Does etiology of acute pancreatitis matter? A review of 391 consecutive episodes.

Context: Acute pancreatitis can be triggered by a variety of factors ranging from short lasting to sustained disruptions. It is plausible that the characteristics and course of disease differ among etiologies. Data distinguishing characteristics of patients with pancreatitis of biliary, alcoholic, idiopathic or other origin are scarce and conflicting.

[A curricular training of fourth year medical students in writing discharge summaries: the graduate view after two years].

Background: Preparing high quality discharge summaries is difficult for first year residents. For 5 years we have been training fourth year students how to write discharge summaries. Our goal is to facilitate the students' start into clinical work.

Effects of a rater training on rating accuracy in a physical examination skills assessment.

Background: The accuracy and reproducibility of medical skills assessment is generally low. Rater training has little or no effect. Our knowledge in this field, however, relies on studies involving video ratings of overall clinical performances.

Detrimental effect of high volume fluid administration in acute pancreatitis - a retrospective analysis of 391 patients.

Background: Early fluid resuscitation is recommended for the therapy of acute pancreatitis in order to prevent complications. There are, however, no convincing data supporting this approach.

Methods: We reviewed 391 consecutive cases of confirmed acute pancreatitis.

Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis.

Objectives: This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure.

Methods: Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator in patients with acute respiratory failure.

Heart rate variability and metabolic rate in healthy young adults with low birth weight.

Objective: Low birth weight (LBW) is associated with obesity and a higher cardiovascular risk in adult life. Since autonomic dysfunction could be a pathophysiological factor for this association, we assessed the impact of LBW on cardiac autonomic activity and metabolic rate in young adulthood. We hypothesized that the autonomic tone could be coupled with the metabolic rate in subjects with LBW.

Question-writing as a learning tool for students--outcomes from curricular exams.

Background: Writing exam questions can be a valuable learning tool. We asked students to construct multiple choice questions for curricular exams in Internal Medicine. The questions for the particular exams were chosen from a pool of at least 300 student-written questions.

Differences between students and physicians in their entitlement towards procedural skills education--a needs assessment of skills training in internal medicine.

Objective: Procedural skills education has a high priority for medical students. However, it is not clear what kind of skills they consider important and whether their perception differs from the physicians' view.

Methods: We conducted a survey on 26 skills in internal medicine among medical students and physicians.

Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity.

Unlabelled: Survival after in-hospital pulseless electrical activity (PEA) cardiac arrest is poor and has not changed during the last 10 years. Effective chest compressions may improve survival after PEA. We investigated whether a mechanical device (LUCAS™-CPR) can ensure chest compressions during cardiac arrest according to guidelines and without interruption during transport, diagnostic procedures and in the catheter laboratory.

Automated continuous chest compression for in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity: a report of five cases.

Of patients with in-hospital cardiac arrest, those with pulseless electrical activity (PEA) have the worst outcome. Especially in these patients effective chest compressions according to the guidelines may be the key strategy to improve survival. Recently, a novel automatic mechanical chest compression device (LUCAS-CPR) has been shown to ensure effective continuous compressions without interruption during transport, diagnostic procedures and in the catheter laboratory, and may thus significantly improve outcome after resuscitation of in-hospital cardiac arrest.

Endotoxemia causes central downregulation of sympathetic vasomotor tone in healthy humans.

Experimental endotoxemia as a model of the initial septic response affects the autonomic nervous system with profound cardiovascular sequelae. Whether the postsynaptic sympathoneural activity to the muscle vascular bed is altered in the early septic phase remains to be determined. The present study aimed to elucidate the early effects of LPS on muscle sympathetic nerve activity (MSNA) and cardiovascular regulation in healthy humans.

Prehospital noninvasive pressure support ventilation for acute cardiogenic pulmonary edema.

Severe acute cardiogenic pulmonary edema (ACPE) can successfully be treated with noninvasive pressure support ventilation (NIPSV) in a clinical setting. Whether prehospital NIPSV starting early at patients' home and being continued until hospital arrival is feasible and improves ACPE emergency care is examined in this study. End points of the study were oxygen saturation at hospital admission and clinical outcome.

