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Pre-hospital factors relating to prognosis in acute myocardial infarction in a coronary care unit
International
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International Abstracts Management and complications of intraoperative hemorrhagic shock in a liver resection series. M. Okida, K. Mukaida, K. Yuasa, K. Ohtani, T. Higashi, N. Nagasue, H. Yukaya. Jpn J Acute Med 1985;9:739-744. Liver resection was performed on 99 patients with hepatoma between January 1982 and April 1984. Of these patients, 14 developed hypotension and shock because of massive hemorrhaging. Recent innovations in resection technique have significantly reduced intraoperative blood loss in liver surgery. Improved monitoring and resuscitative procedures facilitate prompt recovery from hypotension, and prolonged shock during surgery as caused by hemorrhage has now become a relative rarity. In this study, the authors analyzed the intraoperative management and postoperative influence of hemorrhagic shock in liver surgery. In 12 of 14 patients who suffered hemorrhagic shock, the blood pressure was restored to a normal level within 5 minutes by prompt administration of lactated Ringer’s solution, blood, adrenocortical hormones, aprotinin agents, CaCl,, and NaHCO,. Nevertheless, patients who suffered transient hypotension demonstrated a higher rate of post-operative mortality, a higher incidence of postoperative complications, and more postoperative aggravation of liver function, platelet count, PT, and APTT. Pre-hospital factors relating to prognosis in acute myocardial infarction in a coronary care unit. T. Miyamoto, F. Yoshino, T. Unoki, K. Fukagawa. Jpn J Acute Med 1985;9:747-751. From June 1983 to May 1984, 36 patients were admitted to a coronary care unit (CCU). Of these, 15 patients (42%) called directly for the ambulance, nine patients (29%) were examined in the CCU within two hours of the onset of symptoms, 20 patients (65%) were examined in the CCU within 6 hours of onset, and 25 patients (18%) were examined within 24 hours of onset; six patients experienced onset more than 24 hours before being admitted to the CCU. These six patients were all men who interpreted atypical signs of coronary occlusion as simple chest pain or abdominal pains. Physicians who first saw the patients without proper investigation were also responsible for
misdiagnosis. Nine patients (25%) had no previous medical history of coronary occlusion or other disorders. Eight patients (22%) died. Pump failure accounted for five deaths, and cardiac rupture accounted for three. Myocardial infarction was repeated in four of eight fatalities. TRH test in acute head injury. H. Matsuura, S. Nakazawa, I. Wakabayashi, Y. Tsuji. Jpn J Acute Med 1985;9:855-858. Thyrotropin-releasing hormone (TRH) tests were performed in 30 patients soon after trauma to evaluate the effects of acute head injury on the hypothalamohypophyseal functions. Plasma prolactin (PRL) and thyrotropin (TSH) were measured before and after TRH loading. The mean basal level of plasma PRL was significantly elevated in the patients with severe head injury as compared with those without such injury. Patients with severe head injury exhibited a lower level of response of PRL to TRH. The mean basal level of plasma TSH and its response to TRH remained within normal range. Patients who showed abnormal PRL levels had poor prognoses. The findings suggest that the TRH test is useful for evaluating the severity of injury and prognoses of the patients with head injuries. An experimental study of cerebrocardiopulmonary resuscitation (CCPR) using a newly devised resuscitative solution. Y. Irinoda. Jpn J Acute Med 1985;9:861-873. Since 1974, the author has studied CCPR, a selective brain-cooling method in cardiac arrest. In this investigation, a newly devised cerebral resuscitative solution (CRS-I), the temperature of which was kept at 15°C was used for cartoid infusion in experimental dogs. Reduced glutation (GSH) and prostaglandine I, (PGI,) were also infused to maintain improved cerebral circulation and metabolism. Seven minutes of cardiac arrest were produced by an electrical stimulation. The cartoid infusion with the resuscitative solution was carried out immediately after resumption of cardiac beat following cardiac arrest. Use of the resuscitative solution resulted in an increase in regional cerebral blood flow and CMRO,, improved mitochon87
