ARTICLE TITLE: Which beta-blocker for heart failure?
ARTICLE SOURCE: Am Heart J (United States), Jun 2001, 141(6)
p884-9
AUTHOR(S): Adams KF
AUTHOR'S ADDRESS: Departments of Medicine and Radiology, University
of North Carolina at Chapel Hill, Chapel Hill, NC.
PUBLICATION TYPE: Journal Article
MB: They have not decided yet but are breathlessly searching through
meta-analyses with excitement.
ARTICLE TITLE: Angiotensin-converting enzyme inhibitor dosing in
heart failure: what is optimal?
COMMENTS: : Am Heart J. 2001 Mar; 141(3):410-7/21152255
ARTICLE SOURCE: Am Heart J (United States), Mar 2001, 141(3)
p331-3
AUTHOR(S): Gattis WA; Galanos A; O'Connor CM
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Aldosterone inhibition and heart failure: too good
to be true?
COMMENTS: : Am Heart J. 2001 Jan; 141(1):41-6/20575120
ARTICLE SOURCE: Am Heart J (United States), Jan 2001, 141(1) p1-2
AUTHOR(S): Francis GS
PUBLICATION TYPE: Comment; Editorial
MB: There is a revolution going on in cardiac failure. They do not
understand the mechanisms but things are looking good. All the things
that anaesthetists use to fix the CV system are bad in the long term.
I have avoided them in the short term too, mainly for aesthetic
reasons. They're not cool.
ARTICLE TITLE: Hemodynamics as surrogate end points for survival
in advanced heart failure: An analysis from FIRST (Flolan
International Randomized Survival Trial)
ARTICLE SOURCE: Am Heart J (United States), Jun 2001, 141(6)
p908-14
AUTHOR(S): Shah MR; Stinnett SS; McNulty SE; Gheorghiade M; Zannad F;
Uretsky B; Adams KF; Califf RM; O'connor CM
AUTHOR'S ADDRESS: Duke Clinical Research Institute, Durham, NC;
Northwestern Medical Center, Chicago, Ill; Hopital Jeanne d'Arc,
Dommartin Les Toul, France; University of Texas at Galveston; and the
University of North Carolina at Chapel Hill.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Hemodynamics often are used as surrogate end
points in phase II trials of acute heart failure (HF). We reviewed
the Flolan International Randomized Survival Trial (FIRST) database
to identify the hemodynamic variables that best predict survival in
patients with advanced HF receiving epoprostenol therapy and to
determine whether hemodynamics could predict the overall effect of a
drug. METHODS: The trial enrolled 471 patients with class IIIb/IV HF
and ejection fraction </=25% for >/=3 months, all of whom
underwent screening pulmonary artery catheter insertion. Patients
were randomly assigned to receive either epoprostenol (n = 201) or
placebo (n = 235); epoprostenol therapy was guided by pulmonary
artery catheter measures, and standard treatment was guided by
clinical findings. Multivariable modeling was used to identify and
quantify the demographic, clinical, and hemodynamic variables most
associated with 1-year survival. RESULTS: In multivariable modeling,
HF class, decreased pulmonary capillary wedge pressure (PCWP), and
age best predicted 1-year survival. After adjustment for age and HF
class, decreased PCWP still significantly predicted survival (hazard
ratio, 0.96 for every 1-mm Hg decrease; 95% confidence interval, 0.94
to 0.99; P =.003). Survival was significantly higher with decreases
in PCWP >/=9 versus <9 mm Hg, even after adjustment for age and
HF class. Survival of patients in the PCWP >/=9 group was
comparable with, and that of the PCWP <9 group was significantly
higher than, survival of patients in the control group (hazard ratio,
1.44; 95% confidence interval, 1.05 to 1.99; P =.024). CONCLUSIONS:
The reduction in PCWP was the hemodynamic measure most predictive of
survival in patients with advanced HF. However, patients with a
>/=9-mm Hg decrease had no better survival than patients in the
control group, who had limited changes in hemodynamics. Thus,
improvement in hemodynamics may not predict the overall effect of a
drug.
ARTICLE TITLE: The use of intra-aortic balloon counterpulsation in
patients with cardiogenic shock complicating acute myocardial
infarction: data from the National Registry of Myocardial Infarction
2
ARTICLE SOURCE: Am Heart J (United States), Jun 2001, 141(6)
p933-9
AUTHOR(S): Barron HV; Every NR; Parsons LS; Angeja B; Goldberg RJ;
Gore JM; Chou TM
AUTHOR'S ADDRESS: University of California, San Francisco, USA.
barron.hal@gene.com; Collective Name: Investigators in the National
Registry of Myocardial Infarction 2.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Patients with acute myocardial infarction (AMI)
complicated by cardiogenic shock may have substantial benefit from
intra-aortic balloon counterpulsation (IABP) when used in combination
with thrombolytic therapy.
ARTICLE TITLE: Percutaneous coronary intervention for cardiogenic
shock in the SHOCK Trial Registry
ARTICLE SOURCE: Am Heart J (United States), Jun 2001, 141(6)
p964-70
AUTHOR(S): Webb JG; Sanborn TA; Sleeper LA; Carere RG; Buller CE;
Slater JN; Baran KW; Koller PT; Talley JD; Porway M; Hochman JS
AUTHOR'S ADDRESS: St Paul's Hospital, Vancouver, British Columbia,
Canada. webb@providencehealth.bc.ca; Collective Name: SHOCK
Investigators.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: The SHOCK Registry prospectively enrolled
patients with cardiogenic shock complicating acute myocardial
infarction in 36 multinational centers. METHODS: Cardiogenic shock
was predominantly attributable to left ventricular pump failure in
884 patients. Of these, 276 underwent percutaneous coronary
intervention (PCI) after shock onset and are the subject of this
report. RESULTS: The majority (78%) of patients undergoing
angiography had multivessel disease. As the number of diseased
arteries rose from 1 to 3, mortality rates rose from 34.2% to 51.2%.
Patients who underwent PCI had lower in-hospital mortality rates than
did patients treated medically (46.4% vs 78.0%, P < .001), even
after adjustment for patient differences and survival bias (P =
.037). Before PCI, the culprit artery was occluded (Thrombolysis In
Myocardial Infarction grade 0 or 1 flow) in 76.3%. After PCI, the
in-hospital mortality rate was 33.3% if reperfusion was complete
(grade 3 flow), 50.0% with incomplete reperfusion (grade 2 flow), and
85.7% with absent reperfusion (grade 0 or 1 flow) (P < .001).
