The purpose of this paper is to describe a fundamental and practical approach to the interpretation of portable chest radiographs. The authors discuss the technical characteristics of the portable radiograph, assessment of pneumothorax and pleural effusion, evaluation of intra and extra vascular volume, and monitoring of tubes and lines.

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Introduction: More than 6, 000 patients in Sakai City, Osaka Prefecture suffered from acute food poisoning caused by verocytotoxin-producing Escherichia coli (VTEC) O-157 in the summer of 1996. Hemolytic uremic syndrome (HUS) occurred in about 100 cases. Ten patients with HUS were transferred to our emergency center. This study is aimed at evaluating the effectiveness of plasma exchange (PE) for HUS caused by VTEC O-157.
Materials and methods: Five of the 10 cases (age 1-17 years) were male. In all cases, VTEC O-157 was either isolated from the stool or the antibodies were detected in the serum. Platelet counts and LDH were assessed daily for 14 days after admission.
Results: Five patients received PE and the other 5 patients did not. Platelet counts, LDH BUN and serum creatinine were not significantly different between the PE and non-PE groups on admission. Hemolytic anemia, thrombocytopenia and renal function improved with no significant difference between the two groups. All cases had complete recovery without any renal impairment.
Conclusion: Significant benefits of PE were not found in 10 cases with HUS from VTEC O-157 indicating PE is not a necessity in the treatment of HUS caused by VTEC O-157.

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Three methods of continuous renal replacement therapy, continuous hemodialysis (CHD), continuous hemofiltration (CHF) and continuous hemodiafiltration (CHDF) were compared using a polyacrylonitrile filter. Clearance of blood urea nitrogen, vitamin B₁₂, dextran, cytochrome C, and myoglobin was calculated at various dialysate and/or filtration flow rates. With CHF, clearances of all substances measured increased linearly as the filter flow rate increased. With CHD, a linear increase of clearance was observed only for blood urea nitrogen. Increased clearance due to increases in dialysate flow rate was less for substances with greater molecular weights. The results of CHDF were always between those of CHF and CHD. For substances with higher molecular weights, clearance was highest with CHF.

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We investigated the effects of dopamine, prostaglandin E₁ and olprinone on renal blood flow in the early postoperative period following coronary artery bypass grafting (CABG) by means of 2-D Doppler echographic measurement. Twenty-four patients scheduled for elective CABG surgery were randomly assigned to one of three groups: dopamine group (n=8) (Group D), prostaglandin E₁ group (n=8) (Group P) and olprinone group (n=8) (Group O). We assessed renal blood flow in the interlobular arteries along the right renal pyramid, which were identified under color Doppler guidance four hours after the end of surgery. We measured the maximum systolic blood flow velocity (V_max) and the minimum diastolic blood flow velocity (V_min) as baseline data with the pulse doppler system (Aloka SSD-2000 Tokyo). We calculated the V_max/V_min ratio (V_max/V_min) and the resistance index (RI=(V_max-V_min)/V_max). After baseline measurement, the dopamine loading dosage was increased through the central venous catheter from 3 to 5μg·kg^-1·min^-1 in group D, prostaglandin E₁ from 0.02 to 0.05μg·kg^-1·min^-1 in group P and olprinone from 0.1 to 0.2μg·kg^-1·min^-1 in group O every 60 minutes. Renal blood flow was measured at each point.
V_max and V_min did not significantly increase but V_max/V_min and RI significantly decreased compared to baseline in all groups after the loading with each drug. The decreases of the V_max/V_min ratio and RI indicate increases of renal blood flow when constant blood flow velocity is constant. We demonstrated that dopamine, prostaglandin E₁ and olprinone in the early postoperative period following CABG led to an increase of renal blood flow.

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A 24-year-old pregnant woman was admitted at 32 weeks of gestation because of vomiting. She had a fever of 39.5°C and a white cell count of 23, 300 per cubic millimeter. She developed reduced consciousness without neck stiffness and her score on the Glasgow coma scale was 13. There were no signs of infection according to urinalysis, chest radiograph, computed tomography of the head or ultrasonography of the abdomen. Cerebrospinal fluid (CSF) and blood cultures yielded Streptococcus pneumoniae. As the patient became delirious, we sedated and managed her with a respirator. Antibiotics and glucocorticoids were administered to treat pneumococcal meningitis and bacteremia. On the second hospital day, C-reactive protein increased to 24mg per deciliter but this level decreased to 2mg per deciliter on the twelfth day. Cytokine concentrations in the CSF decreased as the patient recovered. She delivered a healthy boy at 36 weeks of gestation. This is a rare case of bacterial meningitis in which a basicranial bone defect from Wegener's granulomatosis was a cause of direct infection from the paranasal sinuses to the meninx. Diabetes mellitus caused the infection to spread.

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A rare case of Salmonella meningitis in an adult patient is reported. A 65-year-old Japanese woman with chronic hepatitis and liver cirrhosis suddenly suffered from severe headache, nausea and vomiting after a trip to Southeast Asia. She had been taking predonine and azathioprine for the treatment of chronic hepatitis. Symptoms and signs resembled a cerebral aneurysm or meningitis. Examination of the cerebrospinal fluid (CSF) and a bacterial culture comfirmed meningitis by Salmonella enteritidis. The patient responded to antibiotic therapy and recovered well except for left ptosis, anisocoria and a sensory disturbance from the right upper arm to the palm. This case suggests Salmonella infection may result in septicemia and meningitis in adult patients with compromised health.

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We reported a case of severe encephalopathy encountered in an outbreak of Escherichia coli O-157 infection in Sakai, Osaka, Japan in 1996. We saw 1491 outpatients and had 16 hospitalized patients during this period. A seven-year-old girl with anuria, fragmentation of red blood cells, and low platelet count was diagnosed with hemolytic uremic syndrome (HUS). Her stool culture was positive for E. coli O-157: H7. Impaired consciousness with abnormal eye movement was noticed on referral from another hospital, but convulsion was not apparent. Brain computed tomography showed infarction in the genu of corpus callosum. Plasma exchange (PE) was instituted immediately against the verotoxin, followed by absorption of the endotoxin and continuous hemodialysis (CHD). Mechanical ventilation and catecholamine support were also instituted. But multiple brain infarctions progressed and the electroencephalogram was almost flat in 3 days. Increased vascular permeability caused pericardial and pleural effusions along with acute cardiomyopathy and pulmonary edema. The patient recovered from multiple organ failure after 20 days of illness, but did not recover brain functions. Urine output increased eliminating the need for CHD. The patient remained in a coma, however, and died after 205 days of illness. PE and absorption of the endotoxin were not effective against encephalopathy.

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