Lazarus-Phänomen

Background

In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation (SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are discussed.

Methods

A literature search in Medline, PubMed, Embase, Google Scholar and Google from 1982 to 2009 was carried out for the terms “Lazarus phenomenon”, “cessation of cardiopulmonary resuscitation and return of spontaneous circulation (ROSC)”, “spontaneous return of circulation (SROC)”, “resuscitation and spontaneous defibrillation”, “spontaneous recovery and cardiopulmonary resuscitation”. Related secondary literature which was cited in the relevant articles was included as well as publications found in our personal literature base.

Results

More than 10,000 articles and comments could be recovered and of these 45 were considered to be medically relevant articles (letters to the Editor, abstracts, case reports and literature reviews).

Conclusions

In the relevant medical literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are poorly understood. In the literature several mechanisms are discussed which could be important for this phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations seem to be necessary to gain a better understanding of this phenomenon.     

Mesenteric Histiocytosis or Only an Inflammatory Infiltration of Histiocytes? A Case Report From a Surgical Point of View

The mesenteric sclerosing processes are very rare tumors. There are only a few cases of mesenteric fibromatosis described in literature. A case of mesenteric histiocytosis or a mesenteric infiltration by histocytes as a reactive inflammatory process is not described in the surgical literature. Because of its clinical and macroscopic similarity to a fibromatosis or a reactive inflammatory process and a lack of articles in the literature on mesenteric histiocytosis we concentrated our research in literature on the mesenteric fibromatosis and its differential diagnosis.     

Useful benchmarks to evaluate outcomes after esophagectomy and pancreaticoduodenectomy

BACKGROUND: Multiple publications have suggested that outcomes after complex operations are better at high-volume centers. However, of all the potential "outcomes" to measure, only mortality has been studied extensively. The broadest difference in mortality between low- and high-volume centers has been measured after esophagectomy (EG) and pancreaticoduodenectomy (PD). If a low-volume center recorded high mortality, then a broader set of outcomes beyond mortality would be useful for self-assessment. METHODS: Two single-surgeon prospective databases for outcomes of EG and PD were reviewed in a multispecialty clinic within a tertiary-referral, resident-training hospital. Between January 1996 and December 2002, 174 consecutive patients underwent EG performed by 1 surgeon (25 cases/y), and 232 consecutive patients underwent PD performed by another surgeon (34 cases/y). We measured hospital and 30-day mortality rate, mean operation time (OR time), mean estimated intraoperative blood loss (EBL), mean length of stay (LOS), and the anastomotic leak rate. These outcomes were compared with those of recently published cases for EG and PD. RESULTS: Mortality for both operations was zero. After EG, OR time was 394 minutes (literature = 336), EBL was 204 mL (literature = 964), transfusion rate was 3.5% (literature = 34%), LOS was 11.1 days (literature = 16.6), leak was 2.9% (literature = 9.1%), and reoperation was 1.7% (literature = not stated). After PD, OR time was 450 minutes (literature = 431), EBL was 382 mL (literature = 1,183), transfusion rate was 7.3% (literature = not stated), LOS was 11.2 days (literature = 17.8), leak was 6.5% (literature = 9.9%), and reoperation was 0.4% (literature = 3.8%). CONCLUSIONS: These 2 single-surgeon series provide benchmarks to help better define acceptable outcomes after EG and PD. This assessment demonstrated lower mortality and LOS in a high-volume surgical practice. These outcomes are not associated with OR time but with lower EBL, less need for transfusion, and lower need for reoperation. Anastomotic leaks occurred in both series; however, this was not associated with mortality because of early recognition and the use of nonsurgical minimally invasive techniques. If mortality is high at a low-volume center, then the additional benchmarks of this study, in addition to mortality and LOS, could be used to lower mortality through self-assessment by identifying specific outcomes that need improvement.     

How good is the orthopaedic literature?

Randomized trials constitute approximately 3% of the orthopaedic literature Concerns regarding quality of the orthopaedic literature stem from a widespread notion that the overall quality of the surgical literature is in need of improvement. Limitations in surgical research arises primarily from two pervasive issues: 1) A reliance on low levels of evidence to advance surgical knowledge, and 2) Poor reporting quality among the high level surgical evidence that is available. The scarcity of randomized trials may be largely attributable to several unique challenges which make them difficult to conduct. We present characteristics of the orthopaedic literature and address the challenges of conducting randomized trials in surgery.     

Appraisal of the quality of assessment of memory in anesthesia and psychopharmacology literature

To test the hypothesis that there are important differences between studies on memory published in anesthesia literature and those published in the psychopharmacology literature, we compared the two from the period January 1978 through May 1988 to identify deficiencies in the design and methodologies used and to provide guidelines for future experiments. Eight-eight articles in each discipline were reviewed. The sample sizes were larger in the articles in anesthesia journals than in those in psychopharmacology journals (medians 52.5 vs. 18 subjects, respectively). Most (85%) of the studies in the anesthesia literature used patients, who had a median age of 38.9 yr and included a median of 28 women among the subjects per study. In contrast, the majority (60%) of the studies in the psychopharmacology literature used healthy volunteers, who had a median age of 23.6 yr and included a median of only 3.5 females among the subjects per study. Characteristics more common in the psychopharmacology than in the anesthesia literature, respectively, were use of a control or placebo group (90% vs. 42%), double-blind design (80% vs. 47%), use of pre- and posttreatment memory measurements (64% vs. 23%), use of multiple memory tests with distinct equated stimuli (83% vs. 8%), relation of methodology to some theoretical model of memory (72% vs. 17%), and use of other behavioral tests (68% vs. 48%). Relative to the psychopharmacology literature, the anesthesia literature used pictures as stimuli for the memory tests more often (44% vs. 14%, respectively) and words less often (11% vs. 67%) and relied heavily on questions about recall of perioperative events (41% vs. 0%). There is room for improvement in both types of literature, and more so in the anesthesia literature.     

