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1.
J Surg Res ; 283: 898-913, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36915018

RESUMEN

INTRODUCTION: An enteroatmospheric fistula forms when the exposed bowel is perforated with chronic enteric fistula formation. Currently, there is no established preventative method for this condition. Hyperdry (HD) amniotic membrane (AM) can promote early granulation tissue formation on the exposed viscera and is suitable for dressing intractable wounds as it possesses anti-inflammatory, antibacterial, and immunomodulatory properties. This study investigated whether HD-AM promotes early formation of blood vessel-containing granulation tissue for enteroatmospheric fistula treatment. METHODS: An experimental animal model of an open wound with exposed bowel was developed. A 15 × 20 mm wound was prepared on the abdomen of Institute of Cancer Research mice, and the HD-AM was placed. The mice were assigned to one of the following groups: HD-AM group, in which the stromal layer of the HD-AM was placed in contact with the exposed bowel; HD-AM UD group, in which the epithelial layer of the HD-AM was placed in contact with the exposed bowel; and the HD-AM (-) or control group, in which the HD-AM was not used. RESULTS: On postoperative days 7 and 14, granulation tissue thickness significantly increased in the HD-AM and HD-AM UD groups compared with that in the HD-AM (-) group. Macrophages accumulated in the HD-AM epithelium only in the HD-AM group. During HD-AM contact, a subset of invading macrophages switched from M1 to M2 phenotype. CONCLUSIONS: HD-AM is a practical wound dressing with its scaffolding function, regulation of TGF ß-1 and C-X-C motif chemokine 5 (CXCL-5), and ability to induce M1-to-M2 macrophage conversion.


Asunto(s)
Amnios , Apósitos Biológicos , Tejido de Granulación , Fístula Intestinal , Animales , Humanos , Ratones , Fístula Intestinal/terapia
2.
Int J Urol ; 28(6): 645-649, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33626596

RESUMEN

OBJECTIVES: To analyze incidents related to Foley catheter insertion and maintenance, and to compare the rate of incidents before and after a medical staff education program. METHODS: Data regarding Foley catheter insertion incidents and maintenance were collected at Toyama University Hospital, Toyama, Japan. The degree of harm for each incident was assessed. In the middle of the study period, a medical staff education program by urologists was implemented to help understand basic urological anatomy, urethral catheter insertion techniques and catheter safety. The incidents before and after the intervention were then compared. RESULTS: During the study period, Foley catheter insertion was carried out in 12 476 patients. Related incidents were reported in 66 (0.53%), including 22 (0.18%) occurring during catheter insertion and 44 (0.35%) occurring during catheter maintenance. A total of 13 (0.10%) cases of urethral injury were reported. The degree of harm associated with catheter insertion incidents was moderate in 13. Nine of these incidents occurred before the education program (9/6799, 0.13%), and four were reported after the end of the program (4/5677, 0.07%, P = 0.4303). Transient suprapubic cystostomy was required in two due to urethral injury reported before the program. Among 44 incidents occurring during catheter maintenance, 37 catheters were removed or cut by the patient. Such incidents occurred regardless of the education program. CONCLUSIONS: The rate of incidents related to Foley catheter use at our institution is low. A specific medical staff education program might prevent iatrogenic catheter-related urethral injury requiring cystostomy.


Asunto(s)
Catéteres , Cateterismo Urinario , Humanos , Japón/epidemiología , Masculino , Cuerpo Médico , Estudios Retrospectivos , Cateterismo Urinario/efectos adversos
3.
J Infect Chemother ; 26(12): 1324-1327, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32900659

