Cardiopulmonary resuscitation surprise drills for assessing, improving and maintaining cardiopulmonary resuscitation skills of hospital personnel.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel trained in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. Western Galilee Hospital has developed simulator programs for surprise CPR training exercises in all hospital departments and units. This study assessed the efficacy of surprise drills. METHODS: Advanced cardiac life-support instructors performed 131 surprise drills between 2003 and 2005, using a computerized simulation mannequin (SIM 4000). Nine criteria were measured and scored in the drill: reaction time, CPR according to ABC principles, calling for doctor, CPR knowledge, CPR skills, resuscitation management, staff work, resuscitation chart, and defibrillator management. Drills were evaluated, discussed, and compared with previous drills from the same department and from other departments. RESULTS: A gradual improvement was observed in the results of the drills held through 2003-2005, more significantly in the medical departments than in the surgical departments and outpatient clinics. The average score in 2005 was 77.2% (P=0.001), compared with 74% (P=0.012) in 2004 and 59% (P<0.001) in 2003. Major improved criteria were calling for doctor, staff work, CPR knowledge, and defibrillator (P<0.05). CONCLUSION: It is our belief that surprise resuscitation drills constitute an effective tool to improve performance in case of a real emergency resuscitation, both on a departmental and a general hospital level.     

Effect of beta blocker combined with COX-2 inhibitor on colonic anastomosis in rats

Purpose  

Pharmacologic modulation of the perioperative physiologic stress response, using the beta-blocker propranolol, combined with the COX-2 inhibitor etodolac, has been shown to reduce metastatic spread and increase survival rates following surgery for primary tumor excision in rodents. Prior to implantation of this pharmacological approach in clinical trials in patients with colon cancer, the safety of this technique has to be evaluated. This study assessed the effects of these drugs on the healing of colonic anastomosis in rats.     

Age-related changes in salivary antioxidant profile: possible implications for oral cancer

Oral cancer's much higher prevalence among older people may be due to an age-related reduction in protective salivary antioxidant mechanisms and/or an age-related increase in the magnitude of oral carcinogen attack, such as reactive oxygen species (ROS) and reactive nitrogen species (RNS), causing DNA aberrations. This study found a significantly reduced total value of salivary antioxidant capacity in elderly persons (as measured by overall antioxidant capacity [ImAnOx] assay), (46% of healthy individuals, p =.004), increased oxidative stress (86% increase in carbonyl concentrations--indicators of enhanced ROS attack, p =.001), and increased salivary concentrations and total values of RNS (7-fold and 3-fold higher respectively, p =.001), all contributing to increased DNA oxidation of oral epithelial cells. Salivary oxidative stress-related changes in the intimately related saliva and oral epithelium compounded with higher viscosity of saliva may explain the higher prevalence of oral cancer in the elderly population. Administration of local therapeutic agents (i.e., antioxidants) to the oral cavity should be considered.     

Should ileoanal pouch surgery be staged for patients with mucosal ulcerative colitis on immunosuppressives?

Introduction and objective Much debate has revolved around whether patients with mucosal ulcerative colitis (MUC) receiving immunosuppression should be weaned off immunosuppressives before undergoing ileal pouch surgery. Therefore, the aim of this study was to assess the affect of immunosuppressive drugs on postoperative complications after ileoanal pouch surgery. Materials and methods A retrospective medical record review of patients with MUC who underwent ileal pouch surgery while taking immunosuppressive drugs such as azathioprine, 6-mercaptopurine (6-MP), methotrexate, and cyclosporin A was performed. Postoperative complications in the study group were compared to three matched groups: patients with MUC who had ileoanal pouch surgery while taking systemic steroids, patients with MUC not receiving any immunosuppressive drugs, and patients with familial adenomatous polyposis. Results Twenty-two patients with MUC who underwent ileoanal pouch surgery while taking immunosuppressive drugs were identified from a prospectively entered database of patients who had this surgery between 1988 and 2005. All but two patients underwent temporary fecal diversion. Fifteen patients were taking 6-MP or azathioprine; six were on cyclosporine A, and one both on azathioprine and cyclosporine A. Fifteen patients were also taking steroids at the time of ileoanal pouch surgery. Early (within 30 days of surgery) and late complications occurred in 36 and 50% of the study group patients, respectively, but did not significantly differ from a matched group of patients with MUC who did not take immunosuppressive drugs. Patients with familial adenomatous polyposis had a significantly lower long-term complication rate. Conclusion This retrospective case-matched study suggests that the use of immunosuppressive drugs and cyclosporine A may not be associated with an increased rate of complications after ileoanal pouch surgery. This paper was presented at the annual meeting of the American Society of Colon and Rectal Surgeons, June 2–7, 2001, San Diego, CA and at the biennial meeting of the International Society of University Colon and Rectal Surgeons, April 10–14, 2002, Osaka, Japan.     

Production of recombinant channel catfish (Ictalurus punctatus) FSH and LH in S2 Drosophila cell line and an indication of their different actions

Due to the lack of purified, native gonadotropins (GtH) for almost all species of fish, we designed a system for the production of recombinant bioactive luteinizing hormone (LH) and follicle stimulating hormone (FSH) using the channel catfish (Ictalurus punctatus) as a model animal. The strategy was to produce the three subunits composing FSH and LH, i.e. the common alpha-subunit (alpha-glycoprotein hormone (alpha-GP)), beta-FSH, and beta-LH subunit, individually in stable recombinant insect cells (S2) with C-terminal His-tag. This expression system was also used to co-express the alpha-subunit without the His-tag with each of the His-tagged beta-subunits. The recombinant S2 cells were capable of secreting FSH and LH heterodimers and alpha-GP in abundance; however, expression of the individual beta-subunits was much less successful. The recombinant GtHs were partially purified from the cell medium by immobilized metal affinity chromatography to ~15% purity with a yield of 7 and 4 mg per liter of medium for FSH and LH respectively. These recombinant GtHs activated their receptors in vitro, enhanced estrogen secretion, up-regulated several steroidogenic enzyme genes in channel catfish ovarian follicles, and increased androgen secretion from African catfish testis. Interestingly, the FSH and LH dose-response curves for each of these biological activities clearly demonstrate differences in their cellular action and physiological roles. This expression system may be an important development for the production of species-specific GtHs so that FSH- and LH-specific mechanisms of actions within the reproductive endocrine processes can finally be examined with homologous, albeit recombinant, hormones.     

