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At least 145 records · Page 8Linked to original sources
PubMed1996

Ultrasound training during ATLS: an early start for surgical interns.

OBJECTIVES: Determine if: (1) surgical interns could learn essential ultrasound principles of the focused assessment for the sonographic examination of the trauma patient (FAST) during Advanced Trauma Life Support (ATLS), and (2) swine are adequate models for learning the FAST. DESIGN: Lecture, videotape, pre/posttests, and practical examination. METHODOLOGY: Day 1: Survey, pretest, lecture, and videotape. Day 2: Three swine, used in ATLS, had diagnostic peritoneal lavage catheters reinserted to infuse fluid and produce "positive" ultrasound examinations. Two fresh swine were "negatives"; however, all five swine were draped similarly to disguise interventions. Interns were tested individually by surgeon-sonographers to determine whether the ultrasound image was "positive" or "negative." Posttests were completed while surgeons performed postmortem examinations on two swine. STATISTICS: Paired Student's t test and Wilcoxon Rank Sum test. RESULTS: Survey (5 min): 48% had exposure to ultrasound. Relationship of test scores showed no significant difference (p = 0.46 to 0.91) between interns with and without ultrasound experience. Tests (30 min): Mean pre- and posttests scores = 65.6 and 90.8, respectively (p < 0.001). Practical examination (140 min): Mean score = 89.6. Postmortem examinations: Left hepatic lobe partially obscured the spleen. CONCLUSIONS: (1) Surgical interns can learn essential ultrasound principles of the FAST during ATLS (2) Swine are feasible models for learning the FAST.

Animals↗
PubMed1999

Advanced trauma life support (ATLS) courses: should training be refocused towards rural physicians?

Recently there has been an increase in the number of courses designed to improve the theoretical knowledge and practical skills of health workers for immediate emergency management under life-threatening conditions. However, the numbers of applicants for these courses far exceed the available places. Priorities should be reviewed to solve the current shortfall. The purpose of this study was to compare the improvement in basic knowledge associated with the advanced trauma life support (ATLS) programme for paediatricians practising in a metropolitan area, with those practising in rural hospitals. This should facilitate proper use of the limited existing resources for training of physicians. A retrospective, comparative analysis of the impact of the ATLS courses for pediatricians was assessed by analysing scores of multiple choice tests before and after the programme. The study group comprised all Israeli paediatricians (n = 72) who completed the course during 1996. Performance was compared between paediatricians working in major, level I (n = 39) and rural, level II trauma centres (n = 33). After the course, all paediatricians improved their scores; those in level I trauma centres improved their mean precourse scores from 72 +/- 13.6 to 85 +/- 5.4, while those working in level II trauma centres improved from 67 +/- 12.4 to 85 +/- 5.0. The impact of the course was reflected in the net and proportional gains. Both were higher for paediatricians working in level II trauma centres, compared with those working in metropolitan trauma centres. Furthermore, the net gain was significantly higher (p < 0.05). Efforts should be made to increase the participation of paediatricians practising in rural level II trauma centres in trauma care courses. Further research should address the applicability of these results for recruiting primary care physicians to the ATLS courses.

Education, Medical, Continuing↗
PubMed2003

Do factors other than trauma volume affect attrition of ATLS-acquired skills?

