MB's Articles of Interest - November 2001

ARTICLE TITLE: Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Aug 2001, 45(7) p812-7
AUTHOR(S): Nilsson U; Rawal N; Unestahl LE; Zetterberg C; Unosson M
AUTHOR'S ADDRESS: Department of Medicine and Care, Division of Nursing Science, Faculty of Health Science, Linkoping, Sweden. ulrica.nilsson@orebroll.se.
PUBLICATION TYPE: Journal Article
RESULTS: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups. CONCLUSION: This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.
MB: I don't think I 'd bother.

ARTICLE TITLE: Being awake intermittently during propofol-induced hypnosis: A study of BIS, explicit and implicit memory
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jul 2001, 45(7) p834-8
AUTHOR(S): Barr G; Anderson RE; Owall A; Jakobsson JG
AUTHOR'S ADDRESS: Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital and Department of Anaesthesiology, Sabbatsberg Hospital, Stockholm, Sweden.
PUBLICATION TYPE: Journal Article
CONCLUSION: The Bispectral index (BIS) decreases with increasing sedation but because of the large individual variations, the real-time BIS-index for the individual subject cannot reliably discriminate wakefulness from unconsciousness during propofol infusion. Propofol causes such profound amnesia that lack of postoperative recall does not assure that episodes of awareness have not occurred during propofol-induced hypnosis.
MB: Well does it matter then?

ARTICLE TITLE: Do anaesthetized patients recover better after Bispectral Index Monitoring?
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Jun 2001, 29(3) p239-45
AUTHOR(S): Burrow B; McKenzie B; Case C
AUTHOR'S ADDRESS: Department of Anaesthetics, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld. 4102.
PUBLICATION TYPE: Journal Article
ABSTRACT: Could Bispectral Index (BIS) monitoring during anaesthesia improve the recovery characteristics of patients? Previous studies have shown conflicting results. To eliminate bias, a control group of 75 cases anaesthetized by the authors was compared to a reference group of 141 cases anaesthetized by other anaesthetists. A study group of 71 cases was then anaesthetized by the authors titrating to BIS 40-50 and this was compared with the control group. Recovery characteristics were assessed using a Modified Aldrete score. BIS monitored cases had improvements in blood pressure stability (P = 0.023) and respiratory score (P = 0.016) throughout the study period. Activity and consciousness levels were higher on arrival in PACU in the BIS monitored group (P = 0.015 and P = 0.017) but were not maintained. There was no significant difference in mean oxygen saturation scores. The improved recovery characteristics in BIS monitored patients may have positive implications for safety, nursing workload, staffing, and cost savings in the PACU.
MB: It does not look as though it is a blind trial. Maybe if they are more awake at the end there was more awareness.

ARTICLE TITLE: Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jul 2001, 45(7) p795-804
AUTHOR(S): Walder B; Schafer M; Henzi I; Tramer MR
AUTHOR'S ADDRESS: Division of Surgical Intensive Care, and Division of Anaesthesiology, Department APSIC, Geneva University Hospitals, Geneva, Switzerland.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: The usefulness of intravenous patient-controlled analgesia (PCA) with opioids for postoperative analgesia is not well defined. METHODS: We systematically searched (MEDLINE, EMBASE, Cochrane Library, bibliographies, any language, to January 2000) for randomised trials comparing opioid-based PCA with the same opioid given intramuscularly, intravenously, or subcutaneously. Weighted mean differences (WMD) for continuous data, relative risks (RR) and numbers-needed-to-treat (NNT) for dichotomous data were calculated with 95% confidence intervals (CI) using fixed and random effects models. RESULTS: Data from 32 trials were analysed: 22 (1139 patients) were with morphine, five (682) with pethidine, three (184) with piritramide, one (47) with nalbuphine and one (20) with tramadol. In three morphine and one pethidine trial (352 patients), more patients preferred PCA (89.7% vs 65.8%, RR 1.41 (95%CI 1.11 to 1.80), NNT 4.2). Combined dichotomous data on pain intensity and relief, and the need for rescue analgesics from eight morphine, one pethidine, one piritramide, and one nalbuphine trial (691 patients), were in favour of PCA (RR 1.22 (1.00 to 1.50), NNT 8). In two morphine trials (152), pulmonary complications were more frequently prevented with PCA (100% vs 93.3%, RR 1.07 (1.01 to 1.14), NNT 15). There was equivalence for cumulative opioid consumption, pain scores, duration of hospital stay, and opioid-related adverse effects. CONCLUSION: These trials provide some evidence that in the postoperative pain setting, PCA with opioids, compared with conventional opioid treatment, improve analgesia and decrease the risk of pulmonary complications, and that patients prefer them.
MB: This is not very good assuming they wanted to find a positive result. A lot did not prefer PCA. There was not much evidence for reduction of respiratory complications.

ARTICLE TITLE: Meta-analysis - a valuable but easily misused tool
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jul 2001, 45(6) p657-8
AUTHOR(S): Rasmussen LS; Dahl JB
AUTHOR'S ADDRESS: Departments of Anaesthesia, Rigshospitalet and Herlev Hospital, Copenhagen, Denmark.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Late mortality after orthotopic liver transplantation.
ARTICLE SOURCE: Am J Surg (United States), May 2001, 181(5) p475-9
AUTHOR(S): Rabkin JM; de La Melena V; Orloff SL; Corless CL; Rosen HR; Olyaei AJ
AUTHOR'S ADDRESS: Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health Sciences University and Portland Veterans Affairs Medical Center, 3181 SW Sam Jackson Park Road, L590, Portland, OR 97201-3098, USA. rabkinj@ohsu.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Malignancy and disease recurrence are the major causes of late mortality among adult OLTx recipients. Pharmacologic immunosuppression is associated with many of the causes of late mortality. Advances in immunosuppression with less toxicity may improve long-term survival after OLTx.

ARTICLE TITLE: Does patient position during liver surgery influence the risk of venous air embolism?
ARTICLE SOURCE: Am J Surg (United States), Apr 2001, 181(4) p366-7
AUTHOR(S): Moulton CA; Chui AK; Mann D; Lai PB; Chui PT; Lau WY
AUTHOR'S ADDRESS: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: It is generally believed that positioning of the patient in a head-down tilt (Trendelenberg position) decreases the likelihood of a venous air embolism during liver resection. METHODS: The physiological effect of variation in horizontal attitude on central and hepatic venous pressure was measured in 10 patients during liver surgery. Hemodynamic indices were recorded with the operating table in the horizontal, 20 degrees head-up and 20 degrees head-down positions. RESULTS: There was no demonstrable pressure gradient between the hepatic and central venous levels in any of the positions. The absolute pressures did, however, vary in a predictable way, being highest in the head-down and lowest during head-up tilt. However, on no occasion was a negative intraluminal pressure recorded. CONCLUSION: The effect on venous pressures caused by the change in patient positioning alone during liver surgery does not affect the risk of venous air embolism.
MB: I would have thought that keeping the IVC pressure relatively high by filling of the circulation, positive end expiratory pressure and avoiding excessive flow if veno-venous bypass is used would help. Monitoring femoral vein pressure would be essential when air embolism was a risk. We had a major air embolism in our 3 ^rd liver transplant. The surgeon heard the hiss of the air.

ARTICLE TITLE: Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy.
ARTICLE SOURCE: Am J Surg (United States), Feb 2001, 181(2) p138-41
AUTHOR(S): Wilson EB; Bass CS; Abrameit W; Roberson R; Smith RW
AUTHOR'S ADDRESS: Department of Surgery, Scott and White Clinic and Memorial Hospital, Texas A&M University System Health Science Center College of Medicine, Temple 76508, USA. erikbwilson@yahoo.com.
ABSTRACT: BACKGROUND: Postoperative nausea and vomiting are significant problems in laparoscopic surgery. This double-blind, randomized, prospective trial compares the prophylactic use of metoclopramide, ondansetron, and placebo for the treatment of postoperative nausea and vomiting in patients undergoing outpatient laparoscopic cholecystectomy. CONCLUSION: Prophylactic administration of metoclopramide or ondansetron significantly reduces the incidence of postoperative vomiting for laparoscopic cholecystectomy, but neither drug was found to be significantly more effective than the other. Metoclopramide is a more cost-effective treatment.
MB: We have instituted a institutional PONV protocol. Metoclopramide has been eliminated from it.

ARTICLE TITLE: Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials.
COMMENTS: : Ann Intern Med. 2001 Aug 7; 135(3):205-8
ARTICLE SOURCE: Ann Intern Med (United States), Aug 7 2001, 135(3) p149-64
AUTHOR(S): Wilkes MM; Navickis RJ
AUTHOR'S ADDRESS: Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949, USA. mwilkes@hygeiaassociates.com.
PUBLICATION TYPE: Journal Article; Meta-Analysis
ABSTRACT: PURPOSE: To test the hypothesis that albumin administration is not associated with excess mortality. DATA SOURCES: Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists. STUDY SELECTION: Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin. DATA EXTRACTION: Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated. DATA SYNTHESIS: Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced. CONCLUSIONS: Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
MB: I have a feeling that they are asking the wrong questions.

ARTICLE TITLE: Colloid use for fluid resuscitation: evidence and spin.
COMMENTS: : Ann Intern Med. 2001 Aug 7; 135(3):149-64
ARTICLE SOURCE: Ann Intern Med (United States), Aug 7 2001, 135(3) p205-8
AUTHOR(S): Cook D; Guyatt G
PUBLICATION TYPE: Comment; Editorial
MB: There are still a lot of bad studies. Some blind ones are still going on.

