pajes G; Putini RL; Salustri A; Bottero G; Pasquale M
AUTHOR'S ADDRESS: Dipartimento di Cardiologia, Ospedale Santo Spirito, Frascati, Italy.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: After uncomplicated first acute myocardial infarction (AMI), early and long-term treatment with captopril alone attenuates left ventricular remodeling better than its combination with metoprolol. In the head-to-head captopril versus metoprolol therapy strategy comparison, captopril alone seems more effective in reducing postinfarction enlargement, but a definite difference was not demonstrated.

ARTICLE TITLE: Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol
ARTICLE SOURCE: Am Heart J (United States), Oct 2001, 142(4) p704-13
AUTHOR(S): Khattar RS; Senior R; Soman P; Van Der Does R; Lahiri A
AUTHOR'S ADDRESS: Department of Cardiovascular Medicine, Northwick Park and St Mark's Hospital National Health Service Trust, and the Institute for Medical Research, Harrow, United Kingdom.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Although angiotensin-converting enzyme inhibitor therapy did not alter left ventricular volume, treatment with carvedilol was associated with reductions in chamber volume; both drugs reduced left ventricular mass and sphericity. These beneficial effects on remodeling may help to explain the relative prognostic benefits of these therapies.
MB: I'd thought that the term 'remodeling' was the good result. It apparently means the dilatation of the ventricles occurring after any damage of the muscle. It is prevented by recent changes in therapy.

ARTICLE TITLE: Cost-effectiveness of beta-blocker therapy with metoprolol or with carvedilol for treatment of heart failure in Canada.
ARTICLE SOURCE: Am Heart J (United States), Sep 2001, 142(3) p537-43
AUTHOR(S): Levy AR; Briggs AH; Demers C; O'Brien BJ
AUTHOR'S ADDRESS: Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada. alevy@cheos.ubc.ca.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In addition to conventional therapy with furosemide and angiotensin converting enzyme inhibitors, treatment with either metoprolol or carvedilol confers a survival benefit that is attractive from a cost-effectiveness point of view. Until better information becomes available, it is not possible to distinguish between the two beta-blockers on the basis of cost-effectiveness. This means that the choice of beta-blockers for HF should be based largely on clinical considerations because both beta-blockers prolong life at relatively low cost

ARTICLE TITLE: Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure
ARTICLE SOURCE: Am Heart J (United States), Oct 2001, 142(4) p698-703
AUTHOR(S): Demers C; McKelvie RS; Negassa A; Yusuf S
AUTHOR'S ADDRESS: Preventive Cardiology and Therapeutics Research Program, Division of Cardiology, Hamilton Health Sciences Corporation-General Division and McMaster University, Hamilton, Ontario, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The 6-minute walk test (6MWT) is highly reproducible in patients with symptoms of heart failure (HF). It is somewhat correlated to to the New York Heart Association functional classification (NYHA-FC) and quality of life. Overall, quality of life was most responsive to change, whereas 6MWT and NYHA-FC were comparable but less responsive to change in the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) study.
MB: They see how far they can walk in 6 minutes. They are allowed to stop & rest but are encouraged to keep going.

ARTICLE TITLE: Decade-long trends (1986 to 1997) in the medical treatment of patients with acute myocardial infarction: A community-wide perspective
ARTICLE SOURCE: Am Heart J (United States), Oct 2001, 142(4) p594-603
AUTHOR(S): Spencer F; Scleparis G; Goldberg RJ; Yarzebski J; Lessard D; Gore JM
AUTHOR'S ADDRESS: Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The results of this population-based observational study provide insights into changing prescribing patterns in the hospital treatment of patients with with acute myocardial infarction (AMI. Despite encouraging increases in the use of several of these agents, considerable opportunities for increased utilization remain.

ARTICLE TITLE: Are activated clotting times helpful in the management of anticoagulation with subcutaneous low-molecular-weight heparin?
ARTICLE SOURCE: Am Heart J (United States), Oct 2001, 142(4) p590-3
AUTHOR(S): Henry TD; Satran D; Knox LL; Iacarella CL; Laxson DD; Antman EM
AUTHOR'S ADDRESS: Hennepin County Medical Center, Minneapolis, Minn; University of Minnesota, Minneapolis; and Brigham and Women's Hospital, Boston, Mass.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In contrast to heparin, and activated clotting times (ACTs) are not useful for assessment of anticoagulation with subcutaneous enoxaparin and should not be relied on in patients receiving enoxaparin who require acute percutaneous coronary intervention (PCI). Studies to determine the optimal dose, safety, and efficacy of enoxaparin in patients undergoing PCI are underway.

