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Acute Medicine & Surgery

Masahiro Kashiura, Shunsuke Amagasa, Hiroyuki Tamura, Akira Shimoyama, Takashi Moriya
No abstract text is available yet for this article.
January 2019: Acute Medicine & Surgery
Shinya Yaguchi, Hitoshi Yamamura, Kousuke Kamata, Norihito Shimamura, Shinya Kakehata, Atsushi Matsubara
Case: Vertebral artery injury is a low-frequency but high-mortality injury. The surgical approach to a bleeding vertebral artery injury is one of the most difficult procedures in trauma surgery.A 64-year-old woman was transported to our emergency department after being stabbed in the middle side of the right neck with a large kitchen knife. Her initial hospital examination indicated a shock state, and computed tomography images revealed a right vertebral artery injury. We undertook angiography and transcatheter arterial embolization before the surgical operation...
January 2019: Acute Medicine & Surgery
Tatsunori Nagamura, Yoshihiro Tanaka, Takero Terayama, Daishi Higashiyama, Soichiro Seno, Naoaki Isoi, Yuka Katsurada, Akiko Matsubara, Yuya Yoshimura, Yasumasa Sekine, Shinji Akitomi, Kimiya Sato, Hitoshi Tsuda, Daizoh Saitoh, Hisashi Ikeuchi
Case: We describe a rare case of antibiotic-associated fulminant pseudomembranous enterocolitis caused by Klebsiella oxytoca . A 79-year-old man with a history of antibiotic therapy was admitted to our emergency department, complaining of consciousness disturbance. Initially, we suspected septic shock and diabetic ketoacidosis caused by intestinal infection. Although we administered sufficient extracellular fluid, his blood pressure was not elevated and his abdomen gradually swelled. Outcome: The patient died of shock and abdominal compartment syndrome...
January 2019: Acute Medicine & Surgery
Shuzo Yamamoto, Tatsushi Mutoh, Yasuko Tatewaki, Hisanobu Tsurutani, Noriaki Watabe, Hiroshi Saito, Nobuyuki Yasui, Yasuyuki Taki
Case: Non-convulsive status epilepticus (NCSE) is among the differential diagnoses of decreased consciousness, but often presents a diagnostic challenge. A 65-year-old woman was admitted to our emergency department with bradylalia. No abnormal finding was detected by computed tomography or magnetic resonance imaging. Subsequently, acquired arterial spin-labeling images showed hyperperfusion in the right hemisphere. Outcome: After the examination, the patient began experiencing left hemifacial seizures, which were relieved by diazepam; however, she was still agitated...
January 2019: Acute Medicine & Surgery
Takeshi Unoki, Hideaki Sakuramoto, Akira Ouchi, Shigeki Fujitani
Aims: Physical restraints are often used for patients undergoing mechanical ventilation to protect important medical equipment. However, they have adverse physical and psychological effects and could pose ethical hazards. Physical restraint use varies by country, but so far there is little understanding of the frequency of physical restraint use among intensive care unit (ICU) patients in Japan. The present study aims to describe the frequency of physical restraint use among Japanese patients undergoing mechanical ventilation...
January 2019: Acute Medicine & Surgery
Shuichi Kobashi, Takaaki Maruhashi, Tomoya Nakamura, Erika Hatabayashi, Akihide Kon
Aim: Continuous renal replacement therapy (CRRT) with a cytokine-adsorbing hemofilter (CAH) is effective in the treatment of sepsis. Two filter types, namely polymethyl methacrylate (PMMA) and surface-treated AN69 (AN69ST) hemofilters, have been successfully used for CRRT, but no direct comparisons have been published to date. This study compared the efficacy, as measured by 28-day survival rates, of PMMA and AN69ST hemofilters in patients receiving CAH-CRRT. Methods: This retrospective observational study reviewed the medical records of 142 patients who received CAH-CRRT between November 2013 and February 2015...
