研究者詳細 - 湯本　哲也

論文 - 湯本　哲也

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Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Yasuaki Yamakawa, Atsuyoshi Iida, Kohei Tsukahara, Atsunori Nakao

Acute medicine & surgery 4 ( 4 ) 394 - 400 2017年10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）

Aim: Venous thromboembolism (VTE) can be a life-threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D-dimer for screening for VTE in major trauma cases among the Japanese population. Methods: We examined a single-center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D-dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D-dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE. Results: The study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D-dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704-0.866; P < 0.001). The cut-off that maximized the Youden index was 12.45 μg/mL. Conclusions: At least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D-dimer levels on day 10 can be a useful predictor of VTE.

DOI： 10.1002/ams2.290

Occult Sources of Bleeding in Blunt Trauma : A Narrative Review. 査読

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

Acta medica Okayama 71 ( 5 ) 363 - 368 2017年10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）

Worldwide, hemorrhagic shock in major trauma remains a major potentially preventable cause of death. Controlling bleeding and subsequent coagulopathy is a big challenge. Immediate assessment of unidentified bleeding sources is essential in blunt trauma patients with hemorrhagic shock. Chest/pelvic X-ray in conjunction with ultrasonography have been established classically as initial diagnostic imaging modalities to identify the major sources of internal bleeding including intra-thoracic, intra-abdominal, or retroperitoneal hemorrhage related to pelvic fracture. Massive soft tissue injury, regardless of whether isolated or associated with multiple injuries, occasionally causes extensive hemorrhage and acute traumatic coagulopathy. Specific types of injuries, including soft tissue injury or retroperitoneal hemorrhage unrelated to pelvic fracture, can potentially be overlooked or be considered "occult" causes of bleeding because classical diagnostic imaging often cannot exclude such injuries. The purpose of this narrative review article is to describe "occult" or unusual sources of bleeding associated with blunt trauma.

DOI： 10.18926/AMO/55433

Citrobacter braakii bacteremia-induced septic shock after colonoscopy preparation with polyethylene glycol in a critically ill patient: a case report. 査読国際誌

Tetsuya Yumoto, Yoshiyasu Kono, Seiji Kawano, Chihiro Kamoi, Atsuyoshi Iida, Motoko Nose, Keiji Sato, Toyomu Ugawa, Hiroyuki Okada, Yoshihito Ujike, Atsunori Nakao

Annals of clinical microbiology and antimicrobials 16 ( 1 ) 22 - 22 2017年4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: Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG. CASE PRESENTATION: A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock. He ingested PEG to prepare for a colonoscopy examination, which was performed to identify the source of his bleeding over a 5-h period, but suddenly exhibited septic shock and markedly elevated procalcitonin levels. A blood culture subsequently revealed Citrobacter braakii. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition. CONCLUSIONS: Clinicians should be aware of the possibility of deteriorating conditions after bowel preparation with PEG among severely ill patients with recent episodes of hemorrhagic shock.

DOI： 10.1186/s12941-017-0201-5

A Successfully Treated Case of Criminal Thallium Poisoning. 査読国際誌

Tetsuya Yumoto, Kohei Tsukahara, Hiromichi Naito, Atsuyoshi Iida, Atsunori Nakao

Journal of clinical and diagnostic research : JCDR 11 ( 4 ) OD01-OD02 2017年4月

担当区分：筆頭著者,　責任著者記述言語：英語

Thallium was once commonly used as a household rodent or ant killer, but many countries have banned such use due to unintentional or criminal poisonings of humans. A common initial clinical manifestation of thallium poisoning is gastrointestinal symptoms followed by delayed onset of neurological symptoms and alopecia. These clinical characteristics can provide important diagnostic clues regarding thallium poisoning. Here, we report a 23-year-old woman who was poisoned by a business colleague when she unknowingly drank tea containing the toxic substance several times. The patient was treated with multi-dose activated charcoal with airway protection and Prussian blue.

