Alcohol-Intoxicated Patients With Blunt Trauma and Head Injuries Have Better Outcomes Than Sober Patients.

BACKGROUND: Although alcohol-intoxicated patients have difficulties evaluating their consciousness level and being transported prehospital, there is some evidence that the survival outcomes for alcohol-intoxicated patients with head injuries are better. The present study evaluated whether the survival and brain function outcomes in alcohol-intoxicated trauma patients with head injuries were better than those in sober patients using the Japan Trauma Data Bank (JTDB), a nationwide trauma registry in Japan. METHODS: The 17,823 patients with blunt trauma, including head injuries, who were registered in the JTDB database between January 2019 and December 2021 were retrospectively analyzed. Logistic regression analyses were performed for in-hospital survival in patients with blunt trauma, including those with head injuries, and for good brain function based on the Glasgow outcome scale (GOS) in patients with only head injuries. Survival rates by head injury score using the abbreviated injury scale (AIS) 2008 or injury severity score (ISS) categories were compared between drinking and nondrinking groups. RESULTS: Drinking significantly affected survival (odds ratio 1.800, p<0.001) and good brain function (odds ratio 1.546, p<0.001), as indicated by logistic regression analysis using head injuries alone or blunt multisite trauma (including head injuries), respectively. According to analyses by the ISS category or head AIS score, there were significant differences between the drinking and non-drinking groups in several categories (ISS 9-15, 16-24, and 25-40 and AIS 3 and 5) regarding survival rates with blunt trauma, including head injuries, or good GOS rates with head injuries alone. CONCLUSIONS: The survival rates for blunt trauma, including head injuries, and the prognosis for brain function based on the GOS were better in the drinking group than in the control group for cases with head injuries alone. A multivariate analysis also showed that alcohol consumption was significantly associated with better outcomes.

Edoxaban Improved End-QRS Notches and Early Repolarizations.

Cardiac computed tomography (CT) images sometimes show a donut-like oval structure on the antero-superior wall of the left atrium (LA). What is a donut? Left atrium diverticula (LADs) are common, but there are many unknown features of LADs. The direct effects of pulmonary vein thrombi (PVTs) on the heart are poorly understood. Herein, we report a case report in which we describe the different effects of edoxaban on LA thrombi, the LAD, coronary artery collaterals, early repolarizations, and end-QRS notches using cardiac CT and transesophageal echocardiography (TEE). First, we showed that there was a LAD on the anterior wall of the LA where the LA thrombi from the right lower pulmonary vein (RLPV) thrombi were connected. To our knowledge, this is the first report to reveal LAD's annular transformation and the beneficial effect of edoxaban on the end-QRS notch.

Right Lower Pulmonary Vein Thrombi and Right Upper Pulmonary Vein Thrombi Connected on the Anterior Wall of the Left Atrium.

The interaction between the right upper pulmonary vein (RUPV) and the right lower pulmonary vein (RLPV) is poorly understood. In this paper, using transesophageal echocardiography (TEE) and 80-slice multidetector computed tomography (80-MDCT), we report that the RUPV thrombi and the RLPV thrombi invade the left atrium (LA) and reach the anterior wall of the LA. To our knowledge, this is the first study to directly show the connection between the RUPV thrombi and the RLPV thrombi on the anterior wall of the LA using TEE and 80-MDCT.

The Standard-Dose Heparin-Warfarin Remedy Partially Resolves Thrombi in the Right Superior Pulmonary Vein and Left Atrium and Ameliorates Type 2 Diabetes Mellitus.

Pulmonary vein thrombosis is common and underdiagnosed. Previously, we reported several cases of pulmonary vein thrombi (PVTs) using cardiac computed tomography (CT) and transesophageal echocardiography (TEE). We reported that warfarin and direct oral anticoagulants (DOACs) partially resolved PVTs; however, it is difficult to resolve all PVTs completely. Therefore, we evaluated the effects of standard-dose heparin-warfarin remedy on PVTs and left atrium (LA) thrombi using TEE and cardiac CT. A 64-year-old male with type 2 diabetes mellitus (T2DM) and hypertension was assessed for thrombi in the LA and pulmonary veins using TEE and 80-slice multidetector computed tomography (80-MDCT). After one month of standard-dose heparin-warfarin remedy, the patient's right superior pulmonary vein (RSPV) thrombi and expanded LA thrombi from the RSPV thrombi had partially resolved. The RSPV thrombi and the expanded LA thrombi from the RSPV thrombi were detected using cardiac CT and TEE; however, they were depicted as black areas on TEE. They periodically moved inward with the patient's heartbeats. Additionally, the standard-dose heparin-warfarin remedy ameliorated the patient's T2DM, and the remedy effect could be maintained for five months to some extent by administering a standard dose of warfarin. The standard-dose heparin-warfarin remedy can ameliorate not only T2DM but also diabetic complications such as diabetic nephropathy and gestational diabetes mellitus.

Left Atrial Diverticula Present in the Right Lower Pulmonary Vein Thrombus Attachment Area.

Left atrial diverticula (LADs) are thought to be associated with atrial fibrillation and an ischemic brain state. However, the mechanisms of LAD formation are unknown. Pulmonary vein thrombi (PVTs) can cause acute myocardial infarction (AMI) and ischemic stroke by releasing rather large particles. Additionally, PVTs can release much smaller particles, including neutrophil extracellular traps (NETs) and/or other components of NETs, such as DNA and histones. To treat these diseases, it may be crucial to know the specific traits of PVTs. However, these issues are not direct effects of PVTs on the left atrium (LA). It is unclear whether PVTs affect the LA directly. We checked the direct effects of PVTs on the LA using cardiac computed tomography (CT) and transesophageal echocardiography (TEE). The patient was a 73-year-old female with hypertension. TEE revealed extended LA thrombi from the right lower pulmonary vein, which were attached to the anterosuperior wall of the LA. Cardiac CT revealed the attaching area as a defect of enhancement and dimly revealed LAD with full thrombi on the attaching area. It was difficult to recognize the LAD at first; however, after one month of standard-dose heparin-warfarin treatment, the LAD was clearly detected using cardiac CT. LA thrombi could not be detected using cardiac CT.

Left Atrial Diverticula Supplied by the Anomalistic Branch of the Right Coronary Artery.

We have reported several cases of pulmonary vein thrombosis in elderly individuals with or without chest pain; pulmonary vein thrombosis is common in aged individuals and should be evaluated further. However, the properties and roles of pulmonary vein thrombi (PVTs) have not been determined. During infection, neutrophil extracellular traps (NETs) are produced to kill pathogens, and arterial thrombi (ATs) are produced in pulmonary veins to prevent pathogens from spreading to all organs. We reported that fine PVTs became larger PVTs and extended to the LA wall. PVTs can cause acute myocardial infarction (AMI) and ischemic stroke (IS) by releasing larger particles; therefore, the characteristics of PVTs need to be determined to prevent the occurrence of AMI and IS. PVTs can cause several diseases by releasing smaller particles, such as NETs, for which cumulative effects should be determined. PVTs and their effects on human health need to be studied to avoid missing the chances of treating patients with these diseases moderately. We reported that PVTs often extend to the left atrium (LA) and attach to the LA wall; however, the effects of attachment remain unclear. According to cardiac computed tomography (CT), left atrial diverticula (LADs) reportedly occur in 10%-50% of patients; however, the details of the LAD are unknown. Therefore, we examined the relationships among PVTs, LA thrombi, and LADs using cardiac CT and transesophageal echocardiography (TEE). The patient was a 65-year-old male with hypertension and severe palpitations. He had no history of AMI or IS. TEE revealed that the LA thrombi were attached to the anterior wall of the right lower pulmonary vein and that they were attached to the anterior wall of the LA. TEE revealed an LAD near the attachment area. Cardiac CT revealed an LAD without thrombi near the attachment area. Sagittal images from a cardiac CT scan revealed that a part of the attachment region in the LA was a dark line, where no blood flow was observed in the LA, and that there seemed to be the LAD on top of the dark line. The anomalistic branch of the right coronary artery (#1) connected around the top of the LAD.

