In the Emergency and Critical Care Center, there were many subarachnoid hemorrhages (SAH) in cardiopulmonary arrest (CPA) patients detected by CT or autopsy. We thought that not all of these were caused by rupture of an aneurysm. So to determine the etiology of SAH in CPA patients, we conducted experiments using Wistar rats (200g) in cardiac arrest after apnea. Thirty-eight rats anesthetized with Eter were intubated after receiving a muscle relaxant and under mechanical ventilation. In 17 rats in which cardiac arrest was induced by ventilation-off, cardiopulomary resuscitation (CPR) with catecholamine was attempted as soon as possible. In 8 of these rats CPR was successuful, All rats were examined at autopsy. In macroscopic changes, SAH was detected in 5 rats with successuful CPR and in 1 rat with non-cariac arrest. According to Fisher's analysis, there was a close relationship between successuful CPR and SAH in the 17 cardiac arrest cases. In microscopic changes, there was no aneurysm or thrombosis of the vessel, and we thought the rupture of a venule on the surface of the cortex was the bleeding point of SAH. We suspected that the etiology of SAH in cardiac arrest is, first, vasoparalysis after recirculation ohe cerebral blood and, second, increased venous pressure due to increased intrathoracic pressure caused by cardiomassage and positive pressure ventilation.

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To clarify the early prediction of outcome in severe head injury patients with evacuated mass lesions, 32 patients with a Glasgow Coma Scale (GCS) score of 8 or less were classified as having a good outcome (11 cases) or a poor outcome (21 cases). The following parameters affecting the prognosis were analyzed, i, e., the patient's age and sex, type of injury, the presence of hypotension and/or hypoxia, time from injury to arrival at the emergency room and/or operating room, the admission GCS, pupillary abnormalities, CT findings, and continuous monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and jugular venous oxygen saturation (SjO₂) for 1-5 days after the injury. The patient's age, the admission GCS score, ICP on day 1 after the injury, and CPP on day 0 after injury were powerful factors that affected the prognosis. Other parameters showed little difference between the two groups. However, the presence of hypotension and/or hypoxia showed a tendency for poorer outcomes, and episodes of jugular venous desaturation (SjO₂<50%) were common during the initial 3 days in the poor outcome group. These results suggest that the first prognostic evaluation can be performed after 3 days by considering primary and secondary brain damage.

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Vibrio vulnificus is a gram-negative halophilic marine bacterium which can cause life-threatening illness with sepsis. Two cases, 74-and 46-year old men, with V. vulnificus infection and the clinical and histopathological characteristics of soft tissue are reported. Men were infected from an injured finger during raw fish preparation or by eating raw fish and shellfish, respectively. Suppurative inflammatory skin lesions, initial tenderness, redness and swelling of the upper or lower limb, progressively extended and septic shock developed within 24 hours after the onset. On admission, the patients had hepato-renal dysfunction and disseminated intravascular coagulation with circulatory insufficiency. Skin lesions were diffuse. Mechanical ventilation, fluid resuscitation, administration of catecholamines and antibiotics, as well as surgical debridement of necrotic soft tissues, were performed. The patient with the wound infection survived with upper limb amputation and intensive care, but the other patient who had been infected via the gastrointestinal tract died. Histopathological examination of infected soft tissues showed extensive necrosis of subcutaneous fat cells, the underlying fascia and muscle. Inflammatory cell infiltration was remarkable in skin layers, but slight in the fascia and muscle. Soft tissue infection caused by V. vulnificus progresses rapidly and is often lethal. It is important for physicians to suspect this infectious disease upon encountering patients with soft tissue infection. Understanding the clinical characteristics of this disease and early suspicion can lead to efficacious, life-saving therapy.

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