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3.
Stud Health Technol Inform ; 103: 315-26, 2004.
Article in English | MEDLINE | ID: mdl-15747936

ABSTRACT

This paper reports the results of the first of the two systems developed by JUST, a collaborative project supported by the European Union under the Information Society Technologies (IST) Programme. The most innovative content of the project has been the design and development of a complementary training course for non-professional health emergency operators, which supports the traditional learning phase, and which purports to improve the retention capability of the trainees. This was achieved with the use of advanced information technology techniques, which provide adequate support and can help to overcome the present weaknesses of the existing training mechanisms.


Subject(s)
CD-I , Emergency Treatment , Internet , Teaching/methods , Volunteers/education , Adolescent , Adult , Clinical Competence , Computer Simulation , Emergency Medical Technicians/education , Female , Humans , Male , Middle Aged
8.
Resuscitation ; 48(3): 199-205, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11278083

ABSTRACT

The European Resuscitation Council (ERC) last issued guidelines for Basic Life Support (BLS) in 1998 [1]. These were based on the "Advisory Statements" of the International Liaison Committee on Resuscitation (ILCOR) published in 1997 [2]. Following this, the American Heart Association, together with representatives from ILCOR, undertook a series of evidence-based evaluations of the science of resuscitation [3] which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" in August 2000 [4,5]. The Basic Life Support and Automated External Defibrillation Working Group (BLS&AED Group) has considered this document and has recommended changes in the ERC BLS guidelines. These are presented in this paper.


Subject(s)
Airway Obstruction/therapy , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Adult , Airway Obstruction/diagnosis , Heart Arrest/diagnosis , Humans , Pulmonary Ventilation/physiology , Pulse
9.
Resuscitation ; 48(3): 207-9, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11278084

ABSTRACT

The European Resuscitation Council (ERC) last issued guidelines for Automated External Defibrillators (AEDs) in 1998 [1]. The American Heart Association, together with representatives from the International Liaison Committee on Resuscitation (ILCOR), then undertook a series of evidence-based evaluations of the science of resuscitation [2] which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" in August 2000 [3,4]. The Basic Life Support and Automated External Defibrillation Working Group (BLS&AED Working Group of the ERC) has considered this document and has recommended changes in the ERC AED guidelines. These are presented in this paper.


Subject(s)
Cardiopulmonary Resuscitation , Electric Countershock/methods , Heart Arrest/therapy , Algorithms , Cardiopulmonary Resuscitation/methods , Humans , Shock/therapy
10.
Resuscitation ; 44(3): 215-8, 2000 May.
Article in English | MEDLINE | ID: mdl-10825623

ABSTRACT

Kawasaki disease (KD) is an uncommon cause of sudden death in young adults in Europe. Angiographically, the disease is characterized by coronary artery aneurysms which can be fully obstructed by acute thrombosis or by progression of the disease. If diagnosis of KD is made, immediate investigation should be made to determine whether ischemia is occurring and if so, to establish optimal time for revascularisation or cardiac transplantation. We describe an 18-year-old Caucasian male who was not previously known to have KD and who suffered from an acute myocardial infarction complicated by ventricular fibrillation, caused by acute thrombosis of a coronary artery aneurysm.


Subject(s)
Mucocutaneous Lymph Node Syndrome/complications , Ventricular Fibrillation/etiology , Adolescent , Coronary Thrombosis/etiology , Electrocardiography , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/etiology , Humans , Male , Mucocutaneous Lymph Node Syndrome/drug therapy , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Radiography, Thoracic
11.
Neurology ; 54(7): 1433-41, 2000 Apr 11.
Article in English | MEDLINE | ID: mdl-10751252

