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Sakanashi S, Tanaka H, Yokota H, Otomo Y, Masuno T, Nakano K, Inoue J, Sugita M, Tokunaga T, Kato N, Kinoshi T, Inoue H, Numata H, Nakagawa K, Sagisaka R, Tanaka S, Miyamoto T, Akama T. Injuries and illness of athletes at the Tokyo 2020 Olympic and Paralympic summer games visiting outside facilities. Sports Med Health Sci 2024; 6:48-53. [PMID: 38463667 PMCID: PMC10918355 DOI: 10.1016/j.smhs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games. Data on 567 injuries and other illnesses of athletes treated at the on-site clinics were collected from the Tokyo 2020 Organizing Committee. Of these, 84 athletes who required outpatient care during the Games were registered for this survey. During the Olympic and Paralympic Games, 66 (8.3/1 000) and 18 (7.2/1 000) athletes, respectively, consulted external medical facilities. In the Olympic Games, the reasons for these visits included 48 cases (72.7%) of injuries, 13 (19.7%) cases of illnesses, and 5 (7.6%) cases of heat stroke illness (HSI). Of these patients, 56 (84.9%) were treated as outpatients and 10 (15.1%) were hospitalized, while three of these patients required hospitalization for > 7 days. On the other hand, in the Paralympics Games, there were 7 (38.8%) cases of injuries, 9 (50.0%) other illnesses, 1 (5.6%) case of HSI, and 1 (5.6%) other cases, of which 11 (61.1%) were treated as outpatients and 7 (38.9%) were hospitalized, but none was hospitalized for > 7 days. Injuries accounted for 70% of the total cases at the 2021 Olympic Games, but only three (0.05%) were severe cases that required hospitalization for more than 1 week. In contrast, in the Paralympic Games, other illnesses accounted for approximately half of the total cases. This study provides details on the extent of injuries and other illnesses that were transferred to outside facilities, which has not been documented in previous games.
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Affiliation(s)
- Shuji Sakanashi
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine Kokushikan University, Tokyo, Japan
| | - Hideharu Tanaka
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine Kokushikan University, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
- Research Institute of Disaster Management and EMS Kokushikan University, Tokyo, Japan
| | - Hiroyuki Yokota
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Health and Medical Science, Nippon Sports Science University, Japan
| | - Yasuhiro Otomo
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tomohiko Masuno
- Graduate School of Medicine, Nippon Medical University, Tokyo, Japan
| | - Kousuke Nakano
- Saitama City Hospital, Emergency Department, Saitama, Japan
| | - Junichi Inoue
- Nippon Medical School Musashikosugi Hospital, Emergency and Critical Care Center, Knagawa, Japan
| | - Manabu Sugita
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takahiko Tokunaga
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
- Emergency Lifesaving Academy Tokyo, Tokyo, Japan
| | - Nagisa Kato
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Tokyo Medical and Dental University Hospital, Trauma and Acute Critical Care Center, Tokyo, Japan
| | - Tomoya Kinoshi
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine Kokushikan University, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
- Research Institute of Disaster Management and EMS Kokushikan University, Tokyo, Japan
| | - Hironori Inoue
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Hiroto Numata
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Health and Medical Science, Nippon Sports Science University, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Ryo Sagisaka
- Department of Integrated Science and Engineering for Sustaiable Society, Chuo University, Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS Kokushikan University, Tokyo, Japan
| | - Tetsuya Miyamoto
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Takao Akama
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Arashiro T, Miwa M, Nakagawa H, Takamatsu J, Oba K, Fujimi S, Kikuchi H, Iwasawa T, Kanbe F, Oyama K, Kanai M, Ogata Y, Asakura T, Asami T, Mizuno K, Sugita M, Jinta T, Nishida Y, Kato H, Atagi K, Higaki T, Nakano Y, Tsutsumi T, Doi K, Okugawa S, Ueda A, Nakamura A, Yoshida T, Shimada-Sammori K, Shimizu K, Fujita Y, Okochi Y, Tochitani K, Nakanishi A, Rinka H, Taniyama D, Yamaguchi A, Uchikura T, Matsunaga M, Aono H, Hamaguchi M, Motoda K, Nakayama S, Yamamoto K, Oka H, Tanaka K, Inoue T, Kobayashi M, Fujitani S, Tsukahara M, Takeda S, Stucky A, Suzuki T, Smith C, Hibberd M, Ariyoshi K, Fujino Y, Arima Y, Takeda S, Hashimoto S, Suzuki M. COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study). Vaccine 2024; 42:677-688. [PMID: 38114409 DOI: 10.1016/j.vaccine.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. METHODS A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. RESULTS The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes. CONCLUSION Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron.
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Affiliation(s)
- Takeshi Arashiro
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan; Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Maki Miwa
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Junpei Takamatsu
- Department of Emergency Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Hitoshi Kikuchi
- Department of Emergency Medicine, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Takamasa Iwasawa
- Department of Cardiology, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Fumiko Kanbe
- Intensive Care Unit, Ageo Central General Hospital, Saitama, Japan
| | - Keisuke Oyama
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Masayuki Kanai
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Takanori Asakura
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Takahiro Asami
- Department of Internal Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Yusuke Nishida
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Kazuaki Atagi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Taiki Higaki
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Yoshio Nakano
- Department of Internal Medicine, Kinan Hospital, Wakayama, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiro Ueda
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Akira Nakamura
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Toru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kaoru Shimada-Sammori
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan TAMA Medical Center, Tokyo, Japan
| | - Keiki Shimizu
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan TAMA Medical Center, Tokyo, Japan
| | - Yasuo Fujita
- Department of Emergency, Akita Red Cross Hospital, Akita, Japan
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kentaro Tochitani
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Asuka Nakanishi
- Department of Pulmonary Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hiroshi Rinka
- Department of Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Daisuke Taniyama
- Department of Infectious Diseases, Showa General Hospital, Tokyo, Japan
| | - Asase Yamaguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Toshio Uchikura
- Department of Emergency and General Internal Medicine, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Maiko Matsunaga
- Department of Pharmacy, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiromi Aono
- Department of Respiratory Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Masanari Hamaguchi
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Kentaro Motoda
- Department of Clinical Research, Yao Tokushukai General Hospital, Osaka, Japan
| | - Sohei Nakayama
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kei Yamamoto
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Hideaki Oka
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Katsushi Tanaka
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Takeshi Inoue
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Mieko Kobayashi
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Maki Tsukahara
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Saki Takeda
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ashley Stucky
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chris Smith
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Martin Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yuji Fujino
- Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuzo Arima
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shinhiro Takeda
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan; Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Satoru Hashimoto
- Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
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Muto M, Sasaki Y, Kano T, Fukao Y, Hosoya R, Nomura T, Sugita M, Io H, Suzuki Y. Successful Management of Critical Acute Respiratory Distress Syndrome following COVID-19 through Extracorporeal Membrane Oxygenation in a Patient with Concurrent Nephrotic Syndrome Relapse. Intern Med 2023; 62:3209-3214. [PMID: 37558472 PMCID: PMC10686741 DOI: 10.2169/internalmedicine.2293-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/15/2023] [Accepted: 07/02/2023] [Indexed: 08/11/2023] Open
Abstract
A 44-year-old man with coronavirus disease 2019 (COVID-19) and nephrotic syndrome relapse was admitted to our intensive-care unit for respiratory failure. Despite receiving mechanical ventilation and immunomodulators, the patient experienced refractory hypoxemia, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy. Due to a worsening renal function, continuous hemodiafiltration was initiated. After 11 days, his respiratory status gradually improved, and VV-ECMO was withdrawn. The kidney function and proteinuria improved, and hemodialysis was subsequently discontinued. The patient was discharged 64 days after admission. This case highlights the potential benefit of early ECMO application in dramatically promoting recovery in severe COVID-19 cases.
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Affiliation(s)
- Masahiro Muto
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yu Sasaki
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Toshiki Kano
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yusuke Fukao
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Reina Hosoya
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
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Tanaka H, Tanaka S, Yokota H, Otomo Y, Masuno T, Nakano K, Sugita M, Tokunaga T, Sugimoto K, Inoue J, Kato N, Kinoshi T, Sakanashi S, Inoue H, Numata H, Nakagawa K, Miyamoto T, Akama T. Acute in-competition medical care at the Tokyo 2020 Olympics: a retrospective analysis. Br J Sports Med 2023; 57:1361-1370. [PMID: 37055080 DOI: 10.1136/bjsports-2022-105778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To analyse injuries and illnesses during the 2020 Tokyo Olympic Summer Games. METHODS This retrospective descriptive study included 11 420 athletes from 206 National Olympic Committees and 312 883 non-athletes. Incidences of injuries and illnesses during the competition period from 21 July to 8 August 2021 were analysed. RESULTS A total of 567 athletes (416 injuries, 51 non-heat-related illnesses and 100 heat-related illnesses) and 541 non-athletes (255 injuries, 161 non-heat-related illnesses and 125 heat-related illnesses) were treated at the competition venue clinic. Patient presentation and hospital transportation rates per 1000 athletes were 50 and 5.8, respectively. Marathons and race walking had the highest incidence of injury and illness overall (17.9%; n=66). The highest incidence of injury (per participant) was noted in boxing (13.8%; n=40), sport climbing (12.5%; n=5) and skateboarding (11.3%; n=9), excluding golf, with the highest incidence of minor injuries. Fewer infectious illnesses than previous Summer Olympics were reported among the participants. Of the 100 heat-related illnesses in athletes, 50 occurred in the marathon and race walking events. Only six individuals were transported to a hospital due to heat-related illness, and none required hospital admission. CONCLUSION Injuries and heat-related illnesses were lower than expected at the 2020 Tokyo Olympic Summer Games. No catastrophic events occurred. Appropriate preparation including illness prevention protocols, and treatment and transport decisions at each venue by participating medical personnel may have contributed to these positive results.
