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Tetsuo Yukioka

Publications and source records attributed to Tetsuo Yukioka.

10 recordsLinked to original sources
PubMed2006

Remote support for emergency medicine using a remote-control laser pointer.

We have developed a laser pointing system, the GestureLaser, which allows a remote operator to control a videocamera and a laser beam via a networked personal computer. The laser spot can be moved by the mouse cursor controlled by the remote instructor. The system was tested by giving remote instruction in thoracentesis to inexperienced operators using a training mannekin. Seven medical students received instructions using the laser pointer and another seven received instruction without the laser pointer. All operators completed the task correctly. The laser pointer group correctly identified the centesis space and performed the task on the first trial. When the laser pointer was not used, four operators (57%) made a mistake in selecting the centesis space at the first trial. The mean times for both stage 1--verbal versus GestureLaser 59 s (SD 13) versus 44 s (SD 5), p = 0.015 - and stage 2--verbal versus GestureLaser 98 s (SD 20) versus 64 s (SD 7), P = 0.002 - were significantly shorter when the GestureLaser was used. The study shows that the laser pointing system can be used to remotely instruct a novice operator in performing thoracentesis. It could improve collaboration between geographically separated sites.

Abdominal Wall↗
PubMed2004

[Prevalence of substance abuse through biological method among patients with physical diseases seen in an emergency room].

According to a nationwide general population survey on drug use in Japan, using self-administered questionnaires, the lifetime prevalence of methamphetamine usage was low, compared with those of Western countries. Recent validation studies suggested that only about half or less of the recent illicit drug abuse was self-reported and the biological measurement of drug abuse was necessary to evaluate the prevalence of the illicit drug abuse. We collected blood or urine specimens in an emergency room located in an urban area of Tokyo, Japan, and analyzed the sera or the urine, using REMEDi-HS based on an unlinked anonymous method from 2000 to 2002. The prevalence of the methamphetamine abusers aged form 10 to 60 yrs was 2.94, 7.02, and 5.63 each year. The mean prevalence of these three years was 5.20 (95% confidence interval 2.42-7.05). It is necessary to look at the methodological differences between this study and previous studies. This finding supports the lower point prevalence of methamphetamine usage in an ER of Japan rather than in an ER of the US. However, it is not necessarily lower than that of trauma patients in the urban area of the UK, or drivers, and the ER population in France.

Adolescent↗
PubMed2002

Prospective evaluation of hemoclip application with injection of epinephrine in hypertonic saline solution for hemostasis in unstable patients with shock caused by upper GI bleeding.

BACKGROUND: It is difficult to arrest severe upper GI bleeding with any of the available hemostatic modalities in unstable patients who are in shock, and the rates of persistent bleeding and mortality in this group remain high. This prospective study evaluated hemoclip application alone and in combination with injection of hypertonic saline solution with epinephrine in this subgroup of patients with GI bleeding. METHODS: Twenty-two patients in shock because of upper GI bleeding were enrolled and divided into 2 groups based on the response of systolic blood pressure to rapid infusion of 1000 mL of lactated Ringer's solution: an unstable shock group, in which systolic blood pressure did not stabilize at greater than 90 mm Hg, and a stable shock group, in which systolic blood pressure stabilized at greater than 90 mm Hg. Emergency endoscopy was performed in both groups; those in the stable group were treated by hemoclip application alone and those in the unstable group were treated by hemoclip application combined with injection of hypertonic saline solution with epinephrine. The following parameters were compared: vital signs on admission and after infusion of lactated Ringer's solution, hemoglobin concentration, endoscopic classification of type and site of bleeding, number of hemoclips required to arrest bleeding, volume of hypertonic saline solution with epinephrine injected, initial hemostatic rate, rate of recurrent bleeding, the need for additional preventive therapy (hemoclip application), and mortality. RESULTS: The rate of initial hemostasis was 92% in the stable shock group and 100% in the unstable shock group. Bleeding did not recur in either group. The volume of packed red cells transfused and the endotracheal intubation rate were significantly greater in the unstable shock group. Preventive application of hemoclips was performed at endoscopic follow-up 12 times in 10 patients in the stable shock group and 9 times in 7 patients in the unstable shock group. There were no deaths in either group. CONCLUSION: Endoscopic injection of hypertonic saline solution with epinephrine combined with hemoclip application provides effective hemostasis in unstable patients in shock caused by severe upper GI bleeding. The hemostatic result is comparable with that achieved by hemoclip application alone in patients with bleeding but less severe shock.

