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Abstract
Malposition of a central venous catheter (CVC) in the accessory hemiazygos vein is an uncommon but potentially fatal complication; however, there is limited information regarding the preferred removal technique. We report a patient, a 57-year-old woman, who presented with overdose of her prescribed sedatives, who experienced this catheter complication after CVC insertion in the left internal jugular vein. The CVC was placed without resistance but routine postplacement chest X-ray showed abnormal coursing of the catheter close to the descending aorta. We used non-enhanced CT as an adjunct to safely identify the catheter position and assess for any bleeding during removal. CT images taken after retraction of the catheter tip by 10 cm showed no bleeding and we were able to remove the catheter safely. We recommend using CT as an adjunct to safely remove malpositioned catheters and reduce the risk of further complication.
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Affiliation(s)
- Yuki Izumi
- Anesthesiology and Critical Care, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ivor Cammack
- Cammack & Evans Surgery, Wellington, New Zealand
| | - Takeshi Yokoyama
- Anesthesiology and Critical Care, Teine Keijinkai Hospital, Sapporo, Japan
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2
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Aga M, Naganuma T, Ohashi Y, Matsuzawa H, Matsuzaka S, Cammack I, Yamada G, Serizawa Y. Association of early antibiotic therapy and in-hospital mortality in adult mild-to-moderate acute aspiration pneumonitis: a cohort study. Intern Emerg Med 2021; 16:1841-1848. [PMID: 33713284 DOI: 10.1007/s11739-021-02695-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with aspiration pneumonitis often receive empiric antibiotic therapy despite it being due to a non-infectious, inflammatory response. OBJECTIVE To study the benefits of early antibiotic therapy in patients with suspected aspiration pneumonitis in an acute care hospital. DESIGN Retrospective cohort study using electronic medical records from Teine Keijinkai Hospital. PARTICIPANTS Adults aged over 18 years admitted with a diagnosis of aspiration pneumonitis to the Department of General Internal Medicine or Emergency Department between January 1, 2008, and May 31, 2019. A diagnosis of aspiration pneumonitis was defined as a documented macro-aspiration event and a chest radiograph demonstrating new radiographic infiltrates. MAIN MEASURES Patients were classified into the "early antibiotic treatment" group and the "no or late treatment" group depending on whether they received antibiotic therapy for respiratory bacterial pathogens within 8 h of arrival. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included length of hospital stay, antibiotic-free days, duration of fever, readmission within one month, and incidence of complications. KEY RESULTS Of the 146 patients enrolled, 52 (35.6%) did not receive early antibiotic therapy, while the remaining 94 (64.4%) did. There was no difference in in-hospital mortality rates between the groups after adjustment for potential confounding variables using Cox proportional hazards analysis (hazard ratio 2.78; 95% confidence interval, 0.57-13.50, p = 0.20). Patients in the no or late treatment group had more antibiotic-free days (p < 0.001) and a shorter length of hospital stay among survivors (p = 0.040) than did those in the early antibiotic treatment group. There were no statistically significant differences between the groups with respect to other secondary outcomes. CONCLUSIONS Early antibiotic therapy for acute aspiration pneumonitis was not associated with in-hospital mortality, but was associated with a longer hospital stay and prolonged use of antibiotics.
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Affiliation(s)
- Masaharu Aga
- Department of General Internal Medicine and Infectious Disease, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Sapporo Shi Teine Ku, Hokkaido, 006-0811, Japan.
