研究者詳細 - 湯本　哲也

論文 - 湯本　哲也

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Impact of contrast extravasation on computed tomography of the psoas major muscle in patients with blunt torso trauma. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Takao Hiraki, Yasuaki Yamakawa, Taihei Yamada, Atsunori Nakao

The journal of trauma and acute care surgery 86 ( 2 ) 268 - 273 2019年2月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The clinical significance of contrast extravasation (CE) on computed tomography (CT) of the psoas major muscle after blunt torso trauma and the optimal management of patients requiring transcatheter arterial embolization (TAE) of the lumbar artery have not been well elucidated. The aim of this study was to investigate the impact of CE on CT to determine the need for TAE of the lumbar artery. METHODS: We examined a single-center retrospective cohort of blunt torso trauma patients who underwent contrast-enhanced CT from 2008 to 2017. Basic demographics and clinical data were obtained, including the number of lumbar transverse process fractures (LTPFs) and maximum psoas major muscle hematoma (PMMH) size and ratio. Maximum PMMH size was analyzed by measuring the cross-sectional area of hematoma size at the level of CE. Psoas major muscle hematoma size ratio was obtained by dividing maximum PMMH size by psoas major muscle size of the unaffected side at the same slice level. RESULTS: A total of 762 patients were included. One hundred seventeen patients had LTPFs and/or PMMH. Of 117 patients, 25 had CE on CT of the psoas major muscle and had significantly higher rates of older age and severe injury compared with those without CE. Of the 25 patients with CE, 13 required TAE of the lumbar artery. Patients who required TAE had a significantly higher number of LTPFs (4 vs. 2, p = 0.011) and higher PMMH size ratio (2.10 vs. 1.32, p = 0.016). Psoas major muscle hematoma size ratio revealed moderate accuracy (area under the receiver operating characteristic curve, 0.782). CONCLUSIONS: Approximately half of the blunt torso trauma patients with CE on CT of the psoas major muscle will require TAE of the lumbar artery. Higher number of LTPFs and larger PMMH size can be a predictor of the need for TAE of the lumbar artery among patients with CE on CT. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

DOI： 10.1097/TA.0000000000002121

Case of Nontraumatic Rectus Sheath Hematoma from Muscle Training Mimicking Acute Abdomen. 査読国際誌

Yukino Ariyoshi, Hiromichi Naito, Hiromi Ihoriya, Tetsuya Yumoto, Noritomo Fujisaki, Kohei Tsukahara, Taihei Yamada, Yasuhiro Mandai, Takaaki Osako, Atsunori Nakao

Case reports in emergency medicine 2019 3158969 - 3158969 2019年

記述言語：英語

Rectus sheath hematoma is an unusual but well-known clinical problem. Our hospital admitted a 54-year-old woman complaining of harsh right-sided hypogastric pain that started while muscle training. Computed tomography of the abdomen and pelvis demonstrated a right rectus sheath hematoma. As the hematoma did not increase, the patient was conservatively treated. Despite increased awareness of rectus sheath hematoma, its early diagnosis and treatment still present a challenge to emergency physicians. Swift acknowledgement of this rare cause of abdominal pain may avoid more intrusive examination, unnecessary hospitalization, and laparotomy. Careful consideration of the patient's medical history and a high index of suspicion are needed to diagnose this complication.