Premedication with orally administered lorazepam in adults undergoing ERCP: a randomized double-blind study.

Background: Restlessness often complicates ERCP and may be a reason for premature termination of the procedure.

Objective: Our purpose was to evaluate whether a premedication with orally administered lorazepam could reduce the need for sedatives and improve sedation quality.

Design: Randomized double-blind trial.

Central sleep apnea is associated with blunted baroreflex sensitivity in patients with myocardial infarction.

Objectives: The purpose of this study was to investigate the association of central sleep apnea (CSA) and baroreflex sensitivity (BRS) after acute myocardial infarction.

Background: Both, CSA and blunted BRS have been shown to be independent predictors for cardiovascular mortality in patients with heart failure. But in contrast to BRS, which has been extensively studied in the setting of AMI, the incidence of CSA in patients recovering from AMI is thus far unknown.

Ventricular repolarization dynamics during different sleep stages in the subacute phase of myocardial infarction.

Background: Ventricular arrhythmias after myocardial infarction (MI) are often nocturnal. However, the arrhythmogenic effects of sleep after MI are unknown. We examined the effects of sleep stages on QT dynamicity and tested the hypothesis of a differential effect of sleep stage on the QT/RR relationship after recent MI, versus in healthy controls (HC).

Modulation of ventricular repolarization in patients with transient left ventricular apical ballooning: a case control study.

Objective: Even though diffuse T wave inversion and prolongation of the QT interval in the surface electrocardiogram (ECG) have been consistently reported in patients with transient stress-induced left ventricular apical ballooning (AB), ventricular repolarization has not yet been systematically investigated in this clinical entity.

Background: AB, an emerging syndrome that mimics acute ST-segment elevation myocardial infarction (MI), is characterized by reversible left ventricular wall motion abnormalities in the absence of obstructive coronary heart disease and significant QT interval prolongation.

Methods: We prospectively enrolled 22 consecutive patients (21 women, median age 65 years) with transient left ventricular AB.

Differential effects of hydrocortisone on sympathetic and hemodynamic responses to sympathoexcitatory manoeuvres in men.

Aim of the present study was to investigate the influence of hydrocortisone on muscle sympathetic nerve activity (MSNA) and hemodynamic parameters during different sympathoexcitatory manoeuvres in humans. The study focuses on the interaction of the hypothalamo-pituitary-adrenal system and the sympathetic nervous system. Hydrocortisone 100 mg or placebo was administered intravenously to eight young healthy subjects in a double-blind crossover design.

Changes in heart rate, heart rate variability, and heart rate turbulence during evolving reperfused myocardial infarction.

Depressed cardiac parasympathetic activity is associated with electrical instability and adverse outcomes after myocardial infarction (MI). Heart rate turbulence (HRT), reflecting reflex vagal activity, and heart rate variability (HRV), reflecting tonic autonomic variations are both reduced in the subacute phase of MI. However, the evolution of these components of cardiac autonomic control between subacute and chronic phase of MI has not been defined.

Serum procalcitonin differentiates inflammatory bowel disease and self-limited colitis.

Background: The distinction between idiopathic inflammatory bowel disease (IBD) and infectious, usually self-limited enterocolitis is still a diagnostic dilemma. Procalcitonin (PCT) is the prohormone of calcitonin and is considered a specific marker of bacterial infection. The aim of this prospective study was to determine the value of PCT in differentiating flares of IBD from self-limited colitis.

Love and death in Wagner's Tristan und Isolde--an epic anticholinergic crisis.

In Wagner's opera the main protagonists take a love potion, which has various side effects and possibly causes Isolde's death. Gunther Weitz argues that the symptoms fit with severe anticholinergic syndrome

Evidence for lower sympathetic nerve activity in young adults with low birth weight.

Objective: A dysfunction of the sympathetic nervous system may contribute to the development of hypertension and obesity in subjects with low birth weight (LBW). The present study examines resting sympathetic nerve traffic and its baroreflex modulation to the muscle vascular bed in healthy LBW subjects.

Design: Case-control studies of 13 healthy LBW subjects (< 2500 g at term) aged 20-30 years and 13 normal birth weight subjects (NBW; 3200-3700 g) closely matched for age, gender and body mass index.