Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation

Aims. Survival rates for cardiac arrest in acute medicine are higher following out-of-hospital restoration of spontaneous circulation (OH-ROSC). However, data pertaining to OH-ROSC is limited in the elderly population. We aimed to assess the predictors of neurological outcome among elderly patients with OH-ROSC. Methods. We retrospectively analyzed the data of patients 65 years and older who achieved OH-ROSC and who presented to the emergency department (ED) between 2009 and 2013. The following parameters were considered: age, sex, medical history, vital signs, blood values, initial electrical rhythm, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, resuscitation duration, attempted defibrillation, and neurological outcome. Neurological outcomes were evaluated 3 months after cardiac arrest, using the cerebral performance category (CPC) score, and were classified into two groups: favorable outcome (CPC = 1–2) and unfavorable outcome (CPC = 3–5). Results. Fifty-five patients were studied, of which 21 and 34 patients were classified as having favorable and unfavorable outcomes, respectively. The following values were associated with favorable outcomes: resuscitation duration, initial cardiac rhythm, base excess, pH, lactate levels, the motor response on the Glasgow Coma Scale (GCS), and the number of patients with GCS ≤8 (p < 0.01). Logistic regression analysis confirmed that motor response scores and lactate levels were independent predictors of neurological outcomes. Conclusions. Lactate levels and GCS motor response measured immediately at ED arrival are likely to be useful to assess the neurological outcomes among elderly patients with OH-ROSC

Good Clinical Response to Erlotinib in a Non-Small Cell Lung Cancer Patient Harboring Multiple Brain Metastases and a Double Active Somatic Epidermal Growth Factor Gene Mutation

Recently, 2 small molecule kinase inhibitors (TKIs), targeting epidermal growth factor receptor (EGFR), have proven effective in the treatment of non-small cell lung cancer. However, it is unknown whether the EGFR double activating mutation of L858R in exon 21 and the in-frame deletion in exon 19 is a predictor of the effectiveness of EGFR-TKIs. We report for the first time a case of non-small cell lung cancer with central nervous system metastases harboring a rare EGFR double activating mutation who showed a good clinical response to erlotinib, regardless of his poor performance status, as swallowing is not possible. Therefore, we suggest that erlotinib may become a therapeutic choice in cases of central nervous system metastases even with poor performance status

Outcome of Surgical Treatment for Metastatic Vertebra Bone Tumor in Advanced Lung Cancer

Background: Spinal metastases of patients with advanced stage lung cancer are an important target for palliative therapy, because their incidence is high, and they often cause severe symptoms and worsen the quality of life. Surgery is one of the most effective treatment options, but the indication of surgery is unclear as the procedure is invasive and patients with spinal metastasis have a rather short life expectancy. Furthermore, there have been few studies that have focused on lung cancer with poor prognosis. Methods: We reviewed all of the cases of lung cancer from January 1999 to July 2007 in the Department of Respiratory Medicine, Kyoto University Hospital, Japan. Thirteen patients with metastatic spinal tumor of lung cancer underwent surgery, and all of them had a poor performance status score (3 or 4). Results: Neurological improvement by at least 1 Frankel grade was seen in 10 of 14 cases (71%). Improvement of the movement capacity was noted in 9 of 14 cases (64%), and pain improvement was noted in 12 of 14 (86%). Median postoperative survival was 5 months (1–25 months). In particular, the group with a good postoperative performance status score (0–2) was shown to have a better median postoperative survival of 13 months. Conclusions: Surgical treatment for symptomatic metastatic spinal tumor of lung cancer can improve quality of life in a substantially high percentage of patients. Surgery should be considered even if preoperative performance status is poor

Serious hazards of transfusion: evaluating the dangers of a wrong patient autologous salvaged blood in cardiac surgery.

BACKGROUND: The past half century has seen the near eradication of transfusion-associated hazards. Intraoperative cell salvage while widely used still poses significant risks and hazards due to human error. We report on a case in which blood collected from a patient with lung cancer was mistakenly administered to a patient undergoing cardiac surgery who should have received his own collected blood. The initial investigation found that the cause of the patient harm was violations of procedures by hospital personnel. A detailed investigation revealed that not only violations were the cause, but also that the underlying causes included haphazard organizational policies, poor communication, workload and staffing deficiencies, human factors and cultural challenges. CASE PRESENTATION: On August 14, 2019, a 72-year-old male was admitted to our hospital for angina pectoris and multivessel coronary artery disease. Cardiac surgery was performed using an autologous salvage blood collection system, and there were no major problems other than the prolonged operation time. During the night after the surgery, when the patient\u27s blood pressure dropped, a nurse retrieved a blood bag from the ICU refrigerator that had been collected during the surgery and administered it at the physician\u27s direction, but at this time neither the physician nor the nurse performed the required checking procedures. The blood administered was another patient\u27s blood taken from another surgery the day before; an ABO mismatch transfusion occurred and the patient was diagnosed with DIC. The patient was discharged 65 days later after numerous interventions to support the patient. An accident investigation committee was convened to analyze the root causes and develop countermeasures to prevent a recurrence. CONCLUSION: This adverse event occurred because the protocol for intraoperative blood salvage management was not clearly defined, and the procedure was different from the standard transfusion practices. We developed a new workflow based on a human factors grounded, systems-wide improvement strategy in which intraoperative blood collection would be administered before the patient leaves the operating room to completely prevent recurrence, instead of simply requiring front-line staff to do a double-check. Implementing strong systems processes can reduce the risk of errors, improve the reliability of the work processes and reduce the likelihood of patient harm occurring in the future