ARTICLE TITLE: International differences in treatment effects in
cardiovascular clinical trials.
ARTICLE SOURCE: Am Heart J (United States), May 2001, 141(5)
p875-80
AUTHOR(S): O'Shea JC; Califf RM
AUTHOR'S ADDRESS: Division of Cardiology, Department of Medicine,
Duke University Medical Center, Durham, NC 27715, USA.
oshea002@mc.duke.edu.
MAJOR SUBJECT HEADING(S): Cardiovascular Diseases [therapy];
International Cooperation; Randomized Controlled Trials
[methods]
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Postoperative atrial fibrillation after heart
surgery: What are the goals of prevention?
ARTICLE SOURCE: Am Heart J (United States), May 2001, 141(5)
p691-3
AUTHOR(S): Kim MH; Eagle KA
PUBLICATION TYPE: Editorial; Review; Review, Tutorial
ARTICLE TITLE: Electrocardiographic diagnosis of acute myocardial
infarction: Current concepts for the clinician.
ARTICLE SOURCE: Am Heart J (United States), Apr 2001, 141(4)
p507-17
AUTHOR(S): Sgarbossa EB; Birnbaum Y; Parrillo JE
AUTHOR'S ADDRESS: Section of Cardiology, Rush Presbyterian-St. Luke's
Medical Center, 1750 W. Harrison St., Chicago, IL 60612, USA.
esgarbos@rush.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: BACKGROUND: Over the past 2 decades, the 12-lead
electrocardiogram has attained special significance for the diagnosis
and triage of patients with chest pain because timely detection of
myocardial injury and a rapid assessment of myocardium at risk proved
pivotal to implementing effective reperfusion therapies during acute
myocardial infarction. However, this wealth of information could
still be underutilized by clinicians who may restrict their
diagnostic quest in patients with chest pain to the more classic
electrocardiographic signs. METHODS: The medical literature on
electrocardiographic manifestations of acute myocardial infarction
was extensively reviewed. RESULTS: The widespread utilization of both
coronary angiography and methods to determine myocardial function and
metabolism in patients with acute myocardial infarction over the last
10 years has provided the means for rigorous comparisons with
electrocardiographic information. We summarize these
electrocardiographic signs and patterns in terms of their relevance
to the clinician to help reduce the incidence of "nondiagnostic
electrocardiograms" and improve timely decision-making. CONCLUSIONS:
The electrocardiogram continues to be an invaluable tool in the
initial evaluation of patients with chest pain. The plethora of data
currently available on electrocardiographic changes correlating with
myocardial injury allows clinicians to make faster and better
decisions than ever before.
ARTICLE TITLE: Cardiac enzyme elevations after cardiac surgery:
the cardiologist's perspective.
COMMENTS: : Am Heart J. 2001 Mar; 141(3):447-55/21152261
ARTICLE SOURCE: Am Heart J (United States), Mar 2001, 141(3)
p321-4
AUTHOR(S): Mahaffey KW; Alpert JS
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Characterization and clinical course of patients
not receiving aspirin for acute myocardial infarction: results from
the MITRA and MIR studies.
ARTICLE SOURCE: Am Heart J (United States), Feb 2001, 141(2)
p200-5
AUTHOR(S): Frilling B; Schiele R; Gitt AK; Zahn R; Schneider S; Glunz
HG; Gieseler U; Baumgartel B; Asbeck F; Senges J
AUTHOR'S ADDRESS: Hezzentrum Ludwigshafen, Department of Cardiology,
Bremserstr. 79, 67063 Ludwigshafen, Germany. frillin@klilu.de;
Collective Name: Maximum Individual Therapy in Acute Myocardial
Infarction (MITRA); Collective Name: Myocardial Infarction Registry
(MIR) Study Groups.
PUBLICATION TYPE: Evaluation Studies; Journal Article; Multicenter
Study
CONCLUSIONS: Only a minority of AMI patients (7.8%) did not receive
aspirin. Relative contraindications to aspirin and a critical
clinical state at admission were the main factors associated with
withholding aspirin for AMI. Even after adjustment for patient
characteristics, the mortality of patients without aspirin was almost
three times higher.
ARTICLE TITLE: Perioperative beta-blocker withdrawal and mortality
in vascular surgical patients.
ARTICLE SOURCE: Am Heart J (United States), Jan 2001, 141(1)
p148-53
AUTHOR(S): Shammash JB; Trost JC; Gold JM; Berlin JA; Golden MA;
Kimmel SE
AUTHOR'S ADDRESS: Division of General Internal Medicine, Cornell
Medical Associates, Weill Medical College of Cornell University, New
York, NY, USA. jshammas@med.cornell.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: Our purpose was to determine the effect of
postoperative beta-blocker withdrawal on mortality and cardiovascular
events after vascular surgery. METHODS: Detailed data were collected
on perioperative cardiovascular medication use and discontinuation
and cardiovascular risk factors among consecutive major vascular
surgical procedures at two university hospitals. RESULTS: A total of
140 patients received beta-blockers preoperatively. Mortality in the
8 patients who had beta-blockers discontinued postoperatively (50%)
was significantly greater than in 132 patients who had beta-blockers
continued (1.5%, odds ratio 65.0, P<.001). The effect of
beta-blocker discontinuation was unaffected by adjustment by
stratification for risk factors (all P< or =.01), for
contraindications to restarting beta-blockers (P = .006), and by
multivariable analyses adjusting for potential confounders (adjusted
odds ratio 17.0, P =.01). beta-Blocker discontinuation also was
associated with increased cardiovascular mortality (0% vs 29%, P
=.005) and postoperative myocardial infarction (odds ratio 17.7, P
=.003). CONCLUSION: Discontinuing beta-blockers immediately after
vascular surgery may increase the risk of postoperative
cardiovascular morbidity and mortality.
