Rescue Tool Research Articles

Stand-alone 3D-ultrasound navigation after failure of conventional image guidance for deep-seated lesions

Image guidance has proven to be an important tool in surgery for deep-seated or eloquently located cavernomas. However, neuronavigation depending on preoperative images can fail. Thus, the displayed anatomy might be distorted already during the approach. This report demonstrates the use of three-dimensional intraoperative ultrasound (3D-US) as a rescue tool, when conventional navigation is erroneous. Two patients with symptomatic cavernomas, the one located subcortically in the right peritrigonum, the other in the left thalamus, were operated in our clinic via an image-guided approach. An integrated ultrasound-navigation system was used for neuronavigation. In both cases, navigation based on preoperative MRI failed after the craniotomy because patient-to-image registration was lost. In both cases, a simple registration of the patient's orientation was performed. Then a 3D-US volume was acquired and navigation was performed using the 3D-US data set. This is accurate as image acquisition and navigation are done in the same system. The cavernoma was visualized without difficulties in both cases. It could be reached directly via the ultrasound-guided approach. Patients' symptoms improved postoperatively and a complete resection could be documented. Two cavernomas were successfully resected using 3D-US guidance. In our experience, stand-alone 3D-US navigation is an effective option if conventional MRI-based navigation fails.

Extracorporal membrane oxygenation for cardiopulmonary support after open heart surgery

Arterial-venous extracorporal membrane oxygenation (ECMO) is a rescue tool in acute heart failure after cardiopulmonary bypass (CPB) when separation from CPB cannot be achieved by conventional means (volume, inotropes, intra-aortic counterpulsation IABP). The role of ECMO in this scenario is far from clear and factors predicting a poor outcome are lacking. However, such indices would be helpful to find a reasonable approach.

Debt-to-Equity Conversion in the UK and Europe

The current financial crisis had lead to a resurgence of debt-for-equity swaps as a corporate rescue tool throughout Europe. There are a number of common factors to be addressed with any debt-for-equity swap. This article seeks to focus on these factors and how they are typically addressed by debtors, the converting creditors and other stakeholders. The relevant rules and impediments in a number of EU countries are identified.

Switch From Venoarterial Extracorporeal Membrane Oxygenation to Arteriovenous Pumpless Extracorporeal Lung Assist

Extracorporeal membrane oxygenation is an effective rescue tool to treat cardiopulmonary failure. Pumpless systems treat lung failure only; they require adequate cardiac output. We report on 18 patients initially provided with venoarterial extracorporeal membrane oxygenation and then downgraded to a pumpless arteriovenous shunt with a membrane oxygenator by removal of the pump from the circuit after hemodynamic stabilization in the face of persisting pulmonary failure. Main underlying diseases were adult respiratory distress syndrome (44%) and pneumonia (28%). Mean patient age was 44 years, and mean body mass index was 25.7 kg/m(2). Anticoagulation, hemodynamic, and respiratory variables were analyzed. All patients exhibited severe cardiopulmonary failure with a mean oxygenation ratio (partial pressure of oxygen to fraction of inspired oxygen ratio) of 74 +/- 43 mm Hg (mean partial pressure of oxygen, 70 +/- 33 mm Hg) and a mean partial pressure of carbon dioxide of 68 +/- 32 mm Hg despite maximal (ventilatory) conservative therapy (fraction of inspired oxygen, 0.98 +/- 0.08). Initial serum lactate was 51 +/- 43 mg/dL. The sequential organ failure assessment score averaged 11.8 +/- 2.47, and the lung injury score was 3.1 +/- 0.58. Total mechanical respiratory support was performed for a mean of 13.6 +/- 15.7 days. After 24 hours an improvement in oxygenation and a decrease in carbon dioxide was achieved with a mean partial pressure of carbon dioxide of 40 +/- 11 mm Hg (p < 0.001) and a partial pressure of oxygen of 86 +/- 26 mm Hg (p = 0.031). After 6 +/- 3 days of extracorporeal membrane oxygenation, patients were hemodynamically stabilized. Extracorporeal membrane oxygenation was downgraded to pumpless extracorporeal lung assist for another 10 +/- 15 days (range, 2 to 71 days). Twelve patients (66.7%) could be weaned, with a 30-day mortality of 55.6%. Norepinephrine dosage could be reduced significantly within 24 hours (3.2 +/- 1.8 versus 1.5 +/- 1.5 mg/h; p = 0.008). Respiratory support by an extracorporeal device used as last resort therapy allows rapid stabilization of patients with acute lung failure. Early replacement of extracorporeal membrane oxygenation by pumpless extracorporeal lung assist minimizes the negative side effects of extracorporeal circulation.

