論文 - 湯本　哲也

Characteristics and Costs of Ladder Fall Injuries: A Report from a Single Emergency Center in Okayama. 査読

Nobuyuki Nosaka, Yu Goda, Emily Knaup, Kohei Tsukahara, Tetsuya Yumoto, Toyomu Ugawa, Yoshihito Ujike

Acta medica Okayama   69 ( 5 )   275 - 8   2015年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We sought to identify the incidence, injury patterns, and financial burden of ladder fall injuries to provide a reference for reinforcing guidelines on the prevention of such injuries. We enrolled the patients who were injured in a ladder-related fall and required intensive care between April 2012 and March 2014 at Okayama University Hospital, a tertiary care hospital in Okayama City:9 patients injured in 7 stepladder falls and 2 straight ladder falls. The median patient age was 69 years, and 8 were males. Six falls occurred in non-occupational settings. Head injuries predominated, and the injury severity score ranged from 2 to 35 (mean＝21±12). At the time of discharge from the intensive care unit, one patient had died and 5 patients had some neurological disabilities. The case fatality rate was 11%. The total cost of care during the review period was ￥16,705,794, with a mean cost of ￥1,856,199 per patient. Ladder fall injuries are associated with a high rate of neurological sequelae and pose a financial burden on the health insurance system. A prevention education campaign targeting at older-aged males in non-occupational settings may be a worthwhile health service investment in this community.

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Septic shock due to Aeromonas hydrophila bacteremia in a patient with alcoholic liver cirrhosis: a case report. 査読 国際誌

Tetsuya Yumoto, Shingo Ichiba, Nao Umei, Sunao Morisada, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike

Journal of medical case reports   8   402 - 402   2014年12月

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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: Aeromonas hydrophila sometimes causes bacteremia, which can be fatal in compromised patients, such as those with liver cirrhosis. We present a case of septic shock due to Aeromonas hydrophila bacteremia in a patient with liver cirrhosis, which was successfully treated with rapid resuscitation and critical care. CASE PRESENTATION: A 71-year-old Japanese man with liver cirrhosis was transported to our emergency center by ambulance after presenting with gait difficulties and fever. On arrival, he exhibited shock and severe lactic acidosis, which was suggestive of sepsis, and was immediately resuscitated and administered empiric antibiotic therapy. He also displayed catecholamine-resistant hypotension, which was successfully treated with critical care including supportive therapies, such as polymyxin B hemoperfusion and cytokine-absorbing hemofiltration. Aeromonas hydrophila was detected in his initial blood cultures. CONCLUSIONS: Aeromonas septicemia should be considered in patients with alcoholic liver cirrhosis who have profound shock. In addition to goal-directed therapy and the prompt administration of empiric antibiotic therapy, aggressive critical care involving multiple supportive therapies can save such patients.

DOI： 10.1186/1752-1947-8-402

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Mean lung pressure during adult high-frequency oscillatory ventilation: an experimental study using a lung model. 査読

Takahiro Hirayama, Osamu Nagano, Naoki Shiba, Tetsuya Yumoto, Keiji Sato, Michihisa Terado, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Acta medica Okayama   68 ( 6 )   323 - 9   2014年12月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In adult high-frequency oscillatory ventilation (HFOV), stroke volume (SV) and mean lung pressure (PLung) are important for lung protection. We measured the airway pressure at the Y-piece and the lung pressure during HFOV using a lung model and HFOV ventilators for adults (R100 and 3100B). The lung model was made of a 20-liter, airtight rigid plastic container (adiabatic compliance: 19.3 ml/cmH2O) with or without a resistor (20 cmH2O/l/sec). The ventilator settings were as follows: mean airway pressure (MAP), 30 cmH2O; frequency, 5-15 Hz (every 1 Hz); airway pressure amplitude (AMP), maximum;and % of inspiratory time (IT), 50% for R100, 33% or 50% for 3100B. The measurements were also performed with an AMP of 2/3 or 1/3 maximum at 5, 10 and 15 Hz. The PLung and the measured MAP were not consistently identical to the setting MAP in either ventilator, and decreasing IT decreased the PLung in 3100B. In conclusion, we must pay attention to the possible discrepancy between the PLung and the setting MAP during adult HFOV.