RESUMEN

Most patients with coronavirus disease 2019 (COVID-19) have just only mild symptoms, but about 5% are very severe. Although extracorporeal membranous oxygenation (ECMO) is sometimes used in critically patients with COVID-19, ECMO is only an adjunct, not the main treatment. If the patient's condition deteriorates and it is determined to be irreversible, it is necessary to decide to stop ECMO. A 54-year-old man was admitted on day 6 of onset with a chief complaint of high fever and cough. Computed tomography (CT) showed a ground glass opacity in both lungs, and reverse transcription-polymerase chain reaction (RT-PCR) diagnosed COVID-19. He was admitted to the hospital and started to receive oxygen and favipiravir. After that, his respiratory condition deteriorated, and he was intubated and ventilated on day 9 of onset, and ECMO was introduced on day 12. Two days after the introduction of ECMO, C-reactive protein (CRP) increased, chest X-p showed no improvement in pneumonia, and PaO2/FiO2 decreased again. As D-dimer rose and found a blood clot in the ECMO circuit, we had to decide whether to replace the circuit and continue with ECMO or stop ECMO. At this time, the viral load by RT-PCR was drastically reduced to about 1/1750. We decided to continue ECMO therapy and replaced the circuit. The patient's respiratory status subsequently improved and ECMO was stopped on day 21 of onset. In conclusion, viral load measurement by RT-PCR may be one of the indicators for promoting the treatment of severe COVID-19 patients.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Oxigenación por Membrana Extracorpórea/métodos , Neumonía Viral/terapia , Neumonía Viral/virología , Carga Viral/métodos , Amidas/uso terapéutico , Antivirales/uso terapéutico , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Toma de Decisiones , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Pirazinas/uso terapéutico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
4.
Microscopy (Oxf) ; 71(1): 66-76, 2022 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-34536007

RESUMEN

Amnion membrane studies related to miscarriage have been conducted in the field of obstetrics and gynecology. However, the distribution of stem cells within the amnion and the differences in the properties of each type of stem cells are still not well understood. We address this gap in knowledge in the present study where we morphologically classified the amnion membrane, and we clarified the distribution of stem cells here to identify functionally different amniotic membrane-derived stem cells. The amnion can be divided into a site that is continuous with the umbilical cord (region A), a site that adheres to the placenta (region B), and a site that is located opposite the placenta (region C). We found that human amnion epithelial stem cells (HAECs) that strongly express stem cell markers were abundant in area A. HAEC not only expressesed stem cell-specific surface markers TRA-1-60, Tra-1-81, SSEA4, SSEA3, but was also OCT-3/4 positive and had alkaline phosphatase activity. Human amniotic mesenchymal stem cells expressed KLF-A, OCTA, Oct3/4, c-MYC and Sox2 which is transcription factor. Especially, in regions A and B they have expressed CD73, and the higher expression of BCRP which is drug excretion transporter protein than the other parts. These data suggest that different types of stem cells may have existed in different area. The understanding the relation with characteristics of the stem cells in each area and function would allow for the efficient harvest of suitable HAE and HAM stem cells as using tool for regenerative medicine.


Asunto(s)
Amnios , Células Epiteliales , Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/metabolismo , Amnios/metabolismo , Diferenciación Celular/fisiología , Femenino , Humanos , Proteínas de Neoplasias/metabolismo , Embarazo , Células Madre/metabolismo
5.
Drug Healthc Patient Saf ; 14: 135-146, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36039072

RESUMEN

Purpose: Our aim was to inform a new definition of wrong-patient errors, obtained through an analysis of incident reports related to medication errors. Methods: We investigated wrong-patient medication errors in incident reports voluntarily reported by medical staff using a web-based incident reporting system from 2015 to 2016 at a university hospital in Japan. Incident report content was separately evaluated by four evaluators using investigational methods for clinical incidents from the Clinical Risk Unit and the Association of Litigation and Risk Management. They investigated whether it was the patient or drug that was incorrectly chosen during wrong-patient errors in drug administration in incident reports and assessed contributory factors which affected the error occurrence. The evaluators integrated the results and interpreted them together. Results: Out of a total 4337 IRs, only 30 cases (2%) contained wrong-patient errors in medication administration. The cases where the intended drugs were administered to incorrect patients occurred less frequently than cases where the wrong drugs were administered to the intended patients through the investigation of wrong targets. After a discussion, the evaluators concluded that the patient - drug/CPOE screen mismatch, caused by choosing the wrong patient, drug, or CPOE screen (mix-ups), occurred in the wrong-patient medication errors. These errors were caused by three conditions: (1) where two patients/drugs were listed next to one another, (2) where two patients' last names/drugs' names were the same, and (3) where the patient/drug/CPOE screen in front of the staff involved was believed to be the correct one. Additionally, these errors also involved insufficient confirmation, which led to failure to detect and correct the mismatch occurrences. Conclusion: Based on our study, we propose a new definition of wrong-patient medication errors: they consisted of choosing a wrong target and insufficient confirmation. We will investigate other types of wrong-patient errors to apply this definition.

