Suffocation caused by a foreign body in the upper intra-thoracic esophagus.
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Asphyxia↗
Biomedical subjects
Toshihisa Sakamoto
Publications and source records attributed to Toshihisa Sakamoto.
Diffusion-weighted MRI predicts prognosis in severe hypoglycemic encephalopathy.
A 20-year-old woman presented unconscious due to hypoglycemia after a self-administered insulin injection. Diffusion-weighted MRI (DWI), performed 5 days after admission, demonstrated heterogeneous high-intensity signal areas in both the cortex and subcortex but sparing the motor and sensory centers. On the 11th day after admission, she began making incomprehensible verbal sounds, eye opening spontaneously and moving her extremities with pyramidal tract signs. Three months later, she had aphasia, agnosia and apraxia but a normal gait without pyramidal tract signs or ataxia. DWI is thus considered useful to predict the functional outcome of patients with severe hypoglycemia.
Adult↗
Indications and limitations of induced hypothermic therapy for out-of-hospital cardiopulmonary arrest.
PURPOSE: To identify candidates indicated to undergo induced hypothermic therapy (IHT) among comatose survivors of out-of-hospital cardiopulmonary arrest (CPA) based on a retrospective review of medical charts. METHODS: Between 1995 and 2004, 49 patients who recovered from CPA and treated by IHT were analyzed. The subjects were divided into 2 groups. The first group (GR, n = 16) consisted of patients with a recovery of consciousness and the second group (VD, n = 33) consisted of patients who either remained unconscious or who died. RESULTS: Using a multiple logistic regression analysis, out-of-hospital return of spontaneous circulation was the only factor independently associated with the outcome (odds ratio, 0.03; 95% confidence interval, 0.00-0.23; P = .001). CONCLUSION: IHT may be beneficial for CPA patients with out-of-hospital return of spontaneous circulation. Because of the small sample size, further large human studies are warranted.
Adult↗
A satisfactory recovery after emergency direct cardiac massage in type A acute aortic dissection with cardiac arrest.
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Acute Disease↗
Effect of induction rate for mild hypothermia on survival time during uncontrolled hemorrhagic shock in rats.
BACKGROUND: Rapid induction of hypothermia has been shown to improve survival in uncontrolled hemorrhagic shock (UHS) rat studies. We hypothesized that prolonged induction of hypothermia would be equally beneficial for survival during UHS. METHODS: Light anesthesia was induced with halothane in 30 rats, and spontaneous breathing was maintained. Rectal temperature (Tr) was monitored and maintained at 38 degrees C. UHS was induced by blood withdrawal of 2.5 mL/100 g during a 15-minute period, followed by 75% tail amputation. Immediately after cutting the tail, rats were randomized into three groups of 10 rats each: Group 1, maintained at Tr 38 degrees C; group 2, passively cooled to 34 degrees C by exposure to room temperature (23 degrees C); and group 3, actively cooled to 34 degrees C by applying alcohol to the skin and under an electric fan. Next, rats were controlled at each target Tr and observed without fluid resuscitation until either death or a maximum of 240 minutes. RESULTS: Cooling rate was -0.09 +/- 0.01 degrees C/min in group 2 and -0.36 +/- 0.9 degrees C/min in group 3 (p < 0.01). Mean survival time was 72 +/- 21 minutes in group 1 (38 degrees C), and was nearly doubled by hypothermia to 132 +/- 62 minutes for group 2 (p < 0.01 vs. group 1) and 150 +/- 69 minutes for group 3 (p < 0.01 vs. group 1). No significant difference in survival was noted between groups 2 and 3. Additional blood loss from the tail stump did not differ significantly between groups. CONCLUSION: Therapeutic mild hypothermia, induced either slowly (approximately -0.1 degrees C/min) or rapidly (approximately -0.4 degrees C/min) prolongs survival during lethal UHS in rats.
Animals↗
Intubation without premedication may worsen outcome for unconsciousness patients with intracranial hemorrhage.