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Actual treatments for out-of-hospital ventricular fibrillation at critical care medical centers in Osaka: a pilot descriptive study. 査読 国際誌

Tomohiko Sakai, Tetsuhisa Kitamura, Taku Iwami, Yasuyuki Hayashi, Hiroshi Rinka, Yasuo Ohishi, Tomoyoshi Mohri, Masafumi Kishimoto, Ryosuke Kawaguchi, Kentaro Kajino, Tetsuya Yumoto, Toshifumi Uejima, Masahiko Nitta, Tatsuya Nishiuchi, Chizuka Shiokawa, Taro Irisawa, Osamu Tasaki, Hiroshi Ogura, Yasuyuki Kuwagata, Takeshi Shimazu

Acute medicine & surgery   1 ( 3 )   150 - 158   2014年7月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aim: Although advanced treatments are provided to improve outcomes after out-of-hospital ventricular fibrillation, including shock-resistant ventricular fibrillation, the actual treatments in clinical settings have been insufficiently investigated. The aim of the current study is to describe the actual treatments carried out for out-of-hospital ventricular fibrillation patients, including shock-resistant ventricular fibrillation patients, at critical care medical centers. Methods: We registered consecutive adult patients suffering bystander-witnessed out-of-hospital cardiac arrest of cardiac origin, for whom resuscitation was attempted by emergency medical service personnel, who had ventricular fibrillation as an initial rhythm, and who were transported to critical care medical centers in Osaka from March 2008 to December 2008. This study merged data on treatments after transportation, collected from 11 critical care medical centers in Osaka with the prehospital Utstein-style database. Results: During the study period, there were 260 bystander-witnessed ventricular fibrillation arrests of cardiac origin. Of them, 252 received defibrillations before hospital arrival, 112 (44.4%) were transported to critical care medical centers, and 35 had shock-resistant ventricular fibrillation. At the critical care medical centers, 54% (19/35), 40% (14/35), and 46% (16/35) of shock-resistant ventricular fibrillation patients were treated with extracorporeal life support, percutaneous coronary interventions, and therapeutic hypothermia, respectively, but their treatments differed among institutions. Some patients with prolonged arrest without prehospital return of spontaneous circulation who received advanced treatments had neurologically favorable survival, whereas approximately two-thirds of shock-resistant ventricular fibrillation patients with advanced treatments did not. Conclusion: This pilot descriptive study suggested that actual treatments for prehospital ventricular fibrillation patients differed between critical care medical centers. Further studies are warranted to evaluate the effectiveness of in-hospital advanced treatments for ventricular fibrillation including shock-resistant ventricular fibrillation.

DOI： 10.1002/ams2.27

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Immediate screening method for predicting the necessity of massive transfusions in trauma patients: a retrospective single-center study. 査読 国際誌

Tetsuya Yumoto, Atsuyoshi Iida, Takahiro Hirayama, Kohei Tsukahara, Naoki Shiba, Hideo Yamanouchi, Keiji Sato, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Journal of intensive care   2 ( 1 )   54 - 54   2014年

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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: Hemostatic resuscitation might improve the survival of severely injured trauma patients. Our objective was to establish a simplified screening system for determining the necessity of massive transfusions (MT) at an early stage in trauma cases. METHODS: We retrospectively analyzed the cases of trauma patients who had been transported to our institution between November 2011 and October 2013. Patients who were younger than 18 years of age or who were confirmed to have suffered a cardiac arrest at the scene or on arrival were excluded. MT were defined as transfusions involving the delivery of ≥10 units of red blood cell concentrate within the first 24 h after arrival. RESULTS: A total of 259 trauma patients were included in this study (males: 178, 69%). Their mean age was 49 ± 20, and their median injury severity score was 14.4. Thirty-three (13%) of the patients required MT. The presence of a shock index of ≥1, a base excess of ≤ -3 mmol/L, or a positive focused assessment of sonography for trauma (FAST) result was found to exhibit sensitivity and specificity values of 0.97 and 0.81, respectively, for predicting the necessity of MT. Furthermore, this method displayed an area under the receiver operating characteristic curve of 0.934 (95% confidence interval, 0.891-0.978), which indicated that it was highly accurate. CONCLUSIONS: Our screening method based on the shock index, base excess, and FAST result is a simple and useful way of predicting the necessity of MT early after trauma.