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Affiliation(s)
- Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Japan
| | - Hiroyuki Yokota
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Health and Medical Science, Nippon Sport Science University, Setagaya-ku, Japan
| | - Yasuhiro Otomo
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Tomohiko Masuno
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Japan
| | - Kousuke Nakano
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency Department, Saitama City Hospital, Saitama, Japan
| | - Manabu Sugita
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Medicine, Juntendo University, Bunkyo-ku, Japan
| | - Takahiko Tokunaga
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency Life Saving Academy Tokyo, Tokyo, Japan
| | - Katsuhiko Sugimoto
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine, Kokushikan University, Tama, Japan
| | - Junichi Inoue
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Nagisa Kato
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency and Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Japan
| | - Tomoya Kinoshi
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Syuji Sakanashi
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Hironori Inoue
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Hiroto Numata
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine, Kokushikan University, Tama, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
| | - Tetsuya Miyamoto
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Takao Akama
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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Asako S, Suyama Y, Sugita M. Woman with sudden oral discomfort. Emerg Med J 2023; 40:699-736. [PMID: 37758292 DOI: 10.1136/emermed-2022-212641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 10/03/2023]
Affiliation(s)
- Suguru Asako
- Department of Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Yasuhiro Suyama
- Division of Rheumatology, JR Tokyo General Hospital, Tokyo, Japan
| | - Manabu Sugita
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
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Usuda D, Kato M, Sugawara Y, Shimizu R, Inami T, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Hotchi Y, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Secondary pulmonary infection by Fusarium solani and Aspergillus niger during systemic steroid treatment for COVID-19: A case report. World J Clin Cases 2023; 11:6280-6288. [PMID: 37731582 PMCID: PMC10507554 DOI: 10.12998/wjcc.v11.i26.6280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated invasive pulmonary aspergillosis presents a diagnostic challenge due to its non-specific clinical/ imaging features, as well as the fact that the proposed clinically diagnostic algorithms do not necessarily apply to COVID-19 patients. In addition, Fusarium spp. is a rare cause of opportunistic life-threatening fungal infections. Disseminated Fusarium infection in an immunocompromised host is intractable, with a high likelihood of resulting mortality. To our knowledge, this is the first case of secondary pulmonary infection by Fusarium solani (F. solani) and Aspergillus niger (A. niger) during systemic steroid treatment for COVID-19. CASE SUMMARY A 62-year-old male was transported to our hospital by ambulance with a complaint of fever and dyspnea. We established a diagnosis of pneumococcal pneumonia, complicated with COVID-19 and septic shock, together with acute renal failure. He was admitted to the intensive care unit, to be treated with piperacillin/tazobactam, vancomycin, and 6.6 mg per day of dexamethasone sodium phosphate, along with noradrenaline as a vasopressor, ventilator management, and continuous hemodiafiltration. His condition improved, and we finished the vasopressor on the fifth hospital day. We administered dexamethasone for ten days, and finished the course of treatment. On the eleventh day, patient respiratory deterioration was observed, and a computed tomography scan showed an exacerbation of bilateral ground-glass-opacity-like consolidation, together with newly appeared cavitary lesions in the lung. we changed antibiotics to meropenem plus vancomycin. In addition, a fungal infection was considered as a possibility based on microscopic findings of sputum, and we began coadministration of voriconazole. However, the pneumonia worsened, and the patient died on the seventeenth day of illness. Later, F. solani and A. niger were identified from sputum collected on the twelfth day. It was believed that he developed a cell-mediated immune deficiency during COVID-19 treatment, which led to the complication of pneumonia caused by the above-mentioned fungi, contributing to his death. CONCLUSION Because early initiation of intense antifungal therapy offers the best chance for survival in pulmonary fusariosis, computed tomography scans and appropriate microbiologic investigations should be obtained for severely immunocompromised patients.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Masashi Kato
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuto Sugawara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Runa Shimizu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomotari Inami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Sports Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
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7
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Fukui S, Inui A, Komatsu T, Ogura K, Ozaki Y, Sugita M, Saita M, Kobayashi D, Naito T. A Predictive Rule for COVID-19 Pneumonia Among COVID-19 Patients: A Classification and Regression Tree (CART) Analysis Model. Cureus 2023; 15:e45199. [PMID: 37720137 PMCID: PMC10500617 DOI: 10.7759/cureus.45199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND In this study, we aimed to identify predictive factors for coronavirus disease 2019 (COVID-19) patients with complicated pneumonia and determine which COVID-19 patients should undergo computed tomography (CT) using classification and regression tree (CART) analysis. METHODS This retrospective cross-sectional survey was conducted at a university hospital. We recruited patients diagnosed with COVID-19 between January 1 and December 31, 2020. We extracted clinical information (e.g., vital signs, symptoms, laboratory results, and CT findings) from patient records. Factors potentially predicting COVID-19 pneumonia were analyzed using Student's t-test, the chi-square test, and a CART analysis model. RESULTS Among 221 patients (119 men (53.8%); mean age, 54.59±18.61 years), 160 (72.4%) had pneumonia. The CART analysis revealed that patients were at high risk of pneumonia if they had C-reactive protein (CRP) levels of >1.60 mg/dL (incidence of pneumonia: 95.7%); CRP levels of ≤1.60 mg/dL + age >35.5 years + lactate dehydrogenase (LDH)>225.5 IU/L (incidence of pneumonia: 95.5%); and CRP levels of ≤1.60 mg/dL + age >35.5 years + LDH≤225.5 IU/L + hemoglobin ≤14.65 g/dL (incidence of pneumonia: 69.6%). The area of the curve of the receiver operating characteristic of the model was 0.860 (95% CI: 0.804-0.915), indicating sufficient explanatory power. CONCLUSIONS The present results are useful for deciding whether to perform CT in COVID-19 patients. High-risk patients such as those mentioned above should undergo CT.
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Affiliation(s)
- Sayato Fukui
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, JPN
| | - Akihiro Inui
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, JPN
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, JPN
| | - Kanako Ogura
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo, JPN
| | - Yutaka Ozaki
- Department of Diagnostic Radiology, Juntendo University Nerima Hospital, Tokyo, JPN
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, JPN
| | - Mizue Saita
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, JPN
| | - Daiki Kobayashi
- Department of General Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, JPN
| | - Toshio Naito
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, JPN
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8
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Usuda D, Kaminishi N, Kato M, Sugawara Y, Shimizu R, Inami T, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Hotchi Y, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive man: A case report. World J Clin Cases 2023; 11:5811-5816. [PMID: 37727727 PMCID: PMC10505994 DOI: 10.12998/wjcc.v11.i24.5811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period, and a variety of metallic and non-metallic objects are used. On the other hand, penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications. The goal of treating penile incarceration is to remove the foreign object as soon as possible. On the other hand, removal can be very challenging, and often requires resourcefulness and a multidisciplinary approach. CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain, accompanying swelling due to strangulation by stainless steel rings. His medical history included acquired immunodeficiency syndrome. One day prior, he had put three stainless steel rings on his penis and scrotum before sexual intercourse. After sexual intercourse, he was unable to remove them, due to swelling of his penis and scrotum. The swelling persisted, and he felt pain in the affected area the next day, then he was transferred to our hospital by ambulance. The emergency department found that his penis and scrotum were markedly engorged and swollen. We established a diagnosis of penile and scrotal strangulation by stainless steel rings. We unsuccessfully attempted to cut the rings using a cutter, then requested a rescue team via emergency medical service. They cut through each ring in two places, using an electric-powered angle grinder, and successfully removed all of the pieces. Finally, he was discharged and went home. CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.
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Affiliation(s)
- Daisuke Usuda
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Nobuyoshi Kaminishi
- Clinical Training Center, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Masashi Kato
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuto Sugawara
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Runa Shimizu
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomotari Inami
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Katou
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Sports Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan
| | - Jiro Oba
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
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9
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Shimozawa S, Usuda D, Sasaki T, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Hotchi Y, Tokunaga S, Osugi I, Katou R, Ito S, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. High doses of dextromethorphan induced shock and convulsions in a 19-year-old female: A case report. World J Clin Cases 2023; 11:3870-3876. [PMID: 37383112 PMCID: PMC10294160 DOI: 10.12998/wjcc.v11.i16.3870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication. There has been a growing number of reported cases of toxicity in recent years. Generally, there are numerous instances of mild symptoms, with only a limited number of reports of severe cases necessitating intensive care. We presented the case of a female who ingested 111 tablets of dextromethorphan, leading to shock and convulsions and requiring intensive care that ultimately saved her life.
CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance, having overdosed on 111 tablets of dextromethorphan (15 mg) obtained through an online importer in a suicide attempt. The patient had a history of drug abuse and multiple self-inflicted injuries. At the time of admission, she exhibited symptoms of shock and altered consciousness. However, upon arrival at the hospital, the patient experienced recurrent generalized clonic convulsions and status epilepticus, necessitating tracheal intubation. The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock, and noradrenaline was administered as a vasopressor. Gastric lavage and activated charcoal were also administered after intubation. Through systemic management in the intensive care unit, the patient’s condition stabilized, and the need for vasopressors ceased. The patient regained consciousness and was extubated. The patient was subsequently transferred to a psychiatric facility, as suicidal ideation persisted.
CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.
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Affiliation(s)
- Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Toru Sasaki
- Clinical Training Center, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Suguru Asako
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo-city 113-8421, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
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10
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Inoue H, Tanaka H, Sakanashi S, Kinoshi T, Numata H, Yokota H, Otomo Y, Masuno T, Nakano K, Sugita M, Tokunaga T, Sugimoto K, Inoue J, Kato N, Nakagawa K, Tanaka S, Sagisaka R, Miyamoto T, Akama T. Incidence and factor analysis for the heat-related illness on the Tokyo 2020 Olympic and Paralympic Games. BMJ Open Sport Exerc Med 2023; 9:e001467. [PMID: 37051574 PMCID: PMC10083866 DOI: 10.1136/bmjsem-2022-001467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 02/25/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Among the 43 venues of Tokyo 2020 Olympic Games (OG) and 33 venues of Paralympic Games (PG) were held, the heat island effect was highly expected to cause heat-related illnesses in the outdoor venues with maximum temperatures exceeding 35°C. However, the actual number of heat-related illness cases during the competition was lower than that was initially expected, and it was unclear under what conditions or environment-related heat illnesses occurred among athletes. Object To clarify the cause and factors contributing to the occurrence of heat-related illness among athletes participating in the Tokyo 2020 Olympic and Paralympic Games. Method This retrospective descriptive study included 15 820 athletes from 206 countries. From 21 July 2021 to 8 August 2021 for the Olympics, and from 24 August 2021 to 5 September 2021 for the Paralympics. The number of heat-related illness cases at each venue, the incidence rate for each event, gender, home continent, as well as the type of competition, environmental factors (such as venue, time, location and wet-bulb globe temperature (WBGT)), treatment factor and the type of competition were analysed. Results More number of heat-related illnesses among athletes occurred at the OG (n=110, 76.3%) than at the PG (n=36, 23.7%). A total of 100 cases (100%) at the OG and 31 cases (86.1%) at the PG occurred at the outdoors venues. In the OG, a total of 50 cases (57.9%) occurred during the competition of marathon running and race walking at Sapporo Odori Park. Six of those, were diagnosed with exertional heat illness and treated with cold water immersion (CWI) at OG and one case at PG. Another 20 cases occurred in athletics (track and field) competitions at Tokyo National Olympic Stadium. In total, 10 cases (10.0%) were diagnosed with severe heat illness in the OG and 3 cases (8.3%) in the PG. Ten cases were transferred to outside medical facilities for further treatment, but no case has been hospitalised due to severe condition. In the factor analysis, venue zone, outdoor game, high WBGT (<28°C) and endurance sports have been found to have a higher risk of moderate and severe heat-related illness (p<0.05). The incidence rate and severity could be attenuated by proper heat-related illness treatment (CWI, ice towel, cold IV transfusion and oral hydration) reduced the severity of the illness, providing summer hot environment sports. Conclusion The Tokyo 2020 Olympic and Paralympic summer games were held. Contrary to expectations, we calculated that about 1 in 100 Olympic athletes suffered heat-related illness. We believe this was due to the risk reduction of heat-related illness, such as adequate prevention and proper treatment. Our experience in avoiding heat-related illness will provide valuable data for future Olympic summer Games.
