Electron Microscopy Revealed Massive Lipid Droplets in Cardiomyocytes in a Patient with Cardiogenic Shock Following a Fulminant Type 1 Diabetes Mellitus.

A 52-year-old man with consciousness disorder following a 2-day history of general fatigue, diarrhea, vomiting and excessive thirst was admitted to our hospital. Severe hyperglycemia (1,739 mg/dL) with a slightly elevated HbA1c level (6.9%), ketonuria and low C-peptide level (0.07 ng/mL) confirmed the diagnosis of fulminant type 1 diabetes mellitus (FT1DM). Following sudden unexplained cardiogenic shock shortly after the initiation of insulin therapy with no evidence of myocardial ischemia assessed by coronary angiography, the patient was supported with percutaneous venoarterial extracorporeal membrane oxygenation. Electron microscopic analysis of the myocardium revealed massive lipid droplets without the infiltration of inflammatory cells. His left ventricular function began to recover during the following days and returned to a normal level on day 14. Currently, the impact of FT1DM on intramyocardial lipid deposition is poorly understood. However, this case suggests that even short-term exposure to high concentrations of glucose can be responsible for lipotoxicity followed by severe cardiac dysfunction.

Tiger attack at a Japanese safari park: a case report.

BACKGROUND: Big cat bites are highly lethal due to the enormous bite force of these animals. This article reviews the morphology of these types of injuries and key points of management through a survival case at a Japanese safari park. CASE PRESENTATION: We report the case of a 26-year-old female keeper who was attacked by a tiger. She was quickly transported to our university hospital by ambulance helicopter. The keeper was severely bitten on the head and face and had wounds all over her body. Craniofacial repair was performed by emergency surgery. She suffered mild facial nerve paralysis and trismus because of being bitten by the tiger and is currently recovering. CONCLUSIONS: A multidisciplinary approach of the severe tiger bites successfully treated a young woman cosmetically and mentally. Animal farms and zoos that keep tigers should take strict measures to avoid direct confrontation with tigers.

Contrast medium-induced transient severe leukopenia.

Case: Contrast medium-induced transient leukopenia is very rare. Here, we report a case of a 73-year-old man diagnosed with contrast media-induced transient leukopenia. The patient underwent abdominal contrast-enhanced computed tomography, where he was given non-ionic iodinated contrast medium i.v. His medical history included an allergic reaction to a different contrast medium. One hour later, the patient was admitted to the emergency department complaining of chest discomfort. He had leukopenia and a fever (temperature of 38.9°C). Complete blood count showed a white blood cell count of 930/µL and an absolute neutrophilic count of 232/µL. Outcome: The patient was given i.v. antibiotics and 5 mg chlorpheniramine maleic acid, 20 mg famotidine, and 125 mg methylprednisolone. The patient's white blood cell count recovered the next day, and he was discharged after 2 days of hospitalization. Conclusion: We diagnosed the patient with contrast media-induced transient leukopenia, which is a rare phenomenon.

Using kidney size for early detection of contrast-induced nephropathy in the emergency department setting.

AIM: We aimed to examine the relationship between kidney size and contrast-induced nephropathy (CIN) in patients who underwent contrast-enhanced computed tomography (CT) in the emergency department. METHODS: This single-center retrospective observational study was undertaken to evaluate risk factors for CIN at Okayama Saiseikai General Hospital (Okayama, Japan) from January 2014 through to December 2016. Contrast-induced nephropathy was defined as an absolute increase in serum creatinine level of ≥0.5 mg/dL or ≥25% over the baseline value within 72 h after contrast-enhanced CT. Independent risk factors for CIN were determined by multiple logistic regression analysis. The thickness of the kidney was evaluated as a predictor of CIN using the area under the receiver operating characteristic curve. We also analyzed CIN as an outcome using the Kaplan-Meier method. RESULTS: The incidence of CIN was 26/262 (9.9%). In the multivariate analysis, CIN was associated with renal thickness (odds ratio = 0.65; 95% confidence interval, 0.53-0.81). No patient underwent renal replacement therapy. CONCLUSION: Renal thickness could be used as a reliable, simple, and easily obtainable marker for identifying CIN in patients undergoing contrast-enhanced CT in the emergency department.

Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men.

Cases: Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain. Outcomes: This study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging. One patient underwent hematoma removal and decompression by corpectomy, whereas the other patient received conservative treatment and observation. The patients were discharged without sequelae. Conclusion: Spinal epidural hematomas are difficult to diagnose, and a delayed diagnosis can adversely affect the patient's quality of life. These hematomas should be considered in the differential diagnosis of cerebrovascular diseases.