研究者詳細 - 上村　修二

論文 - 上村　修二

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Successful resuscitation for cardiac arrest due to severe accidental hypothermia accompanied by mandibular rigidity: A case of cold stiffening mimicking rigor mortis

Naofumi Bunya, Keigo Sawamoto, Ryuichiro Kakizaki, Kenshiro Wada, Yoichi Katayama, Hirotoshi Mizuno, Hiroyuki Inoue, Shuji Uemura, Keisuke Harada, Eichi Narimatsu

International Journal of Emergency Medicine ( BioMed Central Ltd. ) 11 ( 1 ) 2018年11月

Background: In cases of severe accidental hypothermia, it was recommended that resuscitation should be continued until the patient has rewarmed, as hypothermia itself can preserve cerebral function, and hypothermic cardiac arrest is reversible. During cardiopulmonary resuscitation for normothermic patients, muscle rigidity suggests the initiation of postmortem changes such as rigor mortis and can lead to the termination of resuscitation. Currently, the prognosis of cardiac arrest due to severe accidental hypothermia accompanied by rigidity is unknown. Case presentation: A 29-year-old woman was found unresponsive near a snowy mountain trail. Upon discovery, she was found to be in cardiac arrest with an initial asystole rhythm and exhibited mandibular rigidity. On admission, her core temperature was 22 °C. Although cardiac arrest continued, and she showed no response to normal resuscitation, blood gas analysis revealed that her initial serum potassium level was 5.4 mmol/L. Extracorporeal membrane oxygenation (ECMO) for systemic perfusion and rewarming was initiated. After ECMO was introduced, return of spontaneous circulation was achieved. She showed no neurological impairments at discharge. Conclusions: Muscle rigidity does not rule out the possibility of resuscitation in patients with severe accidental hypothermia under cardiac arrest. Serum potassium levels may assist in deciding whether ECMO should be introduced, even if a patient is in asystole. This knowledge may help emergency physicians to save the lives of such patients.

DOI

長距離トライアスロンレースの救護体制についてアイアンマン・ジャパン北海道3年間の経験

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

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 1 ) 38 - 44 2018年09月

IRONMANレースはスイム3.8km、バイク180.2km、ラン42.2kmのロングディスタンスのトライアスロン競技であり、2013年から2015年まで北海道で開催され、我々は3年間救護体制に関わった。救護範囲が広く、レース時間が長いため救護体制の構築に難渋した。救護率(救護対応数/参加者)は6.6〜8.9%と高く、ゴール後の脱水症や低体温症への対応が最も多かったが、スイムでは心停止や肺水腫、バイクでは転倒による外傷や低体温と各種目に応じた医療活動が必要であった。レース中の医療本部の役割は、救護班への指示や連絡、傷病者の治療方針の決定、地元医療機関への受け入れや地元消防への搬送の依頼、大会本部内での連絡と調整などがあり、その役割は大きかった。ロングディスタンスのトライアスロン競技の救護では全体を統括する医療本部と3種目の特性に応じた救護体制の構築が重要であった。(著者抄録)

寒冷地での病院前輸液保温管理の実態調査

上村修二, 吉田有法, 水野浩利, 沢本圭悟, 稲村広敏, 田口裕紀子, 村中沙織, 春名純平, 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 ) 21 ( 2 ) 278 - 278 2018年04月

北海道マラソン2017におけるコース上のWBGTと熱中症発生の関連

田口裕紀子, 上村修二, 沢本圭悟, 水野浩利, 稲村広敏, 村中沙織, 春名純平, 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

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 21 ( 2 ) 356 - 356 2018年04月

Risk factors for acute pancreatitis in patients with accidental hypothermia

Hiroyuki Inoue, Shuji Uemura, Keisuke Harada, Hirotoshi Mizuno, Naofumi Bunya, Kazuhito Nomura, Ryuichiro Kakizaki, Eichi Narimatsu

American Journal of Emergency Medicine ( W.B. Saunders ) 2018年 [査読有り]

