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Kamijo Y.,Kitasato University | Takai M.,Kitasato University | Fujita Y.,Iwate Medical University | Hirose Y.,Niigata City General Hospital | And 5 more authors.
Internal Medicine | Year: 2014

Objective We conducted a multicenter retrospective survey of patients poisoned by synthetic chemicals (SCs) in Japan.Methods Letters were sent to 467 emergency facilities requesting participation in the study, and questionnaires were mailed to facilities that agreed to participate.Patients The study participants were patients who were transported to emergency facilities between January 2006 and December 2012 after consuming SC-containing products.Results We surveyed 518 patients from 60 (12.8%) facilities. Most patients were male (82.0%), in their 20s or 30s (80.5%), and had inhaled SCs (87.5%) contained in herbal products (86.0%). Harmful behavior was observed at the scene of poisoning for 56 patients (10.8%), including violence to others or things in 32, traffic accidents in seven, and self-injury or suicide attempts in four. Other than physical and neuropsychiatric symptoms, some patients also had physical complications, such as rhabdomyolysis (10.0%). Of the 182 patients (35.1%) admitted to hospitals, including 29 (5.6%) who needed respirators, all of the 21 (4.1%) hospitalized for at least seven days were male, and 20 had physical complications (rhabdomyolysis, 12; liver dysfunction, 5; renal dysfunction, 11; and physical injuries, 3). Most patients (95.6%) completely recovered, although 10 (1.9%) were transferred to a psychiatric department or hospital, and three (0.6%) were handed over to the police due to combative or violent behavior. SCs such as synthetic cannabinoids, synthetic cathinones, or methoxetamine were detected in 20 product samples.Conclusion Consuming products containing SCs can result in physical complications, including rhabdomyolysis, injuries, and physical or neuropsychiatric symptoms, which may require active interventions, such as respirator use or prolonged hospitalization. © 2014 The Japanese Society of Internal Medicine.


Sugimoto Y.,Red Cross | Ito Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | Tanaka M.,Okayama University of Science | And 3 more authors.
Spine | Year: 2010

Study Design: A retrospective study. Objective: We assessed risk factors for lumbosacral plexus palsy related to pelvic fracture that can be evaluated during the acute injury phase with diagnostics such as computed tomography (CT). Summary of Background Data: Many patients with pelvic fracture are in vital shock, with polytrauma and loss of consciousness, making an accurate neurologic examination very difficult in the emergency room. Methods: This study included 22 patients who had AO classification type B or C pelvic fractures. The 22 patients had 27 posterior osteoligamentary lesions. The average injury severity score (ISS) was 27.5 (range, 16-50). Age, sex, ISS, suicidal jump, longitudinal displacement, sacral transverse fracture, pubic fracture, lumbar transverse process fracture, type of pelvic fracture (AO), and type of sacral fracture (Denis) were examined for a correlation with the lumbosacral plexus palsy. Using coronal reconstruction CT, we considered a 10 mm or greater displacement at the sacrum or sacroiliac joint to be a longitudinal displacement. Transverse sacral fracture was diagnosed by sagittal reconstruction CT. Results: Of the 22 patients, 5 (22.7%) had lumbosacral plexus palsy (8 of 27 pelvic fractures) detected during treatment. The incidence of lumbosacral plexus palsy was not related to age, sex, ISS. Incidence of palsy was significantly higher when the patient's affected side had longitudinal displacement. Patients who had made a suicidal jump or had a sacral transverse fracture also had a significantly higher risk for lumbosacral plexus palsy. Palsy was not related to the type of pelvic fracture (AO) or sacral fracture (Denis). Conclusion: In this study, longitudinal displacement of the pelvis, transverse sacral fracture, and trauma from a suicidal jump were risk factors for lumbosacral plexus palsy. These risk factors were helpful in our examination of patients who had severe pelvic fracture with loss of consciousness. © 2010, Lippincott Williams & Wilkins.


Shiozakr Y.,Okayama University of Science | Ito Y.,Red Cross | Sugimoto Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | And 5 more authors.
Acta Medica Okayama | Year: 2012

In this study, we studied the relationship between fracture patterns and motor function recovery in 70 consecutive patients with cervical spinal cord injury. Fractures were categorized into 6 fracture types and subdivided into stages according to the Allen-Ferguson classification system: compressive flexion (CF), distractive flexion (DF), compressive extension (CE), distractive extension (DE), vertical com-pression (VC) and lateral flexion (LF). Paralysis was evaluated using theAmerican Spinal Injury Association (ASIA) impairment scale at the time of injury and 3 months afterwards. The residual rate of complete motor palsy (ASIA grade A or B) at the final examination was higher in those patients with DE fractures thanthose with CF, DF or CE. The final outcomes were as follows. Of the 14 patients who were classified with CF fractures, residual palsy was frequently seen in patients who had stage 5 injury. Of the 27 patients with DF fractures, residual palsy occurred in about half of the patients who had stage 4 or 5 injury. Of the 18 patients with CE fractures, residual palsy occurred in half of the patients with stage 3 injury or higher. Finally, of the 7 patients with DE fractures, the rate of residual palsy was high even for the stage 1 and 2 cases; indeed, all DE patients who had complete motor palsy at the first examination had residual palsy at the final examination. Accordingly, we conclude that motor recovery may be related to fracture pattern. © 2012 by Okayama University Medical School.


