Publications by authors named "Akira Kuriyama"

150 Publications

A pandemic recap: lessons we have learned.

World J Emerg Surg 2021 09 10;16(1):46. Epub 2021 Sep 10.

Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Los Angeles, USA.

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-021-00393-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430288PMC
September 2021

Melanosis Coli.

Authors:
Akira Kuriyama

JMA J 2021 Jul 9;4(3):291-292. Epub 2021 Jul 9.

Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31662/jmaj.2021-0031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8355635PMC
July 2021

Incidence and timing of biphasic anaphylactic reactions: a retrospective cohort study.

Acute Med Surg 2021 Jan-Dec;8(1):e689. Epub 2021 Jul 30.

Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan.

Aim: We investigated the frequency of overall biphasic reactions, biphasic reactions that met the diagnostic criteria of anaphylaxis, and biphasic reactions that caused a severe abnormality in vital signs in patients who visited the emergency department of a tertiary hospital.

Methods: This retrospective cohort study included patients aged 18 years or over who presented with anaphylaxis at the emergency department of a tertiary care hospital between January 2014 and December 2016. The primary outcome was the incidence of biphasic reactions that caused a severe abnormality in vital signs and developed within 7 days. Secondary outcomes were the frequency of overall biphasic reactions and those that met the diagnostic criteria of anaphylaxis.

Results: In total, 437 patients aged over 18 years visited the emergency department during the study period. Among them, 202 were enrolled in this study. The proportion of patients who had overall biphasic reactions, those that met the diagnostic criteria of anaphylaxis, and those with a severe abnormality in vital signs was 8.9%, 3.0%, and 1.0%, respectively. Overall, 32.7% of patients were hospitalized, but hospitalization aided in the treatment of severe biphasic reactions at the early stage in only one patient.

Conclusion: We found that 8.9% of adult patients with anaphylaxis had a biphasic reaction, but biphasic reactions together with severe abnormalities in vital signs were rare.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ams2.689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323456PMC
July 2021

Tips for Busy Clinicians to Gauge Conclusions from Clinical Trials.

J Gen Intern Med 2021 Jul 29. Epub 2021 Jul 29.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11606-021-07037-4DOI Listing
July 2021

Prevalence of bacterial contamination of touchscreens and posterior surfaces of smartphones owned by healthcare workers: a cross-sectional study.

BMC Infect Dis 2021 Jul 13;21(1):681. Epub 2021 Jul 13.

Department of Anesthesiology, Kurashiki Central Hospital, Okayama, Japan.

Background: Mobile phones used by healthcare workers (HCWs) are contaminated with bacteria, but the posterior surface of smartphones has rarely been studied. The aim of this study was to compare the prevalence of microbial contamination of touchscreens and posterior surfaces of smartphones owned by HCWs.

Methods: A cross-sectional study of smartphones used by HCWs employed at two intensive care units at a Japanese tertiary care hospital was performed. Bacteria on each surface of the smartphones were isolated separately. The primary outcomes were the prevalence of microbial contamination on each surface of smartphones and associated bacterial species. Fisher's exact test was used to compare dichotomous outcomes.

Results: Eighty-four HCWs participated in this study. The touchscreen and posterior surface were contaminated in 27 (32.1%) and 39 (46.4%) smartphones, respectively, indicating that the posterior surface was more frequently contaminated (p = 0.041). Bacillus species and coagulase-negative staphylococci were isolated from each surface of the smartphones.

Conclusions: The posterior surface of a smartphone was more significantly contaminated with bacteria than the touchscreen, regardless of having a cover. Therefore, routine cleaning of the posterior surface of a smartphone is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-021-06379-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276544PMC
July 2021

A sudden decrease in voice volume: A rare manifestation of spontaneous pneumomediastinum.

J Gen Fam Med 2021 Jul 16;22(4):218-220. Epub 2021 Feb 16.

Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan.

