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Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.
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Reanimación Cardiopulmonar/historia , Historia del Siglo XVI , Historia del Siglo XVIII , Historia del Siglo XIX , Historia Medieval , HumanosRESUMEN
This case report refers to a victim of intraoperative cardiac arrest, who restored spontaneous circulation despite of cessation of cardiopulmonary resuscitation (CPR). The victim, a 53-year-old man, was undergoing a surgical investigation and rehabilitation of a thigh hematoma. Two minutes after discontinuation of a 46 min CPR, a normotensive sinus node rhythm appeared at monitor. Despite of lack of an adequate explanation, the authors believe that the combination of the high total dose of adrenaline with the cessation of mechanical ventilation might augment venous return and lead to restoration of spontaneous circulation.
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BACKGROUND/AIMS: There is little information in the literature on the use of bevacizumab (BV) combination chemotherapy in multiple lines with regimens including irinotecan and oxaliplatin, in metastatic colorectal cancer (mCRC) patients with disease progression. The aim of this small retrospective institutional study is to compare the efficacy and safety of the continuation of BV in combination with various chemotherapeutic agents, within the framework of multiple line therapy in progressed mCRC patients. METHODOLOGY: Our retrospective study included 21 patients with mCRC that had received at least one course of irinotecan-based or oxaliplatin-based chemotherapy with BV before disease progression. BV treatment was continuously dispensed after disease progression. Subgroup analysis was performed in terms of age, site of metastases, spread and co-morbidity. RESULTS: The median overall survival (OS) was 23+ months (range 4-51 months) with no statistically significant differences between the aforementioned subgroups of patients, except from the subgroup according to spread (p=0.044). Time to progression was 17 months. Anemia (all grades) was reported in 33.3% of the patients, while hemorrhage and thrombosis were reported in 28.6% and 14.3%, respectively. CONCLUSIONS: Multiple line treatment in advanced colorectal cancer, including BV combined with standard chemotherapy, may improve OS with an acceptable toxicity profile in patients with mCRC after disease progression.
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Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Anciano de 80 o más Años , Bevacizumab , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Progresión de la Enfermedad , Humanos , Irinotecán , Persona de Mediana Edad , Metástasis de la Neoplasia , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Estudios RetrospectivosRESUMEN
OBJECTIVE: The study objective was to present a comprehensive literature review on the monitoring of patients with cardiac arrest (CA) and the nursing contribution in this crucial situation. Monitoring techniques during cardiopulmonary resuscitation and in the peri-arrest period (just before or after CA) are included. METHODS: Approaches used to access the research studies included a comprehensive search in relevant electronic databases (Medline, CINAHL, EMBASE, Cochrane Review, British Nursing Index) using relevant keywords (eg, cardiac arrest, resuscitation, monitoring, nurse, survival, outcome). Books and journals known to the authors were also used. RESULTS: The nurse's role in patients with CA is extremely significant and if performed correctly adds great insight to treatment planning and correct management. CONCLUSION: Early recognition of CA and invasive (methods and equipment that require endarterial or intravenous access) and noninvasive monitoring should be prompt and appropriate for early return of spontaneous circulation and improved neurologic outcome in patients.
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Reanimación Cardiopulmonar/métodos , Paro Cardíaco/enfermería , Rol de la Enfermera , Monitores de Conciencia , Paro Cardíaco/terapia , Humanos , Monitoreo Fisiológico , Oximetría , Factores de TiempoRESUMEN
This article reviews the right atrioventricular and pulmonary valves, along with their anatomic variations as well as the papillary muscles and chordae tendineae of the right ventricle of the human heart. A brief anatomical background is given for every structure, as well as a gross review of their embryological basis. Although the normal morphology of the right atrioventricular valve is tricuspid, this is not always the case; its anatomic variations involve, firstly, the number of cusps and accessory leaflets. Anatomic variations of the right atrioventricular valve may occur in association with other congenital anomalies and syndromes. Also the number, length and shape of the papillary muscles and chordae tendineae are variable. This can be of clinical significance since the papillary muscles play an important role in the contraction of the right ventricle and in the closure of the tricuspid valve so as to prevent ventricular blood from passing back into the right atrium. The pulmonary valve may present variations in the number of cusps, stenosis or atresia, either as isolated clinical findings or in association with congenital syndromes.
