MB's Articles of Interest - May 2001

 

ARTICLE TITLE: Clinical trials of beta-blockers in heart failure: a class review
ARTICLE SOURCE: Am J Med (United States), Apr 2 2001, 110(5 Suppl 1) p7-10
AUTHOR(S): Yancy CW
AUTHOR'S ADDRESS: Division of Cardiology, Congestive Heart Failure Program, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Heart failure remains a clinically challenging illness, with increasing incidence and prevalence and a high risk of mortality. The introduction of agents that interfere with the neurohormonal response to chronic left-ventricular dysfunction has resulted in improved patient outcomes. Owing to slowed disease progression and reduced mortality, angiotensin-converting enzyme (ACE) inhibitors are indicated in all patients with heart failure. New data indicate that in appropriate patients, beta-blocker therapy relieves the symptoms associated with heart failure, reduces hospitalizations, and improves survival when added to standard therapy. Questions still remain regarding the ideal use of beta blockers in heart failure, and ongoing trials will attempt to clarify those points.

ARTICLE TITLE: Outcomes of noncardiac surgery after coronary bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI
ARTICLE SOURCE: Am J Med (United States), Mar 2001, 110(4) p260-6
AUTHOR(S): Hassan SA; Hlatky MA; Boothroyd DB; Winston C; Mark DB; Brooks MM; Eagle KA
AUTHOR'S ADDRESS: Henry Ford Hospital, Detroit, Michigan, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Rates of myocardial infarction and death after noncardiac surgery are similarly low after contemporary bypass surgery or angioplasty in patients with multivessel coronary artery disease.

ARTICLE TITLE: Assessing and reducing cardiac risks of noncardiac surgery
ARTICLE SOURCE: Am J Med (United States), Mar 2001, 110(4) p320-3
AUTHOR(S): Goldman L
PUBLICATION TYPE: Editorial

ARTICLE TITLE: The benefits of, controversies surrounding, and professional recommendations for routine PSA testing: what do men believe?
ARTICLE SOURCE: Am J Med (United States), Mar 2001, 110(4) p309-13
AUTHOR(S): Zemencuk JK; Hayward RA; Katz SJ
AUTHOR'S ADDRESS: Center for Practice Management and Outcomes Research, Ann Arbor VA Medical Center Health Services Research and Development Field Program, PO Box 130170, Ann Arbor, Michigan 48113-0170, USA.
PUBLICATION TYPE: Journal Article
MB: It does not say what the controversies are---just that the patients don't know about them. I would like to know myself 'cause my PSA's been up a bit for ages.

ARTICLE TITLE: Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries.
COMMENTS: Am J Med. 2001 Feb 15; 110(3):233-5/21090617
ARTICLE SOURCE: Am J Med (United States), Feb 15 2001, 110(3) p210-6
AUTHOR(S): Mangione S
AUTHOR'S ADDRESS: Department of Medicine and Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Auscultatory proficiency was poor in all three countries. Although there were slight differences among countries, the most striking finding was the consistent inaccuracy of all trainees. This suggests that variables other than teaching and testing affect proficiency.
MB: I just want to know if there are heart sounds.

ARTICLE TITLE: Cardiac auscultation and teaching rounds: how can cardiac auscultation be resuscitated?
COMMENTS: Am J Med. 2001 Feb 15; 110(3):210-6/21090610
ARTICLE SOURCE: Am J Med (United States), Feb 15 2001, 110(3) p233-5
AUTHOR(S): Schneiderman H
PUBLICATION TYPE: Comment; Editorial
MB: What he is proposing will not happen . So the answer to the question is, 'No'.
He proposed that we who he thinks know how to listen to the heart ---like me---should once a month grab 3-4 young ones and get them to hear things ---like differences in volume of valves closing and splitting of sounds---that I could never do. I pretended to hear them when I was a student. I was able to recognise a mitral diastolic murmur in the FFARCS examination but it was very obvious.

ARTICLE TITLE: Outcome of acute myocardial infarction: low-tech value in a high-tech era.
COMMENTS: Am J Med. 2001 Feb 15; 110(3):165-74/21090603
ARTICLE SOURCE: Am J Med (United States), Feb 15 2001, 110(3) p221-3
AUTHOR(S): Goldman L :

ARTICLE TITLE: Does good clinical teaching really make a difference?
COMMENTS: Am J Med. 2001 Feb 15; 110(3):205-9/21090609
ARTICLE SOURCE: Am J Med (United States), Feb 15 2001, 110(3) p231-2
AUTHOR(S): Irby DM; Papadakis M
PUBLICATION TYPE: Comment; Editorial
MB: They assume that is there is some behaviour in teachers which makes a difference. It is an interaction between student & teacher ie thought on both sides shown as behavious. The first author is a PhD so I presume he is not a clinical teacher.

ARTICLE TITLE: Doubt and certainty about nonsteroidal anti-inflammatory drugs in the year 2000: a multidisciplinary expert statement.
ARTICLE SOURCE: Am J Med (United States), Jan 8 2001, 110(1A) p79S-100S
AUTHOR(S): Hawkey CJ; Lanas AI
AUTHOR'S ADDRESS: Division of Gastroenterology, University Hospital Nottingham, Queen's Medical Centre, Nottingham, United Kingdom; Collective Name: Sardinia NSAID meeting.
PUBLICATION TYPE: Journal Article; Review; Review, Academic

ARTICLE TITLE: Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors.
COMMENTS: Am J Med. 2000 Dec 1; 109(8):683-5/20554413
ARTICLE SOURCE: Am J Med (United States), Dec 1 2000, 109(8) p605-13
AUTHOR(S): Philbin EF; Rocco TA; Lindenmuth NW; Ulrich K; Jenkins PL
AUTHOR'S ADDRESS: Section of Heart Failure and Cardiac Transplantation (EFP), Henry Ford Hospital, Detroit, Michigan, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Among patients with heart failure, there is controversy about whether there are clinical features and laboratory tests that can differentiate patients who have low ejection fractions from those with normal ejection fractions..CONCLUSIONS: Among patients treated for heart failure in community hospitals, 42% of those whose ejection fraction was measured had a relatively normal systolic function (ejection fraction > or 0.40). The clinical characteristics and mortality of these patients differed from those in patients with low ejection fractions. Among the patients with ejection fractions > or =0.40, the prescription of ACE inhibitors at discharge was associated favorable effects.

ARTICLE TITLE: Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome.
COMMENTS: Am J Med. 2000 Dec 1; 109(8):686-7/20554414
ARTICLE SOURCE: Am J Med (United States), Dec 1 2000, 109(8) p614-20
AUTHOR(S): Hamel MB; Phillips RS; Davis RB; Teno J; Connors AF; Desbiens N; Lynn J; Dawson NV; Fulkerson W; Tsevat J
AUTHOR'S ADDRESS: Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study
CONCLUSIONS: Ventilator support and intensive care for acute respiratory failure due to pneumonia or acute respiratory distress syndrome are relatively cost-effective for patients with >50% probability of surviving 2 months. However, for patients with an expected 2-month survival < or =50%, the cost per QALY quality -adjusted life-year is more than threefold greater at >$100,000.

ARTICLE TITLE: Extreme hyponatremia of 87 mmol/l without neurologic complications in a severely hypovolemic patient.
COMMENTS: Am J Med. 2000 Dec 1; 109(8):688-92/20554415
ARTICLE SOURCE: Am J Med (United States), Dec 1 2000, 109(8) p679-81
AUTHOR(S): Scheuren A; Jurgensen JS; Kruger A; Frei U; Eckardt K
AUTHOR'S ADDRESS: Department of Nephrology and Medical Intensive Care, Charite, Campus Virchow-Klinikum, Humboldt University Berlin, Berlin, Germany.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Diastolic heart failure: miles to go before we sleep.
COMMENTS: Am J Med. 2000 Dec 1; 109(8):605-13/20554402
ARTICLE SOURCE: Am J Med (United States), Dec 1 2000, 109(8) p683-5
AUTHOR(S): Sweitzer NK; Stevenson LW
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The results of a randomized trial of a quality improvement intervention in the care of patients with heart failure. The MISCHF Study Investigators.
COMMENTS: Am J Med. 2000 Oct 15; 109(6):501-3/20498707
ARTICLE SOURCE: Am J Med (United States), Oct 15 2000, 109(6) p443-9
AUTHOR(S): Philbin EF; Rocco TA; Lindenmuth NW; Ulrich K; McCall M; Jenkins PL
AUTHOR'S ADDRESS: Section of Heart Failure and Cardiac Transplantation (EFP), Henry Ford Hospital, Detroit, Michigan, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
.CONCLUSIONS: The incremental effect of regional collaboration among peer community hospitals toward the goal of quality improvement was small and limited to a slightly, but not significantly, shorter length of stay.

ARTICLE TITLE: The stress of being a doctor: steroid excretion rates in internal medicine residents on and off duty.
ARTICLE SOURCE: Am J Med (United States), Oct 15 2000, 109(6) p492-4
AUTHOR(S): Vierhapper H; Nowotny P
AUTHOR'S ADDRESS: Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna, Vienna, Austria.
PUBLICATION TYPE: Journal Article
MB: The levels on days off are similar to normals. They should look at variations in consultants' levels.

ARTICLE TITLE: Prescribing potassium despite hyperkalemia: medication errors uncovered by linking laboratory and pharmacy information systems.
ARTICLE SOURCE: Am J Med (United States), Oct 15 2000, 109(6) p494-7
AUTHOR(S): Schiff GD; Aggarwal HC; Kumar S; McNutt RA
AUTHOR'S ADDRESS: Department of Medicine, Cook County Hospital, Chicago, Illinois, USA. gdschiff@aol.com.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: What is normal intra-abdominal pressure?
ARTICLE SOURCE: Am Surg (United States), Mar 2001, 67(3) p243-8
AUTHOR(S): Sanchez NC; Tenofsky PL; Dort JM; Shen LY; Helmer SD; Smith RS
AUTHOR'S ADDRESS: Department of Surgery, The University of Kansas School of Medicine-Wichita, 67214, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Leonardo da Vinci: anatomist and physiologist.
ARTICLE SOURCE: Am Surg (United States), Jan 2001, 67(1) p100-2
AUTHOR(S): Wise MW; O'Leary JP
AUTHOR'S ADDRESS: Department of Surgery, Louisiana State University Medical Center, New Orleans, USA.
PUBLICATION TYPE: Biography; Historical Article; Journal Article

ARTICLE TITLE: Does cell-saver blood administration and free hemoglobin load cause renal dysfunction?
ARTICLE SOURCE: Am Surg (United States), Jan 2001, 67(1) p44-7
AUTHOR(S): Klodell CT; Richardson JD; Bergamini TM; Spain DA
AUTHOR'S ADDRESS: Department of Surgery, University of Louisville School of Medicine, and the Veterans Administration Medical Center, Kentucky 40292, USA.
PUBLICATION TYPE: Journal Article
There was an association between the amount of free hemoglobin load and subsequent renal dysfunction. This may warrant further study toward establishing policies and limits regarding maximal free hemoglobin blood.

