PRE-HOSPITAL EMERGENCY CARE: EVALUATION OF AN AUSTRALIAN SYSTEM

The efficacy of the Sydney ambulance paramedic service in dealing with out-of-hospital cardiac and other emergencies was examined. The outcome of 182 cases (from a total of 1,799 casualty calls) treated by a paramedic service was compared with the outcome of 104 similar cases (from a total of 2,376 calls) treated by a general duties service. There were 33 cases of cardiac arrest in the general duties group; resuscitation was attempted in 12 and none survived. There were 49 cases of cardiac arrest in the paramedic group; resuscitation was attempted in 21 cases and 4 survived. There were 35 cases of suspected myocardial infarction in the general duties group; 7 died compared with 58 cases and 4 deaths, in the paramedic group (mortality 20%, cf. 7%; difference not significant). The increased cost of a paramedic call, less than half of an entire hospital day, appears justified by better results.     

Intrapulmonary shunting in the biliary atresia/polysplenia syndrome: reversal after liver transplantation

One hundred and seventy three children, including 93 with biliary atresia, received liver grafts at Addenbrooke's Hospital between 1983 and 1993. Of these, only seven developed cyanosis due to intrapulmonary shunting as a complication of their liver disease, and all seven of these had the biliary atresia/polysplenia syndrome. Intrapulmonary shunting was confirmed by a radioisotope scan in four children. Only one child with the syndrome did not have cyanosis when undergoing transplantation. Seven of the eight children are alive 6-54 months after transplantation, with normal pulmonary and hepatic function. Cyanosis recurred in one child who developed chronic rejection with liver failure. In conclusion: (a) there is a strong association between the biliary atresia/polysplenia syndrome and cyanosis due to intrapulmonary shunting; (b) intrapulmonary shunting is fully reversible after successful liver transplantation; and (c) cyanosis, once present, is progressive, and these children should be considered for liver transplantation as soon as it occurs.     

Neurological and adrenal dysfunction in the adrenal insufficiency/alacrima/achalasia (3A) syndrome

Review of 20 patients with glucocorticoid deficiency (three cases also with salt loss) associated with absent tear secretion (19 cases) and achalasia of the cardia (15 cases) revealed neurological abnormalities in 17 including hyper-reflexia, muscle weakness, dysarthria, and ataxia together with impaired intelligence and abnormal autonomic function, particularly postural hypotension. These findings indicate that significant neurological problems are common in this multisystem disorder.     

The effect of water with varying isotopic composition on the proliferative activity of endothelial cell in vitro]

Effects of water with varying isotopic composition (high and low deuterium content) were studied on the model of cultivated human endothelial cells. In laboratory conditions, changes in the isotopic content of water in nutrient substrate did not affect significantly the cell proliferative activity. In cells cultivated in no-serum medium increased deuterium concentration inhibited growth with a consequent of cell death. Both decreased and increased concentration of deuterium activated proliferation in originally low-density cell cultures supplemented with serum. It is hypothesized that changed isotopic composition of water has an effect only when combined with some other cell cultivation factors.     

Studies of the primary effects of chronic clinostatting of embryonal mice stem cells in vitro]

Effects of randomized gravity vector (clinostatting) on embryonal stem cells (ESC) of mice were evaluated in vitro with respect to proliferation, proliferative potential, and differentiability. Colony formation remained normal up to hour 72 of clinostatting; however, further exposure led to fusion of the ESC colonies. No reliable shifts in the proliferative activity were found, whereas morphometric analysis showed different dynamics of the ESC colonies size in specific periods of the experiment comparing with the control. Evaluation of the ESC proliferative potential after the experiment revealed a trend upward in the number of colonies when compared with the dynamic and static controls. However, the number of resulted EBs in the control tended upward contrary to EBs formed under the conditions of clinostatting and continuous agitation pointing to the importance of local medium conditioning at the beginning of ESC differentiation.