Spontaneous pneumomediastinum (SPM) is a rare condition characterized by free air in the mediastinum that primarily affects young individuals between the ages of 10 and 30 years. The most frequent symptoms of SPM are chest pain and dyspnea. However, a decrease in voice volume without a change of tone is a rare presentation. SPM is generally a benign and self-limiting condition, but it can occasionally cause tension pneumothorax. If a young patient presents with a sudden decrease in voice volume without a change of tone, SPM should be considered as a possible diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgf2.426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245747PMC
July 2021

Clenbuterol poisoning due to a mix-up between clenbuterol hydrochloride and other similarly shaped drug tablets.

Geriatr Gerontol Int 2021 Aug 19;21(8):746-747. Epub 2021 Jun 19.

Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ggi.14221DOI Listing
August 2021

Bodily Distress Syndrome After Routine Vaccination: A Case Report.

Authors:
Akira Kuriyama

J Acad Consult Liaison Psychiatry 2021 Sep-Oct;62(5):557-558. Epub 2021 Mar 30.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaclp.2021.03.002DOI Listing
March 2021

Bodily Distress Syndrome After Routine Vaccination: A Case Report.

Authors:
Akira Kuriyama

J Acad Consult Liaison Psychiatry 2021 Sep-Oct;62(5):557-558. Epub 2021 Mar 30.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaclp.2021.03.002DOI Listing
March 2021

Laboratory Risk Indicator for Necrotizing Fasciitis Score and Patient Outcomes.

J Emerg Trauma Shock 2021 Jan-Mar;14(1):38-41. Epub 2021 Mar 23.

Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan.

Context: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score helps to diagnose necrotizing soft-tissue infection (NSTI). The LRINEC score has been reported to be associated with poor prognosis, although few studies have evaluated this association.

Aims: We aimed to describe the characteristics of NSTI and assess whether the LRINEC score was associated with mortality and amputation.

Settings And Design: We conducted a retrospective observational study from January 2007 to May 2018, in a Japanese tertiary care hospital.

Subjects And Methods: Patients with NSTI were identified through our hospital database using the discharge diagnosis. We extracted data on patient characteristics, laboratory examinations, microbiological information, treatment, and in-hospital mortality.

Statistical Analysis Used: We estimated the odds ratios (ORs) and associated 95% confidence intervals (CIs) for in-hospital mortality using logistic regression models.

Results: We identified 58 patients. The median LRINEC score was 8 (interquartile range [IQR]: 6-9). Forty-four patients (75.9%) scored 6 or more. The eight patients with amputations had a median score of 6 (IQR: 4.5-7.5) versus 8 (IQR: 7-9) for patients who underwent debridement ( = 0.091). Survivors and nonsurvivors had median scores of 8 (IQR: 6-9) and 6 (IQR: 5-8), respectively ( = 0.148). The OR for mortality in patients with liver cirrhosis was 10.5 (95% CI: 1.00-110.36; = 0.050).

Conclusions: There was no association between the LRINEC score and patients' outcomes: mortality and amputation. Further studies are warranted to evaluate the utility of the LRINEC score and factors associated with poor prognosis in patients with NSTI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/JETS.JETS_17_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054806PMC
March 2021

Thrombophlebitis of the external jugular vein: A variant of Lemierre's syndrome.

IDCases 2021 24;24:e01074. Epub 2021 Mar 24.

Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hospital, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.idcr.2021.e01074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024591PMC
March 2021

Translation, Cultural Adaptation, and Validation of the Mini-Z 2.0 Survey among Japanese Physicians and Residents.

Intern Med 2021 Aug 22;60(15):2405-2411. Epub 2021 Feb 22.

Department of General Medicine, Faculty of Medicine, Shimane University, Japan.

