MB's Articles of Interest - September 2002

 

ARTICLE TITLE: Remifentanil pharmacokinetics
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1674
AUTHOR(S): Dahaba AA
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care Medicine, Karl Franzens University, Graz, Austria.
PUBLICATION TYPE Journal Article

ARTICLE TITLE: Reversal of delayed paraplegia with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair [In Process Citation]
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1674
AUTHOR(S): Tsusaki B; Grigore A; Cooley DA; Collard CD
AUTHOR'S ADDRESS: Departments of Cardiovascular Anesthesiology and Surgery, Texas Heart Institute, Saint Luke's Episcopal Hospital, Houston, TX.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Gastric Distention in a Spontaneously Ventilating Patient with a ProSeal Laryngeal Mask Airway
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1656-8
AUTHOR(S): O'Connor CJ; Davies SR; Stix MS; Dolan RW
AUTHOR'S ADDRESS: Departments of Anesthesiology and Otolaryngology, Lahey Clinic, Burlington, Massachusetts.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: Partial upper airway obstruction during spontaneous respiration with a ProSeal(TM) laryngeal mask airway can result in gastric distention.
MB. I thought it was supposed to stop that from happening.

ARTICLE TITLE: Acute Vision Impairment: Does It Affect an Anesthesiologist's Ability to Intubate the Trachea?
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1566-9
AUTHOR(S): Tessler MJ; Trihas ST; Overbury O; Ducruet T
AUTHOR'S ADDRESS: Departments of Anesthesia, Ophthalmology, and Clinical Epidemiology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: We found that acute severe vision impairment adversely affects the anesthesiologist's ability to intubate the trachea. This implies that anesthesiologists with acute onset of severe visual handicaps might have more difficulty intubating the trachea, which could initiate more critical incidents.
MB. Artificially induced visual defects.

ARTICLE TITLE: Music and preoperative anxiety: a randomized, controlled study
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1489-94
AUTHOR(S): Wang SM; Kulkarni L; Dolev J; Kain ZN
AUTHOR'S ADDRESS: Departments of Anesthesiology, Pediatrics, and Child Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
PUBLICATION TYPE: Journal Article
That is, the postintervention anxiety level of subjects in the Music group decreased by 16% as compared with the preintervention level, whereas the anxiety level of the Control group did not change significantly. Two-way repeated-measures analysis of variance performed for the electrodermal activity, blood pressure, heart rate, cortisol, and catecholamine data demonstrated no group difference and no time x group interaction (P = not significant). In conclusion, under the conditions of this study, patients who listened to music before surgery reported lower levels of state anxiety. Physiological outcomes did not differ, however, between the two study groups. IMPLICATIONS: Patients who listen to music of their choice during the preoperative period report less anxiety.
MB. No objective endpoint.

ARTICLE TITLE: The Bispectral Index and Explicit Recall During the Intraoperative Wake-up Test for Scoliosis
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1474-8
AUTHOR(S): McCann ME; Brustowicz RM; Bacsik J; Sullivan L; Auble SG; Laussen PC
AUTHOR'S ADDRESS: Departments of Anesthesia, Children's Hospital and Harvard Medical School, Boston, Massachusetts.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: The relationship between bispectral index (BIS) and purposeful intraoperative patient movement is consistent with previous BIS utility studies. We conclude that BIS may be a useful clinical monitor for predicting patient movement to command during the intraoperative wake-up test, particularly when controlled hypotension is used and hemodynamic responses to emergence of anesthesia are blunted.

ARTICLE TITLE: An increase in body temperature during radiofrequency ablation of liver tumors
ARTICLE SOURCE: Anesth Analg (United States), Jun 2002, 94(6) p1416-20
AUTHOR(S): Sawada M; Watanabe S; Tsuda H; Kano T
AUTHOR'S ADDRESS: Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan.
PUBLICATION TYPE: Status: In-Process
Journal Article
IMPLICATIONS: The increase in body temperature (BT) is predictable during radiofrequency ablation (RFA) of liver tumors under general anesthesia. Close observation of total output energy delivered and BT are required, and preparation of cooling measures is important, in RFA of liver tumors.

ARTICLE TITLE: Fibrinolysis during liver transplantation is enhanced by using solvent/detergent virus-inactivated plasma (ESDEP).
ARTICLE SOURCE: Anesth Analg (United States), May 2002, 94(5) p1127-31, table of contents
AUTHOR(S): de Jonge J; Groenland TH; Metselaar HJ; IJzermans JN; van Vliet HH; Visser L; Tilanus HW
AUTHOR'S ADDRESS: Department of Surgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: The use of solvent/detergent virus-inactivated plasma is of increasing importance in the prevention of human immunodeficiency virus and hepatitis C virus transmission. Since the use of this plasma during orthotopic liver transplantation has increased, the incidence of hyperfibrinolysis was observed. Clotting analysis of the patients revealed small alpha(2)-antiplasmin concentrations because of the solvent/detergent process.