DOI： 10.1155/2019/3158969

Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Hiromi Ihoriya, Takashi Yorifuji, Atsunori Nakao

PloS one 14 ( 1 ) e0207049 2019年

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

Annually, many physicians attend national academic meetings. While participating in these meetings can have a positive impact on daily medical practice, attendance may result in reduced medical staffing during the meeting dates. We sought to examine whether there were differences in mortality after trauma among patients admitted to the hospital during, before, and after meeting dates. Using the Japan Trauma Data Bank, we analyzed in-hospital mortality in patients with traumatic injury admitted to the hospital from 2004 to 2015 during the dates of two national academic meetings-the Japanese Association for Acute Medicine (JAAM) and the Japanese Association for the Surgery of Trauma (JAST). We compared the data with that of patients admitted with trauma during identical weekdays in the weeks before and after the meetings, respectively. We used multiple logistic regression analysis to compare outcomes among the three groups. A total of 7,491 patients were included in our analyses, with 2,481, 2,492, and 2,518 patients in the during, before, and after meeting dates groups, respectively; their mortality rates were 7.3%, 8.0%, and 8.5%, respectively. After adjusting for covariates, no significant differences in in-hospital mortality were found among the three groups (adjusted odds ratio [95% CI] of the before meeting dates and after meeting dates groups; 1.18 [0.89-1.56] and 1.23 [0.93-1.63], respectively, with the during meeting dates group as the reference category). No significant differences in in-hospital mortality were found among trauma patients admitted during, before, and after the JAAM and JAST meeting dates.

DOI： 10.1371/journal.pone.0207049

A patient presenting painful chest wall swelling: Tietze syndrome. 査読国際誌

Kohei Sawada, Hiromi Ihoriya, Taihei Yamada, Tetsuya Yumoto, Kohei Tsukahara, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

World journal of emergency medicine 10 ( 2 ) 122 - 124 2019年

Gastric Emphysema in a Critically Ill Patient Successfully Treated without Surgery. 査読国際誌

Hiromi Ihoriya, Tetsuya Yumoto, Masaya Iwamuro, Noritomo Fujisaki, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Case reports in critical care 2019 1824101 - 1824101 2019年

担当区分：責任著者記述言語：英語

Gastric emphysema is a relatively rare clinical entity caused by injury to the gastric mucosa. A 62-year-old Japanese male with a history of heavy alcohol consumption and smoking was admitted to the emergency intensive care unit due to severe hypercapnic respiratory acidosis. His body mass index was only 12.6. Ten days after initiation of enteral feeding, he complained of abdominal pain. Computed tomography revealed intraluminal air in the distended gastric wall. Esophagogastroduodenoscopy showed diffuse edema, redness, and erosion throughout the stomach. Based on the findings of narrow angle and short distance of the aorta-superior mesenteric artery, the patient was diagnosed with gastric emphysema associated with superior mesenteric artery syndrome. He was successfully managed nonoperatively with treatments including intravenous antibiotics, gastric decompression, and bowel rest. Physicians should be aware of this unusual condition in such critically ill patients complaining of abdominal pain and needing close monitoring and observation to exclude gastric necrosis or perforation.

DOI： 10.1155/2019/1824101

Orbital Emphysema as a Consequence of Forceful Nose-Blowing: Report of a Case. 査読国際誌

Yukino Ariyoshi, Hiromichi Naito, Tetsuya Yumoto, Atsuyoshi Iida, Hirotsugu Yamamoto, Noritomo Fujisaki, Toshiyuki Aokage, Kohei Tsukahara, Taihei Yamada, Yasuhiro Mandai, Takaaki Osako, Atsunori Nakao

Case reports in emergency medicine 2019 4383086 - 4383086 2019年

記述言語：英語

Orbital emphysema occurs when air enters the soft tissue surrounding the orbit. Although orbital blowout fractures are often caused by face trauma, nontraumatic orbital fractures can also occur but have been rarely described. Here, a case of orbital and palpebral emphysema caused by forceful nose-blowing is presented. Examination uncovered gross swelling of the right eye and discernable subcutaneous emphysema. The patient had normal eye movement and visual acuity. Orbital computed tomography (CT) revealed orbital emphysema secondary to an orbit floor fracture into the maxillary sinus, resulting from high intranasal pressure upon blowing her nose. The patient received conservative management with antibiotics and was given instructions not to sneeze or blow her nose. She fully recovered and all her symptoms completely resolved.