To clarify the influence of an intubation maneuver with or without premedication for an intracranial hemorrhage in an unconsciousness patient, we retrospectively analyzed 70 patients who had received intubation for unconsciousness and in whom a nontraumatic intracranial hemorrhage was found by CT over a 6-year period. They were divided into 2 groups, consisting of a drug group (n=15), wherein drugs were used before intubation, and control group (n=55), wherein no drugs were used before were intubation. The physical findings on admission, CT findings, Glasgow Outcome Score (GOS) at 3 months from admission were analyzed between the groups. There were no significant differences in the backgrounds of the subjects between the groups. The GOS in the control group was significantly higher than in the drug group (P<.001). In cases of intubation for unconscious patients who may have intracranial hemorrhaging, premedication is considered associated with a more favorable outcome.
Analgesics, Opioid↗
Spermatic cord injury associated with blunt trauma.
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Emergency Medicine↗
Lymphocytosis without anemia in a patient presenting with anaphylactic shock.
We retrospectively investigated whether anaphylactic shock tends to be associated with lymphocytosis or not. We reviewed the medical charts of patients who had shock between January 1999 and September 2004. The subjects were divided into 4 groups, consisting of anaphylactic, hemorrhagic, cardiogenic, and septic groups. The results of laboratory examinations were analyzed. Regarding cellular differences, the lymphocyte-total leukocyte ratio in the anaphylactic group was significantly greater than that in the other groups. The average number of lymphocytes in the anaphylactic group was also significantly greater than that in both the hemorrhagic and septic groups. In addition, the average value of hemoglobin in the anaphylactic group was significantly greater than that in the other groups. The identification of lymphocytosis without anemia may therefore enable clinicians to accurately differentiate various states of shock in patients presenting with shock at the ED.
Age Distribution↗
Cerebral density on CT immediately after a successful resuscitation of cardiopulmonary arrest correlates with outcome.
PURPOSE: To evaluate whether cerebral CT findings taken immediately after successful resuscitation from cardiopulmonary arrest (CPA) correlate with the outcome or not. MATERIAL AND METHODS: We analyzed retrospectively brain sections with the Housfield unit (CT number). Between May 2001 and March 2004, 16 consecutive patients, who recovered from CPA, were included as subjects in this study. They satisfied all of the following criteria: (a) a helical multislice head CT was performed within 1 h of the return of the spontaneous circulation (ROSC); (b) patients died within 24 h after ROSC, and any patients with trauma or cerebral vascular disease were excluded. The subjects were divided into two groups; those with a cerebral performance category of 1-3 (GR group) and those with a cerebral performance category of 4-5 (VD group). RESULTS: There were no significant differences between the two groups except for age. The average ventricle size on the brain CT showed no significant difference between the two groups. The average CT number of the putamen and cerebral cortex, and the corticomedullary contrast in the GR group were higher than those in the VD group. CONCLUSION: Although the influence of age cannot be disregarded, the CT number of the putamen and cortex, and also the corticomedullary contrast correlated with outcome of hypoxic encephalopathy even when cerebral CT was performed within 1 h after ROSC following CPA.
Aged↗
Therapeutic hypothermia limited to the resuscitation period does not prolong survival after severe hemorrhagic shock in rats.
