To evaluate the cerebral blood flow and cerebral oxygen metabolism of the various resuscitation techniques, continuous monitoring of jugular oxygen saturation (SjO2) was carried out during various cardiopulmonary cerebral resuscitation (CPCR) procedures. Forty-four patients who were suffering from cardiopulmonary arrest in the ICU or emergency room, were continuously monitored for SjO2 just before the cardiopulmonary arrest. There were 24 males and 6 females, with a mean age of 56.3±2.1 years (range, 14-81 years). During the recording of SjO2, the level of saturation of arterial oxygen (SaO2) was maintained at over 95%. Closed chest cardiac massage (standard CPR) was carried out on only 16 of 30 patients, active compression-decompression CPR (ACD-CPR) was used for 5 patients, open chest cardiac massage for 4 patients, and percutaneous cardiopulmonary support (PCPS) for 5 patients. The level of SjO2 was 69.1±8.6% during standard CPR. During ACD-CPR, open chest cardiac massage (Open-CPR), and PCPS the levels of SjO2 were 74.8±14.1%, 75.1±10.3%, and 70.0±10.8%, respectively. These differences were not statistically significant. The systolic blood pressure of the patients receiving CPCR ranged from 56mmHg to 100mmHg. It is well known that jugular saturation demonstrates the ratio of cerebral blood flow to cerebral oxygen metabolism. If the level of SjO2 was within 60∼80% with SaO2 over 95%, the balance between cerebral blood flow and blood oxygen metabolism was maintained. During all of the CPCR procedures, the level of SjO2 was maintained between 60% and 80%. Our series suggested that the cerebral blood flow were perfused much enough to consumption of cerebral oxygen metabolism during the standard CPCR as well as ACD-CPR, closed chest massage CPR, and PCPS.

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Protein C, a potent vitamin K dependent protein, which is activated by the endothelial cell cofactor thrombomodulin, plays a major role in anticoagulant and profibrinolytic activity. We have studied the changes in protein C (PC) activity in septic patients. Samples were collected from 30 septic patients who fulfilled the criteria of systemic inflammatory response syndrome (SIRS) for more than 3 consecutive days. Among these patients, 4 developed DIC (DIC group), 11 multiple organ dysfunction other than DIC (MODS group) and 15 had no complications (SIRS group). The results showed that PC activities on the third day after the onset of SIRS in the DIC group (47.3±23.3%) and MODS group (32.0±9.0%) were significantly lower than that of the SIRS group (68.9±22.5%, p<0.01 respectively). Chronological PC activity changes in the SIRS group showed recovery by the seventh day after the onset of SIRS. On the other hand, these recoveries were not recognized in many of the cases in the MODS and DIC groups. A strong correlation was recognized between PC activity and protein C antigen (r=0.91, p<0.01). A negative relationship was recognized between plasma thrombomodulin and PC activity (r=-0.48, p<0.01), and between plasminogen activator inhibitor-1 and PC activity (r=-0.40, p<0.05). A weak but positive correlation was observed between PC activity and plasmin-plasmin inhibitor complex (r=0.31, p<0.01). On the other hand, no correlation was observed between PC activity and thrombin-antithrombin III complex or between PC activity and tissue factor. Marked reduction in functional activity of protein C may contribute to development of the thromboembolic complications often observed in patients with severe sepsis.

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The case of a 60-year-old woman with a ruptured splenic artery aneurysm is presented. She arrived at our hospital with severe abdominal pain and in shock. After resuscitation, angiography revealed a splenic artery aneurysm measuring 5cm×3cm at the distal portion of the splenic artery and perihepatosplenic fluid collection. Her vital signs were stable, so we attempted TAE for the ruptured splenic artery aneurysm. First of all, we occluded the root of the splenic artery using a balloon catheter. Next, we allowed the microcatheter to pass through the balloon catheter and the aneurysm, and we implanted 16 microcoils from the distal to the proximal side of the splenic artery aneurysm. Complete TAE of the splenic artery aneurysm was confirmed by post TAE angiography. This TAE using a balloon catheter and a microcatheter for ruptured splenic artery aneurysm was considered to be safe and effective.

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A 25-year-old man with a history of toluene sniffing was admitted to the hospital because of tetraparesis. Laboratory examination revealed severe hypopotassemia, hyperchloremia, metabolic acidosis with a normal anion gap, elevation of serum GOT, GPT, CK, and alkaluria, and incresed urinary excretion of hippuric acid. Alkaluria despite metabolic acidosis and severely decreased serum bicarbonate were consistent with distal renal tubular acidosis. Increased urinary excretion of hippuric acid indicated exposure to toluene, and these findings were highly suggestive of toluene-induced renal tubular acidosis. He gradually recovered with abstinense from toluene sniffing and oral supplement with potassium and bicarbonate.

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