Single nucleotide polymorphisms (SNPs) are present on the human genome with high density (about one per 350 bases) and being applied to the analysis of disease susceptibility genes. Especially, regulatory and coding SNPs are being concentratedly studied as candidate gene approach. SNP is a common change of base found in more than 1% of the population and not responsible for the disease alone as in hereditary disorders. It is hypothesized that combination of plural SNPs causes common diseases. Association of sepsis with SNPs has recently been studied in the area of intensive care medicine. The SNP of -308G/A is known in the promoter region of TNF-α gene. The frequency of A allele (TNF2) is significantly higher in a group of patients with sepsis than in that of healthy adults. Furthermore, the deceased showed a significantly higher incidence of TNF2 compared to the survived in a group of patients. It is expected that we will be able to decide the therapeutic modality most pertinent for each patient with sepsis by accumulating knowledges of the SNPs associated with the pathophysiology and prognosis.

View full abstract

An Objective of this study is to describe the characteristics of ventricular fibrillation (Vf) for successful defibrillation. Ten piglets were subjected to this study. Animals were ventilated with room air under anesthesia and Vf was induced with 50 volt AC for 3 seconds. Cardiopulmonary resuscitation was started 8 minutes after the induction. Closed-chest compression was standardized by using a mechanical chest compressor. Either epinephrine or propranolol, lidocaine and bretylium were given intravenously and DC shocks (100 joules) were delivered every one minute for 5 minutes until cardiac rhythm was restored. The lead II ECG in the course of resuscitation were recorded every one minute after induction of Vf. The Vf patterns were also recorded as digital signals for 4 seconds and used for fast fourier transform analysis on line. Both amplitude and frequency at peak level were successively presented on the spectrum analysis. As a result we succeeded in defibrillation in 5 piglets (=Success group) out of ten. Electrophysiological study revealed that the peak amplitude suddenly decreased at 3 minutes after the induction of Vf and thereafter (P<0.01 vs baseline), that the peak frequency remained more than 10Hz for 5 minutes and gradually decreased following time course (P<0.01 vs baseline), that the increase of amplitude resulted from CPR (P<0.01 vs at beginning of CPR), and that the increase of frequency was observed just before the successful DC (P<0.01 vs at 8 beginning of CPR) in Success group. The amplitude-frequency distribution of successful defibrillation on a scatter diagram was clearly defined from that of failed DC's (P<0.01). We conclude that spectral analysis of Vf waveforms offers us better information for successful defibrillation than raw Vf waveforms and that successful defibrillation seems to depend on recovery in both frequency and amplitude.

View full abstract

A 74-year-old man, who got stung about 50 times by vespa mandarinia, was transferred to our ICU from a nearby hospital because of oliguria. His consciousness was clear, blood pressure was 190/130mmHg, and heart rate was 113min^-1 on admission. Laboratory data indicated renal dysfunction (BUN 38mg·dl^-1, Cr 2.5mg·dl^-1), liver dysfunction (GOT 10, 120IU·l^-1, GPT 2, 550IU·l^-1), and rhabdomyolysis (CPK 86, 290IU·l^-1). Continuous hemofiltration and five rounds of plasma exchange were performed in order to supplement renal and hepatic functions and to remove vespa poisons. His consciousness level fell to the Japan Coma Scale of III-100, and the Glasgow Coma Scale of 6 in accordance with the gradual increase of serum total bilirubin concentrations. He died of progressive disseminated intravascular coagulation with massive melena on the 16th ICU day. His autopsy specimen of skeltal muscle, myocardium and brain revealed scattered fusion necrosis and that of liver and kidney revealed necrotic changes. We suggest that plasma exchange should be initiated as soon as possible, because hornet venom contains many kinds of cellulotoxic macromolecular substances.

View full abstract

A 24-year-old man attempted suicide by taking 20g of aspirin. Twelve hours after ingestion he admitted to the hospital with complaint of severe nausea and fever. His symptoms included tachycardia, tachypnea, hyperidrosis and severe dehydration which was confirmed by laboratory data. In order to correct dehydration and facilitate salycylate elimination, massive fluid was infused for 48 hours together with furosemide 10mg·hr^-1 and intravenous bicarbonate. Although urine volume was maintained, the levels of blood urea nitrogen, creatinine and creatinine kinase were elevated continuously. We induced hemodialysis for acute renal failure caused in part by rhabdomyolysis. Two times of hemodialysis decreased serum salycylate concentration lower than the pharmacokinetically calculated value and improved patient's symptoms. This case study suggests the effectiveness of hemodialysis on high-dose aspirin ingestion.

View full abstract

Impetigo herpetiformis, a dermatologic disorder occurring predominantly in the latter months of pregnancy, is frequently associated with severe maternal complications. We present a case of impetigo herpetiformis complicated by severe systemic inflammatory response syndrome (SIRS), in whom plasma cytokine and soluble adhesion molecule levels were determined.
The patient was a 26-year-old primigravida. At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with pain, fever, and leukocytosis. Treatment commenced with an immediate child delivery by Cesarean section, intravenous administration of methyl prednisolone' and steroid ointment. Within 72 hours of delivery, there was marked improvement in the patient's general and skin conditions.
Plasma IL-6 and IL-1RA levels were elevated before the child delivery. Plasma pro- and anti-inflammatory cytokine levels decreased into the normal ranges on the Day 17 when the findings of SIRS were completely disappeared. The skin of the affected area showed intraepidermal pustules with an intensive neutrophilic infiltrate. Plasma level of IL-8, a chemokine which is known to induce neutrophil infiltration, was elevated before the child birth. Plasma sE-selectin and sICAM-1 levels were also elevated, reflecting increased gene expression of these adhesion molecules essential for the local accumulation of neutrophils. Plasma chemokine and soluble adhesion molecule levels decreased with resolution of the erythroderma and pustulation. These findings suggest that increased gene expression of cytokine, chemokine and adhesion molecules play an important role in the pathophysiology of SIRS as well as skin disorder of impetigo herpetiformis.

View full abstract

The purpose of this study is to evaluate an automated (A) measurement of pressure-volume (P-V) curve compared with a manual (M) measurement by using a super-syringe technique. The automated system comprises a linear slider to drive a plunger, an electromechanical controller, and a personal computer.
Six white rabbits were mechanically ventilated at a rate of 20min^-1, pressure control level 10cmH₂O, T_I 0.6sec, and PEEP 3cmH₂O. The lungs of each animal were inflated in steps of 5ml to a total of 50ml and PV curves were measured both in physiological model and pathological model made by bronchoalveolar lavage. Total inflation time was 20.5±0.02sec in A and 19.9±1.54sec in M. The dispersion seen in M was mainly attributable to unequal plateau time and also total time of each inflation step. The automated inflation system in this study repeatedly proved its reliability by showing a very small margin of error.

View full abstract