MB: The Mangano studies stopped beta-blockers already being given to
the control group. Their enigmatic results could be due to our lack
of understanding of cardiac failure and non-optimal treatment of some
of the patients in their studies
ARTICLE TITLE: Electrical short circuit as a possible cause of
death in patients on PCA machines: report on an opiate overdose and a
possible preventive remedy
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p940
AUTHOR(S): Doyle DJ; Vicente KJ
PUBLICATION TYPE: Letter
MB: We have had 3 cases of this malfunction due to in-house
repairs.
ARTICLE TITLE: Bronchospasm after rapacuronium in infants and
children
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p926-7
AUTHOR(S): Meakin GH; Pronske EH; Lerman J; Orr R; Joffe D; Savaree
AM; Lynn AM
AUTHOR'S ADDRESS: University Department of Anaesthesia, Royal
Manchester Children's Hospital, Pendlebury, United Kingdom.
george.meakin@man.ac.uk.
PUBLICATION TYPE: Journal Article
MB: Well it'd gone now. This is what happens if you obscessively go
after replacing a fairly good drug which is absolutely indicated
under some circumstances. I am sure that more damage has been done by
avoiding sux than by using it. I wonder why the drug companies keep
trying----no one else is.
ARTICLE TITLE: How serious is the bronchospasm induced by
rapacuronium?
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p924-5
AUTHOR(S): Naguib M
AUTHOR'S ADDRESS: Department of Anesthesia, University of Iowa
College of Medicine, Iowa City 52242-1009, USA.
mohamed-naguib@uiowa.edu.
PUBLICATION TYPE: Journal Article.
MB: Serious enough to have it withdrawn by the pedlars. I think we
can stop trying to gild the lily.
ARTICLE TITLE: Severe bronchospasm and desaturation in a child
associated with rapacuronium
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p923-4
AUTHOR(S): Kron SS
AUTHOR'S ADDRESS: Anesthesia Department, New Britain General
Hospital, Connecticut 06050, USA. skmel@aol.com.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Rapacuronium and bronchospasm
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p727-8
AUTHOR(S): Goudsouzian NG
PUBLICATION TYPE: Editorial
MB: The author's deparment has had 3 after 150 doses. He sounds as
though he is fundamentalist anti-suxist. So they will, I suppose, try
each new muscle relaxant as they come out.
ARTICLE TITLE: The role of World War II and the European theater
of operations in the development of anesthesiology as a physician
specialty in the USA
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p907-14
AUTHOR(S): Waisel DB
AUTHOR'S ADDRESS: Department of Anesthesia, Children's Hospital,
Harvard Medical School, Boston, Massachusetts 02115, USA.
waisel@hub.tch.harvard.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: World War II was a time of growth and development of
anesthesia as a physician specialty. Wartime training exposed
neophyte physician-anesthetists to role models who showed the
potential of anesthesiology and to the richness of practicing
anesthesia. Wartime anesthesia required dexterity, imagination, and
pluck, and surgeons and other physicians were suitably impressed.
Drawing historical conclusions about cause and effect is hazardous.
Recognized and unrecognized biases, preconceived notions, and the
quality and type of resources available affect writers. With this in
mind, consider how the effects of World War II on the growth of
physician anesthesia loosely parallel the growth of anesthesia in
Great Britain during the 19th century. Anesthesia became a medical
profession in Great Britain because of the interest and support of
physicians and the complexity of administering chloroform anesthesia.
Similarly, World War II physician-anesthetists showed they could
provide complex anesthesia care, such as pentothal administration,
regional anesthesia, and tracheal intubation, with aplomb and gained
the support of surgical colleagues who facilitated their growth
within a medical profession. They returned to a medium ready to
support their growth and helped to establish the medical profession
of anesthesiology in the United States.
MB: It was not just Britain that got anaesthesia started
properly.
ARTICLE TITLE: Anesthesiology's greatest generation?
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p725-6
AUTHOR(S): Bacon DR; Albin M; Pender JW
PUBLICATION TYPE: Editorial
MB: Its about WW2 & medicine. I heard that in WW2 if a doctor
could not do anything else they made them do pathology, psychiatry or
anaesthetics.
ARTICLE TITLE: Current issues in spinal anesthesia
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p888-906
AUTHOR(S): Liu SS; McDonald SB
AUTHOR'S ADDRESS: Department of Anesthesiology, Virginia Mason
Medical Center, Seattle, Washington 98111, USA. anessl@vmmc.org.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Pharyngolaryngeal morbidity with the laryngeal mask
airway in spontaneously breathing patients: does size matter?
ARTICLE SOURCE: Anesthesiology (United States), May 2001, 94(5)
p760-6
AUTHOR(S): Grady DM; McHardy F; Wong J; Jin F; Tong D; Chung F
AUTHOR'S ADDRESS: Department of Anesthesia, Toronto Western Hospital,
University of Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Selection of a small laryngeal mask airway (size 4) in
spontaneously breathing male patients may be more appropriate to
limit the occurrence of sore throat on the first postoperative day.
All patients had a fourfold increased risk of developing sore throat
when a large LMA was used.
ARTICLE TITLE: Is ventilator-associated pneumonia an independent
risk factor for death?
ARTICLE SOURCE: Anesthesiology (United States), Apr 2001, 94(4)
p554-60
AUTHOR(S): Bregeon F; Ciais V; Carret V; Gregoire R; Saux P; Gainnier
M; Thirion X; Drancourt M; Auffray JP; Papazian L
AUTHOR'S ADDRESS: Laboratoire de Physiopathologie Respiratoire,
Universite de la Mediterranee, France.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Ventilator-associated pneumonia (VAP) has been
implicitly accused of increasing mortality. However, it is not
certain that pneumonia is responsible for death or whether fatal
outcome is caused by other risk factors for death that exist before
the onset of pneumonia. The aim of this study was to evaluate the
attributable mortality caused by VAP by performing a matched-paired,
case-control study between patients who died and patients who were
discharged from the intensive care unit after more than 48 h of
mechanical ventilation. METHODS: During the study period, 135
consecutive deaths were included in the case group. Case-control
matching criteria were as follows: (1) diagnosis on admission that
corresponded to 1 of 11 predefined diagnostic groups; (2) age
difference within 10 yr; (3) sex; (4) admission within 1 yr; (5)
APACHE II score within 7 points; (6) ventilation of control patients
for at least as long as the cases. Precise clinical, radiologic, and
microbiologic definitions were used to identify VAP. RESULTS:
Analysis was performed on 108 pairs that were matched with 91% of
success. There were 39 patients (36.1%) who developed VAP in each
group. Multivariate analysis showed that renal failure, bone marrow
failure, and treatment with corticosteroids but not VAP were
independent risk factors for death. There was no difference observed
between cases and controls concerning the clinical and microbiologic
diagnostic criteria for pneumonia. CONCLUSION: Ventilator-associated
pneumonia does not appear to be an independent risk factor for
death.
