Objective and Background: Although short-duration, high-dose glucocorticoid therapy is reportedly ineffective for early-phase acute respiratory distress syndrome (ARDS), steroid pulse therapy is often used in Japan for life-threatening cases because of its beneficial effects on oxygenation. Thus, we evaluated the effect of steroid pulse therapy on oxygenation for early-phase ARDS. Method: Cases of early-phase ARDS treated with steroid pulse therapy in intensive care units of four critical care medical centers in Japan from 2000 to 2003 were investigated. Clinical course and serial changes in PaO₂/F_IO₂ ratio were evaluated. Results: Twenty-nine patients received methylprednisolone 1 g/day for 3 days; 20 patients subsequently received prolonged methylprednisolone treatment. Causes of ARDS were pneumonia (n=23), extrapulmonary sepsis (n=4) and other factors (n=2). The overall mortality rate was 24.1%. PaO₂/F_IO₂ ratios improved significantly after initiation of steroid pulse therapy, in comparison to pretreatment values (day 0: 119.8 ± 30.6, day 1: 172.1 ± 63.7^*, day 2: 196.4 ± 90.0^*, day 3: 218.4 ± 92.0^*, mean ± SD, ^*p < 0.05 vs. day 0). Significant improvement in oxygenation was observed in both survivors and non-survivors, but the PaO₂/F_IO₂ ratio in non-survivors subsequently deteriorated. In seven patients with life-threatening hypoxemia (PaO₂/F_IO₂ ratio < 100 at day 0), oxygenation improved significantly after pulse treatment; five of these patients survived. Conclusions: Three day steroid pulse therapy can improve oxygenation in patients with progressive ARDS even in the early phase. Steroid therapy for early-phase ARDS should be reconsidered.

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We responded to an incident in accordance with a mass casualty chemical incident where a large number of injured were transported as a result of the spread of a fire extinguishing agent. In coalition with all related authorities, the procedures of the response were comparatively tested against the NBC Terrorism Site Management Cooperation Model. We have indicated the difficulty of coordinating activities of the fire department and police force at the site of the incident and the need for improvements such as the use of wireless communications by firefighter contact personnel dispatched to medical institutions for the interactive exchange of information between the On-site command center and medical institutions. We also indicated the importance of increasing awareness for the involvement of the Japan Poison Information Center. We reported the importance of using computer software for information control in instances where a large number of injured are treated at medical facilities and when implementing Triage systems, to adopt standards that are specific to chemical disaster situations and the importance of a flexible category division. We have also indicated that in the instance of NBC disasters, centralizing transportation of the injured as opposed to dispersed transportation is an area requiring further consideration.

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Successful surgical treatment of patients with complex craniofacial injuries is dependent on the primary trauma management and diagnostic imaging examination. Following the primary survey based on JATEC guideline, we made use of the MDCT examination for assessing crashed facial bones and soft tissues in two craniofacial trauma patients. Neurosurgical, ophthalmological and reconstructive plastic surgical operative indicators were identified by reconstructed MDCT images in both a 25 year-old male traffic accident victim and a 65 year-old man who suffered from a work-related accident, respectively. As a preoperative adjunct study, MDCT was also able to help with recognizing cervical spine clearance. Recent advances in skull base approaches and imaging techniques have allowed for successful surgical correction of these craniofacial injuries.

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There is a consensus that blunt traumatic intraperitoneal bladder rupture should undergo water-tight suturing and be decompressed by a transurethral catheter. This is the first report of the non-operative management of blunt traumatic intraperitoneal bladder rupture with a severe pelvic fracture. A 32-year-old male was run over by a power shovel, and brought to our emergency department. Upon arrival, he was in severe shock because of massive bleeding from a severe pelvic fracture. Transcatheter arterial embolization and an external fixation for the pelvic fracture was performed. Retrograde cystography showed an intraperitoneal bladder rupture. On the day of admission, the non-operative management of the intraperitoneal bladder rupture was performed to prevent additional bleeding. We could continue the conservative management on the day after admission because urine could be constantly drained. At one week after admission, the bladder rupture healed. The non-operative management for an intraperitoneal bladder rupture with a severe pelvic fracture is an important treatment modality in order to carry out damage control after a severe pelvic fracture. Such non-operative management can be continued when a celiotomy is not needed for other abdominal organ injuries, no intravesical bone spicule is detected, and urine can be constantly drained.

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