Most deaths from acute myocardial infarction (AMI) occur before the patient arrives at the hospital. In the previous symposium at Sapporo, it was emphasized that in order to reduce mortality from AMI, it was extremely urgent to increase public education concerning ischemic heart disease (IHD) and the popularization of by-stander cardiopulmonary resuscitation, and to establish a rapid patient transport system.

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We compared effect of CPD (citrate, phosphate, dextrose) and MAP (mannitol, adenine, phosphate), a new preservation solution for the concentrated red cells, on the time course changes in neutrophil elastase·α₁-antitrypsin complex (EAC) and white blood cell counts in the concentrated red cells (CRC). All samples, MAP-CRC or CPD-CRC, were made from bloods withdrawn from 7 volunteers and they were stored in a refrigerator with its temperature kept at 4°C during the study. EAC level in the CPD-CRC sharply increased from 7 to 42 days after withdrawal. However, EAC level in the MAP-CRC started to increase from 14 days after sampling and this increase in EAC was statistically lower than that in CPD-CRC at each preservation date. White blood cells in MAP-CRC decreased more slowly than those in CPD-CRC. These results indicate that MAP delayed the rate of an increase of EAC in stored blood. These differences of EAC level between MAP-CRC and CPD-CRC may depend on the removal rate of white blood cells from the blood as well as the decay of white blood cells for the preservation day.

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Recently it has been revealed that when patients with dependent lung disease (DLD) are placed in the prone position with the healthy lung dependent, there is an improvement of pulmonary oxygenation which is positively correlated with the duration of prone position (8∼46h). However, since there are potential deleterious consequences of prologed duration of prone position and the optimal time of this therapeutic position is not well defined, we studied therefore the effect of short-period prone position on gas exchange in the early stage of acute respiratory failure.
The prone position was kept for a period of less than 2h (49.5±14.5min) in 19 critically ill patients with DLD. The mean PaO₂/F_IO₂ ratio rose significantly from 202.7±60.1 to 297.7±88.4, but decreased slightly in only 2 cases with chronic obstructive lung disease. On changing back to the supine position, 14 (73.7%) patients could maintain better pulmonary function than the pretreatment values even at 4h later. Additionally it caused no significant changes in the efficacy of CO₂ elimination (VP-index), respiratory volume (V_T and V_E) as well as lung compliance (Ceff).
In conclusion, as a posture for chest physiotherapy, short-period prone position was found to be therapeutically effective, better tolerated and less troublesome than long-period prone position. Consequently it may be employed more frequently to restore respiratory function to normal in critically ill patients. Pathophysiological aspects of DLD and the effect of the prone position was discussed.

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Gastric intramucosal pH (pHi) was examined to estimate the splanchnic circulation after open-heart surgery in fourteen patients without low cardiac output syndrome including five patients with coronary artery bypass grafting, five with mitral valve replacement, two with aortic valve replacement and two mitral and aortic valve replacement. A gastric tonometric catheter was inserted after surgery and pHi was measured immediately, 6, 12 and 24 hours after the admission to the intensive care unit (ICU). On admission, the cardiac index was over 4l·min^-1·m^-2 and mixed venous oxygen saturation over 70%. However, pHi was lower than 7.32 of the critical level and it recovered to the normal level within 24 hours after the admission to the ICU. These data indicate that the splanchnic blood flow decreased after cardiopulmonary bypass although cardiac output was preserved in normal range. The monitoring of pHi is noninvasive and useful to estimate the splanchnic circulation.

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The authors previously reported a case on barbiturate therapy, complicated with porphyrinuria, and in the present study, confirmed the existence of porphyrinuria during the barbiturate therapy, by determination of porphyrin body in the urine. The subjects were 9 cases on barbiturate therapy, hospitalized for central neuvons system disease during last 4 years. These disease were acute subdural hematoma (4 cases) and traumatic intracerebral hematoma, subarachnoid hemorrhage, arteriovenous malformation, anoxic brain and herpes simplex encephalitis (1 case, each). These subjects averaged 38.9 years and showed mean Glasgow coma scale of 6.5 points on admission. Barbiturate therapy consisted of continuous intravenous infusion of thiamylal at a dose of 1-5mg·kg^-1·hr^-1. The medication averaged 8.6 days in duration with average total dose of 667.4mg·kg^-1. Complicated porphyrinuria, abnormally high urinary coproporphyrin, uroporphyrin and porphobilinogen were noted in 3, 2 and 1 cases, respectively. These 3 cases of complicated porphyrinuria had longer medication and larger total dose of barbiturate and were all compicated with liver dysfunction. The present examination suggests that prophyrinuria should also be kept in mind as a complication of barbiturate therapy.

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We presented three severe asthmatics who were improved dramatically by frequent inhalations of aerosolized β₂-agonist, using a metered dose inhaler.
Aerosolized β₂-agonist was inhaled repeatedly till patients were free from attack and/or wheezing. One was improved without an artificial ventilation and the other two were on the ventilator because of acute respiratory distress. Durations of an artificial ventilation (13hrs and 36hrs) were markedly shorter than that of previous report.
Frequent inhalations of β₂-agonist improved severe asthma attack rapidly without any severe cardiac and metabolic adverse effects.

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The aim of this study was an evaluation of the climical usefulness of a new ion-selective electrode for ionized magnesium (iMg²⁺). In 36 healthy volunteers (Group-H) and 24 postoperative patients (Group-P), blood levels of iMg²⁺ were measured by a Stat Profile 8 Analyzer (NOVA Biomedical, U. S. A.).
In Group-H, the mean level of whole blood iMg²⁺ was 0.53±0.04mmol·l^-1 and was higher than that of plasma iMg²⁺ obtained immediately after centrifugation. The mean plasma or serum levels of iMg²⁺ obtained after centrifugation and preserved at -20°C for one week were lover than those obtained without preservation, respectively. However, when preserved at -80°C, they were not significantly different from those obtained without preservation, respectively.
The mean level of whole blood iMg²⁺ in Group-P (0.43±0.07mmol·l^-1) was significantly lower than that in Group-H.
We concluded that an ion-selective electrode for iMg²⁺ was useful for investigation of various pathophysiologic processes related to blood iMg²⁺ in critically ill patients.

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