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Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score. 国際誌

Emily Knaup, Nobuyuki Nosaka, Takashi Yorifuji, Kohei Tsukahara, Hiromichi Naito, Hirokazu Tsukahara, Atsunori Nakao

Journal of intensive care 7 38 - 38 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the Japanese pediatric ICU patients based on their LOS. Second, we aimed to develop a simple scoring system to predict long-stay pediatric ICU patients on admission. METHODS: We performed a retrospective cohort study using consecutive pediatric data (aged < 16 years) registered in the Japanese Registry of Pediatric Acute Care (JaRPAC) from October 2013 to September 2016, which consisted of descriptive and diagnostic information. The factors for long-stay patients (LSPs; LOS > 14 days) were identified using multiple regression analysis, and subsequently, a simple predictive scoring system was developed based on the results. The validity of the score was prospectively tested using data from the JaRPAC registration from October 2016 to September 2017. RESULTS: Overall, 4107 patients were included. Although LSPs were few (8.0% [n = 330]), they consumed 38.0% of ICU bed days (9750 for LSPs versus 25,659 overall). Mortality was seven times higher in LSPs than in short-stay patients (9.1% versus 1.3%). An 11-variable simple predictive scoring system was constructed, including Pediatric Index of Mortality 2 ≥ 1 (2 points), liver dysfunction (non-post operation) (2 points), post-cardiopulmonary resuscitation (1 point), circulatory disorder (1 point), post-operative management of liver transplantation (1 point), encephalitis/encephalopathy (1 point), myocarditis/cardiomyopathy (1 point), congenital heart disease (non-post operation) (1 point), lung tissue disease (1 point), Pediatric Cerebral Performance Category scores ≥ 2 (1 point), and age < 2 years (1 point). A score of ≥ 3 points yielded an area under the receiver operating characteristic curve (AUC) of 0.79, sensitivity of 87.0%, and specificity of 59.4% in the original dataset. Reproducibility was confirmed with the internal validation dataset (AUC 0.80, sensitivity 92.6%, and specificity 60.2%). CONCLUSIONS: Pediatric LSPs possess a significant presence in Japanese ICUs with high rates of bed utilization and mortality. The newly developed predictive scoring system may identify pediatric LSPs on admission.

DOI： 10.1186/s40560-019-0392-2

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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

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Caffeine Intoxication in Pregnancy; a case Report. 国際誌

Tsuyoshi Nojima, Hiromichi Naito, Yoshinori Kosaki, Takaaki Osako, Kimiaki Tanaka, Atsuo Murata, Atsunori Nakao

Archives of academic emergency medicine 7 ( 1 ) e67 2019年

記述言語：英語

Although fatalities due to caffeine intoxication are uncommon, a caffeine overdose may cause profound toxicity, resulting in tachycardia, arrhythmia, convulsions, vomiting, coma, and possibly death. In particular, high caffeine consumption while pregnant can cause increased fetal catecholamine levels, which could lead to increased fetal heart rate and placental vasoconstriction and impair fetal oxygenation. Therefore, caffeine intoxication in pregnant women should be treated immediately. Herein, we present a 33-year-old pregnant woman who was treated in our department after ingesting 4000mg of caffeine in an attempt to commit suicide. We successfully treated our patient, and she delivered a healthy baby at 38 weeks.

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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

Heat-not-burn cigarettes induce fulminant acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation. 国際誌

Toshiyuki Aokage, Kohei Tsukahara, Yasushi Fukuda, Fumiaki Tokioka, Akihiko Taniguchi, Hiromichi Naito, Atsunori Nakao

Respiratory medicine case reports 26 87 - 90 2019年

記述言語：英語

Background: Although the cause of acute eosinophilic pneumonia (AEP) has not yet been fully clarified, cigarette smoking is reported to be a risk factor for developing AEP. The heat-not-burn cigarette (HNBC) was developed to reduce the adverse effects of smoke on the user's surroundings. However, the health risks associated with HNBCs have not yet been clarified. We report a successfully treated case of fatal AEP presumably induced by HNBC use. Presentation of case: A 16-year-old man commenced HNBC smoking two weeks before admission and subsequently suffered from shortness of breath that gradually worsened. The patient was transferred to emergency department and immediately intubated because of respiratory failure. Computed tomography showed mosaic ground-glass shadows on the distal side of both lungs with a PaO2/FIO2 ratio of 76. The patient required veno-venous extracorporeal membrane oxygenation (ECMO) for severe respiratory failure. He was diagnosed with AEP by clinical course and detection of eosinophils in sputum; thus, methylprednisolone was administrated. The patient was weaned off ECMO four days after initiation and extubated the day after. He fully recovered without sequelae. Conclusion: As far as we know, our patient is the first case of AEP induced by HNBC use successfully treated with ECMO. Emergency physicians must be aware that HNBCs can induce fatal AEP.