DOI： 10.7860/JCDR/2017/24286.9494

Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease: a case report. 査読国際誌

Atsuyoshi Iida, Hiromichi Naito, Kohei Tsukahara, Tetsuya Yumoto, Nobuyuki Nosaka, Shinnichi Kawana, Keiji Sato, Nobuhiro Takeuchi, Jyunichi Soneda, Atsunori Nakao

Journal of medical case reports 11 ( 1 ) 55 - 55 2017年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Pneumatosis cystoides intestinalis, marked by numerous gas-filled cysts in the intestinal wall and submucosa or intestinal submucosa, is a very uncommon condition. CASE PRESENTATION: A 79-year-old Asian man presented to our emergency department after 2 days of lower abdominal pain with nausea and constipation. His past medical history included chronic obstructive pulmonary disease and he had been treated with home oxygen therapy. The patient was hemodynamically stable and had mild generalized abdominal pain and a soft, distended abdomen without signs of peritonism. A computed tomography scan showed diffuse intraluminal gas and intraperitoneal free gas. Based on the images, a clinical diagnosis of pneumatosis cystoides intestinalis with pneumoperitoneum was made. Considering the patient's physical examination, the peritoneal free air was drained by aspiration and he was observed for 12 h, but remained well. Abdominal symptoms and pneumoperitineum resolved after drainage of the peritoneal air by aspiration. The suspected etiopathogenic mechanism of pneumatosis cystoides intestinalis in the presented patient may have been alveolar air leakage secondary to high airway pressure due to chronic obstructive pulmonary disease; air leakage from an alveolar rupture may have traveled to the retroperitoneum through the mediastinal vessels and entered the mesentery of the bowel. CONCLUSION: Emergency physicians should be aware of the potential development of pneumatosis cystoides intestinalis in chronic obstructive pulmonary disease patients.

DOI： 10.1186/s13256-017-1198-2

Successfully-treated asymptomatic celiac artery aneurysm: A case report. 査読国際誌

Nobuhiro Takeuchi, Junichi Soneda, Hiromichi Naito, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Atsunori Nakao

International journal of surgery case reports 33 115 - 118 2017年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Celiac artery aneurysm is a rare vascular lesion. It is frequently discovered after rupture, which leads to death in most cases. We present a case of an asymptomatic celiac artery aneurysm discovered in a 72-year-old female during an evaluation for high grade fever and general fatigue. CASE PRESENTATION: The patient visited our department with complaints of fever and general fatigue. The patient's medical history included type 2 diabetes mellitus with poor control and hypertension. Blood culture and urine culture that were submitted at arrival presented E. Coli. Then, she was diagnosed with bacteremia by urinary tract infection. Transesophageal echocardiography revealed no vegetation at her valves. Computed tomography was performed for investigating her urological abnormalities, revealing a 28×30 mm aneurysm at the trunk of the celiac artery. Blood and urine cultures submitted at arrival were positive for E. coli. Surgical repair performed after the improvement of her urinary tract infection revealed a non-infective aneurysm; thus, aneurysm closure and prosthetic grafting were conducted. CONCLUSION: Clinician awareness regarding this rare entity and discovery efforts to discover the splanchnic aneurysm before rupturing are imperative.

DOI： 10.1016/j.ijscr.2017.02.018

A case of traumatic cardiopulmonary arrest with good neurological outcome predicted by amplitude-integrated electroencephalogram. 査読国際誌

Ko Harada, Kohei Tsukahara, Tetsuya Yumoto, Yasuaki Yamakawa, Atsuyoshi Iida, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 36 42 - 45 2017年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Traumatic cardiopulmonary arrest has a very high mortality, and survival of patients with this condition without neurological disability is rare. PRESENTATION OF CASE: We herein report a case of traumatic cardiopulmonary arrest secondary to accidental amputation of the left lower leg that was successfully treated without any higher brain dysfunction. Although the long duration of cardiopulmonary arrest in this patient suggested hypoxic ischemic encephalopathy, amplitude-integrated electroencephalogram showed normal findings. DISCUSSION: This system may help intensivists evaluate the neurological conditions of patients with suspected hypoxic ischemic encephalopathy in the early stage of the clinical course and may assist in guiding therapeutic interventions. CONCLUSION: Our case supports the usefulness of neurological monitoring using amplitude-integrated electroencephalogram.

