PURPOSE: A recent report introduce a new option for cardiopulmonary resuscitation by using of a continuous descending aortic balloon occlusion. The aim of the present study was to evaluate the effect of balloon occlusion of the descending aorta during cardiopulmonary resuscitation on brain ischemia. METHODS: Twelve rabbits were enrolled in this study. A 4 French Swan-Ganz catheter was advanced through the right femoral artery into the descending aorta. Ventricular fibrillation was induced with an AC current delivered through an electrode catheter advanced into the right ventricle. After 3 minutes of untreated ventricular fibrillation, the rabbits were randomized in two groups: (1) chest compression without balloon occlusion (control group) and (2) chest compression with balloon occlusion of the descending aorta (experimental group). The balloon was inflated for 3 minutes during resuscitation. Defibrillation was attempted at 3 minutes after start of chest compression. At 24 hours after return of spontaneous circulation, brain tissues were fixed in 4% paraformaldehyde and stained with hematoxylin eosin. Then, the ischemic cells in the hippocampal CA1 area were counted. RESULTS: There was significant difference in ischemic neuronal cells between the two groups (control group: 41.8 +/-10.9%, experimental group: 16.8+/-6.8%, p < 0.05). In the experimental group, carotid blood flow was better than it was in the control group during chest compression (control group: 2.4+/-1.0 mL/min, experimental group: 7.6+/-1.9 mL /min, p < 0.05). CONCLUSION: These results suggests that balloon occlusion of the descending aorta during resuscitation decreases brain ischemia in rabbits during cardiac arrest.
Aorta, Thoracic ; Balloon Occlusion* ; Brain Ischemia* ; Brain* ; Cardiopulmonary Resuscitation* ; Catheters ; Electrodes ; Eosine Yellowish-(YS) ; Femoral Artery ; Heart Arrest ; Heart Ventricles ; Hematoxylin ; Neurons ; Rabbits* ; Resuscitation ; Thorax ; Ventricular Fibrillation

Acute aortic dissection is a catastrophic, often life threatening event that usually presents as a sudden, severe, exquisitely painful, ripping sensation in the chest or back. Painless dissection occurs in approximately 5% of the patients, and the diagnosis may often be delayed. It can be associated with neurologic sequelae, such as ischemic stroke, spinal cord ischemia, ischemic peripheral neuropathy, in as many as one-third of the patients. As an initial manifestation, neurologic deficit is seen in about 20% of patients. The diagnosis of ischemic stroke in patients who present within a 3-hour time window is generally made on clinical grounds before administration of thrombolytic therapy. The etiology of the stroke is not definitely determined until well after the patient has received recombinant tissae plasminogen activator. It is likely that poor outcomes will occur in ischemic stroke resulting from aortic dissection if r-tPA is administered intravenously. Therefore, it is important to clinically recog-nize this possibility. We report the case of a patient who presented with symptoms consistent with acute ischemic stroke and was given r-tPA. Further investigation demon-strated an aortic dissection as the cause of her stroke.
Diagnosis ; Humans ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Plasminogen Activators ; Sensation ; Spinal Cord Ischemia ; Stroke* ; Thorax ; Thrombolytic Therapy

PURPOSE: Although mechanical ventilation is used to improve oxygenation, this strategy can impose injurious mechanical stress on lung tissue. This is recognized as ventilator-induced lung injury (VILI). Recently, several studies have reported that inflammatory cells and mediators play an important role in the progression of VILI. This study was designed to investigate, in a rat model, the expression of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha, as well as the anti-inflammatory activity of steroids in VILI. METHODS: Male Sprague-Dawley rats were divided into 3 groups. The control group received low tidal volume (6ml/kg) ventilation. The second group received high tidal volume (25 ml/kg) ventilation and the third group received high tidal volume (25 ml/kg) ventilation with methylprednisolone (30 mg/kg) treatment. After 60 minutes of mechanical ventilation, the animals in each group were sacrificed. Resected lungs were immunostained with antisera for IL-1beta and TNF-alpha. The stained areas were evaluated with an image analyzer. RESULTS: In the groups that received a high tidal volume, the number of positive pixels in IL-1 beta and TNF-alpha was significantly higher than it was in the low tidal volume group. The high tidal volume group showed greater expression of I L - 1beta and TNF-alpha,but this was significantly decreased by methylprednisolone. CONCLUSION: Our study suggests that an inflammatory response related with IL-1beta and TNF-alpha is involved in the development of VILI. The expression of IL-1beta and TNF-alpha was lessened by treatment with methylprednisolone, which might have contributed to improving lung dysfunction after mechanical ventilation.
Animals ; Humans ; Immune Sera ; Interleukin-1beta* ; Interleukins ; Lung ; Male ; Methylprednisolone ; Models, Animal ; Oxygen ; Rats* ; Rats, Sprague-Dawley ; Respiration, Artificial ; Steroids* ; Stress, Mechanical ; Tidal Volume* ; Tumor Necrosis Factor-alpha* ; Ventilation ; Ventilator-Induced Lung Injury*

PURPOSE: Cardiac arrest and resuscitation produce global cerebral ischemia and reperfusion injury to the brain, which lead to high mortality and delayed neuronal death. Adenosine has been suggested as an endogenous neuroprotective molecule, acting through multiple potential mechanisms. We investigated the possible neuroprotective effects of adenosine on cerebral recovery following global ischemia induced by asphyxial cardiac arrest. METHODS: Twenty-four rats were randomized into three groups. Group I, II, and III had anesthesia, procedures, and asphyxia for 7 minutes and then survived to 72 hours. Group I(n=8) was not administered N6- L - phenylisopropyl adenosine(L-PIA). Group II(n=8) was administered LPIA(0.8 mg/kg), and group III(n=8) was administered LPIA(1.5 mg/kg) after spontaneous circulation. The dosedependent neuroprotective effects of L-PIA were compared to the control by using a histopathological method. RESULTS: Histological observations of CA1 showed a more significant reduction of neuronal cell loss in groups II and III than in group I(p<0.05). Histological observations of CA2 and CA3 didn't show a significant reduction of neuronal cell loss in groups II and III compared to group I. CONCLUSION: These results show that post-ischemic administration of adenosine protected against delayed neuronal damage in the hippocampal CA1 area following a 7-min asphyxial cardiac arrest in rats.
Adenosine* ; Anesthesia ; Animals ; Asphyxia ; Brain ; Brain Ischemia ; Heart Arrest* ; Ischemia ; Mortality ; Neurons ; Neuroprotective Agents ; Rats* ; Reperfusion Injury ; Resuscitation

PURPOSE: Considerable variation exists in hospital admission rates for patients with community-acquired pneumonia (CAP). The objective of this study was to evaluate whether the pneumonia severity index (PSI) could be applied to patients with CAP as a method for triage in an emergency medical center. METHODS: A total number of 110 patients admitted with community-acquired pneumonia between January 1997 and September 2001. Their medical records were reviewed, with pneumonia severity index, and other risk factors, the time to resolution, and the results of treatment being evaluated. RESULTS: The pneumonia severity index accurately identified the patients with community-acquired pneumonia. Factors we evaluated were related to significant differences statistically, including such as PaCO2, WBC count, suffered lobe count, hypoxic index (PaO2/ F i O2), diabetes, hypertension, number of coexisting illness, period of admission and intravenous antibiotic therapy, and aggravated PaO2. If body temperature was less than 38.5 degrees C, it was considerable for outpatients clinics in Class I and II. CONCLUSION: The pneumonia severity index was a useful screening tool for patients with community-acquired pneumonia. Admission and an active therapeutic plan could be recommended for patients assigned to Class III. Inappropriate admissions were reduced to 27.3% by modified triage algorithm.
Body Temperature ; Emergencies ; Humans ; Hypertension ; Mass Screening ; Medical Records ; Outpatients ; Pneumonia* ; Risk Factors ; Triage*

BACKGROUND: A brief episode of global forebrain ischemia produces selective and often extensive neuronal loss in several vulnerable brain structures. This cell death does not occur immediately, but is delayed for hours to days. This process is termed delayed neuronal death (DND). Recently, several reports have suggested that an apoptotic process may be involved in DND. The most effective treatment at present is intraischemic hypothermia. Thus, we designed this study to investigate whether intraischemic mild hypothermia could inhibit apoptosis following transient forebrain ischemia in gerbils. METHODS: Twenty-four gerbils were divided into two groups based on intraischemic rectal temperature: 34 degrees C(n=12) and 37 degrees C(n=12). Two additional gerbils underwent a sham operation. Cerebral ischemia was produced by occluding both carotid arteries for 10 minutes. The DNA fragmentation in the gerbil hippocapal CA1 area was determined by using the TUNEL method, and the results for the normothermic and the hypothermic groups were compared at 1, 3, and 7 days following 10-min transient ischemia (n=4 for each time point, respectively). RESULTS: 1. Percent dead hippocampal neurons were significantly decreased in the hypothermic group compared with the normothermic group at 1, 3, and 7 days following transient ischemia (p<0.05). 2. In the intraischemic normothermic group, TUNEL positive cells were first detected in the hippocampal CA1 at 3 days (1.9+/-0.6 cells/section), and the number was larger at 7 days following transient ischemia (127.8+/-16.3 cells/section). 3. In the intraischemic hypothermic group, no TUNEL positive cells were detected in the hippocampal CA1 at 1, 3, and 7 days following transient ischemia. CONCLUSION: The data suggest that delayed neuronal death following transient ischemia is, in part, apoptotic and that intraischemic mild hypothermia affords significant neuronal protection and prevents DNA fragmentation.
Apoptosis* ; Brain ; Brain Ischemia ; Carotid Arteries ; Cell Death ; DNA Fragmentation ; Gerbillinae* ; Hypothermia* ; In Situ Nick-End Labeling ; Ischemia* ; Neurons ; Prosencephalon*

BACKGROUND: A major pathway leading toward neuronal injury following ischemia-reperfusion of the brain involves elevation of extracellular glutamate and activation of glutamate receptors, with a subsequent increase in intracellular calcium, resulting in a generation of free radicals. Oxygen free radicals cause brain injury following resuscitation from cardiac arrest. Oxyradicals produce strand breakage in DNA, which triggers energy-consuming DNA repair mechanisms and activates the nuclear enzyme poly(ADP-ribose) synthetase(PARS). However, excessive PARS activation leads to energy depletion and exacerbation of neuronal damage in cerebral ischemia. METHODS: We investigated the effect of a potent, free-radical scavenger, N-acetylcysteine(NAC), on hippocampal neuronal death in an asphyxial cardiac arrest model of rats. The effect of NAC on hippocampal neuronal death was studied in 32 rats which were subjected to asphyxial cardiac arrest for 7 minutes, followed by resuscitation. The animals were divided into four group(8 rats in each group) as follows: Group I was saline treated for 3 days, Group II was NAC treated for 3 days, Group III was saline treated for 6 days, and Group IV was NAC treated for 6 days. In the NAC-treated groups, NAC(150 mg/kg) was intravenously injected after return of spontaneous circulation. The coronal sections with hippocampus levels were stained with hematoxylin-eosin(H-E) and PARS antibodies at 3 and 6 days after survival. In addition, the levels of myeloperoxidase(MPO) and malondialdehyde(MDA) were determined in the brains of each group. RESULTS: The results are as follows: 1. MPO and MDA levels were significantly lower in the NAC-treated groups, II and IV, than in the saline-treated groups, I and III. 2. The histologic damage score(HDS), as determined by H-E staining, was significantly lower in the NAC-treated groups, II and IV, than in the saline-treated groups, I and III. 3. In PARS immunohistochemical staining, the HDS was significantly lower in the NAC-treated groups, II and IV, than in the saline-treated groups, I and III. CONCLUSION: These results suggest that a free-radical scavenger, N-acetylcysteine, may effectively prevent neuronal damages after reperfusion from asphyxial cardiac arrest in rats. Further studies will be required to examine both the mechanism of the action and the clinical application of NAC in patients with cardiac arrest.
Acetylcysteine* ; Animals ; Antibodies ; Brain ; Brain Injuries ; Brain Ischemia ; Calcium ; DNA ; DNA Repair ; Free Radicals ; Glutamic Acid ; Heart Arrest* ; Hippocampus ; Humans ; Neurons ; Neuroprotective Agents* ; Oxygen ; Poly Adenosine Diphosphate Ribose ; Rats* ; Receptors, Glutamate ; Reperfusion ; Reperfusion Injury ; Resuscitation

BACKGROUND: Routine cultures of blood in febrile patients being hospitalized with uncomplicated pyelonephritis are parts of accepted management and are advocated in several textbooks of medicine and in several review articles. For a better understanding of the importance of blood cultures for patients admitted with pyelonephritis, we did a retrospective chart review of patients admitted to a medical center over a 2-year period. METHODS: To evaluate the usefulness of blood cultures in patients admitted with pyelonephritis, we conducted a retrospective chart review of patients who were admitted to hospital from 1998 through 1999 with a primary discharge diagnosis of uncomplicated pyelonephritis. RESULTS: Among the 329 patients admitted, 177 patients were included in the study. Sixteen(9.0%) were men, and 161(91%) were women. The mean age was 52.24+/-18.08. The most common precipitating factor was diabetes mellitus (19.2%). Urinalysis results showed E.coli as the causative agent in 155 patients(87.6%). Positive blood culture results were be seen in 67 patients with a 37.9% sensitivity. The usefulness of blood cultures in acute pyelonephritis was statistically significant only in the case of fever(P=0.003). CONCLUSION: In the setting of uncomplicated pyelonephritis in the adults, if urine cultures can be obtained, blood cultures are not usually necessary. Settings where blood cultures might be appropriate include immunosuppressed patients, patients in whom the diagnosis is not clear, patients in whom bacteremic seeding of the kidney is suspected, and patients who have a prior history of urinary tract infection.
Adult ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Kidney ; Male ; Precipitating Factors ; Pyelonephritis* ; Retrospective Studies ; Urinalysis ; Urinary Tract Infections

BACKGROUND: This study evaluated the inhibitory effects of N-acetylcysteine(NAC) and methylprednisolone on lung injury in the paraquat-poisoned rat model. METHODS: Sixty rats were divided into four groups(n=15 in each group) accordingly to the drug administered : group I, only intraperitoneally injected paraquat (20 mg/kg); group II, intraperitoneally injected paraquat and NAC(300 mg/kg); group III, intraperitoneally injected paraquat and methylprednisolone(60 mg/kg); and group IV, intraperitoneally injected paraquat, NAC(300 mg/kg), and methylprednisolone(60 mg/kg). On the 7th day after injection, the survival rate of experimental rats and the positive area of collagen fiber in the injured lung stained by Masson's trichrome were evaluated. RESULTS: 1. There were no differences in the 7-day survival rates for the four groups. 2. The percent of collagen fiber for group II(6.3+/-4.7%) was significantly decreased in comparison with that for group I (14.4+/-9.7%). 3. The percent of collagen fiber for Group III(13.2+/-5.9%) was not significantly different from that for group I(14.4+/-9.7%). 4. The percent of collagen fiber for Group IV(6.9+/-4.6%) was significantly decreased in comparison with that for group I, but was not different from that for group II. CONCLUSION: These results suggest that NAC protects against pulmonary fibrosis in paraquat-poisoned rats whereas methylprednisolone does not protect against pulmonary fibrosis.
Acetylcysteine* ; Animals ; Collagen ; Lung Injury* ; Lung* ; Methylprednisolone* ; Models, Animal* ; Paraquat ; Pulmonary Fibrosis ; Rats* ; Survival Rate

BACKGROUND: Doxylamine succinate(DS) is an antihistamine commonly used as an over-the-counter medication to relieve insomnia and frequently involved in overdoses. Its overdoses are dominated by anticholinergic effect. Recently it was revealed that DS had a direct effect on muscle, while its exact mechanism is not clear yet. We evaluated the patients with rhabdomyolysis induced by DS overdose for patients disposition based upon clinical decision, especially by creatinine phosphokinase(CPK). METHODS: We reviewed retrospectively the medical records of patients admitted by DS overdose from Jan. 1998 to Oct. 1999. Seventy and nine cases of DS overdose were evaluated with respect to age and sex distribution, amount ingested, clinical symptomatology, time from ingestion to visit, pattern of CPK, amount of bicarbonate used as therapy, complication and prognosis, especially in patients complicated rhabdomyolysis. RESULTS: Rhabdomyolysis, diagnosed as more than 1,000I. U/L of CPK, has been noted in 25(31.6%) of 79 cases of DS overdose visited to our emergency department(ED). In patients diagnosed rhabdomyolysis, the number of man was 10 cases(40%) and the number aged between 20 and 40 years was 22 cases(88%). The average time from DS ingestion to ED visit was 459 minutes. The amount of DS ingested was 500-5,000mg(mean, 1,980mg). 13(52%) cases ingested less than 2,250mg of DS. The initial levels of CPK(range, 48-14900I. U/L; normal range, 26-200I. U/L) after admitting to our emergency department were normal in 15 cases(60%) of rhabdomyolysis patients. The range of peak CPK levels after ingestion was 607 to 412,500I. U/L(mean, 33,550I. U/L). Its peak time was 6 to 96 hours(mean, 28.96 hours). In 14 cases(67%) of 21 visiting within 24 hours after ingestion, peak time of CPK ranged 12 to 24 hours after ingestion. The amount of bicarbonate used as therapy of rhabdomyolysis ranged 100 to 2,740mEq(mean, 656mEq) and all patients was discharged after improvement without other complication including acute renal failure. CONCLUSIONS : Although patients ingested less than 2,250mg of DS, emergency physicians should observe them more than 24 hours after DS ingestion with CPK follow-up after gastric irrigation and charcoal administration.
Acute Kidney Injury ; Charcoal ; Creatinine ; Doxylamine* ; Eating ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Gastric Lavage ; Humans ; Medical Records ; Prognosis ; Reference Values ; Retrospective Studies ; Rhabdomyolysis* ; Sex Distribution ; Sleep Initiation and Maintenance Disorders ; Succinic Acid*