Reporting standard for describing first responder systems, smartphone alerting systems, and AED networks

Standardized reporting of data is crucial for out-of-hospital cardiac arrest (OHCA) research. While the implementation of first responder systems dispatching volunteers to OHCA is encouraged, there is currently no uniform reporting standard for describing these systems. A steering committee established a literature search to identify experts in smartphone alerting systems. These international experts were invited to a conference held in Hinterzarten, Germany, with 40 researchers from 13 countries in attendance. Prior to the conference, participants submitted proposals for parameters to be included in the reporting standard. The conference comprised five workshops covering different aspects of smartphone alerting systems. Proposed parameters were discussed, clarified, and consensus was achieved using the Nominal Group Technique. Participants voted in a modified Delphi approach on including each category as a core or supplementary element in the reporting standard. Results were presented, and a writing group developed definitions for all categories and items, which were sent to participants for revision and final voting using LimeSurvey web-based software. The resulting reporting standard consists of 68 core items and 21 supplementary items grouped into five topics (first responder system, first responder network, technology/algorithm/strategies, reporting data, and automated external defibrillators (AED)). This proposed reporting standard generated by an expert opinion group fills the gap in describing first responder systems. Its adoption in future research will facilitate comparison of systems and research outcomes, enhancing the transfer of scientific findings to clinical practice.

Dementia with Lewy bodies: a pure case

A pure case of autopsy-confirmed dementia with Lewy bodies (DLB) is described. The patient presented with distinctive verbal fluency deficits in the context of mild language impairment, intact recognition memory, and impaired paragraph recall. Neuroimaging (CT and SPECT) showed progressive medial temporal lobe atrophy. Neuropathology revealed Lewy bodies, degeneration in the substantia nigra, nucleus basalis of Meynert (Nakano & Hirano, 1984), and locus ceruleus, but no pathology characteristic of Alzheimer's disease. It is in this sense that the case is "pure" DLB. Early neuropsychological diagnosis of DLB is essential (Salmon et al., 1996) given the potentially fatal hazard of neuroleptics (McKeith et al., 1992) and the difficulties associated with clinical neurological diagnoses (Litvan et al., 1998).

Moyamoya disease: no need for anastomotic surgery?

This paper describes an Australian of Caucasian descent with severe Moyamoya disease. She presented at the age of 34 with a subarachnoid haemorrhage. Between the ages of 45 and 48 she had multiple episodes of cerebrovascular ischaemia. Anastomotic surgery was carefully considered but not undertaken. Ten year follow up showed her to be extremely well without any further episodes of cerebrovascular disease. Accordingly it is recommended that surgery is probably not necessary in some cases, particularly in adults.

Endocrine aspects of mitochondrial cytopathy: marked phenotypic variation in two affected siblings

Two siblings with 'mitochondrial myopathy', one of whom was found to have hypergonadotrophic hypogonadism whilst the other had normal endocrine function are reported. The inheritance suggests an autosomal recessive mode. The protean manifestations of the disorder are emphasized. Attention is drawn to the possible association of endocrine abnormalities in addition to the more widely recognized neuromuscular signs.

MR imaging of cerebral vascular malformations

Fifteen vascular malformations, including six supratentorial arteriovenous malformations (AVMs), three venous malformations, and six brainstem vascular malformations, were examined on 0.5 T magnetic resonance (MR) and GE 9800 and 8800 computed tomographic (CT) scanners. All the malformations were shown by MR, and the arterial and venous drainage of AVMs was precisely delineated. Hematoma was always differentiated from calcification by MR signal characteristics. Increased signal in the brain parenchyma was often seen adjacent to AVMs. The signal of blood within venous malformations altered with spin-echo techniques using various repetition times and was distinguished from rapidly flowing blood in AVMs that lacked signal in all imaging sequences. Brainstem malformations were seldom demonstrated by angiography. Hemorrhage was common and was invariably associated with multiple areas of absent signal that may have represented abnormal vessels. These appearances are distinct from those of intrinsic tumors and are probably pathognomonic of brainstem vascular malformations.

Spinal-cord syndrome due to non-compressive Paget's disease of bone: a spinal-artery steal phenomenon reversible with calcitonin

A 76-year-old man had progressive low back pain, leg weakness, and sensory loss. Radiology showed changes consistent with wide-spread Paget's disease, but no cord compression or involvement of nerve roots was detected by myelography or computerised axial tomography. His symptoms were relieved within 12 days of starting 100 MRC units of subcutaneous salmon calcitonin and recurred when calcitonin was discontinued for 5 days. The improvement continued on calcitonin treatment for 1 year, with falls in serum alkaline phosphatase and urinary hydroxyproline excretion. It is suggested that calcitonin treatment, in reducing the abnormally high metabolic activity of the diseased bone, and hence its vascular perfusion, allows more blood to reach the spinal cord.

Familial trigeminal neuralgia

A family had four cases of trigeminal neuralgia occurring in three generations. More cases of a familial nature probably exist.

Creutzfeld-Jakob disease and corneal grafts

The possible danger of surgical transmission of Creutzfeld-Jakob disease from one human being to another has been reported in three instances. Although laboratory attempts at transmission of this disease by corneal grafting have so far failed in animals, it is emphasized that great care should be exercised in the selection of donor material for corneal grafts and renal transplants.

Mood change and magnesium. A possible interaction between magnesium and lithium?

Magnesium and lithium are chemically related. Magnesium is an essential ion in many enzyme systems and lithium is of value in the treatment of manic-depressive disease. A significant sex difference in mean plasma magnesium levels is reported in 44 depressed patients. It is suggested that further studies of magnesium metabolism are indicated and that they may provide a better understanding of manic-depressive disease and the mode of action of lithium.

Brain damage and abnormal behaviour in children

Behavioural problems in children with suspected brain damage may present considerable diagnostic and management problems. Methods of assessment are still imprecise and minor degrees of brain damage are seldom detectable. Data from clinical studies highlight the interrelationship between environmental and organic factors in the pathogenesis of disturbed behaviour. Children from large families of low socioeconomic status, who are subject to parental neglect, are particularly susceptible to the development of psychiatric disorder in the presence of brain damage.

Neurological investigation of dementia

Fifty-two patients thought to be suffering from dementia when first seen as neurological out-patients were fully investigated. Four of them were found to have tumours, whilst in five the dementia was due to a treatable cause. Neither a long history nor an age above sixty-five precludes a dementia being due to a treatable cause.