Faculty Profiles - NAKAO Atsunori

Papers - NAKAO Atsunori

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Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report

Taiki Higaki, Kohei Tsukahara, Takafumi Obara, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Respiratory Medicine Case Reports 31 101182 - 101182 2020

Three-year-old traumatic liver injury patient treated successfully using transcatheter arterial embolization

Atsuyoshi Iida, Tsuyoshi Ryuko, Masaichi Kemmotsu, Hiroaki Ishii, Hiromichi Naito, Atsunori Nakao

International Journal of Surgery Case Reports 70 205 - 208 2020

A family intoxicated by daffodil bulbs mistaken for onions. International journal

Kohei Ageta, Hiromasa Yakushiji, Yoshinori Kosaki, Takafumi Obara, Tsuyoshi Nojima, Akira Gochi, Hiromichi Naito, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e595 2020

Retropharyngeal hematoma presenting airway obstruction: A case report. Reviewed International journal

Atsuyoshi Iida, Ayumi Nishida, Seiji Yoshitomi, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 77 321 - 324 2020

Language：English

INTRODUCTION: Blunt neck trauma patients can suffer from an airway emergency and are necessary to careful observation. PRESENTATION OF CASE: A 79-year-old man under anticoagulation therapy presented to our hospital three hours after a fall. Shortly after arrival, he developed dyspnea. Oral intubation was attempted, but with no success; therefore, an emergency tracheotomy was performed. Contrast-enhanced computed tomography (CT) and subsequent angiography revealed active bleeding from a branch of the right ascending cervical artery. Subsequently, the right thyrocervical trunk, which is upstream from the ascending cervical artery, was embolized and hemostasis was achieved. He was discharged 52 days after the emergency admission. DISCUSSION: This is the first case report of an ascending cervical artery injury due to blunt trauma that resulted in an airway emergency. Contrast-enhanced CT and cervical angiography are useful for confirming the area of injury and size of the hematoma. Half of patients with respiratory distress accompanied by a cervical spine injury require definitive airway management within five hours of the injury and all by 24 h. Neck trauma can lead to fatal airway obstruction and careful monitoring is warranted to detect any signs of impeding respiratory obstruction. CONCLUSION: All emergency physicians need to keep their airway management skills updated in order to perform reliably and rapidly in difficult and urgent situations.

DOI： 10.1016/j.ijscr.2020.11.007

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COVID-19 pandemic and shortage of personal protective equipment in Tokyo clinics. International journal

Mototaka Inaba, Hiromichi Naito, Taizo Sakata, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e527 2020

Incidence and related factors of hypoxia associated with elderly femoral neck fractures in the emergency department setting. International journal

Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Mototaka Inaba, Noritomo Fujisaki, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e618 2020

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

AIM: Femoral neck fractures in elderly patients needing oxygen therapy are often encountered in the emergency department. This single-center, retrospective, observational study aimed to examine the frequency, cause, and factors related to hypoxia in elderly patients with femoral neck fractures. METHODS: We analyzed data from 241 patients admitted to Okayama Saiseikai General Hospital (Okayama, Japan) from April 2016 to March 2019. Hypoxia was defined as PaO2 / FiO2 ratio under 300. The independent factors for hypoxia were determined by multiple logistic regression analysis. RESULTS: There were 194 patients who met the study inclusion criteria, 148 in the non-hypoxia group and 46 in the hypoxia group. The hypoxia group included patients with pneumonia (n = 3), chronic obstructive pulmonary disease (n = 2), pulmonary edema (n = 1), and pulmonary embolization (n = 1). The cause of hypoxia was undetermined in 39 cases. However, occult fat embolism syndrome was suspected in 29 of these 39 cases based on Gurd and Wilson criteria after considering clinical examination results. Barthel indexes were significantly lower in the hypoxia group on discharge. Age (adjusted odds ratio [OR] 1.07; 95% confidence interval [CI], 1.00-1.14; P = 0.038), D-dimer (adjusted OR 1.02; 95% CI, 1.00-1.03; P = 0.005), and transtricuspid pressure gradient (adjusted OR 1.03; 95% CI, 1.00-1.07; P = 0.015) were independently associated with the hypoxia. CONCLUSION: We found that hypoxia, including undetermined hypoxia, was commonly encountered in the emergency department. Hypoxia in elderly patients with femoral neck fractures was associated with age, D-dimer, and transtricuspid pressure gradient and needs further investigation.

