Procalcitonin, a propeptide of calcitonin, is normally produced in the C-cells of the thyroid gland, but it's plasma level markedly increases, mostly due to extra-thyroidal production in cases of severe infections (bacterial, parasitic and fungal) with systemic manifestations, especially in the presence of septic shock. Since noninfectious inflammatory reaction, viral infection and localized bacterial infections manifest only small to modest increases of procalcitonin in plasma, procalcitonin levels may be useful in differentiating between these diseases and sepsis. In addition, it has been suggested that procalcitonin is an early and good marker of elevated cytokines in patients with sepsis, and that it's plasma level is correlated with Sepsis-related Organ Failure Assessment (SOFA) score. On the other hand, traditional markers of infection such as body temperature and white blood cell count are unreliable and often misleading, since they are markers of systemic inflammation which may be noninfectious in origin and therefore non-specific and non-sensitive for sepsis. Although plasma C-reactive protein (CRP) level has been suggested as a good indicator of sepsis and being superior to body temperature and white blood cell count, CRP may increase markedly following severe non-septic systemic inflammatory response syndrome (SIRS) as well as sepsis and thus may not be a good indicator of infection in patients with severe SIRS. Furthermore, plasma CRP level is not correlated with SOFA score. Since plasma procalcitonin is measured easily, quickly and accurately by immunoluminometric assay, it is useful for early diagnosis of sepsis in patients with severe SIRS and as an indicator of severity of sepsis in such patients.

View full abstract

This study was designed to determine the clinical significance of nausea and vomiting (NV) in relation to the onset of chest pain in patients with acute Q-wave myocardial infarction (MI). Two hundred forty patients with acute Q-wave MI admitted≤12 hours from the onset of chest pain were divided into two groups according to the presence or absence of NV in the prehospital phase; 79 patients (33%) had NV (group I) and 161 patients had no NV (group II). Group I was subdivided into 2 subgroups, i. e., group Ia: 36 patients with NV anteceding and/or simultaneously with the onset of chest pain, and group Ib: 43 patients with NV after the onset of chest pain. Group Ia had significantly higher prevalence of young MIs (≤40 years), smokers, proximal coronary artery lesions, pericardial rubs and larger number of left ventricular asynergic segments than those in group Ib and group II. In addition, group Ib had significantly higher incidence of inferior MI compared to group Ia. We concluded that NV anteceding chest pain was associated with larger MI, and was more frequently observed in young and transmural MI.

View full abstract

Hepatic oxygenation in the isolated rat liver was investigated using micro-lightguide spectroscopy and a computercontrolled scanning device. After washed bovine erythrocytes had been introduced into the perfusion system, the liver was scanned via a 70μm micro-lightguide in preset steps of 100μm by a scanning system. Making use of the Kubelka-Munk theory, the intracapillary hemoglobin oxygen saturation (HbO₂) was derived from the hemoglobin spectra (500-630nm) obtained by Erlangen micro-lightguide spectroscopy II (EMPHO II). On the basis of the derived HbO₂ values, a map of HbO₂ levels was reconstructed by a computer. The HbO₂ mapping showed that heterogeneous oxygenation exists in the rat liver: for example, we identified both high (periportal region) and low (centrilobular region) oxygenation areas. A decrease in the temperature of the liver from 32°C to 23°C caused a slight decrease in perfusion flow rate, and a significant increase in HbO₂ values in the centrilobular region of the liver. These data indicate that the centrilobular region, being far from the portal vein (inflow vessel), has a hemoglobin oxygenation level that is significantly influenced by changes in temperature. When norepinephrine (0.1μg+1.0μg) was injected into the perfusate, the perfusion flow rate (portal flow) decreased only slightly, while the HbO₂ values were greatly decreased in both centrilobular and periportal regions. These data suggested that norepinephrine may impair tissue oxygenation in the liver by disturbing the microcirculation, rather than by constricting the portal vein.
In conclusion, mapping methods of HbO₂ using rapid micro-lightguide spectroscopy and scanning device may have a great potential to access in detail the changes in the hepatic oxygenation at both periportal and centrilobular regions not only under physiological but also pathophysiological conditions.