DOI： 10.1186/s40560-014-0054-3

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Seat belt injury to the inguinal region presenting with hemorrhagic shock. 査読 国際誌

Tetsuya Yumoto, Keiji Sato, Reiichiro Tanaka, Yoshihito Ujike

The Journal of emergency medicine   45 ( 6 )   828 - 30   2013年12月

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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: Seat belts uncommonly result in various injuries to the abdominal area, such as mesenteric tears, bowel perforations, and abdominal aortic ruptures. We describe a case of a massive subcutaneous hematoma causing hemorrhagic shock from significant lacerations to the inguinal region, related to the use of a seat belt. OBJECTIVES: To describe a seat belt injury to the inguinal region that presented with a massive subcutaneous hematoma, and to speculate about the mechanism that caused the injury. CASE REPORT: A 60-year-old woman, who was wearing a seat belt, was brought to our tertiary hospital Emergency Department after a head-on motor vehicle accident. The patient had vascular injury around the right inguinal region resulting in hemorrhagic shock. Transcatheter arterial embolization (TAE) was successfully performed to stop the bleeding. CONCLUSION: Seat belts can cause serious injury to the inguinal region, mainly due to shearing forces. In addition to gauze packing, TAE was used effectively to control the hemorrhage in this patient.

DOI： 10.1016/j.jemermed.2012.07.093

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Left anomalous brachiocephalic vein in a patient with right lung cancer. 査読 国際誌

Ryota Nakamura, Inage Yoshihisa, Kenichi Iwasaki, Tetsuya Yumoto, Kenji Yuzawa, Hamaichi Ueki

The Annals of thoracic surgery   96 ( 1 )   307 - 9   2013年7月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The left anomalous brachiocephalic vein is a rare anomaly without congenital heart disease. It is important to recognize this anomalous vein especially in patients with lung cancer because misinterpretation as a superior mediastinal lymph node enlargement may cause serious complications. We report a case of a 62-year-old lung cancer patient with left anomalous brachiocephalic vein, who underwent surgical treatment safely under video-assisted thoracoscopic surgery after confirmation of this anomaly on contrast-enhanced computed tomographic scan.

DOI： 10.1016/j.athoracsur.2012.11.030

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Overheated and melted intracranial pressure transducer as cause of thermal brain injury during magnetic resonance imaging: case report. 査読 国際誌

Reiichiro Tanaka, Tetsuya Yumoto, Naoki Shiba, Motohisa Okawa, Takao Yasuhara, Tomotsugu Ichikawa, Koji Tokunaga, Isao Date, Yoshihito Ujike

Journal of neurosurgery   117 ( 6 )   1100 - 9   2012年12月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Magnetic resonance imaging is used with increasing frequency to provide accurate clinical information in cases of acute brain injury, and it is important to ensure that intracranial pressure (ICP) monitoring devices are both safe and accurate inside the MRI suite. A rare case of thermal brain injury during MRI associated with an overheated ICP transducer is reported. This 20-year-old man had sustained a severe contusion of the right temporal and parietal lobes during a motor vehicle accident. An MR-compatible ICP transducer was placed in the left frontal lobe. The patient was treated with therapeutic hypothermia, barbiturate therapy, partial right temporal lobectomy, and decompressive craniectomy. Immediately after MRI examination on hospital Day 6, the ICP monitor was found to have stopped working, and the transducer was subsequently removed. The patient developed meningitis after this event, and repeat MRI revealed additional brain injury deep in the white matter on the left side, at the location of the ICP transducer. It is suspected that this new injury was caused by heating due to the radiofrequency radiation used in MRI because it was ascertained that the tip of the transducer had been melted and scorched. Scanning conditions--including configuration of the transducer, MRI parameters such as the type of radiofrequency coil, and the specific absorption rate limit--deviated from the manufacturer's recommendations. In cooperation with the manufacturer, the authors developed a precautionary tag describing guidelines for safe MR scanning to attach to the display unit of the product. Strict adherence to the manufacturer's guidelines is very important for preventing serious complications in patients with ICP monitors undergoing MRI examinations.

DOI： 10.3171/2012.9.JNS12738

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Presentation of Garcin syndrome due to lung cancer. 査読 国際誌

Masanori Fujii, Katsuyuki Kiura, Nagio Takigawa, Tetsuya Yumoto, Yoshihide Sehara, Masahiro Tabata, Mitsune Tanimoto

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer   2 ( 9 )   877 - 8   2007年9月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Garcin syndrome consists of unilateral palsies of almost all cranial nerves without either sensory or motor long-tract disturbances and without intracranial hypertension, and it is caused by a malignant osteoclastic lesion at the skull base. A 60-year-old woman presented with dizziness and left facial palsy. Progressive left cranial nerve palsies developed over 2 months until gadolinium-enhanced magnetic resonance imaging of the brain revealed an intracranial extension of a tumor from the left skull base. A systemic survey revealed adenocarcinoma of the lung, which had metastasized along the skull base. We experienced a rare case of Garcin syndrome due to skull base metastases from lung cancer.

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