ARTICLE TITLE: Assessing errors in the determination of base excess.
ARTICLE SOURCE: Anesth Analg (United States), May 2002, 94(5) p1141-8, table of contents
AUTHOR(S): Mentel A; Bach F; Schuler J; Herrmann W; Koster A; Crystal GJ; Gatzounis G; Mertzlufft F
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, Kraukenaustalten Gilead, von Bodelschwinghsche Anstalten Bethel, Bielefeld, Germany.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: A clinically useful way to quantify nonrespiratory disturbances of the acid-base balance is calculation of the base excess of extracellular fluid by using blood gas analyzers. In this study, we found significant variability in estimates of base excess of extracellular fluid obtained with five analyzers from different manufacturers. This variability is attributable to multiple factors, including lack of correction for deoxygenated hemoglobin (Haldane effect).
MB. I assume they all went in the same direction.

ARTICLE TITLE: The effect of remifentanil or fentanyl on postoperative vomiting and pain in children undergoing strabismus surgery.
ARTICLE SOURCE: Anesth Analg (United States), May 2002, 94(5) p1173-7, table of contents
AUTHOR(S): Eltzschig HK; Schroeder TH; Eissler BJ; Felbinger TW; Vonthein R; Ehlers R; Guggenberger H
AUTHOR'S ADDRESS: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. heltzschig@partners.org.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: Opioids increase the incidence of postoperative vomiting (POV). Remifentanil is characterized by the shortest half-life of all opioids used in anesthetic practice. Therefore, we studied the effect of remifentanil on POV compared with the longer-acting opioid fentanyl in children undergoing strabismus surgery.

ARTICLE TITLE: Guidelines on perioperative cardiovascular evaluation: what have we learned over the past 6 years to warrant an update?
COMMENTS: Comment On: Comment On: RefSource:Anesth Analg. 2002 May; 94(5):1052-64
ARTICLE SOURCE: Anesth Analg (United States), May 2002, 94(5) p1378-9
AUTHOR(S): Fleisher LA; Eagle KA
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time.
ARTICLE SOURCE: Anesth Analg (United States), Apr 2002, 94(4) p933-42, table of contents
AUTHOR(S): Dexter F; Traub RD
AUTHOR'S ADDRESS: Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA. Franklin-Dexter@UIowa.edu.
PUBLICATION TYPE: Journal Article
We conclude that for facilities at which the goals are, in order of importance, safety, patient and surgeon access to OR time, and then efficiency, few restrictions need to be placed on patient scheduling to achieve an efficient use of OR time.

ARTICLE TITLE: Korean hand acupressure reduces postoperative nausea and vomiting after gynecological laparoscopic surgery.
ARTICLE SOURCE: Anesth Analg (United States), Apr 2002, 94(4) p872-5, table of contents
AUTHOR(S): Boehler M; Mitterschiffthaler G; Schlager A
AUTHOR'S ADDRESS: University Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Innsbruck, Austria.
PUBLICATION TYPE: Journal Article
We conclude that Korean hand acupressure of the acupuncture point K-K9 is an effective method for reducing postoperative nausea and vomiting in women after minor gynecological laparoscopic surgery.

ARTICLE TITLE: Continuous three-in-one block for postoperative pain after lower limb orthopedic surgery: where do the catheters go?
ARTICLE SOURCE: Anesth Analg (United States), Apr 2002, 94(4) p1001-6, table of contents
AUTHOR(S): Capdevila X; Biboulet P; Morau D; Bernard N; Deschodt J; Lopez S; d'Athis F
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France. x-capdevilla@chu-montpellier.fr.
PUBLICATION TYPE: Journal Article
We conclude that during a continuous three-in-one block, the threaded catheter rarely reached the lumbar plexus. The quality of sensory and motor blockade and initial pain relief depend on the location of the catheter tip under the fascia iliaca. IMPLICATIONS: The course of a continuous three-in-one block catheter is unpredictable. Only 23% of the catheters lie near the lumbar plexus. The success of sensory and motor blocks, as well as postoperative analgesia, depend on the position of the catheter under the fascia iliaca.
MB. Well we can give up on this. I would have been very sceptical.