Objective The Mini-Z 2.0 is a new, simple, and nonproprietary tool for assessing physician well-being and burnout. To date, a non-English version of the Mini-Z 2.0 survey has not been validated. Therefore, we aimed to develop a Japanese version of the Mini-Z 2.0 and to evaluate its validity and reliability using survey data from physicians affiliated with an internal medicine academic society. Methods The Mini-Z 2.0 survey was translated into Japanese using a forward-backward translation method. The participants belonged to the American College of Physicians' Japan Chapter. The translated version of the Mini-Z 2.0 survey was distributed to participants using an electronic mailing list. Convergent validity was assessed between burnout and other items using Pearson's product-moment statistic. Structural validity was evaluated using an exploratory factor analysis and confirmatory factor analysis, and reliability was assessed using internal consistency. Results Of the 1,255 physicians and medical residents contacted, 283 responded (22.5%). Burnout was present in 34.6% of the participants, with 48.8% reporting high stress levels. Convergent validity was demonstrated, with satisfactory correlations between burnout and satisfaction, value alignment, work control, and stress. An exploratory factor analysis identified two factors (i.e., Well-Being and Relationships and Work-Related Stressors); however, the three models evaluated using the confirmatory factor analysis revealed a poor fit. Cronbach's alpha for the sample was 0.80. Conclusion The Japanese version of the Mini-Z 2.0 demonstrated good internal consistency and convergent validity. Despite its inadequate structural validity, it can be used to measure physician well-being and related workplace conditions in Japan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2169/internalmedicine.6749-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381173PMC
August 2021

Wheezing of unexpected etiology: A case report of pea aspiration mimicking bronchus obstruction caused by a tumor.

Ann Med Surg (Lond) 2021 Feb 22;62:265-268. Epub 2021 Jan 22.

Emergency and Critical Care Center, Kurashiki Central Hospital, Japan,1-1-1 Miwa, Kurashiki Okayama, 710-8602, Japan.

Introduction: Geriatric patients with foreign body aspiration (FBA) lack a detailed medical history. Meanwhile, FBA can mimic other diseases and present with wheezing. Here, we report on the difficulty of making a diagnosis of FBA in an elderly man with wheezing.

Case Presentation: An 84-year-old man presented with wet cough. He had progressive lung cancer, for which only supportive care was provided. His physical examination revealed wheezing. We presumptively diagnosed acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) and administered inhaled procaterol and parenteral methylprednisolone, which did not mitigate his symptoms. Computed tomography revealed a round nodule, 1 cm in diameter, in his right intermediate bronchus. Central airway obstruction (CAO) caused by the tumor was initially suspected. However, bronchoscopy revealed a pea () lodged in his right bronchus, which was removed using forceps.

Discussion: The typical clinical presentations of FBA are sudden-onset cough and dyspnea. However, some geriatric patients do not have cough or lack the cognitive capacity to inform of an episode of FBA. FBA can mimic other entities including AE-COPD and CAO, as seen in our case. Clinicians should not terminate the diagnostic process until all available information explaining the patient's signs and symptoms is collected.

Conclusion: Despite the lack of apparent aspiration, FBA is an important differential diagnosis of new wheezing in the elderly. Physicians need to carefully evaluate "trivial" information or collect additional information when encountering airway symptoms in elderly patients to avoid missing an FBA diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amsu.2021.01.064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841212PMC
February 2021

Clinical Utility of Venous Blood Gas Analysis for the Evaluation of Psychogenic Hyperventilation in the Emergency Department.

Cureus 2020 Dec 25;12(12):e12273. Epub 2020 Dec 25.

Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JPN.