DOI： 10.1155/2019/4383086

Emphysematous cystitis successfully treated with hyperbaric oxygen therapy: case report 査読

Hirotaka Yasuhara, Hiromichi Naito, Yoshinori Kosaki, Yasuaki Yamakawa, Atsuyoshi Iida, Tetsuya Yumoto, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Takaaki Osako, Yasuhiro Mandai, Atsunori Nakao

UNDERSEA AND HYPERBARIC MEDICINE 45 ( 6 ) 701 - 703 2018年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：UNDERSEA & HYPERBARIC MEDICAL SOC INC

Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2 therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis.

Subperiosteal Hematoma of the Iliac Bone: An Unusual Cause of Acute Hip Pain after a Fall. 査読国際誌

Tetsuya Yumoto, Ryoji Joko, Yasuaki Yamakawa, Taihei Yamada, Hiromichi Naito, Atsunori Nakao

The American journal of case reports 19 1083 - 1086 2018年9月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND Subperiosteal hematoma (SPH) of the iliac bone is an extremely uncommon clinical entity that occurs mostly in young patients with a history of a recent fall or sports-related injury. Patients usually complain of severe hip pain after a fall, mimicking femoral neck fracture. CASE REPORT An 18-year-old female was transported to our hospital complaining of pain in her left hip after falling on her buttocks while engaging in martial arts. Ultrasound of her left iliac region revealed a subperiosteal mass on the internal aspect of the iliac bone lifting the iliac muscle. SPH of the iliac bone was suspected, which was also evident on pelvis and hip magnetic resonance imaging. Repetitive ultrasound did not reveal hematoma expansion. She was discharged from the hospital the next day without femoral neuropathy. CONCLUSIONS Physicians should be aware of our report, which highlights a patient with the rare clinical condition of SPH of the iliac bone occurring immediately after a fall. The differential diagnosis of acute hip pain, which mimics femoral neck fracture, should be considered in young patients. Ultrasound of the iliac region may be useful in detection and further management of SPH of the iliac bone.

DOI： 10.12659/AJCR.910010

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome. 査読

Hirotsugu Yamamoto, Hiromichi Naito, Takaaki Osako, Kohei Tsukahara, Taihei Yamada, Tetsuya Yumoto, Atsuyoshi Iida, Yoshinori Kosaki, Makio Oka, Fumika Endo, Akira Gochi, Atsunori Nakao

Acta medica Okayama 72 ( 3 ) 297 - 300 2018年6月

記述言語：英語

A healthy 10-year-old boy vomited during sleep and later complained of abdominal pain; he became drowsy and uncommunicative. At the nearby hospital E.R., he deteriorated rapidly, and his respiratory movements were absent with cardiac arrest. He was immediately resuscitated. Brain MRI showed no abnormalities. EEG revealed an abnormal pattern with recurrent multifocal epileptiform activity over the bilateral occipital and frontal regions during sleep. Based on the clinical/radiological findings we diagnosed Panayiotopoulos syndrome (PS), a benign form of early-onset pediatric epilepsy characterized by autonomic symptoms. Lifethreating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.

DOI： 10.18926/AMO/56076

Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury: A case report. 査読国際誌

Tetsuya Yumoto, Yoshitaka Kondo, Kento Kumon, Yoshihisa Masaoka, Takao Hiraki, Taihei Yamada, Hiromichi Naito, Atsunori Nakao

Medicine 97 ( 23 ) e11022 2018年6月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

RATIONALE: Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. PATIENT CONCERNS: A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. DIAGNOSES: CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. INTERVENTIONS: Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. OUTCOMES: His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. LESSONS: Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.

