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Bunya N, Ohnishi H, Kasai T, Katayama Y, Kakizaki R, Nara S, Ijuin S, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Narimatsu E. Prognostic Significance of Signs of Life in Out-of-Hospital Cardiac Arrest Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation. Crit Care Med 2024; 52:542-550. [PMID: 37921512 DOI: 10.1097/ccm.0000000000006116] [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] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Signs of life (SOLs) during cardiac arrest (gasping, pupillary light reaction, or any form of body movement) are suggested to be associated with favorable neurologic outcomes in out-of-hospital cardiac arrest (OHCA). While data has demonstrated that extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes in cases of refractory cardiac arrest, it is expected that other contributing factors lead to positive outcomes. This study aimed to investigate whether SOL on arrival is associated with neurologic outcomes in patients with OHCA who have undergone ECPR. DESIGN Retrospective multicenter registry study. SETTING Thirty-six facilities participating in the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan II (SAVE-J II). PATIENTS Consecutive patients older than 18 years old who were admitted to the Emergency Department with OHCA between January 1, 2013, and December 31, 2018, and received ECPR. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were classified into two groups according to the presence or absence of SOL on arrival. The primary outcome was a favorable neurologic outcome (Cerebral Performance Category 1 or 2) at discharge. Of the 2157 patients registered in the SAVE-J II database, 1395 met the inclusion criteria, and 250 (17.9%) had SOL upon arrival. Patients with SOL had more favorable neurologic outcomes than those without SOL (38.0% vs. 8.1%; p < 0.001). Multivariate analysis showed that SOL on arrival was independently associated with favorable neurologic outcomes (odds ratio, 5.65 [95% CI, 3.97-8.03]; p < 0.001). CONCLUSIONS SOL on arrival was associated with favorable neurologic outcomes in patients with OHCA undergoing ECPR. In patients considered for ECPR, the presence of SOL on arrival can assist the decision to perform ECPR.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yoichi Katayama
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
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Ibe Y, Kakizaki R, Inamura H, Ishigo T, Fujiya Y, Inoue H, Uemura S, Fujii S, Takahashi S, Narimatsu E, Fukudo M. Tazobactam/ceftolozane and tobramycin combination therapy in extensively drug-resistant Pseudomonas aeruginosa infections in severe burn injury: a case report. J Pharm Health Care Sci 2023; 9:25. [PMID: 37550794 PMCID: PMC10408163 DOI: 10.1186/s40780-023-00294-x] [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: 03/28/2023] [Accepted: 06/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Combination therapy with tazobactam/ceftolozane (TAZ/CTLZ) and high-dose aminoglycosides has been reported to be efficacious in extensively drug-resistant (XDR)-Pseudomonas aeruginosa infection. However, there are no reports of efficacy in XDR-P. aeruginosa infection for combination therapy with low-dose aminoglycosides and TAZ/CTLZ. Herein, we describe a rare case of severe burn injury patients with persistent bacteremia due to XDR-P. aeruginosa, which was successfully treated with TAZ/CTLZ and low-dose tobramycin (TOB). CASE PRESENTATION A 31-year-old man was admitted to the intensive care unit with severe burn injury involving 52% of the total body surface area and a prognostic burn index of 79.5. The patient had recurrent bacterial infections since admission, and blood cultures collected on the 37th day of admission revealed the presence of P. aeruginosa strains that were resistant to all β-lactams and amikacin (AMK). The results of the antimicrobial synergistic study showed no synergistic effect of low-dose meropenem (MEPM) and AMK combination therapy. The patient had acute renal failure, and it was difficult to increase the dose of MEPM and AMK, respectively. Thus, we initiated TAZ/CTLZ 1.5 g/8 h instead of the AMK and MEPM combination therapy on the 43rd day of hospitalization. Low-dose TAZ/CTLZ was continued because of prolonged renal dysfunction and resulted in a transient clinical improvement. However, the dosage of TAZ/CTLZ could be increased as the renal function improved, but despite an increased TAZ/CTLZ dose, bacteremia persisted, and the blood cultures remained positive. Thus, TOB was added to TAZ/CTLZ at low doses for synergistic effect against Gram-negative bacteria. Blood cultures collected after initiation of combination therapy with TAZ/CTLZ and low-dose TOB were negative on two consecutive follow-up evaluations. Thereafter, although the patient had several episodes of fever and increased inflammatory response, blood cultures consistently tested negative, and all of the wounds healed. On the 93rd day, due to the good healing progress, the patient was transferred to another hospital. CONCLUSIONS TAZ/CTLZ and low-dose TOB combination therapy showed the potential for synergistic effects. Our present report suggests a novel synergistic treatment strategy for rare cases that are refractory to the treatment of infections, such as XDR-P. aeruginosa infection.
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Affiliation(s)
- Yuta Ibe
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirotoshi Inamura
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Tomoyuki Ishigo
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Yoshihiro Fujiya
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Inoue
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahide Fukudo
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan.
