Faculty Profiles - NAKAO Atsunori

Papers - NAKAO Atsunori

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A successfully treated case of penetrating facial trauma. Reviewed

Yumoto T, Iida A, Tsukahara K, Naito H, Terado M, Sato K, Date I, Nakao A.

Int J Case Rep Images 8 ( 2 ) 120 - 123 2021.2

Reply to comment on “the psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe”

Takeshi Nishimura, Hiromichi Naito, Noritomo Fujisaki, Atsunori Nakao

Surgery Today 51 ( 2 ) 329 - 330 2021.2

Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches

Yuta Oda, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

Acute Medicine & Surgery 8 ( 1 ) 2021.1

State‐of‐the‐art methods for the treatment of severe hemorrhagic trauma: selective aortic arch perfusion and emergency preservation and resuscitation—what is next?

Atsuyoshi Iida, Hiromichi Naito, Tsuyoshi Nojima, Tetsuya Yumoto, Taihei Yamada, Noritomo Fujisaki, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery 8 ( 1 ) 2021.1

Cardiac arrest due to liquid nicotine intoxication: a case report

Atsuyoshi Iida, Yuki Fujiwara, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery 8 ( 1 ) 2021.1

集中治療室管理を要した重症頭部外傷症例の長期予後

安原隆雄, 湯本哲也, 村井智, 中尾篤典, 伊達勲

日本脳神経外傷学会プログラム・抄録集 44回 53 - 53 2021.1

Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study. International journal

Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Takaki Naito, Yosuke Homma, Yoshihisa Fujimoto, Morooka Takaya, Yuji Yamamori, Taka-Aki Nakada, Tsuyoshi Nojima, Atsunori Nakao, Shigeki Fujitani

Acute medicine & surgery 8 ( 1 ) e690 2021

Language：English Publishing type：Research paper (scientific journal)

AIM: The rapid response system (RRS) is an in-hospital medical safety system. To date, not much is known about patient disposition after RRS activation, especially discharge home. This study aimed to investigate the prevalence, characteristics, and outcomes of patients with adverse events who required RRS activation. METHODS: Retrospective data from the In-Hospital Emergency Registry in Japan collected from April 2016 to November 2020 were eligible for our analysis. We divided patients into Home Discharge, Transfer, and Death groups. The primary outcome was the prevalence of direct discharge home, and independently associated factors were determined using multivariable logistic regression. RESULTS: We enrolled 2,043 patients who met the inclusion criteria. The prevalence of discharge home was 45.7%; 934 patients were included in the Home Discharge group. Age (adjusted odds ratio [AOR] 0.96; 95% confidence interval [CI], 0.95-0.97), malignancy (AOR 0.69; 95% CI, 0.48-0.99), oxygen administration before RRS (AOR 0.49; 95% CI, 0.36-0.66), cerebral performance category score on admission (AOR 0.38; 95% CI, 0.26-0.56), do not attempt resuscitation order before RRS (AOR 0.17; 95% CI, 0.10-0.29), RRS call for respiratory failure (AOR 0.50; 95% CI, 0.34-0.72), RRS call for stroke (AOR 0.12; 95% CI, 0.03-0.37), and intubation (AOR 0.20; 95% CI, 0.12-0.34) were independently negative, and RRS call for anaphylaxis (AOR 15.3; 95% CI, 2.72-86.3) was positively associated with discharge home. CONCLUSION: Less than half of the in-hospital patients under RRS activation could discharge home. Patients' conditions before RRS activation, disorders requiring RRS activation, and intubation were factors that affected direct discharge home.

DOI： 10.1002/ams2.690

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Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report. International journal

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao

Archives of academic emergency medicine 9 ( 1 ) e16 2021

Language：English

Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.

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Unrecognized Orbital Images Cause Diagnostic Confusion: Silicone Oil and Implanted Silicone Encircling Bands. International journal

Tsuyoshi Nojima, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Case reports in emergency medicine 2021 9940395 - 9940395 2021

Language：English

Introduction: Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We present a patient with head trauma who had surgery for retinal detachment with implantation of silicone encircling bands. This case report may help clinicians recognize imaging characteristics after ophthalmic surgery to prevent misdiagnosis and unnecessary workup. Case Report. An 18-year-old man with severe head trauma was admitted to our hospital. Initial computed tomography (CT) revealed a high attenuation of intraocular silicone that could be mistaken for a hemorrhage. Ophthalmological examination and detailed ophthalmic history confirmed silicone oil in his eye for treatment of retinal detachment. Knowledge of the anatomical changes and radiological appearance of postsurgical findings following retinal detachment, including the surgical materials of silicone oil or bands, can prevent unnecessary alarm. Conclusion: Implanted ophthalmic devices, for example, silicone oil, appear similar to hemorrhages on CT and magnetic resonance imaging and cause diagnostic confusion. When in doubt, it is useful to assess the clinical presentation and obtain an accurate medical history.