ARTICLE TITLE: Inotropic therapy for heart failure: an evidence-based approach.
ARTICLE SOURCE: Am Heart J (United States), Sep 2001, 142(3) p393-401
AUTHOR(S): Felker GM; O'Connor CM
AUTHOR'S ADDRESS: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. felke001@onyx.dcri.duke.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
CONCLUSIONS: On the basis of the available evidence, the routine use of inotropes as heart failure therapy is not indicated in either the acute or chronic setting.

ARTICLE TITLE: On the uniformity of cardiopulmonary exercise testing in chronic heart failure.
COMMENTS: Am Heart J. 2001 Sep; 142(3):466-75
ARTICLE SOURCE: Am Heart J (United States), Sep 2001, 142(3) p384-7
AUTHOR(S): Myers J
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Paraplegia Immediately following Removal of a Cerebrospinal Fluid Drainage Catheter in a Patient after Thoracoabdominal Aortic Aneurysm Surgery [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2001, 95(5) p1285-7
AUTHOR(S): Heller LB; Chaney MA
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Reversal of acute paraplegia with cerebrospinal fluid drainage after endovascular thoracic aortic aneurysm repair
ARTICLE SOURCE: Anesthesiology (United States), Nov 2001, 95(5) p1288-9
AUTHOR(S): Ortiz-Gomez JR; Gonzalez-Solis FJ; Fernandez-Alonso L; Bilbao JI
PUBLICATION TYPE: Journal Article
MB: Factors involved in paraplegias with thoraco-abdominal aortas appear to be mystical

ARTICLE TITLE: The effects of aprotinin on thromboelastography with three different activators [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Nov 2001, 95(5) p1169-74
AUTHOR(S): Avidan MS; Da Fonseca J; Parmar K; Alcock E; Ponte J; Hunt BJ
PUBLICATION TYPE: Journal Article
CONCLUSION: The thromboelastography trace is altered in the presence of aprotinin when celite and kaolin are used as activators but not when tissue factor is the activator.

ARTICLE TITLE: Prospective Randomized Trial of Normothermic versus Hypothermic Cardiopulmonary Bypass on Cognitive Function after Coronary Artery Bypass Graft Surgery
ARTICLE SOURCE: Anesthesiology (United States), Nov 2001, 95(5) p1110-9
AUTHOR(S): Grigore AM; Mathew J; Grocott HP; Reves JG; Blumenthal JA; White WD; Smith PK; Jones RH; Kirchner JL; Mark DB; Newman MF
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Hypothermic cardiopulmonary bypass (CPB) does not provide additional central nervous system protection in adult cardiac surgical patients who were maintained at either 30 or 35 degrees C during CPB.

ARTICLE TITLE: Cerebral Blood Volume (CBV) in Humans during Normo- and Hypocapnia: Influence of Nitrous Oxide (N2 O)
ARTICLE SOURCE: Anesthesiology (United States), Nov 2001, 95(5) p1079-82
AUTHOR(S): Reinstrup P; Ryding E; Ohlsson T; Dahm PL; Uski T
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Nitrous oxide inhalation had no effect either on cerebral blood volume (CBV) or on the normal CBV-CO2 response in humans.

ARTICLE TITLE: Double-masked Randomized Trial Comparing Alternate Combinations of Intraoperative Anesthesia and Postoperative Analgesia in Abdominal Aortic Surgery
ARTICLE SOURCE: Anesthesiology (United States), Nov 2001, 95(5) p1054-67
AUTHOR(S): Norris EJ; Beattie C; Perler BA; Martinez EA; Meinert CL; Anderson GF; Grass JA; Sakima NT; Gorman R; Achuff SC; Martin BK; Minken SL; Williams GM; Traystman RJ
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In patients undergoing surgery of the abdominal aorta, thoracic epidural anesthesia combined with a light general anesthesia and followed by either intravenous or epidural patient-controlled analgesia, offers no major advantage or disadvantage when compared with general anesthesia alone followed by either intravenous or epidural patient-controlled analgesia.

ARTICLE TITLE: Drug-induced amnesia is a separate phenomenon from sedation: electrophysiologic evidence.
ARTICLE SOURCE: Anesthesiology (United States), Oct 2001, 95(4) p896-907
AUTHOR(S): Veselis RA; Reinsel RA; Feshchenko VA
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. veselisr@mskcc.org.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Midazolam and propofol affect memory differentially from their sedative effects, and these are indexed by specific components of the auditory event-related potential (ERP). These components of the ERP are associated with specific, but not necessarily unique, neuroanatomic structures. Thus, these drugs act by additional mechanisms beyond general central nervous system depression to produce the effects of sedation and memory impairment.

