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Nakama R, Arai Y, Horii T, Kobayashi T. Computed tomography-guided percutaneous needle biopsy for middle mediastinal tumors with retroaortic paravertebral approach: A case report. Radiol Case Rep 2024; 19:1440-1444. [PMID: 38292803 PMCID: PMC10827543 DOI: 10.1016/j.radcr.2023.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
A 74-year-old man was referred to our hospital for a close examination of a mediastinal mass. Contrast-enhanced CT showed a middle mediastinal tumor. We planned to perform a CT-guided percutaneous needle biopsy of the tumor using a retroaortic paravertebral approach to avoid transpulmonary puncture. A coaxial blunt-tip needle with a side hole was used to create space in the mediastinum and avoid azygos vein injury. After injecting normal saline, a blunt-tip needle was advanced through the space between the aorta and the vertebral body to the anterior surface of the tumor, and tissue was obtained. The patient was discharged the following day with no complications. For percutaneous middle mediastinal tumor biopsy, the retroaortic paravertebral approach may be a safe, effective route.
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Affiliation(s)
- Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Yasunori Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Toshihiro Horii
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Nakama R, Inoue N, Miyamoto Y, Arai Y, Kobayashi T, Fushimi K. Patient characteristics and procedural and safety outcomes of percutaneous transesophageal gastro-tubing: A nationwide database study in Japan. Surgery 2024; 175:368-372. [PMID: 37945482 DOI: 10.1016/j.surg.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Percutaneous transesophageal gastro-tubing (PTEG) is an alternative interventional procedure in cases where gastrostomy is not feasible. However, the safety and complication rates of PTEG have not yet been evaluated. We aimed to describe the characteristics of patients who underwent PTEG and investigate complications using a nationwide Japanese inpatient database. METHODS In this retrospective cohort study, we used the Diagnosis Procedure Combination database in Japan to identify patients who underwent PTEG from April 2012 to March 2020. The outcomes were the occurrence of complications, invasive treatment within 7 days after PTEG, and tube replacement within 14 days after PTEG. We statistically compared patient background, complication rates, and outcomes using PTEG indications. RESULTS A total of 3,684 patients underwent PTEG, which was performed in 1,455 patients for decompression and 2,193 patients for feeding. The patients' mean age was 73.1 years, and 62.1% were men. More patients in the decompression group had cancer than those in the feeding group. The overall number of complications was 47 cases (1.3%). The most common treatment administered after PTEG was red blood cell transfusion (3.9%), followed by early tube replacement (3.3%). As invasive treatments for PTEG complications, percutaneous drainage and transcatheter arterial embolization were required in 4 and 1 cases, respectively, and no cases required surgery. CONCLUSION We performed a descriptive study on PTEG using a nationwide database in Japan. This study also showed a low complication rate after PTEG in the real world. Our findings provide practical information on the safety of PTEG in Japan.
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Affiliation(s)
- Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, Japan.
| | - Norihiko Inoue
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | | | - Yasunori Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, Japan; Department of Diagnostic and Interventional Radiology, St. Marianna University, School of Medicine, Kanagawa, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Muacevic A, Adler JR, Kaito D, Nakama R, Izawa Y. Blast Injuries by an Improvised Explosive Device in Japan: A Case Report. Cureus 2022; 14:e32118. [PMID: 36601169 PMCID: PMC9805535 DOI: 10.7759/cureus.32118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/05/2022] Open
Abstract
Blast injuries caused by an improvised explosive device (IED) are becoming more common in civilian settings. However, physicians may not be familiar with the treatment and management of blast-injured victims. To the best of our knowledge, this is the first case report of a blast injury caused by an IED in Japan. A 64-year-old man was admitted to our hospital's emergency department after sustaining a blast injury. His vital signs were stable, but he had multiple small wounds with embedded foreign bodies that were consistent with injuries sustained by IED victims. The patient was treated for his injuries and was moved to another hospital on day 37. Knowledge about blast injuries caused by IEDs and management strategies for mass casualties are both necessary.