ARTICLE TITLE: Use of hepatitis B core antibody-positive donors in orthotopic liver transplantation
ARTICLE SOURCE: Arch Surg (United States), May 2002, 137(5) p572-6
AUTHOR(S): Holt D; Thomas R; Van Thiel D; Brems JJ
AUTHOR'S ADDRESS: Loyola University, Chicago, EMS Building 110, 2160 S First Ave, Maywood, IL 60153. jbrems@lumc.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: HYPOTHESIS: Hepatic allografts from donors positive for antibody to hepatitis B core antigen (anti-HBc) frequently transmit hepatitis B virus (HBV) infection to recipients. Therefore, most transplantation centers will not use these organs for orthotopic liver transplantation (OLT). CONCLUSION: Perioperative use of hepatitis B immune globulin (HBIG) combined with long-term use of lamivudine can prevent hepatitis B virus (HBV) infection in recipients who receive hepatic allografts from hepatitis B core antibody (HbcAb) -positive donors.

ARTICLE TITLE: Effect of hypoventilation on bleeding during hepatic resection: a randomized controlled trial.
ARTICLE SOURCE: Arch Surg (United States), Mar 2002, 137(3) p311-5
AUTHOR(S): Hasegawa K; Takayama T; Orii R; Sano K; Sugawara Y; Imamura H; Kubota K; Makuuchi M
AUTHOR'S ADDRESS: Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: This randomized trial suggested no beneficial effect of reduction of tidal volume on bleeding during hepatic resection.
MB. The idea was to lower the CVP by lowering ventilation. There was a small lowering of CVP. They don't talk about fiddling with the inspiratory to expiratory ratio.

ARTICLE TITLE: Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care unit.
ARTICLE SOURCE: Arch Surg (United States), Feb 2002, 137(2) p133-6
AUTHOR(S): McNelis J; Marini CP; Jurkiewicz A; Fields S; Caplin D; Stein D; Ritter G; Nathan I; Simms HH
AUTHOR'S ADDRESS: Department of Surgery, Northshore-Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, NY, USA. jmcnelis@lij.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: The results of this study indicate that 24-hour fluid balance and peak airway pressure are 2 independent variables predictive of the development of abdominal compartment syndrome (ACS) in nontrauma surgical patients.

ARTICLE TITLE: Pro/con clinical debate: Are steroids useful in the management of patients with septic shock?
ARTICLE SOURCE: Crit Care (England), Apr 2002, 6(2) p113-6
AUTHOR(S): Ritacca FV; Simone C; Wax R; Craig KG; Walley KR
AUTHOR'S ADDRESS: Resident, Department of Medicine, University of Toronto, Canada.
PUBLICATION TYPE:Editorial
Steroid use in septic shock is an example of a therapy that makes some sense but has conflicting support in the literature. In this issue of Critical Care Forum, the two sides of this often heated debate are brought to the forefront in an interesting format.

ARTICLE TITLE: Eighth World Congress of Intensive and Critical Care Medicine, 28 October-1 November 2001, Sydney, Australia: Harm minimization and effective risk management.
ARTICLE SOURCE: Crit Care (England), Feb 2002, 6(1) p89-91
AUTHOR(S): Ramakrishnan N
AUTHOR'S ADDRESS: Royal Melbourne Hospital, Parkville, Victoria, Australia. dr_nramakrishnan@hotmail.com.
PUBLICATION TYPE: Congresses
ABSTRACT: The 8th World Congress saw the presentation of several late-breaking findings, such as the role of insulin in reducing mortality, and technologies such as vital microscopy. There were heated debates for and against the role of gastric tonometry, enteral nutrition, extracorporeal membrane oxygenation, the question of 'closed' or 'open' intensive care units, and several others. The overall message was the need to study outcomes and practise intensive care in a sensitive and humane fashion.

ARTICLE TITLE: Pro/con clinical debate: is high-volume hemofiltration beneficial in the treatment of septic shock?
ARTICLE SOURCE: Crit Care (England), Feb 2002, 6(1) p18-21
AUTHOR(S): Reiter K; Bellomo R; Ronco C; Kellum JA
AUTHOR'S ADDRESS: University Children's Hospital, Muenchen, Germany.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Pro/con clinical debate: the use of prone positioning in the management of patients with acute respiratory distress syndrome.
ARTICLE SOURCE: Crit Care (England), Feb 2002, 6(1) p15-7
AUTHOR(S): Marini JJ; Rubenfeld G
AUTHOR'S ADDRESS: University of Minnesota, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Protocol-driven care in the intensive care unit: a tool for quality.
COMMENTS: Comment On: Comment On: RefSource:Crit Care. 2001 Dec; 5(6):349-54
ARTICLE SOURCE: Crit Care (England), Dec 2001, 5(6) p283-5
AUTHOR(S): Wall RJ; Dittus RS; Ely EW
AUTHOR'S ADDRESS: Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
PUBLICATION TYPE: Comment; Journal Article
ABSTRACT: Advances in organization and patient management in the intensive care unit (ICU) have led to reductions in the morbidity and mortality suffered by critically ill patients. Two such advances include multidisciplinary teams (MDTs) and the development of clinical protocols.

