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Objectives: Prolonged ventricular fibrillation (VF) is associated with a low rate of return of spontaneous circulation (ROSC) following electric shock. Moreover, electric shock that does not reestablish spontaneous circulation causes myocardial dysfunction even if ROSC is subsequently achieved. Amplitude spectral area (AMSA), calculated by analysis of VF waveforms immediately before electric shock, is considered to predict the outcome of electric shock. This study aimed to evaluate the prognostic value of AMSA in relation to waveforms of defibrillators in prehospital settings., Methods: The AMSA values of 81 patients with VF confirmed by ambulance crews were compared according to the type of defibrillators with different waveforms and between those with and without ROSC., Results: With a biphasic defibrillator, the mean AMSA was significantly different between the 14 patients who achieved ROSC (25.3 ± 9.5 mV-Hz) and the 43 subjects who did not achieve ROSC (15.4 ± 8.1 mV-Hz; p = 0.0006). No significant difference was seen in the corresponding values when a monophasic defibrillator was used, at 19.1 ± 2.4 mV-Hz for 3 ROSC patients and 16.1 ± 7.5mV-Hz for 21 non-ROSC patients., Conclusion: AMSA may serve as a predictive measure for ROSC following electric shock delivered by a biphasic defibrillator.

Objective: Indexes such as amplitude spectrum area (AMSA) and power spectrum area (PSA) obtained from electrocardiogram waveform analysis are possible predictors of outcome after electrical defibrillation for ventricular fibrillation (VF). In this study, we examined AMSA and PSA to determine whether these parameters can predict defibrillation outcome., Materials and Methods: A total of 83 out-of-hospital VF victims were classified into four groups according to type of cardiac rhythm after shock: return of spontaneous circulation (ROSC), VF, pulseless electrical activity (PEA), and asystole. AMSA and PSA were calculated from electrocardiograms prior to shock and compared between groups., Results: The mean AMSA (4.0-48 Hz) in the ROSC group was 24.2 ± 8.5 mV-Hz, which was significantly higher than that in the VF and asystole groups., Conclusion: It is possible by analyzing the AMSA of VF to predict cases where electrical defibrillation is more likely to return cardiac rhythm. Furthermore, unnecessary electrical shocks with a low possibility of ROSC can be avoided, and chest compression should be continued to prevent myocardial damage and consequently improve prognosis.

We report a case of Yersinia pseudotuberculosis (Y. pseudotuberculosis) septicemia in a healthy 22-year-old woman with clinical manifestations including high fever and general fatigue. The patient's ferer sudden elevation of her fever, and, liver damage and elevated inflammatory markers were indicated. General fatigue and appetite loss were noted on hospitalization. Exanthema was recognized, and all oral medications, including antibiotics, was stopped. The fever continued and high inflammatory parameters developed. After chemotherapy with imipenem, subjective symptoms ameliorated. Membranous desquamation without itching appeared between the fingers of both hands but improved naturally. Y. psuedotuberculosis septicemia was diagnosed as Y. psuedotuberculosis isolated from blood and elevated serum antibody titer against Y. psuedotuberculosis 4b detected at 1:160.

A 64-year-old man was referred to us because of pneumonia refractory to panipenem/betamipron. His chest radiography showed patchy consolidations in the lower lobe of the right lung and in the middle field of the left lung, and severe hypoxia was present. He was diagnosed as having acute respiratory distress syndrome due to severe pneumonia, and was treated with pulse methylprednisolone and sivelestat sodium in combination with intravenous erythromycin and ciprofloxacin. The patient recovered with this treatment. Serological examination using blood samples collected on the 12th and 28th hospital days revealed elevation of anti-L. pneumophila serogroup I antibody. It is suggested that administration of methylprednisolone and sivelestat sodium in combination with intravenous erythromycin and ciprofloxacin in a case of severe Legionella pneumonia complicated with acute respiratory distress syndrome is effective, and may be of use in similar cases.