INTERNATIONAL NOTES

Differential ICP in traumatic intracranial mass lesions. M. Yano, Y. Ikeda, T. Otsuka. Jpn J Acute Med 1985;9:1787- 1792.

Differential ICP was studied in 16 head-injured pa- tients. The 16 patients were divided into three groups according to type and pathology of intracranial mass lesions. Group I (eight cases) included cases of unilat- eral mass lesions without decompression craniotomy, group II (six cases) consisted of cases of unilateral mass lesion with decompression craniotomy, and group III (two cases) comprised cases of bifrontal de- compression craniotomy. Differential ICP was re- corded simultaneously through bifrontal subarachnoid catheters. Hourly differential ICP was obtained from the three groups. A total of 116 recordings were ob- tained from group I (12-24 recordings per patient), 114 were obtained from group II (15-34 per patient), and 139 were obtained in group III (52 and 87, respec- tively). Hourly differential ICPs between ipsilateral and contralateral side of the mass lesion were com- pared. The relationship between the ipsi- and contra- lateral sides was y = 1.063 x - 2.440 (r = 0.956), y = 0.94~ + 0.928 (r = 0.992), and y = I .004X - 0.846 (r = 0.951), respectively, for groups I, 11, and III. Differential ICPs were not influenced by the type or the pathology of the intracranial mass lesions. The authors confirmed the supratentoral space to be one compartmental space where pressure distribution is uniform.

Application of a severity index in emergency helicopter transportation. Y. Minowa, T. Oisi, K. Ishidate, Y. Yamamoto, H. Sasaki. Jpn J Acute Med 1986;10:61-67.

A prospective study was carried out to evaluate the emergency interhospital transfer system of the Tokyo metropolitan government with respect to acuteness, safety, and economy. From April 1, 1982. to March 3 1, 1984, 332 patients were transferred from remote is- lands to Tokyo. They were transported by helicopter from the islands. Date and time, sex and age of the patient, time required until call for helicopter, severity index, and clinical state of the patients on admission were recorded. The results are summarized as follows: 1) The mean transport time was 5 hrs 25 mins. 2) Severity index correlated well with the clinical state

of the patients (20 patients’ conditions were underesti- mated). 3) The 128 patients recorded as severe on ad- mission included 25 with intracranial disorders, 17 with acute myocardial infarctions, nine with upper gastrointestinal bleeding, and 19 newborns. 4) Emer- gency helicopter transportation occupies 10.1% of the annual flight time of the Aviation Corps of the Tokyo Fire Department. The authors conclude that applica- tion of a severity index is extremely useful in long-dis- tance interhospital transportation of emergency pa- tients by helicopter.

Continuous measurement of intramuscular pressure (IMP). H. Kuroki, T. Mizutani, H. Tsutsumi, H. Ta- kahashi, H. Tanabe, K. lde, H. Toyooka, K. Mii, M. Tsuzuki. Jpn J Acute Med 1986;10:69-74.

Compartment syndrome, which is not rare in trauma patients, may easily lead to the development of Volkmann’s ischemic contracture. Early diagnosis of the compartment syndrome is especially difficult in cases complicated by coma, nerve injury, and multiple injuries. Intramuscular pressure (IMP) is at present considered the only objective means to diagnose com- partment syndrome. Many procedures, including wick catheterization, have been reportedly used to measure IMP. However, monitoring IMP is still uncommon, perhaps because of the uncommercialized special catheters and the complexity of the procedure. Using a Touhy needle and an epidural catheter with pores, continuous monitoring can be easily performed, and changes in IMP value can be measured rapidly and accurately in this procedure. By monitoring IMP, not only the indication to decompress, but also the loca- tion and depth of decompression escharotomy can be determined accurately.

Computed tomography in diagnosis of thoracic trauma. K. Kitamura, S. Wantanabe, M. Kamachi, T. Ishii, Y. Sasaki, K. Kuwata. Jpn J Acute Med 1986;10:75-80.

Computed tomography (CT) was used to study 41 patients with chest injuries in 1983 and 1984. Positive findings were demonstrated in 35 cases. Computed to- mography revealed pleural, pulmonary, mediastinal, diaphragmatic, and chest-wall injuries. Computed to- mography was useful in planning the therapy of a chest injury as well as in its diagnosis.

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