ARTICLE TITLE: Comparison of safety and cost of percutaneous versus surgical tracheostomy.
ARTICLE SOURCE: Am Surg (United States), Jan 2001, 67(1) p54-60
AUTHOR(S): Bowen CP; Whitney LR; Truwit JD; Durbin CG; Moore MM
AUTHOR'S ADDRESS: Division of Surgical Oncology, University of Virginia Medical Center, Charlottesville 22908-0709, USA.
PUBLICATION TYPE: Evaluation Studies; Journal Article
That is, no learning curve associated with performing percutaneous dilatational tracheostomy (PDT) was evident. In addition there was no association seen between physician specialty and complication rate. PDT in the intensive care unit costs less than surgical tracheostomy performed in the operating room and can be performed in less time. Several other studies have recommended that bronchoscopy during PDT provides additional safety; however, in our series all three major complications took place during bronchoscopy-assisted percutaneous procedures. Our series suggests that PDT carries an appreciable risk of major complications. Careful patient selection and additional experience with the procedure may decrease complication rates to an acceptable level.

ARTICLE TITLE: Game theory in the operating room environment.
ARTICLE SOURCE: Am Surg (United States), Jan 2001, 67(1) p92-6
AUTHOR(S): Marco AP
AUTHOR'S ADDRESS: Department of Anesthesiology, Medical College Hospital, Toledo, Ohio 43614-2598, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: To optimize the functioning of an operating room the interactions of the staff (physicians and nurses) and other stakeholders (administrators) must be understood. Game theory provides a representation of the interactions that typically take place in the operating room environment. By understanding the types of games/interactions that occur the participants can better predict outcome and adapt their own behavior to optimize that outcome. Types of games seen in the operating room include fixed-sum, zero-sum, and non-zero-sum games. The Prisoner's Dilemma game and some of its variations are used to illustrate common interactions in the operating room. Examples of strategies for typical scenarios are discussed as well as ways to improve the outcome of the games. A better understanding of human behavior can improve the functioning of complex systems such as that found in the operating room.

ARTICLE TITLE: In search of a reliable awareness monitor
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p801-4
AUTHOR(S): Tempe DK
AUTHOR'S ADDRESS: Department of Anaesthesiology, G. B. Pant Hospital, J.L. Nehru Marg, New Delhi, India.
PUBLICATION TYPE: Journal Article
MB: Pretty hopeless. They hope against hope that there can be a reliable monitor of awareness. They mention a suggestion of no relaxants. It did not occur to him to have just under maximal neuromuscular block.

ARTICLE TITLE: Explicit Intraoperative Recall at a Bispectral Index of 47 [In Process Citation]
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p808-9
AUTHOR(S): Mychaskiw G; Horowitz M; Sachdev V; Heath BJ
AUTHOR'S ADDRESS: Departments of Anesthesiology and Surgery, University of Mississippi School of Medicine.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Falsely elevated bispectral index during deep hypothermic circulatory arrest.
ARTICLE SOURCE: Br J Anaesth (England), Nov 2000, 85(5) p798-800
AUTHOR(S): Mychaskiw G; Heath BJ; Eichhorn JH
AUTHOR'S ADDRESS: University of Mississippi School of Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: A 2-month-old infant underwent repair of a ventricular septal defect under deep hypothermic circulatory arrest. Bispectral index and EEG suppression ratio were evaluated using an Aspect BIS monitor. Erroneous readings from the monitor could have led to a potentially dangerous alteration in surgical and anaesthetic management.
MB: It might have had they taken notice of it. How would have they checked up on whether an awareness monitor was effective in a 2 month old?

ARTICLE TITLE: Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p848-54
AUTHOR(S): Von Dossow V; Welte M; Zaune U; Martin E; Walter M; Ruckert J; Kox WJ; Spies CD
AUTHOR'S ADDRESS: Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital Charite, Campus Charite Mitte, Humboldt-University, Berlin, Germany.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Fifty patients underwent lung surgery through the opened chest wall requiring ventilation of only one lung. Patients were randomly assigned to receive either general anesthesia alone or in combination with regional anesthesia via a catheter in the back. Oxygen content in the blood and blood pressure was better maintained in the group receiving the combination of general with regional anesthesia.
MB: Trivial benefit.

ARTICLE TITLE: The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p877-81
AUTHOR(S): Bannister CF; Brosius KK; Sigl JC; Meyer BJ; Sebel PS
AUTHOR'S ADDRESS: Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, and Aspect Medical Systems, Newton, Massachusetts.
PUBLICATION TYPE: Journal Article
There was a 25%-40% decrease in measured recovery times. In the patients 0-6 mo of age undergoing IH, sevoflurane concentrations during maintenance (2.0 +/- 0.4% standard practice (SP), 0.9 +/- 0.8 bispectral index (BIS)), during the last 15 min (1.6 +/- 0.4% SP, 0.6 +/- 0.6% BIS), and at the end of the procedure (1.1 +/- 0.6% SP, 0.3 +/- 0.3% BIS) were smaller in the BIS group. Emergence and recovery measures were unaffected by BIS titration. In the children 6 mo-3 yr of age, there were no significant differences between the SP and BIS groups in anesthetic use or recovery measures. Implications: Bispectral index monitoring in children results in less anesthetic use and faster recovery than standard practice.
MB: We don't know what were the criteria used in the standard practice.

ARTICLE TITLE: A lack of evidence of superiority of propofol versus midazolam for sedation in mechanically ventilated critically ill patients: a qualitative and quantitative systematic review
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p975-83
AUTHOR(S): Walder B; Elia N; Henzi I; Romand JR; Tramer MR
AUTHOR'S ADDRESS: Divisions of Surgical Intensive Care, Anaesthesiological Investigations, and Anaesthesiology, Department APSIC, University Hospitals of Geneva, Geneva, Switzerland.
PUBLICATION TYPE: Journal Article
Implications: The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation <36 h, weaning is faster with propofol. The clinical relevance of these differences remains unclear. Specific adverse effects are more common with propofol. For rational decision making, reliable data are needed on cost, mortality, intensive care unit populations other than postoperative, and long-term sedation.
MB: I used no sedation in any ventilated patients between 1962 & 1972. I was prepared to sedate &/or paralyse but it was never necessary.

ARTICLE TITLE: The Effects of an Increase of Central Blood Volume Before Spinal Anesthesia for Cesarean Delivery: A Qualitative Systematic Review .
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p997-1005
AUTHOR(S): Morgan PJ; Halpern SH; Tarshis J
AUTHOR'S ADDRESS: Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario.
PUBLICATION TYPE: Journal Article
We evaluated in this qualitative systematic review the efficacy of increasing central blood volume on the incidence of hypotension after spinal anesthesia for elective cesarean delivery

ARTICLE TITLE: The effects of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics in patients with severe chronic obstructive pulmonary disease
ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p1015-9
AUTHOR(S): Gruber EM; Tschernko EM; Kritzinger M; Deviatko E; Wisser W; Zurakowski D; Haider W
AUTHOR'S ADDRESS: Department of Cardiothoracic and Vascular Anesthesia & Intensive Care Medicine and Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
PUBLICATION TYPE: Journal Article
ABSTRACT: Therefore, we evaluated the effect of TEA on maximal inspiratory pressure, pattern of breathing, ventilatory mechanics, and gas exchange in 12 end-stage COPD patients.. Implications: Thoracic epidural anesthesia with bupivacaine 0.25% does not impair ventilatory mechanics and inspiratory respiratory muscle strength in severely limited chronic obstructive pulmonary disease patients. Thus, thoracic epidural anesthesia can be used safely in patients with end-stage chronic obstructive pulmonary disease.
MB: 12 patients!!!

ARTICLE TITLE: Lactate is correlated with the indocyanine green elimination rate in liver resection for cirrhotic patients ARTICLE SOURCE: Anesth Analg (United States), Apr 2001, 92(4) p1064-70
AUTHOR(S): Orii R; Sugawara Y; Hayashida M; Uchida K; Yamada Y; Takayama T; Makuuchi M; Hanaoka K
AUTHOR'S ADDRESS: Department of Anesthesiology and Hepatobiliary Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
PUBLICATION TYPE: Journal Article
Implications: In cirrhotic patients who underwent liver resection with Pringle's maneuver, the lactate increase and decrease during the ischemic and postischemic phases correlated with the change in the indocyanine green elimination rate. The blood lactate profile might be a reliable indicator of liver metabolic capacity during surgery.
MB: Lactate in bank blood is the most important source of blood lactate during liver surgery. In the study they say they gave FFP but don't mention blood??????

ARTICLE TITLE: Thromboelastography: the next step.
COMMENTS: Anesth Analg. 2001 Mar; 92(3):565-71/21124037; : Anesth Analg. 2001 Mar; 92(3):572-7/21124038
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p563-4
AUTHOR(S): Samama CM
PUBLICATION TYPE: Comment; Editorial
MB: They imply what I have always thought ie that there is no validation of the instrument.

ARTICLE TITLE: Thromboelastography for monitoring prolonged hypercoagulability after major abdominal surgery.
COMMENTS: Anesth Analg. 2001 Mar; 92(3):563-4/21124035
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p572-7
AUTHOR(S): Mahla E; Lang T; Vicenzi MN; Werkgartner G; Maier R; Probst C; Metzler H
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Graz, Graz, Austria. elisabeth.mahla@kfunigraz.ac.at.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Postoperative hypercoagulability, occurring for at least 1 wk after major abdominal surgery, may be demonstrated by standard and modified thromboelastography. This hypercoagulability is not reflected by standard coagulation monitoring and seems to be predominantly caused by increased platelet reactivity.
MB: I think they have the dogma that the thromobelastogram has coagulation meaning.

ARTICLE TITLE: The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery.
COMMENTS: Anesth Analg. 2001 Mar; 92(3):563-4/21124035
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p565-71
AUTHOR(S): Haisch G; Boldt J; Krebs C; Kumle B; Suttner S; Schulz A
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
We conclude that administration of moderate doses of the new HES 130/0.4 preparation in patients undergoing major abdominal surgery results in similar coagulation alterations as those after using an established gelatin-based volume-replacement regimen. IMPLICATIONS: We compared the effects of infusion of a new hydroxyethyl starch preparation (6% hydroxyethyl starch; mean molecular weight 130,000 daltons; degree of substitution 0.4) on coagulation with a gelatin-based intravascular volume replacement regimen in patients undergoing major abdominal surgery. After moderate doses of hydroxyethyl starch (2430 +/- 310 mL until the morning of the first postoperative day), coagulation monitoring, including modified thrombelastography, did not show impaired hemostasis.

ARTICLE TITLE: The effect of anxiety and personality on the pharmacokinetics of oral midazolam.
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p621-4
AUTHOR(S): Martens-Lobenhoffer J; Eisenhardt S; Troger U; Rose W; Meyer FP
AUTHOR'S ADDRESS: Institute of Clinical Pharmacology, University Hospital, Magdeburg, Germany.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: We conclude that personality traits and anxiety levels had no effect on the pharmacokinetic variables of midazolam. Therefore, it is not necessary to obtain anxiety or personality scores to find the proper midazolam dose for the individual patient.

ARTICLE TITLE: The effect of dexamethasone on postoperative vomiting after tonsillectomy.
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p636-40
AUTHOR(S): Aouad MT; Siddik SS; Rizk LB; Zaytoun GM; Baraka AS
AUTHOR'S ADDRESS: Department of Anesthesiology, American University of Beirut, Beirut, Lebanon.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: In this double-blinded, placebo-controlled study, we examined the efficacy of a single dose of dexamethasone 0.5 mg/kg IV on posttonsillectomy vomiting and oral intake in children 2-12 yr old. Dexamethasone significantly decreased the incidence of postoperative vomiting during the first 24 h, shortened the time to the first oral intake and the duration of IV hydration, and improved the quality of oral intake and the satisfaction scores of the patients.
MB: It seems frivilous to use steroids for post-operative vomiting. There must be a small incidence of GI bleeding.

