MB's Articles of Interest - October '99

ARTICLE TITLE: The hemodynamic effects of local anesthetic injection into the carotid body during carotid endarterectomy.
ARTICLE SOURCE: Am Surg (United States), Jul 1999, 65(7) p648-51; discussion 651-2
AUTHOR(S): Fardo DJ; Hankins WT; Houskamp W; Robson L
AUTHOR'S ADDRESS: Department of Surgery, Spectrum Health, Grand Rapids, Michigan, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
We were unable to detect a significant difference in hypotension, hypertension, or bradycardia either during or after surgery. Therefore, on the basis of this study, routine use of local anesthetic injection into the carotid body cannot be recommended.
MB. I used to get them to do this but nothing much seems to have happened lately

ARTICLE TITLE: "Blind" placement of long-term central venous access devices: report of 589 consecutive procedures.
ARTICLE SOURCE: Am Surg (United States), Jun 1999, 65(6) p520-3; discussion 523-4
AUTHOR(S): Kincaid EH; Davis PW; Chang MC; Fenstermaker JM; Pennell TC
AUTHOR'S ADDRESS: Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Placement of long-term central venous access devices, such as Hickman catheters and implanted subcutaneous ports, has traditionally been performed in the operating room with fluoroscopy. This study reports our experience with percutaneous placement of these devices in the outpatient clinic setting without the use of real-time imaging. Results were generated from a prospective database of all adult patients undergoing placement of central venous access in the outpatient clinic of the Wake Forest University Baptist Medical Center. This database revealed that during the years 1996 and 1997, long-term central venous catheter placement was attempted in 589 adult patients in the outpatient clinic. Technical success was achieved in 558 patients (92%). This included 278 tunneled catheters and 280 totally implanted devices. Repositioning of the catheter tip was required in 16 patients (2.9%). The incidence of pneumothorax was 1.9 per cent. Late complications, including infection and thrombosis, occurred in 9 per cent. The average procedure-related charge for placement of a single-lumen central venous port in the outpatient clinic was $1691 versus $4559 in the operating room and $3890 in the radiology department. We conclude that routine placement of long-term central venous access devices in the outpatient clinic, without the use of real-time imaging, yields acceptable success rates and may have economic advantages over procedures performed in the operating room or radiology department.

ARTICLE TITLE: Prophylactic anti-emetic efficacy of ondansetron in laparoscopic cholecystectomy under total intravenous anaesthesia. A randomised, double-blind comparison with droperidol, metoclopramide and placebo.
ARTICLE SOURCE: Anaesthesia (England), Mar 1999, 54(3) p266-71
AUTHOR(S): Helmy SA
AUTHOR'S ADDRESS: Department of Anaesthesia, Faculty of Medicine, Cairo University, Egypt.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
The incidence of vomiting was lower in the ondansetron, droperidol and metoclopramide groups than in the placebo group between 1 and 4 h but was the same between 4 and 24 h. As a result of the lower incidence of nausea and vomiting between 1 h and 4 h in the ondansetron group, the overall incidence of nausea and vomiting was lower during the first 24 h after surgery in this group than in the other three groups.

ARTICLE TITLE: Prevention of needle-stick injury. Efficacy of a safeguarded intravenous cannula.
ARTICLE SOURCE: Anaesthesia (England), Mar 1999, 54(3) p258-61
AUTHOR(S): Asai T; Matsumoto S; Matsumoto H; Yamamoto K; Shingu K
AUTHOR'S ADDRESS: Department of Anaesthesiology, Kansai Medical University, Osaka, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: One possible method of reducing the incidence of needle-stick injury is to use needles with safeguard mechanisms. The needle of the Insyte AutoGuard intravenous cannula can be retracted into the safety barrel. One hundred patients were randomly allocated to receive either an 18-gauge conventional Insyte intravenous cannula (group C) or the AutoGuard cannula (group AG) to assess the ease of use and efficacy of the AutoGuard device. It was possible to insert the cannula into the vein within two attempts in all patients; there was no significant difference between two groups with respect to ease of insertion. No problems, such as inadvertent withdrawal of the needle, occurred during insertion in any patient. Handling the withdrawn needle was judged significantly safer in group AG than in group C (p < 0.001). Blood contamination often occurred where a withdrawn needle was placed in group C, whereas no blood stain was detected in any case in group AG (p < 0.001). The AutoGuard cannula provides safer handling of a withdrawn needle without reducing its ease of insertion.

ARTICLE TITLE: Peri-operative silent myocardial ischaemia in patients undergoing lower limb joint replacement surgery: an indicator of postoperative morbidity or mortality?
ARTICLE SOURCE: Anaesthesia (England), Mar 1999, 54(3) p235-40
AUTHOR(S): French GW; Lam WH; Rashid Z; Sear JW; Foex P; Howell S
AUTHOR'S ADDRESS: Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
New symptoms (chest pain, palpitations, breathlessness or fatigue) were associated with both silent myocardial ischaemia and ischaemic load (p < 0.05). Thus cardiac risk factors do not predict the occurrence of silent myocardial ischaemia or adverse outcome. Peri-operative silent myocardial ischaemia was associated with increased postoperative fatigue.
MB. I was surprised at the whole abstract as it seemed to imply little connection between silent ischaemia and outcome. The whole article confirmed that impression. I assume it is not the result they wanted.

ARTICLE TITLE: Perioperative ST-segment depression and troponin T release. Identification of patients with highest risk for myocardial damage.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1999, 43(2) p124-9
AUTHOR(S): Rapp HJ; Rabethge S; Luiz T; Haux P
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care Medicine, Universitatsklinikum Mannheim, University of Heidelberg, Germany.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE

ARTICLE TITLE: Perioperative myocardial ischemia in patients undergoing noncardiac surgery: does prolonged ischemia result in myocardial necrosis? [editorial]
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1999, 43(2) p121-3
AUTHOR(S): Hynynen M
PUBLICATION TYPE: EDITORIAL
MB. It’s about the preceeding article. I think they think that they can’t think what to do about it

ARTICLE TITLE: Cost-effectiveness of ondansetron for postoperative nausea and vomiting.
ARTICLE SOURCE: Anaesthesia (England), Mar 1999, 54(3) p226-34
AUTHOR(S): Tramer MR; Phillips C; Reynolds DJ; McQuay HJ; Moore RA
AUTHOR'S ADDRESS: Nuffield Department of Anaesthetics, University of Oxford, Churchill Hospital, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The decision as to whether prophylaxis against postoperative nausea and vomiting is better than treatment of established postoperative nausea and vomiting could be made on the basis of cost-effectiveness. The cost-effectiveness of ondansetron was calculated using data from published quantitative systematic reviews of randomised trials. Milligrams of ondansetron required to achieve a desired endpoint were chosen as a cost unit. Modelling was based on a cohort of 1000 patients, and examined control event rates (i.e. incidence of postoperative nausea and vomiting without prophylaxis) of between 10 and 90%. In a sensitivity analysis, cost-effectiveness of recommended intravenous doses (4 mg for treatment and prophylaxis) was compared with minimal effective doses as shown by meta-analysis (1 mg for treatment, 8 mg for prophylaxis). Fewer patients experience any postoperative nausea and vomiting symptoms with prophylaxis compared with treatment. But prophylaxis is only marginally more effective than treatment, and treatment of established postoperative nausea and vomiting with effective doses (i.e. 1 or 4 mg) is more cost-effective and safer than prophylaxis with effective doses (i.e. 4 or 8 mg). Reasons for this are the selective treatment of patients who actually need treatment, the high success rate with a lowest dose tested (1 mg) in established postoperative nausea and vomiting, and the disappointing antinausea effect of prophylactic ondansetron even at an eight-fold higher dose.

ARTICLE TITLE: Why mothers die--report on confidential enquiries into maternal deaths in the United Kingdom 1994-96 [editorial]
ARTICLE SOURCE: Anaesthesia (England), Mar 1999, 54(3) p207-9
AUTHOR(S): Crowhurst JA; Plaat F
PUBLICATION TYPE: EDITORIAL
It seems to have got a bit worse.

ARTICLE TITLE: The impact of percutaneous tracheostomy on intensive care unit practice and training.
ARTICLE SOURCE: Anaesthesia (England), Feb 1999, 54(2) p186-9
AUTHOR(S): Simpson TP; Day CJ; Jewkes CF; Manara AR
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: We studied the impact of introducing percutaneous tracheostomy to our intensive care unit on the incidence and timing of tracheostomy and on the implications for surgical training. The proportion of patients receiving intensive care who underwent tracheostomy doubled from a median of 8.5% to 16.8% (p < 0.01) following the introduction of the percutaneous technique with the procedure being undertaken significantly earlier during the intensive care stay. The opportunity for surgical trainees to gain experience in open surgical tracheostomy has been virtually lost. The increase in tracheostomy rate may reflect a previous under-utilisation caused by the logistic problems of transferring a critically ill patient to theatre, or alternatively a relaxation of the indications for tracheostomy caused by a perceived benefit for the patient. An increased workload may also have contributed to the rise. Surgical trainees should be encouraged to learn percutaneous techniques and training opportunities in open surgical techniques should be maximised.
MB. This begs the question what should the tracheostomy rate be. Maybe they are doing the tracheostomies for practice or fun. It’s as silly as trying to decide on caesarian section rates

ARTICLE TITLE: Use and safety of percutaneous tracheostomy in intensive care. Report of a postal survey of ICU practice.
ARTICLE SOURCE: Anaesthesia (England), Dec 1998, 53(12) p1209-12
AUTHOR(S): Cooper RM
AUTHOR'S ADDRESS: Department of Anaesthesia, Royal Lancaster Infirmary, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A brief questionnaire was sent to 231 clinical directors of intensive care units in England and Wales to investigate the use of percutaneous tracheostomy. There was a 76% response rate. Percutaneous tracheostomies were in use in 78.4% of units. The Ciaglia technique was the most commonly used, with 31.3% routinely using fibreoscopy as part of their technique. Only 12% of units routinely provided long-term follow up of their percutaneous tracheostomies. Overall, 78.4% thought that percutaneous tracheostomy was safe and 66.7% considered percutaneous tracheostomy to be the technique of choice for Intensive Care patients. Percutaneous tracheostomy is now a well-established technique. However, the limited use of fibreoscopy and the lack of long-term follow-up are areas of concern.

ARTICLE TITLE: Death in the dental chair [editorial]
ARTICLE SOURCE: Anaesthesia (England), Feb 1999, 54(2) p105-7
AUTHOR(S): Cartwright DP
PUBLICATION TYPE: EDITORIAL
MB. It looks as though dentist administered anaesthesia is on the way out in the UK.

ARTICLE TITLE: Diagnosing brain death: the importance of documenting clinical test results.
ARTICLE SOURCE: Anaesthesia (England), Jan 1999, 54(1) p81-5
AUTHOR(S): Keogh AT; Akhtar TM
AUTHOR'S ADDRESS: Department of Intensive Care Medicine, Queen Mary's Hospital, Kent, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Eighty-three cases of brain stem death referred to the South Thames Transplant Co-ordination Service were audited to determine the quality of brain stem death test records. Documentation of brain stem death tests were complete in only 41 (44%) cases at the time of referral. There was no significant difference in completeness, whether documentation was in patient's notes or on a designated checklist (p = 0.14). There were a greater number of omissions when the tests were documented in patient's notes rather than on a form (p = 0.01). There is a necessity to improve the quality of brain stem death test documentation in order to facilitate organ donation and safeguard the integrity of brain stem death testing. This requires a commitment by clinicians to improve the quality of documentation, which can be accomplished by recording all aspects of brain stem death tests, including the conclusion on a single designated checklist.
MB. This hopeless. No wonder there are rumours.

ARTICLE TITLE: Brain stem death defines death in law.
ARTICLE SOURCE: BMJ (England), Jun 26 1999, 318(7200) p1755
AUTHOR(S): Jennett B
AUTHOR'S ADDRESS: Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Can pediatricians define and apply the concept of brain death?
ARTICLE SOURCE: Pediatrics (United States), Jun 1999, 103(6) pe82
AUTHOR(S): Harrison AM; Botkin JR
AUTHOR'S ADDRESS: Department of Pediatrics, Division of Critical Care, SUNY Health Science Center at Syracuse, Syracuse, New York 13210, USA. harrisoa@hscsyr.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Pediatric residents and attendings have difficulty defining and applying the concept of brain death. This concept is difficult to grasp and internalize for many pediatricians. To ensure that critical decisions are made by knowledgeable physicians and well-informed families, more effective educational strategies need to be identified.
MB. Such faith in the power of educational activity.