DOI： 10.1016/j.rmcr.2018.12.002

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A case of spontaneous mesenteric hematoma successfully diagnosed and treated with aggressive imaging. 査読国際誌

Shunsuke Nakamura, Taihei Yamada, Tsuyoshi Nojima, Hiromichi Naito, Hitoshi Koga, Hisashi Yamashita, Akira Gochi, Atsunori Nakao

International journal of surgery case reports 65 124 - 126 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Spontaneous mesenteric hematoma is an uncommon syndrome triggered by bleeding localized in the mesenteric vascular tree of a bowel segment for no apparent underlying reason. We herein report a surgical patient with an extremely rapidly growing spontaneous mesenteric hematoma that we successfully diagnosed using careful radiologic examination. PRESENTATION OF CASE: A 56-year-old old male presenting sudden onset lower abdominal pain was referred to our emergency department. At the time of admission, his physical examination revealed stable vital signs without radiological abnormality. On the following day, the patient suddenly presented hypotension, tachycardia, and increased abdominal pain. Contrast-enhanced computed tomography examination showed a mass with both high- and low-density areas with a 130 mm maximum diameter bordering the transverse colon. Since interventional radiologists were not available, we decided to perform emergency exploratory laparotomy. On laparotomy, a 13 × 8 cm hematoma was found in the mesentery of the transverse colon. As bleeding was noted from the branches of the middle colic artery and gastrocolic artery, these responsible vessels were ligated. The patient was finally given the diagnosis of spontaneous mesenteric hematoma. DISCUSSION AND CONCLUSION: The present case, initially diagnosed as enterocolitis, suddenly manifested hypovolemic shock. Close monitoring for any signs of further deterioration, as well as aggressive imaging diagnosis, enabled us to avoid delays in treatment. Early diagnosis and treatment of mesenteric hematomas are essential to prevent them from rupturing and triggering life-threatening adverse events.

DOI： 10.1016/j.ijscr.2019.10.058

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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.

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アンモニアガス曝露による気管狭窄・肺胞障害を認めた症例

沢田孝平, 小崎吉訓, 山本浩継, 藤崎宣友, 青景聡之, 山田太平, 塚原紘平, 万代康弘, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 437 - 437 2018年10月

学会開催日とその前後で外傷患者の死亡率に差はあるか? 日本外傷データバンクより

湯本哲也, 内藤宏道, 庵谷紘美, 小崎吉訓, 山川泰明, 飯田淳義, 山本浩継, 山田太平, 塚原紘平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 473 - 473 2018年10月

腹部CTからみた薬物過量内服

浅田遼, 塚原紘平, 内藤宏道, 飯田淳義, 小崎吉訓, 山川泰明, 湯本哲也, 山本浩継, 山田太平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 444 - 444 2018年10月

腹筋運動が誘因となったと思われる特発性腹直筋血腫の1症例

山田太平, 小崎吉訓, 湯本哲也, 飯田淳義, 山本浩継, 藤崎宣友, 青景聡之, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 553 - 553 2018年10月

大動脈のCT値を利用した重症外傷患者における新規大量輸血予測ツールの開発

庵谷紘美, 湯本哲也, 小崎吉訓, 山川泰明, 飯田淳義, 山本浩継, 山田太平, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 473 - 473 2018年10月

本人・家族からの申告のなかった農薬中毒例の検討

有吉雪乃, 内藤宏道, 萩岡信吾, 小崎吉訓, 飯田淳義, 湯本哲也, 山田太平, 塚原紘平, 尾迫貴章, 森本直樹, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 446 - 446 2018年10月

A rapid caliber change in the inferior vena cava during multiphasic contrast-enhanced computed tomography may signal an acute anaphylactic reaction to nonionic contrast medium. 国際誌

Takayoshi Shinya, Akihiro Tada, Yoshihisa Masaoka, Nanako Ogawa, Satoko Makimoto, Hiroki Ihara, Ryuichiro Fukuhara, Noriaki Akagi, Takao Hiraki, Atsunori Nakao, Susumu Kanazawa

Radiology case reports 13 ( 5 ) 970 - 974 2018年10月

記述言語：英語

Severe anaphylactic reactions to an intravenous nonionic iodine contrast medium (NICM) are uncommon but can result in permanent morbidity or death if not managed appropriately. An anaphylactic reaction to an NICM typically manifests as clinical symptoms that include an itchy nose, sneezing, and skin redness. To our knowledge, a rapid change in the caliber of the inferior vena cava (IVC) during multiphasic contrast-enhanced computed tomography (CT) has not been reported. Here, we report the computed tomographic findings in three cases of hypovolemic shock caused by an anaphylactic reaction to an NICM. We suspect that a decrease in caliber of the IVC during multiphasic contrast-enhanced CT may be a predictor of an allergic-like reaction to an NICM. Patients in whom physicians and radiographers detect a rapid caliber change in the IVC during multiphasic contrast-enhanced CT should be managed carefully.

DOI： 10.1016/j.radcr.2018.07.002

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高度救命救急センターにおけるCRRT膜のlifetimeに関する検討

岡田真澄, 平山隆浩, 末永健二, 藤原宏成, 落葉佑昌, 岩藤晋, 内藤宏道, 中尾篤典, 廣畑聡

日本急性血液浄化学会雑誌 9 ( Suppl. ) 139 - 139 2018年9月

Usefulness of 3-D computed tomography for diagnosis of abusive head trauma. 国際誌

Kazumasa Zensho, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao

Pediatrics international : official journal of the Japan Pediatric Society 60 ( 9 ) 889 - 891 2018年9月

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome

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：英語掲載種別：研究論文（学術雑誌）出版者・発行元：OKAYAMA UNIV MED SCHOOL

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. Life-threating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.

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Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome.

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

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Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury

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

Medicine 97 ( 23 ) e11022 - e11022 2018年6月

下部尿路損傷を伴う骨盤輪損傷の治療戦略

山川泰明, 小崎吉訓, 湯本哲也, 飯田淳義, 山田太平, 内藤宏道, 野田知之, 中尾篤典

日本外傷学会雑誌 32 ( 2 ) 300 - 300 2018年6月

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