Order this document
Am J Emerg Med 2002 Mar;20(2):126
Publication Types:
PMID: 11880880, UI: 21868150
Other Formats: Links:
Am J Emerg Med 2002 Mar;20(2):83-7
Department of Pediatrics, Division of Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA. mark_hostetler@kids.wustl.edu
The objective of the study was to describe parenteral analgesic and sedative (PAS) use among patients treated in US emergency departments (EDs). Data representing 6 consecutive years (1992-1997) from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined and analyzed. Patients were identified as having received PAS if they received fentanyl, ketamine, meperidine, methohexital, midazolam, morphine, nitrous oxide, or propofol. Patients were stratified according to age (pediatric <18 years), race, gender, insurance, type of hospital, urgency of visit, and ICD-9 diagnostic codes. Logistic regression was performed to determine independent associations and calculate odds ratios (OR) for receiving analgesia or sedation. A total of 43,725 pediatric and 114,207 adult ED encounters were analyzed and represented a weighted sample of 555.3 million ED visits. For patients with orthopedic fractures, African American children covered by Medicaid insurance were the least likely to receive PAS (OR 0.2, 95% confidence interval 0.1-0.6). These results suggest that variations may be occurring among ED patients receiving PAS. Copyright 2002, Elsevier Science (USA). All rights reserved).
PMID: 11880868, UI: 21868138
Anesth Analg 2002 Apr;94(4):1042
Professor and Holder of the Margaret Milam McDermott Distinguished Chair in Anesthesiology, Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
[Medline record in process]
PMID: 11916826, UI: 21914031
Anesth Analg 2002 Apr;94(4):1040-1
Department of Anesthesiology, Vakif Gureba Hospital, Istanbul, Turkey.
PMID: 11916821, UI: 21914026
Anesth Analg 2002 Apr;94(4):1001-6
Department of Anesthesia and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Continuous three-in-one block is widely used for postoperative analgesia after proximal lower limb surgery, but location of the catheter has not been well addressed in the literature. We prospectively studied, in 100 patients, the characteristics of catheter threading under the iliac fascia and the correlations between catheter tip location and effective sensory and motor blockade of the three principal nerves of the lumbar plexus. Postoperatively, in conscious patients, 16 to 20 cm of a catheter was placed in the fascial sheath after femoral nerve location with a nerve stimulator. Contrast media (3 mL Iopamidol 390((R))) was injected, and the catheter tip was located by means of an anteroposterior pelvic radiograph. An equal-volume mixture of 0.5% bupivacaine/2% lidocaine with epinephrine (30 mL) was injected through the catheter. Patient and catheter-insertion characteristics were noted. Thirty minutes after injection, sensory blockade was evaluated in the cutaneous territories of the lateral femoral cutaneous, femoral, and obturator nerves, along with motor blockade of the last two nerves. Pain scores at 30 min were also recorded. Seven block failures were noted. The tip of the catheter reached the lumbar plexus (Group 1) in 23% of the patients and lay deep to the medial (Group 2) or lateral (Group 3) part of the fascia iliaca in 33% and 37% of the patients, respectively. Demographic data and catheter threading characteristics were comparable among the groups. A three-in-one block was noted in 91% of Group 1 patients, but in only 52% and 27% of Group 2 and 3 patients, respectively (P < 0.05). Comparing Group 2 and 3 patients, sensory block was achieved in respectively 100% and 94% for the femoral nerve, 52% and 94% for the lateral femoral cutaneous nerve (P < 0.05), and 82% and 27% for the obturator nerve (P < 0.05). Visual analog scale pain scores on movement were significantly lower in Group 1 patients (P < 0.05). We conclude that during a continuous three-in-one block, the threaded catheter rarely reached the lumbar plexus. The quality of sensory and motor blockade and initial pain relief depend on the location of the catheter tip under the fascia iliaca. IMPLICATIONS: The course of a continuous three-in-one block catheter is unpredictable. Only 23% of the catheters lie near the lumbar plexus. The success of sensory and motor blocks, as well as postoperative analgesia, depend on the position of the catheter under the fascia iliaca.