Background Patients with psychogenic hyperventilation frequently visit emergency departments (EDs). Arterial blood gas (ABG) analysis is performed to evaluate patients with dyspnea. This may show respiratory alkalosis in patients with hyperventilation. ABG may also reveal elevated serum lactate levels, although psychogenic hyperventilation syndrome is a benign condition. However, arterial puncture is a painful and risky procedure. We hypothesized that venous blood gas (VBG) analysis would be sufficient for evaluating patients with suspected psychogenic hyperventilation. Objectives To compare the clinical utility of VBG analysis with ABG analysis for evaluating psychogenic hyperventilation. Methods This was a single-center retrospective cross-sectional study of patients aged ≥18 years with psychogenic hyperventilation attending a tertiary care hospital. We extracted data on age, sex, vital signs, blood gas components, and serum lactate. Spearman's rank correlation coefficient (ρ) was used to examine the associations between the serum lactate levels and the carbon dioxide partial pressure (PCO) in the ABG and VBG groups. Results A total of 236 patients (ABG group, n=57; VBG group, n=179) were included in the analysis. Both the ABG and VBG groups had respiratory alkalosis and similarly elevated serum lactate levels (p=0.44). The PCO and serum lactate levels were inversely correlated, and the ρ values were -0.74 and -0.50 for the ABG and VBG groups, respectively (both p<0.001). In addition, the bicarbonate ion ([Formula: see text]) level was inversely correlated with the serum lactate level, and the pH was positively correlated with the serum lactate levels in both the ABG and VBG groups. Conclusions Among patients with psychogenic hyperventilation, respiratory alkalosis, and the correlation between the PCO and serum lactate levels were similar in the ABG and VBG groups, indicating that VBG analysis might be used as an alternative to ABG analysis for evaluating psychogenic hyperventilation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.12273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834592PMC
December 2020

Green urine due to propofol.

Authors:
Akira Kuriyama

Postgrad Med J 2020 Dec 30. Epub 2020 Dec 30.

Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki 710-8602, Okayama, Japan

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/postgradmedj-2020-139486DOI Listing
December 2020

Effect of dexmedetomidine on delirium during sedation in adult patients in intensive care units: A systematic review and meta-analysis.

J Clin Anesth 2021 May 3;69:110157. Epub 2020 Dec 3.

Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Electronic address:

Study Objective: To compare the effect of sedation protocols with and without dexmedetomidine on delirium risk and duration in adult patients in intensive care units (ICUs).

Design: A meta-analysis of randomized controlled trials.

Review Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and ISI Web of Science from inception to September 3, 2020. We included studies comparing the effect of dexmedetomidine-based sedation on delirium risk with non-dexmedetomidine-based sedation in adult patients in ICUs. We pooled the data using a random-effects model using Review Manager 5.2, and assessed publication bias using Stata 11.0. The quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation system.

Main Results: We included 36 studies involving 9623 participants. The use of dexmedetomidine was associated with reduced risk of delirium (risk ratio [RR], 0.63; 95% confidence interval [CI], 0.54-0.75; very low-quality evidence), but higher incidences of hypotension and bradycardia during hospital stay. Dexmedetomidine was also associated with shorter durations of ICU stay, hospital stay and mechanical ventilation. Dexmedetomidine did not affect ICU mortality (RR, 1.01; 95% CI, 0.89-1.14; low-quality evidence), hospital mortality (RR, 1.01; 95% CI, 0.91-1.12; very low-quality evidence), or 30-day mortality (RR, 0.77; 95% CI, 0.58-1.01; moderate-quality evidence), or duration of delirium (mean difference, -0.74 days; 95% CI, -1.83 to 0.36 days; very low-quality evidence). We identified publication bias for risk and duration of delirium, length of ICU stay, and hospital stay.

Conclusions: Low- or very low-quality evidence suggests that dexmedetomidine was associated with a clinically-small reduction of delirium risk, ICU/hospital stay and mechanical ventilation duration, but were not associated with improved mortality or shorter delirium duration in ICU patients. These findings were inconclusive because of publication bias, heterogeneity, and limited sample size. Significant adverse effects of dexmedetomidine include hypotension and bradycardia. PROSPERO registration number: CRD42018095358.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2020.110157DOI Listing
May 2021

Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis.

Crit Care 2020 11 7;24(1):640. Epub 2020 Nov 7.

Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.

Background: Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for post-extubation stridor. Previous systematic reviews demonstrated excellent specificity of the cuff leak test but disagreed with respect to sensitivity. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings.

Methods: We searched Medline, EMBASE, Scopus, ISI Web of Science, the Cochrane Library for eligible studies from inception to March 16, 2020, without language restrictions. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Two authors in duplicate and independently assessed the risk of bias using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We pooled sensitivities and specificities using generalized linear mixed model approach to bivariate random-effects meta-analysis. Our primary outcomes were post-extubation airway obstruction and reintubation.