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Ventrículos Cardíacos/anomalías , Músculos Papilares/anomalías , Válvula Pulmonar/anomalías , Válvula Tricúspide/anomalías , Cuerdas Tendinosas/anomalías , Cuerdas Tendinosas/fisiología , Cardiopatías Congénitas/patología , Humanos , Músculos Papilares/fisiología , Circulación Pulmonar/fisiología , Válvula Pulmonar/fisiología , Sístole/fisiología , Válvula Tricúspide/fisiologíaRESUMEN
BACKGROUND: Amiodarone is a commonly used medication in the treatment of atrial fibrillation (AF) of recent onset. STUDY OBJECTIVES: The aim of the study was to identify a possible formula for selecting Emergency Department (ED) patients with paroxysmal AF who will spontaneously restore sinus rhythm (SR), successfully restore SR with the use of loading intravenous (i.v.) amiodarone, or require 24-h maintenance amiodarone infusion. METHODS: This retrospective pilot study included 141 patients with recent-onset AF. Patients who did not restore SR spontaneously received i.v. amiodarone (5 mg/kg) within a period of 30 min. In case of no response, an additional dosage of 1000 mg of i.v. amiodarone was administered over a period of 24 h. Binary logistic regression models were used to determine the predictors of spontaneous conversion and the response to amiodarone administration. RESULTS: The formula ([heart rate/systolic blood pressure] + 0.1 × number of past AF incidences) was chosen as the one with the highest combined sensitivity and specificity. This index identified the patients who spontaneously restored SR (cutoff point 1.31 with 78.6% sensitivity and 77.9% specificity), whereas for patients who responded to the loading i.v. amiodarone dose, the use of the index (cutoff point 1.24) exhibited 84.1% sensitivity and 75.3% specificity. CONCLUSIONS: This formula may be a useful and reliable bedside diagnostic tool to identify AF patients most likely to spontaneously convert, or respond to loading amiodarone administration in the emergency setting. The use of this index also can assist in patient risk stratification.
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Amiodarona/administración & dosificación , Antiarrítmicos/administración & dosificación , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/tratamiento farmacológico , Técnicas de Apoyo para la Decisión , Anciano , Fibrilación Atrial/fisiopatología , Presión Sanguínea , Servicio de Urgencia en Hospital , Femenino , Frecuencia Cardíaca , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Curva ROC , Estudios RetrospectivosRESUMEN
Groove pancreatitis, a form of chronic pancreatitis affecting the head of the pancreas, is localized within the groove between the pancreas head, duodenum, and common bile duct. We report a case of a male patient with groove pancreatitis who initially underwent a duodenal preserving gastrenteranastomosis. Unfortunately, the patient's symptoms were only partially controlled, necessitating a pancreaticoduodenectomy in due course as the definite surgical restoration procedure. The surgical approach selected proved inadequate since the patient's symptoms did not resolve over time. This reflects that by-pass operations like these are not indicated for the management of patients with groove pancreatitis.
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Breast cancer is a daunting disease and constitutes a continuing medical health problem through the ages for millions of women worldwide. Physicians, from the early periods of recorded history have tried to heal breast cancer patients, with results that were fairly promising at times and disappointing at others. The science of medicine evolved through the ages under the careful scrutiny and critical thought of the many prominent scholars and researchers of their times who constantly added to the therapeutic armamentarium. Surgeons described new therapeutic approaches, and anatomists, through their elaborate descriptions, added useful insights on the art of healing. Theories about the origin of cancer change as new scientific data are presented and validated. Although the Middle Ages hindered temporarily any progress in the field of medicine, the Renaissance became the vaulting horse for science in its broadest sense. However, it was not until the 19th century, with the discovery of anesthesia, the introduction of antisepsis, and the establishment of microscopy that giant scientific leaps in the field of breast cancer treatment occurred. The 20th century with the development of chemotherapy and radiation and the undertaking of numerous clinical trials offered new insights regarding breast cancer management. This article attempts a historical journey through the ages unfolding the problem of breast cancer through the different eras.
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Neoplasias de la Mama/terapia , Medicina/tendencias , Neoplasias de la Mama/diagnóstico , Terapia Combinada , Quimioterapia/tendencias , Femenino , Cirugía General/tendencias , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Humanos , Radioterapia/tendenciasRESUMEN
BACKGROUND: Cardiac arrest (CA) is a leading cause of death worldwide. The European Resuscitation Council (ERC) has developed basic life support/automated external defibrillation (BLS/AED) courses for uniform training in out-of-hospital CA. OBJECTIVE: The present study compares the resuscitation skills of two groups of nursing staff, one taught by newly trained ERC nurse-instructors and the other by newly trained doctor-instructors. METHOD: Eighteen doctors and 18 nurses were asked to teach a total of 108 nurses in a (BLS/AED) course. One month after its completion, all 108 nurses were asked to be re-evaluated, with the use of the objective structured clinical examination. CONCLUSIONS: No statistical significant difference between the two groups was noted in the written test, in contrast with data collected from the practice skills check-list. Nurses in group A could easily identify the patient in cardiac arrest but had difficulties concerning chest compressions and handling the AED. Nurses in group B were more focused during the performances, used AED more accurately and continued cardiopulmonary resuscitation with no delays. Nurses prove to be more efficient in training nurses.