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Nakayama R, Bunya N, Katayama S, Goto Y, Iwamoto Y, Wada K, Ogura K, Yama N, Takatsuka S, Kishimoto M, Takahashi K, Kakizaki R, Sawamoto K, Uemura S, Harada K, Narimatsu E. Correlation between the hysteresis of the pressure–volume curve and the recruitment-to-inflation ratio in patients with coronavirus disease 2019. Ann Intensive Care 2022; 12:106. [PMID: 36370227 PMCID: PMC9652597 DOI: 10.1186/s13613-022-01081-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Since the response to lung recruitment varies greatly among patients receiving mechanical ventilation, lung recruitability should be assessed before recruitment maneuvers. The pressure–volume curve (PV curve) and recruitment-to-inflation ratio (R/I ratio) can be used bedside for evaluating lung recruitability and individualing positive end-expiratory pressure (PEEP). Lung tissue recruitment on computed tomography has been correlated with normalized maximal distance (NMD) of the quasi-static PV curve. NMD is the maximal distance between the inspiratory and expiratory limb of the PV curve normalized to the maximal volume. However, the relationship between the different parameters of hysteresis of the quasi-static PV curve and R/I ratio for recruitability is unknown. Methods We analyzed the data of 33 patients with severe coronavirus disease 2019 (COVID-19) who received invasive mechanical ventilation. Respiratory waveform data were collected from the ventilator using proprietary acquisition software. We examined the relationship of the R/I ratio, quasi-static PV curve items such as NMD, and respiratory system compliance (Crs). Results The median R/I ratio was 0.90 [interquartile range (IQR), 0.70–1.15] and median NMD was 41.0 [IQR, 37.1–44.1]. The NMD correlated significantly with the R/I ratio (rho = 0.74, P < 0.001). Sub-analysis showed that the NMD and R/I ratio did not correlate with Crs at lower PEEP (− 0.057, P = 0.75; and rho = 0.15, P = 0.41, respectively). On the contrary, the ratio of Crs at higher PEEP to Crs at lower PEEP (Crs ratio (higher/lower)) moderately correlated with NMD and R/I ratio (rho = 0.64, P < 0.001; and rho = 0.67, P < 0.001, respectively). Conclusions NMD of the quasi-static PV curve and R/I ratio for recruitability assessment are highly correlated. In addition, NMD and R/I ratio correlated with the Crs ratio (higher/lower). Therefore, NMD and R/I ratio could be potential indicators of recruitability that can be performed at the bedside. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01081-x.
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Narimatsu E, Kakizaki R, Nomura K, Sawamoto K, Takahashi K, Uemura S, Ishiguro M. Dexmedetomidine improves excessive extracellular glutamate-induced synaptic depression (BRAINRES-D-21-00941). Brain Res 2022; 1789:147949. [DOI: 10.1016/j.brainres.2022.147949] [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: 09/15/2021] [Revised: 01/19/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
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5
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Ito H, Kakizaki R, Harada K, Kyuno D, Kubo T, Bunya N, Kasai T, Uemura S, Narimatsu E. Disseminated mucormycosis in a patient with severe COVID-19 on venovenous extracorporeal membrane oxygenation: A case report. IDCases 2022; 29:e01578. [PMID: 35874315 PMCID: PMC9295314 DOI: 10.1016/j.idcr.2022.e01578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/27/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hazuki Ito
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
- Correspondence to: Department of Emergency Medicine Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8556, Hokkaido, Japan.
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Daisuke Kyuno
- Department of Pathology, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, Japan
| | - Terufumi Kubo
- Department of Pathology, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
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6
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Hagiwara J, Kakizaki R. Traumatic complete medulla/cervical spinal cord transection due to atlanto‐occipital dislocation with atlanto‐axial subluxation. Acute Med Surg 2022; 9:e778. [PMID: 36092463 PMCID: PMC9450097 DOI: 10.1002/ams2.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/21/2022] [Accepted: 08/07/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Junya Hagiwara
- Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan
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7
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Kakizaki R, Tojo R, Bunya N, Mizuno H, Uemura S, Narimatsu E. A 48-Year-Old Previously Healthy Man Presenting with Acute Respiratory Distress Syndrome (ARDS), Negative Tests for SARS-CoV-2, and Positive Serology for Parainfluenza Virus Type 3 (PIV-3). Am J Case Rep 2021; 23:e934362. [PMID: 34987146 PMCID: PMC8744503 DOI: 10.12659/ajcr.934362] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patient: Male, 48-year-old
Final Diagnosis: Acute respiratory distress syndrome (ARDS) • parainfluenza virus infection
Symptoms: Dyspnea
Medication: —
Clinical Procedure: —
Specialty: Infectious Diseases • Pulmonology
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Affiliation(s)
- Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Ryutaro Tojo
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Hirotoshi Mizuno
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
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8
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Nakayama R, Iwamoto Y, Bunya N, Sawada A, Takahashi K, Goto Y, Kasai T, Kakizaki R, Uemura S, Narimatsu E. Bilateral phrenic nerve block as an effective means of controlling inspiratory efforts in a COVID-19 patient. Respir Med Case Rep 2021; 33:101455. [PMID: 34189030 PMCID: PMC8222048 DOI: 10.1016/j.rmcr.2021.101455] [Citation(s) in RCA: 1] [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: 05/05/2021] [Revised: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
Bilateral continuous phrenic nerve block effectively regulates refractory persistent, strong inspiratory effort in a patient with coronavirus disease (COVID-19). A 73-year-old man with acute respiratory distress syndrome (ARDS) due to COVID-19 was admitted to the intensive care unit (ICU). Use of neuromuscular blocking agents (NMBAs) was stopped due to uncontrollable strong inspiratory efforts and worsened lung injury. We performed bilateral continuous phrenic nerve block, which suppressed inspiratory efforts, resulting in lung injury improvement. A bilateral continuous phrenic nerve block is a viable alternative to control refractory strong inspiratory effort leading to lung injury in cases with prolonged NMBA use.