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Affiliation(s)
- Hironori Inoue
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Hideharu Tanaka
- Department of EMS System, Kokushikan University, Setagaya-ku, Japan
| | - Shuji Sakanashi
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Tomoya Kinoshi
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Hiroto Numata
- Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo, Japan
| | - Hiroyuki Yokota
- Graduate School of Health and Medical Science, Nippon Sports Science University, Yokohama, Kanagawa, Japan
| | - Yasuhiro Otomo
- Tokyo Medical and Dental University Graduate School of Medicine and Dentistry, Bunnkyouku, Japan
| | | | - Kousuke Nakano
- Saitama City Hospital, Emergency Department, Saitama, Japan, Saitama, Japan
| | | | | | - Katsuhiko Sugimoto
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Junichi Inoue
- Emergency and Critical Care Center, Yamanashi, Japan
| | - Nagisa Kato
- Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Trauma and Acute Critical Care Center, Tokyo, Japan
| | - Koshi Nakagawa
- Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Shota Tanaka
- Research Institute of Disaster and EMS, Kokushikan University, Tama City, Tokyo, Japan
| | - Ryo Sagisaka
- Department of EMS System, Kokushikan University, Tama City, Tokyo, Japan
| | - Tetsuya Miyamoto
- Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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11
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Sasaki S, Inoue K, Shiozaki M, Lee CC, Chiang SJ, Suwa S, Fukuda K, Hiki M, Kubota N, Tamura H, Sugita M, Sumiyoshi M, Minamino T. One-Year Outcome of Patients with Chest Pain in the Rule-Out Group According to the 0-Hour/1-Hour Algorithm. Int Heart J 2023; 64:590-595. [PMID: 37518339 DOI: 10.1536/ihj.23-076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The European Society of Cardiology recommends the 0/1-hour algorithm for risk stratification of patients with suspected non-ST-elevation myocardial infarction as class I, level B; however, there are few reports on the long-term prognosis, resulting in a rule-out group. We aimed to determine whether implementation of the 0-hour/1-hour algorithm is safe and effective in emergency department (ED) patients with possible acute coronary syndrome (ACS) through a 1-year follow-up period. Our study analyzed the 1-year follow-up data from a prospective pre-post study of 1106 ED patients with possible ACS from 4 hospitals in Japan and Taiwan. Patients were 18 years or older. Accrual occurred for 1 year after implementing the 0-1-hour algorithm from November 2014 to December 2018. Overall, 520 patients were stratified into the rule-out group. Major advanced cardiovascular events (all-cause death, acute myocardial infarction [AMI], stroke, unstable angina, and revascularization) at 1-year were determined using data from health records and phone calls. The 0-1-hour algorithm stratified 47.0% of patients in the rule-out group. Over the 1-year follow-up period (follow-up rate = 86.9%), cardiovascular death and subsequent AMI did not occur in the rule-out group. Among the 27 patients who underwent the procedure within 30 days post-index visit, 3 patients (0.7%) had a stroke, 6 patients (1.3%) died of non-cardiovascular cause, and 30 patients (6.7%) underwent coronary revascularization within 1 year. At the 1-year follow-up, implementation of the 0-hour/1-hour algorithm was associated with very low rates of adverse event among patients in the rule-out group.
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Affiliation(s)
- Shun Sasaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | - Kenji Inoue
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | | | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch
| | - Satoru Suwa
- Department of Cardiovascular Biology and Medicine, Juntendo University Shizuoka Hospital
| | - Kentaro Fukuda
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | - Naozumi Kubota
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | - Hiroshi Tamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital
| | - Masataka Sumiyoshi
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine
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12
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Usuda D, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Takano H, Shimozawa S, Hotchi Y, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Amebic liver abscess by Entamoeba histolytica. World J Clin Cases 2022; 10:13157-13166. [PMID: 36683647 PMCID: PMC9851013 DOI: 10.12998/wjcc.v10.i36.13157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
Abstract
Amebic liver abscesses (ALAs) are the most commonly encountered extraintestinal manifestation of human invasive amebiasis, which results from Entamoeba histolytica (E. histolytica) spreading extraintestinally. Amebiasis can be complicated by liver abscess in 9% of cases, and ALAs led to almost 50000 fatalities worldwide in 2010. Although there have been fewer and fewer cases in the past several years, ALAs remain an important public health problem in endemic areas. E. histolytica causes both amebic colitis and liver abscess by breaching the host’s innate defenses and invading the intestinal mucosa. Trophozoites often enter the circulatory system, where they are filtered in the liver and produce abscesses, and develop into severe invasive diseases such as ALAs. The clinical presentation can appear to be colitis, including upper-right abdominal pain accompanied by a fever in ALA cases. Proper diagnosis requires nonspecific liver imaging as well as detecting anti-E. histolytica antibodies; however, these antibodies cannot be used to distinguish between a previous infection and an acute infection. Therefore, diagnostics primarily aim to use PCR or enzyme-linked immunosorbent assay to detect E. histolytica. ALAs can be treated medically, and percutaneous catheter drainage is only necessary in approximately 15% of cases. The indicated treatment is to administer an amebicidal drug (such as tinidazole or metronidazole) and paromomycin or other luminal cysticidal agent for clinical disease. Prognosis is good with almost universal recovery. Establishing which diagnostic methods are most efficacious will necessitate further analysis of similar clinical cases.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
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13
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Kamada A, Komatsu T, Asako S, Mizuno K, Takami H, Nomura T, Sugita M. A rare distributive shock diagnosed only by medical history and inspection. Clin Case Rep 2022; 10:e6746. [PMID: 36540880 PMCID: PMC9755815 DOI: 10.1002/ccr3.6746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/10/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
A 78-year-old Japanese man was in a state of shock with skin flushing. Although he denied, his wife revealed his prescription disulfiram for alcoholism. Disulfiram-ethanol reaction, even though it is a rare cause of distributive shock, could be easily and quickly differentiated only based on accurate medical history and inspection.
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Affiliation(s)
- Ayaka Kamada
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan,Department of NephrologyTohoku Medical And Pharmaceutical University HospitalMiyagiJapan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan,Department of Sports MedicineJuntendo University Faculty of medicineTokyoJapan
| | - Suguru Asako
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan,Department of EmergencyJR Tokyo General HospitalTokyoJapan
| | - Keiko Mizuno
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
| | - Hiroki Takami
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
| | - Manabu Sugita
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
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14
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Oba J, Usuda D, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Takano H, Shimozawa S, Hotchi Y, Usami K, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Hemorrhagic shock due to submucosal esophageal hematoma along with mallory-weiss syndrome: A case report. World J Clin Cases 2022; 10:9911-9920. [PMID: 36186194 PMCID: PMC9516938 DOI: 10.12998/wjcc.v10.i27.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal submucosal hematoma is a rare condition. Although the exact etiology remains uncertain, vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation; the vessel was ruptured by a sudden increase in pressure due to nausea, and the hematoma was enlarged by antiplatelet or anticoagulant therapy. Serious conditions are rare, with a better prognosis. We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm. The patient received aspirin and clopidogrel before surgery and heparin during surgery, and was well during the surgery. Several hours after returning to the ICU, she complained of chest discomfort, vomited 500 mL of fresh blood, and entered hemorrhagic shock. Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography. In addition to a massive fluid and erythrocyte transfusion, we performed a temporary compression for hemostasis with a Sengstaken-Blakemore (S-B) tube. Afterwards, she became hemodynamically stable. On postoperative day 1, we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding; therefore, we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction. We started oral intake on postoperative day 10. The patient made steady progress, and was discharged on postoperative day 33.
CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
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Affiliation(s)
- Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenki Usami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
- Faculty of Medicine, Juntendo University, Bunkyo-ku 113-8421, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
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15
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Nakajima E, Sugita M, Morishita Y, Miyazaki T, Kanzawa H, Kawaguchi Y, Ono S, Hirsch F, Ikeda N, Furukawa K. EP16.03-029 SLIT2 Expression in NSCLC With Long-Term Response to Pemetrexed. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Usuda D, Tanaka R, Suzuki M, Shimozawa S, Takano H, Hotchi Y, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Obligate aerobic, gram-positive, weak acid-fast, nonmotile bacilli, Tsukamurella tyrosinosolvens: Minireview of a rare opportunistic pathogen. World J Clin Cases 2022; 10:8443-8449. [PMID: 36157836 PMCID: PMC9453373 DOI: 10.12998/wjcc.v10.i24.8443] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/09/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
Tsukamurella species are obligate aerobic, gram-positive, weak acid-fast, nonmotile bacilli. They are found in various environments, such as soil, water, sludge, and petroleum reservoir wastewater, and belong to the order Actinomycetales. In 2016, there was a reclassification of species within the genus Tsukamurella, merging the species Tsukamurella tyrosinosolvens (T. tyrosinosolvens) and Tsukamurella carboxydivorans. Tsukamurella species are clinically considered to be a rare opportunistic pathogen, because most reported cases have been related to bacteremia and intravascular prosthetic devices and immunosuppression. To date, it has been isolated only from human specimens, and has always been associated with clinical disease; human infections are very rare. Reported infections have included pneumonia, brain abscesses, catheter-related bloodstream infections, ocular infections, bacteremia, and sepsis presenting with septic pulmonary emboli in patients who are immunocompromised. To date, there is no commercially available test for identification. On the other hand, sequence-based identification, including matrix-assisted laser desorption ionization time-of-flight mass spectrometry, is an alternative method for identifying clinical isolates that are either slow growers or difficult to identify through biochemical profiling. The golden standards for diagnosis and optimal management still remain to be determined. However, newer molecular biological techniques can provide accurate identification, and contribute to the appropriate selection of definitive therapy for infections caused by this organism. Combinations of several antimicrobial agents have been proposed for treatment, though the length of treatment for infections has yet to be determined, and should be individualized according to clinical response. Immunocompromised patients often experience severe cases due to infection, and life-threatening T. tyrosinosolvens events associated with dissemination and/or failure of source control have occurred. Favorable prognoses can be achieved through earlier identification of the cause of infection, as well as successful management, including appropriate antibiotic therapy together with source control. Further analyses of similar cases are required to establish the most adequate diagnostic methods and treatment regimens for infections.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
- Department of Medicine, Juntendo University, Bunkyo-ku 113-8421, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
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17
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Kagiyama N, Komatsu T, Nishikawa M, Hiki M, Kobayashi M, Matsuzawa W, Daida H, Minamino T, Naito T, Sugita M, Miyazaki K, Anan H, Kasai T. Impact of a telemedicine system on work burden and mental health of healthcare providers working with COVID-19: a multicenter pre-post prospective study. JAMIA Open 2022; 5:ooac037. [PMID: 35642177 PMCID: PMC9129187 DOI: 10.1093/jamiaopen/ooac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic impacts not only patients but also healthcare providers. This study seeks to investigate whether a telemedicine system reduces physical contact in addressing the COVID-19 pandemic and mitigates nurses' distress and depression. Methods Patients hospitalized with COVID-19 in 4 hospitals and 1 designated accommodation measured and uploaded their vital signs to secure cloud storage for remote monitoring. Additionally, a mat-type sensor placed under the bed monitored the patients' respiratory rates. Using the pre-post prospective design, visit counts and health care providers' mental health were assessed before and after the system was introduced. Results A total of 100 nurses participated in the study. We counted the daily visits for 48 and 69 patients with and without using the telemedicine system. The average patient visits were significantly less with the system (16.3 [5.5-20.3] vs 7.5 [4.5-17.5] times/day, P = .009). Specifically, the visit count for each vital sign assessment was about half with the telemedicine system (all P < .0001). Most nurses responded that the system was easy to use (87.1%), reduced work burden (75.2%), made them feel relieved (74.3%), and was effective in reducing the infection risk in hospitals (79.1%) and nursing accommodations (95.0%). Distress assessed by Impact of Event Scale-Revised and depression by Patient Health Questionnaire-9 were at their minimum even without the system and did not show any significant difference with the system (P = .72 and .57, respectively). Conclusions Telemedicine-based self-assessment of vital signs reduces nurses' physical contact with COVID-19 patients. Most nurses responded that the system is easy and effective in reducing healthcare providers' infection risk.