ARTICLE TITLE: Severe anaphylactic reaction to cisatracurium in a child.
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p648-9
AUTHOR(S): Legros CB; Orliaguet GA; Mayer MN; Labbez F; Carli PA
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care, Groupe Hospitalier Necker-Enfants Malades, Paris, France.
PUBLICATION TYPE: Journal Article
MB: Did not sound all that bad to me.

ARTICLE TITLE: The effects of low-flow sevoflurane and isoflurane anesthesia on renal function in patients with stable moderate renal insufficiency.
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p650-5
AUTHOR(S): Higuchi H; Adachi Y; Wada H; Kanno M; Satoh T
AUTHOR'S ADDRESS: Department of Anesthesia, Self Defense Force Central Hospital, Tokyo, Japan. higu-chi@ka2.so-net.ne.jp.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: The serum creatinine and blood urea nitrogen data indicate that, for exposures of <130 ppm/h in Compound A inspired area under the curve, renal effects of low-flow sevoflurane are similar to those of isoflurane in patients with stable renal insufficiency.

ARTICLE TITLE: Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study.
ARTICLE SOURCE: Anesth Analg (United States), Mar 2001, 92(3) p745-8
AUTHOR(S): Ho ST; Wang JJ; Tzeng JI; Liu HS; Ger LP; Liaw WJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei. painlab@tpts5.seed.net.tw.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. We found that dexamethasone 5 mg was as effective as 10 mg. We recommend the smaller dose for this purpose.
MB: How about not giving the epidural narcotics.

ARTICLE TITLE: How much are patients willing to pay to avoid postoperative nausea and vomiting?
ARTICLE SOURCE: Anesth Analg (United States), Feb 2001, 92(2) p393-400
AUTHOR(S): Gan T; Sloan F; Dear G de L; El-Moalem HE; Lubarsky DA
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. gan00001@mc.duke.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Postoperative nausea and vomiting (PONV) are unpleasant experiences. However, there is no drug that is completely effective in preventing PONV. Whereas cost effectiveness analyses rely on specific health outcomes (e.g., years of life saved), cost-benefit analyses assess the cost and benefit of medical therapy in terms of dollars. We hypothesized that patients were willing to pay for a hypothetical new drug that would eliminate PONV. Eighty elective day surgical patients using general anesthesia participated in the study. After their recovery in the postanesthetic care unit, they were asked to complete an interactive computer questionnaire on demographics, the value of avoiding PONV, and their willingness to pay for an antiemetic. Patients were willing to pay US$56 (US$26--US$97; median, 25%--75%) for an antiemetic that would completely prevent PONV. Patients who developed nausea (n = 21; 26%) and vomiting (n = 9; 11%) were willing to pay US$73 (US$44--US$110) and $100 (US$61--US$200; median, 25%--75%), respectively (P < 0.05). Seventy-six percent of patients considered avoiding postoperative nausea and 78% of patients considered avoiding vomiting as important (> or = 50 mm on a 0--100-mm visual analog scale). Nausea or vomiting in the postanesthetic care unit, greater patient income, previous history of PONV, more importance placed on avoiding nausea and vomiting, increasing age, and being married are independent covariates that increase the willingness to pay estimates. Patients associated a value with the avoidance of PONV and were willing to pay between US$56 and US$100 for a completely effective antiemetic.

ARTICLE TITLE: A randomized, double-blinded comparison of intrathecal morphine, sufentanil and their combination versus IV morphine patient-controlled analgesia for postthoracotomy pain.
ARTICLE SOURCE: Anesth Analg (United States), Jan 2001, 92(1) p31-6
AUTHOR(S): Liu N; Kuhlman G; Dalibon N; Moutafis M; Levron JC; Fischler M
AUTHOR'S ADDRESS: Department of Anesthesiology, Hopital Foch, Suresnes, France.
UBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
. Implications: As compared with IV patient-controlled analgesia, intrathecal morphine or combined sufentanil and morphine provided superior postoperative pain relief both at rest (11 h) and on coughing (8 h) than did IV patient-controlled analgesia morphine alone. IV morphine requirement was decreased during the first postoperative day after posterolateral thoracotomy.

ARTICLE TITLE: Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery.
COMMENTS: Anesth Analg. 2001 Jan; 92(1):3-4/20578013
ARTICLE SOURCE: Anesth Analg (United States), Jan 2001, 92(1) p189-93
AUTHOR(S): Fredman B; Zohar E; Tarabykin A; Shapiro A; Mayo A; Klein E; Jedeikin R
AUTHOR'S ADDRESS: Department of Anesthesiology, Meir Hospital, Kfar Saba, Israel.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
Implications: After major abdominal surgery performed through a 20-cm incision, repeated 0.25% bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements.

ARTICLE TITLE: How can local anesthetic in the wound not help?
COMMENTS: Anesth Analg. 2001 Jan; 92(1):189-93/20578047
ARTICLE SOURCE: Anesth Analg (United States), Jan 2001, 92(1) p3-4
AUTHOR(S): Rowlingson JC
PUBLICATION TYPE: Comment; Editorial
MB: This editorial written by another Pain Doctor points out many of the problems in the whole pain enterprise and its continuous encouragement of trying out new methods with the endless further investigations to find out why they get negative results. It started about 1980. We are still waiting for evidence of success. The writer obviously would like positive results which is not what a scientist should do.

ARTICLE TITLE: Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention.
ARTICLE SOURCE: Anesth Analg (United States), Jan 2001, 92(1) p252-6
AUTHOR(S): Pollard JB
AUTHOR'S ADDRESS: Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, California 94304-1207, USA. John.Pollard@med.va.gov.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting.
ARTICLE SOURCE: Anesth Analg (United States), Jan 2001, 92(1) p112-7
AUTHOR(S): Goll V; Akca O; Greif R; Freitag H; Arkilic CF; Scheck T; Zoeggeler A; Kurz A; Krieger G; Lenhardt R; Sessler DI
AUTHOR'S ADDRESS: Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: Supplemental oxygen maintained during and for 2 h after colon resection halves the incidence of nausea and vomiting. Whether supplemental oxygen restricted to the intraoperative period is sufficient remains unknown. Similarly, the relative efficacy of supplemental oxygen and ondansetron is unknown. We tested the hypothesis that intraoperative supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Patients (n = 240) undergoing gynecological laparoscopy were given a standardized isoflurane anesthetic. After induction, they were randomly assigned to the following three groups: routine oxygen administration with 30% oxygen, balance nitrogen (30% Oxygen group), supplemental oxygen administration with 80% oxygen, balance nitrogen (80% Oxygen group), and Ondansetron 8 mg (immediately after induction), combined with 30% oxygen, balance nitrogen (Ondansetron group). The overall incidence of nausea and/or vomiting during the initial 24 postoperative h was 44% in the patients assigned to 30% oxygen and 30% in the Ondansetron group, but only 22% in those given 80% oxygen. The incidence was thus halved by supplemental oxygen and was significantly less than with 30% oxygen. There were, however, no significant differences between the 30% oxygen and ondansetron groups, or between the ondansetron and 80% oxygen groups. We conclude that supplemental oxygen effectively prevents postoperative nausea and vomiting after gynecological laparoscopic surgery; furthermore, ondansetron is no more effective than supplemental oxygen. Implications: Supplemental oxygen reduces the risk of postoperative nausea and vomiting (PONV) as well or better than 8 mg of ondansetron. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen is a preferable method of reducing PONV.
MB: How depressing. ;-)

ARTICLE TITLE: Pathophysiological mechanisms of postrevascularization hyperkalemia in orthotopic liver transplantation.
ARTICLE SOURCE: Anesth Analg (United States), Dec 2000, 91(6) p1351-5
AUTHOR(S): Nakasuji M; Bookallil MJ
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan. nksuji@msic.med.osaka-cu.ac.jp.
PUBLICATION TYPE: Clinical Trial; Journal Article
ABSTRACT: The underlying mechanisms of hyperkalemia occurring immediately after revascularization in orthotopic liver transplantation (OLT) are unknown. We investigated the possible pathophysiological mechanisms of hyperkalemia in relation to the donor and recipient. The study included 64 consecutive patients undergoing OLT. Recipients were divided into two groups: Group 1 consisted of 47 patients with serum K(+) concentration <5.5 mmol/L at 1-min postrevascularization, and Group 2 consisted of 17 patients with serum K(+) exceeding 5.5 mmol/L. Increased serum K(+) concentration, more progressive metabolic acidosis, and decreased mean arterial blood pressure and cardiac index during the anhepatic phase were recognized in Group 2. Multiple regression analysis showed that cardiac index, serum lactate, and serum K(+) concentration during the anhepatic phase were independent and significant factors that could predict serum K(+) concentration 1-min postrevascularization. Hyperkalemia at 1-min postrevascularization did not correlate with the extent of preservation injury of the graft liver (represented by the peak value of aspartate aminotransferase measured within the first 72 h after OLT) or the duration of cold ischemia. We conclude that hyperkalemia occurring immediately after revascularization in OLT is mainly caused by metabolic acidosis as a result of insufficient cardiac output during the anhepatic phase.

ARTICLE TITLE: The comparison of hypertonic saline (7.5%) and normal saline (0.9%) for initial fluid administration before spinal anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Dec 2000, 91(6) p1461-5
AUTHOR(S): Jarvela K; Honkonen SE; Jarvela T; Koobi T; Kaukinen S
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
.We conclude that f 7.5% hypertonic saline (HS) was as good as NS for the initial fluid administration before spinal anesthesia when the amount of sodium was kept unchanged.

ARTICLE TITLE: Is there a learning curve associated with the use of remifentanil?
COMMENTS: Anesth Analg. 2000 Nov; 91(5):1047-8/20503923
ARTICLE SOURCE: Anesth Analg (United States), Nov 2000, 91(5) p1049-55
AUTHOR(S): Joshi GP; Jamerson BD; Roizen MF; Fleisher L; Twersky RS; Warner DS; Colopy M
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas 75235-9068, USA. girish.joshi@email.swmed.edu.
PUBLICATION TYPE: Journal Article; Multicenter Study
Implications: This study demonstrated that anesthesiologists rapidly acquire the ability to use remifentanil with limited experience. However, there is a learning curve that aids reduction of minor adverse effects associated with the use of analgesic medications administered at the end of surgery in outpatients, which might have reduced the incidence of postoperative vomiting and the duration of postanesthesia care unit stay.

ARTICLE TITLE: Lessons on learning about learning curves.
COMMENTS: Anesth Analg. 2000 Nov; 91(5):1049-55/20503924
ARTICLE SOURCE: Anesth Analg (United States), Nov 2000, 91(5) p1047-8
AUTHOR(S): Reves JG
PUBLICATION TYPE: Comment; Editorial
MB: They set a protocol of what had to be done so it did not take long to learn that.

ARTICLE TITLE: Why do women reject surgical careers?
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Oct 2000, 82(9 Suppl) p290-3
AUTHOR(S): Richardson HC; Redfern N
AUTHOR'S ADDRESS: Postgraduate Institute for Medicine and Dentistry, University of Newcastle-upon-Tyne.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Women reject surgical careers because of perceptions of 'male bias' and 'negative attitudes'. An increase in the number of surgical role models among women could improve this situation, as could apparent enthusiasm for teaching and enjoyment of their specialty by consultants.
MB: I would have thought that to be successful any aspirant to any speciality should be turned on by the speciality not by identifying with a practitioner of that speciality.