ARTICLE TITLE: Safe pre-operative fasting times after milk or clear fluid in children. A preliminary study using real-time ultrasound.
ARTICLE SOURCE: Anaesthesia (England), Jan 1999, 54(1) p51-9
AUTHOR(S): Sethi AK; Chatterji C; Bhargava SK; Narang P; Tyagi A
AUTHOR'S ADDRESS: Department of Anaesthesiology, University College of Medical Sciences & GTB Hospital, Delhi, India.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
It was concluded that 3% fat milk or 17.5% glucose in a volume of 10 ml.kg-1 (maximum volume of 100 ml) can be given in children safely 3 h and 2 h, respectively, before anaesthesia. More real-time studies are required on breast milk to establish guidelines for its potential use as a pre-operative feed 3 h before anaesthesia.
MB.Why is everyone trying to set minimum safe periods. There has to be a range. To be safe you have to assume the longest period.

ARTICLE TITLE: A survey of undergraduate teaching in anaesthesia.
ARTICLE SOURCE: Anaesthesia (England), Jan 1999, 54(1) p4-12
AUTHOR(S): Cheung V; Critchley LA; Hazlett C; Wong EL; Oh TE
AUTHOR'S ADDRESS: Department of Anaesthesia & Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Currently, no well accepted and clearly defined 'core' curriculum for undergraduate anaesthesia, teaching exists. To address this deficiency, we surveyed 73 university departments of anaesthesia and intensive care. Sixty-five replied from South-east Asia (12), Australasia (13), the UK and Ireland (28) and Canada (12). A questionnaire containing 37 items ranging from departmental structure to curriculum content was used. We found significant regional differences. Overall, most departments taught pharmacology of anaesthetic drugs (83%), pre-operative assessment (92%) and care of the unconscious patient (77%). Ninety-seven per cent taught airway management and intubation and 80% taught intravenous cannulation. Basic life support was taught by 92% and advanced life support by 71%. Fewer than half taught advanced trauma life support principles (44%). Critical care teaching was less well defined, but a consensus of schools taught respiratory failure and ventilation, management of circulatory shock and principles of sepsis and multi-organ system failure. Practical clinical skills were taught mainly using patients and simulators, 46% had a skills laboratory and six employed a resuscitation officer. However, it should be noted that we did not assess the quality and outcome of teaching.
MB Very higgily piggily

ARTICLE TITLE: Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS).
ARTICLE SOURCE: Anaesthesia (England), Jan 1999, 54(1) p19-26
AUTHOR(S): Kluger MT; Short TG
AUTHOR'S ADDRESS: Department of Anaesthesia, North Shore Hospital, Auckland, New Zealand.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Two-hundred and forty incidents of vomiting/regurgitation and aspiration were reported to the Anaesthetic Incident Monitoring Study database consisting of 5000 reports. Of these, 133 cases of aspiration were recorded. Passive regurgitation occurred three times more commonly than active vomiting. Aspiration was reported twice as often in elective compared with emergency surgery, with 56% of incidents taking place during induction of anaesthesia. Anti-aspiration prophylaxis was prescribed in 14% of patients who subsequently aspirated; however, the majority of cases had at least one predisposing factor for regurgitation, vomiting or aspiration evident peri-operatively. While a major immediate physiological disturbance was common, long-term morbidity was not. Death ensued in five cases, all of whom had significant co-morbidities. Factors reported as contributing to the incident included error of judgement and fault of technique, while clinical experience and anaesthetic assistance tended to minimise the incident. Aspiration remains an important anaesthetic-related morbidity. The application of simple guidelines may have prevented the incident in 60% of all cases of aspiration. Ensuring airway security may be as important as chemoprophylaxis in its prevention.
MB. I would have thought it was of the essence.

ARTICLE TITLE: Hygienic practices of consultant anaesthetists: a survey in the north-west region of the UK.
ARTICLE SOURCE: Anaesthesia (England), Jan 1999, 54(1) p13-8
AUTHOR(S): el Mikatti N; Dillon P; Healy TE
AUTHOR'S ADDRESS: Anaesthetic Department of TU 3, South Manchester University Hospital NHS Trust, Withington Hospital, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Questionnaires were distributed to all 213 consultant anaesthetists in the North-West region of the UK with a response rate of 68%. <snip>. The results of this study show that, although anaesthetists are well aware of proper hygienic practices, their performance falls short of accepted recommendations.
MB.How are we to get people to change bloody gloves?. At least most would wash body fluid from hsnds.

ARTICLE TITLE: Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery [see comments]
COMMENTS: Comment in: BMJ 1999 Apr 24; 318(7191):1087-8
ARTICLE SOURCE: BMJ (England), Apr 24 1999, 318(7191) p1099-103
AUTHOR(S): Wilson J; Woods I; Fawcett J; Whall R; Dibb W; Morris C; McManus E
AUTHOR'S ADDRESS: Department of Anaesthetics, York District Hospital, York YO31 8HE. jonathan@critbase.demon.co.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: OBJECTIVES: SUBJECTS: 138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions. Interventions: Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care. CONCLUSION: Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.
MB. Pretty silly experiment. Monitoring + an adrenergic agent compared to neither.
These people are coming here late in the year. Paid for by Baxter. I am being invited. :-)

ARTICLE TITLE: Reducing the risk of major elective surgery [editorial; comment]
COMMENTS: Comment on: BMJ 1999 Apr 24; 318(7191):1099-103
ARTICLE SOURCE: BMJ (England), Apr 24 1999, 318(7191) p1087-8
AUTHOR(S): Treasure T; Bennett D
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Managing atrial fibrillation in elderly people [editorial]
ARTICLE SOURCE: BMJ (England), Apr 24 1999, 318(7191) p1088-9
AUTHOR(S): English KM; Channer KS
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Assessing operative skill. Needs to become more objective [editorial]
ARTICLE SOURCE: BMJ (England), Apr 3 1999, 318(7188) p887-8
AUTHOR(S): Darzi A; Smith S; Taffinder N
PUBLICATION TYPE: EDITORIAL
MB. Obviously this is a pretty hopeless task.

ARTICLE TITLE: Better blood transfusion [editorial]
ARTICLE SOURCE: BMJ (England), May 29 1999, 318(7196) p1435-6
AUTHOR(S): Provan D
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: When doctors might kill their patients: foreseeing is not necessarily the same as intending [editorial]
ARTICLE SOURCE: BMJ (England), May 29 1999, 318(7196) p1431-2
AUTHOR(S): Gillon R
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Evidence based cardiology: prevention of congestive heart failure and management of asymptomatic left ventricular dysfunction.
ARTICLE SOURCE: BMJ (England), May 22 1999, 318(7195) p1400-2
AUTHOR(S): McKelvie RS; Benedict CR; Yusuf S
AUTHOR'S ADDRESS: Department of Medicine, Division of Cardiology, McMaster University, Hamilton Health Sciences Corporation-General Division, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2. mckelrob@hamcivhos.on.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (32 references); REVIEW, TUTORIAL

ARTICLE TITLE: Influence of hospital and clinician workload on survival from colorectal cancer: cohort study [see comments]
COMMENTS: Comment in: BMJ 1999 May 22; 318(7195):1386
ARTICLE SOURCE: BMJ (England), May 22 1999, 318(7195) p1381-5
AUTHOR(S): Kee F; Wilson RH; Harper C; Patterson CC; McCallion K; Houston RF; Moorehead RJ; Sloan JM; Rowlands BJ
AUTHOR'S ADDRESS: Department of Epidemiology and Public Health, Queen's University of Belfast, Belfast BT12 6BJ.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: There was no detectable caseload effect for surgeons managing colorectal cancer, but survival of patients treated in hospitals with caseloads above 33 cases per year was slightly worse than for those treated in hospitals with fewer caseloads. Imprecise measurement of clinician specific "events rates" and the lack of routinely collected case mix data present major challenges for clinical audit and governance in the years ahead.
MB. Not convincing.

ARTICLE TITLE: Hyponatraemia after orthopaedic surgery [editorial]
ARTICLE SOURCE: BMJ (England), May 22 1999, 318(7195) p1363-4
AUTHOR(S): Lane N; Allen K
PUBLICATION TYPE: EDITORIAL
MB. I think this is from giving hyponatraemic fluids IV. They talk about fluid retention and diuretics.

ARTICLE TITLE: Experience with rationing health care in New Zealand.
ARTICLE SOURCE: BMJ (England), May 15 1999, 318(7194) p1346-8
AUTHOR(S): Feek CM; McKean W; Henneveld L; Barrow G; Edgar W; Paterson RJ
AUTHOR'S ADDRESS: Ministry of Health, PO Box 503, Wellington, New Zealand. ColenFeek@moh.govt.nz.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial.
ARTICLE SOURCE: BMJ (England), May 15 1999, 318(7194) p1311-6
AUTHOR(S): Tonnesen H; Rosenberg J; Nielsen HJ; Rasmussen V; Hauge C; Pedersen IK; Kehlet H
AUTHOR'S ADDRESS: Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: One month of preoperative abstinence reduces postoperative morbidity in alcohol abusers. The mechanism is probably reduced preclinical organ dysfunction and reduction of the exaggerated response to surgical stress.

ARTICLE TITLE: Withdrawing or withholding life prolonging treatment [editorial]
ARTICLE SOURCE: BMJ (England), Jun 26 1999, 318(7200) p1709-10
AUTHOR(S): Luttrell S
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: How do you choose antibiotic treatment?
ARTICLE SOURCE: BMJ (England), Jun 12 1999, 318(7198) p1614-6
AUTHOR(S): Leibovici L; Shraga I; Andreassen S
AUTHOR'S ADDRESS: Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 69978 Israel. leibovic@post.tau.ac.il.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (32 references); REVIEW, TUTORIAL

ARTICLE TITLE: Towards an understanding of oedema.
ARTICLE SOURCE: BMJ (England), Jun 12 1999, 318(7198) p1610-3
AUTHOR(S): Diskin CJ; Stokes TJ; Dansby LM; Carter TB; Radcliff L; Thomas SG
AUTHOR'S ADDRESS: Hypertension, Nephrology, Dialysis, and Transplantation Clinic, School of Pharmacy, Auburn University, Auburn, AL 36849, USA.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: The effect of age on the pharmacokinetics and pharmacodynamics of midazolam.
ARTICLE SOURCE: Clin Pharmacol Ther (United States), Jun 1999, 65(6) p630-9
AUTHOR(S): Albrecht S; Ihmsen H; Hering W; Geisslinger G; Dingemanse J; Schwilden H; Schuttler J
AUTHOR'S ADDRESS: Department of Anesthesiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: These results suggest that the lower doses needed to reach sedation in the elderly subjects were attributable to a 50% decrease in EC50, not to changes in pharmacokinetics.

ARTICLE TITLE: Influence of arteriovenous sampling on remifentanil pharmacokinetics and pharmacodynamics.
ARTICLE SOURCE: Clin Pharmacol Ther (United States), May 1999, 65(5) p511-8
AUTHOR(S): Hermann DJ; Egan TD; Muir KT
AUTHOR'S ADDRESS: Pharsight, Cary, NC 27511, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: If this study had been conducted with venous samples alone, inappropriate conclusions such as acute tolerance could have been inferred. When designing studies to measure the acute time course (ie, non-steady state) of concentration and effect, the potential effects of sampling site on pharmacokinetic and pharmacodynamic characteristics must be carefully considered, particularly when the arteriovenous drug concentration difference is large.

ARTICLE TITLE: The effects of ramipril on sympathetic nervous system function in older patients with hypertension.
ARTICLE SOURCE: Clin Pharmacol Ther (United States), Apr 1999, 65(4) p420-7
AUTHOR(S): Lee CC; Sidani MA; Hogikyan RV; Supiano MA
AUTHOR'S ADDRESS: University of Michigan Medical Center, Ann Arbor, USA. clchopra@umich.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Ramipril therapy did not suppress systemic sympathetic nervous system activity, alter other norepinephrine kinetic parameters, or alter alpha-adrenergic responsiveness in older patients with hypertension.

