YPD, PombePD and WormPD: model organism volumes of the BioKnowledge library, an integrated resource for protein information.

The BioKnowledge Library is a relational database and web site (http://www.proteome.com) composed of protein-specific information collected from the scientific literature. Each Protein Report on the web site summarizes and displays published information about a single protein, including its biochemical function, role in the cell and in the whole organism, localization, mutant phenotype and genetic interactions, regulation, domains and motifs, interactions with other proteins and other relevant data. This report describes four species-specific volumes of the BioKnowledge Library, concerned with the model organisms Saccharomyces cerevisiae (YPD), Schizosaccharomyces pombe (PombePD) and Caenorhabditis elegans (WormPD), and with the fungal pathogen Candida albicans (CalPD). Protein Reports of each species are unified in format, easily searchable and extensively cross-referenced between species. The relevance of these comprehensively curated resources to analysis of proteins in other species is discussed, and is illustrated by a survey of model organism proteins that have similarity to human proteins involved in disease.

One-year survival after out-of-hospital cardiac arrest in Copenhagen according to the 'Utstein style'.

OBJECTIVE: To determine survival after out-of-hospital cardiac arrest (CA) in Copenhagen, according to the Utstein recommendations, and compare this with other emergency medical services systems. DESIGN: Register-based cohort study. SETTING: Copenhagen, population 465000, area 90 km(2). PATIENTS: Consecutive group of patients with out-of-hospital CA occurring between January 1 1991 and December 31 1993, followed up via the hospital database systems. MATERIALS: Two specially equipped advanced life support (ALS) units, staffed with an anaesthesiologist and a specially trained fireman, operating to support basic life support units. RESULTS: Of 2225 patients who were unconscious without a pulse or breathing, 1461 were declared dead by the anaesthesiologist. Advanced cardiac life support was initiated in 764, 61 of which were of non-cardiac aetiology. The presumed aetiology was cardiac in 703: in 235 the event was unwitnessed, in 464 witnessed and in four the information was missing. Of 464 witnessed CA the initial rhythm was asystole in 72 cases, in 302 ventricular fibrillation (VF) or ventricular tachycardia (VT), and in 90 were in other rhythms. In these subgroups discharged rates were 5 (7%), 62 (21%) and 1 (1%), and 1-year survival rates were 4 (6%), 49 (16%) and 1 (1%), respectively. The median ALS call-response interval was 6 min. CONCLUSIONS: Survival after CA is more likely if the collapse was witnessed and in patients with VF/VT of cardiac aetiology.

Prehospital care of the burned patient.

For optimal treatment of burns an understanding of the pathophysiological changes occurring locally and systemically after injury is necessary. Accurate estimation of burn size and depth as well as early treatment is essential. Knowledge of the circumstances of the accident and experience in diagnosing physical signs are required in terms of the need for intubation, treatment of poisoning and the occurrence of other trauma.

Use of Z-skin plasty in scar revisions and skin contractures of the lower extremity.

A discussion of the design and use of the Z-skin plasty to revise scars and lengthen skin contractures of the lower extremities is presented. One of the most commonly used rotational flaps to alter scar direction or relieve tension on the existing scar or skin, the Z-plasty can also be the most difficult to perform and carries a high risk of flap loss if inaccurately planned or poorly placed. Several variations of the standard procedure and examples of common usage are presented.

Body mass and weight as indicators for cholesterol screening.

BACKGROUND: Universal screening of serum cholesterol levels in adults has been recommended but not achieved. We were interested in factors that affected screening rates, and whether obese patients were more likely to have elevated cholesterol levels than other patients in our practice. METHODS: A sequential sample of charts was reviewed for height, weight, race, sex, diagnosis of hypertension or diabetes, and evidence of cholesterol screening. RESULTS: Of 604 adult patients, 32% had serum cholesterol measurements. No correlation was found between weight or body mass index and cholesterol levels. Patients with hypertension or diabetes were more frequently screened. Sex and race did not influence screening rates. CONCLUSIONS: In this population neither weight nor body mass index was associated with elevated serum cholesterol levels, suggesting that screening must be offered without regard to level of obesity in order to find those patients who will benefit from intervention.

[Malignant bone pain]. / Maligne knoglesmerter.

Bone pain is one of the most frequent causes of pain in patients with cancer, and the levels of metastases and bone pain are not directly correlated. Nociceptors in the periosteum are probably stimulated by halisteresis or by inflammatory oedema leading to an increase in the intraosseous pressure. Some authors believe that the nociceptors in bone are mediated via intraosseous mechanoreceptors in the bone-matrix. At a low pain level the initial treatment is acetylsalicylic acid, paracetamol or other nonsteroidal antiinflammatory drugs. At increasing pain level initial doses of oral opioids are added. In severe bone pain, where conventional therapy seems difficult, opioids are administered by invasive techniques. In localised bone pain palliative radiation is the first treatment of choice. Corticosteroids induce an analgetic effect indirectly by reducing the inflammatory oedema, inhibiting the synthesis of prostaglandins and may inhibit excitatory nerve fibres. Endocrine treatment, calcitonin and biophosphonates have shown a documented pain-relieving effect in patients with disseminated breast and prostate cancer. Chemotherapy has shown a pain-relieving effect in patients with disseminated breast cancer, surgical intervention is used in stabilizing osteolytic bones before or after a fracture ensuring a reasonable relief of pain.