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Affiliation(s)
- Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Masanori Nishikawa
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Emergency Medicine, Juntendo University, Tokyo, Japan
| | - Mariko Kobayashi
- Ogino Memorial Laboratory, Nihon Kohden Corporation, Tokyo, Japan
| | - Wataru Matsuzawa
- Ogino Memorial Laboratory, Nihon Kohden Corporation, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Hideaki Anan
- Emergency Medical Center, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan
| | - Takatoshi Kasai
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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18
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Usuda D, Tanaka R, Suzuki M, Takano H, Hotchi Y, Shimozawa S, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. ST-Elevation Acute Myocardial Infarction in a Young Man. J Med Cases 2022; 13:281-289. [PMID: 35837083 PMCID: PMC9239518 DOI: 10.14740/jmc3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022] Open
Abstract
Acute myocardial infarction (AMI) in young patients is very rare, but the incidence has increased over years past at younger ages, likely due to the presence of multiple risk factors. We present the first known case of ST-elevation AMI (STEMI) in a young man. A 22-year-old Japanese man was transferred to our hospital due to suddenly occurred anterior chest pain. An electrocardiogram revealed ST elevation in anteroseptal leads together with reciprocal ST depression in inferior leads. An emergency coronary angiogram was performed, revealing a 100% occlusion at segment 6 of the coronary artery and we established a diagnosis of STEMI. The lesion was expanded to 0% stenosis through plain old balloon angioplasty, after which a third-generation drug-eluting stent was installed there. Afterwards, the patient was discharged on day 17. In this case, a combination of mild six risk factors plus family history of hypertension might lead to this atypical event.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
- Corresponding Author: Daisuke Usuda, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
- Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
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19
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Mizuno K, Komatu T, Usuda D, Hocchi S, Ashizawa K, Aoki T, Ogura K, Takami H, Nomura T, Sugita M. 363. Characteristics of Envelope and Nuclear Gene Expression Patterns in Asymptomatic SARS-CoV-2 Patients: A Single Center Retrospective Observational Study. Open Forum Infect Dis 2021. [PMCID: PMC8644072 DOI: 10.1093/ofid/ofab466.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reverse transcription-polymerase chain reaction (RT-PCR) is used for the diagnosis of COVID-19, caused by SARS-CoV-2. RT-PCR is a method that detects the virus by amplifying two regions of the target viral genome, namely the nuclear (N) and envelope (E) encoding sequences. However, no reports have shown a relationship between the symptoms and the gene expression patterns, especially in asymptomatic patients. Herein, we validated the characteristics of E and N gene expression patterns using RT-PCR on samples obtained from asymptomatic COVID-19-positive patients.
Methods
In this retrospective cohort study, conducted at Juntendo University Nerima Hospital, Tokyo, Japan, SARS-Cov-2 RT-PCR positive patients whose specimens had been obtained and analyzed by our laboratory technicians from September 1, 2020 to December 31, 2020 were enrolled. For RT-PCR, the LightMix Modular SARS-CoV-2 reagent (TIB MOLBIOL company) was used. After excluding patients who had symptoms, background, demographic, laboratory, and gene expression pattern data were collected from RT-PCR-positive asymptomatic patients. We also investigated patients who met the release criteria of the Center for Disease Control and prevention. Continuous and categorical variables were analyzed, with p< 0.05 set as statistical significance using the student-t test, chi-square test, or Fisher’s exact test, respectively.
Results
Of 92 RT-PCR-positive asymptomatic patients, 57 comprised the expression E only group (Group E) and 35 comprised the E+N group (Group E+N). Significantly more patients in Group E met the release criteria compared to those in Group E+N [41 (71%) vs 10 (28%), p< 0.001]. Among patients who met the release criteria, those in Group E+N had significantly more immunosuppression [7 (70%) vs 8 (30%), p=0.004].
Moreover, among the patients who underwent RT-PCR screening, no patients in Group E developed symptoms [0 vs 6 (42%), p=0.02].
Conclusion
The results of this study suggest that RT-PCR-positive asymptomatic patients can be divided into three patterns: pre-symptomatic, gene E+N-positive patients; post-symptomatic covid-19-recovered patients, regardless of gene E and N expression patterns; and false positive, gene E-positive patients.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- Keiko Mizuno
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | | | - Daisuke Usuda
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | - Shiori Hocchi
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | - Karin Ashizawa
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | - Takashi Aoki
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | - Kanako Ogura
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | - Hiroki Takami
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
| | | | - Manabu Sugita
- Juntenodo University Nerima Hospital, Nerima, Tokyo, Japan
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20
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Usuda D, Higashikawa T, Hotchi Y, Usami K, Shimozawa S, Tokunaga S, Osugi I, Katou R, Ito S, Yoshizawa T, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Exophiala dermatitidis. World J Clin Cases 2021; 9:7963-7972. [PMID: 34621853 PMCID: PMC8462220 DOI: 10.12998/wjcc.v9.i27.7963] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/03/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
Exophiala is a genus comprising several species of opportunistic black yeasts, which belongs to Ascomycotina. It is a rare cause of fungal infections. However, infections are often chronic and recalcitrant, and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people, detailed knowledge remains scarce regarding infection mechanisms, virulence factors, specific predisposing factors, risk factors, and host response. The most common manifestations of Exophiala infection are skin infections, and the most frequent type of deep infection is pulmonary infection due to inhalation. The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs. The final identification of the causative organism should be achieved through a combination of several methods, including the newly introduced diagnostic analysis, matrix-assisted laser desorption/ ionization-time-of-flight mass spectrometry, together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi, and histological and culture findings. Regarding treatment, because anti-infective agents and natural compounds exhibited poor antibiofilm activity, few treatments have ultimately been found to be effective for specific antifungal therapy, so the optimal antifungal therapy and duration of therapy for these infections remain unknown. Therefore, most forms of disease caused by Exophiala dermatitidis require aggressive combination therapies: Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Toshihiro Higashikawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenki Usami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Toshihiko Yoshizawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Suguru Asako
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
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21
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Usuda D, Higashikawa T, Hotchi Y, Usami K, Shimozawa S, Tokunaga S, Osugi I, Katou R, Ito S, Yoshizawa T, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Angiotensin receptor blocker neprilysin inhibitors. World J Cardiol 2021; 13:325-339. [PMID: 34589168 PMCID: PMC8436684 DOI: 10.4330/wjc.v13.i8.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a clinical syndrome that results from a structural or functional cardiac disorder that reduces the ability of the ventricle of the heart to fill with, or eject, blood. It is a multifaceted clinical condition that affects up to 2% of the population in the developed world, and is linked to significant morbidity and mortality; it is therefore considered a major concern for public health. Regarding the mechanism of HF, three neurohumoral factors - the renin-angiotensin-aldosterone system, the sympathetic nervous system, and natriuretic peptides — are related to the pathology of chronic HF (CHF), and the targets of treatment. Angiotensin receptor blocker and neprilysin inhibitor (angiotensin-receptor neprilysin inhibitor), namely sacubitril/valsartan (SAC/VAL), has been introduced as a treatment for CHF. SAC/VAL is an efficacious, safe, and cost-effective therapy that improves quality of life and longevity in patients with HF with reduced ejection fraction (HFrEF), and reduces hospital admissions. An in-hospital initiation strategy offers a potential new avenue to improve the clinical uptake of SAC/VAL. In the last five years, SAC/VAL has been established as a cornerstone component of comprehensive disease-modifying medical therapy in the management of chronic HFrEF. On the other hand, further work, with carefully designed and controlled preclinical studies, is necessary for understanding the molecular mechanisms, effects, and confirmation of issues such as long-term safety in both human and animal models.
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Affiliation(s)
- Daisuke Usuda
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Toshihiro Higashikawa
- Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama, Japan
| | - Yuta Hotchi
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenki Usami
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Katou
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Toshihiko Yoshizawa
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Suguru Asako
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Jiro Oba
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
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22
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Usuda D, Izumida T, Terada N, Sangen R, Higashikawa T, Sekiguchi S, Tanaka R, Suzuki M, Hotchi Y, Shimozawa S, Tokunaga S, Osugi I, Katou R, Ito S, Asako S, Takagi Y, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M, Kasamaki Y. Diffuse large B cell lymphoma originating from the maxillary sinus with skin metastases: A case report and review of literature. World J Clin Cases 2021; 9:6886-6899. [PMID: 34447839 PMCID: PMC8362537 DOI: 10.12998/wjcc.v9.i23.6886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common type of malignant lymphoma (ML), accounting for 30%-40% of cases of non-Hodgkin’s lymphoma (NHL) in adults. Primary paranasal sinus lymphoma is a rare presentation of extranodal NHL that accounts for only 0.17% of all lymphomas. ML from the maxillary sinus (MS) is a particularly rare presentation, and is thus often difficult to diagnose. We have reported the first known case of DLBCL originating from the MS with rapidly occurrent multiple skin metastasis.