BACKGROUND: We previously demonstrated that trauma patient volume affects attrition rate of Advanced Trauma Life Support (ATLS)-acquired skills. This study assesses the possible roles of age, gender, and practice specialty on attrition of these skills over 8 years. METHODS: Cognitive (assessed by the 40-item Multiple Choice Question Examination [MCQE]) and clinical (assessed by four trauma Objective Structured Clinical Examination [OSCE] stations) skills performance were compared among physicians who completed the ATLS course 0 months, 6 months, 2 years, 4 years, 6 years, and 8 years previously. The physicians were further divided into the following groups: age < 32 years (n = 72) or 32 years or older (n = 72), gender (41 women and 103 men), and specialty (54 surgeons, 90 nonsurgeons, and 22 general surgeons). Multivariate analysis of variance was used for statistical comparison over time and unpaired t tests for between-group comparisons for each time period, with p < 0.05 being considered statistically significant. RESULTS: Regarding age, MCQE decreased from 82.3 +/- 2.8% to 62.7 +/- 3.0% (mean +/- SD) for age < 32 and from 84.1 +/- 3.6% to 62.8 +/- 2.1% for age 32 or older (p = not significant). Overall OSCE score (maximum, 20) decreased similarly for age < 32 (18.0 +/- 0.4 to 13.6 +/- 2.0) and age > 32 or older (18.0 +/- 0.3 to 12.4 +/- 1.3). Decrease in Priorities and Organized Approach scores also showed no differences between the groups. Regarding gender, MCQE decreased similarly in both groups (women, 81.5 +/- 2.2% to 64.4 +/- 2.4%; men, 83.3 +/- 3.2% to 64.1 +/- 4.2%) and so did OSCE, Priorities, and Organized Approach scores. Regarding specialty, surgeons (83.0 +/- 3.1% to 66.1 +/- 4.5%), nonsurgeons (82.9 +/- 3.2% to 63.3 +/- 3.9%), and general surgeons (82.5 +/- 3.5% to 63.8 +/- 5.3%) showed similar decreases in MCQE scores. Overall OSCE scores and Priority and Approach scores decreased similarly in all specialty groups. When trauma volume was controlled, there was still no difference in attrition rate between surgeons and nonsurgeons. CONCLUSION: Trauma patient volume is the most critical determinant of attrition rate of ATLS-acquired skills. Gender, age (at time of taking the course), and practice specialty do not alter this attrition rate.

Adult↗
PubMed1994

Expression of fos proto-oncogene product by monoclonal antibody FO-120 in smouldering adult T-cell leukaemia (ATL).

We investigated the expression of c-fos gene product in peripheral blood mononuclear cells of patients with smouldering adult T-cell leukaemia (ATL) and healthy human T-lymphotropic virus type-I (HTLV-I) carriers by an immunofluorescence assay, using a mouse monoclonal antibody (FO-120) specific for fos gene product. Peripheral blood mononuclear cells derived from healthy HTLV-I carriers were rarely positive for FO-120, less than 2% of the cells weakly reacted with FO-120, whereas positive cells were detected in more than about 10% of cells from patients with smouldering ATL. FO-120 appears to be a useful tool for detecting smouldering ATL in asymptomatic HTLV-I infected people without using molecular techniques.

Adult↗
PubMed1997

Localized perforation of the cell wall by a major autolysin: atl gene products and the onset of penicillin-induced lysis of Staphylococcus aureus.

We investigated the cell surface localization of the atl gene products of Staphylococcus aureus exposed to a lytic concentration (4 MIC) of penicillin G (PCG) by means of immunoelectron microscopy using anti-62-kDa N-acetylmuramyl-L-alanine amidase or anti-51-kDa endo-beta-N-acetylglucosaminidase immunoglobulin G. Protein A-gold conjugates reacting with antigen-antibody complex localized at sites of defects of the cell wall at the nascent cross wall. Anti-62-kDa N-acetylmuramyl-L-alanine amidase or anti-51-kDa endo-beta-N-acetylglucosaminidase immunoglobulin G inhibited the decreased turbidity caused by PCG-induced lysis and the formation of defects in the wall. The autolysis-defective mutant, S. aureus RUSAL2 (atl::Tn551), exposed to 4 MIC of PCG resisted autolysis and formation of the wall defect. These results suggest that activation or deregulation of the atl gene products at localized sites where formation of new cross wall was disturbed by PCG causes small defects in the cell wall in situ, eventually leading to general autolysis.

Antibodies↗
PubMed2005

Human T-cell leukemia virus type I (HTLV-I) infection and the onset of adult T-cell leukemia (ATL).