ARTICLE TITLE: Treatment planning in pain medicine. Integrating medical, physical, and behavioral therapies.
ARTICLE SOURCE: Med Clin North Am (United States), May 1999, 83(3) p823-49, viii
AUTHOR(S): Gallagher RM
AUTHOR'S ADDRESS: Comprehensive Pain and Rehabilitation Center, MCP/Hahnemann School of Medicine, Philadelphia, Pennsylvania, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (71 references); REVIEW, TUTORIAL

ARTICLE TITLE: Roadblocks to effective pain treatment.
ARTICLE SOURCE: Med Clin North Am (United States), May 1999, 83(3) p809-21, viii
AUTHOR(S): Stieg RL; Lippe P; Shepard TA
AUTHOR'S ADDRESS: Colorado Compensation Insurance Authority, University of Colorado Health Sciences Center, Denver, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (48 references); REVIEW, TUTORIAL
ABSTRACT: Managed care "backlash" rhetoric to the contrary, roadblocks to effective pain treatment occur both intrinsic and extrinsic to the healthcare system. Pain medicine, an emerging, formally recognized specialty, and the special population of patients which it serves, experience additional discreet barriers. Chief among these is a lack of clear identity and recognition of the specialty and the disenfranchisement of many of the patients it serves in the American healthcare system. Special problems within various healthcare financing environments is discussed.

ARTICLE TITLE: Interventional pain management. Appropriate when less invasive therapies fail to provide adequate analgesia.
ARTICLE SOURCE: Med Clin North Am (United States), May 1999, 83(3) p787-808, vii-viii
AUTHOR(S): Krames ES
AUTHOR'S ADDRESS: Pacific Pain Treatment Centers, San Francisco, California, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (73 references); REVIEW, TUTORIAL
ABSTRACT: Unrelieved chronic pain is costly to patients and society. Noninvasive and less costly therapies should be used before more invasive and more costly therapies. Therapies for pain control should be used according to a pain treatment continuum. Nerve-blocking techniques, neurolytic techniques, and implantable neuromodulatory technologies, such as SCC and spinal delivery of analgesics, are cost-effective when less invasive therapies fail to provide adequate analgesia.

ARTICLE TITLE: Opioid use in the management of chronic pain.
ARTICLE SOURCE: Med Clin North Am (United States), May 1999, 83(3) p761-86
AUTHOR(S): Savage SR
AUTHOR'S ADDRESS: Department of Anesthesiology, Dartmouth Medical School, Lebanon, New Hampshire, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (62 references); REVIEW, TUTORIAL

ARTICLE TITLE: Cancer pain management.
ARTICLE SOURCE: Med Clin North Am (United States), May 1999, 83(3) p711-36, vii
AUTHOR(S): Chang HM
AUTHOR'S ADDRESS: Department of Internal Medicine, University of Texas Health Science Center at Houston, USA. mchang@heart.med.uth.tmc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (37 references); REVIEW, TUTORIAL

ARTICLE TITLE: Central mechanisms in pain.
ARTICLE SOURCE: Med Clin North Am (United States), May 1999, 83(3) p585-96
AUTHOR(S): Urban MO; Gebhart GF
AUTHOR'S ADDRESS: Department of Pharmacology, College of Medicine, University of Iowa, Iowa City, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (30 references); REVIEW, TUTORIAL
The significant role that modulatory influences in the central nervous system have in the development and maintenance of chronic pain and hyperalgesia clearly supports continued investigation into the physiologic mechanisms contributing to these events.

ARTICLE TITLE: Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trail. Was the best treatment used?
ARTICLE SOURCE: Med J Aust (Australia), Jun 7 1999, 170(11) p564-5
AUTHOR(S): Unsworth IP
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Primary stenting in acute myocardial infarction: paving the way to arterial patency [editorial; comment]
COMMENTS: Comment on: Med J Aust 1999 Jun 7; 170(11):537-40
ARTICLE SOURCE: Med J Aust (Australia), Jun 7 1999, 170(11) p518-9
AUTHOR(S): Meredith IT
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (19 references); REVIEW, TUTORIAL

ARTICLE TITLE: Organ donor index: a benchmark for comparing hospital organ donor rates.
ARTICLE SOURCE: Med J Aust (Australia), May 17 1999, 170(10) p479-81
AUTHOR(S): Holt AW; Hodgeman GK; Vedig AE; Heard PE
AUTHOR'S ADDRESS: Flinders Medical Centre, Adelaide, SA.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: ICD-9-CM codes (i.e., diagnostic codes from the International classification of diseases, 9th revision, clinical modification) codes can be used to describe organ donors and hospital populations from which potential organ donors may be found. The casemix-controlled organ donor indices can be used to compare the organ donor rates of individual hospitals and to examine reasons for low rates (other than purely casemix variation).

ARTICLE TITLE: Improving organ donor rates [editorial]
ARTICLE SOURCE: Med J Aust (Australia), May 17 1999, 170(10) p463-4
AUTHOR(S): Pearson IY; Chapman JR
PUBLICATION TYPE: EDITORIAL
MB. They mention the "Spanish" method used in S Australia with increase in donor rate. It should be used all over. Our liver waiting list is now about 46 but the number of donors is not increasing.

ARTICLE TITLE: "Don't confuse me with facts...": evidence-based practice confronts reality.
ARTICLE SOURCE: Med J Aust (Australia), May 17 1999, 170(10) p465-6
AUTHOR(S): Anderson J
AUTHOR'S ADDRESS: Centre for Clinical Effectiveness Monash University/Southern Health Care Network.
PUBLICATION TYPE: CONGRESSES

ARTICLE TITLE: Australian doctors' beliefs and practice regarding Helicobacter pylori [see comments]
COMMENTS: Comment in: Med J Aust 1999 Apr 19; 170(8):348-9
ARTICLE SOURCE: Med J Aust (Australia), Apr 19 1999, 170(8) p354-7
AUTHOR(S): Mollison LC; Jamrozik KD; Plant AJ
AUTHOR'S ADDRESS: Bethesda Hospital, Perth, WA. lindsay.mollison@health.wa.gov.au.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Significant differences exist between specialist groups in beliefs and self-reported behaviours regarding H. pylori.

ARTICLE TITLE: Facts and fables in management of Helicobacter pylori [editorial; comment]
COMMENTS: Comment on: Med J Aust 1999 Apr 19; 170(8):354-7
ARTICLE SOURCE: Med J Aust (Australia), Apr 19 1999, 170(8) p348-9
AUTHOR(S): Barbezat GO
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Euthanasia consultants or facilitators? [editorial; comment]
COMMENTS: Comment on: Med J Aust 1999 Apr 19; 170(8):360-3
ARTICLE SOURCE: Med J Aust (Australia), Apr 19 1999, 170(8) p351-2
AUTHOR(S): Hendin H
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Colorectal cancer after open-access colonoscopy: a community and case survey [see comments]
COMMENTS: Comment in: Med J Aust 1999 Mar 15; 170(6):244
ARTICLE SOURCE: Med J Aust (Australia), Mar 15 1999, 170(6) p251-4
AUTHOR(S): Croese J
AUTHOR'S ADDRESS: jcroese@medeserv.com.au.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Patients aged over 50 years who had previously undergone a colonoscopy and ensuing treatment were less likely to be diagnosed with CRC than otherwise expected. Surveillance colonoscopy led to diagnosis of CRCs with lower Dukes grades.

ARTICLE TITLE: Shedding light on bowel cancer prevention [editorial; comment]
COMMENTS: Comment on: Med J Aust 1999 Mar 15; 170(6):251-4
ARTICLE SOURCE: Med J Aust (Australia), Mar 15 1999, 170(6) p244-5
AUTHOR(S): Bolin TD; Korman MG
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Anesthesia during the Civil War.
ARTICLE SOURCE: Arch Surg (United States), Jun 1999, 134(6) p680
AUTHOR(S): Rutkow IM
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE

ARTICLE TITLE: Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary?
ARTICLE SOURCE: Arch Surg (United States), Jun 1999, 134(6) p611-3; discussion 614
AUTHOR(S): Higgins A; London J; Charland S; Ratzer E; Clark J; Haun W; Maher DP
AUTHOR'S ADDRESS: Exempla Saint Joseph Hospital, Denver, Colo, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Based on our data, use of prophylactic antibiotics does not decrease the rate of wound infections in elective laparoscopic cholecystectomy.

ARTICLE TITLE: Medical education in early 19th century America.
ARTICLE SOURCE: Arch Surg (United States), Apr 1999, 134(4) p453
AUTHOR(S): Rutkow IM
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE

ARTICLE TITLE: Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure.
ARTICLE SOURCE: Arch Surg (United States), Apr 1999, 134(4) p375-9; discussion 379-80
AUTHOR(S): Masiakos PT; Islam S; Doody DP; Schnitzer JJ; Ryan DP
AUTHOR'S ADDRESS: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Nonneonatal survival with Extracorporeal membrane oxygenation (ECMO) therapy is strongly dependent on the diagnosis. Pre-ECMO intubation for less than 9 days had little effect on survival. Survival rates decreased when the length of time of receiving ECMO exceeded 300 hours.

ARTICLE TITLE: ECMO in adults: what is its role? [editorial; comment]
COMMENTS: Comment on: Can J Anaesth 1998 Nov; 45(11):1097-102
ARTICLE SOURCE: Can J Anaesth (Canada), Nov 1998, 45(11) p1044-8
AUTHOR(S): Wassermann J; Mazer CD
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Differential nerve block [editorial; comment]
COMMENTS: Comment on: Can J Anaesth 1998 Nov; 45(11):1049-53
ARTICLE SOURCE: Can J Anaesth (Canada), Nov 1998, 45(11) p1039-43
AUTHOR(S): Reid D
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Haemodynamic effects of induction of general anaesthesia with propofol during epidural anaesthesia.
ARTICLE SOURCE: Can J Anaesth (Canada), Nov 1998, 45(11) p1061-5
AUTHOR(S): Kasaba T; Kondou O; Yoshimura Y; Watanabe Y; Takasaki M
AUTHOR'S ADDRESS: Department of Anesthesiology, Miyazaki Medical College, Japan. binjik@post1.miyazaki-med.ac.jp.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: The hypotensive effects of propofol are additive to those of epidural anaesthesia, resulting in a profound decrease in mean arterial pressure.

ARTICLE TITLE: Economic evaluation of sevoflurane vs propofol for ambulatory anaesthesia [editorial; comment]
COMMENTS: Comment on: Can J Anaesth 1998 Dec; 45(12):1148-50
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 1998, 45(12) p1141-3
AUTHOR(S): Wong J; Chung F
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Midazolam-sufentanil vs sufentanil-enflurane for induction of anaesthesia for CABG surgery.
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 1998, 45(12) p1207-10
AUTHOR(S): Murphy T; Landymore RW; Hall RI
AUTHOR'S ADDRESS: Department of Anaesthesia, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Compared with sufentanil-enflurane, midazolam-sufentanil anaesthesia resulted in comparable and acceptable haemodynamics and myocardial oxygenation in CABG patients.

ARTICLE TITLE: Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance vs TIVA in CABG surgery.
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 1999, 46(3) p240-6
AUTHOR(S): Gravel NR; Searle NR; Taillefer J; Carrier M; Roy M; Gagnon L
AUTHOR'S ADDRESS: Departement d'Anesthesie, Institut de Cardiologie de Montreal, Universite de Montreal, Quebec, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Induction of anesthesia in patients with CAD, VCRII with sevoflurane supplemented by sufentanil provided hemodynamic responses comparable with those of TIVA although bradycardia was observed more often with sevoflurane. Intraoperative control of systemic blood pressure was achieved with fewer interventions with a sevoflurane/sufentanil maintenance than with a propofol/sufentanil technique in CABG surgery.

ARTICLE TITLE: ST-segment depression and myocardial contractility during cesarean section under spinal anesthesia.
ARTICLE SOURCE: Can J Anaesth (Canada), Jan 1999, 46(1) p52-5
AUTHOR(S): Roy L; Ramanathan S
AUTHOR'S ADDRESS: Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, PA 15044 USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: ST-segment depression occurring during CS is associated with a hyperkinetic myocardial contractile state.

ARTICLE TITLE: Is skin puncture beneficial prior to arterial catheter insertion?
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 1999, 46(2) p129-32
AUTHOR(S): Bhardwaj D; Norris A; Wong DT
AUTHOR'S ADDRESS: Department of Anaesthesiology, Toronto Hospital, Ontario.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: There are no differences in insertion time or catheter damage between skin puncture and no skin puncture techniques prior to arterial catheter insertion. The practice of skin puncture may be abandoned resulting in decreased risk of needlestick injury.
MB. They used angiocaths. I am sure it does not apply some other catheters.