January 2019: Acute Medicine & Surgery
Kazunari Azuma, Shiro Mishima, Keiichiro Shimoyama, Yuri Ishii, Yasuhiro Ueda, Masako Sakurai, Kentaro Morinaga, Tsubasa Fujikawa, Jun Oda
Aim: Subsyndromal delirium is associated with prolonged intensive care unit stays, and prolonged mechanical ventilation requirements. The Prediction of Delirium for Intensive Care (PRE-DELIRIC) model can predict delirium. This study was designed to verify if it can also predict development of subsyndromal delirium. Methods: We undertook a single-center, retrospective observation study in Japan. We diagnosed subsyndromal delirium based on the Intensive Care Delirium Screening Checklist...
January 2019: Acute Medicine & Surgery
Hidenobu Ochiai, Tomohiro Abe
Aim: Athletes who suffer sport-related concussions but continue playing have a high probability of experiencing more severe symptoms with any subsequent concussion. This study used data from the authors' clinical department to retrospectively investigate the clinical characteristics of sport-related concussion and factors associated with delays in examinations. Methods: The study included 38 patients with sport-related concussions who were treated at the authors' hospital...
January 2019: Acute Medicine & Surgery
Keita Iyama, Takamitsu Inokuma, Shuntaro Sato, Shuhei Yamano, Goro Tajima, Tomohito Hirao, Osamu Tasaki
Aim: Because severe trauma patients frequently manifest coagulopathy, it is extremely important to detect venous thromboembolism (VTE) in the acute phase. However, no reference value for D-dimer in post-traumatic VTE has been reported given the substantial increase in its levels after injury. Therefore, this study evaluates the ability of our screening criteria using D-dimer to detect VTE in severe trauma patients. Methods: Trauma patients ( n  = 455) who were admitted to our emergency medical center during October 2011-June 2015 were included in this study...
January 2019: Acute Medicine & Surgery
Hidemitsu Miyatake, Kazunori Fujino, Sachiko Tanaka, Yasuyuki Tsujita, Minoru Horie, Yutaka Eguchi
Aim: To examine lymphocyte counts as a predictive prognostic marker in patients with coma after cardiac arrest. Methods: We retrospectively evaluated patients with coma after cardiac arrest admitted to the intensive care unit of Shiga University of Medical Science (Otsu, Japan). Lymphocyte counts were measured for 6 days from admission. Neurological outcome was assessed as favorable or unfavorable using cerebral performance categories. Associations between lymphocyte count and prognosis were investigated using multivariate logistic regression analysis and receiver operating characteristic curves...
January 2019: Acute Medicine & Surgery
Jun Oda, Tetsuo Yukioka, Kazunari Azuma, Takao Arai, Junji Chida, Hiroshi Kido
Aim: In serious heatstroke, elevated body temperature (>40°C) is considered the main cause of illness. Mitochondrial carnitine palmitoyltransferase II (CPT II) plays an important role in adenosine triphosphate (ATP) generation from long-chain fatty acids, and its thermolabile phenotype of CPT2 polymorphisms leads to ATP production loss under high fever. Whether by heatstroke or influenza, high fever suppresses mitochondrial ATP production in patients with the thermolabile phenotype of CPT2 polymorphisms...
January 2019: Acute Medicine & Surgery
Jun Okamoto, Yusuke Katayama, Tetsuhisa Kitamura, Junya Sado, Ryuta Nakamura, Nobuhiro Kimura, Hirotsugu Misaki, Shinpei Yamao, Shota Nakao, Masahiko Nitta, Taku Iwami, Satoshi Fujimi, Yasuyuki Kuwagata, Takeshi Shimazu, Tetsuya Matsuoka
Aim: To describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in-hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan. Methods: The Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on-scene emergency medical service personnel and has been accumulating all ambulance records...
January 2019: Acute Medicine & Surgery
Koichi Izumikawa
We encounter many natural disasters in Japan and various infectious diseases could occur during and after natural disasters. Two recent major natural disasters, the Great East Japan Earthquake and the Kumamoto Earthquake in 2011 and 2016, respectively, killed tremendous numbers of people and many were affected with infectious diseases in evacuation centers as well as shelters for long period. Infection control teams of medical facilities inside or outside of affected areas were dispatched, supported evacuees, and made great contributions to: (i) control epidemic infectious diseases such as influenza and norovirus infection, (ii) educate and encourage people, (iii) improve environments...
