Luthe S.K.,Urasoe General Hospital |
Sato R.,Urasoe General Hospital
Journal of Emergency Medicine | Year: 2016
Background: Various complications are reported with Clostridium difficile infection (CDI), including fulminant CDI. Fulminant CDI is an underappreciated lifethreatening condition associated with complications such as toxic megacolon and bowel perforation. Case Report: A 79-year-old woman presented to the Emergency Department with altered mental status. She was admitted and conservatively treated for a left thalamic hemorrhage. While hospitalized, she developed watery diarrhea due to Clostridium difficile.Although metronidazole was initiated, she developed altered mental status and septic shock. Abdominal x-ray study and computed tomography revealed a significantly dilatated colon and a massive pneumoperitoneum. She underwent subtotal colectomy with a 14-day course of intravenous meropenem. Why Should an Emergency Physician Be Aware of This?: This case suggests that we must be aware of the complications that CDI may present and adequately consider surgical management because early diagnosis and surgical treatment is critical to reduce the mortality of fulminant CDI. © 2016 Elsevier Inc.
Sato R.,Urasoe General Hospital |
Luthe S.K.,Urasoe General Hospital |
Nasu M.,Urasoe General Hospital
Critical Care | Year: 2017
Maintaining the optimal blood pressure is an important aspect of preventing acute kidney injury (AKI), especially for vasopressor-dependent patients. Although mean arterial pressure (MAP) has played an important role in previous trials for prevention of AKI, there is little evidence that MAP actually reflects organ perfusion. In fact, several studies have suggested that perfusion pressure, including diastolic perfusion pressure and mean perfusion pressure (MPP) and calculated with central venous pressure (CVP), may be more useful than the widely used MAP to help prevent AKI. This emphasizes the importance of maintaining diastolic arterial pressure and avoiding elevation of CVP to prevent AKI in patients with sepsis or invasive surgery. To achieve this, further investigation regarding titrated fluid therapy and vasopressors is warranted. © 2017 The Author(s).
Hadano Y.,Rakuwakai Otowa Hospital |
Shimizu T.,Emory University |
Takada S.,Osaka City General Hospital |
Inoue T.,Urasoe General Hospital |
Sorano S.,Kobe University
International Journal of General Medicine | Year: 2012
Purple urine bag syndrome is characterized by the urinary drainage bag turning purple in patients on prolonged urinary catheterization, especially those in the bedridden state. It is associated with bacterial urinary tract infections caused by indigo-producing and indirubin-producing bacteria, usually affects women, and is associated with alkaline urine, constipation, and a high bacterial load in the urine. Almost all patients with purple urine bag syndrome are catheterized due to significant disability, and the urinary pH is 7.0 or more. In general, intensive treatment with antibiotics is not recommended. Purple urine bag syndrome per se almost always appears to be asymptomatic and harmless. However, caution is needed, because some cases have been reported to show progression to severe disease states, so further research into the morbidity and mortality of this infection is warranted. © 2012 Hadano et al, publisher and licensee Dove Medical Press Ltd.
PubMed | Fukuoka University, Ueo Breast Cancer Hospital, Oita Prefectural Hospital, Urasoe General Hospital and 5 more.
Type: | Journal: Breast (Edinburgh, Scotland) | Year: 2017
Despite the survival benefit and acceptable tolerability of eribulin for advanced/metastatic breast cancer (MBC) patients pretreated with anthracyclines and taxanes, there is limited evidence of the clinical benefit of early eribulin use. We investigated the efficacy and safety of first- to third-line eribulin use in patients with MBC.In this phase II, open-label, single-arm study conducted at 14 sites in Kyushu, Japan, women with histologically confirmed human epidermal growth factor receptor 2-negative MBC were enrolled between December 1, 2011 and November 30, 2013 (Data cut-off: November 30, 2014). Objective response rate (ORR; primary endpoint), disease control rate (DCR), progression-free survival (PFS), duration of response (DOR), overall survival (OS), and safety were evaluated.Of 53 recruited patients, 47 were enrolled. The ORR was 17.0% (95% confidence interval, 7.6-30.8), DCR was 66.0% (51.2-77.8), median PFS was 4.9 months (3.5-7.0), DOR was 6.6 months (1.9-14.3), and median OS was 17.4 months (10.1-not evaluable). The common grade 3/4 adverse events were neutropenia (25 patients; 53.2%), leucopenia (16 patients; 42.1%) and febrile neutropenia (4 patients; 8.5%). Toxicity did not increase during the long-term treatment. Subgroup analysis indicated that first-line treatment led to higher ORR and prolonged PFS and OS than second-/third-line treatment and that incidence of adverse events in patients of second-/third-line treatment was not higher than that in patients of first-line treatment.Eribulin exhibited efficacy and manageable tolerability in Japanese women with pretreated MBC in first- to third-line use. (ID: UMIN000007121).