7.
Am J Emerg Med ; 29(2): 196-202, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20825789

RESUMEN

OBJECTIVES: The Emergency Coma Scale (ECS) was developed in Japan in 2003. We planned a multicenter study to evaluate the utility of the ECS by comparison of the ECS and the Glasgow Coma Scale (GCS). METHODS: Ten medical facilities, including 4 university hospitals in Japan, participated in this study. We evaluated and recorded the level of consciousness, using the ECS and GCS, of all patients transported to these medical facilities by ambulance. We then performed a statistical analysis of the level of rater agreement of each scale using the average weighted κ coefficient according to the types of diagnosis at time of discharge and the occupations of the raters. We then evaluated the relationship between outcome of patients and their scores on the ECS and GCS by logistic regression analysis. RESULTS: The ECS showed the greater agreement among raters in patient scoring (0.802). In patients with traumatic brain injury and cerebrovascular disease, the ECS also yielded the higher agreement (0.846 and 0.779, respectively). The ECS score appears to be more strongly related than the GCS to patient outcome as measured by the Glasgow Outcome Scale (GOS). CONCLUSIONS: Our results showed that the ECS is a simple and readily understandable coma scale for a wide range of professionals in the field of neurologic emergencies. Furthermore, ECS appears to be suitable for evaluating patients in neurologic emergency settings.


Asunto(s)
Coma/clasificación , Escala de Coma de Glasgow , Adolescente , Adulto , Niño , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Adulto Joven
8.
Nihon Rinsho ; 69(4): 684-90, 2011 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-21591423

RESUMEN

The Immediate Cardiac Life Support (ICLS) course was developed and launched by Japanese Association for Acute Medicine (JAAM) for resident training, in April 2002. The ICLS course is designed as multi-professional one-day (8 hours) resuscitation course and teaches the essential skills and team dynamics required to manage a patient in cardiac arrest for 10 minutes before the arrival of a cardiovascular specialist. The course consists of skill stations and scenario stations. The skill stations provide basic life support (BLS) with automated external defibrillator (AED), basic airway management and in-hospital management with electrocardiographic (ECG) monitoring with manual external defibrillator. In total, 117,246 candidates attended 6,971 ICLS courses until the end of December 2010. Furthermore, we developed additional course of ICLS to manage stroke, Immediate Stroke Life Support (ISLS). We also describe the development and structure of, and rationale for the ICLS course.


Asunto(s)
Apoyo Vital Cardíaco Avanzado/educación , Paro Cardíaco/terapia , Humanos , Internado y Residencia , Japón , Sociedades Médicas , Accidente Cerebrovascular/terapia
9.
Open Access Emerg Med ; 13: 305-310, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34285600