ARTICLE TITLE: Australian major incident nomenclature: it may be a 'disaster' but in an 'emergency' it is just a mess.
ARTICLE SOURCE: ANZ J Surg (Australia), Mar 2001, 71(3) p162-6
AUTHOR(S): Nocera A
AUTHOR'S ADDRESS: Department of Emergency Medicine, Peninsula Health, Frankston Hospital, Victoria, Australia. tonynoce@ozemail.com.au.
PUBLICATION TYPE: Journal Article
CONCLUSION: Australia lacks a uniform system of classifying and recording mass casualty incidents. This prevents both the independent clinical audit of the medical response to an incident and the cross-border comparison of the effectiveness of trauma systems to deal with multiple casualties. Australia's geography highlights the need to develop a nomenclature that allows medical practitioners, in isolated environments, to accurately describe an incident and the medical support that is required. The Potential Injury-Creating Event (PICE) nomenclature is a simple system to describe the functional impact of an event upon a community and the level of medical support required. It can be used to provide the basis for the uniform reporting of the medical management of major incidents within Australia.
MB: Does anyone have such a system & do they use it?

ARTICLE TITLE: The case for beta-adrenergic blockade as prophylaxis against perioperative cardiovascular morbidity and mortality ARTICLE SOURCE: Arch Surg (United States), Mar 2001, 136(3) p286-90
AUTHOR(S): Selzman CH; Miller SA; Zimmerman MA; Harken AH
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery, Department of Surgery, Box C-310, University of Colorado Health Sciences Center, 4200 E Ninth Ave, Denver, CO 80262, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
This article reviews the physiologic and clinical basis for using these agents as prophylaxis against cardiovascular events in high-risk surgical patients.

ARTICLE TITLE: A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection
ARTICLE SOURCE: Arch Surg (United States), Mar 2001, 136(3) p305-10
AUTHOR(S): Bohm B; Rotting N; Schwenk W; Grebe S; Mansmann U
AUTHOR'S ADDRESS: Department of General, Visceral, Vascular and Thoracic Surgery, Charite, Campus Mitte, Humboldt University, Schumannstr, 20-21, D-10117 Berlin, Germany. bboehm@charite.de.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Performing laparoscopic colorectal surgery causes higher mental strain in surgeons than performing conventional surgery.
MB: Should we give them some midazolan.

ARTICLE TITLE: Risk stratification in emergency surgical patients: is the APACHE II score a reliable marker of physiological impairment?
ARTICLE SOURCE: Arch Surg (United States), Jan 2001, 136(1) p55-9
AUTHOR(S): Koperna T; Semmler D; Marian F
AUTHOR'S ADDRESS: Department of Surgery, Hospital Mistelbach, Liechtensteinstrasse 67, A-2130 Mistelbach, Austria.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: For risk stratification in emergency surgical patients, it is essential to measure the APACHE II (Acute Physiology and Chronic Health Evaluation II) score before surgical treatment. Longitudinal APACHE II scoring reveals continuous improvement of the score in surviving patients but has no therapeutic relevance in the individual patient.

ARTICLE TITLE: American Gastroenterological Association medical position statement: nausea and vomiting.
ARTICLE SOURCE: Gastroenterology (United States), Jan 2001, 120(1) p261-3
AUTHOR'S ADDRESS: Collective Name: American Gastroenterological Association.
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline
MB: Only a little bit about PONV.

ARTICLE TITLE: Postoperative nausea and vomiting--time for balanced antiemesis?
COMMENTS: Br J Anaesth. 2000 Nov; 85(5):678-82
ARTICLE SOURCE: Br J Anaesth (England), Nov 2000, 85(5) p675-7
AUTHOR(S): Heffernan AM; Rowbotham DJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The utility of pulmonary artery catheterization.
COMMENTS: Br J Anaesth. 2000 Oct; 85(4):611-5
ARTICLE SOURCE: Br J Anaesth (England), Oct 2000, 85(4) p501-3
AUTHOR(S): Swann DG
PUBLICATION TYPE: Comment; Editorial
MB: Rather verbose polite argument indicating the impossibility of proving that monitors are good or bad.

ARTICLE TITLE: Pulmonary artery catheterization and mortality in critically ill patients.
COMMENTS: Br J Anaesth. 2000 Oct; 85(4):501-3
ARTICLE SOURCE: Br J Anaesth (England), Oct 2000, 85(4) p611-5
AUTHOR(S): Murdoch SD; Cohen AT; Bellamy MC
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care Medicine, St James's University Hospital, Leeds, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: Pulmonary artery catheters are widely used in intensive care, but evidence to support their widespread use in sparse. Some published data suggest that greater mortality is associated with use of these catheters. The largest study to date looked at > 5500 patients in several centres in America and found a greater 30 day mortality in those patients receiving a pulmonary artery catheter. We tested the hypothesis that, on our intensive care unit, mortality was greater for those patients receiving a pulmonary artery catheter. Using a propensity score to account for severity of illness, the odds ratio for mortality in those patients receiving a pulmonary artery catheter was 1.08 (95% confidence interval 0.87-1.33). We believe that continued use of the pulmonary artery catheter is safe; a large randomized controlled trial examining outcome is unlikely to provide an adequate answer.
MB: Silly appraoch. They presumable put the catheters in 'casue they thought they were high risk.

ARTICLE TITLE: Older surgeons' records for endarterectomy worse than those of younger surgeons.
ARTICLE SOURCE: Circulation (United States), Nov 14 2000, 102(20) pE9040
AUTHOR(S): So Relle R
PUBLICATION TYPE: News
MB: Does the same apply in anaesthesia?

ARTICLE TITLE: Congestive heart failure: fifty years of progress.
ARTICLE SOURCE: Circulation (United States), Nov 14 2000, 102(20 Suppl 4) pIV14-23
AUTHOR(S): Braunwald E; Bristow MR
AUTHOR'S ADDRESS: Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA.
PUBLICATION TYPE: Historical Article; Journal Article

ARTICLE TITLE: The past 50 years of cardiovascular surgery.
ARTICLE SOURCE: Circulation (United States), Nov 14 2000, 102(20 Suppl 4) pIV87-93
AUTHOR(S): Cooley DA; Frazier OH
AUTHOR'S ADDRESS: Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA. dcooley@heart.thi.tmc.edu.
PUBLICATION TYPE: Historical Article; Journal Article

ARTICLE TITLE: First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation.
ARTICLE SOURCE: Circulation (United States), Oct 17 2000, 102(16) p1879-82
AUTHOR(S): Natale A; Pisano E; Shewchik J; Bash D; Fanelli R; Potenza D; Santarelli P; Schweikert R; White R; Saliba W; Kanagaratnam L; Tchou P; Lesh M
AUTHOR'S ADDRESS: Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. natalea@ccf.org.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS: This novel ultrasound ablation system can successfully isolate multiple pulmonary veins. At early follow-up, this approach seems to be effective in preventing recurrent atrial fibrillation in a significant number of patients.

ARTICLE TITLE: Alcohol consumption and risk of intermittent claudication in the Framingham Heart Study.
ARTICLE SOURCE: Circulation (United States), Dec 19 2000, 102(25) p3092-7
AUTHOR(S): Djousse L; Levy D; Murabito JM; Cupples LA; Ellison RC
AUTHOR'S ADDRESS: Department of Medicine, Section of Preventive Medicine & Epidemiology Boston University School of Medicine, Boston, Massachusetts, USA. ldjousse@bu.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Our data are consistent with a protective effect of moderate alcohol consumption on Intermittent claudication (IC) risk, with lowest risk observed in men consuming 13 to 24 g/d (1 to 2 drinks/d) and in women consuming 7 to 12 g/d (0.5 to 1 drink/d).

ARTICLE TITLE: Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group.
ARTICLE SOURCE: Circulation (United States), Dec 12 2000, 102(24) p2973-7
AUTHOR(S): Liu JY; Birkmeyer NJ; Sanders JH; Morton JR; Henriques HF; Lahey SJ; Dow RW; Maloney C; Di Scipio AW; Clough R; Leavitt BJ; O'Connor GT
AUTHOR'S ADDRESS: Departments of Surgery, Medicine, Community and Family Medicine, and the Center for the Evaluative and Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
PUBLICATION TYPE: Clinical Trial; Controlled Clinical Trial; Journal Article
CONCLUSIONS: Preoperative dialysis-dependent renal failure is a strong independent risk factor for in-hospital mortality and mediastinitis after CABG.

ARTICLE TITLE: Are patients with renal failure good candidates for percutaneous coronary revascularization in the new device era?
ARTICLE SOURCE: Circulation (United States), Dec 12 2000, 102(24) p2966-72
AUTHOR(S): Rubenstein MH; Harrell LC; Sheynberg BV; Schunkert H; Bazari H; Palacios IF
AUTHOR'S ADDRESS: Cardiac Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
PUBLICATION TYPE: Clinical Trial; Controlled Clinical Trial; Journal Article
CONCLUSIONS: Although patients with renal failure can be treated with a high procedural success rate in the new device era, they have an increased rate of major events both in hospital and at long-term follow-up. Nevertheless, utilization of stenting and debulking techniques improves immediate and long-term outcomes.
MB: I would have thought that the risk would be less with less invasive procedures. I don't think the presence of renal failure would inhibit anyone doing a cardiac procedure if it was really indicated.

ARTICLE TITLE: How many medicines do patients with heart failure need?
ARTICLE SOURCE: Circulation (United States), Mar 27 2001, 103(12) p1611-2
AUTHOR(S): Parmley WW
AUTHOR'S ADDRESS: University of California at San Francisco.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Trauma centers bleeding dollars with balance sheets in the red
ARTICLE SOURCE: Circulation (United States), Mar 13 2001, 103(10) pE9019-21
AUTHOR(S): So Relle R
PUBLICATION TYPE: Journal Article
MB: It sounds as though the emergency services in the US are breaking down. In fact I think they are probably better than here. It would appear that in Texas they are loosing money but they are attached to hospitals that are still going.
On of the areas going broke is Houston. Several years ago it took only 70 minutes there from the reporting of a stabbing to theatre. I have heard that it is now 20 minutes. I suppose if less money is put into it might fall back to 30 minutes which I think would still be alright.

ARTICLE TITLE: Gas exchange efficiency in congestive heart failure II
ARTICLE SOURCE: Circulation (United States), Feb 20 2001, 103(7) p916-8
AUTHOR(S): Johnson RL
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Getting fat in the ICU.
ARTICLE SOURCE: Gastroenterology (United States), Aug 2000, 119(2) p592-4
AUTHOR(S): Koretz RL
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Covert transmission of hepatitis C virus during bloody fisticuffs.
ARTICLE SOURCE: Gastroenterology (United States), Aug 2000, 119(2) p507-11
AUTHOR(S): Bourliere M; Halfon P; Quentin Y; David P; Mengotti C; Portal I; Khiri H; Benali S; Perrier H; Boustiere C; Jullien M; Lambot G
AUTHOR'S ADDRESS: Department of Hepatogastroenterology, Hopital Saint Joseph, Marseille, France. mbourliere@hopital-saintjoseph.fr.
PUBLICATION TYPE: Journal Article
ABSTRACT: Hepatitis C virus (HCV) is transmitted primarily through direct percutaneous exposure to infected blood. Sporadic HCV cases exist and may represent more than 10% of HCV transmission. We report the first case of documented transmission of HCV during a fight from a person who unknowingly had chronic HCV infection to a person who subsequently contracted acute hepatitis C. Patient-to-patient transmission was ascertained by sequence analysis of part of the NS5B genome and phylogenetic analysis. This case report suggests that sporadic HCV infection may be a result of blood exposure. This example of transmission could have a major impact in sports such as boxing or rugby. We suggest that in any fight, single use or nondisposable material should be used to dry blood to avoid such contamination.
MB: It about time that all these barbaric activities were stopped by the United Nations.

