A 44-year-old man with coronavirus disease 2019 (COVID-19) and nephrotic syndrome relapse was admitted to our intensive-care unit for respiratory failure. Despite receiving mechanical ventilation and ...immunomodulators, the patient experienced refractory hypoxemia, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy. Due to a worsening renal function, continuous hemodiafiltration was initiated. After 11 days, his respiratory status gradually improved, and VV-ECMO was withdrawn. The kidney function and proteinuria improved, and hemodialysis was subsequently discontinued. The patient was discharged 64 days after admission. This case highlights the potential benefit of early ECMO application in dramatically promoting recovery in severe COVID-19 cases.
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) is a gram-negative bacillus commonly isolated from aquatic environments and various aquatic animals. It rarely causes infections in humans, but rare human infections occur primarily through ...ingestion of infected seafood or aquatic animals. Symptoms include fever, gastroenteritis, and diarrhea, but severe extraintestinal infections have also been reported. This report describes a 76-year-old female developing
infection with iliopsoas abscess following acute pyelonephritis. Her chief complaint was fatigue and difficulty moving. Blood tests showed an increased inflammatory response, but the cause could not be identified from the patient's medical history, physical findings, and imaging findings. We diagnosed it as a urinary tract infection from the results of gram staining and started treatment, but the fever persisted thereafter, and a contrast-enhanced CT scan performed for re-evaluation revealed an iliopsoas abscess. After CT-guided abscess drainage, the patient made good progress and was transferred to a rehabilitation hospital on day 48 of the presentation. To the best of our knowledge, this is the first report of a case of
infection with iliopsoas abscess following acute pyelonephritis. Iliopsoas abscess is often difficult to diagnose. In this case report, we also present how we diagnosed and treated iliopsoas abscesses.
Objective To identify pulmonary thromboembolism (PTE) using the thrombus attenuation value on unenhanced computed tomography (CT).Design Single-center retrospective study (January 2015-Marcg ...2020).Methods Patients who underwent both unenhanced and enhanced CT for suspected PTE were enrolled. Patients with a hyperdense lumen on unenhanced CT and thrombi in the peripheral pulmonary artery (PA) were excluded. Patients were classified into two groups: thrombi (thrombi detected in PA by enhanced CT) and non-thrombi (attenuations of the main PA evaluated as thrombi). Mean CT attenuation values of the thrombi, main PA, and pulmonary trunk (blood pool) were measured. The attenuation values of the thrombus (T) and the thrombus to blood-pool (T/P), thrombus to hemoglobin (T/Hb), and thrombus to hematocrit (T/Ht) ratios were evaluated. The cut-off attenuation value of the thrombus was calculated by a receiver operating characteristic curve and its accuracy in detecting PTE was determined.Results Of the 260 patients enrolled, 40 were included, of whom 24 had confirmed PTE. The mean T was 27.25 Hounsfield units(HU) and 36.66HU (p<0.001), and the T/P ratio was 0.74 and 0.99 (p=0.004) in the PTE and non-PTE groups, respectively. The thrombus cut-off value for PTE diagnosis was 30.85 HU. The sensitivity and specificity were 79. 9% and 87.5%.Conclusions Measuring and evaluating the attenuation value for the central PA and T/P ratio on unenhanced CT improves the diagnostic ability of central PTE in patients suspected to have PTE but cannot tolerate contrast medium.
A 78‐year‐old Japanese man was in a state of shock with skin flushing. Although he denied, his wife revealed his prescription disulfiram for alcoholism. Disulfiram‐ethanol reaction, even though it is ...a rare cause of distributive shock, could be easily and quickly differentiated only based on accurate medical history and inspection.
Even if disulfiram–ethanol reaction is difficult to diagnose especially under a state of shock and disturbance of consciousness, it could be easily and quickly differentiated by not laboratory findings, but only inspection and a medical history.
A 42-year-old Japanese woman with a 10-year history of schizophrenia was admitted due to a disturbance in consciousness that met the diagnostic criteria for both neuroleptic malignant syndrome (NMS) ...and malignant catatonia. Despite systemic supportive treatments, the catatonic symptoms preceding autonomic symptoms persisted. The symptoms improved after lorazepam administration, leading to a retrospective diagnosis of malignant catatonia. Catatonia is thought to be caused by a dysfunction of ganmma-aminobutyric acid type A receptors in the cortico-cortical networks of the frontal lobes, which causes hypoactivity of the dopaminergic transmission in the subcortical areas. Identifying the catatonic symptoms preceding autonomic symptoms could aid in distinguishing malignant catatonia from NMS.
We found no association between the number of systems of symptoms and the incidence of biphasic reactions. Currently, predicting the onset of biphasic reactions is difficult. Further prospective and ...nationwide studies are required to research biphasic reactions.
Aim
Anaphylaxis is a severe, life‐threatening, generated or systemic reaction, and biphasic reaction could occur in some cases. We investigated the clinical course of anaphylaxis in our hospital and studied the relationship between biphasic reactions and the symptoms and treatments for predicting the onset of biphasic reactions.
Methods
We retrospectively reviewed the medical records of 120 patients with anaphylaxis who were admitted to our hospital from the emergency department during April 2008–October 2015.
