Endoscopic sphincterotomy for removal of stones from the common bile duct, in particular in high-risk patients is an established procedure. However, the size of the stones and the appearance of the terminal bile duct prior to sphincterotomy have an influence on the outcome. In the period 1984-1987, thirty-four patients considered to be at high risk for surgery were treated endoscopically by insertion of a biliary endoprosthesis (15 cm long, 3.2 mm diameter) after unsuccessful attempts to remove common bile duct (CBD) stones following endoscopic sphincterotomy. These patients were admitted to the hospital with biliary colic, obstructive jaundice and/or cholangitis. Eight patients were lost to follow-up. The remaining patients comprised 20 females and 6 males, with a mean age of 81 years (range: 60-96). Five patients underwent surgical treatment for perforation (one patient, 11 months after insertion), persistent jaundice (one patient) or recurrent obstructive jaundice (endoprosthesis clogging in one, endoprosthesis dislodgement in two patients) 2 to 40 months after insertion. In one patient, recurrent obstructive jaundice was successfully treated by replacing the clogged endoprosthesis 4 months after the initial treatment. Ten patients died of unrelated causes (myocardial infarction, accident, etc.) 2 to 28 months after insertion. The remaining ten patients were still alive without symptoms after a median follow-up of 26 months. On the basis of these findings we therefore conclude that endoscopic insertion of a biliary endoprosthesis is a safe and effective treatment for huge CBD stones in high-risk patients in whom endoscopic sphincterotomy and attempts to remove the stones are not successful.
Previously, we have determined that human annexin V (hAV), a Ca2+-dependent phospholipid-binding protein, and not rat AV, binds specifically to small hepatitis B surface antigen (SHBsAg), and that transfection of a rat hepatoma cell line with a construct containing the hAV gene led to hAV expression and conferred susceptibility to hepatitis B virus (HBV) infection. In this work, we have examined the effect of administration of hAV on in vitro binding of SHBsAg to human and to rat hepatocytes and on in vitro HBV infection. The results showed that hAV could bind to human as well as to rat hepatocytes. Because of this property, excess hAV was unable to prevent HBV infection in primary cultures of human hepatocytes. On the other hand, it enabled rat hepatocytes to specifically bind SHBsAg and conferred susceptibility to HBV infection. After infection of primary cultures of rat hepatocytes in the presence of hAV, HBV mRNA, covalently closed circular (ccc) DNA, replicative intermediates, hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg) and secreted HBV DNA were detected. After infection in the absence of hAV, no markers of HBV replication were detected. Hence, from the present study we conclude that hAV is involved in facilitating HBV entry, leading to successful HBV infection in primary cultures of rat hepatocytes, while it is not effective in preventing HBV infection in primary cultures of human hepatocytes.
Introduction: The aim of the study is to investigate the effect of using Automated External Defibrillator (AED) audiovisual feedback on the quality of cardiopulmonary resuscitation (CPR) in a manikin training setting. Materials and Methods: Five cycles of 30 chest compressions were performed on a manikin without CPR prompts. After an interval of at least 5 minutes, the participants performed another 5 cycles with the use of real time audiovisual feedback via the ZOLL E-Series defibrillator. Performance data were obtained and analysed. Results: A total of 209 dialysis centre staff participated in the study. Using a feedback system resulted in a statistically significant improvement from 39.57% to 46.94% (P = 0.009) of the participants being within the target compression depth of 4 cm to 5 cm and a reduction in those below target from 16.45% to 11.05% (P= 0.004). The use of feedback also produced a significant improvement in achieving the target for rate of chest compression (90 to 110 compressions per minute) from 41.27% to 53.49%; (P <0.001). The mean depth of chest compressions was 4.85 cm (SD = 0.79) without audiovisual feedback and 4.91 (SD = 0.69) with feedback. For rate of chest compressions, it was 104.89 (SD = 13.74) vs 101.65 (SD = 10.21) respectively. The mean depth of chest compression was less in males than in females (4.61 cm vs 4.93 cm, P = 0.011), and this trend was reversed with the use of feedback. Conclusion: In conclusion, the use of feedback devices helps to improve the quality of CPR during training. However more studies involving cardiac arrest patients requiring CPR need to be done to determine if these devices improve survival.
Key words: Cardiopulmonary resuscitation, Chest compression, Quality
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