DOI： 10.1155/2021/9940395

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Urinary Retention as the Presenting Clinical Manifestation of Unstable Thoracic Spinal Fracture with Diffuse Idiopathic Skeletal Hyperostosis. International journal

Hisashi Hamaguchi, Tetsuya Yumoto, Soichiro Mae, Ayumu Takeshita, Minae Aoyama, Keiya Yamana, Atsunori Nakao

Clinical medicine insights. Case reports 14 11795476211027988 - 11795476211027988 2021

Language：English

Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition.

DOI： 10.1177/11795476211027988

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Incidence and characteristics of medical emergencies related to dental treatment: a retrospective single-center study. International journal

Kyoichi Obata, Hiromichi Naito, Hiromasa Yakushiji, Takafumi Obara, Kisho Ono, Tsuyoshi Nojima, Kohei Tsukahara, Taihei Yamada, Akira Sasaki, Atsunori Nakao

Acute medicine & surgery 8 ( 1 ) e651 2021

Language：English Publishing type：Research paper (scientific journal)

AIM: Although uncommon, medical emergencies arise in general dental practice. Inadequate data on their severity and frequency makes targeting medical education for general dental practitioners difficult. This also makes planning for unexpected events challenging for practitioners and makes collaborating with emergency physicians burdensome. We aimed to clarify the incidence and characteristics of a dental outpatient department's medical emergencies. METHODS: This single-center, retrospective, observational study was undertaken with patients who visited the dental outpatient department of Okayama University Hospital during the 8-year period. The primary outcome of the study was to identify the incidence and characteristics of medical emergencies in the dental outpatient department. Then we examined the timing of medical emergencies, administered medications, and final disposition (home/admission). RESULTS: During the period, 1,146,929 patients were enrolled. Forty-two patients (0.0037%) were consulted as medical emergencies. More than 60% of the incidents were vasovagal syncope, and dehydration and hypoglycemia were the second most prevalent at 9.5%. The most common types of dental treatments were tooth extraction (45.2%), followed by general dental treatment (28.6%), and other dental surgery such as implant placement (14.3%). Types of medical emergencies occurred equally before, during, and after dental treatment. Antihypertensive agents, sedatives, or glucose were used. For patients with emergencies, 90.5% recovered during the day and returned home, and 9.5% were hospitalized. CONCLUSION: The incidence of medical emergencies was low in our dental outpatient department. Knowledge of basic management principles, regular education for emergency care, and practicing first aid skills are mandatory for safe patient management.

DOI： 10.1002/ams2.651

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Oral Ethanol Treatment for Ethylene Glycol Intoxication. International journal

Misa Sasanami, Taihei Yamada, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

Cureus 12 ( 12 ) e12268 2020.12

Language：English

Ethylene glycol is an odorless, sweet-tasting liquid found in industrial solutions such as antifreeze and windshield wiper fluid. Brake fluid, an automobile transmission liquid, contains poisonous alcohols such as glycol ethers and ethylene glycols. The toxicity of ethylene glycol is associated with toxic metabolite production by the liver enzyme alcohol dehydrogenase. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. A 42-year-old male car mechanic was transferred to our hospital after accidentally ingesting approximately 100 mL of brake fluid. Immediately after ingestion, he threw up most of the ingested liquid; however, he complained of nausea and throat pain and was moved to our emergency department. The patient was successfully treated with administration of oral ethanol in the form of whisky through a nasogastric tube since neither intravenous ethanol nor fomepizole was available in our hospital at the time of his presentation. Our case demonstrates that oral ethanol can be used as an alternative treatment for patients with ethylene glycol intoxication.

DOI： 10.7759/cureus.12268

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Potentially fatal ingestion of heat-not-burn cigarettes successfully treated by gastric lavage. Reviewed International journal

Tetsuya Yumoto, Hisashi Hamaguchi, Souichiro Mae, Atsunori Nakao

Journal of the American College of Emergency Physicians open 1 ( 6 ) 1709 - 1711 2020.12

Language：English

Newly introduced heat-not-burn or electronic cigarettes can cause lethal nicotine intoxication if ingested at higher doses. Although routine gastric lavage is not recommended, it should be considered if the amount of intoxicant is lethal. A 59-year-old man with a history of depression was brought to our emergency department after intentional ingestion of 8 heat-not-burn cigarettes, which were estimated to contain a total of 100 mg of nicotine. Abdominal computed tomography confirmed the gastric contents, detecting multiple stick-like and rod-shaped high-density structures. Gastric lavage was performed to minimize absorption of the potentially lethal nicotine dose. The patient exhibited only mild gastrointestinal symptoms. Emergency physicians should be aware of this novel heat-not-burn cigarette and its toxicity.