ARTICLE TITLE: Noradrenaline and the kidney: friends or foes?
ARTICLE SOURCE: Crit Care (England), Dec 2001, 5(6) p294-8
AUTHOR(S): Bellomo R; Giantomasso DD
AUTHOR'S ADDRESS: Department of Intensive Care and Medicine, Austin and Repatriation Medical Centre, Melbourne, Australia. rb@austin.unimelb.edu.au.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: The World Trade Center attack. Observations from New York's Bellevue Hospital.
ARTICLE SOURCE: Crit Care (England), Dec 2001, 5(6) p307-9
AUTHOR(S): Roccaforte JD
AUTHOR'S ADDRESS: Department of Anesthesiology, Bellevue Hospital Center, New York, USA. JDavidR@mail.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics.

ARTICLE TITLE: Red blood cell transfusion does not increase oxygen consumption in critically ill septic patients.
ARTICLE SOURCE: Crit Care (England), Dec 2001, 5(6) p362-7
AUTHOR(S): Fernandes CJ; Akamine N; De Marco FV; De Souza JA; Lagudis S; Knobel E
AUTHOR'S ADDRESS: Intensive Care Unit, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. constantino@einstein.br.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Hemoglobin increase does not improve either global or regional oxygen utilization in anemic septic patients. Furthermore, red blood cell (RBC) transfusion may hamper right ventricular ejection by increasing the pulmonary vascular resistance index.

ARTICLE TITLE: A primer of nutritional support for gastroenterologists
ARTICLE SOURCE: Gastroenterology (United States), May 2002, 122(6) p1677-87
AUTHOR(S): Klein S
AUTHOR'S ADDRESS: Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Awakening the sleeping postsurgical abdomen.
ARTICLE SOURCE: Gastroenterology (United States), Apr 2002, 122(4) p1178-9
AUTHOR(S): Shaheen NJ
PUBLICATION TYPE: Journal Article
MB. About postoperative ileus.

ARTICLE TITLE: Fantastic voyage through the gut.
ARTICLE SOURCE: Gastroenterology (United States), Mar 2002, 122(3) p828-30
AUTHOR(S): Raju GS; Yusuf T
PUBLICATION TYPE: Journal Article
MB. About capsule endoscopy.

ARTICLE TITLE: Discordant research opportunities and human resources: can we meet the challenge?
ARTICLE SOURCE: Gastroenterology (United States), Mar 2002, 122(3) p603-4
AUTHOR(S): Sartor RB
PUBLICATION TYPE Editorial

ARTICLE TITLE: Scalene regional anesthesia for shoulder surgery in a community setting: an assessment of risk
ARTICLE SOURCE: J Bone Joint Surg Am (United States), May 2002, 84-A(5) p775-9
AUTHOR(S): Weber SC; Jain R
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: A retrospective review of shoulder procedures using scalene block anesthesia was performed. METHODS: The records of all 218 patients who had undergone scalene block anesthesia over a three-year period at two facilities were retrospectively reviewed. All blocks were performed with use of a standard blunt-needle technique with the patient awake and with use of preoperative nerve stimulation to localize the brachial plexus. RESULTS: Adjunctive general anesthesia was used for 179 (82%) of the 218 patients. Seventy-two patients (33%) required intravenous pain medication immediately on arrival in the recovery room, and twenty-eight blocks (13%) failed. One grand mal seizure, one episode of cardiovascular collapse, and four episodes of severe respiratory distress were noted. Two patients had temporary neurologic injuries that persisted at six weeks. The mean duration of the block was 9 +/- 4.6 hours. Two hundred (92%) of the 218 patients required parenteral narcotics despite the use of scalene block anesthesia. CONCLUSION: Informed consent discussions regarding scalene block anesthesia should include information on the prevalence of complications and the efficacy of the technique.
MB. sounds pretty hopeless.