CASE SUMMARY An 81-year-old Japanese man visited our hospital due to continuous pain for 12 d in the left maxillary nerve area. His medical history included splenectomy due to a traffic injury, an old right cerebral infarction from when he was 74-years-old, hypertension, and type 2 diabetes mellitus. A plain head computed tomography (CT) scan revealed a 3 cm × 3.1 cm × 3 cm sized left MS. On day 25, left diplopia and ptosis occurred, and a follow-up CT on day 31 revealed the growth of the left MS mass. Based on an MS biopsy on day 50, we established a definitive diagnosis of DLBCL, non-germinal center B-cell-like originating from the left MS. The patient was admitted on day 62 due to rapid deterioration of his condition, and a plain CT scan revealed the further growth of the left MS mass, as well as multiple systemic metastasis, including of the skin. A skin biopsy on day 70 was found to be the same as that of the left MS mass. We notified the patient and his family of the disease, and they opted for palliative care, considering on his condition and age. The patient died on day 80.
CONCLUSION This case suggests the need for careful, detailed examination, and for careful follow-up, when encountering patients presenting with a mass.
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Affiliation(s)
- Daisuke Usuda
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Toshihide Izumida
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Nao Terada
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Ryusho Sangen
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Toshihiro Higashikawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Sayumi Sekiguchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Suguru Asako
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Yoshie Takagi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
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Morimura N, Mizobata Y, Sugita M, Takeda S, Kiyozumi T, Shoko T, Inoue Y, Otomo Y, Sakurai A, Koido Y, Tanabe S, Okumura T, Yamasawa F, Tanaka H, Kinoshi T, Kaku K, Matsuda K, Kitamura N, Hayakawa T, Kuroda Y, Kuroki Y, Sasaki J, Oda J, Inokuchi M, Kakuta T, Arai S, Sato N, Matsuura H, Nozawa M, Osamura T, Yamashita K, Okudera H, Kawana A, Koshinaga T, Hirano S, Sugawara E, Kamata M, Tajiri Y, Kohno M, Suzuki M, Nakase H, Suehiro E, Yamase H, Otake H, Morisaki H, Ozawa A, Takahashi S, Otsuka K, Harikae K, Kishi K, Mizuno H, Nakajima H, Ueta H, Nagayama M, Kikuchi M, Yokota H, Shimazu T, Yukioka T. Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020). Acute Med Surg 2021; 8:e626. [PMID: 33552526 PMCID: PMC7852170 DOI: 10.1002/ams2.626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023] Open
Abstract
Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health‐care system, it can provide the opportunity for long‐term benefits of public health‐care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID‐19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.
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Affiliation(s)
- Naoto Morimura
- Japanese Association for Acute Medicine Tokyo Japan.,The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan
| | | | | | - Satoshi Takeda
- The Education and Training Working Group of AC2020 Tokyo Japan.,AED Foundation of Japan Tokyo Japan
| | | | - Tomohisa Shoko
- The Education and Training Working Group of AC2020 Tokyo Japan
| | - Yoshiaki Inoue
- The Education and Training Working Group of AC2020 Tokyo Japan
| | - Yasuhiro Otomo
- The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan.,Japanese Association for the Surgery of Trauma Tokyo Japan
| | | | - Yuichi Koido
- Japanese Association for Disaster Medicine Tokyo Japan
| | - Seizan Tanabe
- Japanese Association for Disaster Medicine Tokyo Japan
| | - Tetsu Okumura
- Japanese Society for Clinical Toxicology Tokyo Japan
| | | | | | - Tomoya Kinoshi
- Japanese Association of First Aid and Emergency Medicine Kyoto Japan
| | - Koki Kaku
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | - Kiyoshi Matsuda
- Japan Prehospital Trauma Evaluation and Care Council Tokyo Japan
| | | | | | - Yasuhiro Kuroda
- Japanese Society of Intensive Care Medicine Tokyo Japan.,Japanese Society of Reanimatology Ube Japan
| | - Yumiko Kuroki
- Japanese Society for Clinical Toxicology Tokyo Japan
| | - Junichi Sasaki
- Japanese Society for Burn Injuries Tokyo Japan.,Japanese Association for Infectious Diseases Tokyo Japan
| | - Jun Oda
- Japanese Society for Burn Injuries Tokyo Japan
| | | | | | | | - Noriaki Sato
- Japanese Association for Emergency Nursing Tokyo Japan
| | | | | | | | | | - Hiroshi Okudera
- Japanese Association of First Aid and Emergency Medicine Kyoto Japan
| | - Akihiko Kawana
- Japanese Association for Infectious Diseases Tokyo Japan
| | | | | | - Erisa Sugawara
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | | | | | | | | | | | | | | | | | | | - Akiko Ozawa
- Japanese Society of Anesthesiologists Kobe Japan
| | - Sho Takahashi
- Japanese Society of Psychiatry and Neurology Tokyo Japan
| | - Kotaro Otsuka
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | - Kiyokazu Harikae
- Japan Prehospital Trauma Evaluation and Care Council Tokyo Japan
| | - Kazuo Kishi
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | - Hiroshi Mizuno
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | | | | | | | | | - Hiroyuki Yokota
- The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan
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24
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Yamazaki T, Sugita M, Martinet J, Boyer O, Galluzzi L, Guzman M, Formenti S. Boosting CAR T Cell Expansion and Therapeutic Activity with Low-dose Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Affiliation(s)
- So Sakamoto
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Manabu Sugita
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
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26
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Nomura T, Sekii H, Sugita M, Nakahara S. Association between biphasic reactions and the systems of symptoms and treatment in patients with anaphylaxis hospitalized from the emergency department. Acute Med Surg 2020; 7:e599. [PMID: 33209335 PMCID: PMC7659525 DOI: 10.1002/ams2.599] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/06/2022] Open
Abstract
AIM Anaphylaxis is a severe, life-threatening, generated or systemic reaction, and biphasic reaction could occur in some cases. We investigated the clinical course of anaphylaxis in our hospital and studied the relationship between biphasic reactions and the symptoms and treatments for predicting the onset of biphasic reactions. METHODS We retrospectively reviewed the medical records of 120 patients with anaphylaxis who were admitted to our hospital from the emergency department during April 2008-October 2015. RESULTS The incidence of biphasic reactions of anaphylaxis in our hospital was 10.8% (13 patients) without significant difference when compared with that in previous reports. Regarding the development of biphasic reactions, symptoms, the number of systems of symptoms and severity of the initial reaction, and treatment with adrenaline and corticosteroid were not clearly related with biphasic reaction. Use of adrenaline in the initial treatment was approximately 60%. Of the 13 biphasic reactions, 11 (84.5%) were as equal/mild as the original symptoms. CONCLUSION This study could not show the factors predicting the onset of biphasic reactions. Further prospective and nationwide studies are required to research biphasic reactions.
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Affiliation(s)
- Tomohisa Nomura
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
| | - Hajime Sekii
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
| | - Manabu Sugita
- Department of Emergency and Critical Care MedicineJuntendo University Nerima HospitalTokyoJapan
| | - Shinji Nakahara
- Graduate School of Health InnovationKnagawa University of Human ServicesYokosukaJapan
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27
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Gando S, Shiraishi A, Yamakawa K, Ogura H, Saitoh D, Fujishima S, Mayumi T, Kushimoto S, Abe T, Shiino Y, Nakada TA, Tarui T, Hifumi T, Otomo Y, Okamoto K, Umemura Y, Kotani J, Sakamoto Y, Sasaki J, Shiraishi SI, Takuma K, Tsuruta R, Hagiwara A, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Fujimi S, Tasaki O, Mizobata Y, Funakoshi H, Okuyama T, Yamashita I, Kanai T, Yamada Y, Aibiki M, Sato K, Yamashita S, Yamashita S, Yoshida K, Kasaoka S, Kon A, Rinka H, Kato H, Okudera H, Narimatsu E, Fujiwara T, Sugita M, Shichinohe Y, Nakae H, Iiduka R, Murata Y, Nakamura M, Sato Y, Ishikura H, Myojo Y, Tsujita Y, Kinoshita K, Yamaguchi H, Sakurai T, Miyatake S, Saotome T, Yasuda S, Abe T, Ogura H, Umemura Y, Shiraishi A, Kushimoto S, Saitoh D, Fujishima S, Sasaki J, Mayumi T, Shiino Y, Nakada TA, Tarui T, Hifumi T, Otomo Y, Kotani J, Sakamoto Y, Shiraishi SI, Takuma K, Tsuruta R, Hagiwara A, Yamakawa K, Takeyama N, Yamashita N, Ikeda H, Mizushima Y, Gando S. Role of disseminated intravascular coagulation in severe sepsis. Thromb Res 2019; 178:182-188. [DOI: 10.1016/j.thromres.2019.04.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/23/2019] [Accepted: 04/23/2019] [Indexed: 01/16/2023]
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29
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Iguchi S, Yamaguchi N, Takami H, Komatsu T, Ookubo H, Sekii H, Inoue K, Okazaki S, Okai I, Maruyama S, Nomura T, Sugita M. Higher efficacy of direct hemoperfusion using coated activated-charcoal column for disopyramide poisoning: A case report. Medicine (Baltimore) 2017; 96:e8755. [PMID: 29245231 PMCID: PMC5728846 DOI: 10.1097/md.0000000000008755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/24/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cases of severe disopyramide poisoning are rare and few have been reported. We report a case in which activated-charcoal column hemoperfusion was dramatically effective for life-threatening disopyramide poisoning. PATIENT CONCERNS A teenage girl who had overdosed on disopyramide (total dose, 4950 mg) was brought to our hospital. She was resuscitated from short period cardiopulmonary arrest and subsequently showed severe cardiogenic shock and ventricular arrhythmia. DIAGNOSES Disopyramide poisoning (self-evident). INTERVENTIONS As hemodynamics remained unstable after providing percutaneous cardiopulmonary support and intra-aortic balloon pumping, we attempted direct hemoperfusion using a coated activated-charcoal hemoperfusion column. OUTCOMES Hemodynamics including electrocardiography and serum disopyramide concentration were dramatically improved, and the patient was ambulatory by hospital day 14. LESSONS Because disopyramide has low molecular weight and a small distribution volume, blood purification is considered to be the most effective therapy. We selected direct hemoperfusion for relatively high protein-binding rate. In fact, clinical status was dramatically improved, and the calculated half-life of the direct hemoperfusion phase was the shortest of all phases. In cases of severe or life-threatening disopyramide poisoning, blood purification therapy including direct hemoperfusion using a coated activated-charcoal column should be performed.