ARTICLE TITLE: The new relaxants: are they worth it?
ARTICLE SOURCE: Can J Anaesth (Canada), May 1999, 46(5 Pt 2) pR88-100
AUTHOR(S): Bevan DR
AUTHOR'S ADDRESS: Department of Anesthesia, Vancouver Hospital & Health Sciences Centre, B.C., Canada.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (32 references); REVIEW, TUTORIAL
MB. Last sentence "Muscle Relaxants are Cheap."

ARTICLE TITLE: Awareness during anesthesia.
ARTICLE SOURCE: Can J Anaesth (Canada), May 1999, 46(5 Pt 2) pR80-7
AUTHOR(S): McLeskey CH
AUTHOR'S ADDRESS: Department of Anesthesiology, Scott & White Hospital & Clinic/Texas A&M University Health Science Center, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (17 references); REVIEW, TUTORIAL

ARTICLE TITLE: Antibiotics in acute bronchitis: a meta-analysis.
ARTICLE SOURCE: Am J Med (United States), Jul 1999, 107(1) p62-7
AUTHOR(S): Bent S; Saint S; Vittinghoff E; Grady D
AUTHOR'S ADDRESS: Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco Veterans Affairs Medical Center, 94121, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSION: This meta-analysis suggests a small benefit from the use of the antibiotics erythromycin, doxycycline, or trimethoprim/sulfamethoxazole in the treatment of acute bronchitis in otherwise healthy patients. As this small benefit must be weighed against the risk of side effects and the societal cost of increasing antibiotic resistance, we believe that the use of antibiotics is not justified in these patients.

ARTICLE TITLE: Evidence-based organ allocation.
ARTICLE SOURCE: Am J Med (United States), Jul 1999, 107(1) p52-61
AUTHOR(S): Zenios SA; Wein LM; Chertow GM
AUTHOR'S ADDRESS: Graduate School of Business, Stanford University, CA, USA.
MAJOR SUBJECT HEADING(S): Evidence-Based Medicine; Health Care Rationing [methods]; Organ Procurement; Patient Selection; Transplants [supply & distribution]
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Evidence-based organ allocation strategies in cadaveric kidney transplantation would yield improved equity and efficiency measures compared with existing algorithms.

ARTICLE TITLE: In pursuit of folly.
ARTICLE SOURCE: Am J Med (United States), Jun 1999, 106(6) p655-9
AUTHOR(S): Stimmel B
AUTHOR'S ADDRESS: Department of Medicine, Mount Sinai School of Medicine of The City University of New York, New York 10029, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Despite the agreement of most of the professional organizations that are concerned with medical education and health manpower that there is an increasing physician surplus, little has been done to address this problem. The number of entering first-year residency positions has remained relatively stable during the past several years, with the number of applicants consistently in excess of the number of positions. Nonetheless, national or state incentives to decrease the number of residency positions have been criticized frequently. The reasons for the physician surplus, the resistance to adjusting the size of residency training efforts, and the feasibility of existing solutions to balance physician supply with demand are critically reviewed.

ARTICLE TITLE: Methicillin-resistant Staphylococcus aureus: long-term care concerns.
ARTICLE SOURCE: Am J Med (United States), May 3 1999, 106(5A) p2S-10S; discussion 48S-52S
AUTHOR(S): Bradley SF
AUTHOR'S ADDRESS: Geriatric Research Education and Clinical Center, Department of the Veterans Affairs Medical Center, University of Michigan, Ann Arbor 48105, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (40 references); REVIEW, TUTORIAL
ABSTRACT: Colonization of residents of long-term care facilities with methicillin-resistant Staphylococcus aureus (MRSA) is an important healthcare concern. MRSA colonization is prevalent; in two of the most common sites of colonization, nares and wounds, colonization rates range from 8% to 53%, and 30% to 82%, respectively. With such a large number of patients harboring the organism, it is imperative that long-term care facilities are knowledgeable regarding the overall significance of MRSA, are aware of MRSA infection rates at their facilities, and have established a threshold above which outbreak precautions will be instituted. More importantly, facilities must ensure that appropriate precautions (e.g., hand washing, glove changes, gowns) are utilized to prevent transmission of MRSA to noncolonized residents. If these basic measures are taken, MRSA-colonized residents of long-term facilities should be able to be fully integrated into the everyday activities within the long-term care environment. In the event of an outbreak of MRSA infection, stricter isolation of colonized and infected residents is warranted, and such isolation should be discontinued as soon as the chain of transmission has been disrupted. Systemic antibiotics should be avoided in asymptomatic colonized patients; topical antibiotics like mupirocin should be reserved for short-term administration in outbreak situations.

ARTICLE TITLE: Control of methicillin-resistant Staphylococcus aureus in the hospital setting.
ARTICLE SOURCE: Am J Med (United States), May 3 1999, 106(5A) p11S-18S; discussion 48S-52S
AUTHOR(S): Herwaldt LA
AUTHOR'S ADDRESS: Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242-1081, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (52 references); REVIEW, TUTORIAL
ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of nosocomial infections. Healthcare professionals in the United States should develop programs to prevent transmission of this organism within their institutions. Aggressive control efforts are justified for several reasons: (1) the incidence of nosocomial MRSA reflects the general effectiveness of infection control practice; (2) MRSA do not replace susceptible strains but instead increase the overall rate of nosocomial S. aureus infections; (3) MRSA infections cause substantial morbidity and mortality; (4) serious MRSA infections must be treated with vancomycin. Thus, in hospitals with high rates of MRSA, use of this antimicrobial agent increases, which in turn may increase the risk for selecting vancomycin-resistant enterococci. Hospitals have used numerous different approaches to control nosocomial spread of MRSA. Staff should choose a control method based on the prevalence of MRSA in their institution and in their referring facilities, the rate of nosocomial transmission of MRSA in their hospital, the risk factors present in their patient population, the reservoirs and modes of transmission specific to their hospital, and their resources. Any MRSA control plan must stress adherence to basic infection control measures, such as hand washing and contact isolation precautions. In addition, decolonization of patients and staff, control of antimicrobial use, surveillance cultures, and molecular typing may be helpful adjuncts.

ARTICLE TITLE: The medical evaluation of the sexually abused child: lessons from a decade of research.
ARTICLE SOURCE: Pediatrics (United States), Jul 1999, 104(1 Pt 2) p178-86
AUTHOR(S): Atabaki S; Paradise JE
AUTHOR'S ADDRESS: Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (76 references); REVIEW, TUTORIAL

ARTICLE TITLE: Procedural pain in newborn infants: the influence of intensity and development.
ARTICLE SOURCE: Pediatrics (United States), Jul 1999, 104(1) pe13
AUTHOR(S): Porter FL; Wolf CM; Miller JP
AUTHOR'S ADDRESS: Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA. fran@wubios.wustl.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Similar to what has been shown in adults, newborn and developing infants show increased magnitude physiologic and behavioral responses to increasingly invasive procedures, demonstrating that even very prematurely born infants respond to pain and differentiate stimulus intensity. However, the considerable overlap of magnitude with invasiveness suggests that there is not a physiologic or behavioral threshold that clearly marks the presence of pain. Inconsistencies in physiologic and behavioral responses make reliance on a pain index difficult. The best approach may be one of universal precaution to provide pain management systematically to reduce the acute and long-term impact of early procedural pain. development, stimulus intensity, pain response.
MB. Very obvious conclusion.

ARTICLE TITLE: Toilet training methods, clinical interventions, and recommendations. American Academy of Pediatrics.
ARTICLE SOURCE: Pediatrics (United States), Jun 1999, 103(6 Pt 2) p1359-68
AUTHOR(S): Stadtler AC; Gorski PA; Brazelton TB
AUTHOR'S ADDRESS: Children's Hospital, Touchpoint Project, Boston, Massachusetts, USA.
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE
MB. This seems to have been neglected by anaesthetists’ mothers. :- (

ARTICLE TITLE: Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation?
ARTICLE SOURCE: Pediatrics (United States), May 1999, 103(5 Pt 1) p961-7
AUTHOR(S): Lindner W; Vossbeck S; Hummler H; Pohlandt F
AUTHOR'S ADDRESS: Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: In our setting, the individualized intubation strategy in the delivery room DR restricted endotracheal intubation & mechanical ventilation EI/MV to those in extremely low birth weight infants (ELBWI; <1000 g, >/=24 weeks). who ultimately needed it, without increasing morbidity or mortality in infants with secondary EI/MV attributable to RDS. We speculate that an individualized intubation strategy of the ELBWI < 1000g, >/=24/52 is superior to immediate intubation of all ELBWIs with slight signs of respiratory distress after birth.

ARTICLE TITLE: Trampolines at home, school, and recreational centers. American Academy of Pediatrics. Committee on Injury and Poison Prevention and Committee on Sports Medicine and Fitness.
ARTICLE SOURCE: Pediatrics (United States), May 1999, 103(5 Pt 1) p1053-6
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ABSTRACT: The latest available data indicate that an estimated 83 400 trampoline-related injuries occurred in 1996 in the United States. This represents an annual rate 140% higher than was reported in 1990. Most injuries were sustained on home trampolines. In addition, 30% of trampoline-related injuries treated in an emergency department were fractures often resulting in hospitalization and surgery. These data support the American Academy of Pediatrics' reaffirmation of its recommendation that trampolines should never be used in the home environment, in routine physical education classes, or in outdoor playgrounds. Design and behavioral recommendations are made for the limited use of trampolines in supervised training programs.
MB. It is difficult to buy them in the US..

ARTICLE TITLE: Too many pediatric trampoline injuries.
ARTICLE SOURCE: Pediatrics (United States), May 1999, 103(5) pe57
AUTHOR(S): Furnival RA; Street KA; Schunk JE
AUTHOR'S ADDRESS: Division of Pediatric Emergency Medicine, Primary Children's Medical Center, Salt Lake City, UT 84113, USA. furnival@med.utah.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: pediatric trampoline injuries (PTI) are dramatically increasing in number, and result in considerable childhood morbidity. Most PTI occur on privately owned trampolines. Few, if any, safety recommendations for the trampoline are followed. We support recommendations for a ban on the recreational, school, and competitive pediatric use of trampolines.
MB. Its worse if used under a ceiling fan

ARTICLE TITLE: Evidence-based medicine: a new science or an epidemiologic fad? [comment]
COMMENTS: Comment on: Pediatrics 1999 May; 103(5 Pt 1):941-7
ARTICLE SOURCE: Pediatrics (United States), May 1999, 103(5 Pt 1) p1029-31
AUTHOR(S): Bauchner H
AUTHOR'S ADDRESS: Boston University School of Medicine/Boston Medical Center, Boston, MA 02118, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
MB. Points out that evidence-based analyses are only part of the problem.

ARTICLE TITLE: Dyspnea during interscalene block after recent coronary bypass surgery.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p55-6
AUTHOR(S): Hashim MS; Shevde K
AUTHOR'S ADDRESS: Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York 11219, USA.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Nocturnal oxygenation during patient-controlled analgesia [see comments]
COMMENTS: Comment in: Anesth Analg 1999 Jul; 89(1):3-6
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p104-10
AUTHOR(S): Stone JG; Cozine KA; Wald A
AUTHOR'S ADDRESS: Department of Anesthesiology, New York Medical College, St. Vincents Medical Center, New York 10011, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
IMPLICATIONS: Oxygen saturation was measured postoperatively in patients using morphine patient-controlled analgesia. Substantial nocturnal hypoxemia occurred in half of the patients while they breathed room air. The severity of the hypoxemia was reduced when patients received supplemental oxygen.
MB. This is not surprising. The authors think that PCA is the safest method of giving narcotics. They say there is no associated mortality or permenant morbitiy but report one in their study requiring resusciatatiion and 12 references to ‘anecdotes’ of overdose.

ARTICLE TITLE: Just when we thought we understood patient-controlled analgesia... [editorial; comment]
COMMENTS: Comment on: Anesth Analg 1999 Jul; 89(1):104-10
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p3-6
AUTHOR(S): Rowlingson JC
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. I am not included in the ‘we’.

