The association between the experience of lay responders and response interval to medical emergencies in a rural area: an observational study.

AIM: The aim of this retrospective observational study was to determine how response intervals correlated to the experience of the community first responders (CFRs) using data collected from the Danish Island of Langeland via a global positioning system (GPS)-based system. METHODS: All medical emergency calls involving CFRs in the time period from 21st of April 2012 to 31st of December 2017 were included. Each emergency call activated 3 CFRs. Response intervals were calculated using the time from when the system alerted the CFRs to CFR time of arrival at the emergency site measured by GPS. CFRs response intervals were grouped depending on their level of experience according to ≤ 10, 11-24, 25-49, 50-99, ≥ 100 calls accepted and arrived on-site. RESULTS: A total of 7273 CFR activations were included. Median response interval for the CFR arriving first on-site (n = 3004) was 4:05 min (IQR 2:42-6:01) and median response interval for the arrival of the CFR with an automated external defibrillator (n = 2594) was 5:46 min (IQR 3:59-8:05). Median response intervals were 5:53 min (3:43-8:29) for ≤ 10 calls (n = 1657), 5:39 min (3:49-8:01) for 11-24 calls (n = 1396), 5:45 min (3:49-8:00) for 25-49 calls (n = 1586), 5:07 min (3:38-7:26) for 50-99 calls (n = 1548) and 4:46 min (3:14-7:32) for ≥ 100 calls (n = 1086) (p < 0.001). There was a significant negative correlation between experience and response intervals (p < 0.001, Spearman's rho = -0.0914). CONCLUSION: This study found an inverse correlation between CFR experience and response intervals, which could lead to increased survival after a time-critical incident.

Evidence for heterophilic adhesion of embryonic retinal cells and neuroblastoma cells to substratum-adsorbed NCAM.

The adhesion of embryonic chicken retinal cells and mouse N2A neuroblastoma cells to purified embryonic chicken retinal NCAM adsorbed on a solid substratum was examined using a quantitative centrifugal adhesion assay. Both cell types adhered to NCAM and the adhesion was specifically inhibited by monovalent anti-NCAM antibody fragments. N2A cell adhesion depended on the amount of NCAM applied to the substratum, was cation independent, and was insensitive to treatment with the cytoskeletal perturbing drugs colchicine and cytochalasin D. These results indicated that the tubulin and actin cytoskeletons were not critically required for adhesion to NCAM and make it unlikely that the cell surface ligand for NCAM is an integrin. Adhesion was however temperature dependent, strengthening greatly after a brief incubation at 37 degrees C. CHO cells transfected with NCAM cDNAs did not adhere specifically to substratum-bound NCAM and pretreatment of N2A cells and retinal cells with anti-NCAM antibodies did not inhibit adhesion to substratum-bound NCAM. These results suggest that a heterophilic interaction between substratum-adsorbed NCAM and a non-NCAM ligand on the surface of the probe cells affects adhesion in this system and support the possibility that heterophilic adhesion may be a function of NCAM in vivo.

Contamination of subclavian vein catheters: an intraluminal culture method.

An intraluminal culture method was evaluated for central venous catheters and compared to conventional catheter tip cultures and cultures from the insertion site. The colonization-rate of the catheters was 43.7% using conventional tip culture, 34.4% with the intraluminal method and 40.1% at the skin puncture site. Only 37.5% of the catheters showed identical bacteria at the skin puncture site and catheter-tip, compared with 87.5% between intraluminal culture and catheter-tip culture (P less than 0.05).

The prevalence and significance of incidental paranasal sinus abnormalities on MRI.

Morphological changes in the paranasal sinuses are regularly noted on MRI, but little is known about the incidence and significance of these changes in the general population. The purpose of this study was 1) to classify the morphological changes in the paranasal sinuses seen on MRI 2) to investigate the prevalence, site and type of paranasal abnormalities and 3) to evaluate the significance of the findings by relating them to the presence of sinusitis symptoms, allergy, smoking habits and seasonal variations. In a one-year period, 404 patients referred to MRI for suspected intracranial neurological pathology were prospectively investigated. Before undergoing the scan the patients completed a questionnaire. The observed morphological conditions were classified so that mucous thickening < 5 mm was recorded as normal; > or = 5 mm, total sinus opacification or fluid and polyps as pathological. According to this classification 31.7% of the patients had pathological findings in the sinuses. A significantly higher incidence was found in the winter period and in patients with symptoms associated to sinusitis. "Blocked nose" was the only symptom occurring significantly more often in patients with pathological changes. There was no significant relationship between paranasal sinus abnormalities and sex, age, allergy, smoking habits, previous events of sinusitis or frequent events of colds. Criteria for pathological MRI findings in the paranasal sinuses are desirable and might improve the basis for a decision on the correct medical or surgical treatment.

[A case of adiposis dolorosa--Dercum's disease]. / Et tilfaelde af adiposis dolorosa--morbus Dercum.