PMID: 11916812, UI: 21914017
Anesth Analg 2002 Apr;94(4):981-6, table of contents
Department of Anesthesiology and Intensive Care Medicine, Ludwig Boltzmann Institute of Experimental Anesthesiology and Research in Intensive Care Medicine, Wilhelminenspital, Vienna, Austria. wolfgang.jaksch@chello.at
Several studies report that when small-dose racemic ketamine, an N-methyl-D-aspartate receptor antagonist, is administered perioperatively, opioid consumption is reduced postoperatively. S(+)-ketamine has a higher affinity for the N-methyl-D-aspartate receptor and less-serious side effects than racemic ketamine. Thirty patients scheduled for elective arthroscopic anterior cruciate ligament repair were enrolled in this randomized, double-blinded clinical trial designed to determine the preemptive effect of S(+)-ketamine on postoperative analgesia requirements in a setting of clinically relevant perioperative analgesia. Total IV anesthesia was induced and maintained with remifentanil (0.125-1.0 microg x kg(-1) x min(-1)) and a propofol target-controlled infusion (target 2-4 microg/mL). The Ketamine group received a bolus of 0.5 mg/kg S(+)-ketamine before incision, followed by a continuing infusion of 2 microg x kg(-1) x min(-1) until 2 h after emergence from anesthesia. The Control group received NaCl in the same sequence. After IV morphine provided pain relief down to < or =3 on a visual analog scale scored from 0 to 10, patients were connected to a patient-controlled analgesia device. There were no significant differences between the two groups in terms of total morphine consumption or VAS scores, either at rest or with movement. In our study, S(+)-ketamine did not contribute to postoperative pain reduction, possibly because of the clinically routine perioperative opioid analgesia. IMPLICATIONS: Small-dose S(+)-ketamine had no positive effect on postoperative analgesia when administered perioperatively for elective arthroscopic anterior cruciate ligament repair. Unlike investigations of the racemic mixture of ketamine, our study methods included timely standard-practice perioperative opioid analgesia, which seems to make supplemental analgesia unnecessary.
PMID: 11916808, UI: 21914013
Anesth Analg 2002 Apr;94(4):859-62
Department of Pediatric Anesthesiology and Division of Otolaryngology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois.
Peripheral nerve blocks of the surgical site can reduce the need for perioperative opioids thereby decreasing their unwanted adverse effects, such as postoperative nausea and vomiting. In this prospective, randomized, double-blinded study, we examined the efficacy of a great auricular nerve (GAN) block compared with IV morphine sulfate in children undergoing tympanomastoid surgery. After the induction of general anesthesia, children were randomized to receive either a GAN block with 2 mL of 0.25% bupivacaine with epinephrine (1:200,000) and a sham IV injection of 2 mL of saline solution or a sham GAN block with 2 mL of saline solution with an IV injection of 0.1 mg/kg morphine sulfate diluted to 2 mL. Patients' objective pain scores were assessed by a blinded observer and the incidence of vomiting was recorded. The GAN-Block patients as a group required more pain rescue in the postanesthesia care unit; this difference was not statistically different from the IV-morphine group (P = 0.084). Nine GAN-Block patients never received opioid or other analgesics at any time in the first 24 h after surgery. The group that received the GAN block also had a less frequent incidence of vomiting requiring intervention (7 versus 19) during their entire hospitalization or at home (P = 0.027). The GAN-Block group also had more patients who never experienced vomiting (13 of 20 versus 5 of 20, P = 0.026). In this cohort, a peripheral nerve block decreased the overall incidence of postoperative vomiting thereby reducing associated costs. IMPLICATIONS: We prospectively compared the use of a great auricular nerve block versus IV morphine sulfate in a randomized double-blinded study in children undergoing tympanomastoid surgery. Analgesia was comparable between groups but nearly half the Block group never required additional analgesics and the number of vomiting events was nearly 66% less.