MB: Now they tell us.
ARTICLE TITLE: What's new about ventilator-associated
pneumonia
ARTICLE SOURCE: Anesthesiology (United States), Apr 2001, 94(4)
p551-3
AUTHOR(S): Kollef MH
PUBLICATION TYPE: Editorial
MB: I think the concept is too vague to make general statements. When
ventilators are applied to patients with normal lungs eg neurological
causes, they don't get respirator lung.
ARTICLE TITLE: Implications of 2,457 consecutive surgical
infections entering year 2000
ARTICLE SOURCE: Ann Surg (United States), Jun 2001, 233(6)
p867-74
AUTHOR(S): Sawyer RG; Raymond DP; Pelletier SJ; Crabtree TD; Gleason
TG; Pruett TL
AUTHOR'S ADDRESS: Charles O. Strickler Transplant Center, University
of Virginia Department of Surgery, Charlottesville, Virginia.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To assess the demographics and characteristics
of infections in surgical patients to define areas that deserve
emphasis in surgical education. SUMMARY BACKGROUND DATA: As a result
of evolving technology and diseases, the complexity of diagnosing and
treating infections has increased during the past three decades for
all patients, including those treated primarily by surgeons. No
comprehensive analysis of these conditions in a single surgical
cohort has been recently published. METHODS: The authors conducted a
prospective, observational study of all infections occurring on the
general and trauma surgery services at a single university hospital
during a 3.5-year period. RESULTS: The authors identified 2,457
infections: 608 community-acquired, 1,053 occurring on the wards, and
796 occurring in the intensive care unit. Although dependent on
patient location, the most common sites were abdomen, lung, and
wound; the most common isolates were Staphylococcus epidermidis,
Staphylococcus aureus, and Candida albicans; and the most commonly
used antibiotics were ciprofloxacin, vancomycin, and metronidazole.
The overall death rate was 13%, ranging from 5% after
community-acquired infections to 25% after infections acquired in the
intensive care unit. CONCLUSIONS: Most infections treated by surgeons
are hospital-acquired. Infections with gram-positive cocci and fungi
are common, with pulmonary infections becoming more common.
Fluoroquinolones have become important therapeutic agents. Depending
on the type of practice, these data should be helpful to direct
educational efforts so that surgeons can remain knowledgeable and
active in the nonsurgical care of their patients.
ARTICLE TITLE: Prospective clinical trial of robotically assisted
endoscopic coronary grafting with 1-year follow-up
ARTICLE SOURCE: Ann Surg (United States), Jun 2001, 233(6)
p725-32
AUTHOR(S): Prasad SM; Ducko CT; Stephenson ER; Chambers CE; Damiano
Jr a R
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery, Washington
University School of Medicine, St. Louis, Missouri, and the Division
of Cardiothoracic Surgery and Cardiology, Pennsylvania State
University, Hershey, Pennsylvania.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The results from the first prospective clinical trial of
robotically assisted endoscopic coronary bypass surgery in the United
States showed favorable short-term outcomes with no adverse events.
Robotic assistance is an enabling technology allowing the performance
of endoscopic coronary anastomoses.
MB: Soon we will be having robots doing the operation. That will be
good.
ARTICLE TITLE: Liver transplantation for hepatocellular
carcinoma
ARTICLE SOURCE: Ann Surg (United States), May 2001, 233(5) p652-9
AUTHOR(S): Hemming AW; Cattral MS; Reed AI; Van Der Werf WJ; Greig
PD; Howard RJ
AUTHOR'S ADDRESS: University of Florida, Gainesville, Florida, and
the University of Toronto, Toronto, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: For well-selected patients with HCC, liver
transplantation in the current era can achieve equivalent results to
transplantation for nonmalignant indications. Vascular invasion is an
indicator of high risk of tumor recurrence but is difficult to detect
before transplantation.
ARTICLE TITLE: Surgical technique for right lobe adult living
donor liver transplantation without venovenous bypass or portocaval
shunting and with duct-to-duct biliary reconstruction.
ARTICLE SOURCE: Ann Surg (United States), Apr 2001, 233(4) p502-8
AUTHOR(S): Grewal HP; Shokouh-Amiri MH; Vera S; Stratta R; Bagous W;
Gaber AO
AUTHOR'S ADDRESS: Division of Transplant Surgery, University of
Tennessee, Memphis, Tennessee, USA.
METHODS: Between March 1999 and March 2000, 11 adult living donor
liver transplantation (ALDLT) were performed at the authors'
institution. All procedures were performed without venovenous bypass,
portocaval decompression, or caval clamping. After a modification to
the procedure, five of the last six recipients underwent biliary
reconstruction with a direct duct-to-duct anastomosis. Data regarding
donor, recipient, and graft survival, complications, and graft
function were collected. RESULTS: Recipients comprised five women and
six men, mean age 48 years. Donors comprised five women and six men,
mean age 36.5 years. Donor to recipient relationships included
sibling, spouse, son, and daughter. Indications for transplantation
were hepatitis C, hepatitis C with hepatocellular carcinoma, primary
biliary cirrhosis, primary sclerosing cholangitis, ethanol, and
cryptogenic. No case required venovenous bypass or portocaval
shunting. The right hepatic vein of the donor graft was anastomosed
to the confluence of the left and middle hepatic veins in all cases.
All donors are alive and well, with no adverse complications
reported
MB: There were strong rumours about donor deaths at the World
Congress of Liver Transplantation in Argentina in 2000.
ARTICLE TITLE: Appendicitis in Sweden: quality results.
COMMENTS: : Ann Surg. 2001 Apr; 233(4):455-60/21199304
ARTICLE SOURCE: Ann Surg (United States), Apr 2001, 233(4) p461-2
AUTHOR(S): Meakins JL
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Mortality after appendectomy in Sweden,
1987-1996.
