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Papers 【 display / non-display 】

• TAKOTSUBO CARDIOMYOPATHY INDUCED BY SUICIDAL NECK HANGING

  Keigo Sawamoto, Mamoru Hase, Shuji Uemura, Takehiko Kasai, Eichi Narimatsu

  JOURNAL OF EMERGENCY MEDICINE ( ELSEVIER SCIENCE INC )  48 ( 2 ) E35 - E38  2015.02  [Refereed]

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  Background: Takotsubo cardiomyopathy (TC) is an uncommon immune-endocrinologic cause of acute reversible heart failure, generally caused by some form of stress. Case Report: We report a case of TC after hanging for attempted suicide. Upon admission, the patient demonstrated an almost entirely normal electrocardiogram (ECG) and mild hypotension. However, on the third day after hanging, she developed chest and back pain with inverted T waves and QTc prolongation on ECG. Her coronary arteries were normal on angiogram, but the left ventricle showed apical ballooning, consistent with TC. She was treated with an intra-aortic balloon pump and fully recovered. We observed that the QTc interval seemed to be a good guide for clinical course in this case. Why Should an Emergency Physician Be Aware of This?: TC should be considered in any acute stressful presentation, and to assist in the diagnosis as TC, we suggest following the QTc on ECG. TC should be taken into consideration in patients after suicide attempt with low blood pressure or an abnormal ECG, including ST segment elevation, Twave inversion, and QTc prolongation. (C) 2015 Elsevier Inc.

  DOI PubMed

• Outcome from severe accidental hypothermia with cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation

  Keigo Sawamoto, Steven B. Bird, Yoichi Katayama, Kunihiko Maekawa, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu

  AMERICAN JOURNAL OF EMERGENCY MEDICINE ( W B SAUNDERS CO-ELSEVIER INC )  32 ( 4 ) 320 - 324  2014.04  [Refereed]

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  Purpose: This study aimed to identify factors of neurologic prognosis in severe accidental hypothermic patients with cardiac arrest. Basic procedures: This retrospective observational study was performed in a tertiary care university hospital in Sapporo, Japan (January 1994 to December 2012). We investigated 26 patients with accidental hypothermic cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR). We evaluated the neurologic outcome in patients who were resuscitated with ECPR at discharge from hospital. Main findings: In those 26 patients, their median age was 50.5 years; and 69.2% were male. The cause of hypothermia was exposure to cold air in 46.1%, submersion in 46.1%, and avalanche in 7.8%. Ten (38.5%) of these patients survived to favorable neurological outcome at discharge. Factors associated with favorable neurological outcome were a cardiac rhythm other than asystole (P=.009), nonasphyxial hypothermia (P=.006), higher pH (P =.01), and lower serum lactate (P =.01). In subgroup analyses, the patients with hypothermic cardiac arrest due to submersion or avalanche (asphyxia group) showed no factors associated with good neurological outcome, whereas the nonasphyxia group showed a significantly lower core temperature (P =.02) and a trend towards a lower serum lactate (P =.09). Principal conclusions: Patients with hypothermic cardiac arrest due to nonasphyxial hypothermia have improved neurologic outcomes when treated with ECPR compared to patients with asphyxial hypothermic cardiac arrest. Further investigation is needed to develop a prediction rule for patients with nonasphyxial hypothermic cardiac arrest to determine which patients would benefit from treatment with ECPR. (c) 2014 Elsevier Inc. All rights reserved.

