How to select a full-body harness.
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Accidental Falls↗
Biomedical subjects
I Smith
Publications and source records attributed to I Smith.
Day surgery, including the preoperative assessment of the patient: a UK experience by a Belgian anaesthetist.
In some European countries like Belgium, a lot of hospitals are today dealing with two extremely real issues: adult day surgery and the preoperative anaesthesia consultation. Although efforts are made, there is often still a search for a clear-cut identity on these subjects. As in the rest of Europe, Belgian political, financial and medical driving forces are strongly favouring the shift of surgical procedures towards more day care practice. However, our country has not already reached the level of the United Kingdom, Canada, Australia, or the USA, where the greater majority of all surgery is ambulatory surgery. The development of new surgical technology, however, favours minimal invasiveness, whereas 'newer' anaesthetic agents result in fast recovery. In setting up real surgical day care facilities, Belgian medical and nursing staff, together with the hospital management, will have to cope with the worldwide existing variation in performing ambulatory surgery, at a hospital level, at a surgeon's and anaesthetist's level and at a provision level. Careful patient selection, conscientious anaesthetic management, and being attentive to caring for a patient leaving the hospital, are the cornerstones of decent ambulatory anaesthesia and surgery, and the key for long-term success. Together with dedicated facilities, it is therefore mandatory to have competent and enthusiastic staff. The nursing director, as well as the medical director of the day unit will have to use their power in order to avoid abuse of ambulatory beds for other purposes. As the perioperative specialist, the anaesthetist is ideally suited for the pre-, per-, and postoperative management of the ambulatory patient. Moreover, concerning the preoperative assessment clinic, UK anaesthetists have organized a valuable and interesting alternative to the expensive and time/manpower consuming system used in the USA.
Ambulatory Care Facilities↗
Misjudged threat. The word about AIDS still needs to get out, especially among African Americans.
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Acquired Immunodeficiency Syndrome↗
Spastic paraparesis after anaesthesia.
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Adolescent↗
Vertebral bone mineral density, content and area in 8789 normal women aged 33-73 years who have never had hormone replacement therapy.
The vertebral bone mineral density (BMD), bone mineral content (BMC) and bone area of the lumbar spine were measured using a bone densitometer in 8789 women aged 33-73 years who had had no previous hormone replacement therapy (HRT). The overall relationship between BMD and age was analyzed on a year-by-year basis, and comprised three separate regions that could each be described by a straight line: 33-46 years (gradient = 0.00166 g cm(-2)/year), 47-63 years (gradient = 0.0121 g cm(-2)/year) and 64-73 years (gradient = 0.0045 g cm(-2)/year). Above the age of 50 years our results were higher than the BMD in most previous reports. In those 3198 women who knew the time of their last menstrual period (mean age 49.25 years, SD 4. 83) bone loss was most rapid in the first 10 menopausal years. In the whole group, the relationship between BMC and age was found to be similar to that of BMD, with three distinct regions, including a rapid drop between the ages of 47 and 63 years (gradient 0.781 g/year). Bone area showed a much more gradual (though significant) decrease with age. Based on WHO definitions and using BMD as an indicator, the percentage of women with osteoporosis varied from zero in the younger age group to about 30% of women aged over 70 years; in contrast, where BMC was used, although the trend with age had a similar shape, the percentages at each year were about half those derived from the corresponding BMD values. Osteopenia derived in the same way occurred in about 50% of women over 70 years using either BMD or BMC. The results presented here provide a reliable local reference range for lumbar spine bone densitometry measurements. They also show that for this site BMD and BMC cannot be used interchangeably to define osteoporosis.
Absorptiometry, Photon↗
Endogenous hematopoietic reconstitution induced by human umbilical cord blood cells in immunocompromised mice: implications for adoptive therapy.