ARTICLE TITLE: Assessing a Patient's Capacity to Refuse Treatment
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Apr 2002, 84-A(4) p691-3
AUTHOR(S): Capozzi JD; Rhodes R
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Should the term "Required" be banned?
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Apr 2002, 84-A(4) p684-5
AUTHOR(S): Shaw BA; Diab M
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Alfred R. Shands, Jr., lecture: our humanitarian orthopaedic opportunity.
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Mar 2002, 84-A(3) p478-84
AUTHOR(S): White AA
AUTHOR'S ADDRESS: Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. awhite2@caregroup.harvard.edu.
PUBLICATION TYPE: Lectures

ARTICLE TITLE: A randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Apr 2002, 14(2) p102-7
AUTHOR(S): Fabling JM; Gan TJ; El-Moalem HE; Warner DS; Borel CO
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
Administration of single-dose ondansetron (8 mg intravenously) at wound closure was partially effective in reducing acute nausea and vomiting but had little delayed benefit. Scheduled prophylactic administration of antiemetic therapy during the first 48 hours after infratentorial craniotomy should be evaluated for efficacy and safety.

ARTICLE TITLE: "Inside" Australia's Woomera detention centre.
ARTICLE SOURCE: Lancet (England), Feb 23 2002, 359(9307) p683
AUTHOR(S): Loff B; Snell B; Creati M; Mohan M
PUBLICATION TYPE: News

ARTICLE TITLE: Blinding in randomised trials: hiding who got what.
ARTICLE SOURCE: Lancet (England), Feb 23 2002, 359(9307) p696-700
AUTHOR(S): Schulz KF; Grimes DA
AUTHOR'S ADDRESS: Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. KSchulz@fhi.org.
PUBLICATION TYPE: Journal Article
We recommend placing greater credence in results when investigators at least blind outcome assessments, except with objective outcomes, such as death, which leave little room for bias. If investigators properly report their blinding efforts, readers can judge them. Unfortunately, many articles do not contain proper reporting. If an article claims blinding without any accompanying clarification, readers should remain sceptical about its effect on bias reduction.

ARTICLE TITLE: Time to look beyond MMR in autism research.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Feb 23; 359(9307):705-6/PMID:11879886
ARTICLE SOURCE: Lancet (England), Feb 23 2002, 359(9307) p637
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The right to sell or buy a kidney: are we failing our patients?
COMMENTS: Comment In: Comment In: RefSource:Lancet. 2002 Mar 16; 359(9310):906-7/PMID:11918904
ARTICLE SOURCE: Lancet (England), Mar 16 2002, 359(9310) p971-3
AUTHOR(S): Friedlaender MM
AUTHOR'S ADDRESS: Nephrology and Hypertension Services, Hadassah University Hospital, PO Box 12000, 91120, Jerusalem, Israel.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Paid non-related living organ donation: Horn of Plenty or Pandora's box?
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Mar 16; 359(9310):971-3
ARTICLE SOURCE: Lancet (England), Mar 16 2002, 359(9310) p906-7
AUTHOR(S): Schlitt HJ
AUTHOR'S ADDRESS: Viszeral-und Transplantationschirurgie, Medizinische Hochschule,D 30623, Hannover, Germany.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Controversy surrounds proposed xenotransplant trial.
ARTICLE SOURCE: Lancet (England), Mar 16 2002, 359(9310) p949
AUTHOR(S): Archer K; McLellan F
PUBLICATION TYPE: News

ARTICLE TITLE: Myocardial salvage after coronary stenting plus abciximab versus fibrinolysis plus abciximab in patients with acute myocardial infarction: a randomised trial.
ARTICLE SOURCE: Lancet (England), Mar 16 2002, 359(9310) p920-5
AUTHOR(S): Kastrati A; Mehilli J; Dirschinger J; Schricke U; Neverve J; Pache J; Martinoff S; Neumann FJ; Nekolla S; Blasini R; Seyfarth M; Schwaiger M; Schomig A
AUTHOR'S ADDRESS: Deutsches Herzzentrum, Technische Universitat, Munich, Germany. kastrati@dhm.mhn.de; Collective Name: The Stent versus Thrombolysis for Occluded Coronary Arteries in Patients With Acute Myocardial Infarction (STOPAMI-2) Study.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
INTERPRETATION: In patients with acute myocardial infarction, a reperfusion strategy based on stenting with abciximab produced more myocardial salvage than the combination of fibrinolysis plus abciximab. Larger studies are needed to assess whether these effects translate into clinical benefit.