Background: Pancreatic damage is commonly observed as a consequence of accidental hypothermia (core body temperature below 35 °C). We aimed to investigate the risk factors for pancreatic damage and the causal relationship in patients with accidental hypothermia. Methods: This retrospective, single-center, observational case-control study was conducted in the emergency department of a tertiary care medical center. We investigated patients who were admitted for accidental hypothermia over a course of ten years (January 2008 to December 2017). Results: Of the 138 enrolled patients, 70 had elevated serum amylase levels (51%). We observed a correlation between initial core body temperature and serum amylase level (Spearman's rank correlation coefficient −0.302, p < 0.001). Patients who developed acute pancreatitis had a significantly lower initial core body temperature than those who did not develop it (odds ratio = 0.76 95% confidence interval [CI] = 0.61–0.94 p = 0.011). Receiver operating characteristic analysis showed that a body temperature lower than 28.5 °C at the time of visit was predictive of acute pancreatitis (area under the curve = 0.71, 95% CI = 0.54–0.88, sensitivity = 0.67, specificity = 0.69, p = 0.017). Conclusions: We concluded that an initial core body temperature lower than 28.5 °C was a risk factor for acute pancreatitis in accidental hypothermia cases. In such situations, careful follow-up is necessary.

DOI

重症急性心原性肺水腫に対する救急外来からの非侵襲的換気法(NIV)導入効果の検討

葛西毅彦, 武山佳洋, 平山傑, 坂脇園子, 坂脇英志, 小黒武雄, 北村裕之, 笹岡悠太, 野田昇宏, 山岡歩, 山口智佳, 上村修二, 成松英智

函館医学誌 ( 市立函館病院 ) 41 ( 1 ) 6 - 9 2017年10月

当センターに救急搬送された重症急性心原性肺水腫125例を対象に、救急外来における非侵襲的換気法(NIV)導入の効果について検討した。NIV非導入群54例とNIV導入群71例で比較したところ、患者背景に有意差は認めなかったが、救急外来での気管挿管率はNIV導入群で有意な減少を認めた。NIV使用の気管挿管回避率はNNT(number needed to treat):6.9であった。次に治療法により標準的酸素治療(ST群)92例、NIV群20例、気管挿管(TI)群13例に分け比較すると、入院時の二酸化炭素分圧濃度はNIV群で有意に高かった。HCU、ICU滞在期間はTI群が他の2群より有意に長かったが、7日後の死亡率、病院内死亡率については3群間で有意差は認められなかった。

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.

Naofumi Bunya, Keigo Sawamoto, Shuji Uemura, Ryoko Kyan, Hiroyuki Inoue, Junichi Nishida, Hidemichi Kouzu, Nobuaki Kokubu, Tetsuji Miura, Eichi Narimatsu

Acute medicine & surgery 4 ( 3 ) 334 - 337 2017年07月 [国際誌]

Case: Sibutramine 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. Outcome: She was successfully resuscitated without any neurological deficits by using extracorporeal membrane oxygenation for refractory ventricular fibrillation. Conclusion: This case indicates that sibutramine can cause cardiac arrest even in subjects without pre-existing cardiovascular disease when combined with agents that promote QT prolongation.

DOI PubMed

多発肋骨骨折による陽圧呼吸管理開始のIndication

平山傑, 豊原隆, 山岡歩, 沢本圭悟, 上村修二, 葛西毅彦, 坂脇英志, 武山佳洋, 成松英智

日本外傷学会雑誌 ( (一社)日本外傷学会 ) 31 ( 2 ) 322 - 322 2017年05月

Cerebral air embolism associated with penetrating lung injury: a case report and review of the literature.

Ayumu Yamaoka, Kei Miyata, Eichi Narimatsu, Eiji Sakawaki, Sonoko Sakawaki, Suguru Hirayama, Shuji Uemura, Naoya Yama

Acute medicine & surgery 4 ( 2 ) 213 - 216 2017年04月 [国際誌]

CASE: A 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. OUTCOME: Right 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. CONCLUSION: We 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.

DOI PubMed

悪性症候群治療中に投与したプロポフォールの効果から、カタトニア症候群の関与が疑われた一例

野村和史, 山岡歩, 相坂和貴子, 坂脇英志, 坂脇園子, 岡本博之, 武山佳洋, 上村修二, 成松英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 ) 24 ( Suppl. ) DP133 - 5 2017年02月

シートベルト着用は自動車同乗者の頭部および顔面外傷を予防する

山岡歩, 宮田圭, 葛西毅彦, 平山傑, 武山佳洋, 上村修二, 入船秀仁, 原田敬介, 成松英智

日本脳神経外傷学会プログラム・抄録集 ( (一社)日本脳神経外傷学会 ) 40回 140 - 140 2017年02月

Adaptive Cross-Resistance to Aminoglycoside Antibiotics in Pseudomonas aeruginosa Induced by Topical Dosage of Neomycin

Shuji Uemura, Shin-ichi Yokota, Tsukasa Shiraishi, Manabu Kitagawa, Suguru Hirayama, Ryoko Kyan, Hirotoshi Mizuno, Keigo Sawamoto, Hiroyuki Inoue, Atsushi Miyamoto, Eichi Narimatsu