Results: We included 28 studies involving 4493 extubations. Three studies were at low risk for all QUADAS-2 risk of bias domains. The pooled sensitivity and specificity of cuff leak test for post-extubation airway obstruction were 0.62 (95% CI 0.49-0.73; I = 81.6%) and 0.87 (95% CI 0.82-0.90; I = 97.8%), respectively. The pooled sensitivity and specificity of the cuff leak test for reintubation were 0.66 (95% CI 0.46-0.81; I = 48.9%) and 0.88 (95% CI 0.83-0.92; I = 87.4%), respectively. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction.

Conclusions: The cuff leak test has excellent specificity but moderate sensitivity for post-extubation airway obstruction. The high specificity suggests that clinicians should consider intervening in patients with a positive test, but the low sensitivity suggests that patients still need to be closely monitored post-extubation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13054-020-03358-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648377PMC
November 2020

Progressive First-Degree Atrioventricular Block as a Warning Sign for Perioperative Bradyarrhythmia.

J Cardiothorac Vasc Anesth 2021 01 1;35(1):360-362. Epub 2020 Oct 1.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.jvca.2020.09.136DOI Listing
January 2021

Diabetic Ketoacidosis as a Delayed Immune-Related Event after Discontinuation of Nivolumab.

J Emerg Med 2021 Mar 20;60(3):342-344. Epub 2020 Oct 20.

Department of Diabetic Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.

Background: Nivolumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody with immune checkpoint inhibitory activity, represents a novel treatment for several cancers. Immune checkpoint inhibitors cause side effects, known as immune-related adverse events (irAEs) or delayed immune-related events (DIRE), after immunotherapy discontinuation. Type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis have been reported to develop as an irAE during the treatment with nivolumab. Here, we report on a patient who developed T1DM and diabetic ketoacidosis after discontinuation of treatment with nivolumab as a DIRE.

Case Report: A 59-year-old man, who received nivolumab for an alpha fetoprotein-producing gastric cancer, presented with acute fatigue 4 months after discontinuation of nivolumab. Throughout therapy with nivolumab, the patient's hemoglobin A1c (HbA1c) level was ≤ 6%. However, 1 month prior to the patient's emergency department visit, he noticed weight loss, and 3 weeks prior to that, his HbA1c was 7.1%. Urinalysis showed ketone bodies, and arterial blood gas analysis suggested metabolic acidosis with hyperglycemia (690 mg/dL), which established the diagnosis of diabetic ketoacidosis. An endogenous insulin deficiency without verifiable anti-islet autoantibodies was confirmed; the patient had a human leukocyte antigen haplotype that does not increase the risk of acute-onset T1DM. We considered that T1DM in this patient developed possibly due to nivolumab. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the need for clinicians to be vigilant of the fact that a history of anti-PD-1 monoclonal antibody therapy may increase the risk of diabetic ketoacidosis, whether treatment is ongoing or discontinued.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jemermed.2020.09.023DOI Listing
March 2021

Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise.

Am J Emerg Med 2021 05 7;43:291.e1-291.e3. Epub 2020 Oct 7.

Emergency and Critical Care Center, Kurashiki Central Hospital, Japan. Electronic address:

Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE) is gradually gaining recognition. In this case series, we describe the presentation of ALPE in the emergency department setting and its clinical course. In Case 1, an 18-year-old man presented with acute-onset nausea, vomiting, and right flank pain after playing basketball, with a creatinine level of 6.42 mg/dL on initial presentation. He received fluid therapy and intravenous furosemide for 2 days. His creatinine level was 1.80 mg/dL on day 8 and finally declined to 0.71 mg/dL on day 39. In Case 2, a 31-year-old man presented with acute-onset nausea and right lower abdominal pain after swimming, with a creatinine level of 4.68 mg/dL on initial presentation. He only received fluid therapy, and his creatinine level finally declined to 0.90 mg/dL on day 11. In both cases, severe loin pain began after anaerobic exercise, and acute kidney injury without myoglobinuria was observed. The findings of our case series suggest that emergency physicians should consider ALPE in the differential diagnosis of abdominal and loin pain accompanied by an elevated creatinine level in young patients because it can be treated conservatively and has a good prognosis. Moreover, watchful waiting is recommended for ALPE while also emphasizing the need to exclude potentially life threatening or treatable kidney diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.10.007DOI Listing
May 2021

Validity of a five-level prehospital triage system in Japan: A cohort study.