ARTICLE TITLE: Comparison of two different temperature maintenance strategies during open abdominal surgery: upper body forced-air warming versus whole body water garment.
ARTICLE SOURCE: Anesthesiology (United States), Oct 2001, 95(4) p868-74
AUTHOR(S): Janicki PK; Higgins MS; Janssen J; Johnson RF; Beattie C
AUTHOR'S ADDRESS: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4125, USA. piotr.janicki@mcmail.vanderbilt.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: A new system has been developed that circulates warm water through a whole body garment worn by the patient during surgery. In this study the authors compared two different strategies for the maintenance of intraoperative normothermia. One strategy used a new water garment warming system that permitted active warming of both the upper and lower extremities and the back. The other strategy used a single (upper body) forced-air warming system. METHODS: In this prospective, randomized study, 53 adult patients were enrolled in one of two intraoperative temperature management groups during open abdominal surgery with general anesthesia. The water-garment group (n = 25) received warming with a body temperature (rectal) set point of 36.8 degrees C. The forced-air-warmer group (n = 28) received routine warming therapy using upper body forced-air warming system (set on high). The ambient temperature in the operating room was maintained constant at approximately 20 degrees C. Rectal, distal esophageal, tympanic, forearm, and fingertip temperatures were recorded perioperatively and during 2 h after surgery. Extubated patients in both groups were assessed postoperatively for shivering, use of additional warming devices, and subjective thermal comfort. RESULTS: The mean rectal and esophageal temperatures at incision, 1 h after incision, at skin closure, and immediately postoperatively were significantly higher (0.4-0.6 degrees C) in the group that received water-garment warming when compared with the group that received upper body forced-air warming. The calculated 95% confidence intervals for the above differences in core temperatures were 0.7-0.1, 0.8-0.2, 0.8-0.2, and 0.9-0.1, retrospectively. In addition, 14 and 7% of patients in the control upper body forced-air group remained hypothermic (< 35.5 degrees C) 1 and 2 h after surgery, respectively. No core temperature less than 35.5 degrees C was observed perioperatively in any of the patients from the water-garment group. A similar frequency of the thermal stress events (shivering, use of additional warming devices, subjective thermal discomfort) was observed after extubation in both groups during the 2 h after surgery. CONCLUSIONS: The investigated water warming system, by virtue of its ability to deliver heat to a greater percentage of the body, results in better maintenance of intraoperative normothermia that does forced-air warming applied only to the upper extremities, as is common practice.
MB: Surely prophylaxis with adequate environmental temperature and with insulation before & during anaesthesia is what we should be doing rather than applying external heat.

ARTICLE TITLE: Effect of epidural analgesia with ambulation on labor duration.
ARTICLE SOURCE: Anesthesiology (United States), Oct 2001, 95(4) p857-61
AUTHOR(S): Vallejo MC; Firestone LL; Mandell GL; Jaime F; Makishima S; Ramanathan S
AUTHOR'S ADDRESS: Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. vallejomc@anes.upmc.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation.
MB: I wonder haw many fall over.

ARTICLE TITLE: Changes in plasma creatinine concentration after cardiac anesthesia with isoflurane, propofol, or sevoflurane: a randomized clinical trial.
ARTICLE SOURCE: Anesthesiology (United States), Oct 2001, 95(4) p842-8
AUTHOR(S): Story DA; Poustie S; Liu G; McNicol PL
AUTHOR'S ADDRESS: Department of Anaesthesia, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia. davids@austin.unimelb.edu.
CONCLUSIONS: Sevoflurane did not produce greater increases in creatinine than isoflurane or propofol after elective coronary artery surgery.

