Usefulness of the Endotoxin Activity Assay to Evaluate the Degree of Lung Injury

PURPOSE: It has been reported that the Pulse Contour Cardiac Output (PiCCO) is very useful mainly in the field of intensive care and treatment to grasp the pathophysiological conditions of pulmonary edema because of its capability of obtaining data such as Pulmonary Vascular Permeability Index (PVPI) and Extra Vascular Lung Water (EVLW). Furthermore, a high degree of usability of various markers has been reported for better understanding of the pathological conditions in cases with septicemia. MATERIALS AND METHODS: The correlation between the cardiorespiratory status based upon the PiCCO monitor (EVLW and PVPI) and inflammatory markers including C reactive protein, procalcitonin (PC), and Endotoxin Activity Assay (EAA) were evaluated in 11 severe cases that required treatment with a respirator in an intensive care unit. RESULTS: The EAA values were significantly higher in patients with abnormal EVLW at 0.46+/-0.20 compared to the normal EVLW group at 0.21+/-0.19 (p=0.0064). In a similar fashion, patients with abnormal PVPI values tended to have higher PC levels at 18.9+/-21.8 compared to normal PVPI cases at 2.4+/-2.2 (p=0.0676). On the other hand, PVPI was significantly higher in the abnormal EAA group at 3.55+/-0.48 in comparison with the normal EAA group at 1.99+/-0.68 (p=0.0029). The abnormal EAA group tended to have higher PVPI values than the normal EAA group. CONCLUSION: The EAA is a measurement method designed to estimate the activity of endotoxins in the whole blood. Our results suggest that the EAA value, which had the greatest correlation with lung disorders diagnosed by the PiCCO monitoring, reflects inflammatory reactions predominantly in the lungs.

Studies on Therapeutic Effects and Pathological Features of an Antithrombin Preparation in Septic Disseminated Intravascular Coagulation Patients

PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.

Monshinhyo That Are Also Comprehensible to Foreigners: Monshinhyo Comprehension Research / 国際保健医療

<b>Introduction</b><br> Recently, foreign residents' difficulties using the Japanese medical system are being acknowledged. This study investigates the case of the medical intake forms, <i>monshinhyo</i>, that new patients at Japanese medical facilities must complete.Many patients, especially non-native ones, find them difficult.<br><b>Method</b><br> First, 6 foreign and 6 Japanese students (hereafter, FS and JS) at 4-year universities were interviewed regarding their understanding of <i>monshinhyo</i> taken from three different departments -obstetrical, surgical, and internal medicine - at a hospital in Kansai; then, a questionnaire was developed and given to 25 FS and 85 JS.<br><b>Results</b><br> Both FS and JS noted language problems. JS could pronounce medical terms better than FS but comprehended them only about as well as FS. Moreover, both FS and JS found the styles, layouts, and purposes of some questions unclear, and they sometimes had to guess the details of what <i>monshinhyo</i> requested. These included questions involving symptoms, divisions of medical departments, and semantic range of terms for blood relations. Also, medical practices/norms not found in the native country sometimes puzzled FS.<br><b>Conclusions</b><br> Problems with <i>monshinhyo</i> arise from <i>both</i> the patients' side-Japanese as well as foreign-due to limited medical-related vocabulary/kanji and/or a lack of experience using Japanese medical services, <i>and</i> the <i>monshinhyo</i> themselves, due to their inclusion of unclear questions and ambiguous expressions. Probably, <i>monshinhyo's</i> authors' familiarity with medical terms and the Japanese medical system caused them to take for granted more knowledge than many patients actually have. To improve medical services, therefore, we suggest reexamining and reorganizing questions that already exist, introducing multiple choice and yes/no questions when possible, and providing <i>furigana</i> for <i>kanji</i>. Fundamentally, throughout the medical system, patients should be able to understand all the language they encounter. Clarifying the language, cultural assumptions, and purpose(s) of <i>monshinhyo</i> is a good starting point.