Success Rate of Orotracheal Intubation via GlideScope®versus Direct Laryngoscopy in Manikin-Only–Trained Medical Personnel

Success Rate of Orotracheal Intubation <i>via</i> GlideScope®<i>versus</i> Direct Laryngoscopy in Manikin-Only–Trained Medical Personnel

The much-loved knife [Swiss army knife products

Victorinox, manufacturer of the original Swiss Army Knife, is a world favorite. The article discovers just how much goes into manufacturing these pocket marvels. Among the factory&apos;s new products is the Victorinox Rescue Tool, developed in co-operation with Swiss emergency and rescue services. With its one-thumb-opening blade, a disc glass saw and a glass breaker, it can be opened and made ready for use in seconds.

Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

BACKGROUND AND OBJECTIVES:Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation.PATIENTS AND METHODS:From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4.RESULTS:All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO.CONCLUSION:Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care.

Operational restructuring: reviving an ailing business

PurposeWhen firms are dealing with negative earnings and/or economic downturns, operational restructuring is often initiated as a rescue tool. Some firms recover and prevail, while the others fail to survive and are subsequently delisted from stock exchange. The purpose of this paper is to identify factors that are significantly associated with the delisting risk of restructuring firms.Design/methodology/approachThe authors draw on a sample of firms with negative earnings that undertook restructuring during the 2001 economic recession. Logistic regression estimation is used to examine the delisting risk of these firms following the restructuring.FindingsThe paper finds that delisting risk increases when firms undertake repetitive restructurings, massive workforce reduction, and large‐scale asset downsizing. Firms with high levels of debt and failure to cut costs and/or narrowing its focus on core competencies are also more likely to delist.Practical implicationsBy analyzing and synthesizing the information from empirical data and business experience, this paper provides a guide for managers to effectively plan and implement a restructuring program to improve performance amid an economic downturn.Originality/valueThis is the first study to examine the survivability or delisting risk of a poorly performing firm undergoing restructuring amid an economic recession.

Base-flipping mutations of uracil DNA glycosylase: substrate rescue using a pyrene nucleotide wedge.

We recently introduced a new substrate rescue tool for investigating enzymatic base flipping by uracil DNA glycosylase (UDG) in which a bulky pyrene nucleotide wedge (Y) was placed opposite a uracil in duplex DNA (i.e., a U/Y pair), thereby preorganizing the target base in an extrahelical conformation [Jiang, Y. L., et al. (2001) J. Biol. Chem. 276, 42347-54]. The pyrene wedge completely rescued the large catalytic defects resulting from removal of the natural Leu191 wedge, presumably mimicking the pushing and plugging function of this group. Here we employ the pyrene rescue method in combination with transient kinetic approaches to assess the functional roles of six conserved enzymatic groups of UDG that have been implicated in the "pinch, push, plug, and pull" base-flipping mechanism (see the preceding paper in this issue). We find that a U/Y base pair increases the apparent second-order rate constant for damaged site recognition by L191G pushing mutation by 45-fold as compared to a U/A pair, thereby fully rescuing the kinetic effects of the mutation. Remarkably, the U/Y pair also allows L191G to proceed through the conformational docking step that is severely comprised with the normal U/A substrate, and allows the active site of UDG to clamp around the extrahelical base. Thus, pyrene also fulfills the plugging role of the Leu191 side chain. Preorganization of uracil in an extrahelical conformation by pyrene allows diffusion-controlled damage recognition by all of these base-flipping mutants, and allows the UDG conformational change to proceed as rapidly as the rate of uracil flipping with the natural U/A base pair. Thus, the pyrene wedge substrate allows UDG to recognize uracil by a lock-and-key mechanism, rather than the natural induced-fit mechanism. Unnatural pyrene base pairs may provide a general strategy to promote site-specific targeting of other enzymes that recognize extrahelical bases.

The house as a search and rescue tool

Abstract This paper presents the experiences of Greater Philadelphia Search and Rescue (GPSR) and other organizations it has been in contact with in organizing a mounted search unit within a larger multi-skilled land search organization. Much of this material is anecdotal in nature but should be considered in light of the long operational history of GPSR and the studied approach taken with regard to organizing the mounted unit.