Blast Injuries by an Improvised Explosive Device in Japan: A Case Report.

Blast injuries caused by an improvised explosive device (IED) are becoming more common in civilian settings. However, physicians may not be familiar with the treatment and management of blast-injured victims. To the best of our knowledge, this is the first case report of a blast injury caused by an IED in Japan. A 64-year-old man was admitted to our hospital's emergency department after sustaining a blast injury. His vital signs were stable, but he had multiple small wounds with embedded foreign bodies that were consistent with injuries sustained by IED victims. The patient was treated for his injuries and was moved to another hospital on day 37. Knowledge about blast injuries caused by IEDs and management strategies for mass casualties are both necessary.

Difference in severity and distribution of bodily injuries following collision between drivers of K-cars and standard vehicles.

BACKGROUND: Although K-cars, small four-wheeled vehicles with an engine capacity of <660 cc, have been used almost exclusively in Japan, they have recently become increasingly popular in other countries. Therefore, reporting the characteristics of bodily injuries sustained by K-car drivers after road traffic accidents (RTAs) may be important not only for health professionals but also for car manufacturers. METHODS: A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2010 and December 2017, 494 restrained drivers (331 men/163 women with a mean age of 45.1 years) whose vehicles had been severely damaged in RTAs underwent whole-body computed tomography prospectively. They were subsequently dichotomized into 221 K-car drivers and 273 standard vehicle drivers and compared for severity and distribution of bodily injuries. RESULTS: K-car drivers tended to be older and were significantly more likely to be female than standard vehicle drivers. The frequency of subjects with severe bodily injuries significantly higher among K-car drivers than among standard vehicle drivers (21.7% vs. 14.3%; p = 0.04), and the frequency of bowel/mesentery injuries tended to be higher in the former (9.0% vs. 4.4%; p = 0.06). However, the frequency of abdominal solid viscus injuries did not differ significantly between the two groups. Multivariable regression analysis showed that age [odds ratio (OR): 1.022; 95% confidence interval (CI): 0.998-1.047; p = 0.07] and K-cars (OR: 3.708; 95% CI: 0.984-6.236; p = 0.05) tended to be associated with bowel/mesentery injuries in restrained drivers. The frequency of pelvic/hip fractures also tended to be higher in K-car drivers than in standard vehicle drivers (5.9% vs. 2.6%; p = 0.10). By contrast, the severity and frequency of the upper torso injuries were similar between the two groups. CONCLUSIONS: Compared to standard vehicle drivers, K-car drivers seem to experience more severe bodily injuries after severe RTAs. Despite there being no answer for the increased frequency of only hollow viscus injuries but not solid viscus injuries among restrained K-car drivers, advanced age may, at least in part, be responsible. Given the limitations inherent to this study's single-center, retrospective design, multi-center prospective studies are warranted to verify our findings.

Transcatheter arterial embolization for initial hemostasis in a hemodynamically unstable patient with mesenteric hemorrhage: A case report.

Surgical treatment of mesenteric injuries is necessary to control hemorrhage, manage bowel injuries, and evaluate bowel perfusion. It has recently been suggested that some patients can be managed with transcatheter arterial embolization (TAE) for initial hemostasis. We present a hemodynamically unstable patient who was initially managed by TAE for traumatic mesenteric hemorrhage. A 60-year-old man was injured in a motor vehicle accident and transported to our facility. On arrival, the patient was hemodynamically stable, and had abdominal pain. Physical examination revealed a seatbelt sign on the lower abdomen. A contrast-enhanced computed tomography (CT) scan showed intra-abdominal hemorrhage, mesenteric hematoma, and a giant-pseudoaneurysm, but no intra-abdominal free air or changes in the appearance of the bowel wall. After the CT scan, his vital signs deteriorated and surgical intervention was considered, but TAE was performed to control the hemorrhage. After TAE, the patient was hemodynamically stable and had no abdominal tenderness. A follow-up CT scan was performed 2 days later which showed partial necrosis of the transverse colon and some free air. Resection of the injured transverse colon with primary anastomosis was performed. The patient improved and was discharged 35 days after injury. TAE can be effective as the initial hemostatic procedure in patients with traumatic mesenteric hemorrhage.

Frequency and characteristics of traumatic brain injury in restrained drivers involved in road traffic accidents.