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Affiliation(s)
- Shigekazu Iguchi
- Department of Emergency and Critical Care Medicine
- Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | | | - Hajime Sekii
- Department of Emergency and Critical Care Medicine
| | - Kenji Inoue
- Department of Cardiology, Juntendo University Nerima Hospital
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University Nerima Hospital
| | - Iwao Okai
- Department of Cardiology, Juntendo University Nerima Hospital
| | - Sonomi Maruyama
- Department of Cardiology, Juntendo University Nerima Hospital
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Hatta K, Kishi Y, Wada K, Takeuchi T, Ito S, Kurata A, Murakami K, Sugita M, Usui C, Nakamura H. Preventive Effects of Suvorexant on Delirium: A Randomized Placebo-Controlled Trial. J Clin Psychiatry 2017; 78:e970-e979. [PMID: 28767209 DOI: 10.4088/jcp.16m11194] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE No highly effective pharmacologic interventions to prevent delirium have been identified. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the prevention of delirium. METHODS We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more. Seventy-two patients were randomly assigned using the sealed envelope method to receive suvorexant (15 mg/d; 36 patients) or placebo (36 patients) every night for 3 days. The primary outcome measure was incidence of delirium as determined by the DSM-5. Trained psychiatrists assessed for delirium. RESULTS We found that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (0% [n/N = 0/36] vs 17% [6/36], respectively, P = .025). Comparison by log-rank test also showed that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (χ² = 6.46, P = .011). Analysis of variance revealed a tendency for main effect of treatment (F = 3.79, P = .053) on the sleep-wake cycle disturbance score (item 1) of the Japanese version of the Delirium Rating Scale-Revised-98 (DRS-R-98-J). There were no significant differences in adverse events. CONCLUSIONS Suvorexant administered nightly to elderly patients admitted for acute care may provide protection against delirium. Larger studies are needed to show the potential of suvorexant to improve the circadian core domain of delirium. TRIAL REGISTRATION UMIN Clinical Trials Registry identifier: UMIN000015681.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, Tokyo 177-8521, Japan. .,Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Ken Wada
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Takeuchi
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeo Ito
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Akiko Kurata
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
| | - Kazunori Murakami
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Chie Usui
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Nakajima E, Sugita M, Furukawa K, Takahashi H, Kawaguchi Y, Ohira T, Ikeda N, Hirsch F, Franklin W. P2.03-019 Sizing Capillary Electrophoresis with PCR to Detect Various EGFR Exon 19 Deletions in Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Inokuchi S, Masui Y, Miura K, Tsutsumi H, Takuma K, Atsushi I, Nakano M, Tanaka H, Ikegami K, Arai T, Yaguchi A, Kitamura N, Oda S, Kobayashi K, Suda T, Ono K, Morimura N, Furuya R, Koido Y, Iwase F, Nagao K, Kanesaka S, Okada Y, Unemoto K, Sadahiro T, Iyanaga M, Muraoka A, Hayashi M, Ishimatsu S, Miyake Y, Yokokawa H, Koyama Y, Tsuchiya A, Kashiyama T, Hayashi M, Oshima K, Kiyota K, Hamabe Y, Yokota H, Hori S, Inaba S, Sakamoto T, Harada N, Kimura A, Kanai M, Otomo Y, Sugita M, Kinoshita K, Sakurai T, Kitano M, Matsuda K, Tanaka K, Yoshihara K, Yoh K, Suzuki J, Toyoda H, Mashiko K, Shimizu N, Muguruma T, Shimada T, Kobe Y, Shoko T, Nakanishi K, Shiga T, Yamamoto T, Sekine K, Izuka S. A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan: A Prospective Study. J Emerg Med 2017; 53:345-352. [DOI: 10.1016/j.jemermed.2017.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
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Komatsu T, Takahashi E, Mishima K, Toyoda T, Saitoh F, Yasuda A, Matsuoka J, Sugita M, Branch J, Aoki M, Tierney L, Inoue K. A Simple Algorithm for Predicting Bacteremia Using Food Consumption and Shaking Chills: A Prospective Observational Study. J Hosp Med 2017; 12:510-515. [PMID: 28699938 DOI: 10.12788/jhm.2764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Predicting the presence of true bacteremia based on clinical examination is unreliable. OBJECTIVE We aimed to construct a simple algorithm for predicting true bacteremia by using food consumption and shaking chills. DESIGN A prospective multicenter observational study. SETTING Three hospital centers in a large Japanese city. PARTICIPANTS In total, 1,943 hospitalized patients aged 14 to 96 years who underwent blood culture acquisitions between April 2013 and August 2014 were enrolled. Patients with anorexia-inducing conditions were excluded. INTERVENTIONS We assessed the patients' oral food intake based on the meal immediately prior to the blood culture with definition as "normal food consumption" when >80% of a meal was consumed and "poor food consumption" when <80% was consumed. We also concurrently evaluated for a history of shaking chills. MEASUREMENTS We calculated the statistical characteristics of food consumption and shaking chills for the presence of true bacteremia, and subsequently built the algorithm by using recursive partitioning analysis. RESULTS Among 1,943 patients, 223 cases were true bacteremia. Among patients with normal food consumption, without shaking chills, the incidence of true bacteremia was 2.4% (13/552). Among patients with poor food consumption and shaking chills, the incidence of true bacteremia was 47.7% (51/107). The presence of poor food consumption had a sensitivity of 93.7% (95% confidence interval [CI], 89.4%-97.9%) for true bacteremia, and the absence of poor food consumption (ie, normal food consumption) had a negative likelihood ratio (LR) of 0.18 (95% CI, 0.17-0.19) for excluding true bacteremia, respectively. Conversely, the presence of the shaking chills had a specificity of 95.1% (95% CI, 90.7%-99.4%) and a positive LR of 4.78 (95% CI, 4.56-5.00) for true bacteremia. CONCLUSION A 2-item screening checklist for food consumption and shaking chills had excellent statistical properties as a brief screening instrument for predicting true bacteremia.
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Affiliation(s)
- Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Erika Takahashi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takeo Toyoda
- Department of Internal Medicine, Nerima General Hospital, Tokyo, Japan
| | - Fumihiro Saitoh
- Department of General Medicine, Oizumi Health Cooperative Hospital, Tokyo, Japan
| | - Akari Yasuda
- Department of Nursing, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Joe Matsuoka
- Juntendo Clinical Research Support Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Joel Branch
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Makoto Aoki
- Consultant to Sakura Seiki Co Ltd, Tokyo, Japan
| | - Lawrence Tierney
- Department of Internal Medicine, University of California San Francisco, San Francisco, California
| | - Kenji Inoue
- of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
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Sugita M. Thoughts from a clinical stand point. Chudoku Kenkyu 2017; 30:9-13. [PMID: 30549921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Yanagawa Y, Kondo A, Yoshizawa T, Jitsuiki K, Miyake T, Ohsaka H, Sugita M. The Migration of Air into the Aorta from a Pneumothorax in a Patient with a Penetrating Injury of the Aorta. Aorta (Stamford) 2016; 4:102-104. [PMID: 28097188 DOI: 10.12945/j.aorta.2016.16.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/12/2016] [Indexed: 11/18/2022]
Abstract
A tree fell on the back of a 77-year-old male. A postmortem computed tomographic pan scan revealed systemic air embolism, multiple rib fractures with a penetrating injury to the aorta, pneumohemothorax, and air in the aorta. A massive amount of air entered the site of a penetrating injury of the aorta. This unique case adds one more cause to the list of documented etiologies of air in the aorta.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima ku, Tokyo, Japan
| | - Toshihiko Yoshizawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Takahito Miyake
- Department of Orthopedics, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima ku, Tokyo, Japan
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Mishima K, Itoi A, Sugita M, Yanagawa Y. A case of fracture through fused cervical segments following trauma in a patient with Klippel-Feil syndrome. J Emerg Trauma Shock 2016; 9:85-6. [PMID: 27162441 PMCID: PMC4843572 DOI: 10.4103/0974-2700.179455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kentaro Mishima
- Department of Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Akira Itoi
- Department of Orthopedics, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni, Japan E-mail:
| | - Youichi Yanagawa
- Department of Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
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Inokuchi S, Masui Y, Miura K, Tsutsumi H, Takuma K, Atsushi I, Nakano M, Tanaka H, Ikegami K, Arai T, Yaguchi A, Kitamura N, Oda S, Kobayashi K, Suda T, Ono K, Morimura N, Furuya R, Koido Y, Iwase F, Nagao K, Kanesaka S, Okada Y, Unemoto K, Sadahiro T, Iyanaga M, Muraoka A, Hayashi M, Ishimatsu S, Miyake Y, Yokokawa H, Koyama Y, Tsuchiya A, Kashiyama T, Hayashi M, Oshima K, Kiyota K, Hamabe Y, Yokota H, Hori S, Inaba S, Sakamoto T, Harada N, Kimura A, Kanai M, Otomo Y, Sugita M, Kinoshita K, Sakurai T, Kitano M, Matsuda K, Tanaka K, Yoshihara K, Yoh K, Suzuki J, Toyoda H, Mashiko K, Shimizu N, Muguruma T, Shimada T, Kobe Y, Shoko T, Nakanishi K, Shiga T, Yamamoto T, Sekine K, Izuka S. Investigation and treatment of pulmonary embolism as a potential etiology may be important to improve post-resuscitation prognosis in non-shockable out-of-hospital cardiopulmonary arrest: report on an analysis of the SOS-KANTO 2012 study. Acute Med Surg 2016; 3:250-259. [PMID: 29123793 DOI: 10.1002/ams2.183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/16/2015] [Indexed: 11/05/2022] Open
Abstract
Background The prognosis of non-shockable out-of-hospital cardiac arrest is worse than that of shockable out-of-hospital cardiac arrest. We investigated the associations between the etiology and prognosis of non-shockable out-of-hospital cardiac arrest patients who experienced the return of spontaneous circulation after arriving at hospital. Methods and Results All subjects were extracted from the SOS-KANTO 2012 study population. The subjects were 3,031 adults: (i) who had suffered out-of-hospital cardiac arrest, (ii) for whom there were no pre-hospital data on ventricular fibrillation/pulseless ventricular tachycardia until arrival at hospital, (iii) who experienced the return of spontaneous circulation after arriving at hospital. We compared the patients' prognosis after 1 and 3 months between various etiological and presumed cardiac factors. The proportion of the favorable brain function patients that developed pulmonary embolism or incidental hypothermia was significantly higher than that of the patients with presumed cardiac factors (1 month, P < 0.0001 and P < 0.0001, respectively; 3 months, P = 0.0018 and P < 0.0001, respectively). In multiple logistic regression analysis, pulmonary embolism and incidental hypothermia were found to be significant independent prognostic factors for 1- and 3-month survival and the favorable brain function rate. Conclusions In patients who suffer non-shockable out-of-hospital cardiac arrest, but who experience the return of spontaneous circulation after arriving at hospital, the investigation and treatment of pulmonary embolism as a potential etiology may be important for improving post-resuscitation prognosis.
