Appendicitis as the presenting manifestation of Kawasaki disease

In cases of Kawasaki’s disease (KD) presenting as acute surgical abdomen, rarely has the presence of acute appendicitis been found. We report two cases of histologically confirmed acute appendicitis in the presence of KD and a review of the literature as it pertains to acute abdomen and atypical presentations of KD.     

Prospective Population-Based Study of Intermittent and Continuous Convulsive Status Epilepticus in Richmond, Virginia

PURPOSE: Previous work suggested that there is a lower mortality for convulsive status epilepticus (SE) with intermittent seizures (intermittent SE) as opposed to SE with continuous seizure activity (continuous SE). A plausible hypothesis to explain this difference is that the shorter ictal time in intermittent SE is responsible for the lower mortality in this group. This study investigates the relative contributions of total ictal time and SE duration to the differing mortalities of intermittent and continuous SE. METHODS: Six hundred forty-five cases of prospectively identified convulsive SE were examined. Nonparametric statistical methods were used to compare continuous SE and intermittent SE variables. Multivariate logistic regression analyses were used to determine which factors were most highly associated with mortality. Intermittent SE cases were analyzed to evaluate the relative contributions of ictal time versus SE duration to mortality. RESULTS: Intermittent SE had a significantly lower mortality than continuous SE (19.6 vs. 31.4%; p < 0.001) in adults but not in children. Intermittent and continuous SE durations did not significantly differ in adult cases but did differ in pediatric cases. Ictal time was significantly shorter than SE duration for intermittent SE in both adults and children. After adjusting for age, etiology, and SE duration, SE type (continuous SE vs. intermittent SE) was shown to have an independent effect on mortality in adults. The relative risk of mortality for continuous SE was 1.79 times that of intermittent SE (p = 0.04). After controlling for SE duration, ictal time did not significantly affect mortality in adults. CONCLUSIONS: Intermittent and continuous convulsive SE were common in both pediatric and adult populations. Intermittent SE had a significantly lower mortality than did continuous SE. This difference in mortality was not completely explained by differences in SE duration, total ictal time, etiology, or age. Further research is needed to identify the factor(s) contributing to the significant difference in mortality between intermittent SE and continuous SE.     

老年人血浆溶血磷脂酸和磷脂酸水平综合干预后的效果比较

目的:通过对老年人进行血浆溶血磷脂酸和磷脂酸的筛检,从而认识血浆溶血磷脂酸和磷脂酸在血栓预防中的作用。方法:对2004-04/07期间的1657名和2005-04/07期间的1748名离休干部进行血浆溶血磷脂酸和磷脂酸含量测定,并对溶血磷脂酸>3.0μmol/L和磷脂酸>5.0μmol/L的阳性人员进行药物干预。同时,选择2004年溶血磷脂酸和/或磷脂酸阳性人员119人,随机分为两组:①干预组(n=72):男63人,女9人,平均年龄78岁。口服阿司匹林100mg/d,持续1个月。②对照组(n=47):男42人,女5人,平均年龄76岁。干预后,测定两组血浆中溶血磷脂酸和磷脂酸的含量。结果:纳入对象全部进入结果分析。2005年磷脂酸及血浆溶血磷脂酸 磷脂酸阳性率均明显低于2004年(P<0.01),尤其是磷脂酸的阳性率降低的更为明显。2005年血浆溶血磷脂酸和磷脂酸的平均值均明显低于2004年(P<0.01)。干预组干预后血浆溶血磷脂酸和磷脂酸明显低于干预前及对照组(P<0.01)。结论:①血浆溶血磷脂酸和磷脂酸的测定可作为血栓预警和了解抗血栓药物疗效的一种手段。②阿司匹林干预后,血浆溶血磷脂酸和磷脂酸的含量均降低,可作为一种降低缺血性疾病发生率的有效途径。     

Cost-effectiveness of defibrillation by emergency medical technicians

Effective emergency systems using emergency medical technicians (EMTs) trained to defibrillate or paramedics can save more lives from out-of-hospital cardiac arrest due to ventricular fibrillation than can emergency systems staffed with basic EMTs who cannot defibrillate. This article focuses on the cost-effectiveness of systems staffed with each type of EMT. Data were collected from all 50 states and from the District of Columbia to determine the number of hours and estimated cost of initial training for the three types of EMTs in the United States in 1986. The median initial training hours for basic EMTs, EMTs trained in defibrillation, and paramedics were 110, 129, and 700, respectively. Median costs for initial training at each EMT level were +123, +150, and +1580/student. According to published survival data for emergency medical systems staffed with EMTs at each level, the total initial training personnel and equipment cost per life saved from ventricular fibrillation was +7687, +2126, and +2289 for systems staffed by the respective EMTs. The initial cost per life saved from ventricular fibrillation is more than three times greater in systems staffed by basic EMTs than in systems staffed by EMTs trained in defibrillation or paramedics. From a medical and a cost-effective standpoint, all communities served by basic EMTs should consider upgrading them to at least the defibrillation-trained EMT level.     

Older persons' performance on auditory, visual, and auditory-visual presentations of the Edgerton and Danhauer Nonsense Syllable Test

The speech sound discrimination abilities of 15 normal-hearing and 15 sensorineural hearing-impaired subjects between 55 and 65 years of age were assessed using videotaped presentations of the Nonsense Syllable Test (NST). Stimuli were presented in auditory (A), visual (V), and auditory-visual (AV) modes. All subjects received the stimuli in two trials for each presentation mode; hearing-impaired subjects were unaided for the first, and wore their own hearing aids for the second. Responses were transcribed phonemically and were scored by the phoneme method. Intra- and interjudge reliability was greater than 90%. Mean phoneme discrimination scores were plotted for each group across the three presentation modes. The results revealed that: both groups' performance improved from V to A to AV modes, but differences were apparent in the amount of increase across modes within each group; the NST differentiated between groups in the A and AV modes, but not in the V mode; the NST identified "poor" speechreaders in each group under both V and AV conditions; and consonant errors in the V mode formed seven homophenous categories based on place of articulation. The NST can be a useful screening test in auditory rehabilitation to distinguish those hearing-impaired persons who naturally take advantage of visual cues from those who do not.