The clinical entity of adult T-cell leukemia (ATL) was established around 1977, and human T-cell leukemia virus type 1 (HTLV-I) was subsequently identified in 1980. In the 25 years since the discovery of HTLV-I, HTLV-I infection and its associated diseases have been extensively studied, and many of their aspects have been clarified. However, the detailed mechanism of leukemogenesis remains unsolved yet, and the prognosis of ATL patients still poor because of its resistance to chemotherapy and immunodeficiency. In this review, I highlight the recent progress and remaining enigmas in HTLV-I infection and its associated diseases, especially ATL.

Adult↗
PubMed2003

Predicting verbal memory decline following anterior temporal lobectomy (ATL).

OBJECTIVE: To develop a multivariate risk factor model for predicting postoperative verbal memory decline in an individual patient following dominant or nondominant anterior temporal lobectomy (ATL). METHODS: The authors studied 132 consecutive ATL patients who 1). were older than 16 years at surgery, 2). had estimated preoperative Full Scale IQ score of >69, 3) had unilateral language dominance based on the intracarotid amobarbital procedure (IAP), and 4) underwent neuropsychological testing at baseline and >or=6 months postoperatively (mean 1.2 years). Five potential risk factors for postoperative verbal memory decline were selected a priori that reflect the functional adequacy of the to-be-resected temporal lobe. These were 1). resection in the dominant hemisphere, 2). MRI findings other than exclusively unilateral mesial temporal sclerosis, intact preoperative 3). immediate and 4). delayed verbal memory function, and 5). intact IAP memory performance following injection contralateral to the seizure focus. Verbal memory decline was defined using two verbal memory tests and published reliable change indices. RESULTS: Thirty-eight percent of the sample declined reliably on one or both verbal memory measures. Logistic regression analysis demonstrated that all five risk factors were significantly and independently associated with outcome, with side of surgery having the strongest association (p < 0.0001) and preoperative immediate verbal memory the weakest (p < 0.05). CONCLUSIONS: An individual patient's risk for postoperative verbal memory decline following dominant or nondominant ATL can be predicted using clinical data routinely available preoperatively (side of surgery, qualitative MRI, baseline memory testing, IAP performance). This information may be useful for preoperative patient counseling.

Adult↗
PubMed2005

Orthopaedic surgeons in Yorkshire--are we ATLS positive?

INTRODUCTION: In 1993, the Major Trauma Working Group of Yorkshire proposed that hospitals should be accredited as Trauma Reception Hospitals with a policy for the response to the arrival of a trauma patient. These requirements include specific criteria for orthopaedics. METHODS: To evaluate if these criteria are being fulfilled, we carried out an audit comparing the response in the hospitals within the Yorkshire deanery to the arrival of major trauma. All consultant and middle-grade orthopaedic surgeons on call for trauma were contacted and questioned as to their ATLS provider status and involvement in the "trauma call". RESULTS: 16 hospitals were included of which 13 have a "trauma team". 191 surgeons (96% response) were included. 175 have completed an ATLS course. Of these, 72 (41%) had out-of-date qualifications. Only 9 (13%) were waiting to revalidate. Variation was seen in the frequency of accident and emergency department attendance by different grades of surgeon for major trauma. DISCUSSION: All hospitals have a response for major trauma although variations occur. The vast majority of orthopaedic surgeons in Yorkshire have been adequately trained in ATLS management (more so than any study has previously shown), particularly the middle grades, who are usually first to attend. The level of revalidation is low and reasons for this are discussed with recommendations for revalidation in the future.

Clinical Competence↗
PubMed1987

Establishment and characterization of T-cell lines (Yana-I and Yana-II) derived from a patient with chronic adult T-cell leukemia (ATL).