PMID: 11916785, UI: 21913990
Anesth Analg 2002 Feb;94(2):438-44, table of contents
Department of Anaesthesia, HCI International Medical Centre, Clydebank, Scotland. john_murdoch@btinternet.com
We evaluated the efficacy and safety of three concentrations of levobupivacaine infused epidurally as analgesia for patients undergoing orthopedic procedures. Patients undergoing elective hip or knee joint replacement were enrolled in the study (n = 105). Sensory blockade was established preoperatively with 10-15 mL of 0.75% levobupivacaine. Patients were then randomized to receive 0.0625%, 0.125%, or 0.25% levobupivacaine as a continuous epidural infusion at 6 mL/h for 24 h. IV morphine patient-controlled analgesia was given as rescue analgesia, and time to first request for analgesia and total dose of morphine consumed were recorded. Sensory blockade, motor blockade, visual analog scale pain score, and cardiovascular variables were also recorded at regular intervals postoperatively. Ninety-one patients were included in the primary intent-to-treat analysis. Total normalized dose of morphine, number of patient-controlled analgesia requests, and overall postoperative visual analog scale pain scores were significantly lower for the 0.25% group compared with the other two groups, and the time to first request for rescue analgesia was longer. There was no significant difference between the 0.125% and 0.25% groups in terms of maximum motor blockade achieved and time to minimal motor blockade. Safety data were equivalent among the three groups. We conclude that levobupivacaine as a continuous epidural infusion provided adequate postoperative analgesia and that the 0.25% concentration provided significantly longer analgesia than 0.125% or 0.0625% levobupivacaine without any significant increase in detectable motor blockade relative to the 0.125% group. IMPLICATIONS: Postoperative epidural infusion of levobupivacaine can provide safe and effective analgesia for patients having hip or knee joint replacement. Of the three concentrations we infused at a constant rate, 0.25% provided significantly better pain relief.
PMID: 11812715, UI: 21670883
Anesth Analg 2002 Feb;94(2):417-20, table of contents
Department of Anestesia, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA. Dunbar.StuartMD@bhs.org
The analgesic mechanism of epidural steroids in reducing pain associated with degenerative spinal disease (DSD) is poorly understood. We report increased inline epidural infusion pressure in patients with DSD and assess whether this phenomenon is affected by administration of an epidural steroid injection. We collected data during epidural placement for routine surgery or epidural steroid therapy. Using a 17-gauge Tuohy needle, with patients in the right lateral decubitus position, loss of resistance to 2 mL of saline identified the epidural space. Two minutes later the needle was attached to saline-filled tubing connected to a pressure transducer (Baxter PX 260 pressure monitoring kit with Truwave TM disposable pressure transducer). In the first part of the study, 4 successive boluses of 3 mL of local anesthetic were administered at a rate of 6 mL/min to 15 patients (age 47 +/- 6 yrs) with radicular back pain and magnetic resonance imaging (MRI) or computed tomography (CT) evidence of DSD, and to 8 control patients with no history of back pain (age 44 +/- 5 yr) while inline epidural infusion pressure was measured. In the second part of the study 44 patients with low back pain and MRI or CT evidence of DSD presenting to the pain clinic were infused with 8 mL of 0.125% bupivacaine and 40 mg of methylprednisolone (20 mg/mL) at a rate of 6 mL/min while inline epidural infusion pressure was measure and recorded. This was repeated 3 wk later. Initially, DSD patients had significantly increased infusion pressures over normals, which most likely reflects outflow resistance or obstruction. A significant decrease in inline epidural infusion pressure was observed after epidural steroid treatment. This change in pressure may indicate efficacy from epidural steroid injection. IMPLICATIONS: During injection into the epidural space we observed increased resistance in patients with degenerative spinal disease. This resistance was significantly less when measured 3 wk after an epidural steroid injection. This change in pressure may indicate efficacy from epidural steroid injection.
