論文

A case of a 38-year-old male with traumatic shock complicated by methamphetamine intoxication is presented. The patient was involved in an assault which resulted in cardiac tamponade and right ventricular outflow laceration. Pericardiocentesis was immediately performed. However, profound metabolic acidosis greatly in excess of that expected from the short duration of the shock was revealed by arterial blood gas analysis. Another cause of the metabolic acidosis was suspected. The patient subsequently admitted to intravenous use of methamphetamine. Following hemodynamic and metabolic stabilization by continuous pericardial drainage and intravenous administration of sodium bicarbonate, the patient underwent cardiac surgery. His postoperative course was uneventful. There is a substantial association between methamphetamine users and traumatic accidents. In such cases, early identification of drug use is important. Marked metabolic acidosis, which conflicts with the diagnosed cause of shock, may be a clinical clue to methamphetamine intoxication.

A clinical investigation of intravenous ciprofloxacin (CPFX) in the surgical and gynecological fields was conducted in patients with sepsis, peritonitis, biliary tract infections, secondary infections (due to trauma, burns and operative wounds) and gynecological infections, all of which were severe and/or refractory. CPFX was administered intravenously 300 mg twice a day for 3 to 14 days to 87 patients: 4 with sepsis, 22 with peritonitis, 11 with biliary tract infections, 33 with secondary infections, 13 with gynecological infections and 4 with other infections. The clinical efficacy rate was 85.1% (63/74 cases): 100% (2/2 cases) with sepsis, 88.2% (15/17 cases) with peritonitis, 63.6% (7/11 cases) with biliary tract infections, 90.6% (29/32 cases) with secondary infections and 83.3% (10/12 cases) with gynecological infections. The eradication rate of causative organisms was 67.9% (55/81 strains) in terms of bacteriological efficacy. Side effects were noted in 1 case (1.2%) who developed anemia. Abnormal laboratory findings were observed in 18 cases (21.2%) and major findings were increased eosinophil counts and elevated transaminases. The evaluations of overall safety and usefulness were 80.0% (68/85 cases) and 83.8% (62/74 cases), respectively. Therefore, we found that intravenous CPFX is a highly effective drugs for severe and/or refractory surgical infections in the surgical and gynecological fields.

We studied blood MIP-1α and IL-8 in 38 septic patients and 5 healthy volunteers. Both chemokines were undetectable in the healthy volunteers. In sepsis, serum MIP-1α was detected in 45% of the patients and IL-8 in 84%. The levels of MIP-1α, but not of IL-8, correlated with CRP, IL-6 and TNFα levels. Complications, including various organ failures and mortality, showed no correlation with serum MIP-1α levels. In contrast, we found increased levels of serum IL-8 in septic patients with disseminated intravascular coagulation, central nervous system (CNS) dysfunction or renal failure, and the mortality rate was higher in the IL-8-detectable group than in the IL-8 undetectable group (50% vs 0%, p < 0.05). In conclusion, the production of both MIP-1α and IL-8 was increased and initially detectable levels of circulating IL-8 predicted high mortality in sepsis.

The pharmacokinetics and clinical studies were undertaken to evaluate the effect of intravenously administered cefluprenam (CFLP) on the surgical infections. 1. Peritoneal exudate was collected for 3 consecutive days through a Foleys balloon catheter inserted to the subphrenic space at the end of surgery. One g of CFLP was administered twice a day to 3 patients after gastrectomy for gastric cancer. CFLP levels in exudate at 1, 2 and 3 postoperative days were 8.0, 11. 1 and 11.1μg/ml in avarage respectively. The relative mean concentration of CFLP was 5.1μg/ml and belonged to the high value group among 30 β-lactams. 2. Concentration of CFLP in choledocus bile was studied on 1 patient of choledocolithiasis after cholecytectomy and T-tube drainage. Bile levels at 1, 2, 4, 6 and 8 hours after CFLP (1.0g) administration were 0.3, 0.3, 1.9, 4.0 and 4.7μg/ml respectively. 3. In the clinical study, 16 patients received intravenous CFLP (1 or 2g), bid for 4 ~ 16 days. Sixteen patients consisted of 2 cholangitis, 2 panperitonitis, 5 localized peritonitis, 3 postoperative wound infection, 1 burn wound infection, 1 ileopsoas abscess, 1 abdominal wall abscess and 1 periproctal abscess. The clinical effects were excellent in 2 cases, good in 12 cases, fair in 1 case and poor in 1 case ; overall clinical response rate in 16 cases was 87.5%. No adverse drug reaction was noted but slight abnormal laboratory finding in S-GPT was recognized in 1 case. These results suggested CFLP may be useful drug to surgical infections including intraperitoneal infections.

It is occasionally difficult to record the standard 12-lead electrocardiograph (ECG) in emergency patients. The aim of this study was to evaluate the influence on electrocardiographic wave form recordings of moving the location of electrodes from the standard limb lead position to the trunk. The participants were 10 normal subjects and 20 patients with heart disease. In the new lead system, the limb electrodes were placed on the anterior acromial region and the anterior superior iliac spine using adhesive electrodes. Conventional 12-lead ECGs were recorded by the standard and the new lead system simultaneously in the supine position. Wave form analysis was done by an automatic analysis program. Motion artifacts in the recordings were less in the new lead system. The R wave amplitude of the new lead system increased in leads II, III and aVF, and decreased in leads I and aVL. However, the amplitudes of each wave obtained by standard electrocardiography and the new lead system correlated well (y = 1.008x + 2.038, r = 0.99, n = 2,880). In 99.6% of all wave forms, the differences in amplitudes were within 5% of the values of standard recordings. The average of differences in the ST-segment was 2.6 ± 11.4 μV. The frontal plane QRS axis obtained by the new lead system showed a vertical shift of 7.8 ± 8.5 degrees (y = 0.94911x + 10.346, r = 0.98, n = 30). The recording errors produced by the new lead system were within the permissible range of variation. The new lead system is a reasonable alternative for recording ECGs if application of the standard lead is difficult in an emergency. © 1995.

This report describes a patient with food-dependent exercise-induced anaphylaxis (FEA). A 25-year-old female has had three episodes of syncopal attack associated with urticaria in the past two years: the attacks have been developed by exercise after taking meals made of wheat flour. She has an allergic predisposition to metals. No abnormal findings were observed in the routine work up for syncope including, ECG, 24-hour Holter ECG, UCG, tilt table test, and EEG examinations. A provocative test for FEA was performed. It included food (sandwich) intake followed by exercise. The serum histamine concentration was elevated to a three times higher than the control value after the provocation. Accordingly, she was diagnosed as FEA and advised not to take wheat flour prior to physical exercise. No syncopal episode has been observed during the 16 months since the diagnosis.