ARTICLE TITLE: Vasoactive agents in intrahepatic portal hypertension and fibrogenesis: implications for therapy.
COMMENTS: Gastroenterology. 2000 Jun; 118(6):1149-56; : Gastroenterology. 2000 Jun; 118(6):1169-78
ARTICLE SOURCE: Gastroenterology (United States), Jun 2000, 118(6) p1261-5
AUTHOR(S): Rockey DC
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial

ARTICLE TITLE: Laparoscopic minimal-access surgery: where are we now? Where are we going?
ARTICLE SOURCE: Gastroenterology (United States), Feb 2000, 118(2 Suppl 1) pS148-65
AUTHOR(S): Young-Fadok TM; Smith CD; Sarr MG
AUTHOR'S ADDRESS: Department of Surgery, Mayo Clinic Rochester, Minnesota 55905, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Helicobacter eradication versus prompt endoscopy for dyspepsia
ARTICLE SOURCE: Gastroenterology (United States), Apr 2001, 120(5) p1298-9
AUTHOR(S): Nelson DB
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Liver transplantation: current status and novel approaches to liver replacement.
ARTICLE SOURCE: Gastroenterology (United States), Feb 2001, 120(3) p749-62
AUTHOR(S): Keeffe EB
AUTHOR'S ADDRESS: Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine; and Liver Transplant Program, Stanford University Medical Center, Stanford, California 94304-1509, USA. ekeeffe@stanford.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: The major challenge currently facing liver transplantation is the performance of a greater number of liver transplants, which has been fueled by the large and growing disparity between the increasing number of qualified patients listed for transplantation and the relatively static number of available cadaver donor organs. In the past 2 years, approximately 4500 liver transplants have been performed annually, with 1-year survival rates in the 85%-90% range, while the waiting list has expanded as of November 2000 to more than 16,000 patients, resulting in an increasing death rate among listed patients. In the short term, there will continue to be a major focus on more effective use of available cadaver donor organs to balance the competing principles of justice (patients with most urgent need for transplant and lower probability of posttransplant survival) and medical utility (patients with less urgent need for transplant and higher odds of postoperative survival). Over the long term, there will be an increasing application of novel approaches to liver replacement including cadaver split liver transplantation and adult living donor liver transplantation and possibly, in the more distant future, xenotransplantation and hepatocyte transplantation. The treatment, and ideally the prevention, of recurrent disease after liver transplantation, particularly chronic hepatitis C-the most common indication for transplantation-is a major priority to optimize the use of liver grafts. Finally, improved immunosuppressive strategies, including movement toward minimal immunosuppression and steroid withdrawal and the development of safer and more effective drugs, is another important factor that has the potential to increase the success of liver transplantation.

ARTICLE TITLE: Postapproval drug surveillance and the first principle of medicine.
ARTICLE SOURCE: Gastroenterology (United States), Jan 2001, 120(1) p5
AUTHOR(S): Camilleri M; Podolsky DK
PUBLICATION TYPE: Editorial

ARTICLE TITLE: MARS: a new treatment for hepatorenal failure. Molecular adsorbent and recirculating system.
ARTICLE SOURCE: Gastroenterology (United States), Dec 2000, 119(6) p1799-800
AUTHOR(S): Kapoor D; Williams R; Jalan R
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Colon cancer screening.
ARTICLE SOURCE: Gastroenterology (United States), Sep 2000, 119(3) p837-53
AUTHOR(S): Burt RW
AUTHOR'S ADDRESS: Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, Utah 84132, USA. randall.burt@hsc.utah.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Effects of human pregnancy on cardiac autonomic function above and below the ventilatory threshold.
ARTICLE SOURCE: J Appl Physiol (United States), Jan 2001, 90(1) p321-8
AUTHOR(S): Avery ND; Wolfe LA; Amara CE; Davies GA; McGrath MJ
AUTHOR'S ADDRESS: School of Physical and Health Education, Queen's University, Kingston, Ontario, Canada.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Periodic breathing in heart failure patients: testing the hypothesis of instability of the chemoreflex loop.
ARTICLE SOURCE: J Appl Physiol (United States), Dec 2000, 89(6) p2147-57
AUTHOR(S): Pinna GD; Maestri R; Mortara A; La Rovere MT; Fanfulla F; Sleight P
AUTHOR'S ADDRESS: Department of Biomedical Engineering, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Montescano, 27040 Montescano (PV), Italy. bioing.montescano@fsm.it.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Acute head-down tilt decreases the postexercise resting threshold for forearm cutaneous vasodilation.
ARTICLE SOURCE: J Appl Physiol (United States), Dec 2000, 89(6) p2306-11
AUTHOR(S): Kenny GP; Jackson DN; Reardon FD
AUTHOR'S ADDRESS: School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada, K1N 6N5. gkenny@uottawa.ca.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Postexercise rehydration: effect of Na(+) and volume on restoration of fluid spaces and cardiovascular function.
ARTICLE SOURCE: J Appl Physiol (United States), Oct 2000, 89(4) p1302-9
AUTHOR(S): Mitchell JB; Phillips MD; Mercer SP; Baylies HL; Pizza FX
AUTHOR'S ADDRESS: Exercise Physiology Laboratory, Department of Kinesiology, Texas Christian University, Fort Worth, Texas 76129, USA. J.Mitchell@tcu.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Invited review: mechanisms of ventilator-induced lung injury: a perspective.
COMMENTS: J Appl Physiol. 2000 Oct; 89(4):1253-4/20463159
ARTICLE SOURCE: J Appl Physiol (United States), Oct 2000, 89(4) p1645-55
AUTHOR(S): Dos Santos CC; Slutsky AS
AUTHOR'S ADDRESS: Department of Medicine, St. Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article; Review; Review, Academic

ARTICLE TITLE: Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm.
ARTICLE SOURCE: J Appl Physiol (United States), Sep 2000, 89(3) p967-76
AUTHOR(S): Hodges PW; Gandevia SC
AUTHOR'S ADDRESS: Prince of Wales Medical Research Institute, University of New South Wales, Sydney, New South Wales 2031, Australia. p.hodges@unsw.edu.au.
PUBLICATION TYPE: Journal Article
These results show that coactivation of the diaphragm and abdominal muscles causes a sustained increase in intra-abdominal pressure, whereas inspiration and expiration are controlled by opposing activity of the diaphragm and abdominal muscles to vary the shape of the pressurized abdominal cavity.

ARTICLE TITLE: Nine months in space: effects on human autonomic cardiovascular regulation.
ARTICLE SOURCE: J Appl Physiol (United States), Sep 2000, 89(3) p1039-45
AUTHOR(S): Cooke WH; Ames JEIV; Crossman AA; Cox JF; Kuusela TA; Tahvanainen KU; Moon LB; Drescher J; Baisch FJ; Mano T; Levine BD; Blomqvist CG; Eckberg DL
AUTHOR'S ADDRESS: Center for Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931, USA. whcooke@mtu.edu.
PUBLICATION TYPE: Journal Article
Our results suggest that long-duration spaceflight reduces vagal-cardiac nerve traffic and decreases vagal baroreflex gain and that these changes may persist as long as 2 wk after return to Earth.

ARTICLE TITLE: Cardiac and respiratory activity at arousal from sleep under controlled ventilation conditions
ARTICLE SOURCE: J Appl Physiol (United States), Apr 2001, 90(4) p1455-63
AUTHOR(S): Trinder J; Padula M; Berlowitz D; Kleiman J; Breen S; Rochford P; Worsnop C; Thompson B; Pierce R
AUTHOR'S ADDRESS: Department of Psychology, University of Melbourne, Parkville, Victoria 3052, Australia.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Invited Review: Physiological and pathophysiological responses to intermittent
ARTICLE SOURCE: J Appl Physiol (United States), Apr 2001, 90(4) p1593-9
AUTHOR(S): Neubauer JA
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019.
PUBLICATION TYPE: Journal Article
MB: Sounds like most anaesthetics

ARTICLE TITLE: Invited Review: Physiological consequences of intermittent hypoxia: systemic blood pressure
ARTICLE SOURCE: J Appl Physiol (United States), Apr 2001, 90(4) p1600-5
AUTHOR(S): Fletcher EC
AUTHOR'S ADDRESS: Division of Respiratory, Critical Care and Environmental Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40292.
PUBLICATION TYPE: Journal Article
ABSTRACT: One of the major manifestations of obstructive sleep apnea is profound and repeated hypoxia during sleep. <snip>. It appears that adrenergic and renin-angiotensin system overactivity contributes to the early chronic elevated blood pressure in rat intermittent hypoxia and perhaps to human hypertension associated with obstructive sleep apnea.

ARTICLE TITLE: Effects of marked hyperthermia with and without dehydration on &Vdot; O(2) kinetics during intense exercise [In Process Citation]
ARTICLE SOURCE: J Appl Physiol (United States), Mar 2001, 90(3) p1057-64
AUTHOR(S): Nybo L; Jensen T; Nielsen B; Gonzalez-Alonso J
AUTHOR'S ADDRESS: Department of Human Physiology, Institute of Exercise and Sport Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: A comparison of neuropsychologic deficits after extracardiac and intracaradiac surgery
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Feb 2001, 15(1) p9-14
AUTHOR(S): Andrew MJ; Baker RA; Bennetts J; Kneebone AC; Knight JL
AUTHOR'S ADDRESS: Department of Surgery, Flinders Medical Centre and Flinders University of South Australia, Adelaide.
PUBLICATION TYPE: Journal Article
CONCLUSION: There are some differences in the neuropsychologic outcome of extracardiac and intracardiac surgery. Patients undergoing isolated coronary artery bypass graft (CABG) surgery showed a greater reduction in the incidence of persisting deficits at 6 months than patients undergoing valve surgery with or without CABG surgery. This finding warrants further investigation, with particular attention to patients undergoing combined valve and coronary artery procedures.

ARTICLE TITLE: Correlation of peripheral venous pressure and central venous pressure in surgical patients
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Feb 2001, 15(1) p40-3
AUTHOR(S): Amar D; Melendez JA; Zhang H; Dobres C; Leung DH; Padilla RE
AUTHOR'S ADDRESS: Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Under the conditions of this study, peripheral venous pressure (PVP) showed a consistent and high degree of agreement with CVP in the perioperative period in patients without significant cardiac dysfunction. PVP -2 was useful in predicting CVP over common clinical ranges of CVP. PVP is a rapid noninvasive tool to estimate volume status in surgical patients.
MB: I did this quite a lot before Cava Fix for peripheral CVP cannulation. PVC readings can't be less that the CVP.

