研究者詳細 - 上村　修二

論文 - 上村　修二

分割表示 66 件中 21 - 40 件目／全件表示 >>

青柳有沙, 宮田圭, 山岡歩, 葛西毅彦, 上村修二, 成松英智

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 32 ( 6 ) 314 - 319 2021年06月

標準的な外傷診療では生理学的機能の管理および安定化を重視しており,神経学的所見は見逃されやすい。内因性脳梗塞が先行した外傷症例の診療について検討した。症例は78歳の男性,階段2階の踊り場から転落した。右共同偏視,右片麻痺,Glasgow coma scale(GCS) 12の意識障害を認めた。外傷全身computed tomography(CT)で頭蓋内に占拠性病変は認めず,動脈優位相で左中大脳動脈の造影欠損を認めた。急性期脳梗塞と診断し,機械的血栓回収療法を行った。外傷機転を介在する内因性脳梗塞では,見逃しや治療介入に時間を要する可能性がある。病院前脳卒中スケールが症状検出に役立つ可能性があり,頭頂部の動脈優位相を含む造影CT検査で主幹動脈閉塞の検索が可能である。画像評価には熟練を要するため,3次元画像処理を行うとともに,適切に専門医へコンサルトし早期診断治療へつなげることが重要である。(著者抄録)

Successful diagnosis and treatment of pulmonary aspergillosis-related malignant catatonia using propofol and quetiapine: A case report.

Kazuhito Nomura, Sonoko Sakawaki, Eiji Sakawaki, Ayumu Yamaoka, Wakiko Aisaka, Hiroyuki Okamoto, Yoshihiro Takeyama, Shuji Uemura, Eichi Narimatsu

Medicine 100 ( 19 ) e25967 2021年05月 [国際誌]

INTRODUCTION: Malignant catatonia (MC) is a movement disorder syndrome characterized by immobility, rigidity, and consciousness disorders that develops in association with mental and physical diseases. It is often fatal due to hyperthermia, rhabdomyolysis, and acute kidney injury. Its clinical symptoms are similar to those of another disorder, neuroleptic malignant syndrome (NMS), and it is often difficult to distinguish between the 2 disorders. PATIENT CONCERNS: An Asian woman in her 60s with history of schizophrenia. She was admitted to our hospital because of symptoms such as fever, unconsciousness, and muscle rigidity. Blood tests showed kidney injury and high creatinine kinase levels. DIAGNOSES: At the time of admission, she had been diagnosed with NMS complicated by pulmonary aspergillosis and was undergoing treatment although there was no improvement. INTERVENTIONS: Subsequently, the administration of propofol, a gamma-aminobutyric acid A agonist, markedly improved the symptoms, and the diagnosis was corrected to MC. At the beginning of her hospitalization, she received dantrolene, bromocriptine, amantadine, and L-3,4-dihydroxyphenylalanine as treatment for NMS, but her symptoms did not improve. With propofol, which is used for sedation, her catatonic symptoms improved markedly. Quetiapine administration further improved the symptoms, and it eventually resolved completely. OUTCOMES: The patient's MC was in remission. Prolonged intensive care management resulted in a decline in activities of daily living, and she required rehabilitation at another hospital. CONCLUSION: This is the first report of MC with suspected involvement of pulmonary aspergillosis. MC differs from NMS, in that it is treated more effectively with gamma-aminobutyric acid A agonists. Although benzodiazepines are the first choice for the diagnosis and treatment of MC, they are ineffective for majority of patients with schizophrenia. However, even in such cases, propofol and quetiapine are effective, and they facilitate diagnosis and treatment.

DOI PubMed

Pathophysiologic Mechanisms of Hypothermia-Induced Pancreatic Injury in a Rat Model of Body Surface Cooling

Hiroyuki Inoue, Keisuke Harada, Eichi Narimatsu, Shuji Uemura, Wakiko Aisaka, Naofumi Bunya, Kazuhito Nomura, Yoichi Katayama

