AMERICAN JOURNAL OF EMEWENCY MEDICINE I Volume I, Numbrr 2 I March 1227

ICP whether barbiturates wem lnfuti or not, In endotra- choaI ructionlng, ICP slavatlon wu extremely high com- pamd to the other four maneuver, Barbltumter euppresead tho olovatlon of ICP in all numlng nuutouvam, particularly in sndotracheal auctioning and in posture changing. Serial endotracw suctioning turuited in II tial increase in the rate of ICP olovatlon, which WM niro euppmrecd by bar- biturate lnfulion, Our conclurlon ie that numlng care, es- pecllrlly on&tracheal suctioning for herd-l&tmd patients, mud be performed camfully and that barbituratea effectively pmvent ICP elevation.

Toxklty of a utdlum a&ate rolutIon u& aa concrete hardener: An experImentnI rtudy, Yokote T, Ozawa H, Ogata T, et al. Jpn J Acute Mod 1986;IO:lOI i-1013.

Mannol@, a hardening accelerator of concreta, ir a strong aikailne aolutlon of itodium rlllcrtc, The lolutlon is a com- mon lnduetrlai material, but no exporimentai Btudy of its toxicity hna been reported as yet. Thir rrtudy WM dorlgned to olucldata the toxic effects of Mannolo by using experl- mental animals, Male Wlster rats mcelved a mingle oral admlnl~tmtion of various amounta of Mannol@, correrpond- lng to 2,600, 1,300,650, and 325 mg/kg of rodlum silicate, and wore killed one, three, Ave, seven, and 10 days after adminlrtration. Moat rate treated with 2,600 mg/kg wore dead by the wcond experimental day. By light microscopy, severe ncphtotoxlc effects wore observed in addition to di- rect injury of the gutric mucora. The nephrotoxlc effects related to the dooe t&ctlvoly oxlrted in the dlatal tubules, which became necrotic on the Ant day after the ttuatment, The tubular damage led to aequontlai caIclAcatlon, exudative response, and regoneratlon,

FluM therapy and lb Influence on pulmonary fbnctIon ln rwrely burned children, Okabayiuhl K, Nagarakl K, Mukada K, et al, Jpn J Acute Mod 1986;10:1123-1129.

A retroqective rtudy on fluid therapy during the Ant 24 hours &or bum was conducted in 12 chikiren with travorc bum ranging from 20 to 99% of body rurfaco atua (BSA). In children, it WM necwary to administer much huger amount of Lac-Ringer’s tmlution and collold than ln adult patients or the amount calculated by Baxter’8 formula. De- nplta the fact that children requited larger amounts of fluid, inCM of the respiratory index (A-aD@aos) WM mod- erate during the Ant four days after bum and none of the pntlentBdavelopedxu@mmrylnlutmclencyThelulMonwhy severely burned children required mom fluid than adultr did 8eemed to be due to the fact that children had luger amounta of extracellulu fluid than dld adultrr, CardlopuImonary com- pllcatio~ were thought to be earlly prevented by prophy lactic mechanical vontlIatlon and appllcatlon of poaltlve ond- oxpiratoty premum (PEEP).

~-4-chungcw~urtury~ In

-aw #bUClC~.Yunurroto Y, Kato K, Murate S, et ai, Jpn J Acute Mod 1986; 10:1131-1137.

Pationte in shock ueually manlfeet metabolic dlrordere of perlpheml tlrrwr in the aoquenco of wvom functional din- ordom of the circulatory ryetern, At tho aame time, deatruc- tlon of the lyttoxome mambmne occur0 in the celluiar level and eubquently varlour protem~ are deviated into blood to form rhock viclou~ cycle. The kidney, in pattkulu, is eald to be the target organ for thb &&uctlon, and blood flow dleorder occurs Ant in the kidney among other lm- portant orgfme, which m&feet lrmvemlblo orgrn feihuu8~ Urlnaty trypnln inhibitor, urlnutatin, le a gIucoprotaln of molecular weight of 67,000, which la oxtmcted from he8ithy male urine. It has been mported that urlnaatatln hno a pra- tective effect on hemorrhagic shock, e&toxin rhock, and bum shock, In this study, urinutatln wa8 administered to canine hemorrhagic rhock models, and itr effect on cimu- latory functions WM investigated. Urinutatin Bhowe a ten- dency of improvement in decmased moan arterial proretire caused by dehomatlzatlon. There wan a tendency of im- provement of MAP in the urlnutatin group compared to the control group lmmediatoly before blood mm&u&on. Bo- fore starting the blood rctmnafurlon, cardiac output tendud to be improved in the uri~tatin group compamd to the control group. Urinartatln showed a tembncy of lncroaaing the decmaaed renal blood flow caulled by dehematization. The urlnastatln group aiao showed a tendency to lncmase the docreased renal blood flow compared to the control group, just before etatting blood retran6flwion.

CUnlcaI rtudy of acutely ill patienta with carbun dbxk retentbn. Mateubam I, Tedo I, Ando M et ai, Jpn J Acute Mad 1986;10:1139-I 143.

Ptoblema m8oclnted with m@mtoly maqpmom of acutely 111 patlente with CO2 mtontlon were lnve~tlgatod. Fifty-one patients wore markedly hypemapnb duo to acute or chronic obrtructive lung dirsare, status uthmaticue, heart failure, or pneumonia, Reaplratory mnnagement of there patlenui were done by controlled Oz therapy, drug thempy , or me- chanical ventilation. Four critical-rtate pntient# with statue aethmaticue were managed by inhairtion art&& with haiothane.

hv-dMUta_MIun InwptlcI\urga&bm!kIung,HanhlmotoK,TeraiC, Yukioka T, et al. Jpn J Acute Mal1986;10:1145-1151.

The puIpom of thin study was to olucldate the pntho- phyriologlc dlffemnce b6tween 8eptic lung and other types of acute puhnonuy fallum (APF), e8peclnuy with respect to CO2 ellmlnatlon. Seventeen patIont0 with APP foIIowlng