DOI： 10.1097/MD.0000000000011022

Raoultella planticola bacteremia-induced fatal septic shock following burn injury. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Hiromi Ihoriya, Kohei Tsukahara, Tomoyuki Ota, Toshiyuki Watanabe, Atsunori Nakao

Annals of clinical microbiology and antimicrobials 17 ( 1 ) 19 - 19 2018年5月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Raoultella planticola, a Gram-negative, aerobic bacillus commonly isolated from soil and water, rarely causes invasive infections in humans. Septic shock from R. planticola after burn injury has not been previously reported. CASE PRESENTATION: A 79-year-old male was admitted to the emergency intensive care unit after extensive flame burn injury. He accidently caught fire while burning trash and plunged into a nearby tank filled with contaminated rainwater to extinguish the fire. The patient developed septic shock on day 10. The blood culture detected R. planticola, which was identified using the VITEK-2 biochemical identification system. Although appropriate antibiotic treatment was continued, the patient died on day 12. CONCLUSIONS: Clinicians should be aware of fatal infections in patients with burn injury complicated by exposure to contaminated water.

DOI： 10.1186/s12941-018-0270-0

Bias flow rate and ventilation efficiency during adult high-frequency oscillatory ventilation: a lung model study. 査読国際誌

Osamu Nagano, Tetsuya Yumoto, Atsunori Nishimatsu, Shunsuke Kanazawa, Takahisa Fujita, Sunao Asaba, Hideo Yamanouchi

Intensive care medicine experimental 6 ( 1 ) 11 - 11 2018年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Bias flow (BF) is essential to maintain mean airway pressure (MAP) and to washout carbon dioxide (CO2) from the oscillator circuit during high-frequency oscillatory ventilation (HFOV). If the BF rate is inadequate, substantial CO2 rebreathing could occur and ventilation efficiency could worsen. With lower ventilation efficiency, the required stroke volume (SV) would increase in order to obtain the same alveolar ventilation with constant frequency. The aim of this study was to assess the effect of BF rate on ventilation efficiency during adult HFOV. METHODS: The R100 oscillator (Metran, Japan) was connected to an original lung model internally equipped with a simulated bronchial tree. The actual SV was measured with a flow sensor placed at the Y-piece. Carbon dioxide (CO2) was continuously insufflated into the lung model ([Formula: see text]CO2), and the partial pressure of CO2 (PCO2) in the lung model was monitored. Alveolar ventilation ([Formula: see text]A) was estimated as [Formula: see text]CO2 divided by the stabilized value of PCO2. [Formula: see text]A was evaluated by setting SV from 80 to 180 mL (10 mL increments, n = 5) at a frequency of 8 Hz, a MAP of 25 cmH2O, and a BF of 10, 20, 30, and 40 L/min (study 1). Ventilation efficiency was calculated as [Formula: see text]A divided by the actual minute volume. The experiment was also performed with an actual SV of 80, 100, and 120 mL and a BF from 10 to 60 L/min (10 L/min increments: study 2). RESULTS: Study 1: With the same setting SV, the [Formula: see text]A with a BF of 20 L/min or more was significantly higher than that with a BF of 10 L/min. Study 2: With the same actual SV, the [Formula: see text]A and the ventilation efficiency with a BF of 30 L/min or more were significantly higher than those with a BF of 10 or 20 L/min. CONCLUSIONS: Increasing BF up to 30 L/min or more improved ventilation efficiency in the R100 oscillator.

DOI： 10.1186/s40635-018-0176-3

Portal Venous Gas Following Ingestion of Hydrogen Peroxide Successfully Treated with Hyperbaric Oxygen Therapy. 査読

Chika Tsuboi, Hiromichi Naito, Shingo Hagioka, Hiroaki Hanafusa, Takahiro Hirayama, Yoshinori Kosaki, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Naoki Morimoto, Atsunori Nakao

Acta medica Okayama 72 ( 2 ) 181 - 183 2018年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

The primary toxicity of hydrogen peroxide results from its interaction with catalase, which liberates water and oxygen. We report the case of a 14-year-old Japanese girl with portal venous gas that was caused by oxygen liberated from intentionally ingested hydrogen peroxide. Although she had a past history of atrial septal defect, recovery without cardiac or neurological sequelae was achieved using hyperbaric oxygen therapy. Emergency physicians must be aware of the danger of liberated oxygen due to hydrogen peroxide ingestion.

