We examined a case of rapid helicopter transportation, which was crucial to the survival of a ruptured abdominal aortic aneurysm (AAA) patient with profound shock. A 70-year-old woman, who presented at home with acute severe back pain, was transferred by helicopter 50km to our hospital. On arrival, she had no detectable blood pressure and soon developed bradycardia with subsequent cardiac arrest, which required an emergency room thoracotomy Å @ (ERT). After open cardiac massage and thoracic aortic cross-clamping, her heart beat was recovered. Additional laparotomy revealed about 500ml of blood from intraperitoneal bleeding and a large dilated and ruptured retroperitoneal hematoma. The AAA was reconstructed using a Y-graft. On the 78 hospital day, she was discharged from our hospital without any neurological defects. In this case, all factors such as the intimate cooperation between the ambulance EMTs and aviation team, early call and prompt dispatch of the helicopter, and effective therapy by the receiving hospital were necessary for the survival of this patient. We concluded that we should promptly prepare an emergency helicopter system for improving the outcome of patients in local areas, and that these systems will prove effective in case of natural or civil disaster.
One case of a 17-year-old woman with anorexia nervosa is reported. We measured the concentration of the serum leptin and IGF-I (insulin-like growth factor-I) before and after partial weight recovery. During this period, the serum leptin level was low, but the IGF-I increased as her weight increased. When the percentage of adipose tissue to total body mass is severely low, the serum leptin level, which is widely reported to be a good indicator of recovery from anorexia nervosa, does not accurately reflect the real nutritive state. On the other hand, even in this circumstance we consider IGF-I to be a good indicator.