Peter Rosen - Academia.edu (original) (raw)

Papers by Peter Rosen

Research paper thumbnail of Memoriam to Richard Edlich, MD

The Journal of Emergency Medicine, 2015

Research paper thumbnail of Physicians should be expert witnesses

The Journal of Emergency Medicine, 1990

Physicians have a responsibility to society, their peers, and patients to participate in malpract... more Physicians have a responsibility to society, their peers, and patients to participate in malpractice litigation in a manner that ensures that medical malpractice cases are properly evaluated. Physicians are reluctant to involve themselves as expert witnesses in medical malpractice litigation because of not wanting to further any malpractice suits, mistrust of attorneys and misconceptions about expert witnesses and the legal system in general. The expert witness should be an impartial practicing physician who can select those suits that should or should not be filed and identify which parties were negligent in each case. If impartial physicians do not evaluate cases for attorneys, other more partisan and less objective physicians will.

Research paper thumbnail of Concerning ski equipment

The Journal of Emergency Medicine, 1989

Research paper thumbnail of Emergency medicine and other contact sports

The Journal of Emergency Medicine, 1987

Research paper thumbnail of Epikardiales Fett als Ursache der kardialen Dysfunktion im Diabetes? Das Meerschweinchenherz als experimentelles Modell

Diabetologie und Stoffwechsel, 2007

Research paper thumbnail of A first-in-human study of AMG 208, an oral MET inhibitor, in adult patients with advanced solid tumors

Oncotarget, Jan 19, 2015

This first-in-human study evaluated AMG 208, a small-molecule MET inhibitor, in patients with adv... more This first-in-human study evaluated AMG 208, a small-molecule MET inhibitor, in patients with advanced solid tumors. Three to nine patients were enrolled into one of seven AMG 208 dose cohorts (25, 50, 100, 150, 200, 300, and 400 mg). Patients received AMG 208 orally on days 1 and days 4-28 once daily. The primary objectives were to evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of AMG 208. Fifty-four patients were enrolled. Six dose-limiting toxicities were observed: grade 3 increased aspartate aminotransferase (200 mg), grade 3 thrombocytopenia (200 mg), grade 4 acute myocardial infarction (300 mg), grade 3 prolonged QT (300 mg), and two cases of grade 3 hypertension (400 mg). The MTD was not reached. The most frequent grade ≥3 treatment-related adverse event was anemia (n = 3) followed by hypertension, prolonged QT, and thrombocytopenia (two patients each). AMG 208 exposure increased linearly with dose; mean plasma half-life estimates were 2...

Research paper thumbnail of A phase I study of cetuximab/paclitaxel in patients with advanced-stage breast cancer

Clinical breast cancer, 2006

The epidermal growth factor receptor (EGFR) is part of the ErbB family of receptor tyrosine kinas... more The epidermal growth factor receptor (EGFR) is part of the ErbB family of receptor tyrosine kinases and is known to be variably expressed in breast cancers. Cetuximab is a humanized monoclonal antibody directed against the EGFR that works by blocking the downstream signaling function of this protein and thereby interfering with cancer cell proliferation. Preclinical studies have indicated a synergistic effect for the combination of anti-EGFR therapy plus paclitaxel in breast cancer models. Hence, we conducted a dose-escalation phase I trial using cetuximab/paclitaxel in patients with metastatic breast cancer to evaluate the feasibility of this combination. Patients with EGFR-positive metastatic breast cancer treated with <or= 1 previous therapy, excluding taxanes, were eligible. Treatment consisted of weekly cetuximab therapy and every-3-week paclitaxel, with dose escalation of cetuximab until the maximum tolerated dose was reached. Twelve patients were enrolled to 3 treatment co...