Am J Emerg Med 2021 07 28;45:329-334. Epub 2020 Aug 28.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.

Background: The increasing worldwide demand for ambulance transport may worsen patient prognosis due to a prolonged response time and overcrowding in the emergency department. Triage in the prehospital setting may reduce the demand for ambulance transport by advising low-acuity patients seek non-emergency medical care. In Japan, a five-level triage system that allows emergency medical services (EMS) to triage patients has been implemented since 2014. This study aimed to validate the five-level triage system.

Methods: We conducted a retrospective cohort study in patients aged ≥16 years who were transported by EMS to a tertiary-care hospital in Japan from April 2018 to June 2018. We used admission to the intensive care unit (ICU) as the primary outcome. Our secondary outcome was overall admission. We conducted multivariable logistic regression analysis to determine the strength of association between triage acuity and admission (ICU and overall).

Results: A total of 1261 patients were included in the analysis. The odds ratios of ICU admission were 9.62 (95% confidence interval: 5.66-16.3) in Level 1 and 2.93 (95% confidence interval: 1.60-5.38) in Level 2 compared with reference groups composed of Levels 4 and 5. Similar associations were found for triage acuity and overall admission.

Conclusions: Our study validates the five-level prehospital triage system for patients transported by EMS and demonstrates an association between the triage acuity and ICU admissions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.08.079DOI Listing
July 2021

Malperfusion-associated transient monoplegia as an initial manifestation of aortic dissection.

Am J Emerg Med 2021 05 30;43:289.e1-289.e3. Epub 2020 Sep 30.

Emergency and Critical Care Center, Kurashiki Central Hospital, Japan. Electronic address:

Acute aortic dissection (AD) is a life-threatening emergency. The most common symptom of AD is chest pain, more frequently associated with Type-A AD per the Stanford classification, while Type-B AD is associated with back and abdominal pain. Conversely, monoplegia is an uncommon symptom of AD. We encountered a case of transient monoplegia caused by Stanford type-B AD. A 75-year-old man presented with acute-onset lumbar back pain with monoplegia. Lumbar radiography revealed multiple compression fractures and spinal-canal stenosis, and accordingly acute spinal-cord compression was suspected. Monoplegia subsided after a diclofenac suppository was administrated to reduce his pain. However, the patient's right lower-extremity pain and paralysis worsened at rest during the stay. Computer tomography angiography revealed Stanford type-B AD and the false lumen obstructing the right common iliac artery. Monoplegia in type-B AD can develop due to spinal-cord or lumbosacral-plexus ischemia. Malperfusion, determined by the balance of the pressure in the false and true lumens and subsequent end-organ ischemia, may produce transient or persistent symptom patterns. Emergency physicians need to suspect AD when a patient presents with monoplegia or transient symptom patterns of unknown etiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.09.073DOI Listing
May 2021

Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review.

Scand J Trauma Resusc Emerg Med 2020 Sep 11;28(1):92. Epub 2020 Sep 11.

Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.

Background: Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases.

Methods: This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019.

Results: Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian-vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; re-thoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%.

Conclusions: Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13049-020-00783-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488342PMC
September 2020

5-Fluorouracil-induced encephalopathy.

Cleve Clin J Med 2020 Aug 31;87(9):532-533. Epub 2020 Aug 31.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.87a.19126DOI Listing
August 2020

Adverse events associated with prophylactic corticosteroid use before extubation: a cohort study.