Human umbilical cord blood (HUCB) cells show promising advantages over bone marrow (BM) cells for a variety of diseases that require transplantation. We observed that lethally irradiated SJL/J mice given a single injection of HUCB cells survive, whereas vehicle-injected mice do not. Because survival is not due to long-term engraftment of HUCB cells, we used this HUCB/mouse model to investigate additional therapeutic benefits of HUCB cells. We investigated the mechanism by which HUCB cells accelerated endogenous hematopoiesis in mice that received either lethal (9.5 Gy) or lower-dose (8.0 Gy) radiation and then were given a single injection of HUCB mononuclear cells. Compared to irradiated control mice, the lethally irradiated, HUCB-injected group showed significant increases in peripheral white blood cell counts, red blood cell indices, and granulocyte-macrophage colony-forming units (CFU-GM) by 3 weeks. In contrast, no significant differences in these parameters were observed between control and HUCB-injected mice that received the lower dose of irradiation. Moreover, regardless of the radiation dose, only HUCB-injected mice exhibited immune responses comparable to those of age-matched normal mice. The clinical relevance of these observations was determined in long-term, culture-initiating cell assays with human BM stem cells and irradiated (gamma-) HUCB cells. CFU-GM colonies were detectable in cultures containing gamma-HUCB cells by day 15, but were undetectable in cultures without gamma-HUCB cells until day 40, suggesting a hematopoietic stimulatory role for HUCB cells. Overall, the results indicate that in addition to their use for transplantation, HUCB cells also may be used as an adjuvant therapy to enhance hematopoietic reconstitution and immunocompetence of the host. This hematopoiesis-enhancing effect represents a heretofore unrecognized function of HUCB cells.
Adjuvants, Immunologic↗
Secondary tonsillectomy haemorrhage and non-steroidal anti-inflammatory drugs.
Modern non-steroidal anti-inflammatory drugs (NSAIDs), are now widely accepted analgesics for post-tonsillectomy patients, but their effect on secondary haemorrhage has not been fully evaluated. This study attempts to evaluate the influence of NSAIDs on the secondary haemorrhage rate, and also whether mode of dissection is an important factor. The records of 557 consecutive patients undergoing tonsillectomy were studied to determine if there was a relationship between the secondary haemorrhage rate and discharge prescription of NSAIDs. There was an overall secondary haemorrhage rate of 5.2 per cent (29) and a significantly increased secondary haemorrhage rate in those taking regular NSAIDs, 11 per cent, compared to those not taking NSAIDs, 1.47 per cent, (chi 1(2) = 41.25, p < 0.001). There was a higher rate of secondary haemorrhages with bipolar dissection than with standard dissection for both those taking and not taking NSAIDs (13 per cent vs seven per cent and 2.75 per cent vs 0.87 per cent) however this was not statistically significant (chi 1(2) = 1.17, p = 0.19 and chi 1(2) = 0.773, p = 0.17). Both bipolar dissection and standard dissection individually showed very significant increases in secondary haemorrhage rate when on regular NSAIDs (chi 1(2) = 14.03, p = 0.004 and chi 1(2) = 6.19, p = 0.003). Although NSAIDs are very good analgesics, they may cause an increased secondary haemorrhage rate, and should be prescribed at discharge prescription with caution.
Adult↗
Outbreak of meningococcal disease in western Norway due to a new serogroup C variant of the ET-5 clone: effect of vaccination and selective carriage eradication.
A new sulphonamide resistant (SR) C: 15:P1.7,16 meningococcal strain, a variant of the ET-5 clone, dominated in an outbreak of 22 cases in western Norway commencing in 1995. The first eight patients were 15-21 years old from the Nordhordland area, initiating a carrier study in the local high schools. Carriage of SR serogroup C meningococci was detected by routine methods and treated with a single dose of ofloxacin 400 mg. Of 20 treated carriers, 14 harboured the outbreak strain C: 15:P1.7,16. Vaccination of 4000 children, adolescents and close contacts of patients was also performed. After the intervention, 14 additional cases of meningococcal disease occurred, 8 due to the outbreak strain. However, incidence rates dropped from 180 to 30 per 100000 per year in the student population, but increased from 0 to 13 in the rest of the population in Nordhordland. Carriage eradication is not generally recommended in Norway. However, tracing and treating meningococcal carriage may have reduced transmission and disease in this outbreak situation.
Adolescent↗
Association between variants at the GABAAbeta2, GABAAalpha6 and GABAAgamma2 gene cluster and alcohol dependence in a Scottish population.
