[Present condition of the poisoning reason substance analysis in an advanced critical care center].

We investigated the significance of analyzing substances causing intoxication in emergency centers. The poison analysis room was established 6 years before this study. We analyzed a total of 504 patients with intoxication (203 males and 301 females). Concerning the prognosis, 23 patients died; 16 patients (10 males, 6 females) died of paraquat/diquat intoxication, 3 patients (3 males) died of intoxication with organic phosphate agents, 1 patient (male) died of intoxication with a phenoxy agent, and 3 patients (1 male, 2 females) died of intoxication with antipsychotic agents. The other 481 patients were discharged after improvement or referred to another department. Furthermore, we examined the presence or absence of information on intoxication at consultation in the patients with intoxication. In 69 (71.9%) of 96 episodes of intoxication with pesticides, the results of analysis were consistent with the information. In 27episodes (28.1%), there was no information at consultation, or the results of analysis were not consistent with the information. In 299 (79.9%) of 374 episodes of drug poisoning, the results of analysis were consistent with the information. In 75 episodes (20.1%), there was no information at consultation, or the results of analysis were not consistent with the information. These results suggest that the analysis of substances causing intoxication is essential in 20% of patients. We investigated the serum cholinesterase (ChE) level on the initial consultation in the patients with intoxication with pesticides. Ingestion of organic phosphate agents markedly reduced the serum ChE level. However, our results suggest that the serum ChE level depends on the type/amount of pesticides and the interval after ingestion. In addition, many patients took several types of pesticides or drugs, suggesting the importance of analyzing substances causing intoxication.

Preoperative diagnosis of obturator hernia by computed tomography.

A retrospective study of 6 patients with obturator hernia diagnosed before surgery by X-ray and computed tomography (CT) was conducted between 1993 and 2000. The initial CT of the abdomen including the pelvic area revealed incarcerated bowel in the obturator foramen of all 6 patients. All patients underwent laparotomy as soon as possible after CT scans were obtained. Resection of the small bowel was performed in 3 patients, and release of the small bowel was performed in the remaining 3 patients. There were no perioperative deaths. In elderly women who show evidence of small bowel obstruction by abdominal plain x-ray studies, we recommend performing CT scans of the abdomen including the pelvic area for detection of obturator hernia.

Effects of hypertonic saline and dextran 70 on cardiac diastolic function after hemorrhagic shock.

BACKGROUND: A bolus of 7.5% NaCl-6% Dextran 70 (HSD) is effective in resuscitating hypovolemic shock. Common hemodynamic findings with HSD are restoration of cardiac output, increased blood pressure, and improvement of peripheral circulation. However, the effect of HSD upon cardiac function is still controversial. In our previous study, when HSD did not improve cardiac contractility, it was speculated that it might affect cardiac diastolic function without a change in contractility. Therefore, we studied the effects of HSD on cardiac diastolic function. METHODS: Hemorrhagic shock was created by exsanguination of 31.4 +/- 0.9 ml/kg (NS group) or 29.0 +/- 3.6 ml/kg (HSD group). Then mean BP was maintained at 50 mm Hg for 30 min in both groups. The HSD group (n = 6) received HSD (4 ml/kg) and the NS (control) group (n = 5) received normal saline (40 ml/kg) after the shock. Cardiac diastolic functions were measured in both groups using the peak negative dP/dt and the left ventricular end-diastolic pressure-volume relationship (EDPVR) during the experimental period: before shock, immediately, and 2 h after resuscitation. RESULTS: Hemodynamic parameters in both groups demonstrated similar changes throughout the experimental period. The peak negative dP/dt, stiffness constant, and elasticity obtained by EDPVR did not differ significantly between the two groups. CONCLUSION: HSD seems to be an effective resuscitation fluid after hemorrhagic shock because the volume of HSD required to maintain circulation is significantly smaller than that of normal saline. However, our data revealed that HSD does not change cardiac diastolic function after hemorrhagic shock.