Crustacean hyperglycemic hormone (CHH) neuropeptides family: Functions, titer, and binding to target tissues

The removal of the eyestalk (s) induces molting and reproduction promoted the presence of regulatory substances in the eyestalk (ES), particularly medulla terminalis X-organ and the sinus gland (MTXO-SG). The PCR-based cloning strategies have allowed for isolating a great number of cDNAs sequences of crustacean hyperglycemic hormone (CHH) neuropeptides family from the eyestalk and non-eyestalk tissues, e.g., pericardial organs and fore- and hindguts. However, the translated corresponding neuropeptides in these tissues, their circulating concentrations, the mode of actions, and specific physiological functions have not been well described. The profiles of CHH neuropeptides present in the MTXO-SG may differ among decapod crustacean species, but they can be largely divided into two sub-groups on the basis of structural homology: (1) CHH and (2) molt-inhibiting hormone (MIH)/mandibular organ-inhibiting hormone (MOIH)/vitellogenesis/gonad-inhibiting hormone (V/GIH). CHH typically elevating the level of circulating glucose from animals under stressful conditions (hyper- and hypothermia, hypoxia, and low salinity) has multiple target tissues and functions such as ecdysteroidogenesis, osmoregulation, and vitellogenesis. Recently, MIH, known for exclusively suppressing ecdysteroidogenesis in Y-organs, is also reported to have an additional role in vitellogenesis of adult female crustacean species, suggesting that some CHH neuropeptides may acquire an extra regulatory role in reproduction at adult stage. This paper reviews the regulatory roles of CHH and MIH at the levels of specific functions, temporal and spatial expression, titers, their binding sites on the target tissues, and second messengers from two crab species: the blue crab, Callinectes sapidus, and the European green crab, Carcinus maenas. It further discusses the diverse regulatory roles of these neuropeptides and the functional plasticity of these neuropeptides in regard to life stage and species-specific physiology.     

Laparoscopic colectomy for colonic polyps

Background  Benign colonic polyps not amenable to colonoscopic resection or those containing carcinoma require surgical excision. Traditionally, formal colectomy with clearance of the lymphatic basin has been performed. The aim of this study was to review our experience with the laparoscopic approach for retrieval of colonic polyps with specific emphasis on safety, feasibility, and tumor localization. Methods  Retrospective chart review of all patients who underwent laparoscopic colectomy for colonic polyps was performed. Initial colonoscopic biopsies were compared with the postoperative pathology report of the resected specimen. Results  Forty-nine patients (22 males, 27 males, mean age 66 years) underwent laparoscopic colectomy for colonic polyps. Indications for surgery were presumably benign polyps in 38 patients, and superficial carcinoma in a polyp, diagnosed by colonoscopy, in 11; twenty-three patients underwent preoperative localization procedures. In 19% of patients who did not have preoperative localization, difficulties locating the polyp were encountered during surgery, requiring intraoperative endoscopy or conversion to laparotomy. In 7 of the 38 patients with presumably benign lesion, colon cancer was diagnosed in the colectomy specimen. None of the 18 patients who had cancerous lesions had any positive lymph nodes. Conclusions  Laparoscopic surgery for the treatment of colonic polyps seems to be feasible and safe, with a low complication rate. Tumor localization is crucial for adequate resection. Although one-fifth of presumably benign polyps harbored cancer, none of these patients had positive lymph nodes. These preliminary results may question the need for radical lymph node clearance in these patients. Poster presentation at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, TX, USA, April 26–29, 2006. Poster presentation at the annual meeting of the European Society for Endoscopic Surgeons (EAES), Berlin, Germany, September 13–16, 2006.     

Laparoscopic colectomy is associated with decreased postoperative gastrointestinal dysfunction

Background  Major abdominal surgery is associated with early postoperative gastrointestinal dysfunction, which may lead to abdominal distention and vomiting, requiring nasogastric (NGT) tube insertion. This study aimed to compare the rates of early postoperative NGT insertion after open and laparoscopic colorectal surgery. Methods  A retrospective chart review was performed for patients who underwent colorectal surgery with removal of the NGT at completion of surgery. Patients who required reinsertion of the NGT in the early postoperative course were identified. The reinsertion rate for patients who underwent laparoscopic surgery was compared with that for the open group. Results  There were 103 patients in the open group and 227 in the laparoscopic group. In the laparoscopic group, 42 patients underwent conversion to open surgery. Reinsertion of the NGT was required for 18.4% of the patients in the open group, compared with 8.6% of the patients for whom the procedure was completed laparoscopically (p = 0.02). Conversion to open surgery resulted in a reinsertion rate of 17%. Conclusion  Laparoscopic colorectal surgery is associated with decreased postoperative gastrointestinal dysfunction, resulting in a significantly lower NGT reinsertion rate. Presented as a poster at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, (SAGES), Dallas, Texas, 26–29 April 2006, and at the annual meeting of the European Society for Endoscopic Surgeons (EAES), Berlin, Germany, 13–16 September 2006.