Positron emission tomography (PET) can visualize the changes in regional cerebral blood flow and metabolism associated with neuronal activity. Interuption of oxygen supply to the brain due to the reduction of blood flow immediately disturbs aerobic glycolysis, resulting in functional impairment of neuronal activity and irreversible neruonal damage. Both the severity and the duration of ischemia determine the outcome, but the delayed neuronal loss is also responsible in the later period. On the other hand, the functional recovery from the damaged brain becomes an important issue for the next century. Noninvasive imaging methods, including PET, will play a major role to clarify the plastic changes in neuronal network.

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Neuronal cells of the brain after birth cannot be re-placed spontaneously once they are lost. It is, therefore, difficult to reverse neurological deficits completely with conventional therapies after severe brain damage, such as those caused by trauma, ischemia or hypoxemia. In order to overcome such a limitation of conventional therapies, we have been conducting laboratory experiments for establishing transplantation procedures of neuronal cells for therapeutic applications. Our technique involves preparation of cell-suspension from the fetus, cryopreservation of the cell-suspension and stereotactic transplantation with intracerebral injection. The neuronal cells obtained from the hippocampus of the rat fetus, when transplanted with these procedures into the ischemic lesions of the hippocampus, can survive, show synaptic connections with the host brain and restore memory function in adult rats with very high success rate. We summarize the data obtained from these experiments and discuss possible therapeutic applications of the technique.

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We studied to detect autonomic nervous system dysfunction using the maximum entropy method ( MEM ) to perform spectral analysis of heart rate variability ( HRV ) in 6 patients with brain damage. We assesed the amplitude of total power spectrum (TP ), low frequency ( LF 0.03-0.15 Hz) and high frequency ( HF: 0.15-0.40 Hz) components, LF / HF ratio and a Blunt of spectrum. The dead patients showed an decrease in the amplitude of TP, LF components, LF / HF ratio and a slope of spectrum.
We suggest that spectral analysis of HRV is a useful moniter for quantifying autonomic nervous system dysfunction in patients with brain damage.

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Ninety six fifth-year students at the Department of Medicine, Kanazawa MedicalUniversity served as subjects to determine how well students who had completed only a theory class on cardiopulmonary resuscitation (CPR) could actually perform CPR on a simulator. The simulator which was controlled by a microcomputer was set on the normal mode (opens eyes in response to voice, respiratory abdominal movement, and palpable pulse) . Each student performed CPR on the simulator and was evaluated by the same instructor on observation, judgement and treatment (emphasis on observation and judgement) .
Of the 96 students, 26 (27%) correctly identified consciousness; 67 (69.8%) asked for assistance; 48 (50%) correctly identified breathing; and 34 (35.4%) correctly identified pulse. Only six students (6.2%) were able to correctly identify everything. Of 42 students who judged the situation as cardiopulmonary arrest, 34 students actu-ally secured airway, and performed artificial respiration and closed chest massage.
These findings suggested that students lacked an ability to observe and judge basic life support situation, thus suggesting the necessity to provide cardiopulmonary resuscitation education that also emphasizes primary care.

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Many antiarrhythmic drugs have been said to increase the ventricular defibrillation threshold (DFT) . Although lidocaine and /or mexiletine are usually administered to treat arrhythmic patients who are taking another antiar-rythmic agent, there have been no previous studies concerning the combined effects of these drugs. The effect of lidocaine and mexiletine combined with flecainide on DFT was investigated in the present study. Experiments were performed on 16 mongrel dogs under general anesthesia with pentobarbital. Flecainide 2 mg/kg was administered intravenously as the loading dose, then 2 mg/kg/hr was given subsequently. Next, lidocaine (n = 8) or mexiletine (n = 8), 1, 2, 3, 4, 5 mg/kg was administered every 10 min. In these two groups, fibrillation/defibrillation trials were repeated. The heart was allowed to fibrillate for a total of 20 sec by applying the fibrilation inducing electrodes to the heart. Energy levels of 2, 3, 5, 7, 10, 20, and 30 joule maximum were used for the defibrillation. The minimum energy inducing the ventricular fibrilation was defined as FIE and that of defibrillation as DFT. Although the FIE increased correlating to the increase of the concentrations of three drugs, no statistical correlations were found between the lidocaine and mexiletine concentrations and the DFT.
In conclusion, although the present study was performed in a canine model, results might be applied in clinical practice. In patients, who had been treated with flecainide, showing malignant ventricular arrhythmia during anesthesia or in ICU, lidocaine or mexiletine can be administered without risk of increasing the DFT.