ARTICLE TITLE: Physician burnout.
ARTICLE SOURCE: Ann Intern Med (United States), Jul 17 2001, 135(2) p145-8
AUTHOR(S): Gundersen L
PUBLICATION TYPE: Journal Article
MB: It says that doctors are driven & encouraged to be involved. I don't know many like that. Maybe in the US they are.

ARTICLE TITLE: Surgical treatment of atrial fibrillation using radiofrequency energy.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jun 2001, 71(6) p1939-43; discussion 1943-4
AUTHOR(S): Williams MR; Stewart JR; Bolling SF; Freeman S; Anderson JT; Argenziano M; Smith CR; Oz MC
AUTHOR'S ADDRESS: Divisio of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA. mw365@columbia.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Radiofrequency atrial ablation was effective in 81% of patients with AF at restoring sinus rhythm at an average follow-up of 4 months. This procedure is simple to perform and should broaden the number of patients that receive an AF treatment procedure during concurrent cardiac operation.
MB: They did during coincidental open cardiac surgery.

ARTICLE TITLE: Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2) p527-33; discussion 534
AUTHOR(S): Wilkes MM; Navickis RJ; Sibbald WJ
AUTHOR'S ADDRESS: Hygeia Associates, Grass Valley, California 95949, USA. mwilkes@hygeiaassociates.com.
PUBLICATION TYPE: Journal Article
Conclusions. Postoperative blood loss is significantly lower in cardiopulmonary bypass patients exposed to albumin than hydroxyethyl starch (HES).

ARTICLE TITLE: Postoperatively administered aprotinin or epsilon aminocaproic acid after cardiopulmonary bypass has limited benefit.
ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2) p521-6
AUTHOR(S): Ray MJ; Hales MM; Brown L; O'Brien MF; Stafford EG
AUTHOR'S ADDRESS: Department of Haematology, The Prince Charles Hospital, Brisbane, Australia. michael_ray@health.qld.gov.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Aprotinin or EACA administered in the early postoperative period was ineffective in reducing postoperative bleeding with the exception of a small group of patients having valve operations in whom aprotinin treatment may have shown some benefit.
MB: Should have said no effect.

ARTICLE TITLE: Prevention and detection of spinal cord injury during thoracic and thoracoabdominal aortic repairs.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jul 2001, 72(1) p80-4; discussion 85
AUTHOR(S): Wada T; Yao H; Miyamoto T; Mukai S; Yamamura M
AUTHOR'S ADDRESS: Department of Thoracic and Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan. wadatora@hyo-med.ac.jp.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Spinal cord injury is a most dreaded and unpredictable complication. In this study, based on our experimental results in dogs and early clinical results, we reviewed the incidence of paraplegia and the detection of spinal cord injury. METHODS: Eighty-two patients who underwent elective surgical repair of the descending thoracic and thoracoabdominal aorta over 17 years were subjects for this study. Sixty-two patients were male and 20 were female. Their mean age was 61.6 years (range, 17 to 81 years). Monitoring somatosensory evoked potentials (SEP) and measurement of mean distal aortic pressure and cerebrospinal fluid pressure were performed perioperatively. RESULTS: Sixty patients had no ischemic change in SEP. In 17 patients with significant ischemic changes of SEP, SEP recovered by increasing spinal cord perfusion pressure to more than 40 mm Hg. Two patients with complete loss of SEP experienced paraplegia. One patient had delayed paraplegia. CONCLUSIONS: These results strongly suggest that SEP, mean distal aortic pressure, cerebrospinal fluid pressure should be monitored during aortic cross-clamping. Maintaining spinal cord perfusion pressure at more than 40 mm Hg by increasing mean distal aortic pressure or withdrawal of cerebrospinal fluid is valuable for preventing paraplegia.
MB: Retrospective, not randomised. No universal conclusion is possible.

ARTICLE TITLE: Thoracic epidural anesthesia does not influence the occurrence of postoperative sustained atrial fibrillation.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jul 2001, 72(1) p65-71
AUTHOR(S): Jideus L; Joachimsson PO; Stridsberg M; Ericson M; Tyden H; Nilsson L; Blomstrom P; Blomstrom-Lundqvist C
AUTHOR'S ADDRESS: Department of Surgical Sciences, University Hospital, Uppsala, Sweden. lena.jideus@kirurgi.uu.se.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: thoracic epidural anesthesia (TEA) has no effect on the incidence of postoperative sustained atrial fibrillation (AF, despite a significant reduction in sympathetic activity.
MB: Another inconclusive study. How long does this nonsense have to continue to root out the deeply entrenched view/wish/hope that epidurals must be better than no epidurals? It is an extra invasion and has occasional catastrophic results & no benefit other than hope.

ARTICLE TITLE: Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of "limited" resuscitations.
ARTICLE SOURCE: Arch Intern Med (United States), Jul 23 2001, 161(14) p1751-8
AUTHOR(S): Dumot JA; Burval DJ; Sprung J; Waters JH; Mraovic B; Karafa MT; Mascha EJ; Bourke DL
AUTHOR'S ADDRESS: Anesthesiology Service, Baltimore Veterans Affairs Medical Center, 13004 Gent Rd, Reisterstown, MD 21136-5717, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Very ill patients in unmonitored beds are at increased risk for a nonwitnessed cardiac arrest and poor resuscitation outcome during the night. Closer vigilance of these patients at night is warranted. The outcome of limited resuscitation efforts is very poor.

ARTICLE TITLE: Severe bradycardia after a methylprednisolone "minipulse" treatment.
ARTICLE SOURCE: Arch Intern Med (United States), Jul 23 2001, 161(14) p1778-9
AUTHOR(S): Pudil R; Hrncir Z
PUBLICATION TYPE: Journal Article
MB: The cases reported incidences some time after the slow infusion which had been repeated over several days. The causation sounds pretty far fetched to me.

ARTICLE TITLE: What killed Mozart?
ARTICLE SOURCE: Arch Intern Med (United States), Jun 11 2001, 161(11) p1381-9
AUTHOR(S): Hirschmann JV
AUTHOR'S ADDRESS: Medical Service (111), Puget Sound Veterans Affairs Medical Center, 1660 S Columbian Way, Seattle, WA 98108, USA. pepsi@u.washington.edu.
PUBLICATION TYPE: Biography; Historical Article; Journal Article
MB: Very good. Much better ---& longer---than anything else I have read on the subject. They can never work out what people died of in the preModern era except for recognised epidemic diseases. There seems to have been 'something' going around in Vienna at the time with a similar clinical course. Modern composers die of real diseases. Mahler sub-acute bacterial endocasrditis. Bartok polycythaemia vera which turned into leukaemia.

ARTICLE TITLE: The effect of explicit financial incentives on physician behavior.
ARTICLE SOURCE: Arch Intern Med (United States), May 28 2001, 161(10) p1261-6
AUTHOR(S): Armour BS; Pitts MM; Maclean R; Cangialose C; Kishel M; Imai H; Etchason J
AUTHOR'S ADDRESS: Kerr L. White Institute for Health Services Research, 315 W Ponce de Leon Ave, Suite 321, Decatur, GA 30030, USA. barmour@klwi.org.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Managed care organizations use explicit financial incentives to influence physicians' use of resources. This has contributed to concerns regarding conflicts of interest for physicians and adverse effects on the quality of patient care. In light of recent publicized legislative and legal battles about this issue, we reviewed the literature and analyzed studies that examine the effect of these explicit financial incentives on the behavior of physicians. The method used to undertake the literature review followed the approach set forth in the Cochrane Collaboration handbook. Our literature review revealed a paucity of data on the effect of explicit financial incentives. Based on this limited evidence, explicit incentives that place individual physicians at financial risk appear to be effective in reducing physician resource use. However, the empirical evidence regarding the effectiveness of bonus payments on physician resource use is mixed. Similarly, our review revealed mixed effects of the influence of explicit financial incentives on the quality of patient care. The effect of explicit financial incentives on physician behavior is complicated by a lack of understanding of the incentive structure by the managed care organization and the physician. The lack of a universally acceptable definition of quality renders it important that future researchers identify the term explicitly.
MB: That's is what makes Managed Care Organisations as other monolithic or would be monolithic systems hopeless in controlling costs. What about all the non-explicit financial incentives.

ARTICLE TITLE: Iatrogenic vCJD from surgical instruments.
ARTICLE SOURCE: BMJ (England), Jun 30 2001, 322(7302) p1558-9
AUTHOR(S): Frosh A; Joyce R; Johnson A
PUBLICATION TYPE: Editorial
MB: I would have thought there were more important defects in the British NHS than the risk of contaminating surgical instruments with vCJD. I suppose this can be fixed with bureaucratic fiat which is the only function of centralised bureaucracies.

ARTICLE TITLE: Racism in medicine.
ARTICLE SOURCE: BMJ (England), Jun 23 2001, 322(7301) p1503-4
AUTHOR(S): Bhopal R
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Ethnic minority doctors hit glass ceiling in NHS.
ARTICLE SOURCE: BMJ (England), Jun 23 2001, 322(7301) p1505
AUTHOR(S): Gulland A
PUBLICATION TYPE: News

GMC member forced to stand down from disciplinary panel BMJ 2001;322:1565 ( 30 June )
Clare Dyer, legal correspondent
MB: They had an elected member to the GMC who had previously herself been de-registered but had changed her name and they had not checked her qualifications when she stood for election. She had got herself onto the disciplinary panel. This shows the absolute impossibility of British medicine to fix itself. Their posturing of rectitude is pathetic.