PMID: 11812711, UI: 21670879
Anesth Analg 2002 Feb;94(2):266-70, table of contents
Department of Pediatric Anesthesiology, Children's Memorial Hospital, Chicago, Illinois 60614, USA. r-dsida@northwestern.edu
Published data suggest that ketorolac pharmacokinetics are different in children than in adults. We sought to better characterize ketorolac pharmacokinetics in children. Thirty-six children, aged 1-16 yr, were stratified into four age groups: 1-3 yr, 4-7 yr, 8-11 yr, and 12-16 yr. Each child received 0.5 mg/kg of ketorolac tromethamine IV after completion of elective surgery. A maximum of 16 venous blood samples (mean, 13 +/- 2) were collected at predetermined times up to 10 h after drug administration. Plasma ketorolac concentrations were measured by high-performance liquid chromatography after solid-phase extraction. Individual concentration-versus-time relationships were best fit to a two-compartment pharmacokinetic model by using SAAM II. Body weight-normalized pharmacokinetic variables did not differ among the age groups and were similar to those reported for adults, including a volume of distribution at steady state of 113 +/- 33 mL/kg (mean +/- SD) and an elimination clearance of 0.57 +/- 0.17 mL x min(-1) x kg(-1). Our study demonstrates that a single dose of ketorolac (0.5 mg/kg) results in plasma concentrations in the adult therapeutic concentration range for 6 h in most children. Our data provide no evidence that children require either larger weight-adjusted doses or shorter dosing intervals than adults to provide similar plasma drug concentrations. IMPLICATIONS: The literature suggests that ketorolac disposition differs between children and adults. We characterized ketorolac pharmacokinetics in 36 children. Body weight-normalized two-compartment pharmacokinetic variables did not differ among pediatric patients <17 yr old and were similar to adult values.
PMID: 11812682, UI: 21670850
Other Formats:
Eur J Anaesthesiol 2002 Jan;19(1):52-6
Akdeniz University Medical Faculty, Department of Anaesthesiology and Reanimation, Turkey. kara_hanife@hotmail.com
BACKGROUND AND OBJECTIVE: Magnesium has antinociceptive effects in animal and human models of pain. These effects are primarily based on the regulation of calcium influx into the cell. The aim of this study was to determine whether perioperative infusion of magnesium would reduce postoperative pain and anxiety. METHODS: Twenty-four patients, undergoing elective hysterectomy, received a bolus of 30 mg kg(-1) magnesium sulphate or the same volume of isotonic sodium chloride solution intravenously before the start of surgery and 0.5 g h(-1) infusion for the next 20 h. Intraoperative and postoperative analgesia were achieved with fentanyl and morphine respectively. Patients were evaluated pre- and postoperatively for anxiety. RESULTS: Fentanyl consumption and total morphine requirements were significantly decreased in the magnesium group compared to the control group. Postoperative anxiety scores and sedation were similar between groups. CONCLUSIONS: Continuous magnesium infusion, including the pre-, intra-, and postoperative periods reduces analgesic requirements. These results demonstrate that magnesium can be an adjuvant for perioperative analgesic management.
PMID: 11913804, UI: 21910479
Eur J Anaesthesiol 2002 Jan;19(1):47-51
Department of Anesthesiology, Medical Faculty, Trakya University, Edirne, Turkey. dilmemis@mynet.com
BACKGROUND AND OBJECTIVE: To compare the efficacy of tramadol and ondansetron in minimizing the pain due to injection of propofol in 100 patients. METHODS: An intravenous cannula was inserted in the dorsum of the hand. After tourniquet application to the forearm, tramadol 50 mg (Group 1, n = 50) or ondansetron 4 mg (Group 2, n = 50) was injected. The tourniquet was released after 20 s, and propofol 5 mL was administered over 5 s. The patients were observed and asked if they had pain in the arm and the response was assessed. Nausea and vomiting and degree of sedation were recorded for the first postoperative 24 h. RESULTS: Twenty-one patients in Group 1 and 14 patients in Group 2 reported no pain. Slight pain was seen in 15 patients in Group 1 and in 18 patients in Group 2. Moderate pain was seen in 10 patients in Group 1 and 15 patients in Group 2. Severe pain was seen in four of the patients in Group 1 and three patients in Group 2. There was no significant difference of pain between Groups 1 and 2, but we found a significant reduction of nausea and vomiting in the ondansetron group compared with the tramadol group (P = 0.033). CONCLUSIONS: Tramadol or ondansetron are equally effective in preventing pain from propofol injection. The added benefit of a reduction in nausea and vomiting after operation in the ondansetron group may be a reason to prefer this drug.
PMID: 11913803, UI: 21910478
Eur J Pharmacol 2002 Jan 25;435(2-3):187-94
Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Sector 67, Phase-X, S.A.S. Nagar-160 062, Punjab, India.
