Citations

Background— The incidence and significance of gasping after cardiac arrest in humans are controversial. Methods and Results— Two approaches were used. The first was a retrospective analysis of consecutive confirmed out-of-hospital cardiac arrests from the Phoenix Fire Department Regional Dispatch Center text files to determine the presence of gasping soon after collapse. The second was a retrospective analysis of 1218 patients with out-of-hospital cardiac arrests in Arizona documented by emergency medical system (EMS) first-care reports to determine the incidence of gasping after arrest in relation to the various EMS arrival times. The primary outcome measure was survival to hospital discharge. An analysis of the Phoenix Fire Department Regional Dispatch Center records of witnessed and unwitnessed out-of-hospital cardiac arrests with attempted resuscitation found that 44 of 113 (39%) of all arrested patients had gasping. An analysis of 1218 EMS-attended, witnessed, out-of-hospital cardiac arrests demonstrated that the presence or absence of gasping correlated with EMS arrival time. Gasping was present in 39 of 119 patients (33%) who arrested after EMS arrival, in 73 of 363 (20%) when EMS arrival was <7 minutes, in 50 of 360 (14%) when EMS arrival time was 7 to 9 minutes, and in 25 of 338 (7%) when EMS arrival time was >9 minutes. Survival to hospital discharge occurred in 54 of 191 patients (28%) who gasped and in 80 of 1027 (8%) who did not (adjusted odds ratio, 3.4; 95% confidence interval, 2.2 to 5.2). Among the 481 patients who received bystander cardiopulmonary resuscitation, survival to hospital discharge occurred among 30 of 77 patients who gasped (39%) versus only 38 of 404 among those who did not gasp (9%) (adjusted odds ratio, 5.1; 95% confidence interval, 2.7 to 9.4). Conclusions— Gasping or abnormal breathing is common after cardiac arrest but decreases rapidly with time. Gasping is associated with increased survival. These results suggest that the recognition and importance of gasping should be taught to bystanders and emergency medical dispatchers so as not to dissuade them from initiating prompt resuscitation efforts when appropriate.

Multiple sclerosis (MS) is a chronic relapsing disease of the central nervous system (CNS) in which immune processes are believed to play a major role. To date, there is no reliable method by which to characterize the immune processes and their changes associated with different forms of MS and disease progression. We performed antigen microarray analysis to characterize patterns of antibody reactivity in MS serum against a panel of CNS protein and lipid autoantigens and heat shock proteins. Informatic analysis consisted of a training set that was validated on a blinded test set. The results were further validated on an independent cohort of relapsing–remitting (RRMS) samples. We found unique autoantibody patterns that distinguished RRMS, secondary progressive (SPMS), and primary progressive (PPMS) MS from both healthy controls and other neurologic or autoimmune driven diseases including Alzheimer's disease, adrenoleukodystropy, and lupus erythematosus. RRMS was characterized by autoantibodies to heat shock proteins that were not observed in PPMS or SPMS. In addition, RRMS, SPMS, and PPMS were characterized by unique patterns of reactivity to CNS antigens. Furthermore, we examined sera from patients with different immunopathologic patterns of MS as determined by brain biopsy, and we identified unique antibody patterns to lipids and CNS-derived peptides that were linked to each type of pathology. The demonstration of unique serum immune signatures linked to different stages and pathologic processes in MS provides an avenue to monitor MS and to characterize immunopathogenic mechanisms and therapeutic targets in the disease.

Abstract Background: Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement. Content: The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion. Discussion: Clinical needs have been identified for standardization of (a) urine collection methods, (b) urine albumin and creatinine measurements based on a complete reference system, (c) reporting of test results, and (d) reference intervals for the ACR.

Wegener’s granulomatosis (WG) is a multisystemic necrotising granulomatous vasculitis of small and medium sized vessels, that primarily involves the upper and lower respiratory tracts, lung tissues and kidneys. Serum antineutrophil cytoplasmic antibodies (ANCA) are a sensitive and specific marker of WG. Whereas the peripheral nervous system is often involved in WG, central nervous system manifestations are reported only in 2–8%, and are rarely present at onset. We report on a patient with atypical neurological presentation of ANCA negative WG in whom the diagnosis was made only after a meningeal biopsy.