Sugimoto Y.,Red Cross | Ito Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | Shimokawa T.,Red Cross | And 3 more authors.
Acta Neurochirurgica | Year: 2010

Background: Cervical pedicle screws, when misplaced, tend to perforate laterally. One of the reasons for lateral perforation is vertebral rotation during screw insertion. However, actual vertebral rotation during pedicle screw insertion is unknown. In this study, we measured vertebral rotation during pedicle screw insertion in patients with cervical injury. Methods: We inserted 76 pedicle screws into 38 vertebrae (C2 to C7) in 17 patients. All patients had some type of cervical injury. Screws were placed using intraoperative acquisition of data acquired with the isocentric C-arm fluoroscope (Iso-C3D) and computer navigation. We made screw holes using an image-guided awl, and we took images of cervical vertebrae in the neutral and rotational positions using navigation. Images of 76 insertions and rotational positions were taken while each cervical vertebra was under maximum stress at the time we were making the pedicle hole by awl. Results: Average cervical vertebra rotation was 10.6° (range 6 to 17) at C2, 9.1° (5 to 13) at C3, 7.8° (6 to 9) at C4, 6.7° (4 to 11) at C5, 4.9° (2 to 8) at C6, and 2.8° (0 to 4) at C7. Vertebrae in the upper and middle cervical spine rotated more than the lower cervical spine vertebrae. Of the 76 pedicle screws inserted into vertebrae between C2 and C7, 74 screws (97.4%) were classified as grade 1 (no pedicle perforation). Conclusions: In this study, upper and middle cervical vertebrae in patients with neck injuries rotated more than the lower vertebrae. We should be especially careful of cervical rotation during screw insertion from C2 to C6, so as to prevent vertebral artery injury. © 2010 Springer-Verlag.


Tamura N.,Kurashiki Central Hospital | Ishihara S.,Hyogo Emergency Medical Center | Kuriyama A.,Kurashiki Central Hospital | Watanabe S.,Kawasaki Medical School | Suzuki K.,Kawasaki Medical School
World Journal of Surgery | Year: 2015

Introduction Some case series have reported that hepatectomy was used to treat major bile leakage and biloma. However, it is unknown whether non-operative management (NOM) can be used to treat these complications. Our hospital uses NOM primarily for blunt liver injuries. This study describes the incidence and treatment of newly developed biloma in hemodynamically stable patients with blunt liver trauma and investigates NOM as a treatment option. Methods A retrospective chart review was conducted from January 2006 to May 2012 at a tertiary care hospital in Japan. The primary outcome measures were the incidence of biloma and the number of patients who required operative management. Biloma was defined as a cystic lesion with low density near the site of liver injury on contrast-enhanced abdominal computed tomography. Results Chart review identified 98 patients (63 males and 35 females). Thirty-five of 98 patients (35.7% [95% CI, 26.2-45.2]) developed biloma. Infected biloma in three, of whom one required percutaneous drainage. Hepatectomy was not performed. Conclusion Our data suggest that biloma after NOM of blunt liver injury is common (36%), but infected biloma is rare. All patients with bilomas were treated using NOM. Most bilomas are self-limited, and NOM is feasible. ©Socié té Internationale de Chirurgie 2014.


Anan H.,Fujisawa City Hospital | Akasaka O.,Fujisawa City Hospital | Kondo H.,National Hospital Organization Disaster Medical Center | Nakayama S.,Hyogo Emergency Medical Center | And 4 more authors.
Disaster Medicine and Public Health Preparedness | Year: 2014

Objective The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake. Methods Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes. Results New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed. Conclusion The revised DMAT training program will provide practical training better suited to the present circumstances in Japan. (Disaster Med Public Health Preparedness. © 2014 Society for Disaster Medicine and Public Health, Inc.


PubMed | Fujisawa City Hospital, Tottori University, National Hospital Organization Disaster Medical Center, Yamagata Prefectural Medical Center for Emergency and 2 more.
Type: Journal Article | Journal: Disaster medicine and public health preparedness | Year: 2015

The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake.Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes.New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed.The revised DMAT training program will provide practical training better suited to the present circumstances in Japan.


