The timing of Adrenaline administration varies depending on the medical control (MC) area in Japan, because Emergency-Life-Saving-Technicians (ELSTs) must follow the local MC protocol. The purpose of the study was to compare the time between the ELSTs contact to administer the first adrenaline (Adrenaline Time) and to compare with good neurological outcome (CPC1-2) among the 47 prefectures. A total of 40,970 Adrenaline administrated patients were extracted from the Utstein style data between 2006 and 2012. Following parameters were compared by 47 prefectures, The correlation of Adrenaline Time and CPC1-2. The average of nationwide Adrenaline Time was 15.5 ± 7.3 min. However, 9.5 ± 5.1 min was the shortest and 19.8 ± 7.5 min was the longest among the 47 prefectures. A statistically significant negative correlation was found between Adrenaline Time and CPC1-2 (y＝-0.1592 x + 5.6343 ; R2＝0.1844). In conclusion, each local MC council must analyze their own outcomes from Utstein data. We suggest the local MC council re-design the protocol for being able to give Adrenaline as quick as possible after ELSTs get on the scene.

　We experienced four cases of sepsis with liver infection. Case 1 was a 66 years female, who was in shock by liver abscess of 8 cm in diameter. Case 2 was a 77 years male, who had depressed level of consciousness and general fatigue. He had a liver cyst of 10 cm in diameter. Case 3 was a 70 years male, who had general fatigue, appetite loss and headache. He had a liver abscess of 10 cm in diameter. These 3 cases were treated with percutaneous drainage and washout with antibiotics. Case 4 was a 44 years male, who had high fever and general fatigue. He was diagnosed as miliary tuberculosis by bone marrow biopsy. He was treated with anti tuberculosis agents with steroid. For liver　abscess,　percutaneous　drainage　with　washout　by　antibiotics　was　effective,　and　for　miliary　tuberculosis, bone marrow biopsy was useful for diagnosis.

　To know the effects of midazolam on seizure after surgery for brain hemorrhage or contusion, intensive care records of 50 patients, who received intravenous midazolam to treat seizure after surgery for brain hemorrhage or contusion were retrospectively analyzed. In 28 patients, midazolam suppressed seizure with the first dose in 12 patients, with the second dose in 6 patients, and with the third dose in 10 patients. Phenobarbital in 4 patients, thiamylal in 8 patients, and diazepam in 7 patients failed to treat seizure, but additional midazolam was effective. However, in 3 patients, midazolam could not suppress seizure and adding thiamylal was effective. Midazolam alone did not decrease blood pressure so as to need treatment. Therefore, midazolam might be useful to treat seizure after surgery for brain hemorrhage or contusion.

　Postoperative stroke remains one of the most devastating complications after cardiac surgery. We experienced postoperative stroke in four patients　after cardiac surgery. Each patient had risk factors for　stroke during cardiac surgery. A patient with coronary artery bypass grafting (CABG) had a prior history of stroke that occurred 2 months before CABG, left vertebral artery hypoplasia, and atherosclerotic cervical and cerebral vessels. A patient with off-pump CABG (OPCAB) had silent brain infarctions, severe bilateral internal carotid artery stenosis and postoperative　atrial fibrillation. A patient with pulmonary valve replacement had a　postoperative atrial fibrillation. A patient with minimal invasive mitral valve plasty had no risk factors without intracardiac air during the operation. The causes of stroke during cardiac surgery include emboli, cerebral hypoperfusion, and postoperative atrial fibrillation. The severity of postoperative stroke in two patients with coronary artery disease (CABG, OPCAB) who had developed systemic atherosclerosis was more marked than in patients with valvular disease without atherosclerosis. Microemboli could be trapped more easily and were more difficult to be washed out of vessels with severe atherosclerosis. Care should be taken regarding the development of systemic atherosclerotic disease to evaluate the embolic burden and cerebral vessel disease.