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Key Words
- ARDS, acute respiratory distress syndrome
- Acute respiratory distress syndrome
- COVID-19
- COVID-19, coronavirus disease
- CT, computed tomography
- Case report
- Edi, electrical activity of the diaphragm
- ICU, intensive care unit
- ICU-AW, intensive care unit-acquired weakness
- NMBAs, neuromuscular blocking agents
- Neuromuscular blocking agents
- P-SILI, patient self-inflicted lung injury
- PEEP, positive end-expiratory pressure
- Patient self-inflicted lung injury
- Pes, oesophageal pressure
- Phrenic nerve block
- ⊿Pes, change in oesophageal pressure
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Affiliation(s)
- Ryuichi Nakayama
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Yusuke Iwamoto
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Atsushi Sawada
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Kazunobu Takahashi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Yuya Goto
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
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Kato A, Minami Y, Asakura K, Katamine M, Katsura A, Muramatsu Y, Sato T, Kakizaki R, Hashimoto T, Meguro K, Shimohama T, Ako J. Plaque erosion is associated with less systemic atherosclerosis than other plaque types of acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1713] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies have demonstrated that plaque erosion is associated with less atheromatous plaque at both culprit and non-culprit lesion than other plaque types of acute coronary syndrome (ACS). However, the status of systemic atherosclerosis in patients with plaque erosion remains to be elucidated.
Purpose
To clarify if plaque erosion is associated with less systemic atherosclerosis than other plaque types of ACS.
Methods
A total of 239 consecutive patients with ACS who underwent optical coherence tomography (OCT) imaging of the culprit lesion were enrolled. Patients were classified into either plaque erosion (PE, n=45) or non-plaque erosion (non-PE, n=194) including plaque rupture and calcified nodule based on OCT findings of the culprit lesions. The status of systemic atherosclerosis was assessed by the findings of carotid echography, the severity of aortic arch calcification (AAC; grade 0–3) on chest X-ray, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial pressure index (ABPI).
Results
The maximum intima media thickness (IMT) was significantly thinner in the PE group than in the non-PE group (1.9±0.8 vs. 2.3±0.9 mm, p=0.023) (Panel A). The prevalence of heterogeneous plaque and calcified plaque was significantly lower in the PE group than in the non-PE group (25.0 vs. 50.4%, p=0.010, 18.8 vs. 38.5%, p=0.037, respectively). The prevalence of AAC grade was significantly different between the two groups with a tendency toward lower AAC grade in the PE group than the non-PE group (Panel B). The mean baPWV (1588.1±420.6 vs. 1686.5±363.5 cm/sec, p=0.186) and ABPI (1.1±0.1 vs. 1.1±0.1, p=0.270) was comparable between the two groups.
Conclusion
Plaque erosion was associated with less atherosclerosis in carotid artery and aortic arch than non-plaque erosion. These findings may help further clarify the distinct pathophysiology of plaque erosion.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Kato
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Y Minami
- Kitasato University School of Medicine, Sagamihara, Japan
| | - K Asakura
- Kitasato University School of Medicine, Sagamihara, Japan
| | - M Katamine
- Kitasato University School of Medicine, Sagamihara, Japan
| | - A Katsura
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Y Muramatsu
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T Sato
- Kitasato University School of Medicine, Sagamihara, Japan
| | - R Kakizaki
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T Hashimoto
- Kitasato University School of Medicine, Sagamihara, Japan
| | - K Meguro
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T Shimohama
- Kitasato University School of Medicine, Sagamihara, Japan
| | - J Ako
- Kitasato University School of Medicine, Sagamihara, Japan
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Bunya N, Ohnishi H, Wada K, Kakizaki R, Kasai T, Nagano N, Kokubu N, Miyata K, Uemura S, Harada K, Narimatsu E. Gasping during refractory out-of-hospital cardiac arrest is a prognostic marker for favourable neurological outcome following extracorporeal cardiopulmonary resuscitation: a retrospective study. Ann Intensive Care 2020; 10:112. [PMID: 32778971 PMCID: PMC7417467 DOI: 10.1186/s13613-020-00730-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/29/2019] [Accepted: 08/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background Gasping during cardiac arrest is associated with favourable neurological outcomes for out-of-hospital cardiac arrest. Moreover, while extracorporeal cardiopulmonary resuscitation (ECPR) performed for refractory cardiac arrest can improve outcomes, factors for favourable neurological outcomes remain unknown. This study aimed to examine whether gasping during cardiac arrest resuscitation during transport by emergency medical services (EMS) was independently associated with a favourable neurological outcome for patients who underwent ECPR. This retrospective study was based on medical records of all adult patients who underwent ECPR due to refractory cardiac arrest. The primary endpoint was neurologically intact survival at discharge. The study was undertaken at Sapporo Medical University Hospital, a tertiary care centre approved by the Ministry of Health, Labour and Welfare, located in the city of Sapporo, Japan, between January 2012 and December 2018. Results Overall, 166 patients who underwent ECPR were included. During transportation by EMS, 38 patients exhibited gasping, and 128 patients did not. Twenty patients who exhibited gasping during EMS transportation achieved a favourable neurological outcome (20/38; 52.6%); 14 patients who did not exhibit gasping achieved a favourable neurological outcome (14/128; 10.9%). Gasping during transportation by EMS was independently associated with favourable neurological outcome irrespective of the type of analysis performed (multiple logistic regression analysis, odds ratio [OR] 9.52; inverse probability of treatment weighting using propensity score, OR 9.14). Conclusions The presence of gasping during transportation by EMS was independently associated with a favourable neurological outcome in patients who underwent ECPR. The association of gasping with a favourable neurological outcome in patients with refractory cardiac arrest suggests that ECPR may be considered in such patients.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan.