Sugimoto Y.,Red Cross | Ito Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | Shimokawa T.,Red Cross | And 3 more authors.
Acta Medica Okayama | Year: 2010

Correct screw placement is especially difficult in the upper thoracic vertebrae. At the cervicothoracic junction (C7-T2), problems can arise because of the narrowness of the pedicle and the difficulty of using a lateral image intensifler there. Other upper thoracic vertebrae (T3-6) pose a problem for screw insertion also because of the narrower pedicle. We inserted 154 pedicle screws into 78 vertebrae (C7 to T6) in 38 patients. Screws were placed using intraoperative data acquisition by an isocentric C-arm fluoroscope (Siremobile Iso-C3D) and computer navigation. Out of 90 pedicle screws inserted into 45 vertebrae between C7 and T2, 87 of the 90 (96.7%) screws were classified as grade 1 (no perforation). Of 64 pedicle screws inserted into 33 vertebrae between T3 and T6, 61 of 64 (95.3%) screws were classified as grade 1. In this study, we reduced pedicle screw misplacement at the level of the C7 and upper thoracic (Tl-6) vertebrae using the three-dimensional fluoroscopy navigation system. © 2010 by Okayama University Medical School.


Sugimoto Y.,Red Cross | Ito Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | Shimokawa T.,Red Cross | And 3 more authors.
Acta Medica Okayama | Year: 2010

We used a navigation system to insert 128 pedicle screws into 69 vertebrae (LI to L3) of 49 consecutive patients. We assessed the pedicle isthmic width and the permission angle for pedicle screw insertion. The permission angle is the angle defined by the greatest medial and lateral trajectories allowable when placing the screw through the center of the pedicle. The rate of narrow-width pedicles (isthmic width less than 5mm) was 5 of 60 pedicles (8%) at LI, 4 of 60 pedicles (7%) at L2, and none (0%) at L3, L4 and L5. The rate of narrow-angle pedicles (a permission angle less than 15 degrees) was 21 of 60 pedicles (35%) at LI, 7 of 60 (12%) at L2, 3 of 60 (5%) at L3, and none (0%) at L4 and L5. Of 128 pedicle screws inserted into 69 vertebrae from LI to L3, 125 (97.7%) were classified as Grade 1 (no pedicle perforation). In general, the upper lumbar vertebrae have more narrow-width and -angle pedicles. However, we could reduce the rate of pedicle screw misplacement in upper lumbar vertebra using a three-dimensional fluoroscopy and navigation system. © 2010 by Okayama University Medical School.


Kamiutsuri K.,Osaka City General Hospital | Okutani R.,Osaka City General Hospital | Kozawa S.,Hyogo Emergency Medical Center
Journal of Anesthesia | Year: 2013

Objectives: Advanced airway management in the prehospital setting is a serious issue in Japan because emergency medical technicians are not authorized to perform such management, whereas physicians - who are authorized to perform advanced airway management - do not usually engage in prehospital emergency medical activity. The purpose of this investigation was to investigate the success rate for endotracheal intubation (ETI) procedures and other methods of airway management employed by physicians in the prehospital setting in a single institution, as well as to examine the risk factors associated with difficult or failed endotracheal intubation (D/F ETI). Methods: We performed a retrospective survey of patients treated in the prehospital setting by emergency physicians of the Hyogo Emergency Medical Center from 2004 to 2011. Patients were divided into two groups: a cardiopulmonary arrest (CPA) group and a non-CPA group. Data on cases of D/F ETI were obtained, and risk factors for these two groups were identified using univariate and statistical analysis. Results: During the investigation period, ETI was attempted in the prehospital setting on 742 eligible patients; in 30 (4.04 %) of these cases, the attempts at ETI proved difficult or failed. Of those 30 patients, 13 patients received a surgical airway (attempts to provide a surgical airway failed in two patients), a blind ETI was performed in four, a video-assisted airway device was used in another four, and esophageal intubation was performed in four patients. Bag-valve ventilation alone was performed in one patient. The incidence of D/F ETI was higher in the non-CPA group than in the CPA group (6.27 vs. 2.63 %: p < 0.05). Facial or neck injury was a risk factor for D/F ETI in the prehospital setting in the CPA group (odds ratio 7.855; 95 % CI 1.754-36.293: p = 0.042). On the other hand, no risk factors for D/F ETI in the prehospital setting in the non-CPA group were identified. Conclusion: The success rate for ETI performed by physicians in the prehospital setting at a single emergency medical center was high, and the incidence of D/F ETI was 4.31 %. The success rate for ETI in the CPA group was greater than that in the non-CPA group. © 2012 Japanese Society of Anesthesiologists.

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