Studies on the Tuberculin Reaction Part 1. on the Changes of Tuberculin Antigen due to Digestive and chemical and Chemical Degeneration

By making protein degenerant and protein digestive enzyme act on old tuberculin the author performed the tuberculin reaction, and obtained the following results. 1. In loading a strong potassium iodide solution to old tuberculin the tuberculin reaction grows weaker along with an increase in the concentration of potassium iodide. This suggests that free tyrodine radical in the old tuberculin protein is involved in the tuberculin reaction. 2. In loading sodium nitrite to old tuberculin the tuberculin reaction likewise grows weaker with increase in the concentration of sodium nitrite 3. In the addition of formalin to old tuberculin the tuberculin raction is weakened along with increaes in the concentration of formalin solution. 4. When crystalline trypsine is made to act on old tuberculin, the tuberculin reaction is weakened along with lapse in the digestion time. 5. When pepsin is made to act on old tuberculin, the tuberculin reaction is likewise weakened along with lapse in the digestion time. 6. From these results it is deduced that the tuberculin reastion is mainly controlled by tuberculin protein

Studies on the Tuberculin Reaction Part 3. A Study on the Tuberculin Reaction, Erythrocyte Coagulation Reaction and the Paperelectrophoresis of Serum in Pulmonectomized Cases

The author executed the tuberculin reaction and the paperelectrophoresis of the lung tuberculosis patients after pulmonectomy and also the paperelectrophoresis of the patients' sera, and obtained the following results. 1. Of 16 tuberculosis patients 9 cases (56.2%) showed the weakening in the tuberculin reaction after pulmonectomy, and 5 cases (31.2%) showed a transient weakening of the reaction but a later recovery. 2. When the aqueous solution of old tuberculin is used in the dilution of 1:100, 1:2, 000, and 1:10, 000, the tuberculin reaction after pulmonectomy shows a weakening tendency in 2 cases (11.1%) out of 18 cases; a transient strengthening and a later weakening in 3 cases (16.6%); a transient weakening then a later strengthening in 11 cases (61.1%); and changes obscure in 2 cases (11.1%). 3. In the tuberculin reaction performed after pulmonectomy with the use of old tuberculin aqueous solution diluted 100-fold, 2, 000-fold, and 10, 000-fold the red color area and the concentration of tuberculin solution show a parallel relationship. 4. In the erythrocyte coagulation reaction performed after pulmonectomy those showing a decreasing tendency in the reaction amounted to 54.5 per cent of the total cases; those showing a weakening and a later strengthening tendency amounted to 18.2 per cent; and in 27-3 per cent no clear-cut fluctuation of the reaction. 5. The tuberculin reaction and erythrocyte coagulation values show a parallel relationship. 6. In the results of paperelectrophoresis it has been found that after pulmonectomy serum albumin is decreased; γ-globulin decreases temporarily but later recovers back to the original level; and α- and β-globulins increase transiently, but each fraction recovers to the level before pulmonectomy after three weeks

Studies on the Tuberculin Reaction Part 2. A Study on Tuberculin Protein, Nuclear Protein, and Polysaccharide Fraction in the Tuberculin Reaction and Erythrocyte coagulation reaction

Using the protein, nuclear protein and polysaccharide fractions obtained from old tuberculin by salt analysis or by paperelectrophoresis the author performed the tuberculin reaction and erythrocyte coagulation reaction, and obtained the following results: 1. In the tuberulin reaction conducted in each of the protein, nuclear protein and polysaccharide fractions from old tuberculin the intesnity of the tuberculin reaction has been found in the descending order of protein, nuclear protein, and polysaccharide fractions. In the erythrocyte coagulation reaction the intensity is in the order of polysaccharide, nuclear protein and protein fractions. 2. By the paperelectrophoresis of old tuberculin with ninhybrin reaction phoretic peaks, A, B, C, and D were obtained in the order of phoretic speed. Of them the peak C seems to be dialytic substance. 3. By ammonia silver nitrate reaction two phoretic peaks A' and B' were obtained according to the phoretic speed. 4. After the paperelectrophoresis of old tuberculin and making l cm strips each from the starting point, when the fractions are extracted by physiological saline solution, the further away from the starting point the lighter is the color. Moreover, the tuberculin reaction and erythrocyte coagulation reaction likewise grow weaker as the distance is further away from the starting point, but there seems to be no marked correlation among the three tests