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Showing 1 - 200 of 1583 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 11, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 53, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 43, SJR: 0.547, h-index: 30)
ACEP NOW     Free  
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 50, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 132, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 54, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 7, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 5, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 2)
Addiction     Hybrid Journal   (Followers: 32, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 24, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 25, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 47, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 246, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 4, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 4)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 14, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 9, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 28, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 50, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 126, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 89, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 28, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 30, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Orthopsychiatry     Hybrid Journal   (Followers: 4, SJR: 0.756, h-index: 69)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 35, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 234, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 15, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 115, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 15)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 152)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 203, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 34, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 5, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 8, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 42, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 66, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 6, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 126, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 47, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 13, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 34, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 24, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 201, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 48, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 26, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 13)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 316, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 3, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 13, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 7, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 42, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 21, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 16, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 380, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 64, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 9, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 3, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 7, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 21, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 14, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 2, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 44, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 134, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 17, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 33, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)

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Journal Cover Acute Medicine & Surgery
  [2 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2052-8817
   Published by John Wiley and Sons Homepage  [1582 journals]
  • A case of non-cardiogenic pulmonary edema provoked by intravenous
    • Authors: Yuichiro Ono; Makiko Morifusa, Satoru Ikeda, Chika Kunishige, Yoshiki Tohma
      Abstract: CaseA 61-year-old man was diagnosed with severe chest trauma after a car accident and had had difficulty in weaning from a ventilator because of flail chest and dilated cardiomyopathy. On the 17th day in the intensive care unit, he received i.v. acetazolamide to increase urine output. One hour after the injection, he suddenly developed severe hypoxia. Chest radiography revealed a butterfly shadow. He received other diuretics and a vasodilator, which seemed slowly to resolve the respiratory failure. Five days later, acetazolamide was again given and he experienced the same deterioration.OutcomeWe concluded that the episodes were attributed to pulmonary edema provoked by acetazolamide.ConclusionAcute non-cardiogenic pulmonary edema is an uncommon and lethal adverse effect of acetazolamide. Careful attention may be warranted when administering acetazolamide to critically ill patients.Acetazolamide is a carbonic anhydrase inhibitor that is widely use in various clinical settings, although it is associated with rare episodes of potentially lethal adverse effects, such as non-cardiogenic pulmonary edema. We report our experience with a critically ill patient who experienced two episodes of pulmonary edema after received acetazolamide.
      PubDate: 2017-04-24T06:27:47.894088-05:
      DOI: 10.1002/ams2.279
  • Investigation of Japan Disaster Medical Assistance Team response
           guidelines assuming catastrophic damage from a Nankai Trough earthquake
    • Authors: Hideaki Anan; Hisayoshi Kondo, Osamu Akasaka, Kenichi Oshiro, Mitsunobu Nakamura, Tetsuro Kiyozumi, Norihiko Yamada, Masato Homma, Kazuma Morino, Shinichi Nakayama, Yasuhiro Otomo, Yuichi Koido
      Abstract: AimTransporting critically ill patients outside of disaster-affected areas for treatment is an important activity of Japan Disaster Medical Assistance Teams (DMATs). We investigated whether this activity is possible after possible catastrophic damage from a Nankai Trough earthquake.MethodsJapan was divided into three areas based on the level of predicted damage (definitely, possibly, and non-affected areas). A survey of DMATs and the locations of emergency base hospitals and intensive care units (ICUs) in each area was carried out, and the ability to support disaster areas was investigated. Next, a survey of wide-area medical transport by Self-Defense Force aircraft and the medical transport abilities of helicopter ambulances was carried out. The numbers of ICU beds in each area were compared, and the capacity to accept patients was investigated. Finally, subjects for further study were examined.ResultsThe number of DMATs that could be sent from non-affected areas was insufficient. The number of patients that can be transported by Self-Defense Force aircraft and helicopter ambulance during the first 3 days was determined to be 1,443. The number of patients that can be accepted by ICUs in non-affected areas was insufficient. A system needs to be developed to provide medical treatment for critically ill patients within disaster areas during the acute phase. This will require DMAT operational reforms and the creation of logistics systems such as the supply of resources for earthquake-reinforced hospitals.ConclusionIn addition to patient transport, systems to provide medical care inside disaster-affected areas are needed.We investigated the specific medical response capabilities and considered Japan Disaster Medical Assistance Team activity guidelines that should be changed assuming a Nankai Trough earthquake. The investigations indicate an overwhelming shortage in the number of responding Disaster Medical Assistance Teams, aircraft transport capacity, and the number of intensive care unit beds that can accept critically ill patients estimated to need transport out of the affected areas.
      PubDate: 2017-04-24T06:27:40.506439-05:
      DOI: 10.1002/ams2.280
  • Characteristic of the acute drug intoxication conveyed by Kanagawa
           helicopter emergency medical service
    • Authors: Mariko Sugita; Shigeo Higami, Shigeaki Inoue, Seiji Morita, Yoshihide Nakagawa, Sadaki Inokuchi
      Abstract: AimVarious critical cases have been transported since the use of the Kanagawa Helicopter Emergency Medical Service (HEMS) started at Tokai University Hospital (Isehara, Japan) in 2002, including cases of acute poisoning. We analyzed the characteristics of acute poisoning cases conveyed by the HEMS.MethodsKanagawa HEMS conveyed 3,814 cases from July 2002 to March 2013, and acute drug and poison intoxication was diagnosed in 131 of these cases. We undertook a descriptive statistical study of these cases.ResultsThe causative agent was found to be psychiatric prescription drugs in 39.7% of cases, pesticides in 29.7%, alcohol in 8.4%, analgesics in 5.3%, detergent or bleach in 6.1%, oil, natural gas, or thinner in 4.6%, and others in 6.1%. At HEMS contact, systolic blood pressure was less than 90 mmHg in 18.3% of cases, and 40.2% were in coma. Endotracheal intubation was carried out in 44.5% of cases, and 6.9% died within 24 h of hospital admission. The cases of poisoning that we transported in the HEMS were often in shock and/or coma on arrival at the field, and rapid endotracheal intubation was required in nearly half of them, as many were in a serious condition.ConclusionWe believe that outcomes were more likely to be improved by appropriate early treatment by the HEMS. It will be necessary to further compare the ambulance service with the HEMS to evaluate their efficacy in the future.We treat a severely affected patient by Japanese helicopter emergency medical service (HEMS) every day. The acute drug intoxication was one and studied the characteristic of patients with drug intoxication conveyed by Kanagawa HEMS. A lot of severe poisoning mainly on the pesticide was available for the quick start of therapy by the physician.