ARTICLE TITLE: GMC extends restrictions on Bristol heart surgeon.
ARTICLE SOURCE: BMJ (England), Jun 16 2001, 322(7300) p1441
AUTHOR(S): Dyer C
PUBLICATION TYPE: News

ARTICLE TITLE: Kennedy refused to read the General Medical Council's reports.
ARTICLE SOURCE: BMJ (England), Jul 28 2001, 323(7306) p183
AUTHOR(S): Dyer C
PUBLICATION TYPE: News
MB: That is the chair of a Bristol Committee. The report was on the Bristol Affair.

ARTICLE TITLE: Bristol inquiry condemns hospital's "club culture"
ARTICLE SOURCE: BMJ (England), Jul 28 2001, 323(7306) p181
AUTHOR(S): Dyer C
PUBLICATION TYPE: News

ARTICLE TITLE: One Bristol, but there could have been many.
ARTICLE SOURCE: BMJ (England), Jul 28 2001, 323(7306) p179-80
AUTHOR(S): Smith R
PUBLICATION TYPE: Editorial
MB: At least the BMJ editorial recognises that the NHS is Bristol through & through. He probably cannot bring himself to suggest breaking it up. It is of course a sacred cow. It has the same features as the whole governance bureaucracy in the ex-communist countries. In oz we have division of bureaucracy between Commonwealth & States. That is a bit better. In the US they have HMOs which are trying to control things. Where is it all going to end.

ARTICLE TITLE: Preventing renal failure in the critically ill. There are no magic bullets-just high quality intensive care.
ARTICLE SOURCE: BMJ (England), Jun 16 2001, 322(7300) p1437-9
AUTHOR(S): O'Leary MJ; Bihari DJ
PUBLICATION TYPE: Editorial
MB: What a relief? I have been fighting the irrationality since 1966. I have little that hope wide spread irrationality will stop now.

ARTICLE TITLE: Use of dopamine in acute renal failure: A meta-analysis [In Process Citation]
ARTICLE SOURCE: Crit Care Med (United States), Aug 2001, 29(8) p1526-31
AUTHOR(S): Kellum JA; MDecker J
AUTHOR'S ADDRESS: Departments of Anesthesiology/Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (JAK); and the Department of Nursing, Intensive Care Unit, Veteran's Administration Medical Center, East Orange, NJ (JMD).
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The use of low-dose dopamine for the treatment or prevention of acute renal failure cannot be justified on the basis of available evidence and should be eliminated from routine clinical use.
MB: It never was justified on evidence. How did the disease infect just about everyone? I must have been exposed to the disease in a previous existence.

ARTICLE TITLE: Euthanasia: where the Netherlands leads will the world follow? No. Legalisation is a diversion from improving care for the dying.
ARTICLE SOURCE: BMJ (England), Jun 9 2001, 322(7299) p1376-7
AUTHOR(S): Emanuel EJ
PUBLICATION TYPE: Editorial
MB: That does not mean that other will not follow as the euthanasia lobby will continue to agitate. I have seen an article trying to explain the rare use of the assisted killing laws in Oregon.

ARTICLE TITLE: Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study.
ARTICLE SOURCE: BMJ (England), Jun 9 2001, 322(7299) p1385-8
AUTHOR(S): Pell JP; Sirel JM; Marsden AK; Ford I; Cobbe SM
AUTHOR'S ADDRESS: Department of Medical Cardiology, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Reducing ambulance response times to 5 minutes could almost double the survival rate for cardiac arrests not witnessed by ambulance crews.
MB: You'd have to have lot of ambulances cruising around all the time. Some parts of not-so-Outback Oz eg Bowral, NSW has its ambulances come from about 30km, I think.

ARTICLE TITLE: Using clinical evidence. Randomised controlled trials are not the only evidence.
ARTICLE SOURCE: BMJ (England), Jul 21 2001, 323(7305) p165; discussion 166
AUTHOR(S): Knapp MS
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Survival of trauma patients who have prehospital tracheal intubation without anaesthesia or muscle relaxants: observational study.
ARTICLE SOURCE: BMJ (England), Jul 21 2001, 323(7305) p141
AUTHOR(S): Lockey D; Davies G; Coats T
AUTHOR'S ADDRESS: Department of Accident and Emergency, Royal London Hospital, London E1 1BB. dj99@hotmail.com.
PUBLICATION TYPE: Journal Article
MB: They think that if it can be done then the patients are probably beyond help.

ARTICLE TITLE: Bill will give Americans right to buy cheaper drugs.
ARTICLE SOURCE: BMJ (England), Jul 21 2001, 323(7305) p130
AUTHOR(S): Gottlieb S
PUBLICATION TYPE: News
MB: Prices are higher in the US 'cause they don't have circumstances that keep prices lower elsewhere like here where the PBS prices are determined by a committee which the government has recently 'reformed' to the advantage of the drug companies. I suppose our prices will now go up.

ARTICLE TITLE: Drugs for Alzheimer's disease.
ARTICLE SOURCE: BMJ (England), Jul 21 2001, 323(7305) p123-4
AUTHOR(S): O'Brien JT; Ballard CG
PUBLICATION TYPE: Editorial

ARTICLE TITLE: A better oral rehydration solution?. An important step, but not a leap forward.
COMMENTS: : BMJ. 2001 Jul 14; 323(7304):81-5/21344716
ARTICLE SOURCE: BMJ (England), Jul 14 2001, 323(7304) p59-60
AUTHOR(S): Fuchs GJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review.
COMMENTS: : BMJ. 2001 Jul 14; 323(7304):59-60/21344698
ARTICLE SOURCE: BMJ (England), Jul 14 2001, 323(7304) p81-5
AUTHOR(S): Hahn S; Kim Y; Garner P
AUTHOR'S ADDRESS: Medical and Pharmaceutical Statistics Research Unit, University of Reading, Reading RG6 6FN. s.hahn@rdg.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: OBJECTIVES: To compare reduced osmolarity oral rehydration solution with standard World Health Organization oral rehydration solution in children with acute diarrhoea. DESIGN: Systematic review of randomised controlled trials. STUDIES: 15 randomised controlled trials including 2397 randomised patients. OUTCOMES: The primary outcome was unscheduled intravenous infusion; secondary outcomes were stool output, vomiting, and hyponatraemia. RESULTS: In a meta-analysis of nine trials for the primary outcome, reduced osmolarity rehydration solution was associated with fewer unscheduled intravenous infusions compared with standard WHO rehydration solution (odds ratio 0.61, 95% confidence interval 0.47 to 0.81). Three trials reported that no patients required unscheduled intravenous infusion. Trials reporting secondary outcomes suggested that in the reduced osmolarity rehydration solution group, stool output was lower (standardised mean difference in the log scale -0.214 (95% confidence interval -0.305 to -0.123; 13 trials) and vomiting was less frequent (odds ratio 0.71, 0.55 to 0.92; six trials). Six trials sought presence of hyponatraemia, with events in three studies, but no significant difference between the two arms. CONCLUSION: In children admitted to hospital with dehydration associated with diarrhoea, reduced osmolarity rehydration solution is associated with reduced need for unscheduled intravenous infusions, lower stool volume, and less vomiting compared with standard WHO rehydration solution.
MB: This and the above editorial are about WHO solution with 90 mmols Na/litre and its overall benefit in under developed countries with oral therapy as the primary treatment. It does not apply here where hospital management would be used and there would be no guessing what fluid to use.

ARTICLE TITLE: Training in basic and advanced life support in UK medical schools: questionnaire survey.
ARTICLE SOURCE: BMJ (England), Jul 7 2001, 323(7303) p22-3
AUTHOR(S): Phillips PS; Nolan JP
AUTHOR'S ADDRESS: Faculty of Medicine, Southampton University, Southampton General Hospital, Southampton SO16 6YD. seamsuphillips@hotmail.com.
PUBLICATION TYPE: Journal Article
MB: This is obviously hopeless. Some medical schools had no under graduate course in resuscitation.

ARTICLE TITLE: The challenge of regulating care for older people in Australia
ARTICLE SOURCE: BMJ (England), Aug 25 2001, 323(7310) p443-6
AUTHOR(S): Braithwaite J
AUTHOR'S ADDRESS: Research School of Social Sciences, Australian National University, Canberra, ACT 0200, Australia.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Bayer decides to withdraw cholesterol lowering drug
ARTICLE SOURCE: BMJ (England), Aug 18 2001, 323(7309) p359A
AUTHOR(S): Charatan F
AUTHOR'S ADDRESS: Florida.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: "Time out" from anaesthesia: why, what, and when?
ARTICLE SOURCE: BMJ (England), Aug 11 2001, 323(7308) pS2-S7308
AUTHOR(S): Rechner J; Streets C
AUTHOR'S ADDRESS: Oxford.
MB: They don't seem to think that there is not already adequate general training before starting professional anaesthetic training. Our 2 years compulsory general training with a limit on how much of that can be anaesthetics must not apply in Britain.

ARTICLE TITLE: Indian doctors defend "unethical" anticancer drug trial
ARTICLE SOURCE: BMJ (England), Aug 11 2001, 323(7308) p299
AUTHOR(S): Mudur G
AUTHOR'S ADDRESS: New Delhi.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Enhancing patient safety for pediatric bronchoscopy: alternatives to conscious sedation
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p341-2
AUTHOR(S): Slonim AD; Ognibene FP
PUBLICATION TYPE: Editorial
MB: The following article is on LMA for paediatric bronchoscpoies. There's more room than with an ETT.