Research paper thumbnail of Reconstructing paleoenvironmental conditions during the past 50 ka from the biogeochemical record of Laguna Potrok Aike, southern Patagonia

Research paper thumbnail of Rapid sequence intubation in the field versus hospital in trauma patients 1 1 Selected Topics: Prehospital Care is coordinated by Peter Pons, MD, of Denver General Hospital, Denver, Colorado

Journal of Emergency Medicine

We conducted a retrospective review of all adult trauma patients who underwent prehospital field ... more We conducted a retrospective review of all adult trauma patients who underwent prehospital field rapid sequence intubation (RSI) by aeromedical crews from 1988 through 1995 and compared them to all trauma patients who arrived by ground transportation and underwent RSI in the trauma suite from 1992 through 1995 at a University hospital. Of the 47 field RSI patients, 46 (97.9%) were successfully intubated, whereas 263 of the 267 (98.5%) hospital RSI patients were successfully intubated. There were no statistical differences in success rates, number of attempts, or immediate intubation events in the procedure between the two groups. There were no differences in delayed events with the exception of pneumonia, which occurred more frequently in the field RSI group (28% vs. 6%, respectively). We performed a subgroup analysis on isolated head injury patients to evaluate outcome. There was no difference in total hospital days, length of ICU stay, mortality or final disposition in the two head injury groups. Though this study is limited by small sample size, we conclude that field RSI is equally successful and safe as hospital RSI.

Research paper thumbnail of Climate induced changes as registered in inorganic and organic sediment components from Laguna Potrok Aike (Argentina) during the past 51 ka

Total organic carbon, total inorganic carbon, biogenic silica content and total organic carbon/to... more Total organic carbon, total inorganic carbon, biogenic silica content and total organic carbon/total nitrogen ratios of the Laguna Potrok Aike lacustrine sediment record are used to reconstruct the environmental history of south-east Patagonia during the past 51 ka in high resolution. High lake level conditions are assumed to have prevailed during the Last Glacial, as sediments are carbonate-free. Increased runoff linked to permafrost and reduced evaporation due to colder temperatures and reduced influence of Southern Hemispheric Westerlies (SHW) may have caused these high lake levels with lake productivity being low and organic matter mainly of algal or cyanobacterial origin. Aquatic moss growth and diatom blooms occurred synchronously with southern hemispheric glacial warming events such as the Antarctic A-events, the postglacial warming following the LGM and the Younger Dryas chronozone. During these times, a combination of warmer climatic conditions with related thawing permafrost could have increased the allochthonous input of nutrients and in combination with warmer surface waters increased aquatic moss growth and diatom production. The SHW were not observed to affect southern Patagonia during the Last Glacial. The Holocene presents a completely different lacustrine system because (a) permafrost no longer inhibits infiltration nor emits meltwater pulses and (b) the positioning of the SHW over the investigated area gives rise to strong and dry winds. Under these conditions total organic carbon, total organic carbon/total nitrogen ratios and biogenic silica cease to be first order productivity indicators. On the one hand, the biogenic silica is influenced by dissolution of diatoms due to higher salinity and pH of the lake water under evaporative stress characterizing low lake levels. On the other hand, total organic carbon and total organic carbon/total nitrogen profiles are influenced by reworked macrophytes from freshly exposed lake level terraces during lowstands. Total inorganic carbon remains the most reliable proxy for climatic variations during the Holocene as high precipitation of carbonates can be linked to low lake levels and high autochthonous production. The onset of inorganic carbon precipitation has been associated with the southward shift of the SHW over the latitudes of Laguna Potrok Aike. The refined age-depth model of this record suggests that this shift occurred around 9.4 cal. ka BP.

Research paper thumbnail of Resuscitative thoracotomy: the effect of the field time on outcome

The Journal of trauma

In the past 5 years, 72 moribund patients have undergone resuscitative thoracotomy (RT) at the Me... more In the past 5 years, 72 moribund patients have undergone resuscitative thoracotomy (RT) at the Medical University of South Carolina: 62 patients underwent the procedure before the adoption of a policy of mandatory rapid transport (scoop and run) for penetrating and unstable victims of trauma by our EMS system (Group I). Group II is comprised of ten patients who underwent RT following adoption of this policy. Resuscitation was successful in three patients in Group I (4.8%) and there were only two survivors (3.2%). In contrast, resuscitation was successful in two of ten patients in Group II (20%) and there was one survivor (10%). Nineteen patients in Group I (31%) were in traumatic full arrest on the scene, all of whom died. Twenty-five patients in Group I (40%) had a measureable pulse and/or blood pressure when EMS personnel arrived at the scene and subsequently &quot;died&quot; before their arrival at the trauma center. RT was also uniformly unsuccessful in this subgroup. Eighteen patients in Group I (29%) suffered cardiac arrest following their arrival at the hospital. Three of these patients (16.6%) were successfully resuscitated and two (11%) survived to leave the hospital. There were four traumatic full arrests in Group II (40%) and all four died. Only two patients in Group II (20%) lost their vital signs in transport and both died. Four patients in Group II (40%) suffered cardiac arrest after arrival at the hospital. Two of these patients (50%) were successfully resuscitated and one left the hospital (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Research paper thumbnail of Effects of hypoxia and adrenergic stimulation induced alterations in PGI2 synthesis by diabetic coronary arteries