RESUMEN

PURPOSE: To obtain effective systemic blood flow and coronary perfusion by chest compressions during cardiopulmonary resuscitation, it is recommended that the interruption time of chest compressions be kept to a minimum, and that the chest compression fraction (CCF) should be kept high. In this study, we examined the effects of advanced airway management by paramedics in out-of-hospital cardiac arrest (OHCA) cases on CCF and on return of spontaneous circulation (ROSC) before arrival at the hospital. PARTICIPANTS AND METHODS: A total of 283 adult, non-traumatic OHCA cases who were in cardiopulmonary arrest at the time of EMS contact between April 2015 and March 2017 were registered for this study. We retrospectively investigated the presence or absence of advanced airway clearance, CCF and ROSC during CPR. CCF was calculated by measuring the chest compression interruption time from the ECG waveform recorded on a semiautomatic defibrillator (Philips HeartStart MRX). The data obtained were recorded on a computer, and comparisons between groups were examined using an untested t-test and χ2- test. RESULTS: Of the 283 patients with OHCA, 159 were included in the analysis. The CCF of the AAM group was 89.4%, which was significantly higher than that in the BMV group (84.3%) (P<0.01). Forty-one patients had ROSC at the time of arrival at the hospital, and the CCF of ROSC patients was 89.7%, which was significantly higher than that of non-ROSC patients (87.2%) (P<0.01). ROSC was also obtained in 31.8% of the patients in the AAM group, which was significantly higher than that in the BMV group (12.2%). CONCLUSION: In this study, we found that advanced airway management during prehospital emergency transport by paramedics showed high CCF and ROSC rates and contributed to improving the prognosis of OHCA patients through high-quality resuscitation.

10.
Acute Med Surg ; 8(1): e626, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33552526

RESUMEN

Mass gatherings are events characterized by "the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community." Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health-care system, it can provide the opportunity for long-term benefits of public health-care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID-19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.

11.
J Adv Med Educ Prof ; 8(1): 10-17, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32039268

RESUMEN

INTRODUCTION: The present study aimed to determine the validity and usefulness of scales and training programs for clinical staff to evaluate nerve signs as an initial response to stroke. We developed a stroke workshop, using the analysis, design, development, implementation, and evaluation (ADDIE) model method based on instructional systems design theory. METHODS: The workshop aimed to improve the basic first aid skills of clinical staff for stroke. The participants (n=46) were randomly assigned to conventional Cincinnati Pre-hospital Stroke Scale (CPSS) or modified CPSS groups (simple randomization). Short-term case simulation was conducted immediately after the training as well as 6 months later to evaluate the nurses' skills. We conducted evaluations, using an instructional framework throughout the ADDIE process. We used the Kirkpatrick model to evaluate the educational effect of up to level 3 in this study. The Wilcoxon signed-rank test was used to analyze differences between the pre-test and post-test groups. RESULTS: The evaluation of the new clinical staff stroke emergency training program, either using the conventional CPSS or the modified CPSS, showed that the participants were highly satisfied and exhibited improved knowledge and skills (conventional CPSS: 3.05 ± 0.73 vs 3.64 ± 0.59, P = 0.012 and modified CPSS: 2.95 ± 0.97 vs 3.61 ± 0.49, P = 0.111, before training vs after training, respectively). On the other hand, it was difficult for the participants to evaluate neurologic conditions using the modified CPSS compared with the conventional CPSS. CONCLUSION: These results demonstrated that stroke care training is effective in reaction, learning, and behavior. The modified CPSS could be useful as with the conventional CPSS. In future, evaluation of neurological conditions should be improved.

12.
Burns Trauma ; 8: tkaa014, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32733973

RESUMEN

BACKGROUND: Severe burn injuries create large skin defects that render the host susceptible to bacterial infections. Burn wound infection often causes systemic sepsis and severe septicemia, resulting in an increase in the mortality of patients with severe burn injuries. Therefore, appropriate wound care is important to prevent infection and improve patient outcomes. However, it is difficult to heal a third-degree burn injury. The aim of this study was to investigate whether hyperdry human amniotic membrane (HD-AM) could promote early granulation tissue formation after full-thickness skin excision in third-degree burn injury sites in mice. METHODS: After the development of HD-AM and creation of a third-degree burn injury model, the HD-AM was either placed or not placed on the wound area in the HD-AM group or HD-AM group, respectively. The groups were prepared for evaluation on postoperative days 1, 4 and 7. Azan staining was used for granulation tissue evaluation, and estimation of CD163, transforming growth factor beta-1 (TGF-ß1), vascular endothelial growth factor (VEGF), CD31, alpha-smooth muscle actin (α-SMA) and Iba1 expression was performed by immunohistochemical staining. Quantitative reverse-transcription polymerase chain reaction (PCR) was used to investigate gene expression of growth factors, cell migration chemokines and angiogenic and inflammatory markers. RESULTS: The HD-AM group showed significant early and qualitatively good growth of granulation tissue on the full-thickness skin excision site. HD-AM promoted early-phase inflammatory cell infiltration, fibroblast migration and angiogenesis in the granulation tissue. Additionally, the early infiltration of cells of the immune system was observed. CONCLUSIONS: HD-AM may be useful as a new wound dressing material for full-thickness skin excision sites after third-degree burn injuries, and may be a new therapeutic technique for improving the survival rate of patients with severe burn injuries.

