ABSTRACT
BACKGROUND: We modified the dispatch protocol for cardiopulmonary resuscitation (CPR) using results of a retrospective analysis that identified descriptions by laypersons of possible patterns of agonal respiration. The purpose of this study was to assess the effectiveness of this modified protocol by comparing the frequency of dispatch instructions for CPR and bystander CPR before and after protocol implementation. We also identified descriptions of abnormal breathing patterns among 'Not in cardiac arrest (CA)' unresponsive cases. METHODS: This study was conducted prospectively using the population-based registry of out-of-hospital cardiac arrests (OHCAs). For 8 months we implemented this modified protocol in cooperation with 4 fire departments that cover regions with a total population of 840,000. RESULTS: There were 478 and 427 OHCAs before and after implementation, respectively. Among them, 69 and 71 layperson-witnessed OHCAs for pre- and post-implementation, respectively, were analyzed. Dispatchers provided CPR instructions more frequently after protocol implementation than before (55/71 [77.5 %] vs. 41/69 [59.4 %], p < 0.05). Based on breathing patterns described by emergency callers, dispatchers assessed 143 'Not in CA' unresponsive cases and provided CPR instruction for 45 cases. Sensitivity and specificity of this protocol was 93 % and 50 %, respectively. CONCLUSIONS: This modified protocol based on abnormal breathing described by laypersons significantly increased CPR instructions. Considering high sensitivity and low specificity for abnormal breathing to identify CA and the low risk of chest compression for 'Not in CA' cases, our study suggested that dispatchers can provide CPR instruction assertively and safely for those unresponsive individuals with various abnormal breathing patterns.
Subject(s)
Cardiopulmonary Resuscitation , Emergency Medical Service Communication Systems/organization & administration , Emergency Medical Services/organization & administration , Out-of-Hospital Cardiac Arrest/therapy , Aged , Aged, 80 and over , Female , Humans , Male , Prospective Studies , Registries , Retrospective Studies , Sensitivity and SpecificityABSTRACT
OBJECTIVES: The effect of adjuvant radiation therapy (RT) in extrahepatic bile duct (EHBD) cancer patients with microscopic-positive resection margins (R1 resection) is still controversial. METHODS: Between January 2000 and March 2010, 52 patients with EHBD cancer underwent surgery at our institution, of whom 36 were subjected to a retrospective analysis. Eleven patients received adjuvant RT after resection [surgery (S)+RT group], which included 9 patients with R1 resection and 2 with para-aortic lymph node metastasis. Their oncological outcomes were analyzed and compared with those of the 25 patients with R0 resection who did not receive adjuvant RT (S group). RESULTS: Patients in the S+RT group had significantly more advanced disease than those in the S group. However, there was no significant difference in disease-free survival or overall survival between the 2 groups. Median survival times for the S+RT and the S groups were 44 and 47 months, respectively, whereas the 5-year survival rates were 38.9% and 46%, respectively (P=0.707). Locoregional recurrence was less frequent in the S+RT group as compared with the S group, but the incidence of distant metastasis was unaffected by the adjuvant RT. CONCLUSIONS: Our results support the beneficial effect of adjuvant RT in EHBD cancer patients with R1 resection. This effect seems to result from an improved control of the locoregional tumor by adjuvant RT.
Subject(s)
Bile Duct Neoplasms/pathology , Bile Ducts, Extrahepatic/pathology , Neoplasm Recurrence, Local/pathology , Neoplasm, Residual/pathology , Radiotherapy, Adjuvant , Adult , Aged , Aged, 80 and over , Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/radiotherapy , Bile Duct Neoplasms/surgery , Bile Ducts, Extrahepatic/radiation effects , Bile Ducts, Extrahepatic/surgery , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/radiotherapy , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Neoplasm, Residual/mortality , Neoplasm, Residual/radiotherapy , Neoplasm, Residual/surgery , Prognosis , Retrospective Studies , Survival RateABSTRACT
BACKGROUND/AIMS: Similar oncological outcomes of laparoscopic and open surgery for advanced colon cancer have been reported by several large-scale studies. Whether those results are applicable to community hospitals is questionable. METHODOLOGY: From January 2007 to December 2010, 95 patients with colon cancer underwent laparoscopic surgery at Seirei Mikatahara General Hospital. Of these, 40 patients with pathological stage II/III colon cancer were subjected to this retrospective analysis (laparoscopic resection (LAP) group). Their outcomes were compared with those of 58 patients with pathological stage II/III colon cancer who underwent open surgery between January 2005 and December 2006 (open resection (OP) group). RESULTS: Surgical complications were significantly less frequent in the LAP group than in the OP group. Three-year disease-free survival (DFS) and overall survival (OS) for stage II colon cancer were 88.9% and 100% in the LAP group, and 90% and 86.7% in the OP group (p=0.976 and p=0.285), respectively. Three-year DFS and OS for stage III colon cancer were 85.4% and 86.9% in the LAP group, and 75.3% and 83.8% in the OP group (p=0.613 and p=0.837), respectively. CONCLUSIONS: Laparoscopic surgery for advanced colon cancer seems feasible and the oncological outcome is adequate in a community hospital setting.
Subject(s)
Colectomy/methods , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Laparoscopy , Adult , Aged , Aged, 80 and over , Blood Loss, Surgical , Colectomy/adverse effects , Disease-Free Survival , Female , Hospitals, Community , Humans , Kaplan-Meier Estimate , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
A 73-year-old man underwent coronary artery bypass grafting, abdominal aortic aneurysm resection, and prosthetic implantation as a single procedure in 2002. His progress was favorable until April 2008, when he was admitted to our hospital with melena. B-mode ultrasonography revealed a 5-mm defect in the abdominal aorta at the graft anastomosis, and an umbilicated lesion was seen projecting between the posterior wall of the third part of the duodenum and the abdominal aorta. A color signal was noticed at this site on color Doppler ultrasonography, leading to the diagnosis of a secondary aortoduodenal fistula (ADF). We resected the inflammatory mass comprising the graft and the third part of the duodenum, and performed prosthetic re-implantation, omentopexy, and duodenojejunostomy. We could not find any previous reports of successful identification of secondary ADF using ultrasonography. When a patient with gastrointestinal hemorrhage following reconstructive aortic surgery is encountered in the emergency department, ultrasonography may be considered to be a useful modality in the diagnosis of secondary ADF.
