MB's Articles of Interest - September '99

ARTICLE TITLE: Efficacy of invasive strategy for the management of acute myocardial infarction complicated by cardiogenic shock.
ARTICLE SOURCE: Am J Cardiol (United States), Apr 1 1999, 83(7) p989-93
AUTHOR(S): Perez-Castellano N; Garcia E; Serrano JA; Elizaga J; Soriano J; Abeytua M; Botas J; Rubio R; Lopez de Sa E; Lopez-Sendon JL; Delcan JL
AUTHOR'S ADDRESS: Division of Cardiology, Gregorio Maranon University General Hospital, Madrid, Spain. npc@jet.es.
PUBLICATION TYPE: JOURNAL ARTICLE
In conclusion, we have failed to demonstrate that a strategy of urgent coronary revascularization within 24 hours of symptom onset for patients with AMI complicated by cardiogenic shock is independently associated with a lower in-hospital mortality. This strategy was limited by the high mortality within 1 hour of admission in patients with cardiogenic shock, the modest success rate of angioplasty in this setting, and the powerful influence of some adverse baseline characteristics on prognosis.

ARTICLE TITLE: Comparison of quality of life after coronary and/or valvular cardiac surgery in patients > or =75 years of age with younger patients.
ARTICLE SOURCE: Am J Cardiol (United States), Apr 1 1999, 83(7) p1129-32, A9
AUTHOR(S): Heijmeriks JA; Pourrier S; Dassen P; Prenger K; Wellens HJ
AUTHOR'S ADDRESS: Department of Cardiology, Academic Hospital, Maastricht, The Netherlands. cardio@kabelfoon.nl.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Quality of life after cardiac surgery appeared to be comparable in patients aged > or =75 years and younger patients. Preoperative depression had more impact on postoperative well-being in the elderly compared with younger patients.

ARTICLE TITLE: I view with alarm (1999) [editorial]
ARTICLE SOURCE: Am J Cardiol (United States), Apr 1 1999, 83(7) p1095
AUTHOR(S): Hurst JW
MAJOR SUBJECT HEADING(S): Education, Medical, Undergraduate [standards]; Education, Premedical [standards]
MINOR SUBJECT HEADING(S): United States
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Use of three-dimensional echocardiography for analysis of outflow obstruction in congenital heart disease.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 15 1999, 83(6) p921-5
AUTHOR(S): Dall'Agata A; Cromme-Dijkhuis AH; Meijboom FJ; Spitaels SE; McGhie JS; Roelandt JR; Bogers AJ
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, The Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT Three-D echocardiography is feasible and accurate for analyzing both outflow tracts of the heart. Particularly, generation of nonconventional horizontal cross sections allows a good definition of extension and severity of lesions.

ARTICLE TITLE: Intravenous three-dimensional coronary angiography using contrast enhanced electron beam computed tomography.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 15 1999, 83(6) p840-5
AUTHOR(S): Budoff MJ; Oudiz RJ; Zalace CP; Bakhsheshi H; Goldberg SL; French WJ; Rami TG; Brundage BH
AUTHOR'S ADDRESS: Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
This study demonstrates, by using intravenous contrast enhancement, that electron beam computed tomography (EBCT), with its 3-dimensional capabilities can clearly depict the coronary artery anatomy and can permit identification of coronary artery stenosis.

ARTICLE TITLE: The implantable cardioverter defibrillator and primary prevention of sudden death: the Multicenter Automatic Defibrillator Implantation Trial and the Coronary Artery Bypass Graft (CABG)-Patch Trial.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 11 1999, 83(5B) p74D-78D
AUTHOR(S): Block M; Breithardt G
AUTHOR'S ADDRESS: Stiftsklinik Augustinum Munchen.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (18 references); REVIEW, TUTORIAL

ARTICLE TITLE: Secondary prevention of sudden death: the Dutch Study, the Antiarrhythmics Versus Implantable Defibrillator Trial, the Cardiac Arrest Study Hamburg, and the Canadian Implantable Defibrillator Study.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 11 1999, 83(5B) p68D-73D
AUTHOR(S): Cappato R
AUTHOR'S ADDRESS: Second Department of Internal Medicine, St. Georg Hospital, Hamburg, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (45 references); REVIEW, TUTORIAL
ABSTRACT: Data from these trials provide support for implantable cardioverter defibrillator (ICD) as a therapy superior to antiarrhythmic drugs in prolonging survival in patients meeting the entry criteria. This review briefly summarizes the methods, results, limitations, and clinical implications of these 4 studies.

ARTICLE TITLE: Beta blockers: evidence versus wishful thinking.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 11 1999, 83(5B) p64D-67D
AUTHOR(S): Andresen D; Ehlers HC; Wiedemann M; Bruggemann T
AUTHOR'S ADDRESS: Department of Cardiology, Urban Hospital, Berlin, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (29 references); REVIEW, TUTORIAL
ABSTRACT: Catecholamines and ischemia play an important role in the induction of ventricular tachyarrhythmias. Beta blockers antagonize the effect of catecholamines and have anti-ischemic properties. Several controlled studies performed in the early 1980s in patients after myocardial infarction have shown that beta-blocker therapy clearly decreases sudden and nonsudden cardiac death. Despite the lack of recent randomized trials, data from uncontrolled studies suggest that the beneficial effect of beta blockers is still present in the thrombolytic era. Thus, it is incomprehensible that today in the United States and in most parts of Europe, < 40% of post-myocardial infarction patients are treated with beta blockers. Even in patients with documented sustained ventricular tachycardias (VTs) or ventricular fibrillation (VF), clinical studies indicate that beta blockers improve survival. Thus, even in the thrombolytic era, beta blockers should be used as a basic therapy in patients who are at risk of sudden cardiac death.

ARTICLE TITLE: Navigation in the mega-trials waters: reflections on the Multicenter Automatic Defibrillator Implantation Trial and the Antiarrhythmics Versus Implantable Defibrillators Study.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 11 1999, 83(5B) p5D-7D
AUTHOR(S): Farre J
AUTHOR'S ADDRESS: Department of Cardiology, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Spain.
MAJOR SUBJECT HEADING(S): Anti-Arrhythmia Agents [therapeutic use]; Defibrillators, Implantable; Tachycardia, Ventricular [therapy]; Ventricular Fibrillation [therapy]
MINOR SUBJECT HEADING(S): Coronary Disease [complications] [therapy]; Multicenter Studies; Myocardial Infarction [complications] [therapy]; Randomized Controlled Trials; Tachycardia, Ventricular [etiology]; Treatment Outcome; Ventricular Fibrillation [etiology]
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (28 references); REVIEW, TUTORIAL
ABSTRACT: Today, cardiology seems to be driven by mega-trials and meta-analyses. Guidelines published by scientific and professional cardiovascular societies, such as the American Heart Association, the American College of Cardiology, and the European Society of Cardiology, follow the rules of evidence-based medicine. Such evidence is not always sufficiently conclusive to practice clinically helpful medicine. Sometimes, relatively small trials, such as the Multicenter Automatic Defibrillator Implantation Trial and the Antiarrhythmics Versus Implantable Defibrillators study, may be taken as guides for current clinical decisions and as inspiration for future investigations. Large mega-trials with a great lack of homogeneity among the recruited patients are less important for clinically helpful medicine than studies enrolling well-defined, high-risk patients. It is probably important to acknowledge that the best possible treatment for many patients with ventricular tachyarrhythmias remains obscure. Among these situations are the following: (1) sustained ventricular tachycardia (VT) in patients without coronary artery disease; (2) sustained, nonsyncopal VT in patients with coronary artery disease and left ventricular dysfunction; (3) post myocardial infarction survivors with an ejection fraction < or = 35%, frequent/complex ventricular arrhythmias, depressed heart rate variability, and inducible sustained ventricular tachyarrhythmias during electrophysiologic study. Many studies are being conducted to add light where uncertainty exists, but probably only a few will contribute to the practice of clinically helpful medicine, although some will be used to produce meta-analysis to sustain evidence-based medicine.

ARTICLE TITLE: Has the survival of the heart failure population changed? Lessons from trials.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 11 1999, 83(5B) p112D-119D
AUTHOR(S): Cleland JG; Clark A
AUTHOR'S ADDRESS: Department of Cardiology, University of Hull, United Kingdom.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (54 references); REVIEW, TUTORIAL
ABSTRACT: Heart failure is a common and growing problem with a poor prognosis both in terms of morbidity and mortality. Furthermore, the natural history of heart failure can be modified dramatically by appropriate therapy. The purposes of this article are to (1) describe briefly the epidemiology and current therapy of heart failure; (2) examine potential differences between heart failure as studied in the clinical trials, compared with heart failure in the community; and (3) suggest a number of areas where improvements might be made or further research is required.

ARTICLE TITLE: Nasal oxygen effects on arterial carbon dioxide pressure and heart rate in chronic heart failure.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 1 1999, 83(5) p795-8, A10
AUTHOR(S): Andreas S; Plock EH; Heindl S; Scholz KH
AUTHOR'S ADDRESS: Department of Cardiology and Pneumology, Georg-August-University, Gottingen, Germany. Sandreas@med.uni-goettingen.de.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: Nasal oxygen applied by nasal prongs reduced tidal volume and increased carbon dioxide partial pressure in patients with chronic heart failure but not in comparable controls, whereas the patients showed a more pronounced decrease in heart rate with oxygen. These findings indicate that nasal oxygen has distinct effects on ventilation and heart rate in chronic heart failure.

ARTICLE TITLE: Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure.
ARTICLE SOURCE: Am J Cardiol (United States), Jan 21 1999, 83(2A) p1A-38A
MAJOR SUBJECT HEADING(S): Heart Failure, Congestive [drug therapy]; Practice Guidelines
MINOR SUBJECT HEADING(S): Chronic Disease; Heart Failure, Congestive [diagnosis] [etiology] [physiopathology]; Randomized Controlled Trials; Treatment Outcome
PUBLICATION TYPE: CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE; REVIEW (404 references)

ARTICLE TITLE: Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency.
ARTICLE SOURCE: Am J Cardiol (United States), Jan 15 1999, 83(2) p260-3, A5
AUTHOR(S): Abizaid AS; Clark CE; Mintz GS; Dosa S; Popma JJ; Pichard AD; Satler LF; Harvey M; Kent KM; Leon MB
AUTHOR'S ADDRESS: Department of Internal Medicine, Washington Hospital Center, DC, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: In phase 1 of this study, 60 patients undergoing coronary angioplasty were randomized to receive saline, dopamine, or aminophylline; the overall incidence of contrast-induced renal failure was 38%, without difference among the 3 groups. In phase 2 of this study, 72 patients with established contrast-induced renal failure were randomized to receive saline or dopamine; dopamine had a deleterious effect on the severity of renal failure, prolonging the course.
MB. I love it.