13.
SAGE Open Med ; 8: 2050312120930906, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32587691

RESUMEN

OBJECTIVES: Medical oncologists and pharmacists at our institution established an integrated support program aimed at preventing unnecessary treatment interruption or dose reduction during oral targeted therapy with lenvatinib. Here, we evaluated the benefits of this program in managing patients with thyroid cancer receiving lenvatinib. METHODS: We retrospectively evaluated thyroid cancer patients who received lenvatinib between May 2015 and March 2017. This descriptive study collected records in which pharmacists contributed to changing doctors' prescriptions and categorized the interventions. RESULTS: During the study period, 24 thyroid cancer patients were treated with lenvatinib. Among patients, the incidence of temporary interruption and dose reduction of lenvatinib due to adverse drug reactions was 100% (n = 24) and 83.3% (n = 20), respectively. There were 193 temporary interruptions of lenvatinib due to adverse drug reactions. A total of 501 outpatient pharmacy services were conducted by pharmacists in collaboration with oncologists, of which 125 were interventions (24.9%). In addition, pharmacists conducted 156 telephone follow-up services; 18 (11.5%) of these were to consult an oncologist about a patient's confirmed problems and resulted in the decision to continue observation with no medical intervention while 41 (26.2%) resulted in the oncologist deciding to temporarily interrupt lenvatinib treatment after the report of an adverse drug reaction from the pharmacist. CONCLUSION: Pharmacist interventions in collaboration with medical oncologists improved lenvatinib therapy. Interventions for outpatients were conducted not only in outpatient clinics but also by telephone follow-up, clarifying the importance of continuous management for patients at risk of adverse reactions and misuse of oral medicine.

14.
Transplant Proc ; 51(10): 3213-3218, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810504

RESUMEN

BACKGROUND: Among Organisation for Economic Co-operation and Development countries, the number of cadaveric donors per population is the lowest in Japan. The present study investigated whether a continuing educational intervention for medical staff, such as Donor Action Program (DAP) that is aimed at increasing the number of cadaveric donors, improved the confirmation rate of organ donation in potential donors. MATERIAL AND METHODS: We studied 2 hospitals with emergency centers in Toyama, Japan. DAP was conducted 2 to 3 times each year. We extracted mortality cases recorded in the emergency care departments of each hospital for over 10 years between 2007, prior to DAP's implementation, and 2017 to examine the confirmation rate of the intent of the families of potential donors for organ donation and the timing and methods for confirming intent to donate in cases that resulted in organ donation. RESULTS: The confirmation rate increased after the introduction of DAP and remained high (over 80%) in both hospitals after 2012. Regarding actual organ donation, some patients were asked by staff about their intent when they became potential donors in addition to the hospitalization intake form; it was offered by family members of some of the patients. CONCLUSION: Regular educational training on organ donation improved the confirmation rate of potential organ donors' donation intention. For organ donation, medical practitioners must take the appropriate steps to confirm the patient's intent to donate when he/she is determined as a potential donor.


