Misc - UEMURA Shuuji

新しい時代を迎えた北海道の航空機救急医療について

奈良 理, 水野 浩利, 前川 邦彦, 上村 修二, 丹野 克俊, 森 和久, 浅井 康文

交通科学研究資料   49   50 - 51  2008.05

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A Case of Adrenal Insufficiency That Presented as Hypothermia

HIRAYAMA Suguru, TANNO Katsutoshi, WARABI Ryoko, UEMURA Shuji

日本救急医学会雑誌   19 ( 2 ) 131 - 135  2008.02

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A Case of Adrenal Insufficiency That Presented as Hypothermia

Hirayama Suguru, Tanno Katsutoshi, Warabi Ryoko, Uemura Shuji

Nihon Kyukyu Igakukai Zasshi ( Japanese Association for Acute Medicine )  19 ( 2 ) 131 - 135  2008

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This case involves a 29-year-old male who had, until 8 years ago, undergone radiation therapy for pituitary germinoma and was taking 20mg hydrocortisone daily for panhypopituitarism. Suffering profuse diarrhea, he was transported to our emergency department with exhaustion and hypothermia. Hypothermia treatment started with electric blankets for surface rewarming and warm gastric lavage for internal rewarming. Hypotension resulted from rewarming and rewarming shock suspected. Fluid loading was performed with no response. Dopamine was started but hypotension continued. Acute adrenal insufficiency was suspected due to the patient's medical history and catecholamine resistant shock, so 100 mg of hydrocortisone was administered intravenously 11 hours after arrival. Blood pressure slowly increased, allowing gradual reduction of fluid loading and dopamine. Before administering the hydrocortisone, serum cortisol concentration was 1.4μg/dl. On the 4th day of hospitalization, the patient was transferred from ICU and on the 11th day received an ambulatory discharge. Acute adrenal insufficiency is well known, but emergency room encounters are rare. Symptoms vary and lab findings are non-specific, making diagnosis difficult. When faced with catecholamine resistant shock, early diagnosis and treatment can influence the prognosis. Based upon the patient's medical history and developments, acute adrenal insufficiency should initially be suspected and steroids administered.

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A Case of Methemoglobinemia by Hyponex^【○!R】 in Toxication

UEMURA Shuji, TANNO Katsutoshi, HIRAYAMA Suguru

Nihon Kyukyu Igakukai Zasshi ( Japanese Association for Acute Medicine )  18 ( 10 ) 713 - 717  2007.10

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A 63-year-old female was admitted to our Emergency Department 18 hrs after ingesting 0.9 L of distilled white liquor and about 150 ml of liquid fertilizer (Hyponex®), in an attempted suicide. Hyperkalemia and methemoglobinemia (arterial methemoglobin 25.6%) were present. Following admission, the level of methemoglobin gradually decreased and at 12 hrs after admission, the level had returned to normal. The patient was discharged on the third day of hospitalization. Deaths due to Hyponex? have been reported but there have been no reports of it leading to the development of methemoglobinemia. Methemoglobin is produced when nitrates are reduced to nitrites within the body. We suspected oxidation of hemoglobin to methemoglobin by nitrates within the blood. Reports of poisoning by liquid fertilizer are uncommon, but caution is advised because there is the possibility that it may lead to methemoglobinemia.

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Pain management for extensine burns

上村 修二, 奈良 理, 浅井 康文

The Japanese journal of acute medicine ( へるす出版 )  31 ( 7 ) 796 - 798  2007.07

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Low back pain

上村 修二, 森 和久, 浅井 康文

The Japanese journal of acute medicine ( へるす出版 )  31 ( 5 ) 557 - 561  2007.05

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敗血症ショックにおける high mobility group box-1 (HMGB-1) 血中濃度と予後に関する検討

升田 好樹, 須佐 泰之, 今泉 均, 黒田 浩光, 巽 博臣, 杉山 由紀, 上村 修二, 宮庄 拓, 浅井 康文, 山田 晋吾

Shock : 日本Shock学会雑誌   21 ( 2 ) 43 - 48  2006.12

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A Case of Generalized Tetanus Complicated with Hyperglycemic Coma

UEMURA Shuji, TANNO Katsutoshi, HIRAYAMA Suguru

Nihon Kyukyu Igakukai Zasshi ( Japanese Association for Acute Medicine )  17 ( 9 ) 645 - 650  2006.09

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The patient was a 62-year-old male. The patient had collapsed an estimated 5 days before being discovered and was transported to our hospital after first being brought to another hospital. The patient was treated in the ICU for hyperglycemic coma and infectious disease. On the third day of hospitalization, sudden respiratory arrest occurred following suction induced irritation, and nasal intubation was performed. Antificial ventilation was undertaken. Following those clinical course, stimulation evoked worsening rigidity and autonomic dysfunction in the limbs. On the seventh day of hospitalization, tetanus was diagnosed and treatment for tetanus was begun. Under intensive care, the patient's status improved. On the 82nd day of hospitalization, the patient changed hospitals for rehabilitation. Even though clinical signs indicating tetanus were present from the first day of hospitalization, it was very difficult to establish correct diagnosis due to comorbid conditions. This case showed the importance of early diagnosis of tetanus from the clinical symptoms, anticipation of the condition worsening and early treatment.