ABSTRACT

OBJECTIVE: After implicating Streptococcus pyogenes as causing acute disseminated encephalomyelitis (ADEM) in a child, we wanted to prove that in vivo activation of autoreactive T lymphocytes by superantigens of this Streptococcus contributed to the dramatic demyelination. BACKGROUND: ADEM is a demyelinating disorder of the CNS sharing many similarities with MS. Demyelination in MS is considered to be the result of an autoimmune process mediated by autoreactive T lymphocytes with specificity for myelin antigens. METHODS: Phenotypic analysis and proliferation assays on blood monocytes, as well as isolation of myelin basic protein (MBP)-reactive T-cell lines/clones; and TCR repertorium analysis by PCR-ELISA and cytokine production. RESULTS: 1) The blood T-cell receptor (TCR) repertoire was compatible with in vivo expansion induced by S. pyogenes exotoxins. 2) TCR expression analysis indicated clonal expansion of CD8+ MBP-reactive T cells, suggesting in vivo activation. MBP-reactive T cells showed crossreactivity to S. pyogenes supernatant and exotoxins. 3) Cytokine mRNA quantification of the mononuclear cells revealed a Th2-biased profile. CONCLUSION: In vivo exposure to S. pyogenes may have induced activation of pathogenic myelin reactive T cells, contributing to the dramatic inflammatory demyelination.


Subject(s)
Autoimmunity/immunology , Encephalomyelitis, Acute Disseminated/immunology , Exotoxins/immunology , Myelin Sheath/immunology , Streptococcal Infections/immunology , Streptococcus pyogenes/isolation & purification , Brain/pathology , CD8-Positive T-Lymphocytes/cytology , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , Cells, Cultured , Child, Preschool , Cross Reactions/immunology , Cytokines/metabolism , Encephalomyelitis, Acute Disseminated/diagnosis , Encephalomyelitis, Acute Disseminated/drug therapy , Encephalomyelitis, Acute Disseminated/microbiology , Humans , Immunophenotyping , Magnetic Resonance Imaging , Male , Myelin Basic Protein/immunology , Quadriplegia/etiology , Streptococcal Infections/diagnosis , Superantigens/immunology
12.
Resuscitation ; 36(1): 37-44, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9547842

ABSTRACT

The aim of the study was to develop a scoring system for outcome classification at the start of prehospital first tier resuscitation for patients with cardiac arrest from ventricular fibrillation (VF). We studied a consecutive sample of 100 out-of-hospital cardiac arrest patients, presenting with VF of presumed cardiac etiology on arrival of the first tier (in a two-tiered urban Emergency Medical Services system). The number of patients discharged was 29 ('survivors') and 71 died ('non-survivors'). The electrocardiography (ECG) tracings recorded during resuscitation using a semi-automatic defibrillator were retrospectively analysed. For each patient, VF amplitude in mV (VF_a) and the number of base-line crossings per second (VF_blc) were calculated. Fisher's linear discriminant analysis was applied to discriminate between survivors and non-survivors using the variables VF_a, VF_blc and age. Patients were classed as potential survivors or non-survivors using a survival index = 0.6*(VF_a) + 0.4*(VF_blc)-4.0. If for a given patient the survival index is < 0, he is classified in the non-survivor group, if the survival index is > 0, he is classified in the survivor group. Using this index 79% of the survivors and 70% of the non-survivors could be classified correctly. Adding age to the formula increased the correct classification of survivors to 86 and 73% for the non-survivors. The survival index provides a research tool for the discrimination between potential survivors and non-survivors, which opens the possibility for the development of alternative treatment protocols in cardiac arrest.


Subject(s)
Cardiopulmonary Resuscitation , Electrocardiography , Heart Arrest/mortality , Ventricular Fibrillation/mortality , Aged , Algorithms , Discriminant Analysis , Electric Countershock , Female , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Prognosis , Retrospective Studies , Severity of Illness Index , Ventricular Fibrillation/complications , Ventricular Fibrillation/therapy
13.
Hum Exp Toxicol ; 16(10): 600-1, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9363478

ABSTRACT

Amitraz, 1,5 di-(2,4-dimethylphenyl)-3-methyl-1,3,5-triaza-penta-1,4-diene, a formamidine pesticide, is used worldwide. It causes side-effects in animals that resemble those caused by pure alpha 2-adrenergic agonist drugs such as clonidine. Data on poisonings in humans are scanty. We report on a case of human poisoning with amitraz with typical signs of alpha 2-adrenoreceptor stimulation.


