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Nishi-Tokyo-shi, Japan

Ikeda T.,Toho University | Yusu S.,Kyorin University | Yokoyama Y.,National Disaster Medical Center
Heart Rhythm | Year: 2012

BACKGROUND: It has been reported that intracardiac electrogram T-wave alternans (IE-TWA) is greater prior to spontaneous ventricular tachyarrhythmia (VTA) than for baseline recordings. OBJECTIVE: To investigate IE-TWA just prior to VTA episodes and at baseline and compare these with microvolt TWA (M-TWA) measured during exercise. METHODS: We analyzed right ventricular ring-can electrogram recordings just prior to VTA episodes and compared T-wave pattern and degree of variation to baseline recordings from 3 patients (2 with idiopathic ventricular fibrillation and 1 with hypertrophic cardiomyopathy) who were enrolled in the Japan Intracardiac Electrogram TWA Study of ICD Recipients. In a stable state, we measured the M-TWA of the surface electrocardiogram during treadmill exercise in these 3 patients. RESULTS: We found 3 patterns of IE-TWA among these 3 patients with implantable cardioverter-defibrillator immediately prior to spontaneous VTAs. Case 1 had AB pattern of IE-TWA, case 2 ABC pattern, and case 3 nonspecific pattern but great T-wave amplitude variations. These IE-TWA amplitudes and the distribution of T-amplitude difference were greater than at baseline. Case 1 had a positive outcome in regard to the M-TWA determination, whereas cases 2 and 3 did not. CONCLUSIONS: We indicate different patterns of IE-TWA prior to spontaneous VTAs. The phenomena of IE-TWA correspond to outcomes of M-TWA measured during exercise in the surface electrocardiogram. © 2012 Heart Rhythm Society. All rights reserved.

We report the first case of cardiopulmonary arrest (CPA), caused by oesophageal achalasia, which recovered completely with cardiopulmonary resuscitation (CPR) followed by therapeutic hypothermia. A 53-year-old woman arrived at our hospital with recovery of spontaneous circulation (ROSC) after cardiac arrest. Dysphagia, vomiting and general fatigue had progressed for a week before. After an ambulance was called for severe dyspnoea, she collapsed in CPA. Emergency medical technicians arrived and CPR was started immediately. She experienced CPA and ROSC twice during transport to the hospital. On arrival, the patient was in respiratory distress prompting immediate intubation to eliminate airway obstruction. A CT scan revealed a transformed, occluded trachea owing to a dilated oesophagus. A large amount of food, air and saliva was suctioned with a nasogastric tube, and the patient was admitted to the intensive care unit for therapeutic hypothermia. Neurological recovery was evident. On the 11th day, pneumatic dilatation was performed and she was discharged on the 33rd day.

Matsuoka Y.,National Institute of Mental Health | Matsuoka Y.,National Disaster Medical Center | Matsuoka Y.,Japan Science and Technology Agency
BioPsychoSocial Medicine | Year: 2011

Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms. © 2011 Matsuoka; licensee BioMed Central Ltd.

Hashimoto M.,The University of Shimane | Maekawa M.,RIKEN | Katakura M.,The University of Shimane | Hamazaki K.,University of Toyama | And 5 more authors.
Journal of Pharmacological Sciences | Year: 2014

Increasing evidence from the fields of neurophysiology and neuropathology has uncovered the role of polyunsaturated fatty acids (PUFA) in protecting neuronal cells from oxidative damage, controlling inflammation, regulating neurogenesis, and preserving neuronal function. Numerous epidemiological studies have shown that deficits in the dietary PUFA docosahexaenoic acid and eicosapentaenoic acid are associated with the onset and progression of neuropsychiatric illnesses such as dementia, schizophrenia, depression, and posttraumatic stress disorder (PTSD). Recent clinical trials have offered compelling evidence that suggests that n-3 PUFA could reduce depressive, psychotic, and suicidal symptoms, as well as aggression. Although many studies have had the validity of their results questioned because of small sample size, several studies have indicated that n-3 PUFA are useful therapeutic tools for the treatment of dementia, major depression, bipolar disorder, and PTSD. These findings suggest that the pharmacological and nutritional actions of n-3 PUFA may be beneficial in certain neuropsychiatric illnesses. This review article outlines the role of PUFA in neurodevelopment and the regulatory mechanisms in neuronal stem cell differentiation and also the possible use of PUFA as a prescription medicine for the prophylaxis or treatment of neuropsychiatric illnesses such as dementia, mood disorder, and PTSD. © The Japanese Pharmacological Society.

The Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake. In this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms. The PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.

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