Although fractures of the fifth metacarpal neck (boxer's fractures) are common, their treatment can be problematic. A description of a technique utilizing traction reduction is presented in this paper. The records and radiographs of 59 patients who underwent reduction using longitudinal traction and subsequent immobilization in a specially molded cast were retrospectively reviewed. On average, 80% of initial fracture angulation in the sagittal plane was corrected, and only 1° of this correction was lost at the discontinuation of casting (3–4 weeks). We have found this technique to be highly effective in the treatment of boxer's fractures. Advantages of this treatment include its efficacy, ease, and improved patient tolerance over other casting techniques.

Purpose The purpose of this study was to investigate the functional and clinical outcomes of a consecutive series of patients who underwent fibular collateral ligament (FCL) and posterolateral corner (PLC) reconstruction by use of a single Achilles tendon allograft construct. Methods Patients were identified through prospective sports medicine databases at 2 academic institutions. Only patients who had undergone FCL and PLC reconstruction (as opposed to repair) were included. All patients followed a standard postoperative rehabilitation protocol. Various patterns of combined ligament injuries were included and divided into 2 groups (2 ligament v multiligament). Functional and clinical outcomes were assessed by clinical examination, Lysholm scores, and International Knee Documentation Committee subjective scores. Statistical analysis was performed by use of Wilcoxon paired rank‐sum tests and multivariate regression. Results We identified 16 knees in 16 patients, with a minimum of 2 years' follow‐up. There were 13 men and 3 women. The mean age was 30 years (range, 19 to 61 years). The mean length of clinical follow‐up was 30 months (range, 24 to 75 months). The mean International Knee Documentation Committee subjective scores were 80 points and 80 points ( P = .79) in the 2‐ligament and multiligament groups, respectively, and the mean Lysholm scores were 90 points and 89 points ( P = .96), respectively. Age ( P = .41), gender ( P = .84), and interval between injury and surgery ( P = .72) did not affect the clinical and functional outcomes between the 2 groups. Arthrofibrosis requiring manipulation developed in 1 patient. Residual varus laxity (1+) was noted in 4 patients, none of whom displayed functional instability. No patient has required revision reconstruction to date. Conclusions We describe a novel technique that takes into account the main static PLC stabilizers (FCL, popliteofibular ligament, and posterolateral capsule) that has not been previously reported. Our series showed no significant differences in clinical and functional outcomes between 2‐ligament and multiligament PLC‐based reconstructions. However, given the heterogeneity and small sample size of our study group, it is difficult to draw qualitative conclusions. Level of Evidence Level IV, therapeutic case series.

Background and Purpose— Size of an unruptured intracranial aneurysm (UIA) may be an important risk factor for rupture. Accordingly, serial noninvasive imaging is commonly used to assess untreated UIA for enlargement. Few data exist regarding the frequency and predictors of enlargement. We obtained this information from a group of patients followed with serial MR angiography (MRA). Methods— We retrospectively identified 165 patients with 191 UIA followed with serial MRA. Fusiform aneurysms, UIA <2 mm, and UIA that were surgically or endovascularly treated before the first MRA were excluded. MRA was performed using 1.5-T and 3-T MRI. Maximal diameter was determined on MRA source images. Multivariate regression analysis was used to determine independent risk factors for growth. Results— Twenty aneurysms (10%) grew over a median follow-up period of 47 months. Frequency of enlargement was 6.9%, 25%, and 83% for aneurysms <8 mm, 8 to 12 mm, and ≥13 mm, respectively ( P <0.001 for trend). Of the variables we evaluated, original aneurysm diameter (OR, 1.28 per mm; 95% CI, 1.07 to 1.58) was the only independent predictor of enlargement. Aneurysms ≥8 mm in diameter were at highest risk for enlargement (OR, 7.25; 95% CI, 1.96 to 27.1). There was a trend toward increased risk of enlargement in patients with multiple aneurysms (OR, 2.50; 95% CI, 0.86 to 7.53). Conclusions— Over a median follow-up period of 47 months, 10% of UIA enlarged. Larger aneurysms had a significantly increased risk of enlargement. The likelihood of enlargement was highest in aneurysms with diameters ≥8 mm. However, a clinically significant proportion of small aneurysms grow, and this growth can be detected by serial MRA.