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Cardioversión Eléctrica , Capacitación en Servicio/métodos , Personal de Enfermería en Hospital/educación , Resucitación/educación , Enseñanza , Reanimación Cardiopulmonar/educación , Grecia , Humanos , Enfermeras y Enfermeros , MédicosRESUMEN
Small-cell lung cancer is the most aggressive lung cancer, with a dismal prognosis. The authors present a case report of a patient with limited-stage small-cell lung cancer who underwent a thoracotomy for diagnostic purposes, with the diagnosis being made after surgical excision. Combination chemotherapy remains the cornerstone of treatment for both limited and extensive disease. Radiotherapy has been established as an adjunct to chemotherapy in limited-stage disease, while in extensive-stage disease it is mostly reserved for the treatment of brain metastases. As for surgery, the potential benefits of resection are predominantly seen in patients who present with a solitary pulmonary nodule. Since small-cell lung cancer becomes highly resistant to chemotherapy, second-line chemotherapeutic schemes are used for disease progression, with topotecan being the highlighted agent. Despite the unusual therapeutic approach, where surgery was preferred over the standard diagnostic and staging procedures, the patient's more than ten years' survival makes this case presentation a very interesting one.
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Carcinoma de Células Pequeñas/diagnóstico , Carcinoma de Células Pequeñas/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Antineoplásicos/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/cirugía , Quimioterapia Adyuvante , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Topotecan/uso terapéuticoRESUMEN
Cardiac neoplasms, whether primary or secondary, are more and more easily diagnosed in the present era. For the primary heart tumors, myxomas and sarcomas constitute the most common neoplasms, whereas for the secondary ones, lung cancer constitutes the most common primary location. Cardiac neoplasms may involve the endocardium, the myocardium, the epicardium, the valves or any combination of these. Their clinical manifestations are not specific and depend on their anatomic location and size. Diagnosis of cardiac neoplasms has become more feasible with the use of echocardiography and other imaging techniques (computed tomography and magnetic resonance). The major problem, however, still remains that most diagnoses are late, especially for malignant tumors. For resectable tumors, surgery remains the mainstay of treatment, whereas for metastatic disease palliative treatment remains the only therapeutic option. This paper reviews the types of heart tumors, their clinical symptoms, the diagnostic approaches and the therapeutic tools used by physicians.
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Procedimientos Quirúrgicos Cardíacos/métodos , Diagnóstico por Imagen/métodos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Diagnóstico Diferencial , Humanos , Metástasis de la Neoplasia , PronósticoRESUMEN
STUDY OBJECTIVES: The use of adenosine on failure of vagal maneuvers in patients with paroxysmal supraventricular tachycardia (PSVT) is recommended. The aim of the present study was to identify a possible prognostic index for the efficacy of adenosine in PSVT. METHODS: This retrospective study included 321 patients with PSVT, in whom vagal maneuvers failed to restore normal sinus rhythm and who received 6 mg adenosine, followed by 12 mg adenosine (repeated if necessary). A 2-step clustering algorithm was used to reveal nonapparent groupings. Various patients' characteristics were inserted into the model. RESULTS: A straightforward index has been chosen that would aid the distinction of patients failing to respond to adenosine. The formula, (age / heart rate at admission) + number of past PSVT episodes, was chosen as the one that combined the highest sensitivity (96.2%) and specificity (71.2%). CONCLUSIONS: This prognostic index constitutes a useful and reliable bedside diagnostic tool to identify patients with PSVT who were less likely to respond to adenosine administration in the emergency setting.
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Adenosina/uso terapéutico , Antiarrítmicos/uso terapéutico , Taquicardia Supraventricular/tratamiento farmacológico , Algoritmos , Electrocardiografía , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento , Maniobra de ValsalvaRESUMEN
Silent myocardial ischemia (SMI) is a relatively common, yet poorly understood, clinical entity. The most accurate means of detecting SMI and the precise treatment endpoints remain unclear. However, the presence of SMI correlates with the likelihood of future adverse cardiac events. Evidence suggests that patients at high risk of severe cardiac ischemia, even with the absence of symptoms, derive the greatest benefit from an aggressive diagnostic and therapeutic approach. This paper is giving a detailed review of SMI in regards to specific patient subgroups, i.e. populations with diabetes mellitus, hypertension, elderly patients, post-revascularization patients, women, the suggested screening procedures for each subgroup, as well as the emersion of new markers for the selection of high-risk patients for screening.