January 2019: Acute Medicine & Surgery
Toshiaki Iba, Hiroshi Tanaka
Although SCARLET could not achieve its primary end-point, the conditions of this trial were different from that of clinical practice in Japan. The effectiveness of the anticoagulant therapy for septic disseminated intravascular coagulation should be examined further in future studies.
January 2019: Acute Medicine & Surgery
Shunsuke Kudo, Mayuko Soma, Keiji Tanaka, Jun Hashimoto
No abstract text is available yet for this article.
October 2018: Acute Medicine & Surgery
Chiaki Toida, Takashi Muguruma, Katsutaka Hashiba, Masayasu Gakumazawa, Naoto Morimura
Case: Previous research has suggested that venovenous extracorporeal membrane oxygenation (vvECMO) is useful for patients refractory to conventional therapy. We report a pediatric case of influenza A(H1N1)pdm09 infection with a good outcome following rapid initiation of vvECMO.This patient was a 13-year-old boy with severe acute respiratory distress syndrome due to influenza virus. Severe acute respiratory distress syndrome according to the Berlin definition, Murray score of 3.3, and severe air leak syndrome were found...
October 2018: Acute Medicine & Surgery
Reiichiro Obata, Kazunari Azuma, Itaru Nakamura, Jun Oda
Case: Several successful uses of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome in patients with novel HIV/AIDS infection have been reported; however, the therapeutic keys have not always been discussed.A 47-year-old man was admitted with progressive shortness of breath. He was in respiratory failure with a PaO2 /FI O2 ratio of 110.8 requiring intubation. Chest computed tomography showed diffuse ground glass opacities. An HIV infection was suspected, and a diagnosis of acute respiratory distress syndrome was made...
October 2018: Acute Medicine & Surgery
Tomoya Nishino, Shinjirou Wakai, Hiromichi Aoki, Sadaki Inokuchi
Case: A 45-year-old man presented to our emergency department with disturbance of consciousness; he had mentioned to his family earlier about a drug overdose. When first responders arrived, he suffered cardiac arrest. Cardiac arrest due to drug overdose was diagnosed.The patient was supported with venoarterial extracorporeal membrane oxygenation. Arterial blood gas showed mixed acidosis, and electrocardiogram showed junctional rhythm and complete right bundle branch block. Outcome: The patient's blood pressure gradually decreased, and he died on the third day of hospitalization...
October 2018: Acute Medicine & Surgery
Daisuke Kudo, Junichi Sasaki, Hiroto Ikeda, Yasukazu Shiino, Nobuaki Shime, Toru Mochizuki, Masanori Morita, Hiroshi Soeda, Hiroki Ohge, Jong Ja Lee, Masahisa Fujita, Isao Miyairi, Yasuyuki Kato, Manabu Watanabe, Hiroyuki Yokota
Aim: Infection control in the emergency department is important for hospital risk management; however, few clinical guidelines have been established. This study aimed to determine whether hospitals in Japan have infection control manuals, and investigate the contents of manuals, consulting systems, and isolation facilities for emergency departments. Methods: A total of 517 hospitals certified as educational institutions for board-certified acute care physicians in Japan were requested between March and May 2015 to provide a written evaluation of the infection control in the emergency department...
October 2018: Acute Medicine & Surgery
Kosuke Kiyohara, Chika Nishiyama, Takeyuki Kiguchi, Daisuke Kobayashi, Taku Iwami, Tetsuhisa Kitamura
Aim: This study aimed to reveal the characteristics and outcomes of patients with out-of-hospital cardiac arrests (OHCAs) occurring in the toilet. These traits provide useful clues for the prevention of OHCAs and the improvement of prehospital care for these patients. Methods: Out-of-hospital cardiac arrest data were obtained from the population-based, Utstein-style registry in Osaka City, Japan, between 2009 and 2015. This study identified patients with OHCAs that occurred inside the toilet...
October 2018: Acute Medicine & Surgery
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