DOI： 10.18926/AMO/55859

Hyperammonemic encephalopathy in a patient receiving fluorouracil/oxaliplatin chemotherapy. 査読国際誌

Hiromi Ihoriya, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Kanae Inoue, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Clinical case reports 6 ( 4 ) 603 - 605 2018年4月

Cushing's sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Hiroki Maeyama, Yoshinori Kosaki, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao

BMJ open 8 ( 3 ) e020781 2018年3月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. DESIGN: Retrospective cohort study using Japan Trauma Data Bank. SETTING: Emergency and critical care centres in secondary and tertiary hospitals in Japan. PARTICIPANTS: Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. PRIMARY OUTCOME MEASURES: Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. RESULTS: In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. CONCLUSIONS: Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-age children and young adolescents.

DOI： 10.1136/bmjopen-2017-020781

Far East Scarlet-like Fever Masquerading as Adult-onset Kawasaki Disease. 査読

Kazuki Ocho, Masaya Iwamuro, Kou Hasegawa, Hideharu Hagiya, Kammei Rai, Tetsuya Yumoto, Fumio Otsuka

Internal medicine (Tokyo, Japan) 57 ( 3 ) 437 - 440 2018年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

A previously healthy 31-year-old man was referred to us with refractory septic shock accompanied by bilateral conjunctival congestion and erythema of his right lower limb. Nine days after admission, he had bilateral desquamation of the fingertips, and his presentation satisfied the criteria for Kawasaki disease. A serological examination was positive for Yersinia pseudotuberculosis, and he was diagnosed with Far East scarlet-like fever (FESLF). Interestingly, his 11-month-old baby boy had similar symptoms around the same time, indicating the intrafamilial transmission of the pathogen. We should consider FESLF when we encounter a familial occurrence of systemic manifestations of Kawasaki disease.

DOI： 10.2169/internalmedicine.9250-17

Traumatic Globe Luxation with Complete Optic Nerve Transection Caused by Heavy Object Compression. 査読

Yoshinori Kosaki, Tetsuya Yumoto, Hiromichi Naito, Nobushige Tsuboi, Masahiro Kameda, Masayuki Hirano, Yuki Morizane, Takaya Senoo, Eijirou Tokuyama, Atsunori Nakao

Acta medica Okayama 72 ( 1 ) 85 - 88 2018年2月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

Traumatic eyeball luxation is a rare clinical condition with a dramatic presentation. Here, we describe a unique case of traumatic globe luxation and complete optic nerve transection caused by heavy object compression. A 45-year-old male automobile mechanic was injured when a truck slipped from its supports, crushing his head and face. On arrival, his right eyeball was obviously displaced anteriorly and he had no light perception. Computed tomography revealed complex frontal bone and facial fractures with underlying brain contusion in addition to complete transection of the right optic nerve. The patient was successfully treated using a multidisciplinary approach.

DOI： 10.18926/AMO/55669

Penetrating thoracic ice pick injury extending into pulmonary artery: Report of a case. 査読国際誌

