Publications by authors named "Makoto Sawano"

14 Publications

  • Page 1 of 1

Hinged elbow fixation and treatment of unstable elbow dislocation with ipsilateral arteriovenous shunts: A case report.

J Orthop Sci 2021 Aug 19. Epub 2021 Aug 19.

Emergency and Critical Care Medicine Service, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.

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http://dx.doi.org/10.1016/j.jos.2021.06.014DOI Listing
August 2021

A perspective on hospital-acquired (nosocomial) infection control of COVID-19: usefulness of spatial separation between wards and airborne isolation unit.

J Breath Res 2021 07 30;15(4). Epub 2021 Jul 30.

Center for Advanced Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Saitama, Japan.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a considerable burden on hospitals and healthcare workers (HCWs) worldwide, increasing the risk of outbreaks and nosocomial transmission to 'non-COVID-19' patients, who represent the highest-risk population in terms of mortality, and HCWs. Since HCWs are at the interface between hospitals on the one hand and the community on the other, they are potential reservoirs, carriers, or victims of severe acute respiratory syndrome coronavirus 2 cross-transmission. In addition, there has been a paradigm shift in the management of viral respiratory outbreaks, such as the widespread testing of patients and HCWs, including asymptomatic individuals. In hospitals, there is a risk of aerosol transmission in poorly ventilated spaces, and when performing aerosol-producing procedures, it is imperative to take measures against aerosol transmission. In particular, spatial separation of the inpatient ward for non-COVID-19 patients from that designated for patients with suspected or confirmed COVID-19 as well as negative-pressure isolation on the floor of the ward, using an airborne infection isolation device could help prevent nosocomial infection.
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http://dx.doi.org/10.1088/1752-7163/ac1721DOI Listing
July 2021

RT-PCR diagnosis of COVID-19 from exhaled breath condensate: a clinical study.

J Breath Res 2021 06 10;15(3). Epub 2021 Jun 10.

Department of General Medicine, Saitama Medical Center, Saitama, Japan.

Current diagnostic testing for coronavirus disease 2019 (COVID-19) is based on detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal swab samples by reverse transcription polymerase chain reaction (RT-PCR). However, this test is associated with increased risks of viral dissemination and environmental contamination and shows relatively low sensitivity, attributable to technical deficiencies in the sampling method. Given that COVID-19 is transmitted via exhaled aerosols and droplets, and that exhaled breath condensate (EBC) is an established modality for sampling exhaled aerosols, detection of SARS-CoV-2 in EBC offers a promising diagnostic approach. However, current knowledge on the detection and load of the virus in EBC collected from COVID-19 patients remains limited and inconsistent. The objective of the study was to quantify the viral load in EBC collected from COVID-19 patients and to validate the feasibility of SARS-CoV-2 detection from EBC as a diagnostic test for the infection. EBC samples were collected from 48 COVID-19 patients using a collection device, and viral loads were quantified by RT-PCR targeting the E gene. Changes in detection rates and viral loads relative to patient characteristics and days since disease onset were statistically evaluated. Need for mechanical ventilation was significantly associated with higher viral load (< 0.05). Need for oxygen administration or mechanical ventilation, less than 3 d since onset, and presence of cough or fever were significantly associated with higher detection rates (< 0.05). Among spontaneously breathing patients, viral load in EBC attenuated exponentially over time. The detection rate was 86% at 2 d since onset and deteriorated thereafter. In mechanically ventilated patients, detection rate and viral load were high regardless of days since onset. These results support the feasibility of using RT-PCR to detect SARS-CoV-2 from EBC for COVID-19 patients within 2 d of symptom onset.
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http://dx.doi.org/10.1088/1752-7163/ac0414DOI Listing
June 2021

A short perspective on a COVID-19 clinical study: 'diagnosis of COVID-19 by RT-PCR using exhale breath condensate samples'.

J Breath Res 2020 10 6;14(4):042003. Epub 2020 Oct 6.

Center for Advanced Emergency Medicine and Critical Care, Saitama Medical Center, Kawagoe, Japan.