OBJECTIVE: Controlled hypothermia induced during hemorrhagic shock (HS) has been shown previously to improve survival in HS rat outcome models. We hypothesized that hypothermia (34 degrees C) induced immediately with reperfusion would also improve survival. METHODS: Twenty-four rats were lightly anesthetized with halothane and maintained spontaneous breathing. The rats underwent: an HS phase I of 75 min, with an initial blood withdrawal of 2.5 mL/100 g over 15 min, followed by either additional blood withdrawal or re-infusion in order to maintain a mean arterial pressure (MAP) of 30 mmHg over 60 min; a resuscitation phase II of 60 min with return of shed blood and infusion of lactated Ringer's solution to maintain a MAP of 75 mmHg; and an observation phase III without anesthesia for 72 h. Five minutes before the start of phase II, 12 rats were randomized into either a normothermia (38 degrees C) group or hypothermia (34 degrees C) group. The rectal temperature in each group was carefully maintained during the 60-min period of phase II. Survival at 72 h, as well as gut damage were assessed. RESULTS: All 24 rats survived beyond phases I and II. At 72 h, 8 of 12 rats survived in the hypothermia group, while and 6 of 12 survived in the normothermia group (p=0.64). Intestines of the 72 h survivors were macroscopically normal. In rats that died during phase III, total gut scores did not differ statistically between the groups (1.2+/-0.6 versus 1.0+/-0.9). CONCLUSION: Brief resuscitative hypothermia of 60 min duration induced immediately with reperfusion after HS did not improve survival in this model.
Animals↗
Post-traumatic mutism caused by corpus callosum injury diagnosed by fluid-attenuated inversion recovery on magnetic resonance imaging.
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Accidents, Traffic↗
Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients.
BACKGROUND: The diameter of the inferior vena cava in trauma patients may be useful for evaluating hypovolemia. METHODS: Between June 2003 and September 2003, 35 injured patients transferred to the authors' hospital were prospectively investigated. They were divided into two groups: a shock group (n = 10) and a control group (n = 25). The maximum anteroposterior diameter of the inferior vena cava was measured using a sonography at arrival and on hospital day 5. RESULTS: The average diameter of the inferior vena cava in the shock group was significantly smaller than in the control group. There was no significant change in the diameter of the inferior vena cava in the control group, but significant change was seen in the shock group between arrival and hospital day 5. CONCLUSION: The diameter of the inferior vena cava was found to correlate with hypovolemia in trauma patients.
Adult↗
Ionized magnesium in the cerebrospinal fluid of patients with head injuries.
BACKGROUND: In head injury patients, a decrease in the serum ionized magnesium (iMg) concentration is considered to be related to the severity of the injury, however, this phenomenon is still not completely understood. The cerebrospinal fluid (CSF) iMg concentration has not been well documented under such conditions and, moreover, its normal value has not yet been established. We hereby intended to investigate the role of the iMg concentration and other parameters in both the serum and CSF of head injury patients and identify any relationship with other parameters. MATERIALS AND METHODS: The subjects consisted of head injury patients without any other serious injuries. Ten healthy volunteers were selected as control subjects. Arterial blood and CSF specimens were simultaneously obtained and measured. We measured the Glasgow Coma Scale scores (GCS), the intracranial pressure (ICP), pH, po2, pco2, sodium, potassium, iCa, iMg, glucose, lactate, urea nitrogen. All data are expressed as the mean+/-SD and the units of iMg and iCa (corrected under pH 7.40) are given in mmol/L. RESULTS: In the healthy subjects, the iMg concentration in the serum/CSF was 0.48 +/- 0.02 / 0.66 +/- 0.14, and iCa was 1.14 +/- 0.05 / 0.94 +/- 0.07. The GCS of the 15 head injury subjects at examination was 8.7 +/- 4.5. When the subjects were divided into 3 groups according to the GCS level (3 and 4, 5-8, and > or =9) at the time of examination, the serum iMg concentration was thus found to be related to the severity of injury based on the GCS level (p = 0.028), but not the CSF iMg concentration (p = 0.89). No relationship was observed between the iMg concentration in the serum and CSF when all specimens were compared, but an extremely close correlation was seen in the group with GCS 3 and 4 (p < 0.0001, r = 0.995), although no such correlation was seen in the other 2 groups (p = 0.12, r = -0.56 in the group with GCS 5-8, and p = 0.26, r = -0.35 in the group with GCS > or = 9). There was a significant correlation between the serum iMg and iCa (p = 0.0093, r = 0.47), and also between the CSF iMg and iCa concentrations (p < 0.0001, r = 0.67). CONCLUSION: The serum iMg concentration has been suggested to possibly affect the neurologic state through CSF iMg in patients with the most severe head injury. In patients with moderate or mild head injuries, however, the ionized magnesium concentration is also probably associated with the degree of neurologic deficit based on the ionized calcium level. The CSF and serum ionized magnesium dissociation may thus result from the slow movement of ionized magnesium through the blood brain barrier.
