International Abstracts

Emergency cases of brain tumors. Yuki K, Kodama Y, Emoto, et al. Jpn J Acute Med 1989;13:711-716.

Two hundred forty-nine patients suffering from brain tu- mors, some in need of critical emergency care, were seen. A retrospective study of 18 patients with brain tumors who required critical care, including an operation within 24 hours after admission, was undertaken. The sites of brain tumors were cerebral hemisphere in nine cases, cerebellar in three, parasellar in three, pineal in two, and CP-angle in one. Initial consciousness levels of six cases were shown as III accord- ing to the score of Japan Coma Scale, of seven cases as II, and only five patients were presented as I. The most fre- quent critical condition was hydrocephalus, and second to it were bleedings and hemiations. Eight ventricular drainages, five craniotomies, and one VP-shunt in 18 patients were per- formed but four other patients had no operations. In many cases, with proper treatment, emergency could have been avoided, and some had good prognosis.

An experimental study of local brain shifts and raised intra- cranial pressure caused by a s&cortically or deeply seated mass lesion in the frontal lobe. Kuchiwaki H, Misu N, Hirai N, et al. Jpn J Acute Med 1989;13:717-723.

A miniature strain gauge probe was inserted in both the temporal lobe (T) and the parietal lobe (P) of the midbrain (M) of anesthetized monkeys to detect coronal or sagittal displacement respectively. Frontal balloons were seated in subcortical region (S-balloon, two animals) and in the cau- date nucleus (C-balloon, two animals) and inflated at 0.103 mL/min; intracranial pressure, 0 to 1,300 mm H,O. The S- balloon local shift (LS) in T showed a medial displacement toward the center of the cranium followed by a reverse dis- placement at the terminal stage. LS in M showed a displace- ment toward the antiballoon side first and then toward the balloon side (paradoxical movement, PM). The C-balloon LS in T showed simple lateral displacement. LSs at P and M showed displacements similar to those by the S-balloon. A vasopressor response correlated with the beginning of PM of M by both balloons. Among these, PM of M seems to be important for detecting maximum shifts in supratentorial space and failure of brainstem function.

A clinical study of iatrogenic disease lending to emergency hospitalization. Morita H, Kaneda Y, Nakayama A, et al. Jpn J Acute Med 1989;13:725-729.

A retrospective study of all patients, excluding trauma, suicide attempts, and drug abuse, admitted to the hospital to characterize current incidence and cause of iatrogenic ad- missions. Of 909 patients admitted in the course of 30 months, 40 cases (4.4%) were hospitalized because of iatro- genie disease. More than 50% of these admissions were due to anti-arrhythmic drugs and antibiotics. Cardiovascular dis- orders were involved in 65% of the patients. Iatrogenic dis- ease was fatal in three cases (7.5%), life-threatening in 12 (30%), and moderate in nine (22.5%). Attention should be paid to educational efforts to reduce the risks of iatrogenic

illness resulting from potentially avoidable therapeutic er- rors.

Acute traumatic pneumocephalus. Onishi H, Ito H, Tohma Y. Jpn J Acute Med 1989;13:731-736.

Thirty-two cases of acute traumatic pneumocephalus were seen during the past 10 years. They were divided into three groups according to the amount and distribution of intracra- nial air. Group A. localized small pneumocephalus (16 cases); group B, localized large pneumocephalus (eight cases); group C, diffuse pneumocephalus (eight cases). Ce- rebrospinal fluid leak occurred in 12 cases, and six of them belonged to group B. Cranial nerve injuries were seen in 11 cases, and five of them belonged to group C. Intracranial hematoma and cerebral contusion were demonstrated in 19 cases by CT scans. Seven belonged to group A, four to group B, and eight to group C. Six patients died (19%) and three demonstrated continuing severe neurological deficits (9%) in our series. Fifteen patients in group A made a functional recovery; however, two died and three patients in group C became severely disabled.

Renal oxygenation during acute hemodilution: Reduction in renal oxygen transport without ischemia. Murakawa K, Kono K, Kobayashi A. Jpn J Acute Med 1989;13:737-742.

The acute renal failure accompanying clinical shock has been assumed to be due to renal hypoxia secondary to renal ischemia, but this study has challenged this concept. In the present study, tissue oxygen tension (Proa) was used to evaluate renal oxygenation during acute hemodilution, in the sense of reduction in renal oxygen transport without isch- emia. Renal tissue gas tensions were measured with a teflon membrane mass spectrometer system during progressive he- modilution in dogs. After control studies were completed the animals were bled 20 ml/kg/h and replaced by 6% HES in normal saline. There was no significant change in hemody- namics until hemoglobin (Hb) decreased below 2 g/dL. Renal tissue gas tensions showed gradual changes when Hb de- creased below 7 g/dL. However, a Pro, decrease was only 25% of control at Hb levels 3 g/dL without hypotension. It was concluded that marked reduction in oxygen transport to the kidney produced only mild tissue hypoxia. Renal hyp- oxia may not be the main factor responsible for the acute renal failure after hemorrhagic shock.

A clinical study of suicidal poisoning patients. Nishina M, Suzuki K, Fujii C, et al. Jpn J Acute Med 1989;13:843-847.

The 149 suicidal poisoning patients admitted to the clinic from 1983 to 1987 were retrospectively evaluated. Seventy- three patients were men, and 63 patients died. Paraquat poi- soning was observed in 71 patients and 60 of those died. 17 cases were organophosphate poisoning. Other drug poison- ing was seen in 51 cases. Major and minor tranquilizers were common drugs. Many paraquat poisoning patients suffered from schizophrenia and depression. Most drug poisoning pa- tients suffered from neurosis and related disorders.

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