AMERICAN JOURNAL OF EMERGENCY MEDICINE m Volume 7, Number 2 m March 1989

Endotoxin levels and endocrine function in patients with multiple organ failure. Tsubo T, Tanioka F, Ishihara H, et al. Jpn J Acute Med 1989;12:1131-1134.

The relationship between plasma levels of endotoxin and hormones were studied in patients with multiple organ failure (MOF). Thirty-one blood samples from nine patients with MOF were evaluated in this study. Twenty samples from preoperative patients were used as controls. The average level of plasma endotoxin was 188.7 + 37.0 pg/mL (mean ? SE) in MOF pa- tients, but it was 12.4 + 3.3 pg/mL in control patients (P < .005). Plasma levels of cortisol, aldosterone and plasma renin activity levels increased, but plasma lev- els of T,+, T,, and TSH decreased in MOF patients compared with levels in control patients. However, little correlation was observed between plasma levels of endotoxin and hormones. Other factors other than endotoxin levels may also be involved in alteration of hormone levels in MOF patients.

Acute paraquat death and standard laboratory data on admission. Sato S, Tonouchi S, Yamaguchi H, et al. Jpn J Acute Med 1988;12: 1125-l 129.

Fifty-five cases of acute paraquat poisoning in a se- ries of 115 patients were studied retrospectively, and the value of laboratory data on admission concerning the possibility of acute death was investigated. The value of serum creatinin, potassium, and HCO, in ar- terial blood showed significant differences between the early death group (during the first 48 hours after ingestion) and the survival group (P < .05). As a cause of acute death, renal insufficiency, especially renal tu- bular disturbances, was suspected. In paraquat poi- soning, patients who showed a strong positive reaction to urine qualitative test and (1) elevation of serum cre- atinin, (2) hypopotassemia, or (3) metabolic acidosis have a high possibility of death during the first 48 hours after ingestion.

Management of blunt hepatlc trauma. Shimoyama T, Fukuda Y, Kusano H, et al. Jpn J Acute Med 1988;12:1145-1152.

One hundred three consecutive cases of blunt he- patic trauma seen at an emergency department since 1965 were reviewed. Fifty-two patients had minor in-

jury, 31 had moderate injury, and twenty had severe injury. Fifty-six patients (54.6%) also sustained one or more associated injuries. Thirty of 43 patients over the last 10 years were diagnosed by ultrasound or com- puted tomography. Eighty-eight patients (85.4%) un- derwent laparotomy; laparotomy and drainage alone in 13, suture and packs in 56, debridement and/or minbr liver resection in 10, and right lobectomy in 9. The

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results in treated patients were assessed according to the grading of liver injury and associated injury. The overall mortality was 14.6% (15 of 103). Fifteen pa- tients were conservatively managed, with only one death, and 14 survivors who had no complications and had healed completely by 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for a massive injury, conservative management for mild or moderate ruptures is recommended.

A clinical study on patients with severe congestive heart failure treated with mechanical ventilation. Saitoh T, Kamijima G, Ohishi T, et al. Jpn J Acute Med 1988;12:1137-1144.

Seventy-six patients with severe congestive heart failure treated with the mechanical ventilator were the basis for this clinical analysis. Forty-three of the 76 patients (64%) survived. There was no relationship be- tween the survival rate and the data in blood gas anal- ysis examined before respiratory treatment with the ventilator. However, the survival rate decreased in proportion to the severity of cardiac function, and was lowered by a delay of initial treatment with the venti- lator. In respiratory treatment, the application of a ventilator or positive end expiratory pressure (5 to 10 cm H,O) did not deteriorate patients’ cardiac function. Complications associated with ventilator control took place in the early stage, but lung edema after weaning from the ventilator should be observed carefully. These results suggest that respiratory therapy with the ventilator should be initiated earlier, especially for pa- tients with decreased cardiac function.

Evaluation of a large-dose intravenous administration of urinastatin. Sugiura Y, Nakajima K, Kawase H, et al. Jpn J Acute Med 1988;12:1153-1156.

The effects of three different infusing techniques of a large dose of urinastatin on plasma concentration change in patients undergoing abdominal surgery were examined. In the group given 300,000 units in a bolus, the plasma concentration was 91.5 (U/mL) at two min- utes, 52.6 at 30 minutes, and 1.5 at 210 minutes, re- spectively. A bolus administration exhibited an ex- tremely high plasma concentration at 30 minutes and a lower concentration at 210 minutes compared with continuous infusion techniques. Second, the intrave- nous bolus urinastatin of 300,OUO units inhibited the increase of serum enzyme levels of amylase, glutamic oxaloacetic transaminase, and lactic dehydrogenase, usually induced by surgical stress, but the compliment elements (C3, C4, CH50) did not change. These results suggest that a high-dose intravenous administration of urinastatin in a bolus is simple, safe, and effective.