DOI： 10.1002/emp2.12283

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Delay in Emergency Medical Service Transportation Responsiveness during the COVID-19 Pandemic in a Minimally Affected Region. Reviewed

Kohei Ageta, Hiromichi Naito, Takashi Yorifuji, Takafumi Obara, Tsuyoshi Nojima, Taihei Yamada, Kohei Tsukahara, Hiromasa Yakushiji, Atsunori Nakao

Acta medica Okayama 74 ( 6 ) 513 - 520 2020.12

Language：English Publishing type：Research paper (scientific journal)

Few studies have investigated the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on emer-gency medical service (EMS) systems, especially in areas less affected or unaffected by COVID-19. In this study, we investigated changes in prehospital EMS activity and transport times during the COVID-19 pandemic. All patients transported by EMS in the city of Okayama from March-May 2019 or March-May 2020 were included. Interfacility transports were excluded. The primary outcome was the time from a patient's first emergency call until hospital arrival (total prehospital time). Secondary outcomes included three segments of total prehospital time: the response time, on-scene time, and transportation time. Total prehospital time and the durations of each segment were compared between corresponding months in 2020 (COVID19-affected) and 2019 (control). The results showed that total prehospital times in April 2020 were significantly higher than those in 2019 (33.8 ± 11.6 vs. 32.2 ± 10.8 min, p < 0.001). Increases in total prehospital time were caused by longer response time (9.3 ± 3.8 vs. 8.7 ± 3.7 min, p < 0.001) and on-scene time (14.4 ± 7.9 vs. 13.5 ± 6.2min, p < 0.001). The COVID-19 pandemic was thus shown to affect EMS and delayed arrival/response even in a minimally affected region. A system to minimize transportation delays should be developed for emerging pandemics.

DOI： 10.18926/AMO/61210

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Feasibility study of a portable transparent vinyl chloride shield for use in an ambulance during the COVID-19 pandemic. Reviewed International journal

Kohei Tsukahara, Hiromichi Naito, Tsuyoshi Nojima, Takashi Yorifuji, Atsunori Nakao

Critical care (London, England) 24 ( 1 ) 651 - 651 2020.11

Burning Mouth Syndrome Induced by Angiotensin-Converting Enzyme Inhibitors. International journal

Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Hitoshi Koga, Atsunori Nakao

Cureus 12 ( 11 ) e11376 2020.11

Language：English

Burning mouth syndrome (BMS) is characterized as the sensation of burning in the tongue or any other area of the oral mucosa without a medical or dental cause. BMS's pathophysiology is poorly understood and may be caused by its association with various factors, particularly with antihypertensive or psychotropic medicines. Although BMS is a relatively common intraoral disorder in the dental field, emergency physicians rarely recognize it. We report a 53-year-old Japanese woman who presented to our ED with a three-week history of a strange taste and burning tongue. The patient had poor control of hypertension, captopril, an angiotensin-converting enzyme (ACE) inhibitor, was added three weeks before presentation. We discontinued her ACE inhibitor and changed her medication to a beta-blocker. After two weeks, her symptoms improved. Emergency physicians must be aware that ACE inhibitors play some roles in the pathogenesis of BMS. The correct diagnosis of the condition depends on recognizing the disease and improving the quality of life.

DOI： 10.7759/cureus.11376

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敗血症治療後嚥下障害の発症頻度とリスク因子(Frequency and Risk Factors of Dysphagia Following Sepsis Treatment)

本郷貴識, 内藤宏道, 藤原俊文, 野崎哲, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 2261 - 2261 2020.11

食事に関する詳細な問診を必要とした壊血病の一例

小出恭大, 山田太平, 小崎吉訓, 野島剛, 塚原紘平, 藤崎宣友, 尾迫貴章, 内藤宏道, 城端慧, 高岡諒, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 2105 - 2105 2020.11

当院における産科救急の現状

藤崎宣友, 山本浩継, 野島剛, 小崎吉訓, 青景聡之, 塚原紘平, 山田太平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 1921 - 1921 2020.11

amplitude-integrated EEGが意識障害患者の診断・早期治療に有効であった悪性症候群の1例

中村俊介, 内藤宏道, 野島剛, 小崎吉訓, 山本浩継, 藤崎宣友, 青景聡之, 塚原紘平, 山田太平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 1105 - 1105 2020.11

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Papers - NAKAO Atsunori