COMMENTS: : Ann Surg. 2001 Apr; 233(4):461-2/21199305
ARTICLE SOURCE: Ann Surg (United States), Apr 2001, 233(4)
p455-60
AUTHOR(S): Blomqvist PG; Andersson RE; Granath F; Lambe MP; Ekbom
AR
AUTHOR'S ADDRESS: Karolinska Institutet, Department of Medical
Epidemiology, Stockholm, Sweden.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To study mortality after appendectomy. SUMMARY
BACKGROUND DATA: The management of patients with suspected
appendicitis remains controversial, with advocates of early surgery
as well as of expectant management. Mortality is not known. METHODS:
The authors conducted a complete follow-up of deaths within 30 days
after all appendectomies in Sweden (population 8.9 million) during
the years 1987 to 1996 (n = 117,424) by register linkage. The case
fatality rate (CFR) and the standardized mortality ratio (SMR) were
analyzed by discharge diagnosis. RESULTS: The CFR was 2.44 per 1,000
appendectomies. It was strongly related to age (0.31 per 1,000
appendectomies at 0-9 years of age, decreasing to 0.07 at 20-29
years, and reaching 164 among nonagenarians) and diagnosis at surgery
(0.8 per 1,000 appendectomies after nonperforated appendicitis, 5.1
after perforated appendicitis, 1.9 after appendectomies for
nonsurgical abdominal pain, and 10.0 for those with other diagnoses).
The SMR showed a sevenfold excess rate of deaths after appendectomy
compared with the general population. The relation to age was less
marked (SMR of 44.4 at 0-9 years, decreasing to 2.4 in patients aged
20-29 years. and reaching 8.1 in nonagenarians). The SMR was doubled
after perforation compared with nonperforated appendicitis (6.5 and
3.5, respectively). Nonsurgical abdominal pain and other diagnoses
were associated with a high excess rate of deaths (9.1 and 14.9,
respectively). The most common causes of deaths were appendicitis,
ischemic heart diseases and tumors, followed by gastrointestinal
diseases. CONCLUSIONS: The case fatality rate (CFR) after
appendectomy is high in elderly patients. The excess rate of death
for patients with nonperforated appendicitis and nonsurgical
abdominal pain suggests that the deaths may partly be caused by the
surgical trauma. Increased diagnostic efforts rather than urgent
appendectomy are therefore warranted among frail patients with an
equivocal diagnosis of appendicitis.
ARTICLE TITLE: Attitudes to evidence-based practice in urology:
results of a survey .
ARTICLE SOURCE: ANZ J Surg (Australia), May 2001, 71(5) p297-300
AUTHOR(S): Stapleton AM; Cuncins-Hearn A; Pinnock C
AUTHOR'S ADDRESS: Centre of Clinical Excellence in Urological
Research, Repatriation General Hospital, Australia.
alan.stapleton@rgh.sa.gov.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Urologists express a need for evidence-based practice
resources, in particular clinical guidelines. Nevertheless their
clinical approach is not necessarily consistent with existing
guidelines, particularly for lower urinary tract symptoms (LUTS). An
alteration in the recommendation when the respondent is the patient
of interest and endorses the recommendation that patients with
prostate cancer should be involved in treatment decisions.
MB: Evidence is not the whole universe. You can't expect urologists
to be up with the latest fads.
ARTICLE TITLE: In-hospital mortality from abdominal aortic surgery
in Great Britain and Ireland: Vascular Anaesthesia Society audit.
ARTICLE SOURCE: Br J Surg (England), May 2001, 88(5) p687-92
AUTHOR(S): Bayly PJ; Matthews JN; Dobson PM; Price ML; Thomas DG
AUTHOR'S ADDRESS: Department of Anaesthetics, Freeman Hospital,
Newcastle upon Tyne, UK. Phil.Bayly@tfh.nuth.northy.nhs.uk.
PUBLICATION TYPE: Journal Article; Multicenter Study
METHODS: This was a multicentre, prospective audit of 177 hospitals
throughout the UK and Ireland. Data were collected by questionnaire
to include all patients undergoing elective or urgent surgery for
infrarenal abdominal aortic aneurysm or aortoiliac occlusive disease
over 4 months. RESULTS: Nine hundred and thirty-three patients were
recruited into the audit. The overall mortality rate was 7.3 per
cent. Factors increasing the risk of death by up to fivefold included
age over 74 years, urgent surgery, operation for occlusive disease,
limited exercise capacity, a history of severe angina or cardiac
failure, the presence of ventricular ectopics and abnormalities
suggesting ischaemic heart disease on electrocardiography.
CONCLUSION: Although the in-hospital mortality rate was similar to
previously published figures, the rate increased considerably when
commonly encountered risk factors were present.
ARTICLE TITLE: Anesthesia for cerebral aneurysms: a comparison
between interventional neuroradiology and surgery
ARTICLE SOURCE: Can J Anaesth (Canada), Apr 2001, 48(4) p391-5
AUTHOR(S): Lai YC; Manninen PH
AUTHOR'S ADDRESS: Department of Anesthesia, Toronto Western Hospital,
University of Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSION: There were some differences in the anesthetic management
of patients undergoing endovascular treatment of a cerebral aneurysm
compared with treatment in the operating room. The patients in the
interventional neuroradiology (INR) suite were sicker and somewhat
older and they received less invasive monitoring, but the
complication rate and outcome did not differ.
ARTICLE TITLE: Spinal vs general anesthesia: the patient's
perspective
ARTICLE SOURCE: Can J Anaesth (Canada), Apr 2001, 48(4) p323-5
AUTHOR(S): Girard M; Drolet P
PUBLICATION TYPE: Editorial
MB: Its about ambulatory surgery. There is not much in it. Why do
they keep looking?
ARTICLE TITLE: Walking spinals: a myth or reality?
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 2001, 48(3) p222-4
AUTHOR(S): Ganapathy S
PUBLICATION TYPE: Editorial
MB: It's mythical enough that I will wait till it's 'no humbug'
before bothering with it. We need another Bigelow.
ARTICLE TITLE: Cochrane Anesthesia Review Group
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 2001, 48(3) p313
AUTHOR(S): Doyle DJ
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Combined pre- and post-surgical bupivacaine wound
infiltrations decrease opioid requirements after knee ligament
reconstruction
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 2001, 48(3) p245-50
AUTHOR(S): Butterfield NN; Schwarz SK; Ries CR; Franciosi LG; Day B;
MacLeod BA
AUTHOR'S ADDRESS: Clinical Pharmacology Research Organization,
Department of Pharmacology & Therapeutics, The University of
British Columbia, Vancouver, Canada.
