Patient rescue and blood utilization in the Ogasawara blood rotation system.

BACKGROUND: In the past, blood products were not transported to the Ogasawara Islands because of the distance; the islands are approximately 1000 km from the mainland and lack an airport. The Ogasawara Blood Rotation system involves the routine, long-distance transportation of Type O, RhD-positive, irradiated red blood cells to rescue patients with acute hemorrhage and severe anemia and to reduce wastage from the expiration of red blood cell solution. STUDY DESIGN AND METHODS: Blood transfusion and utilization in the Ogasawara blood rotation (BR) system were examined from December 2014 to March 2017. Two packs of RBC solution (one pack = 280 mL) were transported in an active transport refrigerator by scheduled ships between Tokyo City and the Ogasawara Islands. RESULTS: Eight packs of red blood cell (RBC) solution were received as transfusions by four patients who had acute upper gastrointestinal bleeding or severe anemia (eight of 232 packs; 3.4%). The blood utilization rate at the time of re-use was 84.6% (196 of 232 packs), with neither adverse reactions nor wastage. Twenty-eight packs of RBC solution expired because of a delay in scheduled ships as the result of a typhoon (12.1%). CONCLUSION: The Ogasawara BR system was effectively capable of delivering RBC solution for transfusion in patients residing in distant islands and contributed to reducing the wastage of RBC solution by facilitating blood utilization at another hospital.

Acute necrotizing colitis due to sigmoid colon cancer.

When obstructive colitis becomes fulminant, it is known as 'acute necrotizing colitis'. We report a rare case of acute necrotizing colitis due to sigmoid colon cancer, in which shock status occurred within ten hours of onset. A 79-year-old female with acute abdominal pain was transported to our hospital with acute shock. Abdominal enhanced computed tomography revealed thickening of the wall of the sigmoid colon and marked dilation of the proximal colon. Emergency surgery was performed with the intraoperative findings of severe sigmoid colon stenosis and proximal dilation of the colon without perforation, and a large volume of putrid ascitic fluid. The intestine was proximally dilated and black in color, from the sigmoid colon to the ileum 60 cm proximal to the terminal ileum, suggesting acute necrosis. Total colectomy with 80 cm resection of terminal ileum and ileostomy was performed. Whereas acute necrotizing colitis is a rare condition and its etiology remains obscure, the chronic ischemic state must play some role. Our patient was of advanced age and had diabetes mellitus and hypertension. These factors might lead to a chronic ischemic state of the bowel due to arteriosclerosis. In addition to the underlying condition, massive bacterial reflux into the ileum from the colon might cause the capillary vasoconstriction of the bowel that led to her critical state.

Evaluation of the outcome of traumatic thoracic aortic rupture in patients in a trauma and critical care center.

OBJECTIVES: Multiple injuries may lead to traumatic thoracic aortic rupture (TTAR), which can be fatal. We evaluated the relationship between the clinical findings and outcomes of 26 patients with TTAR who were treated at our institution. METHODS: A total of 26 patients (men, 21; women, 5; average age, 45.8 ± 19.6 years) with a diagnosis of TTAR received from 1999 to 2009 were studied. We categorized patients into groups based on the outcome (survival or death) and investigated the relationship between the outcome and the following factors: injury mechanism, vital signs, other combined injuries, injury severity score (ISS), revised trauma score, and probability of survival (Ps). RESULTS: Of the 26 TTAR patients, 7 underwent emergency operations, 5 underwent delayed operations, 1 received conservative treatment, and 13 suffered cardiopulmonary arrest immediately after consultation and died. Of the 13 patients who died, 11 died within 2 hours after injury because of bleeding. Two of the 7 patients who underwent emergency operations died within 1 day of consultation, whereas all those who underwent delayed operations survived. Patients who underwent TTAR repair had a relatively favorable outcome. Analysis of the relationship between the clinical data and outcome showed that a young age was significantly correlated with survival, and that the Glasgow coma scale (GCS), heart rate, respiratory rate, or occurrence of shock were not significantly related to the outcome. The abbreviated injury scale (AIS) was used to score the severity of multiple injuries, and ISS was calculated from the AIS score. ISS was significantly higher in the death group (P = 0.007). ISS did not significantly differ among body parts (P = 0.077), but ISS of the extremities was higher than those of other parts. Pelvic fractures were frequent in the death group. Our strategy, whereby the patient initially underwent pelvic external fixation followed by TTAR repair was found to be very effective. The P-values calculated by the trauma and injury severity score method were significantly higher in the survival group (both, P = 0.007). CONCLUSION: To treat TTAR, it is important to accurately evaluate the damage due to multiple injuries and apply an appropriate treatment strategy. Immediate repair of TTAR after bleeding due to combined injury improves the outcome. (English Translation of Jpn J Vasc Surg 2012; 21:5-9).

Traumatic diaphragmatic injury: experience from a tertiary emergency medical center.

OBJECTIVE: We investigated our 12-year experience of traumatic diaphragmatic injury (TDI) in our emergency medical center. This study aimed to clarify clinical features of TDI and identify factors affecting mortality and morbidity in TDI treatment. METHODS: We analyzed clinical characteristics, Injury Severity Score (ISS), probability of survival (Ps), and mortality of patients treated for TDI at the Tertiary Emergency Medical Center of Tokyo Metropolitan Bokutoh Hospital between January 1999 and December 2010. RESULTS: TDI occurred in 28 patients. Of 21 TDI patients (75 %) who underwent surgery, 2 died (operative mortality, 9.5 %). Seven (25 %) presented with cardiopulmonary arrest, and TDI was detected during thoracotomy in the emergency room; all of these patients died. Blunt TDI occurred in 12 patients; penetrating TDI in 16. Blunt trauma patients had significantly more injured organs (3.75 ± 0.28, P = 0.043), higher ISS (P = 0.024), and lower Ps (P = 0.048). Lengths of intensive care unit (ICU) stay and hospital stay were greater in blunt cases than in penetrating cases (P = 0.004 and P = 0.02, respectively). Non-survivors had significantly higher ISS (P < 0.001), lower Ps (P = 0.0025), and larger injured diaphragm size (8.44 ± 1.97, P = 0.048). In blunt cases, delays in diagnosis and repair of TDI led to significantly increased ICU stay (16.25 ± 3.64, P = 0.017). CONCLUSION: TDI occurs in cases of multiple trauma. Higher ISS and lower Ps predict death; therefore, prompt diagnosis of TDI and immediate repair of diaphragmatic injury are important.