The aging of the patient population and the advancement of medical science contribute to the increasing isolation frequency of methicillin-resistant Staphylococcus aureus (MRSA) from hospitalized patients. In Yamagata University Hospital, isolation of Staphylococcus aureus has also shown an annual increase, making up more than 20% of all isolates from clinical specimens, 70 to 80% of which are MRSA. Prevention of MRSA infection in ICU patients is especially important, because most patients are compromised hosts in whom MRSA infections tend to be refractory and severe. We conducted an investigation to examine the possibility of MRSA nosocomial outbreaks among patients admitted to the ICU from January 2000 to April 2001, using DNA analysis. Among the isolates, three cases were strongly suspected to be cross infections. Such sound epidemiological evidence was effective in improving infection control in the ICU.

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A 68-year-old man with chronic renal failure developed hyperkalemia during continuous hemodiafiltration (CHDF) most likely due to nafamostat mesirate (NM) administration. He went into cardiopulmonary arrest due to pulmonary edema. Immediately, he was treated by CHDF with NM 30mg•hr^-1 under mechanical ventilation. His serum K⁺ level was 4.7mEq•l^-1 on admission, and it rose gradually until it reached a maximum of 6.5mEq•l^-1, 25 hours later. Neither hyperventilation, bicarbonate i.v. nor glucose-insulin therapy were successful in reducing the serum K⁺ level. NM was replaced by heparin. Thereafter the serum K⁺ level decreased and normalized.Hyperkalemia is one of the side effects of NM. The mechanism of NM-induced
hyperkalemia has been attributed to the suppression of the potassium excretion mechanism in renal tubules. However, this was not likely with our case, because he had been anuric due to chronic renal failure. We assumed that extrarenal NM effects caused this hyperkalemia.

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We experienced a case (76 years old) with uterine cancer who was scheduled for a hysteroscopy. She suffered from bronchiectasis for about 10 years but had no symptoms except minimum hemoptysis. Soon after diazepam 3.5mg and ketamine 30mg were administered intravenously, airway obstruction due to hemorrhage occurred and her SpO₂ decreased to 55%. Tracheal intubation was immediately performed by an anesthesiologist. There was no bleeding, and we administered thrombin 10, 000 units to the lower left lobe by the bronchoscopy. The airway hemorrhage was suspected to be caused due to underlying infection of bronchi and the hypertension caused by the ketamine. Blood pressure should be well controlled during anesthesia, especially in patients with bronchiectasis, because hypertension may lead to fatal airway hemorrhaging.

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An 84-year-old man suffered from frequent transient ischemic attacks because of left internal carotid artery stenosis (99%). He received emergency carotid endarterectomy under hypothermia (34°C)4 days before the elected day of surgery because of sudden deterioration in his condition. His pulmonary artery blood temperature and cardiac index were maintained at 34°C and 3.0-3.6l•min^-1•m^-2,
respectively. The patient was fully awake and extubated after returning to a normal temperature without neurologic deterioration.

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