ARTICLE TITLE: The financial impact of teaching surgical residents in the operating room.
ARTICLE SOURCE: Am J Surg (United States), Jan 1999, 177(1) p28-32
AUTHOR(S): Bridges M; Diamond DL
AUTHOR'S ADDRESS: Department of Surgery, University of Tennessee Medical Center-Knoxville, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: There have been no published data regarding the cost of training surgical residents in the operating room. METHODS: At the University of Tennessee Medical Center-Knoxville, in addition to resident-performed teaching cases, some cases are performed without the assistance of residents by the same faculty. RESULTS: Sixty-two case categories involving 14,452 cases were compared for operative times alone. In 46 case categories (10,787 procedures), resident operative times were longer than faculty alone. In 16 case categories, resident operating times were shorter than faculty times. The net incremental operative time cost was 2,050 hours between July 1993 and March 1997. Assuming 4 years of operative training for 11 graduating chief residents, the cost per graduating resident was $47,970. CONCLUSION: Extrapolated to a national annual cost for the 1,014 general surgery residents who completed training in the 1997 academic year, the annual cost of training residents in the operating room is $53 million. This high monetary cost suggests the need for digital skills, selection criteria, the development of training curriculum and resource facilities, the pre-operating room need for suturing and stapling techniques, and perhaps the acquisition of virtual surgery training modules.

ARTICLE TITLE: Preoperative cardiac evaluation is unnecessary in most patients undergoing vascular operations.
ARTICLE SOURCE: Am J Surg (United States), Dec 1998, 176(6) p671-5
AUTHOR(S): Itani KM; Miller CC; Guinn G; Jones JW
AUTHOR'S ADDRESS: Department of Surgery, Houston Veterans Affairs Medical Center and Baylor College of Medicine, Texas 77030, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: This study evaluated the impact of Goldman's index (GI), radionuclide ventriculography (RVG), and dipyridamole-thallium scintigraphy (DTS) on predicting cardiac outcome after vascular operations. METHODS: A total of 463 consecutive patients undergoing vascular operations were divided into those who had no DTS, those who had reversible ischemia by DTS, and those who had no reversible ischemia by DTS. GI, ejection fraction, wall motion abnormalities, rate of coronary angiography, and revascularization were determined for each group. RESULTS: Coronary revascularization was ultimately performed in 8% of patients with no DTS, 7% of patients with no ischemia by DTS, and 9% of patients with ischemia by DTS. The GI of 6.1 in patients who died postoperatively was significantly higher than the GI of 3.6 in patients who survived (P = 0.02). RVG did not predict mortality, morbidity, or need for coronary revascularization. CONCLUSION: Clinical assessment remains a good predictor for cardiac outcome in patients undergoing vascular operations. More extensive cardiac testing should be reserved for patients with higher GI and active cardiac problems.
MB.The title is wrong. It should have been :"Preoperative RVG & DTS are etc."

ARTICLE TITLE: Management of casualties from the bombing at the centennial olympics.
ARTICLE SOURCE: Am J Surg (United States), Dec 1998, 176(6) p538-43
AUTHOR(S): Feliciano DV; Anderson GV Jr; Rozycki GS; Ingram WL; Ansley JP; Namias N; Salomone JP; Cantwell JD
AUTHOR'S ADDRESS: Department of Surgery, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, Georgia, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 AM on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and care of the victims, emphasizing those with significant injuries. METHODS: Retrospective review of triage and care of injured patients. RESULTS: Ninety-six of the 111 victims of the blast were triaged in the first half hour to four hospitals within 3 miles of the bombing. Only four minor operations were performed in 61 patients evaluated at community hospitals. Ten of 35 patients evaluated at the regional trauma center underwent emergency or urgent operations, and all who were seriously injured did well. CONCLUSIONS: Although overtriage to the regional trauma center occurred, outcome was excellent in all seriously injured victims treated there.
MB. Are we ready?

ARTICLE TITLE: Hypothermia does not result in more complications after colon surgery.
ARTICLE SOURCE: Am Surg (United States), Apr 1999, 65(4) p356-9
AUTHOR(S): Barone JE; Tucker JB; Cecere J; Yoon MY; Reinhard E; Blabey RG Jr; Lowenfels AB
AUTHOR'S ADDRESS: Department of Surgery, The Stamford Hospital, Connecticut 06902, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Our objective was to determine the incidence of complications in postoperative patients who were either normothermic or hypothermic. A recent, widely publicized paper concluded that the maintenance of normothermia could reduce the incidence of infectious complications and shorten hospitalization in patients undergoing colorectal surgery. However, some controversy arose regarding the methods of this paper. Patients were deliberately rendered hypothermic, were given more than 3.5 days of prophylactic antibiotics and were transfused significantly more units of blood. We reviewed the charts of 150 consecutive patients who underwent elective partial or subtotal colectomy with primary anastomosis. Among the key items analyzed were intraoperative and postoperative temperature, use of warming devices, duration of surgery, transfusions, interval to oral intake and bowel function, length of stay, complications, infections, and laboratory values. Hypothermia was defined as intraoperative temperature <95.5 degrees F. There were 101 normothermic patients and 49 hypothermic patients. Hypothermic patients had a mean age of 68.7 years versus 66.8 for the normothermic patients (P = 0.472). Comorbidities were similar in both groups. Warming devices were used in >90 per cent of the patients in both groups. The rates of postoperative infections and complications were similar in both groups. Postoperative lengths of stay were also not different. Despite finding that one-third of our patients were hypothermic during elective colon resection, hypothermia had no effect on outcome variables. In contrast to the previous study, the incidence of infectious complications was identical in our patients. Before ascribing postoperative complications and increased resource utilization as adverse effects of hypothermia, further studies are indicated.
MB Sessler's work has not been confirmed. It is still a good idea to keep patients warm.

ARTICLE TITLE: Preferred route of tracheostomy--percutaneous BP versus open BO at the bedside: a randomized, prospective study in the surgical intensive care unit.
ARTICLE SOURCE: Am Surg (United States), Feb 1999, 65(2) p142-6
AUTHOR(S): Porter JM; Ivatury RR
AUTHOR'S ADDRESS: University of California, Davis-East Bay, Oakland 94602, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
These data support that experienced surgical intensivists can perform BO tracheostomies with lower risk and cost, when compared with BP tracheostomy.
MB. Do them in theatre.

ARTICLE TITLE: When doctors marry doctors: a survey exploring the professional and family lives of young physicians.
ARTICLE SOURCE: Ann Intern Med (United States), Feb 16 1999, 130(4 Pt 1) p312-9
AUTHOR(S): Sobecks NW; Justice AC; Hinze S; Chirayath HT; Lasek RJ; Chren MM; Aucott J; Juknialis B; Fortinsky R; Youngner S; Landefeld CS
AUTHOR'S ADDRESS: Cleveland Veterans Affairs Medical Center, University Hospitals of Cleveland, and Case Western Reserve University, Ohio 44106-7124, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Soon, half of all physicians may be married to other physicians (that is, in dual-doctor families). Little is known about how marriage to another physician affects physicians themselves. OBJECTIVE: To learn how physicians in dual-doctor families differ from other physicians in their professional and family lives and in their perceptions of career and family. DESIGN: Cross-sectional survey. SETTING: Two medical schools in Ohio. PARTICIPANTS: A random sample of physicians from the classes of 1980 to 1990. MEASUREMENTS: Responses to a questionnaire on hours worked, income, number of children, child-rearing arrangements, and perceptions about work and family. RESULTS: Of 2000 eligible physicians, 1208 responded (752 men and 456 women). Twenty-two percent of male physicians and 44% of female physicians were married to physicians (P < 0.001). Men and women in dual-doctor families differed (P < 0.001) from other married physicians in key aspects of their professional and family lives: They earned less money, less often felt that their career took precedence over their spouse's career, and more often played a major role in child-rearing. These differences were greater for female physicians than for male physicians. Men and women in dual-doctor families were similar to other physicians in the frequency with which they achieved career goals and goals for their children and with which they felt conflict between professional and family roles. Marriage to another physician had distinct benefits (P < 0.001) for both men and women, including more frequent enjoyment from shared work interests and higher family incomes. CONCLUSIONS: Men and women in dual-doctor families differed from other physicians in many aspects of their professional and family lives, but they achieved their career and family goals as frequently. These differences reflect personal choices that will increasingly affect the profession as more physicians marry physicians.
MB. I suppose if you have to get married you may as well inflict yourself on another doctor. Why make a normal person suffer.

ARTICLE TITLE: Solid organ transplantation. 2: Ethical considerations.
ARTICLE SOURCE: Ann Intern Med (United States), Jan 19 1999, 130(2) p169-70
AUTHOR(S): Kefalides P
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: It is time for action: improving hand hygiene in hospitals [editorial; comment]
COMMENTS: Comment on: Ann Intern Med 1999 Jan 19; 130(2):126-30
ARTICLE SOURCE: Ann Intern Med (United States), Jan 19 1999, 130(2) p153-5
AUTHOR(S): Boyce JM
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Compliance with handwashing in a teaching hospital. Infection Control Program [see comments]
COMMENTS: Comment in: Ann Intern Med 1999 Jan 19; 130(2):153-5
ARTICLE SOURCE: Ann Intern Med (United States), Jan 19 1999, 130(2) p126-30
AUTHOR(S): Pittet D; Mourouga P; Perneger TV
AUTHOR'S ADDRESS: University of Geneva Medical School and University of Geneva Hospitals, Switzerland. didier.pittet@hcuge.ch.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Compliance with handwashing was moderate. Variation across hospital ward and type of health care worker suggests that targeted educational programs may be useful. Even though observational data cannot prove causality, the association between noncompliance and intensity of care suggests that understaffing may decrease quality of patient care.

ARTICLE TITLE: Cardiac reoperations in octogenarians: analysis of outcomes.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 1999, 67(1) p93-8
AUTHOR(S): Blanche C; Khan SS; Chaux A; Denton TA; Sandhu M; Tsai TP; Trento A
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Cardiac reoperations can be performed successfully in most octogenarians, although with an increased risk, particularly in the combined CABG and valve group. Long-term survival is acceptable with improved quality of life and functional status. However, it is possible that these results could be improved in this high-risk group of patients with earlier referral and surgical intervention, for the effective use of health care resources.

