ARTICLE TITLE: Epidural analgesia and active management of labor:
effects on length of labor and mode of delivery.
ARTICLE SOURCE: Obstet Gynecol (United States), Jun 1999, 93(6)
p995-8
AUTHOR(S): Rogers R; Gilson G; Kammerer-Doak D
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, University
of New Mexico Health Sciences Center, Albuquerque, USA.
becky-roger@somasf.unm.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Early epidural placement did not affect lengths of labor
or cesarean rates and was actually associated with shorter labor
compared with late epidural placement. Women managed actively in
labor, regardless of timing of epidural placement, had shorter labors
than controls.
ARTICLE TITLE: Informed consent, patient choice, and physician
responsibility [editorial]
ARTICLE SOURCE: Obstet Gynecol (United States), Jul 1999, 94(1)
p142-3
AUTHOR(S): Cruikshank DP
MAJOR SUBJECT HEADING(S): Choice Behavior; Ethics, Medical;
Gynecology [standards]; Informed Consent; Obstetrics
[standards]; Social Responsibility
PUBLICATION TYPE: EDITORIAL
MB. I had to go to the library to check this one out. Full text was
not on the web. It is very sensible. It points out that you can't
just give a patient a list of options without your recommendation He
gives 5 very good examples. He expects that from his car
mechanic.
I had a problem at my car repair place of 45y standing where they
tried to improve efficiency by having a clerk making phone bookings
for surgery on my car. I did not know what operation I wanted done as
I only knew the symptoms of my car's illness but not the diagnosis,
prognosis and/or treatment or how long inpatient stay would be
required. The girl could not help me even though her initial question
to me was, "Can I help you?"
I had one and then both head-lights fail on a day that I was not in
the OR till after dark. I called to have it repaired. The girl told
me I could not have anything done for several days. I was then asked
to be put onto the service manager whose name I still do not know. I
announced myself as Michael Bookallil to which he replied, "Yes,
Doctor". I explained my problem. He said, "Bring it down now
doctor."
They must have had many complaints similar to mine so they replaced
the girl phone answerer with a boy. That was even worse as when one
calls a car repair joint one expects anyone outside the accounts
department to know something about cars.
A cardiac surgeon I know said, "I believe in informed consent. I am
informed and the patient consents". The next 2 abstracts are about
the patient choosing cardiac surgery.
ARTICLE TITLE: What kind of coronary revascularization does the
average American really want
COMMENTS: Comment on: Am Heart J 1999 Jun; 137(6):1153-62
ARTICLE SOURCE: Am Heart J (United States), Jun 1999, 137(6)
p1005-6
AUTHOR(S): Oz MC
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. Sounds like the breast malignany treatment choice night-mare.
ARTICLE TITLE: Patient preferences in coronary revascularization
[see comments]
COMMENTS: Comment in: Am Heart J 1999 Jun; 137(6):1005-6
ARTICLE SOURCE: Am Heart J (United States), Jun 1999, 137(6)
p1153-62
AUTHOR(S): Hornberger J; Bloch DA; Hlatky MA; Baumgartner W
AUTHOR'S ADDRESS: Departments of Health Research & Policy and of
Medicine, Stanford University School of Medicine, CA, USA.
john.hornberger@roche.com.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: These data suggest that patient preference should
influence individual and policy recommendations when choosing among
coronary revascularization procedures.
ARTICLE TITLE: Henry Knowles Beecher and the development of
informed consent in anesthesia research
COMMENTS: Comment in: Anesthesiology 1999 Jun; 90(6):1499-501
ARTICLE SOURCE: Anesthesiology (United States), Jun 1999, 90(6)
p1756-65
AUTHOR(S): Kopp VJ
AUTHOR'S ADDRESS: Department of Anesthesiology, School of Medicine,
The University of North Carolina at Chapel Hill, 27599-7010, USA.
vkopp@aims.unc.edu.
PUBLICATION TYPE: BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE
MB. Very interesting. Read the full text. One classical example of
unethical anasthesia research which produced angst at the time had am
ex-staff specialist from this hospital as its lst but not most famous
author.
ARTICLE TITLE: Informed consent for research: the achievements of
the past and the challenges of the future
COMMENTS: Comment on: Anesthesiology 1999 Jun; 90(6):1756-65
ARTICLE SOURCE: Anesthesiology (United States), Jun 1999, 90(6)
p1499-501
AUTHOR(S): Truog RD; Robinson W
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Violations of informed consent during war.
ARTICLE SOURCE: JAMA (United States), May 5 1999, 281(17) p1657
AUTHOR(S): Schofer JM
AUTHOR'S ADDRESS: Hahnemann School of Medicine, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Shivering and shivering-like tremor during labor
with and without epidural analgesia.
ARTICLE SOURCE: Anesthesiology (United States), Jun 1999, 90(6)
p1609-16
AUTHOR(S): Panzer O; Ghazanfari N; Sessler DI; Yucel Y; Greher M;
Akca O; Donner A; Germann P; Kurz A
AUTHOR'S ADDRESS: Outcomes Research, Department of Anesthesia and
General Intensive Care, University of Vienna, Austria.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: This study confirms the clinical impression that some
peripartum shivering-like tremor is nonthermoregulatory. The authors
also identified nonthermoregulatory sweating. These data indicate
that shivering-like tremor and sweating in the peripartum period is
multifactorial.
ARTICLE TITLE: Patient-controlled antiemesis: a randomized,
double-blind comparison of two doses of propofol versus placebo.
ARTICLE SOURCE: Anesthesiology (United States), Jun 1999, 90(6)
p1564-70
AUTHOR(S): Gan TJ; El-Molem H; Ray J; Glass PS
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University
Medical Center, Durham, North Carolina 27710, USA.
gan00001@mc.duke.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Propofol is effective in managing PONV with shorter PACU
stay and great degree of patient satisfaction. There were two
episodes of oversedation in the P-40 group. Hence, propofol at a
demand dose of 20 mg seems more appropriate.
MB.I can't imagine anything sillier than trying to treat PONV with
more anaesthetic. I can't remember any PONV that had an important
impact at the time.
In the above study there was at first a high incidence of severe
nausea which may have been due to narcotics. 2 of 22 at the higher
dose of propofol became over sedated.
ARTICLE TITLE: Continuous cardiac output in septic shock by
simulating a model of the aortic input impedance: a comparison with
bolus injection thermodilution.
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1317-28
AUTHOR(S): Jellema WT; Wesseling KH; Groeneveld AB; Stoutenbeek CP;
Thijs LG; van Lieshout JJ
AUTHOR'S ADDRESS: Department of Internal Medicine, Academic Medical
Center, University of Amsterdam, The Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: In mechanically ventilated patients with septic shock,
changes in bolus bolus injection thermodilution (TDCO) are reflected
by calibrated model-simulated cardiac output (MCO) over a range of
cardiac output values. A single calibration of the model appears
sufficient to monitor continuous cardiac output over a 2-day period
with a bias of -0.1 +/- 0.8 l/min.
ARTICLE TITLE: Acupressure-acupuncture antiemetic prophylaxis in
children undergoing tonsillectomy.
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1311-6
AUTHOR(S): Shenkman Z; Holzman RS; Kim C; Ferrari LR; Di Canzio J;
Highfield ES; Van Keuren K; Kaptchuk T; Kenna MA; Berde CB; Rockoff
MA
AUTHOR'S ADDRESS: Department of Anesthesia, Children's Hospital,
Harvard Medical School, Boston, Massachusetts, USA.
z.shenkman@ipc.co.il.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Perioperative acupressure and acupuncture did not
diminish emesis in children following tonsillectomy.
MB. I think we can stop investigating acu-medicine. The craze started
about 1970 during the cultural revolution
ARTICLE TITLE: Sex differences in morphine-induced ventilatory
depression reside within the peripheral chemoreflex loop.
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1329-38
AUTHOR(S): Sarton E; Teppema L; Dahan A
AUTHOR'S ADDRESS: Department of Anesthesiology, Leiden University
Medical Center, The Netherlands.
E.Sarton@Anesthesiology.Medfac.LeidenUniv.nl.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The data indicate the existence of sex differences in
morphine-induced depression of responses mediated via the peripheral
chemoreflex pathway, with more depression in women, but not of
responses mediated via the central chemoreflex pathway. In men and
women, morphine did not change the translation of the initial
hyperventilatory response to short-term hypoxia into the secondary
decrease in inspired minute ventilation (Vi) caused by sustained
hypoxia.
ARTICLE TITLE: Sevoflurane-induced reduction of hypoxic drive is
sex-independent.
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1288-93
AUTHOR(S): Sarton E; van der Wal M; Nieuwenhuijs D; Teppema L;
Robotham JL; Dahan A
AUTHOR'S ADDRESS: Department of Anesthesiology, Leiden University
Medical Center, The Netherlands.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: In contrast to morphine, the influence of a low dose of
the inhalational anesthetic sevoflurane on the ventilatory response
to hypoxia is independent of sex.