      PubDate: 2017-04-24T06:27:32.699653-05:
      DOI: 10.1002/ams2.255
  • Two cases of life-threatening arrhythmia induced by risperidone:
           evaluation of risperidone and 9-hydroxy-risperidone concentrations
    • Authors: Asami Ito; Tomoyuki Enokiya, Eiji Kawamoto, Yoshiaki Iwashita, Taichi Takeda, Kenji Ikemura, Masahiro Okuda, Hiroshi Imai
      Abstract: CasesCase 1: A 20-year-old woman suffering a suspected overdose was transported to the hospital. She presented bradycardia with wide QRS waves and QT prolongation, followed by cardiac arrest. Extracorporeal cardiopulmonary resuscitation was implemented, improving circulation. Risperidone and 9OH-RIS levels were 9.6 ng/mL and 127.6 ng/mL, respectively. Case 2: A 54-year-old woman was hospitalized for femoral fracture and underwent surgery. Her electrocardiogram showed bradycardia and complete AV block. Risperidone and 9OH-RIS levels were 3.2 ng/mL and 61.4 ng/mL, respectively.OutcomeIn both cases, only serum concentration of 90H-RIS were elevated.ConclusionArrhythmia related to risperidone has proven rare but sometimes fatal. Serum concentrations of risperidone and the metabolite 9-hydroxy-risperidone (9OH-RIS) during these events are seldom documented. As 9OH-RIS shows pharmacological activity equivalent to risperidone, it may induce life-threatening arrhythmia (regardless of the intake dosage). It is critical to evaluate the serum concentration of 9OH-RIS in suspected risperidone toxicity.Two cases of risperidone-induced arrhythmia reporting the serum concentration of risperidone and its active metabolite 9OH-RIS. Case 1 is a 20-year-old woman who presented with cardiac arrest; case 2 is a 54-year-old woman who presented with complete AV block. In both cases, serum 9OH-RIS concentrations were elevated, whereas serum risperidone concentrations fell within the normal range.
      PubDate: 2017-04-24T06:27:27.129874-05:
      DOI: 10.1002/ams2.277
  • Cardiac arrest caused by rapidly increasing ascites in a patient with
           TAFRO syndrome: a case report
    • Authors: Masatoshi Okumura; Atsushi Ujiro, Yasunori Otsuka, Hiroshi Yamamoto, Sho Wada, Hirofumi Iwata, Toshiaki Kan, Seiji Miyauchi, Atsushi Hashimoto, Yuko Sato, Yoshihito Fujita, Yoshihiro Fujiwara, Hideki Shimaoka
      Abstract: CaseThrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly (TAFRO) syndrome is a newly defined systemic inflammatory disorder with gradual progression of symptoms. A 59-year-old man with fever and ascites of unknown cause developed sudden-onset shock and respiratory failure in the general ward. Cardiac arrest immediately followed. Although he was resuscitated, frequent administration of adrenaline was required to maintain his blood pressure. His circulation was most effectively stabilized by drainage of fluid from his distended abdomen. The volume of discharged ascites reached 4,000 mL at that time, and several liters continued to be discharged for >1 month. The diagnosis of TAFRO syndrome was based on the clinical features and laboratory and histological findings.OutcomeThe ascites volume and concentrations of inflammatory parameters decreased with treatment using several immunosuppressive agents.ConclusionThe newly defined TAFRO syndrome may be life-threatening. Patients should be monitored for progression to shock and cardiac arrest, especially those with rapidly increasing ascites.TAFRO syndrome may be life-threatening. Patients should be monitored for progression to shock and cardiac arrest, especially those with rapidly increasing ascites.
      PubDate: 2017-04-17T22:00:37.19037-05:0
      DOI: 10.1002/ams2.278
  • A case of cerebral tuberculoma mimicking neurocysticercosis
    • Authors: Hiroko Yuzawa; Yousuke Hirose, Tomonori Kimura, Sho Kimura, Hisanori Sugawara, Asako Yanagisawa, Sono Toi, Takashi Ohashi, Tomohito Sadahiro
      Abstract: CaseA 42-year-old Peruvian woman residing in Japan for 11 years with a family history of neurocysticercosis presented to our intensive care unit with fever and intense headache.Computed tomography indicated multiple micronodular lesions in the brain parenchyma, and cerebral tuberculoma and neurocysticercosis were considered in the differential diagnosis. Neurocysticercosis was initially suspected, and oral praziquantel was initiated. However, because of a high adenosine deaminase level in the cerebrospinal fluid and positive peripheral blood interferon gamma release test result, cerebral tuberculoma was subsequently considered.OutcomeAntituberculous drugs with steroids were initiated on day 10, after which the symptoms gradually resolved; the patient was discharged on day 29. Gadolinium-contrast magnetic resonance imaging 8 months later showed reduced nodular shadows, confirming cerebral tuberculoma.ConclusionImmediate diagnosis and treatment are imperative for cerebral tuberculoma, a lethal infection. Considering the recent increases in immigration worldwide, increased cases of tuberculoma mimicking neurocysticercosis are expected.We encountered a case of cerebral tuberculoma associated with intense headache and fever, which mimicked neurocysticercosis. Both diseases are rare in Japan but prevalent in endemic areas such as Latin America, Sub-Saharan Africa, and Southeast Asia. Considering the recent increases in immigration worldwide, increased cases of tuberculoma mimicking neurocysticercosis are expected.
      PubDate: 2017-04-04T21:40:26.345413-05:
      DOI: 10.1002/ams2.272
  • Performance review of regional emergency medical service pre-arrival
           cardiopulmonary resuscitation with or without dispatcher instruction: a
           population-based observational study
    • Authors: Hidetada Fukushima; Yasuyuki Kawai, Hideki Asai, Tadahiko Seki, Kazunobu Norimoto, Yasuyuki Urisono, Kazuo Okuchi
      Abstract: BackgroundTo investigate variations in emergency medical service (EMS) pre-arrival cardiopulmonary resuscitation (CPR), including both bystander CPR without dispatch assistance and dispatch-assisted CPR (DACPR).MethodsWe carried out an observational study by implementing EMS pre-arrival CPR reports in three fire agencies. We included adult, non-traumatic, and non-EMS witnessed out-of-hospital cardiac arrests. This reporting system comprised the dispatch instruction process and bystander CPR quality based on evaluations by EMS crews who arrived on the scene. Bystander CPR was categorized as “ongoing CPR” if the bystander was performing CPR when the EMS reached the patient's side and “good-quality CPR” if the CPR was performed proficiently. We compared the frequencies of ongoing and good-quality CPR in the bystander CPR already started without dispatch assistance (CPR in progress) group and DACPR group.ResultsOf 688 out-of-hospital cardiac arrests, CPR was already started in 150 cases (CPR in progress group). Dispatcher CPR instruction was provided in 368 cases. Among these, callers started chest compressions in 162 cases (DACPR group). Ongoing CPR was performed in 220 cases and was more frequent in the DACPR group (128/162 [79.0%] versus 92/150 [61.3%], P < 0.001). Good-quality CPR was more frequent in the CPR in progress group, but the difference was not statistically significant (36/92 [39.1%] versus 42/128 [29.0%], P = 0.888).ConclusionsOngoing CPR and good-quality CPR were not frequent in EMS pre-arrival CPR. Detailed analysis of dispatch instructions and bystander CPR can contribute to improvement in EMS pre-arrival CPR.We implemented EMS pre-arrival CPR reporting in regional fire departments and investigated the performance of EMS pre-arrival CPR including dispatch-assisted CPR and CPR without dispatch assistance.
      PubDate: 2017-04-02T19:35:23.481855-05:
      DOI: 10.1002/ams2.273
  • Do not attempt resuscitation order in Japan
    • Authors: Yoshihide Nakagawa; Sadaki Inokuchi, Nobuo Kobayashi, Yoshinobu Ohkubo
      Abstract: AimIn Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR-related issues, and improve the application of DNAR.MethodsA questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out.ResultsThe results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in-hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home.ConclusionIt is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.A questionnaire survey of medical institutions in Kanagawa Prefecture about the current status of do not attempt resuscitation was conducted. It showed various problems in clinical settings. There is an urgent need for prefectures or municipalities to establish relevant laws and for local medical control authorities to develop guidelines.