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Diabetes Mellitus Tipo 2/epidemiología , Hipertensión/epidemiología , Fallo Renal Crónico/epidemiología , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/métodos , Comorbilidad , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Electrocardiografía , Femenino , Humanos , Hipertensión/diagnóstico , Incidencia , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Stents , Análisis de SupervivenciaRESUMEN
Predicting the neurological outcome after resuscitation and a return of spontaneous circulation of resuscitated patients still remains a difficult issue. Over the past decade numerous studies have been elaborated to provide the physician with tools to assess as early as possible the neurological outcome of patients with cardiac arrest and return of spontaneous circulation and to decide about further therapeutic management. We summarise the most important ones, giving special focus to three biochemical markers (neuron specific enolase, a protein soluble in 100% ammonium sulfate and interleukin-8), which, when combined with standard neuro-functional and imaging techniques, can serve as potent predictors of neurological outcome in these patients. Despite current limitations about the prognostic significance of these markers - their inferior sensitivity, the different cut-off levels used by several investigators and their variable unequal rise over time - they can give useful information about short and long-term neurological outcome. A comprehensive set of clinical, electrophysiological, biochemical and imaging measures, obtained in a uniform manner in a cohort of patients without limitations in care, could provide a more objective set of comprehensive prognostic indicators.
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Isquemia Encefálica/metabolismo , Reanimación Cardiopulmonar/métodos , Paro Cardíaco/sangre , Interleucina-8/metabolismo , Fosfopiruvato Hidratasa/metabolismo , Proteínas S100/metabolismo , Biomarcadores/metabolismo , Isquemia Encefálica/prevención & control , Paro Cardíaco/terapia , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Ventricular fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine model of cardiac arrest. METHODS AND RESULTS: Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfully resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p=0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. CONCLUSIONS: Both algorithms' resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation.
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Apoyo Vital Cardíaco Avanzado/normas , Paro Cardíaco/terapia , Apoyo Vital Cardíaco Avanzado/métodos , Algoritmos , Animales , Guías de Práctica Clínica como Asunto , Porcinos , Resultado del TratamientoRESUMEN
AIM: To determine the mechanical properties of anastomotic colonic tissue in experimental settings and therefore give a measure of wound healing. METHODS: Thirty-six male Wistar rats were used as experimental models of anastomotic tissue integrity. On the 5th post-operative day, the tensile strength was measured by application of an axial force, providing a quantitative measure of anastomotic dehiscence and leakage. RESULTS: Diagrams of the load as a function of the time [P = P (t)] and of the displacement also as a function of time [Delta s = Delta s (t)] were recorded for each test, permitting the design of the load versus the displacement diagram and thus providing significant data about the critical values of anastomotic failure. Quantitative data were obtained concerning the anastomotic strength of both control specimens (healthy rats), as well as specimens from non-healthy rats for comparison. CONCLUSION: This experimental model provides an excellent method of measuring anastomotic strength. Despite the relative small number of specimens used, this method provides an accurate way of measuring wound repair. More experimental measurements need to be performed to correlate emerging tensile strength values to anastomotic failure.
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Colon/fisiología , Colon/cirugía , Cicatrización de Heridas/fisiología , Anastomosis Quirúrgica/métodos , Animales , Masculino , Modelos Animales , Modelos Teóricos , Ratas , Ratas Wistar , Dehiscencia de la Herida Operatoria/fisiopatología , Dehiscencia de la Herida Operatoria/prevención & control , Resistencia a la Tracción/fisiologíaRESUMEN
This paper reviews the negative impact of diabetes mellitus or hypothyroidism on wound healing, both in experimental and clinical settings. Since both are metabolic disorders of great clinical importance, special attention is given, not only to their pathophysiology, but also to their biochemical and histological effects on tissue integrity and regeneration. Also, special focus is awarded on wound healing of the gastrointestinal tract, i.e. in intestinal anastomosis, and how these disorders can lead to wound dehiscence. Since diabetes mellitus and hypothyroidism can coexist in clinical settings, more research must be directed on their influence on wound healing, considering them as one clinical entity.