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Nakama R, Arai Y, Horii T, Kobayashi T. Air Embolism with Electrocardiogram Abnormality after Lung Biopsy. Intern Med 2022; 62:1383-1384. [PMID: 36198592 DOI: 10.2169/internalmedicine.0292-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Japan
| | - Yasunori Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Japan
| | - Toshihiro Horii
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Japan
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Kaito D, Yamamoto R, Nakama R, Hashizume K, Ueno K, Sasaki J. D-dimer for screening of aortic dissection in patients with ST-elevation myocardial infarction. Am J Emerg Med 2022; 59:146-151. [PMID: 35868207 DOI: 10.1016/j.ajem.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/22/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Acute aortic dissection (AAD) with concurrent ST-segment elevation myocardial infarction (STEMI) is relatively rare and sometimes overlooked. As D-dimer testing has been reported to have high sensitivity to diagnose AAD in a clinical scale, Aortic Dissection Detection Risk Score (ADD-RS), a point-of-care D-dimer analyzer capable of measuring in 10 min would be useful to deny AAD with concurrent STEMI. However, an optimal cut-off value of D-dimer in such population remains unclear. Therefore, the aim of this study was to elucidate the optimal D-dimer threshold in patients clinically diagnosed with STEMI. METHODS This retrospective cohort study was conducted at two tertiary care centers between 2014 and 2019. Patients clinically diagnosed with STEMI who underwent serum D-dimer measurement on hospital arrival were included. The primary outcome was the diagnosis of AAD. The area under the receiver operating characteristic curve (AUROC) for D-dimer values to diagnose AAD was evaluated, particularly in patients with low to moderate risks of AAD (1 of ADD-RS). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with several cut-off values. RESULTS A total of 322 patients were included, and 28 were diagnosed with AAD. The AUROC for D-dimer to diagnose AAD was 0.970 (95% confidence interval: 0.948-0.993) in 262 patients with 1 of ADD-RS. If D-dimer ≥750 ng/mL was used as a cut-off value, sensitivity, specificity, PPV and NPV were 100%, 86.4%, 37.7%, and 100%, respectively. AAD could be denied in 209 (79.8%) patients using the cut-off value (D-dimer <750 ng/mL). CONCLUSIONS Serum D-dimer ≥750 ng/mL exhibited high sensitivity and NPV to diagnose AAD with concurrent STEMI, while the ADD-RS originally utilized ≥500 ng/mL as a cut-off for any suspected AAD. A point-of-care D-dimer measurement with the new cut-off would be useful to rule-out AAD among patients with STEMI.
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Affiliation(s)
- Daiki Kaito
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Kenichi Hashizume
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi 321-0974, Japan
| | - Koji Ueno
- Department of Cardiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi 321-0974, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Nakama R, Arai Y, Kobayashi T. Sedation With Dexmedetomidine During Lymphangiography and Thoracic Duct Embolization in an Elderly Man. Cureus 2022; 14:e24466. [PMID: 35637799 PMCID: PMC9131845 DOI: 10.7759/cureus.24466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
An 83-year-old man underwent cervical esophagectomy and developed a chylothorax as a postoperative complication. We decided to perform lymphangiography and thoracic duct embolization for chylous leakage, but it was expected to be challenging to maintain bed rest. Therefore, dexmedetomidine was administered for procedural sedation. The patient's blood pressure and heart rate were mostly stable during the procedure, and the sedation level was maintained within the desired limits. Due to its specific sedative pattern and mild analgesic effect, Dexmedetomidine is suitable for procedural sedation in various painless interventional radiology procedures, such as lymphangiography and thoracic duct embolization. Therefore, it may be the best sedative for the elderly and should be widely and effectively used in interventional radiology.
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Affiliation(s)
- Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, JPN
| | - Yasunori Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, JPN
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, JPN
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Nakama R, Arai Y, Hosoi K, Kobayashi T. Computed tomography-guided percutaneous intranodal mesenteric lymphangiography for the identification of a lymphatic leak. J Vasc Interv Radiol 2022; 33:854-855. [DOI: 10.1016/j.jvir.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
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Nakama R, Arai Y, Takei Y, Kobayashi T. Successful transcatheter arterial embolization for uretero-inferior epigastric arterial fistula: A rare complication of cutaneous ureterostomy. Urol Case Rep 2021; 38:101726. [PMID: 34094878 PMCID: PMC8166751 DOI: 10.1016/j.eucr.2021.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
A 70-year-old man presented with pulsatile bleeding upon changing his catheter for cutaneous ureterostomy. He was suspected to have a uretero-arterial fistula. Computed tomography showed an abnormally dilated right inferior epigastric artery, the suspected bleeding source. Angiography revealed a tortuous dilated branch from the inferior epigastric artery. Transcatheter arterial embolization was performed with a gelatin sponge and coil. He was discharged 15 days after the procedure. Uretero-arterial fistula is a rare but fatal complication among patients with long-term indwelling ureter catheters. An abnormal inferior epigastric artery surrounding the cutaneous ureterostomy should be considered a rare cause of uretero-arterial fistula.
