Masayoshi Nishina

A New Method for Predicting the Outcome and Survival Period in Paraquat Poisoning

1 To elucidate the importance of lung damage in the prognosis of paraquat poisoning, the respiratory index (RI: A-aDO2/PO2) was analysed in 51 patients with paraquat poisoning. 2 Progressive deterioration of the RI was observed in 43 non-survivors, but not in 8 survivors. In addition, the RI of non-survivors became greater than 1.5 in the course of their poisoning, while that of the survivors remained less than 1.5. 3 The level of the RI (i.e. whether it became greater than 1.5 or not) was found to be a good indicator for the prognosis for life. 4 The RI-time, defined as the time taken from ingestion for the RI to be greater than 1.5, was found to be a good indicator for predicting the survival period in fatal cases. 5 As a result, we conclude that it is important and useful to examine a series of RI and the RI-time in poisoned patients not only to provide proper respiratory care, but also to predict outcome and survival period.

Effects of Hypertonic Saline and Dextran 70 on Cardiac Contractility after Hemorrhagic Shock

OBJECTIVE The effects of a bolus of 7.5% NaCl-6% dextran 70 (HSD) on cardiac contractility were evaluated in anesthetized sheep with hemorrhagic shock. BACKGROUND HSD has been shown to be effective at resuscitation in cases of hypovolemia caused by hemorrhage. Common hemodynamic findings after the injection of HSD in hemorrhagic shock are the restoration of cardiac output, increased blood pressure, and improvement of peripheral circulation. Some mechanisms by which HSD maintains circulation in hemorrhagic shock have been proposed: rapid shift of fluid from intracellular to extracellular space, improved peripheral perfusion, and increased cardiac contractility. Conflicting data exist, however, regarding the positive effect of HSD on cardiac contractility after hemorrhagic shock. METHODS Hemorrhagic shock was induced by shedding mean blood volume of 31.4 mL/kg, and mean blood pressure was maintained at 50 mm Hg for 30 minutes. The HSD group (n = 6) received HSD (4 mL/kg), and the saline group (n = 6) received normal saline (40 mL/kg) after shock. Cardiac functions were measured in both groups using the left ventricular end-systolic pressure-volume relationship and preload recruitable stroke work during the experimental period: before shock, immediately after the resuscitation, and 2 hours after resuscitation. RESULTS Hemodynamic parameters in both groups demonstrated similar changes throughout the experimental period without significant difference between the two groups. Not only the slopes of end-systolic pressure-volume relationship and preload recruitable stroke work but also their placements did not result in any significant differences between the groups. CONCLUSION HSD seems to be an effective resuscitation fluid after hemorrhagic shock because the volume required to maintain circulation is smaller than that of normal saline. Our data, however, show that HSD does not enhance cardiac contractility after hemorrhagic shock.

Preoperative Diagnosis of Obturator Hernia by Computed Tomography

A retrospective study of 6 patients with obturator hernia diagnosed before surgery by X-ray and computed tomography (CT) was conducted between 1993 and 2000. The initial CT of the abdomen including the pelvic area revealed incarcerated bowel in the obturator foramen of all 6 patients. All patients underwent laparotomy as soon as possible after CT scans were obtained. Resection of the small bowel was performed in 3 patients, and release of the small bowel was performed in the remaining 3 patients. There were no perioperative deaths. In elderly women who show evidence of small bowel obstruction by abdominal plain x-ray studies, we recommend performing CT scans of the abdomen including the pelvic area for detection of obturator hernia.

Changes in left ventricular preload and contractility following severe burns in the dog

SummaryTo examine the effects of severe burns on preload and left ventricular (LV) contractility, we continuously measured LV pressures and dimensions in severely burned dogs throughout the early part of the postburn period. Hemodynamic parameters, including cardiac output (CO), mean aortic pressure (MAP), heart rate (HR), LV pressures and their first derivatives (dP/dt), and the LV regional dimension, were measured and compared before and every 30 min after burns were produced (up to 360 min) in four groups: group A (n=7), dogs with sham burns; group B (n=5), dogs with nonresuscitated full-thickness burns involving 50% of the total body surface area; group C (n=6), dogs with burns resuscitated with lactated Ringers solution at 4 ml × kg × % burn/24 h; and group D (n=6), dogs with burns resuscitated with 1.5% dextran in lactated Ringers solution at 2 ml × kg × % burn/24 h. From these measurements, we obtained the LV end-diastolic segment length (EDL) as an index of preload and three indices of cardiac contractility, i.e., peak dP/dt, the percentage of shortening (%ΔL), and mean Vcf. Our results showed that CO, MAP, and preload (i.e., EDL) decreased significantly more in the three burn groups (groups B, C, and D) than in the sham burn group, but that there were no significant differences in CO, MAP, and EDL among the three burn groups. The three indices of contractility also decreased significantly more in the three burn groups than in the sham burn group. When changes in LV end-diastolic pressure (LVEDP) and EDL during the experiment were examined, apparent discrepancies were found in the changes between LVEDP and EDL in the burn-resuscitated groups (C and D); the postburn decreases in LVEDP in the burn-resuscitated groups were significantly smaller than those in the burn-nonresuscitated group, but there were no significant differences in the postburn decreases in EDL among the three burn groups. These findings indicate that: (1) the fall in cardiac output following severe burns was due to both the decreased preload and decreased LV contractility; (2) the decreased preload and LV contractility could not be restored to preburn levels by conventional fluid therapy during the 6-h experimental period; and (3) the possible decrease in LV compliance was more prominent in the burn-resuscitated groups.

Hemorrhage from a dieulafoy type ulcer of the jejunum. Report of a case.

今回われわれは, 大量出血をきたした小腸のDieulafoy型潰瘍の1例を経験し, 術前に出血部位を診断し, 観血的に治療しえた.症例は68歳, 男性.下血と出血性ショックのため受診した.出血シンチグラフィ (99mTc-RBC) で左上腹部に集積がみられ, 上腸間膜動脈造影では空腸動脈からextravasationを認めた.小腸切除術を施行し, 粘膜面に小さな露出血管を認めたが潰瘍などはなかった.病理組織学的にはpersistant calibar arteryの所見であった.本邦ではいまだこのような症例の報告はなく, きわめてまれと思われる.出血源の不明な消化管出血においては, シンチグラフィおよび血管造影が, 診断・治療上有用である.