ARTICLE TITLE: Pediatric fiberoptic bronchoscopy with a laryngeal mask airway
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p614-6
AUTHOR(S): Nussbaum E; Zagnoev M
AUTHOR'S ADDRESS: Division of Pediatric Pulmonary Medicine and Cystic Fibrosis Center (Dr. Nussbaum), and Department of Anesthesiology (Dr. Zagnoev), Miller Children's Hospital at Long Beach Memorial Medical Center, Long Beach, CA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Background and objectives: Bedside flexible fiberoptic bronchoscopy (FFB) with sedation has been recognized as a diagnostic modality in children. In certain circumstances, general anesthesia with endotracheal intubation is advocated. This study evaluates the usefulness of the laryngeal mask airway (LMA) as an alternative to endotracheal intubation during pediatric FFB. Design, setting, and patients: Between July 1995 and June 2000, we studied 92 children (51 girls; age range, 1 through 15 years) in the operating theater of a major tertiary children's hospital. The LMA was used in children with atelectasis, diffuse infiltrates, and those who required BAL under general anesthesia. The size of the LMA was chosen to accommodate a bronchoscope appropriate for the child's weight and age. RESULTS: Procedures were well tolerated, no complications were observed, and oxygen saturation exceeded 95% in all patients. Major findings included mucoid impaction and purulent bronchial secretions, and BAL was successfully accomplished in all individuals. CONCLUSIONS: Diagnostic BAL or extraction of mucous plugs should be accomplished with optimal control of the airway under general anesthesia. The use of the LMA during FFB is safe, provides excellent patient comfort, and should be utilized as an alternative to endotracheal intubation.

ARTICLE TITLE: The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p555-61
AUTHOR(S): Ibrahim EH; Tracy L; Hill C; Fraser VJ; Kollef MH
AUTHOR'S ADDRESS: Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO 63110, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These data suggest that VAP is a common nosocomial infection in the community hospital setting. The risk factors for the development of VAP and risk factors for hospital mortality in a community hospital are similar to those identified from university-affiliated hospitals. These risk factors can potentially be employed to develop local strategies for the prevention of VAP. Clinical implications: ICU clinicians should be aware of the risk factors associated with the development of VAP and the impact of VAP on clinical outcomes. More importantly, they should cooperate in the development of local multidisciplinary strategies aimed at the prevention of VAP and other nosocomial infections.
MB: That seems a pretty obvious recommendation. It's probably not going to work.

ARTICLE TITLE: Overnight pulse oximetry for sleep-disordered breathing in adults : a review
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p625-33
AUTHOR(S): Netzer N; Eliasson AH; Netzer C; Kristo DA
AUTHOR'S ADDRESS: Pulmonary and Critical Care Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington DC.
PUBLICATION TYPE: Journal Article
ABSTRACT: Pulse oximetry is a well-established tool routinely used in many settings of modern medicine to determine a patient's arterial oxygen saturation and heart rate. The decreasing size of pulse oximeters over recent years has broadened their spectrum of use. For diagnosis and treatment of sleep-disordered breathing, overnight pulse oximetry helps determine the severity of disease and is used as an economical means to detect sleep apnea. In this article, we outline the clinical utility and economical benefit of overnight pulse oximetry in sleep and breathing disorders in adults and highlight the controversies regarding its limitations as presented in published studies.

ARTICLE TITLE: Factors associated with reintubation in intensive care : an analysis of causes and outcomes
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p538-42
AUTHOR(S): Beckmann U; Gillies DM
AUTHOR'S ADDRESS: Division of Anesthesia, Intensive Care and Pain Management, John Hunter Hospital, Newcastle, Australia.
PUBLICATION TYPE: Journal Article
CONCLUSION: This study indicated that reintubation not related to accidental extubation resulted in major physiologic complications and potentially contributed to increased length of stay. Its findings suggest that the adequate provision of highly qualified, intensive-care-trained staff is essential for the avoidance or minimization of these incidents.
MB: That's pretty obvious too.

ARTICLE TITLE: Effect of hyperoxia on left ventricular function and filling pressures in patients with and without congestive heart
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p467-73
AUTHOR(S): Mak S; Azevedo ER; Liu PP; Newton GE
AUTHOR'S ADDRESS: Bayer Cardiovascular Clinical Research Laboratory (Drs. Mak, Azevedo, and Newton), Department of Medicine, Mount Sinai Hospital, and The Toronto Hospital (Dr. Liu), University of Toronto, Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Hyperoxia was associated with impairment of cardiac relaxation and increased left ventricular (LV) filling pressures in patients with and without without congestive heart failure (CHF). These observations indicate that caution should be used in the administration of high inspired O(2) fractions to normoxic patients, especially in the setting of CHF.

ARTICLE TITLE: Outcome prediction of emergency patients by noninvasive hemodynamic monitoring
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p528-37
AUTHOR(S): Shoemaker WC; Wo CC; Chan L; Ramicone E; Kamel ES; Velmahos GC; Belzberg H
AUTHOR'S ADDRESS: Departments of Anesthesia (Dr. Shoemaker) and Surgery (Drs. Shoemaker, Wo, Kamel, Velmahos, and Belzberg), Los Angeles County/USC Medical Center.
PUBLICATION TYPE: Journal Article
The noninvasive monitoring systems consisted of a bioimpedance method for estimating cardiac output together with pulse oximetry to reflect pulmonary function, transcutaneous oxygen tension to reflect tissue perfusion, and BP to reflect the overall circulatory status. These continuously monitored noninvasive measurements were used to prospectively evaluate circulatory patterns in 151 consecutively monitored severely injured patients beginning with admission to the ED in a university-run county hospital. CONCLUSIONS: Noninvasive monitoring systems provided continuously monitored on-line displays of data in the early postadmission period from the emergency department (ED) to the operating room and to the ICU for early recognition of circulatory dysfunction in short-term emergency conditions. Survival was predicted by discriminant analysis models based on the quantitative assessment of the net cumulative deficits of CI, arterial hypoxemia, and tissue perfusion, which were significantly greater in the nonsurvivors.

ARTICLE TITLE: Noninvasive cardiac output monitoring.
ARTICLE SOURCE: Chest (United States), Aug 2001, 120(2) p339-41
AUTHOR(S): Dueck R
AUTHOR'S ADDRESS: Dr. Dueck is Clinical Professor of Anesthesiology, University of California, San Diego, and Veterans Affairs Medical Center, San Diego.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Thromboembolic prophylaxis in total joint replacement.
ARTICLE SOURCE: Chest (United States), Jul 2001, 120(1) p302-4
AUTHOR(S): Pierson JL; Tavel ME
AUTHOR'S ADDRESS: Indiana University School of Medicine, Indianapolis, IN, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Motivating factors in futile clinical interventions.
ARTICLE SOURCE: Chest (United States), Jun 2001, 119(6) p1944-7
AUTHOR(S): Rivera S; Kim D; Garone S; Morgenstern L; Mohsenifar Z
AUTHOR'S ADDRESS: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. il1md@home.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: With modern medical technology, it is now possible to sustain life for prolonged periods in critically ill patients, even when there is no reasonable hope of improvement or achieving the goals of therapy. Such futile and medically inappropriate interventions may violate both the ethical and medical precepts generally accepted by patients, families, and physicians. In this study, we sought to determine who was primarily responsible for such interventions, the nature of their motivation, and the role of a timely bioethical consultation. In a retrospective review, we identified 100 patients of 331 bioethical consultations who had futile or medically inappropriate therapy. The average age of patients was 73.5 +/- 32 years (mean +/- 2 SD) with 57% being male. Fifty-seven percent of the patients were admitted to the hospital with a degenerative disorder, 21% with an inflammatory disorder, and 16% with a neoplastic disorder. The family was responsible for futile treatment in 62% of cases, the physician in 37% of cases, and a conservator in one case. Unreasonable expectation for improvement was the most common underlying factor. Family dissent was involved in 7 of 62 cases motivated by family, but never when physicians were primarily responsible. Liability issues motivated physicians in 12 of 37 cases where they were responsible but in only 1 of 62 cases when the family was (chi² 5 degrees of freedom = 26.7, p < 0.001). When the bioethics consultation resulted in cessation of the therapy, patients died in a median of 2 days as opposed to 16 days if therapy continued (p < 0.001).
MB: I wonder how they measured futility.

ARTICLE TITLE: Do all patients require supplemental oxygen during flexible bronchoscopy?
ARTICLE SOURCE: Chest (United States), Jun 2001, 119(6) p1906-9
AUTHOR(S): Jones AM; O'Driscoll R
AUTHOR'S ADDRESS: Department of Cardio-Respiratory Medicine, Hope Hospital, Salford, Manchester, UK. andmarkj@hotmail.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This study supports guidelines that suggest that all patients should be monitored by pulse oximetry during flexible bronchoscopy. Desaturation may occur at any FEV(1) level even without sedation. The majority of our patients did not require routine oxygen supplementation, especially the group with an FEV(1) above 1 L.
MB: How surprising?

ARTICLE TITLE: The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing.
ARTICLE SOURCE: Chest (United States), Jun 2001, 119(6) p1858-64
AUTHOR(S): Weindler J; Kiefer RT
AUTHOR'S ADDRESS: Department of Ophthalmology, University of the Saarland, Germany.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Incentive spirometers differ considerably in their additional imposed work of breathing (WBimp) with a potential impact on the efficacy of postoperative incentive spirometry performance. Maximum inspriratory pressure (Pimax) might be an easy clinical estimate for the WBimp during incentive spirometry. Incentive spirometers with low WBimp permit increased maximal sustained inspiration and, thus, enhanced incentive spirometry performance, and, therefore, it might be more suitable for use in postoperative respiratory care.
MB: Seems a bit dodgy. I have not seen any of them recently. Maybe the patients are not staying here long enough to get used to them.