Notes
International Abstracts Management and complications of intraoperative hemorrhagic shock in a liver resection series. M. Okida, K. Mukaida, K. Yuasa, K. Ohtani, T. Higashi, N. Nagasue, H. Yukaya. Jpn J Acute Med 1985;9:739-744. Liver resection was performed on 99 patients with hepatoma between January 1982 and April 1984. Of these patients, 14 developed hypotension and shock because of massive hemorrhaging. Recent innovations in resection technique have significantly reduced intraoperative blood loss in liver surgery. Improved monitoring and resuscitative procedures facilitate prompt recovery from hypotension, and prolonged shock during surgery as caused by hemorrhage has now become a relative rarity. In this study, the authors analyzed the intraoperative management and postoperative influence of hemorrhagic shock in liver surgery. In 12 of 14 patients who suffered hemorrhagic shock, the blood pressure was restored to a normal level within 5 minutes by prompt administration of lactated Ringer’s solution, blood, adrenocortical hormones, aprotinin agents, CaCl,, and NaHCO,. Nevertheless, patients who suffered transient hypotension demonstrated a higher rate of post-operative mortality, a higher incidence of postoperative complications, and more postoperative aggravation of liver function, platelet count, PT, and APTT. Pre-hospital factors relating to prognosis in acute myocardial infarction in a coronary care unit. T. Miyamoto, F. Yoshino, T. Unoki, K. Fukagawa. Jpn J Acute Med 1985;9:747-751. From June 1983 to May 1984, 36 patients were admitted to a coronary care unit (CCU). Of these, 15 patients (42%) called directly for the ambulance, nine patients (29%) were examined in the CCU within two hours of the onset of symptoms, 20 patients (65%) were examined in the CCU within 6 hours of onset, and 25 patients (18%) were examined within 24 hours of onset; six patients experienced onset more than 24 hours before being admitted to the CCU. These six patients were all men who interpreted atypical signs of coronary occlusion as simple chest pain or abdominal pains. Physicians who first saw the patients without proper investigation were also responsible for
misdiagnosis. Nine patients (25%) had no previous medical history of coronary occlusion or other disorders. Eight patients (22%) died. Pump failure accounted for five deaths, and cardiac rupture accounted for three. Myocardial infarction was repeated in four of eight fatalities. TRH test in acute head injury. H. Matsuura, S. Nakazawa, I. Wakabayashi, Y. Tsuji. Jpn J Acute Med 1985;9:855-858. Thyrotropin-releasing hormone (TRH) tests were performed in 30 patients soon after trauma to evaluate the effects of acute head injury on the hypothalamohypophyseal functions. Plasma prolactin (PRL) and thyrotropin (TSH) were measured before and after TRH loading. The mean basal level of plasma PRL was significantly elevated in the patients with severe head injury as compared with those without such injury. Patients with severe head injury exhibited a lower level of response of PRL to TRH. The mean basal level of plasma TSH and its response to TRH remained within normal range. Patients who showed abnormal PRL levels had poor prognoses. The findings suggest that the TRH test is useful for evaluating the severity of injury and prognoses of the patients with head injuries. An experimental study of cerebrocardiopulmonary resuscitation (CCPR) using a newly devised resuscitative solution. Y. Irinoda. Jpn J Acute Med 1985;9:861-873. Since 1974, the author has studied CCPR, a selective brain-cooling method in cardiac arrest. In this investigation, a newly devised cerebral resuscitative solution (CRS-I), the temperature of which was kept at 15°C was used for cartoid infusion in experimental dogs. Reduced glutation (GSH) and prostaglandine I, (PGI,) were also infused to maintain improved cerebral circulation and metabolism. Seven minutes of cardiac arrest were produced by an electrical stimulation. The cartoid infusion with the resuscitative solution was carried out immediately after resumption of cardiac beat following cardiac arrest. Use of the resuscitative solution resulted in an increase in regional cerebral blood flow and CMRO,, improved mitochon87