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Nakama R, Kadoya T, Kimura T, Arakawa K, Ogura T, Kase K. Transcatheter Arterial Embolization of a Gluteal Pseudoaneurysm Due to Ground-Level Fall in an Elderly Woman Taking Apixaban. Interventional Radiology 2021; 6:1-3. [PMID: 35910527 PMCID: PMC9327326 DOI: 10.22575/interventionalradiology.2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022]
Abstract
A 90-year-old woman prescribed with apixaban was admitted to a hospital after a ground-level fall. She was transferred to our hospital for advanced evaluation and treatment. Contrast-enhanced computed tomography showed a pseudoaneurysm inside the right gluteus maximus muscle. Angiography revealed an aneurysm of the peripheral branch of the inferior gluteal artery and multiple slight pseudoaneurysms of the peripheral branch of the internal iliac artery. We performed transcatheter arterial embolization using a gelatin sponge. After embolization, the hemoglobin stabilized. She was transferred to another hospital for rehabilitation. The use of direct oral anticoagulants in the elderly can lead to significant hemorrhage with minimal trauma. Transcatheter arterial embolization is a minimally invasive and safe procedure for such cases of trauma.
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Affiliation(s)
- Rakuhei Nakama
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
- Department of Radiology, Saiseikai Utsunomiya Hospital
| | - Takashi Kadoya
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | - Takuya Kimura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | | | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | - Kenichi Kase
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
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Nakama R, Yagami T, Kaito D, Tsukamoto R, Kase K. Urolithiasis mimic: isolated spontaneous renal artery dissection in the emergency department. Acute Med Surg 2020; 7:e466. [PMID: 31988778 PMCID: PMC6971423 DOI: 10.1002/ams2.466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2019] [Accepted: 10/16/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rakuhei Nakama
- Department of Emergency and Critical Medicine Saiseikai Utsunomiya Tochigi Japan
| | | | - Daiki Kaito
- Department of Emergency and Critical Medicine Saiseikai Utsunomiya Tochigi Japan
| | - Ryo Tsukamoto
- Department of Urology Saiseikai Utsunomiya Hospital Utsunomiya Tochigi Japan
| | - Kenichi Kase
- Department of Emergency and Critical Medicine Saiseikai Utsunomiya Tochigi Japan
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Nakama R, Yagami T, Kono I, Arakawa K, Usui K, Kato K, Tanimura K, Honda M. Outflow of N-butyl-2-cyanoacrylate into the Pancreatic Duct: Transcatheter Arterial Embolization for Hemosuccus Pancreaticus. Interventional Radiology 2020; 5:85-88. [PMID: 36284663 PMCID: PMC9550426 DOI: 10.22575/interventionalradiology.2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/30/2020] [Indexed: 12/05/2022]
Abstract
A 54-year-old Japanese woman, hospitalized for recurrent chronic alcoholic pancreatitis, manifested bloody stools. An esophagogastroduodenoscopy revealed active bleeding from the papilla of Vater. Contrast-enhanced computed tomography (CECT) revealed a pseudoaneurysm in the pancreatic pseudocyst (hemosuccus pancreaticus). Angiography demonstrated pseudoaneurysm of the dorsal pancreatic artery branch. We selected N-butyl-2-cyanoacrylate (NBCA) as an embolus material because of the existing coagulopathy and difficulty in selecting the arterial branch. The administered NBCA outflowed into the pancreatic duct over the pseudoaneurysm. However, transcatheter arterial embolization (TAE) was successful, and no complication or rebleeding was observed after TAE. CECT showed NBCA cast in the pancreatic duct; however, the chronic pancreatitis improved. NBCA may be used to regulate hemosuccus pancreaticus in emergency settings; however, interventional radiologists must carefully consider the complications caused by NBCA.
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Affiliation(s)
- Rakuhei Nakama
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
- Department of Radiology, Saiseikai Utsunomiya Hospital
| | | | - Isao Kono
- Department of Radiology, Saiseikai Utsunomiya Hospital
| | | | - Koki Usui
- Department of Radiology, Saiseikai Utsunomiya Hospital
| | - Koki Kato
- Department of Radiology, Saiseikai Utsunomiya Hospital
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Nakama R, Izawa Y, Kujirai D, Yagami T, Kono I, Tanimura K, Honda M, Kase K, Lefor AK. Transcatheter arterial embolization for initial hemostasis in a hemodynamically unstable patient with mesenteric hemorrhage: A case report. Radiol Case Rep 2018; 14:251-254. [PMID: 30479682 PMCID: PMC6250752 DOI: 10.1016/j.radcr.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Surgical treatment of mesenteric injuries is necessary to control hemorrhage, manage bowel injuries, and evaluate bowel perfusion. It has recently been suggested that some patients can be managed with transcatheter arterial embolization (TAE) for initial hemostasis. We present a hemodynamically unstable patient who was initially managed by TAE for traumatic mesenteric hemorrhage. A 60-year-old man was injured in a motor vehicle accident and transported to our facility. On arrival, the patient was hemodynamically stable, and had abdominal pain. Physical examination revealed a seatbelt sign on the lower abdomen. A contrast-enhanced computed tomography (CT) scan showed intra-abdominal hemorrhage, mesenteric hematoma, and a giant-pseudoaneurysm, but no intra-abdominal free air or changes in the appearance of the bowel wall. After the CT scan, his vital signs deteriorated and surgical intervention was considered, but TAE was performed to control the hemorrhage. After TAE, the patient was hemodynamically stable and had no abdominal tenderness. A follow-up CT scan was performed 2 days later which showed partial necrosis of the transverse colon and some free air. Resection of the injured transverse colon with primary anastomosis was performed. The patient improved and was discharged 35 days after injury. TAE can be effective as the initial hemostatic procedure in patients with traumatic mesenteric hemorrhage.