ARTICLE TITLE: Platelet function and anesthetics in cardiac surgery: an in vitro and ex vivo study.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p26-31
AUTHOR(S): Parolari A; Guarnieri D; Alamanni F; Toscano T; Tantalo V; Gherli T; Colli S; Foieni F; Franze V; Stanghellini M; Gianotti GA; Biglioli P; Tremoli E
AUTHOR'S ADDRESS: Department of Cardiac Surgery, University of Milan, Milano, Italy. corallo@imiucca.csi.unimi.it.
PUBLICATION TYPE: JOURNAL ARTICLE
IMPLICATIONS: Thiopental inhibited prostaglandin-induced platelet activation at therapeutic concentrations both in vitro and ex vivo in cardiac surgical patients whereas adenosine diphosphate-induced activation was affected only at supratherapeutic drug concentrations. Thus, administration of sodium thiopental may contribute to the in vivo impairment of platelet function in patients undergoing elective cardiac surgery.

ARTICLE TITLE: The effects of residual neuromuscular blockade and volatile anesthetics on the control of ventilation.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p243-51
AUTHOR(S): Eriksson LI
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden. alie@kir.ks.se.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (67 references); REVIEW, TUTORIAL

ARTICLE TITLE: Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p187-90
AUTHOR(S): Tu HN; Saidi N; Leiutaud T; Bensaid S; Menival V; Duvaldestin P
AUTHOR'S ADDRESS: Department of Anesthesia, Henri-Mondor Hospital, Creteil, France.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL . IMPLICATIONS: In patients anesthetized with nitrous oxide, the inflation of the tracheal tube cuff with a gas mixture of the same composition as the inhaled mixture can prevent excessive cuff pressure and reduce the incidence of tracheal injury.
MB. I have never been aware of a real problem related to this mechanism.

ARTICLE TITLE: The effectiveness of rapidly infused intravenous fluids for inducing moderate hypothermia in neurosurgical patients.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p163-9
AUTHOR(S): Baumgardner JE; Baranov D; Smith DS; Zager EL
AUTHOR'S ADDRESS: Department of Anesthesia, University of Pennsylvania, Philadelphia, USA. jbaumgar@mail.med.upenn.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
IMPLICATIONS: Chilled IV fluids can be much more effective for the induction of hypothermia than commonly assumed, but they must be administered very rapidly to avoid heat gains in IV tubing.
MB. If you do the sums involved it should not be a surpise. O.3 deg C/litre at room temp.

ARTICLE TITLE: Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Ropivacaine Hip Replacement Multicenter Study Group.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p111-6
AUTHOR(S): Wulf H; Biscoping J; Beland B; Bachmann-Mennenga B; Motsch J
AUTHOR'S ADDRESS: Department of Anesthesiology, University Hospital of Kiel, Germany. wulf@anaesthesie.uni-kiel.de.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
IMPLICATIONS: Compared with general anesthesia and postoperative IV patient-controlled analgesia with morphine, epidural anesthesia and analgesia with the new local anesthetic ropivacaine enables patients to be discharged sooner from a postanesthesia care unit and provides superior pain relief during the first 24 h after hip replacement.

ARTICLE TITLE: Maximizing operating room utilization: a landmark study [editorial; comment]
COMMENTS: Comment on: Anesth Analg 1999 Jul; 89(1):7-20
ARTICLE SOURCE: Anesth Analg (United States), Jul 1999, 89(1) p1-2
AUTHOR(S): Mazzei WJ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis [see comments]
COMMENTS: Comment in: Anesth Analg 1999 Jun; 88(6):1200-2
ARTICLE SOURCE: Anesth Analg (United States), Jun 1999, 88(6) p1370-9
AUTHOR(S): Domino KB; Anderson EA; Polissar NL; Posner KL
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA. kdomino@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
Ondansetron and droperidol were more effective than metoclopramide in reducing postoperative vomiting. The overall risk of adverse effects did not differ.

ARTICLE TITLE: The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis [see comments]
COMMENTS: Comment in: Anesth Analg 1999 Jun; 88(6):1200-2
ARTICLE SOURCE: Anesth Analg (United States), Jun 1999, 88(6) p1362-9
AUTHOR(S): Lee A; Done ML
AUTHOR'S ADDRESS: Department of Anaesthetics, Liverpool Hospital, New South Wales, Australia. annal@nch.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
IMPLICATIONS: This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children.

ARTICLE TITLE: D-Dimer formation during cardiac and noncardiac thoracic surgery.
ARTICLE SOURCE: Anesth Analg (United States), Jun 1999, 88(6) p1226-31
AUTHOR(S): Whitten CW; Greilich PE; Ivy R; Burkhardt D; Allison PM
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
IMPLICATIONS: We assessed the ability of a readily available D-dimer assay to detect excessive fibrinolysis in patients undergoing thoracic surgery with and without extracorporeal circulation. The findings demonstrate that the assay used in this investigation reflected variable amounts of fibrinolysis in patients undergoing both types of thoracic surgery.

ARTICLE TITLE: Tissue heat content and distribution during and after cardiopulmonary bypass at 17 deg C.
ARTICLE SOURCE: Anesth Analg (United States), Jun 1999, 88(6) p1220-5
AUTHOR(S): Rajek A; Lenhardt R; Sessler DI; Grabenwoger M; Kastner J; Mares P; Jantsch U; Gruber E
AUTHOR'S ADDRESS: Department of Cardiothoracic and Vascular Anesthesia, University of Vienna, Austria.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
IMPLICATIONS: Temperature afterdrop after bypass at 17 degrees C was 2.2+/-0.4 degrees C, with approximately 73% of the decrease in core temperature resulting from core-to-peripheral redistribution of body heat. Cooling and rewarming were associated with large radial tissue temperature gradients in the thigh.

ARTICLE TITLE: The effect of intravenously administered magnesium on platelet function in patients after cardiac surgery.
ARTICLE SOURCE: Anesth Analg (United States), Jun 1999, 88(6) p1213-9
AUTHOR(S): Gries A; Bode C; Gross S; Peter K; Bohrer H; Martin E
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Heidelberg, Germany. ANDRE_GRIES@med.uni-heidelberg.de.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
IMPLICATIONS: In a randomized, blinded, placebo-controlled study of patients 24 h after coronary artery bypass grafting, IV administered magnesium inhibited platelet function in vitro and in vivo.

ARTICLE TITLE: Has the use of meta-analysis enhanced our understanding of therapies for postoperative nausea and vomiting? [editorial; comment]
COMMENTS: Comment on: Anesth Analg 1999 Jun; 88(6):1354-61; Comment on: Anesth Analg 1999 Jun; 88(6):1362-9; Comment on: Anesth Analg 1999 Jun; 88(6):1370-9
ARTICLE SOURCE: Anesth Analg (United States), Jun 1999, 88(6) p1200-2
AUTHOR(S): White PF; Watcha MF
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (28 references); REVIEW, TUTORIAL

ARTICLE TITLE: The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers.
ARTICLE SOURCE: Anesth Analg (United States), May 1999, 88(5) p999-1003
AUTHOR(S): Williams EL; Hildebrand KL; McCormick SA; Bedel MJ
AUTHOR'S ADDRESS: Anesthesiology Department, Allegheny University Hospitals, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. ewilliam@AHERF.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
IMPLICATIONS: Large volumes of lactated Ringer's solution administered to healthy humans produced small transient changes in serum osmolality. Large volumes of sodium chloride did not change osmolality but resulted in lower pH.

ARTICLE TITLE: The epidural test dose in obstetric patients: has it outlived its usefulness? [editorial]
ARTICLE SOURCE: Anesth Analg (United States), May 1999, 88(5) p971-2
AUTHOR(S): Birnbach DJ; Chestnut DH
PUBLICATION TYPE: EDITORIAL
MB. I would have thought that all epidural doses should be test doses.

ARTICLE TITLE: The effects of subanesthetic concentrations of sevoflurane and nitrous oxide, alone and in combination, on analgesia, mood, and psychomotor performance in healthy volunteers.
ARTICLE SOURCE: Anesth Analg (United States), May 1999, 88(5) p1149-54
AUTHOR(S): Janiszewski DJ; Galinkin JL; Klock PA; Coalson DW; Pardo H; Zacny JP
AUTHOR'S ADDRESS: Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: We studied the effects of subanesthetic concentrations of sevoflurane and nitrous oxide, alone and in combination, on analgesia, mood, and psychomotor performance in human volunteers. We hypothesized that nitrous oxide and sevoflurane would produce both opposing and potentiating effects within the same study. Over the course of three sessions, 20 subjects inhaled 0%, 0.2%, or 0.4% end-tidal sevoflurane for a 68-min period that was divided into four 17-min blocks. During either the second or fourth block, 30% end-tidal nitrous oxide was added to the concentration of sevoflurane being inhaled. Pain response, psychomotor performance, and mood were evaluated during the second and fourth blocks. Pain ratings were higher when sevoflurane and nitrous oxide were administered together than when nitrous oxide was administered alone, which indicates that sevoflurane attenuated the analgesic effects of nitrous oxide. Sevoflurane increased self-reported ratings of sleepiness, and the addition of nitrous oxide decreased these ratings. Nitrous oxide potentiated psychomotor impairment that was induced by sevoflurane. The combination of sevoflurane and nitrous oxide produced both opposing and potentiating effects within the same study. The results suggest that nitrous oxide and sevoflurane may act through different neurochemical mechanisms on some end points, such as analgesia and sleepiness. IMPLICATIONS: Healthy volunteers inhaled subanesthetic concentrations of sevoflurane and nitrous oxide. Sevoflurane made nitrous oxide less effective as an analgesic, and nitrous oxide made sevoflurane less effective as a sedative. The two drugs may work at cross purposes on different end points of anesthesia.

ARTICLE TITLE: Distress during the induction of anesthesia and postoperative behavioral outcomes.
ARTICLE SOURCE: Anesth Analg (United States), May 1999, 88(5) p1042-7
AUTHOR(S): Kain ZN; Wang SM; Mayes LC; Caramico LA; Hofstadter MB
AUTHOR'S ADDRESS: Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA. kain@biomed.med.yale.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
IMPLICATIONS: Anesthesiologists who care for children who are anxious during the induction of anesthesia should inform parents that these children have an increased likelihood of developing postoperative negative behavioral changes.
MB Why encourage anxiogenic parents? I think it could make things worse to tell them.

ARTICLE TITLE: Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 1999, 43(5) p542-4
AUTHOR(S): Aono J; Mamiya K; Manabe M
AUTHOR'S ADDRESS: Department of Anesthesiology, Kochi Medical School, Japan.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: The boys who were anxious before anesthesia showed a significantly greater incidence of problematic behavior on emergence from halothane anesthesia, compared with the boys who were calm before anesthesia.

ARTICLE TITLE: A comparison of train-of-four monitoring: mechanomyography at the thumb vs acceleromyography at the big toe.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 1999, 43(5) p550-5
AUTHOR(S): Heier T; Hetland S
AUTHOR'S ADDRESS: Department of Anesthesia, Ulleval University Hospital, Oslo, Norway.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: We conclude that clinically acceptable agreement between thumb mechanomyography and big toe acceleromyography was found for the period of no-twitch response, suggesting that the timing of supplemental doses of vecuronium can be guided by AMG at the big toe. However, the spontaneous recovery time agreement (to TOF ratio = 0.75) between the thumb and the big toe was poor.

ARTICLE TITLE: Cardiopulmonary cerebral resuscitation--present and future perspectives.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 1999, 43(5) p526-35
AUTHOR(S): Rubertsson S
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care, Uppsala University Hospital, Sweden.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (122 references); REVIEW, TUTORIAL

ARTICLE TITLE: Splanchnic circulation is maintained during passive hyperventilation in orthotopic liver recipients.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 1999, 43(5) p515-9
AUTHOR(S): Krenn CG; Pernerstorfer T; Pokorny H; Metnitz PG; Steltzer H
AUTHOR'S ADDRESS: Department of Anesthesiology & General Intensive Care, University of Vienna, School of Medicine, Austria.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: We did not observe any statistically significant circulatory effects or changes in indocyanine green kinetics in liver transplant recipients in the immediate OLT postoperative period caused by short-term mechanical hyperventilation.
MB. What a relief!!!!!

ARTICLE TITLE: Paraplegia, a severe complication to epidural analgesia.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1999, 43(2) p233-5
AUTHOR(S): Bulow PM; Biering-Sorensen F
AUTHOR'S ADDRESS: Center for Spinal Cord Injured, Copenhagen University Hospital, Denmark.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: We report four cases where continuous epidural analgesia resulted in epidural abscesses (EA) causing spinal cord damage and paraplegia. The first symptom of EA was intense back pain, which developed 0-20 days after removal of the epidural catheter. The diagnosis of EA was not made prior to the development of severe neurologic disturbances in any of the patients. In all cases there was a time lag of 2-4 days between the first symptoms and institution of the appropriate treatment.