CHEMOTHERAPY ( KARGER ) 62 ( 2 ) 121 - 127 2017年 [査読有り]

Background: Topical antimicrobial formulations containing neomycin are commonly used to prevent and treat burn infections. However, Pseudomonas aeruginosa shows rapid acquisition of adaptive resistance to neomycin. This study aimed to evaluate the survival of P. aeruginosa during exposure to neomycin at high concentrations comparable to those used in topical formulations, and to investigate the effect of adaptive resistance to neomycin on the susceptibility to other aminoglycosides. Methods: Strain IID1130 [neomycin minimal inhibitory concentration (MIC) = 4 mu g/ml] was incubated on an agar medium containing neomycin at high concentrations (8-4,096 mu g/ml), and growing colonies were macroscopically observed. Acquisition of adaptive resistance was examined for 5 P. aeruginosa strains. Cells were sequentially passaged on agar medium containing neomycin with step-wise increased concentrations (82,048 mu g/ml). To assess reversion of antibiotic susceptibility, the resulting colonies were repeatedly subcultured on antibiotic-free agar plates. Results: Growing IID1130 colonies were macroscopically detected on a neomycin-containing ( 2,048 mu g/ml) agar plate for 48 h. These cells showed increasing MIC for not only neomycin, but also gentamicin and amikacin; the MIC values were occasionally higher than the breakpoints. When the adapted cells were subcultured on antibiotic-free agar, several passages were required for reversion of susceptibility. Conclusions: Our findings suggest that P. aeruginosa can survive in the presence of neomycin with a concentration typically used in topical dosage forms, and that the acquired adaptive resistance is persistent and is accompanied by cross-resistance to other aminoglycosides. (C) 2016 S. Karger AG, Basel

DOI

マラソンにおけるMass Gathering Medicine アイアンマン・ジャパン北海道における医療救護体制救護本部の役割について

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

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 19 ( 2 ) 249 - 249 2016年04月

Therapeutic temperature modulation in severe or moderate traumatic brain injury: a propensity score analysis of data from the Nationwide Japan Neurotrauma Data Bank

Kei Miyata, Hirofumi Ohnishi, Kunihiko Maekawa, Takeshi Mikami, Yukinori Akiyama, Satoshi Iihoshi, Masahiko Wanibuchi, Nobuhiro Mikuni, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu, Yasufumi Asai

JOURNAL OF NEUROSURGERY ( AMER ASSOC NEUROLOGICAL SURGEONS ) 124 ( 2 ) 527 - 537 2016年02月 [査読有り]

OBJECTIVE In patients with severe traumatic brain injury (TBI), a randomized controlled trial revealed that outcomes did not significantly improve after therapeutic hypothermia (TH) or normothermia (TN). However, avoiding pyrexia, which is often associated with intracranial disorders, might improve clinical outcomes. The objective of this study was to compare neurological outcomes among patients with moderate and severe TBI after therapeutic temperature modulation (TTM) in the absence of other interventions. METHODS Data from 1091 patients were obtained from the Japan Neurotrauma Data Bank Project 2009, a cohort observational study. Patients with cardiac arrest, those with a Glasgow Coma Scale score of 3 and dilated fixed pupils, and those whose cause of death was injury to another area of the body were excluded, leaving 687 patients aged 16 years or older in this study. The patients were divided into 2 groups: the TTM group underwent TN (213 patients) or TH (82 patients), and the control group (392 patients) did not receive TTM. The primary end point for this study was the rate of poor outcome at hospital discharge, and the secondary end point was in -hospital death. Out of the 208 total items in the database, 29 variables that could potentially affect outcome were matched using the propensity score (PS) method in order to reduce selection bias and balance the baseline characteristics. RESULTS From each group, 141 patients were extracted using the PS -matching process. Among the patients in the TTM group, 29 had undergone TH and 112 had undergone TN. In a log -rank test using Kaplan -Meier survival curves, no significant differences in patient outcome or death were observed between the 2 groups (poor outcome, p = 0.83; death, p = 0.18). A Cox proportional -hazards regression analysis established the HR for poor outcome and mortality at 1.03 (95% CI 0.78-1.36, p = 0.83) and 1.34 (95% CI 0.87-2.07, p = 0.18), respectively. CONCLUSIONS There was no clear improvement in neurological outcomes after TTM in patients with moderate or severe TBI. To elucidate the role of TTM in patients with these injuries, a prospective study is needed with long-term follow-up using specific target temperatures.