Blood Pressure↗
PubMed2002

Burn depth affects dermal interstitial fluid pressure, free radical production, and serum histamine levels in rats.

BACKGROUND: We measured the amount of edema and the free radical production in burn-injured skin and the serum histamine levels, as well as changes in dermal interstitial fluid pressure. METHODS: Thirty-six Wistar rats with 20% total body surface area burns of different depth were resuscitated by lactated Ringer's solution intravenously. The rats were divided into a deep burn (DB) group (n = 12), a superficial dermal burn (SDB) group (n = 12), and a sham burn (Sham) group (n = 12). Dermal interstitial fluid hydrostatic pressure (Pif), total skin water and xanthine oxidase activity, and serum histamine levels were measured until 60 minutes postburn. RESULTS: In the DB group, dermal Pif significantly fell to -35.9 +/- 11.0 and -40.9 +/- 7.0 mm Hg at 10 and 15 minutes postburn, respectively (p < 0.05); it returned to preburn values at 50 minutes postburn. In the SDB group, dermal Pif was slightly negative but did not markedly change. Total skin water was significantly higher than that of the DB and the Sham groups; however, in the SDB group, serum histamine and dermal xanthine oxidase were significantly higher than in the DB group at 15, 30, and 45 minutes postburn (p < 0.05). CONCLUSION: The fluid-resuscitated DB produced a more negative dermal Pif than the SDB, but less dermal edema. In contrast, the SDB appeared to mainly generate dermal edema formation by wound free radical production and serum histamine release. The dermal Pif is one of the factors associated with edema formation immediately after deep burns. However, an increase in vascular permeability associated with oxygen radical production plays a more important role in dermal edema formation than does dermal Pif.

Animals↗
PubMed2002

Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.

BACKGROUND: We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. METHODS: Thirty-seven consecutive severe flail chest patients who required mechanical ventilation were enrolled in this study. All the patients received identical respiratory management, including end-tracheal intubation, mechanical ventilation, continuous epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage, and pulmonary hygiene. At 5 days after injury, surgical stabilization with Judet struts (S group, n = 18) or internal pneumatic stabilization (I group, n = 19) was randomly assigned. Most respiratory management was identical between the two groups except the surgical procedure. Statistical analysis using two-way analysis of variance and Tukey's test was used to compare the groups. RESULTS: Age, sex, Injury Severity Score, chest Abbreviated Injury Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2 ratio at admission were all equivalent in the two groups. The S group showed a shorter ventilatory period (10.8 +/- 3.4 days) than the I group (18.3 +/- 7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 +/- 7.4 days; I group, 26.8 +/- 13.2 days; p < 0.05), and lower incidence of pneumonia (S group, 24%; I group, 77%; p < 0.05). Percent forced vital capacity was higher in the S group at 1 month and thereafter (p < 0.05). The percentage of patients who had returned to full-time employment at 6 months was significantly higher in the S group (11 of 18) than in the I group (1 of 19). CONCLUSION: This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the early phase after surgical fixation. Also, patients with surgical stabilization could return to their previous employment quicker than those with internal pneumatic stabilization, even in those with the same severity of flail chest. We therefore concluded that surgical stabilization with Judet struts may be preferably applied to patients with severe flail chest who need ventilator support.