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Kenshiro Wada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan
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11
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Kakizaki R, Bunya N, Uemura S, Narimatsu E. Successful difficult airway management with emergent venovenous extracorporeal membrane oxygenation in a patient with severe tracheal deformity: a case report. Acute Med Surg 2020; 7:e539. [PMID: 32724660 PMCID: PMC7377931 DOI: 10.1002/ams2.539] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Difficult airway management is occasionally encountered in the emergency department, and recent studies suggest that extracorporeal membrane oxygenation can be useful in these cases. Case Presentation A 74-year-old man was transferred to our hospital due to worsening dyspnea. On arrival, it was found that he was in respiratory distress and was comatose. Arterial blood gas analysis showed severe hypercapnia and respiratory acidosis. Intubation could not be done because he had severe tracheal deformity due to cervical-thoracic kyphosis secondary to vertebral tuberculosis. Therefore, we carried out surgical tracheostomy under venovenous extracorporeal membrane oxygenation. The patient's oxygenation gradually improved, and extracorporeal membrane oxygenation was withdrawn on day 8. He was transferred to another hospital on day 46 and suffered no neurological deficits. Conclusion Severe tracheal deformity can result in a difficult airway. Extracorporeal membrane oxygenation is an effective life-saving approach in cases of difficult airway management due to severe tracheal deformity.
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Affiliation(s)
- Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
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12
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Kasai T, Bunya N, Wada K, Kakizaki R, Mizuno H, Inoue H, Uemura S, Takahashi S, Narimatsu E, Takeda S. Veno-venous extracorporeal membrane oxygenation and prone ventilation for therapeutic management of COVID-19. Acute Med Surg 2020; 7:e546. [PMID: 32793357 PMCID: PMC7419213 DOI: 10.1002/ams2.546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/06/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background The efficacy and safety of the combined use of veno‐venous extracorporeal membrane oxygenation (ECMO) and prone ventilation are currently not known for coronavirus disease 2019 (COVID‐19). Case presentation We report two cases in which the combination of veno‐venous ECMO and prone ventilation for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pneumonia were successfully carried out. Both patients had developed severe respiratory failure due to SARS‐CoV‐2 pneumonia, thus requiring veno‐venous ECMO. Prone ventilation was also administered safely. Conclusion Oxygenation and lung compliance gradually improved during prone ventilation, and both patients were successfully extubated. For patients with severe SARS‐CoV‐2 pneumonia who require veno‐venous ECMO, the use of prone ventilation could be beneficial, and should be considered.
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Affiliation(s)
- Takehiko Kasai
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Kenshiro Wada
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Hirotoshi Mizuno
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Hiroyuki Inoue
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine Sapporo Medical University Sapporo Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
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13
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Kakizaki R, Bunya N, Uemura S, Narimatsu E. 1487: SUCCESSFUL RESUSCITATION FROM DIFFICULT AIRWAY CAUSED BY SEVERE TRACHEAL DEFORMITY WITH ECMO. Crit Care Med 2020. [DOI: 10.1097/01.ccm.0000645856.44926.de] [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] [Indexed: 11/25/2022]
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14
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Muramatsu Y, Minami Y, Ishida K, Kato A, Katsura A, Sato T, Kakizaki R, Nemoto T, Hashimoto T, Fujiyoshi K, Meguro K, Shimohama T, Ako J. P686Cancer is not associated with increased cardiac and bleeding events after 2nd- and 3rd-generation drug-eluting stents implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0291] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies demonstrated the impact of concomitant cancer on the increased risk of adverse cardiac and bleeding events after percutaneous coronary intervention (PCI). However, the impact in this 2nd- and 3rd-generation drug-eluting stent (DES) era remains to be elucidated.
Purpose
To clarify the impact of cancer on clinical outcomes in patients after 2nd- or 3rd -generation DES implantation.
Methods
A total of 932 patients who underwent PCI with 2nd- or 3rd -generation DES were included. Patients who were diagnosed with cancer after PCI were excluded from the present cohort. The incidence of major adverse cardiac events (MACE) including cardiac death, myocardial infarction and target or non-target vessel revascularization, and bleeding events was compared between the patients with cancer or the history of treatment for cancer (cancer group, n=140) and the patients without cancer (no cancer group, n=792). Bleeding events were evaluated according to the Thrombolysis in Myocardial Infarction definition. Further comparisons were performed between the 2 groups (cancer group, n=126; no cancer group, n=252) after the adjustment of baseline clinical characteristics using 1:2 propensity score-matching analysis.
Results
The incidence of MACE at median 577 [340–1043] days after the PCI was comparable between the 2 groups in both unadjusted (15.0% vs. 15.0%, p=0.984) (Panel A) and adjusted cohorts (14.3 vs. 13.1%, p=0.796), although the incidence of all cause death in the cancer group was significantly greater than the no cancer group (15.1 vs. 9.5%, p=0.007, in the adjusted cohort). The increased risk of MACE was not observed in any types of cancer or treatment (Panel B). The incidence of bleeding events was also comparable between the 2 groups (4.0 vs. 2.0%, p=0.297, in the adjusted cohort).
Conclusion
The increased incidence of MACE and bleeding events in patients with cancer was not demonstrated after the 2nd- or 3rd-generation DES implantation. Further studies are required to clarify the safety and efficacy of PCI in patients with cancer.
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Affiliation(s)
- Y Muramatsu
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Y Minami
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - K Ishida
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - A Kato
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - A Katsura
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - T Sato
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - R Kakizaki
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - T Nemoto
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - T Hashimoto
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - K Fujiyoshi
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - K Meguro
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - T Shimohama
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - J Ako
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
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15
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Nemoto T, Minami Y, Yamaoka-Tojo M, Sato T, Muramatsu Y, Kakizaki R, Hashimoto T, Fujiyoshi K, Meguro K, Shimohama T, Ako J. P6416Lower serum syndecan-1 level is associated with higher prevalence of vulnerable plaque in patients with coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Syndecan-1 is a component of endothelial glycocalyx which maintains vascular integrity. Thus, it may be impaied in patients with coronary artery disease (CAD).
Purpose
To assess the association between serum syndecan-1 level and the severity and vulnerability of CAD.
