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A male infant developed abdominal compartment syndrome (ACS) due to stage-4S neuroblastoma and hepatic enlargement. Because of tumor lysis syndrome by chemotherapy and radiationtherapy, his condition deteriorated and he underwent emergent abdominal counterincision surgical operation in the intensive care unit. General anesthesia was maintained with O2 (100%), midazolam (0.25-0.3 mg x kg(-1) x hr(-1)), fentanyl, and rocuronium infusion. By removal of the ACS, the breathing improved. At the end of the operation, we inserted GamCath catheter from his internal jugular vein for CHDF performed after the operation. We used midazolam, fentanyl and rocuronium for sedation. Subsequently, 8 days later, his general condition markedly improved, and we could evade performing CHDF.

Background: The purpose of this study is to examine the effects of neutrophil elastase inhibitor on postoperative cytokine levels in patients after esophagectomy., Methods: Fifteen patients were divided into two groups; group 1: 9 patients receiving neutrophil elastase inhibitor (0.2 mg x kg(-1) x hr(-1) from the admission to ICU to extubation), group 2: 6 patients as a control. We measured neutrophil elastase activity, interleukin 1-beta, interleukin 6 and interleukin 8 preoperatively, just after the admission to ICU, and 24, 48 and 72 hours after the surgery., Results: There were significant differences in neutrophil elastase activity and interleukin 8 in group 1 24 hours after the surgery, compared with those in group 2. The time necessary for mechanical ventilation in group 1 was shorter than that in group 2 (group 1: 44.7 +/- 24.7 hrs, group 2: 112.8 +/- 90.3 hrs, P = 0.048)., Conclusions: The administration of neutrophil elastase inhibitor may be useful for patients after esophagectomy to reduce overexpression of plasma cytokine levels after surgery.

Fulminant myocarditis is a fetal disease characterized by a distinct viral prodrome, sudden onset of severe hemodynamic compromise, and marked myocardial inflammation. One possible therapy to improve the poor prognosis of such patients may be the implantation of circulatory support systems that allow myocardial recovery. We report here successful management of a patient with fulminant myocarditis using percutaneous cardiopulmonary support (PCPS), intra-aortic balloon pump (IABP), and continuous hemodiafiltration (CHDF). A 37-year-old Japanese man suddenly experienced cardiopulmonary dysfunction shortly after general fatigue, and was diagnosed as having fulminant myocarditis. PCPS was immediately initiated because catecholamine infusion and IABP were not enough to support circulation. Although severe dyskinesis was observed on his admission, cardiac function recovered twelve days after PCPS initiation with ejection fraction from 16% to 73%. Renal and hepatic failure also recovered with the improvement of cardiac function. We describe our clinical experiences in cardiogenic shock after acute fulminant myocarditis and discuss therapeutic guidelines for the use of PCPS, with its management and complications.

A 19-year-old woman suffered from a severe asthmatic attack. She did not respond to any of the conventional therapies and eventually lapsed into a state of unconsciousness. We administered isoflurane 1-2% via an endotracheal tube, but, she still required a ventilator. This study was carried out in order to compare the effects of halothane, isoflurane and sevoflurane in the treatment of a severe asthmatic patient. The inhalation of isoflurane, halothane and sevoflurane decreased the airway resistance and systemic vascular resistance in direct relationship to the dosage administered. Because the patient's metabolic rate is low and the occurrence of arrhythmias is rare with isoflurane, we concluded that isoflurane is the best alternative for the patient with asthma.

The Do2/VO2 balance of splanchnic organs after heart surgery was evaluated using two different methods; the measurement of hepato-splanchnic oxygen extraction ratio (OERspl) and gastric intramucosal pH (pHi) employing a hepatic venous catheter and a gastric tonometric catheter. Systemic oxygen extraction ratio was within normal ranges during the 24 hours of the experiment, but pHi decreased and OERspl increased significantly at 6 hours after admission to the ICU. Both pHi and OERspl returned gradually to normal levels after 24 hours. We conclude that a period of 24 hours is required to restore sufficient blood flow in the visceral organs to meet oxygen demand and that the pHi reflects the splanchnic DO2/VO2 balance as well as OERspl.

Hemodynamic effects of amrinone and the changes in pulmonary shunt were studied in patients for open heart surgery. Eighteen patients were allocated into two groups (group L, H) on the first day of surgery. Group L consisted of 10 patients who received moderate-dose catecholamine (DOA + DOB < 12 micrograms.kg-1.min-1) and group H consisted of 8 patients who needed high-dose catecholamine (DOA + DOB > or = 12 micrograms.kg-1.min-1) to maintain normal hemodynamics. After baseline measurement, amrinone infusion was started and the dose was increased by every 2 hours (5, 10, 20 micrograms.kg-1.min-1). At dose of 20 micrograms.kg-1.min-1, cardiac index increased significantly in group L but not in group H. SVRI and PVRI decreased by dose related fashion in both groups. Systemic arterial pressure was unaltered in group L while it decreased significantly in group H. PaO2 decreased and pulmonary shunt increased in both groups. These results suggest that inotropic response of amrinone depends on the basal level of myocardial contractility although vasodilative property and the effect on the pulmonary shunt are almost similar in both groups.