Pancreas ( NLM (Medline) ) 50 ( 2 ) 235 - 242 2021年02月

OBJECTIVE: The mechanisms underlying hypothermia-induced pancreatic injury are unclear. Thus, we investigated the pathophysiology of hypothermia-induced pancreatic injury. METHODS: We created a normal circulatory model with body surface cooling in rats. We divided the rats into control (36°C-38°C), mild hypothermia (33°C-35°C), moderate hypothermia (30°C-32°C), and severe hypothermia (27°C-29°C) (n = 5 per group) groups. Then, we induced circulatory failure with a cooling model using high-dose inhalation anesthesia and divided the rats into control (36°C-38°C) and severe hypothermia (27°C-29°C) (n = 5 per group) groups. Serum samples were collected before the introduction of hypothermia. Serum and pancreatic tissue were collected after maintaining the target body temperature for 1 hour. RESULTS: Hematoxylin and eosin staining of the pancreas revealed vacuoles and edema in the hypothermia group. Serum amylase (P = 0.056), lactic acid (P < 0.05), interleukin 1β (P < 0.05), interleukin 6 (P < 0.05), and tumor necrosis factor α (P = 0.13) levels were suppressed by hypothermia. The circulatory failure model exhibited pancreatic injury. CONCLUSIONS: Hypothermia induced bilateral effects on the pancreas. Morphologically, hypothermia induced pancreatic injury based on characteristic pathology typified by vacuoles. Serologically, hypothermia induced protective effects on the pancreas by suppressing amylase and inflammatory cytokine levels.

DOI PubMed

Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review.

Kazuhito Nomura, Eiji Sakawaki, Sonoko Sakawaki, Ayumu Yamaoka, Wakiko Aisaka, Hiroyuki Okamoto, Yoshihiro Takeyama, Shuji Uemura, Eichi Narimatsu

BMC infectious diseases 21 ( 1 ) 37 - 37 2021年01月 [国際誌]

BACKGROUND: Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer. CASE PRESENTATION: An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to. CONCLUSION: This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.

DOI PubMed

Gasping during refractory out-of-hospital cardiac arrest is a prognostic marker for favourable neurological outcome following extracorporeal cardiopulmonary resuscitation: a retrospective study

Naofumi Bunya, Hirofumi Ohnishi, Kenshiro Wada, Ryuichiro Kakizaki, Takehiko Kasai, Nobutaka Nagano, Nobuaki Kokubu, Kei Miyata, Shuji Uemura, Keisuke Harada, Eichi Narimatsu

Annals of Intensive Care ( Springer ) 10 ( 1 ) 2020年12月

Background: Gasping during cardiac arrest is associated with favourable neurological outcomes for out-of-hospital cardiac arrest. Moreover, while extracorporeal cardiopulmonary resuscitation (ECPR) performed for refractory cardiac arrest can improve outcomes, factors for favourable neurological outcomes remain unknown. This study aimed to examine whether gasping during cardiac arrest resuscitation during transport by emergency medical services (EMS) was independently associated with a favourable neurological outcome for patients who underwent ECPR. This retrospective study was based on medical records of all adult patients who underwent ECPR due to refractory cardiac arrest. The primary endpoint was neurologically intact survival at discharge. The study was undertaken at Sapporo Medical University Hospital, a tertiary care centre approved by the Ministry of Health, Labour and Welfare, located in the city of Sapporo, Japan, between January 2012 and December 2018. Results: Overall, 166 patients who underwent ECPR were included. During transportation by EMS, 38 patients exhibited gasping, and 128 patients did not. Twenty patients who exhibited gasping during EMS transportation achieved a favourable neurological outcome (20/38 52.6%) 14 patients who did not exhibit gasping achieved a favourable neurological outcome (14/128 10.9%). Gasping during transportation by EMS was independently associated with favourable neurological outcome irrespective of the type of analysis performed (multiple logistic regression analysis, odds ratio [OR] 9.52 inverse probability of treatment weighting using propensity score, OR 9.14). Conclusions: The presence of gasping during transportation by EMS was independently associated with a favourable neurological outcome in patients who underwent ECPR. The association of gasping with a favourable neurological outcome in patients with refractory cardiac arrest suggests that ECPR may be considered in such patients.