View full abstract

A 5-year-old boy with acute lymphoblastic leukemia (ALL) and renal insufficiency caused by the infiltration of lymphoblastic cells suffered tumor lysis syndrome (TLS) from chemotherapy and was transferred to the ICU. His renal dysfunction due to TLS was characterized by hyperuricemia and hyperphosphatemia. Mechanical ventilation and continuous hemodialysis (CHD) were initiated to treat TLS instead of chemotherapy. About 12 hours CHD followed by the second one for 9 hours successfully normalized the serum levels of uric acid and phosphate. According as renal function recoverd, urinary output has increased and thus lung congestion has improved. The patient was weaned from a ventilator and the second course of chemotherapy was underwent without recurrence of TLS. This case suggests that prophylactic CHD may be a choice in chemotherapy of risky cases.

View full abstract

A 52-year-old man after coronary bypass surgery developed severe cardiac failure and percutaneous cardiopulmonary support (PCPS) was started. In order to evaluate his hemodynamics, the authors tried to insert a pulmonary artery catheter (PAC) through the right subclavian vein. As we advanced a PAC, a ballooned-tip was drawn into the venous cannula of the PCPS and it was quite difficult to direct it to the right ventricle and the pulmonary artery. After several futile attempts we found that the PAC had formed a knot and impossible to be withdrawn. However hemostatic surgery for hemomediastinum was carried out on the same day and the operator released the knot by gentle manual manipulation of the superior vena cava. Two days later, when cardiac function had improved and the flow of PCPS was decreased, we were able to insert a PAC smoothly. In conclusion attention should be paid to knotting formation of a PAC when it is put into and back many times, especially during PCPS.

View full abstract

A 24-year-old female patient who developed bronchiolitis obliterans organizing pneumonia (BOOP) in association with graft-versus-host disease following bone marrow transplantation for acute lymphoid leukemia at the age of 21. Extreme pulmonary overinflation was exacerbated by BOOP, and mechanical ventilation was initiated to treat worsening dyspnea and hypercapnia. As the patient had responded poorly to steroids and weaning from ventilation was considered difficult, pressure control ventilation with permissive hypercapnia was used to prevent barotrauma. Due to markedly reduced lung compliance, PaCO₂ remained at levels higher than recommended in the literature, ranging between 80 and 120mmHg during the course of the ventilation. As oxygenation was normal and no dysfunction was observed in other organs, ventilation was maintained with minimal sedation and an emphasis on the level of consciousness as a treatment index despite PaCO₂ levels above 80mmHg. The results of this strategy, which enabled the patient to communicate throughout the 87-day ventilation period, demonstrate a possible approach to preserving quality of life in long-term mechanical ventilation.

View full abstract

A 55-year-old woman, who had an operation of screws removement for total hip replacement, fell into cardiopulmonary collapse shortly after rehabilitation in the ward. Cardiopulmonary resuscitation was initiated immediately and she was transferred to the ICU. Acute pulmonary thromboembolism was diagnosed from the clinical course and echocardiographic findings. Although a bolus of tissue plasminogen activator and continuous infusion of heparin along with catecholamines successfully relieved her critical condition, hypotension with tachycardia persisted for 2 hours after these treatments, possibly because large thrombi remained in the main pulmonary artery. A pulmonary artery catheter was inserted to attempt mechanical removal of the thrombi. After several difficult trials, her hemodynamic state was restored as soon as the tip of a catheter reached the main pulmonary artery. The authors concluded that insertion of a pulmonary artery catheter might be an alternative therapy for patients with pulmonary thromboembolism who respond poorly to the conventional thrombolytic therapy.

View full abstract