Marina Kawaguchi, Hirotsugu Yamamoto, Taihei Yamada, Tetsuya Yumoto, Toshiyuki Aokage, Hiromi Ihoriya, Koki Eto, Takanori Suezawa, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 52 63 - 66 2018年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Penetrating thoracic traumas have a wide spectrum, ranging from mild traumas to life-threatening injuries. PRESENTATION OF CASE: This paper illustrates a 40-year-old male with a penetrating pulmonary artery injury that was successfully treated with emergency surgery. The patient visited local hospital by foot complaining of moving object on his chest and was found that an ice pick was penetrating the man's left chest. An ambulance took the patient to our emergency department. Computed tomography of the chest showed linear metallic density in the pulmonary trunk and a small amount of pericardial fluid. Emergency surgery for removal of the object and repair of the pulmonary artery was performed. The ice pick had been stuck in the main pulmonary artery through the pericardium without any injury to the left lung or internal thoracic artery. Postoperative course was uneventful. DISCUSSION: A multidisciplinary team designed our treatment strategy, enabling us to select the optimal treatment, including diagnostic techniques and surgical approach. A successful trauma management depends on whether a life-threatening conditionexists. Major vascular injury should be rapidly assessed in these cases. Psychiatric aspects of the case are also discussed. CONCLUSION: Early removal of the foreign body is recommended to prevent further damage to the heart.

DOI： 10.1016/j.ijscr.2018.09.052

Acute Agitation as an Initial Manifestation of Neuro-Behçet's Disease. 査読国際誌

Yuki Otsuka, Tetsuya Yumoto, Hiromi Ihoriya, Namiko Matsumoto, Kota Sato, Koji Abe, Hiromichi Naito, Atsunori Nakao

Case reports in emergency medicine 2018 5437027 - 5437027 2018年

担当区分：責任著者記述言語：英語

Managing acutely agitated or violent patients in the emergency department (ED) represents a significant challenge. Acute agitation as an initial manifestation of neuro-Behcet's disease (NBD) is an extremely rare clinical entity. A 44-year-old male, who had been complaining about a severe headache and fever for several days, was admitted to our ED due to acutely presented incontinence and agitation. On admission, physical restraint and sedation with sevoflurane and propofol were required for his combative and violent behavior. Cerebrospinal fluid examination revealed increased cell count. Fluid attenuated inversion recovery magnetic resonance imaging showed a high intensity signal in the left parietal lobe and bilateral occipital lobe. As infectious meningoencephalitis was suspected, empirical therapy was immediately started. He recovered uneventfully without neurological defect in seven days. Based on positive human leukocyte antigen B-51 and clinical manifestations, the diagnosis of NBD was made and remitted by steroid therapy. Although acute NBD commonly presents with focal neurological symptoms, psychiatric symptoms could be considered the first manifestation. A focused and thorough examination coupled with appropriate management strategies can assist emergency clinicians safely and effectively manage these patients.

DOI： 10.1155/2018/5437027

Indirect Calorimetry Measurement of Energy Expenditure Related to Body Position Changes in Healthy Adults. 査読

Kengo Obata, Tetsuya Yumoto, Soichiro Fuke, Kohei Tsukahara, Hiromichi Naito, Atsuyoshi Iida, Tetsuya Takahashi, Yoshihito Ujike, Atsunori Nakao

Acta medica Okayama 71 ( 6 ) 467 - 473 2017年12月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

Early mobilization is advocated to prevent intensive care unit-acquired physical weakness, but the patient's workload and its changes in response to body position changes have not been established. We used indirect calorimetry to determine the energy expenditure (EE) in response to body position changes, and we assessed EE's correlation with respiratory parameters in healthy volunteers: 8 males and 8 females, mean age 23.4±1.3 years. The subjects started in the resting supine position followed by a 30° head-up position, a 60° head-up position, an upright sitting position, a standing position, and the resting supine position. EE was determined in real time by indirect calorimetry monitoring the subject's respiratory rate, tidal volume (VT), and minute volume (MV). The highest values were observed immediately after the subjects transitioned from standing to supine, and this was significantly higher compared to the original supine position (1,450±285 vs. 2,004±519 kcal/day, p<0.01). Moderate correlations were observed between VT and EE (r=0.609, p<0.001) and between MV and EE (r=0.576, p<0.001). Increasing VT or MV indicates an increasing patient workload during mobilization. Monitoring these parameters may contribute to safe rehabilitation. Further studies should assess EE in critically ill patients.

DOI： 10.18926/AMO/55583

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