Kuriyama A.,Kurashiki Central Hospital |
Umakoshi N.,Kurashiki Central Hospital |
Fujinaga J.,Kurashiki Central Hospital |
Takada T.,Urasoe General Hospital
Intensive Care Medicine | Year: 2015
Purpose: Whether closed tracheal suctioning systems (CTSS) reduce the incidence of ventilator-associated pneumonia (VAP) compared with open tracheal suctioning systems (OTSS) is inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials that compared CTSS and OTSS.Methods: PubMed, the Cochrane Central Register of Controlled Trials, the Web of Science, Google Scholar, and a clinical trial registry from inception to October 2014 were searched without language restrictions. Randomized controlled trials of CTSS and OTSS that compared VAP in mechanically ventilated adult patients were included. The primary outcome was the incidence of VAP. Secondary outcomes were mortality and length of mechanical ventilation. Data were pooled using the random effects model.Results: Sixteen trials with 1,929 participants were included. Compared with OTSS, CTSS was associated with a reduced incidence of VAP (RR 0.69; 95 % CI 0.54–0.87; Q = 26.14; I2 = 46.4 %). Compared with OTSS, CTSS was not associated with reduction of mortality (RR 0.96; 95 % CI 0.83–1.12; Q = 2.27; I2 = 0.0 %) or reduced length of mechanical ventilation (WMD −0.45 days; 95 % CI −1.25 to 0.36; Q = 6.37; I2 = 5.8 %). Trial sequential analysis suggested a lack of firm evidence for 20 % RR reduction in the incidence of VAP. The limitations of this review included underreporting and low quality of the included trials, as well as variations in study procedures and characteristics.Conclusions: Based on current, albeit limited evidence, it is unlikely that CTSS is inferior to OTSS regarding VAP prevention; however, further trials at low risk of bias are needed to confirm or refute this finding. © 2014, Springer-Verlag Berlin Heidelberg and ESICM.
Morishima Y.,Urasoe General Hospital |
Arakaki K.,Urasoe General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2015
A 61-year-old woman was diagnosed with combined valvular disease and atrial fibrillation, and was admitted for surgery. We performed double valve replacement, tricuspid annuloplasty and maze operation. At the operation, a 19 mm St. Jude Medical Regent valve was implanted with non-everting mattress sutures at the aortic supra-annular position after mitral valve replacement. Although pulling down of the prosthesis into the aortic annulus was easy, the leaflets were unable to open at all in a movability test. After removing several stitches on the mitral side of the hinges, the subvalvular tissue was seen bulging into the hinge, hindering the free movement. The prosthesis was removed and replaced with a 17 mm Regent valve by the same technique. The patient's postoperative course was uneventful. We suggest it is necessary to pay special attention to the structural characteristics of the prosthesis.
