Nitric oxide (NO) synthesized from an amino acid L-arginine has become one of the most notable substance in the central nervous system in the present decade. NO is supposed to mediate the long-term depression in the cerebellum and long-term potentiation in the hippocampus. It is also involved in the system of NMDA receptors, neurotoxicity, ischemic damage, epilepsy, neurotransmitter's release and sensory system. In this article, we review these phenomena relating NO in the central nervous system with a recent progress in the research of NO.

View full abstract

The aim of this study was to investigate the effects of milrinone (MLN) on lung water and hemodynamics in dogs with oleic acid induced lung edema. Extravascular lung water volume (EVLWV) was measured as an index of lung water using a themo/sodium double indicator method. After baseline measurements, 0.08ml/kg of oleic acid was injected into the caval vein. Twelve mongrel dogs were divided into the following two groups; MLN group and control group (C). In the MLN group, 100μg/kg of MLN was administrated by bolus injection followed by infusion at 1.0μg/kg min. The same volume of saline was infused in to the C group. Values were again obtained at 30, 60 120, and 180 minutes after the start of MLN. EVLWV was significantly increased by oleic acid and was significantly reduced in the MLN group compared to the C group. Hypoxemia was improved by MLN. Pulmonary vascular resistance in the MLN group was significantly lower than that in the C group.

View full abstract

The treatment of intracerebral hematomas (ICHs) in 14 patiens with chronic renal failure (CRF) was studied over 15 episodes. Thirteen of the cases had neurogical grading from NG1 to NG4b Six cases were teated surgically (surgical group 1) and seven cases conservatively (surgical group 2). Preoperatively, surgical group 1 included more serious cases than surgical group 2 in both consciousness level and hematoma size, but surgical group l exhibited prolonged outcome similar to surgical group 2. The number of patients with NG 1 or 2 was six, NG 3, 4 a or 4 b was seven, and NG 5 was two. Five cases. of NG 1 or 2 were treated conservatively and the frequency of activity of daily living (ADL) of I or II, 6 months after the treatment was 60% (3/5). Five cases of NG 3, 4 a, or 4 b were treated surgically and the frequency of the ADL I or II 6 month after the treatement was 20% (1/5). In two cases of NG 5, hemodialysis was stopped due to disappearance of the brain stem reflex.
These findings suggest that the ICHs with CRF may result in the same outcome and effecfiveuess as with conventional hypertensive ICHs and that surgical treatment may be equally effective.

View full abstract

We reported on a case with left lung hemorrhage which was unresponsive to conventional therapy but successfully treated with differential lung ventilation using high contnvous positive air way pressure (CPAP).
A 22 yr-old woman with anorexia nervosa developed organ failure and unilateral lung hemorrhage. Coagulants and fresh frozen plasma were given and intratracheal injections of adrenaline and thrombin through a bronchofiberscope were tried without success. A double-lumen endotracheal tube was intubated and differential ventilation was started to prevent blood from pouring from the left lung into the right. High continuous positive airway pressure of 20cm H₂O was applied to the left lung. The right lung was ventilated with 400ml of tidal volume, 15cm H₂O of pressure support ventilation, 15·min^-1 of synchronized intermittent mandatory ventilation and 7cm H₂O of positive end expiratory pressure. Differential lung ventilation using high CPAP on the left lung was continued for 40hrs. The lung hemorrhage was stopped completely without segmential pneumonia.

View full abstract

We describe the case of a 42 year-old man who complained of chest pain and dyspnea following the inhalation of a water-proof spray containing 1, 1, 1-trichloroethane (TCE). An electrocardiogram on admission showed right axis deviation and SIQIII pattern in limb leads. A 2-dimensional echocardiogram revealed an asynergy of the right ventricular wall with a dilatation consistent with pressure overloading in the right ventricle. His chest X-ray showed a hyperlucent area in the right lower lung field and interstitial shadow in all lung fields except the right lower field. A ventilation/perfusion lung scan was performed and demonstrated on unmatched perfusion defect in both upper lung fields. Conventional pulmonary arteriography showed multiple segmental vasoconstriction in right A₃. The abnormalities on the electrocardiogram and echocardiogram improved within a few days and a perfusion lung scintigram repeated 6 months after the inhalation of the water-proof spray was normal. These findings suggest that inhalation of a water-proof spray induced transient disturbance of pulmonary blood flow with subsequent pressure overloading in the right ventricle. If the effects of TCE on pulmonary circulation is severe enough, resulting acute cor pulmonale with life threatening arrythmias may lead to death asbas been were reported in the past in association with TCE inhalation.