ARTICLE TITLE: The mammography screening debate: time to move on.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Mar 16; 359(9310):909-19
ARTICLE SOURCE: Lancet (England), Mar 16 2002, 359(9310) p904-5
AUTHOR(S): Gelmon KA; Olivotto I
AUTHOR'S ADDRESS: British Columbia Cancer Agency-Vancouver Cancer Centre, BC, V5Z 4E6, Vancouver, Canada. kgelmon@bccancer.bc.ca.
PUBLICATION TYPE: Comment; Journal Article
MB. 30% reduction in mortality since 1990 but they don't know why.

ARTICLE TITLE: The globalisation of the NHS.
ARTICLE SOURCE: Lancet (England), Apr 27 2002, 359(9316) p1447-8
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: UK's budget commits to rebuild National Health Service.
ARTICLE SOURCE: Lancet (England), Apr 27 2002, 359(9316) p1496-7
AUTHOR(S): Ashraf H
PUBLICATION TYPE: News
MB. They are going to fix the mess with lots of money - but not too much.

ARTICLE TITLE: Science and myth.
ARTICLE SOURCE: Lancet (England), Apr 20 2002, 359(9315) p1364
AUTHOR(S): Barbour V
AUTHOR'S ADDRESS: The Lancet, NW1 7BY, London, UK.
PUBLICATION TYPE: Journal Article
MB. A passionate apology for evolution as against creationism. I don't know why they are so excited about it all.

ARTICLE TITLE: Eradication of a disease: how we cured symptomless prostate cancer.
ARTICLE SOURCE: Lancet (England), Apr 13 2002, 359(9314) p1341-2
AUTHOR(S): Tannock IF
AUTHOR'S ADDRESS: Department of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada M5G 2M9. ian.tannock@uhn.on.ca.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial.
ARTICLE SOURCE: Lancet (England), Apr 13 2002, 359(9314) p1276-82
AUTHOR(S): Rigg JR; Jamrozik K; Myles PS; Silbert BS; Peyton PJ; Parsons RW; Collins KS
AUTHOR'S ADDRESS: Department of Public Health, University of Western Australia, Western, Crawley, Australia. john.rigg@sjog.org.au; Collective Name: MASTER Anaethesia Trial Study Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
ABSTRACT: BACKGROUND: Epidural block is widely used to manage major abdominal surgery and postoperative analgesia, but its risks and benefits are uncertain. We compared adverse outcomes in high-risk patients managed for major surgery with epidural block or alternative analgesic regimens with general anaesthesia in a multicentre randomised trial. METHODS: 915 patients undergoing major abdominal surgery with one of nine defined comorbid states to identify high-risk status were randomly assigned intraoperative epidural anaesthesia and postoperative epidural analgesia for 72 h with general anaesthesia (site of epidural selected to provide optimum block) or control. The primary endpoint was death at 30 days or major postsurgical morbidity. Analysis by intention to treat involved 447 patients assigned epidural and 441 control. FINDINGS: 255 patients (57.1%) in the epidural group and 268 (60.7%) in the control group had at least one morbidity endpoint or died (p=0.29). Mortality at 30 days was low in both groups (epidural 23 [5.1%], control 19 [4.3%], p=0.67). Only one of eight categories of morbid endpoints in individual systems (respiratory failure) occurred less frequently in patients managed with epidural techniques (23% vs 30%, p=0.02). Postoperative epidural analgesia was associated with lower pain scores during the first 3 postoperative days. There were no major adverse consequences of epidural-catheter insertion. INTERPRETATION: Most adverse morbid outcomes in high-risk patients undergoing major abdominal surgery are not reduced by use of combined epidural and general anaesthesia and postoperative epidural analgesia. However, the improvement in analgesia, reduction in respiratory failure, and the low risk of serious adverse consequences suggest that many high-risk patients undergoing major intra-abdominal surgery will receive substantial benefit from combined general and epidural anaesthesia intraoperatively with continuing postoperative epidural analgesia.
MB. Looking at the data presented does not support even the limited claims made in the last sentence.
[Editor's Note: The control group was statistically significantly sicker pre-op. This, of course, does not rate a mention in either the conclusions or the abstract. The positive spin put on the finding by the authors is the same as that in the larger American study recently published. The actual (as opposed to statistical) difference, even in pain scores, is minuscule in both studies (score differences of only 1/10 with coughing on the first post-op day, essentially no difference at all while at rest at any stage post-op). If you reckon that's an improvement in analgesia then good luck to you. More people died in the epidural groups in both studies (not statistically significant).]