Ann Transl Med 2020 Jul;8(14):853

Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

Background: Systemic corticosteroid use is recommended before extubation in mechanically ventilated patients to prevent postextubation airway complications and reintubation. However, the adverse events associated with such use remain unclear. This study aimed to describe the incidence of adverse events associated with prophylactic corticosteroid use before extubation in mechanically ventilated adult patients.

Methods: This is a retrospective cohort study of 251 mechanically ventilated adults who received prophylactic corticosteroids in the intensive care units of four tertiary-care hospitals. The patients received 20 mg methylprednisolone at 12, 8, 4, and 0 hours before extubation (total dose, 80 mg) and were followed for 72 hours after extubation. The primary outcome was a clinically significant increase in blood glucose levels of ≥100 mg/dL within 24 and 72 hours after prophylactic corticosteroid administration.

Results: Fifty-seven (23.1%) out of 247 patients and 73 (30.3%) out of 241 patients showed a clinically significant increase in blood glucose levels within 24 and 72 hours after receiving prophylactic corticosteroids, respectively. The clinically significant increase in blood glucose levels was significantly associated with underlying diabetes mellitus and was not significantly associated with hyperglycemia within 3 days before the initiation of prophylactic corticosteroids or with patient age. New-onset infections and delirium were also common, with incidences of 7.6% and 7.7%, respectively.

Conclusions: Prophylactic corticosteroid use before extubation was associated with adverse events, the most common of which was increased blood glucose levels. Lower doses of prophylactic corticosteroids may need to be considered in patients with diabetes mellitus or hyperglycemia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-20-1790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396740PMC
July 2020

Health and Economic Burden of Injurious Falls Into Irrigation Canals in Japan: A Retrospective Cohort Study.

J Emerg Med 2020 Sep 5;59(3):424-431. Epub 2020 Aug 5.

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.

Background: Falls into small water bodies can cause drowning and trauma. Such falls, especially into irrigation canals, and the subsequent trauma are common in Japan. However, few studies have investigated their characteristics, costs, and prognosis.

Objective: Our aim was to clarify the characteristics, prognosis, and economic burden of trauma due to falls into irrigation canals in Kurashiki City, Japan.

Methods: This 4-year, single-center, retrospective cohort study was conducted at a Japanese tertiary care hospital between January 1, 2013 and December 31, 2016. We enrolled patients who had fallen into irrigation canals constructed more than 300 years ago, and transported to our hospital by ambulance. The study outcomes included the characteristics, prognosis, and health care costs of such trauma.

Results: We enrolled 266 patients with a median age of 66 years (range 19-64 years). Most patients fell into irrigation canals while walking (49.3%), riding a bicycle (35.0%), or driving or riding in a car (7.1%). Extremities were the most frequently affected body parts, and the head and chest were less frequently affected. Four patients (1.5%) died in the emergency department (ED), and 121 (45.5%) were hospitalized (109 in our hospital and 12 transferred to other hospitals). The total costs of ED and hospital stays were 777,625 US dollars (266 patients) and 712,059 US dollars (109 patients hospitalized in our hospital), respectively.

Conclusions: Trauma due to falls into irrigation canals can be severe and even fatal, and the related costs are high. Our study highlights the importance of implementing appropriate measures to prevent falls into irrigation canals and of promoting awareness among citizens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jemermed.2020.06.065DOI Listing
September 2020

Venoarterial Extracorporeal Membranous Oxygenation: Treatment Option for Sepsis-Induced Cardiogenic Shock? A Systematic Review.

Crit Care Med 2020 08;48(8):e722-e729

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.

Objectives: Clinicians often encounter adult patients with septic shock who fail to respond to fluid therapy and vasopressors. There is an increasing interest in venoarterial extracorporeal membranous oxygenation in the treatment of patients with septic shock, but its outcomes and safety remain unclear. The aim of this study is to describe in-hospital mortality and complication rate in adult patients with septic shock who underwent venoarterial extracorporeal membranous oxygenation, and to identify patients who may potentially benefit from venoarterial extracorporeal membranous oxygenation.