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重症例における早期経腸栄養の実際とその問題点 (特集 Critical Care Nutrition)

奈良 理, 上村 修二, 浅井 康文

ICUとCCU ( 医学図書出版 )  30 ( 9 ) 617 - 623  2006.09

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敗血症ショックにおける High mobility group box-1 (HMGB1) 血中濃度と予後に関する検討

升田 好樹, 須佐 泰之, 今泉 均, 黒田 浩光, 巽 博臣, 上村 修二, 浅井 康文, 山田 晋吾

Shock : 日本Shock学会雑誌   21 ( 1 ) 25 - 25  2006.04

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International Repatriation from the Far Eastern Russia and Medical Exchange by Hokkaido/Russia Medical Fund

ASAI Yasufumi, ITOH Yasushi, YOSHIDA Masashi, NARA Satoshi, UEMURA Shuji, MAEKAWA Kunihiko, IMAIZUMI Hitoshi, KANEKO Masamitsu, SAITOH Yuu, EZOE Kyouri, ABE Seishu

熱傷   31 ( 2 ) 96 - 101  2005.06

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日本外傷学会臓器損傷分類改正のための再評価 : 心・大血管損傷分類の問題点

浅井 康文, 栗本 義彦, 上村 修二, 武山 佳洋, 米田 斉史, 鹿野 恒, 丹野 克俊, 佐藤 守仁, 奈良 理, 森 和久

日本外傷学会雑誌 = Journal of the Japanese Association for the Surgery of Trauma   18 ( 1 ) 76 - 81  2004.01

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A Case Of A Ruptured Abdominal Aortic Aneurysm Referred Due To Acute Cardiac Failure

MATSUO Kunihiro, ASAI Yasufumi, KURIMOTO Yoshihiko, TAGUCHI Dai, UEMURA Shuuji, URA Hideki, IMAIZUMI Hitoshi

Nihon Kyukyu Igakukai Zasshi ( Japanese Association for Acute Medicine )  14 ( 9 ) 467 - 470  2003.09

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We report a case of an abdominal aortic aneurysm which ruptured into the inferior vena cava indicated by CT and angiography in a patient that had been transferred to our hospital with a diagnosis of acute cardiac failure. The patient was a 73-year-old male who had been examined at another hospital for chest pain, hypotension, vomiting and vertigo and had been admitted to our hospital for examination of acute cardiac failure of unknown cause. A pulsating giant mass was palpable in the abdomen, and a continuous murmur was also audible in the abdomen. The patient showed no anemia or abdominal pain, but CT indicated the possibility of the rupture of an abdominal aortic aneurysm into the inferior vena cava. Emergency surgery was successfully performed following confirmation of the rupture by angiography. The results of this case indicate the need to consider a ruptured abdominal aortic aneurysm as a possible cause of symptoms resembling acute cardiac failure.

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A Case Of A Ruptured Abdominal Aortic Aneurysm Referred Due To Acute Cardiac Failure

Matsuo Kunihiro, Asai Yasufumi, Kurimoto Yoshihiko, Taguchi Dai, Uemura Shuuji, Ura Hideki, Imaizumi Hitoshi

Nihon Kyukyu Igakukai Zasshi ( Japanese Association for Acute Medicine )  14 ( 9 ) 467 - 470  2003

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We report a case of an abdominal aortic aneurysm which ruptured into the inferior vena cava indicated by CT and angiography in a patient that had been transferred to our hospital with a diagnosis of acute cardiac failure. The patient was a 73-year-old male who had been examined at another hospital for chest pain, hypotension, vomiting and vertigo and had been admitted to our hospital for examination of acute cardiac failure of unknown cause. A pulsating giant mass was palpable in the abdomen, and a continuous murmur was also audible in the abdomen. The patient showed no anemia or abdominal pain, but CT indicated the possibility of the rupture of an abdominal aortic aneurysm into the inferior vena cava. Emergency surgery was successfully performed following confirmation of the rupture by angiography. The results of this case indicate the need to consider a ruptured abdominal aortic aneurysm as a possible cause of symptoms resembling acute cardiac failure.

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