Background:Initial blood ammonia level is associated with neurologic outcomes in out-of-hospital cardiac arrest (OHCA). We tested the usefulness of blood ammonia for prediction of long-term ...neurological outcome of OHCA.Methods and Results:A total of 3,011 hospitalized adult OHCA patients were enrolled. Blood samples were obtained at the ED. Cut-offs (ammonia <100 μmol/L and lactate <12 mmol/L) were determined in a previous study. Neurological outcomes in survivors were assessed at 3 months. A logistic regression model with adjustment for within-hospital clustering and other risk factors was used to evaluate the association between biomarkers and outcomes. Of 3,011 patients, 380 (13.8%) had favorable neurological outcomes. Ammonia and lactate predicted neurological outcome with an AUC of 0.80 (95% CI: 0.76–0.84) and 0.77 (95% CI: 0.72–0.82), respectively. Adjusted OR for ammonia <100 μmol/L (4.55; 95% CI: 2.67–7.81) was higher than that for lactate <12 mmol/L (2.63; 95% CI: 1.61–4.28) and most other risk factors, such as cardiac etiology (3.47; 95% CI: 2.55–4.72), age<80 years (3.16; 95% CI: 2.17–4.61), bystander CPR (2.39; 95% CI: 1.70–3.38), and initial rhythm shockable (1.66; 95% CI: 1.16–2.37). The combination of ammonia and lactate had an increased predictive value (AUC, 0.86; 95% CI: 0.85–0.87) compared with that without biomarkers (AUC, 0.81; 95% CI: 0.80–0.82).Conclusions:Initial blood ammonia level is as useful as other traditional prognostic indicators such as lactate. Measurement of both initial blood ammonia and lactate helped accurately predict neurological outcomes after OHCA.
Little is known about the risk of metachronous liver metastases following laparoscopic resection for gastrointestinal malignancies. The effect of CO2 pneumoperitoneum on the growth of established ...liver micrometastases was investigated in a rabbit model. Male Japanese white rabbits weighing 2.8 to 3.3 kg were randomized to three groups (n= 15 per group) 3 days following intraportal inoculation of a tumor suspension containing 5 × 104 cells of VX2 cancer. In the pneumoperitoneum group, insufflation with CO2 was maintained at a pressure of 10 mmHg for 30 minutes. In the laparotomy group the abdominal cavity remained open through a 45 mm midline incision for 30 minutes; in the control group no treatment other than anesthesia was performed. Cancer nodules on the liver surface were compared among the three groups on day 17. There was no difference in the number of cancer nodules among the groups (p= 0.72). A significant difference in the total area of cancer nodules (mean ± SEM) was found only between the pneumoperitoneum group (696.0 ± 177.0 mm2) and the control group (247.2 ± 60.7 mm2) (p < 0.05). The frequency of cancer nodules larger than 3.0 mm in maximal diameter tended to be highest in the pneumoperitoneum group (p= 0.053). These results suggests that CO2 pneumoperitoneum may promote the growth of established liver micrometastases in this animal model.
Aim
The current study compares pre‐ and in‐hospital management and outcomes of out‐of‐hospital cardiac arrest cases between 2002 and 2012 in the Kanto region of Japan.
Methods
We compared the data ...collected for the SOS‐KANTO study project in 2002 and 2012. We included adult patients (aged >18 years) who experienced bystander‐witnessed out‐of‐hospital cardiac arrest of cardiac etiology. The outcomes were as follows: proportion of favorable neurological outcomes at 1 month, bystander cardiopulmonary resuscitation provision, and pre‐ and postresuscitation treatment administration.
Results
Of 4,171 patients (1,982 in SOS‐KANTO in 2002 and 2,189 in 2012), the proportion of those with favorable neurological outcomes at 1 month (4.8% versus 9.0%, P < 0.001), and bystander cardiopulmonary resuscitation rates increased significantly between 2002 and 2012 (24.5% versus 38.9%, P < 0.001). Although none were documented in 2002, 118 cases (5.4%) of layperson use of an automated external defibrillator were recorded in 2012. Relative to 2002, use of an i.v. line to provide fluid was more frequently attempted and carried out successfully by emergency medical service providers in 2012. Among cases in which return of spontaneous circulation was achieved, more postresuscitation treatment was provided in 2012 (13.3% versus 43.8%, P < 0.001) relative to that provided in 2002.
