[in Japanese]

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A Study of Patients with Severe Bronchial Asthma Fumihiro Nozu, Sigeru Hakota, Masaya Kiritoushi, Yasunari Uedono, Yasuhide Kitazawa and Takaya Tanaka Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Osaka, Japan Artificial respiration is often required in the treatment of status asthmaticus, and the management of quite a few of these patients becomes problematic. In the present study we reviewed the 19 cases in which artificial respiration was required among the 52 outpatients in whom a bronchial asthma attack was the principal lesion over the past 11 years.

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The effect of stimulation of the mammillary bodies(MM) on electrical phenomena in the central nervous system of rabbits investigated and the followings observed.
1) The threshold of the arousal reaction, induced by stimul ation of the brain stem reticular formation(RF) and the cerebral cortex, decreased by stimulation of the MM with 3Hz, but increased by stimulation with 100Hz. The threshold of the evoked muscular discharge(EMG) of the fore-and hind-limbs, due to stimulation of the RF and the cerebral cortex, increased by stimulation of the MM with 100Hz.
The results indicate that s timulation of the MM with a low frequency results in activation of consciousness while stimulation of the MM with a high frequency results in a depression of both consciousness and pyramidal motor activity.
2) The threshold of the EMG, due to stimulation of the hippocampus, decreased by stimulation of the MM with 100Hz. The result suggests that the extrapyramidal system was facilitated by stimulation of the MM with 100Hz.
3) In the rabbit, in which th e nucleus ventralis anterior had been electrically destroyed beforehand, there was no significant change in the threshold of the arousal reaction and EMG with stimulation of the RF following stimulation of the MM with either 3 or 100Hz.
The findings suggest an involvement of the diffuse thalamocortical projec t ion system in the activation or inhibition of both consciousness and motor activity by stimulation of the MM.

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The effect of stimulation of the mammillary bodies (MM) on the reflex activity and autonomic nervous activity was investigated and the followings observed.
1) The amplitude of the photo-evoked eyelid mic rovibration (MV) increased by stimulation of the MM with 3 Hz but decreased with 100 Hz.
2) The amplitude of the sciatic-evoked ey elid microvibration (SMV) decreased by stimulation of the MM with both 3 and 100 Hz.
3) The amplitude of the nociceptiv e reflex decreased by stimulation of the MM with 100Hz.
4) The amplitude of both the M and H waves decreased by stimulation of the MM with both 3 and 100 Hz.
5) Intestinal movement was facilitated by stimulation of the MM with both 3 and 100 Hz.
6) Stimulation of the MM with both 3 and 100 Hz had almost no effect on the blood flow volume in the common carotid artery and the femoral artery.

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EEG topography by a minicomputer system (ATAC-3700) was performed in the rabbit in order to investigate the effect of stimulation of the mammillary bodies (MM) on the EEG activity.
1) Stimulation of the MM with 3 Hz resulted in an increase in both absolute power (itiV)and relative power (%) in beta 1 and beta 2 and a decrease in relative power in theta band.
2) Stimulation of the MM with 100 Hz resulted in a decrease in both absolute p ower and relative power in alpha, beta 1 and beta 2 and an increase in delta and theta bands.
3) In the rabbit, in which the nucleus ventralis anterior had been electrica lly destroyed beforehand, there was no significant change in relative power topograms following stimulation of the MM with either 3 or 100 Hz.
The findings suggest that the diffuse thalamocortical projection system is involved in the change in EEG activity following stimulation of the MM.

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Because preoperative diagnosis of diaphragmatic injury is sometimes difficult and this injury tends to be overlooked, attention needs to be paid to the possible presence of this type of injury in treating cases of trauma. Bearing this in mind, we recently analyzed 7 cases of diaphragmatic injury enocountered at our hospital.
The diaphragmatic injury co nsisted of rupture in 4 cases, penetration in 2 and laceration in 1. The mean APACHE (Acute Physiology And Chronic Health Evaluation) II score upon arrival was 8.9. The patient's life could be saved in all cases. Complications such as intestinal injury, splenic rupture, vesical rupture or pelvic fracture were observed in all cases. Pneumothorax was noted in 2 cases and hemothorax in 4 cases. A definite preoperative diagnosis of diaphragmatic injury was made in 5 cases. Laparotomy was performed in 4 cases, thoracotomy in 1 case and both in 2 cases. The left side was affected in all 4 cases of diaphragmatic rupture.
These findings suggest the necessity of being mindful of the possibility of abdomin al pressure elevation in cases of blunt trauma and the possibility of diaphragmatic injury in cases of stab wound. In any event, a definite diagnosis of traumatic diaphragmatic injury based on appropriate examinations is indispensable for appropriate and rapid surgical treatment. Key Words: diaphragmatic injury, traumatic diaphragmatic hernia, diaphra gmatic rupture, diaphragmatic laceration, diaphragmatic penetration.

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