Methods
A total of 259 consecutive patients with stable angina requiring percutaneous coronary intervention (PCI) were prospectively enrolled. Patients were classified into 2 groups according to the median syndecan-1 value (Lower syndecan-1 group [syndecan-1 <99.0], n=130; Higher syndecan-1 group [syndecan-1 ≥99.0], n=129). Severity of CAD and focal plaque vulnerability in target lesion was evaluated using findings of angiography and optical coherence tomography (OCT), respectively. Thin-cap fibroatheroma (TCFA) was defined as a lipid-rich plaque covered with thin fibrous cap (<65 μm).
Results
There was no significant difference in baseline clinical characteristics between the lower syndecan-1 group and the higher syndecan-1 group other than the prevalence of family history of ischemic heart disease (19 vs. 32%, p=0.022) and prior PCI history (45 vs. 60%, p=0.015). The prevalence of multivessel disease (70 vs. 68%, p=0.627), left main disease (4 vs. 5%, p=0.748) and chronic total occlusion (15 vs. 15%, p=0.959) was comparable between the 2 groups. On the other hand, the prevalence of lipid-rich plaque (40 vs. 19%, p=0.004) and TCFA (20 vs. 6%, p=0.006) was significantly higher in the lower syndecan-1 groupthan the higher syndecan-1 group (Figure). The lower syndecan-1 was independently associated with the higher prevalence of lipid-rich plaque (Table).
Table 1. Multivariate analysis for lipid-rich plaque Odds ratio 95% CI pvalue Lower syndecan-1 2.981 1.448–6.411 0.003 Dyslipidemia 1.693 0.738–4.142 0.218 Chronic kidney disease 1.354 0.669–2.765 0.400 Smoking 0.975 0.453–2.154 0.951 Diabetes mellitus 0.819 0.400–1.661 0.580
Conclusions
Lower syndecan-1 level was associated with higher prevalence of vulnerable plaque in patients with CAD. Serum syndecan-1 may have a potential as a marker for the presence of vulnerable coronary plaque.
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Affiliation(s)
- T Nemoto
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - Y Minami
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - M Yamaoka-Tojo
- Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - T Sato
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - Y Muramatsu
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - R Kakizaki
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - T Hashimoto
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - K Fujiyoshi
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - K Meguro
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - T Shimohama
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
| | - J Ako
- Kitasato University School of Medicine, Cardiovascular medicine, Sagamihara, Japan
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16
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Arakawa Y, Fukaya H, Kakizaki R, Oikawa J, Matsuura G, Kobayashi S, Shirakawa Y, Nishinarita R, Horiguchi A, Ishizue N, Nabeta T, Igarashi G, Kishihara J, Niwano S, Ako J. P1495Energy loss by right ventricular pacing: normal left ventricular function vs. hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0259] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) pacing causes left ventricular (LV) dysfunction. On the other hand, RV pacing for hypertrophic obstructive cardiomyopathy (HOCM) is an established treatment. LV flow energy loss (EL) is a new hemodynamic index for assessing cardiac function. However, the impact of RV pacing on EL remains unknown.
Objective
The objective of this study was to investigate the EL by RV pacing on normal LV function and hypertrophic cardiomyopathy (HCM).
Methods
A total of 28 patients underwent echocardiography for EL assessment under AAI (without RV pacing) and DDD (with all RV pacing) mode. Among them, 16 were sick sinus syndrome (SSS) patients with normal LV function, and 12 were HCM patients. EL was calculated from color Doppler images using a vector flow mapping.
Results
There were no significant difference in patients' background parameters between the SSS and the HCM groups. In the SSS group, mean systolic EL was significantly increased from AAI to DDD mode (14.9 to 19.2 mW/m, P<0.01, Panel A), whereas diastolic EL was not changed from AAI to DDD mode (22.3 to 18.8 mW/m, P=0.12). In the HCM group, systolic mean EL was significantly decreased from AAI to DDD mode (29.9 to 22.5 mW/m, P<0.01, Panel B) irrespectively of with or without LV outflow obstruction, whereas diastolic mean EL was not changed from AAI to DDD mode (28.6 to 24.3 mW/m, P=0.47).
Change of flow energy loss
Conclusion
RV pacing increased mean systolic EL in normal LV function, but decreased in HCM with or without LV outflow obstruction. In the patients with HCM, the impact of RV pacing on EL is different compared with normal LV function.
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Affiliation(s)
- Y Arakawa
- Kitasato University School of Medicine, Sagamihara, Japan
| | - H Fukaya
- Kitasato University School of Medicine, Sagamihara, Japan
| | - R Kakizaki
- Kitasato University School of Medicine, Sagamihara, Japan
| | - J Oikawa
- Kitasato University School of Medicine, Sagamihara, Japan
| | - G Matsuura
- Kitasato University School of Medicine, Sagamihara, Japan
| | - S Kobayashi
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Y Shirakawa
- Kitasato University School of Medicine, Sagamihara, Japan
| | - R Nishinarita
- Kitasato University School of Medicine, Sagamihara, Japan
| | - A Horiguchi
- Kitasato University School of Medicine, Sagamihara, Japan
| | - N Ishizue
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T Nabeta
- Kitasato University School of Medicine, Sagamihara, Japan
| | - G Igarashi
- Kitasato University School of Medicine, Sagamihara, Japan
| | - J Kishihara
- Kitasato University School of Medicine, Sagamihara, Japan
| | - S Niwano
- Kitasato University School of Medicine, Sagamihara, Japan
| | - J Ako
- Kitasato University School of Medicine, Sagamihara, Japan
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17
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Katsura A, Minami Y, Kato A, Sato T, Muramatsu Y, Kakizaki R, Nemoto T, Hashimoto T, Fujiyoshi K, Meguro K, Shimohama T, Tojo T, Ako J. 6109A novel parameter for stent expansion is superior to conventional parameters for predicting adverse events after drug-eluting stent implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0135] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Among several parameters for stent expansion, which is better for predicting adverse events remains to be elucidated.