Conclusions
Proportions of bystander cardiopulmonary resuscitation, layperson use of automated external defibrillator, provision of prehospital adrenaline and postresuscitation treatment, and favorable neurological outcomes at 1 month increased significantly over 10 years in the Kanto region of Japan.
Antiarrhythmic drugs (AAD) are often used for fatal ventricular arrhythmias during cardiopulmonary resuscitation (CPR). However, the efficacy of initial AAD administration during CPR in improving ...long-term prognosis remains unknown. This study retrospectively evaluated the effect of AAD administration during CPR on 1-month prognosis in the SOS-KANTO 2012 study population.
Of the 16,164 out-of-hospital cardiac arrest cases, 1350 shock-refractory patients were included: 747 patients not administered AAD and 603 patients administered AAD. Statistical adjustment for potential selection bias was performed using propensity score matching, yielding 1162 patients of whom 792 patients were matched (396 pairs). The primary outcome was 1-month survival. The secondary outcome was the proportion of patients with favorable neurological outcome at 1 month. Logistic regression with propensity scoring demonstrated an odds ratio (OR) for 1-month survival in the AAD group of 1.92 (P < 0.01), whereas the OR for favorable neurological outcome at 1 month was 1.44 (P = 0.26).
Significantly greater 1-month survival was observed in the AAD group compared with the non-AAD group. However, the effect of ADD on the likelihood of a favorable neurological outcome remains unclear. The findings of the present study may indicate a requirement for future randomized controlled trials evaluating the effect of ADD administration during CPR on long-term prognosis.
The effects of conventional laparotomy and laparoscopic surgery on the peritoneal dissemination of VX2 tumors were evaluated in a rabbit model. Either 5 x 10(3) or 5 x 10(4) of VX2 tumor cells were ...inoculated into the peritoneal cavities of rabbits which were divided into three groups according to the procedure performed, namely, a conventional laparotomy group (group 1), a laparoscopy group (group 2), and a control group (group 3). All the animals were killed 2 weeks after the treatment to examine the spread of the VX2 tumor in the omentum. In the experiment in which 5 x 10(3) tumor cells were inoculated, no significant difference was found in the number of metastases among the three groups. Conversely, after inoculating 5 x 10(4) tumor cells, the mean numbers of metastatic colonies greater than 1 mm in diameter in the greater omentum were 14.4+/-4.7 in group 1, 9.9+/-2.4 in group 2, and 3.3+/-1.1 in group 3, with a significant difference between groups 1 and 3, and between groups 2 and 3, but not between groups 1 and 2. In conclusion, conventional laparotomy facilitated the greatest peritoneal dissemination of a VX2 tumor in this animal model when 5 x 10(4) tumor cells were inoculated. Furthermore, laparoscopic surgery influences tumor growth to almost the same degree as conventional laparotomy.
Acute poisoning due to waterproof spray Kondo, Akihiko; Yanagawa, Youichi; Omori, Kazuhiko ...
Acute medicine & surgery,
10/2014, Volume:
1, Issue:
4
Journal Article
Peer reviewed
Open access
A search of the database Ichushi (Japana Centra Revuo Medicana), which collects summaries of Japanese medical articles, was undertaken to identify articles published between 1983 and 2013, using the ...key word “waterproof”. There was one original article and 19 case reports describing acute poisoning due to inhalation of waterproof spray gas, and providing information about the patient's smoking habit. Twenty‐three of the 25 cases (92% of male patients, 71% of female patients) had a smoking habit. The one female case who did not have a smoking habit was in an environment exposed to secondhand smoke, because her husband had smoking habit. All cases had respiratory symptoms, and 24 cases had lung edema confirmed by computed tomography. There were no fatal cases among these patients. The one original article reported that 93% of males and 49% of females among a total of 104 cases with acute poisoning due to inhalation of waterproof spray gas had a smoking habit. Accordingly, people with a smoking habit tend to be vulnerable to exposure to waterproof spray gas.
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