DOI： 10.1002/ams2.618

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Transient Global Amnesia in a Patient Presenting with Hypertensive Emergency; a Case Report. International journal

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

Archives of academic emergency medicine 8 ( 1 ) e66 2020

Language：English

Transient global amnesia (TGA) is characterized by the abrupt onset of global amnesia, particularly anterograde amnesia. The pathophysiology of TGA is poorly understood and it could be caused by various factors and be associated with various diseases. We report a 58-year-old man who presented to the local emergency room with TGA lasting for several hours. The patient had complete anterograde amnesia without a past medical history of migraine or neurological findings. His systolic blood pressure on presentation was 220 mmHg, which was immediately treated with intravenous calcium ion influx inhibitor. Other than global amnesia, there was no evidence of neurological disturbance. Computed tomography and magnetic resonance imaging results were unremarkable. After treatment of his hypertension, his amnesia resolved within 12 hours. Emergency department physicians may encounter TGA. Correct diagnosis of the condition depends on recognizing the disease.

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Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report. International journal

Yasuhiro Koide, Takaaki Osako, Masahiro Kameda, Hiromi Ihoriya, Hirotsugu Yamamoto, Noritomo Fujisaki, Toshiyuki Aokage, Tetsuya Yumoto, Isao Date, Hiromichi Naito, Atsunori Nakao

Journal of medical case reports 13 ( 1 ) 361 - 361 2019.12

Language：English

INTRODUCTION: Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst. CASE PRESENTATION: A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management. CONCLUSION: Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.

DOI： 10.1186/s13256-019-2308-0

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大規模地震時医療活動訓練における医療資機材の空輸航空会社との連携と今後の課題

三木真彩菜, 三橋乙矢, 加藤湖月, 平山隆浩, 野島剛, 山田太平, 塚原紘平, 尾迫貴章, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 338 - 338 2019.12

Higher enhanced computed tomography attenuation value of the aorta is a predictor of massive transfusion in blunt trauma patients. Reviewed International journal

Tetsuya Yumoto, Hiromi Ihoriya, Ryo Tanabe, Hiromichi Naito, Atsunori Nakao

Clinical and experimental emergency medicine 6 ( 4 ) 330 - 339 2019.12

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

OBJECTIVE: Several scoring systems have been developed to identify patients who require massive transfusion (MT) after major trauma to improve survival. The primary goal of this study was to investigate the usefulness of enhanced computed tomography attenuation values (CTAVs) of major vessels to determine the need for MT in patients with major blunt trauma. METHODS: This single-center retrospective cohort study evaluated patients aged 16 years or older who underwent contrast-enhanced computed tomography scan of the torso after major blunt trauma. The CTAVs of six major vessel points in both the arterial and portal venous phases at initial computed tomography examination were assessed and compared between the MT and the no MT group. The capability of enhanced CTAVs to predict the necessity for MT was estimated based on the area under the receiver operating characteristic curve. RESULTS: Of the 254 eligible patients, 36 (14%) were in the MT group. Patients in the MT group had significantly higher CTAVs at all sites except the inferior vena cava in both the arterial and portal venous phases than that in the no MT group. The descending aorta in the arterial phase had the highest accuracy for predicting MT, with an AUROC of 0.901 (95% confidence interval, 0.855 to 0.947; P<0.001). CONCLUSION: Initial elevation of enhanced CTAV of the aorta is a predictor for the need for MT. A higher CTAV of the aorta should alert the trauma surgeon or emergency physician to activate their MT protocol.

DOI： 10.15441/ceem.18.090

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岡山大学病院における多数傷病者受入れの現状と課題(続報)

高田洋介, 渡邉暁洋, 山田太平, 小崎吉訓, 塚原紘平, 内藤宏道, 中尾博之, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 246 - 246 2019.12

災害時、都道府県庁には、いつ、だれが行く?西日本豪雨災害を経験した岡山県の取り組み

山田太平, 小崎吉訓, 塚原紘平, 内藤宏道, 高田洋介, 渡邉暁洋, 大川恭昌, 加藤湖月, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 242 - 242 2019.12

岡山市におけるG20保健大臣会合を見据えた爆弾テロ対策訓練の報告

三橋乙矢, 大川恭昌, 小崎吉訓, 加藤湖月, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 443 - 443 2019.12

岡山大学医学部医学科クリニカルクラークシップでの災害医学教育の取り組み

小崎吉訓, 高田洋介, 渡邊暁洋, 山田太平, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 369 - 369 2019.12

Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients. Reviewed International journal

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Toshiyuki Aokage, Noritomo Fujisaki, Atsunori Nakao

BMC emergency medicine 19 ( 1 ) 65 - 65 2019.11

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

BACKGROUND: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. METHODS: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. RESULTS: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. CONCLUSIONS: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

DOI： 10.1186/s12873-019-0282-x

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VV-ECMOを駆使して他院に収容された超重症呼吸不全をECMOで救命するチーム派遣・ECMO導入・搬送まで担う高度ECMO搬送システムの構築

青景聡之, 小崎吉訓, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 30 ( 9 ) 557 - 557 2019.9