ARTICLE TITLE: The effects of recent aspirin ingestion on platelet function in cardiac surgical patients
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Feb 2001, 15(1) p55-9
AUTHOR(S): Gibbs NM; Weightman WM; Thackray NM; Michalopoulos N; Weidmann C
AUTHOR'S ADDRESS: Department of Anaesthesia, Sir Charles Gairdner Hospital, and PathCentre, Nedlands, Western Australia.
PUBLICATION TYPE: Journal Article
CONCLUSION: Cardiac surgical patients who ingest aspirin < or =2 days preoperatively have greater impairment of platelet function than patients who have a longer preoperative aspirin-free interval.

ARTICLE TITLE: Pro: aprotinin should be used in patients undergoing hypothermic circulatory arrest [In Process Citation]
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Feb 2001, 15(1) p121-5
AUTHOR(S): Royston D
AUTHOR'S ADDRESS: Department of Anaesthesia, Royal Brompton and Harefield NHS Trust, Harefield Hospital, United Kingdom.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Con: aprotinin should not be used in patients undergoing hypothermic circulatory arrest [In Process Citation]
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Feb 2001, 15(1) p126-8
AUTHOR(S): Gravlee GP
AUTHOR'S ADDRESS: Department of Anesthesiology, Ohio State University Medical Center, Columbus 43210, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Carinal hook wrapped in curvature maneuver: an easy insertion technique for Carlens endobronchial catheter intubation [In Process Citation]
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Feb 2001, 15(1) p142-3
AUTHOR(S): Tripathi M; Pandey M
PUBLICATION TYPE: Letter
MB: They can't have heard of the screwing technique.

ARTICLE TITLE: Anesthetic techniques and early extubation: does it matter?
COMMENTS: J Cardiothorac Vasc Anesth. 2000 Dec; 14(6):631-8/21020047
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p627-30
AUTHOR(S): Cheng D
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Fast-track cardiac anesthesia: a comparison of remifentanil plus intrathecal morphine with sufentanil in a desflurane-based anesthetic.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p645-51
AUTHOR(S): Latham P; Zarate E; White PF; Bossard R; Shi C; Morse LS; Douning LK; Chi L
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Use of remifentanil in combination with intrathecal morphine did not facilitate earlier tracheal extubation or improve intraoperative hemodynamic stability compared with sufentanil alone for fast-track cardiac anesthesia.
MB: How disappointing.

ARTICLE TITLE: Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p662-5
AUTHOR(S): Groban L; Dolinski SY; Zvara DA; Oaks T
AUTHOR'S ADDRESS: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: atrial arrhythmias (AAs) after thoracotomy were common. These AAs were associated with increased age, cardiac history, abnormal ECG, increased cost, increased length of hospital stay, and time of epidural catheter removal. Although a cause-and-effect relationship cannot be inferred from this study, the presence or absence of thoracic epidural analgesia (TEA) was found to have a temporal relationship with the incidence of AAs.

ARTICLE TITLE: The effects of aprotinin on blood product transfusion associated with thoracic aortic surgery requiring deep hypothermic circulatory arrest.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p676-81
AUTHOR(S): Seigne PW; Shorten GD; Johnson RG; Comunale ME
AUTHOR'S ADDRESS: Department of Anesthesiology, Cork University Hospital and University College, Ireland.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Low-dose aprotinin administration significantly decreases blood product transfusion requirements in the setting of thoracic aortic surgery requiring deep hypothermic circulatory arrest, and it does not appear to be associated with renal or myocardial dysfunction.
MB: As it was retrospective I assume it was not blinded etc.

ARTICLE TITLE: Electroencephalogram bispectral index predicts hemodynamic and arousal reactions during induction of anesthesia in patients undergoing cardiac surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p693-7
AUTHOR(S): Heck M; Kumle B; Boldt J; Lang J; Lehmann A; Saggau W
AUTHOR'S ADDRESS: Department of Anesthesiology and Operative Intensive Care, and the Clinic of Cardiac Surgery, Ludwigshafen am Rhein, Germany.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: OBJECTIVE: To evaluate hemodynamic and clinical responses to induction of anesthesia and intubation at 3 different values of the electroencephalogram bispectral index (BIS). DESIGN: Prospective randomized trial. SETTING: University-affiliated hospital. PARTICIPANTS: Forty-five patients undergoing elective coronary artery bypass graft surgery. INTERVENTIONS: Patients were assigned to 3 groups (n = 15 for each group). Anesthesia was induced with midazolam, sufentanil, and pancuronium. In each group, sufentanil was titrated to a BIS value of 60, 50, or 40 before intubation. Mean arterial blood pressure, heart rate, incidence of coughing, tearing, and need for fluid replacement or injections of norepinephrine were recorded before intubation as well as immediately and 1 and 2 minutes after intubation. MEASUREMENTS AND MAIN RESULTS: Thirteen patients intubated at a BIS value of 60 coughed and 14 experienced tearing after intubation, whereas no patient of the other groups showed signs of arousal. Mean arterial blood pressure remained stable in the BIS 60 and 50 groups, whereas in the BIS 40 group it decreased significantly to lower values before and after intubation. Patients in the BIS 40 group needed significantly more fluid replacement and injections of norepinephrine compared with the other groups. No significant changes in heart rate were detected. CONCLUSIONS: Electroencephalogram BIS predicts hemodynamic and arousal reaction resulting from induction of anesthesia and endotracheal intubation. BIS value should be kept at 50 before intubation to ensure safe hemodynamic conditions during induction of anesthesia in cardiac surgical patients.
MB: Sounds pretty low quality anaesthesia if they were giving vasoactive drugs to elevate the blood pressure.

ARTICLE TITLE: Pro: nonsteroidal anti-inflammatory drugs should be routinely administered for postoperative analgesia after cardiac surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p731-4
AUTHOR(S): Ralley FE; Day FJ; Cheng DC
AUTHOR'S ADDRESS: Department of Anesthesia, University Hospital University of Western Ontario, Canada.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Con: nonsteroidal anti-inflammatory drugs should not be routinely administered for postoperative analgesia after cardiac surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Dec 2000, 14(6) p735-8
AUTHOR(S): Griffin M
AUTHOR'S ADDRESS: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: I don't think debating is a sensible to decide a scientific matter.

ARTICLE TITLE: Pro: tracheal extubation should occur routinely in the operating room after cardiac surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Oct 2000, 14(5) p603-10
AUTHOR(S): Lee TW; Jacobsohn E
AUTHOR'S ADDRESS: Department of Anesthesia, Health Sciences Centre, University of Manitoba, Winnipeg, Canada.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Con: tracheal extubation should not occur routinely in the operating room after cardiac surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Oct 2000, 14(5) p611-3
AUTHOR(S): Peragallo RA; Cheng DC
AUTHOR'S ADDRESS: Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Thermal energy balance as a measure of adequate rewarming from hypothermic cardiopulmonary bypass.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Aug 2000, 14(4) p388-92
AUTHOR(S): Deakin CD; Clewlow F; Pierce JM
AUTHOR'S ADDRESS: Department of Anaesthetics, Southampton General Hospital, England. cddeakin@hotmail.com.
PUBLICATION TYPE: Journal Article
CONCLUSION: Thermal energy balance (TEB) (net heat supplied to or removed from the body, from initiation to termination of cardiopulmonary bypass (CPB)) is a better predictor than corresponding values of core temperature on termination of CPB in predicting the coldest postoperative temperature and time to rewarm to 37 degrees C.

ARTICLE TITLE: Heat preservation during cardiac surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Oct 2000, 14(5) p499-500
AUTHOR(S): Sessler DI; Weakley L; Weakley S
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: sufentanil-midazolam versus remifentanil-propofol.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Aug 2000, 14(4) p416-20
AUTHOR(S): Lehmann A; Zeitler C; Thaler E; Isgro F; Boldt J
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Germany.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Both anesthesia regimens provided stable hemodynamics and adequate anesthesia in patients undergoing coronary artery bypass graft surgery.

ARTICLE TITLE: Sevoflurane-fentanyl versus etomidate-fentanyl for anesthetic induction in coronary artery bypass graft surgery patients.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Aug 2000, 14(4) p421-4
AUTHOR(S): Cheong KF; Choy JM
AUTHOR'S ADDRESS: Department of Anaesthesia, National University Hospital, Singapore, Singapore.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Sevoflurane inhalation induction produced minimal changes in cardiac index and no airway complications in patients with coronary artery disease with good left ventricular function. Induction was faster with etomidate, however, and blood pressure remained higher.

ARTICLE TITLE: Pharmacologic neuroprotection in experimental spinal cord ischemia: a systematic review.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jan 2001, 13(1) p3-12
AUTHOR(S): de Haan P; Kalkman CJ; Jacobs MJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Academic Hospital, University of Amsterdam, The Netherlands.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Various surgical procedures may cause temporary interruption of spinal cord blood supply and may result in irreversible ischemic injury and neurological deficits. The cascade of events that leads to neuronal death following ischemia may be amenable to pharmacological manipulations that aim to increase the tolerable duration of ischemia. Many agents have been evaluated in experimental spinal cord ischemia (SCI). In order to investigate whether an agent is available that justifies clinical evaluation, the literature on pharmacological neuroprotection in experimental SCI was systematically reviewed to assess the neuroprotective efficacy of the various agents. In addition, the strength of the evidence for neuroprotection was investigated by analyzing the methodology. The authors used a systematic review to conduct this evaluation. The included studies were analyzed for neuroprotection and methodology. In order to be able to compare the various agents for neuroprotective efficacy, relative risks and confidence intervals were calculated from the data in the results sections. A total of 103 studies were included. Seventy-nine different agents were tested. Only 14 of the agents tested did not afford protection at all. A large variation was observed in the experimental models to produce SCI. This variation limited comparison of the individual agents. In 48 studies involving 31 single agents, the relative risks and confidence intervals could be calculated. An analysis of the methodology revealed poor temperature management and lack of statistical power in the majority of the 103 studies. The results suggest that numerous agents may protect the spinal cord from transient ischemia. However, poor temperature management and lack of statistical power severely weakened the evidence. Consequently, clinical evaluation of pharmacological neuroprotection in surgical procedures that carry a risk of ischemic spinal cord damage is not justified on the basis of this study.

ARTICLE TITLE: So much promise, so little power.
COMMENTS: J Neurosurg Anesthesiol. 2001 Jan; 13(1):13-8/21017522
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jan 2001, 13(1) p1-2
AUTHOR(S): Hartung J
PUBLICATION TYPE: Comment; Editorial
MB: A very cynical summary of the hopeless studies reviewed in the preceding paper.

ARTICLE TITLE: Asleep-Awake-Asleep general anesthesia for open cervical rhizotomy: case report and description of the technique [In Process Citation]
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Oct 2000, 12(4) p356-8
AUTHOR(S): O'Shea JP; Sarwat MA; Sutcliffe CJ
AUTHOR'S ADDRESS: Royal London Hospital, Whitechapel, United Kingdom.
PUBLICATION TYPE: Journal Article
ABSTRACT: The authors describe the technique of Asleep-Awake-Asleep anesthesia for open dorsal rhizotomy in a 78-year-old female patient, admitted to the hospital with intractable pain in the distribution of C2 dermatome following a road traffic accident. The patient was anesthetised and the rhizotomy performed using the intradural approach. Anesthesia was conducted by Total Intravenous Anesthesia using a Target Controlled Infusion system. The patient was awakened twice intraoperatively to verify success of the rhizotomy. Complete pain relief was obtained and maintained at 1 year follow-up.
MB: I would think this was about the only indication for cervical epidural.