ARTICLE TITLE: As originally published in 1992: Synchronous operation for ischemic cardiac and cerebrovascular disease: early results and long-term follow-up. Updated in 1998.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 1999, 67(1) p287-8
AUTHOR(S): Vermeulen FE; Hamerlijnck RP; Defauw JJ; Ernst SM; Morshuis WJ; Schepens MA
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 1999, 67(1) p27-35
AUTHOR(S): Nitta T; Lee R; Schuessler RB; Boineau JP; Cox JL
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The radial approach may represent a more physiologic atrial transport function.

ARTICLE TITLE: Propranolol for the prevention of postoperative arrhythmias in general thoracic surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 1999, 67(1) p182-6
AUTHOR(S): Bayliff CD; Massel DR; Inculet RI; Malthaner RA; Quinton SD; Powell FS; Kennedy RS
AUTHOR'S ADDRESS: Department of Pharmacy Services, London Health Sciences Centre, Ontario, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Prevention of postoperative arrhythmias in patients undergoing general thoracic surgery is desirable to prevent morbidity. METHODS: A randomized, double-blind, placebo controlled trial of propranolol (10 mg every 6 hours) for 5 days was undertaken in patients undergoing major thoracic operations to determine whether arrhythmias requiring treatment could be reduced. Secondary outcomes included overall arrhythmia rate, adverse events, and length of stay. Arrhythmias were assessed by 72-hour Holter monitoring. Patients with a history of heart failure, asthma, advanced heart block, preexisting arrhythmias, sensitivity to propranolol, or use of antiarrhythmic drugs were excluded. RESULTS: Using the intention-to-treat principle there was a 70% relative risk reduction from 20% to 6% in the rate of treated arrhythmias with propranolol (p = 0.071, 95% confidence interval 0.6% to 27.2%). Overall arrhythmias were common but usually benign. Adverse effects were common, although generally mild with hypotension and bradycardia being reported more often in the propranolol group. Length of stay was not different. CONCLUSIONS: There was a trend to a reduction in the risk of perioperative arrhythmias with propranolol. Moreover, propranolol was well tolerated showing a slight increase in minor adverse events.

ARTICLE TITLE: Cadaveric organ donation: rethinking donor motivation [see comments]
COMMENTS: Comment in: Arch Intern Med 1999 Mar 8; 159(5):427-8
ARTICLE SOURCE: Arch Intern Med (United States), Mar 8 1999, 159(5) p438-42
AUTHOR(S): Sade RM
AUTHOR'S ADDRESS: Department of Surgery, Medical University of South Carolina, Charleston 29425, USA. sader@musc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (25 references); REVIEW, TUTORIAL

ARTICLE TITLE: Cadaveric organ donation: rethinking SPRT. Selection of Potential Recipients of Transplants [editorial; comment]
COMMENTS: Comment on: Arch Intern Med 1999 Mar 8; 159(5):438-42
ARTICLE SOURCE: Arch Intern Med (United States), Mar 8 1999, 159(5) p427-8
AUTHOR(S): Korzick KA; Terry PB
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Hyponatremia, hyposmolality, and hypotonicity: tables and fables.
ARTICLE SOURCE: Arch Intern Med (United States), Feb 22 1999, 159(4) p333-6
AUTHOR(S): Oster JR; Singer I
AUTHOR'S ADDRESS: Department of Veterans Affairs Medical Center, and the Department of Medicine, University of Miami School of Medicine, Fla 33125, USA.
etiology]; Mannitol [blood]; Osmolar Concentration; Sodium [blood]
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (23 references); REVIEW, TUTORIAL
ABSTRACT: The difficulty that nonnephrologists sometimes have with the differential diagnosis of hyponatremic patients often results from misinterpreting the significance of measured and calculated serum osmolalities, effective serum osmolalities (tonicities), and the influence of various normal (eg, serum urea nitrogen) and abnormal (eg, ethanol) solutes. Among the more commonly held misconceptions are that high serum urea or alcohol levels will, by analogy with glucose, cause hyponatremia, and that a normal (or elevated) measured serum osmolality in a hyponatremic patient excludes the possibility of hypotonicity. This article describes typical and deliberately comparative data of the serum levels of sodium, glucose, urea nitrogen, and mannitol and/or ethanol (if present); calculated and measured osmolality; effective osmolality; and the potential risk of hypotonicity-induced cerebral edema for each of 6 prototypical hyponatremic states. This provides a helpful educational tool for untangling these interrelationships and for clarifying the differences among various hyponatremic conditions.

ARTICLE TITLE: Quality of survival after cardiopulmonary resuscitation.
ARTICLE SOURCE: Arch Intern Med (United States), Feb 8 1999, 159(3) p249-54
AUTHOR(S): de Vos R; de Haes HC; Koster RW; de Haan RJ
AUTHOR'S ADDRESS: Resuscitation Committee, Academic Medical Center, University of Amsterdam, The Netherlands. r.vos@amc.uva.nl.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Cardiopulmonary resuscitation is frequently unsuccessful, but if survival is achieved, a relatively good quality of life can be expected. Quality of life after CPR is mostly determined by factors known before CPR. These findings may be helpful in informing patients about the outcomes of CPR.

ARTICLE TITLE: Protection against influenza after annually repeated vaccination: a meta-analysis of serologic and field studies.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 25 1999, 159(2) p182-8
AUTHOR(S): Beyer WE; de Bruijn IA; Palache AM; Westendorp RG; Osterhaus AD
AUTHOR'S ADDRESS: World Health Organization National Influenza Centre, Institute of Virology, Erasmus University, Rotterdam, The Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: BACKGROUND: According to common recommendations, influenza vaccination should be performed annually. It has been suggested that vaccination in previous years reduces vaccine efficacy in the long term. OBJECTIVE: To determine whether the protection of influenza vaccine decreases when vaccination is repeated annually. METHODS: Articles published between 1966 and 1997 were selected from MEDLINE. The end point for field studies was the influenza-related morbidity or mortality during influenza outbreaks (resulting in field protection rates). The end point for serologic studies was exceeding a protective postvaccination hemagglutination-inhibition titer (serologic protection rates). Protection rate differences between groups with single and multiple vaccinations were subjected to meta-analysis. RESULTS: Seven field studies (including 13 trials) supported the hypothesis that protection in multiple-vaccination groups is at least as good as that in single-vaccination groups. Ten trials with 5117 observations could be subjected to meta-analysis. The pooled protection-rate difference was close to 0 (1.1%; 95% confidence interval, -0.2% to 2.4%), thus detecting no difference between single or multiple vaccination. Twelve serologic studies (including 53 trials) showed heterogeneous results: 9 trials were significantly in favor of single vaccination, and 7 were in favor of multiple vaccination, but in most cases, there was no significant difference between the 2 vaccination groups. The pooled serologic protection-rate difference from 52 trials (12341 observations) was again close to 0 (1.7%; 95% confidence interval, -1.3% to 4.8%). CONCLUSIONS: We did not detect any evidence for a decreasing protection with annually repeated influenza vaccination. Annual vaccination should not be discouraged in populations at risk.
MB. In oz there is a different vaccine each year. There is usually time to prepare a vaccine from the nothern winter.

ARTICLE TITLE: Preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 25 1999, 159(2) p137-41
AUTHOR(S): Hull RD; Brant RF; Pineo GF; Stein PD; Raskob GE; Valentine KA
AUTHOR'S ADDRESS: Thrombosis Research Unit, Foothills Hospital, University of Calgary, Alberta, Canada. jeanne.sheldon@crha-health.ab.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Our findings support the need for a randomized comparison of preoperative and postoperative initiation of pharmacological prophylaxis of DVT. Such a trial would resolve the divergent practices for DVT prophylaxis between Europe and the North American countries, the United States and Canada, and would affect the treatment for thousands of patients on both continents.

ARTICLE TITLE: Derivation of a clinical decision rule for the discontinuation of in-hospital cardiac arrest resuscitations [see comments]
COMMENTS: Comment in: Arch Intern Med 1999 Jan 25; 159(2):119-21
ARTICLE SOURCE: Arch Intern Med (United States), Jan 25 1999, 159(2) p129-34
AUTHOR(S): van Walraven C; Forster AJ; Stiell IG
AUTHOR'S ADDRESS: Department of Medicine, University of Ottawa, Ontario, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Most patients undergoing in-hospital cardiac resuscitation will not survive to hospital discharge. OBJECTIVE: To derive a decision rule permitting the discontinuation of futile resuscitation attempts by identifying patients with no chance of surviving to hospital discharge. PATIENTS AND METHODS: Patient, arrest, and outcome data for 1077 adult patients undergoing in-hospital cardiac resuscitation was retrieved from 2 randomized clinical trials involving 5 teaching hospitals at 2 university centers. Recursive partitioning was used to identify a decision rule using variables significantly associated with death in hospital. RESULTS: One hundred three patients (9.6%) survived to hospital discharge. Death in hospital was significantly more likely if patients were older than 75 years (P<.001), the arrest was unwitnessed (P = .003), the resuscitation lasted longer than 10 minutes (P<.001), and the initial cardiac rhythm was not ventricular tachycardia or fibrillation (P<.001). All patients died if there was no pulse 10 minutes after the start of cardiopulmonary resuscitation, the initial cardiac rhythm was not ventricular tachycardia or fibrillation, and the arrest was not witnessed. As a resuscitation rule, these parameters identified all patients who survived to hospital discharge (sensitivity, 100%; 95% confidence interval, 97.1%-100%). Resuscitation could have been discontinued for 119 (12.1%) of 974 patients who did not survive, thereby avoiding 47 days of postresuscitative care. CONCLUSIONS: A practical and highly sensitive decision rule has been derived that identifies patients with no chance of surviving in-hospital cardiac arrest. Prospective validation of the rule is necessary before it can be used clinically.
MB. The conclusions appear contradictory.

ARTICLE TITLE: Rapid intraoperative reduction of intracranial pressure with thiopentone. 1973 [classical article]
ARTICLE SOURCE: Br J Anaesth (England), Nov 1998, 81(5) p798-803; discussion 797
AUTHOR(S): Shapiro HM; Galindo A; Wyte SR; Harris AB
PUBLICATION TYPE: BIOGRAPHY; CLASSICAL ARTICLE; HISTORICAL ARTICLE; JOURNAL ARTICLE
NAMED SUBJECT(S): Shapiro HM; Galindo A; Wyte SR
MB. I did not notice at the time. It must not have had a revolutionay impact.

