Haruhiko Tsutsumi

Estimation of intracranial pressure using computed tomography scan findings in patients with severe head injury

The relationship between initial intracranial pressure and the findings of the first computed tomography scan on admission was assessed in 100 consecutive moderate-to-severe head injury patients using a method of multiple regression analysis. Intracranial pressure was measured through a slender subarachnoid catheter with a transducer. Thirty-nine checkpoints of computed tomography findings, including a shift of midline structure, the status of ventricles or cisterns, and the amount of subarachnoid hemorrhage, were investigated. The results were as follows: (1) The computed tomography findings that contributed to estimating intracranial pressure were the appearance of cisterns, the size of a subdural hematoma (number of slices), ventricular size, status of subarachnoid hemorrhage, status of cerebral contusion, magnitude of midline shift, and ventricular index, in that order. (2) Approximately 80% of predicted cases of intracranial pressure were included within the range of measured intracranial pressure +/- 10 mmHg. When the predicted intracranial pressure was less than 30 mmHg, the discrepancy between both intracranial pressures was small. It is concluded that an equation using several computed tomography findings gives a reasonably accurate intracranial pressure for the initial stage of severe head injury.

The Relationship Between Intracranial Pressure, Cerebral Perfusion Pressure and Outcome in Head-Injured Patients: The Critical Level of Cerebral Perfusion Pressure

In the past many reports have been devoted to the issue of the relationship between intracranial pressure (ICP) and outcome (Langfitt, 1976), but ICP alone does not seem to be fully reliable as an indicator of prognosis, for ICP changes are in some degree influenced by changes in arterial pressure. For example, identical ICP values with different arterial pressures do not represent similar conditions of intracranial hypertension. The aim of this study is to make an overall assessment of the relationship between ICP and outcome, taking cerebral perfusion pressure (CPP) into consideration, and to try to obtain the clinically relevant values of ICP and CPP as a guide to management.

Nocturnal dyspnea treated by diaphragm pacing

A case of nocturnal dyspnea secondary to atlantoaxial dislocation is reported. Noctural dyspnea was not alleviated by a decompressive laminectomy of C-1 and a half of C-2 vertebrae made by a transoral pharyngeal approach. Diaphragm pacing at night was effective for the longterm management of nocturnal dyspnea.

Usefulness of ICP Histogram and ICP Histogram Array in ICP Monitoring

The importance of ICP monitoring is now well recognized. It is and will remain as one of the significant subjects for the processing of ICP values and ICP waveforms, not only in the treatment of severely brain-damaged patients but also in the understanding of pathophysiology. We present a minicomputerized system of a new method for the analysis of ICP and discuss its usefulness with clinical examples.

Automatic and Serial Monitoring of Auditory Evoked Brain-stem Responses

Auditory evoked brain-stem responses (ABRs) reflect activities of the auditory pathway in the brain-stem and by inference activities of the structures surrounding the auditory pathway. It is said that ABR is a reliable diagnostic tool for predicting the outcome of patients with primary or secondary brain-stem injuries as a result of head trauma, cerebrovascular disorders, and others. However, the evaluation of ABRs has depended mostly on the delay of the fifth wave, and such parameters as intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), were not considered. The authors have made a new automatic and serial monitoring system of ABRs, which is composed of an audio-stimulator, a stimulus-controller, an amplifier, a signal processor, and a X-Y recorder. The stimulus-controller enables to monitor ABRs automatically and serially. The clinical study consisted of 17 patients with severe brain damage, including 10 head injuries, five cerebrovascular disorders and others. Following findings were observed. 1) The fifth wave delayed synchronously with a decrease in CPP in critical brain failure. 2) In some cases, decreases in the amplitude of the waves except the fifth wave were exaggerated during trans-tentorial herniation. For better use of the new monitoring system, the ABR-ICP-MAP correlative arrays are being made up, in which ICP, MAP, and other vital signs are evaluated at a glance, which makes it easy to recognize the status of the brain failure and to decide on the appropriate therapy.

Enhanced electron phase-transfer catalysis due to the formation of substrate–catalyst inclusion complexes

A redox-active macrocyclic ionene oligomer, cyclobis(paraquat-p-phenylene), exhibited an enhanced activity as an electron phase-transfer catalyst for the reduction of quinones compared with acyclic benzyl viologen, due to the inclusion of the substrate into the catalyst cavity.

Emergency Medical Service System (EMSS) in Tokyo: Special Reference to the Disaster Program

The Emergency Medical Service System in Tokyo has been developed through the cooperative efforts and achievements of many. EMS in Tokyo consists of three parts: 1) the network system of emergency hospitals; 2) the transportation system of emergency patients (Ambulance System); and 3) the communications system (Emergency Medical Information System). Emergency services are controlled by the Japanese Ministry of Home Affairs and the Ministry of Health and Welfare. The former is in charge of ambulance and rescue services located in the fire department, the latter has to do with medical affairs.