Preparing teams for low-frequency emergencies in Norwegian hospitals

BACKGROUND: Medical emergencies and major trauma require optimal team function. Leadership, co-operation and communication are the most essential issues. Due to low caseloads such emergencies occur rarely in most Norwegian hospitals. Team training of personnel between real emergencies is expected to improve performance in comparable settings. Most hospitals have cardiac arrest teams, but it is known that the training of such multiprofessional teams varies widely. We wanted to know if this also was the case for trauma teams and resuscitation teams for newborns. METHODS: A telephone survey of training practices in all the Norwegian hospitals with acute cover was conducted in 2002. Information was obtained on whether trauma teams and neonatal resuscitation teams had participated in practical multiprofessional training during the previous 6 or 12 months. RESULTS: Information was obtained from all 50 hospitals. Of the acute care hospitals, 30% had trained their trauma teams during the previous 6 months, and an additional 18% when considering the previous year, while 38% of neonatal wards had multiprofessional training during the previous 6 months, and additionally 13% had had training during the previous year. Additionally four neonatal wards had had regular training of nurses only. More than 80% of all respondents judged regular team training to be achievable, and none considered this training impossible. CONCLUSION: Only half the Norwegian acute care hospitals reported at least yearly training of trauma and neonatal resuscitation teams. Regular team training represents an underused potential to improve handling of low-frequency emergencies.     

Facial rhytides—subsurfacing or resurfacing? A review

STUDY DESIGN/BACKGROUND AND OBJECTIVES: Currently, ablative laser therapy (with CO2/Er:YAG lasers) is considered an effective and promising method of skin rejuvenation. The induction of collagen synthesis was observed after treatments with the CO2 laser and with the long-pulsed Er:Yag laser. In past years, the undesirable side effects and risks of these methods have led to intensified research efforts in the fields of non-ablative facial rejuvenation as well as subsurfacing by means of non-ablative laser systems and intense pulsed light systems. The objective is to achieve selective, heat-induced denaturalization of dermal collagen that leads to subsequent reactive synthesis of neocollagen but does not damage the epidermis. This article reviews the use of different types of lasers and intense pulsed light sources for the non-ablative treatment of facial rhytides. RESULTS: The results of numerous clinical and histological investigations have recently indicated that these new technologies are successful. Some studies demonstrated remarkable effects with non-ablative systems; others, however, showed only limited cosmetic improvement or none at all. CONCLUSIONS: After critical review and assessment of current literature on the treatment of rhytides, we have found that non-ablative methods do not appear to be a comparable alternative to ablative skin resurfacing in terms of their efficacy and side effects.     

Cyclosporin A for the treatment of severe Henoch-Schönlein glomerulonephritis

We evaluated the efficacy of cyclosporin A (CyA) for treating pediatric patients with severe Henoch-Schönlein glomerulonephritis (HSP-GN) and nephrotic-range proteinuria. Seven pediatric HSP-GN patients (5 boys, 2 girls) were treated with CyA, with a mean age of 10.6 years at diagnosis (range 7.2–15.2 years) and mean follow-up times of 6.0 years (range 4.4–8.9 years) from diagnosis and 5.2 years (range 3.4–7.7 years) from the beginning of the CyA treatment. All had developed nephrotic-range proteinuria within 1–3 months of the HSP diagnosis. A renal biopsy was performed on all the patients, and two showed rapidly progressive glomerulonephritis. They all received additional angiotensin converting enzyme inhibitor medication and one to three types of immunosuppressive treatment had been tried in five of the seven patients before CyA was initiated at a mean interval of 0.7 years after diagnosis (range 0.1–2.0 years). All the patients responded to the CyA treatment within a mean of 1.4 months (range 1 week to 4 months). Four patients achieved a stable remission and had been without CyA treatment for a mean of 3.7 years (range 2.9–5.3 years) by the end of the follow-up. Three patients seemed to become CyA dependent, since they developed proteinuria when the treatment was stopped. CyA treatment had been started significantly earlier (P=0.045) in the former group (mean 0.2 years, range 0.1–0.3 years) than in the latter (mean 1.5 years, range 1.2–2.0 years). Renal function was preserved in all patients, the glomerular filtration rate, plasma cystatin C, serum albumin, and serum creatinine being within normal limits at the end of the follow-up. We conclude that CyA treatment for severe treatment-resistant HSP-GN is promising, since four of the seven patients enjoy stable remission and all have retained their renal function after a mean follow-up of 6.0 years. However, some patients seem to develop CyA-dependent nephritis.The results were presented as a poster at the 36th meeting of the European Society for Pediatric Nephrology in Bilbao     

Breast-conserving therapy with adjuvant paclitaxel and radiation therapy: feasibility of concurrent treatment