ARTICLE TITLE: Paraplegia after thoracotomy--not caused by the epidural catheter.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1999, 43(2) p230-2
AUTHOR(S): Lovstad RZ; Steen PA; Forsman M
AUTHOR'S ADDRESS: Dept. of Anaesthesiology, Ullevaal University Hospital, Oslo, Norway.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.

ARTICLE TITLE: The potential for increased risk of infection due to the reuse of convective air-warming/cooling coverlets.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1999, 43(2) p173-6
AUTHOR(S): Sigg DC; Houlton AJ; Iaizzo PA
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Minnesota, Minneapolis, USA.
MAJOR SUBJECT HEADING(S): Bedding and Linens [microbiology]; Cross Infection [epidemiology]; Equipment Reuse
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: This study demonstrates that the use of the coverlets, intra- or postoperatively, can lead to significant bacterial contamination. It is concluded that it is not advisable to reuse coverlets for multiple clinical applications.

ARTICLE TITLE: Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma.
ARTICLE SOURCE: Ann Surg (United States), May 1999, 229(5) p684-91; discussion 691-2
AUTHOR(S): Moon MR; Luchette FA; Gibson SW; Crews J; Sudarshan G; Hurst JM; Davis K Jr; Johannigman JA; Frame SB; Fischer JE
AUTHOR'S ADDRESS: Department of Surgery, University of Cincinnati College of Medicine, Ohio, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Epidural analgesia significantly reduced pain with chest wall excursion compared with PCA. The route of analgesia did not affect the catecholamine response. However, serum levels of IL-8, a proinflammatory chemoattractant that has been implicated in acute lung injury, were significantly reduced in patients receiving epidural analgesia on days 2 and 3. This may have important clinical implications because lower levels of IL-8 may reduce infectious or inflammatory complications in the trauma patient. Also, tidal volume and maximal inspiratory force were improved with epidural analgesia by day 3. These results demonstrate that epidural analgesia is superior to PCA in providing analgesia, improving pulmonary function, and modifying the immune response in patients with severe chest injury.

ARTICLE TITLE: Irrigation fluid absorption during transurethral resection of the prostate: spinal vs. general anaesthesia.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Apr 1999, 43(4) p458-63
AUTHOR(S): Gehring H; Nahm W; Baerwald J; Fornara P; Schneeweiss A; Roth-Isigkeit A; Schmucker P
AUTHOR'S ADDRESS: Department of Anaesthesiology, Medical University, Luebeck, Germany.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: The absorption of irrigation fluid during the TURP is significantly more marked amongst spontaneously breathing patients with regional anaesthesia in comparison to patients undergoing general anaesthesia with positive pressure ventilation. The markedly lower central venous pressure before the start of irrigation should be considered as a possible cause of this effect.

ARTICLE TITLE: Cauda equina syndrome after spinal anaesthesia with hyperbaric 5% lignocaine: a review of six cases of cauda equina syndrome reported to the Swedish Pharmaceutical Insurance 1993-1997.
COMMENTS: Comment in: Acta Anaesthesiol Scand 1999 Apr; 43(4):369-70
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Apr 1999, 43(4) p371-9
AUTHOR(S): Loo CC; Irestedt L
AUTHOR'S ADDRESS: Dept. of Anaesthesia, KK Women's & Children's Hospital, Republic of Singapore.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Six cases of cauda equina syndrome with varying severity were reported to the Swedish Pharmaceutical Insurance during the period 1993-1997. All were associated with spinal anaesthesia using hyperbaric 5% lignocaine. Five cases had single-shot spinal anaesthesia and one had a repeat spinal anaesthetic due to inadequate block. The dose of hyperbaric 5% lignocaine administered ranged from 60 to 120 mg. Three of the cases were most likely caused by direct neurotoxicity of hyperbaric 5% lignocaine. In the other 3 cases, direct neurotoxicity was also probable, but unfortunately radiological investigations were not done to definitely exclude a compressive aetiology. All cases sustained permanent neurological deficits. We recommend that hyperbaric lignocaine should be administered in concentrations not greater than 2% and at a total dose preferably not exceeding 60 mg.

ARTICLE TITLE: Lidocaine may still be an excellent drug for spinal anaesthesia [editorial; comment]
COMMENTS: Comment on: Acta Anaesthesiol Scand 1999 Apr; 43(4):371-9
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Apr 1999, 43(4) p369-70
AUTHOR(S): Gisvold SE
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Intra-subject variability in post-operative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl?
ARTICLE SOURCE: Pain (Netherlands), Apr 1999, 80(3) p545-53
AUTHOR(S): Woodhouse A; Ward ME; Mather LE
AUTHOR'S ADDRESS: Department of Anaesthesia and Pain Management, University of Sidney at Royal North Shore Hospital, St. Leonards, NSW, Australia.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
The findings of this study, like that of its predecessor, suggest that morphine, pethidine and fentanyl can be used successfully in PCA and that for some patients who are responding poorly, changing the opioid may be beneficial.

ARTICLE TITLE: Anesthesia-based pain services improve the quality of postoperative pain management.
ARTICLE SOURCE: Pain (Netherlands), Mar 1999, 80(1-2) p23-9
AUTHOR(S): Miaskowski C; Crews J; Ready LB; Paul SM; Ginsberg B
AUTHOR'S ADDRESS: Department of Physiological Nursing, University of California, San Francisco 94143-0610, USA. nursing%chris-miaskowski@ccmail.ucsf.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
ABSTRACT: Anesthesia-based pain services are facilitating improvements in the quality of care of surgical patients by developing and directing institution-wide perioperative analgesia programs that include interdisciplinary collaborations. However, the impact of anesthesia-based pain services has not been evaluated in a systematic fashion. This prospective multisite study (n = 23 hospitals) utilized a standardized approach to evaluate the quality of pain care provided to patients who were and who were not cared for by an anesthesia-based pain service. A total of 5837 patients were evaluated using a standardized survey that consisted of a medical record review and a patient interview. The data were collected as part of the hospitals' quality improvement activities. Forty-nine percent of the patients were cared for by an anesthesia-based pain service. Patients who received pain service care reported significantly lower pain intensity scores; had lower levels of pain in the postoperative period; had a lower incidence of pruritus, sedation, and nausea; and experienced significantly less pain than expected. In addition, these patients were more likely to receive patient education about postoperative pain management; were more satisfied with their postoperative pain management; and were discharged sooner from the hospital. The findings from this study demonstrate that the care provided by anesthesia-based pain services has a significant impact on patient outcomes.

ARTICLE TITLE: Heel lancing in term new-born infants: an evaluation of pain by frequency domain analysis of heart rate variability.
ARTICLE SOURCE: Pain (Netherlands), Mar 1999, 80(1-2) p143-8
AUTHOR(S): Lindh V; Wiklund U; Hakansson S
AUTHOR'S ADDRESS: Department of Pediatrics, University Hospital, Umea, Sweden. vialih96@student.umu.se.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: The aim of the investigation was to assess pain by frequency domain analysis of heart rate variability (HRV) during a routine heel lancing procedure in term new-born infants. Beat-to-beat heart rate (HR) was recorded in 23 healthy new-born infants on the maternity ward during blood sampling for neonatal screening. A sham heel prick prior to the sharp lancing procedure was performed randomly in half of the infants. Spectral analysis of HRV was assessed for each of the following sequences: (1) baseline (2) sham heel prick (3) sharp heel prick and (4) squeezing the heel for blood sampling. The response to the sham prick did not differ significantly from the sharp prick. Compared with the baseline, sharp lancing gave rise to minor increases in HR and variability in the low frequency band of the spectral analysis. A clear stress response was provoked when the heel was squeezed for blood sampling, indicated by an increased HR and a decreased spectral power in the high frequency band (i.e. lower vagal tone). The different stress responses during the lancing and the squeezing of the heel were clearly illustrated when principal component analysis was applied and the vectors for the changes in HR and spectral pattern were indicated. In conclusion, the squeezing of the heel is the most stressful event during the heel prick procedure.

ARTICLE TITLE: Postoperative pain assessment and management in adolescents.
ARTICLE SOURCE: Pain (Netherlands), Feb 1999, 79(2-3) p207-15
AUTHOR(S): Gillies ML; Smith LN; Parry-Jones WL
AUTHOR'S ADDRESS: University of Glasgow, Department of Child and Adolescent Psychiatry, Royal Hospital for Sick Children, UK. mlg1n@clinmed.gla.ac.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE

ARTICLE TITLE: Investigation and management of stable angina: revised guidelines 1998. Joint Working Party of the British Cardiac Society and Royal College of Physicians of London.
ARTICLE SOURCE: Heart (England), May 1999, 81(5) p546-55
AUTHOR(S): de Bono D
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE

ARTICLE TITLE: Wine and health [editorial]
ARTICLE SOURCE: Heart (England), May 1999, 81(5) p459-60
AUTHOR(S): Broustet JP
AUTHOR'S ADDRESS: Hopital Cardiologique Haut Leveque Pessac, France.
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Introducing new treatments in clinical practice: the Italian approach to beta blockers in heart failure [editorial]
ARTICLE SOURCE: Heart (England), May 1999, 81(5) p453-4
AUTHOR(S): Maggioni AP; Tavazzi L
AUTHOR'S ADDRESS: Research Center of the Italian Association of Hospital Cardiologists (ANMCO) Via La Marmora 34 50121, Florence, Italy. maggioni@anmco.it.
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Quality of life four years after acute myocardial infarction: short form 36 (SF36) scores compared with a normal population.
ARTICLE SOURCE: Heart (England), Apr 1999, 81(4) p352-8
AUTHOR(S): Brown N; Melville M; Gray D; Young T; Munro J; Skene AM; Hampton JR
AUTHOR'S ADDRESS: Division of Cardiovascular Medicine, University Hospital, Nottingham NG7 2UH, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The SF 36 provides valuable additional information for the practising clinician. Compared to community norms the greatest impact on quality of life is seen in patients of working age. Impaired quality of life was reported by patients unfit for work, those with angina and dyspnoea, patients with coexistent lung disease, and those with anxiety and sleep disturbances. Improving quality of life after myocardial infarction remains a challenge for physicians.

ARTICLE TITLE: Prospective study of health related quality of life before and after coronary artery bypass grafting: outcome at five years [see comments]
COMMENTS: Comment in: Heart 1999 Apr; 81(4):331-2
ARTICLE SOURCE: Heart (England), Apr 1999, 81(4) p347-51
AUTHOR(S): Caine N; Sharples LD; Wallwork J
AUTHOR'S ADDRESS: Papworth Hospital NHS Trust, Papworth Everard, Cambridgeshire CB3 8RE, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
Absence of dyspnoea before surgery, indicating relatively good left ventricular function, was a predictor of good outcome at both one and five years CONCLUSIONS: Evidence of deterioration in physical function is compatible with expected decline in graft patency; specific rather than generic measures were most sensitive to this change.
MB. It seems that those who were alright before were alright after and visa versa.

ARTICLE TITLE: Determinants of an impaired quality of life five years after coronary artery bypass surgery.
COMMENTS: Comment in: Heart 1999 Apr; 81(4):331-2
ARTICLE SOURCE: Heart (England), Apr 1999, 81(4) p342-6
AUTHOR(S): Herlitz J; Wiklund I; Caidahl K; Karlson BW; Sjoland H; Hartford M; Haglid M; Karlsson T
AUTHOR'S ADDRESS: Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Goteborg, Sweden.
PUBLICATION TYPE: JOURNAL ARTICLE
Multivariate analysis showed that a poor preoperative QoL was a strong independent predictor for an impaired QoL five years after CABG. An impaired QoL was also predicted by previous disease. CONCLUSIONS: Female sex, an impaired quality of life (QoL) before surgery, and other diseases such as diabetes mellitus are independent predictors for an impaired QoL after CABG in survivors five years after operation.
MB. Same comment as above.