ARTICLE TITLE: Women emerge from general anesthesia with
propofol/alfentanil/nitrous oxide faster than men.
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1283-7
AUTHOR(S): Gan TJ; Glass PS; Sigl J; Sebel P; Payne F; Rosow C;
Embree P
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University
Medical Center, Durham, North Carolina 27710, USA.
gan00001@mc.duke.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Gender appears to be an important variable in recovery
from general anesthesia. These findings may explain the increased
reported incidence of awareness in women (three times more frequent)
and support the need to include gender as a variable in
pharmacokinetic and pharmacodynamic studies of anesthetic drugs.
MB. Recovery seems a bit long in both groups and the difference is
trivial.
The last 3 articles investigated trivial differences in anaesthesia
related to sex differences. It is difficult to find any worth-while
articles in Anesthesiology.
ARTICLE TITLE: Use of the cuffed oropharyngeal airway as an
alternative to the laryngeal mask airway with positive-pressure
ventilation.
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1306-10
AUTHOR(S): van Vlymen JM; Fu W; White PF; Klein KW; Griffin JD
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: Positive-pressure ventilation is possible with the
laryngeal mask airway and cuffed oropharyngeal airway devices.
Although the cuffed oropharyngeal airway can be inserted easily by
inexperienced users with a high first-attempt success rate (>
90%), manipulations of the device may be required to maintain a
patent airway. The laryngeal mask airway device allows
positive-pressure ventilation at slightly greater peak inspiratory
pressures.
ARTICLE TITLE: Spinal versus epidural anesthesia for cesarean
section in severely preeclamptic patients: a retrospective survey
[see comments]
COMMENTS: Comment in: Anesthesiology 1999 May; 90(5):1252-4
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1276-82
AUTHOR(S): Hood DD; Curry R
AUTHOR'S ADDRESS: Department of Anesthesiology, Wake Forest
University School of Medicine, Winston-Salem, North Carolina
27157-1009, USA. dhood@wfubmc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Although we cannot exclude the possibility that the
spinal and epidural anesthesia groups were dissimilar, the magnitudes
of maternal blood pressure declines were similar after spinal or
epidural anesthesia in this series of severely preeclamptic patients
receiving cesarean section. Maternal and fetal outcomes also were
similar.
ARTICLE TITLE: Spinal anesthesia in severely preeclamptic women:
when is it safe? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 May; 90(5):1276-82
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1252-4
AUTHOR(S): Santos AC
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Rapid saline infusion produces hyperchloremic
acidosis in patients undergoing gynecologic surgery [see
comments]
COMMENTS: Comment in: Anesthesiology 1999 May; 90(5):1247-9
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1265-70
AUTHOR(S): Scheingraber S; Rehm M; Sehmisch C; Finsterer U
AUTHOR'S ADDRESS: Clinic of Anesthesiology,
Ludwig-Maximilians-University, Klinikum Grosshadern, Munich,
Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Infusion of approximately 30 ml x kg(-1) x h(-1) saline
during anesthesia and surgery inevitably leads to metabolic acidosis,
which is not observed after administration of lactated Ringer's
solution. The acidosis is associated with hyperchloremia.
MB. A trivial experiment with an obvious result if you actually
understand pH.
The surgery could not have been too good as its was elective
gynecology with average blood loss about 800 mls.
ARTICLE TITLE: Hyperchloremic metabolic acidosis is a predictable
consequence of intraoperative infusion of 0.9% saline [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 1999 May; 90(5):1265-70
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1247-9
AUTHOR(S): Prough DS; Bidani A
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. Hopeless starting point. They think that the phenomenon was not
noticed before 1994. It is in my acid base stuff written around 1970.
See it in Virtual
Anaesthesia Textbook.
ARTICLE TITLE: Ineffectiveness of burst suppression therapy in
mitigating perioperative cerebrovascular dysfunction. Multicenter
Study of Perioperative Ischemia (McSPI) Research Group [see
comments]
COMMENTS: Comment in: Anesthesiology 1999 May; 90(5):1243-7
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1255-64
AUTHOR(S): Roach GW; Newman MF; Murkin JM; Martzke J; Ruskin A; Li J;
Guo A; Wisniewski A; Mangano DT
AUTHOR'S ADDRESS: Ischemia Research and Education Foundation, San
Francisco, California, USA. dtb@crucis.iref.org.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Electroencephalographic burst suppression surgery with
propofol during cardiac valve replacement did not significantly
reduce the incidence or severity of neurologic or neuropsychologic
dysfunction. The authors' results suggest that neither cerebral
metabolic suppression nor reduction in cerebral blood flow reliably
provide neuroprotection during open heart surgery. Other therapeutic
approaches must be evaluated to address this important medical
problem.
MB. If it has no effect in patients without pryor CNS disease we can
take it that it has no effect in neurosurgery or carotid
operations.
ARTICLE TITLE: Improving neurologic outcome after cardiac surgery
[editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 May; 90(5):1255-64
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1243-7
AUTHOR(S): Hindman BJ; Todd MM
PUBLICATION TYPE: COMMENT; EDITORIAL
It seems pretty hopeless. The last sentence says that the situation
is bad but it is good that there is something worthwhile to
investigate. : -(
ARTICLE TITLE: Propofol in the treatment of moderate and severe
head injury: a randomized, prospective double-blinded pilot
trial.
ARTICLE SOURCE: J Neurosurg (United States), Jun 1999, 90(6)
p1042-52
AUTHOR(S): Kelly DF; Goodale DB; Williams J; Herr DL; Chappell ET;
Rosner MJ; Jacobson J; Levy ML; Croce MA; Maniker AH; Fulda GJ;
Lovett JV; Mohan O; Narayan RK
AUTHOR'S ADDRESS: Division of Neurosurgery, University of California
Medical Center, Los Angeles, USA. dfkelly@ucla.edu.
MB. Morphine and propofol are the same. Maybe both are useless.
ARTICLE TITLE: Intrapartum epidural analgesia and neonatal sepsis
evaluations: a casual or causal association? [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 1999 May; 90(5):1271-5
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1250-2
AUTHOR(S): Camann W
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. Should be post-partum. Neonatal refers to baby.
ARTICLE TITLE: Epidural analgesia during labor and maternal fever
[see comments]
COMMENTS: Comment in: Anesthesiology 1999 May; 90(5):1250-2
ARTICLE SOURCE: Anesthesiology (United States), May 1999, 90(5)
p1271-5
AUTHOR(S): Philip J; Alexander JM; Sharma SK; Leveno KJ; McIntire DD;
Wiley J
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Texas
Southwestern Medical Center, Dallas 75235-9068, USA.
jphili@mednet.swmed.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Epidural analgesia is associated with maternal fever.
However, nulliparity and dysfunctional labor are also significant
cofactors in the fever attributed to epidural analgesia.
ARTICLE TITLE: Risk scoring in surgical patients.
ARTICLE SOURCE: Br J Surg (England), Feb 1999, 86(2) p149-57
AUTHOR(S): Jones HJ; de Cossart L
AUTHOR'S ADDRESS: Countess of Chester Hospital, Chester, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (72 references); REVIEW
LITERATURE
RESULTS AND CONCLUSION: The advantages of an accurate assessment of a
patient's risk include, on an individual level, the opportunity to
give a more accurate prognosis and choose the most appropriate
treatment. If the risk of an adverse outcome is known for a group of
patients, the actual outcome can be compared with the predicted
outcome, and comparison can be made between groups in different
surgical units for the purposes of audit or research. The
Physiological and Operative Severity Score for enUmeration of
Mortality and morbidity (POSSUM) is the most appropriate of the
currently available scores for general surgical practice.
ARTICLE TITLE: Carotid endarterectomy before and after publication
of randomized controlled trials.
ARTICLE SOURCE: Br J Surg (England), Feb 1999, 86(2) p206-10
AUTHOR(S): Brittenden J; Murie JA; Jenkins AM; Ruckley CV; Bradbury
AW
AUTHOR'S ADDRESS: University Department of Surgery, Royal Infirmary,
Edinburgh, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Publication of European Carotid Surgery Trial (ECST) and
North American Symptomatic Carotid Endarterectomy Trial (NASCET) data
has been associated with a major increase in the number of carotid
endarterectomies (CEAs) performed for symptomatic disease in this
unit. Despite a greater proportion of high-risk patients, the results
have improved progressively.
ARTICLE TITLE: Day-case haemorrhoidectomy.
ARTICLE SOURCE: Br J Surg (England), Feb 1999, 86(2) p255-8
AUTHOR(S): Hunt L; Luck AJ; Rudkin G; Hewett PJ
AUTHOR'S ADDRESS: Department of Surgery, Leicester Royal Infirmary
NHS Trust, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Ligation excision haemorrhoidectomy can be performed
successfully as a day-case procedure.
MB. I'd better have one of these.
ARTICLE TITLE: Randomized trial of open versus closed day-case
haemorrhoidectomy.
