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Kunihiro Mashiko

Publications and source records attributed to Kunihiro Mashiko.

12 recordsLinked to original sources
PubMed2006

Use of an air ambulance system improves time to treatment of patients with acute myocardial infarction.

OBJECTIVE: The aim of this study was to clarify whether a helicopter ambulance system (doctor helicopter system; DHS) could shorten the time interval to coronary intervention in the treatment of patients with acute myocardial infarction (AMI), in comparison with ground ambulance (GA). METHODS: The time from the emergency call to coronary angiography (CAG time) or to percutaneous coronary intervention (PCI time), and the inhospital outcome were evaluated in 76 AMI patients. Twenty patients were transported by DHS, and the other 56 were by GA. RESULTS: Both CAG time and PCI time were significantly shorter in the DHS (98.8+/-29.2 min, and 169.6+/-57.4 min) than those of the GA (126.6+/-48.7 min, and 203.2+/-57.0 min; p<0.05) group. Inhospital mortality was lower in the DHS (5.0%) versus the GA (10.7%) group. CONCLUSION: Use of DHS shortened the time interval to coronary intervention and also improved the inhospital prognosis of AMI patients.

Aged↗
PubMed2006

Effectiveness of a "doctor-helicopter" system in Japan.

BACKGROUND: In Japan, helicopters have rarely been used for emergency medical services. The use of helicopters not only ensures rapid evacuation but may also serve to provide emergency management to patients with life-threatening injuries in the prehospital setting. OBJECTIVES: To evaluate a Japanese helicopter-based emergency medical system including an onboard physician, particularly in terms of probability of survival. METHODS: We conducted a retrospective review of trauma victims, and calculated two estimates of PS--at the scene and on arrival at the emergency department--based on patient age, Injury Severity Score, and Revised Trauma Score. RESULTS: We identified trauma victims who had an ISS above 15 and were transported from the scene by helicopter. Excluding cardiopulmonary arrest at the scene, 151 cases were studied. Thirty-two patients had hemodynamic instability with systolic blood pressures below 90 mmHg, caused by hemorrhagic shock (29 cases) or obstructive shock (3 cases). Their PS values were 0.56 +/- 0.38 in the prehospital setting and 0.65 +/- 0.38 on arrival at the ED, representing a significant difference (P = 0.0003). Twenty-four of these patients survived, reflecting successful resuscitation during prehospital and ED management. CONCLUSIONS: A doctor-helicopter system was shown to improve probability of survival for life-threatening trauma in the Japanese emergency medical system.

Adolescent↗
PubMed2005

Trauma systems in Japan: history, present status and future perspectives.

As trauma is the leading cause of death for persons 1 to 24 years in Japan, the trauma system must be established to save lives and to reduce serious sequelae. However, the trauma system has not been evaluated since 2000. In May 2002, it revealed that the deaths of about 40% of expired trauma patients who arrived at emergency centers with some vital signs were probably preventable. This result increased the awareness of the need for establishing the trauma system. Then, the Japan Prehospital Trauma Evaluation and Care program for emergency medical technicians was developed, the doctor helicopter system was promoted, the Japan Advanced Trauma Evaluation and Care program for physicians was developed, and the trauma registry program was started. The extension of the procedures that can be performed by Japanese paramedics should be extended with the establishment of a medical control system. However, the key to securing quality regional trauma care is to designate a trauma care hospital as a trauma center and to transport severely injured patients there as rapidly as possible.

Forecasting↗
PubMed2004

Detection of circulating superantigens in an intensive care unit population.

OBJECTIVE: Plasma concentrations of superantigens were measured in an intensive care unit (ICU) population and the relationship of superantigen positive rates with the presence of sepsis was investigated. METHODS: Plasma samples were collected at least twice a week from 78 patients whose primary diagnoses were abdominal disorders (n = 27), respiratory disorders (n = 11), trauma (n = 10), burns (n = 10), cardiovascular disorders (n = 4), neurological disorders (n = 2), and others (n = 14). Five different species of superantigens, i.e., staphylococcal enterotoxins A, B, and C (SEA, SEB, and SEC), toxic shock syndrome toxin-1 (TSST-1), and streptococcal pyrogenic exotoxin A (SPEA), were measured using an enzyme-linked immunosorbent assay. RESULTS: Significant levels of plasma superantigens were detected in 16 patients. SEA was found in seven patients, SEB in four patients, SEC in two patients, TSST-1 in six patients, and SPEA in five patients. Superantigen detection rates were 6% (1/17) in patients without systemic inflammatory response syndrome (SIRS), 0% (0/21) in SIRS patients without infection, 31% (5/16) in septic patients without shock, and 42% (10/24) in septic shock patients. CONCLUSIONS: The presence of superantigens was confirmed in part of the ICU population. The role of superantigens in the pathogenesis of sepsis remains to be determined.