      PubDate: 2017-04-02T19:20:26.891404-05:
      DOI: 10.1002/ams2.271
  • Early administration of fibrinogen concentrates improves the short-term
           outcomes of severe pelvic fracture patients
    • Authors: Koichi Inokuchi; Makoto Sawano, Koji Yamamoto, Atsushi Yamaguchi, Satoru Sugiyama
      Abstract: AimHemorrhage from pelvic fracture is a major cause of mortality after blunt trauma. Several studies have suggested that early fibrinogen supplementation improves outcomes of traumatic hemorrhage. Thus, we revised our massive transfusion protocol (MTP) in April 2013 to include early off-label administration of fibrinogen concentrate. The objective of this study was to evaluate the impact of the revision on the short-term outcomes of pelvic fracture patients.MethodsThis was a single-center, retrospective, cohort study. A total of 224 consecutive pelvic fracture patients hospitalized in Saitama Medical Center (Saitama, Japan), 115 before the revision (Group E) and 109 after (Group L), were enrolled. Characteristics of the patients were compared between the groups. Impacts of the revision were evaluated by hazard ratios adjusted for characteristics, injury severity, and coagulation status using Cox's multivariate proportional hazard model. The impact was also evaluated by log–rank test and relative risk of 28-day mortality between the groups.ResultsThe characteristics were equivalent between the groups. The multivariate analysis revealed that the revision of MTP was significantly related to improved survival with an adjusted hazard ratio (95% confidence interval) of 0.45 (0.07–0.97). The log–rank test gave χ2-test values of 5.2 (P = 0.022) and 6.7 (P = 0.009), and the relative risks were 0.37 (0.15–0.91) and 0.33 (0.13–0.84), in patients with all Injury Severity Scores and Injury Severity Score ≥21, respectively.ConclusionThe revision of MTP to include aggressive off-label treatment with fibrinogen concentrate was related to improved short-term outcomes of severe pelvic fracture patients. However, due to the limitations of the study, the improvement could not be attributed totally to the revision.Twenty-eight-day survival curves of pelvic fracture patients compared between treatment groups. Broken lines represent the curve of Group E (those hospitalized before April 2013) and solid lines represent that of Group L (those hospitalized in April 2013 and later). The curves of patients with all Injury Severity Scores (top) and those of patients with Injury Severity Score ≥21 (bottom) are shown.
      PubDate: 2017-04-02T19:15:23.998737-05:
      DOI: 10.1002/ams2.268
  • Microsurgical replantation of an amputated ear
    • Authors: Tomoya Sato; Shigeru Ichioka
      Abstract: We report a case of successful microsurgical reattachment of an amputated ear. Microsurgical reattachment should be considered whenever possible.
      PubDate: 2017-03-30T23:10:51.511909-05:
      DOI: 10.1002/ams2.274
  • Cardiac arrest caused by sibutramine obtained over the Internet: a case of
           a young woman without pre-existing cardiovascular disease successfully
           resuscitated using extracorporeal membrane oxygenation
    • Authors: Naofumi Bunya; Keigo Sawamoto, Shuji Uemura, Ryoko Kyan, Hiroyuki Inoue, Junichi Nishida, Hidemichi Kouzu, Nobuaki Kokubu, Tetsuji Miura, Eichi Narimatsu
      Abstract: CaseSibutramine is a weight loss agent that was withdrawn from the market in the USA and European Union because it increases adverse events in patients with cardiovascular diseases. However, non-prescription weight loss pills containing sibutramine can be still easily purchased over the Internet.A 21-year-old woman without history of cardiovascular diseases developed cardiac arrest. She was a user of a weight loss pills, containing sibutramine and hypokalemia-inducing agents, imported from Thailand over the Internet.OutcomeShe was successfully resuscitated without any neurological deficits by using extracorporeal membrane oxygenation for refractory ventricular fibrillation.ConclusionThis case indicates that sibutramine can cause cardiac arrest even in subjects without pre-existing cardiovascular disease when combined with agents that promote QT prolongation.Even banned high risk agents are readily accessible for the general population over the Internet, and emergency physicians need to be aware of the potential toxicities of weight loss agents. Sibutramine is one such agent that potentially causes cardiac arrest even in subjects without pre-existing cardiovascular disease, particularly when combined with drugs that lead to QT prolongation.
      PubDate: 2017-03-29T20:40:23.446487-05:
      DOI: 10.1002/ams2.275
  • Differences in coagulofibrinolytic changes between post-cardiac arrest
           syndrome of cardiac causes and hypoxic insults: a pilot study
    • Authors: Takeshi Wada; Satoshi Gando, Asumi Mizugaki, Akira Kodate, Yoshihiro Sadamoto, Hiromoto Murakami, Kunihiko Maekawa, Kenichi Katabami, Yuichi Ono, Mineji Hayakawa, Atsushi Sawamura, Subrina Jesmin, Masahiro Ieko
      PubDate: 2017-03-27T20:10:21.64085-05:0
      DOI: 10.1002/ams2.270
  • Delayed autonomic neuropathy in a patient with diethylene glycol
           poisoning: a case report
    • Authors: Hiroki Kamada; Hideaki Suzuki, Saori Yamamoto, Ryosuke Nomura, Shigeki Kushimoto
      Abstract: CaseA 72-year-old man presented to our hospital after ingesting insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient recovered from critical symptoms on acute phase until day 3, but received artificial ventilation for muscle weakness secondary to sensorimotor neuropathy on days 11–54.OutcomeEven after marked improvement from sensorimotor neuropathy, the patient continued to complain of orthostatic hypotension. Autonomic neuropathy was identified by positive result of a head-up tilt test, and reduction in coefficient of variation of R-R intervals and cardiac iodine-123-metaiodobenzylguanidine uptake for the assessment of cardiac sympathetic activity. The patient's symptoms fully recovered 2 years after the exposure to diethylene glycol.ConclusionThis case shows the first report of delayed autonomic neuropathy after recovery from severe sensorimotor neuropathy, and suggests the importance of continuous monitoring for late-onset neurological complications.A 72-year-old man ingested insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient presented with autonomic neuropathy represented by orthostatic hypotension (Figure) after recovery from severe sensorimotor neuropathy. Continuous monitoring is important for the late onset of neurological complications of diethylene glycol poisoning.