ARTICLE TITLE: Do blood transfusions improve outcomes related to mechanical ventilation?
ARTICLE SOURCE: Chest (United States), Jun 2001, 119(6) p1850-7
AUTHOR(S): Hebert PC; Blajchman MA; Cook DJ; Yetisir E; Wells G; Marshall J; Schweitzer I
AUTHOR'S ADDRESS: Critical Care Programs, University of Ottawa, Ottawa, Ontario. phebert@ottawahospital.on.ca; Collective Name: The Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group.
PUBLICATION TYPE: Journal Article
CONCLUSION: In this study, there was no evidence that a liberal RBC transfusion strategy (Hb 7-9 gl/dl rather than10-2g/dl) decreased the duration of mechanical ventilation in a heterogeneous population of critically ill patients.

ARTICLE TITLE: Predictors of outcome for patients with COPD requiring invasive mechanical ventilation.
ARTICLE SOURCE: Chest (United States), Jun 2001, 119(6) p1840-9
AUTHOR(S): Nevins ML; Epstein SK
AUTHOR'S ADDRESS: Pulmonary and Critical Care Division, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: We conclude that among variables available within the first 6 h of mechanical ventilation, the presence of comorbidity and a measure of the severity of the acute illness are predictors of in-hospital mortality among patients with COPD and acute respiratory failure. The occurrence of extubation failure or the need for mechanical ventilation beyond 72 h also portends a worse prognosis.
MB: The worse they are and the worse the management the worse they do. That's a surprise.

ARTICLE TITLE: Angiotensin-converting enzyme inhibitor therapy improves respiratory muscle strength in patients with heart failure.
ARTICLE SOURCE: Chest (United States), Jun 2001, 119(6) p1755-60
AUTHOR(S): Coirault C; Hagege A; Chemla D; Fratacci MD; Guerot C; Lecarpentier Y
AUTHOR'S ADDRESS: U451 INSERM, Laboratoire d'Optique Appliquee-ENSTA-Ecole Polytechnique, Palaiseau, France. coirault@enstay.ensta.fr.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In patients with chronic heart failure, long-term therapy with the angiotensin-converting enzyme (ACE) inhibitor perindopril improved respiratory muscle strength, as indicated by significant increases in PImax and PEmax.

ARTICLE TITLE: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.
COMMENTS: : Crit Care Med. 2001 Jul; 29(7):1472-4/21338338
ARTICLE SOURCE: Crit Care Med (United States), Jul 2001, 29(7) p1303-10
AUTHOR(S): Angus DC; Linde-Zwirble WT; Lidicker J; Clermont G; Carcillo J; Pinsky MR
AUTHOR'S ADDRESS: Critical Care Medicine Division, Department of Anesthesiology and Critical Care Medicine, and the Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA. angusdc@anes.upmc.edu.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction. It is especially common in the elderly and is likely to increase substantially as the U.S. population ages.

ARTICLE TITLE: Corticosteroids for septic shock.
ARTICLE SOURCE: Crit Care Med (United States), Jul 2001, 29(7 Suppl) pS117-20
AUTHOR(S): Annane D
AUTHOR'S ADDRESS: Service de Reanimation Medicale, Hopital Raymond Poincare, Faculte de Medecine Paris-Ouest, University Paris V, Garches, France. djillali.annane@rpc.ap-hop-paris.fr.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
CONCLUSIONS: Current evidence that the therapeutic interest of replacement therapy with corticosteroids increases suggests that low doses of hydrocortisone should be offered to patients with catecholamine-dependent septic shock.

ARTICLE TITLE: Epidemiology of sepsis: an update.
ARTICLE SOURCE: Crit Care Med (United States), Jul 2001, 29(7 Suppl) pS109-16
AUTHOR(S): Angus DC; Wax RS
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, PA, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
CONCLUSION: Many studies have documented many aspects of the epidemiology of sepsis. However, the composite picture they provide, although rich in many aspects, remains incomplete and emphasizes the heterogeneity of the condition. Unfortunately, few population-based prospective cohort studies exist that allow us to accurately delineate the risk factors for sepsis, its course, and its outcome. To place new information, such as the role of genetic predisposition, in the correct context, it is essential that such studies be conducted.

ARTICLE TITLE: Succinylcholine-induced hyperkalemia in a patient with mucositis secondary to chemotherapy.
ARTICLE SOURCE: Crit Care Med (United States), Jun 2001, 29(6) p1274-6
AUTHOR(S): Al-Khafaji AH; Dewhirst WE; Cornell CJ; Quill TJ
AUTHOR'S ADDRESS: Section of Critical Care Medicine, Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Oral mucositis is a frequent and potentially severe complication of cancer chemotherapy. We believe that mucositis was a contributing factor to this case of fatal hyperkalemia after administration of succinylcholine, with a mechanism similar to that reported with thermal injury. Only nondepolarizing muscle relaxants should be used in patients who are at risk for mucositis. Mucositis should be added to the list of conditions in which succinylcholine is contraindicated.
MB: I wonder if belief based medicine is any better than the evidence based one.

ARTICLE TITLE: Association of pulmonary artery catheter use with in-hospital mortality.
ARTICLE SOURCE: Crit Care Med (United States), Jun 2001, 29(6) p1145-8
AUTHOR(S): Afessa B; Spencer S; Khan W; La Gatta M; Bridges L; Freire AX
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care, Department of Medicine, University of Florida Health Science Center, Jacksonville, FL, USA. afessa.bekele@mayo.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This study could not detect an association between PAC use and mortality. The APACHE II-predicted mortality rate and the development of multiple organ dysfunction were the main determinants of poor outcome in critically ill patients admitted to medical intensive care units (MICU)
MB: I am surprised thet there was not even an association as the factors indicating the PAC should have been associated with death.

ARTICLE TITLE: Assessing medical competence--virtual reality?
ARTICLE SOURCE: Crit Care Med (United States), Jun 2001, 29(6) p1290-1
AUTHOR(S): Jain M
PUBLICATION TYPE: Editorial
MB: I can tell during the initial conversation on the phone from the junior to me as a consultant.

ARTICLE TITLE: Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in
ARTICLE SOURCE: Gastroenterology (United States), Aug 2001, 121(2) p382-8
AUTHOR(S): Gonzalez-Abraldes J; Albillos A; Banares R; Del Arbol LR; Moitinho E; Rodriguez C; Gonzalez M; Escorsell A; Garcia-Pagan JC; Bosch J
AUTHOR'S ADDRESS: Hepatic Hemodynamics Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clinic, Institut de Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
PUBLICATION TYPE: Journal Article
Conclusions: Unlike propranolol, long-term losartan administration does not significantly reduce hepatic venous pressure gradient in patients with cirrhosis treated after a variceal bleeding episode, and it caused hypotension and reduced GFR in patients with moderate liver failure. Therefore, losartan is not an alternative to propranolol in preventing variceal rebleeding.

ARTICLE TITLE: Cardiac atrophy after bed rest and spaceflight
ARTICLE SOURCE: J Appl Physiol (United States), Aug 2001, 91(2) p645-53
AUTHOR(S): Perhonen MA; Franco F; Lane LD; Buckey JC; Blomqvist CG; Zerwekh JE; Peshock RM; Weatherall PT; Levine BD
AUTHOR'S ADDRESS: Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas and Department of Internal Medicine and Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75231.
PUBLICATION TYPE: Journal Article
In conclusion, cardiac atrophy occurs during prolonged (6 wk) horizontal bed rest and may also occur after short-term spaceflight. We suggest that cardiac atrophy is due to a physiological adaptation to reduced myocardial load and work in real or simulated microgravity and demonstrates the plasticity of cardiac muscle under different loading conditions.

ARTICLE TITLE: Ventilation-perfusion inhomogeneity increases gas uptake in anesthesia: computer modeling of gas exchange.
ARTICLE SOURCE: J Appl Physiol (United States), Jul 2001, 91(1) p10-6
AUTHOR(S): Peyton PJ; Robinson GJ; Thompson B
AUTHOR'S ADDRESS: Department of Anaesthesia, Austin and Repatriation Medical Centre, Heidelberg 3084, Australia. phil@austin.unimelb.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: Ventilation-perfusion (VA/Q) inhomogeneity was modeled to measure its effect on overall gas exchange during maintenance-phase N(2)O anesthesia with an inspired O(2) concentration of 30%. A multialveolar compartment computer model was used based on physiological log normal distributions of VA/Q inhomogeneity. Increasing the log standard deviation of the distribution of perfusion from 0 to 1.75 paradoxically increased O(2) uptake (VO(2)) where a low mixed venous partial pressure of N(2)O [high N(2)O uptake (VN(2)O)] was specified. With rising mixed venous partial pressure of N(2)O, a threshold was observed where VO(2) began to fall, whereas VN(2)O began to rise with increasing VA/Q inhomogeneity. This phenomenon is a magnification of the concentrating effects that VO(2) and VN(2)O have on each other in low VA/Q compartments. During "steady-state" N(2)O anesthesia, VN(2)O is predicted to paradoxically increase in the presence of worsening VA/Q inhomogeneity.

ARTICLE TITLE: Combined aortic valve replacement and orthotopic liver transplantation
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Aug 2001, 15(4) p474-6
AUTHOR(S): Parker BM; Mayes JT; Henderson JM; Savage RM
AUTHOR'S ADDRESS: Departments of General Anesthesiology, General Surgery, and Cardiothoracic Anesthesiology, The Cleveland Clinic Foundation, Cleveland, Ohio.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Combined heart and liver transplantation for familial amyloidosis
ARTICLE SOURCE: Intern Med J (Australia), Jan-Feb 2001, 31(1) p66-7
AUTHOR(S): Ruygrok PN; Gane EJ; McCall JL; Chen XZ; Haydock DA; Munn SR
PUBLICATION TYPE: Letter
MB: We had an oxylosis with severe cardiac infiltration. It got better without doing anything to the heart.