Purpose
To assess the predictive significance of several parameters for stent expansion on the incidence of adverse cardiac events.
Methods
A total of 183 consecutive patients with de novo lesion treated with drug-eluting stent (DES) under optical coherence tomography (OCT) guidance were enrolled. The stent expansion was retrospectively assessed on the final OCT images after the stent implantation by both conventional and novel parameters. The conventional parameters included the minimum stent cross-sectional area (MSA) and %stent expansion defined as [MSA/mean reference lumen cross-sectional area × 100]. The novel parameter was the minimum expansion index (MEI) calculated by using a novel algorhythm which yields the ideal lumen area in each frame by taking into account vessel tapering. The expansion index was calculated by [actual lumen area/ideal lumen area × 100] in each frame through the stented segment. The MEI was the minimum value of expansion index through the stented segment. The both conventional and novel parameters were compared between cases with and without device-oriented cardiac events (DoCE). Receiver operating characteristics (ROC) curves were constructed to assess the ability of those parameters to predict DoCE.
Results
The MSA and MEI in the DoCE group (n=12) were significantly smaller than the no DoCE group (n=171) (3.29±0.72 vs. 4.45±1.97 mm2, p<0.001, 66.9±10.6 vs. 78.3±14.8%, p=0.01, respectively), although the %stent expansion was not significantly different between the two groups (62.7±11.9 vs. 70.7±16.3%, p=0.094). In ROC analyses, the area under curve of MEI to predict DoCE was the largest among the parameters (Figure).
Conclusion
Among several parameters for stent expansion, a novel MEI was better to predict device-oriented cardiac events after DES implantation.
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Affiliation(s)
- A Katsura
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Y Minami
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - A Kato
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - T Sato
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Y Muramatsu
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - R Kakizaki
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - T Nemoto
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - T Hashimoto
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - K Fujiyoshi
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - K Meguro
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - T Shimohama
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - T Tojo
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - J Ako
- Kitasato University of Medicine, Cardiovascular Medicine, 1–15–1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
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18
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Wada K, Bunya N, Kakizaki R, Kasai T, Uemura S, Harada K, Narimatsu E. Successful use of veno-arterial extracorporeal membrane oxygenation for septic cardiomyopathy in a patient with pre-existing chronic heart failure. Acute Med Surg 2019; 6:301-304. [PMID: 31304033 PMCID: PMC6603327 DOI: 10.1002/ams2.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/01/2018] [Accepted: 02/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background Indications for using veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) in sepsis cases remain unclear. Case Presentation A 66‐year‐old man with pre‐existing chronic heart failure developed severe pneumonia resulting in refractory septic shock. He was diagnosed with septic cardiomyopathy based on depressed left ventricular ejection fraction and a dilated left ventricle based on a transthoracic echocardiogram. We initiated V‐A ECMO on day 3 because the shock did not respond to conventional therapy. The patient's hemodynamics improved, and his infection was reduced. He recovered fully and was discharged on day 107 with his cardiac function restored to its baseline. Conclusion Septic cardiomyopathy is a form of reversible myocardial dysfunction. Veno‐arterial extracorporeal membrane oxygenation should be considered for septic cardiomyopathy with intractable circulatory failure. Pre‐existing chronic heart failure is not a contraindication for VA‐ECMO.
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Affiliation(s)
- Kenshiro Wada
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Takehiko Kasai
- Emergency Department Hakodate Municipal Hospital Hokkaido Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Keisuke Harada
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
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19
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Kakizaki R, Bunya N, Uemura S, Odagiri A, Kasai T, Narimatsu E. Takotsubo cardiomyopathy developed during rewarming of accidental hypothermia with extracorporeal membrane oxygenation. Acute Med Surg 2019; 6:201-205. [PMID: 30976450 PMCID: PMC6442525 DOI: 10.1002/ams2.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/05/2018] [Accepted: 01/30/2019] [Indexed: 11/09/2022] Open
Abstract
Background We here present the first case report of takotsubo cardiomyopathy that developed during rewarming of a patient with severe accidental hypothermia with extracorporeal membrane oxygenation. Case A 74-year-old woman was found unresponsive outdoors and suffered cardiopulmonary arrest during transfer to our hospital. On arrival, she was still in cardiopulmonary arrest. Veno-arterial extracorporeal membrane oxygenation was initiated for resuscitation and rewarming. After admission to the intensive care unit, her blood pressure suddenly dropped, and coronary angiography on day 2 indicated intact coronary arteries. Left ventriculography showed typical takotsubo-like dysfunction in the end-systolic phase, which led to the diagnosis of takotsubo cardiomyopathy. Left ventricular wall motion gradually improved, and echocardiography on day 6 revealed that abnormalities in the left ventricular wall motion had almost disappeared. Conclusion Takotsubo cardiomyopathy might arise during rewarming of patients with severe accidental hypothermia.
