Lack of knowledge about electricity, medical gases and other hospital installations may cause misuses, errors and mistakes and results in many accidents. There also is neglected risk management system including quality control of medical equipments. Early detection of any abnormality or malfunction of medical equipments mainly due to earlier aging ensures safe clinical operation; therefore it is important to educate medical staffs on electrical devices, hospital installations and trouble shootings. Maintenance and safety control system of medical equipments should be substantially established in every medical institute. This article describes how to construct safety management system for medical equipments and installations, and shows some examples of its trouble.

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Objective: The purpose of this study is to extract predictive factors of successful weaning from blood purification therapy (BP therapy). Methods: Over the past 7 years, we conducted BP therapy in 128 patients at our CCU (postoperative patients, patients with chronic HD and prophylactic HD after the usage of contrast medium were excluded). We investigated the clinical parameters involving age, sex, 24-hour urine volume (UV) prior to initiating the therapy, BUN, Cre, K, BE, pH, systolic Bp, and doses of diuretics and catecholamines (CA) at the start of the procedure. Using logistic regression analysis, we gauged the predictive value of these parameters of weaning from BP therapy. Results: A total of 77 patients were successfully weaned from BP therapy and 51 were unsuccessful. Among these parameters, only 24-hour UV prior to the institution of the therapy was a significant predictor of weaning from BP therapy (P=0.02, 95% CI 0.995-1.000). Systolic Bp at the initiation of the therapy may influence the possibility of weaning from BP therapy (P=0.06). Successful patients exhibited a 24-hour UV of 624±339ml and the unsuccessful did 104±350ml. Systolic Bp in the successful patients was 132±29mmHg (CA 8.0±6.3μg·kg^-1·min^-1) and that in the unsuccessful ptients was 104±27mmHg (CA 14.7±8.6μg·kg^-1·min^-1). Further, 24-hour UV of successful patients 2.7±3.3 days after sparing the therapy exceeded 1, 000ml. Conclusions: We should encourage BP therapy in patients with cardiovascular diseases before the decline of 24-hour UV under 600ml, without the medications such as diuretics and CA.

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Purpose: In Japan nifekalant is the only potassium channel blocker used intravenously due to the fact that the amiodarone for intravenous injection is not yet approved by the Japanese regulatory authority. We report the effectiveness of nifekalant at the initial treatment for intractable ventricular fibrillation (VF) in the emergency room. Materials and methods: We retrospectively investigated the records of patients who had cardiopulmonary arrest (CPA) on arrival with VF from April 2000, to March 2002. We divided patients into two groups as follows; patients used nifekalant intravenously (group N) and the other patients (group C). Results: As the background information, significant differences were observed in the frequency of defibrillation and age of patients between two groups. The proportion of ROSC was significantly higher in the group N than in the group C (59% vs 36%, P<0.05). However, there were no significant differences in the proportion of admission to intensive care unit, survival longer than 24 hours and survival to hospital discharge. Conclusions: Although all patients in group N were those who failed to be resuscitate from the treatments for group C, nifekalant seemed to improve the rate of ROSC in patients with intractable VF. This result suggests nifekalant could be effective way for intractable VF. We conclude that further prospective study will be needed to make the effect of nifekalant clear.

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We report a case of Vibrio vulnificus infection who survived the complicating septic shock. The patient was a 53 year-old cirrhotic male, who had eaten raw fish on July 19, 2001. He was admitted to a hospital on July 21st with high fever and low blood pressure. He was transferred to our ICU on July 22nd, presenting septic shock. He received ceftazidime (CAZ), minocycline (MINO), and cathecholamines to stabilize circulation, and underwent continuous hemodiafiltration (CHDF) for 4 days for cytokine modulation. Vibrio vulnificus was detected in blood culture obtained at the previous hospital, although he presented no skin lesion when transferred to our ICU. He was transferred to a local hospital on the 12th ICU day after recovery from severe infection and in good general condition. Patients with immunosuppressive disorders such as liver cirrhosis are known to be highly vulnerable to Vibrio vulnificus infection, and it is also reported that infection complicating shock like this case is very difficult for a patient to survive. We believe that early diagnosis and treatment against Vibrio vulnificus and effective management of shock lead to survival of the patient.