      PubDate: 2017-03-27T19:30:25.092633-05:
      DOI: 10.1002/ams2.267
  • A study of the effect of introduction of JTAS in the emergency room
    • Authors: Toru Koyama; Takeshi Kashima, Motoyoshi Yamamoto, Kenjiro Ouchi, Takayuki Kotoku, Yuta Mizuno
      Abstract: AimThe purpose of this study was to better understand the effects of introducing the Japan Triage and Acuity Scale (JTAS) in the emergency room for walk-in patients.MethodsA simple triage was used in Term A (from April 2006 to December 2010, 4 years and 9 months) and the JTAS was introduced in Term B (from January 2011 to September 2015, 4 years and 9 months). The number of patients who had a sudden turn for the worse after arrival in the emergency room and the time between attendance and emergency catheterization (TBAEC) due to acute coronary syndrome were reviewed.ResultsThere were 653 patients in Term A and 626 patients in Term B who were finally diagnosed as having serious causes. There was no significant difference in the frequency of a sudden turn for the worse between the two terms. There were 182 patients in Term A and 167 patients in Term B who underwent emergency catheterization due to acute coronary syndrome. When ST elevation was recognized in the first electrocardiogram, the median time between attendance and medical attention during Term B improved significantly, by 4.5 min. However, there was no significant difference in medians for TBAEC. When ST elevation was not recognized, there was no significant difference between the two terms, neither in terms of median time between attendance and medical attention, nor TBAEC.ConclusionThe data suggests that the effects of introducing the JTAS in the emergency room were restrictive in these two aspects.There was no significant difference in the frequency of a sudden turn for the worse between the two terms. When ST elevation was recognized in the first electrocardiogram, median time between attendance and medical attention of Term B improved significantly, by 4.5 min. The data suggests that the effects of introducing the JTAS in the emergency room were restrictive.
      PubDate: 2017-03-13T04:20:24.585588-05:
      DOI: 10.1002/ams2.266
  • Indications of early intubation for patients with inhalation injury
    • Authors: Shinya Onishi; Akinori Osuka, Yuichi Kuroki, Masashi Ueyama
      Abstract: AimFor patients with inhalation injury, the indications for early intubation are diverse. The purpose of this study was to identify the most reliable symptoms, physical findings, and medical examinations with which to determine the indications for early intubation in patients with inhalation injury.MethodsWe retrospectively collected patient data from medical records. Collected data included age, sex, burn size, symptoms, physical findings, carboxyhemoglobin levels (COHb), and bronchial wall thickness (BWT) determined from chest computed tomography images. We analyzed the relationships between these findings and the early intubation. We performed fiberoptic bronchoscopy in all patients, and analyzed the relationships between bronchoscopic severity and other findings.ResultsOf the 205 patients, 80 patients were diagnosed as having inhalation injury, and 34 patients were intubated. Burn size, facial burns, neck burns, use of accessory respiratory muscles, and COHb seemed to be related with intubation, whereas singed nasal hair was not. If the patients suffered ≥27% total body surface area burn and BWT ≥3.5 mm, the positive predictive value for early intubation was 1.00. If the patients suffered smaller cutaneous burn without neck burn, and their COHb
      PubDate: 2017-03-06T03:31:17.400106-05:
      DOI: 10.1002/ams2.269
  • Local anesthetic toxicity: acute and chronic management
    • Authors: Kenichi Sekimoto; Masaru Tobe, Shigeru Saito
      Abstract: Local anesthetics are commonly used medicines in clinical settings. They are used for pain management during minor interventional treatments, and for postoperative care after major surgeries. Cocaine is the well-known origin of local anesthetics, and the drug and related derivatives have long history of clinical usage for more than several centuries. Although illegal use of cocaine and its abuse are social problem in some countries, other local anesthetics are safely and effectively used in clinics and hospitals all over the world. However, still this drug category has several side-effects and possibilities of rare but serious complications. Acute neurotoxicity and cardiac toxicity are derived from unexpected high serum concentration. Allergic reactions are observed in some cases, especially following the use of ester structure drugs. Chronic toxicity is provoked when nerve fibers are exposed to local anesthetics at a high concentration for a long duration. Adequate treatments for acute toxic reactions can secure complete recovery of patients, and careful use of drugs prevents long-lasting neurological complications. In addition to respiratory and circulatory management, effectiveness of lipid rescue in the acute toxicity treatment has been certified in many clinical guidelines. Prevention of the use of high concentration of local anesthetics is also validated to be effective to decrease the possibility of nerve fiber damage.Mechanisms and symptoms of acute local anesthetic toxicity.
      PubDate: 2017-03-06T03:25:43.386804-05:
      DOI: 10.1002/ams2.265
  • Serum levels of interleukin-6 may predict organ dysfunction earlier than
           SOFA score
    • Authors: Takashi Shimazui; Yosuke Matsumura, Taka-aki Nakada, Shigeto Oda
      Abstract: AimTo investigate the clinical utility of interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) as predictive markers in consideration of the time-course changes in critically ill patients with organ dysfunction.MethodsSerum levels of IL-6, PCT, CRP, and Sequential Organ Failure Assessment (SOFA) scores were measured sequentially in 92 patients during their initial 5 days following admission to the intensive care unit. Maximum values were analyzed. Patients were assigned to a low ( ≤ 8), intermediate ( > 8 and ≤ 16), or high ( > 16 and ≤ 24) SOFA score group.ResultsThere were significant differences in the maximum serum levels of IL-6 and PCT among the three SOFA score groups (IL-6, P < 0.0001; PCT, P = 0.0004). Specifically, comparisons between the groups revealed significant differences in IL-6 levels (low versus intermediate, P = 0.0007; intermediate versus high, P = 0.0010). The probability of patients with the maximum value was greatest on day 1 (56.5%) for IL-6, on day 1 (39.1%) or day 2 (38.0%) for PCT, on day 3 (39.1%) for CRP, and on day 1 (43.5%) for SOFA score. The median (interquartile range) peak day of IL-6 was day 1 (1–2), which was significantly earlier than that of SOFA score at day 2 (1–3) (P = 0.018).ConclusionSerum levels of IL-6 reflected the severity of organ dysfunction in critically ill patients most accurately compared to PCT and CRP. Interleukin-6 elevated soonest from the insult and reached its peak earlier than SOFA score.IL-6 reflected SOFA score more accurately and increased earlier than PCT or CRP. IL-6 is useful to assess severity in the early phase of critical illness.
      PubDate: 2017-03-06T03:20:25.629393-05:
      DOI: 10.1002/ams2.263
  • A case of circumferential type A aortic dissection with intimal
           intussusception diagnosed using repeat transthoracic echocardiography
    • Authors: Toshinobu Yamagishi; Masahiro Kashiura, Kazuya Nakata, Kazuki Miyazaki, Takahiro Yukawa, Takahiro Tanabe, Kazuhiro Sugiyama, Akiko Akashi, Yuichi Hamabe
      Abstract: CaseSometimes it is difficult to diagnose circumferential aortic dissection with enhanced computed tomography alone. A 58-year-old woman presented with sudden-onset chest discomfort and loss of consciousness. Transthoracic echocardiogram showed mild aortic regurgitation. Enhanced computed tomography scans showed no obvious intimal tear or flap at the proximal ascending aorta, but an intimal flap was observed from the aortic arch to both common iliac arteries. Stanford type B dissection was tentatively diagnosed. Repeat detailed transthoracic echocardiography examination showed an intimal tear and flap at the ascending aorta; prolapse into the left ventricle caused severe aortic regurgitation. Type A aortic dissection was definitively diagnosed; emergent operation showed a circumferential intimal tear originating from the ascending aorta.OutcomeThe ascending aorta was replaced; aortic regurgitation disappeared. The patient was discharged in a good condition 58 days postoperatively.ConclusionDynamic evaluations with transthoracic echocardiography should be carried out to diagnose circumferential aortic dissection.Sometimes it is difficult to diagnose circumferential aortic dissection by only enhanced computed tomography. Dynamic evaluations with transthoracic echocardiography should be performed to diagnose this.