PubMed | Kurashiki Central Hospital and Urasoe General Hospital
Type: | Journal: Headache | Year: 2017
Jolt accentuation has been considered to be the most sensitive physical finding to predict meningitis. However, there are only a few studies assessing the diagnostic accuracy of jolt accentuation. Therefore, we aimed to evaluate the diagnostic accuracy of jolt accentuation and investigate whether it can be extended to patients with mild altered mental status.We performed a single center, retrospective observational study on patients who presented to the emergency department in a Japanese tertiary care center from January 1, 2010 to March 31, 2016. Jolt accentuation evaluated in patients with fever, headache, and mild altered mental status with Glasgow Coma Scale no lower than E2 or M4 was defined as jolt accentuation in the broad sense. Jolt accentuation evaluated in patients with fever, headache, and no altered mental status was defined as jolt accentuation in the narrow sense. We evaluated the sensitivity and specificity in both groups.Among 118 patients, the sensitivity and specificity of jolt accentuation in the broad sense were 70.7% (95% confidence interval (CI): 58.0%-80.8%) and 36.7% (95% CI: 25.6%-49.3%). The positive likelihood ratio and negative likelihood ratio were 1.12 (95% CI: 0.87-1.44) and 0.80 (95% CI: 0.48-1.34), respectively. Among 108 patients, the sensitivity and specificity of jot accentuation in the narrow sense were 75.0% (95% CI: 61.8%-84.8%) and 35.1% (95% CI: 24.0%-48.0%). The positive likelihood ratio and negative likelihood ratio were 1.16 (95% CI: 0.90-1.48) and 0.71 (95% CI: 0.40-1.28), respectively.Jolt accentuation itself has a limited value in the diagnosis of meningitis regardless of altered mental status. Therefore, meningitis should not be ruled out by negative jolt accentuation.
PubMed | Yamaguchi University and Urasoe General Hospital
Type: Comparative Study | Journal: Heart and vessels | Year: 2016
The external lumen of a stent [defined as extra-stent lumen (ESL)] assessed by optical coherence tomography (OCT) may be related to the risk of thrombus formation after sirolimus-eluting stent (SES) implantation. An everolimus-eluting stent (EES) might provide relatively minimal inflammatory reaction and appropriate neointimal coverage. The purpose of this study was to compare the neointimal thickness and ESL between SES and EES. Patients who underwent OCT examination more than 7 months after either SES or EES implantation were enrolled. Stent area (SA), lumen area (LA), neointimal area (NIA) and neointimal thickness (NIT) of each strut were measured at 1-mm intervals between stented segments. The area, angle (summation per cross-section) and depth (maximum distance from adjacent vessel surface to the outline of stent) of ESL were analyzed. A total of 49 lesions were included (SES n = 20, EES n = 29). Mean follow-up period was 11 months. A total of 998 cross-sections and 9874 struts were analyzed. There were no differences in stent area, lumen area and neointimal area (SA: 6.01 1.60 vs. 6.02 1.40 mm(2), p = 0.572, LA: 5.37 1.52 vs. 5.29 1.34 mm(2), p = 0.692, NIA: 0.64 0.49 vs. 0.72 0.37 mm(2), p = 0.493). Mean NIT of SES and EES were 0.11 0.05 and 0.10 0.05 mm, respectively (p = 0.367). Conversely, area, angle and depth of ESL in SES group were significantly greater than those in EES group (0.20 0.39 vs. 0.03 0.09 mm(2), p < 0.001, 56.2 59.1 vs. 20.1 41.9, p < 0.001, 0.10 0.09 vs. 0.03 0.03 mm, p < 0.001). OCT showed that the efficacy of neointimal growth suppression is similar between SES and EES, whereas the adverse vascular response after EES implantation is smaller than that after SES implantation.
PubMed | Urasoe General Hospital
Type: Case Reports | Journal: The American journal of emergency medicine | Year: 2016
Pleocytosis of the cerebrospinal fluid is a key finding for the diagnosis of bacterial meningitis. Bacterial meningitis presenting in normal cerebrospinal fluid is rare in adult patients. We describe the case of a patient with pneumococcal meningitis without cerebrospinal fluid pleocytosis. This case suggests that immediate antibiotic therapy should be started when meningitis is suspected, even with normal cerebrospinal fluid findings. (See Figure.)
PubMed | Kurashiki Central Hospital and Urasoe General Hospital
Type: Journal Article | Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy | Year: 2016
Rat-bite fever (RBF) is a challenging diagnosis transmitted by the bite of the rats. We present the first reported case of RBF complicated by vertebral osteomyelitis. It is important to consider performing the MRI to differentiate vertebral osteomyelitis from simple back pain to determine the appropriate duration of antibiotic therapy.