ARTICLE TITLE: Randomized study comparing the "sniffing position" with simple head extension for laryngoscopic view in elective surgery patients.
COMMENTS: Anesthesiology. 2001 Oct; 95(4):825-7
ARTICLE SOURCE: Anesthesiology (United States), Oct 2001, 95(4) p836-41
AUTHOR(S): Adnet F; Baillard C; Borron SW; Denantes C; Lefebvre L; Galinski M; Martinez C; Cupa M; Lapostolle F
AUTHOR'S ADDRESS: Department of Anesthesiology, Hjpital Avicenne, University Paris 13, France. frederic.adnet@avc.ap-hop-paris.fr.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: The "sniffing position" is recommended for optimization of glottic visualization under direct laryngoscopy. However, no study to date has confirmed its superiority over simple head extension. In a prospective, randomized study, the authors compared the sniffing position with simple head extension in orotracheal intubation. METHODS: The study included 456 consecutive patients. The sniffing position was obtained by placement of a 7-cm cushion under the head of the patient. The extension position was obtained by simple head extension. The anesthetic procedure included two Laryngoscopies without paralysis: the first was used for topical glottic anesthesia. During the second direct laryngoscopy, intubation of the trachea was performed. The head position was randomized as follows: group A was in the sniffing position during the first Laryngoscopy and the extension position during the second, group B was in the extension position during the first laryngoscopy and the sniffing position during the second. Glottic exposure was assessed by the Cormack scale. RESULTS: The sniffing position improved glottic exposure (decreased the Cormack grade) in 18% of patients and worsened it (increased the Cormack grade) in 11% of patients, in comparison with simple extension. The Cormack grade distribution was not significantly modified between the two groups. Multivariate analysis showed that reduced neck mobility and obesity were independently related to improvement in laryngoscopic view with application of the sniffing position. CONCLUSIONS: Routine use of the sniffing position appears to provide no significant advantage over simple head extension for tracheal intubation in this setting. The sniffing position appears to be advantageous in obese and head extension-limited patients.
MB: They only had 7cm elevation which is much less than I use. They do not show that intubation is usually not easier with the head elevated. Using head elevation I can often get the tube in while someone else looks.

ARTICLE TITLE: Common practice and concepts in anesthesia: time for reassessment: is the sniffing position a "gold standard" for laryngoscopy?
COMMENTS: Anesthesiology. 2001 Oct; 95(4):836-41
ARTICLE SOURCE: Anesthesiology (United States), Oct 2001, 95(4) p825-7
AUTHOR(S): Isono S
PUBLICATION TYPE: Comment; Editorial
MB: Balanced but not definitive.

ARTICLE TITLE: What is the clinical relevance of dilutional acidosis?
ARTICLE SOURCE: Anesthesiology (United States), Sep 2001, 95(3) p810-2
AUTHOR(S): Roth JV
PUBLICATION TYPE: Letter
MB: This letter betrays much confusion. They could do with a look at my pH stuff. http://www.usyd.edu.au/su/anaes/lectures/acidbase_mjb/acidbase.html
http://www.usyd.edu.au/su/anaes/lectures/acidbase_mjb/causes.html#metacidosis
section 6.3.3.1.3.2

ARTICLE TITLE: Is chloride or dilution of bicarbonate the cause of metabolic acidosis from fluid administration?
ARTICLE SOURCE: Anesthesiology (United States), Sep 2001, 95(3) p809; discussion 810-2
AUTHOR(S): Mathes DD
PUBLICATION TYPE: Letter
MB: Ditto

ARTICLE TITLE: The anesthesiologist in critical care medicine: past, present, and future.
ARTICLE SOURCE: Anesthesiology (United States), Sep 2001, 95(3) p781-8
AUTHOR(S): Hanson CW; Durbin CG; Maccioli GA; Deutschman CS; Sladen RN; Pronovost PJ; Gattinoni L
AUTHOR'S ADDRESS: Department of Anesthesia, University of Pennsylvania School of Medicine, Philadelphia, USA. hansonb@mail.med.upenn.edu.
PUBLICATION TYPE: Journal Article
MB: Recognises that all anesthesiologists cannot be intensivists. They note that the situation in the USA differs from elsewhere. I don't think that will continue.

ARTICLE TITLE: Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: postoperative nausea with vomiting and economic analysis.
ARTICLE SOURCE: Anesthesiology (United States), Sep 2001, 95(3) p616-26
AUTHOR(S): Visser K; Hassink EA; Bonsel GJ; Moen J; Kalkman CJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Academic Medical Center, University of Amsterdam, The Netherlands.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Propofol total intravenous anesthesia (TIVA) results in a clinically relevant reduction of postoperative nausea and vomiting compared with isoflurane-nitrous oxide anesthesia (number needed to treat = 6). Both anesthetic techniques were otherwise similar. Anesthesia costs were more than three times greater for propofol TIVA, without economic gains from shorter stay in the postanesthesia care unit.

ARTICLE TITLE: Postoperative visual loss: still no answers--yet.
COMMENTS: Anesthesiology. 2001 Sep; 95(3):793-5
ARTICLE SOURCE: Anesthesiology (United States), Sep 2001, 95(3) p575-7
AUTHOR(S): Roth S; Barach P
PUBLICATION TYPE: Comment; Editorial
MB: A mystery. There is a register trying to get 100 cases.

ARTICLE TITLE: Pain and postoperative recovery.
COMMENTS: Anesthesiology. 2001 Sep; 95(3):578-84
ARTICLE SOURCE: Anesthesiology (United States), Sep 2001, 95(3) p573-4
AUTHOR(S): Carli F; Bennett GJ
PUBLICATION TYPE: Comment; Editorial
MB: About beliefs but not much else.