      PubDate: 2017-03-02T00:06:26.157185-05:
      DOI: 10.1002/ams2.262
  • Comparison of quality of human serum albumin preparations in two
           pharmaceutical products
    • Authors: Hajime Nakae; Kouki Tomida, Yoshihiro Kikuya, Manabu Okuyama, Toshiko Igarashi
      Abstract: AimHuman serum albumin (HSA) is known for its multiple functions, such as maintenance of colloid osmotic pressure, transport of endogenous and exogenous substances, and antioxidation. The aim of this study was to measure the redox state and concentrations of β-d-glucan and endotoxin to compare the quality of 5% HSA preparations from two different manufacturers.MethodsThe quality of 5% HSA preparations in two different pharmaceutical products (groups A and B) was compared in terms of the percentage of reduced and oxidized albumin and the contaminant level of β-d-glucan and endotoxin.ResultsThe percentage of human mercaptoalbumin in group A was significantly higher than that in group B (P < 0.01), whereas that of human non-mercaptoalbumin-2 in group A was significantly lower (P < 0.01). The concentration of β-d-glucan in group A was significantly lower than in group B (P < 0.01).ConclusionsThe present findings indicate the need for quality control of HSA preparations in applications involving the use of large volumes.Representative chromatograms and comparison of redox status of human serum albumin preparations according to the manufacturer. The percentage of human mercaptoalbumin (HMA) in group A was significantly higher than that in group B. The percentage of human non-mercaptoalbumin (HNA)-2 in group A was significantly lower than that in group B.
      PubDate: 2017-03-01T00:16:18.869563-05:
      DOI: 10.1002/ams2.259
  • Unexpected complications immediately after cranioplasty
    • Authors: Akihito Kato; Hiroyuki Morishima, Goro Nagashima
      Abstract: CaseAn 84-year-old man with subarachnoid hemorrhage underwent craniotomy and clipping with external decompression. Perfusion magnetic resonance imaging showed subclinical sinking skin flap syndrome, and he underwent cranioplasty on postoperative day 58. No problems occurred during the operation, but cerebral edema and hemorrhage were recognized on immediate postoperative computed tomography. Edema continued to progress, but edema and bleeding eventually improved without additional surgery.OutcomeNeurological symptoms improved to presurgical baseline and stabilized.ConclusionCauses of cerebral edema and hemorrhage immediately after cranioplasty include reperfusion, reduction of automatic adjustment function, sinking skin flap syndrome, negative pressure due to s.c. drain, venous stasis, vascular damage following restoration of midline shift, and allergic reaction. Although cranioplasty itself is a relatively minor surgery, the fatality rate for this complication is high. Most complications are due to infection, convulsions, or epidural hematoma, but brain edema and hemorrhage also occur. It is necessary to elucidate the etiology before corrective surgery.Unexpected complications.
      PubDate: 2017-02-22T22:15:27.057982-05:
      DOI: 10.1002/ams2.260
  • Issue Information
    • Pages: 143 - 144
      PubDate: 2017-04-24T06:17:01.330565-05:
      DOI: 10.1002/ams2.243
  • High-grade traumatic torso visceral injury with hemodynamic instability:
           effectiveness of transarterial embolization using n-butyl cyanoacrylate
    • Authors: Junya Tsurukiri; Shoichi Ohta, Akira Hoshiai, Hidefumi Sano, Eitaro Okumura, Nobuhiko Tsubouchi, Hiroyuki Konishi, Tetsuo Yukioka
      Pages: 145 - 151
      Abstract: Trauma patients with uncontrolled hemorrhage encountering coagulopathy are often associated with poor outcome. Recently, the concept of damage control interventional radiology, which focuses on “speedy stoppage of bleeding” by interventional radiology among trauma patients with hemodynamic instability and acute traumatic coagulopathy, was proposed as an alternative to damage control surgery. N-butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non-traumatic situations, where it has been shown to have a high technical success rate and low recurrent bleeding rate, especially in patients with coagulopathy. In this case, we treated a young patient with hemodynamic instability caused by a high-grade hepatic injury, who underwent arterial embolization (AE) using NBCA assisted with resuscitative endovascular balloon occlusion of the aorta and achieved successful hemostasis. A review of published works using PUBMED was carried out, and 10 published reports involving 23 trauma patients who underwent AE using NBCA were identified. Among them, only four reports involving five trauma patients with torso visceral injuries were identified. Three of five patients who were hemodynamically unstable underwent AE using NBCA, resulting in the stabilization of hemodynamics. We concluded that AE with resuscitative endovascular balloon occlusion of the aorta as a damage control interventional radiology procedure might be acceptable for the hemodynamically unstable hepatic injury, and NBCA could be one of the effective hemostatic agents for this purpose, in cases of trauma-induced coagulopathy.Arterial embolization with resuscitative endovascular balloon occlusion of the aorta as a damage control interventional radiology procedure might be acceptable for the hemodynamically unstable hepatic injury. N-butyl cyanoacrylate could be one of the effective hemostatic agents for this purpose, in cases of trauma-induced coagulopathy.
      PubDate: 2017-03-06T03:25:33.097373-05:
      DOI: 10.1002/ams2.264
  • Efficacy of direct hemoperfusion with a polymyxin B-immobilized fiber
           column in miliary tuberculosis
    • Authors: Yasumasa Kawano; Ryotaro Nagashima, Shinichi Morimoto, Yoshito Izutani, Reiko Yamasaki, Takeshi Nishida, Mitsutoshi Iwaasa, Hiroyasu Ishikura
      Abstract: CaseA 75-year-old woman presented with a 10-day history of intermittent fever, general fatigue, and progressive dyspnea. Although she had a low PaO2/FIO2 ratio, the cause of acute respiratory distress syndrome was not clear until day 9 in hospital.OutcomeWe treated the patient with direct hemoperfusion with a polymyxin B-immobilized fiber column incidentally; the PaO2/FIO2 ratio improved following this therapy. Acid-fast bacilli, which were not seen in the sputum on admission, were detected in cultures from sputum, urine, bone marrow, liver biopsy, and blood samples, with a real-time polymerase chain reaction assay confirming tuberculosis. She was immediately transferred to a specialized tuberculosis hospital, and after a 3-month treatment, was discharged.ConclusionTreatment with polymyxin B-immobilized fiber column may provide good results for pulmonary oxygenation in acute respiratory distress syndrome caused by tuberculosis.Clinical course of the PaO2/FiO2 ratio, C-reactive protein (CRP) levels, neutrophil count, treatment, and ventilator settings of a 75-year-old woman with acute respiratory distress syndrome due to tuberculosis. Direct hemoperfusion with a polymyxin B-immobilized fiber column likely initiated fast improvement of the PaO2/FiO2 ratio before initiation of antituberculosis therapy. PEEP, positive end expiratory pressure.