ARTICLE TITLE: Inadvertent inhalation anaesthesia during surgery under retrobulbar eye block.
ARTICLE SOURCE: Br J Anaesth (England), Nov 1998, 81(5) p793-4
AUTHOR(S): Smith WQ
AUTHOR'S ADDRESS: Department of Anaesthesia, Sunderland Royal Hospital.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: I describe a case of inadvertent inhalation anaesthesia during surgery under retrobulbar anaesthesia and its management. Some of the hazards of supplementary oxygen delivery during monitored anaesthetic care and the actions taken to prevent this mishap recurring are discussed.
MB. There should be separate oxygen flow meter on every anaesthetic machine. I know of a similar case who died.

ARTICLE TITLE: Evoked responses in anaesthesia.
ARTICLE SOURCE: Br J Anaesth (England), Nov 1998, 81(5) p771-81
AUTHOR(S): Thornton C; Sharpe RM
AUTHOR'S ADDRESS: Department of Anaesthetics, Imperial College School of Medicine, Northwick Park Hospital, Harrow.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (90 references); REVIEW, ACADEMIC

ARTICLE TITLE: Comparison of the analgesic potency of xenon and nitrous oxide in humans evaluated by experimental pain.
ARTICLE SOURCE: Br J Anaesth (England), Nov 1998, 81(5) p742-7
AUTHOR(S): Petersen-Felix S; Luginbuhl M; Schnider TW; Curatolo M; Arendt-Nielsen L; Zbinden AM
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care, University Hospital of Bern, Switzerland.

PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT:. There was no difference in MAC-equivalent concentrations of xenon and nitrous oxide. Both increased reaction time in a similar manner. Xenon and nitrous oxide evoked nausea and vomiting in a large number of volunteers.

ARTICLE TITLE: Balanced pre-emptive analgesia: does it work? A double-blind, controlled study in bilaterally symmetrical oral surgery.
ARTICLE SOURCE: Br J Anaesth (England), Nov 1998, 81(5) p727-30
AUTHOR(S): Campbell WI; Kendrick RW; Fee JP
AUTHOR'S ADDRESS: Department of Anaesthetics, Ulster Hospital, Dundonald.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
There was no significant difference in pain intensity at any time after surgery. Our findings indicate that the combined use of pre-emptive analgesia from 0.5% bupivacaine, tenoxicam and alfentanil did not reduce postoperative pain intensity in patients undergoing molar exodontia.
MB. Let's stop preemptive studies. I don't think one has had a positive result yet.

ARTICLE TITLE: Laryngeal mask airway and incidence of gastro-oesophageal reflux in paralysed patients undergoing ventilation for elective orthopaedic surgery.
ARTICLE SOURCE: Br J Anaesth (England), Oct 1998, 81(4) p537-9
AUTHOR(S): Agro F; Brimacombe J; Verghese C; Carassiti M; Cataldo R
AUTHOR'S ADDRESS: Department of Anaesthesia, University School of Medicine, Rome, Italy.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: We have studied the incidence of gastro-oesophageal reflux associated with the laryngeal mask airway (LMA) in 82 paralysed patients undergoing ventilation for elective orthopaedic surgery. Anaesthesia was managed by skilled LMA users. A pH-sensitive probe was passed nasally into the oesophagus before induction and recordings made during five phases of anaesthesia. Anaesthesia was induced with propofol and fentanyl and maintained with 0.5-1.5% isoflurane and nitrous oxide in oxygen. Neuromuscular block was produced with vecuronium and the train-of-four count maintained at < or = 1. Towards the end of surgery, neuromuscular function was allowed to recover spontaneously. All LMAs were inserted at the first attempt and ventilation was successful in all patients. There were no adverse airway events. Mean oesophageal pH values during each phase of anaesthesia were: before insertion 5.88 (SD 0.77), placement 5.85 (0.74), maintenance 5.89 (0.73), emergence 5.71 (0.78) and removal 5.82 (0.75). There were no reflux events (pH < 4.0) during any phase of anaesthesia. We conclude that the incidence of gastro-oesophageal reflux is low in paralysed patients undergoing ventilation for elective orthopaedic surgery when antagonism of neuromuscular block is avoided. The validity of these findings for unskilled LMA users is unknown.
MB. Regurgitation was also uncommon before universal intubation in patients at risk. Are we going to go through the same---40y--- provess with LMAs.

ARTICLE TITLE: Molecular mechanisms of anaesthesia: light at the end of the channel? [editorial]
ARTICLE SOURCE: Br J Anaesth (England), Oct 1998, 81(4) p491-3
AUTHOR(S): Lees G
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: The usefulness of celite-activated thromboelastography for evaluation of fibrinolysis.
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 1998, 45(10) p993-6
AUTHOR(S): Yamakage M; Tsujiguchi N; Kohro S; Tsuchida H; Namiki A
AUTHOR'S ADDRESS: Department of Anesthesiology, Sapporo Medical University, School of Medicine, Hokkaido, Japan. yamakage@sapmed.ac.jp.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: PURPOSE: Although thromboelastography is useful for measuring both coagulability and fibrinolysis, it takes about two hours to measure all parameters including fibrinolytic rate. The present study aimed to investigate the usefulness of celite-activated thromboelastography (TEGc) to evaluate fibrinolytic status in non-cardiac surgery. METHODS: Whole blood samples were obtained from 30 patients for non-cardiac surgery, and used for measurements of both native TEG (TEGn) and TEGc. The final concentration of 1% (w/v) celite was used for TEGc. RESULTS: Time for measurement of the fibrinolytic rate (FR) of TEGc in patients (56.7 +/- 4.0 min) was less than half that of FR of TEGn (123.3 +/- 15.6 min) (P < 0.05), suggesting a more rapid assessment of fibrinolytic status. A linear relationship was observed between FR values of TEGc and those of TEGn (r = 0.93, P < 0.0001), suggesting the usefulness of the fibrinolytic parameter of TEGc. CONCLUSION: TEGc is a useful technique for a more rapid assessment of fibrinolytic status.
MB. I have yet to see anything which tells me how it is useful. I think it makes the user feel better.

ARTICLE TITLE: Single vital capacity inhalational anaesthetic induction in adults--isoflurane vs sevoflurane.
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 1998, 45(10) p949-53
AUTHOR(S): Ti LK; Pua HL; Lee TL
AUTHOR'S ADDRESS: Department of Anaesthesia, National University Hospital, Singapore. anatilk@nus.edu.sg.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: PURPOSE: To evaluate whether isoflurane is as suitable as sevoflurane for the single vital capacity breath (VCB) method of inhalational induction in patients premedicated with midazolam. METHODS: A randomised, controlled, double-blind study involving 67 ASA I-II patients aged between 18-50 yr undergoing elective surgery under general anaesthesia. All participants received premedication with 0.03 mg.kg-1 midazolam i.v. Using a primed circle absorber circuit, inhalational induction of anaesthesia was performed with the single VCB method using either isoflurane 3.5% or sevoflurane 7.5% in nitrous oxide 67% in oxygen, representing approximately equivalent MAC-multiples of 3.6 MAC. Isoflurane was compared with sevoflurane in terms of rapidity, efficacy, safety and acceptability of induction. RESULTS: With the single VCB method, sevoflurane produced a faster (45 +/- 21 vs 71 +/- 22 sec, P < 0.01), more successful (100% vs 75.8%, P < 0.01) induction of anaesthesia, with fewer induction-related complications (11.8% vs 84.8%, P < 0.01) than did isoflurane. There was also greater patient acceptability of induction with sevoflurane (76.4% vs 42.4%, P < 0.05). CONCLUSION: In adults given midazolam premedication, isoflurane is not as suitable as sevoflurane for single VCB inhalational anaesthetic induction technique as it is associated with slower, more complicated induction and less patient acceptability.
MB Neither is a good a cyclopropane. Holding a single breath will be slower than continuing to take deep breaths.

ARTICLE TITLE: Preoperative education and outcome of patient controlled analgesia.
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 1998, 45(10) p943-8
AUTHOR(S): Griffin MJ; Brennan L; McShane AJ
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, St. Vincent's Hospital, Dublin, Ireland. michael.griffin@yale.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Our results suggest that specific preoperative education of patients using PCA does not alter pain scores, morphine consumption or patient satisfaction but may result in earlier and more effective use of anti-emetic medication.
MB. How sad. ;-)

ARTICLE TITLE: TEE monitoring [editorial; comment]
COMMENTS: Comment on: Can J Anaesth 1998 Oct; 45(10):925-32
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 1998, 45(10) p919-24
AUTHOR(S): Beique FA; Lavoie J
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Evolution of 20th century attitudes to prophylaxis of pulmonary aspiration during anaesthesia.
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 1998, 45(10) p1024-30
AUTHOR(S): McIntyre JW
AUTHOR'S ADDRESS: Department of Anaesthesia, University of Alberta Hospitals, Edmonton.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
CONCLUSION: The consensus of information in textbooks since 1970 was lacking in the previous part of the century. Current textbooks are fewer and are published less frequently. Their role in contemporary anaesthesia education and update merits review.

ARTICLE TITLE: Digitalis.
ARTICLE SOURCE: Circulation (United States), Mar 9 1999, 99(9) p1265-70
AUTHOR(S): Hauptman PJ; Kelly RA
AUTHOR'S ADDRESS: Department of Medicine, Division of Cardiology, Saint Louis University School of Medicine, St. Louis, MO, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (30 references); REVIEW, TUTORIAL
Although, in our opinion, the data on balance warrant the continued use of these drugs for the treatment of symptoms of heart failure in patients already receiving contemporary multidrug therapy for this disease, the use of digitalis preparations will inevitably decline with the maturation of newer pharmacotherapies.

ARTICLE TITLE: Exercise training for heart failure: coming of age [editorial]
ARTICLE SOURCE: Circulation (United States), Mar 9 1999, 99(9) p1138-40
AUTHOR(S): Coats AJ
PUBLICATION TYPE: EDITORIAL; REVIEW (22 references); REVIEW, TUTORIAL

ARTICLE TITLE: Addition of angiotensin II receptor blockade to maximal angiotensin-converting enzyme inhibition improves exercise capacity in patients with severe congestive heart failure.
ARTICLE SOURCE: Circulation (United States), Mar 2 1999, 99(8) p990-2
AUTHOR(S): Hamroff G; Katz SD; Mancini D; Blaufarb I; Bijou R; Patel R; Jondeau G; Olivari MT; Thomas S; Le Jemtel TH
AUTHOR'S ADDRESS: Departments of Medicine, Divisions of Cardiology, The Albert Einstein College of Medicine, Bronx, NY, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Losartan enhances peak exercise capacity and alleviates symptoms in patients with CHF who are severely symptomatic despite treatment with maximally recommended or tolerated doses of ACE inhibitors.