Subject(s)
Insecticides/poisoning , Toluidines/poisoning , Blood Pressure/drug effects , Bradycardia/chemically induced , Coma/chemically induced , Heart Rate/drug effects , Humans , Male , Middle Aged , Receptors, Adrenergic, alpha-2/drug effects , Toluidines/blood , Toluidines/pharmacokinetics
16.
Cytokine ; 8(11): 873-6, 1996 Nov.
Article in English | MEDLINE | ID: mdl-9047084

ABSTRACT

Although elevated concentrations of a few cytokines have been shown to be present in the bronchoalveolar lavage (BAL) fluid (BALF) of patients with the acute (adult) respiratory distress syndrome (ARDS), the pathogenesis of ARDS is largely unknown. Leukaemia inhibitory factor (LIF), a growth factor recently recognised as a polyfunctional cytokine integrated in cytokine networks was measured in unconcentrated BALF of patients from different patient groups. LIF was measured in BALF by means of a specific and sensitive ELISA (detection limit 10 pg/ml) in BALF (lavage of 3 x 50 ml in the right middle lobe). LIF was not detected in the BALF of 13 healthy control patients and in only one (34 pg/ml) out of 25 patients at risk for ARDS (after cardiopulmonary bypass surgery) who underwent BAL 4 h after the end of the extracorporeal circulation. High and detectable levels were found in the unconcentrated BALF of 10 out of 12 patients with full-blown ARDS (212 +/- 116, mean +/- SEM, range 10-985 pg/ml). There was a good correlation between the level of LIF in the BALF and a number of markers of inflammation such as neutrophils/ml, albumin and protein levels. The biological role of LIF in these BALFs is not readily explained by its currently known actions and it is unknown whether LIF contributes to or is a response to local tissue damage. Our results indicate that this cytokine is part of the inflammatory cytokine cascade in ARDS.


Subject(s)
Bronchoalveolar Lavage Fluid/chemistry , Growth Inhibitors/metabolism , Interleukin-6 , Lymphokines/metabolism , Respiratory Distress Syndrome/metabolism , Adult , Aged , Enzyme-Linked Immunosorbent Assay , Female , Humans , Infant, Newborn , Leukemia Inhibitory Factor , Male , Middle Aged
17.
Resuscitation ; 32(3): 213-6, 1996 Oct.
Article in English | MEDLINE | ID: mdl-8923584

ABSTRACT

A patient with an acute myocardial infarction had to be resuscitated due to recurring ventricular fibrillation. After stabilisation, she received thrombolytic treatment with anistreplase. Fourteen hours later, clinical signs of hemoperitoneum developed and the diagnosis of liver rupture was made. After abdominal surgery and coronary revascularisation, the subsequent clinical course was uncomplicated. The literature on liver trauma after CPR as well as thrombolysis in association with CPR is reviewed. This observation suggests that there are no convincing arguments to withhold thrombolytic therapy in acute myocardial infarction after CPR in the absence of gross trauma. We stress that a high degree of clinical alertness is necessary to diagnose this life-threatening condition because of its frequent subacute evolution in patients that are per se hemodynamically unstable.


Subject(s)
Cardiopulmonary Resuscitation/adverse effects , Liver/injuries , Thrombolytic Therapy , Ventricular Fibrillation/therapy , Adult , Female , Humans , Myocardial Infarction/drug therapy , Rupture
18.
Eur J Nucl Med ; 23(7): 748-55, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8662112

ABSTRACT

Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to underestimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of 99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest 99mTc-sestamibi SPET, low-dose dobutamines stress echocardiography and quantitative coronary angiography were performed in 51 patients with a recent myocardial infarction. Perfusion activity and regional wall motion were scored semi-quantitatively using the same segmental division of the left ventricle. Assessment of 99mTc-sestamibi uptake as a marker of viability was performed by comparing a binary uptake score (viable=>50% vs necrotic =/=65%-100%) and particularly those with "late" reperfusion therapy (time delay >/=180 min). In patients without a severe infarct-related stenosis, 99mTc-sestamibi was able to accurately distinguish viable from necrotic segments. Thus, rest 99mTc-sestamibi scintigraphy early after acute myocardial infarction may underestimate residual viability within the infarct region, particularly in patients with low flow state coronary anatomy, as a result of a severe infarct-related stenosis and/or late reperfusion therapy.