Diagnosis of SARS-COV-2 infection (COVID-19) is currently based on detection of the viral RNA in nasopharyngeal swab samples by reverse transcription polymerase chain reaction (RT-PCR). However, sampling via nasopharyngeal swabs frequently provokes sneezing or coughing, which results in increased risk of the viral dissemination and environmental contamination. Furthermore, the sensitivity associated with the PCR tests s limited to 60%-70%, which is mainly attributable to technical deficiency in sampling. Given that the disease is transmitted via exhaled aerosol and droplets, and that the exhaled breath condensate (EBC) is the established modality for sampling exhaled aerosol, detection of the viral RNA in EBC is a promising approach for safe and efficient diagnosis of the disease. Subjects are those patients who are diagnosed with COVID-19 by positive nasopharyngeal swab PCR test and admitted to Saitama Medical Center, Japan. EBC samples will be collected using an R-tube or R-tubeVent device. Collected EBC samples will be introduced into a nucleic acid purifier. The purified nucleic acids will undergo amplification through RT-PCR for detection and quantification of SARS-COV-2 RNA. To date we have collected eight samples from seven subjects. Among them, two samples from two subjects tested positive for SARS-COV-2 RNA by the RT-PCR. Reflecting the second wave of COVID-19 prevalence in Japan, new admissions of COVID-19 patients to the Saitama Medical Center are increasing, and we are expecting to collect at least 50 EBC samples from 25 patients before the end of this year.
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http://dx.doi.org/10.1088/1752-7163/abb99bDOI Listing
October 2020

Two-Staged Circumferential Decompression and Fusion Surgery for Upper Thoracic Myelopathy Caused by Concurrent Beak-Type Ossification of the Posterior Longitudinal Ligament and Ligamentum Flavum at T1-T2 Level: A Case Report.

World Neurosurg 2019 Feb 1;122:144-149. Epub 2018 Nov 1.

Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.

Background: Upper thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is relatively rare. This clinical condition is difficult to treat, and a surgical method has not been fully established. We report an extremely rare case of severe thoracic myelopathy caused by concurrent beak-type OPLL and OLF at T1-T2.

Case Description: A 53-year-old woman with paresthesia of both legs and an inability to hold a standing position presented to our hospital. Radiological images showed a large beak-type OPLL at T1-T2 and an OLF at T1-T7. The spinal cord was severely compressed at T1-T2. First, posterior decompression and instrumentation fusion at C6-T4 was performed, with a T1-T2 bilateral parallel gutter along the dural tube into the vertebral bodies covering the extent of the OPLL. Second, anterior decompression of the OPLL with corpectomy of T1-T2 and fusion using iliac bone grafting was performed after the sternal manubrium splitting approach. In the deep operating field of the second surgery, the gutters created during the first surgery were helpful for judging the width and thickness of the OPLL during the anterior decompression procedure. Postoperatively, her neurological symptoms greatly improved, the patient could walk independently, and the Japanese Orthopaedic Association score had improved from 3 preoperatively to 8 at the final follow-up examination at 16 months postoperatively.

Conclusions: Two-stage circumferential decompression and fusion surgery can be considered an effective surgical method for upper thoracic concurrent OPLL and OLF. The bilateral gutters created during the first surgery improved the safety and feasibility of this difficult operation.
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http://dx.doi.org/10.1016/j.wneu.2018.10.142DOI Listing
February 2019

A case series of pelvic fracture patients who developed lower urinary tract symptoms after transarterial embolization of bilateral internal iliac arteries.

Acute Med Surg 2017 07 30;4(3):358-362. Epub 2017 May 30.

Department of Emergency Medicine and Critical Care Saitama Medical Center Saitama Medical University Saitama Japan.

Cases: Transarterial embolization of bilateral internal iliac arteries (TAE) is a useful hemostatic method for the management of pelvic fracture patients, but its effects on urinary functions remain unclear. In this study, we evaluated the impact of TAE on lower urinary tract symptoms (LUTS) in 10 pelvic fracture patients.

Outcomes: Lower urinary tract symptoms before and after hospitalization were evaluated by International Prostate Symptoms Score, Overactive Bladder Symptoms Score, and Quality Of Life score. All scores showed significant worsening. The changes did not correlate with sex, age, injury severity score, or durations of unstable hemodynamics or urethral catheterization. Changes of International Prostate Symptoms Score and Quality Of Life score showed significant positive correlations with intervals between the evaluations.