ATL-cell lines producing C-type retroviruses were established by culture of the peripheral blood mononuclear cells from a patient with chronic ATL. These cell lines had the surface feature of inducer/helper T-cells with electron microscopic finding of C-type retrovirus on the cell surface. Chromosome analysis revealed the presence of a marker chromosome, but did not identify 7 trisomy nor 14q+. Of the cell lines, the line established by culture with TCGF was named "Yana-I" and the line established by culture of Yana-I without adding TCGF was named "Yana-II". Serum ATLA-antibody was positive in 1.5% of the healty individuals examined (4/257). Among malignant lymphoma patients, ATLA antibody was positive in none of the patients with B-cell type lymphoma (0/10) and Hodgkin's disease (0/2). In contrast, ATLA antibody was found in half of the patients with T-cell type lymphoma (3/6) and all with ATL (4/4). This suggested that C-type retrovirus in closely associated with ATLL.

Antibodies, Viral↗
PubMed1996

Adult T-cell leukemia (ATL) with an unusual immunophenotype and a high cellular proliferation rate.

A patient with adult T-cell leukemia (ATL) characterized by a suppressor phenotype is reported. A 52-year-old mulatto male presented with symptoms and signs of hypercalcemia. His laboratory finding disclosed a peripheral blood specimen with abnormal cells characterized by a rather pleomorphic morphology and polylobated nucleous typical of ATL cells. Serum calcium and LDH were 18.2 mg/dl and 1373 IU, respectively. The phenotype of these cells was CD2+, CD4-, CD8+, CD28+ associated with the expression of activated antigens such as CD25, CD38, CD71 and CD30. Ki-67 positive were found in 20% of cells. The argyrophilic stain for nuclear organizer regions (AgNORs) was shown one cluster in 35% of abnormal cells. The serum antibodies were positive against human T-cell lymphotropic virus type I (HTLV-I) and clinical features were compatible with the diagnosis of ATL acute type. The combination therapy with cyclophosphamide, vincristine, prednisone decreased the number of leukemic cells but the clinical course was aggressive. He only responded transiently to treatment and died of multiorgan failure due to uncontrollable septicemia two weeks after admission.

Adult↗
PubMed1998

Granulocyte colony-stimulating factor in the combination chemotherapy for adult T-cell leukemia (ATL).

We evaluated the effect of granulocyte colony-stimulating factor (G-CSF) on the median survival of 17 patients with Adult T-cell leukemia (ATL). Standard-dose combination chemotherapy using the response-oriented cyclic multidrug (RCM) protocol with G-CSF (lenograstim 2 microg/kg/day or filgrastim 50 microg/m2/day) was administered between October 1990 and December 1994. Complete responses (CR) were achieved in 11 (64.7%) patients, and partial responses (PR) in 4 (23.5%) patients. The median duration of survival was 7.4 months, compared with 6.0 months in ATL patients treated with the RCM protocol alone (historical controls) (n.s.). Infectious complications were the cause of death in 4 (26.7%) of the 15 patients who died. The median duration of neutropenia (absolute neutrophil count < 1.0 x 10(9)/L) was 6 days. G-CSF, in the doses and schedules used here, may have shortened the duration of neutropenia and reduced the incidence of fatal infectious complications. However, concomitant use of G-CSF did not prolong the median duration of survival in patients with ATL treated according to the RCM protocol.

Adjuvants, Immunologic↗
PubMed2000

Pediatricians and the Advanced Trauma Life Support (ATLS): time for reconsideration?

BACKGROUND: General pediatricians in Israel are actively involved in the initial evaluation, resuscitation and management of traumatized children. However, pediatric trauma care is not a part of pediatric specialty training in Israel, and the few Advanced Trauma Life Support courses per year are insufficient for most pediatricians working in accident and emergency care. OBJECTIVE: To examine the value of the course in relation to the limited resources available for such training. METHODS: A telephone survey of 115 pediatricians who had taken the course between 1990 and 1994 was conducted. The responding physicians (67%) were asked to complete a specially designed questionnaire on life-saving procedures that were taught in the course. In addition, they were asked to subjectively assess the practical utility of the course. RESULTS: Forty-three (56%) pediatricians reported that they routinely treated both adult and pediatric trauma cases. Of these, 81% performed 27 life-saving ATLS procedures. Pediatric trauma was treated by only 22 (28%), of whom 72.3% performed 18 life-saving ATLS procedures. These pediatricians ranked the courses as being "very high" to "high" in impact. CONCLUSIONS: These figures indicate that an ATLS course designed specifically for pediatricians can markedly improve pediatric trauma care. To ensure standard education and patient care, such a course should be developed and made a mandatory component of residency training. Further studies to examine the objective impact of the courses on pediatric trauma care should be carried out.