      PubDate: 2016-12-26T20:50:24.65843-05:0
      DOI: 10.1002/ams2.258
  • Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a
           case report
    • Authors: Yo Kawahara; Yoshihiro Tanaka, Naoaki Isoi, Kohsuke Hatanaka, Kentaro Yamada, Masayoshi Yamamoto, Teppei Okamura, Tatsumi Kaji, Toshihisa Sakamoto, Daizoh Saitoh, Hisashi Ikeuchi
      Abstract: CaseA 64-year-old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out.OutcomeThe DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms.ConclusionNo other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients
      PubDate: 2016-12-09T08:00:36.581951-05:
      DOI: 10.1002/ams2.257
  • Pulmonary edema following tonic–clonic seizure
    • Authors: Hiroaki Izumida; Koichiro Homma, Junichi Sasaki, Shingo Hori
      PubDate: 2016-12-09T07:12:11.496377-05:
      DOI: 10.1002/ams2.251
  • A case of tetanus treated with Kampo medicines such as Kakkonto and
    • Authors: Hajime Nakae; Yuri Saito, Manabu Okuyama, Toshiko Igarashi
      Abstract: CaseA 74-year-old man developed tetanus 3 days after working with cow and poultry manure. Kakkonto and shakuyakukanzoto, traditional Japanese herbal medicines that are effective for the relief of pain primarily related to muscle contraction, were given to control the trismus and painful contracture of the neck. Generalized convulsions were controlled without the use of muscle relaxants.OutcomeAfter 30 days, the patient was discharged from the hospital without any sequelae.ConclusionKakkonto and shakuyakukanzoto may be useful for the control of muscle spasms resulting from generalized tetanus.Clinical course of a 74-year-old man with tetanus. Kakkonto and Shakuyakukanzoto were administered to control the trismus and painful contracture of the neck. Generalized convulsions were controlled without the use of muscle relaxants. After 30 days, the patient was discharged from the hospital without any sequelae.
      PubDate: 2016-12-01T04:56:31.179506-05:
      DOI: 10.1002/ams2.254
  • Development of new equipment for intra-arrest brain cooling that uses
           cooled oxygen in the lungs: volunteer study
    • Authors: Atsushi Sakurai; Rumi Tagami, Shingo Ihara, Junko Yamaguchi, Atsunori Sugita, Nami Sawada, Tomohide Komatsu, Satoshi Hori, Kosaku Kinoshita
      Abstract: AimsMany experimental studies have reported that intra-arrest cooling during cardiac arrest is a promising treatment to mitigate brain injury. However, there is no clinically established method for cooling the brain during cardiac arrest. We hypothesized that, as blood flow in the lungs must be very slow during cardiopulmonary resuscitation, the blood could be cooled by ventilating the lungs with cooled oxygen like a radiator, and that this cooled blood would in turn cool the brain. The aim of this study was to develop equipment to cool oxygen for this purpose and to confirm its safety on a group of volunteers.MethodsWe developed new equipment that cools oxygen by running it through a vinyl chloride coil submerged in a bottle of water and frozen at −80°C. Using this equipment, seven volunteers were given oxygen by mask, and their blood pressure, heart rate, and peripheral saturation of oxygen were measured. The temperature in the mask was also measured.ResultsThis equipment was able to decrease the temperature in the mask to −5°C at the Jackson Rees circuit for an oxygen flow of 10 L/min. Among the volunteer group, vital signs were unchanged and the temperature in the mask decreased from 30.1 ± 2.6°C (mean ± standard deviation) to 15.9 ± 9.6°C. No adverse effects were observed in the volunteers after experimentation.ConclusionWe successfully developed new equipment to cool oxygen and established its safety in a volunteer study.A new equipment was developed to cool oxygen to cool lung during cardiopulmonary resuscitation for the brain protection. Two sets of the coil/bottle equipment, each administrating oxygen at 10L/min (20L/min totally), were attached to the Jackson Rees circuit and a heat and moisture exchanger with mask.
      PubDate: 2016-11-17T02:46:50.70709-05:0
      DOI: 10.1002/ams2.253
  • Accidental falls related to clearing heavy snow on rooftops in a rural
           heavy snow area in Japan
    • Authors: Seigo Yamaguchi; Hiroshi Endoh, Masakazu Nitta
      Abstract: AimThe purpose of this study is to describe our experience with patients who fell from rooftops while clearing snow. The falls occurred in rural areas that receive heavy snowfall and are undergoing depopulation and an increasing proportion of elderly residents.MethodsA retrospective observational chart review was carried out at the sole hospital providing emergency services in a rural heavy snow area in Japan.ResultsA total of 70 patients were enrolled during four winter seasons between December 2009 and March 2013. Their mean age was 61 years, and 90% were male. The mean vertical height of falls was 4.1 m. A total of 174 injuries was observed, averaging 2.5 injuries per patient. Fractures accounted for 78% of all injuries, and main fractures included vertebra with lower extremities or rib fractures; 86% of patients sustained a maximum abbreviated injury scale score of 2–3.ConclusionsIn a rural heavy snow area in Japan, the incidence of accidental falls related to clearing snow was high, and the victims were elderly. Fractures accounted for 78% of all injuries, and most patients suffered from moderate to serious injuries.Distribution of Abbreviated Injury Scale (AIS). AIS1: minor, AIS2: moderate, AIS3: severe (not life threatening), AIS4: severe (life threatening), AIS5: critical. No injury was seen in neck or body surface region.
      PubDate: 2016-11-17T02:42:32.205279-05:
      DOI: 10.1002/ams2.246
  • Cerebral air embolism associated with penetrating lung injury: a case
           report and review of the literature
    • Authors: Ayumu Yamaoka; Kei Miyata, Eichi Narimatsu, Eiji Sakawaki, Sonoko Sakawaki, Suguru Hirayama, Shuji Uemura, Naoya Yama
      Abstract: CaseA 44-year-old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation.OutcomeRight hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course.ConclusionWe concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered.In this case, a man who stabbed himself in the left thorax recieved positive pressure ventilation. Right hemiparesis appeared upon weaning from mechanical ventilation. DWI findings demonstrated characteristic laminar cortical hyperintense lesions in multiple lobes. Cerebral air embolism was strongly suspected from the imaging findings and clinical course.
      PubDate: 2016-11-10T02:25:57.154-05:00
      DOI: 10.1002/ams2.250
  • Management of maternal anaphylaxis in pregnancy: a case report
    • Authors: Yasunobu Tsuzuki; Mitsuo Narita, Masayuki Nawa, Urara Nakagawa, Toshiaki Wakai
      Abstract: CaseA 26-year-old woman (gravida 2, para 1) at 25 weeks’ gestation was brought to the emergency department because of anaphylactic symptoms. She reported eating Japanese soba and developed symptoms of dyspnea, generalized itchy rash, abdominal pain, and severe uterine contractions within 15–30 min of eating. She was immediately treated by normal saline infusion, two injections of epinephrine (intramuscularly), and a nebulized short-acting β2-receptor agonist, followed by H1-antihistamine and methylprednisolone. Obstetrical management was undertaken by an obstetrician.OutcomeThe patient recovered rapidly without a biphasic reaction of anaphylaxis. After 11 weeks, a healthy, neurologically intact baby was born.ConclusionManagement of anaphylaxis in pregnant patients is basically the same of that in non-pregnant ones. Treatment should commence immediately to prevent further development of the anaphylaxis reaction and fetal neurological deficiency.Fetal heart rate during maternal anaphylaxis. The mother experienced strong and frequent uterine contractions (lower panel), but examination of the fetus revealed a normal heart rate (140–160 b.p.m) with variability (upper panel).