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Affiliation(s)
- Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Arisa Odagiri
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Takehiko Kasai
- Emergency and Critical Care Center Hakodate Municipal Hospital Hokkaido Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
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20
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Bunya N, Wada K, Yamaoka A, Kakizaki R, Katayama Y, Kasai T, Kyan R, Murakami N, Kokubu N, Uemura S, Narimatsu E. The prognostic value of agonal respiration in refractory cardiac arrest: a case series of non-shockable cardiac arrest successfully resuscitated through extracorporeal cardiopulmonary resuscitation. Acute Med Surg 2019; 6:197-200. [PMID: 30976449 PMCID: PMC6442523 DOI: 10.1002/ams2.398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 11/09/2022] Open
Abstract
Background Agonal respiration following out-of-hospital cardiac arrest is associated with favorable neurological outcomes. Resuscitation using extracorporeal membrane oxygenation could contribute to achieving favorable neurological outcomes in patients with refractory cardiac arrest. Case presentation We report two cases of refractory cardiac arrest with non-shockable rhythms and agonal respiration; both patients were successfully resuscitated through extracorporeal cardiopulmonary resuscitation (ECPR). Both patients were breathing spontaneously upon arrival. One patient was asystolic and the other experienced pulseless electrical activity followed by ventricular fibrillation. Agonal respiration was observed in both and ECPR was implemented, leading to a favorable neurological outcome at discharge. Conclusion The presence of agonal respiration has the potential to confer a favorable neurological outcome in patients with refractory cardiac arrest if maintained, even when the initial cardiac rhythm is not shockable. In these cases, resuscitation should not be abandoned, and ECPR should be considered.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Kenshiro Wada
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Ayumu Yamaoka
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan.,Department of Neurosurgery Sapporo Medical University Sapporo Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Yoichi Katayama
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Takehiko Kasai
- Emergency Department Hakodate Municipal Hospital Hakodate Japan
| | - Ryoko Kyan
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Naoto Murakami
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University Sapporo Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University Sapporo Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
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21
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Inoue H, Uemura S, Harada K, Mizuno H, Bunya N, Nomura K, Kakizaki R, Narimatsu E. Risk factors for acute pancreatitis in patients with accidental hypothermia. Am J Emerg Med 2019; 37:189-193. [DOI: 10.1016/j.ajem.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 01/01/2023] Open
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Bunya N, Sawamoto K, Kakizaki R, Wada K, Katayama Y, Mizuno H, Inoue H, Uemura S, Harada K, Narimatsu E. Successful resuscitation for cardiac arrest due to severe accidental hypothermia accompanied by mandibular rigidity: a case of cold stiffening mimicking rigor mortis. Int J Emerg Med 2018; 11:46. [PMID: 31179929 PMCID: PMC6326142 DOI: 10.1186/s12245-018-0205-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/05/2018] [Accepted: 10/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background In cases of severe accidental hypothermia, it was recommended that resuscitation should be continued until the patient has rewarmed, as hypothermia itself can preserve cerebral function, and hypothermic cardiac arrest is reversible. During cardiopulmonary resuscitation for normothermic patients, muscle rigidity suggests the initiation of postmortem changes such as rigor mortis and can lead to the termination of resuscitation. Currently, the prognosis of cardiac arrest due to severe accidental hypothermia accompanied by rigidity is unknown. Case presentation A 29-year-old woman was found unresponsive near a snowy mountain trail. Upon discovery, she was found to be in cardiac arrest with an initial asystole rhythm and exhibited mandibular rigidity. On admission, her core temperature was 22 °C. Although cardiac arrest continued, and she showed no response to normal resuscitation, blood gas analysis revealed that her initial serum potassium level was 5.4 mmol/L. Extracorporeal membrane oxygenation (ECMO) for systemic perfusion and rewarming was initiated. After ECMO was introduced, return of spontaneous circulation was achieved. She showed no neurological impairments at discharge. Conclusions Muscle rigidity does not rule out the possibility of resuscitation in patients with severe accidental hypothermia under cardiac arrest. Serum potassium levels may assist in deciding whether ECMO should be introduced, even if a patient is in asystole. This knowledge may help emergency physicians to save the lives of such patients.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Kenshiro Wada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoichi Katayama
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hirotoshi Mizuno
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroyuki Inoue
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Fujiyoshi K, Yamaoka-Tojo M, Minami Y, Kutsuna T, Obara S, Takahashi Y, Sekine E, Aoyama A, Katsura A, Kakizaki R, Nemoto T, Namba S, Hashimoto T, Noda C, Ako J. P2503Cardiac rehabilitation improves cognitive function in elderly patients with cardiovascular disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2503] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bunya N, Harada K, Kuroda Y, Toyohara T, Toyohara T, Kubota N, Kakizaki R, Irifune H, Uemura S, Narimatsu E. The effectiveness of hybrid treatment for sever multiple trauma: a case of multiple trauma for damage control laparotomy and thoracic endovascular repair. Int J Emerg Med 2017; 10:18. [PMID: 28585119 PMCID: PMC5459779 DOI: 10.1186/s12245-017-0145-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/03/2017] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Time is a crucial factor for the successful early management of the multi-trauma patient. Hybrid operating theaters, which support the integration of surgical treatment and interventional radiology, provide opportunities to reduce the time-to-surgery for life threatening conditions. Case presentation We describe the early successful treatment of a 54-year-old male who sustained multiple injuries when he was hit by a 1000 kg bale of wheat that fell from a height. He was admitted with hemorrhagic shock due to intra-abdominal bleeding, an unstable fracture of the pelvis, and blunt aortic injury, which was considered to be at high risk of rupture. External fixation was applied to the pelvis in the resuscitation bay, and the patient was transferred to a hybrid operating theater for treatment of both the intra-abdominal hemorrhage and blunt aortic injury. Damage control laparotomy and thoracic endovascular aortic repair were performed uneventfully. Conclusions Hybrid treatment, which combines emergency surgery and intraoperative interventional radiology, provides a prompt and appropriate management approach for the treatment of patients with severe multiple trauma and may improve patient outcomes.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tsubasa Toyohara
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takashi Toyohara
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Narumi Kubota
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hideto Irifune
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Saito H, Soma Y, Nakajima M, Koeda J, Kawaguchi H, Kakizaki R, Chiba R, Aisawa T, Munakata A. A case-control study evaluating occult blood screening for colorectal cancer with hemoccult test and an immunochemical hemagglutination test. Oncol Rep 2000; 7:815-9. [PMID: 10854550 DOI: 10.3892/or.7.4.815] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A case control study to evaluate the occult blood screening for colorectal cancer was conducted in a town where colorectal cancer screening had been performed by Hemoccult test during the early years and subsequently by an immunochemical hemagglutination test. All residents aged >/=40 years had been offered the annual screening. Case series consisted of 51 subjects with fatal colorectal cancer. Three controls per case were selected from the list of residents who were alive at the time of diagnosis of the corresponding case and had been living in the town, matched by gender and by age. The odds ratio (OR) of dying of colorectal cancer for those having their most recent screening histories with Hemoccult test or the immunochemical test during the preceding 1 year and 1-2 year segment before case diagnosis were 0.20 [95% confidence interval (CI): 0.08-0.49] and 0. 17 (95% CI: 0.04-0.75), respectively. The OR increased towards 1.0 as the number of years since the most recent screening increased. The OR of dying of colorectal cancer was calculated to be 0.19 (95% CI: 0.05-0.70) for those screened with the immunochemical test alone during the preceding 1 year after adjustment for previous screening histories with the Hemoccult test. Corresponding OR was 0.36 (95% CI: 0.11-1.17) for those screened with Hemoccult test during the preceding 1 year. These results suggest that screening for colorectal cancer by fecal occult blood testings or immunochemical test alone would reduce mortality and that efficacy of the screening would be higher for the immunochemical test than for Hemoccult test.