Results
The incidence of biphasic reactions of anaphylaxis in our hospital was 10.8% (13 patients) without significant difference when compared with that in previous reports. Regarding the development of biphasic reactions, symptoms, the number of systems of symptoms and severity of the initial reaction, and treatment with adrenaline and corticosteroid were not clearly related with biphasic reaction. Use of adrenaline in the initial treatment was approximately 60%. Of the 13 biphasic reactions, 11 (84.5%) were as equal/mild as the original symptoms.
Conclusion
This study could not show the factors predicting the onset of biphasic reactions. Further prospective and nationwide studies are required to research biphasic reactions.
Abstract Objective To determine if the POSSUM, SOFA, MPI, and SAS scores provide a better measure of severity for patients with prognostic factors undergoing surgery for colorectal perforation. ...Subjects Fifty-nine patients who underwent surgery between 1996 and 2012. Methods We retrospectively reviewed background factors, blood and physiological test results, and intraoperative findings of patients who survived and those who died. We also compared the POSSUM, SOFA, MPI, and SAS scores. Multivariate analysis was performed for factors that were significant by univariate analysis, and selected factors were used to produce a predictive prognostic model. Results Univariate analysis revealed significant differences in age, anticoagulant/steroid administration, serum creatinine level, PF ratio, base excess (BE), chest radiography, pulse rate, and severity of peritoneal soiling. Age, serum creatinine level, pulse rate, and severity of peritoneal soiling were selected for multivariate analysis; only pulse rate was significantly different. There were significant differences between the two groups in POSSUM PS, OSS, SOFA, and MPI scores, and a comparison in terms of the ROC curve showed that our model had the highest peak; the area under the curve was 94.8% compared with 70–80% for the other systems, suggesting that our model is better than those systems. Conclusions POSSUM and SOFA are valid methods of evaluating risk from colorectal perforation, but our study revealed addition risk factors: (1) the PF ratio and BE, which are not included in POSSUM; (2) the pulse rate and severity of peritonitis, which are not included in SOFA; and (3) anticoagulant/steroid hormone administration.
Our hospital is the only hospital in Nerima where emergency doctors are available to provide medical care 24 hours a day, and is in the position to accept patients in the event of disaster as a ...disaster base hospital. Even though Nerima-ward is a commuter town in Tokyo with a population of 700,000, the number of beds per capita is the lowest among the 23 wards. That being said, we have been working to build a regional collaboration among local hospitals, medical associations, and administrative bodies since our establishment as our contribution toward disaster control. For our in-hospital measures, we provide triage training and BCP (Business Continuity Plan) simulations, and have upgraded our facilities and increased our on-hand supplies for potential disasters. Moreover, we managed to send 13 staff to the site of the Great East Japan Earthquake in March 2011 for medical support. Other measures include our participation in and management of MIMMS (Major Incident Medical Management and Support), which is a course for disaster simulation training and DMAT (Disaster Medical Assistance Team) activity.
A search of the database Ichushi (Japana Centra Revuo Medicana), which collects summaries of Japanese medical articles, was undertaken to identify articles published between 1983 and 2013, using the ...key word “waterproof”. There was one original article and 19 case reports describing acute poisoning due to inhalation of waterproof spray gas, and providing information about the patient's smoking habit. Twenty‐three of the 25 cases (92% of male patients, 71% of female patients) had a smoking habit. The one female case who did not have a smoking habit was in an environment exposed to secondhand smoke, because her husband had smoking habit. All cases had respiratory symptoms, and 24 cases had lung edema confirmed by computed tomography. There were no fatal cases among these patients. The one original article reported that 93% of males and 49% of females among a total of 104 cases with acute poisoning due to inhalation of waterproof spray gas had a smoking habit. Accordingly, people with a smoking habit tend to be vulnerable to exposure to waterproof spray gas.
Out-of-hospital cardiac arrest (OHCA) is a serious condition. The volume-outcome relationship and various post-cardiac arrest care elements are believed to be associated with improved neurological ...outcomes. Although previous studies have investigated the volume-outcome relationship, adjusting for post-cardiac arrest care, intra-class correlation for each institution, and other covariates may have been insufficient.
To investigate the volume-outcome relationships and favorable neurological outcomes among OHCA cases in each institution.
We conducted a prospective observational study of adult patients with non-traumatic OHCA using the OHCA registry in Japan. The primary outcome was 30-day favorable neurological outcomes, and the secondary outcome was 30-day survival. We set the cutoff values to trisect the number of patients as equally as possible and classified institutions into high-, middle-, and low-volume. Generalized estimating equations (GEE) were performed to adjust for covariates and within-hospital clustering.
Among the 9909 registry patients, 7857 were included. These patients were transported to either low- (2679), middle- (2657), or high- (2521) volume institutions. The median number of eligible patients per institution in 19 months of study periods was 82 (range, 1-207), 252 (range, 210-353), and 463 (range, 390-701), respectively. After multivariable GEE using the low-volume institution as a reference, no significant difference in odds ratios and 95% confidence intervals were noted for 30-day favorable neurological outcomes for middle volume 1.22 (0.69-2.17) and high volume 0.80 (0.47-1.37) institutions. Moreover, there was no significant difference for 30-day survival for middle volume 1.02 (0.51-2.02) and high volume 1.09 (0.53-2.23) institutions.
The patient volume of each institution was not associated with 30-day favorable neurological outcomes. Although this result needs to be evaluated more comprehensively, there may be no need to set strict requirements for the type of institution when selecting a destination for OHCA cases.
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