DOI

Mechanism of central hypopnoea induced by organic phosphorus poisoning

Kazuhito Nomura, Eichi Narimatsu, Hiroyuki Inoue, Ryoko Kyan, Keigo Sawamoto, Shuji Uemura, Ryuichiro Kakizaki, Keisuke Harada

Scientific Reports ( Springer Science and Business Media LLC ) 10 ( 1 ) 2020年12月

Abstract Whether central apnoea or hypopnoea can be induced by organophosphorus poisoning remains unknown to date. By using the acute brainstem slice method and multi-electrode array system, we established a paraoxon (a typical acetylcholinesterase inhibitor) poisoning model to investigate the time-dependent changes in respiratory burst amplitudes of the pre-Bötzinger complex (respiratory rhythm generator). We then determined whether pralidoxime or atropine, which are antidotes of paraoxon, could counteract the effects of paraoxon. Herein, we showed that paraoxon significantly decreased the respiratory burst amplitude of the pre-Bötzinger complex (p < 0.05). Moreover, pralidoxime and atropine could suppress the decrease in amplitude by paraoxon (p < 0.05). Paraoxon directly impaired the pre-Bötzinger complex, and the findings implied that this impairment caused central apnoea or hypopnoea. Pralidoxime and atropine could therapeutically attenuate the impairment. This study is the first to prove the usefulness of the multi-electrode array method for electrophysiological and toxicological studies in the mammalian brainstem.

DOI

細胞外液補充液製剤の長期加温保管による成分変化の検討

村中沙織, 田口裕紀子, 稲村広敏, 上村修二, 水野浩利, 沢本圭悟, 成松英智

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 23 ( 3 ) 486 - 486 2020年08月

Veno-venous extracorporeal membrane oxygenation and prone ventilation for therapeutic management of COVID-19.

Takehiko Kasai, Naofumi Bunya, Kenshiro Wada, Ryuichiro Kakizaki, Hirotoshi Mizuno, Hiroyuki Inoue, Shuji Uemura, Satoshi Takahashi, Eichi Narimatsu, Shinhiro Takeda

Acute medicine & surgery 7 ( 1 ) e546 2020年 [国際誌]

BACKGROUND: The efficacy and safety of the combined use of veno-venous extracorporeal membrane oxygenation (ECMO) and prone ventilation are currently not known for coronavirus disease 2019 (COVID-19). CASE PRESENTATION: We report two cases in which the combination of veno-venous ECMO and prone ventilation for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia were successfully carried out. Both patients had developed severe respiratory failure due to SARS-CoV-2 pneumonia, thus requiring veno-venous ECMO. Prone ventilation was also administered safely. CONCLUSION: Oxygenation and lung compliance gradually improved during prone ventilation, and both patients were successfully extubated. For patients with severe SARS-CoV-2 pneumonia who require veno-venous ECMO, the use of prone ventilation could be beneficial, and should be considered.

DOI PubMed

平成30年北海道胆振東部地震におけるDMATの船舶を用いた出動に関する検討

村中沙織, 田口裕紀子, 水野浩利, 上村修二, 稲村広敏, 沢本圭悟, 新山紗千, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 24 ( 3 ) 305 - 305 2019年12月

平成30年北海道胆振東部地震における当院の災害対応の課題

新山紗千, 田口裕紀子, 村中沙織, 上村修二, 水野浩利, 稲村広敏, 沢本圭悟

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 24 ( 3 ) 305 - 305 2019年12月

救命救急センターにおける医師事務作業補助者の活用と効果

井上弘行, 上村修二, 小出梨紗, 舘祐希, 喜屋武玲子, 文屋尚史, 片山洋一, 葛西毅彦, 成松英智

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 22 ( 6 ) 761 - 767 2019年12月

目的:医師の業務負担軽減のため、当センターでは2016年に医師事務作業補助者(以下、DC)の業務内容を見直し、病棟庶務から本来業務に変更(以下、業務改革)した。2018年度からはDCを増員し2名体制としたため、それらの効果を検討した。方法:改革前、改革後、DC増員後それぞれの、DCによる各種文書の代行作成数、文書遅滞によるクレーム数、オーダー代行数、各種記録数、症例登録入力数、および医師の残業時間、患者受入応需率、医師満足度などを調査した。結果:業務改革によってDCによるすべての文書作成と記録の件数は増加した。多くの業務がDCに移行され、患者受入応需率は6.7%増加、医師の残業時間は14%減少し、医師の満足度は100%であった。結論:業務改革により医師の負担は軽減し、診療にエフォートをシフトし得た。また、業務が効率化され、生産性と医療の質を上げた。救急医の働き方改革の鍵はDCの活用にある。(著者抄録)

Elderly-onset acute necrotizing encephalopathy mimicking severe heat stroke: a case report and review of the literature.