Data Sources: The protocol for this systematic review was registered at International Prospective Register of Systematic Reviews (CRD42018098848). We searched MEDLINE, Embase, and Igaku Chuo Zasshi for studies of any design in which patients with septic shock were treated with venoarterial extracorporeal membranous oxygenation. Our search was updated on October 6, 2019.

Study Selection: Two independent reviewers assessed whether titles and abstracts met the eligibility criteria. Studies were included when patients met the following criteria: 1) age 18 years old or older; 2) septic shock; and 3) treated with venoarterial extracorporeal membranous oxygenation as hemodynamic support. When there were disagreements between reviewers, the full text was reviewed, and discussion was continued until a consensus was reached.

Data Extraction: Two authors independently extracted the selected patient and study characteristics and outcomes.

Data Synthesis: A total of 6,457 studies were screened. Six retrospective studies were included. The in-hospital mortality rate of patients with septic shock who underwent venoarterial extracorporeal membranous oxygenation was 76.7% (188/245). Four studies provided cardiac function with left ventricular ejection fraction and/or cardiac index. In two of these four studies where median left ventricular ejection fraction and cardiac index were 16.0% and 1.3 L/min/m and median left ventricular ejection fraction and mean cardiac index were 30.0% and 2.4 L/min/m, respectively, the in-hospital mortalities were markedly lower (14.8% and 28.6%, respectively) than the other two studies (78.1% and 91.5%, respectively) that included populations with median left ventricular ejection fraction of 25.0% and mean cardiac index of 2.1 L/min/m. Complications were reported in five studies (39 events/174 cases), hemorrhage (22 events/174 cases) being the most common.

Conclusions: Venoarterial extracorporeal membranous oxygenation remains a controversial treatment strategy in septic shock. The reported in-hospital mortality rates in patients with sepsis-induced cardiogenic shock who underwent venoarterial extracorporeal membranous oxygenation were quite inconsistent. There is a need for well-designed studies to assess the benefit and safety of venoarterial extracorporeal membranous oxygenation in patients with sepsis-induced cardiogenic shock.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000004432DOI Listing
August 2020

Descriptive epidemiology of high frequency component based on heart rate variability from 10-second ECG data and daily physical activity among community adult residents: the Nagahama Study.

Biosci Trends 2020 Sep 4;14(4):241-247. Epub 2020 Jul 4.

Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.

Characteristics of high frequency (HF) component based on heart rate variability (HRV) in a large general population remain unclear, particularly on the relationship with daily physical activity. We aimed to characterize the distribution of HF component and examine the association with daily physical activity among community residents. We performed spectral analysis of HRV from 10-second ECG recordings among 9135 residents aged 30 to 74 years in Nagahama City, Japan. HF components were log-transformed to consider the distribution. Simple correlations between HF and age were determined. Age-adjusted mean values of HF component were calculated for each questionnaire item related to daily physical activity. Multiple regression analysis was performed to examine the effect of daily physical activity on HF component value. Mean values of logarithmically-transformed HF component (lnHF) were higher in women than in men (p < 0.001). lnHF was inversely associated with age (r = -0.40, -0.49 for men, women, respectively). Adjusted mean lnHF for physically active people was significantly higher than that in inactive people (p < 0.001). HF components from 10-second ECG recordings were moderately and negatively correlated with age in both sexes, and positively correlated with daily physical activity in the general adult population. Maintaining the level of daily physical activity, especially to exercise regularly could keep the parasympathetic function high.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5582/bst.2020.03146DOI Listing
September 2020

Mesosalpinx hernia of the sigmoid colon: A cause of lower abdominal pain in women.

Clin Case Rep 2020 May 26;8(5):855-857. Epub 2020 Feb 26.

Emergency and Critical Care Center Kurashiki Central Hospital Kurashiki Okayama Japan.

Diseases of the uterus and adnexa uteri should be considered when evaluating female patients with lower abdominal pain. Diseases caused by defects in the supporting ligaments of the female reproductive system should also be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccr3.2754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250968PMC
May 2020
-->