Compartment syndrome after femoral contusion. Case report and review of the literature]

Compartment syndromes of the lower arm and lower leg are quite well known by now and have been often described in the literature. Those of the upper arm and thigh are rarer and those after pure closed lesion of the soft parts of the thigh are the subject of only sporadic reports in the literature. A recently observed case of this kind prompted the present case report and review of the literature.     

Transitional cell carcinoma of ileal loop following cystectomy

This is the second case reported in the literature involving transitional cell carcinoma in an ileal loop. The case is described and the literature reviewed.     

Mesotheliomas of spermatic cord

Mesotheliomas of the spermatic cord are exceedingly rare and scarcely mentioned in the urologic literature. An additional case of spermatic cord mesothelioma is presented and the literature reviewed.     

Leiomyosarcoma of renal vein

Primary leiomyosarcoma of the renal vein has not been previously reported in the urologic literature. A case report with long-term survival is described and the literature reviewed.     

Primary tracheal rhabdomyosarcoma. Case report

A case of primary tracheal rhabdomyosarcoma is presented--the second in the English-language literature. The treatment policy is discussed on the basis of this case and the literature is reviewed.     

Urachal carcinoma.

Urachal carcinoma is rare and has a grim prognosis. One hundred forty-two cases have been reported in the literature. We report a new case and review the related literature.     

Research Priorities and Methodological Implications

European Spine Journal - Best evidence synthesis. To report on gaps in the literature and make methodologic recommendations based on our review of the literature on frequency and risk factors,...     

Focal myositis - a new presentation.

This article is a case report and review of literature of a very rare condition, not previously written in general surgical literature, including a new presentation Copyright 2000 Harcourt Publishers Ltd.     

Twenty years of trauma:Psychological Abstracts 1970 through 1989

The present study represents an objective assessment of the growth in trauma literature, and of the thematic trends which have been part of its historical evolution. For these purposes a systematic, manual search ofPsychological Abstracts from 1970 to 1990 was conducted to identify literature on trauma-related topics. Fifteen hundred and ninety-six (1596) citations between 1970–1990 were identified, and a trend showing increasing numbers of trauma publications was in evidence. This increase was most apparent in literature involving war- and sexual abuse-related traumatization, but not in publications about natural and technological disaster. These findings reflect a dynamic and growing field, and will provide an important benchmark for assessing the changing status of the PTSD literature.     

Granuloma faciale: a case report and review of the literature

Granuloma faciale is an uncommon but well-defined cutaneous condition which is seen almost exclusively on the face [1]. Reports are confined mainly to the dermatology and pathology literature. Between 1966 and 1996 only three articles have appeared in the oral and maxillofacial, otolaryngology or plastic surgery literature [2–4]. A case of granuloma faciale is reported together with a review of the existing literature on this condition. Received: 30 December 1997 / Accepted: 18 March 1998     

Verrucous carcinoma of the bladder

Verrucous carcinoma of the bladder unassociated with bilharzial cystitis is an exceedingly rare entity, with only 3 cases reported in the literature. We describe a patient and review the literature concerning verrucous carcinoma.     

Prostate specific antigen doubling time calculation: not as easy as 1, 2, 4

PURPOSE: Although prostate specific antigen doubling time is widely used to predict outcomes such as time to progression and prostate cancer specific mortality, clinicians may be unaware of the impact of method on prostate specific antigen doubling time calculation. We present a critical review of the literature to assess the diversity of methods used to calculate prostate specific antigen doubling time. We then describe the need for methodological consistency with the literature by showing examples from our clinical experience at our institution. MATERIALS AND METHODS: A comprehensive review of articles evaluating prostate specific antigen doubling time as a prognostic and predictive indicator in various prostate cancer disease states was performed using PubMed. Case examples were drawn from the prostate cancer database at our institution. The database is a registry of 4,651 patients with prostate cancer who have been seen at our institution since 1998. RESULTS: The methodology of prostate specific antigen doubling time calculation is inconsistent in the literature. Based on our experience and data presented in the literature the different methods in the literature are not always interchangeable. Small deviations from the methods outlined in a study can sometimes lead to wide variation in calculated prostate specific antigen doubling time. This variation of up to several months or longer is large enough to cause errors in assessment of prognosis and can even lead to incorrect management. The rules for prostate specific antigen doubling time calculation found in the literature can be categorized into 4 parameter groups, including method, calculation interval, data acquisition rules and data analysis rules. Case examples illustrate the importance of adherence to the literature with regard to each parameter. CONCLUSIONS: Consistency with the literature in methodological elements of prostate specific antigen doubling time calculation is essential for the accurate calculation of prostate specific antigen doubling time. Clinicians and researchers should understand how methodological differences influence the value of calculated prostate specific antigen doubling time for purposes of patient care and research.     

Mediastinal seminoma. A case report and review of the literature

A case of mediastinal seminoma presenting with hemoptysis and superior vena cava obstruction is reported. In the literature, only 1 case of mediastinal seminoma presenting with hemoptysis is reported. The relevant literature is reviewed.     

Compartment syndrome: a review of the literature

Compartment syndrome is a rare but severe complication of lower extremity trauma. This article provides an extensive review of the literature, including incidence, physical examination findings, pathophysiology, compartment pressure evaluation, and surgical decompression techniques. Most of the recent compartment syndrome literature shows case reports of atypical causes of this limb-threatening disorder. Although the emphasis of this article is traumatic compartment syndrome, recent literature on chronic lower extremity compartment syndrome, secondary to exercise or activity, is also discussed.