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Affiliation(s)
- Rakuhei Nakama
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
- Department of Radiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
- Corresponding author.
| | - Yoshimitsu Izawa
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Dai Kujirai
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Toshiaki Yagami
- Department of Radiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Isao Kono
- Department of Radiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Keiichi Tanimura
- Department of Radiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Masanori Honda
- Department of Radiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Kenichi Kase
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Yamamoto R, Suzuki M, Nakama R, Kase K, Sekine K, Kurihara T, Sasaki J. Impact of cardiopulmonary resuscitation time on the effectiveness of emergency department thoracotomy after blunt trauma. Eur J Trauma Emerg Surg 2018; 45:697-704. [PMID: 29855670 DOI: 10.1007/s00068-018-0967-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Debate remains about the threshold cardiopulmonary resuscitation (CPR) duration associated with futile emergency department thoracotomy (EDT). To validate the CPR duration associated with favorable outcomes, we investigated the relationship between CPR duration and return of spontaneous circulation (ROSC) after EDT in blunt trauma. METHODS A retrospective observational study was conducted at three tertiary centers over the last 7 years. We included bluntly injured adults who were pulseless and required EDT at presentation, but excluded those with devastating head injuries. After multivariate logistic regression identified the CRP duration as an independent predictor of ROSC, receiver operating characteristic curves were used to determine the threshold CPR duration. Patient data were divided into short- and long-duration CPR groups based on this threshold, and we developed a propensity score to estimate assignment to the short-duration CPR group. The ROSC rates were compared between groups after matching. RESULTS Forty patients were eligible for this study and ROSC was obtained in 12. The CPR duration was independently associated with the achievement of ROSC [odds ratio 1.18; 95% confidence interval (CI) 1.01-1.37, P = 0.04], and the threshold CPR duration was 17 min. Among the 14 patients with a short CPR duration, 13 matched with the patients with a long CPR duration, and a short CPR duration was significantly associated with higher rates of ROSC (odds ratio 8.80; 95% CI 1.35-57.43, P = 0.02). CONCLUSIONS A CPR duration < 17 min is independently associated with higher ROSC rates in patients suffering blunt trauma.
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Affiliation(s)
- Ryo Yamamoto
- Trauma Service, Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Masaru Suzuki
- Department of Emergency Medicine, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Rakuhei Nakama
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Kenichi Kase
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Tomohiro Kurihara
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
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Hirano S, Nakama R, Tamaki M, Masuda N, Oda H. Isolation and characterization of thirteen intestinal microorganisms capable of 7 alpha-dehydroxylating bile acids. Appl Environ Microbiol 1981; 41:737-45. [PMID: 7224633 PMCID: PMC243769 DOI: 10.1128/aem.41.3.737-745.1981] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Thirteen anaerobic bacteria capable of performing the 7 alpha-dehydroxylation of both cholic acid and chenodeoxycholic acid were isolated from human feces and also from sewage. Ten organisms from heat-treated samples were species of Clostridium identical or closely related to the Clostridium bifermentans-C. sordellii group and consisted of four strains elaborating 7 alpha-dehydroxylase alone and six strains capable of catalyzing both 7 alpha-dehydrogenation and 7 alpha-dehydroxylation. The remaining three organisms, recovered from fresh human feces, were gram-positive, nonflagellated, nonsporeforming, anaerobic rods and comprised two distinct species. Strain HD-17, still unidentified, had both activities, but was unique in that it exclusively 7 alpha-dehydroxylated cholic acid while biotransforming chenodeoxycholic acid, preferably though 7 alpha-dehydrogenation. Two unclassified strains, b-8 and c-25, metabolized both acids though 7 alpha-dehydroxylation and 7 alpha-dehydrogenation. Except for strains b-8 and c-25, all of th 7 alpha-dehydroxylating bacteria split the conjugated bile acid series, and hydrolases were detected in cell-free filtrates of early stationary-phase broth cultures.
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