ARTICLE TITLE: Neurohumoral prediction of benefit from carvedilol in ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group.
ARTICLE SOURCE: Circulation (United States), Feb 16 1999, 99(6) p786-92
AUTHOR(S): Richards AM; Doughty R; Nicholls MG; Macmahon S; Ikram H; Sharpe N; Espiner EA; Frampton C; Yandle TG
AUTHOR'S ADDRESS: Department of Medicine, Christchurch Cardioendocrine Group, Christchurch School of Medicine, Christchurch, New Zealand. bgriffin@chmeds.ac.nz.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS--Carvedilol reduced mortality rates and heart failure in those with higher pretreatment brain natriuretic peptide BNP levels but lesser activation of plasma norepinephrine NE. Neurohumoral profiling may guide introduction of beta-blockade in heart failure.

ARTICLE TITLE: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study [see comments]
COMMENTS: Comment in: Circulation 1999 Feb 16; 99(6):733-5
ARTICLE SOURCE: Circulation (United States), Feb 16 1999, 99(6) p779-85
AUTHOR(S): de Lorgeril M; Salen P; Martin JL; Monjaud I; Delaye J; Mamelle N
AUTHOR'S ADDRESS: Explorations Fonctionnelles Cardiorespiratoires et Metaboliques, CHU de Saint-Etienne, France. lorgeril@univ-st-etienne.fr.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS--The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.

ARTICLE TITLE: Dietary prevention of coronary heart disease: the Lyon Diet Heart Study [editorial; comment]
COMMENTS: Comment on: Circulation 1999 Feb 16; 99(6):779-85
ARTICLE SOURCE: Circulation (United States), Feb 16 1999, 99(6) p733-5
AUTHOR(S): Leaf A
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Prediction of myocardial viability by MRI [editorial; comment]
COMMENTS: Comment on: Circulation 1999 Feb 16; 99(6):744-50
ARTICLE SOURCE: Circulation (United States), Feb 16 1999, 99(6) p727-9
AUTHOR(S): Higgins CB
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Rapid platelet-function assay: an automated and quantitative cartridge-based method.
ARTICLE SOURCE: Circulation (United States), Feb 9 1999, 99(5) p620-5
AUTHOR(S): Smith JW; Steinhubl SR; Lincoff AM; Coleman JC; Lee TT; Hillman RS; Coller BS
AUTHOR'S ADDRESS: Accumetrics Inc, San Diego, CA, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The rapid platelet-function assay (RPFA), provides rapid information on platelet function that mirrors turbidimetric platelet aggregation and reflects platelet glycoprotein (GP) IIb/IIIa receptor blockade.

ARTICLE TITLE: Good news for experimental concept but bad news for clinically effective therapy [editorial; comment]
COMMENTS: Comment on: Circulation 1999 Jan 19; 99(2):305-11
ARTICLE SOURCE: Circulation (United States), Jan 19 1999, 99(2) p198-200
AUTHOR(S): Reimer KA; Califf RM
PUBLICATION TYPE: COMMENT; EDITORIAL
MB About problem of Ca channel blockers benefit or damage. Vide infra.

ARTICLE TITLE: Unique cardioprotective action of the new calcium antagonist mibefradil [see comments]
COMMENTS: Comment in: Circulation 1999 Jan 19; 99(2):198-200
ARTICLE SOURCE: Circulation (United States), Jan 19 1999, 99(2) p305-11
AUTHOR(S): Schulz R; Post H; Jalowy A; Backenkohler U; Dorge H; Vahlhaus C; Heusch G
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Mibefradil is a calcium antagonist with few negative inotropic effects at therapeutic concentrations. CONCLUSIONS: The IS-limiting effect of mibefradil, in contrast to that of verapamil, was not dependent on favorable hemodynamics but was abolished by glibenclamide, suggesting a direct cardioprotective action of mibefradil.

ARTICLE TITLE: Is epsilon-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery?: a meta-analysis.
ARTICLE SOURCE: Circulation (United States), Jan 5-12 1999, 99(1) p81-9
AUTHOR(S): Munoz JJ; Birkmeyer NJ; Birkmeyer JD; O'Connor GT; Dacey LJ
AUTHOR'S ADDRESS: Department of Surgery, Dartmouth Medical School, Hanover, NH, USA. john.j.munoz@hitchcock.org.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Because the 2 antifibrinolytic agents appear to have similar efficacies, the considerably less-expensive epsilon-aminocaproic acid may be preferred over aprotinin for reducing hemorrhage with cardiac surgery.
MB.How about using surgical methods

ARTICLE TITLE: Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee.
ARTICLE SOURCE: Circulation (United States), Jan 5-12 1999, 99(1) p168-77
AUTHOR(S): Cheitlin MD; Hutter AM Jr; Brindis RG; Ganz P; Kaul S; Russell RO Jr; Zusman RM
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (33 references); REVIEW, TUTORIAL

ARTICLE TITLE: Preventable causative factors leading to hospital admission with decompensated heart failure [see comments]
COMMENTS: Comment in: Heart 1998 Nov; 80(5):426-7; Comment in: Heart 1998 Nov; 80(5):430-1
ARTICLE SOURCE: Heart (England), Nov 1998, 80(5) p437-41
AUTHOR(S): Michalsen A; Konig G; Thimme W
AUTHOR'S ADDRESS: Humboldt-Krankenhaus, I Innere Abteilung, Berlin, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To determine the distribution and importance of various factors, especially the preventable ones, that contribute to cardiac decompensation and subsequent hospital admission for heart failure. METHODS: During a one year period patients were prospectively recruited and evaluated during their hospital stay by means of a structured personal interview by trained medical staff and through clinical examination and laboratory investigation. SETTING: The cardiological department at a teaching affiliated general community hospital in Berlin, Germany. PATIENTS: Consecutive sample of 179 patients admitted to hospital with acute decompensation of pre-existing heart failure. MAIN OUTCOME MEASURES: Proportional distribution of causative factors leading to hospital admission for heart failure; relative importance of preventable factors; details of patient compliance with diet and medication, and knowledge about medication. RESULTS: Mean (SD) age was 75.4 (9.9) years. Potential causative factors for decompensated heart failure were identified in 85.5% of patients. Lack of adherence to the medical regimen was the most commonly identified factor and was regarded as the cause of the cardiac decompensation in 41.9% of cases. Non-compliance with drugs was found in 23.5% of patients. Other factors related to hospital admission were coronary ischaemia (13.4%), cardiac arrhythmias (6.1%), uncontrolled hypertension (5.6%), and inadequate preadmission treatment (12.3%). In all, 54.2% of admissions could be regarded as preventable. CONCLUSIONS: Many hospital admissions for decompensation of chronic heart failure in patients at a district hospital in Berlin are preventable. Measures are necessary to improve this situation and evaluation of programmes that include patient education, patient follow up, and physician training is needed.

ARTICLE TITLE: Heart failure clinics: a possible means of improving care [editorial]
ARTICLE SOURCE: Heart (England), Nov 1998, 80(5) p428-9
AUTHOR(S): Erhardt L; Cline C
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Effect of increasing central venous pressure during passive heating on skin blood flow.
ARTICLE SOURCE: J Appl Physiol (United States), Feb 1999, 86(2) p605-10
AUTHOR(S): Crandall CG; Levine BD; Etzel RA
AUTHOR'S ADDRESS: Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, Dallas 75231, Texas, USA. crandall@email.swmed.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
These data suggest that cardiopulmonary baroreceptor unloading during passive heating may attenuate the elevation in skin blood flow (SkBF) in humans, whereas loading cardiopulmonary baroreceptors in normothermia has no effect on SkBF.
MB. It is really active warming. Passive warming is insulation and allowing accumulation of body heat energy.

ARTICLE TITLE: Drink composition, voluntary drinking, and fluid balance in exercising, trained, heat-acclimatized boys.
ARTICLE SOURCE: J Appl Physiol (United States), Jan 1999, 86(1) p78-84
AUTHOR(S): Rivera-Brown AM; Gutierrez R; Gutierrez JC; Frontera WR; Bar-Or O
AUTHOR'S ADDRESS: Department of Physical Medicine, Rehabilitation and Sports Medicine, Center for Sports Health and Exercise Sciences at the Albergue Olimpico, University of Puerto Rico School of Medicine, Salinas, Puerto Rico 00751, USA.anriver@coqui.net.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: This study examined the effects of beverage composition on the voluntary drinking pattern, body fluid balance, and thermoregulation of heat-acclimatized trained boys exercising intermittently in outdoor conditions (wet bulb globe temperature 30.4 +/- 1.0 degreesC). Twelve boys (age 13.4 +/- 0.4 yr) performed two 3-h sessions, each consisting of four 20-min cycling bouts at 60% maximal aerobic power alternating with 25-min rest. One of two beverages was assigned: unflavored water (W) or flavored water plus 6% carbohydrate and 18 mmol/l Na (CNa). Drinking was ad libitum. Total intake was higher (P < 0.05) during CNa (1,943 +/- 190 g) compared with W (1,470 +/- 143 g). Euhydration was maintained with CNa (+0.18% body wt), but a mild dehydration resulted with W (-0.94% body wt; P < 0.05). Sweat loss, much higher than previously published for children of similar age, was similar between conditions (CNa = 1,644.7 +/- 117.5; W = 1,750.2 +/- 152.7 g). The increase in rectal temperature (CNa = 0.86 +/- 0.3; W = 0.76 +/- 0.1 degreesC), heart rate, and all perceptual variables did not differ between conditions. In conclusion, a flavored carbohydrate-electrolyte drink prevents voluntary dehydration in trained heat-acclimatized boys exercising in a tropical climate despite their large sweat losses. Because hydration changes were minor, the thermoregulatory strain observed was similar between conditions.
MB. Commercial electrolye fluids for athelets seem to be wrong.