Adiposis dolorosa or Dercum's disease consists of a painful progressive localized state of obesity with four cardinal symptoms: a) painful circumscribed or diffuse fatty deposits, b) generalized obesity in women usually of menopausal age, c) asthenia, weakness and frequently tendency to fatigue and d) mental phenomena including emotional instability, depression, epilepsy, mental confusion and true dementia. Only a few cases in men have been described. The pain may be treated with intravenous administration of lignocaine or oral mexitil while no causal treatment is known. An illustrative case is reported.

[Healing of scaphoid fractures assessed by tomography. A follow-up study of treated patients]. / Scaphoideumfrakturens heling bedømt ved tomografi. En efterundersøgelse af foerdigbehandlede patienter.

Thirty-five of 40 patients who had sustained an undisplaced fracture of the waist of the scaphoid were reviewed clinically and radiographically (including tomography) at a median of 70 (13-120) weeks after injury. All fractures had been retained in a below elbow scaphoid plaster for a period of median eight (3-12) weeks. End of treatment was based on the absence of "tenderness" over the scaphoid and on radiographical signs of fracture union median ten (5-24) weeks after injury. At review 28 (80%) of the fractures were united based on standard radiographs and tomography. Four fractures ((11%) 95% confidence limits: 3-27%) were nonunions and three fractures (9%) were probably united. Tomography gave additional information about the state of union if the fracture was visible but unclassifiable on standard radiographs. Tenderness over the scaphoid was only found in the nonunions and probably united fractures. Radiographic and clinical evaluation of the fracture six months after injury is recommended.

[Respiratory insufficiency caused by a vocal cord polyp. An accidental finding during respiratory function tests]. / Respiratorisk insufficiens forårsaget af stemmebåndspolyp. Et tilfoeldigt fund ved lungefunktionsundersøgelse.

We present a case in which a 58-year-old woman was admitted for spirometry due to progressive dyspnoea. She had a history of chronic obstructive pulmonary disease treated for more than 20 years. The flow-volume loop indicated an upper airway obstruction. An otolaryngologic examination revealed a vocal cord polyp. It was excised and the patient's dyspnoea was relieved. The following spirometry indicated that the upper airway obstruction had been removed. The aim of this case report is to demonstrate that the flow-volume loop is a useful method in diagnosing and quantifying upper airway obstructions.

[Captopril renography in the diagnosis of renovascular hypertension]. / Captopril-renografi ved diagnosticering af renovaskulaer hypertension.

The value of renography before and after angiotensin converting enzyme inhibition with captopril (captopril renography) as a test for renovascular hypertension was studied in fourteen hypertensive patients. The captopril renography was performed with 99mTc-DTPA by means of a gammacamera, allowing determination of single kidney glomerular filtration rate (SKGFR). In all patients determination of renal vein plasma renin concentration and renal angiography were carried out. Eleven patients showed an elevated unilateral renin secretion. All of these had a significant decrease of SKGFR in one or both kidneys after captopril. Three patients without a lateralized renal renin secretion showed no change in SKGFR. In five patients with presumed essential hypertension there was no change in SKGFR during captopril renography. Captopril renography with 99mTc-DTPA gammacamera renography is a promising tool for identification of unilateral increased renin secretion in hypertensive patients suspected of renovascular hypertension.

[99mTc-HMPAO leukocyte scintigraphy in inflammatory intestinal disease]. / 99mTc-HMPAO-leukocytskintigrafi ved inflammatorisk tarmsygdom.

Eighteen patients, suspected of active inflammatory bowel disease, were investigated. The 99mTc-HMPAO-leucocyte scintigraphy was evaluated using the results of the simultaneous clinical examinations, which included clinical and biochemical parameters, small intestinal series, colonoscopy and, in two patients, operation, as reference. In agreement with the clinical examinations, the leucocyte scintigraphy indicated active inflammatory bowel disease in 14 of the 18 patients. The leucocyte scintigraphy disclosed inflammation in all of the 19 bowel segments, in which the clinical examinations indicated active inflammation. In three patients with Crohn's disease the scintigraphy indicated more extensive inflammation. A correlation between the scintigraphic activity and the Crohn's Disease Activity Index was found. However, the leucocyte scintigraphy did not seem useful as a disease activity index. The 99mTc-HMPAO-leucocyte scintigraphy seemed especially useful in severely ill patients and in patients suspected of relapse.

Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy in the early course of mild acute pancreatitis following endoscopic retrograde cholangiopancreatography.