As commonly used, adjuvant paclitaxel after doxorubicin in high-risk breast cancer patients results in a prolonged delay of the onset of radiation therapy after breast-conserving surgery. Concurrent delivery of breast irradiation with paclitaxel would allow for earlier initiation of radiation. We report on the toxicity of concurrent paclitaxel and breast irradiation after doxorubicin and cyclophosphamide. Twenty-four patients were treated with concurrent breast radiation and paclitaxel. All patients received four cycles of doxorubicin and cyclophosphamide followed by four cycles of paclitaxel, 175 mg/m2 every 3 weeks. The radiation therapy started after the first cycle in 3 patients, after the second cycle in 16, and after the third in 5. The breast received 4680-5040 cGy external beam irradiation, followed by a boost of 1000-2000 cGy. Fifteen patients received supraclavicular irradiation, and a posterior axillary supplement was used in five patients. Median follow-up after completion of irradiation was 11.5 months (range 2-29 months) with 21 patients followed >or=6 months, 12 followed >or=12 months, and 7 followed >or=18 months. Using Radiation Therapy Oncology Group (RTOG) acute toxicity scoring criteria, 7 patients experienced grade 1 skin and/or soft tissue reactions and 17 patients had grade 2 reactions. The average total duration of radiation treatment was 49 days (range 41-57 days). Only eight patients had radiation therapy interruptions for a median of 3.5 days (range 2-8 days): two more than 5 days. None had a chemotherapy dose reduction. One patient discontinued paclitaxel after the third cycle due to bilateral upper extremity neuropathy. No cases of pneumonitis or brachial plexopathy were seen. Concurrent treatment with every 3-week paclitaxel and breast irradiation was well tolerated. Additional study is needed to determine optimal timing, long-term toxicity, and potential benefits of concurrent radiation therapy and paclitaxel.     

Comparative study of prophylactic oral ganciclovir and valacyclovir in high-risk kidney transplant recipients.

BACKGROUND: Cytomegalovirus (CMV) is a major pathogen in renal transplant patients causing significant post-transplant morbidity and mortality. Prophylactic antiviral therapy, currently implemented in most kidney transplant centres, has significantly reduced the incidence of CMV infection after transplantation. Oral ganciclovir has been shown to be an effective prophylactic agent in preventing CMV disease and infection with a demonstrated superior efficacy over oral acyclovir. Valacyclovir, a prodrug of acyclovir with a higher level of bioavailability than acyclovir, has also been shown to be effective in preventing CMV disease when given as prophylactic treatment. METHODS: In a retrospective analysis of 150 renal transplant recipients in our centre, we compared the efficacy of oral ganciclovir with valacyclovir in preventing CMV infection. Seventy-seven consecutive renal transplant recipients prophylactically treated with oral ganciclovir for 12 weeks after transplant were compared with 73 consecutive recipients treated with oral valacylovir for an equal length of time. RESULTS: No difference was noted in the incidence of CMV infection between the two treatment groups (5.1 vs 5.4%) after a 6 month follow-up. Likewise, the incidence of acute rejection was similar in both groups (11.6 vs 6.8%). All cases of CMV infection occurred in high-risk patients (donor positive/recipient negative). CONCLUSION: The prophylactic use of oral valacylovir is as effective as oral ganciclovir in reducing CMV infection and disease after kidney transplantation.     

Nilutamide as second line hormone therapy for prostate cancer after androgen ablation fails

PURPOSE: We investigate the prostate specific antigen (PSA) response rate with nilutamide as a second line hormonal agent in patients with advanced prostate cancer in whom androgen ablation failed. MATERIALS AND METHODS: From 1998 to 2001, 28 patients with hormone resistant prostate cancer were treated with nilutamide as second line hormonal therapy. Average patient age +/- SD was 72.9 +/- 9.1 years. Median time from diagnosis of cancer to hormone failure was 48 months (range 2 to 120). Median followup from initiation of nilutamide therapy was 26 months (range 15 to 44). All patients had previously received at least 1 antiandrogen (flutamide or bicalutamide) in addition to medical or surgical castration, which failed. RESULTS: Upon initiation of nilutamide therapy 18 of the 28 patients (64%) had an initial reduction in PSA and 8 (29%) sustained a PSA response (greater than 50% decrease) beyond 3 months (range 3 to 21). PSA response to nilutamide in patients with a previous antiandrogen withdrawal response versus nonresponse was 100% and 18%, respectively. In 10 of the 28 patients, (36%) PSA continued to increase. Interstitial pneumonitis developed, in 1 patient and 5 had nonspecific complaints (headaches, nausea, dizziness). During followup 6 of the 28 patients died 1 of whom was a nilutamide responder. No patient died while on nilutamide. CONCLUSIONS: Nilutamide can achieve a significant sustained PSA response with a favorable toxicity profile. Patients with a previous antiandrogen withdrawal response have a significantly greater chance of responding to nilutamide.     