ARTICLE SOURCE: Br J Surg (England), May 1999, 86(5) p612-3
AUTHOR(S): Carapeti EA; Kamm MA; McDonald PJ; Chadwick SJ; Phillips
RK
AUTHOR'S ADDRESS: St Mark's Hospital, Northwick Park, Watford Road,
Harrow HA1 3UJ, UK.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ARTICLE TITLE: Randomized clinical trial of laparoscopic versus
open inguinal hernia repair.
ARTICLE SOURCE: Br J Surg (England), Mar 1999, 86(3) p316-9
AUTHOR(S): Juul P; Christensen K
AUTHOR'S ADDRESS: Department of Surgery, Nyborg Hospital,
Denmark.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: This study shows that in patients with a primary
unilateral hernia laparoscopic repair results in less postoperative
pain and a quicker recovery than open repair
MB. & one of these too.
ARTICLE TITLE: Influence of volume of work on the outcome of
treatment for patients with colorectal cancer.
ARTICLE SOURCE: Br J Surg (England), Apr 1999, 86(4) p475-81
AUTHOR(S): Parry JM; Collins S; Mathers J; Scott NA; Woodman CB
AUTHOR'S ADDRESS: Centre for Cancer Epidemiology, Christie Hospital
NHS Trust, Manchester, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Recent recommendations for the reorganization
of cancer services emphasize the importance of a 'minimal acceptable
volume of work'. The influence of both hospital and surgical workload
has been examined using a population-based series of patients with
colorectal cancer. METHODS: Nine hundred and twenty-seven patients
with primary colorectal cancer diagnosed during the period 1 January
to 30 June 1993 were identified from the North Western Regional
Cancer Registry. Case notes were reviewed for information on patient
age and sex, histological diagnosis, disease stage, degree of tumour
differentiation, mode of admission, identity of operating surgeon,
timing of operative procedure, and use of radiotherapy and/or
chemotherapy. A multivariate Cox proportional hazards model was then
constructed to examine, simultaneously, the effects of patient-,
disease- and health service-related variables on survival. RESULTS:
Age, tumour stage and differentiation, and mode of admission were
revealed as significant independent prognostic variables. After
adjusting for these variables, neither operator grade (consultant
versus junior), consultant workload nor hospital throughput were
identified as independently influencing patient survival. CONCLUSION:
The results of this study do not support an association between
volume of work and patient outcome.
MB. I think other similar studies have shown differences. There are
suspicious parts of this study eg those that had the biggest
throughput did less preoperative assessment. The conclusion does not
say that there is no difference.
ARTICLE TITLE: Endoleak after stent-graft treatment of abdominal
aortic aneurysm: a meta-analysis of clinical studies.
ARTICLE SOURCE: Br J Surg (England), May 1999, 86(5) p581-7
AUTHOR(S): Schurink GW; Aarts NJ; van Bockel JH
AUTHOR'S ADDRESS: Department of Surgery, Leiden University Medical
Centre, Leiden, The Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: BACKGROUND: Endoleak is the major complication after
endovascular treatment of abdominal aortic aneurysm (AAA) and its
incidence seems to remain significant. Little is known about the
association of device type and configuration with respect to the
incidence, location, time of onset and fate of endoleakage. METHODS:
A meta-analysis was performed via a Medline search of clinical
studies after 1995 dealing with the endovascular treatment of AAA.
Details of number of patients treated, configuration and type of
endovascular device were collected. Data concerning site of origin,
time of occurrence and fate of the endoleak were retrieved, along
with information on change in diameter of the aneurysm with time.
RESULTS: The 23 publications included reported on 1189 patients. The
1118 patients with successfully inserted transfemoral endovascular
grafts experienced 270 endoleaks (24 per cent). The majority arose
from the distal stent attachment site (36 per cent), were present
immediately after stent-graft placement (66 per cent) and were
persistent in time (37 per cent). Tube grafts were more frequently
affected by endoleakage (35 per cent; P < 0.0001), especially at
the distal stent attachment site (51 per cent), than bifurcated
grafts (18 per cent; P = 0.004) and aortounilateral devices (20 per
cent; P = 0.70). Self- expandable stent-grafts were more frequently
associated with endoleaks (25 per cent) than balloon-expandable
stent-grafts (17 per cent) (P = 0.037). CONCLUSION: Endovascular
treatment of AAA is an evolving field. Even after the initial
learning curve and attention to device-related problems, it is still
accompanied by a significant number of endoleaks. Uniform
presentation of results of treatment is necessary for analysing the
effect of differences between patients, aneurysm morphology and
device type.
MB.We seem to be using a different device each time I anaesthetise
one of these. The average number in each of the studies was 49. It
would take a long time for any starting group to get constant
results. I don't think the statistics quoted would mean much.
At the time our group was quoted as having done 37 with the average
24% endoleak. We have now done over 400. The leaks would now be about
10%.
ARTICLE TITLE: Physiological comparison of open and endovascular
aneurysm repair.
ARTICLE SOURCE: Br J Surg (England), Jun 1999, 86(6) p760-4
AUTHOR(S): Treharne GD; Thompson MM; Whiteley MS; Bell PR
AUTHOR'S ADDRESS: Department of Vascular Surgery, Leicester Royal
Infirmary, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: This prospective study compared morbidity and
mortality rates following conventional and endovascular abdominal
aortic aneurysm (AAA) repair using a physiological scoring system.
METHODS: Between December 1994 and November 1997, 104 elective open
aneurysm repairs and 49 endovascular aneurysm repairs were performed.
These patient cohorts were compared using the Portsmouth predictor
equation (P-POSSUM) scoring system. Data collected prospectively from
patient notes were used to obtain physiological and operative
severity scores which were analysed to compare expected and observed
mortality and morbidity rates. RESULTS: There were three deaths (6
per cent) in the endovascular AAA repair group and 17 (16 per cent)
in the conventional aneurysm repair group, whereas the P-POSSUM
formulae predicted mortality rates of 8 and 19 per cent respectively.
Although the mean physiological scores were similar for both groups
(endovascular 20.8 versus conventional 20.1), the operative severity
score was significantly greater in the conventional group (26.3
versus 19.7; P < 0.001). CONCLUSION: In this study open aortic
aneurysm repair had a higher operative severity than endovascular
repair, which was reflected in the increased mortality rate.
MB. Mortality of open operations seems a bit high
ARTICLE TITLE: Trauma centres: a British perspective.
ARTICLE SOURCE: Br J Surg (England), Jun 1999, 86(6) p723-4
AUTHOR(S): Earlam R
AUTHOR'S ADDRESS: Royal London Hospital, Whitechapel, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Trauma centres in the USA - past and present.
ARTICLE SOURCE: Br J Surg (England), Jun 1999, 86(6) p721-2
AUTHOR(S): Champion HR
AUTHOR'S ADDRESS: R. Adams Cowley Shock Trauma Center, Baltimore,
Maryland 21201-1595, USA.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
ARTICLE TITLE: Meta-analysis of trials comparing beta-blockers,
calcium antagonists, and nitrates for stable angina.
ARTICLE SOURCE: JAMA (United States), May 26 1999, 281(20)
p1927-36
AUTHOR(S): Heidenreich PA; McDonald KM; Hastie T; Fadel B; Hagan V;
Lee BK; Hlatky MA
AUTHOR'S ADDRESS: Veterans Affairs Palo Alto Health Care System,
Calif, USA. pah@smi.stanford.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: beta-Blockers provide similar clinical outcomes and are
associated with fewer adverse events than calcium antagonists in
randomized trials of patients who have stable angina.
ARTICLE TITLE: Drug doings Down Under [news]
ARTICLE SOURCE: JAMA (United States), May 19 1999, 281(19)
p1782-3
AUTHOR(S): Swan N
MAJOR SUBJECT HEADING(S): Drug and Narcotic Control; Substance Abuse,
Intravenous [prevention & control]
MINOR SUBJECT HEADING(S): Australia; HIV Infections [prevention
& control]; Policy Making; Program Development
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Management of prostate cancer after prostatectomy:
treating the patient, not the PSA
COMMENTS: Comment on: JAMA 1999 May 5; 281(17):1591-7
ARTICLE SOURCE: JAMA (United States), May 5 1999, 281(17) p1642-5
AUTHOR(S): Scher HI
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Radiation therapy for clinically localized prostate
cancer: a multi-institutional pooled analysis.
ARTICLE SOURCE: JAMA (United States), May 5 1999, 281(17)
p1598-604
AUTHOR(S): Shipley WU; Thames HD; Sandler HM; Hanks GE; Zietman AL;
Perez CA; Kuban DA; Hancock SL; Smith CD
AUTHOR'S ADDRESS: Department of Radiation Oncology, Massachusetts
General Hospital, Boston 02114, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Estimated PSA control rates in this pooled analysis are
similar to those of single institutions. These rates indicate the
probability of success for subsets of patients with tumors of several
prognostic category groupings. These results represent a
multi-institutional benchmark for evidence-based counseling of
prostate cancer patients about radiation treatment.
ARTICLE TITLE: Rising incidence of renal cell cancer in the United
States.