Conclusion: Pelvic fracture patients treated with TAE showed significant worsening of LUTS. Risk for exacerbation of LUTS should be taken into consideration when deciding to use TAE.
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http://dx.doi.org/10.1002/ams2.286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674459PMC
July 2017

Early administration of fibrinogen concentrates improves the short-term outcomes of severe pelvic fracture patients.

Acute Med Surg 2017 07 2;4(3):271-277. Epub 2017 Apr 2.

Department of Emergency and Critical Care Medicine Saitama Medical Center Saitama Medical University Kawagoe Saitama Japan.

Aim: Hemorrhage from pelvic fracture is a major cause of mortality after blunt trauma. Several studies have suggested that early fibrinogen supplementation improves outcomes of traumatic hemorrhage. Thus, we revised our massive transfusion protocol (MTP) in April 2013 to include early off-label administration of fibrinogen concentrate. The objective of this study was to evaluate the impact of the revision on the short-term outcomes of pelvic fracture patients.

Methods: This was a single-center, retrospective, cohort study. A total of 224 consecutive pelvic fracture patients hospitalized in Saitama Medical Center (Saitama, Japan), 115 before the revision (Group E) and 109 after (Group L), were enrolled. Characteristics of the patients were compared between the groups. Impacts of the revision were evaluated by hazard ratios adjusted for characteristics, injury severity, and coagulation status using Cox's multivariate proportional hazard model. The impact was also evaluated by log-rank test and relative risk of 28-day mortality between the groups.

Results: The characteristics were equivalent between the groups. The multivariate analysis revealed that the revision of MTP was significantly related to improved survival with an adjusted hazard ratio (95% confidence interval) of 0.45 (0.07-0.97). The log-rank test gave χ-test values of 5.2 ( = 0.022) and 6.7 ( = 0.009), and the relative risks were 0.37 (0.15-0.91) and 0.33 (0.13-0.84), in patients with all Injury Severity Scores and Injury Severity Score ≥21, respectively.

Conclusion: The revision of MTP to include aggressive off-label treatment with fibrinogen concentrate was related to improved short-term outcomes of severe pelvic fracture patients. However, due to the limitations of the study, the improvement could not be attributed totally to the revision.
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http://dx.doi.org/10.1002/ams2.268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674452PMC
July 2017

Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway.

Respir Med Case Rep 2017 19;21:36-38. Epub 2017 Mar 19.

Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.

We report a rare case of acquired membranous tracheal stenosis in a patient with anorexia nervosa and a history of self-induced vomiting, but without a history of tracheal intubation or tracheostomy. A 50-year-old woman presented with difficulty in breathing and swallowing, self-expectoration, and impaired consciousness due to acute benzodiazepine intoxication. Bronchoscopic examination was performed after tracheotomy and placement of a tracheostomy tube failed to secure her respiratory tract and ventilation continued to deteriorate. A flap-like membranous structure was identified on the posterior tracheal wall, obstructing the tracheostomy tube. Physical compression of the membranous structure improved ventilation. Bronchoscopic examination is generally recommended prior to performing tracheostomy in patients suspected to have post-intubation tracheal obstruction. Based on our findings, we suggest that these examinations should also be performed in patients with conditions associated with chronic irritation of the respiratory tract, including those with a prolonged history of self-induced vomiting.
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http://dx.doi.org/10.1016/j.rmcr.2017.03.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369857PMC
March 2017

Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma.

Trauma Surg Acute Care Open 2016 2;1(1):e000037. Epub 2016 Dec 2.

Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.

Background: Patients with severe trauma often present with critical coagulopathy, resulting in impaired hemostasis, massive hemorrhage, and a poor survival prognosis. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion has not been studied. We assessed a novel approach of pre-emptive administration of fibrinogen concentrate to improve critical coagulopathy in patients with severe trauma.

Methods: We retrospectively compared blood transfusion volumes and survival prognosis between three groups of patients with trauma, with an Injury Severity Score (ISS) ≥26 over three consecutive periods: group A, no administration of fibrinogen concentrate; group B, administration of 3 g of fibrinogen concentrate after evaluation of trauma severity and a plasma fibrinogen level <1.5 g/L; group C, pre-emptive administration of 3 g of fibrinogen concentrate immediately on patient arrival based on prehospital information, including high-severity injury or assessed need for massive transfusion before measurement of fibrinogen.