      PubDate: 2016-11-10T01:16:23.241852-05:
      DOI: 10.1002/ams2.238
  • Successful non-operative management of traumatic extrahepatic portal
           venous injury without intraperitoneal hemorrhage: a case report
    • Authors: Kunio Hamanaka; Yuusuke Hirokawa, Tsuyoshi Itoh, Mitsuhiro Fujino, Kenichi Kano, Satoru Beppu, Nozomu Sasahashi, Kei Nishiyama
      Abstract: CaseA 52-year-old woman was admitted to our hospital with hypotension after falling from the fifth floor of an apartment building. Contrast-enhanced computed tomography showed liver injury with extravasation of contrast material from the hepatic artery, and extrahepatic portal venous injury with extravasation and pseudoaneurysm. Intra-abdominal hemorrhage was not observed, and bleeding was confined to the retroperitoneal space. Hepatic arteriography showed extravasation, while portal venography showed pseudoaneurysm but no extravasation. After transarterial embolization, the patient's vital signs improved. Non-operative management was selected for the portal venous injury.OutcomeComputed tomography on the 58th hospital day revealed disappearance of the portal venous pseudoaneurysm. The patient was discharged on the 90th hospital day without any complications.ConclusionThis case shows that non-operative management can be selected for portal venous injury when there is no retroperitoneal injury and bleeding is confined to the retroperitoneal space.A 52-year-old woman was admitted to our hospital after falling from the fifth floor. Contrast-enhanced computed tomography showed liver injury with extravasation from the hepatic artery, and extrahepatic portal venous injury. Bleeding was confined to the retroperitoneal space. Hepatic arteriography showed extravasation, while portal venography showed pseudoaneurysm but no extravasation. After transarterial embolization, nonoperative management was selected for the portal venous injury. The patient was discharged on the 90th hospital day without any complications. This case demonstrates that nonoperative management can be selected for portal venous injury when bleeding is confined to the retroperitoneal space.
      PubDate: 2016-11-10T01:16:18.604305-05:
      DOI: 10.1002/ams2.247
  • Diagnostic accuracy of radiographs for detecting supraglottitis: a
           systematic review and meta-analysis
    • Authors: Takashi Fujiwara; Toyohisa Miyata, Hironobu Tokumasu, Hiroko Gemba, Toshio Fukuoka
      Abstract: AimTo assess the diagnostic performance of lateral radiograph of the neck for supraglottitis in adults and children.MethodsElectronic database searches (including PubMed, EMBASE, CINAHL, Web of Science, and WHO International Clinical Trials Registry Platform) were carried out through July 2014. Citations of included studies and recent narrative reviews were searched. Studies that compared lateral radiograph of the neck with a reference standard of direct/indirect laryngoscopy were included. Two reviewers independently assessed the methodological quality of included studies by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).ResultsOf 2,088 potentially relevant citations, two single-gate (cohort) studies and six two-gate (case–control) studies were identified. These included studies of design are at the moderate or high risk of bias in QUADAS-2. The pooled sensitivity from bivariate random-effects regression was 92.9% (95% confidence interval [CI], 88.5–95.9%) and the pooled specificity was 89.2% (95% CI, 85.9–91.9%), but the diagnostic value would be overestimated because of selection bias in the six two-gate studies. The sensitivity and specificity of the single-gate studies were 100.0% (95% CI, 92.2–100.0%) and 30.6% (95% CI, 15.5–35.6%) in children and 81.0% (95% CI, 78.2–93.2%) and 85.7% specificity (95% CI, 78.2–93.2%) in adults.ConclusionThis study determines that there are insufficient studies of lateral neck radiograph for detecting supraglottitis. Lateral radiograph of the neck seems to have moderate accuracy for detecting supraglottitis. Further approximately unbiased studies are needed to obtain more valid and reliable estimates of test accuracy.Lateral radiograph of the neck is used for supraglottitis. Previous studies evaluated the diagnostic value of radiograph, but the diagnostic value was less precise due to the small sample size of these studies. Therefore, we conducted systematic review of lateral neck radiographs in supraglottitis. Two single-gate (cohort) studies and six two-gate (case-control) studies were identified. In the signle-gate studies, the sensitivity and specificity were 100.0% (95% CI = 92.2% to 100.0%) and 30.6% (95% CI = 15.5% to 35.6%) in children and 81.0% (95% CI = 78.2% to 93.2%) and 85.7% (95% CI = 78.2% to 93.2%) in adults.
      PubDate: 2016-11-10T01:11:55.149946-05:
      DOI: 10.1002/ams2.256
  • Right-sided Bochdalek hernia in an elderly patient: a case review of adult
           Bochdalek hernias from 1982 to 2015 in Japan
    • Authors: Yasuhiro Ohtsuka; Tiberiu H. Suzuki
      Abstract: CaseAn 89-year-old woman was admitted to our hospital because of dyspnea following abdominal pain and vomiting. According to chest computed tomography findings, a diagnosis of acute respiratory failure due to right-sided Bochdalek hernia was made.OutcomeEmergency laparotomy revealed that a bowel loop from the terminal ileum to the transverse colon had herniated into the right thoracic cavity through the foramen of Bochdalek. The herniated organs were reduced to the abdominal cavity and the foramen was repaired by direct suturing. The patient had good recovery and was discharged 78 days later.ConclusionBochdalek hernias in elderly patients are rare, but may be complicated by strangulation of the herniated organ. This should be taken into account by acute care physicians. To prevent this fatal complication, regardless of symptoms, surgical treatment may be essential as soon as a diagnosis of adult Bochdalek hernia is made.Plain chest computed tomography findings on admission of an 89-year-old woman with right-sided Bochdalek hernia. A, Scout view revealed bowel loops in the right thoracic cavity, which compressed the right lung to the apex of the thoracic cavity and shifted the mediastinum to the left side. B, C, Axial views at the level of Th4 (B) and Th7 (C) revealed that the bowel loops in the right thoracic cavity seemed to be the colon, which had herniated through the posterolateral portion of the right diaphragm. AA, ascending aorta; AR, arch of aorta; DA, descending aorta; PT, pulmonary trunk.
