The leading edge of growing and regenerating neuron, nerve growth cone, plays important roles in the regenerating process after neuronal injury. The nerve growth cones collapse when they encounter repulsive factors expressed in the surrounding tissues. Lysophosphatidic acid (LPA) is rapidly generated by activated platelets or by cells after tissue damage, and serves as an intercellular messenger. This lipid mediator caused growth cone collapse in primary cultured chick neurons. This action was dose dependent and the potency was almost identical in three different neuron types: dorsal root ganglion neurons, retinal neurons, and sympathetic ganglion cells. Fifty % of growth cones were collapsed by 10^-6 M LPA. The growth cone collapse started within 2 min after LPA exposure and no homologous desensitization was observed. However, this action was reversible and not toxic to the neurons. This result implied that LPA acts as an inhibitory factor of neurite growth after nerve injury in vivo. LPA antagonists seem to be promising as promoting substances of nerve regeneration.

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To elucidate the effects of induced hypotension with ATP on hemodynamics and myocardial infarct size following ischemia and reperfusion, we studied anesthetized rabbits received regional ischemia by 30 min of the left anterior descending artery (LAD) occlusion followed by 3 hrs of reperfusion under ketamine/xylazine anesthesia. The animals were randomly assigned to a control group, and ATP treatment group, in which a continuous infusion of ATP (5.0 mg⋅kg^-1⋅h^-1) was initiated 30 min prior to ischemia to reduce mean arterial blood pressure by approximately 20% throughout ischemia and reperfusion. Hemodynamic changes were measured throughout the experiment. The area at risk was delineated by Evans blue, and infarct size was determined by tetrazolium staining at the end of the experiment by re-ligation of LAD. The area at risk showed no significant difference between two groups; Infarct size/area at risk in the ATP rabbits was significantly reduced to 49.0±4.2% from 61.9±7.1 in control.
These data suggest that ATP has protective effects against myocardial ischemia in an in situ rabbit model.

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We held basic cardiac life support (BCLS) training courses for eighty medical students of the first year in April 1999. At first semi-quantitative evaluation using a checklist was performed both before (T₀) and after the BCLS training (T₁) . Second, quantitative evaluation using the Berden Score was performed after the training course (T₁) . Total score, 21.6±1.7 at T₁ using the checklist was significantly (P<0.0001) higher than 5.1±2.8 at T₀. There was a significant negative correlation (r=-0.372) between total checklist score and Berden Score points at T₁. Evaluation using the checklist was useful to estimate technical skillfulness. However, about half of BCLS course participants who obtained full marks with the checklist evaluation were not always technically perfect with Berden Score for cardiac compression depth and mouth-to-mouth ventilation volume. The application of a quantitative evaluation method with Berden Score can improve achievement of BCLS training both for trainees and for trainers.

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We retrospectively reviewed the hospital records of 20, 616 patients received a general or spinal anesthetic from 1994 through 1998 in order to determine the incidence of hemodynamic or respiratory events. The incidence (rates per 10, 000) were 13.1 for cardiac arrest, 136.8 for severe hypotension, 66.9 for severe bradycardia, 26.7 for severe hypoxia, 13.6 for other complications. Most events were associated with induction of anesthesia (61%), or spinal anesthetic (25%) . Sudden death was associated with cardiac arrest with massive bleeding, cardiac rupture and cardiac tamponade.

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We have presented a case of cardiovascular collapse that occurred in a 100-year-old female having heart disease during orthopedic surgery. The etiology was not determined, but the fat or air emboli, hypersensitivity to methylmethacrylate monomer being implicated. The risk of cardiovascular collapse in a person of advanced age or having heart disease may be high with the use of this material. Thus, the use of bone cement for hip arthroplasty should be extremely cautious and should be best avoided.

