A case of delayed hemothorax with an inferior phrenic artery injury detected and treated endovascularly.

We report the rare case of delayed hemothorax (DHX) with an inferior phrenic artery (IPA) injury due to blunt thoracic trauma. Our case suggests that DHX almost always occurs early after injury, and endovascular treatment is an effective procedure for traumatic hemothorax including DHX.

Effectiveness of an improved medical care system for children in a critical care medical center: is it possible to provide an equivalent level of trauma care for children as we do for adults?

Aim: In trauma care, most events that result in preventable trauma death tend to occur in the initial phase of treatment, and providing prompt and accurate care affects the outcomes of patients with severe trauma. Developing a system for administering prompt and accurate care and encouraging team coordination is essential for children as well as adults. However, differences in physical size and vital signs specific to children are potential obstacles to carrying out physical assessments, decision-making, procedures, and treatments in pediatric patients.

Actual treatments for out-of-hospital ventricular fibrillation at critical care medical centers in Osaka: a pilot descriptive study.

Aim: Although advanced treatments are provided to improve outcomes after out-of-hospital ventricular fibrillation, including shock-resistant ventricular fibrillation, the actual treatments in clinical settings have been insufficiently investigated. The aim of the current study is to describe the actual treatments carried out for out-of-hospital ventricular fibrillation patients, including shock-resistant ventricular fibrillation patients, at critical care medical centers.

Methods: We registered consecutive adult patients suffering bystander-witnessed out-of-hospital cardiac arrest of cardiac origin, for whom resuscitation was attempted by emergency medical service personnel, who had ventricular fibrillation as an initial rhythm, and who were transported to critical care medical centers in Osaka from March 2008 to December 2008.

Ambulance calls and prehospital transportation time of emergency patients with cardiovascular events in Osaka City.

Aim: This study investigated the association between the number of phone calls made to hospitals from ambulances requesting if they can accept prehospital emergency patients with cardiovascular events, and the prehospital transportation time.

Methods: Using ambulance records, we retrospectively enrolled adult patients suffering acute myocardial infarction from 1998 to 2007, and out-of-hospital cardiac arrest of cardiac origin from 2000 to 2007, transported to medical institutions by the emergency medical service in Osaka City.

Results: During the study period, 8,596 patients with acute myocardial infarction without arrest and 9,283 out-of-hospital cardiac arrests of cardiac origin were registered.

Discrepancy between heart rate and makers of hypoperfusion is a predictor of mortality in trauma patients.

Background: Tachycardia is an important early sign of shock in trauma. Although the base deficit (BD) and lactate are indicative of hypoperfusion and known to predict mortality, some cases show a discrepancy between heart rate (HR) and BD or lactate; such cases have poor prognosis. The objective of this study was to examine whether lack of tachycardia after hypoperfusion is associated with increased mortality.

[Examination of motion artifacts for helical and non-helical scanning modes in head CT].

For head computed tomography (CT), non-helical scanning has been recommended even in the widely used multi-slice CT (MSCT). Also, an acute stroke imaging standardization group has recommended the non-helical mode in Japan. However, no detailed comparison has been reported for current MSCT with more than 16 slices.

[What medical technologists can do in disaster...--experiences and prospects--introduction].

Disasters in medical treatment are defined as, "Huge numbers of casualties are generated who cannot be accepted by regional medical facilities", and when more casualties are generated than the regions can accept it is a "Disaster", e.g. earthquake, typhoon or bus, train and aircraft accidents.

Fever in trauma patients: friend or foe?

Background: In trauma patients, elevated body temperature is a common and noninfective procedure soon after injury. We hypothesized that the absence of this febrile response is associated with failure to meet metabolic demands and results in adverse outcomes.

Methods: We collected retrospective data of 253 consecutive trauma patients admitted to the intensive care unit during a 3-year period.

Is this the worst outcome of metabolic syndrome? Hypophosphatemia and resulting cardiac arrest during the treatment of diabetic ketoacidosis with hypertriglyceridemia.

We report a case of diabetic ketoacidosis (DKA) and severe hypertriglyceridemia who developed cardiac arrest due to hypophosphatemia. He was diagnosed with diabetes and hyperlipidemia, indicating metabolic syndrome. Hypophosphatemia was caused by large insulin doses received while treating DKA, which were required because of insulin resistance owing to hypertriglyceridemia.

Survival rate and factors associated with 1-month survival of witnessed out-of-hospital cardiac arrest of cardiac origin with ventricular fibrillation and pulseless ventricular tachycardia: the Utstein Osaka project.

Objective: We reassessed 1-month survival of patients with witnessed out-of-hospital cardiac arrest (OHCA) of cardiac origin with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in Osaka, Japan, and identified factors associated with 1-month survival using updated data from 1998 to 2004 collected based on the Utstein Style.

Methods: Using the Utstein Osaka Project database, we analyzed 1028 cases which met the following criteria: (1) patient age 18 years or older; (2) presumed cardiac origin based on the definition of the Utstein Style; (3) witnessed by citizens; (4) VF or pulseless VT at the time of arrival of the ambulance. The main outcome measure was survival at 1 month after collapse.

Duodenal disruption diagnosed 5 days after blunt trauma in a 2-year-old child: report of a case.