We evaluated the diagnostic accuracy of technetium-99m hexamethylpropylene amine oxime (HMPAO) leucocyte scintigraphy in mild acute pancreatitis. A study design was chosen that gave us an opportunity to assess patients by leucocyte scintigraphy in the very early course of the disease. Thirty-two consecutive patients referred for endoscopic retrograde cholangiopancreatography were followed according to a very rigid protocol with laboratory tests and clinical examination before and after the endoscopic procedure and leucocyte scintigraphy [including single-photon emission tomography (SPET)] performed within 24 h. Planar and SPET images were examined by two observers who were blinded to each other and to the clinical history and diagnosis. Eight (25%) of the 32 patients developed mild acute pancreatitis, and only one of these patients had a positive scan. Sensitivity, specificity and accuracy of 13%, 79% and 63%, respectively, were achieved when both planar and SPET images were considered. When only planar images were considered the sensitivity, specificity and accuracy were 13%, 96% and 75%, respectively. No evidence of pathological leucocyte accumulation in mild acute pancreatitis was found despite the aforementioned very rigid protocol, allowing patients to be assessed by 99mTc-HMPAO leucocyte scintigraphy in the very early phase of the disease (this was true even when using SPET). From a clinical point of view, we believe that leucocyte scintigraphy should be used only when the disease is moderate or severe and serious intra-abdominal complications are suspected.

Carotid endarterectomy in patients with cerebral transient ischemic attacks.

Eighty-seven consecutive patients with cerebral transient ischemic attacks (TIA) subjected to 98 surgical operations for stenosis of the internal carotid artery were followed for a period of 3.5 years in average. In the immediate postoperative period one patient died and two other patients had a severe neurological deficit. These complications occurred in patients where medical risk factors were present preoperatively. During the follow-up period six patients had a stroke. This figure is about 1/3 og the estimated expected number in an untreated patient group of the same size. Three strokes occurred from the hemisphere ipsilateral to the operated internal carotid artery and three from the contralateral hemisphere. Although estimation of expected number of strokes is associated with many uncertainties the present results suggest that carotid endarterectomy in patients with TIA and carotid artery stenosis reduced the frequency of strokes.

Glial regulation of alpha 7-type nicotinic acetylcholine receptor expression in cultured rat cortical neurons.

Primary embryonic cortical cultures were used as an in vitro model to evaluate the influence of glia on developmental expression of alpha 7-type nicotinic acetylcholine receptors in rat brain. In cells cultured in serum-containing medium without mitotic inhibitors, specific 125I-alpha-bungarotoxin binding to alpha 7-type nicotinic receptors was maximal 4-8 days after plating. Treatment with 5'-fluorodeoxyuridine (80 microM) from 1 to 3 days in vitro significantly reduced glial proliferation and concomitantly increased 125I-alpha-bungarotoxin binding, whereas plating onto a glial bed layer decreased binding. There was no significant binding to pure glial cultures. Treatment-induced changes in neuronal binding resulted from alterations in receptor density, with no change in affinity. 5'-Fluorodeoxyuridine treatment also increased cellular expression of alpha 7 receptor mRNA but had no effect on N-[3H]methylscopolamine binding to muscarinic receptors. Glial conditioned medium decreased 125I-alpha-bungarotoxin binding in both control and 5'-fluorodeoxyuridine-treated cultures, suggesting the release of a soluble factor that inhibits alpha 7-type nicotinic receptor expression. An additional mechanism of glial regulation may involve removal of glutamate from the surrounding medium, as added glutamate (200 microM) increased 125I-alpha-bungarotoxin binding in astrocyte-poor cultures but not in those that were astrocyte enriched. These results suggest that glia may serve a physiological role in regulating alpha 7-type nicotinic receptors in developing brain.

Multiple mechanisms of N2A and CHO cell adhesion to NCAM purified from chick embryonic brain and retina.

The neural cell adhesion molecule (NCAM) is thought to have an important role in cell-cell interactions during development. To better understand NCAM function, we studied the adhesion of mouse N2A neuroblastoma cells and Chinese hamster ovary cells to different forms of NCAM using a quantitative centrifugal cell adhesion assay that measures the rate of cell removal from experimental substrates. Embryonic brain NCAM is highly polysialylated and contains both 180- and 140-kDa polypeptide isoforms, whereas embryonic retinal NCAM is less highly polysialylated and contains primarily the 140-kDa isoform. For both forms, cell adhesion to substrate-immobilized NCAM was temperature dependent, cation independent, and time dependent. Cell adhesion to NCAM substrates was not directly affected by drugs inhibiting cytoskeletal function or cellular metabolism, suggesting that NCAM function does not depend critically on cytoskeletal function or metabolic activity. Cell adhesion to retinal NCAM was blocked by anti-NCAM antibodies, and adhesion was increased by neuraminidase treatment of both types of NCAM. Adhesion to brain NCAM was effectively blocked by anti-NCAM antibodies only after neuraminidase treatment, suggesting that these cells adhere to highly sialylated and less-sialylated NCAM by different mechanisms. We propose that multiple mechanisms of cell adhesion involving NCAM may exist in different tissues during development and that the state of polysialylation of NCAM is important in regulating the relative importance of these mechanisms.