Asunto(s)
Educación Médica Continua , Cuerpo Médico de Hospitales/educación , Donantes de Tejidos , Obtención de Tejidos y Órganos , Familia , Femenino , Humanos , Intención , Japón , Masculino , Obtención de Tejidos y Órganos/estadística & datos numéricos , Obtención de Tejidos y Órganos/tendencias
15.
J Clin Neurosci ; 14(1): 68-71, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17092724

RESUMEN

A patient with cerebral deep sinus thrombosis, which was not diagnosed on the first examination, is reported. A 46-year-old woman presented with headache and vomiting. Neurological examination and a brain computed tomography (CT) scan showed no obvious abnormal findings. The patient suffered disturbed consciousness on the day after the examination, and was admitted to our emergency centre. A CT scan and magnetic resonance imaging revealed an ischaemic lesion in the left basal ganglia, suggesting deep sinus occlusion. Anticoagulant therapy was administered. One day after admission, a CT scan showed a haematoma and severe brain swelling in the same region. Cerebral angiography demonstrated a straight sinus occlusion. Intracranial pressure was not controlled with hypothermia, and the patient died 25 days after admission. Review of the initial CT scan revealed subtle, early findings of deep venous thrombosis that were missed on first examination.


Asunto(s)
Trombosis de los Senos Intracraneales/diagnóstico por imagen , Anticoagulantes/uso terapéutico , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/patología , Angiografía Cerebral , Resultado Fatal , Femenino , Cefalea/complicaciones , Humanos , Hipertensión Intracraneal/tratamiento farmacológico , Hipertensión Intracraneal/fisiopatología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Trombosis de los Senos Intracraneales/patología , Tomografía Computarizada por Rayos X , Vómitos/complicaciones
16.
J Int Med Res ; 45(6): 1848-1860, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28703646

RESUMEN

Objective In Japan, stroke care is provided through medical cooperation and standardized treatment. However, various factors affect mortality in the hyperacute phase. The present study investigated factors associated with death within 24 h after admission for acute stroke. Methods Among 2335 patients admitted within 24 h after stroke onset from 1 January 2007 to 31 December 2012, a total of 139 deaths occurred. Forty-eight deaths occurred within 24 h after admission. We retrospectively examined the clinical features of these 48 patients. Results The overall mortality rate was 6.0%. When the initial 72-h period was divided into ≤24 h (Period I), >24 to 48 h (Period II), and >48 to 72 h (Period III), deaths were significantly more frequent in Period I than in the other two periods. The frequency of intracerebral haemorrhage (ICH) was also significantly higher in Period I than in the other two periods. Factors significantly associated with death from ICH were systolic blood pressure, hematoma volume, and surgery. Conclusion The mortality rate was low among patients with stroke transported to the authors' medical center within 24 h of onset. Blood pressure management and the timing of determining indications for surgery are important factors in acute haemorrhagic stroke care.


Asunto(s)
Hospitalización , Accidente Cerebrovascular/mortalidad , Anciano , Anciano de 80 o más Años , Infarto Cerebral/complicaciones , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Razón de Masculinidad , Índices de Gravedad del Trauma
17.
J Neurosurg Anesthesiol ; 18(4): 247-50, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17006122

RESUMEN

We have developed a novel airway apparatus, AirWay Scope, which we have used in the orotracheal intubation of 10 consecutive patients requiring general anesthesia before neurosurgical procedures. The characteristic shape of the introducer (INTLOCK), the tube guiding function and the sighting device of the AirWay Scope has possibility to facilitate tracheal intubation. Here, we report the first clinical application of this system and describe potential advantages of the apparatus.


Asunto(s)
Intubación Intratraqueal/instrumentación , Laringoscopios , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Glotis/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Tráquea/anatomía & histología
18.
Brain Nerve ; 67(5): 569-73, 2015 May.
Artículo en Japonés | MEDLINE | ID: mdl-25957203

RESUMEN

According to the 2010 neuroresuscitation guideline, status epilepticus (SE) is a critical condition that causes respiratory and circulation dysfunction, including "acute consciousness disturbance" and "elevated intracranial pressure." There are two types of SE: general convulsive SE (GCSE) and nonconvulsive SE (NCSE). GCSE is easily diagnosed because the patients show continuous convulsions. In contrast, NCSE can only be diagnosed by electroencephalography (EEG), which can delay diagnosis. Moreover, GCSE and NCSE occasionally manifest in the same patient and alternate. Here, we describe the case of a 64-year-old male patient who experienced losses of consciousness mimicking stroke. We could not diagnose these episodes as NCSE until the patient had a general continuous convulsion. In this case, the delayed diagnosis of NCSE resulted in uncontrollable GCSE that required intensive management, including mechanical ventilation under sedation. It is important to recognize that NCSE can cause consciousness disturbance and to initiate treatment as soon as possible to improve patient prognosis. This could be achieved by performing an EEG earlier, such as at the scene of emergencies.