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We report a case of successful resuscitation with open chest cardiac massage for intraoperative cardiac arrest during abdominal surgery. A 66-year-old man without ischemic disease was scheduled for total gastrectomy under general anesthesia supplemented with epidural anesthesia. During gastric lymph node resection, vagal reflex and transient ventricular tachycardia followed by ST-segment elevation in electrocardiographic Lead II were occurred. After thirty minutes, ventricular fibrillation developed suddenly. Since sinus rhythm was not restored even with repeated defibrillations and drug resuscitations, we started closed chest cardiac massage. However, the massage couldn't keep his blood perssure and endtidal carbon dioxide tension (ET_CO2) enough, we performed open chest cardiac massage via the incision of diaphragm. During one hour of open chest cardiac massage, ET_CO2 was elevated and maintained at about 20 mmHg. Sinus rhythm was restored with defibrillation following the administration of nitroglycerin and diltiazem. Postoperative angiographic examination of coronary vessels showed no atherosclerotic obstructions, but showed ergonovine-induced vasospasm which was reversed with intracoronary nitroglycerin infusion. The patient discharged from hospital without any neurological deficit. This case demonstrated the importance to perform open chest cardiac massage immediately unless we could keep ET_CO2 enough during resuscitation in laparotomy.

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A 64-year-old man was transferred to our ICU with the aid of IABP under the diagnosis of papillary muscle rupture after acute myocardial infarction. Immediately after the admission in ICU, the patient became cardiac standstill and was resuscitated using percutaneous cardiopulmonary support (POPS) system. Under the support of PCPS, he was transferred to the operating room and underwent mitral valve replacement. Unfortunately he died on postoperative 29 day. However, PCPS was useful to manage papillary muscle rupture patient during resuscitation and perioperative periods.

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This report describes a case of organic phosphorus insecticide (malathion) poisoning that developed prolonged respiratory failure. A 56-year-old man was found to be unconscious (JCS 300) in his home and was trans-ferred to our hospital. He presented with miosis (1.0 mm), hypothermia and weak spontaneous breathing. Mechanical ventilation and administration of atropine and pyridine 2-aldoxime methiodide in association with gastric lavage was effective to improve the level of consciousness and general conditions. However, weaning from mechanical ventilation was extremely difficult because of the repeated episodes of sudden apnea accompanied with unconscious-ness, hypotension and miosis, the episodes being observed without any exacerbation of serum cholinesterase level. He eventually weaned from mechanical ventilation and discharged from ICU without any sequelae.
It is suggested that there exists a relapse of respiratory insufficiency following inorganic phosphorus insecticide poisoning even after the serum cholinesterase level recovers to normal level.

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A 60-yr-old man with Chiari malformation was scheduled for occipital decompression. After uneventful anesthetic induction with thiopental and vecuronium, anesthesia was maintained with nitrous oxide and isoflurane. Seventeen minutes after tracheal intubation, cardiovascular collapse (systolic blood pressure was 37 mmHg) developed with a generalized cutaneous rash, but without bronchospasm. Resuscitative treatments including rapid infusion of Ringer's solution of 2, 000 ml and administration of epinephrine and methylprednisolone improved hemodynamic status and cutaneous rash disappeared after 30 min. The operation was postponed. A diagnosis of anaphylactoid shock was obtained from blood tests of immunological markers. Intradermal tests performed on the next day were negative for all of the drugs administered. However, the examination repeated 6 weeks later revealed positive reactions to vecuronium and pancuronium. Anesthesia for the decompression surgery was performed uneventfully without using nondepolarizing neuromuscular blockers three months later. Because of low predictive value of skin tests examined in acute phase, such a test is recommended to be carried out more than 4 to 6 weeks after the allergic event.

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We have instructed dental college students in cardiopulmonary resuscitation in Tokyo Dental College and evaluated the efficacy of the instruction by questionaires
whether the students could make a proper diagnosis and do the appropriate treatment or not when the patients who had fainting fit during dental treatment. Only one third of the students could diagnose correctly. Forty percent of them could check vital signs of the patients in the emergency situation, and half of the students were on the strain. Although seventy percent of the students thought that the training of CPR which they had been taught was helpful, actually, the instruction is not practical perfectly. We think that the training program had to be improved in a more practical way.

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