Journal of Diabetic Complications, 1988

Before the onset of histologically detectable alterations in diabetic arteries, a considerable de... more Before the onset of histologically detectable alterations in diabetic arteries, a considerable decrease in vasodilatory potential is seen. While analyzing this phenomenon, the role of altered PGI2 synthesis in rings of coronary arteries from metabolically healthy and alloxan-diabetic dogs was measured by radioimmunoassay during baseline, under the influence of phenylephrine (100 mumol/L), and during hypoxia with or without the presence of the alpha adrenergic blocker phentolamine (5 mumol/L). Basal levels of PGI2 synthetized by healthy and diabetic coronaries were no different (7.9 +/- 2.1 and 6.4 +/- 1.4 pg/mg vessel). Phenylephrine potentiated PGI2 synthesis in controls (150 +/- 22%), while it proved to be ineffective in the diabetic animals (98 +/- 6%). Under hypoxic conditions, PGI2 production of healthy coronaries (152 +/- 24%) increased, while that in the diabetic ones (82 +/- 7%) decreased (p less than 0.01). In the presence of phentolamine no difference could be detected between the two groups. Given all these data, the decreased ability of the diabetic coronaries to vasodilate develops due to diminished PGI2 production, presumably controlled by adrenergic mechanisms. Furthermore, the more severe outcome of ischaemic heart disease in diabetes mellitus might be explained by the lack of an enhanced coronary PGI2 synthesis under hypoxic conditions.

Research paper thumbnail of Essentials of Emergency Medicine

Research paper thumbnail of Holocene climatic change reconstructed from diatoms, chironomids, pollen and near-infrared spectroscopy at an alpine lake (Sjuodjijaure) in northern Sweden

The Holocene, 2001

... because a small change in climate can cause large biotic changes (MacDonald et al., 1993; Kör... more ... because a small change in climate can cause large biotic changes (MacDonald et al., 1993; Körner, 1998). The Sarek National Park in the Scandes mountain range of northern Sweden is part of the World Heritage Site Lapponia and is one of Europe's largest wilderness areas ...

Research paper thumbnail of Computers in the consulting room: a case study of clinician and patient perspectives

Health care management science, 1998

Few clinicians in the United States use computers during patient encounters and many still worry ... more Few clinicians in the United States use computers during patient encounters and many still worry that computers will depersonalize their interactions with patients. This case study describes patient and clinician reactions to a computer-based health appraisal system. Findings showed no difference in any aspect of patient satisfaction between computer and non-computer groups. Use of a computer in the consulting room neither depersonalized nor enhanced patient satisfaction. Clinicians (in this case, nurse practitioners and physician assistants) were willing to use the system, which they perceived as having benefits for patient care, but were concerned about the increased time required for exams, effort required to learn the system while still interacting appropriately with the patient, increased monitoring of their performance, and other organizational issues. Clinicians who used the system showed a higher tolerance for uncertainty and communicated more frequently with each other and ...

Research paper thumbnail of Climate driven release of carbon and mercury from permafrost mires increases mercury loading to sub-arctic lakes

Science of The Total Environment, 2010

In sub-arctic and arctic regions mercury is an element of concern for both wildlife and humans. O... more In sub-arctic and arctic regions mercury is an element of concern for both wildlife and humans. Over thousands of years large amounts of atmospherically deposited mercury, both from natural and anthropogenic sources, have been sequestered together with carbon in northern peatlands. Many of these peatlands are currently underlain by permafrost, which controls mire stability and hydrology. With the ongoing climate change there is concern that permafrost thawing will turn large areas of these northern peatlands from carbon/mercury-sinks into much wetter carbon/mercury-sources. Here we can show that such a change in mire structure in the sub-arctic Stordalen mire in northern Sweden actually is responsible for an increased export of mercury to the adjacent lake Inre Harrsjön. We also show that sediment mercury accumulation rates during a warm period in the preindustrial past were higher than in the 1970s when atmospheric input peaked, indicating that in areas with permafrost, climate can have an effect on mercury loading to lakes as large as anthropogenic emissions. Thawing of permafrost and the subsequent export of carbon is a widespread phenomenon, and the projection is that it will increase even more in the near future. Together with our observations from Stordalen, this makes northern peatlands into a substantial source of mercury, at risk of being released into sensitive arctic freshwater and marine systems.