A role for the GABA/benzodiazepine receptor complex in alcohol dependence syndrome has been suggested by several lines of evidence. To elucidate the role of GABAA subunits in human alcohol dependence syndrome, we identified polymorphisms in the GABAAbeta2 and GABAAalpha6 receptor subunit genes on 5q33 and assessed their potential contribution in an association study, together with a NciI RFLP at the GABAAgamma2 receptor subunit gene. One hundred and eight alcohol-dependent subjects and 54 unrelated controls were recruited from Scotland. Two novel genetic markers were identified at the GABAAbeta2 and GABAAalpha6 receptor subunit genes and examined for association with the alcohol dependence syndrome and subgroups of subjects with Korsakoff's psychosis and without Korsakoff's psychosis, together with a NciI RFLP at the GABAAgamma2 receptor subunit gene. The chi2 tests demonstrated associations between all alcohol-dependent subjects (not stratified) and the BanI RFLP at the GABAAbeta2 receptor subunit gene (P = 0.015), and the AlwNI RFLP at the GABAAalpha6 receptor gene (P = 0.013). Significant associations were also found between the alcohol-dependent subjects with Korsakoff's psychosis and the BanI RFLP (P = 0.039) and the AlwNI RFLP (P = 0.003). Haplotype analysis also provided evidence of association when all alcohol-dependent subjects (P = 0.013) and the subjects with Korsakoff's psychosis (P = 0.007) were compared with controls. Our findings provide evidence for a role for the GABAA receptor subunit cluster on chromosome 5q33 in susceptibility to the alcohol dependence syndrome and Korsakoff's psychosis.
Adult↗
Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation.
Two hundred and ten obstetric anaesthetists completed a questionnaire assessing how they would perform a rapid sequence induction of anaesthesia for a Caesarean section and their continued management during a failed tracheal intubation. The survey revealed considerable variation in the timing and application of cricoid pressure, the choice and dose of drugs used and the timing of their administration. The management of a difficult intubation also varied. This variability was independent of both grade of anaesthetist and frequency of practice. There appear to be at least two distinct techniques in current practice, characterised by 'fast' or 'slow' rapid sequence induction. Rapid sequence induction is clearly not a standard technique and debate is necessary to clarify the risks and benefits of its components. In particular, the rapidity of the technique and the application of cricoid pressure may contribute to the increased incidence of difficult tracheal intubation in obstetric anaesthesia.
Anesthesia, General↗
Sevoflurane: a comparison between vital capacity and tidal breathing techniques for the induction of anaesthesia and laryngeal mask airway placement.
Sixty unpremedicated adult day-case patients were randomly assigned to either vital capacity or tidal breathing inhalational induction techniques. End points assessed included loss of eyelash reflex, time to drop a weighted syringe, time to jaw relaxation and time to the end of laryngeal mask airway insertion. Complications occurring during the induction of anaesthesia were recorded. The data show that there is no statistical or clinical difference between the two induction techniques. Patient acceptance of both techniques was similarly high. When the time taken to prime the anaesthetic breathing system is taken into consideration, the vital capacity technique is more expensive for induction of anaesthesia. These results therefore question the need for the vital capacity induction technique with sevoflurane 8%.
Adolescent↗
Target-controlled propofol vs. sevoflurane: a double-blind, randomised comparison in day-case anaesthesia.
We compared target-controlled propofol with sevoflurane in a randomised, double-blind study in 61 day-case patients. Anaesthesia was induced with a propofol target of 8 microgram.ml-1 or 8% sevoflurane, reduced to 4 microgram.ml-1 and 3%, respectively, after laryngeal mask insertion and subsequently titrated to clinical signs. Mean (SD) times to unconsciousness and laryngeal mask insertion were significantly shorter with propofol [50 (9) s and 116 (33) s, respectively] than with sevoflurane [73 (14) s and 146 (29) s; p < 0.0001 and p = 0.0003, respectively]; however, these differences were not apparent to the blinded observer. Propofol was associated with a higher incidence of intra-operative movement (55 vs. 10%; p = 0.0003), necessitating more adjustments to the delivered anaesthetic. Emergence was faster after sevoflurane [5.3 (2.2) min vs. 7.1 (3.7) min; p = 0.027], but the inhaled anaesthetic was associated with more nausea and vomiting (30 vs. 3%; p = 0.006), which delayed discharge [258 (102) min vs. 193 (68) min; p = 0.005]. Direct costs were lower with sevoflurane but nausea would have increased indirect costs. Patient satisfaction was high (>/= 90%) with both techniques. In conclusion, both techniques had advantages and disadvantages for day-case anaesthesia.
