Cardiac troponin T is a specific myocardial marker for the diagnosis of acute coronary syndrome. Recently, the rapid bedside cardiac troponin T assay (Trop T), which can provide qualitative determinations within 15 minutes, has been developed. The aim of this study is to evaluate the usefulness of the Trop T test for the diagnosis of myocardial injury in emergency patients. The Trop T test was performed on 56 consecutive emergency patients, whose main diagnoses on admission were non-cardiac diseases. Myocardial injury was evaluated by electrocardiograms and echocardiograms. Additionally, we investigated cardiac complications and the clinical outcomes of these patients. The Trop T test was positive in 10 of 56 patients. The incidence of abnormal electrocardiograms, ventricular arrhythmias and acute heart failure were significantly more frequent in patients with positive Trop T tests than those in patients with negative tests. The incidence of abnormal echocardiograms did not differ significantly between the patients with positive and negative Trop T tests. The mean length of patients' stay in the emergency center was significantly longer in patients with positive Trop T tests than in patients with negative tests. The in-hospital mortality rate of patients with positive tests was not significantly different from that of patients with negative tests (30% versus 11%). These results suggest that the Trop T test is a useful indicator for the screening of myocardial injury and the risk stratification in emergency patients.

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The clinical significance of HMGB-1 was studied in patients with systemic inflammatory response syndrome (SIRS). In addition, the clinical utility of continuous hemodiafiltration (CHDF) for the removal of HMGB-1 was examined. The subjects consisted of 15 patients who fulfilled the diagnostic criteria for SIRS and were treated with CHDF. Blood samples were drawn from each patient prior to the CHDF treatment; additional samples were collected from the inlet and the outlet of the hemofilter 1, 24 and 48 hours after the initiation of CHDF. HMGB-1 was measured using the ELISA method. In addition, we analyzed the clinical usefulness of CHDF as a therapeutic procedure against HMGB-1. In this evaluation, blood samples were taken from the survival group. HMGB-1 was detected in all cases, with higher levels detected in patients of poorer condition. The blood HMGB-1 level was significantly higher in patients who died from their disease than in the survival group (p<0.05). The blood HMGB-1 level was positively correlation with the APACHE II score (p<0.0001), the SOFA score (p=0.0016), and the IL-6 level (p=0.0007). As a result of the hemofiltration, the blood level of HMGB-1 decreased significantly (p<0.05). A significant decrease in the HMGB-1 level was observed in 9 out of 10 cases, 1 to 48 hours after the initiation of CHDF (p<0.05). Also, the APACHE II score decreased significantly 1 to 48 hours after the initiation of CHDF (p<0.05), demonstrating the therapeutic efficacy of CHDF. These results suggest that HMGB-1 plays a critical role in the aggravation of symptoms. Since HMGB-1 can be effectively removed by CHDF, CHDF is likely to be effective for the treatment of pathological conditions caused by an elevation of HMGB-1.

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Background: In blunt trauma patients, a cross-table lateral cervical (CLC) film is often technically inadequate, and focused computed tomographic (CT) scanning of the cervical spine is necessary for reliable evaluation of suspected injuries. The purpose of this study was to calculate the frequency of use of such “supplemental CT scans, ” and to evaluate the efficacy of a CLC film as an indicator of the need for supplemental focused CT scanning. Methods: A review of CLC films was performed; hundred initial CLC films, both from cases with injuries and those without injuries were evaluated to determine the lowest vertebra that could be visualized on the film. The frequency of abnormal signs on the CLC films was then examined. Results: Technically adequate CLC films that showed the upper border of the T1 vertebra were not obtained in 70 patients with injuries and 63 patients without injuries. Eighty-eight patients with injuries and 28 patients without injuries had abnormal findings on the CLC films. Overall, 97 patients with injuries and 74 patients without injuries required supplemental CT scanning. In 19 of the 141 vertebral injuries in 100 patients, the vertebral injury could not be identified, regardless of the level, in the CLC films. Conclusion: Supplemental CT scans are frequently required after CLC films are obtained, even in patients without cervical spine injuries. CLC films are also not efficient indicators of the necessity for focused CT scanning. We believe that revised guidelines should be followed routinely for assessment of the cervical spine in obtunded or symptomatic blunt trauma patients.

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The pharmacokinetics of several drugs are drastically different in patients undergoing continuous hemodiafiltration (CHDF) than in subjects with normal kidney functions, because of drug removal by the filtration or dialysis, and disturbances of metabolism and excretion caused by the complicating organ failures. We performed pharmacokinetic analysis of vancomycin in four patients undergoing continuous hemodiafiltration who were under treatment with the drug. The concentration of vancomycin in the plasma was determined by fluorescence polarization immunoassay (FPIA). The results showed that thetotal body clearance of vancomycin was 12.25±0.85L/hr, elimination half-life was 14.0±0.56hr, respectively. We simulated a plasma concentration-time curve to evaluate the appropriate dose of vancomycin to maintain the effective plasma level, that is, 10.0μg/ml.The simulation suggested that 1.0g of vancomycin administered daily at the dose of 1.0g was sufficient to maintain an effective trough plasma level in patients undergoing continuous hemodiafiltration.

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A 38-year-old man complained of headache and nausea after traveling by aeroplane. On physical examination, high fever and nuchal rigidity were found. Computed tomography showed pneumocephalus. Magnetic resonance imaging showed sphenoid sinusitis. Cerebrospinal fluid examination revealed purulent meningitis. The patient was medically treated using antibiotic agents. The pneumocephalus disappeared and the purulent meningitis was resolved. We suggest that the barotrauma resulted in the pneumocephalus and purulent meningitis. Barotrauma is a potential cause of pneumocephalus, especially if the patient has parasinusitis.

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Tranexamic acid has been therapeutically used in various clinical conditions with bleeding. However, this drug might carry a risk of thrombosis as an adverse effect. We report a patient who developed left popliteal artery thrombosis after the administration of tranexamic acid for the treatment of upper gastrointestinal bleeding. A 96-years-old woman with gastric cancer was admitted to our hospital because of an ischemic stroke. She had severe anemia, and received a blood transfusion. To control the bleeding, a single dosage of tranexamic acid (1, 000mg/day) was administered. Twelve hours after the administration of the drug, she suffered an acute obstruction of the left popliteal artery. Tranexamic acid is frequently used to control gastrointestinal bleeding. However, no definite evidence exists confirming that tranexamic acid is useful for gastrointestinal bleeding. The inhibition of fibrinolysis by tranexamic acid is not considered to be safe in patients with a hypercoagulable state, and the use of tranexamic acid should be carefully determined on an individual basis.

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