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Six patients (five with abdominal trauma and one with strangulated ileus) who were in cardio-pulmonary arrest state on arrival underwent emergency room laparotomy for resuscitation at our hospital. All the six patients resumed heart beat. Of the six patients three (two with abdominal trauma and one with strangulated ileus and septic shock) were transferred to ICU and their lives saved temporarily. The one with the ileus recovered with stupor. The two patients with abdominal trauma eventually died with continuous bleeding at ICU. The remaining three with abdominal trauma died shortly after laparotomy with hemorrhagic or septic shock at the emergency room.
The indications of emergency room laparotomy for resuscitation are 1) cardio-pulmonary arrest or severe hemorrhagic shock induced by abdominal trauma, 2) cardio-pulmonary arrest induced by acute abdominal illness, and 3) a very limited time to rescue the patients and a critical time-loss by transporting them to a regular operation room.
To effectively perform the emergency room laparotomy it requires sufficient well-trained medical staff, and surgical equipment and instruments in the emergency room.

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Acute myocardial infarction occurred in a renal transplant recipient three days after renal transplantation.
The recipient was a 43-yr-old man with chronic renal failure who has been treated with peritoneal and hemodialysis for 7 and a half years. He had no symptom of angina pectoris previously. On the night before and in the early morning of operation, the patient experienced nausea and chest pain which were considered to be possible side effects of the administration of immunosuppressants, cyclosporin, prednisolone and mizoripin.
When the patient entered into the operating room, he continued to have nausea and chest pain and his electrocardiogram ( ECG) showed ST depression. Nitroglycerin, metoclopramide and nicardipine were administered with substantial improvement. Because the operation of the donor (patient's mother) had been already started, the operation was decided to be performed, and eventually completed with no further serious events except a transient episode of ST-T changes.
Two days after the operation, the patient experienced chest pain and echocardiogram on the next day showed inferior myocardial infarction. Subsequent coronary angiography showed 3 vessels disease for which CABG was successfully performed 49 days after the transplantation.
We stress that careful preoperative evaluation for ischemic heart disease is important in the renal transplant recipient even though patient exhibits no symptom.

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It is still controversial whether it is necessary to propose guidelines of “Do-not-resuscitate” in today's Japan. For this issue, we have a suggestion. A Greek physician Stephanus of the sixth century transmitted his prophet to us. It says: medical care system would be seriously confused in future. Because a therapeutic theory can be applied only for population patients, but it can not be indicated for a given patient.
This concept can be also established for intensive medical care. Therefore, “Do not resuscitate”rules for a given patient is not acceptable to other resuscitative patients, as his background is quite different from those of them. Guidelines of “Do not resuscitate”, even if they are necessary, should include only minimum essentials that we should do and should not do

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Being a physician, I express my desire for “do no resuscitate (DNR) ” as a patient. Physicians trained in Japan are tend to believe that the death is the complete defeat in medical practice.This makes DNR impossible in this country. Because the development of such mind has been accomplished under the strong influence of our own imperialism and culture or education, we should not expect a rapid change in the physician's mind. Not all physicians, however, believe that the death is the defeat. Thus, I propose physicians to make public their conviction in life and death or resuscitation so that a patient can choose an appropriate physician for accomplishment of the desire.

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We tried to have a the remote medical conference using Internet at 15 th Annual meeting of Japanese Society for Reaniamatology. E-mail exchange using mailing list and video conference were shown to the audience. Conference room was connected to the network of Fukui Medical School through ISDN and 7 computers were available in the room. CUSeeMe developed by Cornell University was used successfully for the video conference and 7 remote facilities attended the conference through Internet. Mailing list were useful to prepare the workshop. Over 200 messages were exchanged during the preparation and on the day of the demonstration. Although we had trouble at first to connect to the network of Fukui Medical school, the trial was overall successful. It is obvious that the Internet will be indispensable to the field of anesthesiology and reanimatology in the near future for the better medical outcome.

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The Internet is a progressive communication resource that is beginning to have an impact on emergency medicine, and it is expected that the Internet will soon have a great contribution to the improvement of medical practice, and even the outcome, of resuscitation, This report describes the management of the workshop with the Internet informational resources from the planning to the performance.
The use of Internet allows the physician to keep abreast of new developments in resuscitation everywhere, access remote databases, communicate each other by the letter, voice and even the picture in real time, and support in disaster management. However, it deserves several considerations for the use of the Internet on the academic council more efficiently. Most critical thing is a system trouble that may happen on the performance. The other point is that the initial planning for the Internet conference may become stale due to the rapid progress in the telecommunication system. Furthermore, in the attendance through the Internet, other problems such as the qualification of the meeting participation, the membership fee are needed to be settled.

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