Hospital-acquired infections (HAI) caused by multiple drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) have been a serious problem at medical treatment sites. It is generally agreed that ICUs are hotbeds of HAI, so that HAI caused by multiple drug-resistant bacteria is more serious in ICUs. Hand washing with disinfectant, which removes transient flora on hands and isolates multiple drug-resistant bacteria, is the most basic and effective method to prevent HAI. However, there is no one disinfectant that sterilizes all kinds of bacterial flora. Ozonated water is an aqueous solution of ozone gas, with a strong sterilization effect, and except for its slight ozone odor, has the same appearance as water. Ozonated water had a complete sterilization effect on multiple drug-resistant bacterial flora, including MRSA and VRE, and on drug-susceptive bacterial flora. Ozonated water had a complete sterilization effect at much lower concentrations than the other disinfectant used and had an extremely short sterilization time (5 seconds). We believe that ozonated water is a sterilizing disinfectant suitable for the prevention of HAI. However, ozone dissolved in ozonated water naturally decomposes during storage. Thus, it is desirable that ozonated water be generated by an apparatus that ozonated water. Ozonated water used as a sterilization disinfectant must be handled with care. Ozone dissolved in ozonated water reacts easily with the organic compounds dissolved in waste water, causing ozone to changes to oxygen. Ozonated water may also be useful as a treatment system of waste water. Ozonated water offers a new and effective method to prevent HAI.

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The pulmonary artery catheter has helped elucidate the pathophysiology of many diseases. However, the correct position of the transducer, elimination of the resonance artifact, and making readings at the end-expiratory phase are mandatory to measure pulmonary and wedge pressures correctly. Cardiac output obtained by a bolus injection of cold water is the mean value of a few strokes rather than the mean value of cardiac output for a few minutes, thus it is affected by respiratory phase when an indicator is injected. A recently developed method to measure continuous cardiac output is expected to overcome some unfavorable aspects of the bolus method. It cannot detect rapid changes of cardiac output because it expresses the mean value over a 10 minute period or longer.
There has been no definite standard for applying the pulmonary artery catheter to patients. However, it can contribute to the life support of critically ill patients when it is used precisely with correctly obtained measurements.

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The aim of this study was to investigate the dose-related effect of propofol on brain electrical activity and the cerebral pial arterioles in cats. Seven cats were anesthetized and a closed cranial window was made over the left parietal region. After baseline (isoflurane 0.8%, 0.5 MAC) measurement of the diameter of the pial arteriole and the cortical electroencephalogram (EEG), an intravenous infusion of propofol at a rate of 5mg·kg^-1·hr^-1 was started for 20min before all measurements were obtained using this dose of the drug. Subsequently, the infusion rate was increased to 10mg·kg^-1·hr^-1 for 20min, 20mg·kg^-1·hr^-1 for 20min and then 30mg·kg^-1·hr^-1 for 20min, and all measurements were obtained at each of the experimental conditions. EEG changed from fast activity (baseline, 0.5 MAC isoflurane) to a mixture of fast and slow activities (5mg·kg^-1·hr^-1), slow high amplitude activity (10mg·kg^-1·hr^-1), burst and suppression or suppression (20mg·kg^-1·hr^-1) and complete suppression (30mg·kg^-1·hr^-1). The baseline diameters of the pial arterioles were 100.1±17.4μm. The arteriolar diameters at 5, 10 and 20mg·kg^-1·hr^-1 decreased significantly compared with baseline diameters (P<0.05). The diameters were 92.9±14.2μm (5mg·kg^-1·hr^-1), 92.7±13.4μm (10mg·kg^-1·hr^-1) and 88.8±14.2μm (20mg·kg^-1·hr^-1). When the infusion rate was increased from 20mg·kg^-1·hr^-1 to 30mg·kg^-1·hr^-1, four of seven arterioles dilated. At 30mg·kg^-1·hr^-1, the diameters were 90.2±18.4μm. Our results suggest that the diameter of the pial arteriole in cats was influenced directly by propofol and indirectly by decreased brain electrical activity during propofol infusion.

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This study was performed to clarify the prognosis of congestive heart failure (CHF) with various underlying heart diseases in a tertiary care hospital. Among the patients admitted to our hospital from December 1993 to May 1997, 312 consecutive patients who were diagnosed as having CHF on admission were investigated to determine the underlying structual heart disease. They included coronary artery disease (38%), valvular heart disease (21%), dilated cardiomyopathy (13%), hypertensive heart disease (10%), and other diseases (18%). During the hospitalization period, 20 cardiac and 5 noncardiac deaths occurred (6.4% and 1.6%, respectively). Interventricular conduction disturbance was associated with the worst prognosis. The cumulative survival rate was 91% at one year and 78% at three years. The in-hospital mortality rate was comparable to other previous reports.