ARTICLE TITLE: Analytic calculation of physiological acid-base parameters in plasma.
ARTICLE SOURCE: J Appl Physiol (United States), Jan 1999, 86(1) p326-34
AUTHOR(S): Wooten EW
AUTHOR'S ADDRESS: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Analytic expressions for plasma total titratable base, base excess (DeltaCB), strong-ion difference, change in strong-ion difference (DeltaSID), change in Van Slyke standard bicarbonate (DeltaVSSB), anion gap, and change in anion gap are derived as a function of pH, total buffer ion concentration, and conditional molar equilibrium constants. The behavior of these various parameters under respiratory and metabolic acid-base disturbances for constant and variable buffer ion concentrations is considered. For constant noncarbonate buffer concentrations, DeltaSID = DeltaCB = DeltaVSSB, whereas these equalities no longer hold under changes in noncarbonate buffer concentration. The equivalence is restored if the reference state is changed to include the new buffer concentrations.
MB. Thast equation is pretty useless.

ARTICLE TITLE: Effects of prolonged oxygen exposure at 1.5, 2.0, or 2.5 ATA on pulmonary function in men (predictive studies V).
ARTICLE SOURCE: J Appl Physiol (United States), Jan 1999, 86(1) p243-59
AUTHOR(S): Clark JM; Lambertsen CJ; Gelfand R; Flores ND; Pisarello JB; Rossman MD; Elias JA
AUTHOR'S ADDRESS: Environmental Biomedical Research Data Center, Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104-6068, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: As part of a study of human organ O2 tolerance, lung flow-volume and spirometric measurements were performed repeatedly before, during, and after continuous O2 exposures at 1.5, 2.0, and 2.5 ATA for average durations of 17.7, 9.0, and 5.7 h, respectively (effects of O2 breathing at 3.0 ATA for 3.5 h were reported previously; J. M. Clark, R. M. Jackson, C. J. Lambertsen, R. Gelfand, W. D. B. Hiller, and M. Unger. J. Appl. Physiol. 71: 878-885, 1991). Additional measurements of pulmonary mechanical function, gas exchange, and alveolar inflammatory cells were obtained before and after O2 exposure. Rates of pulmonary symptom development and lung volume reduction increased progressively with elevation of O2 pressure. Average rates of vital capacity reduction over a useful range of O2 pressures provided a valuable general description of pulmonary O2 tolerance in humans. However, the existence of multiple pulmonary effects of O2 toxicity and the complexity of their interactions require awareness that deviations from the average relationships may occur in different individuals or under varying conditions of O2 exposure and subsequent recovery. The associated pulmonary function deficits may represent responses to a composite of direct and indirect effects of O2 poisoning, along with related consequences and subsequent reactions to those effects.

ARTICLE TITLE: Respiratory changes associated with rapid eye movements in normo- and hypercapnia during sleep.
ARTICLE SOURCE: J Appl Physiol (United States), Dec 1998, 85(6) p2213-9
AUTHOR(S): Schafer T; Schlafke ME
AUTHOR'S ADDRESS: Department of Applied Physiology, Ruhr-University Bochum, D-44780 Bochum, Germany. Thorsten.Shaefer@ruhr-uni-bochum.de.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Rapid eye movements during rapid-eye-movement (REM) sleep are associated with rapid, shallow breathing. We wanted to know whether this effect persisted during increased respiratory drive by CO2. In eight healthy subjects, we recorded electroencephalographic, electrooculographic, and electromyographic signals, ventilation, and end-tidal PCO2 during the night. Inspiratory PCO2 was changed to increase end-tidal PCO2 by 3 and 6 Torr. During normocapnia, rapid eye movements were associated with a decrease in total breath time by -0.71 +/- 0.19 (SE) s (P < 0.05) because of shortened expiratory time (-0.52 +/- 0.08 s, P < 0.001) and with a reduced tidal volume (-89 +/- 27 ml, P < 0.05) because of decreased rib cage contribution (-75 +/- 18 ml, P < 0.05). Abdominal (-11 +/- 16 ml, P = 0.52) and minute ventilation (-0.09 +/- 0.21 ml/min, P = 0.66) did not change. In hypercapnia, however, rapid eye movements were associated with a further shortening of total breath time. Abdominal breathing was also inhibited (-79 +/- 23 ml, P < 0.05), leading to a stronger inhibition of tidal volume and minute ventilation (-1.84 +/- 0.54 l/min, P < 0.05). We conclude that REM-associated respiratory changes are even more pronounced during hypercapnia because of additional inhibition of abdominal breathing. This may contribute to the reduction of the hypercapnic ventilatory response during REM sleep.

ARTICLE TITLE: Is there evidence for an age-related reduction in metabolic rate?
ARTICLE SOURCE: J Appl Physiol (United States), Dec 1998, 85(6) p2196-204
AUTHOR(S): Piers LS; Soares MJ; McCormack LM; O'Dea K
AUTHOR'S ADDRESS: Unit of Nutrition and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia. sunil.piers@med.monash.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: To determine whether the age-related reduction in basal metabolic rate (BMR) is explained by a quantitative and/or qualitative change in the components of lean tissue, we conducted a cross-sectional study in groups of young (n = 38, 18-35 yr) and older (n = 24, 50-77 yr) healthy individuals. BMR was measured by indirect calorimetry. Body composition was obtained by using dual-energy X-ray absorptiometry (DEXA), which permitted four compartments to be quantified [bone mineral mass, fat mass (FM), appendicular lean tissue mass (ALTM), and nonappendicular lean tissue mass (NALTM)]. Absolute BMR and ALTM were lower, whereas FM was significantly higher in the older, compared with young, subjects. BMR, adjusted for differences in FM, ALTM, and NALTM, was significantly lower in the older subjects by 644 kJ/day. In separate regression analyses of BMR on body compartments, older subjects had significantly lower regression coefficients for ALTM and NALTM, compared with young subjects. Hence, the age-related decline in BMR is partly explained by a reduction in the quantity, as well as the metabolic activity, of DEXA-derived lean tissue components.

ARTICLE TITLE: Volume-outcome relationships in cardiovascular operations: New York State, 1990-1995.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Mar 1999, 117(3) p419-28; discussion 428-30
AUTHOR(S): Sollano JA; Gelijns AC; Moskowitz AJ; Heitjan DF; Cullinane S; Saha T; Chen JM; Roohan PJ; Reemtsma K; Shields EP
AUTHOR'S ADDRESS: International Center for Health Outcomes, (InCHOIR), Columbia University, New York, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: It has been known for nearly 20 years that, in cardiovascular operations, a significant inverse relationship exists between clinical outcomes and the volume of procedures performed. Interestingly, this relationship persists 2 decades after it was recognized. OBJECTIVE: The purpose of this study was to examine the relationship between hospital volume and in-hospital deaths in 3 cardiovascular procedures: coronary artery bypass grafting, elective repair of abdominal aortic aneurysms, and repair of congenital cardiac defects. METHODS: The database includes all patients who were hospitalized in New York State during the years 1990 to 1995. Using standard logistic regression techniques, we analyzed the relationship between hospital volume and outcome. RESULTS: No correlation exists between hospital volume and in-hospital deaths in coronary artery bypass grafting. Statewide, 31 hospitals performed 97,137 operations over the 6-year period (overall mortality rate, 2. 75%). By contrast, most of the hospitals statewide (195 of 230 hospitals) performed 9847 elective abdominal aortic aneurysm repairs with an overall mortality rate of 5.5%. In abdominal aortic aneurysm operations, a significant inverse relationship between hospital volume and in-hospital deaths was determined. Sixteen hospitals performed 7199 repairs for congenital cardiac defects. A significant inverse relationship (which was most pronounced for neonates) was found between volume and death. CONCLUSIONS: The importance of these findings lies in the rather striking difference between the volume-outcome relationship found for operations for abdominal aortic aneurysms and congenital cardiac defects and the lack of such a relationship for coronary artery bypass grafting. This observation may be largely explained by the quality improvement program in New York State for bypass operations since 1989. If so, these results have important implications for expanding the scope of quality improvement efforts in New York State.
MB. It probably means that CABG is often unnessary so that the mortality should be low. The low number places may do easy ones. I would go to a high volume place.

ARTICLE TITLE: Neuropsychologic outcome after deep hypothermic circulatory arrest in adults.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Jan 1999, 117(1) p156-63
AUTHOR(S): Reich DL; Uysal S; Sliwinski M; Ergin MA; Kahn RA; Konstadt SN; McCullough J; Hibbard MR; Gordon WA; Griepp RB
AUTHOR'S ADDRESS: Departments of Anesthesiology, Cardiothoracic Surgery, and Rehabilitation Medicine, The Mount Sinai-New York University Medical Center, New York, NY 10029-6574, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were associated with memory and fine motor deficits and with prolonged hospital stay.

ARTICLE TITLE: Changes in lower limb volume in humans during parabolic flight.
ARTICLE SOURCE: J Appl Physiol (United States), Dec 1998, 85(6) p2100-5
AUTHOR(S): Bailliart O; Capderou A; Cholley BP; Kays C; Riviere D; Techoueyres P; Lachaud JL; Vaida P
AUTHOR'S ADDRESS: Services des Explorations Fonctionnelles et d'Anesthesie-Reanimation, Hopital Lariboisiere, 75010 Paris, France.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: A prospective randomized double-blind controlled trial to evaluate the efficacy of an analgesic epidural paste following lumbar decompressive surgery.
ARTICLE SOURCE: J Neurosurg (United States), Apr 1999, 90(4 Suppl) p191-7
AUTHOR(S): Hurlbert RJ; Theodore N; Drabier JB; Magwood AM; Sonntag VK
AUTHOR'S ADDRESS: University of Calgary Spine Program, Foothills Hospital and Medical Centre, Alberta, Canada. jhurlber@acs.ucalgary.ca.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL

ARTICLE TITLE: Fiberoptic intubation in 327 neurosurgical patients with lesions of the cervical spine.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jan 1999, 11(1) p11-6
AUTHOR(S): Fuchs G; Schwarz G; Baumgartner A; Kaltenbock F; Voit-Augustin H; Planinz W
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, University of Graz, Austria.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: In patients with lesions of the cervical spine, direct laryngoscopy for endotracheal intubation entails the risk of injuring the spinal cord. In an attempt to avoid this complication, the authors used flexible fiberoptic nasal intubation in a series of 327 patients with cervical lesions undergoing elective neurosurgical procedures. The nasal route was preferred for laryngeal intubation because it is easier than the oral route and a restraining collar or halo device does not impair the intubating maneuver. Bronchoscopic intubation was possible in all patients. In 12 patients (3.6%), anatomic abnormalities prevented transnasal insertion of the endotracheal tube, and transoral fiberoptic intubation was necessary. Endotracheal intubation was graded as slightly difficult in 85 patients (26%). The minimal peripheral oxygen saturation during intubation exceeded 90% in 289 patients (88%). In the other 38 patients, the mean O2 saturation was 84.2+/-4.3% (range, 72-89%). Intubation was well tolerated by all patients and none had recall of the procedure. Cervical stabilizers did not have to be removed for intubation in any patient. None of the patients had postoperative neurologic deficits attributable to the intubation procedure. The authors consider fiberoptic transnasal intubation to be a useful alternative to direct laryngoscopic tracheal intubation in patients undergoing elective surgical procedures on the cervical spine to avoid potential injury to the cervical spinal cord.

