A large body of evidence suggests that oxygen free radicals may be important in either the primary or secondary pathophysiological mechanisms underlying stroke. The aim of this review is to provide an overview of the present clinical usefulness of biomarkers of oxidative injury in stroke patients. Measurement of biomarkers of oxidative injury for stroke should be used to provide biochemical evidence of antioxidant effectiveness. Exploration of the relationship between antioxidant profile and early outcome of stroke might provide new insights into the pathogenesis of stroke and open new therapeutic possibilities.

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( (Purpose) ) : To clarify the beneficial blood glucose (BG) level in severely critical ill patients with glucose intolerance. ( (Materials and Methods) ) : Ninety patients were investigated. Their BG control was performed by means of artificial pancreas (AP), STG22. The patients were evaluated at two phases, early phase (E phase about 3 days after admission) and late phase (L phase : about 1 week after E phase) . Based on the daily mean BG level (BGm), patients were classified into 2 groups, i. e., high group (a) and low group (b), which were compared with. Three blood glucose points were selected, on 150, 175, and 200mg/dL (ex. group 150b means the patients with BGm below 150mg/dL) . Parameters studied were included in sex, age, underlying diseases, the amount of administered glucose (G) and insulin (I), rate of septic patients, severity, and mortality. ( (Results) ) : (1) E phase (n=84) ; Group 200b (n=68) had lower glucose, insulin level, and lower mortality (29 vs 56%, p<0.05) as compared to group 200a (n=16) . Other parameters above shown were not significantly different between group 200b and group 200a. (2) L phase (n=88) ; Group 175b (n=58) had lower insulin and lower mortality (28 vs 50%, p<0.05) as compared to group 175a (n=30) . Other parameters were not significantly different between group 175b and group 175a. ( (Interpretation and conclusions) ) : BG control aiming at the BC level lower than 200mg/dL at early stage and that lower than 175mg/dL at about 10 days after admission may link to the improvement of the outcome of the severely critical ill patients from the viewpoint of glucose metabolic state.

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We presented a case of severe acute necrotizing pancreatitis complicated with abdominal compartment syndrome (ACS) . A 66-year-old male was transferred to our hospital three days after the onset of the symptoms of pancreatitis with oligouria and liver failure. Transurethral bladder pressure which closely related to intra-abdominal pressure (IAP) was 15-20 mmHg, high enough to indicate the development of ACS. Intensive therapy including continuous hemodiafiltration and continuous arterial infusion of garbexate mesilate via the celiac artery was started in the ICU, but they didn't improve the high TAP. Decompressive laparotomy was not performed. The patient died of multi-organ failure (MOF) after 24 days. We speculated that ACS itself might have played a crucial role in the progress of MOF in this case.

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We experienced three cases of the esophageal perforation. All patients underwent thoracotomy to relieve empyema of mediastinum under general anesthesia. Preoperatively, one of these patients showed severe septic shock at the arrival at our hospital, and required large amount of fluid administration with high doses of inotoropes during surgery. Postoperatively, this patient developed disseminated intravascular coagulation syndrome, and another one patient developed pneumonia. Fortunately all patient recovered in a month after the surgery under intensive care treatment, and they could be discharged in good condition. In summary, anesthetic managements for spontaneous esophageal rupture require several specific techniques such as rapidsequence induction, or one-lung ventilation and rapid life saving treatment for perioperative lethal cardiorespiratory condition. Since the disease is rare, we need to be aware of possible lethal conditions.

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Four cases of emergency doctor call in the aircraft were reported. A 70 years old man felled down at the rest room. A bowel motion might induce vagal reflex and dehydration added orthostatic hypotension. I attended him to the clinic at the airport. The second case was 60 years old man with hypertension. He lost consciousness with Chine-Stokes breathing and mitosis. He did not respond to cardiopulmonary resuscitation In that flight, no endotracheal tube and laryngoscope were available. No help from flight attendants were obtained. Third case was 15 ?20 years girl who complained dyspnea and anxiety, and she was diagnosed as hyperventilation induced by hysteria. Conversation improved her hyperventilation. The last case was 40 ? 50 years old man who complained of feeling bad. He might be dehydrated and water intake improved it. Only a few physicians responded to the emergency call and the knowledge of flight attendants was very poor. Therefore, we physicians should help emergency cases and more education of the flight attendants is necessary.

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I would like to prosose to the Japanese Society of Reanimatology that critical care physicians, who have various specialities, should collaborate in the prehospital settings, emergency room and ICU.
The surgical ICU of Fujita Health University Hospital was opened in June, 2004 and the author has worked there as a chief with my strong will that “Critical physicians should be doctors who can make decisions in any life-threatening conditions regarding not only acute phase diagnosis and treatment but also resuscitation and constitute the central core of opening system to all physicians working in the field of critical care. The collaboration of critical care physician needs to be made on both sides of on-the-job and off-the-job. Initially the Japanese Society of Reanimatology was established mainly with efforts of anesthesiologists; however, it is now facing a phase that it needs support of any physicians working in the ICU, ER, and OR as well as collaboration of emergency physicians, intensivists, and anesthesiologists to become a larger scale academic society.

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We compared X-ray imaging and CT scan imaging of three types of backboard taking with healthy volunteers and acrylic lumbar spinal phantom. Shadows of handle space, drain, metallic parts and head immobilizer were visualized in X-ray imaging, and they considered to disturb diagnosis of X-ray imaging. Immobilization of a volunteer on a backboard caused superior comfort and convenience for X-ray imaging in the lateral view. There was no disturbance in CT scan imaging except metal buckle. While a patient is taking X-ray imaging, it is recommended to remove metallic parts and shift away the part of backboard which has difference of X-ray absorption.

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