Analysis of the Time-Dependent Changes of Chest Compression Quality and Related Rescuer Factors in Cardio-Pulmonary Resuscitation by Lay-Persons

PURPOSE: The study evaluated changes in the quality of chest compressions over 2 min in 30:2 cardio-pulmonary resuscitation (CPR) by lay-persons and analyzed rescuer factors affecting the quality of chest compressions over time. METHODS: CPR training courses attended by 538 adult hospital and university workers (lay-person) were conducted at a university hospital. After 4-hour CPR training, tests were performed using a manikin with Skill-ReporterTM. Data of 459 subjects were analyzed concerning the quality of chest compressions over time and rescuer factors such as age, gender, body mass index, prior CPR training and CPR experience were also analyzed to determine their effect on the change in the quality of chest compressions. RESULTS: Compression depth (p=0.002) showed significant change over 2 min, but the rate (p=0.133), chest recoil (p=0.442) and hand placement (p=0.991) were insignificant. Ineffective compression depth (mean proportions of correct depth<70%) was not observed during the 2 min CPR. Female gender (p<0.001; OR, 5.882, 95% CI, 3.098-11.167) and no CPR training (p=0.004; OR, 2.163, 95% CI, 1.277-3.663) were associated with decline of compression depth. Time-dependent analysis revealed significant ineffective compression depth (<70%) in females and underweight patients (p<0.001). CONCLUSION: Switching compressors at an interval of 2 min is reasonable for 30:2 CPR by lay-persons. But, significant decline of correct compression depth over time in female and underweight rescuers was evident.

Combined Hyperactive Dysfunction Syndrome of the Cranial Nerves

OBJECTIVE: Combined hyperative dysfunction syndrome (HDS) defined as the combination of HDSs such as trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN), which may or may not occur simultaneously on one or both sides. We reviewed patients with combined HDS and demonstrated their demographic characteristics by comparing them with those of patients with a single HDS. METHODS: Between October 1994 and February 2006, we retrospectively studied a series of 1,720 patients who suffered from HDS and found 51 patients with combined HDSs. We analyzed several independent variables in order to evaluate the prevalence and etiologic factors of combined HDS. RESULTS: The combined HDS group accounted for 51 of 1,720 (2.97%) patients with HDS; 27 cases of bilateral HFS, 10 cases of bilateral TN and 14 cases of HFS with TN. Their mean age was 52.1 years (range, 26-79 years). There were 5 men and 46 women. Seven patients had synchronous and 44 patients metachronous onset of HDSs. By comparison of combined and single HDS groups, we found that age and hypertension were closely associated with the prevalence of combined HDS (p < 0.05). CONCLUSION: This study revealed that combined HDS was very rare. Hypertension and age might be the most important causative factors to evoke combined HDS.

Spinal Cord Hemangioblastoma: Diagnosis and Clinical Outcome after Surgical Treatment

OBJECTIVE: Spinal cord hemangioblastoma is an uncommon vascular neoplasm with a benign nature and is associated with von Hippel-Lindau (VHL) disease in 20-30% of patients. Total removal of these tumors without significant neurological deficit remains a great challenge. The purpose of this study was to investigate the efficacy of VHL mutation analysis and to evaluate surgical outcome of patients with spinal cord hemangioblastomas. METHODS: This study included nine patients treated for spinal cord hemangioblastomas at our institute between December 1994 and March 2006. There were four male and five female patients. Mean age was 37.8 years. The mean follow-up period was 22.4 months. Magnetic resonance imaging (MRI) of the complete neuraxis was done in all cases and VHL mutation analysis was performed in three cases for a definite diagnosis. RESULTS: Six patients had intramedullary tumor, and the remaining patients had intradural extramedullary lesions. Five patients were associated with VHL disease. The von Hippel-Lindau mutation analysis was done in three patients and two of them showed VHL gene abnormality. Tumors were located in the cervical cord in five cases and in the thoracic cord in four cases. All patients underwent surgical intervention, and total removal was achieved in six cases. All patients showed improvement or, at least, clinically stationary state. Surgical complications did not develop in any cases. CONCLUSION: Spinal hemangioblastoma in this series has been safely and effectively removed via a posterior approach. Postoperatively, clinical outcome was excellent in the majority of cases. The VHL mutation analysis was useful in patients with family history and in those with multiple hemangioblastomas.