Adolescent↗
PubMed2002

[ATL (lymphoma type) presented with a mass formation in the heart].

A 50-year-old man was admitted to another hospital with epigastralgia. Malignant lymphoma was suspected because the patient had increased levels of serum LDH and an abnormal Ga scintigraphy finding in his chest. When he was transferred to our hospital, he underwent a right inguinal lymphadenopathy. The laboratory data showed increased levels of serum LDH and soluble IL-2 receptor, but there was no appearance of peripheral abnormal lymphocytes. His chest MRI indicated tumors in the right atrium (4 cm x 4 cm) and in the head of his left humerus. Those tumors were enhanced by Gd-DTPA. There were no other lymphadenopathies. Histopathological and immunohistochemical studies showed T-cell type lymphoma in the right inguinal lymph node. Furthermore, monoclonal rearrangement of HTLV-I proviral DNA was detected from the lymph node by Southern blot analysis. Taken together, we diagnosed the patient as having ATL (lymphoma type). His condition has improved well with systemic chemotherapy. We report a rare case of lymphoma type ATL with initial massive cardiac involvement, although ATL cells sometimes involve the heart at the end of the disease course.

Heart Neoplasms↗
PubMed2005

An ATL cell line with an IgH pseudo-rearranged band pattern by southern blotting: a pitfall of genetic diagnosis.

Adult T-cell leukemia (ATL), which is a mature T-cell malignancy that develops from human T-cell leukemia virus type-1 (HTLV-1)-infected T-cells, is diagnosed based on morphologic, immunophenotypic, serologic, and genetic characteristics. In particular, Southern blot hybridization (SBH) and polymerase chain reaction analyses for antigen receptor genes and the retrovirus of HTLV-1 provide a diagnostic hallmark for the clonality of leukemic cells and the causative agent of the disease. We report here a case of an ATL cell line, designated as SO4 cells, established from primary ATL cells presenting with an irrational genetic abnormality of the immunoglobulin heavy chain (IgH)-rearranged band in spite of harboring a clonally rearranged T-cell receptor gene and a clonally integrated provirus of HTLV-1 within their genomic DNA. Moreover, fluorescence in situ hybridization analysis using the IgH (14q32) dual-color break-apart probe revealed 3 pair-signals of colocalizing red and green spots, implying 2 intact and 1 amplified 14q32 regions without translocation, where the region contains the IgH gene locus. Although the exact mechanism remains to be elucidated, some alteration of a portion of the amplified 14q32 region seems to have a role in the false-positive band pattern in the SBH. The SO4 cells, in the hematology laboratory, will provide a lesson about the pitfalls of genetic tests for mature T-cell neoplasms and contribute to the genetic elucidation of leukomogenesis as an in vitro model.

Adult↗
PubMed1989

[HTLV-I associated myelopathy (HAM) with adult T-cell leukemia (ATL)].