ARTICLE TITLE: Liver transplantation without venovenous bypass: Morbidity and mortality in patients with greater than 50% reduction in cardiac output after vena cava clamping
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Aug 2001, 15(4) p460-2
AUTHOR(S): Schwarz B; Pomaroli A; Hoermann C; Margreiter R; Mair P
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care Medicine and Transplant Surgery, University of Innsbruck School of Medicine, Innsbruck, Austria.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Does isoflurane optimize myocardial protection during cardiopulmonary bypass
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Aug 2001, 15(4) p418-21
AUTHOR(S): Haroun-Bizri S; Khoury SS; Chehab IR; Kassas CM; Baraka A
AUTHOR'S ADDRESS: Anesthesiology Department, American University of Beirut Medical Center, Beirut, Lebanon.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Regional anesthesia for major cardiac and noncardiac surgery: more than just a strategy for effective analgesia?
COMMENTS: : J Cardiothorac Vasc Anesth. 2001 Jun; 15(3):282-7/21319105; : J Cardiothorac Vasc Anesth. 2001 Jun; 15(3):288-92/21319106
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Jun 2001, 15(3) p279-81
AUTHOR(S): Riedel BJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Comparison of continuous thoracic epidural and paravertebral blocks for postoperative analgesia after minimally invasive direct coronary artery bypass surgery.
COMMENTS: : J Cardiothorac Vasc Anesth. 2001 Jun; 15(3):279-81/21319104
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Jun 2001, 15(3) p288-92
AUTHOR(S): Dhole S; Mehta Y; Saxena H; Juneja R; Trehan N
AUTHOR'S ADDRESS: Department of Anaesthesia and Cardiac Surgery, Escorts Heart Institute and Research Centre, New Delhi, India.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial

ARTICLE TITLE: Erectile dysfunction.
ARTICLE SOURCE: J Clin Endocrinol Metab (United States), Jun 2001, 86(6) p2391-4
AUTHOR(S): Cohan P; Korenman SG
AUTHOR'S ADDRESS: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, University of California, Los Angeles, California 90095, USA. pcohan@mednet.ucla.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Androgen replacement therapy in the aging male--a critical evaluation.
ARTICLE SOURCE: J Clin Endocrinol Metab (United States), Jun 2001, 86(6) p2380-90
AUTHOR(S): Vermeulen A
AUTHOR'S ADDRESS: Department of Internal Medicine, Section of Endocrinology, University Hospital, 9000 Gent, Belgium. Alex_Vermeulen@hotmail.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization.
ARTICLE SOURCE: J Neurosurg (United States), Jul 2001, 95(1) p24-35
AUTHOR(S): Hoh BL; Putman CM; Budzik RF; Carter BS; Ogilvy CS
AUTHOR'S ADDRESS: Neurosurgical Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
PUBLICATION TYPE: Journal Article
MB: How about excision & grafting at 10deg C.

ARTICLE TITLE: Use of pH-stat strategy for hypothermic circulatory arrest might obviate the need for leukocyte filtration
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Aug 2001, 122(2) p402
AUTHOR(S): Miyamoto TA; Miyamoto KJ
AUTHOR'S ADDRESS: Research Department, Kokura Memorial Hospital, 1-1 Kifune-cho, Kokura-kitaku Kitakyushu-shi 802-8555, Japan.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Statistics for the rest of us
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Aug 2001, 122(2) p207-8
AUTHOR(S): Wechsler AS
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, MCP Hahnemann University, Philadelphia, Pa.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Level of hydration and renal function in healthy humans
ARTICLE SOURCE: Kidney Int (United States), Aug 2001, 60(2) p748-56
AUTHOR(S): Anastasio P; Cirillo M; Spitali L; Frangiosa A; Pollastro RM; De Santo NG
AUTHOR'S ADDRESS: Department of Pediatrics, Division of Adult and Pediatric Nephrology, Medical School, Second Naples University, Naples, Italy.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In fasting adults, high hydration lowered GFR and increased natriuresis. After a meat meal, GFR increased only in the high hydration regimen and natriuresis only in the low hydration regimen. Hydration affects GFR and natriuresis under fasting conditions and after a meat meal.
MB: Strange

ARTICLE TITLE: Cardiac arrest and sudden death in dialysis units
ARTICLE SOURCE: Kidney Int (United States), Jul 2001, 60(1) p350-7
AUTHOR(S): Karnik JA; Young BS; Lew NL; Herget M; Dubinsky C; Lazarus JM; Chertow GM
AUTHOR'S ADDRESS: Divisions of Nephrology, Moffitt-Long Hospitals and UCSF-Mt. Zion Medical Center, Department of Medicine, University of California, San Francisco, San Francisco, California, and Fresenius Medical Care North America, Lexington, Massachusetts, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Cardiac arrest is a relatively infrequent but devastating complication of hemodialysis. To reduce the risk of adverse cardiac events on hemodialysis, the dialysate prescription should be evaluated and modified on an ongoing basis, especially following hospitalization in high-risk patients.
MB: I think they could deduce something more sensible that that.

ARTICLE TITLE: The natural history of renal disease in Australian Aborigines. Part 1. Changes in albuminuria and glomerular filtration rate over time [In Process Citation]
ARTICLE SOURCE: Kidney Int (United States), Jul 2001, 60(1) p243-8
AUTHOR(S): Hoy WE; Wang Z; Van Buynder P; Baker PR; Mathews JD
AUTHOR'S ADDRESS: Menzies School of Health Research, Darwin, Northern Territory, Australia.
PUBLICATION TYPE: Journal Article
CONCLUSION:: Albuminuria progresses and GFR is lost over time in individuals in this community, at rates that are strongly dependent on levels of pre-existing albuminuria. Much loss of GFR and all renal failure should be avoided by preventing the development of albuminuria and minimizing its progression. This depends on improving the weight, blood pressure, and metabolic profile of the entire community and reducing infections. Modification of the course in people with established disease depends on vigorous control of blood pressure and the metabolic profile and the specific use of angiotensin-converting enzyme inhibitors.

ARTICLE TITLE: The natural history of renal disease in Australian Aborigines. Part 2. Albuminuria predicts natural death and renal failure ARTICLE SOURCE: Kidney Int (United States), Jul 2001, 60(1) p249-56
AUTHOR(S): Hoy WE; Wang Z; Van Buynder P; Baker PR; McDonald SM; Mathews JD
AUTHOR'S ADDRESS: Menzies School of Health Research, Darwin, Northern Territory, Australia.
PUBLICATION TYPE: Journal Article
CONCLUSION:: All renal failure develops out of a background of persistent albuminuria in this population. More important, albuminuria and, inversely, GFR are powerful markers of risk for nonrenal natural death, including, but not restricted to, cardiovascular deaths. Most of the risk for premature death can be assessed by a simple urine test, and interventions that prevent development and progression of albuminuria and loss of GFR should not only prevent renal insufficiency, but powerfully reduce mortality from natural causes as well.

ARTICLE TITLE: Infectious complications of the hemodialysis access
ARTICLE SOURCE: Kidney Int (United States), Jul 2001, 60(1) p1-13
AUTHOR(S): Nassar GM; Ayus JC
AUTHOR'S ADDRESS: Baylor College of Medicine, Houston, Texas, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The web of human sexual contacts.
ARTICLE SOURCE: Nature (England), Jun 21 2001, 411(6840) p907-8
AUTHOR(S): Liljeros F; Edling CR; Amaral LA; Stanley HE; Aberg Y
AUTHOR'S ADDRESS: Department of Sociology, Stockholm University, S-106 91 Stockholm, Sweden. liljeros@sociology.su.se.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Towards a 'knowledge nation'.
ARTICLE SOURCE: Nature (England), Jun 7 2001, 411(6838) p619
PUBLICATION TYPE: Editorial
MB: This fell down on its face, didn't it?

ARTICLE TITLE: Mars rock samples condemned to quarantine.
ARTICLE SOURCE: Nature (England), Jun 7 2001, 411(6838) p625
AUTHOR(S): Reichhardt T
PUBLICATION TYPE: News

ARTICLE TITLE: How commercialization puts a blight on research
ARTICLE SOURCE: Nature (England), Aug 23 2001, 412(6849) p765
AUTHOR(S): Laver G; Mullbacher A; Waring P
AUTHOR'S ADDRESS: Australian National University, Canberra, ACT 2601, Australia.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Medical journals seek means to free authors from industry
ARTICLE SOURCE: Nature (England), Aug 9 2001, 412(6847) p572
AUTHOR(S): Smaglik P
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Johns Hopkins embroiled in fresh misconduct allegations.
ARTICLE SOURCE: Nature (England), Aug 2 2001, 412(6846) p466
AUTHOR(S): Jayaraman KS
PUBLICATION TYPE: News

ARTICLE TITLE: Fruit size as a model for teaching first trimester uterine sizing in bimanual examination
ARTICLE SOURCE: Obstet Gynecol (United States), Aug 2001, 98(2) p341-4
AUTHOR(S): Margulies R; Miller L
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Objective:To examine a commonly used fruit-comparison model for teaching uterine sizing by bimanual examination, to compare the sizes of actual fruits with published first trimester uterine ultrasound measurements, and to estimate the degree of provider agreement with this model.Methods:Actual fruits (pears, juice oranges, navel oranges, and grapefruits) were measured. Published ultrasound measurements of first trimester pregnant uteri were compared with the fruit measurements. A questionnaire was developed and sent to a community-based sample of 300 women's healthcare providers selected from a local medical society roster of obstetrician-gynecologists and a local reproductive healthcare provider list.Results:One hundred twelve (37%) of 300 questionnaires were returned. Of these respondents, 55% were medical doctors, 41% nurse-practitioners, and 4% midwives. Overall, 75% of respondents agreed (responded either "Agree" or "Strongly agree") that a nonpregnant or 5-week pregnant uterus feels like a small, unripe pear. Sixty-one percent agreed that a 6-week pregnant uterus feels like a small (juice) orange. Eighty percent agreed that an 8-week pregnant uterus feels like a large (navel) orange. Eighty-one percent expressed agreement that a 12-week pregnant uterus feels like a grapefruit.Conclusion:The degree of provider agreement with the fruit-based teaching model indicates potential utility of the model.
MB: I think that the metric system would be better.