ARTICLE TITLE: Sevoflurane (0.4 MAC) does not influence cerebral compliance in healthy individuals [In Process Citation]
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Oct 2000, 12(4) p319-23
AUTHOR(S): Kolbitsch C; Lorenz HI; Hormann C; Schocke M; Felber S; Zschiegner F; Pfeiffer PK; Benzer A
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care Medicine, University of Innsbruck, Austria.
PUBLICATION TYPE: Clinical Trial; Journal Article
We conclude that low-dose administration of sevoflurane does not influence cerebral compliance in healthy individuals, but the influence of coexisting intracranial pathology or comedications on cerebral compliance requires further clinical investigation.

ARTICLE TITLE: Neuroendoscopic procedures: anesthetic considerations for a growing trend: a review.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jul 2000, 12(3) p262-70
AUTHOR(S): Ambesh SP; Kumar R
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Giraffes, siphons, and starling resistors. Cerebral perfusion pressure revisited.
COMMENTS: J Neurosurg Anesthesiol. 2000 Jul; 12(3):210-6
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jul 2000, 12(3) p290-6
AUTHOR(S): Munis JR; Lozada LJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Cost-effectiveness of screening for colorectal cancer in the general population.
ARTICLE SOURCE: JAMA (United States), Oct 18 2000, 284(15) p1954-61
AUTHOR(S): Frazier AL; Colditz GA; Fuchs CS; Kuntz KM
AUTHOR'S ADDRESS: Channing Laboratory, 181 Longwood Ave, Boston, MA 02115, USA. lindsay.frazier@channing.harvard.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Screening for colorectal cancer (CRC), even in the setting of imperfect compliance, significantly reduces CRC mortality at costs comparable to other cancer screening procedures. However, compliance rates significantly affect the incremental cost-effectiveness (CE) ratios. In this model of CRC, 60% compliance with an every 5-year schedule of screening was roughly equivalent to 100% compliance with an every 10-year schedule. Mathematical modeling used to inform clinical guidelines needs to take into account expected compliance rates..

ARTICLE TITLE: A proposed national policy on health care workers living with HIV/AIDS and other blood-borne pathogens.
COMMENTS: JAMA. 2000 Oct 18; 284(15):1975-6/20491089
ARTICLE SOURCE: JAMA (United States), Oct 18 2000, 284(15) p1965-70
AUTHOR(S): Gostin LO
AUTHOR'S ADDRESS: Georgetown University Law Center, 600 New Jersey Ave NW, Washington, DC 20001-2075, USA. gostin@law.georgetown.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: In 1991, scientific uncertainty about the risk of transmission of human immunodeficiency virus or hepatitis B virus (hepatitis B e antigen [HBeAg]-positive) led the Centers for Disease Control and Prevention to recommend that infected health care workers (HCWs) be reviewed by an expert panel and inform patients of their serologic status before engaging in exposure-prone procedures. The data demonstrate that risks of transmission in the health care setting are exceedingly low, suggesting that the national policy should be reformed

ARTICLE TITLE: Screening strategies for early detection of lung cancer: the time is now.
ARTICLE SOURCE: JAMA (United States), Oct 18 2000, 284(15) p1977-80
AUTHOR(S): Petty TL
AUTHOR'S ADDRESS: National Lung Health Education Program, 1850 High St, Denver, CO 80218, USA. tlpdoc@aol.com.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Routine screening for lung cancer?: Maybe someday, but not yet.
ARTICLE SOURCE: JAMA (United States), Oct 18 2000, 284(15) p1980-3
AUTHOR(S): Frame PS
AUTHOR'S ADDRESS: Tri-County Family Medicine, Cohocton, NY 14826, USA. psframe@frontiernet.net.
PUBLICATION TYPE: Journal Article
MB: When I was young (1950s) when we had routine compusory chest x-rays for tuberculosis the commonest presentation of carcinoma of the lungs were this TB screening. A lot of congenital heart disease had a similar presentation.

ARTICLE TITLE: Relation between hospital primary angioplasty volume and mortality for patients with acute MI treated with primary angioplasty vs thrombolytic therapy.
COMMENTS: JAMA. 2000 Dec 27; 284(24):3169-71/20578280
ARTICLE SOURCE: JAMA (United States), Dec 27 2000, 284(24) p3131-8
AUTHOR(S): Magid DJ; Calonge BN; Rumsfeld JS; Canto JG; Frederick PD; Every NR; Barron HV
AUTHOR'S ADDRESS: Colorado Permanente Clinical Research Unit, 10350 E Dakota Ave, Denver, CO 80231, USA. David.J.Magid@kp.org; Collective Name: National Registry of Myocardial Infarction 2 and 3 Investigators.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In this study, patients with acute myocardial infarction (AMI) treated at hospitals with high or intermediate volumes of primary angioplasty had lower mortality with primary angioplasty than with thrombolysis, whereas patients with AMI treated at hospitals with low angioplasty volumes had similar mortality outcomes with primary angioplasty or thrombolysis.
MB: Why would anyone object to bypassing other hopsitals to get to RNSH if they had a suspected AMI.

ARTICLE TITLE: Relation between operator and hospital volume and outcomes following percutaneous coronary interventions in the era of the coronary stent.
COMMENTS: JAMA. 2000 Dec 27; 284(24):3169-71/20578280
ARTICLE SOURCE: JAMA (United States), Dec 27 2000, 284(24) p3139-44
AUTHOR(S): McGrath PD; Wennberg DE; Dickens JD; Siewers AE; Lucas FL; Malenka DJ; Kellett MA; Ryan TJ
AUTHOR'S ADDRESS: Center for Outcomes Research and Evaluation, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA. mcgrap@mail.mmc.org.
PUBLICATION TYPE: Journal Article
CONCLUSION: In the era of coronary stents, Medicare patients treated by high-volume physicians and at high-volume centers experience better outcomes following percutaneous coronary interventions (PCIs).
MB: Maybe we don't need the RNSH study. Just send them there. If I lived in the area and I had a suspected infarct I would direct the ambulance to by-pass the other hospitals & take me there. For everything else of course I would direct them over the bridge to RPAH.

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Declines in lung cancer rates--California, 1988-1997.
ARTICLE SOURCE: JAMA (United States), Dec 27 2000, 284(24) p3121-2
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Influence of hospital procedure volume on outcomes following surgery for colon cancer.
ARTICLE SOURCE: JAMA (United States), Dec 20 2000, 284(23) p3028-35
AUTHOR(S): Schrag D; Cramer LD; Bach PB; Cohen AM; Warren JL; Begg CB
AUTHOR'S ADDRESS: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. schragd@mskcc.org.
PUBLICATION TYPE: Journal Article
CONCLUSION: Our data suggest that hospital procedure volume predicts clinical outcomes following surgery for colon cancer, although the absolute magnitudes of these differences are modest in comparison with the variation observed for higher-risk cancer surgeries.
MB: I want to go somewhere where they do lots.

ARTICLE TITLE: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
ARTICLE SOURCE: JAMA (United States), Dec 20 2000, 284(23) p3043-5
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Perspectives on the Fifth Revision of the Declaration of Helsinki.
ARTICLE SOURCE: JAMA (United States), Dec 20 2000, 284(23) p3045-6
AUTHOR(S): Riis P
AUTHOR'S ADDRESS: Committee on Scientific Dishonesty, Ministry of Science, Copenhagen, Denmark.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Consensus statement on the live organ donor.
ARTICLE SOURCE: JAMA (United States), Dec 13 2000, 284(22) p2919-26
AUTHOR(S): Abecassis M; Adams M; Adams P; Arnold RM; Atkins CR; Barr ML; Bennett WM; Bia M; Briscoe DM; Burdick J; Corry RJ; Davis J; Delmonico FL; Gaston RS; Harmon W; Jacobs CL; Kahn J; Leichtman A; Miller C; Moss D; Newmann JM; Rosen LS; Siminoff L; Spital A; Starnes VA; Thomas C; Tyler LS; Williams L; Wright FH; Youngner S
AUTHOR'S ADDRESS: Collective Name: The Live Organ Donor Consensus Group.
PUBLICATION TYPE: Consensus Development Conference; Journal Article
CONCLUSION: The person who gives consent to be a live organ donor should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of the risks, benefits, and alternative treatment available to the recipient. The benefits to both donor and recipient must outweigh the risks associated with the donation and transplantation of the living donor organ.

ARTICLE TITLE: Seven legal barriers to end-of-life care: myths, realities, and grains of truth.
ARTICLE SOURCE: JAMA (United States), Nov 15 2000, 284(19) p2495-501
AUTHOR(S): Meisel A; Snyder L; Quill T
AUTHOR'S ADDRESS: Center for Ethics and Professionalism, American College of Physicians-American Society of Internal Medicine, 190 N Independence Mall W, Philadelphia, PA 19106, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Legal myths about end-of-life care can undermine good care and ethical medical practice. In addition, at times ethics, clinical judgment, and the law conflict. Patients (or families) and physicians can find themselves considering clinical actions that are ethically appropriate, but raise legal concerns. The 7 major legal myths regarding end-of-life care are: (1) forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patient's actual wish; (2) withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal; (3) risk management personnel must be consulted before life-sustaining medical treatment may be terminated; (4) advance directives must comply with specific forms, are not transferable between states, and govern all future treatment decisions; oral advance directives are unenforceable; (5) if a physician prescribes or administers high doses of medication to relieve pain or other discomfort in a terminally ill patient, resulting in death, he/she will be criminally prosecuted; (6) when a terminally ill patient's suffering is overwhelming despite palliative care, and he/she requests a hastened death, there are no legally permissible options to ease suffering; and (7) the 1997 Supreme Court decisions outlawed physician-assisted suicide. Many legal barriers to end-of-life care are more mythical than real, but sometimes there is a grain of truth. Physicians must know the law of the state in which they practice

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Screening with the prostate-specific antigen test--Texas, 1997.
ARTICLE SOURCE: JAMA (United States), Nov 8 2000, 284(18) p2313-4
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: New guidelines for cardiopulmonary resuscitation and emergency cardiac care: changes in the management of cardiac arrest
ARTICLE SOURCE: JAMA (United States), Mar 14 2001, 285(10) p1267-9
AUTHOR(S): Kern KB; Halperin HR; Field J
AUTHOR'S ADDRESS: University of Arizona, Sarver Heart Center, Section of Cardiology, 1501 N Campbell Ave, Tucson, AZ 85724, USA. kernk@u.arizona.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Improving survival from sudden cardiac arrest: the role of the automated external defibrillator
ARTICLE SOURCE: JAMA (United States), Mar 7 2001, 285(9) p1193-200
AUTHOR(S): Marenco JP; Wang PJ; Link MS; Homoud MK; Estes NA
AUTHOR'S ADDRESS: New England Cardiac Arrhythmia Center, Division of Cardiology, New England Medical Center, 750 Washington St, Boston, MA 02111, USA. nestes@lifespan.org.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
CONCLUSION: The automated external defibrillators (AEDs) represents an efficient method of delivering defibrillation to persons experiencing out-of-hospital cardiac arrest and its use by both traditional and nontraditional first responders appears to be safe and effective. The rapidly expanding role of AEDs in traditional emergency medical systems is supported by the literature, and initial studies of public access to defibrillation offer hope that further improvements in survival after sudden cardiac death can be achieved.