ARTICLE TITLE: Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy (Br J Surg 2001; 88: 669-74) ARTICLE SOURCE: Br J Surg (England), Nov 2001, 88(11) p1543-8
AUTHOR(S): Carapeti EA
AUTHOR'S ADDRESS: Department of SurgerySt Thomas' HospitalLondon SE1 7EHUK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The hepatorenal syndrome
ARTICLE SOURCE: Gut (England), Nov 2001, 49(5) p729-37
AUTHOR(S): Dagher L; Moore K
AUTHOR'S ADDRESS: Centre for Hepatology, Royal Free and University College Medical School, London NW3 2PF, UK.
PUBLICATION TYPE: Journal Article , review.
MB: It is supposed to be renal failure associated with hepatic failure without a specific renal defect. They point out that there can be associated prerenal factors. I have always had difficulty with the specific diagnosis ie excluding prerenal factors.

ARTICLE TITLE: Antagonist: Should we eradicate Helicobacter pylori before long term antireflux therapy?
ARTICLE SOURCE: Gut (England), Nov 2001, 49(5) p616-7
AUTHOR(S): Freston JW
AUTHOR'S ADDRESS: University of Connecticut Health Center, Farmington, Connecticut, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Protagonist: Should we eradicate Helicobacter pylori before long term antireflux therapy?
ARTICLE SOURCE: Gut (England), Nov 2001, 49(5) p614-6
AUTHOR(S): Labenz J
AUTHOR'S ADDRESS: Jung-Stilling Hospital, Wichernstr. 40, D-57074 Siegen, Germany.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Increasing realism among gay men in Sydney about HIV treatments: changes in attitudes over time.
ARTICLE SOURCE: Int J STD AIDS (England), May 2001, 12(5) p310-4
AUTHOR(S): Knox S; Van De Ven P; Prestage G; Crawford J; Grulich A; Kippax S
AUTHOR'S ADDRESS: National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia.
PUBLICATION TYPE: Journal Article
On the whole, gay men in Sydney are now less uncertain about highly active antiretroviral therapies (HAART) than at the time of their introduction. Most men remain sceptical that these treatments can cure HIV infection and prevent HIV transmission, but in regard to managing illness among those infected, some initial uncertainty is being replaced by a growing optimism about the efficacy of treatments.

ARTICLE TITLE: Penile fracture.
ARTICLE SOURCE: Int J STD AIDS (England), Jul 2001, 12(7) p479-80
AUTHOR(S): Kingston MA; Carlin EM
AUTHOR'S ADDRESS: Department of Genitourinary Medicine, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: A wide range of patients present to genitourinary medicine (GUM) clinics with diverse conditions, many of which may not be infective. One such condition, albeit rare, is penile fracture. This is a traumatic rupture of the corpus cavernosum usually associated with blunt trauma to the erect penis. Prognosis and management issues are discussed.
MB: Although it is rare I saw one in emergency when I was a resident (2 ^nd year graduate). The consultant thought the prognosis was bad.

ARTICLE TITLE: 'Say no to sex; great idea but...'.
COMMENTS: Int J STD AIDS. 2001 Aug; 12(8):487-92
ARTICLE SOURCE: Int J STD AIDS (England), Aug 2001, 12(8) p485-6
AUTHOR(S): Robinson AJ; Williams O
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Drowning--Louisiana, 1998.
ARTICLE SOURCE: JAMA (United States), Aug 22-29 2001, 286(8) p913-4
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Cost-effectiveness of automated external defibrillators on airlines.
ARTICLE SOURCE: JAMA (United States), Sep 26 2001, 286(12) p1482-9
AUTHOR(S): Groeneveld PW; Kwong JL; Liu Y; Rodriguez AJ; Jones MP; Sanders GD; Garber AM
AUTHOR'S ADDRESS: Center for Primary Care and Outcomes Research, 179 Encina Commons, MC 6019, Stanford, CA 94305, USA. petegro@healthpolicy.stanford.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: The cost-effectiveness of placing automated external defibrillators (AEDs) on commercial aircraft compares favorably with the cost-effectiveness of widely accepted medical interventions and health policy regulations, but is critically dependent on the passenger capacity of the aircraft. Placing AEDs on most US commercial aircraft would meet conventional standards of cost-effectiveness.

