Coronary Artery Thrombosis in a Neonate With Critical Aortic Stenosis

We describe a case of right coronary artery occlusion in a neonate with critical aortic stenosis. We hypothesize that the thrombus was either formed in situ resulting from low cardiac output or secondary to an atrial arrhythmia in the presence of severe left ventricular diastolic dysfunction that may have occurred during air-transfer to our facility. We conclude that attention should be given to the coronary arteries in low-flow critical aortic stenosis, particularly in neonates and infants whose stroke volume is extremely low.

Platypnea-Orthodeoxia Syndrome After Pneumonectomy Relieved by Mediastinal Repositioning

Platypnea-orthodeoxia is a rare syndrome characterized by hypoxemia in the upright position after pneumonectomy and relieved by recumbency. This syndrome is often a post-pneumonectomy complication due to intracardiac shunt, usually at the atrial level. We report a case after right pneumonectomy without interatrial shunt. The patient was successfully treated with a silicone prosthesis implant in the post-pneumonectomy space. We believe that correction of this clinical situation has not been previously described.

Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers

We investigated the effect of pressure application on the acupuncture point "extra 1" and on a control point on the bispectral index (BIS) values and on stress in 25 volunteers. In each volunteer, pressure was applied on the extra 1 point for 10 min and on a control point for 5 min on different days and in a randomized manner. The BIS value was recorded before applying pressure on the extra 1 point, during pressure application every 30 s for 10 min, and after pressure release. Regarding the control point, BIS values were recorded for 5 instead of 10 min during pressure application because acupressure on that point was associated with an unpleasant feeling. Each volunteer was asked to score stress before and after pressure application from 0 to 10. The BIS values were significantly reduced 2.5, 5, 7.5, and 10 min during pressure application on the extra 1 point (P < 0.001 for each comparison, respectively) and returned to the baseline values after pressure release. Pressure application on the control point decreased BIS values (P < 0.01 and P < 0.05 at 2.5 and 5 min, respectively). However, these values were maintained close to 90% and were significantly higher than those obtained during pressure on the extra 1 point (P < 0.001 and P < 0.001 for the 2.5- and 5-min comparisons). The verbal sedation score values obtained after pressure application on the extra 1 point were also lower when compared with the values obtained after pressure application on the control point (P < 0.001).

IMPLICATIONS

This crossover study investigated the effect of pressure application on the acupuncture "extra 1" point in healthy volunteers. Acupressure applied for 10 min on the extra 1 point significantly reduced the BIS values and the verbal stress score when compared with acupressure applied on a control point.

The analgesic effect of gabapentin and mexiletine after breast surgery for cancer

We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardized, and all patients had access to routine postoperative analgesics on demand. The visual analog scale score assessed pain at rest and after movement. Three months later, all patients were interviewed to identify intensity of chronic pain and analgesic requirements. Mexiletine and gabapentin reduced codeine consumed from the second to tenth day by 50% (P = 0.029; P = 0.018 and P = 0.035 for mexiletine versus control and gabapentin versus control comparisons, respectively). Total paracetamol consumption was also reduced during the same time (P = 0.0085; P = 0.007 and P = 0.011 for the mexiletine and gabapentin groups when compared with the control, respectively). Pain at rest and after movement was reduced by both drugs on the third postoperative day. Pain after movement also was reduced by gabapentin between the second and fifth postoperative day. Three months later, the incidence of chronic pain, its intensity, and need for analgesics were not affected by either treatment. However, burning pain was more frequent in the control group (P = 0.033).

IMPLICATIONS

Patients undergoing breast surgery for cancer may develop chronic pain. We evaluated the effect of mexiletine and gabapentin on the acute and chronic pain after breast surgery for cancer. Both drugs reduced the postoperative analgesic requirements, and particularly, gabapentin reduced pain after movement. The overall incidence of chronic pain was unaffected except for burning pain.

Impact factor bias and proposed adjustments for its determination

BACKGROUND

The impact factor (IF), a qualitative parameter used to evaluate scientific journals, has several flaws. The aim of the study was to evaluate two of its important constraints, journal self-citation and scientific field, and to investigate the potential for improvement.

METHODS

We studied the five or six highest impact journals from each of seven medical fields: anesthesiology, dermatology, genetics and heredity, immunology, general and internal medicine, ophthalmology and surgery. To correct for journal self-citation, we divided the number of 1998 citations of papers published in 1996 and 1997, minus the self-citations, by the number of papers published in the same period. For inter-field normalization we divided the IF by the mean of the IFs of the upper quartile for the same category of medical field (IF/fcat).

RESULTS

For the 36 journals, there was a negative correlation between IF and self-cited and self-citing rates (rs = -0.765, P < 0.001 and rs = -0.479, P < 0.003, respectively). Self-cited rate is the ratio of a journal's self-citations to the number of times it is cited by all journals including itself. Self-citing rate relates a journal's self-citations to the total references it makes. The IF/fcat for the 36 journals are positively correlated with their conventional IF (rs = 0.91, P < 0.001).

CONCLUSION

Correcting the IF of the 36 journals for self-citation did not significantly change journal rankings. The adjusted IF/fcat to normalize for the scientific field was positively correlated with the conventional IF.

Academic anesthesiologists' views on the importance of the impact factor of scientific journals: a North American and European survey

PURPOSE

To investigate the views of North American and European anesthesiologists on the value of the impact factor (IF).

METHOD

Four hundred thirty-eight anesthesiologists in Canada, the United States of America (USA), and Europe were polled about the importance of the IF regarding hiring, promotions, funding of research and to express their personal views.

RESULTS

IF of a candidate's publications is a criterion in 38% of academic appointments in Canada and USA vs 81% in Europe (P <0.0001). The importance of IF to obtain funding is greater in Europe (46%) than in North America (17%) (P <0.0001). Twenty-three percent and 50% of Canadian and American anesthesiologists respectively believe that IF affects financial support (P=0.0389). European anesthesiologists value the IF more than the North Americans (67% vs 31%, P <0.0001). Forty-five percent, 67%, and 56% of the Canadian, American and European anesthesiologists respectively estimate that IF reflects journal quality. Sixty-four percent of anesthesiologists in North America vs 81% in Europe (P=0.0175) pursue to publish in high IF journals. Eighty-six percent, 85% and 90% of the Canadian, American and European anesthesiologists believe that the IF of a journal can be manipulated. Finally, 79%, 67%, and 81% of the Canadian, American, and European anesthesiologists believe that IF should be improved but 33%, 35%, and 30% believe that it should be abandoned.

CONCLUSIONS

IF for academic appointments and funding is more important in Europe than in North America. More than 50% of anesthesiologists agree that IF needs to be improved.

Hypnotic and cardiovascular effects of proprietary and generic propofol formulations do not differ

PURPOSE

The aim of the study was to compare the potency of two different propofol formulations: proprietary and generic propofol using the bispectral index (BIS) monitoring.

METHODS

Forty female patients undergoing breast surgery received propofol 3 mg x kg(-1) followed by propofol infusion adjusted to maintain a 40% BIS value, supplemented by 50% nitrous oxide. Proprietary or generic propofol was administered in a randomized double-blind manner.

RESULTS

The propofol mg/BIS% ratio obtained after the bolus dose, the cumulative infused propofol mg/BIS% ratio at the end of each five-minute interval and the total dose of propofol administered as bolus + infusion were similar between the two groups. The two groups did not differ with regard to systolic and diastolic blood pressure, heart rate, end-tidal carbon dioxide and arterial oxygen saturation.

CONCLUSION

The two propofol formulations are equipotent when hypnotic effect is assessed by BIS monitoring.