Arisa Odagiri, Ayumu Yamaoka, Kei Miyata, Naofumi Bunya, Takehiko Kasai, Yoshihiro Takeyama, Shuji Uemura, Takeshi Mikami, Eichi Narimatsu

Acute medicine & surgery 6 ( 3 ) 316 - 320 2019年07月 [国際誌]

Background: Acute necrotizing encephalopathy (ANE), known as influenza-associated encephalitis, typically affects children. Case presentation: A 70-year-old woman was admitted to the hospital with altered consciousness, a high temperature, and severe hypotension. Computed tomography (CT) of the head showed no abnormalities; thus, a diagnosis of suspected severe heat stroke was made. On day 2, repeated head CT revealed bilateral symmetrical lesions to the thalamus, and a rapid influenza antigen test was positive. Based on the CT findings and the medical history of influenza, a differential diagnosis of ANE was made. Subsequently, brain edema spread across the whole brain, and the patient died on day 21. Conclusion: In elderly patients, differentiating ANE from severe heat stroke in a high-temperature environment is difficult because of the similarities in clinical symptoms due to multiple organ failure.

DOI PubMed

The prognostic value of agonal respiration in refractory cardiac arrest: a case series of non-shockable cardiac arrest successfully resuscitated through extracorporeal cardiopulmonary resuscitation.

Naofumi Bunya, Kenshiro Wada, Ayumu Yamaoka, Ryuichiro Kakizaki, Yoichi Katayama, Takehiko Kasai, Ryoko Kyan, Naoto Murakami, Nobuaki Kokubu, Shuji Uemura, Eichi Narimatsu

Acute medicine & surgery 6 ( 2 ) 197 - 200 2019年04月 [査読有り] [国際誌]

BACKGROUND: Agonal respiration following out-of-hospital cardiac arrest is associated with favorable neurological outcomes. Resuscitation using extracorporeal membrane oxygenation could contribute to achieving favorable neurological outcomes in patients with refractory cardiac arrest. CASE PRESENTATION: We report two cases of refractory cardiac arrest with non-shockable rhythms and agonal respiration; both patients were successfully resuscitated through extracorporeal cardiopulmonary resuscitation (ECPR). Both patients were breathing spontaneously upon arrival. One patient was asystolic and the other experienced pulseless electrical activity followed by ventricular fibrillation. Agonal respiration was observed in both and ECPR was implemented, leading to a favorable neurological outcome at discharge. CONCLUSION: The presence of agonal respiration has the potential to confer a favorable neurological outcome in patients with refractory cardiac arrest if maintained, even when the initial cardiac rhythm is not shockable. In these cases, resuscitation should not be abandoned, and ECPR should be considered.

DOI PubMed

大規模停電に対応した札幌医療圏DMAT活動拠点本部の活動報告(北海道胆振東部地震)

水野浩利, 窪田生美, 沢本圭悟, 田口裕紀子, 村中沙織, 上村修二, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 335 - 335 2019年02月

北海道マラソンにおける各救護地点のWBGTと熱中症発生数との関連

田口裕紀子, 沢本圭悟, 上村修二, 水野浩利, 稲村広敏, 村中沙織, 鈴木靖, 成松英智, 北海道救急医学会北海道マラソン準備委員会

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 449 - 449 2019年02月

医療系学生に対する災害医療実習の有効性について

瀬上朋宏, 上村修二, 水野浩利, 沢本圭悟, 田口裕紀子, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 460 - 460 2019年02月

北海道マラソンにおける運動誘発性熱中症の診断率・給水率と競技復帰後転帰の関係

沢本圭悟, 上村修二, 水野浩利, 田口裕紀子, 稲村広敏, 鈴木靖, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 409 - 409 2019年02月

DMAT1.5日隊員の技能維持に養成研修のタスク参加は有効か

村中沙織, 水野浩利, 瀬上朋宏, 稲村広敏, 上村修二, 沢本圭悟, 田口裕紀子, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 468 - 468 2019年02月

「災害医学・医療への先端技術の活用」本部活動クロノロジーのテキストマイニング解析結果は災害医療活動に利用可能か?

上村修二, 稲村広敏, 沢本圭悟, 窪田生美, 田口裕紀子, 村中沙織, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 292 - 292 2019年02月

「災害時の航空機運用」受け入れSCUでのドライブスルー方式による患者搬送方法の検討

上村修二, 沢本圭悟, 水野浩利, 瀬上朋宏, 稲村広敏, 田口裕紀子, 村中沙織, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 317 - 317 2019年02月

　前のページ - 次のページ　

<上村 修二>

論文 - 上村 修二

<上村　修二>

論文 - 上村　修二