ARTICLE TITLE: Postoperative enteral versus parenteral nutrition
ARTICLE SOURCE: Lancet (England), May 11 2002, 359(9318) p1697-8
AUTHOR(S): Pacelli F; Bossola M; Papa V; Sgadari A; Doglietto GB
AUTHOR'S ADDRESS: Department of Surgical Sciences, Digestive Surgery Unit, and Department of Internal Medicine, Catholic University School of Medicine, 00168, Rome, Italy.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The brain and somatic integration: insights into the standard biological rationale for equating "brain death" with death ARTICLE SOURCE: J Med Philos (Netherlands), Oct 2001, 26(5) p457-78
AUTHOR(S): Shewmon AD
AUTHOR'S ADDRESS: MDCC 22-474, UCLA Medical School, University of California, 951752, Los Angeles, CA 90095-1752, USA. ashewmon@mednet.ucla.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: The mainstream rationale for equating "brain death" (BD) with death is that the brain confers integrative unity upon the body, transforming it from a mere collection of organs and tissues to an "organism as a whole." In support of this conclusion, the impressive list of the brain's myriad integrative functions is often cited. Upon closer examination, and after operational definition of terms, however, one discovers that most integrative functions of the brain are actually not somatically integrating, and, conversely, most integrative functions of the body are not brain-mediated. With respect to organism-level vitality, the brain's role is more modulatory than constitutive, enhancing the quality and survival potential of a presupposedly living organism. Integrative unity of a complex organism is an inherently nonlocalizable, holistic feature involving the mutual interaction among all the parts, not a top-down coordination imposed by one part upon a passive multiplicity of other parts. Loss of somatic integrative unity is not a physiologically tenable rationale for equating BD with death of the organism as a whole.
MB. I had already thought much of what this article points out. The main point is that absence of brian function does not necessarily mean that other systems must fail. A whole issue of this journal is devoted to 'brain death'. It is an obvious philosophical muddle as practiced.

ARTICLE TITLE: A requiem for whole brain death: a response to d. alan shewmon's 'the brain and somatic integration'
ARTICLE SOURCE: J Med Philos (Netherlands), Oct 2001, 26(5) p479-91
AUTHOR(S): Potts M
AUTHOR'S ADDRESS: Department of Philosophy, Methodist College, Fayetteville, NC, USA. Mpotts20@hotmail.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: Alan Shewmon's article, 'The brain and somatic integration: Insights into the standard biological rationale for equating "brain death" with death' (2001), strikes at the heart of the standard justification for whole brain death criteria. The standard justification, which I call the 'standard paradigm', holds that the permanent loss of the functions of the entire brain marks the end of the integrative unity of the body. In my response to Shewmon's article, I first offer a brief summary of the standard paradigm and cite recent work by advocates of whole brain criteria who tenaciously cling to the standard paradigm despite increasing evidence showing that it has significant weaknesses. Second, I address Shewmon's case against the standard paradigm, arguing that he is successful in showing that whole brain dead patients have integrated organic unity. Finally, I discuss some minor problems with Shewmon's article, along with suggestions for further elaboration.

ARTICLE TITLE: Clarifying the discussion on brain death
ARTICLE SOURCE: J Med Philos (Netherlands), Oct 2001, 26(5) p503-25
AUTHOR(S): Dagi FT; Kaufman R
AUTHOR'S ADDRESS: Medical College of Georgia and the Georgia Institute of Technology, Augusta, Georgia, U.S.A.
PUBLICATION TYPE: Journal Article
ABSTRACT: Definitions of death are based on subjective standards, priorities, and social conventions rather than on objective facts about the state of human physiology. It is the meaning assigned to the facts that determines whensomeone may be deemed to have died, not the facts themselves. Even though subjective standards for the diagnosis of death show remarkable consistency across communities, they are extrinsic. They are driven, implicitly or explicitly, by ideas about what benefits the community rather than what benefits the indidvidual. The differences that do exist across communities generally reduce to questions about legitimacy and not fact. The questions at the core of the debate about brain death are better framed by asking: "Whom ought we deem to be dead?" rather than: "Who is dead." The rationale for equating brain death with death, therefore, extends well beyond somatic and biological concepts of death.

ARTICLE TITLE: Philosophical debates about the definition of death: who cares?
ARTICLE SOURCE: J Med Philos (Netherlands), Oct 2001, 26(5) p527-37
AUTHOR(S): Youngner SJ; Arnold RM
AUTHOR'S ADDRESS: School of Medicine, Center for Biomedical Ethics, Case Western Reserve University, Cleveland, OH 00106, USA. sxy2@po.cwru.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Since the Harvard Committee's bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committee's proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead.