| | - Toru Naganuma
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Ohashi
- Department of General Internal Medicine and Infectious Disease, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Sapporo Shi Teine Ku, Hokkaido, 006-0811, Japan
| | - Hiroki Matsuzawa
- Department of General Internal Medicine and Infectious Disease, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Sapporo Shi Teine Ku, Hokkaido, 006-0811, Japan
| | - Suguru Matsuzaka
- Department of General Internal Medicine and Infectious Disease, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Sapporo Shi Teine Ku, Hokkaido, 006-0811, Japan
| | | | - Gen Yamada
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshimoto Serizawa
- Department of General Internal Medicine and Infectious Disease, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Sapporo Shi Teine Ku, Hokkaido, 006-0811, Japan
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Kubota T, Mori Y, Yamada G, Cammack I, Shinohara T, Matsuzaka S, Hoshi T. Listeria monocytogenes Ankle Osteomyelitis in a Patient with Rheumatoid Arthritis on Adalimumab: A Report and Literature Review of Listeria monocytogenes Osteomyelitis. Intern Med 2021; 60:3171-3176. [PMID: 34602523 PMCID: PMC8545638 DOI: 10.2169/internalmedicine.5633-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/07/2021] [Indexed: 11/24/2022] Open
Abstract
Localized Listeria infection predominantly occurs in the prosthetic and hip joints. We herein report a case of Listeria monocytogenes ankle osteomyelitis in a 73-year-old man receiving adalimumab who was transferred to our hospital because of suspected rheumatoid arthritis (RA) flare. He reported a four-month history of left ankle swelling. A surgical biopsy revealed L. monocytogenes osteomyelitis in the left tibia and talus bones. The patient was successfully treated with antibiotics and surgical debridement. Thus, infection due to L. monocytogenes can present as ankle osteomyelitis in immunocompromised patients and may mimic an RA flare.
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Affiliation(s)
- Takafumi Kubota
- Department of General Internal Medicine, Teine Keijinkai Hospital, Japan
- Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, U.S.A
| | - Yuichiro Mori
- Department of General Internal Medicine, Teine Keijinkai Hospital, Japan
- Department of Cardiology, Teine Keijinkai Hospital, Japan
| | - Gen Yamada
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Japan
| | | | | | - Suguru Matsuzaka
- Department of General Internal Medicine, Teine Keijinkai Hospital, Japan
| | - Tetsuya Hoshi
- Department of General Internal Medicine, Teine Keijinkai Hospital, Japan
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Watanabe Y, Fuchshuber P, Homma T, Bilgic E, Madani A, Hiki N, Cammack I, Noji T, Kurashima Y, Shichinohe T, Hirano S. An Unmodulated Very-Low-Voltage Electrosurgical Technology Creates Predictable and Ultimate Tissue Coagulation: From Experimental Data to Clinical Use. Surg Innov 2020; 27:492-498. [PMID: 32186463 PMCID: PMC7816550 DOI: 10.1177/1553350620904610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective. We analyzed the underlying principles of an unmodulated very-low-voltage (VLV) mode, designated as “soft coagulation” in hemostasis, and demonstrate its clinical applications. Summary Background Data. While the advantage of the VLV mode has been reported across surgical specialties, the basic principle has not been well described and remains ambiguous. Methods. Characteristics of major electrosurgical modes were measured in different settings. For the VLV mode, the tissue effect and electrical parameters were assessed in simulated environments. Results. The VLV mode achieved tissue coagulation with the lowest voltage compared with the other modes in any settings. With increasing impedance, the voltage of the VLV mode stayed very low at under 200 V compared with other modes. The VLV mode constantly produced effective tissue coagulation without carbonization. We have demonstrated the clinical applications of the method. Conclusions. The voltage of the VLV mode consistently stays under 200 V, resulting in tissue coagulation with minimal vaporization or carbonization. Therefore, the VLV mode produces more predictable tissue coagulation and minimizes undesirable collateral thermal tissue effects, enabling nerve- and function-preserving surgery. The use of VLV mode through better understanding of minimally invasive way of using electrosurgery may lead to better surgical outcomes.
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Affiliation(s)
- Yusuke Watanabe
- Hokkaido University, Sapporo, Hokkaido, Japan.,Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | | | | | | | - Amin Madani
- University Health Network -Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Ivor Cammack
- Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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5
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Affiliation(s)
- Natsuko Ishii
- Department of Cardiology, Teine Keijinkai Hospital, Japan
- Department of Cardiology, National Cerebral and Cardiovascular Center, Japan
| | - Ivor Cammack
- Department of Residency Program, Teine Keijinkai Hospital, Japan
| | - Suguru Matsuzaka
- Department of General Internal Medicine, Teine Keijinkai Hospital, Japan
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6
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Tsushima T, Sasaki S, Yuda S, Ohta M, Cammack I, Sato H, Hayashi K, Hirokami M. Remaining challenges in the diagnosis of early stage cardiac sarcoidosis. Clin Case Rep 2019; 7:1007-1011. [PMID: 31110736 PMCID: PMC6509926 DOI: 10.1002/ccr3.2114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/07/2019] [Accepted: 03/04/2019] [Indexed: 11/29/2022] Open
Abstract
Despite the requirement for histopathological evidence to make a definite diagnosis of cardiac sarcoidosis, the sensitivity of endomyocardial biopsy is still low. Recently, Japanese Circulation Society suggests a new strategy that patients diagnosed clinically do not require the endomyocardial biopsy evidence. Physicians should familiarize themselves with such paradigm shifts.
