PKC and CaMKII play important rolls in the neuronal intracellular signal transduction. During cerebral ischemia, both PKC-γ and CaMKII-α are translocated to synaptic membrane from cytosol. Some reports suggested that prevention of this translocation relates to the neuroprotection. In this study, using 2 min decapitation of cerebral ischemia model in mice, we demonstrated that in the 1 MAC or 2MAC isoflurane inhalation groups, CaMKII but not PKC translocation was significantly inhibited. These results suggest that isoflurane inhibits Thr 286 autophosphorylation of CaMKII. As conclusion, isoflurane may have neuroprotective action through the CaMKII signal transduction cascade.

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We investigated 35 judicial precedents in the emergency/resuscitation field that had been published in legal journals between 1989 and 2000. Among endogenous disorders, the proportion of patients with acute exacerbation of asthma was highest and 50% of the patients in any disorders died within 24 hours. On the other hand, traffic accident-related injury was most common among exogenous disorders. With respect to endogenous disorders, the kind of disorder was limited, and the number of litigation regarding inadequate treatment was large, and 50% of them were lost. With respect to exogenous disorders the number of lawsuits regarding inadequate diagnosis and consultation was the largest, and 50% of them were lost. When there was a fault on the medical side, compensation money was awarded even when there was no probability of its causal relationship to outcome such as death, and the medical side lost some cases. In emergency practice, the medical systems including the hospital′system may be important.

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[Materials and Methods]We retrospectively reviewed the records of patients who had neck hanging from April 2000, to March 2002. Age, sex, past history of psychological disease, type of hanging and outcome were investigated.
[Results]Among 44 patients with neck hanging, 36 patients had cardiopulmonary arrest (CPA) on arrival. Although 4 patients (11%) showed successfull return of spontaneous circulation, all of them died within two weeks. Seventeen patients have past history of psychological disease; majority (76%) was diagnosed as depression. All 8 patients who had not CPA were able to admit to the hospital, and 7 patients of them discharged from hospital without severe physiological and neurological seciuelae.
[Conclusions]This study shows that patients with CPA due to neck hanging had poor outcome. Interruption of the circulation to the brain could lead to disadvantage for brain resuscitation. We conclude that prevention and early detection make prognosis of patients better.

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Preoperative medical examinations in a 58-year-old male scheduled for maxillofacial reconstructive surgery revealed no findings of cardiac dysfunctions and morbidity, including ECG and echocardiography by an experienced cardiologist.
Anesthesia was uneventfully induced with fentanyl, midazolam and vecuronium for tracheal intubation and maintained with N2O-O2-low-flow isoflurane supplemented with fentanyl. Just during cervical angiorrhaphy the short runs of VT abruptly occurred. Immediate bolus injection of lidocaine successfully restored sinus rhythm. Approximately two hours later VT paroxysmally recurred, followed by Vf. Repeated electric defibrillation combined with essential emergency medication was promptly administered without any effects. This persistent dysrhythmias unresponsive to reanimation therapy, which were then judged signs suggestive of der ivation from some myocardial impairment, resulted in cardiac standstill. Autopsy revealed the result that the immediate cause of mortality was estimated as acute cardiac failure due to dilatation of both ventricles, especially marked of right ventricle. Therefore, latent myocardial disorder such as dilated cardiomyopathy was markedly considered to be accompanied by lethal arrhythmogenesis.
This case emphasized that it should be an urgent important question for anesthesiologists as well as cardiologists to establish reliable clinical means of assessing and identifying potential cardiac pathology in asymptomatic carriers with much more accuracy.

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A 72-years old patient developed a cardiac arrest immediately after being placed in the spine position from the prone position for 15 hours due to interlaminar decompression of the lumber spine. He has successfully resuscitated with the conventional treatment after 80 minutes and recovered without any neurological deficit. The postoperative pulmonary scintigraphy indicated a massive pulmonary embolism, which may be the cause of this cardiac arrest. This case suggests that rolling over after the prone position for many hours is a possible cause of pulmonary embolism. It is difficult to make a diagnosis of pulmonary embolism which often leads to a fatal clinical outcome. Thus, it is essential to suspect pulmonary embolism in case of sudden systemic hypotension during anesthesia to initiate an appropriate therapy immediately.

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We report a successful embolectomy for acute massive pulmonary embolism that occurred without remarkable symptoms in a 65-year-old man who complained abdominal pain with diarrhea. Despite an improvement in his abdominal symptoms, hypotension, hypoxemia, metabolic acidosis and the serum AST and ALT were deteriorated after hospitalization. Pulmonary thromboembolism was suspected by repeated medical interview in which he had lost consciousness transiently before hospitalization. There was no lung edema or atelectasis in the chest roentgenogram and no ischemic change in the electrocardiogram. Pulmonary angiogra-phy showed massive thrombosis in the bilateral main pulmonary arteries with a systolic pulmonary arterial pressure of 60 mmHg. He underwent a pulmonary embolectomy under moderate hypothermic complete cardiopulmonary bypass. Following the operation, the patient was in a good condition and the repeated pulmonary angiography showed no signs of recurrent thrombosis. We realized the great importance in the clinical suspicions for diagnosis of pulmonary thromboembolism.

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We experienced a case of emergency surgery for thecardiac perforation due to endomyocardial biopsy. Percutaneous cardiopulmonary supports (PCPs) was usedduring surgery, and acute renal failure was managedwith continuous hemodiafiltration (CHDF) at ICU. Shewas discharged from ICU on the 12th postoperative daywithout sequelae. Cardiac perforation is one of common complications associated with endomyocardial biopsy. It may be lethal if pericardiocentesis is ineffective.Early diagnosis of this complication and cardiac surfiery with institution of cardiopulmonary supports is recommended to prevent mortality.

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