Adolescent↗
Differential expression of 10 sigma factor genes in Mycobacterium tuberculosis.
The ability of Mycobacterium tuberculosis to adapt to different environments in the infected host is essential for its pathogenicity. Consequently, this organism must be able to modulate gene expression to respond to the changing conditions it encounters during infection. In this paper we begin a comprehensive study of M. tuberculosis gene regulation, characterizing the transcript levels of 10 of its 13 putative sigma factor genes. We developed a real-time RT-PCR assay using a family of novel fluorescent probes called molecular beacons to quantitatively measure the different mRNAs. Three sigma factor genes were identified that have increased mRNA levels after heat shock, two of which also responded to detergent stress. In addition, we also identified a sigma factor gene whose mRNA increased after mild cold shock and a second that responded to conditions of low aeration.
Bacterial Proteins↗
Identification and characterization of two divergently transcribed iron regulated genes in Mycobacterium tuberculosis.
SETTING: Low iron availability in the host induces the expression of iron acquisition systems and virulence genes in many pathogens. IdeR is a mycobacterial iron dependent regulator that controls the iron starvation and oxidative stress responses in Mycobacterium smegmatis. It is important to determine the role of IdeR and its regulon in M. tuberculosis, as identification of iron regulated genes can aid in the design of new drugs and generation of attenuated strains. OBJECTIVE: A potential IdeR binding site was found in the M. tuberculosis genome flanked by two divergently oriented open reading frames, irg1 and irg2. The aim of this study was to determine whether irg1 and irg2 were iron and IdeR regulated genes. DESIGN: Interaction of IdeR with the putative binding sequence was examined by gel shift and footprinting assays. Transcriptional fusions of irg1 and irg2 to IacZ were used to study the effect of iron levels on the expression of these genes. RESULTS: IdeR binds to the predicted binding site, which overlaps with the irg1 promoter. irg1 and irg2 expression was decreased by iron in M. tuberculosis and in wild type M. smegmatis, but not in a M. smegmatis ideR mutant. CONCLUSION: Two M. tuberculosis iron/IdeR regulated genes were identified. irg1 is predicted to be the M. tuberculosis hisE gene, which is involved in histidine biosynthesis. It is directly upstream of the M. tuberculosis hisG. irg2 encodes a putative membrane protein that is a member of the PPE family.
Bacterial Proteins↗
Double-blind comparison of sevofluran vs propofol and succinylcholine for tracheal intubation in children.
We have studied intubating conditions in 64 healthy children, aged 3-10 yr, undergoing adenotonsillectomy, in a double-blind, randomized study. Intubation was performed 150 s after induction using either 8% sevoflurane in nitrous oxide and oxygen or propofol 3-4 mg kg-1 with succinylcholine 2 mg kg-1. An anaesthetist blinded to the technique performed intubation and scored intubating conditions using Krieg and Copenhagen Consensus Conference (CCC) scores. The trachea was intubated successfully at the first attempt in all patients under clinically acceptable conditions, although scores were significantly better with propofol and succinylcholine. The sevoflurane technique cost 3.62 +/- 0.55 Pounds to completion of tracheal intubation, significantly more (P < 0.001) than the cost of propofol-succinylcholine and isoflurane (2.04 +/- 0.54 Pounds) when based on actual amount of drug used. This cost increased to 4.38 +/- 0.05 Pounds when based on whole ampoules, which is significantly more than the cost of sevoflurane (P < 0.001).
Adenoidectomy↗
A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol.
Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. Drug and delivery costs were calculated in US$. Induction of anaesthesia was fastest in groups 1 and 2, although spontaneous ventilation resumed earliest in group 3. Emergence times and times at which patients were fit for discharge were similar in all groups. Group 2 had the lowest costs based on actual drug use (mean $14.2 (SEM 0.8) vs $18.7 (0.8) and $17.3 (0.8) in groups 1 and 3, respectively). Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.
Adolescent↗