Purpose of the study: The purpose of this study was to describe the data and outcome of OHCA (according to the Utstein style) in Thessaloniki, which is the second largest city in Greece (population approximately: 1,000,000).1National Statistical Service of Greece. De Facto population of Greece [Census 2001]. Athens: 2003. ISSN: 1106-1499.Google Scholar Materials and methods: Emergency medical service (EMS) in Greece is two-tiered and provides basic life support (BLS) by the ambulance crew (which are in most cases the first responders) and advanced life support (ALS) by a mobile intensive care unit (MICU) with a physician on the head of the crew.2Papaspyrou E. Setzis D. Grosomanidis V. Manikis D. Boutlis D. Ressos C. International EMS systems: Greece.Resuscitation. 2004; 63: 255-259Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar The patients of our study were treated over a 5-year period (from January 1, 2000 to December 31, 2004). Automatic external defibrillators (AEDs) were introduced in the standard BLS ambulance equipment after this period. Results: From a total of 1700 cardiac arrests, resuscitation was attempted in 1458 (85.8%) cases, whereas in 242 (14.2%) cases resuscitation was not attempted. Cardiac arrest was witnessed by bystanders in 1470 (86.5%) and by the EMS personnel in 75 (4.4%) cases. Mean EMS arrival time was 8.18 ± 6.8 min for BLS ambulances and 14.59 ± 10.5 min for MICU. Initial rhythm was ventricular fibrillation in 750 (44.1%), ventricular tachycardia in 18 (1.1%), asystole in 858 (50.5%) and other in 74 (4.3%) cases. 596 (40.9%) patients received classical chest compressions, whereas 862 (59.1%) received active compressions decompressions. Return of spontaneous circulation was achieved in 597 (40.9%) patients, whereas in 167 (11.5%) cases, patients were brought to the Emergency Department under cardiopulmonary resuscitation. 149 patients were discharged from hospital (overall survival rate: 10.2%). Conclusion: Our study results that the survival rate after OHCA is relatively poor but in accordance to other similar studies.3Fischer M. Fischer N. Schiittlert J. One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the 'Utstein style'.Resuscitation. 1997; 33: 233-243Abstract Full Text PDF PubMed Scopus (134) Google Scholar A further study is now conducted concerning data collected after the AEDs introduction in all BLS vehicles.

The purpose of the study was to focus on factors that affected outcome of very elderly patients (≥ 75 years) in a 10-bed polyvalent ICU.

Anastasiou, E.; Geka, H.; Giannakou, M.; Efthimiou, A.; Tsaousi, G.; Argiriadou, H.; Sofianos, E. Author Information

We present a case of Ludwig's angina in a 48-y-old immunocompetent male caused by an unusual pathogen, Gemella morbillorum. The infection was complicated with mediastinitis and despite aggressive management of the disease the patient died after 12 d of hospitalization. This is the first reported case of Ludwig's angina caused by G. morbillorum and emphasizes that the disease remains a potentially lethal infection.

INTRODUCTION:The management of refractory post-traumatic cerebral oedema remains a frustrating endeavor for the neurosurgeon and the intensivist. Mortality and morbidity rates remain high, despite refinements in medical and pharmacological means of controlling intracranial hypertension.METHOD AND MATERIAL:In this retrospective study we have evaluated the efficacy of decompressive craniectomy as a last resort therapy, from the data of nine patients with severe brain injury and delayed cerebral oedema (diffuse injury type III), treated between January 1997 and September 1999. The following parameters were considered: age, Glascow Coma Scale, injury severity, intracranial pressure, CT findings, pupil reaction/posturing. Follow-up period was over at least 2 years and outcome measured on the GOS.RESULTS:Patients have been operated on post-trauma median day 3, mean age 26+/-9, GCS 7+/-3.7, mean APACHE II 16+/-6.4, mean ISS 27.8+/-16.1, mean preoperative ICP 37.7+/-10.0, mean postoperative ICP 18.1+/-16.01. Seven patients have been operated by a frontotemporoparietal approach (six of them bilateral, one unilateral) and two patients have been operated on by a bilateral subtemporal approach. Mortality rates 22%, severe disability 11%, good recovery 66%.DISCUSSION:Patients with STBI, developing delayed intracranial hypertension caused by diffuse cerebral oedema, definitely benefit from craniectomy when current medical treatment has failed. The encouraging results of outcome in this and more recent studies, indicate the need for a multi-institutional randomized prospective study evaluating early indicators of raised ICP, timing, efficacy of treatment, operative technique and complications of decompressive craniectomy.

s and Programme: European Society of Anaesthesiologists; 9th Annual Meeting with the Swedish Society of Anaesthesiology; Gothenburg, Sweden, 7-10 April 2001: Neurosciences: Monitoring Equipment and Computers

A prospective study was conducted to determine the incidence, risk factors and pathogens of ventilator-associated pneumonia (VAP) in 198 patients requiring mechanical ventilation for more than 48 hours. VAP occurred in 67 (33.8%) patients. Risk factors associated with VAP were admission APACHE II score >20 (odds ratio [OR] 4.77, 95% confidence interval [CI] 2.04-11.27, P<0.001), mechanical ventilation > 10 days (OR 44.4, 95% CI 2.16-26.7, P< 0.0001), ICU length of stay >10 days (OR 9.4, 95% CI 3.55-25.65, P< 0.0001), and admission PaO2/FiO2 ratio <200mmHg (OR 3.4, 95% CI 1.00-11.41, P<0.05). Logistic regression analysis showed a relationship between VAP and length of stay in ICU, duration of fever and presence of catheter-related infection. The pathogens isolated were predominantly gram-negative bacteria (83.2%), with a high proportion of Acinetobacter spp. (35%) resistant to commonly used antimicrobial agents. The mortality rate was not influenced by VAP.

European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000

The bacteriology for 21 patients with brain abscesses is presented and correlated with their predisposing conditions. Chronic otomastoiditis was the most common predisposing factor, and the overall most frequent infected sites were the frontal and temporal regions. Gram-negative non-sporeforming anaerobes of the genusBacteroides andFusobacterium followed by aerobic streptococci were the predominant pathogens. Enterobacteria were only identified in postcraniotomy abscesses, while a substantial number of fastidious species was detected in suppurations related to congenital heart disease. Altogether, anaerobes alone were recovered in seven patients, aerobes alone in six, and mixed aerobes and anaerobes in four patients. These findings confirm the predominant role of anaerobes in the etiology of intracranial suppurations.

Since in a previous study (preliminary report) (18) the iv. administration of 15 mg × kg−1 of phenytoin (PNT) over 30 min in men produced toxic levels (25μg/ml), a smallerr iv. dose of 7 mg×kg−1 was given during anaesthesia to 80 patients under going craniotomy, for the prevention of post-operative seizures.