ARTICLE TITLE: The measurement of health related quality of life [editorial; comment]
COMMENTS: Comment on: Heart 1999 Apr; 81(4):342-6; Comment on: Heart 1999 Apr; 81(4):347-51
ARTICLE SOURCE: Heart (England), Apr 1999, 81(4) p331-2
AUTHOR(S): Treasure T
AUTHOR'S ADDRESS: St George's Hospital Cranmer Terrace, London SW17 ORE, UK.
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. The editorial shows some scpeticism

ARTICLE TITLE: New British recommendations for prevention of coronary heart disease in clinical practice.
ARTICLE SOURCE: Heart (England), Apr 1999, 81(4) p335
AUTHOR(S): Faergeman O
AUTHOR'S ADDRESS: Department of Medicine and Cardiology Arhus Amtssygehus University Hospital Tage Hansens Gade 2 8000 Arhus C, Denmark. ole.faergeman@aas.auh.dk.
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Commotio cordis: sudden death due to chest wall impact in sports [editorial]
ARTICLE SOURCE: Heart (England), Feb 1999, 81(2) p109-10
AUTHOR(S): Link MS
AUTHOR'S ADDRESS: Cardiac Arrhythmia Service, New England Medical Center, Boston, MA 02111, USA.
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene?
ARTICLE SOURCE: Heart (England), Jan 1999, 81(1) p47-52
AUTHOR(S): Soo LH; Gray D; Young T; Huff N; Skene A; Hampton JR
AUTHOR'S ADDRESS: Department of Cardiovascular Medicine, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Survival from out-of-hospital cardiac arrest remains poor despite attendance at the scene of the arrest by ambulance crew and other health professionals. Patients resuscitated by a paramedic from out-of-hospital cardiac arrest caused by cardiac disease were more likely to survive to hospital discharge than when resuscitation was provided by an ambulance technician. Resuscitation by a paramedic assisted by a medical practitioner offers a patient the best chances of surviving the event.

ARTICLE TITLE: Sympathetic overactivity in hypertensive patients with chronic renal disease.
COMMENTS: Comment on: N Engl J Med 1999 Apr 29; 340(17):1321-8
ARTICLE SOURCE: N Engl J Med (United States), Apr 29 1999, 340(17) p1360-1
AUTHOR(S): Remuzzi G
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Reduction of sympathetic hyperactivity by enalapril in patients with chronic renal failure.
COMMENTS: Comment in: N Engl J Med 1999 Apr 29; 340(17):1360-1
ARTICLE SOURCE: N Engl J Med (United States), Apr 29 1999, 340(17) p1321-8
AUTHOR(S): Ligtenberg G; Blankestijn PJ; Oey PL; Klein IH; Dijkhorst-Oei LT; Boomsma F; Wieneke GH; van Huffelen AC; Koomans HA
AUTHOR'S ADDRESS: Department of Nephrology and Hypertension, University Hospital Utrecht, The Netherlands. gligtenb@digd.azu.nl.
PUBLICATION TYPE: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: Increased sympathetic activity contributes to hypertension in patients with chronic renal disease. ACE inhibition controls hypertension and decreases sympathetic hyperactivity.

ARTICLE TITLE: Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.
COMMENTS: Comment in: N Engl J Med 1999 May 20; 340(20):1585-6
ARTICLE SOURCE: N Engl J Med (United States), May 20 1999, 340(20) p1539-45
AUTHOR(S): Nienaber CA; Fattori R; Lund G; Dieckmann C; Wolf W; von Kodolitsch Y; Nicolas V; Pierangeli A
AUTHOR'S ADDRESS: Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany. nienaber@uke.uni-hamburg.de.

ARTICLE TITLE: Endovascular stent-graft placement for the treatment of acute aortic dissection [see comments]
COMMENTS: Comment in: N Engl J Med 1999 May 20; 340(20):1585-6
ARTICLE SOURCE: N Engl J Med (United States), May 20 1999, 340(20) p1546-52
AUTHOR(S): Dake MD; Kato N; Mitchell RS; Semba CP; Razavi MK; Shimono T; Hirano T; Takeda K; Yada I; Miller DC
AUTHOR'S ADDRESS: Division of Cardiovascular and Interventional Radiology, Stanford University School of Medicine, Calif., USA. mddake@leland.stanford.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: These initial results suggest that stent-graft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully.

ARTICLE TITLE: Catheter-based treatment of aortic dissection [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 May 20; 340(20):1539-45; Comment on: N Engl J Med 1999 May 20; 340(20):1546-52
ARTICLE SOURCE: N Engl J Med (United States), May 20 1999, 340(20) p1585-6
AUTHOR(S): Vlahakes GJ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: The association between hospital volume and survival after acute myocardial infarction in elderly patients [see comments]
COMMENTS: Comment in: N Engl J Med 1999 May 27; 340(21):1677-9
ARTICLE SOURCE: N Engl J Med (United States), May 27 1999, 340(21) p1640-8
AUTHOR(S): Thiemann DR; Coresh J; Oetgen WJ; Powe NR
AUTHOR'S ADDRESS: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Patients with acute myocardial infarction who are admitted directly to hospitals that have more experience treating myocardial infarction, as reflected by their case volume, are more likely to survive than are patients admitted to low-volume hospitals.

ARTICLE TITLE: The relation between volume and outcome in health care [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 May 27; 340(21):1640-8
ARTICLE SOURCE: N Engl J Med (United States), May 27 1999, 340(21) p1677-9
AUTHOR(S): Hannan EL
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: The demand for documentation for Medicare payment [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jul 29; 341(5):337-41
ARTICLE SOURCE: N Engl J Med (United States), Jul 29 1999, 341(5) p365-7
AUTHOR(S): Iezzoni LI
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Studies of acute coronary syndromes in women--lessons for everyone [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jul 22; 341(4):217-25; Comment on: N Engl J Med 1999 Jul 22; 341(4):226-32
ARTICLE SOURCE: N Engl J Med (United States), Jul 22 1999, 341(4) p275-6
AUTHOR(S): Wexler LF
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Glucocorticoid therapy for chronic obstructive pulmonary disease [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jun 24; 340(25):1941-7; Comment on: N Engl J Med 1999 Jun 24; 340(25):1948-53
ARTICLE SOURCE: N Engl J Med (United States), Jun 24 1999, 340(25) p1990-1
AUTHOR(S): Boushey HA
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Redefining the role of antiarrhythmic drugs [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jun 17; 340(24):1849-54; Comment on: N Engl J Med 1999 Jun 17; 340(24):1855-62
ARTICLE SOURCE: N Engl J Med (United States), Jun 17 1999, 340(24) p1910-2
AUTHOR(S): Podrid PJ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Cigars and public health [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jun 10; 340(23):1773-80
ARTICLE SOURCE: N Engl J Med (United States), Jun 10 1999, 340(23) p1829-31
AUTHOR(S): Satcher D
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Jun 10; 340(23):1829-31
ARTICLE SOURCE: N Engl J Med (United States), Jun 10 1999, 340(23) p1773-80
AUTHOR(S): Iribarren C; Tekawa IS; Sidney S; Friedman GD
AUTHOR'S ADDRESS: Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif 94611, USA. cgi@dor.kaiser.org.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Independently of other risk factors, regular cigar smoking can increase the risk of coronary heart disease, COPD, and cancers of the upper aerodigestive tract and lung.
MB. Why were pipes and cigars thought to be safer than cigaretts?

ARTICLE TITLE: Use of alternative medicine--a marker for distress? [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jun 3; 340(22):1733-9
ARTICLE SOURCE: N Engl J Med (United States), Jun 3 1999, 340(22) p1758-9
AUTHOR(S): Holland JC
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Use of alternative medicine by women with early-stage breast cancer [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Jun 3; 340(22):1758-9
ARTICLE SOURCE: N Engl J Med (United States), Jun 3 1999, 340(22) p1733-9
AUTHOR(S): Burstein HJ; Gelber S; Guadagnoli E; Weeks JC
AUTHOR'S ADDRESS: Department of Adult Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Among women with newly diagnosed early-stage breast cancer who had been treated with standard therapies, new use of alternative medicine was a marker of greater psychosocial distress and worse quality of life.

ARTICLE TITLE: Prone ventilation--it's time.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Apr 1999, 27(2) p194-201
AUTHOR(S): Tobin A; Kelly W
AUTHOR'S ADDRESS: Intensive Care, St Vincent's Hospital, Melbourne, Victoria.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (55 references); REVIEW, TUTORIAL
ABSTRACT: Prone positioning to improve oxygenation in acute lung injury was first reported over 20 years ago. Although this and several subsequent studies have shown that prone positioning improved oxygenation in the majority of patients, it has failed to become common practice in intensive care units. This paper reviews the mechanism by which prone positioning improves oxygenation and the clinical studies of its use to date.

ARTICLE TITLE: Pulmonary perfusion is more uniform in the prone than in the supine position: scintigraphy in healthy humans.
ARTICLE SOURCE: J Appl Physiol (United States), Apr 1999, 86(4) p1135-41
AUTHOR(S): Nyren S; Mure M; Jacobsson H; Larsson SA; Lindahl SG
AUTHOR'S ADDRESS: Department of Diagnostic Radiology, Karolinska Hospital and Institute, SE-171 76 Stockholm, Sweden.
PUBLICATION TYPE: JOURNAL ARTICLE
Lung perfusion was more uniformly distributed in the prone compared with in the supine position, a difference that was more marked during total lung distension (CPAP) than during normal breathing.

ARTICLE TITLE: Subsequent general anaesthesia in patients with a history of previous anaphylactoid/anaphylactic reaction to muscle relaxant.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Apr 1999, 27(2) p190-3
AUTHOR(S): Thacker MA; Davis FM
AUTHOR'S ADDRESS: Department of Anaesthesia, Christchurch Hospital, New Zealand.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Of 151 patients with a possible anaphylactoid/anaphylactic reaction to a muscle relaxant investigated over a 20-year period, follow-up for any subsequent general anaesthesia was complete in 145 (96%). One hundred and twenty-two anaesthetics in 72 patients were documented. There were no anaesthetic-related deaths. No subsequent reactions were seen if muscle relaxants were not used in the subsequent anaesthetic, nor were they in patients with severe reactions if the original intradermal test had been equivocal or negative. In the patients with a severe reaction and a positive intradermal test to one or more muscle relaxants, six out of 40 later anaesthetics using muscle relaxants were associated with clinical problems, three being probable anaphylactic reactions, whilst three were minor. Intradermal testing should be performed prior to surgery in this group of patients for the muscle relaxant(s) planned, or an anaesthetic technique which avoids relaxants should be used. This review should encourage other centres to undertake similar follow-up.

ARTICLE TITLE: Incidence and predictors of central venous catheter related infection in intensive care patients.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Apr 1999, 27(2) p164-9
AUTHOR(S): McKinley S; Mackenzie A; Finfer S; Ward R; Penfold J
AUTHOR'S ADDRESS: Intensive Care Unit, Royal North Shore Hospital, Sydney.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: This study investigated the incidence of and risk factors for central venous catheter (CVC) infection in intensive care. CVCs were prospectively studied in patients who had lines inserted in general or neurosurgical intensive care and were expected to have the line in situ for at least 72 hours. Catheters (n = 119) were cultured for CVC-related infection (CRI; > 15 colony forming units) and blood cultures done when indicated. CRI was identified in 32 (26.9%) catheters, CVC related bacteraemia in five cases (4.2%) and CVC related sepsis in none. After adjustment for duration of catheterization, independent predictors of CVC related infection were catheter insertion site, with jugular sites having the highest risk, and primary diagnosis, with neurosurgical patients at least risk.

ARTICLE TITLE: The cannabinoid acids: nonpsychoactive derivatives with therapeutic potential.
ARTICLE SOURCE: Pharmacol Ther (England), Apr 1999, 82(1) p87-96
AUTHOR(S): Burstein SH
AUTHOR'S ADDRESS: Department of Biochemistry and Molecular Biology, University of Massachusetts Medical School, Worcester 01655-0103, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (77 references); REVIEW, TUTORIAL
ABSTRACT: The discovery of carboxylic acid metabolites of the cannabinoids (CBs) dates back more than three decades. Their lack of psychotropic activity was noted early on, and this resulted in a total absence of further research on their possible role in the actions of the CBs. More recent studies have revealed that the acids possess both analgesic and anti-inflammatory properties and may contribute to the actions of the parent drug. A synthetic analog showed similar actions at considerably lower doses. In this review, a brief survey of the extensive literature on metabolism of delta 9-tetrahydrocannabinol to the acids is presented, while more emphasis is given to the recent findings on the biological actions of this class of CBs. A possible mechanism involving effects on eicosanoids for some of these actions is also suggested. Finally, an analogy with a putative metabolite of anandamide, an endogenous CB, is discussed.