ARTICLE TITLE: The time has come to reform graduate medical education.
COMMENTS: JAMA. 2001 Sep 5; 286(9):1027-34: JAMA. 2001 Sep 5; 286(9):1049-55
ARTICLE SOURCE: JAMA (United States), Sep 5 2001, 286(9) p1075-6
AUTHOR(S): Johns MM
AUTHOR'S ADDRESS: Emory University, 1440 Clifton Rd NE, Atlanta, GA 30322, USA. mmejohns@emory.edu.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Results of a nationwide Veterans Affairs initiative to align graduate medical education and patient care.
ARTICLE SOURCE: JAMA (United States), Sep 5 2001, 286(9) p1061-6
AUTHOR(S): Stevens DP; Holland GJ; Kizer KW
AUTHOR'S ADDRESS: Association of American Medical Colleges, 2450 N St NW, Washington, DC 20037, USA. dstevens@aamc.org.
PUBLICATION TYPE: Journal Article
RESULTS: Over 3 years, primary care training in the VA increased from 38% to 48% of funded positions. Of this total, 39% of the increase was in internal medicine subspecialties, neurology, and psychiatry. CONCLUSION: In this case study of graduate medical education (GME) realignment, national policy was driven more by local patient care issues than by a perceived national need for primary care or specialty positions.
MB: Was the number produced unsatisfactory?

ARTICLE TITLE: US graduate medical education, 2000-2001.
ARTICLE SOURCE: JAMA (United States), Sep 5 2001, 286(9) p1056-60
AUTHOR(S): Brotherton SE; Simon FA; Etzel SI
AUTHOR'S ADDRESS: Division of Undergraduate and Graduate Medical Education Policy and Standards, American Medical Association, 515 N State St, Chicago, IL 60610, USA. sarah_brotherton@ama-assn.org.
PUBLICATION TYPE: Journal Article
ABSTRACT: For the last three quarters of a century, the American Medical Association's national collection of graduate medical education (GME) data has evolved in its scope and methods. This year's GME survey involved new technology. The National GME Census for 2000-2001, jointly administered by the American Medical Association and the Association of American Medical Colleges, was part of an Internet-based product called GME Track. Because of technical problems, data collection was less complete than in previous years. Similar to the 1999-2000 survey, we observed an increase in the number of subspecialty programs, with 79 more than last year (2.1% increase), and a decrease in the number of specialty programs, with 40 (0.9%) fewer. Parallel to this continuing trend was a decrease in the number of graduates of US medical schools who were matched into primary care residencies, particularly family practice programs (20% decrease compared with 1996-1997). The number of graduates of osteopathic medical schools training in allopathic programs continued to rise, increasing 7.9% from last year. Numbers of Hispanic and Asian graduates from US allopathic medical schools (USMDs) in graduate year 1 (GY1) positions increased numerically to 887 and 2356, respectively, and proportionally by 7.2% and 17.3%, respectively. Although the number of white USMDs in GY1 positions increased, their proportion decreased slightly among those with known race or ethnicity from 72.2% to 71.7%, and the number of black USMD GY1 residents, numbering 859, declined from the previous year. Although we observed an overall decline in the average number of on-duty hours expected of residents in their first year in a program (from 55 in 1996-1997 to 54 in 2000-2001; P<.001), the average number of hours reported by the majority of programs that typically report the most on-duty hours did not decrease. The issues of resident work hours and the diversity and specialty distribution of the physician workforce continue to foster debate.
MB: They will have to produce better information.

ARTICLE TITLE: Effect of restricting contact between pharmaceutical company representatives and internal medicine residents on posttraining attitudes and behavior
ARTICLE SOURCE: JAMA (United States), Oct 24-31 2001, 286(16) p1994-9
AUTHOR(S): McCormick BB; Tomlinson G; Brill-Edwards P; Detsky AS
AUTHOR'S ADDRESS: Mount Sinai Hospital, 600 University Ave, Room 427, Toronto, Ontario, Canada M5G 1X5.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Policies restricting pharmaceutical company representatives (PCRs) access to internal medicine trainees and the amount of contact during residency appear to affect future attitudes and behavior of physicians.
MB: They do not present objective evidence of the effect of the restrictions