Flail Chest↗
PubMed2002

[Abdominal compartment syndrome following damage-control surgery: pathophysiology and decompression of intraabdominal pressure].

In Stone's milestone article on damage-control surgery (DCS) (Ann Surg 1983; 197:532-535), detailed clinical observations of abdominal compartment syndrome (ACS) were presented although the concept of ACS had not yet been established at that time. Since then the concept of ACS has been developed concomitantly with the widespread application of DCS for severe trauma victims. Intraabdominal pressure (IAP) is the most important factor for determining the severity of pathophysiological consequences in patients with ACS. Increased IAP pushes the diaphragm upward, which may cause deterioration of pulmonary function. Increased IAP decreases the glomerular filtration rate and urinary secretion. Patients with severe torso injury may have intraabdominal and/or retroperitoneal hematomaor edema formation in the mesentery, and all those can be factors that elevate IAP. About one-third of patients who undergo DCS develop ACS. Decompression of IAP clearly ameliorates physiological parameters in those patients, although the, mortality rate may not be improve despite adequate control of IAP. This suggest that in addition to elevated IAP other factors such as increased cytokine production might be important in ACS. Inserting a plastic infusion bag between intraabdominal organs and the abdominal wall rather than suturing a plastic bag to the edge of the opened abdominal wall may be preferable for further reconstruction of the wall.

Abdomen↗
PubMedDate not supplied

Prevalence of substance abuse among patients with physical diseases seen in an emergency room in Japan.

According to a nationwide general population survey on drug use in Japan, the lifetime prevalence of methamphetamine is low when compared to the United States. To confirm the hypothesis of a lower point prevalence of methamphetamine in an emergency room (ER) in Japan than in the United States, we collected blood specimens from an urban area of heavy methamphetamine prevalence in Tokyo, Japan, and analyzed the sera using REMEDi-HS based on an unlinked anonymity. Twenty kinds of drugs other than psychotropics were detected in 55 of 279 subjects (19.7%). Nineteen kinds of psychotropics were detected in twenty (7.2%) subjects. Psychotropics were detected in eleven patients with physical diseases and no acute intoxication. Methamphetamines were detected in three subjects (1.09%, 95% confidence interval 1.073-1.088) and in one of 46 subjects with injury (2.2%). It is necessary to look at the methodological differences between this study and previous studies; however, this finding supports the lower point prevalence of methamphetamine in an ER in Japan than in an ER in the United States.

Amphetamine-Related Disorders↗
PubMedDate not supplied

Aggressive endoscopic hemostasis for severe gastrointestinal bleeding in critically ill patients to decrease mortality.

BACKGROUND/AIMS: In critically ill patients, with gastrointestinal (GI) bleeding achieving endoscopic hemostasis has been reported to be often difficult, with a high rebleeding rate. The purpose of this study was to examine the efficacy of endoscopic hemoclipping for severe GI bleeding in critically ill patients. METHODOLOGY: This prospective study was performed at the Department of Traumatology and Critical Care Medicine, Kyorin University Hospital from June 1996 to December 1999. Patients with predefined clinically significant GI bleeding were treated using an established endoscopic hemoclipping protocol that covered indications and procedures. RESULTS: A total of 1429 patients were enrolled in this study. Of 11 hospitalized cases meeting the definition of severe GI bleeding, it occurred at 12.3 +/- 3.9 days (mean +/- SD) after admission. Initial hemostasis was possible in all patients. Although rebleeding was seen in 1 patient, the permanent hemostasis rate by additional endoscopic hemostasis was 100%. Of the 11, 9 patients were discharged and there were 2 hospital deaths. The direct cause of death depended on the degree of underlying critical illness and combined severe pneumonia. Complications caused by endoscopic hemostasis were not seen in any patient. CONCLUSIONS: Endoscopic hemostasis is useful in critically ill patients with the severe GI bleeding that occurs during critical care in the intensive care unit.

APACHE↗