DOI PubMed

下行大動脈損傷予防のために肋骨骨折端を摘除した胸部外傷の１例

上村修二, 宮島正博, 窪田生美, 喜屋武玲子, 平山傑, 井上弘行, 渡辺敦, 成松英智

日本外傷学会雑誌 ( The Japanese Association for the Surgery of Trauma ) 30 ( 1 ) 23 - 26 2016年

症例は19歳女性，交通事故で頭部，顔面挫創，両肺挫傷，両側気胸，両側多発肋骨骨折，肝損傷と腸骨開放骨折を受傷．来院後，気道緊急のため気管挿管施行し人工呼吸管理とした．CTで左第９肋骨骨折端と下行大動脈の距離が12mmと近接しており経過観察としていたが，受傷後５日には４mmと近接したため，胸腔鏡下に肋骨骨折端摘除術を施行した．左下後部肋骨骨折による遅発性の下行大動脈損傷は稀ではあるが発生すると致命的である．本症例は予防的に肋骨骨折端を摘除することにより下行大動脈損傷を予防することができた．

DOI CiNii

Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan

Kei Miyata, Satoko Ochi, Rei Enatsu, Masahiko Wanibuchi, Nobuhiro Mikuni, Hiroyuki Inoue, Shuji Uemura, Katsuhiko Tanno, Eichi Narimatsu, Kunihiko Maekawa, Keiko Usui, Masahiro Mizobuchi

NEUROLOGIA MEDICO-CHIRURGICA ( JAPAN NEUROSURGICAL SOC ) 56 ( 5 ) 249 - 256 2016年 [査読有り]

It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9-52 years; interquartile range (IQR), 24-45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5-30; IQR, 3-21), and the median disease duration was 25 years (4-38; IQR, 6-32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention.

DOI PubMed

Severe accidental colchicine poisoning by the autumn crocus: A case of successful treatment

Ryoko Kyan, Shuji Uemura, Katsutoshi Tanno, Keigo Sawamoto, Keisuke Harada, Eiji Sakawaki, Yuji Fujita, Shigeatsu Endo, Eichi Narimatsu

Journal of Acute Medicine ( Elsevier ) 5 ( 4 ) 103 - 106 2015年12月 [査読有り]

Background: The common garden plant autumn crocus contains colchicine and its derivatives. Colchicine poisoning causes abdominal cramps and diarrhea within hours. Several days later, multiorgan failure, pancytopenia, and cardiovascular collapse occur.1,2 Severe colchicine poisoning is associated with high mortality. Case report: A 63-year-old woman who accidentally ingested an autumn crocus, which contained ~0.38 mg colchicine, had severe vomiting and was taken to an emergency center. She presented with symptoms of gastroenterocolitis within 1 hour of ingestion, and bone marrow hypoplasia with pancytopenia developed on the 3rd day after ingestion. We continued administration of granulocyte colony-stimulating factor (300 μg) for 5 days until we confirmed that the patient's white blood cell count was increasing. Also, there was focal and segmental intestinal ischemia and some cakes of charcoal remained in the intestinal tract. Therefore, we presumed that nonocclusive mesenteric ischemia was caused by hypotension with severe dehydration, although pseudo-obstruction due to the activated charcoal may have been a contributing factor. We were able to promptly intervene to treat paralytic ileus and gastrointestinal edema before anticipated worsening of abdominal compartment syndrome, by conducting open peritoneal drainage. Despite severe poisoning, our patient survived with intensive care. Conclusion: Colchicine intoxication may lead to a sudden and extreme critical course. Therefore, as there is no means to predict prognosis from initial severity of symptoms at onset, we suggest that all patients suspected of colchicine intoxication should be managed in hospital with continuous vital sign monitoring and frequent laboratory testing for at least a few days after ingestion.

DOI

超早期手術と計画的手術により救命した広範囲熱傷の1症例

平山傑, 上村修二, 山岡歩, 喜屋武玲子, 沢本圭悟, 井上弘行, 長谷守, 成松英智

熱傷 ( (一社)日本熱傷学会 ) 41 ( 2 ) 98 - 98 2015年06月

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年02月 [査読有り]

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

アイアンマン・ジャパン北海道(トライアスロン)における医療救護体制について

上村修二, 丹野克俊, 沢本圭悟, 田口裕紀子, 稲村広敏, 宮田圭, 山岡歩, 成松英智

日本集団災害医学会誌 ( (一社)日本災害医学会 ) 19 ( 3 ) 551 - 551 2014年12月

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