The role of L-type Ca2+ channels in morphine antinociception was studied in streptozotocin-induced diabetic and control rats, using [3H]PN200-110 [isopropyl 4-(2,1,3-benzoxadiazol-4-yl)-1,4-dihydro-2,6-dimethyl-5-methoxycabonylpyridine-3-caboxylate] binding (0.005-1.0 nmol/l) and rat whole brain membranes, to determine if the attenuation of morphine antinociception was related to alterations in dihydropyridine-sensitive Ca2+ channel binding characteristics. The tail-flick antinociceptive effect of morphine (4 mg/kg, i.p.) was significantly reduced in diabetic rats in comparison to that in controls. Nimodipine (0.1-3 mg/kg, i.p.) did not produce antinociception but significantly potentiated the morphine response in control rats. Nimodipine (0.3-3 mg/kg, i.p.) reversed the attenuation of morphine antinociception in a dose-dependent manner in diabetic rats. Moreover, insulin (2 U/kg, s.c.) [correction of mu/kg] reversed the attenuated morphine antinociception in streptozotocin-diabetic rats. A significant increase in the Bmax (+41%) of [3H]PN200-110 binding was observed in diabetic rat brain membranes compared to that in control rats. However, there was no change in affinity (Kd) value of [3H]PN200-110. The reduced morphine response in diabetic rats, in accordance with up-regulation of dihydropyridine sites, may be due to an increased Ca2+ influx through L-type channels. These results suggest a functional role of L-type Ca2+ channels in morphine antinociception and the diabetic state may lead to alterations in their density.
PMID: 11821025, UI: 21679076
Lancet 2002 Mar 16;359(9310):907-8
Department of Orthopaedic Surgery, Royal Children's Hospital, 3052, Victoria, Parkville, Australia
PMID: 11918905, UI: 21918272
Reg Anesth Pain Med 2002 Mar-Apr;27(2):226-7
PMID: 11915077, UI: 21912606
Reg Anesth Pain Med 2002 Mar-Apr;27(2):214-6
Department of Anesthesiology, Temple University Hospital, Philadelphia, Pennsylvania.
BACKGROUND AND OBJECTIVES: Nerve root pain has been treated with steroid injections since the 1970s. We will describe a novel method for nerve root injection using a directed epidural catheter. Case Report: A case is described where catheter placement accurately reproduced symptoms which were then relieved with local anesthetic and steroid. CONCLUSION: This is a novel approach to treatment of painful nerve roots with a catheter. Reg Anesth Pain Med 2002;27:214-216.
PMID: 11915072, UI: 21912601
Reg Anesth Pain Med 2002 Mar-Apr;27(2):211-3
Departments of Anesthesiology (S.F., S.S., S.N.) and Psychiatry (A.Y.), Shiga University of Medical Science, Shiga, Japan.
BACKGROUND: Recent neuroimaging studies suggested that chronic neuropathic pain may be largely sustained by a complex neuronal network involving the thalamus. Although recent studies have demonstrated the efficacy of electroconvulsive therapy (ECT) in the treatment of a variety of types of chronic neuropathic pain, the effects of ECT on regional cerebral blood flow (rCBF) have not been studied. OBJECTIVES AND METHODS: We present a 50-year-old female postsurgical chronic pain patient whose pain had failed to respond to standard pain treatment, but was resolved by ECT. To investigate the potential role of rCBF in ECT's analgesic effect, we measured significant changes in the rCBF in the thalamus before and after a course of bilateral ECT using technetium-99m ethyl cysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT). RESULTS: 99mTc-ECD SPECT showed a significant bilateral decrease in the thalamus on the side of the pain, and this decreased rCBF in the thalamus increased after ECT. CONCLUSIONS: The results from the SPECT suggest that ECT increases abnormally decreased thalamus activity in chronic neuropathic pain. Reg Anesth Pain Med 2002;27:211-213.
PMID: 11915071, UI: 21912600
Reg Anesth Pain Med 2002 Mar-Apr;27(2):125-31
Department of Anesthesiology and Intensive Care Medicine, University of Bonn (U.M.S., N.M., F.S.), Bonn, Germany; and the Department of Pain Treatment, BG Klinik Bergmansheil Bochum, Ruhr University Bochum, Bochum, Germany.