ARTICLE TITLE: Pharmacology versus social process: competing or complementary views on the nature of addiction?
ARTICLE SOURCE: Pharmacol Ther (England), Dec 1998, 80(3) p265-75
AUTHOR(S): Davies JB
AUTHOR'S ADDRESS: Centre for Applied Social Psychology, University of Strathclyde, Glasgow, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (40 references); REVIEW, TUTORIAL

ARTICLE TITLE: Renal dopamine receptors in health and hypertension.
ARTICLE SOURCE: Pharmacol Ther (England), Nov 1998, 80(2) p149-82
AUTHOR(S): Jose PA; Eisner GM; Felder RA
AUTHOR'S ADDRESS: Department of Pediatrics, Georgetown University Medical Center, Washington, DC 20007, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (477 references); REVIEW, ACADEMIC

ARTICLE TITLE: Lipid-lowering drugs in the management of hyperlipidaemia.
ARTICLE SOURCE: Pharmacol Ther (England), Sep 1998, 79(3) p205-30
AUTHOR(S): Bhatnagar D
AUTHOR'S ADDRESS: Metabolic Medicine and Clinical Biochemistry, The Royal Oldham Hospital, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (182 references); REVIEW, TUTORIAL

ARTICLE TITLE: Quality of life after emergency abdominal aortic aneurysm repair.
ARTICLE SOURCE: Aust N Z J Surg (Australia), Jun 1999, 69(6) p447-9
AUTHOR(S): Bohmer RD; Fleischl J; Knight D
AUTHOR'S ADDRESS: Hastings Memorial, Hospital, Hawkes Bay, New Zealand. rbohmer@xtra.co.nz.
MAJOR SUBJECT HEADING(S): Aortic Aneurysm, Abdominal [rehabilitation] [surgery]; Quality of Life
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Quality of life remains good to excellent in the majority of patients following emergency abdominal aortic aneurysm repairs. This may help justify surgery being offered to patients with this condition. Quality of life should be considered as an important outcome rather than mortality only.

ARTICLE TITLE: Decreasing lengths of stay: the cost to the community.
ARTICLE SOURCE: Aust N Z J Surg (Australia), Jun 1999, 69(6) p433-7
AUTHOR(S): Caplan G; Board N; Paten A; Tazelaar-Molinia J; Crowe P; Yap SJ; Brown A
AUTHOR'S ADDRESS: Prince of Wales Hospital and University of New South Wales, Sydney, Australia. G.Caplan@unsw.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Patients who are discharged earlier from hospital frequently require support from professional and unpaid carers at home after discharge. Hospitals save money per patient by discharging earlier, but it is not known whether the costs to community services and unpaid caters outweigh the savings to the hospital. METHODS: We prospectively studied the total costs, patient satisfaction, time off work and pain scores of 224 patients who underwent elective herniorrhaphy or laparoscopic cholecystectomy and who lived locally before and after re-engineering the elective surgical service. The components of the re-engineered surgical service were a peri-operative unit, pre-admission anaesthetic assessment based on self-reported questionnaires, day of surgery admissions, enhanced patient education, clinical pathways, and post-acute care. RESULTS: The patients treated through the re-engineered surgical service had a significantly shorter length of stay (LOS) (mean LOS: 2.2 vs 3.2 days; P < 0.001) but neither they nor their carers required more time off work. Significant determinants of time off work were smoking, heavy lifting at work and a higher pain score at day 7. Patients treated through the re-engineered surgical service recorded significantly higher satisfaction with their treatment. The cost saving to the hospital outweighed the cost of increased services provided in the community, so that the overall cost of providing treatment was over $200 less per patient through the re-engineered service. Conclusions: This study demonstrates that changes in care provision that result in shorter LOS and greater cost effectiveness may better meet patients' needs than existing systems.

ARTICLE TITLE: Laparoscopic live donor nephrectomy: the preliminary experience.
ARTICLE SOURCE: Aust N Z J Surg (Australia), May 1999, 69(5) p365-8
AUTHOR(S): Hensman C; Lionel G; Hewett P; Rao MM
AUTHOR'S ADDRESS: Department of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Recent improvements in video technology and surgical instrumentation have resulted in the application of minimally invasive techniques to many surgical procedures including splenectomy and adrenalectomy. Nephrectomy requires a long flank incision with division of abdominal musculature and possible subcostal nerve damage. Severe postoperative pain and a prolonged recuperative period may result, and the cosmetic outcome may not be satisfactory. A new surgical approach utilizing laparoscopic dissection and delivery of the kidney through a small incision was performed to circumvent these problems. The aim of this paper is to describe the technique of laparoscopic live donor nephrectomy (LLDN) and present the preliminary outcome. METHODS: Over the 12-month period between May 1997 and April 1998, 16 donors underwent donor nephrectomy by a laparoscopic approach. The procedure was assessed with regard to its safety, feasibility and advantages over the open method. RESULTS: All the nephrectomies were completed without conversion to an open procedure. The average postoperative pain score on a visual analogue scale of 1-10 was 2 in LLDN. The donors required 36 mg morphine on average over 36 h postoperatively. Postoperative stay averaged 3 days. One donor developed an infective complication along the wound drain tract which settled with adequate drainage and antibiotics. All the removed donor kidneys were transplanted with immediate good function. There were no surgical complications or graft losses. The recipients' serum creatinine was in the range of 96-181 mmol/L 3 months after transplantation. CONCLUSIONS: Significant potential advantages of LLDN include less postoperative pain, shorter hospitalization and decreased recuperative time. This preliminary experience indicates LLDN to be effective in terms of safety and feasibility.

ARTICLE TITLE: Redefining resuscitation [editorial; comment]
COMMENTS: Comment on: Aust N Z J Med 1998 Dec; 28(6):795-8
ARTICLE SOURCE: Aust N Z J Med (Australia), Dec 1998, 28(6) p759-60
AUTHOR(S): Hillman KM
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Kinetics of absorption atelectasis during anesthesia: a mathematical model [see comments]
COMMENTS: Comment in: J Appl Physiol 1999 Apr; 86(4):1114-5
ARTICLE SOURCE: J Appl Physiol (United States), Apr 1999, 86(4) p1116-25
AUTHOR(S): Joyce CJ; Williams AB
AUTHOR'S ADDRESS: Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia 4102. c.joyce@mailbox.uq.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Recent computed tomography studies show that inspired gas composition affects the development of anesthesia-related atelectasis. This suggests that gas absorption plays an important role in the genesis of the atelectasis. A mathematical model was developed that combined models of gas exchange from an ideal lung compartment, peripheral gas exchange, and gas uptake from a closed collapsible cavity. It was assumed that, initially, the lung functioned as an ideal lung compartment but that, with induction of anesthesia, the airways to dependent areas of lung closed and these areas of lung behaved as a closed collapsible cavity. The main parameter of interest was the time the unventilated area of lung took to collapse; the effects of preoxygenation and of different inspired gas mixtures during anesthesia were examined. Preoxygenation increased the rate of gas uptake from the unventilated area of lung and was the most important determinant of the time to collapse. Increasing the inspired O2 fraction during anesthesia reduced the time to collapse. Which inert gas (N2 or N2O) was breathed during anesthesia had minimal effect on the time to collapse.

ARTICLE TITLE: Duodenal versus gastric feeding in ventilated blunt trauma patients: a randomized controlled trial.
ARTICLE SOURCE: J Trauma (United States), Jun 1999, 46(6) p992-6; discussion 996-8
AUTHOR(S): Kortbeek JB; Haigh PI; Doig C
AUTHOR'S ADDRESS: University of Calgary, Department of Surgery, Alberta, Canada. kortbeek@supernet.ab.ca.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Length of stay and ventilator days were not significantly different. A larger trial would be required to determine differences in the rates of pneumonia <20%. Transpyloric-duodenal feeds significantly reduce the time required to achieve targeted enteric nutrition.

ARTICLE TITLE: Wound infections after minor limb lacerations: risk factors and the role of antimicrobial agents.
ARTICLE SOURCE: J Trauma (United States), Jun 1999, 46(6) p1078-81
AUTHOR(S): Stamou SC; Maltezou HC; Psaltopoulou T; Tsaroucha A; Kaseta M; Skondras C; Asimacopoulos PJ; Kafetzis DA
AUTHOR'S ADDRESS: Astros Health Center, Greece. sstamou@otenet.gr.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: The requirement for antimicrobial agents in patients with minor limb lacerations was prospectively studied. METHODS: The development of wound infections in patients with minor limb lacerations who received amoxicillin plus clavulanate acid treatment (group A, 52 patients) was studied and compared with patients who did not (group B, 48 patients). RESULTS: Wound infection occurred in 6 (11.5%) and 10 (21%) patients in groups A and B, respectively (p>0.10). Statistically significant risk factors for the development of infection were diabetes mellitus (odds ratio [OR], 15.8; p<0.001), lower limb lacerations (OR, 33.5; p<0.001), lacerations caused by compressive forces (OR, 21.6; p = 0.007), laceration length from 5 to 8 cm (OR, 7.04; p = 0.001), ragged laceration edge (OR, 2.55; p = 0.049), and skin tension (OR, 2.00; p = 0.006). CONCLUSION: The use of antimicrobial agents in minor limb injuries was not associated with a significant reduction of infection rate. Routine antimicrobial treatment is discouraged.

ARTICLE TITLE: Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen.
ARTICLE SOURCE: J Trauma (United States), May 1999, 46(5) p927-32
AUTHOR(S): Calkins MD; Robinson TD
AUTHOR'S ADDRESS: Walter Reed Army Medical Center and the Walter Reed Army Institute of Research, Washington, District of Columbia 20307, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: The Special Operations corpsmen easily learned how to use the esophageal-tracheal combitube (ETC) and LMA. In this study, they showed the ability to appropriately use the endotracheal tube (ETT) as well as the ETC and LMA. For SEAL corpsmen, the alternative airways should not replace the ETT; however, on occasion an advanced combat casualty care provider may not be able to use the laryngoscope or may be unable to place the ETT. The LMA and ETC are useful alternatives in this situation. If none of these airways are feasible, cricothyrotomy remains an option. Regardless of the airway device, refresher training must take place frequently.

ARTICLE TITLE: Multiple organ failure: by the time you predict it, it's already there.
ARTICLE SOURCE: J Trauma (United States), Apr 1999, 46(4) p597-604; discussion 604-6
AUTHOR(S): Cryer HG; Leong K; McArthur DL; Demetriades D; Bongard FS; Fleming AW; Hiatt JR; Kraus JF
AUTHOR'S ADDRESS: Department of Surgery, UCLA School of Medicine, Los Angeles, California 90095, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSION: We have confirmed that the population of patients with Injury Severity Scores > or = 25 who received 6 or more units of blood represent a high-risk group for the development of multiple organ failure. Our data also indicate that multiple organ failure after trauma is established within 24 hours of injury in the majority of patients who develop it. It appears that multiple organ failure is already present at the time when most published models are trying to predict whether or not it will occur.

ARTICLE TITLE: Wine and health [editorial]
ARTICLE SOURCE: Heart (England), May 1999, 81(5) p459-60
AUTHOR(S): Broustet JP
AUTHOR'S ADDRESS: Hopital Cardiologique Haut Leveque Pessac, France.
PUBLICATION TYPE: EDITORIAL
MB This is a good summary by a French cardiologist from a wine area. It appears that the ideas arose from epidemiologial studies of the geographical distribution of vascular cardiac disease being linked to diets of those areas. It sesms that the mechanisms if any are not clear.

ARTICLE TITLE: Are research ethics bad for our mental health?
ARTICLE SOURCE: N Engl J Med (United States), May 6 1999, 340(18) p1427-30
AUTHOR(S): Michels R
AUTHOR'S ADDRESS: Cornell University Medical College, New York, NY 10021, USA.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE

ARTICLE TITLE: Ethical and human-rights issues in research on mental disorders that may affect decision-making capacity.
ARTICLE SOURCE: N Engl J Med (United States), May 6 1999, 340(18) p1430-4
AUTHOR(S): Capron AM
AUTHOR'S ADDRESS: University of Southern California Law School, Los Angeles 90089-0071, USA. mmiller@law.usc.edu.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
MB. This and and the one above are well worth reading as examples of the impossibility of ‘Informed Consent’. They hope to get it by bureaucratic methods ie more and more committees.