Pulmonary thromboembolism (PTE) is a common disorder and an important cause of morbidity and mortality. However, it is an often underestimated and underdiagnosed disease. The main step of the diagnostic procedure is the clinical suspicion of PTE. The diagnosis should always be confirmed by objective tests. The most reliable test for diagnosis of PTE is pulmonary angiography which remains the gold standard. Heparin constitutes the cornerstone of management. Thrombolysis can be lifesaving in patients with massive pulmonary embolism, cardiogenic shock, or overt hemodynamic instability. If thrombolysis is contraindicated or unsuccessful, catheter embolectomy or surgical embolectomy should be considered. Prevention of PTE is of paramount importance. In this article, clinical assessment, imaging techniques, and therapeutic options described in the published literature are discussed.

View full abstract

In persistent pulmonary hypertension of neonate (PPHN), inhaled NO dilates pulmonary vessels and reduces right-to-left extrapulmonary shunt improving arterial oxygen pressure. It is indicated for the treatment of term and near-term neonates with hypoxic respiratory failure with pulmonary hypertension, in which NO inhalation improve oxygenation and reduces the need for extracorporeal membrane oxygenation (ECMO), an invasive and expensive therapy. NO-treated patient may have less incidence of cerebral hemorrage and chronic lung disease. In addition, NO inhalation reduces perioperative pulmonary hypertension in cardiac surgery and increase pulmonary blood flow in Fontan type operation, which may be another indication of inhaled NO. In respiratory failure, NO inhalation improve oxygenation, but mortality is similar with patients treated without NO. Concentration of inhaled NO is different among reports. It is recommended to investigate doseresonse in indivisual patient. The effect of 20ppm NO is similar with 80ppm NO in most patients. Five ppm may be enough. Effects of NO may be evaluated at least after 15 minutes after the start of inhalation in PPHN, and within 30 minutes after the start of inhalation in perioperative period of cardiac surgical patients.

View full abstract

This study was intended to test whether patients undergoing cervical spinal cord surgery had an apparent increase in urinary output during the early postoperative period in comparison with cervical spinal canal surgery. Twenty-three consecutive patients undergoing cervical spine surgery were allocated retrospectively to two groups: spinal cord surgery (n=13) and cervical spinal canal surgery without any spinal cord procedure (n=10). Although intraoperative administered fluids volume, estimated blood loss as well as postoperative fluids regimen were similar in either procedure, patients undergoing spinal cord surgery had significant higher urinary output than those undergoing spinal canal surgery during the early postoperative period through the first postoperative morning (2.0ml·kg^-1·hr^-1vs. 1.2ml·kg^-1·hr^-1, P<0.01). Results suggest that a transient, but an apparent increase in urinary output can occur following spinal cord surgery, even though precise mechanism remains to be elucidated.

View full abstract

We measured serum human hepatocyte growth factor (hHGF) in patients with acute myocardial infarction (AMI: n=58), unstable angina (UAP: n=21), and stable effort angina (AP: n=67). Mean value of serum hHGF was 3.42ng·ml^-1 in AMI group and was significantly higher than those of UAP group (0.86ng·ml^-1) or AP group (0.37ng·ml^-1). In AMI group, serum hHGF rose earlier than serum CK. Peak time of serum hHGF values was in 6-12 hours after the onset and that of CK was in 12-24 hours.
There were no significant difference of serum hHGF values between the subgroups of AMI with collateral circulation and without collateral circulation, although collateral subgroup showed higher serum hHGF values than no-collateral subgroup (4.66ng·ml^-1 v. s. 1.82ng·ml^-1). We considered the serum hHGF in acute coronary syndrome to be of diagnostic value.

View full abstract

A 61 year-old woman, who underwent replacement of the aortic and mitral valves in 1991, complained of chest oppression and dyspnea, and was admitted to the ICU of our hospital in April, 1997. Thrombus around the mitral prosthesis and the immobilized posterior leaflet detected by transesophageal echocardiogram implied a stuck valve due to valvular thrombosis. Emergency mitral valve replacement was planed, but hypotension and pulmonary congestion were deteriorated before the operating room was fit for use. As any one of the inotropics including epinephrine, fluid therapy, and mechanical ventilation could not correct the patient's condition, we decided to apply a percutaneous cardiopulmonary support system (PCPS) to prevent circulatory collapse and probable death. PCPS could effectively maintain cardiopulmonary performance until the operation and the mitral valve was successfully replaced. We conclude that the bridge use of PCPS is effective while waiting for emergency valve replacement for a thrombotic stuck valve associated with fatal cardiac failure.

View full abstract

We experienced a case of a patient with amebic dysentery with presenting a severe disorder of the liver function with hyperbilirubinemia. The case was a 61-year-old male, who had lived in Sri Lanka for three years. On October 18th, 1997, a pyrexia of between 39 and 40 degrees (C) and mucosanguineous stools appeared. After 13days, an amebic hepatic abscess and colitis were diagnosed by X-ray computerized tomography (CT) and the patient was transferred to our emergency center complicated with hepatic and renal failures. The liver abscess was punctured and an anchovy-like abscess was drained. Amebic dysentery protozoan were observed in the stool sample. Thus, amebic dysentery was diagnosed and treatment with metronidazole 750mg·day^-1 was started. Despite a prompt diagnosis and treatments after admission the patient's conditions became fulminant and failures of multiple organs developed. A CT on day 19th after the admission showed an intestinal perforation in the ileocecum. Emergency ileocecal resection failed to recover the patient from shock status and patient expired on the day 20th.

View full abstract