DOI： 10.1016/j.ijscr.2017.04.025

Bacteremia or pseudobacteremia? Review of pseudomonas fluorescens infections. 査読国際誌

Takeshi Nishimura, Kenji Hattori, Akihiko Inoue, Taiji Ishii, Tetsuya Yumoto, Kohei Tsukahara, Astunori Nakao, Satoshi Ishihara, Shinichi Nakayama

World journal of emergency medicine 8 ( 2 ) 151 - 154 2017年

Staphylococcus aureus Bacteremia Complicated by Psoas Abscess and Infective Endocarditis in a Patient with Atopic Dermatitis. 査読国際誌

Ichiro Tsuboi, Tetsuya Yumoto, Tatsuya Toyokawa, Katsunori Matsueda, Joichiro Horii, Hiromichi Naito, Atsunori Nakao

Case reports in infectious diseases 2017 4920182 - 4920182 2017年

担当区分：責任著者記述言語：英語

The close relationship between atopic dermatitis (AD) and infective endocarditis (IE) has been implicated. Staphylococcus aureus colonization is frequently seen observed in AD patients' skin lesions. Although a case of IE due to S. aureus bacteremia in an AD patient has been sporadically reported, a case of S. aureus bacteremia complicated by psoas abscess and IE has not been previously reported. A 42-year-old man with a history of AD presented to our hospital complaining of fever, fatigue, chills, lower right back pain, and poor appetite for a week. His blood cultures showed growth of S. aureus. On day 3, the patient presented acute cardiac failure and was diagnosed with IE based on echocardiogram examination. Since the patient's cardiac failure did not respond to medication, an emergency surgery was performed on the fourth day of hospitalization. The patient underwent successful surgical treatment of the heart lesions and subsequent percutaneous drainage of psoas abscess and received intensive antibiotics, which successfully improved his condition. Our report emphasizes awareness of the association between AD and invasive S. aureus infections.

DOI： 10.1155/2017/4920182

Impact of Cushing's sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study. 査読国際誌

Tetsuya Yumoto, Toshiharu Mitsuhashi, Yasuaki Yamakawa, Atsuyoshi Iida, Nobuyuki Nosaka, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Scandinavian journal of trauma, resuscitation and emergency medicine 24 ( 1 ) 147 - 147 2016年12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: Cushing's reflex usually results from intracranial hypertension. Although Cushing's sign can implicate severe traumatic brain injury (TBI) in injured patients, no major investigations have been made. The purpose of this study was to assess the predictability of life-threatening brain injury requiring immediate neurosurgical intervention (LT-BI) among trauma patients with Cushing's sign in the prehospital setting. METHODS: This was a retrospective study using data from the Japan Trauma Data Bank from the period of 2010 to 2014. Patients 16 years old or older with blunt mechanisms of injury who were transported directly from the scene and Glasgow Coma Scale for eye opening of one in the prehospital setting were included. LT-BI was defined as patients requiring burr hole evacuation or craniotomy within 24 h of hospital arrival and patients who were non-survivors due to isolated severe TBI. Prehospital systolic blood pressure (pSBP) and heart rate (pHR) were assessed using area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis to predict LT-BI. RESULTS: Of 6332 eligible patients, 1859 (29%) exhibited LT-BI. AUROC of LT-BI using pSBP and pHR was 0.666 (95% confidence interval (CI); 0.652-0.681, P < 0.001), and 0.578 (95% CI; 0.563-0.594, P < 0.001), respectively. AUROC of pSBP was the highest among the 60 ≤ pHR ≤ 99 subgroup, of which AUROC was 0.680 (95% CI; 0.662-0.699, P < 0.001). Multiple logistic regression analysis showed that the higher the pSBP and the lower the pHR, the more likely that the patients had LT-BI. In a group with pSBP ≥ 180 mmHg and pHR ≤ 59 beats/min, the odds ratio and 95% CI of LT-BI after adjusting for age, sex, and severity of injuries to other body regions was 4.77 (2.85-7.97), P < 0.001 was compared with the reference group, which was defined as patients with normal vital signs. DISCUSSION: Our study has found that the combination of hypertension and bradycardia, which are the components of Cushing's sign without eye opening in the prehospital setting was a weak but a significant predictor of LT-BI, or death due to possible isolated severe TBI. CONCLUSIONS: Prehospital Cushing's sign with disturbed level of consciousness in trauma patients was a weak but significant predictor of the need for immediate neurosurgical intervention.

