The effect of high-frequency jet ventilation (HFJV) on airway temperature was studied experimentally. A jet ventilator (MERA-S HFO Jet Ventilator^®) and a test lung (21) were assembled similar to when used clinically, and temperature in the test lung was measured using a thermister. The working pressure and frequency of the jet of the HFO ventilator were set at 0.25 to 3.00kg/cm² and from 3 to 40Hz, respectively. Each temperature measurement was carried out using dry gas only and during humidification with normal saline solution 5 or 10ml/hr via a special double-needle. In the dry gas group, the temperature in the test lung increased in the presence of all combinations of working pressure and frequency. The increment in temperature was caused by friction heat produced by intermittent jet gas flow passing through the conducting tube from the HFO ventilator. The maximal temperature increment was 7°C, measured at a frequency of 10Hz and working pressure of 3kg/cm². In the humidified gas group, the temperature decreased 3.1°C at an infusion rate of 5ml/hr and 5.2°C at an infusion rate of 10ml/hr. These result suggest that airway temperature monitoring be recommended during HFJV.

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An analysis of cardiac disorders associated with acute brain infarction is reported. 174 patients were examined by means of echocardiography and/or Holter 24-hour electrocardiography (ECG). Based on mode of onset, infarctions were classified as sudden onset type and slowly progressive type, and based on the size and site, as large, cortical branch, perforator, cerebellar, and brain stem. Forty-four cases (25%) were of the sudden onset type and 130 (75%) of the slowly progressive type. Ninety-seven perforator area infarctions accounted for more than half of the total number of patients (56%). Echocardiographic findings; 158 patients were examined by echocardiography. Valvular disease, myocardial infarction, cardiomyopathy, enlarged left atrium, puffy “moyamoya” echo in the left atrium and ventricle, and left atrial thrombus, which are generally regarded as risk factors for cerebral embolism, were observed in 19 patients (43%) with the sudden onset type and in 17 patients (15%) with the slowly progressive type. There were significant differences between the two types. Findings within normal limits were seen in a total of 81 patients (51%). Holter 24-hour ECG findings; 104 patients were examined by Holter 24-hour ECG. Atrial fibrillation was observed significantly more often in the sudden onset type (9 patients, 32%) than in the slowly progressive type (7 patients, 9%), and significantly more often in infarction patients (16 patients of 104, 15%) than adults in general (0.4%). This examination contributed to the early diagnosis of sick sinus syndrome in one case. Normal findings were found in a total of 41 patients (39%). Summary; 1) Half of the patients with cerebral infarction had cardiac disorders based on echocardiographic and/or Holter 24-hour ECG findings regardless of type. 2) Evidence of valvular disease, myocardial infarction, cardiomyopathy, moyamoya echos in the left atrium and ventricle, or left atrial thrombi were observed significantly more often in the sudden onset type of cerebral brain infarction. 3) Atrial fibrillation was detected significantly more often in cerebral infarction patients and in the sudden onset type. In the acute stage of cerebral infarction, the possibility of complicating cardiac disorders should be taken into consideration and early diagnosis should be performed in order to improve treatment outcome and prevent recurrence of cerebral infarction.

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A rare patient who had rapid spontaneous resolution of an acute subdural hematoma caused by boxing is reported. On admission a CT scan showed a subdural hematoma containing a low-density area over the left cerebral hemisphere. The subdural hematoma had disappeared on a CT scan taken 1 day after the injury. But magnetic resonance imaging showed that the subdural hematoma was not completely resolved. The hematoma was detected diffusely covering the cerebral convexities and the left side of the tentorium. The outcome was good with nonsurgical treatment. We present this case and discuss the mechanisms of rapid resolution of acute subdural hematoma.

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A case of head injury with rhabdomyolysis during thiamylal therapy is reported. The total dose of thiamylal was 489mg/kg, which was higher than that in the usual barbiturate therapy. The blood concentration of thiamylal seemed to be more than 10mg/dl on the CPK max-day, and without plasma exchange, CPK and s-Mb were decreased within 24 hours after stoppage of the thiamylal treatment. This suggests that the cause of this rhabdomyolysis was not pressure necrosis, arterial occlusion nor infection, but thiamylal intoxication. The mechanism of this rhabdomyolysis seemed to involve an abnormality of cell membrane function induced by thiamylal intoxication.

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We report a case of Aeromonas hydrohila septicemia in a previously healthy and non-immunocompromised patient without any trauma. The onset was sudden with symptoms resembling acute deep vein thrombosis. Shortly, the patient suffered progressive myonecrosis and gas gangrene with rapid fatal outcome. A 55-year-old man noticed left elbow pain 12 hours prior to admission. The left upper extremity was diffusely swollen with several hemorrhagic bullae on the dorsum of the hand and forearm. Angiographic findings revealed no obstructive changes in the vein. Despite the intensive therapy, his general condition progressively worsened, and gas production with a foul odor began. With the diagnosis of gas gangrene, disarticulation of the left upper extremity was performed. Postoperatively, the patient became hypotensive without response to intravenous fluid and cathecholamines and he died 24 hours after admission. Aeromonas hydrophila was identified from samples of arm muscle and blood obtained at the operation.

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Early diagnosis of phlebothrombosis of the superior mesenteric vein is difficult, and in most cases this condition must be treated by enterectomy. The patient, a 56-year-old male with no past history of phlebothrombosis, was brought to the hospital with a chief complaint of abdominal pain. Angiography led to a diagnosis of phlebothrombosis of the superior mesenteric vein, and fibrinolytic agents were therefore administered via a catheter placed in the superior mesenteric artery. Following partial enterectomy on the 10th day, a catheter was inserted into the superior mesenteric vein. Continuous fibrinolytic therapy was effective in preventing postoperative recurrence; dissolution of the phlebothrombosis in the portal vein was also observed.

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A rare case of brain stem infarction as a complication of cervical spine injury is reported. A 15-year-old male had sustained a cervical spine injury complicated by quadriplegia. Cervical X-ray and CT scan revealed a right facet dislocation at C4/5. Ten hours after open reduction of the dislocation, he developed cranial nerve deficits. Vertebral angiograms showed complete occlusion of the basilar artery at its origin and of the right vertebral artery. Brain MRI demonstrated infarction of the medulla and pons. The fact that a follow-up angiogram revealed intimal injury of the right vertebral artery suggested embolization of the basilar artery originating at the initial site of injury of the vertebral artery. Vertebral artery injury may be a common lesion following cervical trauma. Consequently, the possibility of secondary infarction of the brain stem or cerebellum should be taken into consideration in managing patiens with cervical spine injuries.

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Two cases of severe gastrointestinal hemorrhage caused by cytomegalovirus (CMV) infection are reported. Case 1: The patient had massive hematochezia caused by a CMV infection of the stomach and ileocecal region during steroid therapy for the treatment of interstitial cystitis. Surgery and the intra-arterial pitressin stopped the hemorrhage, but the patient subsequently died due to multiple organ failure. Case 2: While undergoing postoperative chemotherapy for a tumor of the testis, the patient developed Candida sepsis as a result of agranulocytosis, whereupon massive diarrhea and hematochezia occurred because of a CMV infection of the duodenum. Surgery, however, stopped the hemorrhaging, and the patient recovered favorably and was released from the hospital. CMV is liable to cause increased pathological changes in the gastrointestinal tract, and this should be anticipated even by those in the field of emergency and critical care medicine. Hence, it is necessary to be knowledgeable about CMV infections so that a precise diagnosis can be made.

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