PUBLICATION TYPE: Journal Article
METHODS: In a double-blind, randomized, controlled trial, we studied
23 patients (ASA I or II) scheduled for elective arthroscopic
cruciate ligament reconstruction (ACLR) under general anesthesia. The
treatment group (n = 12) received infiltrations with bupivacaine
0.25% with epinephrine 1:200,000 presurgically (10 ml into the
portals, 10 ml at the medial tibial incision site, 10 ml at the
lateral femoral incision site, and 10 ml intra-articularly) and
postsurgically (5 ml at the medial tibial incision and 10 ml at the
lateral femoral incision). The control group (n = 11) received
infiltrations with saline 0.9% in the same manner. All patients
received a standard intra-articular local anesthetic instillation of
the knee (25 ml of bupivacaine 0.25% with epinephrine 1:200,000) at
the completion of surgery. RESULTS: Postoperative opioid requirements
were lower in the treatment group (5.8 +/- 2.9 mg morphine
equivalent) than in the control group ( 13.7 +/- 5.8 mg; P = 0.008).
Treatment patients were ready for discharge approximately 30 min
earlier than control patients (P = 0.046). There were no adverse
events in the treatment group. In the control group, 2/11 patients
vomited and a third experienced transient postoperative diaphoresis,
dizziness and pallor. CONCLUSION: We conclude that a combination of
selective pre- and post-surgical wound infiltration with bupivacaine
0.25% provides superior analgesia compared with a standard
post-surgical intra-articular injection alone.
MB: Small numbers. Both groups did not have great doses of morphine.
I suppose it is alright but not great.
ARTICLE TITLE: Optimizing obstetrical suite staffing: it's more
than mathematics
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 2001, 48(3) p219-20
AUTHOR(S): Halpern S; Watson-MacDonell J
PUBLICATION TYPE: Editorial
ARTICLE TITLE: Vital capacity inhalation induction with
sevoflurane: an alternative to standard intravenous induction for
patients undergoing cardiac surgery
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2001,
15(2) p169-74
AUTHOR(S): Djaiani GN; Hall J; Pugh S; Peaston RT
AUTHOR'S ADDRESS: Department of Anesthesiology, Division of
Cardiothoracic Anesthesia, Duke University Medical Center, Durham, NC
27710, USA.
PUBLICATION TYPE: Journal Article
MB: I am not sure why they all it 'vital capacity'. They talk about
hyperventilation but don't say if that was achieved by encouragement
or what. The comparison was with etomidate. Sevoflurane inductions
seem good for CV ASA Grade 5 or 6 to me.
ARTICLE TITLE: The effects of volatile anesthetics on the Q-Tc
interval
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2001,
15(2) p188-91
AUTHOR(S): Guler N; Kati I; Demirel CB; Bilge M; Eryonucu B; Topal
C
AUTHOR'S ADDRESS: Departments of Cardiology, Anesthesiology, and
Internal Medicine, School of Medicine Yuzuncu Yil University, Van,
Turkey.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Prone positioning and inhaled nitric oxide:
synergistic therapies for acute respiratory distress syndrome.
ARTICLE SOURCE: J Trauma (United States), Apr 2001, 50(4) p589-95;
discussion 595-6
AUTHOR(S): Johannigman JA; Davis K; Miller SL; Campbell RS; Luchette
FA; Frame SB; Branson RD
AUTHOR'S ADDRESS: Department of Surgery, University of Cincinnati,
College of Medicine, Ohio 45267-0558, USA.
jay.johannigman@uc.edu.
PUBLICATION TYPE: Clinical Trial; Controlled Clinical Trial; Journal
Article
CONCLUSIONS: Inhaled nitric oxide (INO) and prone positioning can
contribute to improved oxygenation in patients with acute respiratory
distress syndrome (ARDS). The two therapies in combination are
synergistic and may be important adjuncts to mechanical ventilation
in the ARDS patient with refractory hypoxemia.
ARTICLE TITLE: Femoral arterial graft failure caused by the
secondary abdominal compartment syndrome.
ARTICLE SOURCE: J Trauma (United States), Apr 2001, 50(4) p740-2
AUTHOR(S): Biffl WL; Moore EE; Burch JM
AUTHOR'S ADDRESS: Department of Surgery, Denver Health Medical
Center, University of Colorado Health Sciences Center, Denver,
Colorado 80204, USA. wbiffl@dhha.org.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Chest tube removal: end-inspiration or
end-expiration?
ARTICLE SOURCE: J Trauma (United States), Apr 2001, 50(4) p674-7
AUTHOR(S): Bell RL; Ovadia P; Abdullah F; Spector S; Rabinovici R
AUTHOR'S ADDRESS: Department of Surgery, Yale University School of
Medicine, New Haven, Connecticut, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
CONCLUSIONS: Discontinuation of chest tubes at the end of inspiration
or at the end of expiration has a similar rate of post-removal
pneumothorax. Both methods are equally safe.
MB: How about not making a big deal about it at all?
In my second year from graduation I took out a chest tube. The
patient wanted to know how the IV fluid could get out.
ARTICLE TITLE: Clinical reality of coronary prevention guidelines:
a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I
and II Group. European Action on Secondary Prevention by Intervention
to Reduce Events.
COMMENTS: : Lancet. 2001 Mar 31; 357(9261):972-3/21188355
ARTICLE SOURCE: Lancet (England), Mar 31 2001, 357(9261)
p995-1001
AUTHOR'S ADDRESS: Collective Name: EUROASPIRE I and II Group;
European Action on Secondary Prevention by Intervention to
ReduceEvents.
PUBLICATION TYPE: Journal Article; Multicenter Study
INTERPRETATION: The adverse lifestyle trends among European coronary
heart disease (CHD patients are a cause for concern, as is the lack
of any improvement in blood-pressure management, and the fact that
most CHD patients are still not achieving the cholesterol goal of
less than 5 mmol/L. There is a collective failure of medical practice
in Europe to achieve the substantial potential among patients with
CHD to reduce the risk of recurrent disease and death.