The Clinical Application of Hydrogen as a Medical Treatment. 査読

Atsuyoshi Iida, Nobuyuki Nosaka, Tetsuya Yumoto, Emily Knaup, Hiromichi Naito, Chihiro Nishiyama, Yasuaki Yamakawa, Kohei Tsukahara, Michihisa Terado, Keiji Sato, Toyomu Ugawa, Atsunori Nakao

Acta medica Okayama 70 ( 5 ) 331 - 337 2016年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

In recent years, it has become evident that molecular hydrogen is a particularyl effective treatment for various disease models such as ischemia-reperfusion injury; as a result, research on hydrogen has progressed rapidly. Hydrogen has been shown to be effective not only through intake as a gas, but also as a liquid medication taken orally, intravenously, or locally. Hydrogen's effectiveness is thus multifaceted. Herein we review the recent research on hydrogen-rich water, and we examine the possibilities for its clinical application. Now that hydrogen is in the limelight as a gaseous signaling molecule due to its potential ability to inhibit oxidative stress signaling, new research developments are highly anticipated.

Intraperitoneally administered, hydrogen-rich physiologic solution protects against postoperative ileus and is associated with reduced nitric oxide production. 査読国際誌

Ayana Okamoto, Keisuke Kohama, Michiko Aoyama-Ishikawa, Hayato Yamashita, Noritomo Fujisaki, Taihei Yamada, Tetsuya Yumoto, Nobuyuki Nosaka, Hiromichi Naito, Kohei Tsukahara, Atsuyoshi Iida, Keiji Sato, Joji Kotani, Atsunori Nakao

Surgery 160 ( 3 ) 623 - 31 2016年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postoperative ileus, a transient impairment of bowel motility initiated by intestinal inflammation, is common after an abdominal operation and leads to increased hospital stays and costs. Hydrogen has potent anti-inflammatory and antioxidant properties and potential therapeutic value. Solubilized hydrogen may be a portable and practical means of administering therapeutic hydrogen gas. We hypothesized that intraperitoneal administration of hydrogen-rich saline would ameliorate postoperative ileus. METHODS: Ileus was induced via surgical manipulation in mice and rats. The peritoneal cavity was filled with 1.0 mL saline or hydrogen-rich saline (≥1.5-2.0 ppm) before closure of the abdominal incision. Intestinal transit was assessed 24 hours postoperatively. Inflammation was examined by quantitation of neutrophil extravasation and expression of proinflammatory markers. Nitric oxide production was assessed in cultured muscularis propria. RESULTS: Surgical manipulation resulted in a marked delay in intestinal transit and was associated with upregulation of proinflammatory cytokines and increased neutrophil extravasation. Bowel dysmotility, induced by surgical manipulation and inflammatory events, was significantly attenuated by intra-abdominal administration of hydrogen-rich saline. Nitric oxide production in the muscle layers of the bowel was inhibited by hydrogen treatment. CONCLUSION: A single intraperitoneal dose of hydrogen-rich saline ameliorates postoperative ileus by inhibiting the inflammatory response and suppressing nitric oxide production.

DOI： 10.1016/j.surg.2016.05.026

Three cases of heparin-induced thrombocytopenia associated with polytrauma. 査読国際誌

Tetsuya Yumoto, Keiji Sato, Nobuharu Fujii, Yo Kinami, Kohei Tsukahara, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Acute medicine & surgery 3 ( 1 ) 46 - 49 2016年1月

担当区分：筆頭著者,　責任著者記述言語：英語

Case: We present three cases in which patients that had suffered polytrauma developed heparin-induced thrombocytopenia after the start of heparin treatment for thrombosis. All three patients had high injury severity scores and required major surgery. They all started receiving unfractionated heparin for deep venous thrombosis with or without an asymptomatic pulmonary embolism. The patients were clinically diagnosed with heparin-induced thrombocytopenia after their platelet counts fell or exhibited a delayed recovery. Outcome: Heparin-induced thrombocytopenia and the associated thromboses were successfully treated by discontinuing all forms of heparin treatment and administering argatroban followed by warfarin. Conclusion: Early recognition and clinical diagnosis of heparin-induced thrombocytopenia is necessary for clinicians in cases in which severely injured trauma patients show reductions or delayed recovery in their platelet counts in combination with thrombosis after starting heparin treatment.