ARTICLE TITLE: Involving the male partner for interpreting the basal body temperature graph(1)
ARTICLE SOURCE: Obstet Gynecol (United States), Jul 2001, 98(1) p133-8
AUTHOR(S): Dunlop AL; Allen AS; Frank E
AUTHOR'S ADDRESS: Department of Family and Preventive Medicine, Emory University Graduate School of Medicine, Atlanta, USA.
PUBLICATION TYPE: Journal Article
.Conclusion:Recording the BBT of women's partners may improve interpretation and accuracy of the BBT method. An increase in the size of a couple's temperature gap accompanies the transition from the pre- to the postovulatory phase. By this method, a given couple could determine their unique temperature gap indicating this transition.
MB: Maybe 2 readers of the thermometer are better than one.

ARTICLE TITLE: Fireworks-related injuries to children
ARTICLE SOURCE: Pediatrics (United States), Jul 2001, 108(1) p190-1
AUTHOR'S ADDRESS: Collective Name: American Academy of Pediatrics: Committee on Injury and Poison Prevention.
PUBLICATION TYPE: Journal Article
ABSTRACT: An estimated 8500 individuals, approximately 45% of them children younger than 15 years, were treated in US hospital emergency departments during 1999 for fireworks-related injuries. The hands (40%), eyes (20%), and head and face (20%) are the body areas most often involved. Approximately one third of eye injuries from fireworks result in permanent blindness. During 1999, 16 people died as a result of injuries associated with fireworks. Every type of legally available consumer (so-called "safe and sane") firework has been associated with serious injury or death. In 1997, 20 100 fires were caused by fireworks, resulting in $22.7 million in direct property damage. Fireworks typically cause more fires in the United States on the Fourth of July than all other causes of fire combined on that day. Pediatricians should educate parents, children, community leaders, and others about the dangers of fireworks. Fireworks for individual private use should be banned. Children and their families should be encouraged to enjoy fireworks at public fireworks displays conducted by professionals rather than purchase fireworks for home or private use.
MB: They banned fireworks sales in NSW without a blind trial as they made seat belts compulsory in Victoria without a blind trial. That's why we have such spectacular world's greatest public fireworks displays.

ARTICLE TITLE: Where children drown, United States, 1995
ARTICLE SOURCE: Pediatrics (United States), Jul 2001, 108(1) p85-9
AUTHOR(S): Brenner RA; Trumble AC; Smith GS; Kessler EP; Overpeck MD
AUTHOR'S ADDRESS: National Institute of Child Health and Human Development, Bethesda, Maryland.
PUBLICATION TYPE: Journal Article
Conclusion. The variety of sites in which children drown, even within specific age groups, emphasizes the need for a multifaceted approach to prevention. Reductions in the relatively high rates of drowning among black adolescent males will require targeted interventions to prevent swimming pool drownings among this group.

ARTICLE TITLE: The risks of sedation for electroencephalograms: data at last
ARTICLE SOURCE: Pediatrics (United States), Jul 2001, 108(1) p178
AUTHOR(S): Freeman JM
AUTHOR'S ADDRESS: Baltimore, MD 21287-7247.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation
ARTICLE SOURCE: Pediatrics (United States), Jul 2001, 108(1) p13-7
AUTHOR(S): Khalaf MN; Brodsky N; Hurley J; Bhandari V
AUTHOR'S ADDRESS: Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
PUBLICATION TYPE: Journal Article
Conclusions. synchronized nasal intermittent positive pressure ventilation (SNIPPV) is more effective than nasal continuous positive airway pressure (NCPAP) in weaning infants with for respiratory distress syndrome (RDS) from the ventilator. Pulmonary function tests (PFT) may be useful in predicting successful extubation.

ARTICLE TITLE: Randomized prospective study comparing preoperative epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation ARTICLE SOURCE: Reg Anesth Pain Med (United States), Jul-Aug 2001, 26(4) p316-21
AUTHOR(S): Lambert Aw; Dashfield Ak; Cosgrove C; Wilkins Dc; Walker Aj; Ashley S
AUTHOR'S ADDRESS: Vascular Surgery Unit and Department of Anaesthesia, Derriford Hospital, Plymouth, United Kingdom.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Using our regimen, perioperative epidural block started 24 hours before the amputation is not superior to infusion of local anaesthetic via a perineural catheter in preventing phantom pain, but gives better relief of stump pain in the immediate postoperative period.
MB: Hope springs eternal.

ARTICLE TITLE: The injection of intrathecal normal saline reduces the severity of postdural puncture headache
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Jul-Aug 2001, 26(4) p301-5
AUTHOR(S): Charsley MM; Abram SE
AUTHOR'S ADDRESS: Albuquerque Veterans Administration Hospital, Albuquerque, New Mexico.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The immediate injection of 10 mL intrathecal normal saline after a wet tap significantly reduced the incidence of PDPH and the need for EBP. When an intrathecal catheter had been placed following a wet tap, injection of 10 mL of normal saline before its removal effectively prevented PDPH.

ARTICLE TITLE: Postdural puncture headache: Mechanisms, treatment, and prevention
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Jul-Aug 2001, 26(4) p293-5
AUTHOR(S): Benzon HT; Wong CA
AUTHOR'S ADDRESS: Department of Anesthesiology, Northwestern University Medical School, Chicago, Illinois.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Postoperative epidural analgesia and possible transient anterior spinal artery syndrome.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), May-Jun 2001, 26(3) p274-7
AUTHOR(S): Crystal Z; Katz Y
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management Service, HaEmek Medical Center, 1810 Afula, Israel.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This complication should be taken into account, especially in patients at risk, when considering epidural analgesia techniques in the postoperative period.
MB: How can you take it into account before you do it?

ARTICLE TITLE: Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), May-Jun 2001, 26(3) p215-22
AUTHOR(S): Hollmann MW; Wieczorek KS; Smart M; Durieux ME
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Use of Epidural anesthesia (EA) prevents immediate postoperative hypercoagulability without affecting physiologic aggregation and coagulation processes. Also, Clot signature analysis (CSA) appears useful in predicting hypercoagulability and detecting platelet dysfunction.
MB: How is hypercoaguation defined. Not the CSA I hope.

ARTICLE TITLE: Measurement of patient satisfaction as an outcome of regional anesthesia and analgesia: a systematic review.
COMMENTS: : Reg Anesth Pain Med. 2001 May-Jun; 26(3):193-5/21258251
ARTICLE SOURCE: Reg Anesth Pain Med (United States), May-Jun 2001, 26(3) p196-208
AUTHOR(S): Wu CL; Naqibuddin M; Fleisher LA
AUTHOR'S ADDRESS: Department of Anesthesiology, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA. chwu@jhmi.edu.
PUBLICATION TYPE: Journal Article; Meta-Analysis

ARTICLE TITLE: Patient satisfaction--politically correct fashion of the nineties or a valuable measure of outcome?
COMMENTS: : Reg Anesth Pain Med. 2001 May-Jun; 26(3):196-208/21258252
ARTICLE SOURCE: Reg Anesth Pain Med (United States), May-Jun 2001, 26(3) p193-5
AUTHOR(S): Schug SA
PUBLICATION TYPE: Comment; Editorial
MB: How could 'satisfaction' be politically correct or otherwise except in the eye of the observer?

ARTICLE TITLE: Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Mar-Apr 2001, 26(2) p131-6
AUTHOR(S): Fong SY; Pavy TJ; Yeo ST; Paech MJ; Gurrin LC
AUTHOR'S ADDRESS: Department of Anaesthesia, King Edward Memorial Hospital for Women, Subiaco, Australia.
MAJOR SUBJECT HEADING(S): Ambulatory Surgical Procedures; Anesthesia, Local; Anesthetics, Local; Bupivacaine; Gynecologic Surgical Procedures; Laparoscopy; Pain, Postoperative [therapy]
CONCLUSIONS: Wound infiltration with local anaesthetic did not significantly reduce pain or opioid requirement after gynecological laparoscopy.
MB: More hope. Laporoscopy is not a very painful operation.

ARTICLE TITLE: Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Mar-Apr 2001, 26(2) p118-24
AUTHOR(S): Torres LM; Rodriguez MJ; Montero A; Herrera J; Calderon E; Cabrera J; Porres R; de la Torre MR; Martinez T; Gomez JL; Ruiz J; Garcia-Magaz I; Camara J; Ortiz P
AUTHOR'S ADDRESS: Department of Anesthesiology, Critical Care and Pain Clinic, Hospital Universitario Puerta del Mar, Cadiz, Spain. lmtorres@arrakis.es.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: Dipyrone and tramadol showed similar efficacy for early pain relief after abdominal hysterectomy. Nausea and vomiting, possibly caused by the tramadol, occurred more frequently in those patients. In this group, the need of the antiemetic drug ondansetron was also higher.

