Acute lung injury (ALI), acute respiratory distress syndrome (ARDS) is a non-hydrostatic pulmonary edema, which is pathologically associated with the findings of diffuse alveolar damage (DAD). On a pathophysiological analysis, neutrophil-mediated acute inflammation and damage of microvascular endothelial cells as well as alveolar epithelial cells are the predominant features. American-European Consensus Conference (AECC) definitions are widely used for the diagnosis, but the specificity is not high enough. There are a wide variety of risk factors or causal diseases / injuries, and their pathophysiological conditions are not uniform. Thus, most effective therapies for patients with ALI/ARDS could be different, depending on their predisposing conditions.

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Objectives: To clarify the characteristics of biphasic encephalopathy, and to determine if we can differentiate biphasic encephalopathy from monophasic encephalopathy before the second phase.
Methods: Characteristics of children diagnosed with biphasic encephalopathy were retrospectively investigated from April 2007 to August 2009. (2) The maximum value of lactate dehydrogenase (LDH), fibrin/fibrinogen degradation products (FDP), and D-dimer concentration was compared in 10 children with biphasic encephalopathy, 26 children in the monophasic encephalopathy group, and 10 children with febrile convulsion or epilepsy until third day.
Results: (1) Thirty-six patients were diagnosed with encephalopathy; among them, 10 (28%) had biphasic encephalopathy. Twenty-two cases had seizure onset in status epilepticus; among them, 8 patients (36%) had biphasic encephalopathy. In all cases, the first symptoms were generalized tonic-clonic seizures. In 8 cases, the seizure was prolonged (more than thirty minutes); in 2 cases, the seizure resolved within thirty minutes. The median time of second seizure occurrence or consciousness deterioration was 5 days (4-8 days). Intracranial pressure was managed using the intracranial pressure sensor and treatment was carried out by administering steroid pulse therapy and/or hypothermia therapy. Aggressive treatment was administered to 2 of 10 patients upon the first seizure, but the occurrence of a second phase was not prevented in all 10 patients. All children survived. One child had no neurological sequelae, 5 children had mild, and 4 children had severe neurological sequelae. (2) For LDH, a significant difference was found between the febrile convulsion or epilepsy group and encephalopathy (p=0.017 and 0.002, respectively), and for FDP and D-dimer, a significant difference were found between the febrile convulsion or epilepsy group and the biphasic encephalopathy group (p=0.018 and 0.033, respectively). No markers detected a difference between monophasic encephalopathy and biphasic encephalopathy before the second phase.
Conclusion: There are frequent poor outcomes among children with encephalopathy in whom convulsions and loss of consciousness recur after a transient improvement following an initial seizure. We cannot differentiate biphasic encephalopathy from monophasic encephalopathy before the second phase. After convulsions in children, we need to consider the possibility of biphasic neurological symptoms.

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Background & Aims: In damage control surgery (DCS) on patients with severe multiple trauma, it is important to complete the operation promptly in order to prevent the development of acute abdominal compartment syndrome (ACS) after operation. We selected vacuum packing closure (VPC) to achieve temporary abdominal closure during DCS and reported the advantages of this procedure. Few studies have reported a comparison between VPC and other methods. In this study, we compared VPC with other methods (including skin closure and silo closure) and evaluated the advantages of VPC.
Methods: Medical records of trauma patients who had undergone DCS from 1994 to 2008 were reviewed. The operation time, total volume of intravenous infusion, development of ACS, and prognosis of patients were compared between VPC and other methods.
Results: A total of 101 VPCs were performed in 58 trauma patients, and 33 other closure procedures were performed in 29 patients. There were no significant background differences between both groups. ACS developed in only 1 patient (1.7%) who underwent VPC and in 7 patients (24.1%) who underwent other closure procedures, although there was no significant difference in the total volume of intravenous infusion between both groups. These findings suggested that VPC prevents ACS after the initial operation of DCS. The prognosis of patients who underwent VPC was superior to the prognosis of those who underwent other closure procedures (survival rate: VPC 51.7% vs. other closure procedures 37.9%).
Conclusion: VPC is an excellent method to achieve temporary closure in DCS because it is possible to complete the operation promptly and to prevent ACS after DCS.

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Mamushi is recognized as one of the most hazardous vipers, and in Japan, more than 1,000 people are bitten by mamushi every year; approximately 10 patients die because of its venom. We report a case of mamushi bite complicated with acute renal and respiratory failure. A 72-year-old man had a mamushi bite on his left palm. The patient was conservatively treated by his family doctor for 12 hr, after which progressive swelling of the left upper limb and myoglobinuria prompted the doctor to refer him to our hospital. In spite of the administration of mamushi antivenin and cepharanthine, hemodialysis, continuous hemodiafiltration and mechanical ventilation were required for acute renal and respiratory failure. The patient left our hospital after 46 days of intensive care. Although the most common complication of mamushi bite is acute renal failure, recent reports have suggested that mamushi venom by itself causes lung toxicity. Acute lung injury and acute renal failure should be carefully monitored during the treatment of mamushi bite.

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Idiopathic spinal epidural hematomas (SEH) and spinal subdural hematomas (SSH) in gravidas without underlying diseases are very rare, and their pathogenesis still remains unclear. This case report describes a rare patient who simultaneously developed an idiopathic SEH and an idiopathic SSH during pregnancy. The patient was a 31-year-old female at 28 weeks of gestation. She was transported to the hospital by ambulance with lumbar pain and lower extremity incomplete paresis. MRI showed a SSH at the thoracic (T) 4-6 vertebrae level and a SEH at the T7-8 vertebrae level. An emergency Caesarean section was thus performed to deliver the fetus, followed by posterior decompression of the thoracic spinal cord. After a favorable postoperative course, the patient successfully achieved full rehabilitation. SEH and SSH are rare diseases. Cross-sectional collaboration with the departments of anesthesiology and obstetrics and gynecology are important, since the diagnosis and treatment of gravidas issues requires special attention to delivery.

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