Results: ∼56% of patients with an ISS ≥26 and transfused with red blood cell concentrates ≥10 units, had hypofibrinogenemia (fibrinogen <1.5 g/L) on arrival. Patients who received fibrinogen concentrate in group C showed significantly higher fibrinogen levels after treatment with this agent than those in group B (2.41 g/L vs 1.88 g/L; p=0.01). Although no significant difference was observed in blood transfusion volumes between the groups, the 30-day survival of patients in group C (all, and those with an ISS ≥26) was significantly better than in group A (p<0.05). The 48-hour mortality rate in patients with an ISS ≥26 was significantly lower in group C than in group A (8.6% vs 22.9%; p=0.005). Further, among patients with an ISS ≥41, the overall mortality was significantly lower in group C than in group A (20% vs 50%; p=0.02).

Conclusion: Pre-emptive administration of fibrinogen concentrate for patients with trauma with critical coagulopathy may contribute to improved survival.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1136/tsaco-2016-000037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891706PMC
December 2016

Demonstration and quantification of the redistribution and oxidation of carbon monoxide in the human body by tracer analysis.

Authors:
Makoto Sawano

Med Gas Res 2016 Apr-Jun;6(2):59-63. Epub 2016 Jul 11.

Department of Emergency Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe-shi, Saitama, Japan.

Numerous studies have confirmed the role of endogenous carbon monoxide (CO) gas as a signal transmitter. However, CO is considered an intracellular transmitter, as no studies have demonstrated the redistribution of CO from the blood to tissue cells. Tracer analyses of CO production following CO gas inhalation demonstrated that CO is oxidized to carbon dioxide (CO) in the body and that CO oxidation does not occur in the circulation. However, these results could not clearly demonstrate the redistribution of CO, because oxidation may have occurred in the airway epithelium. The objective of this study, therefore, was to definitively demonstrate and quantify the redistribution and oxidation of CO using time-course analyses of CO and CO production following CO-hemoglobin infusion. The subject was infused with 0.45 L of CO-saturated autologous blood. Exhaled gas was collected intermittently for 36 hours for measurement of minute volumes of CO/CO exhalation and determination of the CO/CO ratio. CO production significantly increased from 3 to 28 hours, peaking at 8 hours. Of the infused CO, 81% was exhaled as CO and 2.6% as CO. Identical time courses of CO production following CO-hemoglobin infusion and CO inhalation refute the hypothesis that CO is oxidized in the airway epithelium and clearly demonstrate the redistribution of CO from the blood to the tissues. Quantitative analyses have revealed that 19% of CO in the circulating blood is redistributed to tissue cells, whereas 2.6% is oxidized there. Overall, these results suggest that CO functions as a systemic signal transmitter.
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http://dx.doi.org/10.4103/2045-9912.184598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110128PMC
July 2016

Successful early romiplostim use in a case of severe immune thrombocytopenia with critical carotid arterial injury.

Int J Hematol 2017 Jan 5;105(1):100-103. Epub 2016 Oct 5.

Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.

Thrombopoietin receptor (TPO-R) agonists have been shown to be effective in refractory chronic immune thrombocytopenia (ITP); however, their efficacy in patients under critical care is not known. We report the case of a female patient with a newly diagnosed ITP who experienced severe bleeding from an external wound. The patient was administered the standard treatments for ITP, which are high-dose intravenous immunoglobulin (IVIg) and corticosteroids. However, following failure of these treatments, we administered romiplostim on day 6 after the onset of ITP. On day 6 after the initiation of romiplostim, there was improvement in platelet count and bleeding tendency. We were subsequently able to perform a splenectomy successfully. The efficacy of TPO-R agonists in ITP has been reported in several situations, including before surgery in an ITP patient; however, the use of TPO-R for arterial bleeding with shock has not been reported. To our knowledge, the present article is a rare case report of the use of a TPO-R agonist in a patient with critical artery injury. Our data suggest that the early use of romiplostim is effective in emergency cases of newly diagnosed ITP with life-threatening bleeding, which is refractory to standard treatment.
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http://dx.doi.org/10.1007/s12185-016-2094-zDOI Listing
January 2017

[How should we comprehend the guideline for the revised Organ Transplantation Law?].