ARTICLE SOURCE: JAMA (United States), May 5 1999, 281(17)
p1628-31
AUTHOR(S): Chow WH; Devesa SS; Warren JL; Fraumeni JF Jr
AUTHOR'S ADDRESS: Division of Cancer Epidemiology and Genetics,
National Cancer Institute, Bethesda, MD 20892-7240, USA.
choww@exchange.nih.gov.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Increasing detection of presymptomatic tumors by imaging
procedures, such as ultrasonography, computed tomography, and
magnetic resonance imaging, does not fully explain the upward
incidence trends of renal cell carcinoma. Other factors may be
contributing to the rapidly increasing incidence of renal cell cancer
in the United States, particularly among blacks.
ARTICLE TITLE: From the Centers for Disease Control and
Prevention. Ten great public health achievements--United States,
1900-1999.
ARTICLE SOURCE: JAMA (United States), Apr 28 1999, 281(16) p1481
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Understanding resource use in liver transplantation
[editorial; comment]
COMMENTS: Comment on: JAMA 1999 Apr 21; 281(15):1381-6
ARTICLE SOURCE: JAMA (United States), Apr 21 1999, 281(15)
p1431-2
AUTHOR(S): Russell PS
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Resource utilization in liver transplantation:
effects of patient characteristics and clinical practice. NIDDK Liver
Transplantation Database Group [see comments]
COMMENTS: Comment in: JAMA 1999 Apr 21; 281(15):1431-2
ARTICLE SOURCE: JAMA (United States), Apr 21 1999, 281(15)
p1381-6
AUTHOR(S): Showstack J; Katz PP; Lake JR; Brown RS Jr; Dudley RA;
Belle S; Wiesner RH; Zetterman RK; Everhart J
AUTHOR'S ADDRESS: Department of Medicine, University of California,
San Francisco 94143-0936, USA. jas1@itsa.ucsf.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: CONTEXT: Liver transplantation is among the most costly of
medical services, yet few studies have addressed the relationship
between the resources utilized for this procedure and specific
patient characteristics and clinical practices. OBJECTIVE: To assess
the association of pretransplant patient characteristics and clinical
practices with hospital resource utilization. DESIGN: Prospective
cohort of patients who received liver transplants between January
1991 and July 1994. SETTING: University of California, San Francisco;
Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha.
PATIENTS: Seven hundred eleven patients who received single-organ
liver transplants, were at least 16 years old, and had nonfulminant
liver disease. MAIN OUTCOME MEASURE: Standardized resource
utilization derived from a database created by matching all services
to a single price list. RESULTS: Higher adjusted resource utilization
was associated with donor age of 60 years or older (28%
[$53813] greater mean resource utilization; P=.005);
recipient age of 60 years or older (17% [$32795]; P=.01);
alcoholic liver disease (26% [$49596]; P=.002); Child-Pugh
class C (41% [$67 658]; P<.001); care from the intensive
care unit at time of transplant (42% [$77833]; P<.001);
death in the hospital (35% [$67 076]; P<.001); and having
multiple liver transplants during the index hospitalization (154%
increase [$474 740 vs $186 726 for 1 transplant]; P<.001).
Adjusted length of stay and resource utilization also differed
significantly among transplant centers. CONCLUSIONS: Clinical,
economic, and ethical dilemmas in liver transplantation are
highlighted by these findings. Recipients who were older, had
alcoholic liver disease, or were severely ill were the most expensive
to treat; this suggests that organ allocation criteria may affect
transplant costs. Clinical practices and resource utilization varied
considerably among transplant centers; methods to reduce variation in
practice patterns, such as clinical guidelines, might lower costs
while maintaining quality of care.
MB. This would be very difficult to do. Spin off benefits ie skills
and methods developed for this operation will be otherwise useful eg
in blood replacement in major trauma.
ARTICLE TITLE: A prospective study of egg consumption and risk of
cardiovascular disease in men and women.
ARTICLE SOURCE: JAMA (United States), Apr 21 1999, 281(15)
p1387-94
AUTHOR(S): Hu FB; Stampfer MJ; Rimm EB; Manson JE; Ascherio A;
Colditz GA; Rosner BA; Spiegelman D; Speizer FE; Sacks FM; Hennekens
CH; Willett WC
AUTHOR'S ADDRESS: Department of Nutrition, Harvard School of Public
Health, Boston, Mass 02115, USA. Frank.hu@channing.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: These findings suggest that consumption of up to 1 egg
per day is unlikely to have substantial overall impact on the risk of
CHD or stroke among healthy men and women. The apparent increased
risk of CHD associated with higher egg consumption among diabetic
participants warrants further research.
ARTICLE TITLE: Alcohol intake and the risk of coronary heart
disease mortality in persons with older-onset diabetes mellitus
[see comments]
COMMENTS: Comment in: JAMA 1999 Jul 21; 282(3):279-80
ARTICLE SOURCE: JAMA (United States), Jul 21 1999, 282(3) p239-46
AUTHOR(S): Valmadrid CT; Klein R; Moss SE; Klein BE; Cruickshanks
KJ
AUTHOR'S ADDRESS: Department of Ophthalmology and Visual Sciences,
University of Wisconsin-Madison Medical School, 53705-2397, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Our results suggest an overall beneficial effect of
alcohol consumption in decreasing the risk of death due to CHD in
people with older-onset diabetes.
ARTICLE TITLE: False memories, lasting scars [news]
ARTICLE SOURCE: JAMA (United States), Jul 21 1999, 282(3) p224
AUTHOR(S): Lamberg L
MAJOR SUBJECT HEADING(S): Child Abuse, Sexual [psychology];
Fathers [psychology]; Recall
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Intranasal influenza vaccine: adding to the
armamentarium for influenza control
COMMENTS: Comment on: JAMA 1999 Jul 14; 282(2):137-44
ARTICLE SOURCE: JAMA (United States), Jul 14 1999, 282(2) p182-4
AUTHOR(S): Poland GA; Couch R
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Effectiveness of live, attenuated intranasal
influenza virus vaccine in healthy, working adults: a randomized
controlled trial [see commentss]
ARTICLE SOURCE: JAMA (United States), Jul 14 1999, 282(2) p137-44
AUTHOR(S): Nichol KL; Mendelman PM; Mallon KP; Jackson LA; Gorse GJ;
Belshe RB; Glezen WP; Wittes J
AUTHOR'S ADDRESS: Medicine Service, VA Medical Center, and the
University of Minnesota, Minneapolis 55417, USA.
nicho014@tc.umn.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Intranasal trivalent LAIV vaccine was safe and effective
in healthy, working adults in a year in which a drifted influenza A
virus predominated.
ARTICLE TITLE: New options for prevention and control of influenza
[editorial; comment]
COMMENTS: Comment on: JAMA 1999 Jul 7; 282(1):31-5
ARTICLE SOURCE: JAMA (United States), Jul 7 1999, 282(1) p75-7
AUTHOR(S): Patriarca PA
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Zanamivir in the prevention of influenza among
healthy adults: a randomized controlled trial
COMMENTS: Comment in: JAMA 1999 Jul 7; 282(1):75-7
ARTICLE SOURCE: JAMA (United States), Jul 7 1999, 282(1) p31-5
AUTHOR(S): Monto AS; Robinson DP; Herlocher ML; Hinson JM Jr; Elliott
MJ; Crisp A
AUTHOR'S ADDRESS: School of Public Health, University of Michigan,
Ann Arbor 48109-2029, USA. asmonto@umich.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Zanamivir administered once daily is efficacious and
well tolerated in the prevention of influenza for a 4-week period in
healthy adults.
MB. I have some shares in the Australian company who owns this
drug.
ARTICLE TITLE: Effect of mechanical ventilation on inflammatory
mediators in patients with acute respiratory distress syndrome: a
randomized controlled trial [see comments]
COMMENTS: Comment in: JAMA 1999 Jul 7; 282(1):77-8
ARTICLE SOURCE: JAMA (United States), Jul 7 1999, 282(1) p54-61
AUTHOR(S): Ranieri VM; Suter PM; Tortorella C; De Tullio R; Dayer JM;
Brienza A; Bruno F; Slutsky AS
AUTHOR'S ADDRESS: Istituto di Anestesiologia e Rianimazione,
Universita di Bari, Ospedale Policlinico, Italy.
marco.ranieri@utoronto.ca.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: CONTEXT: Studies have shown that an inflammatory response
may be elicited by mechanical ventilation used for recruitment or
derecruitment of collapsed lung units or to overdistend alveolar
regions, and that a lung-protective strategy may reduce this
response. OBJECTIVE: To test the hypothesis that mechanical
ventilation induces a pulmonary and systemic cytokine response that
can be minimized by limiting recruitment or derecruitment and
overdistention. CONCLUSIONS: Mechanical ventilation can induce a
cytokine response that may be attenuated by a strategy to minimize
overdistention and recruitment/derecruitment of the lung. Whether
these physiological improvements are associated with improvements in
clinical end points should be determined in future studies.