ARTICLE TITLE: Carotid endarterectomy surgery and ICU admissions: a regional anesthesia perspective.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Oct 1998, 10(4) p211-7
AUTHOR(S): Sakawi Y; Groudine S; Roberts K; Chang B; Shah D; Lumb P
AUTHOR'S ADDRESS: Anesthesiology Department, University of Alabama at Birmingham, 35233-6810, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACTThese results suggest that a monitoring period of 2 hours in the postanesthesia care unit allows for safe assessment of the postoperative carotid endarterectomy patient, and that routine intensive care unit admission after carotid endarterectomy surgery is not necessary.

ARTICLE TITLE: Prevalence of acute respiratory distress syndrome after cardiac surgery.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Mar 1999, 117(3) p620-1
AUTHOR(S): Asimakopoulos G; Taylor KM; Smith PL; Ratnatunga CP
AUTHOR'S ADDRESS: Cardiothoracic Unit, Hammersmith Hospital, Imperial College School of Medicine, London, United Kingdom.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Venovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Mar 1999, 117(3) p496-505
AUTHOR(S): Hennein HA; Kiziltepe U; Barst S; Bocchieri KA; Hossain A; Call DR; Remick DG; Gold JP
AUTHOR'S ADDRESS: Schneider Children's Hospital of the Long Island Jewish Medical Center, University of Michigan Medical Center, and the Albert Einstein College of Medicine, New Hyde Park, NY, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass.

ARTICLE TITLE: Fatal injury: characteristics and prevention of deaths at the scene.
ARTICLE SOURCE: J Trauma (United States), Mar 1999, 46(3) p457-61
AUTHOR(S): Meislin H; Conroy C; Conn K; Parks B
AUTHOR'S ADDRESS: Arizona Emergency Medicine Research Center, Arizona Health Sciences Center, Tucson 85724, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Almost half of all trauma deaths occur at the scene. It is important to determine if these deaths can be prevented. METHODS: Penetrating or blunt force trauma deaths were identified through the Office of the Medical Examiner during a 2-year period. Data were also obtained through review of these records. RESULTS: There were 312 deaths at the scene that received no medical care. Almost 60% were firearm-related. About 80% of the victims were men, and 55% of these deaths occurred in people between 20 and 49 years old. Suicide accounted for nearly half of these deaths. Eighty percent of these injured people had Abbreviated Injury Scale scores of 5 or 6. CONCLUSION: Almost 60% of deaths at the scene occurred at the same time as injury and reflect severe injury to vital regions of the body. These findings suggest that primary prevention of the initial event causing injury may be more important than definitive prehospital emergency medical care to prevent these deaths.

ARTICLE TITLE: Early and late acute respiratory distress syndrome: two distinct clinical entities.
ARTICLE SOURCE: J Trauma (United States), Mar 1999, 46(3) p361-6; discussion 366-8
AUTHOR(S): Croce MA; Fabian TC; Davis KA; Gavin TJ
AUTHOR'S ADDRESS: Department of Surgery, Presley Regional Trauma Center, University of Tennessee, Memphis 38163, USA. mcroce@utmem.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Despite numerous advances in surgical critical care and ventilatory management, mortality rates for acute respiratory distress syndrome (ARDS) have remained relatively constant. Pressure-limited and non-pressure-limited ventilatory techniques have been advocated with disparate results. We hypothesized that there are two forms of ARDS, which may account for the conflicting clinical reports. METHODS: Patients with posttraumatic ARDS were identified and reviewed. ARDS was defined as PaO2/FiO2 ratio less than 200 with diffuse bilateral infiltrates on chest radiograph and no congestive heart failure. Patients were analyzed relative to injury mechanism, transfusions, fluid balance, presence of pneumonia (defined as > or =10(5) colony-forming units/mL in bronchoalveolar lavage effluent), and outcome. All were managed with a non-pressure-limited strategy. RESULTS: During a 5.5-year period, 178 patients with posttraumatic ARDS were identified. Mean Injury Severity Score and age were 29 and 40 years, respectively. Patients were stratified by time of ARDS diagnosis. Eighty-two patients (46%) had early ARDS (within 48 hours after admission), and 96 patients (54%) had late ARDS (>48 hours between admission and diagnosis). There were no differences in Injury Severity Score, but the late group was significantly older. The early ARDS group was characterized by profound hemorrhagic shock and had significant differences from the late group in incidence of penetrating injury (30 vs. 10%; p<0.001), admission base deficit (-7.7 vs. -4.2 mEq/L; p<0.001), 48-hour transfusions (19.7 vs. 9.4; p<0.0001), initial 5-day fluid balance (19.9 vs. 10.1 L; p<0.0001), and initial PaO2/FiO2 (121 vs. 141; p<0.007). Pneumonia before ARDS was significantly associated with late ARDS (38 vs. 9%; p<0.001). ARDS-related mortality was primarily caused by hemorrhagic shock in the early group and progressive multiple organ failure in the late group. CONCLUSION: There are two distinct forms of posttraumatic ARDS. Early ARDS is characterized by hemorrhagic shock with capillary leak. Late ARDS frequently follows pneumonia and is associated with multiple system injury. Further studies should differentiate between these two distinct syndromes.
MB. The mortality may not have changed but the incidence obviously has.

ARTICLE TITLE: Using queueing theory to determine operating room staffing needs.
ARTICLE SOURCE: J Trauma (United States), Jan 1999, 46(1) p71-9
AUTHOR(S): Tucker JB; Barone JE; Cecere J; Blabey RG; Rha CK
AUTHOR'S ADDRESS: Stamford Hospital/Columbia University College of Physicians and Surgeons, CT 06904, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: In our institution, activation of a second OR team is unnecessary when the first team is busy with a case on the night shift because the likelihood of two cases occurring concurrently is less than one in a thousand. Queueing theory can be a valuable tool to use in determining the staffing needs of many hospital departments. Trauma centers should apply this mathematical model in optimizing the use of their operational resource.
MB.They only 62 late cases in a year. The chance of wanting to do 2 at once was obviously negligible.

ARTICLE TITLE: Health in Russia is broke, but who is to fix it? [editorial]
ARTICLE SOURCE: Lancet (England), Jan 30 1999, 353(9150) p337
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Extracorporeal liver perfusion [letter]
ARTICLE SOURCE: Lancet (England), Jan 9 1999, 353(9147) p120-1
AUTHOR(S): McChesney LP; Fagan EA; Rowell DL; Del Rio JV; Fabrega F; Millis M; Williams JW
PUBLICATION TYPE: LETTER

ARTICLE TITLE: Brains at risk of schizophrenia [comment]
COMMENTS: Comment on: Lancet 1999 Jan 2; 353(9146):30-3
ARTICLE SOURCE: Lancet (England), Jan 2 1999, 353(9146) p3-4
AUTHOR(S): Harrison PJ
AUTHOR'S ADDRESS: University Department of Psychiatry, Warneford Hospital, Oxford, UK.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Beta-blockers for mild to moderate heart failure [comment]
COMMENTS: Comment on: Lancet 1999 Jan 2; 353(9146):9-13
ARTICLE SOURCE: Lancet (England), Jan 2 1999, 353(9146) p2-3
AUTHOR(S): Krumholz HM
AUTHOR'S ADDRESS: Yale University School of Medicine and Yale New Haven Hospital, CT 06520, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Haemodialysis.
ARTICLE SOURCE: Lancet (England), Feb 27 1999, 353(9154) p737-42
AUTHOR(S): Mallick NP; Gokal R
AUTHOR'S ADDRESS: Department of Renal Medicine, Manchester Royal Infirmary, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (30 references); REVIEW, TUTORIAL

ARTICLE TITLE: Can randomised trials inform clinical decisions about individual patients?
ARTICLE SOURCE: Lancet (England), Feb 27 1999, 353(9154) p743-6
AUTHOR(S): Mant D
AUTHOR'S ADDRESS: Department of Primary Health Care, University of Oxford, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (31 references); REVIEW, TUTORIAL

ARTICLE TITLE: Evidence and primary care [comment]
COMMENTS: Comment on: Lancet 1999 Feb 20; 353(9153):661-4
ARTICLE SOURCE: Lancet (England), Feb 20 1999, 353(9153) p609-10
AUTHOR(S): Horton R
AUTHOR'S ADDRESS: The Lancet, London, UK.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Which drug for treatment of hypertension? [comment]
COMMENTS: Comment on: Lancet 1999 Feb 20; 353(9153):611-6
ARTICLE SOURCE: Lancet (England), Feb 20 1999, 353(9153) p604-5
AUTHOR(S): Cutler J
AUTHOR'S ADDRESS: Clinical Applications and Preventive Program, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Laser to the heart: magic but costly, or only costly? [comment]
COMMENTS: Comment on: Lancet 1999 Feb 13; 353(9152):519-24
ARTICLE SOURCE: Lancet (England), Feb 13 1999, 353(9152) p512-3
AUTHOR(S): Pretre R; Turina MI
AUTHOR'S ADDRESS: Department of Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Deep-vein thrombosis.
ARTICLE SOURCE: Lancet (England), Feb 6 1999, 353(9151) p479-85
AUTHOR(S): Lensing AW; Prandoni P; Prins MH; Buller HR
AUTHOR'S ADDRESS: Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (44 references); REVIEW, TUTORIAL
ABSTRACT: Deep-vein thrombosis is an important complication of several inherited and acquired disorders, but may also occur spontaneously. Prevention of recurrent venous thrombosis and pulmonary embolism is the main reason for accurate diagnosis and adequate treatment. This seminar discusses only symptomatic deep-vein thrombosis. The diagnosis can be confirmed by objective tests in only about 30% of patients with symptoms. Venous thromboembolic complications happen in less than 1% of untreated patients in whom the presence of venous thrombosis is rejected on the basis of serial ultrasonography or ultrasonography plus either D-dimer or clinical score. Initial anticoagulant treatment (intravenous or subcutaneous heparin) should continue until oral anticoagulant treatment, started concurrently, increases the international normalised ratio above 2.0 for more than 24 h. The optimum duration of oral anticoagulant treatment is unresolved, but may be guided by the presence of temporary or persistent risk factors or presentation with recurrent venous thromboembolism.