A 42-year-old female case of HTLV-I associated myelopathy (HAM) combined with adult T-cell leukemia (ATL) was reported. The patient noticed paresthesia in the soles at the age of 17, and gait disturbance and urinary retention at the age of 20. These symptoms progressed slowly. The patient showed indurations in both hypothenar regions and leukocytosis of 17,900/microliters in the peripheral blood at the age of 41. On admission to our hospital, she had spastic gait, muscle weakness of four extremities, increased deep tendon reflexes, pathologic reflexes, mild decreased of vibration sense and vesico-rectal disturbance. Anti-HTLV-I antibody (PA method) was increased to 1,024 fold in serum and 64 fold in spinal fluid. Thus, this patient was diagnosed as having HAM. In addition, leukocyte count in the peripheral blood was increased to 17,200/microliters including 33% atypical lymphocytes, and lymphocytes subset analysis showed 96.1% CD4+, 1.8% CD8+ and marked increase in CD4/CD8 ratio. Southern blot analysis of HTLV-I provirus DNA in the lymphocytes was of complete type with a monoclonal mode of integration. These findings indicated a diagnosis of ATL for this patient. HLA typing revealed A2, A11, Bw22, Bw46, Cw1, Cw3, being compatible with HAM type reported by Usuku et al. HAM and ATL were reported to be caused by an identical virus. However, there has been no case report of combination of the two diseases. Usuku et al proposed that the development of each disease was based on the differences in HLA haplotypes and HTLV-I-specific immune responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Mechanism of the gene expression of HTLV-I and its association with ATL.

Human T-cell leukemia virus type 1 (HTLV-1) is the etiologic agent of adult T-cell leukemia (ATL) and a trans-acting viral function was proposed to be involved in ATL development because of the non-specific provirus integration in leukemic cells and the frequent immortalization of helper T-cells by in vitro infection. An extra sequence "pX" in the HTLV-1 genome codes for three proteins, p40x-, p27x- and p21x-, and the p40x- is trans-activator of transcription from the viral LTR. A sequence of 21 bp repeats in the LTR was found to be an enhancer and respond to the trans-activation by p40x-. The transient expression of p40x- also activates a cellular gene for interleukin 2 receptor (IL-2R) in helper T-cell lines. This induction of IL-2R may explain the mechanism of preferential growth of HTLV-1 infected cells and may be an early event of ATL development. For practical purposes, the env gene fragments was expressed in E. coli as fusion proteins with beta-galactosidase. Using these fusion proteins, a diagnostic system detecting anti-env antibodies was developed. Immunization of monkeys with these envelope-fusion proteins protected the monkeys from the viral infection, suggesting possible usage of envelope proteins as vaccine.

Animals↗
PubMed1995

[A HBV carrier with fulminant hepatitis complicated by ATL, multiple myeloma and thyroid cancer].

A 75-year-old female, born in Tochigi Prefecture, was admitted because of lumbago in August of 1991. The leukocyte count was 11,800/microliters with 22.5% atypical lymphocytes. We demonstrated a lymphocyte surface marker, ATL-associated antigen, and proviral DNA. We also identified 2.60 g/dl of serum monoclonal protein, found to be IgG, lambda type, and punched out lesions in the skull. We made a diagnosis of ATL. She was also a HBV carrier. The patient was treated with a modification of CHOP therapy, because of increasing atypical lymphocytes in the peripheral blood in November of 1992. She died of acute hepatitis, suddenly, in March of 1993. Autopsy revealed multiple myeloma, fulminant hepatitis and occult thyroid cancer in addition to ATL.

Acute Disease↗
PubMedDate not supplied

Prevalence of human T-cell leukemia virus type 1 (HTLV-I) in general inhabitants in non-adult T-cell leukemia (ATL)-endemic Hokkaido, Japan.

In contrast to adult T-cell leukemia (ATL)-endemic southwestern Japan, the northernmost island Hokkaido has a small number of ATL patients annually. In this study, we surveyed 32,587 healthy inhabitants throughout Hokkaido for antibodies to human T-cell leukemia virus type 1 (HTLV-I). Only 244 individuals (0.8%) were seropositive as HTLV-I carriers; 0.6% (123 of 19,512) in males and 0.9% (121 of 13,075) in females. In some areas, however, the inhabitants had relatively high seropositivity (> 2%). The highest rate was 5.2% with a cluster of ATL patients in a certain town of the Hidaka area near the Pacific Ocean, in southeast Hokkaido.

Adolescent↗