ARTICLE TITLE: Spain leads world in organ donation and
transplantation [news]
ARTICLE SOURCE: JAMA (United States), Jul 7 1999, 282(1) p17-8
AUTHOR(S): Bosch X
PUBLICATION TYPE: NEWS
MB. Spain has over 30donors/1,000,000/year. We have about 8. :- (
We have over 40 waiting for livers.
ARTICLE TITLE: Hypoxia is the cause of brain damage in
hyponatremia [editorial]
ARTICLE SOURCE: JAMA (United States), Jun 23-30 1999, 281(24)
p2342-3
AUTHOR(S): Knochel JP
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Chronic hyponatremic encephalopathy in
postmenopausal women: association of therapies with morbidity and
mortality.
ARTICLE SOURCE: JAMA (United States), Jun 23-30 1999, 281(24)
p2299-304
AUTHOR(S): Ayus JC; Arieff AI
AUTHOR'S ADDRESS: Department of Medicine, Baylor College of Medicine,
Houston, Tex., USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER
STUDY
RESULTS: Chronic symptomatic hyponatremia (mean [SD] sodium
level 111 [12] mmol/L) was present for 5.2 [4.5]
days. Death or major morbidity occurred in 44 (83%) of 53 patients,
including 10 with orthopedic injury. Twelve patients had hypoxemia
(PO2 = 63 [25] mm Hg) and cerebral edema. Among patients who
received IV sodium chloride before respiratory insufficiency, plasma
sodium levels were increased by 22 (10) mmol/L in 35 hours and
patients had a CPC of 1.0 (normal or slight disability). Among
patients who received IV sodium chloride after respiratory
insufficiency, plasma sodium levels were increased by 30 (6) mmol/L
in 41 hours and patients had a CPC of 3.0 (1.2) (severe disability).
Among patients who had fluid restriction only, plasma sodium levels
were increased by 3 (2) mmol/L in 41 hours and patients had a CPC of
4.6 (0.7) (4 = persistent vegetative state; 5 = death). The outcomes
did not correlate with either the initial plasma sodium level
(r=0.05, P>.12) or the rate of correction (r=0.31, P>.10).
CONCLUSIONS: Chronic symptomatic hyponatremia in postmenopausal women
can be associated with major morbidity and mortality. Therapy with IV
sodium chloride was associated with significantly better outcomes
than fluid restriction.
MB. I always thought the physicians have always got this subject
wrong. The serum Na could be low but urine osmolality high without
those paramaters being inappropriate. Those who were fluid restricted
after developing resiratory failure all died .They did/do not seem to
realise that there could for example be dehydration with low CVP.
None of the literature on inappropriate ADH secretion, which was the
label put onto some of the cases, indicate state of body water as
shown by changes in weight. I am sure some cases of postoperative
hyponatraemia are due to giving IV fluids with low or no Na content.
Not many anaesthetists do that now.
ARTICLE TITLE: Prostate detection possibility [news]
ARTICLE SOURCE: JAMA (United States), Jun 23-30 1999, 281(24)
p2274-5
AUTHOR(S): Gunby P
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Probing informed consent in schizophrenia research
[news]
ARTICLE SOURCE: JAMA (United States), Jun 23-30 1999, 281(24)
p2273-4
AUTHOR(S): Stephenson J
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Preoperative serum potassium levels and
perioperative outcomes in cardiac surgery patients. Multicenter Study
of Perioperative Ischemia Research Group.
ARTICLE SOURCE: JAMA (United States), Jun 16 1999, 281(23)
p2203-10
AUTHOR(S): Wahr JA; Parks R; Boisvert D; Comunale M; Fabian J; Ramsay
J; Mangano DT
AUTHOR'S ADDRESS: Department of Anesthesiology, University of
Michigan, Ann Arbor, USA. jwahr@umich.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: Perioperative arrhythmia and the need for CPR increased
as preoperative serum potassium level decreased below 3.5 mmol/L.
Although interventional trials are required to determine whether
preoperative intervention mitigates these adverse associations,
preoperative repletion is low cost and low risk, and our data suggest
that screening and repletion be considered in patients scheduled for
cardiac surgery.
ARTICLE TITLE: Why the rise in asthma? New insight, few answers
[news]
ARTICLE SOURCE: JAMA (United States), Jun 16 1999, 281(23)
p2171-2
AUTHOR(S): Mitka M
PUBLICATION TYPE: NEWS
MB. I think it might be iatrogenic. That's what you have to suspect
if the treatment is getting better but the patients are getting
worse.
ARTICLE TITLE: From the Centers for Disease Control and
Prevention. Motor-vehicle safety: a 20th century public health
achievement.
ARTICLE SOURCE: JAMA (United States), Jun 9 1999, 281(22) p2080-2
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Current use and timing of spinal surgery for
management of acute spinal surgery for management of acute spinal
cord injury in North America: results of a retrospective multicenter
study.
ARTICLE SOURCE: J Neurosurg (United States), Jul 1999, 91(1 Suppl)
p12-8
AUTHOR(S): Tator CH; Fehlings MG; Thorpe K; Taylor W
AUTHOR'S ADDRESS: Division of Neurosurgery and Spinal Program,
Toronto Western Hospital and University of Toronto, Ontario,
Canada
ARTICLE TITLE: Increased inspired oxygen concentration as a factor
in improved brain tissue oxygenation and tissue lactate levels after
severe human head injury.
ARTICLE SOURCE: J Neurosurg (United States), Jul 1999, 91(1)
p1-10
AUTHOR(S): Menzel M; Doppenberg EM; Zauner A; Soukup J; Reinert MM;
Bullock R
AUTHOR'S ADDRESS: Division of Neurosurgery, Medical College of
Virginia, Virginia Commonwealth University, Richmond 23298-0631,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Local brain surface temperature compared to
temperatures measured at standard extracranial monitoring sites
during posterior fossa surgery.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Apr 1999,
11(2) p90-5
AUTHOR(S): Schuhmann MU; Suhr DF; v.Gosseln HH; Brauer A; Jantzen JP;
Samii M
AUTHOR'S ADDRESS: Department of Neurosurgery, Nordstadt Medical
Center, Medical School Hannover, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Mild hypothermia is assumed to protect against secondary
brain injury. However, the accuracy of brain temperature estimation
remains debatable if direct measurement in the target area is to be
avoided or is impossible. Furthermore, intracerebral temperature
gradients exist, especially under intraoperative conditions. We aimed
to establish how brain surface temperatures (TBrain) relate to
temperatures taken at standard sites in posterior fossa surgery. Ten
patients undergoing cerebellopontine angle tumor removal were
monitored for TBrain, esophageal temperature (TEso), bladder
temperature (TBlad), ipsi- and contralateral tympanic membrane
(TTymp-I, TTymp-C), and scalp temperatures (TScalp). During
monitoring, TEso increased from 35.3+/-0.2 degrees C to 36.0+/-0.3
degrees C. After dura opening, TBrain was -0.14+/-0.1 degrees C below
TEso. At the end of tumor removal, this difference increased to
-0.43+/-0.31 degrees C (P < 0.05). TTymp-C was -0.29+/-0.18
degrees C below TBrain at dura opening. TTymp-C reflected the
behavior of TEso adequately (r = 0.938), however, with a mean
difference of -0.39+/-0.04 degrees C. In contrast, TTymp-I readings
closely followed temperature changes in the area of surgery. TBlad
reflected TEso except in periods of rapid temperature changes. In
posterior fossa (PF) surgery, local TBrain is most accurately
reflected by TEso. For clinical use TBlad and TTymp-C are also
sufficient to assess brain surface temperature in the PF.
Intraoperative surface cooling of the brainstem is less than the
previously described cooling rate of exposed cerebral cortex.
MB. The differences look small to me.
ARTICLE TITLE: Epidural haematoma after removal of an epidural
catheter in a patient receiving high-dose enoxaparin [see
comments]
COMMENTS: Comment in: Br J Anaesth 1999 Feb; 82(2):164-7
ARTICLE SOURCE: Br J Anaesth (England), Feb 1999, 82(2) p288-90
AUTHOR(S): Yin B; Barratt SM; Power I; Percy J
AUTHOR'S ADDRESS: Department of Anaesthesia and Pain Management,
University of Sydney, Royal North Shore Hospital, St Leonards, NSW,
Australia.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A patient developed an epidural haematoma 6 days after
removal of an epidural catheter resulting in paraplegia and death.
Insertion and removal of the epidural catheter during anticoagulation
with prophylactic unfractionated heparin and subsequent
administration of high-dose enoxaparin (Clexane), which commenced 3
days after catheter removal, were implicated.
