Effectiveness of a non-amalgamated ambulance service on out-of-hospital sudden cardiac death

Many Canadian communities rely on non-amalgamated ambulance services to respond to out-of-hospital sudden cardiac arrest victims. These pre-hospital care systems lack a central coordinating and dispatching facility, a publicized, easily-accessible telephone number (911) and vehicles equipped with monitor-defibrillators, and are generally staffed by personnel trained only in basic cardiac life support. To receive definitive care, the victim of a cardiac arrest in these communities must be successfully transported to a hospital. In the study area, 114 victims of out-of-hospital sudden death were identified in a community served by a non-amalgamated ambulance service over a 12-month period for an annual incidence rate of 6.1/10,000. The mean age was 64 +/- 11.5 years with the majority (78%) of arrests occurring in the home. The collapse to CPR time was 10.2 +/- 6.7 minutes and the ambulance response time was 5.2 +/- 3.9 minutes. The estimated time from collapse to the victims receiving definitive care was 36.4 +/- 19.1 minutes. Overall, only 8 victims (8.8%) survived and were discharged from hospital. Based on the data presented, survival rate for cardiac arrest victims treated by a non-amalgamated ambulance system are inferior to those reported for pre-hospital care services capable of providing advanced cardiac life support at the scene. Whether all of the components of an established paramedic program are required to improve survival rates in individual communities remains undetermined.     

An acute inpatient geriatric assessment and treatment unit

The inpatient geriatric assessment unit (GAU) is an important component of the Geriatric Assessment and Treatment Centre (GATC) at the Royal Jubilee Hospital in Victoria, British Columbia. The Centre attempts to accomplish the following: to provide, at the request of the attending physician, diagnostic, treatment, and management services where it best suits the patient (ie, at home, in the outpatient service, or following admission to the ward); and to provide, if necessary, follow-up service after discharge to help prevent readmission to the acute hospital or any part of the geriatric service.     

Interleukin-1 inhibits gamma interferon-induced bacteriostasis in human uroepithelial cells.

The most prominent gamma interferon (IFN-gamma)-induced antimicrobial effector mechanisms are the induction of nitric oxide (NO) synthase (NOS) and of indoleamine 2,3-dioxygenase (IDO) activity. We have recently found that human glioblastoma cells and human macrophages inhibit the growth of group B streptococci after stimulation with IFN-gamma. In this report, we show that in addition, human RT4 (uroepithelial) cells can inhibit the growth of enterococci. Murine macrophages (RAW cells) are unable to inhibit bacterial growth after IFN-gamma stimulation. Stimulation of human glioblastoma cells, macrophages, and RT4 cells with human IFN-gamma results in a strong expression of IDO activity; however, NO production remains undetectable. In strong contrast, murine RAW cells produce large amounts of NO when stimulated with murine IFN-gamma and IDO activity is not detectable. Interleukin-1 (IL-1) induces NO synthase in human RT4 cells when the cells are costimulated with IFN-gamma. We found that IL-1 inhibits IFN-gamma-stimulated IDO activity and antimicrobial effects in RT4 cells, while in human glioblastoma cells, which lack detectable NO synthase activity, neither of these effects was altered by costimulation with IFN-gamma and IL-1. The IL-1-mediated inhibition of IDO activity and of subsequent antibacterial effect is due to the production of NO. This conclusion was supported by evidence that N(G)-monomethyl-L-arginine, a competitive inhibitor of inducible NOS activity, is able to block the inhibitory action of IL-1 on IFN-gamma-induced bacteriostasis. We therefore conclude that NO production does not inhibit the growth of enterococci but might be involved in the regulation of IDO activity in some human cells.     

Recurrence rate and complications after beta irradiation for pterygia.

Of 1102 consecutive patients treated with beta irradiation after pterygium removal at the Queensland Radium Institute from 1973 through 1978, 503 had a follow-up ophthalmologic examination in 1989, while a further 82 had at least a 10-year follow-up from ophthalmologic records. One hundred forty-two patients were lost to follow-up because of death, lack of cooperation, and geographical inaccessibility. A further 375 patients could not be located. Of those not followed for at least 10 years, 162 had a follow-up, recorded from ophthalmologic records, of at least 3 months. After an average dose of 22 Gray, there was a recurrence rate of 12%. A further 13% showed some sign of scleromalacia, which included 4.5% of the study group who had severe thinning.     

Serial quantitative 99mTc DTPA imaging in CMV-associated renal allograft dysfunction

Two cases of cytomegalovirus associated renal allograft dysfunction were monitored by serial 99mTc DTPA imaging and cytomegalovirus specific fluorescent antibody tests. One case of primary cytomegalovirus disease associated with pneumonitis, hepatitis and pyrexia occurred 25 days after transplantation. The second case, due to cytomegalovirus reactivation/reinfection had fewer symptoms and occurred 78 days following transplantation. 99mTc DTPA perfusion index at the height of the cytomegalovirus associated illness remained unaltered in both cases, and did not suggest the presence of acute rejection. This non-reactive response was associated with a rapid return of graft function. The combined use of these rapid diagnostic tests during suspected rejection episodes may be useful in indicating cytomegalovirus associated allograft dysfunction and preventing the addition of further potentially harmful immunosuppressants.     

Systemic and renal hemodynamic consequences of manipulation of serum calcium and/or parathyroid hormone in the intact conscious mongrel dog

Studies were undertaken in conscious mongrel dogs to separate the systemic and renal hemodynamic effects of alterations in serum calcium (Ca) from those of parathyroid hormone (PTH) in an intact conscious animal. Blood pressure was measured intra-arterially, cardiac output was determined by dye-dilution or thermodilution, total peripheral resistance (TPR) was calculated from standard formulae, and renal hemodynamics were estimated by the clearance of inulin and para-aminohippurate. Measurements were made before and after a 2 hour calcium chloride (CaCl2) infusion in 10 dogs (group 1). These animals had previously received a dose of PTH to prevent suppression of PTH during the CaCl2 infusion. Ionized calcium (Ca++) and TPR increased significantly. Blood pressure increased but not significantly. Administration of EDTA did not significantly change any systemic hemodynamic variable in eight thyroparathyroidectomized dogs (group 2). Chelation in seven dogs with intact parathyroid glands (group 3) reduced mean arterial blood pressure and total peripheral resistance. Renal hemodynamic measurements were not affected. Isolated acute elevation of serum Ca++, independent of suppression of PTH, increased total peripheral resistance. Decreased serum Ca++ required normal activity of parathyroids to reduce total peripheral resistance. The renal circulation was resistant to acute manipulation of ionized serum calcium and PTH. CaCl2 infusion to intact dogs (group 1) decreased serum magnesium significantly, increased urine flow rate, and decreased urinary PGE2 excretion. Comparisons between group 2 and group 3 revealed a greater decline in serum Mg and urinary prostaglandin E2 excretion in group 2 vs group 3. Elevation of peripheral resistance due to acute Ca elevations was accompanied by decreased serum Mg and decreased renal prostaglandin excretion.(ABSTRACT TRUNCATED AT 250 WORDS)