[Acute pain service--another in-hospital specialty?]. / Akut smerteservice--endnu en udspecialisering i hospitalet?

Realizing that achievement in postoperative pain treatment was not satisfactory, central health authorities in USA, United Kingdom and Australia have published guidelines for managing acute pain. Establishing acute pain services is thought to be one of the means of improving pain relief in the individual patient. Development and research are secured and achieved results may be presented currently. At this moment, introduction of acute pain services is at a preliminary stage in Denmark, and consequently an overview of results obtained from abroad is given including pain treatment techniques, management and safety measures, as well as visions concerning the impact of optimal pain relief upon convalescence. We conclude that the introduction of acute pain services is bound to optimize postoperative patient care and might well prove to be a significant factor in reducing postoperative morbidity.

[Perioperative fluid therapy. A quality control study]. / Perioperativ vaeskebehandling. En kvalitetskontrolundersøgelse.

This paper presents a retrospective analysis of the fluid balance during the first 12 hours after laparotomy in 60 consecutive patients. The analysis showed that the majority of patients received greater volumes of crystalloid infusions than recommended, and that the actual number of blood transfusions given did in many circumstances not comply with the available guidelines. Perioperative fluid therapy is an area that needs increased attention since overhydration may contribute to cardiopulmonary morbidity. Perioperative fluid therapy regimens should be evaluated in future prospective, controlled, randomized trials.

[Continuous subcutaneous infusion of opioids in cancer patients]. / Kontinuerlig subkutan opioidinfusion til cancerpatienter.

This review article describes pharmacokinetics, pharmaco-dynamics, side effects and the practical use of continuous subcutaneous infusion of opioids in cancer patients with pain. Clinical studies have shown that the analgesic effects of continuous subcutaneous infusion of morphine are comparable to continuous intravenous morphine, and that the treatment modality is associated with a low frequency of side-effects and complications. Continuous subcutaneous infusions of morphine are therefore recommended as the treatment of choice for cancer patients with pain, when oral analgesic treatment is no longer possible.

[Treatment of severe hypovolemia with hypertonic saline]. / Behandling af svaer hypovolaemi med hypertont saltvand.

Hypertonic saline (HS) has been used since 1980 in the treatment of traumatised, hypotensive patients. Studies show more pronounced and stable increments in blood pressure and reduced mortality in various subgroups of patients treated with HS compared to isotonic fluids. When infused in the setting of hypovolaemia HS instantaneously expands plasma volume and improves central haemodynamics through increased filling pressures and direct myocardial stimulation. HS, as compared to isotonic fluids, causes precapillary vasodilation, reduction of cell oedema and decreased haematocrit and hence improves regional and capillary perfusion. Furthermore HS-infusion has been shown to attenuate reperfusion injury and restore cell function in cells damaged during hypovolaemic shock. Animal experiments as well as clinical studies on the use of HS are reviewed. A short description of the pathophysiology of acute hypovolaemic shock and exchange of fluids between body compartments is given.

[Hypertonic saline in the treatment of hypovolemia]. / Hypertont saltvand til behandling af hypovolaemi.

Following infusion of hypertonic saline, interstitial and intracellular fluids are within minutes drawn into the vascular compartment as a result of osmotic gradients. Administration of 5 ml/kg body weight hypertonic saline leads to a degree of plasma expansion corresponding to 8-12 ml/kg. Results from major randomized studies on treatment of acute hypotension demonstrate that infusion of hypertonic saline leads to improved survival. Two case reports of patients suffering from severe septicaemia are presented in which infusion of hypertonic saline (7.5%) was performed in order to stabilize haemodynamic parameters. Case report no. I illustrates the rapid plasma expanding properties of hypertonic saline and no. II the effect on central haemodynamics with increased stroke volume and cardiac index. Consequently, hypertonic saline is considered an important supplement in the treatment of severe hypovolaemic or septic shock.

Fixation of extradural catheters by means of subcutaneous tissue tunnelling.

In 100 patients treated for chronic pain, extradural opioids were administered by means of catheters which were tunnelled subcutaneously. Seventy-three per cent of patients needed only one catheter and 15% had a catheter in place for more than 100 days, the longest being for 434 days. In only 18 patients was the catheter displaced accidentally from the extradural space. There were no instances of extradural infection, although in three patients the tunnel became infected. We conclude that fixation of extradural catheters by subcutaneous tunnelling is a simple method which provides adequate security in clinical practice.