ARTICLE TITLE: Central nerve block and thromboprophylaxis--is
there a problem? [editorial; comment]
COMMENTS: Comment on: Br J Anaesth 1999 Feb; 82(2):288-90
ARTICLE SOURCE: Br J Anaesth (England), Feb 1999, 82(2) p164-7
AUTHOR(S): Checketts MR; Wildsmith JA
MAJOR SUBJECT HEADING(S): Anesthesia, Conduction [adverse
effects]; Anticoagulants [adverse effects]; Postoperative
Complications [prevention & control]; Thrombosis
[prevention & control]
MINOR SUBJECT HEADING(S): Hematoma, Epidural [etiology];
Hematoma, Subdural [etiology]
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: COMMENT; EDITORIAL
MB.The editorial plays down the problem as being uncommon & that
there is benefit from neuraxial block. It is a disaster and this
practice has essentially stopped at the hospital involved. They imply
that it only happens in the US but not in Europe. I suppose they will
have to have disasters in Europe before they stop.
ARTICLE TITLE: Prediction of movement at laryngeal mask airway
insertion: comparison of auditory evoked potential index, bispectral
index, spectral edge frequency and median frequency.
ARTICLE SOURCE: Br J Anaesth (England), Feb 1999, 82(2) p203-7
AUTHOR(S): Doi M; Gajraj RJ; Mantzaridis H; Kenny GN
AUTHOR'S ADDRESS: Department of Anaesthesia, HCI International
Medical Centre, Clydebank, UK.
PUBLICATION TYPE: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL
ARTICLE
ABSTRACT: We have studied 46 patients to compare the efficacy of the
auditory evoked potential (AEP) index, bispectral index (BIS), 95%
spectral edge frequency (SEF) and median frequency (MF) in predicting
movement in response to insertion of the laryngeal mask airway (LMA).
Anaesthesia was induced with target-controlled infusions of propofol
and alfentanil. After loss of eyelash reflex and adequate jaw
relaxation, the LMA was inserted without the assistance of a
laryngoscope or neuromuscular blocker. Patients who showed any
visible spontaneous muscle movement within 1 min of LMA insertion
were defined as movers. Values in movers and non-movers at 30 s
before LMA insertion were analysed. Only AEP index discriminated
between movers and non-movers with a prediction probability of 0.872.
BIS, SEF and MF could not predict movement at LMA insertion. AEP
index was the most reliable predictor of movement in response to LMA
insertion.
ARTICLE TITLE: Changes in plasma potassium concentration during
carbon dioxide pneumoperitoneum.
ARTICLE SOURCE: Br J Anaesth (England), Jan 1999, 82(1) p137-9
AUTHOR(S): Perner A; Bugge K; Lyng KM; Schulze S; Kristensen PA;
Bendtsen A
AUTHOR'S ADDRESS: Department of Anaesthesia, Sundby Hospital,
University of Copenhagen, Denmark.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: Hyperkalaemia with ECG changes had been noted during
prolonged carbon dioxide pneumoperitoneum in pigs. We have compared
plasma potassium concentrations during surgery in 11 patients
allocated randomly to undergo either laparoscopic or open
appendectomy and in another 17 patients allocated randomly to either
carbon dioxide pneumoperitoneum or abdominal wall lifting for
laparoscopic colectomy. Despite an increasing metabolic acidosis,
prolonged carbon dioxide pneumoperitoneum resulted in only a slight
increase in plasma potassium concentrations, which was both
statistically and clinically insignificant. Thus hyperkalaemia is
unlikely to develop in patients with normal renal function undergoing
carbon dioxide pneumoperitoneum for laparoscopic surgery.
MB. About 15y ago there was a big thing about changes associated with
alterations in blood PCO2. It seems to have faded away. I have
forgotten what was supposed to happen. :- (
ARTICLE TITLE: Nocturnal hypoxaemia and respiratory function after
endovascular and conventional abdominal aortic aneurysm repair.
ARTICLE SOURCE: Br J Anaesth (England), Jan 1999, 82(1) p129-31
AUTHOR(S): Thompson JP; Boyle JR; Thompson MM; Bell PR; Smith G
AUTHOR'S ADDRESS: University Department of Anaesthesia, Leicester
Royal Infirmary, UK.
PUBLICATION TYPE: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL
ARTICLE
ABSTRACT: Respiratory function, assessed by pre- and postoperative
spirometry, and overnight pulse oximetry recordings, was compared
prospectively in patients undergoing infrarenal abdominal aortic
aneurysm repair by endovascular or conventional surgery. Episodic
hypoxaemia was common in both groups before operation and up to the
fifth night after operation. The frequency and severity of hypoxaemia
were greater in the conventional group (P < 0.05). FEV1 and FVC
decreased significantly on the third and fifth days after operation
in both groups (P < 0.05); decreases in FVC were greater in
patients undergoing conventional surgery. On the fifth day after
operation, FVC had recovered to 86% and 64% of preoperative values in
the endovascular and conventional groups, respectively (P < 0.05).
Duration of surgery was greater (P < 0.05) and duration of
postoperative artificial ventilation significantly less (P < 0.05)
after endovascular repair. Postoperative PCA morphine consumption and
duration of use were significantly greater (P < 0.05) in patients
undergoing conventional abdominal aortic aneurysm surgery.
MB. Our endoluminals are much quicker than open AAAs. A lot would
have gone by 5 days.
ARTICLE TITLE: The sitting position in neurosurgery: a critical
appraisal.
ARTICLE SOURCE: Br J Anaesth (England), Jan 1999, 82(1) p117-28
AUTHOR(S): Porter JM; Pidgeon C; Cunningham AJ
AUTHOR'S ADDRESS: Department of Anaesthesia, College of Surgeons in
Ireland/Beaumont Hospital, Dublin, Ireland.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (84 references); REVIEW,
ACADEMIC
ABSTRACT: The potential for serious complications after venous air
embolism and successful malpractice liability claims are the
principle reasons for the dramatic decline in the use of the sitting
position in neurosurgical practice. Although there have been several
studies substantiating the relative safety compared with the prone or
park bench positions, its use will continue to decline as
neurosurgeons abandon its application and trainees in neurosurgery
are not exposed to its relative merits. How can individual surgeons
continue to use this position? Will individual, difficult surgical
access cases be denied the obvious technical advantages of the
sitting position? Limited use of the sitting position should remain
in the neurosurgeon's armamentarium. However, several caveats must be
emphasized. Assessment of the relative risk-benefit, based on the
individual patient's physical status and surgical implications for
the particular intracranial pathology, is of paramount importance.
The patient should be informed of the specific risks of venous air
embolism, quadriparesis and peripheral nerve palsies. Appropriate
charting of patient information provided and special consent issues
are essential. An anaesthetic input into the decision to use the
sitting position is a sine qua non. The presence of a patient foramen
ovale is an absolute contraindication. Preoperative contrast
echocardiography should be used as a screening technique to detect
the population at risk of paradoxical air embolism caused by the
presence of a patent foramen ovale. The technique involves i.v.
injection of saline agitated with air and a Valsalva manoeuvre is
applied and released. Use of this position necessitates supplementary
monitoring to promptly detect and treat venous air embolism. Doppler
ultrasonography is the most sensitive of the generally available
monitors to detect intracardiac air. The use of a central venous
catheter is recommended, with the tip positioned close to the
superior vena cava junction with the right atrium, to aspirate
intravascular gas. Measures to minimize hypotension associated with
the sitting position include a slow, staged positioning over 5-10 min
and use of the 'G suit' inflated with compressed air applied to the
lower extremities and pelvis. Use of the sitting or upright position
for patients undergoing posterior fossa and cervical spine surgery
presents unique challenges for the anaesthetist. With appropriate
patient selection and preparation, and using prudent intraoperative
monitoring and anaesthetic techniques, selected patients should still
benefit from the optimum access to mid-line lesions, improved
cerebral venous decompression, lower intracranial pressure and
enhanced gravity drainage of blood and CSF associated with the
sitting position.
MB. I stopped them using the sitting position in about 1970.
ARTICLE TITLE: Methods for reduction of perioperative
bleeding.
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81 Suppl 1
p62-6
AUTHOR(S): Gombotz H; Metzler H; List WF
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care
Medicine, University of Graz, Austria.
MINOR SUBJECT HEADING(S): Blood Coagulation; Hemostasis, Surgical
[methods]
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (84 references); REVIEW,
TUTORIAL
MB. All bleeding is surgical. :- )
ARTICLE TITLE: Does optimizing oxygen transport improve outcome in
intensive care patients?
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81 Suppl 1
p46-9
AUTHOR(S): Brazzi L; Gattinoni L
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care,
University of Milan, Italy.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (28 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Are changes in the evoked electromyogram during
anaesthesia without neuromuscular blocking agents caused by failure
of supramaximal nerve stimulation?