ARTICLE TITLE: Aprotinin in orthotopic liver transplantation: Evidence for a prohemostatic, but not a prothrombotic, effect
ARTICLE SOURCE: Liver Transpl (United States), Oct 2001, 7(10) p896-903
AUTHOR(S): Molenaar IQ; Legnani C; Groenland TH; Palareti G; Begliomini B; Terpstra OT; Porte RJ
AUTHOR'S ADDRESS: Department of Surgery, Leiden University Medical Center Leiden, The Netherlands.
PUBLICATION TYPE: Journal Article
ABSTRACT: Aprotinin reduces blood transfusion requirements in orthotopic liver transplantation (OLT). Concern has been voiced about the potential risk for thrombotic complications when aprotinin is used. The aim of this study is to evaluate the effects of aprotinin on the two components of the hemostatic system (coagulation and fibrinolysis) in patients undergoing OLT. As part of a larger, randomized, double-blind, placebo-controlled study, we compared coagulation (fibrinogen level, activated partial thromboplastin time [aPTT], prothrombin time, and platelet count) and fibrinolytic variables (tissue-type plasminogen activator [tPA] antigen and activity, plasminogen activator inhibitor activity, and D-dimer), as well as thromboelastography (reaction time [r], clot formation time, and maximum amplitude) in 27 patients administered either high-dose aprotinin (2 x 10(6) kallikrein inhibitor units [KIU] at induction, continuous infusion of 1 x 10(6) KIU/h, and 1 x 10(6) KIU before reperfusion; n = 10), regular-dose aprotinin (2 x 10(6) KIU at induction and continuous infusion of 0.5 x 10(6) KIU/h; n = 8), or placebo (n = 9) during OLT. Blood samples were drawn at seven standardized intraoperative times. Baseline characteristics were similar for the three groups. During the anhepatic and postreperfusion periods, fibrinolytic activity (plasma D-dimer and tPA antigen levels) was significantly lower in aprotinin-treated patients compared with the placebo group. Interestingly, coagulation times (aPTT and r) were significantly more prolonged in aprotinin-treated patients than the placebo group. No difference was seen in the incidence of perioperative thrombotic complications in the entire study population (n = 137). Aprotinin has an anticoagulant rather than a procoagulant effect. Its blood-sparing (prohemostatic) effect appears to be the overall result of a strong antifibrinolytic and a weaker anticoagulant effect. These findings argue against a prothrombotic effect of aprotinin in patients undergoing OLT.
MB: Seems strange that there is an anti-coagulant effect.

ARTICLE TITLE: Aprotinin: Safe and effective in all patients undergoing orthotopic liver transplantation?
ARTICLE SOURCE: Liver Transpl (United States), Sep 2001, 7(9) p808-10
AUTHOR(S): Porte RJ; Slooff MJ
AUTHOR'S ADDRESS: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, University Hospital Groningen, Groningen, The Netherlands.
PUBLICATION TYPE: Journal Article
MB: The difference is small 5 as against 7 units RBC during operation and no difference in the postoperative period (in the preceding article). Our blood replacement is much greater than that.

ARTICLE TITLE: Analysis of causes of death in liver transplant recipients who survived more than 3 years
ARTICLE SOURCE: Liver Transpl (United States), Sep 2001, 7(9) p811-5
AUTHOR(S): Pruthi J; Medkiff KA; Esrason KT; Donovan JA; Yoshida EM; Erb SR; Steinbrecher UP; Fong TL
AUTHOR'S ADDRESS: Division of Liver Transplantation, Southern California Permanente Medical Group, Los Angeles, CA.
PUBLICATION TYPE: Journal Article
In summary, de novo malignancies and cardiovascular complications accounted for more than half the late deaths. Patients who died of nonhepatic causes were significantly older than patients who died of hepatic causes. Chronic rejection and recurrent hepatitis C virus (HCV) infection accounted for the majority of hepatic causes of death. With longer follow-up, graft failure resulting from recurrent HCV infection will become the major cause of death in late survivors.

ARTICLE TITLE: Intracardiac thrombus formation and pulmonary thromboembolism immediately after graft reperfusion in 7 patients undergoing liver transplantation
ARTICLE SOURCE: Liver Transpl (United States), Sep 2001, 7(9) p783-9
AUTHOR(S): Gologorsky E; De Wolf AM; Scott V; Aggarwal S; Dishart M; Kang Y
AUTHOR'S ADDRESS: Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Intravascular and/or intracardiac thrombus formation followed by pulmonary thromboembolism with right ventricular dysfunction immediately after graft reperfusion during orthotopic liver transplantation (OLT) is described in 7 patients. This complication may have been related to excessive activation of the coagulation system by graft reperfusion, which overwhelmed anticoagulation mechanisms and was disproportionate to fibrinolysis. Activation of the coagulation system may be more pronounced in patients who receive less than optimal grafts, require massive transfusion, or have septic complications at the time of OLT. It is unclear whether antifibrinolytic therapy during the anhepatic stage had a role. Transesophageal echocardiography was useful in diagnosing and managing intracardiac thrombus and pulmonary thromboembolism.
MB: 5 of 7 patients had epsilon amino caproic acid to counteract fibrinolysis. This could well have been a major factor but it is de-emphasised. That group has promoted EACA with thromboelastogram control.