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A 68-year old man was examined using arthrography, without any apparent complications. However, approximately 12 hours later, the patient went into a state of shock, which we suspected was caused by the contrast media. He was transferred to the ICU, where his blood pressure was found to be 40/20mmHg and his heart rate was 130min^-1. In the ICU, we immediately started fluid therapy and administered catecholamines and steroids. Examination also revealed a decrease in blood platelets and an increase of fibrin degradation product (FDP), and disseminated intravascular coagulation (DIC) was diagnosed. In addition, the patient's liver enzyme levels were elevated and impaired renal function was noted. Anticoagulation therapy and continuous hemodiafiltration (CHDF) were started because of the DIC and renal dysfunction, after which the patient's circulatory condition gradually stabilized. The general condition of the patient improved after 22 days and he was then discharged from the ICU. In vitro lymphocyte stimulation test turned to be positive to the contrast media, Conray. The side effects of arthrography are rare and few reports are available regarding delayed shock caused by the contrast media. Furthermore, this case is unusual, because the shock was delayed until at least 12 hours after the arthrography examination. We concluded that the patients should be carefully monitored for the delayed severe reaction to the contrast media following arthrography.

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We performed septal myectomy and mitral valve replacement successfully to a patient with hypertrophic obstructive cardiomyopathy complicated with mitral valve stenosis and regurgitation. Unexpected paroxysmal atrial fibrillation repeated since 2nd postoperative day and various kinds of class I oral antiarrythmic drugs were administered, to obtain normal sinus rhythm. However, on 9th postoperative day, the patient fell into pulssless ventricular tachycardia and resultant syncope and hemodynamic deterioration. Immediate cardiopulmonary resuscitation was started. Electrical cardioversion, intravenous infusion of disopyramide and verapamil were not effective but consecutive intravenous infusion of nifekalant succeeded to restore sinus rhythm. Nifekalant, a new class III antiarrythmic drug, is expected to be useful for lethal ventricular arrythmia in patients with hypertrophic obstructive cardiomyopathy.

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Hyperbaric oxygen therapy (HBOT) is now a commonly adopted therapeutic option for ileus and is reported to prevent endotoxemia. We had a case of septic shock, however, following HBOT in a patient with ileus. A 60-year-old male patient underwent HBOT after unsuccessful conventional therapies for ileus. He recovered from abdominal distention and, on the other hand, fell into shock with high fever after HBOT. Blood study at admission to ICU showed elevation of CRP and depletion of white blood cell and platelet, which implied sepsis and sepsis-induced disseminated intravascular coagulation. Antibiotics, gamma globulin, gabexate mesilate, and antithrombin III were administered. The patient got well by degrees during one week in ICU to return back to a ward. Serratia marcescens grew in blood culture. We suspect that septic shock was induced by bacterial translocation which has some relation with HBOT.

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A 70-year-old female committed suicide by ingesting organophosphates, fenitrothion and malathion. Acute severe poisoning developed with loss of consciousness, miosis, sweating, salivation and involuntary movements of both upper limbs. Although most of acute symptoms were improved, the extrapyramidal syndrome had persisted for more than 7 months. Only two cases were found in terms of extrapyramidal manifestations lasting longer than 7 months among 36 cases of organophosphate intoxication presenting extrapyramidal symptoms reported in the last two decades. The fact that she has, before the suicide, been suffering from essential tremor suggests, (1) there may be some pathological factors in her extrapyramidal nervous system, and (2) those who have such predisposing factors develop severe and persisted extrapyramidal manifestations when they ingest organophosphate insecticides.

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We experienced an initial case in which the recordings of glutamate level were continuously followed by microdialysis just immediately after ictus. A 51-year-old woman, who had a subarachnoid hemorrhage on computed tomography, was comatose on admission. After ventricle drainage, a microdialysis catheter was inserted using the same drill hole that had been used for ventriculostomy. When systemic blood pressure and intracranial pressure (ICP) suddenly increased 7.5 hours after admission, the glutamate levels from the right frontal lobe were maximally 388.5μmol·l^-1 at that time. Although her pupils and ICP recovered to normal within 1.5 hours, the glutamate level took more than 6 hours to return the normal range. Thereafter, systemic blood pressure and ICP repeated sudden shoot-ups, and the glutamate level was extraordinary high (>400μmol·l^-1) throughout the period. Finally ICP got uncontrollable and we missed this patient. We need further study about the usefulness of the measurement of glutamate using microdialysis in patients with poor grade subarachnoid hemorrhage.

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We have developed a high sensitive method of measuring the serum endocannabinoids (anandamide, ABA and 2-arachidonyl-glycerol, 2-AG) by gas chromatography and mass spectrometry (GC/MS) with isotope dilution. We measured the serum endocannabinoids in 5 esophageal and 5 lung cancer patients perioperatively with GC/MS to clarify the relationship between perioperative inflammation and endocannabinoids. It was demonstrated that ABA didn' t significantly change perioperatively, although the pre and postoperative 2-AG concentrations in the cancer patients were significantly higher than the control value (P<0.05) and that AEA did not change perioperatively in significant manner. Therefore, 2-AG may play a pivotal role in perioperative inflammation.

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