View full abstract

A 49-year-old man ingested about 200ml of Fenvalerate (synthetic pyrethroid)-Dimethoate (organophosphate) mixture with suicidal intent. He was in deep coma (GCS 3) on admission, 1 hour after ingestion, with a pupil size of 6mm on both sides. He had tachycardia, hypotension, hyperemic bulbar conjunctiva, blushed skin, and decreased activity of serum cholinesterase (Δph 0.45). These signs were compatible with pyrethroid poisoning. He was intubated and received gastric lavage. Six hours after ingestion, he developed systemic muscular fasciculation and clonic convulsion. Diazepam, midazolam, and vecuronium were given intravenously, but both conditions gradually worsened. Twelve hours after ingestion, he showed signs of organophosphate poisoning, such as miosis, increased salivation, and low serum cholinesterase (ΔpH 0.01). Atropine was given intravenously and he underwent direct hemoperfusion (DHP) on the 2nd and 3rd hospital days. Strong muscular fasciculation and convulsion markedly decreased after the 1st DHP. The patient was discharged on the 20th hospital day without any neurological sequelae.
This case suggests that the signs of pyrethroid poisoning may develop very early and DHP that is effective for frcating muscular fasciculation and convulsion due to poisoning pyrefhroid.

View full abstract

A 45-year-old woman underwent surgery for osteosarcoma. High-dose methotrexate (MTX) therapy was started during the post operative period. She suddenly developed shock and loss of consciousness, after the 7th dose. She was immediately treated vcTith catecholamines and steroids. Although she recovered from shock, she developed acute renal failure (ARF). She was admitted to our ICU on the next day. to prevent the development of life-threatening complications due to MTX accumulation as a result of decreased renal clearance. Plasma MTX concentration was more than 50 times higher than the safety level at the time of her admission to the ICU. Clearance of MTX was carried out successfully by hemodialysis (20 times) and plasmadsorption (3 times). Massive leucovorin^(R) rescue was performed simultaneously. Mild complications such as mental disturbance, hypoperistalsis, myelosuppression and mucositis were also observed. The complications gradually disappeared as the plasma MTX concentration decreased, and she was discharged from the ICU 18 days later. Hemodialysis and plasmadsorption. performed when he plasma MTX concentration were similar, on the 3rd day showed no singnificant difference in column clearance. Thus, we suggest that hemodialysis alone or with plasmadsorption may be an effective treatment for MTX-poisoning associated with ARF.

View full abstract

Muscle relaxants are used to support mechanical ventilation in the ICU. Large doses of muscle relaxant are given to ICU patients in particular who are sometimes much sicker than general surgical patients.
Many problems are related to use muscle relaxants in the ICU. We presented and discussed problems which occured in our ICU patients who received large doses of two different kinds of muscle relaxants-vecuronium and pipecuronium for more than 24 hours. We found that it took much longer to recover from the blockade with vecuronium than pipecuronium.
Based on these clinical experience, we would like to suggest that data obtained from surgical anesthesia may not apply to ICU patients with many pathophysiological risks. We do not recommend to use muscle relaxants more than 24 hour sand recommend to give sedatives instead of muscle relaxants for supporting mechanical ventilation. We also recommend to monitor neuromuscular function to prevent profound block.

View full abstract

The first aim of this study is to determine the relative effects on intragastric pH of administration of famotidine and pirenzeprne. The second aim is to determine the rate of bacterial growth in gastric juice at various pH values in relation to the addition of famotidine and pirenzepine.
A group of fourteen ventilated patients, six of whom were treated with famotidine (Group F) and eight of whom with pirenzeprne (Group P), were intubated with nasogastric catheter. Gastric aspirate specimens were colleccted every morning to check pH and were cultured quantitatively and identified on admission and on daily for 1, 3, 5, 7 days.
One hundred twenty-two measurements of gastric pH were carried out. Median pH values for the group F was significantly higher than the group P (mean pH F/P=5.63±1.91/2.72±1.51, p<0.01). Furthermore, the rate of gastric pH≥4 in Group F was significantly higer than that in Group P (F/P=81%/13%, p<0.01). Seventy gastric juice cultures revealed 43 (61%) positive cultures. Furthermore, the rate of positive culture in Group F was significantly higher than that in Group P (F/P=83%/43%, p<0.05). No patients showed, clinically macroscopically, upper GI bleeding in this study.
In conclusion, pirenzepine is more useful than famotidine because pirenzepine provides adequate protection against stress upper GI bleeding with less overgrowth of bacteria in the stomach than famotidine.

View full abstract