BACKGROUND: While seatbelt is an important device protecting drivers from traumatic brain injury (TBI), it has rarely been reported how often and in what circumstances restrained drivers sustain TBI after road traffic accident (RTA). Whole-body computed tomography (WBCT) for blunt trauma patients may provide a unique opportunity to investigate the frequency and characteristics of TBI sustained by restrained drivers. METHODS: A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2013 and December 2017, 409 restrained drivers (284 men/125 women, mean age of 45.0 ± 19.1 years) whose vehicle had been severely damaged in RTAs underwent WBCT for evaluation of injuries. Multivariate regression analysis was performed to identify variables predictive of TBI. Influence of collision patterns (frontal, lateral or rollover) on the frequency and severity of TBI was evaluated. Relationship between collision patterns and CT findings was also reviewed. RESULTS: Thirty-one restrained drivers (7.6%) sustained TBI after RTA. The distribution of Glasgow Coma Scale (GCS) scores among the 31 drivers was 15 in 9, 13-14 in 9, 9-12 in 4, and ≤ 8 in 9, indicating that the majority of TBIs were classifiable as mild. The frequency of TBI in alert and oriented drivers, i.e., those with a GCS score of 15, was 2.9%. Multivariate regression analysis showed that both altered mental status (OR, 4.933; 95% CI, 1.135-21.431) and loss of consciousness (OR, 6.492; 95% CI, 1.669-25.249) were associated with TBI. The frequency of TBI tended to be higher in drivers with rollover collision than those with frontal collision (6 vs. 13%, p = 0.07). Interhemispheric acute subdural hematoma and subcortical petechial hemorrhage seemed to be characteristic CT findings in drivers with frontal and lateral collision, respectively. CONCLUSIONS: The key finding of this study, i.e., that (1) TBI was observed in 7.6% of restrained drivers with severe vehicular damage, may provide useful information to neurosurgeons who take care of RTA victims. The majority of the TBIs were mild without need for neurosurgical intervention. While association may exist between type of collision and type of brain injury, further studies with prospective design are warranted.

Necrotizing enterocolitis associated with Clostridium butyricum in a Japanese man.

Case: Necrotizing enterocolitis (NEC) caused by Clostridium butyricum is common in neonates; however, a case of NEC in adults has not been previously reported. An 84-year-old Japanese man developed C. butyricum-related NEC during hospitalization for treatment of stab wounds to the left side of the neck and lower abdomen, without organ damage, and concomitant pneumonia. Outcome: The patient developed acute onset of emesis accompanied by shock during his admission; partial resection of the small intestine was carried out due to necrosis. Pathologic findings showed mucosal necrosis and extensive vacuolation with gram-positive rods in the necrotic small intestine. Blood culture tests revealed C. butyricum infection. The patient's condition improved after the surgery. He was moved to a rehabilitation hospital on day 66. Conclusion: This study suggests that hospitalized adult patients who receive antibiotic treatment are at risk for NEC.

Transumbilical laparoscopic appendectomy performed by residents is safe and feasible.

INTRODUCTION: The aim of this study was to compare the clinical outcomes of single-incision transumbilical laparoscopy-assisted appendectomy performed by surgical residents and attending surgeons. METHODS: We reviewed the clinical outcomes of 131 transumbilical laparoscopy-assisted appendectomies performed from January 2011 to June 2014. During the study period, 13 residents and 6 board-certified attending surgeons performed the procedures. For all operations performed by residents and attending surgeons, we reviewed and compared gender, age, BMI, body temperature, white blood cell count, C-reactive protein serum level, and the presence of a fecalith or abscess. Clinical outcomes including operative time, estimated blood loss, need for additional ports, conversion to open surgery, intraoperative complications, postoperative complications, and postoperative hospital stay were compared between the two groups. RESULTS: The mean preoperative white blood cell count in the resident-operated group was significantly higher than in the attending-operated group (14.0 vs 10.8 ×103 /mm3 , P = 0.007). There were no other significant differences in clinical variables between the two groups. Outcomes show that estimated blood loss was significantly higher (23.4 vs 9.8 mL, P = 0.031) and operative time tended to be longer (86.0 vs 72.0 min, P = 0.056) in the resident-operated group. No other significant differences were observed. CONCLUSION: Transumbilical laparoscopy-assisted appendectomy performed by residents is feasible and safe. It is an acceptable as a part of routine surgical training.