Research paper thumbnail of Airway forum

Internal and emergency medicine, 2006

Research paper thumbnail of Platelet Analysis Using Flowcytometric Procedures

Platelets, 1990

&#39;Ex vivo&#39; testing of functional platelet properties using conventional techniques... more &#39;Ex vivo&#39; testing of functional platelet properties using conventional techniques reflects the overall behaviour of the whole platelet population in the sample under investigation. Since many functional aspects depend on ultrastructural constituents which may vary from one cell to another, multiparameter single cell analysis of platelets may be advantageous in providing direct insight into deviations at the cellular level relevant to the pathophysiology of disease states such as bleeding disorders or thrombophilia. Immunolabelling with monoclonal antibodies against membrane antigens has been combined with flowcytometry to provide a standardized, highly specific and sensitive analytical tool. The assay has been optimized for simultaneous two colour fluorescence staining, and this allows the testing of whole blood to provide a quick monitoring method for the differential diagnosis of thrombasthenic diseases like Bernard Soulier&#39;s syndrome or Glanzmann&#39;s thrombasthenia in which typical staining patterns lack the specific fluorescence for glycoproteins Ib and IIb/IIIa respectively. Also changes in the antigenicity of the outer membrane of activated platelets are detectable with monoclonal antibodies against specific antigenic epitopes such as thrombospondin (a secretion marker) or α-granule and lysosomal proteins (extrusion markers). However, for detection of activated platelets in diseases associated with a prethrombotic state, the procedures for immunolabelling platelets with monoclonal antibodies and instrumental detection sensitivity remain to be optimized. After further development, flowcytometric assays of the functional status of individual platelets may be superior to the measurement of the indirect plasma markers such as platelet factor 4 or β-thromboglobulin for routine diagnosis of the prethrombotic state.

Research paper thumbnail of A 46-year-old man with difficulty breathing and the sensation of choking

Internal and emergency medicine, 2006

Research paper thumbnail of Role of vascular adrenergic mechanisms in the haemodynamic and PGI2 stimulating effects of angiotensin in diabetic dogs

Molecular and Cellular Biochemistry, 1996

In aware of the well-known altered vascular responsiveness in the diabetic vasculature, this stud... more In aware of the well-known altered vascular responsiveness in the diabetic vasculature, this study aimed to compare the haemodynamic and PGI2 releasing effects of angiotensin in metabolically healthy (12) and alloxan-(560 umol/kg) diabetic (12) dogs as well as to analyze the role of vascular adrenoceptors in this. In vivo the effect of intracoronarially administered angiotensin (63-125-250-500-1000 pmol/kg/min) on coronary blood flow, mean arterial blood pressure, myocardial contractile force and heart rate was investigated without and with pretreatment of 2 umol/kg phentolamine. In vitro PGI2 release by isolated coronary rings was induced by 50 nmol/l angiotensin before and after pretreatment with 5 umol/l phentolamine and measured by radioimmunoassay. Angiotensin enhances dose-dependently both the mean arterial blood pressure and coronary blood flow, while it provokes a considerable (p &lt; 0.05) increase of PGI2 formation by isolated coronary arterial rings. These alterations could be prevented by phentolamine administration both in vivo and in vitro, while this drug did not affect the angiotensin-induced enhancement of diabetic coronary blood flow. On the other hand the increase of blood pressure by angiotensin was found to be more (p &lt; 0.05) expressed in diabetes and it could be further potentiated by phentolamine. PGI2 synthesis by isolated diabetic coronary rings could not be modified either by angiotensin alone or in combination with phentolamine. On the basis of above data, the lack of stimulated vascular PGI2 formation mediated by alpha-adrenergic mechanisms is supposed to causatively contribute to the diminished sensitivity of diabetic coronary arteries to vasodilation.