低强度激光照射对大鼠血管平滑肌细胞一氧化氮生成通路的上调作用

目的 观察低强度激光照射(low power laser irradiation,LPLI)对大鼠血管平滑肌细胞(vascular smooth muscle cells,VSMCs)左旋精氨酸(L-Arg)转运、一氧化氮(NO)生成以及NO合酶(nitric oxide synthase,NOS)活性的作用,以探讨LPLI血管保护作用的细胞分子机制.方法 取Wistar大鼠主动脉,贴块法培养VSMCs,分别以能量密度0、0.9.2.7和4.5 J/cm2的He-Ne激光(波长632nm)照射,无照射组为对照组.重氮化学反应法测定培养液中NO含量,细胞孵育液中加入3H-L-Arg测定细胞L-Arg的摄入,测定3H-胍氨酸的生成反映NOS活性.结果 能量密度分别为0.9,2.7和4.5 J/cm2的LPLI照射VSMCs,促进细胞NO生成分别较对照组增加-1.3%(P＞0.05)、60.4%(P＜0.01)和78.6%(P＜0.01);细胞NOS活性分别较对照组增加16.9%(P＞0.05)、44.6%(P＜0.01)和53.0%(P＜0.01);而且细胞摄入L-Arg(Vmax值)分别较对照组增加11.0%(P＜0.05),66.7%(P＜0.01)和38.7%(P＜0.01);激光照射对L-Arg跨细胞膜转运的米氏常数(Km值)无明显影响(均P＞0.05).结论 低强度He-Ne激光照射激活大鼠VSMCs的L-Arg/NOS/NO通路,可能为低强度激光扩张血管、改善器官血流等生物学效应的机制之一.     

Limitations of dynamic contrast-enhanced MRI in monitoring radiation-induced changes in the fraction of radiobiologically hypoxic cells in human melanoma xenografts

Purpose

To investigate the potential of gadopentetate dimeglumine (Gd‐DTPA)‐based dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) in detecting radiation‐induced changes in the fraction of radiobiologically hypoxic cells in A‐07 human melanoma xenografts.

Materials and Methods

A‐07 tumors were randomly assigned to an unirradiated control group or a group given a single radiation dose of 20 Gy. DCE‐MRI and measurement of fraction of hypoxic cells were performed immediately before and 24 h after the radiation exposure. Tumor images of E · F (E is the initial extraction fraction of Gd‐DTPA and F is blood perfusion) and λ (λ is proportional to extracellular volume fraction) were produced by subjecting DCE‐MRI series to Kety analysis. Fraction of hypoxic cells was measured by using a radiobiological assay based on the paired survival curve method.

Results

Fraction of radiobiologically hypoxic cells was higher in irradiated tumors (26.2 ± 5.8%) than in unirradiated tumors (7.5 ± 2.7%) by a factor of 3.5 ± 1.5 (P = 0.0093), whereas only minor radiation‐induced changes in E · F and λ could be detected.

Conclusion

DCE‐MRI does not seem to offer insight into the changes in fraction of radiobiologically hypoxic cells occurring in A‐07 tumors within 24 h after irradiation with 20 Gy. J. Magn. Reson. Imaging 2008;28:1209–1218. © 2008 Wiley‐Liss, Inc.     

输卵管积水的栓塞治疗

目的探讨和评价输卵管积水栓塞治疗方法的可行性。方法在X线透视监视下,行输卵管选择性插管,将微弹簧圈通过微导管送入输卵管近端,达到栓塞输卵管的目的。结果输卵管栓塞98例患者,双侧输卵管栓塞66例,单侧输卵管栓塞32例,共栓塞164侧输卵管,插管均一次性成功。输卵管栓塞后1个月行子宫输卵管造影术,显示有效者164侧为100%,其中显示最佳效果者136侧输卵管,占82.9%;无效者为0。结论输卵管栓塞的介入治疗是行之有效的方法,与目前采用的方法相比,无手术并发症,简便,安全,经济,对卵巢功能无影响。     

Q开关Nd:YAG激光不同波长治疗面部毛细血管扩张疗效比较

目的：观察Q开关Nd：YAG激光不同波长治疗面部毛细血管扩张的疗效及副反应。方法：128例病人按治疗波长随机分为532nm组75例，585nm组53例，治疗光斑2．0mm，能量密度2．2-6．8J／cm。，脉宽10ns；术后3个月根据术前照片判定疗效，标准分为Ⅳ级。结果：治疗次数1-4次，间隔时间3-5个月，两组共治愈71例(55，47％)，疗效与治疗次数成正相关。其中532nm组治愈36例(48．00％)，平均治愈次数2．64次；585nm组治愈35例(66．04％，)，平均治愈次数2．40次，两组痊愈率及副反应差异无显性。结论：Q开关Nd:YAG激光倍频532／nm和585nm两种波长对密度较低、直径较细的面部毛细血管扩张均有可靠疗效，术后除色素沉着发生较高外，其他不良反应较少。