The human brain requests the neuronal recovery of emotions, thinking and mind when the fall in severe brain damage by stroke, trauma, and cardiac arrest. However, the mechanism of production of emotion, thinking, and mind and also the management care method of these neuronal dysfunctions were not demonstrated, precisely. We have been focused on, for long time, the recovery of outer stimulation responding consciousness; outer consciousness as shown as Glasgow Coma Scale by control of brain edema, ICP (intracranial pressure) elevation, and CBF (cerebral blood flow) disturbances. However, human consciousness response to not only for outer stimulation and also for inner consciousness (not always necessary outer stimulation) such as emotion, thinking, and mind. This maybe because there are specific pitfalls associated with the clinical management of previous neuro-protection management and also induced brain hypothermia treatment, in severe TBI (traumatic brain injury) & CPA (cardiopulmonary arrest) patients. The previous brain hypothermia management method is not enough for specific consideration about preventing of damage of thinking, memory, and emotions from acute stage. In this paper, the mechanism of production of emotion, thinking, memory and mind in the human brain have been discussed and presented new concept of Dynamic Center Core (DCC) function that works with union of frontal lobe, striatum-basal ganglia, A10-nerve system, thalamus, hippocampus, and limbic system for producing inner consciousness. Therefore, the successful brain hypothermia treatment for neuronal recovery of emotion, thinking, and mind should be also focused on much more inner consciousness neuronal function such as one definite neuronal concept formation from multi-neuronal firing and also emotional translation from human brain to another human brain by synfire (synchronization of neural firing) in DCC. The management point for these neuronal functions is summarized as follow;
1) Early induction of mild brain hypothermia (∼34°C) with serious control of stress induced hyperglycemia under the anesthesia with analgesia.
2) The prevention of masking neuronal hypoxia by hemoglobin dysfunction with reducing 2,3diphosphoglycerate (DPG) that produces even with normal control of oxygen delivery.
3) Cold saline infusion followed 7% acetic ringer solution drip at initial induction stage of brain hypothermia. This fluid resuscitation method is successful for prevention of selective dopamine nerve excitation, with maintaining other neuronal energy source under mild hypothermia throughout Keton body metabolic substrate.
4) Replacement of albumin for radical scavenging, maintaining of microcirculation, and preventing micro-embolus formation at initial stage of hypothermia were especially important for recovery of inner consciousness. As a new field of brain hypothermia, combination therapy of neuro-hormonal replacement and activation of hypoxia inducible factor with intermittent brain tissue temperature using external systemic circulation were discussed.

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Objective: This study was conducted following the first surveillance in 2006, in order to investigate the characteristics of patients suffering from heatstroke who were treated at either emergency medical centers or emergency departments in Japan.
Methods: The patient' background information was collected and thereafter their medical data were recorded by the responsible medical staff according to the newly prearranged format and then were analyzed by the heatstroke surveillance committee members of the Japanese Association for Acute Medicine (JAAM).
Results: Nine hundred and thirteen patients suffering from heatstroke were treated at 82 hospitals from June to September in 2008. The patients' mean age was 44.6 years, and their severity of heatstroke was categorized as Class I (mild, no need for specific treatment), Class II (moderate, requiring hospitalization for observation) and Class III (severe, requiring intensive care), consisting of 52%, 24% and 24% of patients, respectively. The classical heatstroke group comprised patients older than the exertional heatstroke group. All patients demonstrated their worst condition on the first or the second day of hospitalization, except for those who died. For 13 deaths of 15 Class III fatal cases, the cause of death was multiple organ failure occurred within 4 days of hospitalization. Disturbance of consciousness (2 to300 according to the Japan Coma Scale), shock status (with a systolic arterial pressure of 90mmHg or less), higher body temperature (39°C or higher) and tachycardia (120/BPM or more) have been found to demonstrate significant risk factors requiring hospitalization for advanced treatment. In particular, preexisting status of being confined to bed and/or being unable to care for oneself were found to be associated with classical heatstroke in the elderly people.
Conclusion: In order to reduce morbidity and mortality of multiple organ failure secondary to heatstroke, it is important to identify the early signs and symptoms suggesting the possible onset of heatstroke and to provide first aid treatment as soon as possible.