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Affiliation(s)
- Takahiro Tsushima
- Department of MedicineCase Western Reserve University, University Hospitals Cleveland Medical CenterClevelandOhio
| | | | - Satoshi Yuda
- Division of CardiologyTeine Keijinkai HospitalSapporoJapan
| | - Masayuki Ohta
- Division of CardiologyTeine Keijinkai HospitalSapporoJapan
| | - Ivor Cammack
- Department of General Internal MedicineTeine Keijinkai HospitalSapporoJapan
| | - Hiroyuki Sato
- Division of CardiologyTeine Keijinkai HospitalSapporoJapan
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7
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Dochi H, Nojima M, Matsumura M, Cammack I, Furuta Y. Effect of early tracheostomy in mechanically ventilated patients. Laryngoscope Investig Otolaryngol 2019; 4:292-299. [PMID: 31236461 PMCID: PMC6580064 DOI: 10.1002/lio2.265] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 03/26/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the effect of the timing of tracheostomy in patients who required prolonged mechanical ventilation using two methods: analysis of early versus late tracheostomy and landmark analysis. Study Design Retrospective cohort study. Methods Patients who were emergently intubated and admitted into the intensive care unit or high dependency unit between January 2011 and August 2016, with or without tracheostomy, were included. In the early and late tracheostomy analysis, all patients were divided into early (≤10 days, n = 88) and late (>10 days, n = 132) groups. In the landmark analysis, 198 patients requiring ventilation for more than 10 days were divided into early tracheostomy (≤10 days, n = 57) and nonearly tracheostomy (>10 days, n = 141) groups. We compared 60‐day ventilation withdrawal rate and 60‐day mortality. Results Early tracheostomy was a significant factor for early ventilation withdrawal, as shown by log‐rank test results (early and late tracheostomy: P = .001, landmark: P = .021). Multivariable analysis showed that the early group was also associated with a higher chance of ventilation withdrawal in each analysis (early and late tracheostomy: adjusted hazard ratio [aHR] = 1.69, 95% confidence interval [CI] = 1.20–2.39, P = .003; landmark: aHR = 1.61, 95% CI = 1.06–2.38, P = .027). Early tracheostomy, however, was not associated with improved 60‐day mortality (early and late tracheostomy: aHR = 0.88, 95% CI = 0.46–1.69, P = .71; landmark: aHR = 1.46; 95% CI = 0.58–3.66; P = .42). Conclusion For patients requiring ventilation, performing tracheostomy within 10 days of admission was independently associated with shortened duration of mechanical ventilation; 60‐day mortality was not associated with the timing of tracheostomy. Level of Evidence 2b
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Affiliation(s)
- Hirotomo Dochi
- Department of Otolaryngology-Head and Neck Surgery Teine-Keijinkai Hospital Sapporo Japan
| | - Masanori Nojima
- Center for Translational Research The Institute of Medical Science Hospital, The University of Tokyo Tokyo Japan
| | - Michiya Matsumura
- Department of Otolaryngology-Head and Neck Surgery Teine-Keijinkai Hospital Sapporo Japan
| | - Ivor Cammack
- Clinical Residency Department Teine-Keijinkai Hospital Sapporo Japan
| | - Yasushi Furuta
- Department of Otolaryngology-Head and Neck Surgery Teine-Keijinkai Hospital Sapporo Japan
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8
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Tsushima T, Ishii N, Matsuzaka S, Armitage K, Ohkusu K, Cammack I, Yamada A, Mori Y, Sasaki S, Hayashi K, Serizawa Y. Culture-negative group B streptococcal pericarditis: A case report and literature review of the diagnostic use of polymerase chain reaction. Clin Case Rep 2019; 7:509-514. [PMID: 30899483 PMCID: PMC6406155 DOI: 10.1002/ccr3.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 12/04/2022] Open
Abstract
Although conventional microbiology cultures may be negative, polymerase chain reaction (PCR) can effectively identify both typical and atypical microorganisms. With careful interpretation, PCR could become the gold-standard diagnostic test for culture-negative bacterial pericarditis.