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Affiliation(s)
- H Saito
- First Department of Internal Medicine, Hirosaki University, School of Medicine, Hirosaki 036-8562, Japan
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Saito H, Tsuchida S, Nakaji S, Kakizaki R, Aisawa T, Munakata A, Yoshida Y. An immunologic test for fecal occult blood by counter immunoelectrophoresis. Higher sensitivity and higher positive reactions in colorectal cancer than single radial immunodiffusion and hemoccult test. Cancer 1985; 56:1549-52. [PMID: 3928132 DOI: 10.1002/1097-0142(19851001)56:7<1549::aid-cncr2820560714>3.0.co;2-#] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new immunologic fecal occult blood test has been developed employing counter immunoelectrophoresis (CIEP) with anti-human hemoglobin Ao antiserum (anti-HbAo). Minimum detectable hemoglobin in hemolysate was 7, 9, and 7 micrograms/ml by CIEP, single radial immunodiffusion (SRID), and Hemoccult test (SmithKline Beckman), respectively. The values in stool were 0.5, 1.0, 3.0 mg hemoglobin/g stool in the same order. CIEP was more sensitive than SRID in detecting hemoglobin both in hemolysate and in feces. Of 38 stools from the patients with colorectal cancer, 29 (76%) gave positive tests in CIEP, whereas 22 (58%) (P less than 0.005), and 18 (47%) (P less than 0.05) gave positive tests in SRID and Hemoccult test, respectively. In every stage and at every site of cancer, CIEP showed the highest positive tests. CIEP did not give any false-positive reaction in specimens from 20 patients without gastrointestinal lesion or from 34 asymptomatic healthy controls without diet restriction, whereas Hemoccult test gave one and three positive reactions in these groups. These results clearly indicate that CIEP is specific and more sensitive to human hemoglobin than any other previous methods. CIEP is expected to have a potential for mass screening of colorectal cancer.
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Saito H, Tsuchida S, Fukushi M, Kakizaki R, Aisawa T, Munakata A, Yoshida Y. [An immunological test for fecal occult blood by counter immunoelectrophoresis: second report. Comparison in sensitivity to detect hemoglobin and positive reactions immunodiffusion and hemoccult test]. Nihon Shokakibyo Gakkai Zasshi 1984; 81:2935-9. [PMID: 6442373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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28
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Komatsu Y, Kakizaki R, Tsushima K, Sakata Y. [Clinical study on micronomicin in the field of internal medicine]. Jpn J Antibiot 1983; 36:529-36. [PMID: 6876362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
From clinical study on micronomicin (MCR) [Sagamicin, KW-1062], the following results were obtained. MCR was administered clinically at the daily dose of 120--240 mg for 1--45 days to 23 patients. The clinical effectiveness rate of MCR was 72.7% in all cases. As side effects, exanthema, drop of blood pressure and shortness of breath were observed in 1 patient (malignant lymphoma). Elevations of S-GOT, S-GPT and BUN were encountered in some patients. However, these results might not be due to the administration of MCR, because antitumor agents on the blood transfusion had been applied to the patients suffering from underlying diseases such as leukemia or malignant tumor. Side effects, such as impairment of the 8th nerve, renal and liver function were not noted. MCR is considered to be a useful antibiotic in the treatment of various infectious diseases combined with underlying diseases, such as progressive cancer and leukemia, and the infectious diseases of the aged.
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Arakawa T, Wada Y, Hayashi T, Kakizaki R, Chida N, Chiba R, Konno T. Uracil-uric refractory anemia with peroxidase negative neutrophils. TOHOKU J EXP MED 1965; 87:52-75. [PMID: 4159327 DOI: 10.1620/tjem.87.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Arakawa T, Ohara K, Kakizaki R, Takahashi Y, Hirata K, Fujii M, Konno T, Morikawa T, Chiba F, Chiba R. Folic acid deficiency in hemochromatosis: probably due to a defective storage of folic acid in the liver. TOHOKU J EXP MED 1965; 86:301-6. [PMID: 5832638 DOI: 10.1620/tjem.86.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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