ARTICLE TITLE: Revealing false paternity: some ethical
considerations.
ARTICLE SOURCE: Lancet (England), Mar 31 2001, 357(9261) p1033-5
AUTHOR(S): Lucassen A; Parker M
AUTHOR'S ADDRESS: Department of Clinical Genetics, Churchill
Hospital, Oxford, UK. annekel.@soton.ac.uk.
PUBLICATION TYPE: Journal Article
MB: Many think you should not tell the mother.
ARTICLE TITLE: There's no pain without brain.
ARTICLE SOURCE: Lancet (England), Mar 24 2001, 357(9260) p939
AUTHOR(S): Butcher J
PUBLICATION TYPE: News
MB: Typical pain industry stuff which is of no practical
application.
ARTICLE TITLE: Sutureless mechanical anastomosis of a saphenous
vein graft to a coronary artery with a new connector device.
ARTICLE SOURCE: Lancet (England), Mar 24 2001, 357(9260) p931-2
AUTHOR(S): Eckstein FS; Bonilla LF; Meyer B; Berg TA; Neidhart PP;
Schmidli J; Carrel TP
PUBLICATION TYPE: Letter
ABSTRACT: Construction of vascular anastomoses by manual suturing is
a highly skilled and time-consuming procedure. The St Jude Medical
Anastomotic Technology Group has developed a sutureless mechanical
anastomosis device, which, when tested in animals, produced
anastomoses in less than 3 min and with little training. Here we
present the results of the first clinical saphenous-vein to
coronary-artery anastomosis by means of this device.
ARTICLE TITLE: Effects of hydroxyethylstarch and gelatin on renal
function in severe sepsis: a multicentre randomised study.
ARTICLE SOURCE: Lancet (England), Mar 24 2001, 357(9260) p911-6
AUTHOR(S): Schortgen F; Lacherade JC; Bruneel F; Cattaneo I; Hemery
F; Lemaire F; Brochard L
AUTHOR'S ADDRESS: Medical Intensive-care Unit, Henri Mondor Hospital,
Assistance Publique-H pitaux de Paris, University Paris 12, Creteil,
France.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study;
Randomized Controlled Trial
ABSTRACT: BACKGROUND: Hydroxyethylstarch used for volume restoration
in brain-dead kidney donors has been associated with impaired kidney
function in the transplant recipients. We undertook a multicentre
randomised study to assess the frequency of acute renal failure (ARF)
in patients with severe sepsis or septic shock treated with
hydroxyethylstarch or gelatin. METHODS: Adults with severe sepsis or
septic shock were enrolled prospectively in three intensive-care
units in France. They were randomly assigned 6% hydroxyethylstarch
(200 kDa, 0.60-0.66 substitution) or 3% fluid-modified gelatin. The
primary endpoint was ARF (a two-fold increase in serum creatinine
from baseline or need for renal replacement therapy). Analyses were
by intention to treat. FINDINGS: 129 patients were enrolled over 18
months. Severity of illness and serum creatinine (median 143 [IQR
88-203] vs 114 [91-175] micromol/L) were similar at
baseline in the hydroxyethylstarch and gelatin groups. The
frequencies of ARF (27/65 [42%] vs 15/64 [23%],
p=0.028) and oliguria (35/62 [56%] vs 23/63 [37%],
p=0.025) and the peak serum creatinine concentration (225
[130-339] vs 169 [106-273] micromol/L, p=0.04) were
significantly higher in the hydroxyethylstarch group than in the
gelatin group. In a multivariate analysis, risk factors for acute
renal failure included mechanical ventilation (odds ratio 4.02
[95% CI 1.37-11.8], p=0.013) and use of hydroxyethylstarch
(2.57 [1.13-5.83], p=0.026). INTERPRETATIONS: The use of this
preparation of hydroxyethylstarch as a plasma-volume expander is an
independent risk factor for ARF in patients with severe sepsis or
septic shock.
MB: I have not given any. I think it would be a good idea to do the
study again without using geletin. I have never been a fan of volume
expanders other than albumin. They do suggest that only crystaloids
be used.
ARTICLE TITLE: Death rate of aborigines in prison is
increasing
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1348
AUTHOR(S): Loff B; Cordner S
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Understanding the experience of pain in terminally
ill patients
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1311-5
AUTHOR(S): Weiss SC; Emanuel LL; Fairclough DL; Emanuel EJ
AUTHOR'S ADDRESS: Department of Clinical Bioethics, Warren G Magnuson
Clinical Center, National Institutes of Health, Building 10, Room
1C118, 20892, Bethesda, MD, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Background Terminally ill patients commonly experience
substantial pain. Unresolved pain has been cited as evidence that
end-of-life care is of poor quality. However, the data on which that
conclusion is based are limited. We aimed to provide additional data
on the experience of pain in such patients.Methods We interviewed 988
terminally ill patients from six randomly selected US sites. We asked
them who had treated their pain in the previous 4 weeks (primary-care
physician, pain specialist, or both), and whether they wanted more
pain medication than they were receiving, or why they did not want
more.Findings 496 (50%) terminally ill patients reported moderate or
severe pain. 514 (52%) individuals had seen a primary-care physician
for treatment of pain in the previous 4 weeks and 198 (20%) saw a
pain specialist. Of those who had been treated by their primary-care
physician, 287 (29%) wanted more therapy, 613 (62%) wanted their pain
therapy to remain the same, and 89 (9%) wanted to reduce or stop
their pain therapy. Several reasons for not wanting additional
therapy were offered-fear of addiction, dislike of mental or physical
side-effects, and not wanting to take more pills or injections. We
saw no association between disease and amount of pain between disease
and the desire for more treatment. Black patients were more likely to
seek additional pain therapy, see a pain specialist, and refuse
additional medication because of fear of addiction than other
populations.Interpretation Although half of terminally ill patients
experienced moderate to severe pain, only 30% of them wanted
additional pain treatment from their primary-care physician. The
number of patients experiencing pain remains too high. However, the
number is not as large as perceived. Additionally, most are willing
to tolerate pain. Furthermore, the experience of pain is constant
across major terminal diseases.
MB:The authors seem very confused. They don't seem to be able to cope
with rejection by the patients of medical intervention. The same
applies to the next article.