ARTICLE TITLE: Epidural analgesia and risk of anastomotic leakage.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Mar-Apr 2001, 26(2) p111-7
AUTHOR(S): Holte K; Kehlet H
AUTHOR'S ADDRESS: Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to be associated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.
MB: Why bother giving the epidural in the first place?

ARTICLE TITLE: A patient's pain.
COMMENTS: : Reg Anesth Pain Med. 2001 Jan-Feb; 26(1):57-60/21111622
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Jan-Feb 2001, 26(1) p1
AUTHOR(S): Brown DL
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: J.J. Bonica lecture-2000: Physiology, pathophysiology, and pharmacology of visceral pain [In Process Citation]
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Nov-Dec 2000, 25(6) p632-8
AUTHOR(S): Gebhart GF
AUTHOR'S ADDRESS: Department of Pharmacology, College of Medicine, The University of Iowa, Iowa City, Iowa.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: All pelvic nerve fibers innervating the descending colon can be sensitized and contribute to visceral pain; their responses are modulated by kappa-opioid receptor agonists acting in the periphery

ARTICLE TITLE: Smoking cessation, decline in pulmonary function and total mortality: a 30 year follow up study among the Finnish cohorts of the Seven Countries Study
ARTICLE SOURCE: Thorax (England), Sep 2001, 56(9) p703-7
AUTHOR(S): Pelkonen M; Notkola IL; Tukiainen H; Tervahauta M; Tuomilehto J; Nissinen A
AUTHOR'S ADDRESS: Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland.
PUBLICATION TYPE: Journal Article
CONCLUSION: These results highlight the positive effect of smoking cessation, even intermittent cessation, on decline in pulmonary function. Accelerated decline in pulmonary function was found to be a risk factor for total mortality. The beneficial effect of smoking cessation on mortality may partly be mediated through a reduced decline in pulmonary function.

ARTICLE TITLE: Changing patterns of hospital admission for asthma, 1981-97
ARTICLE SOURCE: Thorax (England), Sep 2001, 56(9) p687-90
AUTHOR(S): Morrison DS; McLoone P
AUTHOR'S ADDRESS: MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Hospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland. METHODS: Linked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45-6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex. RESULTS: There were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children. CONCLUSIONS: After a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

ARTICLE TITLE: Low dose inhaled corticosteroids and the prevention of death from asthma
ARTICLE SOURCE: Thorax (England), Sep 2001, 56 Suppl 2 pII74-II78
AUTHOR(S): Kips JC; Pauwels RA
AUTHOR'S ADDRESS: Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Serious motor vehicle crashes: the cost of untreated sleep apnoea.
COMMENTS: Thorax. 2001 Jul; 56(7):508-12/21306721
ARTICLE SOURCE: Thorax (England), Jul 2001, 56(7) p505
AUTHOR(S): Findley LJ; Suratt PM
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP.
COMMENTS: Thorax. 2001 Jul; 56(7):505/21306719
ARTICLE SOURCE: Thorax (England), Jul 2001, 56(7) p508-12
AUTHOR(S): George CF
AUTHOR'S ADDRESS: University of Western Ontario, London Health Sciences Centre, 375 South Street, London, Ontario N6A 4G5, Canada. cgeorge@uwo.ca.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The risk of motor vehicle collisions (MVCs) due to obstructive sleep apnoea (OSA) is removed when patients are treated with continuous positive airway pressure (CPAP). As such, any restrictions on driving because of OSA could be safely removed after treatment.

ARTICLE TITLE: Australian Medical Council: a view from the inside.
ARTICLE SOURCE: Intern Med J (Australia), May-Jun 2001, 31(4) p243-8
AUTHOR(S): Breen K; Frank I; Walters T
AUTHOR'S ADDRESS: Australian Medical Council, Canberra, Australian Capital Territory.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Although it has an important role in maintaining medical standards, little is known about the work of the Australian Medical Council (AMC) by members of the medical profession. A non-statutory standards authority, the AMC accredits medical schools in Australia and New Zealand, examines overseas-trained doctors for registration purposes and advises Medical Boards and Health Ministers on registration issues. The AMC, in consultation with Specialist Medical Colleges and others, is currently working on a number of initiatives to ensure standards of medical training and practice, including procedures to recognize new specialties and to accredit externally specialist education and training courses.
MB: Yeah, it's quite quiet.

ARTICLE TITLE: Does reading poetry make you a better clinician?
ARTICLE SOURCE: Intern Med J (Australia), Jan-Feb 2001, 31(1) p60-1
AUTHOR(S): Little M
AUTHOR'S ADDRESS: Centre for Values, Ethics and the Law in Medicine, The University of Sydney, New South Wales, Australia. milesl@blackburn.med.su.oz.au.
PUBLICATION TYPE: Journal Article
MB: Have they done any blind trials. My English teacher advised most of our class not to do the poetry questions in the Leaving Certificate Examination. I took his advice. Miles likes poetry but does not think it has any value apart from pleasure. I like music only 'cause it's pleasurable.

ARTICLE TITLE: Do anaesthetists need to wear surgical masks in the operating theatre? A literature review with evidence-based recommendations
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Aug 2001, 29(4) p331-8
AUTHOR(S): Skinner MW; Sutton BA
AUTHOR'S ADDRESS: Department of Anaesthesia, North West Regional Hospital, Burnie, Tasmania.
PUBLICATION TYPE: Journal Article
ABSTRACT: Many operating theatre staff believe that the surgical face mask protects the healthcare worker from potentially hazardous biological infections. A questionnaire-based survey, undertaken by Leyland' in 1993 to assess attitudes to the use of masks, showed that 20% of surgeons discarded surgical masks for endoscopic work. Less than 50% did not wear the mask as recommended by the Medical Research Council. Equal numbers of surgeons wore the mask in the belief they were protecting themselves and the patient, with 20% of these admitting that tradition was the only reason for wearing them. Policies relating to the wearing of surgical masks by operating theatre staff are varied. This indicates some confusion about the role of the surgical mask in modern surgical and anaesthetic practice. This review was undertaken to collate current evidence and make recommendations based on this evidence.
MB: Do they want blood splattered over their faces & into their mouths & noses. Their eyes will be protected 'cause they will be wearing protective goggles.

ARTICLE TITLE: Management of postoperative epidural analgesia: a survey of Australian practice
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Jun 2001, 29(3) p266-72
AUTHOR(S): Jastrzab G; Fairbrother G; Khor KE
AUTHOR'S ADDRESS: Department of Pain Management, Prince of Wales Hospital, High Street, Randwick, N.S.W. 2031.
PUBLICATION TYPE: Journal Article
ABSTRACT: A sample of Australian hospitals was surveyed about their practice preferences in relation to the management of epidural analgesia for postoperative pain. Results indicated substantial variation in practice preference across institutions with respect to observation protocols, epidural analgesia duration, catheter removal where anticoagulant therapy is concurrent and management of catheter problems. Further research appears necessary to develop optimal epidural analgesia management practice.
MB: I would have thought this research should have been undertaken before the wide spread use of this method. It is assumed that the standard of practice during surgery is that an anaesthetist is present. We should not have to wait till catastrophes have occurred.

ARTICLE TITLE: A 10-year experience of liver transplantation for hepatitis c: analysis of factors determining outcome in over 500 patients
ARTICLE SOURCE: Ann Surg (United States), Sep 2001, 234(3) p384-94
AUTHOR(S): Ghobrial RM; Steadman R; Gornbein J; Lassman C; Holt CD; Chen P; Farmer DG; Yersiz H; Danino N; Collisson E; Baquarizo A; Han SS; Saab S; Goldstein LI; Donovan JA; Esrason K; Busuttil RW
AUTHOR'S ADDRESS: Dumont-UCLA Transplant Center, Department of Surgery, Anesthesiology, Biomathematics, Pathology, and Medicine, UCLA School of Medicine, Los Angeles, California, and the Department of Medicine, Kaiser-Permanente, Los Angeles, California.
PUBLICATION TYPE: Journal Article
CONCLUSION: The earlier the recurrence of hepatitis C virus (HCV), the greater the impact on patient and graft survival. The use of HCV-positive donors may accelerate HCV recurrence, and they should be used judiciously. Patient survival at the time of transplantation is predicted by donor gender, , United Network for Organ Sharing (UNOS) status, serum creatinine, and recipient age. Graft survival is affected by donor gender, warm ischemia time, and pretransplant patient condition. The authors' current survival prognostic models require further multicenter validation.

ARTICLE TITLE: Increasing incidence of midterm and long-term complications after endovascular graft repair of abdominal aortic aneurysms: a note of caution based on a 9-year experience
ARTICLE SOURCE: Ann Surg (United States), Sep 2001, 234(3) p323-35
AUTHOR(S): Ohki T; Veith FJ; Shaw P; Lipsitz E; Suggs WD; Wain RA; Bade M; Mehta M; Cayne N; Cynamon J; Valldares J; McKay J
AUTHOR'S ADDRESS: Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, New York, New York.
PUBLICATION TYPE: Journal Article
CONCLUSION: With longer follow-up, complications occurred with increasing frequency. Although most could be managed with some form of endovascular reintervention, some complications resulted in a high death rate. Although endovascular graft repair is less invasive and sometimes effective in the long term, it is often not a definitive procedure. These findings mandate long-term surveillance and prospective studies to prove the effectiveness of endovascular graft repair.
MB: There are long term failures with open