Blunt duodenal injury in children is uncommon and diagnosis is often delayed because of its retroperitoneal location. Both diagnosis and treatment are difficult. We report the case of a 2-year-old boy whose trauma injury was not reported for 5 days.

Classification of acute pancreatitis based on retroperitoneal extension: application of the concept of interfascial planes.

Objective: This study aimed to provide a classification system for acute pancreatitis by applying the principle that the disease spreads along the retroperitoneal interfascial planes.

Materials And Methods: Medical records and computed tomography (CT) images of 58 patients with acute pancreatitis treated between 2000 and 2005 were reviewed. The retroperitoneum was subdivided into 10 components according to the concept of interfascial planes.

Traumatic retroperitoneal hematoma spreads through the interfascial planes.

Background: The purpose of this study was to reevaluate extension of traumatic retroperitoneal hematoma (RH) and related management strategies in light of the new concept of retroperitoneal fascias as interfascial planes communicating with three compartments.

Methods: Diagnostic computed tomographic images of 169 patients with traumatic RH treated between 1997 and 2003 were retrospectively reviewed. The extension of RH was measured in relation to 10 components: 3 compartments and 7 parts of the interfascial planes.

The role of edaravone on the impairment of endothelial barrier function induced by acute oxidative stress in cultured human umbilical vein endothelial cell monolayer.

Background: The aim was to determine the effects of a novel free radical scavenger, edaravone, 3-methyl-1-phenyl-2-pyrazoline-5-one (ED), against endothelial barrier dysfunction induced by acute oxidative stress in cultured human umbilical vein endothelial cells (HUVECs).

Methods: To estimate the integrity of the HUVEC monolayer, transendothelial electrical resistance (TEER) was measured for 3 hours. We investigated the permeability change of the monolayer by measuring the concentration of fluorescence in isothiocyanate-labeled dextran (FITC-Dx), and estimated the degree of oxidative stress in terms of hydrogen peroxide (H2O2) in the apical chambers.

Fluid resuscitation of trauma patients: how fast is the optimal rate?

The Advanced Trauma Life Support guidelines recommend an initial rapid infusion of fluid (1-2 L) in trauma and hemorrhage victims as a diagnostic procedure to aid treatment decisions. Although patient response to initial fluid resuscitation is the key to determining therapeutic strategies, the appropriate rate of infusion is not clearly defined. Ninety-nine adult (age >16 years) blunt trauma victims with hypotension were enrolled.

Incidence and survival rate of bystander-witnessed out-of-hospital cardiac arrest with cardiac etiology in Osaka, Japan: a population-based study according to the Utstein style.

Purpose: To clarify the incidence and survival rate of bystander-witnessed out-of-hospital cardiac arrests (OHCA) with cardiac etiology in Osaka Prefecture, Japan, with a population of nearly 9 million according to the Utstein style.

Subjects And Methods: 5047 consecutive OHCA cases were treated by ambulance personnel during the 12-month period starting since 1 May 1998. 974 cases were considered to be bystander-witnessed OHCA with cardiac etiology and analyzed using the Utstein style.

Impact of mobile clinical analyzers on disaster medicine: a lesson from crush syndrome in the 1995 Hanshin-Awaji earthquake.

The Great Hanshin-Awaji earthquake caused many people to develop crush syndrome. Analysis of these patients revealed that the severity is not related to their hemodynamics but to hematocrit, base deficits, and potassium concentrations soon after their extrications. In the disaster site, these parameters can only be measured using whole-blood samples by mobile instruments.

Assessment of effective hepatic blood flow in critically ill patients by noninvasive pulse dye-densitometry.

Purpose: Effective hepatic blood flow (EHBF) is thought to reflect splanchnic perfusion and the metabolic state of the liver. This study was conducted to examine the relationship between cardiac output (CO) and EHBF using pulse dye-densitometry (PDD) in nonseptic and septic patients, and to assess the prognostic value of this relationship.

Methods: The subjects were 33 critically ill patients, 16 of whom met the criteria for sepsis.

[Paradigm shift from standard surgery to damage control surgery in major trauma].

"Damage control surgery (DCS)" is currently the most commonly used term to describe the surgical strategy for major trauma. Standard surgical approaches to trauma consist of a priority-driven sequence of steps, including exposure, homeostasis, repair, resection, and reconstruction. Patients with massive exsanguination, however, will not survive complex procedures.

Volume supplementation with iso-sodium solution prevents hypernatremia after head injury.

Objective: To evaluate our developed volume supplement protocol in preventing hypernatremia after head injury.

Methods: Iso-sodium solution was infused to keep the 8-hour water balance positive in 20 head-injured patients with hypotonic urine.

Results: Serum sodium concentrations moved to within a normal range in 6 patients and were temporarily increased in 12 patients.

Extensive subdural empyema treated with drainage and barbiturate therapy under intracranial pressure monitoring: case report.

In subdural empyema (SDE), if the mass effect and vasogenic edema are not controlled, the brain can be fatally damaged. Massive SDE over the skull base often requires repeated surgical drainage for removal of accumulated pus. Intracranial pressure (ICP) management until obliteration of the empyema is important to the improvement of clinical outcome.