DOI： 10.1002/ams2.132

Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism. 査読国際誌

Kohei Tsukahara, Keiji Sato, Tetsuya Yumoto, Atsuyoshi Iida, Nobuyuki Nosaka, Michihisa Terado, Hiromichi Naito, Yorihisa Orita, Tomoyuki Naito, Kentaro Miki, Mayu Sugihara, Satoko Nagao, Toyomu Ugawa, Atsunori Nakao

International journal of surgery case reports 26 217 - 20 2016年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare. PRESENTATION OF CASE: An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36days after admission. DISCUSSION: Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression. CONCLUSION: Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.

DOI： 10.1016/j.ijscr.2016.08.002

A case of cricothyroidotomy for facial trauma in a patient taking antiplatelet agents after a simple ground-level fall. 査読国際誌

Tetsuya Yumoto, Tatsushi Matsumura, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike

International journal of surgery case reports 27 87 - 89 2016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）

INTRODUCTION: Cricothyroidotomy is an emergency procedure that can be used to secure the airway in situations in which intubation and ventilation are not possible. PRESENTATION OF CASE: We describe a case of 79-year-old male presenting with facial trauma combined with massive upper airway bleeding and swelling in which cricothyroidotomy was required to open the airway in an elderly male patient taking antiplatelet agents who suffered a simple ground-level fall. DISCUSSION: Although emergency airway management is often required in patients with Le Fort fractures, mandibular condyle fractures exhibit a significant relationship with ground-level falls, which are not usually associated with emergency airway management. Prophylactic intubation should be considered prior to transfer or deterioration in a trauma patient with dual antiplatelet drugs and fractures of bilateral mandibular condyle. CONCLUSION: Clinicians should be aware of the life-threatening injuries that can be caused by simple ground-level falls in patients taking antiplatelet agents.

DOI： 10.1016/j.ijscr.2016.08.027

外傷患者における冷汗の意義－多施設共同前向き観察研究より－査読

湯本哲也, 塚原紘平, 飯田淳義, 寺戸通久, 佐藤圭路, 鵜川豊世武, 氏家良人, 西村哲郎, 定光大海, 土谷飛鳥, 植木浜一, 高間辰雄, 真弓俊彦

日本外傷学会雑誌 30 ( 1 ) 1 - 8 2016年

担当区分：筆頭著者,　責任著者記述言語：日本語出版者・発行元：一般社団法人日本外傷学会

ショックを早期に認知するための皮膚所見の１つとして，外傷患者における冷汗の意義を多施設共同前向き観察研究にて検証した．出血性あるいは閉塞性ショックを離脱するためにinterventionを要した症例をショックと定義，冷汗は２人の観察医師が左右それぞれ４ヵ所を別々に評価し，少なくとも１ヵ所でも一致した場合を冷汗ありと定義した．来院時心肺停止，熱傷，転院搬送例を除外した外傷患者411例のうちショックは54例（13％），冷汗は36例（９％）に認めた．ショックで冷汗ありの症例は19例（35％）で，ショックに対する冷汗の感度，特異度，陽性・陰性的中率はそれぞれ35，95，53，91％であった．また，ショックで冷汗ありの症例はなしの症例と比較し，有意に頻脈で，Base excess（BE）が低く，乳酸値が高値であった．ショックに対する冷汗の特異度は高く，冷汗を認めれば介入が必要なショックと認識できる．また，早期認知のためには積極的に冷汗の所見をとりにいくことが重要である．

DOI： 10.11382/jjast.30.1

Donor pretreatment with carbon monoxide prevents ischemia/reperfusion injury following heart transplantation in rats 査読