ARTICLE TITLE: Window of opportunity for pain control in the
terminally ill
ARTICLE SOURCE: Lancet (England), Apr 28 2001, 357(9265) p1304-5
AUTHOR(S): Ahmedzai SH
AUTHOR'S ADDRESS: Academic Palliative Medicine Unit, University of
Sheffield, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Researcher, clinician, or teacher?
ARTICLE SOURCE: Lancet (England), May 19 2001, 357(9268) p1543
PUBLICATION TYPE: Editorial
MEDLINE INDEXING DATE: 200105
MB: It is pretty hopeless. Those interested in teaching and quality
of clinical care might have to settle for less money & lower
titles. I suppose if the junior staff were paid less the money could
be used to pay teachers. I don't know how you could control this.
Researchers rather than clinician/teachers are not much good as role
models. The only good teachers are those that do it for fun.
ARTICLE TITLE: Efficacy and safety of thrombolytic therapy after
initially unsuccessful cardiopulmonary resuscitation: a prospective
clinical trial
ARTICLE SOURCE: Lancet (England), May 19 2001, 357(9268) p1583-5
AUTHOR(S): Bottiger BW; Bode C; Kern S; Gries A; Gust R; Glatzer R;
Bauer H; Motsch J; Martin E
AUTHOR'S ADDRESS: Departments of Anaesthesiology, University of
Heidelberg, D-69120, Heidelberg, Germany.
PUBLICATION TYPE: Journal Article
Interpretation After initially unsuccessful out-of-hospital
cardiopulmonary resuscitation (CPR),, thrombolytic therapy combined
with heparin is safe and might improve patient outcome. On the basis
of our data a randomised controlled trial might be regarded as
ethical.
ARTICLE TITLE: Thrombolytic therapy during cardiopulmonary
resuscitation
ARTICLE SOURCE: Lancet (England), May 19 2001, 357(9268) p1549-50
AUTHOR(S): Kern KB
AUTHOR'S ADDRESS: Department of Medicine, Sarver Heart Center,
University of Arizona, 85724, Tucson, AZ, USA.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Preventing multiple sclerosis?
ARTICLE SOURCE: Lancet (England), May 19 2001, 357(9268) p1547
AUTHOR(S): Ebers GC
AUTHOR'S ADDRESS: Department of Clinical Neurology, University of
Oxford, Radcliffe Infirmary, OX2 CH2, Oxford, UK.
PUBLICATION TYPE: Journal Article
MB: It appears that there are some effective treatments.
ARTICLE TITLE: Foot and mouth disease in human beings
ARTICLE SOURCE: Lancet (England), May 12 2001, 357(9267) p1463
AUTHOR(S): David W; Brown G
AUTHOR'S ADDRESS: Enteric, Respiratory and Neurological Virus
Laboratory, Central Public Health Laboratory, NW9 5HT, London, UK.
dbrown@phls.org.uk.
PUBLICATION TYPE: Journal Article
MB: Do you get it by biting a sheep or cow?
ARTICLE TITLE: Venous thromboembolism after long flights: are
airlines to blame?
ARTICLE SOURCE: Lancet (England), May 12 2001, 357(9267) p1461-2
AUTHOR(S): Hirsh J; O'Donnell MJ
AUTHOR'S ADDRESS: Hamilton Civic Hospitals Research Centre, McMaster
University, Ontario L8V 1C3, Hamilton, Canada.
jhirsh@thrombosis.hhscr.org.
PUBLICATION TYPE: Journal Article
MB: I wonder who is paying them. They don't think that airlines
should be forced to give more leg room because at present the
evidence is not good enough in their opinion. They think that a paper
showing zero DVTs in passengers wearing compression stockings must be
falsly low and 10% DVTs in those not wearing them is falsly high.
Well, it's good enough for me---stockings, aspirin, business class,
aisle seat, sleeping in a bed --not on the plane, breaking the
journey for one day at stops, walking about frequently, no
alcohol.
ARTICLE TITLE: Postoperative pain control in total joint
arthroplasty: a prospective, randomized study of a fixed-dose,
around-the-clock, oral regimen.
ARTICLE SOURCE: Orthopedics (United States), Mar 2001, 24(3)
p243-6
AUTHOR(S): Flory DA; Fankhauser RA; McShane MA
AUTHOR'S ADDRESS: Department of Orthopedic Surgery, Mt Carmel Health
System, Columbus, Ohio, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: This randomized, prospective study assessed postoperative
pain control in 119 patients undergoing total joint arthroplasty.
Group 1 (59 patients) received scheduled, around-the-clock, oral
opioids and group 2 (60 patients) received oral opioids on an
as-needed basis. Both groups had parenteral opioids available for
breakthrough pain. The average scores for group 1 were lower than
group 2. Differences were significant in sensory scores (AM day 1; AM
and PM day 2), affective scores (PM day 2), total pain (PM day 2),
visual analog scale (PM day 2), and present pain intensity index (AM
day 1; PM day 2). Group 1 averaged 2.05 breakthrough pain doses and
group 2 averaged 3.47 doses (P=.003), an average savings of 17.2% of
the cost of pain medications during the first 2 postoperative days.
The results indicate that scheduled, around-the-clock, oral opioids
are an effective treatment regimen for postoperative pain control in
total joint arthroplasty patients.
ARTICLE TITLE: Comparing world health-care systems: does quality
translate?
ARTICLE SOURCE: Orthopedics (United States), Apr 2001, 24(4) p324,
330
AUTHOR(S): D'Ambrosia R; Kilpatrick JA
PUBLICATION TYPE: Editorial
ARTICLE TITLE: Down and out in Pittsburgh.
ARTICLE SOURCE: Surgery (United States), May 2001, 129(5) p641-2
AUTHOR(S): McFadden DW
AUTHOR'S ADDRESS: Department of Surgery, West Virginia University,
Morgantown, WV 26505, USA.
PUBLICATION TYPE: Biography; Historical Article; Journal Article
MB: It's a good story.
ARTICLE TITLE: Clinical trials of the effectiveness of devices: an
analogy with drugs.
ARTICLE SOURCE: Surgery (United States), May 2001, 129(5) p517-23
AUTHOR(S): Wittes J
AUTHOR'S ADDRESS: Statistics Collaborative, Inc, Washington, DC
20008, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial