AMERICAN JOURNAL OF EMERGENCY MEDICINE H Volume 7, Number 6 E November 1989

fusion volume were compared between the operated group (10 patients) and nonoperated group (5 patients). Most operated cases (8 of 10 patients) had signs and symptoms of traumatic shock. Two patients without shock demonstrated signs of severe peritoneal irrita- tion. There was little difference between the two groups in CT findings and laboratory data. The mean blood transfusion volume was 4,968 2 4,640 mL in the operated group and 443 + 496 mL in the nonoperated group, with a statistically significant difference. In the nonoperated group, abdominal and extra-abdominal injuries were few except for spleen rupture. On the other hand, in patients in the operated group in whom the ruptured spleen was preserved, no other abdomi- nal injuries were seen.

Trials of early diagnosis of gastrointestinal tract perfo- ration by gastrografin test. Yatagai T, Shibagaki K, Kimura T, et al. Jpn J Acute Med 1989;13:593-599.

Gastrografin is hardly absorbed in the gastrointesti- nal tract, but it is absorbed through the pleura, peri- toneum, and retroperitoneum and excreted from the kidney into urine. It was confirmed experimentally that perforation and failure of suture in the gastroin- testinal (GI) tract can be diagnosed early by determi- nation of the amount of gastrografin excreted into urine, making use of the above mechanism, and this method was applied to clinical diagnosis. Six of 10 clinical cases with perforation or failure of suture in the GI tract were positive to the gastrogratin test; in five of these positive cases, plain films of the abdomen revealed no free air. These results suggest that this test may be useful for early diagnosis of these disorders.

Delayed posttraumatic hematoma remote from the site of craniotomy for the decompression of traumatic in- tracranial hematoma. Onishi H, Ito H, Kasihara K, et al. Jpn J Acute Med 1989;13:601-608.

Eleven patients who developed second intracrani- al hematomas remote from the site of craniotomy shortly after evacuation of traumatic intracranial he- matoma are reported. Such delayed posttraumatic in- tracranial hematoma was not evident on the preoper- ative CT in all cases. Of the 11 patients, seven devel- oped epidural hematomas and four subdural and/or intracerebral hematomas after the first operation. They underwent second operations; one patient died, four became severely disabled, and six recovered. This experience suggests (1) that decompression of the intracranial contents by removal of hematoma may promote the development of another delayed he- matoma and (2) that decompressive surgery should be performed as soon as possible if any signs of delayed posttraumatic hematoma appear after the first opera- tion.

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A step-up treatment of cardiac tamponade. Percardio- centesis, percutaneous continuous percardial drain- age, subxiphoid pericardial window, and percardial peritoneal window. Yasuma F, Tsuzuki M, Kami- hara S, et al. Jpn J Acute Med 1989;13:609-612.

Eleven cases of cardiac tamponade were treated by step-up treatment. In the management of cardiac tam- ponade, percardiocentesis (PC) should be attempted first, and when PC proves feasible, it should be fol- lowed by percutaneous continuous percardial drainage (PCPD). Subxiphoid pericardial window (SPW) is in- dicated when PC would involve a high risk of compli- cation and also when PCPD is impossible or fails to improve hemodynamics. Pericardial peritoneal win- dow (PPW) is indicated when PCPD fails to prevent early recurrence of cardiac tamponade due to the rapid reaccumulation of pericardial fluid and when tumor invasion or inflammation extends to the low anterior mediastinum. All these procedures, which can be per- formed under local anesthesia, are considered clini- cally useful even in the high-risk patient with cardiac tamponade .

Clinical evaluation of organ function in brain death. Chishiro T, Akahori M, Kiuchi S, et al. Jpn J Acute Med 1989;13:619-624.

The sex and age distribution, pathological condition on admission, primary disease, time of brain death, visceral disorder, treatment method, and cost of treat- ment were reviewed in 24 brain death patients seen between January 1985 and January 1988. The time from the onset of the disease until brain death ranged from 1 to 23 days. The time from brain death until cardiac standstill ranged from 1 to 21 days. Artificial respiration was continued after brain death in all cases. Catecholamines and other drugs were adminis- tered in 71%, antibiotics were administered in 63%, and cardiopulmonary resuscitation was performed at the time of cardiac standstill in 25%. Thus, life- preservation efforts were not abandoned in spite of brain death. The hepatic, renal, and respiratory func- tions showed abnormal values after brain death in 35%, 63% and 47%, respectively, demonstrating a high incidence of visceral abnormalities following brain death. The positive life-preservation treatment in- volved six times as much cost as nonpositive treat- ment.

The anesthetic management during emergent distal sple- norenal shunt operations for uncontrollable esophage- al variceal bleeding. Okida M, Ohishi M, Kamide T, et al. Jpn J Acute Med 1989;13:613-618.

Over a period of 5 years, 18 emergent operations for uncontrollable esophageal variceal bleeding were per-