Does veno-arterial bypass without an artificial lung improve the outcome in dogs undergoing cardiac arrest?

We hypothesized that maintaining circulation and blood pressure by veno-arterial bypass (V-A bypass) without oxygenation would improve cardiopulmonary resuscitation (CPR) and survival rates. A total of 32 dogs, divided into four groups, were subjected to normothermic ventricular fibrillation (VF) for 15 min. The method of CPR was the same in the four groups, except for the method and timing of V-A bypass. We attempted to resuscitate the dogs without V-A bypass (control), with V-A bypass not including an artificial lung during VF, with V-A bypass not including an artificial lung during CPR, and with V-A bypass including an artificial lung during CPR. CPR was continued until restoration of spontaneous circulation (ROSC) or for 30 min. Although blood pressure was well maintained, severe hypoxemia was observed during V-A bypass without an artificial lung. The resultant hypoxemia was very detrimental. ROSC was achieved more easily in all dogs in the bypass group with an artificial lung. No significant difference in survival rates was demonstrated among the four groups (P = 0.11). We concluded that V-A bypass without oxygenation does not improve the chances for CPR and outcome after cardiac arrest in dogs. Our results suggest that oxygenation is indispensable in CPR.     

Sarcoidosis associated with psoriasis vulgaris

We report a 70-year-old patient with sarcoidosis associated with psoriasis vulgaris. He had a nodule on the medial lower lid of his right eye. Oral corticosteroid for the sarcoid lesions and oral PUVA for psoriasis were employed. The cutaneous lesion disappeared within two months after starting the therapy. No relapse of sarcoidosis has been seen for eight years. The association of sarcoidosis with psoriasis has been previously reported; however, it is still unclear whether this association coincidental or meaningful.     

Association of emergence of HLA antibody and acute rejection in intestinal transplant recipients: a possible evidence of acute humoral sensitization

Development of HLA antibody has been associated with chronic allograft failure in kidney recipients. We tested HLA antibody in posttransplant sera of intestinal recipients: 126 sera from 28 pediatric recipients were tested for HLA antibody by flow PRA (f-PRA). Median age was 1.1 years (0.44-17). Graft types included isolated intestine (n = 6), liver and intestine (n = 3), modified multivisceral (n = 3), and multivisceral grafts (n = 16). Greater than 10% of either class I (CI) or class II (CII) f-PRA was considered positive, and >30% strongly positive. Five of 28 patients had positive f-PRA in multiple samples; the remaining 23 had either no positive or only one positive sample. Three patients had strongly positive f-PRA. Patients with multiple positive samples were recipients of two modified multivisceral and three multivisceral grafts. Only one of these patients had a positive PRA pretransplant. Cytotoxic cross-match at transplant was negative for all. The three with strongly positive f-PRA showed significant episodes of rejection around the time of positive samples. One of them who persistently had f-PRA value >80% (from day 13-113) died of refractory rejection. The other two had f-PRA of 76% and 53% during the early postoperative course with associated episodes of rejection. F-PRA value decreased with rejection therapy. Only one of the 23 patients (4%) with negative f-PRA had an episode of rejection around the time of sample collection. Development of HLA antibody after intestinal transplantation seems to have significant association with acute rejection episodes.     

DESTRUCTION OF EPIDERMAL CELLS IN VITRO BY AUTOLOGOUS SERUM FROM NORMAL ANIMALS

Sera and plasma from normal rats and rabbits were shown to be extremely toxic in vitro to autologous epidermal cells. On the other hand, mouse sera and newborn rat sera were innocuous to autologous epidermal cells. Viability of cells was assessed by the method of eosin dye exclusion upon 2 hour incubation at 37°C. Testicular cells were also killed by autologous sera, but polymorphonuclear leukocytes, lymphocytes, and lymph node cells were not affected. Autotoxicity of sera could be destroyed by the depletion of complement components with an antigen-antibody precipitate, heat, zymosan, and NH₃. Moreover, activity of sera could be absorbed out by epidermal cells, though not by lymph node cells or erythrocytes. Such absorption of toxicity was not individual-specific since homologous epidermal cells also absorbed toxicity, and in addition, were killed by fresh normal serum. Enzyme inhibitors such as soybean trypsin inhibitor and ε-amino-n-caproic acid did not affect the activity of fresh autologous serum. It is suggested that a natural barrier exists between the basal cells of the epidermis and the plasma which prevents the autodestructive process under normal conditions. Any injury to this barrier may than lead to necrosis and death of the epidermis as seen in various pathological conditions.     

A Kumamoto model of clinical training in tracheal intubation for paramedics

BACKGROUND: Since July 2004, the Japanese Ministry of Health, Labor and Welfare approved certified paramedics to perform emergency prehospital tracheal intubation. A specialized training system in tracheal intubation has been established in Kumamoto Prefecture. METHODS: The Kumamoto Prefectural Medical Control Organization, a tracheal intubation task force was established: consisting of the departments of Anesthesiology at Kumamoto University and 11 other major hospitals, along with Kumamoto Prefecture and the 14 prefectural fire-departments. This group published the Kumamoto training guidelines and a training system for paramedics. RESULTS: Kumamoto Prefecture appealed for support of paramedic activity on television and in newspapers as public education. The prefectural governor officially asked hospitals to train paramedics. Because 9 of the 14 fire-departments had no regional teaching hospital, trainees were matched with other hospitals by the task force. The task force published a pamphlet to inform surgical patients about tracheal intubation training and to recruit patients as practice volunteers. Anesthesiologists undertook significant roles in making arrangements to facilitate the project at their hospitals, in addition to teaching paramedics prior to surgical procedures. CONCLUSIONS: The Medical Control Organization, Kumamoto Prefecture, anesthesiologists and emergency response personnel worked together successfully to promote the training program for clinical tracheal intubation by paramedics.