Research paper thumbnail of Memoriam to Richard Edlich, MD

The Journal of Emergency Medicine, 2015

Research paper thumbnail of Physicians should be expert witnesses

The Journal of Emergency Medicine, 1990

Physicians have a responsibility to society, their peers, and patients to participate in malpract... more Physicians have a responsibility to society, their peers, and patients to participate in malpractice litigation in a manner that ensures that medical malpractice cases are properly evaluated. Physicians are reluctant to involve themselves as expert witnesses in medical malpractice litigation because of not wanting to further any malpractice suits, mistrust of attorneys and misconceptions about expert witnesses and the legal system in general. The expert witness should be an impartial practicing physician who can select those suits that should or should not be filed and identify which parties were negligent in each case. If impartial physicians do not evaluate cases for attorneys, other more partisan and less objective physicians will.

Research paper thumbnail of Concerning ski equipment

The Journal of Emergency Medicine, 1989

Research paper thumbnail of Emergency medicine and other contact sports

The Journal of Emergency Medicine, 1987

Research paper thumbnail of Epikardiales Fett als Ursache der kardialen Dysfunktion im Diabetes? Das Meerschweinchenherz als experimentelles Modell

Diabetologie und Stoffwechsel, 2007

Research paper thumbnail of A first-in-human study of AMG 208, an oral MET inhibitor, in adult patients with advanced solid tumors

Oncotarget, Jan 19, 2015

This first-in-human study evaluated AMG 208, a small-molecule MET inhibitor, in patients with adv... more This first-in-human study evaluated AMG 208, a small-molecule MET inhibitor, in patients with advanced solid tumors. Three to nine patients were enrolled into one of seven AMG 208 dose cohorts (25, 50, 100, 150, 200, 300, and 400 mg). Patients received AMG 208 orally on days 1 and days 4-28 once daily. The primary objectives were to evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of AMG 208. Fifty-four patients were enrolled. Six dose-limiting toxicities were observed: grade 3 increased aspartate aminotransferase (200 mg), grade 3 thrombocytopenia (200 mg), grade 4 acute myocardial infarction (300 mg), grade 3 prolonged QT (300 mg), and two cases of grade 3 hypertension (400 mg). The MTD was not reached. The most frequent grade ≥3 treatment-related adverse event was anemia (n = 3) followed by hypertension, prolonged QT, and thrombocytopenia (two patients each). AMG 208 exposure increased linearly with dose; mean plasma half-life estimates were 2...

Research paper thumbnail of A phase I study of cetuximab/paclitaxel in patients with advanced-stage breast cancer

Clinical breast cancer, 2006

The epidermal growth factor receptor (EGFR) is part of the ErbB family of receptor tyrosine kinas... more The epidermal growth factor receptor (EGFR) is part of the ErbB family of receptor tyrosine kinases and is known to be variably expressed in breast cancers. Cetuximab is a humanized monoclonal antibody directed against the EGFR that works by blocking the downstream signaling function of this protein and thereby interfering with cancer cell proliferation. Preclinical studies have indicated a synergistic effect for the combination of anti-EGFR therapy plus paclitaxel in breast cancer models. Hence, we conducted a dose-escalation phase I trial using cetuximab/paclitaxel in patients with metastatic breast cancer to evaluate the feasibility of this combination. Patients with EGFR-positive metastatic breast cancer treated with <or= 1 previous therapy, excluding taxanes, were eligible. Treatment consisted of weekly cetuximab therapy and every-3-week paclitaxel, with dose escalation of cetuximab until the maximum tolerated dose was reached. Twelve patients were enrolled to 3 treatment co...