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A 22-year-old man was admitted to the hospital because of an open fracture in the left thumb following a motorcycle accident. He developed a fever, dyspnea, a dry cough, and hypoxia 15 days after admission. His past history and the clinical course of the fracture were unremarkable, except that he started smoking suddenly and heavily 3 days after admission. After methylprednisolone 1, 000mg was administered intravenously, he was transferred to the ICU of our hospital. At the time of transfer, his temperature was 37.8°C, his respiratory rate was 72min^-1, and his heart rate was 136min^-1. He exhibited marked respiratory distress. He had diffuse crackles on both lungs. His chest X-rays demonstrated both bilateral interstitial and alveolar infiltrates. An echocardiogram showed normal cardiac function and pleural effusion in the right lung. Arterial blood gases while breathing 100% oxygen by mask were as follows: pH 7.41, PaO₂ 78mmHg, PaCO₂ 38mmHg, BE 0.5mmol·l^-1. His peripheral white blood cell count was 14, 000mm^-3, with 2% band forms, 93% segmented neutrophils, 2% lymphocytes, 1% monocytes, and 2% eosinophils. We started treating him with supplemental oxygen and intravenous imipenem/cilastatin, minocycline, and gamma-globulin. Subsequent laboratory data revealed negative HIV antibody, negative ATLA antibody, and positive Candidal antigen. He developed blood eosinophilia (44%) and recovered from acute hypoxic respiratory failure without complication 8 days after admission to the ICU. We diagnosed his illness as acute eosinophilic pneumonia (AEP). We suspected that AEP was induced by sudden and heavy cigarette smoking.

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We reported a case of candidiasis spondylodiscitis and fungal endophthalmitis following surgery for ileus.
A 54-year-old man underwent laparotomy for ileus twice. The patient had a continuous high fever from the first postoperative day. He was transferred to our hospital for treatment of shock. A fungus was detected at the tip of a catheter used for intravenous hyperalimentation, but since blood cultures taken on several occasions were negative, no antimycotic agent was administered. Seven days after transference lumbago appeared Candida tropicalis was isolated from the disk. A diagnosis of candidiasis spondylodiscitis was made, antimycotic therapy was started, and a discectomy was performed. Symptoms of blurred vision appeared, and the fundus oculi was found to be the site of fungal endophthalmitis. We took deepseated mycosis into consideration in the treatment since the patient was an immunocompromised host.

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We report a case of an organophosphate poisoned patient in whom pralidoxime (2-PAM) pharmacokinetics and clearance during continuous venovenous hemodialysis (CVVHD) were assessed. A 67-yr-old male weighing 45kg, who had been undergoing regular hemodialysis therapy for 3 years, ingested 15ml of 47% parathion in an attempt to commit suicide. After successful cardiopulmonary resuscitation using atropine 48.5mg and 2-PAM 2.0g, the patient was admitted to the ICU. He received a continuous infusion of 2-PAM at 0.1g·hr^-1 for 20hrs under CVVHD, and blood and hemodialysis fliud samples were collected to calculate clearance. Then 1.0g of 2-PAM was infused over 30min and blood samples were collected to calculate pharmacokinetic parameters. Blood 2-PAM concentration during the continuous infusion was around 22-23mg·ml^-1, much higher than the “therapeutic level” of 4mg·ml^-1. The calculated clearance by CVVHD was about 8ml·min^-1. The calculated half-life of the elimination phase was 40hrs, which was much greater than the usually expected (1.1hr). The calculated total clearance was 4.5l·hr^-1, which was less than 1/10 of that in healthy volunteers. These results indicate that we have to be very cautious in administering 2-PAM to patients requiring CVVHD.

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We reported on the first verotoxin-producing Escherichia coli (VTEC): O-157 infection outbreak in a hospital in Japan. Ninety-one patients were infected with VTEC: O-157, of whom twenty-two had clinical symptoms. Three cases developed hemolytic uremic syndrome (HUS). Volume loading and diuresis were effective so that why no case needed hemodialysis (HD). Plasma exchange (PE) was performed due to impaired consciousness in the patient who needed HD, but the level of consciousness did not improve.

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We successfully treated two patients with severe tetanus who showed overactive hemodynamics, excessive salivation, and muscle rigidity by using prolonged isoflurane inhalation in combination with dantrolene.
The first case, a 31-year-old female with severe tetanus, required mechanical ventilation in our intensive care unit (ICU) due to dyspnea of muscle rigidity. Medications including calcium antagonists, nitroprusside, α- and β-adrenoceptor blockade, and benzodiazepam or epidural anesthesia were administered for 6 days. Mean arterial pressure (±SD) was 146±40mmHg during intravenous medication therapies, 153±29mmHg during epidural anesthesia, and 137±8mmHg during isoflurane inhalation. The hemodynamics stabilized for the first time after isoflurane inhalation from day 7. Isoflurane inhalation also markedly reduced muscle rigidity and salivation. Mechanical ventilation under isoflurane inhalation was necessary for 25 days. The muscle rigidity was alleviated after oral administration of dantrolene for 10 days. The patient was successfully discharged from the ICU on day 51.
The second 39-year-old female with severe tetanus was mechanically ventilated under isoflurane inhalation from the beginning. Mean arterial pressure before treatment, 149±44mmHg, was stabilized to 137±8mmHg with isoflurane inhalation. However, unstable hemodynamics and muscle spasms appeared as soon as we tried to wean her from isoflurane inhalation, until we tried dantrolene. Muscle rigidity was gradually reduced with oral administration of dantrolene from day 18, and the hemodynamics gradually became stable. Isoflurane was administered for 31 days. Serum free fluoride concentration was 18μmol·l^-1 at an inhalation dose of 272 minimum-alveolar-concentration, which was far less than the renal toxic concentration of 50μmol·l^-1.
We conclude that a combination therapy of isoflurane and dantrolene is useful for the treatment of severe tetanus.

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