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81(6) p902-4
AUTHOR(S): Polhill SL; Clewlow F; Smith DC
AUTHOR'S ADDRESS: Department of Anaesthesia, Southampton General
Hospital.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The evoked electromyogram often decreases during
anaesthesia in the absence of neuromuscular block. We have measured
the electromyogram of the first dorsal interosseous muscle evoked by
train-of-four stimulation of the ulnar nerve in 63 patients
undergoing anaesthesia for minor surgery. We used Medicotest P-00-S
electrodes, a Datex Relaxograph and a current sink in the stimulating
leads in parallel with the current path through the patient. The
current sink was used to shunt some of the maximum available output
current from the Relaxograph while maintaining the supramaximal
stimulus current passing through the patient. After 30 min of
anaesthesia, when the muscle response to train-of-four was stable,
the ulnar nerve stimulus current was increased by reducing the
proportion shunted through the current sink. The electromyographic
response did not change during the study in 13 patients. In the
remaining 50 patients, the response decreased to 78.4% (SD 27.1%,
range 7.5-95.0%) of baseline values over the first 20 min of
anaesthesia. In 22 of these patients, the electromyographic response
increased from 71.4 (SD 22.6)% to 92.3 (9.5)% of baseline responses
when the stimulus current was increased by 12.3 (2.4) mA, while in
the remaining 28 patients the response decreased to 83.7 (10.6)% and
did not increase with increasing stimulus current. These results
suggest that loss of supramaximal stimulation is partly responsible
for the observed changes in the evoked electromyogram during
anaesthesia.
MB.Sounds as though callibration shifts ie the results cannot be
quantitative.
ARTICLE TITLE: Intranasal midazolam for premedication of children
undergoing day-case anaesthesia: comparison of two delivery systems
with assessment of intra-observer variability.
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81(6) p865-9
AUTHOR(S): Griffith N; Howell S; Mason DG
AUTHOR'S ADDRESS: Nuffield Department of Anaesthetics, John Radcliffe
Hospital, Oxford.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: Midazolam is often used for paediatric premedication. We
have compared two methods of administering midazolam intranasally in
44 surgical day-case children allocated randomly to receive midazolam
0.2 mg kg-1 as drops or midazolam 0.1 mg kg-1 from an intranasal
spray device. Behaviour was recorded on a four-point scale by the
parent, nurse and anaesthetist. Coefficients were obtained
representing the change in behaviour score. There was no significant
difference in method of administration (coefficient 0.13, P = 0.39).
Children were significantly more distressed at the time of
premedication and at the time of venous cannulation (coefficients
1.31 and 0.70) than at baseline. There was no significant difference
in the assessments between observers. Midazolam by either method was
equally effective but acceptability of the premedication was poor in
both groups. Intranasal midazolam cannot be recommended as a method
for routine premedication of young children.
MB. I am not surprised that children object to stuff being put into
their noses.
ARTICLE TITLE: Changes in core temperature compartment size on
induction of general anaesthesia.
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81(6) p861-4
AUTHOR(S): Deakin CD
AUTHOR'S ADDRESS: Department of Anaesthetics, Southampton General
Hospital.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A two-compartment model of temperature distribution
estimates the core compartment to occupy 66% of body mass at rest,
while the peripheral compartment comprises the remainder. General
anaesthesia impairs thermoregulation by central and peripheral
actions. Peripheral vasodilatation accelerates heat transfer from the
core to peripheral compartment causing the core compartment to cool
and expand in size. Core hypothermia may be a significant cause of
postoperative morbidity. This undocumented change in the size of the
core compartment on induction of anaesthesia can be calculated. Core
size increased from the established value of 66% before induction of
general anaesthesia to 71.2 (SD 6)% of body mass, 20 min after
induction of anaesthesia (P = 0.0001). On induction of general
anaesthesia, the core compartment cools and expands while the
peripheral compartment warms and contracts by a corresponding amount.
Measurement of the magnitude of changes in core:periphery heat
distribution on induction of anaesthesia contribute to a clearer
understanding of the pathophysiology of perioperative
hypothermia.
MB. I think that the concept of heat compartments which change in
size is a bit contrived.
ARTICLE TITLE: Concentration and second-gas effects in the water
analogue.
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81(6) p837-43
AUTHOR(S): Mapleson WW; Korman B
AUTHOR'S ADDRESS: Department of Anaesthetics and Intensive Care
Medicine, University of Wales College of Medicine, Cardiff.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The water analogue provides a visual model of the process
of anaesthetic exchange. In the standard version, a single pipe
connects the mouth container to the lung container and the
conductance of this mouth-lung pipe is proportional to alveolar
ventilation. This implies that inspired and expired ventilations are
equal. In fact, with high inspired concentrations of nitrous oxide,
early rapid uptake of gas by solution leads to a substantial
difference between inspired and expired ventilation which in turn
leads to concentration and second-gas effects. It is shown that by
representing inspired and expired ventilations separately, and
keeping one of them constant while varying the other to compensate
for rapid uptake, concentration and second-gas effects are reproduced
in the water analogue. Other means of reproducing the effects are
reported but we believe that the first method is the most realistic
and the most appropriate for teaching.
ARTICLE TITLE: Opioids and the immune system
[editorial]
ARTICLE SOURCE: Br J Anaesth (England), Dec 1998, 81(6) p835-6
AUTHOR(S): Webster NR
PUBLICATION TYPE: EDITORIAL
MB. I showed the last sentence "---opoiods---would have a profound
immunomodulatory effect---& we should be cognizant of this effect
when we choose anaesthetic, analgesis of sedative techniques." to a
medical registrar in the library. He thought it was `BS'. So do
I.
ARTICLE TITLE: The winter bed crisis--quantifying seasonal effects
on hospital bed usage.
ARTICLE SOURCE: QJM (England), Apr 1999, 92(4) p199-206
AUTHOR(S): Fullerton KJ; Crawford VL
AUTHOR'S ADDRESS: Belfast City Hospital, UK.
k.fullerton@qub.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
In the 'elective' specialties, bed occupancy fluctuates widely, with
reduced occupancy at weekends and at Christmas. These differences are
entirely amenable to modification. More effective bed management
would make a very significant contribution to avoiding winter bed
crises.
MB. Our dept of Health needs to read this. We don't make any
provision to redistribute sessions when surgeons are away. The NSW
Director-general of Health (not a doctor) can't work out how winter
has moved to November (SMH page 4). 5 Sydney teaching hospitals
including us closed their emergency departments at the same time. All
the political players are blaming the rest of the players
ARTICLE TITLE: Mendel and his legacy [editorial]
ARTICLE SOURCE: QJM (England), Apr 1999, 92(4) p183-6
AUTHOR(S): Cox TM
MAJOR SUBJECT HEADING(S): Genetics [history]
MINOR SUBJECT HEADING(S): Czechoslovakia; History of Medicine, 19th
Cent.
PUBLICATION TYPE: BIOGRAPHY; EDITORIAL; HISTORICAL ARTICLE
NAMED SUBJECT(S): Mendel G
ARTICLE TITLE: Patient-related outcomes five years after coronary
artery bypass graft surgery.
ARTICLE SOURCE: QJM (England), Feb 1999, 92(2) p87-96
AUTHOR(S): Skinner JS; Farrer M; Albers CJ; Neil HA; Adams PC
AUTHOR'S ADDRESS: Departments of Cardiology, Freeman Hospital and
Royal Victoria Infirmary, Newcastle upon Tyne, UK.
jane@enaj.demon.co.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
The significant improvement in angina symptoms and perceived health
status (PHS) after CABG persists for at least 5 years. However, only
one third of patients in this geographical area return to work, and
this is not solely dependent on clinical symptoms.
ARTICLE TITLE: How should we pay doctors? A systematic review of
salary payments and their effect on doctor behaviour.
ARTICLE SOURCE: QJM (England), Jan 1999, 92(1) p47-55
AUTHOR(S): Gosden T; Pedersen L; Torgerson D
AUTHOR'S ADDRESS: National Primary Care Research and Development
Centre, University of Manchester, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (44 references); REVIEW
LITERATURE
ABSTRACT: We reviewed the published and unpublished international
literature to determine the influence of salaried payment on doctor
behaviour. We systematically searched Medline, BIDS Embase, Econlit
and BIDS ISI and the reference lists of located papers to identify
relevant empirical studies comparing salaried doctors with those paid
by alternative methods. Only studies which reported objective
outcomes and measures of the behaviour of doctors paid by salary
compared to an alternative method were included in the review.
Twenty-three papers were identified as meeting the selection
criteria. Only one of the studies in this review reported a proxy for
health status, but none examined whether salaried doctors
differentiated between patients on the basis of health needs.
Therefore, we were unable to draw conclusions on the likely impact of
salaried payment on efficiency and equity. However, the limited
evidence in our review does suggest that payment by salaries is
associated with the lowest use of tests, and referrals compared with
FFS and capitation. Salary payment is also associated with lower
numbers of procedures per patient, lower throughput of patients per
doctor, longer consultations, more preventive care and different
patterns of consultation compared with FFS payment.
MB. Someone told me they pay sheep shearers by the fleece but all
their support staff by salary.
ARTICLE TITLE: Physical inactivity: an easily modified risk
factor? [editorial; comment]
COMMENTS: Comment on: Circulation 1999 Jul 6; 100(1):9-13
ARTICLE SOURCE: Circulation (United States), Jul 6 1999, 100(1)
p2-4
AUTHOR(S): Snell PG; Mitchell JH
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Relationship between delay in performing direct
coronary angioplasty and early clinical outcome in patients with
acute myocardial infarction: results from the global use of
strategies to open occluded arteries in Acute Coronary Syndromes
(GUSTO-IIb) trial.