Research paper thumbnail of Reconstructing paleoenvironmental conditions during the past 50 ka from the biogeochemical record of Laguna Potrok Aike, southern Patagonia

Research paper thumbnail of Rapid sequence intubation in the field versus hospital in trauma patients 1 1 Selected Topics: Prehospital Care is coordinated by Peter Pons, MD, of Denver General Hospital, Denver, Colorado

Journal of Emergency Medicine

We conducted a retrospective review of all adult trauma patients who underwent prehospital field ... more We conducted a retrospective review of all adult trauma patients who underwent prehospital field rapid sequence intubation (RSI) by aeromedical crews from 1988 through 1995 and compared them to all trauma patients who arrived by ground transportation and underwent RSI in the trauma suite from 1992 through 1995 at a University hospital. Of the 47 field RSI patients, 46 (97.9%) were successfully intubated, whereas 263 of the 267 (98.5%) hospital RSI patients were successfully intubated. There were no statistical differences in success rates, number of attempts, or immediate intubation events in the procedure between the two groups. There were no differences in delayed events with the exception of pneumonia, which occurred more frequently in the field RSI group (28% vs. 6%, respectively). We performed a subgroup analysis on isolated head injury patients to evaluate outcome. There was no difference in total hospital days, length of ICU stay, mortality or final disposition in the two head injury groups. Though this study is limited by small sample size, we conclude that field RSI is equally successful and safe as hospital RSI.

Research paper thumbnail of Climate induced changes as registered in inorganic and organic sediment components from Laguna Potrok Aike (Argentina) during the past 51 ka

Total organic carbon, total inorganic carbon, biogenic silica content and total organic carbon/to... more Total organic carbon, total inorganic carbon, biogenic silica content and total organic carbon/total nitrogen ratios of the Laguna Potrok Aike lacustrine sediment record are used to reconstruct the environmental history of south-east Patagonia during the past 51 ka in high resolution. High lake level conditions are assumed to have prevailed during the Last Glacial, as sediments are carbonate-free. Increased runoff linked to permafrost and reduced evaporation due to colder temperatures and reduced influence of Southern Hemispheric Westerlies (SHW) may have caused these high lake levels with lake productivity being low and organic matter mainly of algal or cyanobacterial origin. Aquatic moss growth and diatom blooms occurred synchronously with southern hemispheric glacial warming events such as the Antarctic A-events, the postglacial warming following the LGM and the Younger Dryas chronozone. During these times, a combination of warmer climatic conditions with related thawing permafrost could have increased the allochthonous input of nutrients and in combination with warmer surface waters increased aquatic moss growth and diatom production. The SHW were not observed to affect southern Patagonia during the Last Glacial. The Holocene presents a completely different lacustrine system because (a) permafrost no longer inhibits infiltration nor emits meltwater pulses and (b) the positioning of the SHW over the investigated area gives rise to strong and dry winds. Under these conditions total organic carbon, total organic carbon/total nitrogen ratios and biogenic silica cease to be first order productivity indicators. On the one hand, the biogenic silica is influenced by dissolution of diatoms due to higher salinity and pH of the lake water under evaporative stress characterizing low lake levels. On the other hand, total organic carbon and total organic carbon/total nitrogen profiles are influenced by reworked macrophytes from freshly exposed lake level terraces during lowstands. Total inorganic carbon remains the most reliable proxy for climatic variations during the Holocene as high precipitation of carbonates can be linked to low lake levels and high autochthonous production. The onset of inorganic carbon precipitation has been associated with the southward shift of the SHW over the latitudes of Laguna Potrok Aike. The refined age-depth model of this record suggests that this shift occurred around 9.4 cal. ka BP.

Research paper thumbnail of Resuscitative thoracotomy: the effect of the field time on outcome

The Journal of trauma

In the past 5 years, 72 moribund patients have undergone resuscitative thoracotomy (RT) at the Me... more In the past 5 years, 72 moribund patients have undergone resuscitative thoracotomy (RT) at the Medical University of South Carolina: 62 patients underwent the procedure before the adoption of a policy of mandatory rapid transport (scoop and run) for penetrating and unstable victims of trauma by our EMS system (Group I). Group II is comprised of ten patients who underwent RT following adoption of this policy. Resuscitation was successful in three patients in Group I (4.8%) and there were only two survivors (3.2%). In contrast, resuscitation was successful in two of ten patients in Group II (20%) and there was one survivor (10%). Nineteen patients in Group I (31%) were in traumatic full arrest on the scene, all of whom died. Twenty-five patients in Group I (40%) had a measureable pulse and/or blood pressure when EMS personnel arrived at the scene and subsequently &quot;died&quot; before their arrival at the trauma center. RT was also uniformly unsuccessful in this subgroup. Eighteen patients in Group I (29%) suffered cardiac arrest following their arrival at the hospital. Three of these patients (16.6%) were successfully resuscitated and two (11%) survived to leave the hospital. There were four traumatic full arrests in Group II (40%) and all four died. Only two patients in Group II (20%) lost their vital signs in transport and both died. Four patients in Group II (40%) suffered cardiac arrest after arrival at the hospital. Two of these patients (50%) were successfully resuscitated and one left the hospital (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Research paper thumbnail of Effects of hypoxia and adrenergic stimulation induced alterations in PGI2 synthesis by diabetic coronary arteries

