Noninvasive continuous blood pressure monitoring using microelectromechanical system technology.

BACKGROUND: Continuous blood pressure monitoring is essential in the management of patients in critical conditions, as well as those under anesthesia. However, continuous blood pressure monitoring requires insertion of a catheter into the radial artery. Thus, continuous noninvasive arterial blood pressure monitoring would be ideal. PARTICIPANTS AND METHODS: We designed and built a continuous noninvasive arterial blood pressure monitoring device with a pressure sensor diaphragm using microelectromechanical system technology, a square with 4 mm sides that were 0.4 mm thick. Comparisons between a continuous noninvasive arterial blood pressure monitoring device and a sphygmomanometer were carried out on 92 volunteers, and comparisons between noninvasive and invasive blood pressure monitoring were performed on three patients perioperatively at Fukushima Medical University Hospital. RESULTS: In the comparisons of arterial blood pressure measurements between a sphygmomanometer and our device, the differences became gradually greater over time after starting continuous monitoring in conscious participants. In the comparisons of arterial blood pressure measurements between the invasive and noninvasive methods in unconscious subjects under general anesthesia, the results of noninvasive monitoring were consistent with those of invasive arterial blood pressure monitoring. CONCLUSION: Continuous noninvasive arterial monitoring with a pressure sensor diaphragm using microelectromechanical system technology is a possible alternative to conventional invasive arterial pressure monitoring by an arterial catheter.

Small cell carcinoma of the esophagus: a case report.

A case of esophageal small cell carcinoma successfully treated with combination therapy consisting of preoperative chemotherapy, radiation therapy, and surgical resection. A 76-year-old man presented with a small cell carcinoma measuring 6 cm in diameter in the middle third of the thoracic esophagus. After preoperative therapy, the gross tumor was completely resected. The patient eventually died of metastatic disease 25 months after diagosis. We discuss the treatment of esophageal small cell carcinoma.

Giant appendiceal mucocele: report of a case.

Mucoceles of the appendix are a group of mucus-filled lesions causing obstructive dilation of the ileocecal appendix. We report a rare case of giant appendiceal mucocele. A 48-year-old woman, with no discomfort, was admitted to our hospital after a mass was detected in the right lower quadrant of the abdomen. The patient underwent right hemicolectomy on the basis of the clinical diagnosis of a possible appendiceal tumor. The final pathologic diagnosis was mucocele of the appendix.

Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest.

BACKGROUND: The American Heart Association 2010 resuscitation guidelines recommended adding a fifth link (multidisciplinary postresuscitation care in a regional center) to the previous 4 in the chain of survival concept for out-of-hospital cardiac arrest. Our study aimed to determine the effectiveness of this fifth link. METHODS AND RESULTS: This multicenter prospective cohort study involved all eligible out-of-hospital cardiac arrest patients in the Aizu region (n=1482, suburban/rural, Fukushima, Japan). Proportions of favorable neurological outcomes were evaluated before (January 2006-April 2008) and after (January 2009-December 2010) the implementation of the fifth link. After implementation, all patients were transported directly from the field to the tertiary-level hospital or secondarily from an outlying hospital to the tertiary-level hospital after restoration of circulation. The tertiary hospital provided intensive postresuscitation care, including appropriate hemodynamic and respiratory management, therapeutic hypothermia, and percutaneous coronary intervention. One-month survival with a favorable neurological outcome among all patients treated by emergency medical services providers improved significantly after implementation (4 of 770 [0.5%] versus 21 of 712 [3.0%]; P<0.001). The adjusted odds ratios of favorable neurological outcome were 0.9 (95% confidence interval, 0.7-1.1) for early access to emergency medical care, 3.1 (95% confidence interval, 0.7-14.2) for bystander resuscitation, 14.7 (95% confidence interval, 3.2-67.0) for early defibrillation, 1.0 (95% confidence interval, 1.0-1.1) for early advanced life support, and 7.8 (95% confidence interval, 1.6-39.0) for the fifth link. CONCLUSION: The proportion of out-of-hospital cardiac arrest patients with a favorable neurological outcome improved significantly after the implementation of the fifth link, which may be an independent predictor of outcome. CLINICAL TRIAL REGISTRATION: URL: http://www.apps.who.int/trialsearch. Unique identifier: UMIN000001607.