Adolescent↗
PubMed2004

Analysis of antimicrobial drug resistance of Staphylococcus aureus strains by WHONET 5: microbiology laboratory database software.

OBJECTIVES: To analyze our hospital laboratory microbiological data by using WHONET 5-Microbiology laboratory database software-, and to acquire information about antimicrobial resistance of Staphylococcus aureus strains among every ward. MATERIALS AND METHODS: The database of Staphylococcus aureus strains had been brought to our hospital microbiology laboratory from every ward in our hospital from September 2001 till December 2002. Analysis was performed under the condition as one isolate per one patient. Starting of "resistance profile" analysis in WHONET 5 and analyzing the microbiological laboratory testing reports for every ward. We chose Oxacillin, Levofloxacin, Erythromycin and Gentamicin as the antimicrobials that need to be investigated for resistance. We evaluated the monthly transition of resistance ratios with regard to the specific wards that have the moving lines of inpatients in order to verify the hypothesis that resistant strains may be carried from ward to ward along the moving lines of inpatients. RESULTS: The data of 2,113 Staphylococcus aureus strains were accumulated and analyzed. Overall Oxacillin resistance ratio in our hospital was 65.7%. The ward of the smallest Oxacillin resistance ratio was Pediatrics/Ophthalmology ward. The ratios of Oxacillin resistant were varied as from 67.9% to 96.7% regardless the categories of wards such as internal medicine or surgery. Multi-resistant MRSA strains were overwhelmingly dominant in the wards of surgery. The ratios of the Gentamicin sensitive strains that were resistant to Oxacillin were high over the every ward. The moving lines of inpatients existed between ICU/CCU ward and three rear wards. Two rear wards whose Oxacillin resistance changes were reflected to those of ICU/CCU, but one rear ward was not. CONCLUSION: Variation of resistant degree among wards were very obvious and large. We could survey the wards where patient-to-patient transmission of resistant organisms might occur along the moving lines of inpatients. WHONET 5 will be recognized as an analysis and surveillance tool for every infection control team to survey the suspicious wards.

Anti-Bacterial Agents↗
PubMed2004

Early access to patients with life-threatening cardiovascular disease by an air ambulance service.

The purpose of this study was to determine whether use of an air ambulance service using a helicopter with a critical care physician and nurse on board (doctor helicopter service; DHS) could shorten the prehospital delay. We evaluated the initial treatment time and the transport time in 30 patients transported by DHS and 30 patients transported by ground ambulance service (GAS). The initial treatment time was significantly shorter in the DHS group (11.3+/-5.4 min) than in the GAS group (29.5+/-15.3 min). But the transport time in the DHS group (26.1+/-8.6 min) was not different from that in the GAS group. The difference in the initial treatment time was remarkable for patients transported from distant areas (12.7+/-5.6 min for DHS, and 42.1+/-13.8 min for GAS) and DHS shortened the initial treatment time by 30 min compared with GAS. The transport time was shorter for DHS (30.5+/-9.9 min) than for GAS (42.1+/-13.8 min) for patients transported from distant areas, but it was not significantly different for patients transported from nearby areas (22.3+/-5.0 min for DHS, and 18.4+/-2.4 min for GAS). In conclusion, DHS is important in the management of life-threatening cardiovascular diseases, and has a significant impact when GAS cannot transport a patient to the hospital within 20 min.

Aged↗
PubMed2002

An outcome study of out-of-hospital cardiac arrest using the Utstein template--a Japanese experience.

Publication of the Utstein style template has made it possible to evaluate and compare national, regional, and hospital based Emergency Medical Services. This research was a national investigation to present outcome data for out-of-hospital cardiac arrest (OHCA) patients in Japan. 3029 OHCA patients who were transported to 10 Emergency and Critical Care Medical Center from November 1997 to April 1999 were recorded according to the Utstein style and the outcome evaluated by logistic regression analysis. Among 3029 OHCA patients, 109 were found dead. The remaining 2920 patients who underwent cardiopulmonary resuscitation (CPR) by emergency medical technicians (EMT) were included in this study. Among these patients, 1294 were considered of primary cardiac origin patients by the EMT and 722 of these patients suffered a witnessed cardiac arrest. Bystander CPR were performed in 28.4% of these witnessed patients and the discharge rate was 3.5% overall and 11.4% in witnessed VF/VT. Outcome analysis showed that a discharge rate in witnessed primary cardiac arrest was 30% in prehospital resuscitation which was 7.5 times higher than in-hospital emergency room resuscitation groups (4.0%). The longer the interval between an emergency telephone call and defibrillation, the lower the 1 month survival rate, which reached almost 0% at 30 min. Follow up evaluation after discharge revealed that the survival rate rapidly decreased from 24 h to 3 months, then became a plateau in primary cardiac patients was rapidly decreased from 24 h to 1 month, then became a near plateau in non-cardiac origin group. To improve the resuscitation rate in the prehospital phase, a prehospital medical control system should be developed with expansion of on scene techniques by Japanese paramedics such as tracheal intubation, administration of emergency drugs and early defibrillation with standing orders. Education and motivation of first responders will be needed and every effort should be concentrated on improving bystander CPR rate.

