Effect of location on out-of-hospital cardiac arrests involving older adults in Hong Kong: secondary analysis of a territory-wide cohort.

INTRODUCTION: Most out-of-hospital cardiac arrests in Hong Kong involve older adults. The likelihood of survival varies among locations. This study investigated patient and bystander characteristics, as well as the timing of interventions, that affect the prevalences of shockable rhythm and survival outcomes among cardiac arrests involving older adults in homes, on streets, and in other public places. METHODS: This secondary analysis of a territory-wide historical cohort used data collected by the Fire Services Department of Hong Kong from 1 August 2012 to 31 July 2013. RESULTS: Bystander cardiopulmonary resuscitation was primarily performed by relatives in homes but not in non-residential locations. The intervals in terms of receipt of emergency medical services (EMS) call, initiation of bystander cardiopulmonary resuscitation, and receipt of defibrillation were longer for cardiac arrests that occurred in homes. The median interval for EMS to reach patients was 3 minutes longer in homes than on streets (P<0.001). Forty-seven percent of patients who developed cardiac arrest on streets had a shockable rhythm within the first 5 minutes after receipt of EMS call. Defibrillation within 15 minutes after receipt of EMS call was an independent predictor of 30-day survival (odds ratio=4.07; P=0.02). Fifty percent of patients who received defibrillation within 5 minutes in non-residential locations survived. CONCLUSION: There were significant location-related differences in patient and bystander characteristics, interventions, and outcomes among cardiac arrests involving older adults. A large proportion of patients had a shockable rhythm in the early period after cardiac arrest. Good survival outcomes in out-of-hospital cardiac arrests involving older adults can be achieved through early bystander defibrillation and intervention.

Painful ophthalmoplegia. The Tolusa-Hunt syndrome.

A 36-year-old man had the Tolusa-Hunt syndrome, an unusual cause of painful ophthalmoplegia with a neurologic deficit that may not be distinguishable from the many other disease processes that involve the orbital apex. Diagnosis was made by excluding the other causes, and there was a prompt response to high-dose steroid therapy, which prevents or minimizes any permanent neurologic deficit. Because of this and the fact that the otolaryngologist is often involved in the diagnosis and treatment of the many causes of painful ophthalmoplegia, it is important to be aware of this syndrome.

Luetic hearing loss.

Luetic hearing loss has been noted with increasing frequency in recent years. Four cases of luetic hearing loss seen at Walter Reed General Hospital from 1974 to 1975 are presented and discussed. Symptoms and pathology of luetic involvement of the inner ear are also presented. Serum FTA-ABS and TPI, in addition to VDRL, must be routinely obtained during the workup of hearing loss. CSF FTA-ABS should be obtained if serum FTA-ABS and TPI are positive. Reversibility may be dependent on early detection of luetic hearing loss and treatment with high doses of antibiotics and steroids.

Intranasal mixed tumors (pleomorphic adenomas): a clinicopathologic study of 40 cases.

The clinical, gross, and microscopic features of 40 cases of intranasal mixed tumor (pleomorphic adenoma) are reviewed and studied. The majority of these neoplasms originate from the mucosa of the bony or cartilaginous septum; they also occur on the lateral nasal wall. They may be found at any age, but the majority of our cases occurred in persons in the third through sixth decades of life. There was no significant sex predilection. All patients whose race was recorded (35) were Caucasian. The patients commonly had symptoms of nasal obstruction or the presence of a mass in the nasal cavity, or both. Clinically, the lesions were not unique, frequently being described only as polypoid, broad-based swellings. Microscopically, although similar to mixed tumors of major salivary glands, these tumors differed by being highly cellular (epithelial), with little or no stromal component, and thus simulated more aggressive epithelial neoplasms. Follow-up data (mean 7.5 years) in 34 of the 40 cases showed no evidence to suggest aggressive behavior. Thirty-one of the 34 cases followed showed no recurrence, regardless of the type of excisional procedure used. Those that did recur were either persistent from inadequate primary excisions (2 cases) or recurred locally (1) and were removed without sequelae. Local but adequate excision appears to be the treatment of choice.