ARTICLE SOURCE: Circulation (United States), Jul 6 1999, 100(1)
p14-20
AUTHOR(S): Berger PB; Ellis SG; Holmes DR Jr; Granger CB; Criger DA;
Betriu A; Topol EJ; Califf RM
AUTHOR'S ADDRESS: Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, USA. berger.peter@mayo.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: The time to treatment with direct percutaneous coronary
angioplasty (PTCA), as with thrombolytic therapy, is a critical
determinant of mortality.
ARTICLE TITLE: Insights into the contemporary epidemiology and
outpatient management of congestive heart failure [see
comments]
COMMENTS: Comment in: Am Heart J 1999 Jul; 138(1 Pt 1):5-8
ARTICLE SOURCE: Am Heart J (United States), Jul 1999, 138(1 Pt 1)
p87-94
AUTHOR(S): McAlister FA; Teo KK; Taher M; Montague TJ; Humen D;
Cheung L; Kiaii M; Yim R; Armstrong PW
AUTHOR'S ADDRESS: Division of General Internal Medicine, University
of Alberta, Edmonton, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Our data suggest that a specialized outpatient clinic
can improve practice patterns in patients with CHF. The high
mortality risk in CHF with preserved systolic function suggests the
need to find efficacious (and effective) therapies for this
condition.
ARTICLE TITLE: Contemporary issues in heart failure
[editorial; comment]
COMMENTS: Comment on: Am Heart J 1999 Jul; 138(1 Pt 1):87-94
ARTICLE SOURCE: Am Heart J (United States), Jul 1999, 138(1 Pt 1)
p5-8
AUTHOR(S): Ghali JK
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (29 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Pandora's box is torn asunder [editorial;
comment]
COMMENTS: Comment on: Am Heart J 1999 Jul; 138(1 Pt 1):95-9
ARTICLE SOURCE: Am Heart J (United States), Jul 1999, 138(1 Pt 1)
p9-12
AUTHOR(S): Jaffe AS
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. About next article.
ARTICLE TITLE: A novel biochemical approach to congestive heart
failure: cardiac troponin T [see comments]
COMMENTS: Comment in: Am Heart J 1999 Jul; 138(1 Pt 1):9-12
ARTICLE SOURCE: Am Heart J (United States), Jul 1999, 138(1 Pt 1)
p95-9
AUTHOR(S): Missov E; Mair J
AUTHOR'S ADDRESS: Department of Cardiology and INSERM U-390,
University Hospital of Montpellier, France.
missov@medicine.ucsf.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: These data show that cardiac troponin T is increased in
patients with congestive heart failure and that the level parallels
the severity of the disease. We conclude that cardiac troponin T is a
suitable candidate-marker molecule to monitor congestive heart
failure from a structural perspective.
ARTICLE TITLE: Prophylactic oral amiodarone compared with placebo
for prevention of atrial fibrillation after coronary artery bypass
surgery.
ARTICLE SOURCE: Am Heart J (United States), Jul 1999, 138(1 Pt 1)
p144-50
AUTHOR(S): Redle JD; Khurana S; Marzan R; McCullough PA; Stewart JR;
Westveer DC; O'Neill WW; Bassett JS; Tepe NA; Frumin HI
AUTHOR'S ADDRESS: Division of Cardiology, William Beaumont Hospital,
Royal Oak, Mich., USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Postoperative CABG atrial fibrillation is associated with
prolonged hospital stay and increased cost. Prophylactic oral
amiodarone did not statistically alter the incidence or duration of
atrial fibrillation after CABG, although favorable trends were noted.
Hospital cost was not affected by therapy with amiodarone.
ARTICLE TITLE: Alternate-day dosing of aspirin in atrial
fibrillation: A critical evaluation
COMMENTS: Comment on: Am Heart J 1999 Jul; 138(1 Pt 1):137-43
ARTICLE SOURCE: Am Heart J (United States), Jul 1999, 138(1 Pt 1)
p13
AUTHOR(S): Howes CJ; Ezekowitz MD
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Prophylactic lidocaine use in acute myocardial
infarction: incidence and outcomes from two international trials. The
GUSTO-I and GUSTO-IIb Investigators [see comments]
COMMENTS: Comment in: Am Heart J 1999 May; 137(5):770-3
ARTICLE SOURCE: Am Heart J (United States), May 1999, 137(5)
p799-805
AUTHOR(S): Alexander JH; Granger CB; Sadowski Z; Aylward PE; White
HD; Thompson TD; Califf RM; Topol EJ
AUTHOR'S ADDRESS: Duke Clinical Research Institute, Durham, North
Carolina, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Prophylactic lidocaine use has decreased with the advent
of thrombolysis, although its use may not be associated with
increased mortality rates.
ARTICLE TITLE: Multicenter randomized trial and a systematic
overview of lidocaine in acute myocardial infarction [see
comments]
COMMENTS: Comment in: Am Heart J 1999 May; 137(5):770-3
ARTICLE SOURCE: Am Heart J (United States), May 1999, 137(5)
p792-8
AUTHOR(S): Sadowski ZP; Alexander JH; Skrabucha B; Dyduszynski A;
Kuch J; Nartowicz E; Swiatecka G; Kong DF; Granger CB
AUTHOR'S ADDRESS: Institut Kardiologu and Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC 27710, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; META-ANALYSIS;
MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Lidocaine reduces VF but may adversely affect mortality
rates. The routine use of prophylactic lidocaine in acute MI is not
recommended.
ARTICLE TITLE: Prophylactic lidocaine use in acute myocardial
infarction revisited in the thrombolytic era
COMMENTS: Comment on: Am Heart J 1999 May; 137(5):792-8; Comment on:
Am Heart J 1999 May; 137(5):799-805
ARTICLE SOURCE: Am Heart J (United States), May 1999, 137(5)
p770-3
AUTHOR(S): Tan HL; Lie KI
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (27 references); REVIEW,
TUTORIAL
MB. This was going to be important therapy. Now thought at best
useless
ARTICLE TITLE: Proceedings of a symposium: economics and
cost-effectiveness in evaluating the value of cardiovascular
therapies. What constitutes a useful health economic study for the
pharmaceutical industry?
ARTICLE SOURCE: Am Heart J (United States), May 1999, 137(5)
pS62-6
AUTHOR(S): Gagnon JP
AUTHOR'S ADDRESS: Hoechst Marion Roussel, Inc., Kansas City, MO
64134-0627, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Cause of in-hospital death in 12,232 consecutive
patients undergoing percutaneous transluminal coronary angioplasty.
The Northern New England Cardiovascular Disease Study Group
COMMENTS: Comment in: Am Heart J 1999 Apr; 137(4 Pt 1):582-4
ARTICLE SOURCE: Am Heart J (United States), Apr 1999, 137(4 Pt 1)
p632-8
AUTHOR(S): Malenka DJ; O'Rourke D; Miller MA; Hearne MJ; Shubrooks S;
Kellett MA Jr; Robb JF; O'Meara JR; Ver Lee P; Bradley WA; Wennberg
D; Ryan T Jr; Vaitkus PT; Hettleman B; Watkins MW; McGrath PD;
O'Connor GT
AUTHOR'S ADDRESS: Sections of Cardiology and Clinical Research,
Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
david.malenka@hitchcock.org.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSION: Procedural complications account for half of all post-
percutaneous coronary angioplasty (PTCA) deaths and are a particular
problem for women. Other deaths are more directly related to patient
acuity or noncardiac, comorbid conditions. Understanding why women
face an increased risk of procedural complications may lead to
improved outcomes for all patients.
MB. I thought it was due to smaller size of vessels. The following
editorial implies this when they state that when earlier studies of
CABG mortality were corrected for body size the sex difference went
away. How come I know this. :- (
ARTICLE TITLE: Why is mortality rate after percutaneous
transluminal coronary angioplasty higher in women?
COMMENTS: Comment on: Am Heart J 1999 Apr; 137(4 Pt 1):632-8
ARTICLE SOURCE: Am Heart J (United States), Apr 1999, 137(4 Pt 1)
p582-4
AUTHOR(S): Brodie BR
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: What to do with acute atrial fibrillation?
[editorial]
ARTICLE SOURCE: Am Heart J (United States), Apr 1999, 137(4 Pt 1)
p601-2
AUTHOR(S): Califf RM
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Lone atrial fibrillation: epidemiology and natural
history [editorial; comment]
COMMENTS: Comment on: Am Heart J 1999 Apr; 137(4 Pt 1):686-91
ARTICLE SOURCE: Am Heart J (United States), Apr 1999, 137(4 Pt 1)
p592-5
AUTHOR(S): Gersh BJ; Solomon A
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The abbreviated life of acronyms [editorial;
comment]
COMMENTS: Comment on: Am Heart J 1999 Apr; 137(4 Pt 1):726-65
ARTICLE SOURCE: Am Heart J (United States), Apr 1999, 137(4 Pt 1)
p577-8
AUTHOR(S): French PA; Ohman EM
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. I hate them.