ARTICLE TITLE: Minimizing operating time: does speed kill?
ARTICLE SOURCE: Orthopedics (United States), Sep 2001, 24(9) p853-4
AUTHOR(S): Booth RE
AUTHOR'S ADDRESS: Pennsylvania Hospital, Philadelphia 19107, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Current concepts in joint replacement
ARTICLE SOURCE: Orthopedics (United States), Sep 2001, 24(9) p824, 828
AUTHOR(S): Greenwald AS
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Outcomes in vascular surgery: Volume versus certification
ARTICLE SOURCE: Surgery (United States), Nov 2001, 130(5) p897-8
AUTHOR(S): Finlayson EV; Birkmeyer JD
AUTHOR'S ADDRESS: Department of Veterans Affairs Medical Center, White River Junction, Vt.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The effect of hospital vascular operation capability on outcomes of lower extremity arterial bypass graft procedures ARTICLE SOURCE: Surgery (United States), Oct 2001, 130(4) p561-9
AUTHOR(S): Ebaugh JL; Feinglass J; Pearce WH
AUTHOR'S ADDRESS: Division of Vascular Surgery, Department of Surgery, Division of General Internal Medicine, and Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, Ill.
PUBLICATION TYPE: Journal Article
ABSTRACT: Background. The purpose of this study was to determine whether hospitals with a high capability for vascular operations have lower rates of inpatient mortality, major complication, and major amputation with lower extremity arterial bypass (LEAB) procedures than do less well-equipped hospitals after controlling for hospital procedure volume and patient characteristicsConclusions. Mortality outcomes for lower extremity arterial bypass (LEAB) procedures were superior at high capability hospitals, even after controlling for patient characteristics, disease severity, and LEAB volume. Hospital complication rates were not correlated with mortality rates and may not be a meaningful measure of quality of care.

ARTICLE TITLE: Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative.
COMMENTS: Surgery. 2001 Sep; 130(3):423-4/21446986; : Surgery. 2001 Sep; 130(3):425-8/21446987; : Surgery. 2001 Sep; 130(3):429-31/21446988
ARTICLE SOURCE: Surgery (United States), Sep 2001, 130(3) p415-22
AUTHOR(S): Birkmeyer JD; Finlayson EV; Birkmeyer CM
AUTHOR'S ADDRESS: VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: As part of a broader effort aimed at improving hospital safety, a large coalition of employers, the Leapfrog Group, will soon require hospitals caring for their employees to meet volume standards for 5 high-risk surgical procedures.). CONCLUSIONS: If the Leapfrog volume standards are successfully implemented, employers and health-care purchasers could prevent many surgical deaths by requiring hospital volume standards for high-risk procedures.
MB: Rural hospitals could be exempt.

ARTICLE TITLE: Invited commentary: Volume standards for high-risk operations: an American College of Surgeons' view.
COMMENTS: Surgery. 2001 Sep; 130(3):415-22
ARTICLE SOURCE: Surgery (United States), Sep 2001, 130(3) p423-4
AUTHOR(S): Russell TR
AUTHOR'S ADDRESS: American College of Surgeons, Chicago, IL 60611, USA.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Neostigmine increases postoperative colonic motility in patients undergoing colorectal surgery.
ARTICLE SOURCE: Surgery (United States), Sep 2001, 130(3) p449-56
AUTHOR(S): Kreis ME; Kasparek M; Zittel TT; Becker HD; Jehle EC
AUTHOR'S ADDRESS: Department of General Surgery, University Hospital, Tubingen, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Gastrointestinal motility is frequently impaired after abdominal surgery. We investigated the effects of neostigmine on colonic motility in patients after colorectal surgery and in healthy volunteers. METHODS: Colonic motility was recorded by a manometry/barostat system in 12 patients after left colonic or rectal resection during baseline and after the intravenous administration of increasing doses of neostigmine on postoperative days 1, 2, and 3. In addition, colonic motility was recorded in 7 healthy volunteers. RESULTS: Neostigmine increased the colonic motility index. This increase was from 135 +/- 28 mm Hg/min at baseline to 574 +/- 219 mm Hg/min after administration of 5 microg/kg neostigmine on day 3 after surgery (mean +/- SEM, P <.05). In healthy volunteers, neostigmine at a dose of 5 microg/kg increased the colonic motility index from 184 +/- 73 to 446 +/- 114 mm Hg/min (P <.05). Barostat bag volumes decreased dose-dependently after neostigmine administration in patients as well as in volunteers, indicating an increase in colonic tone. CONCLUSIONS: Colonic motility and tone increased after neostigmine administration at a dose of 5 microg/kg in postoperative patients and in healthy volunteers. Neostigmine can be used to stimulate colonic motility after colorectal surgery and has a similar effect postoperatively as in healthy volunteers.