ARTICLE TITLE: The natural history of ticks.
ARTICLE SOURCE: Med Clin North Am (United States), Mar 2002, 86(2) p205-18
AUTHOR(S): Anderson JF
AUTHOR'S ADDRESS: Connecticut Agricultural Experiment Station, New Haven, Connecticut, USA. John.F.Anderson@po.state.ct.us.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Ticks have evolved to become one of the most important groups of arthropod vectors of human pathogens. One or more of the approximately 840 known species of ticks are found in most terrestrial regions of the earth. Ticks are a highly specialized group of obligate, bloodsucking, nonpermanent ectoparasitic arthropods that feed on mammals, birds, and reptiles. They are classified into two major families, Ixodidae (hard-bodies ticks) and Argasidae (soft-bodied ticks). The Ixodidae is the largest and most important family. There are many taxonomic keys for identifying ticks to assist the serious investigator. Their life cycles are often complex, and even though ticks are associated with their parasitic habits, ticks spend most of their life off hosts and in vegetation or soil. Maintenance of water balance during periods of overhydration while feeding and periods of dehydration while fasting is significant in the distribution, survival, activity, and transmission of disease-causing pathogens to humans and animals. Ticks attach to skin of the host by using their hypostome as an anchor and create a feeding lesion to ingest blood or tissue fluids. Soft-bodied ticks feed relatively rapidly (hours or less) and ingest only blood. Hard-bodied ticks take days to complete feeding and feed on blood, lymph, and lysed tissues from a pool that forms around the mouthparts. Feeding causes direct damage to the skin of the host. Disease-causing organisms may be ingested or expelled during feeding. Ingestion of relatively enormous quantities of blood is characteristic of ticks.
[Editor's note: See our web page on ticks...
http://www.usyd.edu.au/anaes/envenomation.html]

ARTICLE TITLE: Conflicts of interest: can you believe what you read?
ARTICLE SOURCE: Nature (England), Mar 28 2002, 416(6879) p360-3
AUTHOR(S): van Kolfschooten F
PUBLICATION TYPE: News
MB. NO!!!

ARTICLE TITLE: Peer review, unmasked.
ARTICLE SOURCE: Nature (England), Mar 21 2002, 416(6878) p258-60
AUTHOR(S): Gura T
PUBLICATION TYPE: News
MB. Sounds pretty hopeless.

ARTICLE TITLE: Baiting plan to remove fox threat to Tasmanian wildlife.
ARTICLE SOURCE: Nature (England), Mar 28 2002, 416(6879) p357
AUTHOR(S): Dennis C
PUBLICATION TYPEJournal Article

ARTICLE TITLE: Breast-cancer survey sets screening age for women.
ARTICLE SOURCE: Nature (England), Mar 21 2002, 416(6878) p251
AUTHOR(S): Pearson H
PUBLICATION TYPE: Journal Article
MB. There is the possibilty that deaths resulting from treatment of cases that are not carcinoma.

ARTICLE TITLE: Charity launches not-for-profit drug industry.
ARTICLE SOURCE: Nature (England), Apr 4 2002, 416(6880) p465
AUTHOR(S): Butler D
PUBLICATION TYPE: News

ARTICLE TITLE: The diverse molecular mechanisms responsible for the actions of opioids on the cardiovascular system [In Process Citation]
ARTICLE SOURCE: Pharmacol Ther (England), Jan 2002, 93(1) p51-75
AUTHOR(S): Pugsley MK
AUTHOR'S ADDRESS: Department of Pharmacology and Toxicology, XOMA (US) LLC, 2910 Seventh Street, 94710, Berkeley, CA, USA.
PUBLICATION TYPE Journal Article
This review will outline some of the diverse molecular mechanisms that may be responsible for the cardiovascular actions of opioids, and will characterize the role opioid receptors have in several cardiovascular pathophysiological disease states, including hypertension, heart failure, and ischaemic arrhythmogenesis. In many instances, it would appear that the effects of opioid agonists (and antagonists) in cardiovascular disease models may be mediated by opioid receptor-independent actions of these drugs.

ARTICLE TITLE: Are oral appliances a substitute for nasal positive airway pressure?
COMMENTS: Comment On: Comment On: RefSource:Thorax. 2002 Apr; 57(4):305-8
ARTICLE SOURCE: Thorax (England), Apr 2002, 57(4) p283-4
AUTHOR(S): Millman RP; Rosenberg CL
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations.
ARTICLE SOURCE: Thorax (England), Apr 2002, 57(4) p289-304
AUTHOR'S ADDRESS: Collective Name: British Thoracic Society Standards of Care Committee.
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline