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1.
J UOEH ; 46(1): 17-21, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38479870

RESUMEN

Elevated lactate levels are associated with a poor prognosis in patients with sepsis and shock. Intravenous glycerol administration is often used in Japan to treat patients with acute stroke or brain trauma, but such treatment can cause elevated lactate levels. We experienced a case of transient hyperlactatemia induced by intravenous glycerol administration in a patient with brain trauma. A 74-year-old woman underwent decompressive craniotomy because of loss of consciousness and brain edema. Glycerol was administered after the operation for management of the brain edema. Although the patient's hemodynamics remained stable, her lactate level decreased and increased repeatedly. We recognized that the elevation in her lactate level was associated with the administration of intravenous glycerol. This case suggests that intravenous glycerol administration can induce transient hyperlactatemia.


Asunto(s)
Edema Encefálico , Lesiones Traumáticas del Encéfalo , Hiperlactatemia , Humanos , Femenino , Anciano , Hiperlactatemia/inducido químicamente , Hiperlactatemia/complicaciones , Glicerol/efectos adversos , Edema Encefálico/complicaciones , Lactatos , Estudios Retrospectivos
2.
J UOEH ; 40(2): 139-145, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29925733

RESUMEN

A post-marketing surveillance study reported fatalities following tissue plasminogen activator administration in acute aortic dissection (AAD) with the symptoms of acute ischemic stroke (AIS) patients. Therefore, it is important to discriminate AAD from AIS. The present study aimed to investigate whether fibrinogen/fibrin degradation products (FDP) value can be useful in differential diagnosis between AAD and AIS. The study group comprised 20 AAD patients (10 men and 10 women; age 63.9 ± 13.6 years) and 159 AIS patients (91 men and 68 women; age 74.2 ± 10.6 years) who were transported to our hospital from 2007 to 2012. The AAD cases were further divided into patent-type AAD and thrombosed-type AAD. FDP values were significantly higher in the AAD group than in the AIS group (18.15 [5.2 - 249.9] µg/ml vs. 2.3 [1.5 - 4.45] µg/ml ; P < 0.001). In AAD groups, FDP values were significantly higher in the patent-type AAD group (n = 9) than in the thrombosed type AAD group (n = 11) (293.2 µg/ml [63.1 - 419.6 µg/ml ] vs. 5.6 µg/ml [3.8 - 7.9 µg/ml ]. FDP values were significantly higher in patients with AAD than in those with AIS, especially those with patent-type AAD compared with AIS patients. High FDP values may be a useful marker for differential diagnosis between patent-type AAD and AIS.


Asunto(s)
Disección Aórtica/tratamiento farmacológico , Diagnóstico Diferencial , Productos de Degradación de Fibrina-Fibrinógeno/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico
3.
J UOEH ; 39(4): 271-276, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29249740

RESUMEN

Case reports of hyperammonemia due to urease-producing bacteria are found occasionally, but most of them are associated with urinary tract infections. We experienced a case of infectious enterocolitis with hyperammonemia in which the causative bacteria was speculated to be urease-producing bacteria. A Japanese woman in her 70s had been diagnosed with microscopic polyangiitis in a nearby hospital and was transferred to our hospital. Although the microscopic polyangiitis was relatively under control after treatment with steroids and rituximab, frequent diarrhea with hyperammonemia (324 µg/dl) appeared and she became comatose. Her blood ammonia decreased to 47 µg/dl and her consciousness recovered to a normal state after antibiotic treatment for infectious enterocolitis and ammonia detoxification therapy. Liver dysfunction, portosystemic shunt, excessive protein intake and constipation were not observed, and she took no medications that would cause hyperammonemia. Although culture results could not identify urease-producing bacteria, considering the clinical course, acute hyperammonemia was suspected to be due to urease-producing bacteria infection. It is necessary to consider the influence of urease-producing bacteria as a cause of acute hyperammonemia not only in urinary tract infections but also in infective enterocolitis.


Asunto(s)
Enterocolitis/complicaciones , Hiperamonemia/etiología , Dolor Abdominal/etiología , Anciano , Cuidados Críticos , Enterococcus faecium , Enterocolitis/tratamiento farmacológico , Femenino , Humanos , Hiperamonemia/terapia , Dolor Pélvico/etiología
4.
J UOEH ; 38(1): 35-46, 2016 Mar 01.
Artículo en Japonés | MEDLINE | ID: mdl-26972943

RESUMEN

Early direct current (DC) shock is the most important therapy for ventricular fibrillation. Following the increased availability of automated external defibrillators (AED), the survival rate of cardiopulmonary arrest patients with ventricular fibrillation has improved. Although patients with shock-resistant ventricular fibrillation require additional antiarrhythmic drug therapy, the optimal protocol has not been established. Nifekalant is a pure potassium channel blocker with a pyrimidinedione structure. Nifekalant was approved in Japan for the treatment of life-threatening ventricular tachyarrhythmias in 1999, and is widely used as a class III antiarrhythmic intravenous drug. Intravenous amiodarone was approved in Japan in 2007, and exhibits various effects on ion channels, receptors, sympathetic activity, and thyroid function. Nifekalant and amiodarone also exhibit many pharmacological and pharmacodynamic differences. As nifekalant has no negative inotropic effect and a rapid action and clearance with a short half-life, it has some advantages over amiodarone for use in cardiopulmonary resuscitation. Indeed, data from clinical and animal studies suggest that nifekalant is superior to amiodarone for resuscitation of cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation. A 300-mg bolus intravenous injection of amiodarone is considered an overdose for resuscitation of shock-resistant ventricular fibrillation. Further clinical studies are required to evaluate the effects of nifekalant compared with amiodarone, and to determine the optimal dose of amiodaone, for resuscitation of shock-resistant ventricular fibrillation.


Asunto(s)
Amiodarona/uso terapéutico , Antiasmáticos/uso terapéutico , Bloqueadores de los Canales de Potasio/uso terapéutico , Pirimidinonas/uso terapéutico , Fibrilación Ventricular/tratamiento farmacológico , Amiodarona/administración & dosificación , Amiodarona/farmacocinética , Amiodarona/farmacología , Antiasmáticos/administración & dosificación , Antiasmáticos/farmacocinética , Antiasmáticos/farmacología , Desfibriladores , Humanos , Inyecciones Intravenosas , Pirimidinonas/administración & dosificación , Pirimidinonas/farmacocinética , Pirimidinonas/farmacología
5.
J UOEH ; 38(1): 61-4, 2016 Mar 01.
Artículo en Japonés | MEDLINE | ID: mdl-26972946

RESUMEN

Although angiotensin-converting enzyme (ACE) inhibitors are widely used as the first choice drug for treating hypertension, we have only a superficial understanding of their relationship to angioedema. We report a case of life-threatening angioedema. The case was a 60-year-old man who had been taking an ACE inhibitor for hypertension for 11 years. He visited his home doctor for dyspnea, and tongue and neck swelling. He was transported to our hospital because of the possibility of airway obstruction. On admission, his tongue and neck swelling became more severe. We performed an intubation using an endoscope and started airway management. We also stopped his ACE inhibitor. The severe tongue and neck swelling improved gradually and he was extubated on day 3. On the fifth day he was discharged. We diagnosed angioedema caused by an ACE inhibitor. Although the risk of airway obstruction with ACE inhibitors is acknowledged, we have only a superficial understanding of how prolonged ACE inhibitor treatment induces angioedema. So we should consider angioedema in cases of taking ACE inhibitors, especially in cases of prolonged treatment.


Asunto(s)
Obstrucción de las Vías Aéreas/inducido químicamente , Angioedema/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Imidazolidinas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Privación de Tratamiento
6.
Intern Med ; 53(16): 1797-800, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25130113

RESUMEN

We herein present a rare case of acquired methemoglobinemia associated with alkaptonuria. Alkaptonuria is a congenital error of metabolism caused by the deficiency of homogentisic acid oxidase, which subsequently results in the accumulation of homogentisic acid (HGA) in body tissues. As renal dysfunction progresses, the level of HGA excretion in the urine decreases and the blood concentration of HGA increases. HGA oxidizes oxyhemoglobin to methemoglobin, which can induce multiple organ failure accompanied by tissue hypoxia, intravascular hemolysis and metabolic acidosis. The mortality of this disease is high when alkaptonuria is associated with the presence of methemoglobinemia; therefore, treatment should be carefully planned in such cases.


Asunto(s)
Alcaptonuria/complicaciones , Alcaptonuria/diagnóstico , Metahemoglobinemia/diagnóstico , Metahemoglobinemia/etiología , Anciano , Alcaptonuria/metabolismo , Resultado Fatal , Femenino , Ácido Homogentísico/metabolismo , Humanos , Fallo Renal Crónico/etiología , Metahemoglobinemia/tratamiento farmacológico , Enfermedades Raras
7.
J UOEH ; 36(1): 11-6, 2014 Mar 01.
Artículo en Japonés | MEDLINE | ID: mdl-24633180

RESUMEN

A significant relationship between lactate clearance and mortality rates in cardiac arrest cases has been reported. However, the relationship between lactate clearance and neurologic outcomes in cardiac arrest cases is not clear. We examined lactate clearance in cardiac arrest cases induced by ventricular fibrillation. We investigated 13 patients with cardiac arrest induced by ventricular fibrillation from April, 2006 to March, 2012 in which therapeutic hypothermia was performed. Patients were classified into two groups: those with a favorable neurologic outcome (n=7) and those with a poor outcome (n=6). We compared lactate clearance levels between the two groups. There was no significant difference in lactate concentrations at admission and 8 or 24 hours lactate clearance between the two groups 8 or 24 hours after admission. This result suggests we may not predict the neurologic outcome of cardiac arrest cases induced by ventricular fibrillation using lactate clearance.


Asunto(s)
Paro Cardíaco/etiología , Paro Cardíaco/terapia , Hipotermia Inducida , Lactatos/sangre , Fibrilación Ventricular/complicaciones , Adulto , Biomarcadores/sangre , Femenino , Predicción , Paro Cardíaco/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/etiología , Pronóstico , Factores de Tiempo
8.
J Anesth ; 28(4): 587-92, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24389941

RESUMEN

PURPOSE: Nifekalant is a pure potassium channel blocker that has been used to treat ventricular tachyarrhythmias since 1999 in Japan. Intravenous amiodarone was approved later than nifekalant in Japan, and it is still unclear which of the two agents is superior. The aim of this study was to compare the efficacy of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest caused by shock-resistant ventricular fibrillation. METHODS: From December 2005 to January 2011, ambulance services transported 283 out-of-hospital cardiopulmonary arrest patients to our hospital. Of these, 25 patients were treated with nifekalant or amiodarone in response to ventricular fibrillation that was resistant to two or more shocks. We undertook a retrospective analysis of these 25 patients. RESULTS: We enrolled 20 men and 5 women with a mean age (± standard deviation) of 61.1 ± 16.4 years. All 25 patients were treated with tracheal intubation and intravenous epinephrine. Fourteen patients received nifekalant and 11 patients received amiodarone. The rates of return of spontaneous circulation (ROSC) (nifekalant, 5/14, versus amiodarone, 4/11; P = 0.97) and survival to discharge (nifekalant, 4/14, versus amiodarone, 2/11; P = 0.89) were not significantly different between the two groups. The time from nifekalant or amiodarone administration to ROSC was 6.0 ± 6.6 and 20.3 ± 10.0 min, respectively, which was significantly different (P < 0.05). CONCLUSION: In this small sample size study, nifekalant, compared with amiodarone, is equally effective for ROSC and survival to discharge after shock-resistant ventricular fibrillation and can achieve ROSC more quickly. Further prospective studies are needed to confirm our results.


Asunto(s)
Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Reanimación Cardiopulmonar/métodos , Paro Cardíaco Extrahospitalario/tratamiento farmacológico , Pirimidinonas/uso terapéutico , Fibrilación Ventricular/complicaciones , Anciano , Relación Dosis-Respuesta a Droga , Cardioversión Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/etiología , Estudios Prospectivos , Estudios Retrospectivos
9.
Sangyo Eiseigaku Zasshi ; 51(3): 35-40, 2009 May.
Artículo en Japonés | MEDLINE | ID: mdl-19367088

RESUMEN

The primary aim for occupational health care is to appropriately control risks related to health problems arising in workplace environments which are caused by work methods. Lowering risks might not always prevent accidents or illnesses; but initial treatment after an accident or of ill workers is crucial work for occupational health care staff. By implementing appropriate initial treatment, it is possible to increase the survival rate of workplace accidents and decrease the rate of illness. Crisis management at the time of an accident is a very important function of occupational health. Thus there is a close relationship between occupational health care and emergency medicine.


Asunto(s)
Medicina de Emergencia , Salud Mental , Salud Laboral , Accidentes de Trabajo/prevención & control , Adulto , Reanimación Cardiopulmonar , Desfibriladores , Femenino , Humanos , Masculino , Persona de Mediana Edad , Administración de la Seguridad , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos
10.
J UOEH ; 31(1): 57-62, 2009 Mar 01.
Artículo en Japonés | MEDLINE | ID: mdl-19297956

RESUMEN

A 47-year-old man was found at his home in a state of cardiopulmonary arrest. His family performed cardiopulmonary resuscitation on him. He was brought to our hospital by ambulance. On arrival, his pupils were dilated and his heart was in a state of ventricular fibrillation. After returning to spontaneous circulation by the cardiopulmonary resuscitation, the electrocardiogram revealed ST elevation at V2-V5. Cardiac catheterizatin revealed a left anterior descending coronary obstruction. Percutaneous coronary angioplasty was performed. On the 26th day after admission, acalculous cholecystitis was found. It was difficult to perform emergent surgery, because the patient was taking an anticoagulant drug. We performed PTGBA (percutaneous transhepatic gallbladder aspiration) on the same day, and the gallbladder inflammation was improved. We consider that PTGBA is an effective treatment for difficult cases of acalcuous cholecystitis.


Asunto(s)
Colecistitis Alitiásica/etiología , Reanimación Cardiopulmonar , Colecistitis Alitiásica/terapia , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones
11.
J UOEH ; 29(2): 203-8, 2007 Jun 01.
Artículo en Japonés | MEDLINE | ID: mdl-17582992

RESUMEN

A 54 year old man was brought to our hospital by ambulance. He had been injured by falling heavy steel. An examination was performed, and he was diag nosed as having sinking skull, acute extradural hematoma, trauma of the righ eye, right eye laceration, injury of the optic canal (right blind), and multipl fractures. Open fractures were observed in the right ring finger and little finger Simple fractures were observed in the zygomatic bone nasal bone and maxillary bone. An emergency operation (external skeletal fixation, taxis of the skull and maxillary bone, extradural hematoma depletion, suture of right eyelid) was performed. His life was saved by consistent team treatment from preoperation t postoperation. He was discharged from our hospital on foot at 45 days after th operation.


Asunto(s)
Traumatismo Múltiple/terapia , Grupo de Atención al Paciente , Fractura Craneal Deprimida/terapia , Cuidados Críticos , Humanos , Masculino , Persona de Mediana Edad
12.
J UOEH ; 25(3): 325-32, 2003 Sep 01.
Artículo en Japonés | MEDLINE | ID: mdl-14503044

RESUMEN

Basic life support(BLS) does not require any special instruments or drugs, and its skills can be understood and performed easily by the lay person. The main goal of cardiopulmonary resuscitation(CPR) for the victims of cardiac pulmonary arrest(CPA) is not only restoration of cardiopulmonary function but also return to their previous life. An early bystander CPR plays a pivotal role to achieve this target. When encountering an unconscious person, emergency medical systems(EMS) such as calling 119 must be activated immediately. As the next step, cardiopulmonary condition status has to be determined after assurance of airway patency. When there are no signs of breathing or pulse, BLS consisting of artificial respiration and/or chest compression must be started immediately and continued until EMS staffs arrive. In this article, the details of the revised guidelines for BLS by the American Heart Association are described. Current CPR education for pre- or early post-graduate medical students in our institution is reported.


Asunto(s)
American Heart Association , Reanimación Cardiopulmonar , Guías de Práctica Clínica como Asunto , Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/métodos , Educación de Postgrado en Medicina , Educación de Pregrado en Medicina , Humanos , Japón
13.
Transfusion ; 42(12): 1598-602, 2002 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-12473141

RESUMEN

BACKGROUND: Various adverse effects, including cardiac arrest, have been induced by plasma exchange (PE). Electrolyte derangement is frequently observed. The purpose of this study was to assess the effect of PE on the serum ionized magnesium (Mg2+) concentration in acute liver failure patients. STUDY DESIGN AND METHODS: Seven liver failure patients requiring PE were enrolled in this study. PE was performed 21 times in total. Blood samples were drawn before PE and serially after the start of the PE. Serum Mg2+ was measured by the ion- selective electrode method. RESULTS: After PE was started, Mg2+ concentrations began to fall significantly. The low Mg2+ blood concentration continued during PE. After PE, the Mg2+ level recovered to about 80 percent of the control value within 2 hours in six patients. However, in one patient, the Mg2+ concentration was still low even at 2 hours after PE. This patient complained of chest discomfort during PE and ECG analysis showed sporadic supraventricular premature contractions. CONCLUSION: Profound ionized hypomagnesemia was induced by PE in liver failure patients.


Asunto(s)
Fallo Hepático/complicaciones , Deficiencia de Magnesio/etiología , Magnesio/sangre , Intercambio Plasmático/efectos adversos , Equilibrio Ácido-Base , Adulto , Anciano , Calcio/sangre , Femenino , Hematócrito , Humanos , Electrodos de Iones Selectos , Fallo Hepático/terapia , Masculino , Persona de Mediana Edad , Factores de Tiempo , Desequilibrio Hidroelectrolítico/etiología
14.
Am J Kidney Dis ; 39(5): 937-47, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-11979337

RESUMEN

Direct hemoperfusion (DHP) with an adsorbent column using polymyxin B-immobilized fiber (PMX-F) has been shown to improve the state of shock in patients with septic shock. However, no evidence has been presented for a direct link between endotoxin removal by DHP with PMX-F and improvement in septic shock. We retrospectively analyzed clinical profiles of 24 patients with septic shock (16 patients, gram-negative; 8 patients, non-gram-negative septic shock) who underwent DHP with PMX-F. Patients with gram-negative septic shock were characterized by hyperdynamic circulation. DHP with PMX-F reduced blood endotoxin concentrations and ameliorated shock, with an improvement in hyperdynamic circulation in patients with gram-negative septic shock. Mean arterial pressure also was elevated after therapy in patients with non-gram-negative septic shock, but systemic hemodynamics were unaffected. Regardless of the causative microorganism, patients with endotoxemia (blood endotoxin level > 10 pg/mL) showed hyperdynamic shock, and DHP with PMX-F reduced blood endotoxin levels and ameliorated hyperdynamic circulation, whereas patients without endotoxemia showed features of shock without hyperdynamic circulation, and DHP with PMX-F ameliorated shock without affecting cardiac performance. In patients with gram-negative septic shock, blood endotoxin concentration correlated positively with cardiac output and negatively with systemic vascular resistance before DHP therapy. Reduction in blood endotoxin concentration by DHP therapy positively correlated with the reduction in cardiac output. Our findings indicate that the improvement in hyperdynamic circulation was related directly to endotoxin removal by the PMX-F column, and endotoxin has an important role in the development of hyperdynamic circulation in patients with gram-negative septic shock.


Asunto(s)
Endotoxinas/sangre , Hemoperfusión/instrumentación , Hemoperfusión/métodos , Enfermedades Vasculares Periféricas/terapia , Polimixina B/metabolismo , Choque Séptico/terapia , Adsorción , Bacteriemia/terapia , Endotoxinas/farmacocinética , Infecciones por Bacterias Gramnegativas/terapia , Infecciones por Bacterias Grampositivas/terapia , Humanos , Persona de Mediana Edad , Estudios Retrospectivos
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