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Affiliation(s)
| | | | - Yoshihiro Masui
- St. Marianna University School of Medicine Yokohama Seibu Hospital
| | | | | | | | | | | | | | | | - Takao Arai
- Hachioji Medical Center of Tokyo Medical University
| | | | | | - Shigeto Oda
- Chiba University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akio Kimura
- National Center for Global Health and Medicine Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shinichi Izuka
- Fuji Heavy Industries Health Insurance Society OTA Memorial Hospital
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Murata A, Inoue K, Maruyama S, Iguchi S, Sugita M, Hiki M, Okazaki S, Okai I, Fujiwara Y, Sumiyoshi M, Yamamoto T, Amano A, Daimon M, Daida H. Enormous Pedunculated Vegetation Originating in the Left Ventricular Apex in a Patient with Infective Endocarditis. Intern Med 2016; 55:2971-2973. [PMID: 27746434 PMCID: PMC5109564 DOI: 10.2169/internalmedicine.55.7043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/24/2022] Open
Abstract
A healthy teenage Japanese girl was admitted to our hospital after experiencing out-of-hospital cardiac arrest. She had attempted to commit suicide by taking 4,950 mg of disopyramide and 12 mg of flunitrazepam. Mechanical cardiopulmonary support was started with percutaneous cannulation of the femoral vessels. Several days later, a blood culture tested positive for Staphylococcus aureus. Transthoracic echocardiography showed a large mobile and solid mass attached to the apical part of the left ventricle. To the best of our knowledge, the anatomical location of a pedunculated mass originating from the apex is a rare condition.
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Affiliation(s)
- Azusa Murata
- Department of Cardiology, Juntendo University Hospital, Japan
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Komatsu T, Nomura T, Takami H, Sakamoto S, Mizuno K, Sekii H, Hatta K, Sugita M. Catatonic Symptoms Appearing before Autonomic Symptoms Help Distinguish Neuroleptic Malignant Syndrome from Malignant Catatonia. Intern Med 2016; 55:2893-2897. [PMID: 27725556 PMCID: PMC5088557 DOI: 10.2169/internalmedicine.55.6613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 12/29/2022] Open
Abstract
A 42-year-old Japanese woman with a 10-year history of schizophrenia was admitted due to a disturbance in consciousness that met the diagnostic criteria for both neuroleptic malignant syndrome (NMS) and malignant catatonia. Despite systemic supportive treatments, the catatonic symptoms preceding autonomic symptoms persisted. The symptoms improved after lorazepam administration, leading to a retrospective diagnosis of malignant catatonia. Catatonia is thought to be caused by a dysfunction of ganmma-aminobutyric acid type A receptors in the cortico-cortical networks of the frontal lobes, which causes hypoactivity of the dopaminergic transmission in the subcortical areas. Identifying the catatonic symptoms preceding autonomic symptoms could aid in distinguishing malignant catatonia from NMS.
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Affiliation(s)
- Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
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Komatsu T, Takahashi E, Mishima K, Toyoda T, Saitoh F, Sugita M, Branch J, Inoue K. The Diagnostic Efficacy for Combination of Nurse-Assesed Food Consumptions and Shaking Chills in Predicting Bacteremia at the Time of Blood Culture. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yoshizawa T, Jitsuiki K, Obinata M, Ishikawa K, Ohsaka H, Oode Y, Sugita M, Yanagawa Y. A patient with clear consciousness even with a glucose level of 5 mg/dL (0.2 mmol/L). Am J Emerg Med 2015; 34:941.e3-4. [PMID: 26521193 DOI: 10.1016/j.ajem.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022] Open
Abstract
A 74-year-old man noted dysarthria and right hemiparesis. His history included a gastric ulcer 2 years previously, and he had gradually lost 10 kg over a 2-year period due to appetite loss. He daily consumed 120 mg of alcohol. Upon arrival, he had clear consciousness and stable vital signs. He was malnourished. Neurologic findings included a positive finding of Barre sign in the right hand and dysarthria. A venous blood gas analysis demonstrated the following: pH 7.059; PCO2, 21.5 mm Hg; PO2, 59.1 mm Hg; HCO(3-), 5.8 mmol/L; base excess, -22.7 mmol/L; lactate,17 mmol/L; and glucose, 4 mg/dL. After the administration of an infusion of thiamine and glucose, his abnormal neurologic findings subsided completely. Head magnetic resonance image (MRI; diffusion weighted image) disclosed 3 spotty, high-intensity signals in the brain. The main results of biochemical analyses of the blood collected on arrival were as follows: hemoglobin, 5.5 g/dL; glucose, 5 mg/dL; aspartate aminotransferase, 89 IU/L. He was admitted for further examination and was diagnosed as having alcoholic ketoacidosis with hypoglycemic encephalopathy and anemia due to colon cancer.
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Affiliation(s)
- Toshihiko Yoshizawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Mariko Obinata
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Manabu Sugita
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
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Affiliation(s)
- T Nakanishi
- Fifth Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Sugita M. [The perception gap between clinical trials and clinical practice]. Chudoku Kenkyu 2015; 28:37-40. [PMID: 26399013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Tagami T, Tosa R, Omura M, Fukushima H, Kaneko T, Endo T, Rinka H, Murai A, Yamaguchi J, Yoshikawa K, Saito N, Uzu H, Kase Y, Takatori M, Izumino H, Nakamura T, Seo R, Kitazawa Y, Sugita M, Takahashi H, Kuroki Y, Irahara T, Kanemura T, Yokota H, Kushimoto S. Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study. J Intensive Care 2014; 2:67. [PMID: 25705423 PMCID: PMC4336272 DOI: 10.1186/s40560-014-0067-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [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: 07/10/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neutrophil elastase plays an important role in the development and progression of acute respiratory distress syndrome (ARDS). Although the selective elastase inhibitor, sivelestat, is widely used in Japan for treating ARDS patients, its effectiveness remains controversial. The aim of the current study was to investigate the effects of sivelestat in ARDS patients with evidence of increased extravascular lung water by re-analyzing a large multicenter study database. METHODS A post hoc analysis of the PiCCO Pulmonary Edema Study was conducted. This multicenter prospective cohort study included 23 institutions in Japan. Adult mechanically ventilated ARDS patients with an extravascular lung water index of >10 mL/kg were included and propensity score analyses were performed. The endpoints were 28-day mortality and ventilator-free days (VFDs). RESULTS Patients were categorized into sivelestat (n = 87) and control (n = 77) groups, from which 329 inverse probability-weighted group patients (162 vs. 167) were generated. The overall 28-day mortality was 31.1% (51/164). There was no significant difference in 28-day mortality between the study groups (sivelestat vs. control; unmatched: 29.9% vs. 32.5%; difference, -2.6%, 95% confidence interval (CI), -16.8 to 14.2; inverse probability-weighted: 24.7% vs. 29.5%, difference, -4.8%, 95% CI, -14.4 to 9.6). Although administration of sivelestat did not alter the number of ventilator-free days (VFDs) in the unmatched (9.6 vs. 9.7 days; difference, 0.1, 95% CI, -3.0 to 3.1), the inverse probability-weighted analysis identified significantly more VFDs in the sivelestat group than in the control group (10.7 vs. 8.4 days, difference, -2.3, 95% CI, -4.4 to -0.2). CONCLUSIONS Although sivelestat did not significantly affect 28-day mortality, this treatment may have the potential to increase VFDs in ARDS patients with increased extravascular lung water. Prospective randomized controlled studies are required to confirm the results of the current study.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 Japan ; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoichi Tosa
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Mariko Omura
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Tadashi Kaneko
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Tomoyuki Endo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Miyagi, Japan
| | - Hiroshi Rinka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Akira Murai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Yoshikawa
- Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Nobuyuki Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan
| | - Hideaki Uzu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Yoichi Kase
- Critical Care Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Takatori
- Department of Anesthesia and Intensive Care, Hiroshima City Hospital, Hiroshima, Japan
| | - Hiroo Izumino
- Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, Osaka, Japan
| | | | - Ryutarou Seo
- Intensive Care Unit, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yasuhide Kitazawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Yuichi Kuroki
- Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, Aichi, Japan
| | - Takayuki Irahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Takashi Kanemura
- Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Mishima K, Omori K, Ohsaka H, Takeda J, Ishikawa K, Obinata M, Oode Y, Sugita M, Yanagawa Y. A case of the vacuum phenomenon as a mechanism of gas production in the abdominal wall. Am J Emerg Med 2014; 33:863.e1-2. [PMID: 25600235 DOI: 10.1016/j.ajem.2014.12.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 12/26/2014] [Indexed: 11/25/2022] Open
Abstract
A 40-year-old man experienced a collision with a car while driving a motorcycle in which the car was in the opposite lane and made a right turn. The patient was thrown approximately 10 m from the point of collision and, as he exhibited a consciousness disturbance, was transferred to our department. He had a score of 13 on the Glasgow Coma Scale with sinus tachycardia on arrival. He showed guarding of the abdomen. A pan scan disclosed traumatic subarachnoid hemorrhage, intraventricular hemorrhage, fractures of the atlas, thoracic spine, sternum and left femur, and gas in the abdomen located just in front of the stomach. As the gas in the abdomen was initially judged to be free air, the patient underwent emergency laparotomy. However, no signs of perforation or injury were detected throughout the entire digestive tract. The accumulation of minute gas (vacuum phenomenon) occurs as traumatic impact. As representative mimics of free air were not observed during surgery in the present case, we believe that the traumatic impact to the patient's abdomen as a result of the collision caused the accumulation of gas in the abdominal wall due to vacuum phenomenon. Physicians should be aware of this clinical entity to accurately recognize the mechanism of gas formation in patients showing negative laparotomy findings for gas in the abdomen. This unique case adds additional information regarding the documented etiologies of mimics of pneumoperitoneum.
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Affiliation(s)
- Kentaro Mishima
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Jun Takeda
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Mariko Obinata
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Manabu Sugita
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima, Tokyo, Japan.