Atsunori Nakao, Noritomo Fujisaki, Keisuke Kohama, Takeshi Nishimura, Hayato Yamashita, Michiko Ishikawa, Akihiro Kanematsu, Taihei Yamada, Sungsoo Lee, Tetsuya Yumoto, Kohei Tsukahara, Joji Kotani

Medical Gas Research 6 ( 3 ) 122 - 122 2016年

Superior ophthalmic vein thrombosis associated with severe facial trauma: a case report. 査読国際誌

Momoko Mishima, Tetsuya Yumoto, Hiroaki Hashimoto, Takao Yasuhara, Atsuyoshi Iida, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Fumio Otsuka, Yoshihito Ujike

Journal of medical case reports 9 244 - 244 2015年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Superior ophthalmic vein thrombosis is a rare entity, but is associated with significant morbidities. We describe a case in which superior ophthalmic vein thrombosis occurred shortly after severe facial trauma. CASE PRESENTATION: A 77-year-old Japanese man was transferred to our tertiary hospital after a motor vehicle accident. Le Fort III facial bone fractures and a minor cerebral contusion were detected. Follow-up computed tomography scans detected dilatation of his left superior ophthalmic vein on day 3 and thrombosis on day 12; however, no causative carotid cavernous fistula was observed. As he did not present with any symptoms other than slight conjunctival congestion, a conservative management strategy was adopted along with anticoagulant therapy against deep venous thrombosis. The superior ophthalmic vein thrombosis resolved spontaneously and the conjunctival congestion also improved. CONCLUSIONS: Superior ophthalmic vein thrombosis should be taken into consideration and managed properly after severe facial injuries, and further investigation of its cause is necessary to prevent morbidities.

DOI： 10.1186/s13256-015-0737-y

An unusual case of a patient who presented with haemorrhagic shock following massive subcutaneous haematomas of the lower back due to blunt trauma. 査読国際誌

Tetsuya Yumoto, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike

BMJ case reports 2015 2015年10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）

An 83-year-old woman with no significant medical history was transferred to our tertiary hospital after being hit by a car and presenting with haemorrhagic shock. Immediate fluid resuscitation was performed; physical, chest/pelvic X-ray and echographic examinations did not detect any major sources of bleeding. However, a contrast-enhanced CT scan revealed multiple regions of significant contrast extravasation in an extensive part of the subcutaneous tissue of the patient's lower back, which is an unusual source of bleeding. Transcatheter arterial embolisation of the lumbar and internal iliac arteries and their branches was carried out. In addition, haemostatic resuscitation was performed for damage control resuscitation, which successfully resolved the patient's haemorrhagic shock.

DOI： 10.1136/bcr-2015-211645

Prevalence, risk factors, and short-term consequences of traumatic brain injury-associated hyponatremia. 査読

Tetsuya Yumoto, Keiji Sato, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Acta medica Okayama 69 ( 4 ) 213 - 8 2015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）

Hyponatremia, a common electrolyte disorder associated with traumatic brain injuries (TBIs), has high mortality and morbidity rates. The aim of this study was to identify the risk factors for hyponatremia associated with TBI. We retrospectively analyzed the cases of TBI patients who were admitted to the emergency intensive care unit at Okayama University Hospital between October 2011 and September 2014. A total of 82 TBI patients were enrolled. The incidences of hyponatremia (serum sodium level of＜135mEq/L) and severe hyponatremia (serum sodium level of＜130mEq/L) within the first 14 days after admission were 51% (n＝42) and 20% (n＝16), respectively. After admission, hyponatremia took a median period of 7 days to develop and lasted for a median of 3 days. Multivariate analysis demonstrated that higher fluid intake from days 1 to 3 and the presence of cranial fractures were risk factors for hyponatremia. The 58 patients with hyponatremia experienced fewer ventilator-free days, longer intensive care unit stays, and less favorable outcomes compared to the 24 patients without hyponatremia;however, these differences were not significant. Further studies are needed to determine the optimal management strategy for TBI-associated hyponatremia in the intensive care unit setting.

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