  DOI PubMed

• Acquisition of a Transposon Encoding Extended-Spectrum beta-Lactamase SHV-12 by Pseudomonas aeruginosa Isolates during the Clinical Course of a Burn Patient

  Shuji Uemura, Shin-ichi Yokota, Hirotoshi Mizuno, Eiji Sakawaki, Keigo Sawamoto, Kunihiko Maekawa, Katsutoshi Tanno, Kazuhisa Mori, Yasufumi Asai, Nobuhiro Fujii

  ANTIMICROBIAL AGENTS AND CHEMOTHERAPY ( AMER SOC MICROBIOLOGY )  54 ( 9 ) 3956 - 3959  2010.09  [Refereed]

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  Three of seven clonally related Pseudomonas aeruginosa strains isolated from a burn patient produced the extended-spectrum beta-lactamase (ESBL) SHV-12. Its gene was flanked by two IS26 elements with a large transposon (>24 kb). The transposon also contained at least five IS26 elements and a gene encoding the amikacin resistance determinant aminoglycoside 6'-N-acetyltransferase type Ib [aac(6')-Ib]. It was inserted into the gene PA5317 in the P. aeruginosa chromosome.

  DOI PubMed

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Misc 【 display / non-display 】

• 心肺蘇生（CPR）に伴う胃損傷から低体温療法中に大量出血を来した１例

  葛西 毅彦, 武山 佳洋, 柿崎 隆一郎, 江濱 由松, 佐藤 昌太, 諸原 基貴, 俵 敏弘, 井上 弘行, 岡本 博之, 上村 修二

  ( 市立函館病院 )   2014

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  心肺蘇生（Cardiopulmonary resuscitation：CPR）は一般市民にも普及しつつあり，心肺停止患者の救命率向上に貢献している。 しかしCPR に伴う合併症も少なからず報告されており，その度合いによっては心拍再開後の治療に大きく影響することがある。今回，CPR に伴う胃損傷から低体温療法中に大量吐血するも，内視鏡治療にて止血を行い，神経学的予後良好に生存退院となった１例を経験したので報告する。

  CiNii

• 当院に救急搬送された旅行者の現状について

  上村 修二, 岡本 博之, 武山 佳洋, 江濵 由松, 諸原 基貴, 葛西 毅彦, 俵 敏弘, 井上 弘行

  ( 市立函館病院 )   2013

  CiNii

• 破傷風の長期鎮静管理に対し，Airway Pressure Release Ventilation を行った１例

  諸原 基貴, 上村 修二, 江濵 由松, 葛西 毅彦, 俵 敏弘, 井上 弘行, 岡本 博之, 武山 佳洋

  ( 市立函館病院 )   2013

  CiNii

• 緊急Ｏ型未クロス輸血とMassive transfusion が有効であった多発外傷の１例

  葛西 毅彦, 江濱 由松, 俵 敏弘, 岡本 博之, 武山 佳洋, 上村 修二, 文屋 尚文, 井上 弘行, 諸原 基貴

  ( 市立函館病院 )   2013

  CiNii

• Clinical features of low-velocity, crushing head injury;A report of 6 cases

  Miyata Kei, Mikami Takeshi, Mikuni Nobuhiro, Sawamoto Keigo, Uemura Syuji, Mori Kazuhisa, Asai Yasufumi

  Nihon Kyukyu Igakukai Zasshi ( Japanese Association for Acute Medicine )  23 ( 9 ) 415 - 420  2012

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  Head injuries produced by static loading mechanisms have been called low-velocity, crushing head injuries (CHI). If the injury is not fatal, there is usually no severe disturbance of consciousness, but CHI are characterized by damage to the cranial nerves caused by traction, stretching, and fractures of the cranial base due to the distortion of the skull. In this paper, we report on six cases of low-velocity CHI. There were four adults and two pediatric cases (less than five years of age). Cranial nerve palsy was observed in five cases. Skull base fractures traversing the clivus were recognized in four cases, optic canal fractures in two cases, and carotid canal fractures in two cases. The final neurological outcomes were as follows: full recovery (three cases), and minor (two cases) and severe (one case) morbidity. CHI is a rare condition with a unique injury mechanism and clinical symptoms. CHI patients present with a variety of cranial nerve injuries caused by distortion of the cranial base and the distribution of basilar skull fractures. In occupational accidents in adults and traffic accidents in children, CHI caused by static loading forces should be considered, and proper imaging studies are necessary to make an accurate diagnosis.

  DOI CiNii

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