Journal of Diabetic Complications, 1988

Before the onset of histologically detectable alterations in diabetic arteries, a considerable de... more Before the onset of histologically detectable alterations in diabetic arteries, a considerable decrease in vasodilatory potential is seen. While analyzing this phenomenon, the role of altered PGI2 synthesis in rings of coronary arteries from metabolically healthy and alloxan-diabetic dogs was measured by radioimmunoassay during baseline, under the influence of phenylephrine (100 mumol/L), and during hypoxia with or without the presence of the alpha adrenergic blocker phentolamine (5 mumol/L). Basal levels of PGI2 synthetized by healthy and diabetic coronaries were no different (7.9 +/- 2.1 and 6.4 +/- 1.4 pg/mg vessel). Phenylephrine potentiated PGI2 synthesis in controls (150 +/- 22%), while it proved to be ineffective in the diabetic animals (98 +/- 6%). Under hypoxic conditions, PGI2 production of healthy coronaries (152 +/- 24%) increased, while that in the diabetic ones (82 +/- 7%) decreased (p less than 0.01). In the presence of phentolamine no difference could be detected between the two groups. Given all these data, the decreased ability of the diabetic coronaries to vasodilate develops due to diminished PGI2 production, presumably controlled by adrenergic mechanisms. Furthermore, the more severe outcome of ischaemic heart disease in diabetes mellitus might be explained by the lack of an enhanced coronary PGI2 synthesis under hypoxic conditions.

Research paper thumbnail of Essentials of Emergency Medicine

Research paper thumbnail of Holocene climatic change reconstructed from diatoms, chironomids, pollen and near-infrared spectroscopy at an alpine lake (Sjuodjijaure) in northern Sweden

The Holocene, 2001

... because a small change in climate can cause large biotic changes (MacDonald et al., 1993; Kör... more ... because a small change in climate can cause large biotic changes (MacDonald et al., 1993; Körner, 1998). The Sarek National Park in the Scandes mountain range of northern Sweden is part of the World Heritage Site Lapponia and is one of Europe's largest wilderness areas ...

Research paper thumbnail of Computers in the consulting room: a case study of clinician and patient perspectives

Health care management science, 1998

Few clinicians in the United States use computers during patient encounters and many still worry ... more Few clinicians in the United States use computers during patient encounters and many still worry that computers will depersonalize their interactions with patients. This case study describes patient and clinician reactions to a computer-based health appraisal system. Findings showed no difference in any aspect of patient satisfaction between computer and non-computer groups. Use of a computer in the consulting room neither depersonalized nor enhanced patient satisfaction. Clinicians (in this case, nurse practitioners and physician assistants) were willing to use the system, which they perceived as having benefits for patient care, but were concerned about the increased time required for exams, effort required to learn the system while still interacting appropriately with the patient, increased monitoring of their performance, and other organizational issues. Clinicians who used the system showed a higher tolerance for uncertainty and communicated more frequently with each other and ...

Research paper thumbnail of Climate driven release of carbon and mercury from permafrost mires increases mercury loading to sub-arctic lakes

Science of The Total Environment, 2010

In sub-arctic and arctic regions mercury is an element of concern for both wildlife and humans. O... more In sub-arctic and arctic regions mercury is an element of concern for both wildlife and humans. Over thousands of years large amounts of atmospherically deposited mercury, both from natural and anthropogenic sources, have been sequestered together with carbon in northern peatlands. Many of these peatlands are currently underlain by permafrost, which controls mire stability and hydrology. With the ongoing climate change there is concern that permafrost thawing will turn large areas of these northern peatlands from carbon/mercury-sinks into much wetter carbon/mercury-sources. Here we can show that such a change in mire structure in the sub-arctic Stordalen mire in northern Sweden actually is responsible for an increased export of mercury to the adjacent lake Inre Harrsjön. We also show that sediment mercury accumulation rates during a warm period in the preindustrial past were higher than in the 1970s when atmospheric input peaked, indicating that in areas with permafrost, climate can have an effect on mercury loading to lakes as large as anthropogenic emissions. Thawing of permafrost and the subsequent export of carbon is a widespread phenomenon, and the projection is that it will increase even more in the near future. Together with our observations from Stordalen, this makes northern peatlands into a substantial source of mercury, at risk of being released into sensitive arctic freshwater and marine systems.