      PubDate: 2016-11-10T01:11:35.28462-05:0
      DOI: 10.1002/ams2.249
  • Importance of respiratory rate for the prediction of clinical
           deterioration after emergency department discharge: a single-center,
           case–control study
    • Authors: Katsunori Mochizuki; Ryosuke Shintani, Kotaro Mori, Takahisa Sato, Osamu Sakaguchi, Kanako Takeshige, Kenichi Nitta, Hiroshi Imamura
      Abstract: AimThe purpose of the present study was to investigate the predictors of clinical deterioration soon after emergency department (ED) discharge.MethodsWe undertook a case–control study using the ED database of the Nagano Municipal Hospital (Nagano, Japan) from January 2012 to December 2013. We selected adult patients with medical conditions who revisited the ED with deterioration within 2 days of ED discharge (deterioration group). The deterioration group was compared with a control group.ResultsDuring the study period, 15,724 adult medical patients were discharged from the ED. Of these, 170 patients revisited the ED because of clinical deterioration within 2 days. Among the initial vital signs, respiratory rate was less frequently recorded than other vital signs (P < 0.001 versus all other vital signs in each group). The frequency of recording each vital sign did not differ significantly between the groups. Overall, patients in the deterioration group had significantly higher respiratory rates than those in the control group (21 ± 5/min versus 18 ± 5/min, respectively; P = 0.002). A binary logistic regression analysis revealed that respiratory rate was an independent risk factor for clinical deterioration (unadjusted odds ratio, 1.15; 95% confidence interval, 1.04−1.26; adjusted odds ratio, 1.15; 95% confidence interval, 1.01−1.29).ConclusionsAn increased respiratory rate is a predictor of early clinical deterioration after ED discharge. Vital signs, especially respiratory rate, should be carefully evaluated when making decisions about patient disposition in the ED.In the case-control study, 15,724 adult medical patients were discharged from an emergency department (ED). Of these, 170 patients revisited the ED because of clinical deterioration within two days. Overall, patients in the deterioration group had significantly higher respiratory rates than those in the control group (21 ± 5/min vs. 18 ± 5/min, respectively; P = 0.002). In addition, an increased respiratory rate was an independent predictor of clinical deterioration (unadjusted odds ratio (OR): 1.15, 95% confidence interval (CI): 1.04−1.26, adjusted OR: 1.15, 95% CI 1.01−1.29).
      PubDate: 2016-11-10T01:11:28.576842-05:
      DOI: 10.1002/ams2.252
  • Non-traumatic bladder rupture showing less than 10 Hounsfield units of
    • Authors: Naoto Mizumura; Satoshi Okumura, Sho Toyoda, Atsuo Imagawa, Masao Ogawa, Masayasu Kawasaki
      Abstract: AimBladder ruptures are commonly misdiagnosed as gastrointestinal perforations or intestinal ischemia. If a diagnosis is made preoperatively, conservative treatment is a safe and effective option. We evaluated the validity of using the attenuation value of ascites, measured by non-contrast computed tomography (CT), to identify patients with bladder ruptures.MethodsA retrospective search of our hospital database identified 7 patients with confirmed bladder ruptures between 2007 and 2013. We also enrolled 18 patients with gastrointestinal perforations and 10 patients with intestinal ischemia with detectable ascites on abdominal CT that had undergone emergency exploratory laparotomy between 2007 and 2013. Between-group comparisons of attenuation values of ascites as obtained by non-contrast CT were evaluated.ResultsAll attenuation values were less than 10 Hounsfield units (HU) in bladder rupture patients. Moreover, the attenuation value of ascites in cases of bladder rupture (median, 5.7; range, 3.1–6.1) was significantly lower than in cases of gastrointestinal perforation (median, 14.7; range, 4.7–25.4) and intestinal ischemia (median, 13.3; range, 6.0–18.1) (P = 0.004 for both comparisons).ConclusionBladder rupture mimics gastrointestinal perforation and intestinal ischemia with acute kidney injury. Therefore, the diagnosis of bladder rupture using the attenuation value of ascites on non-contrast CT is both useful and highly significant. We suggest that bladder rupture be considered in the differential diagnosis of patients presenting with acute abdominal pain and attenuation values of ascites of less than 10 Hounsfield units.The figure shows attenuation values of ascites on non-contrast CT in patients with bladder rupture, gastrointestinal perforation, and intestinal ischemia. All attenuation values in patients with bladder rupture were less than 10 HU.
      PubDate: 2016-11-10T01:11:25.626156-05:
      DOI: 10.1002/ams2.248
  • An adult case of laryngopharyngeal burn by drinking hot water
    • Authors: Keita Iyama; Tomohiro Ueki, Shuhei Yamano, Goro Tajima, Takamitsu Inokuma, Tomohito Hirao, Kazunori Yamashita, Atsuko Nagatani, Osamu Tasaki
      Abstract: CaseA 61-year-old man who was hospitalized with schizophrenia in a psychiatric hospital drank hot water estimated to be 90°C. Eight hours after injury, laryngopharynx edema gradually progressed, and his breathing deteriorated. Upon arrival at our emergency room, we secured his respiratory tract by nasal intubation under a bronchoscope.OutcomeThe edema gradually improved after peaking at hospital day 2, and he was extubated on hospital day 18. There were no apparent respiratory or esophageal problems, and he was discharged back to the psychiatric hospital on day 28.ConclusionThese types of laryngopharynx burns caused by ingesting hot foods or drinks have been rarely reported for adults. In cases of adults, when the patient is in a special situation such as having a psychiatric disorder, it is necessary to assume that the laryngopharynx burns might be aggravated.
      PubDate: 2016-09-13T23:20:46.718983-05:
      DOI: 10.1002/ams2.237
  • Inter-rater reliability of the American Society of Anesthesiologists
           physical status rating for emergency gastrointestinal surgery
    • Authors: Tsutomu Shichino; Motohiro Hirao, Yoshio Haga
      Abstract: AimThe American Society of Anesthesiologists Physical Status (ASA-PS) classification system is used worldwide and has also been incorporated into various prediction rules. However, concerns have been raised regarding inter-rater agreement in various surgical fields. Although emergency gastrointestinal surgery is relatively common and associated with high postoperative mortality, a reliability study has not yet been undertaken in this field. The aim of the present study was to investigate the inter-rater reliability of ASA-PS for emergency gastrointestinal surgery.MethodsThree sets of scenarios were generated for each ASA-PS class (2E, 3E, and 4E) in emergency gastrointestinal surgery, resulting in nine scenarios. These scenarios described the preoperative profiles of patients in one hospital. Two or three anesthesiologists from 18 other hospitals provided scores for ASA-PS for each scenario.ResultsFifty anesthesiologists scored the ASA-PS class. Between 66% and 90% of these anesthesiologists assigned the same ratings as the reference ratings for the individual scenarios. Inter-rater reliability was assessed using Fleiss’ kappa (95% confidence interval) of 0.55 (0.54–0.56, P < 0.001) and an intraclass correlation coefficient (95% confidence interval) of 0.79 (0.63–0.93, P < 0.001).ConclusionThe results of the present study revealed the consistency of ASA-PS ratings between anesthesiologists for emergency gastrointestinal surgery. The ASA-PS may serve as a reliable variable in the prediction rules for this field.
      PubDate: 2016-09-13T23:20:41.92561-05:0
      DOI: 10.1002/ams2.241
  • Drug-induced anaphylaxis in the emergency room
    • Abstract: Anaphylaxis is a life-threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first-line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid-anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto-injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.The initial treatment strategy, followed by correct diagnosis, in the emergency room (ER) is critical for preventing fatal anaphylaxis. Despite therapeutic benefits of adrenaline and the recommendations for its use, adrenaline injection rates to treat anaphylaxis remain low in many ERs. ER physicians should have proper knowledge regarding the diagnosis and treatment of anaphylaxis.
  • Superior mesenteric artery syndrome leading to reversible mucosal gangrene
    • Abstract: We describe a case in which gastrointestinal distention due to superior mesenteric artery syndrome (SMAS) developed into membranous gangrene, which in turn led to septic shock in a 60-year-old woman with cerebral palsy and cachexia. The association with SMAS and septic shock is considered extremely rare, it is important to consider this combination especially in cachectic patients with gastric distension accompanying refractory shock unknown etiology.
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Heriot-Watt University
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