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Kenji Taki, Kenji Hirahara, Shinji Tomita, Kiyoshi Harano, Hiroshi Koy ...
1996 Volume 14 Issue 3 Pages
89-94
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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A questionaire study was made concering family attitudes toward brain death and organ transplantation using thirty six persons from eleven families. Eighteen family members (50%) accepted the concept of brain death and 27 persons (75%) understood the explanation on brain death offered by the doctor. Fifty percent of the family members were not satisfied with medical treatment after brain death was established. Although the judgment of brain death was mostly acceptable, parents were reluctant to accept the brain death determination, and few of the family members were willing to consider organ transplantation as soon as the judgment of brain death was made. We concluded that we should be prudent to start the discussion of organ transplantation and discontinuation of ventilation just after the judgement of brain death in Japan so far.
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Taro Fujitani, Naoto Adachi, Tatsuru Arai
1996 Volume 14 Issue 3 Pages
95-101
Published: August 20, 1996
Released on J-STAGE: December 08, 2010
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The role of histaminergic system on the changes in extracellular amino acids in normal and ischemic conditions was examined by the microdialysis-HPLC procedure. The extracellular concentration of glutamate was reduced by histamine perfusion to 36% in normal condition. This action was antagonized by mepyramine, an H
1-antagonist. A further increase in this amino acid was observed after administration of high doses of mepyramine. The forebrain ischemia produced marked increase in the extracellular amino acids. The perfusion of histamine resulted in reduction of the rise in amino acids to about 50%. These effects of histamine were completely antagonized by mepyramine or cimetidine. In the ischemic conditions, cimetidine produced a greater increase in amino acids than in the control animals. These findings suggests that transmitter amino acids were regulated through H
1-receptors in normal conditions, but in their rise induced by ischemia were regulated mainly by H
2- receptors.
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Kazuharu Sunami, Yoshimasa Takeda, Asako Ishikawa, Masahisa Hirakawa
1996 Volume 14 Issue 3 Pages
102-106
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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The effects of hyperbaric oxygenation (HBO) on the permanent focal cerebral ischemia were studied. Ischemia was induced by the occlusion of the right middle cerebral artery and right common carotid artery. Rats were pressurized to 3 atmospheres absolute at 10 min after the onset of ischemia for 120 min. During HBO the arterial oxygen tension was increased to 1570±130 mmHg. The arterial oxygen content of HBO group (26±1 ml/dl) was 22% higher than that of control group (21±1 ml/dl) . Although cerebral blood flows were reduced to about 50% of preischemic values in both groups, we could not find any effects of HBO on the cerebral blood flow in both hemispheres. Infarct volume measured at 24 hr after the onset of ischemia was reduced by 18% in the HBO group (132±13 mm
3) compared with the control group (161±29 mm
3) . HBO seems to have protective effects on the stroke by increasing the oxygen supply to the ischemic tissue.
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Osamu Kumode, Takafumi Izumi, Yoshihisa Koga
1996 Volume 14 Issue 3 Pages
107-110
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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In a period of six years from April 1989 through March 1995, surgical operations were performed in 33, 802 cases at Kinki University Hospital and 19 cases out of them developed cardiac arrest during surgical anesthesia. The causes of cardiac arrest were classified into three categories : 1) patient's disease (10 cases), 2) surgery (4 cases) and 3) anesthesia (5 cases) .
Fifteen cases out of 19 cardiac arrests resulted in death. Although all cases attributed to patient's disease and surgery died, only one of 5 cases attributed to anesthesia was lost.The cases of hemorrhagic shock in the category of patient's diseases showed severe hemodynamic disturbance, resulting in poor outcomes. The main cause of the cardiac arrest in the anesthesia group was circulatory failure due to anesthetic drug overdose but the outcome was fairly good. There was a high incidence of cardiac arrest in emergency surgeries (15 of 19 cases), but their age and anesthetic methods were not contributing factors in terms of their prognosis.
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Kohki Nishikawa, Masayasu Nakayama, Motohiko Igarasi, Aya Kumagai, Kaz ...