Research paper thumbnail of Airway forum

Internal and emergency medicine, 2006

Research paper thumbnail of Platelet Analysis Using Flowcytometric Procedures

Platelets, 1990

&#39;Ex vivo&#39; testing of functional platelet properties using conventional techniques... more &#39;Ex vivo&#39; testing of functional platelet properties using conventional techniques reflects the overall behaviour of the whole platelet population in the sample under investigation. Since many functional aspects depend on ultrastructural constituents which may vary from one cell to another, multiparameter single cell analysis of platelets may be advantageous in providing direct insight into deviations at the cellular level relevant to the pathophysiology of disease states such as bleeding disorders or thrombophilia. Immunolabelling with monoclonal antibodies against membrane antigens has been combined with flowcytometry to provide a standardized, highly specific and sensitive analytical tool. The assay has been optimized for simultaneous two colour fluorescence staining, and this allows the testing of whole blood to provide a quick monitoring method for the differential diagnosis of thrombasthenic diseases like Bernard Soulier&#39;s syndrome or Glanzmann&#39;s thrombasthenia in which typical staining patterns lack the specific fluorescence for glycoproteins Ib and IIb/IIIa respectively. Also changes in the antigenicity of the outer membrane of activated platelets are detectable with monoclonal antibodies against specific antigenic epitopes such as thrombospondin (a secretion marker) or α-granule and lysosomal proteins (extrusion markers). However, for detection of activated platelets in diseases associated with a prethrombotic state, the procedures for immunolabelling platelets with monoclonal antibodies and instrumental detection sensitivity remain to be optimized. After further development, flowcytometric assays of the functional status of individual platelets may be superior to the measurement of the indirect plasma markers such as platelet factor 4 or β-thromboglobulin for routine diagnosis of the prethrombotic state.

Research paper thumbnail of A 46-year-old man with difficulty breathing and the sensation of choking

Internal and emergency medicine, 2006

Research paper thumbnail of Role of vascular adrenergic mechanisms in the haemodynamic and PGI2 stimulating effects of angiotensin in diabetic dogs

Molecular and Cellular Biochemistry, 1996

In aware of the well-known altered vascular responsiveness in the diabetic vasculature, this stud... more In aware of the well-known altered vascular responsiveness in the diabetic vasculature, this study aimed to compare the haemodynamic and PGI2 releasing effects of angiotensin in metabolically healthy (12) and alloxan-(560 umol/kg) diabetic (12) dogs as well as to analyze the role of vascular adrenoceptors in this. In vivo the effect of intracoronarially administered angiotensin (63-125-250-500-1000 pmol/kg/min) on coronary blood flow, mean arterial blood pressure, myocardial contractile force and heart rate was investigated without and with pretreatment of 2 umol/kg phentolamine. In vitro PGI2 release by isolated coronary rings was induced by 50 nmol/l angiotensin before and after pretreatment with 5 umol/l phentolamine and measured by radioimmunoassay. Angiotensin enhances dose-dependently both the mean arterial blood pressure and coronary blood flow, while it provokes a considerable (p &lt; 0.05) increase of PGI2 formation by isolated coronary arterial rings. These alterations could be prevented by phentolamine administration both in vivo and in vitro, while this drug did not affect the angiotensin-induced enhancement of diabetic coronary blood flow. On the other hand the increase of blood pressure by angiotensin was found to be more (p &lt; 0.05) expressed in diabetes and it could be further potentiated by phentolamine. PGI2 synthesis by isolated diabetic coronary rings could not be modified either by angiotensin alone or in combination with phentolamine. On the basis of above data, the lack of stimulated vascular PGI2 formation mediated by alpha-adrenergic mechanisms is supposed to causatively contribute to the diminished sensitivity of diabetic coronary arteries to vasodilation.