The Desirable Effects of Edoxaban on Thrombi in the Left Atrium Are Seemingly Connected to Pulmonary Vein Thrombi.

Ischemic stroke (IS) causes various degrees of disability that sometimes induce social problems: therefore, preventing the occurrence and recurrence of IS is important. The recovery of motor function has been extensively studied. The characteristics of retrieved thrombi have become clearer; however, it is unclear what thrombi cause IS. Pulmonary vein thrombi (PVTs), such as those of the IS, can cause systemic thrombosis, by releasing several sizes of particles. PVTs are common but are underrated and can be detected via enhanced computed tomography (CT) and transesophageal echocardiography (TEE). PVTs often extend to the left atrium (LA) and can be mainly diagnosed using not enhanced CT but rather TEE. Extended LA thrombi are characterized by a lack of periodic movement with heartbeats. Direct oral anticoagulants (DOACs) are useful for preventing IS. We reported that rivaroxaban partially dissolved LA thrombi and PVTs using enhanced CT and TEE; however, the effects of edoxaban on LA thrombi and PVTs are unclear. We checked the images using enhanced CT and TEE and treated them with edoxaban. The patient was a 73-year-old female with easy fatigability. Edoxaban desirably affected the LA thrombi, and edoxaban partially dissolved the thrombi in the right lower pulmonary vein (RLPV). A decreased dose of edoxaban (15 mg, once a day) had similar effects on LA thrombi and RLPV thrombi, suggesting that this treatment could be useful for preventing IS.

Association between bystander intervention and emergency medical services and the return of spontaneous circulation in out-of-hospital cardiac arrests occurring at a train station in the Tokyo metropolitan area: A retrospective cohort study.

Aim: The purpose of this study was to stratify patients who achieved return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) with bystander procedures pre-emergency medical service (EMS) arrival and those who achieved ROSC with procedures post-EMS arrival, compare outcomes at 1-month, and identify factors associated with pre-EMS-arrival-ROSC. Methods: A retrospective cohort analysis of OHCAs occurring at stations in the Tokyo metropolitan area between 2014 and 2018 was conducted. Subjects were stratified by ROSC phase (categorized as pre- and post-EMS arrival and non-ROSC). Survival at 1-month post-OHCA and the percentage of favourable neurological function in each ROSC phase were analysed. In addition, factors associated with Pre-EMS-arrival-ROSC were identified using multivariable logistic regression analysis. The time of occurrence of OHCA was classified into four-time categories as follows. Rush hour on morning [7:00-9:00], Rush hour on evening [17:00-21:00], Daytime [9:00-17:00], and Night or Early morning [21:00-7:00]. Results: Among the 63,089 OHCA in the dataset, 702 were analysed. At 1-month after OHCA occurrence, Pre-EMS-arrival ROSC had higher survival rates than post-EMS-arrival ROSC (86.8% vs. 54.1%) and CPC1-2 rates (73.6% vs. 38.5%). Pre-EMS-arrival ROSC was associated (adjusted odds ratio [95% confidence interval]) with non-older-adult patients (1.59 [1.05-2.43]), witnessed OHCA (1.82 [1.03-3.31]), evening rush-hour (17:00-21:00; 2.08 [1.05-4.11]), conventional CPR (33.42 [7.82-868.44]), hands-only CPR (17.06 [4.30-436.48]), bystander defibrillation performed once (3.31 [1.59-6.99]). Conclusions: In an OHCA at a station in Tokyo, ROSC achieved with bystander treatment alone had a better outcome at 1-month compared to ROSC with EMS intervention.

Rivaroxaban lessens the number of thrombi in the left atrium and right lower pulmonary vein, as illustrated by transoesophageal echocardiography but not 80-MDCT.

Stroke is a clinically important problem. A left atrial thrombus is known as a cause of ischaemic stroke. A pulmonary vein thrombus (PVT) is thought to be rare; however, PVT is common in elderly patients. Additionally, images of PVT with transoesophageal echocardiography (TEE) following treatment have not been well contrasted with that from either 64 or 80-slice multidetector CT (80-MDCT). The images of such changes depicted by TEE remain unknown. An 87-year-old man with hypertension was examined by 80-MDCT and TEE to check the cardiac thrombus. Although 80-MDCT did not depict the thrombus, TEE depicted the thrombus in the left atrium and right lower pulmonary vein (RLPV) clearly. After 6 months of rivaroxaban treatment, the thrombus in the RLPV decreased slightly and the thrombus in the left atrium became small and lucent, as estimated with TEE. Rivaroxaban decreased the size of the thrombus and changed the quality of the thrombus.

A network of pulmonary vein thrombi is a risk factor for ischemic stroke, especially after cardiac surgery: A case report and mini review.

Stroke remains a devastating complication following cardiac surgery. Pulmonary vein thrombi (PVT) are believed to be rare, but I have reported 37 cases of PVT in elderly patients with chest pain since 2012, indicating that PVT are not unusual. The present case showed that PVT can make a network among four pulmonary veins and left atrium. Currently, PVT are not recognized as a risk factor for ischemic stroke, especially following cardiac surgery. A 76-year-old male was examined by 64-slice multidetector CT (64-MDCT) to assess chest pain. The 64-MDCT scan revealed thrombi in the left upper and lower pulmonary veins, the right upper and lower pulmonary veins and the left atrium (LA) as the defects of contrast enhancements. The LA thrombi seemed to be connected to PVT forming a network of thrombi. To avoid stroke following cardiac surgery, it is important to cope with PVT. How to treat PVT during cardiac surgery should be developed.

A jumping left atrial thrombus connected to a pulmonary vein thrombus using transthoracic echocardiography and 64-slice multi-detector computed tomography.

Few studies have reported the differences between transthoracic echocardiography (TTE) and 64-slice multidetector CT (64-MDCT) in identifying left atrium (LA) thrombi. I report the case of a 70 year old man with coronary artery disease and angina who was diagnosed with a thrombus in the left lower pulmonary vein extending to the LA using a non-invasive 64-MDCT scan and TTE. TTE was unable to clearly identify a thrombus in the pulmonary veins, whereas a 64-MDCT scan identified a thrombus in the pulmonary vein but was unable to detect a moving thrombus attached to the mitral valves. The 64-MDCT images of LA thrombi are smaller than those of TTE and the video created using TTE demonstrated a moving thrombus connected to the mitral valve, which was underdiagnosed by a 64-MDCT scan. This case illustrates the complementary role for both TTE and 64-MDCT in the noninvasive diagnosis of left atrial-pulmonary vein thrombi.

A long and narrow pulmonary vein thrombus attached to the wall of a pulmonary vein.

Pulmonary vein thrombosis (PVT) is often not diagnosed because PVT has subtle symptoms and PVT is believed to be rare. The mechanism for the formation of PVT is unclear. In this case, I describe a small thrombus in a small branch of a pulmonary vein draining into a larger vein, the right lower pulmonary vein (RLPV). The patient was a 70-year-old male with angina pectoris, and he presented with chest pain. He had no symptoms of cerebral infarction. He previously had been treated with percutaneous coronary intervention and had four stents in the coronary arteries. A 64-slice multidetector computed tomography (64-MDCT) scan was performed to evaluation for in-stent restenosis. A thrombus in the RLPV was shown in axial and sagittal images as a defect in contrast enhancement, representing a small thrombus in a small branch of a pulmonary vein draining into the RLPV. The 64-MDCT scan depicted them well. The effects of PVT are unknown, and more studies are needed.