1996 Volume 14 Issue 3 Pages
111-114
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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A 25-year-old male was admitted for an episode of sudden hematemesis. There were no unusual findings in an endoscopical examination of the upper abdominal trust, but the patient was dehydrated and serum potassium level was 6.7 mEq/l. Therefore, fluid transfusion therapy was started. Eight hours later cardiac arrest suddenly occured. Cardiopulmonary resuscitation was performed uneventful-ly, and an hour later the patient was transfered to the ICU. The laboratory data revealed the following : blood sugar 1584 mg/dl, serum porassium 7.4 mEq/1, pH 7 and urinary acetone body two plus. From these findings, we diagnosed that the parient had diabetic ketoacidosis and we immediately restarted fluid transfusion and insulin therapy. An hour later serum potassium concentration decreased to 4.4 mEq/1, and twenty hours later the blood sugar decreased to 284 mg/dl. Neurological findings after one hour of resuscitation indicated a favorable prognosis, but rhabdomyolsis occurred. On the 5 th day, the patient fell into acute renal failure and showed neurological disturabance. On the 9 th day, the patient died of lung bleeding due to DIC. We suspected that severe hyperglycemia and rhabdomyolysis led to a neurological disturbance caused by an increase in lactate levels in the brain.
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Sukejuro Ohta, Hiromichi Terada, Wakana Sato, Masahiro Suzuki
1996 Volume 14 Issue 3 Pages
115-119
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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A 60-year-old man lapsed into anaphylactic shock during anesthesia for coronary artery bypass grafting, monitoring cerebral oxygenation with near infrared spectroscopy (NIRS) . The concentration of oxygenated hemoglobin (oxy-Hb) and total hemoglobin (tot-Hb) increased simultaneously with the fall in systemic blood pressure, while there were no changes in deoxygenated hemoglobin concentration and the redox level of cytochrome as 3. With a systolic arterial pressure of 45-50 mmHg and a hematocrit of 24 %, the level of tot-Hb increased to a maximum plateau of 13.3, μmol/L, from which the change of regional cerebral blood volume was calculated at 1.13 ml/100 g brain. The administration of epinephrine and the restart of cardiopulmonary bypass rapidly decreased the concentration of oxy- and tot-Hb to pre-shock levels. These suggest that there was an overcompensatory increase of cerebral blood volume (and flow) by cerebral vasodilation at least at the initial stage of anaphylactic shock in this case. To our knowledge, this is the first clinical report describing the changes in cerebral circulation/oxygenation with NIRS in anaphylactic shock.
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Tatewaki Hidaka, Hirofumi Sasaki, Hiromi Matsumoto, Toshiaki Arimura, ...
1996 Volume 14 Issue 3 Pages
120-122
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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Amurinon, a drug currently in clinical use as an inotropic agent and vasodilator in patients with heart failure is a c-GMP-inhibited c-CMP phosphodiesterase (PDE) inhibitor. We present the case of a patient who developed a severe cardiac failure and was successfully treated with Amurinon. A 67 year-old female was admitted with a status asthmaticus. After suffering for 12 hours from status asthmaticus, blood pressure dropped and atrial fibrillation tachycardia appeared. The diagnosis using ECG and echocardiogram was severe cardiac failure with acute myocardial infarction. Amurinon, 10 μg / kg/ min, was administered to the patient when she did not respond to the other catecholamines. Cardiac function recovered rapidly, although the status asthmaticus continued for a while. After recovery from asthma, cardiac function fully recovered. It was speculated that the patient had catecholamine-induced cardiomyopathy and developed down-regulation of β-receptors. Amurinon attenuates airway constriction and increases myocardial contractility by a mechanism different from that of the other catecholamines. Therefore, we consider that Amurinon is quite effective and useful for such a patient as reported.
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Yushi Adachi, Masahiko Taoda, Yoshitaka Uchihashi, Tetuo Sato
1996 Volume 14 Issue 3 Pages
123-126
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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The 2 cases reported here illustrate an incidental venous air embolism occurred during hepatic resection using Cavitron Ultrasonic Surgical Aspiration (CUSA), an instrument comprising a high frequency vibrating titanic tip. In each case, the abrupt increase in central venous pressure (case 1) or pulmonary arterial pressure (case 2) were followed by tremendous circulatory collapse. We found sudden decrease of end-tidal carbon dioxide pressure. These findings suggested overload to the right cardiac system due to air embolism. Resuscitation was successfully performed and liver resection was completed uneventfully with CUSA. These cases suggested the routine use of the full monitoring is necessary for detection of venous air embolism during hepatic resection using CUSA.