Cardiopulmonary Resuscitation↗
PubMed2002

International airport and emergency medical care.

The Nippon Medical School New Tokyo International Airport Clinic (Airport Clinic) was opened in 1992 as Japan's first 24-hour international airport clinic. To date, it has provided medical services to a total of 117,953 patients. Of these, 85,545 (72.5%) were airport employees, 28,662 (24.3%) were passengers, and 3,746 (3.2%) were others. Of the total, non-Japanese patients accounted for 8,485 (7.2%). In the year to March 31, 2001, the Clinic treated an average of 43.9 cases per day. The number of emergency patients was 2,969 or 2.3% of the total, of whom 500 (0.4%) were non-Japanese. There were 47 deaths, with age ranging from 14 to 84 (average age 64.0). The ratio of males to females who died was 28:19. Of the 47 deaths, 18 were non-Japanese. Pulmonary thromboembolism is considered to have played a role in 25 of the deaths. Based on more than 8 years of airport clinical experience, we believe that a first-class international airport should have excellent medical facilities that can provide quality emergency medical services to travelers and disaster victims.

Adolescent↗
PubMed2002

[Damage control for thoracic injuries].

A critically injured chest trauma patient showing profound shock or cardiac arrest en route to the trauma center or in the emergency room sometimes requires emergency room thoracotomy and definitive repair. In some patients damage control must be performed because of the appearance of the deadly triad of hypothermia, acidosis, and coagulopathy. Indications for damage control are believed to be body temperature < 34 degrees C, pH < 7.2, and clinically uncontrollable bleeding. The strategy for damage control consists of three steps: step 1, rapid control of hemorrhaging and abbreviated surgery in the ER or OR; step 2, correction of hypothermia, acidosis, and coagulopathy and reevaluation of the injuries in the intensive care unit; and step 3, definitive surgery in the OR. Damage control procedures for chest injuries include aortic cross-clamping, hilar clamping, major vessel ligation, pulmonary tractotomy, simultaneously stapled pneumonectomy or lobectomy, cardiac stapling, balloon catheter tamponade, temporary intraluminal shunt, towel packing, towel clip closure, single en masse closure of the chest wall, etc. Every surgeon responsible for treating critical chest trauma patients should have knowledge of damage control and also be familiar with the techniques.

Acidosis↗
PubMedDate not supplied

Effect of direct hemoperfusion with a polymyxin B immobilized fiber column on high mobility group box-1 (HMGB-1) in severe septic shock: report of a case.

Because of the many difficult aspects in the treatment of septic shock and poor outcome of this condition, establishing the most appropriate therapeutic strategy is problematic. Recently, high mobility group box-1 (HMGB-1) has been shown to activate inflammatory responses and to be a late mediator in endotoxemia and sepsis. Therefore, we considered that it might be worthwhile to investigate the therapeutic potential of HMGB-1 blockade in cases of septic shock.Herein, we describe the case of a patient with septic shock with hepatic portal venous gas caused by intestinal obstruction. Hepatic portal venous gas is a rare condition associated with significant radiographic findings and a fatal outcome. Our patient, however, recovered from severe septic shock and was saved by the use of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX). This treatment resulted in a decrease in the serum levels of endotoxin, interleukin-6 (IL-6), and HMGB-1.

Aged, 80 and over↗
PubMedDate not supplied

Gastric pneumatosis and portal venous gas in superior mesenteric artery syndrome.

Superior mesenteric artery (SMA) syndrome is a condition where compression of the duodenum between the root of the SMA and the aorta results in intermittent obstruction of the third part of duodenum. Portal venous gas associated with nonischemic bowel is uncommon. We report an 81-year-old man who developed gastric pneumatosis and hepatoportal venous gas due to SMA syndrome, which healed without any sequelae.

Aged, 80 and over↗