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Hypothermia-related deaths--Suffolk County, New York, January 1999-March 2000, and United States, 1979-1998.
ARTICLE SOURCE: JAMA (United States), Feb 28 2001, 285(8) p1009-10
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Public Health Service recommendations for the use of vaccines manufactured with bovine-derived materials.
ARTICLE SOURCE: JAMA (United States), Feb 7 2001, 285(5) p532
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The consent process for cadaveric organ procurement: how does it work? How can it be improved?
COMMENTS: JAMA. 2001 Jan 17; 285(3):334-6/21105411
ARTICLE SOURCE: JAMA (United States), Jan 17 2001, 285(3) p329-33
AUTHOR(S): Wendler D; Dickert N
AUTHOR'S ADDRESS: Department of Clinical Bioethics, Bldg 10, Room 1C118, National Institutes of Health, Bethesda, MD 20892, USA. wendler@nih.gov.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Expanding the legal scope of living wills to cover individuals' organ donation preferences would likely have little impact on procurement rates. In contrast, expanding the legal scope of durable powers of attorney for health care may have a significant impact. A national discussion should take place addressing the underlying ethical issues that appear to account for much of the divergence among organ procurement organizations' (OPOs) consent practices for cadaveric solid organ procurement.

ARTICLE TITLE: Reexamining organ transplantation.
COMMENTS: JAMA. 2001 Jan 17; 285(3):329-33/21105410
ARTICLE SOURCE: JAMA (United States), Jan 17 2001, 285(3) p334-6
AUTHOR(S): Capron AM
AUTHOR'S ADDRESS: The Law School, University of Southern California, 699 Exposition Blvd, Los Angeles, CA 90089-0071, USA. acapron@law.usc.edu.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: One-year survival following early revascularization for cardiogenic shock.
ARTICLE SOURCE: JAMA (United States), Jan 10 2001, 285(2) p190-2
AUTHOR(S): Hochman JS; Sleeper LA; White HD; Dzavik V; Wong SC; Menon V; Webb JG; Steingart R; Picard MH; Menegus MA; Boland J; Sanborn T; Buller CE; Modur S; Forman R; Desvigne-Nickens P; Jacobs AK; Slater JN; Le Jemtel TH
AUTHOR'S ADDRESS: St Luke's-Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY 10025, USA; Collective Name: SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: For patients with acute myocardial infarction (AMI) complicated by Cardiogenic shock (CS), early revascularization (ERV) resulted in improved 1-year survival. We recommend rapid transfer of patients with AMI complicated by CS, particularly those younger than 75 years, to medical centers capable of providing early angiography and revascularization procedures.

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Unpowered scooter-related injuries--United States, 1998-2000.
ARTICLE SOURCE: JAMA (United States), Jan 3 2001, 285(1) p36-7
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: From the Centers for Disease Control and Prevention. End-stage renal disease attributed to diabetes among American Indians/Alaska natives with diabetes--United States, 1990-1996.
ARTICLE SOURCE: JAMA (United States), Jan 3 2001, 285(1) p37-8
PUBLICATION TYPE: Journal Article
MB: I suppose they have the same problems as the Aboriginals.

ARTICLE TITLE: Seeking a simple measure of analgesia for mega-trials: is a single global assessment good enough
ARTICLE SOURCE: Pain (Netherlands), Mar 2001, 91(1-2) p189-94
AUTHOR(S): Collins SL; Edwards J; Moore RA; Smith LA; McQuay HJ
AUTHOR'S ADDRESS: Pain Research Unit and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, The Churchill, Headington, OX3 7LJ, Oxford, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: We sought to investigate the potential of using a simple global estimation ('How effective do you think the treatment was?') as a measure of efficacy by comparing it with at least 50%maxTOTPAR (at least 50% of the maximum possible pain relief) in acute pain studies. One hundred and fifty randomized, double-blind trials included in 11 systematic reviews of single dose, oral analgesics for postoperative pain were used as a source of data. The relationship between the proportion of patients reporting the top two or three values on a five-point global scale and the proportion with at least 50%maxTOTPAR was investigated. Twenty-six trials provided data on the proportion reporting the top two categories (very good or excellent) and 27 gave data on the top three categories (good, very good or excellent). The relationship between the percentage of patients recording the top two categories on a five-point global scale and the proportion with at least 50%maxTOTPAR was fair (r(2)=0.67). That for the top three categories was less good (r(2)=0.57). Similar numbers-needed-to-treat were calculated for aspirin 600/650 mg and ibuprofen 400 mg using at least 50%maxTOTPAR and the top two categories. No real difference was seen in the correlation for standard wording compared to non-standard wording. Individual patient data were also used from four randomized, placebo-controlled, double-blind trials in postoperative pain. The frequency distribution for %maxTOTPAR was plotted for patients reporting each of the five categories on the global scale. A global assessment provides similar measures of analgesic efficacy as TOTPAR derived from hourly measurements, but the effects of adverse effects have yet to be understood.

ARTICLE TITLE: Assessing placebo effects without placebo groups: an untapped possibility?
ARTICLE SOURCE: Pain (Netherlands), Feb 15 2001, 90(3) p201-3
AUTHOR(S): Price DD
AUTHOR'S ADDRESS: Department of Oral and Maxillofacial Surgery,University of Florida, FL, 32605, Gainesville, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Characteristics and prediction of early pain after laparoscopic cholecystectomy [In Process Citation]
ARTICLE SOURCE: Pain (Netherlands), Feb 15 2001, 90(3) p261-9
AUTHOR(S): Bisgaard T; Klarskov B; Rosenberg J; Kehlet H
AUTHOR'S ADDRESS: Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, DK- 2650, Hvidovre, Denmark.
PUBLICATION TYPE: Journal Article
Our results suggest that future analgesic studies after laparoscopic cholecystectomy should focus on reduction of incisional pain.
MB: Do you think it is really necessary?

ARTICLE TITLE: The effect of opioids on phantom limb pain and cortical reorganization [In Process Citation]
ARTICLE SOURCE: Pain (Netherlands), Feb 1 2001, 90(1-2) p47-55
AUTHOR(S): Huse E; Larbig W; Flor H; Birbaumer N
AUTHOR'S ADDRESS: Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University of Tubingen, Gartenstrasse 29, 72074, Tubingen, Germany.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Chronic pain in Australia: a prevalence study [In Process Citation]
ARTICLE SOURCE: Pain (Netherlands), Jan 2001, 89(2-3) p127-34
AUTHOR(S): Blyth FM; March LM; Brnabic AJ; Jorm LR; Williamson M; Cousins MJ
AUTHOR'S ADDRESS: Pain Management and Research Centre, University of Sydney, Royal North Shore Hospital, NSW 2065,., St. Leonards, Australia.
PUBLICATION TYPE: Journal Article
There were strong associations between having interfering chronic pain and receiving disability benefits (adjusted OR=3.31, P<0.001) or being unemployed due to health reasons (adjusted OR=7.94, P<0.001, respectively). The results show that chronic pain impacts upon a large proportion of the adult Australian population, including the working age population, and is strongly associated with markers of social disadvantage.

ARTICLE TITLE: Learning and memory in pain pathways.
ARTICLE SOURCE: Pain (Netherlands), Nov 2000, 88(2) p113-8
AUTHOR(S): Sandkuhler J
AUTHOR'S ADDRESS: Department of Physiology and Pathophysiology, University of Heidelberg, Im Neuenheimer Feld 326, D-69120 Heidelberg, Germany. sandkuhler@urz.uni-heidelberg.de.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers.
ARTICLE SOURCE: Pain (Netherlands), Oct 2000, 88(1) p7-14
AUTHOR(S): Lin CC
AUTHOR'S ADDRESS: School of Nursing, Taipei Medical College, Taiwan. clin@mail.tmc.edu.tw.
PUBLICATION TYPE: Journal Article
Patient concerns were related to their hesitancy to take analgesics and, similarly, caregiver concerns were related to their hesitancy to administer analgesics. Most importantly, patient and caregiver concerns had an impact on how the patients' pain was managed: (1) patients and their family caregivers with higher levels of concerns used inadequate analgesics as compared to patients using adequate analgesics; (2) family caregiver barriers (concerns) were a significant predictor of inadequate management of cancer pain (after controlling for demographic and disease variables). Therefore, educational interventions for overcoming these barriers for both patients and their family caregivers may have potential for improving the management of cancer pain in Taiwan.

ARTICLE TITLE: Dynorphin: friend or foe?
ARTICLE SOURCE: Pain (Netherlands), Sep 2000, 87(3) p235-9
AUTHOR(S): Caudle RM; Mannes AJ
AUTHOR'S ADDRESS: Department of Oral Surgery, Division of Neuroscience, University of Florida College of Dentistry, P.O. Box 100416, FL 32610, Gainesville, USA. rcaudle@dental.ufl.edu.
PUBLICATION TYPE: Journal Article; Review; Review Literature

ARTICLE TITLE: Revascularization for cardiogenic shock
ARTICLE SOURCE: QJM (England), Feb 2001, 94(2) p57-67
AUTHOR(S): Davies C
AUTHOR'S ADDRESS: Department of Cardiology, Oregon Health Sciences University, Portland, Oregon, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea
ARTICLE SOURCE: QJM (England), Feb 2001, 94(2) p95-9
AUTHOR(S): Jenkinson C; Davies R; Mullins R; Stradling J
AUTHOR'S ADDRESS: Health Services Research Unit, Division of Public Health and Primary Health Care, University of Oxford, and Picker Institute Europe, Oxford, Osler Chest Unit, Churchill Hospital Campus, Oxford Radcliffe Trust, Oxford, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Should aminophylline be abandoned in the treatment of acute asthma in adults?
ARTICLE SOURCE: QJM (England), Nov 2000, 93(11) p761-5
AUTHOR(S): Hart SP
AUTHOR'S ADDRESS: Respiratory Medicine Unit, Western General Hospital, Edinburgh, UK. whart@globalnet.co.uk.
PUBLICATION TYPE: Journal Article; Review; Review Literature
There is presently no evidence to support the use of aminophylline in addition to standard therapy for acute asthma in adults.
MB: I thought it worked quite well when I ws a resident in emergency.

ARTICLE TITLE: The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination.
ARTICLE SOURCE: QJM (England), Oct 2000, 93(10) p685-8
AUTHOR(S): Das P; Pocock C; Chambers J
AUTHOR'S ADDRESS: Department of Cardiology, Guy's and St. Thomas' Hospitals, London, UK. pauldas@compuserve.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Snoring, sleep apnoea and stroke: chicken or scrambled egg?
ARTICLE SOURCE: QJM (England), Oct 2000, 93(10) p647-54
AUTHOR(S): Harbison JA; Gibson GJ
AUTHOR'S ADDRESS: Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Is there evidence for exogenous risk factors in the aetiology and spread of Creutzfeldt-Jakob disease?
ARTICLE SOURCE: QJM (England), Sep 2000, 93(9) p617-31
AUTHOR(S): Hillier CE; Salmon RL
AUTHOR'S ADDRESS: Welsh Combined Centres for Public Health, University of Wales College of Medicine, Cardiff, UK. charlie.hillier@cdsc.wales.nhs.uk.
PUBLICATION TYPE: Journal Article; Meta-Analysis

ARTICLE TITLE: Atrial electrical remodelling and atrial fibrillation.
ARTICLE SOURCE: QJM (England), Sep 2000, 93(9) p563-5
AUTHOR(S): Garratt CJ; Fynn SP
PUBLICATION TYPE: Editorial