Nihon Rinsho 2010 Dec;68(12):2202-9

Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University.

In accordance with the revision of the "Organ Transplantation Law", the ordinances and the guideline for the law were also revised. The revision of the guideline, which finds legal basis on the circular notices, raises some issues about its position in the Japanese legislative system. It is quite ambiguous whether we should comprehend the guideline as the interpretation of the law, as the procedural guidance, or as the instruction within the administrative body. Thus, the legal obligation for the healthcare professionals to observe the guideline is also unclear. There are many issues about the transplantation law, the ordinances and the guideline. They include (1) Legal implication of the "brain death" (Is "brain death" absolutely synonymous with "death" ?), (2) Scientific relevance of the criteria for diagnosis of brain death, (3) Definition of the "adequate treatment" which is the prerequisite for diagnosis of brain death, (4) The time of death for the cases who were declared legally brain-dead but did not donate the organs, (5) By whom and when should the organ donation be proposed, and more. The ambiguity about the legal position of the guideline shall cause confusion in the scenes of clinical practice.
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December 2010

A tracer analysis study on the redistribution and oxidization of endogenous carbon monoxide in the human body.

J Clin Biochem Nutr 2010 Sep 17;47(2):107-10. Epub 2010 Jun 17.

Department of Emergency Medicine and Critical Care, Saitama Medical Centre, 1981 Kamoda, Kawagoe, Saitama 350-8558, Japan.

Past studies have suggested that some carbon monoxide (CO) moves from blood haemoglobin to tissue cells and that mitochondrial cytochrome c oxidase oxidizes CO to carbon dioxide (CO(2)). However, no study has demonstrated this redistribution and oxidization of CO under physiological conditions. The objective of this study was to trace the redistribution and oxidization of CO in the human body by detecting (13)CO(2) production after the inhalation of (13)CO. In Experiment 1, we asked a healthy subject to inhale 50 ppm (13)CO gas. In Experiment 2, we circulated heparinized human blood in a cardio-pulmonary bypass circuit and supplied 50 ppm (13)CO gas to the oxygenator. We sequentially sampled exhaled and output gases and measured the (13)CO(2)/(12)CO(2) ratios. In Experiment 1, the exhaled (13)CO(2)/(12)CO(2) ratio increased significantly between 4 to 31 h of (13)CO inhalation. In Experiment 2, the output (13)CO(2)/(12)CO(2) ratio showed no significant increase within 36 h of (13)CO input. Experiment 1 demonstrated the oxidization of CO in the human body under physiological conditions. Experiment 2 confirmed that oxidization does not occur in the circulating blood and indicated the redistribution of CO from blood carboxyhaemoglobin to tissue cells.
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http://dx.doi.org/10.3164/jcbn.10-22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935150PMC
September 2010

Beneficial Effects of Cocoa in Perivascular Mato Cells of Cerebral Arterioles in SHR-SP (Izm) Rats.

J Clin Biochem Nutr 2009 Mar 28;44(2):142-50. Epub 2009 Feb 28.

Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 350-8550, Japan.

As previously reported, the cerebral arterioles are surrounded by unique perivascular Mato cells. They contain many inclusion bodies rich in hydrolytic enzymes, and have strong uptake capacity. They are thus considered scavenger cells of vascular and neural tissues in steady-state. In this study, employing hypertensive SHR-SP (Izm) rats, the viability of Mato cells was investigated. In hypertensive rats, the capacity for uptake of horse radish peroxidase (HRP) and the activity of acid phosphatase (ACPase) of Mato cells were markedly reduced, and on electron-microscopic examination Mato cells were found to include heterogeneous contents and appeared electron-dense and degenerated. Vascular cells exhibited some signs of pathology. However, in hypertensive rats fed chow containing 0.25% cocoa, the uptake capacity and ACPase activity of Mato cells for HRP were enhanced, and on electron-microscopic examination Mato cells appeared healthy, with mitochondria with nearly normal profiles. Signs of pathology in vascular cells were also decreased. Superoxides may impair Mato cells and vascular cells.
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http://dx.doi.org/10.3164/jcbn.08-209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654470PMC
March 2009
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