Asunto(s)
Convulsiones/diagnóstico , Estado Epiléptico/diagnóstico , Intervención Médica Temprana , Electroencefalografía , Urgencias Médicas , Humanos , Guías de Práctica Clínica como Asunto , Convulsiones/tratamiento farmacológico , Convulsiones/fisiopatología , Estado Epiléptico/tratamiento farmacológico , Estado Epiléptico/fisiopatología
19.
Neurosurgery ; 51(4): 989-92; discussion 992, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12234408

RESUMEN

OBJECTIVE: Although several radiolucent head-fixation devices have been developed to allow intraoperative cerebral angiography, no device provides satisfactory freedom to obtain the most suitable head position. We recently designed a multipurpose radiolucent Sugita head frame (modified radiolucent Sugita frame) with satisfactory degrees of freedom and rigidity for intraoperative head positioning and head holding, respectively. DESCRIPTION OF INSTRUMENTATION: A short arm and a ring joint, made of engineering plastic, were added to the prototype radiolucent Sugita frame, to permit side-tilting movements of the frame. The shape of all handles at the joints was also changed and the size was enlarged, to facilitate adjustment of the head position. EXPERIENCE AND RESULTS: We used this modified radiolucent Sugita frame in 20 cases involving aneurysms or arteriovenous malformations. The frame performed satisfactorily in all cases, in terms of firm head fixation and unrestrained freedom of head positioning at the surgeon's request. The modified radiolucent Sugita frame was evaluated with respect to its resistance to physical forces. The physical strength of the modified radiolucent Sugita frame is almost equivalent to that of the metallic Sugita frame and is considered sufficient for clinical usage. CONCLUSION: With its rigidity, satisfactory degrees of freedom, and ease of handling, the clinical applicability of the dramatically improved radiolucent head frame enables us to obtain satisfactory intraoperative angiograms.


Asunto(s)
Angiografía Cerebral/instrumentación , Angiografía Cerebral/métodos , Cabeza , Restricción Física/instrumentación , Técnicas Estereotáxicas/instrumentación , Diseño de Equipo , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Periodo Intraoperatorio
20.
Neurosurgery ; 51(4): 985-8; discussion 988, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12234407

RESUMEN

OBJECTIVE: Microneurosurgery can be performed less invasively with the recent advances in neuronavigation and neuroendoscopy. For even less invasive microneurosurgery, we have developed a telecontrolled micromanipulator system. METHODS: The NeuRobot telecontrolled micromanipulator system was developed. With the use of this system, surgical simulations were performed with a human cadaveric head. RESULTS: The system consists of four main parts, i.e., a micromanipulator (slave manipulator), a manipulator-supporting device, an operation-input device (master manipulator), and a three-dimensional display monitor. Three 1-mm forceps and a three-dimensional endoscope, which could be remotely controlled with three degrees of freedom (rotation, neck swinging, and forward/backward motion), were installed in the slave manipulator. All surgical procedures were accurately performed with this system. CONCLUSION: The use of telecontrolled manipulator systems in neurosurgery is very promising, and we are convinced that this system will facilitate more accurate, less invasive microneurosurgery. The details of the NeuRobot system and preliminary results are presented.


Asunto(s)
Micromanipulación/instrumentación , Microcirugia/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Neurocirugia/instrumentación , Robótica , Telecomunicaciones , Cadáver , Diseño de Equipo , Cabeza/cirugía , Humanos , Equipo Quirúrgico
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