Adolescent↗
Unfavorable outcome of burn patients with neuropsychiatric disorders.
To assess the outcome of burn patients with neuropsychiatric disorders, we performed a 7-year retrospective review of burn patients admitted to the National Defense Medical College. Seventy-seven skin burn patients over 10 years of age were included in this study and divided into two groups, neuropsychiatry and control groups. The neuropsychiatry group consisted of self-inflicted burn patients (n=21) and burn patients with a neurological disorder (n=18), who could not move away from burning source due to neurological problems. The control subjects (n=38) had been healthy before burn. No significant differences in the age, gender or causes of burn were observed between the two groups. Notably, total burned surface area, area of full-thickness burn, and mortality are greater in the neuropsychiatry group than those in the control. However, after matching the patients for the severity of burn injuries, the above parameters show no significant differences between the two groups. Therefore, the outcome of the burned patients depends on the patients' will and ability to move away from the burning source. Whenever we treat severe burn patients, we should assess their neuropsychiatric conditions.
Accidents, Home↗
Type I odontoid fracture--case report.
A 17-year-old man presented with sleeping tendency, tenderness of the back of the neck, and left upper monoplegia after a motorcycle accident. Three-dimensional computed tomography on the 2nd hospital day clearly revealed a type I odontoid fracture. His injuries were treated conservatively and he was discharged on the 60th hospital day, with sequelae due to the cervical root avulsion injuries. Type I odontoid fracture is rare and may be caused by coronal distraction of the head and neck area.
Adolescent↗
[Case of suicide by hanging complicated by cerebral sinus thrombosis].
A 43-year-old male with respiratory arrest due to neck hanging was resuscitated at the scene. The head CT on arrival showed diffuse brain swelling predominantly in the right cerebral hemisphere. The swelling improved but right transverse sinus thrombosis was recognized on the 4th hospital day. His conscious state gradually recovered and recanalization of the sinus was confirmed on a subsequent MR venography. He was discharged without neurological deficit. A sinus thrombosis should be considered as a differential diagnosis of brain swelling after hanging.
Adult↗
[A case of catatonia associated with the ingestion of hydroxyzine].
A twenty-six-year male who presented with a consciousness disturbance induced by the ingestion of an estimated 7g of hydroxyzine. He demonstrated bipolar symptoms which consisted of both stupor and excitement, and both an increase in muscle tension and apnea, however, these symptoms improved after the infusion of diazepam. He was diagnosed to demonstrate catatonia. After treatment composing three days of mechanical ventilation in combination with the administration of sedatives and muscle relaxatants, his symptoms improved. Hydroxyzine is thus considered to be able to induce catatonia and this mechanism of this condition is discussed.
Adult↗
[A case of a dramatic recovery of hypertensive hemorrhage in the mid-pons].
A 50-year-old female who had a past history of non-treated hypertension, demonstrated a coma on arrival. CT revealed a high density lesion measuring 23 mm in transverse diameter and 15 mm in height at the ventral mid pons without breaking into a fourth ventricle or extending to the midbrain. She required mechanical ventilation support. Her consciousness improved on the 2nd hospital day. She showed tetra-plegia, which was especially dominant on her right side. Her symptoms gradually improved until she could stand and she was eventually discharged on the 41st hospital day. At 90 days after the initial presentation, an enhanced head MRI showed the absorption of the hematoma and no existence of any vascular malformation was observed. We herein report a case who dramatically recovered from a hypertensive pontine hemorrhage, despite the fact that she demonstrated several risk factors for a poor prognosis. The fact that the size of the hematoma was not so huge, and the location of the hematoma spared both the ascending reticular activating system and the nuclei, may explain the favorable outcome in this case.
Cerebral Hemorrhage↗