BACKGROUND AND OBJECTIVES: Acute pain services (APS) have been introduced worldwide to improve postoperative pain management. However, data are lacking on organization and quality of these services in Germany. METHODS: A questionnaire on postoperative pain management was mailed to 773 departments of anesthesiology. Practice was compared between hospitals with and without APS and between services that did or did not meet basic quality criteria (QC): personnel assigned for APS, policies during nights and weekends, written protocols of pain management, and regular assessment and documentation of pain scores at least once a day. RESULTS: With 446 responding hospitals, 161 operated an APS. Large hospitals organized an APS more frequently than smaller hospitals (P <.001). Staff being assigned for the APS comprised anesthesiologists in 68.3% and nurses in 23.6% of the departments. In total, only half of the APS complied with basic QC. Regular assessment and documentation of pain scores were the QC most often missing (46.6%). Patient-controlled analgesia (PCA) was performed in 93.8%, 74.1%, and 69.8% of the departments providing APS with QC, APS without QC, and no APS. Epidural analgesia (EA) was available in nearly all departments (96.9%). A total of 75.6% of the departments performed EA on general wards (with QC: 93.8%, without QC: 82.7%, and no APS: 68.4%, P <.001). Frequency of PCA and EA use was highest in hospitals providing an APS with QC. CONCLUSIONS: As 50% of German APS do not comply with QC, we believe structured policies, as well as quality assurance measures, should be emphasized in the future. A comparison to international survey data showed that APS, in general, often do not consider QC. Reg Anesth Pain Med 2002;27:125-131.
PMID: 11915057, UI: 21912586
Reg Anesth Pain Med 2002 Mar-Apr;27(2):117-21
Department of Anesthesiology, Orebro Medical Centre Hospital, Orebro, Sweden.
PMID: 11915055, UI: 21912584
Spine 2002 Apr 1;27(7):E177-E184
Undergraduate Medical Programme, McMaster University, Hamilton, Ontario, Canada, the; Ocean Walk Physiotherapy Clinic, Vancouver, British Columbia, Canada, the; School of Rehabilitation Science McMaster University, Hamilton, Ontario, Canada, and Supportive Cancer Care Research Unit, Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada, the; University Health Network, University of Toronto, Toronto, Ontario, Canada, previously at the; Department of Clinical Epidemiology; Department of Clinical Epidemiology.
[Record supplied by publisher]
STUDY DESIGN: A systematic review was conducted for studies of any design. OBJECTIVES: To evaluate the effectiveness and safety of dorsal root entry zone lesioning in treating central neuropathic pain of patients with traumatic spinal cord injury. SUMMARY OF BACKGROUND DATA: Central neuropathic pain has a great impact on the quality of life of many patients with traumatic spinal cord injury. Dorsal root entry zone lesioning has become one of several treatment options. No previous systematic reviews were found that address this indication for the procedure. METHODS: Several computerized databases were searched along with reference lists of eligible articles and personal files of advisory panel members. Only primary studies of patients older than 13 years with both traumatic spinal cord injury and central neuropathic pain receiving dorsal root entry zone lesioning were included. Two assessors independently performed data extraction and quality assessment for all the studies. RESULTS: The selection criteria were met by 11 studies. All were case series of 5 to 54 patients. As reported by 10 of the studies, at least 50% of the patients attained more than 50% pain relief or experienced no pain limitation of activity and no need for narcotics. However, all the studies had poorly defined eligibility criteria or none at all, no control groups, and inadequate reporting of adverse effects. Only one study provided adequate patient description. None of the studies reported the validity, reliability, or responsiveness of outcome measures. CONCLUSIONS: Reviewed studies indicate promising results from dorsal root entry zone lesioning for the treatment of central neuropathic pain in selected patients with traumatic spinal cord injury. However, the strength of the evidence provided by the studies was poor in terms of study design, outcome measures, reports on the severity of adverse effects, patient selection criteria, and patient description. For these reasons, the evidence is weak for the use of dorsal root entry zone lesioning to relieve central neuropathic pain in patients with traumatic spinal cord injury.
PMID: 11923674
the above reports in Macintosh PC UNIX Text HTML format documents on this page through Loansome Doc