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We describe a case of penetrating injury to the vertebral artery that was treated with transcather arterial embolization. A 39-year-old man was brought to our emergency department with a self-inflicted stab wound to the left side of his neck. He showed no active external hemorrhage on arrival. However, massive bleeding occurred while computed tomography was being performed. Wound exploration revealed massive pulsatile bleeding around the transverse process of the vertebra (C5), which could not be stopped by direct approach. An injury of the left vertebral artery was suspected. Therefore, further angiographic evaluation was performed, and the injury was secured. The proximal part of the vertebral artery was occluded with transcatheter arterial embolization. In general, the requirement of surgical management in patients with Zone II penetrating neck injury can be evaluated by physical examination; however, penetrating vertebral artery injury which required surgical management cannot be detected in some cases because of anatomical features. If the path of the penetrating agent appears to be in proximity to the vertebral arteries, angiography or other radiographic evaluations should be performed.

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Patients with diverticula of the small intestine are rare. A 49-year-old woman, who demonstrated multiple diverticulosis throughout the entire small intestine, underwent partial resection of the small intestine twice (10 months and 2 months before the present surgery) due to diverticulitis of the ileum. She developed severe abdominal pain and was admitted to hospital again. On CT image, ascites and perforated diverticulitis were noted. Surgery was performed with partial resection of the small intestine. The post operative course was uneventful, and the patient was discharged. Thereafter, the patient was indicated for regular outpatient treatment. In Japan, there have been 11 case reports describing multiple diverticulosis of the small intestine, but none of the previously reported cases underwent repeated surgery within such a short time. Multiple diverticulosis of the small intestine are usually situated on the mesenterium side of the enteron, more commonly in the jejunum than in the ileum. However, diverticulitis often occurs in the lower ileum. This patient may develop another episode of severe diverticulitis in the future. Cases of multiple diverticulosis are rare, but may be encountered as an acute abdomen. However, there are no established therapies. To avoid short bowel syndrome due to repeated surgery, such patients should be treated carefully, and needed strict observation by a gastroenterologist.

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We herein report the case of a ruptured pancreaticoduodenal aneurysm that was successfully treated by transcatheter arterial embolization (TAE). The aneurysm had been caused by an increasing blood flow of the pancreaticoduodenal arcade through the superior mesenteric artery due to compression by the median arcuate ligament. The patient was a 70-year-old male who developed sudden abdominal pain and consulted a local doctor. He was thereafter referred to our hospital because his blood pressure at consultation was 80/50 mmHg and an ultrasound examination revealed suspected intraabdominal bleeding. Emergency abdominal computed tomography (CT) showed the presence of a hematoma behind the pancreas head and the neck of the celiac artery was compressed by a median arcuate ligament based on the findings of 3 dimension-CT angiography. Emergency abdominal angiography from the superior mesenteric artery showed an aneurysm of the pancreaticoduodenal artery. We therefore concluded that the pancreatioduodenal aneurysm was due to median arcuate ligament compression syndrome and it had ruptured. TAE using micro-coils was thereafter successfully performed. Our case suggests that the first safest choice for the emergent treatment of a rupture of a pancreaticoduodenal aneurysm is TAE. An indications regarding an operation to cut the median arcuate ligament should be clarified from now on.

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We treated two cases of common bile duct stricture associated with blunt abdominal trauma. Case 1 was a 72-year-old male who was injured during farm work and he needed emergency surgery due to the intra-abdominal hemorrhage. A complete rupture of the pancreatic body and ecchymoma within the hepatoduodenal ligament were observed. Distal pancreatectomy and an external cholecystostomy were performed. Case 2 was a 62-year-old male who was injured in traffic accident. An abdominal computed tomography revealed an intra-abdominal hemorrhage, and emergency angiography was performed. A pseudoaneurysm was found in the gastroduodenal artery, and it was coiled for hemostasis. Stricture of the common bile duct was detected on Day 13 after the surgery and on Day 12 after interventional radiology respectively. Percutaneous transhepatic biliary drainage were performed and tube stent were kept in place for 6 months. It was speculated that obstruction of the blood flow may cause the bile duct stricture secondarily.

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