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Affiliation(s)
- Takahiro Tsushima
- Department of MedicineUniversity Hospitals Cleveland Medical CenterClevelandOhio
| | - Natsuko Ishii
- Division of CardiologyTeine Keijinkai HospitalSapporoJapan
| | - Suguru Matsuzaka
- Department of General Internal MedicineTeine Keijinkai HospitalSapporoJapan
| | - Keith Armitage
- Division of Infectious Diseases and HIV Medicine, Department of MedicineUniversity Hospitals Cleveland Medical CenterClevelandOhio
| | - Kiyofumi Ohkusu
- Department of MicrobiologyTokyo Medical UniversityTokyoJapan
| | - Ivor Cammack
- Department of General Internal MedicineTeine Keijinkai HospitalSapporoJapan
| | - Akira Yamada
- Division of Cardiac SurgeryTeine Keijinkai HospitalSapporoJapan
| | - Yuichiro Mori
- Division of CardiologyTeine Keijinkai HospitalSapporoJapan
| | | | | | - Yoshimoto Serizawa
- Department of General Internal MedicineTeine Keijinkai HospitalSapporoJapan
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9
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Izumi Y, Ishihara S, Cammack I, Miyawaki I. Massive mass embolism detected by transesophageal echocardiography in bone cement implantation syndrome: a case report. JA Clin Rep 2019; 5:5. [PMID: 32026061 PMCID: PMC6967219 DOI: 10.1186/s40981-019-0225-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/16/2019] [Indexed: 12/02/2022] Open
Abstract
Bone cement implantation syndrome (BCIS) is a known complication in patients undergoing cemented orthopedic surgeries; however, the etiology and pathophysiology of BCIS are not fully understood. We report the case of a patient who developed pulseless electrical activity (PEA) due to BCIS after cemented femoral head replacement. Transesophageal echocardiography (TEE) during PEA revealed a massive embolus extending from the main pulmonary artery to the inferior vena cava. Of note, this embolus disappeared completely and rapidly after return of spontaneous circulation. TEE proved to be useful in the diagnosis and management of this case of PEA.
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Affiliation(s)
- Yuki Izumi
- Department of Anesthesiology and Critical Care, Teine Keijinkai Hospital, 006-0085 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan.
| | - Satoshi Ishihara
- Department of Anesthesiology and Critical Care, Teine Keijinkai Hospital, 006-0085 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ivor Cammack
- Department of Clinical Residency, Teine Keijinkai Hospital, 006-0085, 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ikuko Miyawaki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 650-0047, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan
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Kubota T, Inakuma Y, Cammack I, Kisa K. A swollen arm after backcountry snowboarding in Japan. J Travel Med 2019; 26:5185178. [PMID: 30445462 DOI: 10.1093/jtm/tay125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/09/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Takafumi Kubota
- Teine Keijinkai Hospital, Maeda-Ichijo, Teine, Sapporo, Hokkaido, Japan.,Kutchan Kosei General Hospita, Higashi 1-2, Kita-Yonjo, Kutchan, Abuda, Hokkaido, Japan
| | - Yoshihito Inakuma
- Kutchan Kosei General Hospita, Higashi 1-2, Kita-Yonjo, Kutchan, Abuda, Hokkaido, Japan
| | - Ivor Cammack
- Teine Keijinkai Hospital, Maeda-Ichijo, Teine, Sapporo, Hokkaido, Japan
| | - Kengo Kisa
- Kutchan Kosei General Hospita, Higashi 1-2, Kita-Yonjo, Kutchan, Abuda, Hokkaido, Japan
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