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Akio Mohri, Yutaka Tsuda, Masaji Nishimara, Chikara Tashiro
1996 Volume 14 Issue 3 Pages
127-129
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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We experienced a case of CO
2 narcosis caused by 2 mg of rilmazafone hydrochloride (Rhythry
®) adminstered at the night prior to an operation. A 72-year-old female scheduled for right total hip replacement because of rheumatoid arthritis with complications of chronic rheumatism, restrictive pulmonary disease, an electrolytic abnormality, and low body weight (32 kg) . When she was transferred to our operating room, she was lethargy and blood gas analysis revealed hypercapnia of Pa
CO2 87 mmHg. Although she was given doxapram and fulmazenil, she was narcotic owing to hypercapnia. She needed mechanical ventilatory support for more than 36 hours. Rilmazaf one-induced depression of the respiratory center would be responsible for narcosis with hypercapnia.
It is, therefore, important to select a drug and it's dose depending on a patient status.
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Hiroyuki Abe, Noboru Ogawa, Motoyasu Yokoyama, Tadahiko Okada, Tomizou ...
1996 Volume 14 Issue 3 Pages
130-133
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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We reported two cases of respiratory failure caused by blunt trauma treated with Extra-Corporeal Membrane Oxygenation (ECMO) . Case 1 was 18 year-old man who had a motorcycle accident with splenic rupture, multiple bowel perforation, and severe lung contusion. He demon-strated severe respiratory failure 10 hours after surgery in spite of maximum ventilatory support, so we had to employ ECMO to the patient. But 47 hours after the start-ing the ECMO we had to discontinue it because the patient showed the signs of brain death, which was confirmed later by CT. Case 2 was 20 year-old man who had a laceration of right main bronchus caused by motor-cycle accident. Large amount of air leakage was found from right main bronchus and there were some difficulty in ventilation with conventional treatment. The ECMO was started after right middle and lower lobectomy, and the patient weaned from ECMO successfully at 115 hours of ECMO treatment. There are controversies appling ECMO to the traumatic patient. Intracranial hemorrhage is one of the most important risk factors for the ECMO. We conclude that if the bleeding is controllable, ECMO is one option for severe lung contusion caused by traffic accident.
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Michio Shigedomi, Ichiro Inomata
1996 Volume 14 Issue 3 Pages
134-137
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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A 21-yr-old man, having four-times operations for funnel chest at 10 year of age, presented himself in the emergency department with a complaint of severe chest pain. Cardiac arrest developed immediately, but the patient was successfully resuscitated with short period of cardiac massage.
Echocardiogram and CT scan of the chest showed cardiac tamponade due to penetration of the ascending aorta by sternum fixing wire. Both the patient and his family continued to reject emergency operation, in spite of our persuasion. Eleven hours later, cardiac arrest developed again. Despite of emergency operation, he died 7 days later. We should well realize that there is a possibility of cardiac tamponade, though it is rare, due to the penetrating injury by sternum fixing wire.
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Seishiro Marukawa, Kohei Ozaki, Kazumasa Yoshinaga, Junko Yamauchi, Hi ...
1996 Volume 14 Issue 3 Pages
138-143
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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The latest Hanshin-Awaji great earthquake gave us many important lessons for the benefit of medical antidisaster planning. In this article we would propose some basic ideas for antidisaster plan, and suggest to introduce the disastermedicine in this country.
The hospital must be tolerant agaist any types of disaster and function as a shelter for injured sufferers. All logistics of hospital administration must be provided based on the role of multi-dispersed style which is consisted with multiple sources (energies, savings, personnels, etc.) and plural routes (deliveries, transmissions, communications, etc) instead of mono-style which is a standard in this society.
All antidisaster systems should be used as a part of daily activity to maintain and improve themselvs. Once the disaster occured, an agreement for mutual assistance among hospitals and the supportive activity of volunteers groups may effectively compensate the antidisaster systems.
In this country, the disaster medicine is not established yet. We need really it to support and develop the antidisaster plans.
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[in Japanese]
1996 Volume 14 Issue 3 Pages
144-146
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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[in Japanese]
1996 Volume 14 Issue 3 Pages
147-150
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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[in Japanese]
1996 Volume 14 Issue 3 Pages
152
Published: August 20, 1996
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1996 Volume 14 Issue 3 Pages
153
Published: August 20, 1996
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[in Japanese], [in Japanese], M.K. Copass
1996 Volume 14 Issue 3 Pages
154-155
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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[in Japanese]
1996 Volume 14 Issue 3 Pages
156
Published: August 20, 1996
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[in Japanese]
1996 Volume 14 Issue 3 Pages
157-158
Published: August 20, 1996
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[in Japanese]
1996 Volume 14 Issue 3 Pages
159-160
Published: August 20, 1996
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[in Japanese]
1996 Volume 14 Issue 3 Pages
161-162
Published: August 20, 1996
Released on J-STAGE: June 08, 2010
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