ARTICLE TITLE: Effects of recombinant hirudin (lepirudin) compared with heparin on death, myocardial infarction, refractory angina, and revascularisation procedures in patients with acute myocardial ischaemia without ST elevation: a randomised trial. Organisation to Assess Strategies for Ischemic Syndromes (OASIS-2) Investigators [see comments]
COMMENTS: Comment in: Lancet 1999 Feb 6; 353(9151):423-4
ARTICLE SOURCE: Lancet (England), Feb 6 1999, 353(9151) p429-38
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
INTERPRETATION: The data from OASIS-2 suggest that recombinant hirudin is superior to heparin in preventing cardiovascular death, myocardial infarction, and refractory angina with an acceptable safety profile in patients with unstable angina or acute myocardial infarction without ST elevation. Thus, a direct thrombin inhibitor is more effective than an indirect thrombin inhibitor.

ARTICLE TITLE: New antithrombotic treatment in unstable coronary syndrome--for whom? [comment]
COMMENTS: Comment on: Lancet 1999 Feb 6; 353(9151):429-38
ARTICLE SOURCE: Lancet (England), Feb 6 1999, 353(9151) p423-4
AUTHOR(S): Wallentin L
AUTHOR'S ADDRESS: Department of Cardiology, Cardiothoracic Centre, University Hospital, Uppsala, Sweden.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Mortality after all major types of osteoporotic fracture in men and women: an observational study.
ARTICLE SOURCE: Lancet (England), Mar 13 1999, 353(9156) p878-82
AUTHOR(S): Center JR; Nguyen TV; Schneider D; Sambrook PN; Eisman JA
AUTHOR'S ADDRESS: Bone and Mineral Research Division, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia. j.center@garvan.unsw.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
METHODS: We did a 5-year prospective cohort study in the semi-urban city of Dubbo, Australia, of all residents aged 60 years and older (2413 women and 1898 men). INTERPRETATION: All major fractures were associated with increased mortality, especially in men. The loss of potential years of life in the younger age-group shows that preventative strategies for fracture should not focus on older patients at the expense of younger women and of men.

ARTICLE TITLE: Preoperative fasting.
ARTICLE SOURCE: Lancet (England), Mar 13 1999, 353(9156) p862
AUTHOR(S): Simini B
AUTHOR'S ADDRESS: Anaesthesia, Intensive Care, and Pain Management Unit, Ospedale, Lucca, Italy.
PUBLICATION TYPE: JOURNAL ARTICLE ---editorial

ARTICLE TITLE: Air pollution and asthma: the dog that doesn't always bark [see comments]
COMMENTS: Comment in: Lancet 1999 Mar 13; 353(9156):874-8
ARTICLE SOURCE: Lancet (England), Mar 13 1999, 353(9156) p859-60
AUTHOR(S): Burney P
AUTHOR'S ADDRESS: Department of Public Health Sciences, Guy's, King's, and St Thomas' School of Medicine, London, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
MB. Seems to affect other forms of respiratory disease bot asthma only if the IgE was high.

ARTICLE TITLE: Non-invasive ventilation in acute exacerbations of COPD [editorial]
ARTICLE SOURCE: QJM (England), Oct 1998, 91(10) p657-60
AUTHOR(S): Plant PK; Elliott MW
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Survey of non-invasive ventilation (NIPPV) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) in the UK.
ARTICLE SOURCE: Thorax (England), Oct 1998, 53(10) p863-6
AUTHOR(S): Doherty MJ; Greenstone MA
AUTHOR'S ADDRESS: Medical Chest Unit, Castle Hill Hospital, Cottingham, East Yorkshire, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Equipment for NIPPV is available in less than half of the acute hospitals in the UK. In those in which it is available it is generally underused. Lack of training and problems with funding are generally given for the failure to introduce NIPPV.

ARTICLE TITLE: Natural sporting ability and predisposition to cardiovascular disorders.
ARTICLE SOURCE: QJM (England), Sep 1998, 91(9) p641-6
AUTHOR(S): Lean ME; Han TS
AUTHOR'S ADDRESS: University Department of Human Nutrition, Glasgow Royal Infirmary, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
Men with a natural ability in 'power sports' are at increased risk of developing cardiovascular disorders, compared to men with a natural ability in 'endurance sports'. A predominance of type 2, glycolytic muscle fibres, presumably of genetic origin, may predispose to cardiovascular disorders.

ARTICLE TITLE: Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital.
ARTICLE SOURCE: QJM (England), Aug 1998, 91(8) p539-48
AUTHOR(S): Farrington M; Redpath C; Trundle C; Coomber S; Brown NM
AUTHOR'S ADDRESS: Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK. MFarrington@compuserve.com.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A methicillin-resistant Staphylococcus aureus (MRSA) control policy, aimed at eradication, was established at a 1000-bed hospital in 1985, applied consistently for 10.5 years, and then relaxed. Its components included screening of high-risk patients, transfer of carriers to exhaust-ventilated isolation rooms, closure of wards to new admissions when local transmission was detected, MRSA screening during outbreaks, and prospective collection of clinical and epidemiological information. During the eradication policy period, every 6 months, a mean of 5.1 patients (range 1-12) already carrying MRSA were admitted, and a mean of 3.6 (range 0-16) acquired carriage in the hospital. The largest outbreak comprised 11 patients despite epidemic MRSA strain EMRSA-16 being introduced six times, and MRSA did not become endemic. MRSA-positive admissions increased progressively from 1993; nursing staff workload increased, areas available for alternative patient accommodation were reduced, the resulting ward closures interfered with clinical services, and hence the control policy was relaxed in mid-1995. Isolation facilities were overwhelmed with 622 new patient-isolates in the next 18 months, and there were 67 clinical infections in 1996. The proportion of blood cultures positive for MRSA rose nearly sevenfold by 1996 and 27-fold by 1997. Thus, repeated eradication of MRSA, even epidemic strains, by use of a stringent policy, is possible given sufficient resources, whereas flexible national guidelines designed to control, but not eradicate, epidemic staphylococci, are currently unlikely to be successful. The costs of eradication policies need to be weighed against those of endemicity.

ARTICLE TITLE: Early complications after orthotopic liver transplantation.
ARTICLE SOURCE: Surg Clin North Am (United States), Feb 1999, 79(1) p109-29
AUTHOR(S): Mazariegos GV; Molmenti EP; Kramer DJ
AUTHOR'S ADDRESS: Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA. gvm@med.pitt.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (103 references); REVIEW, ACADEMIC
ABSTRACT: The cost and impact of early post-transplant complications continue to be high. Diagnosis and management involves a high index of suspicion, rapid diagnostic and therapeutic interventions, and elimination of technical problems. Preoperative assessment of the donor and recipient medical condition and meticulous attention to detail during the technical performance of OLTx are the mainstays in achieving a good outcome.

ARTICLE TITLE: Endovascular grafting for abdominal aortic aneurysms.
ARTICLE SOURCE: Surg Clin North Am (United States), Oct 1998, 78(5) p845-62
AUTHOR(S): D'Ayala M; Hollier LH; Marin ML
AUTHOR'S ADDRESS: Department of Surgery, Mount Sinai Medical Center, New York, New York, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Despite the initial success of endovascular grafts in a very difficult patient population, many problems remain. These procedures are often time-consuming and quite complicated, requiring the close cooperation of an experienced team of vascular surgeons and interventional radiologists. Access may be difficult through occluded, stenotic, and tortuous vessels. Inadequate graft deployment may result in arterial rupture or graft migration, which could potentially lead to acute occlusion of the renal or iliac arteries. Occlusion of the inferior mesenteric artery may result in ischemic colitis. Also, endovascular grafts may fail to exclude an aneurysm from systemic arterial blood pressure, not protecting the patient against impending rupture, and embolization and thrombosis are ever-present dangers. Concerns have been raised regarding radiation exposure and intravenous contrast loads used during these procedures. Clearly, more experience must be gained and technologic advancements made before the use of these devices becomes commonplace, something that may not be too far off in the future.
MB. This is the method of choice at RPAH.

ARTICLE TITLE: First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma [see comments]
COMMENTS: Comment in: Thorax 1998 Dec; 53(12):1005-6
ARTICLE SOURCE: Thorax (England), Dec 1998, 53(12) p1025-9
AUTHOR(S): Blais L; Suissa S; Boivin JF; Ernst P
AUTHOR'S ADDRESS: Department of Medicine, Royal Victoria Hospital, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: The first regular treatment with inhaled corticosteroids initiated in the year following the recognition of asthma can reduce the risk of admission to hospital for asthma by up to 80% compared with regular treatment with theophylline. This is probably due, at least in part, to reducing the likelihood of a worsening in the severity of asthma.

ARTICLE TITLE: Usefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism [see comments]
COMMENTS: Comment in: Thorax 1998 Oct; 53(10):821-2
ARTICLE SOURCE: Thorax (England), Oct 1998, 53(10) p830-4
AUTHOR(S): Egermayer P; Town GI; Turner JG; Heaton DC; Mee AL; Beard ME
AUTHOR'S ADDRESS: Canterbury Respiratory Research Group, Christchurch School of Medicine, New Zealand.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: All three of these observations are helpful in excluding pulmonary embolism PE. When any two parameters were normal, PE was very unlikely. In patients with a negative SimpliRED test and PaO2 of > or = 80 mm Hg a lung scan is usually unnecessary. Application of this approach for triage in the preliminary assessment of suspected PE could lead to a reduced rate of false positive diagnoses and considerable resource savings.
MB. They did a lung scan on me when I had pneumonia---$300.00

ARTICLE TITLE: A fresh look at D-dimer in suspected pulmonary embolism [editorial; comment]
COMMENTS: Comment on: Thorax 1998 Oct; 53(10):830-4
ARTICLE SOURCE: Thorax (England), Oct 1998, 53(10) p821-2
AUTHOR(S): Miller A
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Sleep apnoea and snoring: potential links with vascular disease.
ARTICLE SOURCE: Thorax (England), Oct 1998, 53 Suppl 3 pS8-11
AUTHOR(S): Sullivan CE; McNamara SG
AUTHOR'S ADDRESS: David Read Laboratory, Department of Medicine, University of Sydney, NSW, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (35 references); REVIEW, TUTORIAL