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Tagami T, Nakamura T, Kushimoto S, Tosa R, Watanabe A, Kaneko T, Fukushima H, Rinka H, Kudo D, Uzu H, Murai A, Takatori M, Izumino H, Kase Y, Seo R, Takahashi H, Kitazawa Y, Yamaguchi J, Sugita M, Takahashi H, Kuroki Y, Kanemura T, Morisawa K, Saito N, Irahara T, Yokota H. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care 2014; 4:27. [PMID: 25593743 PMCID: PMC4273855 DOI: 10.1186/s13613-014-0027-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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] [Received: 03/25/2014] [Accepted: 07/31/2014] [Indexed: 01/11/2023] Open
Abstract
Background The features of early-phase acute respiratory distress syndrome (ARDS) are leakage of fluid into the extravascular space and impairment of its reabsorption, resulting in extravascular lung water (EVLW) accumulation. The current study aimed to identify how the initial EVLW values and their change were associated with mortality. Methods This was a post hoc analysis of the PiCCO Pulmonary Edema Study, a multicenter prospective cohort study that included 23 institutions. Single-indicator transpulmonary thermodilution-derived EVLW index (EVLWi) and conventional prognostic factors were prospectively collected over 48 h after enrollment. Associations between 28-day mortality and each variable including initial (on day 0), mean, maximum, and Δ (subtracting day 2 from day 0) EVLWi were evaluated. Results We evaluated 192 ARDS patients (median age, 69 years (quartile, 24 years); Sequential Organ Failure Assessment (SOFA) score on admission, 10 (5); all-cause 28-day mortality, 31%). Although no significant differences were found in initial, mean, or maximum EVLWi, Δ-EVLWi was significantly higher (i.e., more reduction in EVLWi) in survivors than in non-survivors (3.0 vs. −0.3 mL/kg, p = 0.006). Age, maximum, and Δ-SOFA scores and Δ-EVLW were the independent predictors for survival according to the Cox proportional hazard model. Patients with Δ-EVLWi > 2.8 had a significantly higher incidence of survival than those with Δ-EVLWi ≤ 2.8 (log-rank test, χ2 = 7.08, p = 0.008). Conclusions Decrease in EVLWi during the first 48 h of ARDS may be associated with 28-day survival. Serial EVLWi measurements may be useful for understanding the pathophysiologic conditions in ARDS patients. A large multination confirmative trial is required.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan ; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - Toshiaki Nakamura
- Intensive Care Unit, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi 986-2242, Japan
| | - Ryoichi Tosa
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima 965-8611, Japan
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tadashi Kaneko
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara 634-8522, Japan
| | - Hiroshi Rinka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka 534-0021, Japan
| | - Daisuke Kudo
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi 986-2242, Japan
| | - Hideaki Uzu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Akira Murai
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan
| | - Makoto Takatori
- Department of Anesthesia and Intensive Care, Hiroshima City Hospital, Hiroshima 730-8518, Japan
| | - Hiroo Izumino
- Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, Osaka 570-8507, Japan
| | - Yoichi Kase
- Department of Critical Care Medicine, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Ryutarou Seo
- Intensive Care Unit, Kobe City Medical Center General Hospital, Hyogo 650-0046, Japan
| | - Hiroyuki Takahashi
- Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo 113-8519, Japan
| | - Yasuhide Kitazawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka 570-8506, Japan
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hiroyuki Takahashi
- Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa 230-8765, Japan
| | - Yuichi Kuroki
- Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, Aichi 457-8510, Japan
| | - Takashi Kanemura
- Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
| | - Kenichiro Morisawa
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Nobuyuki Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Chiba Hokusou Hospital, Chiba 270-1694, Japan
| | - Takayuki Irahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama Nagayama Hospital, Tokyo 206-8512, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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Kondo A, Yanagawa Y, Omori K, Ohsaka H, Ishikawa K, Oode Y, Nomura T, Sugita M, Okamoto K. Importance of smoking and the occurrence of acute poisoning due to waterproof spray. Acute Med Surg 2014; 1:191-194. [PMID: 29930847 DOI: 10.1002/ams2.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/14/2014] [Indexed: 11/12/2022] Open
Abstract
A search of the database Ichushi (Japana Centra Revuo Medicana), which collects summaries of Japanese medical articles, was undertaken to identify articles published between 1983 and 2013, using the key word "waterproof". There was one original article and 19 case reports describing acute poisoning due to inhalation of waterproof spray gas, and providing information about the patient's smoking habit. Twenty-three of the 25 cases (92% of male patients, 71% of female patients) had a smoking habit. The one female case who did not have a smoking habit was in an environment exposed to secondhand smoke, because her husband had smoking habit. All cases had respiratory symptoms, and 24 cases had lung edema confirmed by computed tomography. There were no fatal cases among these patients. The one original article reported that 93% of males and 49% of females among a total of 104 cases with acute poisoning due to inhalation of waterproof spray gas had a smoking habit. Accordingly, people with a smoking habit tend to be vulnerable to exposure to waterproof spray gas.
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Affiliation(s)
- Akihiko Kondo
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine Nerima Hospital Juntendo University Tokyo Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine Nerima Hospital Juntendo University Tokyo Japan
| | - Ken Okamoto
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Japan
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Inoue T, Yanagawa Y, Omori K, Osaka H, Oode Y, Sugita M, Okamoto K. A case of thalamic hemorrhage with takotsubo cardiomyopathy. Acute Med Surg 2014; 1:176-180. [PMID: 29930843 DOI: 10.1002/ams2.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/03/2014] [Indexed: 12/11/2022] Open
Abstract
Case A 76-year-old woman was found unconscious by her family. She had suffered a fall and was soaked in kerosene. On arrival at our emergency department, she was unconscious, normotensive, with right hemiplegia and chemical burns. A computed tomographic scan of her head indicated left thalamic hemorrhage. An electrocardiogram showed ST elevation at the precardial leads. An echocardiogram revealed characteristic of takotsubo cardiomyopathy. Outcome The patient was intubated and treated conservatively. She was transferred to another hospital for rehabilitation after complete epithelization of the chemical burn. This is the second reported case of thalamic hemorrhage with takotsubo cardiomyopathy. The thalamic hemorrhage might have induced autonomic disturbances and caused the takotsubo cardiomyopathy in this case. Conclusion Physicians should pay attention to the potential complication of takotsubo cardiomyopathy, which may affect cardiopulmonary function even when patients are being treated for intracerebral hemorrhage.
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Affiliation(s)
- Teruhiro Inoue
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Shizuoka Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Shizuoka Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Shizuoka Japan
| | - Hiromichi Osaka
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Shizuoka Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Shizuoka Japan
| | - Manabu Sugita
- Department of Emergency and Intensive Care Juntendo Nerima Hospital Juntendo University Nerima Tokyo Japan
| | - Ken Okamoto
- Department of Acute Critical Care Medicine Shizuoka Hospital Juntendo University Izunokuni Shizuoka Japan
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Kaneko T, Kawamura Y, Maekawa T, Tagami T, Nakamura T, Saito N, Kitazawa Y, Ishikura H, Sugita M, Okuchi K, Rinka H, Watanabe A, Kase Y, Kushimoto S, Izumino H, Kanemura T, Yoshikawa K, Takahashi H, Irahara T, Sakamoto T, Kuroki Y, Taira Y, Seo R, Yamaguchi J, Takatori M. Global end-diastolic volume is an important contributor to increased extravascular lung water in patients with acute lung injury and acuterespiratory distress syndrome: a multicenter observational study. J Intensive Care 2014; 2:25. [PMID: 25520837 PMCID: PMC4267550 DOI: 10.1186/2052-0492-2-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/05/2013] [Accepted: 03/13/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Extravascular lung water (EVLW), as measured by the thermodilution method, reflects the extent of pulmonary edema. Currently, there are no clinically effective treatments for preventing increases in pulmonary vascular permeability, a hallmark of lung pathophysiology, in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). In this study, we examined the contributions of hemodynamic and osmolarity factors, for which appropriate interventions are expected in critical care, to EVLW in patients with ALI/ARDS. METHODS We performed a subgroup analysis of a multicenter observational study of patients with acute pulmonary edema. Overall, 207 patients with ALI/ARDS were enrolled in the study. Multivariate regression analysis was used to evaluate the associations of hemodynamic and serum osmolarity parameters with the EVLW index (EVLWI; calculated as EVLW/Ideal body weight). We analyzed factors measured on the day of enrollment (day 0), and on days 1 and 2 after enrollment. RESULTS Multivariate regression analysis showed that global end-diastolic volume index (GEDVI) was significantly associated with EVLWI measured on days 0, 1, and 2 (P = 0.002, P < 0.001, and P = 0.003, respectively), whereas other factors were not significantly associated with EVLWI measured on all 3 days. CONCLUSIONS Among several hemodynamic and serum osmolarity factors that could be targets for appropriate intervention, GEDVI appears to be a key contributor to EVLWI in patients with ALI/ARDS. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000003627.
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Affiliation(s)
- Tadashi Kaneko
- Advanced Medical Emergency and Critical Care Center (AMEC3), Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505 Japan
| | - Yoshikatsu Kawamura
- Advanced Medical Emergency and Critical Care Center (AMEC3), Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505 Japan
| | - Tsuyoshi Maekawa
- Advanced Medical Emergency and Critical Care Center (AMEC3), Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505 Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Aidu Chuo Hospital, 1-1 Tsuruga, Aiduwakamatsu, Fukushima, 965-8611 Japan ; Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Toshiaki Nakamura
- Intensive Care Unit, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Nobuyuki Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba, 270-1694 Japan
| | - Yasuhide Kitazawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8506 Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180 Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521 Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shinjo-cho, Kashihara, Nara, 634-8521 Japan
| | - Hiroshi Rinka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, 2-13-22 Miyakojima Hondori, Miyakojima, Osaka, 534-0021 Japan
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Yoichi Kase
- Department of Critical Care Medicine, Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aiba-ku, Sendai, 980-8574 Japan
| | - Hiroo Izumino
- Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, 10-15 Fumizono-machi, Moriguchi City, Osaka, 570-8507 Japan
| | - Takashi Kanemura
- Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa-shi, Tokyo, 190-0014 Japan
| | - Kazuhide Yoshikawa
- Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Hiroyuki Takahashi
- Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosumiyosi, Tsurumi-ku, Yokohama City, Kanagawa, 230-8765 Japan
| | - Takayuki Irahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512 Japan
| | - Teruo Sakamoto
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011 Japan
| | - Yuichi Kuroki
- Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, 1-1-10 Sanjo, Mimami-ku, Nagoya City, Aichi, 457-8510 Japan
| | - Yasuhiko Taira
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511 Japan
| | - Ryutarou Seo
- Department of Anesthesia, Kobe City Medical Center General Hospital, 2-2-1 Minatojimaminamimachi, Chuo-ku, Kobe City, Hyogo, 650-0046 Japan
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Makoto Takatori
- Department of Anesthesia and Intensive Care, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-shi, Hiroshima, 730-8518 Japan
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Shiga T, Watanabe N, Sugita M, Kamada Y, Inoue S, Kubo T. Two cases of osteochondromatosis which developed in the iliopectineal bursa of an osteoarthritic hip. Mod Rheumatol 2014; 11:360-2. [PMID: 24383786 DOI: 10.3109/s10165-001-8072-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract Two osteoarthritis patients had osteochondromatosis in the iliopectineal bursa which communicated with the hip joint space. They received surgical resection of the cystic mass and total hip arthroplasty and had good clinical outcomes. The authors consider that these patients' osteochondromatosis was a secondary development on the synovium of the iliopectineal bursa due to chronic inflammation caused by osteoarthritis.
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Affiliation(s)
- T Shiga
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine , Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 , Japan
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