Subject(s)
Cardiotonic Agents , Coronary Disease/complications , Dobutamine , Echocardiography , Myocardial Infarction/diagnostic imaging , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon , Coronary Angiography/methods , Coronary Disease/diagnostic imaging , Female , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Myocardial Infarction/etiology , Prospective Studies
19.
Resuscitation ; 30(2): 127-31, 1995 Oct.
Article in English | MEDLINE | ID: mdl-8560101

ABSTRACT

Many emergency medical service (EMS) systems are currently implementing semi-automatic external defibrillation (AED) by emergency medical technicians. Surprisingly little information is available on the possible interactions between AEDs and implanted cardiac pacemakers. Therefore, at present there are no clear guidelines for the use of AEDs on patients having a cardiac pacemaker. During resuscitation, multiple interactions between pacemakers and AEDs are possible. External defibrillation can cause damage to several functions of the pacemaker. On the other hand, the presence of pacemaker spikes during cardiac arrest might prohibit recognition of the ventricular fibrillation by the AED. We report on two resuscitation attempts in which the interaction between the ventricular fibrillation, an implanted dual chamber pacemaker and the AED was decisive for the defibrillation success. A clear understanding of these possible interactions is necessary for the further refining of diagnostic algorithms and clinical strategies of prehospital defibrillation.


Subject(s)
Electric Countershock , Pacemaker, Artificial , Resuscitation , Adult , Aged , Algorithms , Automation , Cardiac Pacing, Artificial , Emergency Medical Services , Emergency Medical Technicians , Equipment Design , Equipment Failure , Heart Arrest/therapy , Heart Block/therapy , Humans , Male , Pattern Recognition, Automated , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/therapy
20.
Eur Heart J ; 16(9): 1186-94, 1995 Sep.
Article in English | MEDLINE | ID: mdl-8582380

ABSTRACT

The purpose of this study was to evaluate the accuracy of adenosine Tc-99m sestamibi single photon emission computed tomography (SPECT) in the detection of jeopardized myocardium early after acute myocardial infarction. Coronary arteriography and myocardial scintigraphy were performed in 50 consecutive patients with an uncomplicated myocardial infarction. Myocardium was considered jeopardized if a significant infarct-related vessel stenosis (> 50% diameter stenosis) supplied an infarct area with residual viable tissue. Perfusion reversibility in the infarct region occurred in 25 patients (50%) and was almost solely observed in the presence of jeopardized myocardium. Non-reversible perfusion defects in the infarct region were found in patients without jeopardized myocardium. This subgroup consisted of either patients without significant vessel stenosis or patients without significant residual viability in the infarct region. Adenosine Tc-99m sestamibi SPECT had an accuracy of 88% for the detection of jeopardized myocardium. Side effects during adenosine infusion were frequently observed but well tolerated. These results suggest that adenosine Tc-99m sestamibi SPECT is an accurate non-invasive method for detecting jeopardized myocardium after acute myocardial infarction and may be a valuable non-invasive test for the early selection of patients at risk for future ischaemic events.


Subject(s)
Adenosine , Cardiovascular Agents , Myocardial Infarction/diagnostic imaging , Myocardium/pathology , Tomography, Emission-Computed, Single-Photon , Adenosine/administration & dosage , Adenosine/adverse effects , Aged , Cardiovascular Agents/administration & dosage , Coronary Vessels/diagnostic imaging , Evaluation Studies as Topic , Female , Heart/diagnostic imaging , Humans , Infusions, Intravenous , Male , Middle Aged , Myocardial Infarction/diagnosis , Sensitivity and Specificity , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon/methods
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