Akira Takasu

Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project

BACKGROUNDnChildren have better outcomes after out-of-hospital cardiac arrest (OHCA) than adults. However, little is known about the difference in outcomes between children and adults after OHCA due to drowning.nnnOBJECTIVESnThe aim of this study is to assess the outcome after OHCA due to drowning between children and adults. Our hypothesis is that outcomes after OHCA due to drowning would be in better among children (<18 years old) compared with adults (≥18 years old).nnnMETHODnThis prospective population-based, observational study included all emergency medical service-treated OHCA due to drowning in Osaka, Japan, between 1999 and 2010 (excluding 2004). Outcomes were evaluated between younger children (0-4 years old), older children (5-17 years old), and adults (≥18 years old). Major outcome measures were one-month survival and neurologically favorable one-month survival defined as cerebral performance category 1 or 2. Multivariate logistic regression analyses were used to account for potential confounders.nnnRESULTSnDuring the study period, 66,716 OHCAs were documented, and resuscitation was attempted for 62,048 patients (1300 children [2%] and 60,748 adults [98%]). Among these OHCAs, 1737 (3% of OHCAs) were due to drowning (36 younger children [2%], 32 older children [2%], and 1669 adults [96%]). The odds of one-month survival were significantly higher for younger children (28% [10/36]; adjusted odds ratio [AOR], 20.20 [95% confidence interval {CI} 7.45-54.78]) and older children (9% [3/32]; AOR, 4.47 [95% CI 1.04-19.27]) when compared with adults (2% [28/1669]). However, younger children (6% [2/36]; AOR, 5.23 [95% CI 0.52-51.73]) and older children (3% [1/32]; AOR, 2.53 [95% CI 0.19-34.07]) did not have a higher odds of neurologically favorable outcome than adults (1% [11/1669]).nnnCONCLUSIONnIn this large OHCA registry, children had better one-month survival rates after OHCA due to drowning compared with adults. Most survivors in all groups had unfavorable neurological outcomes.

Community‐acquired lobar pneumonia caused by Pseudomonas aeruginosa infection in Japan: A case report with histological and immunohistochemical examination

Pseudomonas aeruginosa is a common pathogen in nosocomial and/or healthcare‐associated pneumonia, but is rare in community‐acquired pneumonia. A 50‐year‐old previously healthy woman was taken to the emergency department because of rapidly progressing dyspnea. Chest radiograph showed consolidation of the entire right upper lobe, a finding suggestive of lobar pneumonia. The patient died of respiratory failure with bronchial bleeding, on the same day of admission. Autopsy revealed that the alveoli throughout the upper right lobe were filled with dense inflammatory cells mainly consisting of macrophages and neutrophils. Immunoreactive bacilli by using an anti‐P.u2009aeruginosa antibody were localized within macrophages accumulated in the alveoli as well in the vessel walls. Lobar pneumonia composed of dense neutrophils and bacteria‐laden macrophages with total lung congestion and edema may be characteristic for community‐acquired P.u2009aeruginosa pneumonia in a healthy adult.

An atypical case of atypical pneumonia

Atypical pneumonia has been thought to account for 7%‐20% of community‐acquired pneumonia (CAP). The treatment for the pathogens that cause atypical pneumonia is different from that of other bacterial pneumonia. Therefore, identification of the causative pathogen in a primary care situation is crucial for adequate treatment of CAP. Mycoplasma infection is prevalent in the general population, but Mycoplasma pneumoniae with extrapulmonary symptoms is relatively rare. Herein, we report a case of CAP because of M. pneumoniae that presented with a wide variety of extrapulmonary diseases. Delayed administration of appropriate antibiotics may contribute to development of extrapulmonary manifestations.

Prolonged severe hemorrhagic shock at a mean arterial pressure of 40 mmHg does not lead to brain damage in rats

To examine whether prolonged hemorrhagic shock (HS) at a mean arterial pressure (MAP) of 40 mmHg leads to brain damage.

Ileo-ileal knot : a rare case of acute strangulated intestinal obstruction

ABSTRACT Strangulated intestinal obstruction is one of the most common types of acute abdomen and requires urgent surgical treatment. Herein, we report a very rare case of strangulated intestinal obstruction caused by an ileo-ileal knot. An 80-year-old woman was admitted to our hospital with suspicion of strangulation ileus and underwent emergency laparotomy after investigation by exploratory single-port laparoscopy. During surgery, a small bowel gangrene caused by an ileo-ileal knot was found. The gangrenous segment was resected, and primary anastomosis was performed. Post-operative recovery was uneventful except for a minor wound infection. Our extensive search of the literature found only 7 case reports of ileo-ileal knot including ours. An ileo-ileal knot should be considered in the differential diagnosis of acute intestinal obstruction, because this rare phenomenon requires urgent surgical treatment; and some complications should be considered during or after surgery.

Takotsubo cardiomyopathy caused by acute respiratory stress from extubation: A case report

Rational: Takotsubo cardiomyopathy (TCM) is a transient systolic dysfunction of the left ventricular apex without stenosis of coronary arteries and is induced by various psychological and physical factors. TCM sometimes causes lethal complications such as arrhythmia, thrombogenesis, and even cardiac rupture, and thus it should be diagnosed appropriately and managed carefully. Intensive care unit (ICU) patients are exposed to overstress during the treatment process and therefore can are at potential risk for TCM. Patient concerns: The patient was diagnosed as having pneumonia because of influenza A virus mixed with bacteria and underwent intensive care with intubation and mechanical ventilation in the ICU. His respiratory condition soon improved, and so extubation was carried out; however, redeterioration with pulmonary edema occurred at half of a day following extubation. Diagnosis: The chest x-ray revealed pulmonary edema. The electrocardiogram pattern significantly changed with time, and the echocardiogram showed weakness of wall motion around the left ventricular apex. Hence, to confirm the diagnosis, we performed cardiac catheterization immediately, with the results showing a Takotsubo-like form at the systolic phase without significant stenosis of the coronary arteries. Intervention: The patient was reintubated with administration of catecholamine for decreasing blood pressure caused by left ventricular dysfunction. Also, diuretics for pulmonary edema and anticoagulants for prevention of thrombogenesis were administered. Outcomes: As the respiratory condition improved with stabilization of cardiovascular hemodynamics, reextubation was done at ICU day 11 and was discharged from the ICU at ICU day 15. The patient was subsequently treated for pneumonia after leaving the ICU but suffered from repetitive aspiration pneumonia and was finally transferred to another hospital at hospital day 111. Lessons: TCM should be considered especially under the situation of intensive care, and prompt diagnosis should be followed by appropriate management.

A Case of Lumbar Vertebral Osteomyelitis Following Community-Acquired Serratia Marcescens Bacteremia with Enteritis

An 80-year-old man was urgently hospitalized by septic shock due to Serratia marcescens enteritis. The patient had recovered from shock state and been well by antibiotics therapies, but suddenly had a body temperature of 39°C and complained of a lower back pain on the 21st day of hospitalization. Again, Serratia marcescens was isolated from blood culture. A Computed tomography scan examination showed lumbar vertebral osteomyelitis between the levels of L2 and L4 and abscesses in bilateral iliopsoas muscles. He had treatments with intravenous antibiotics for 6 weeks until discharge and followed by 12 weeks of oral antibiotics as an outpatient. This is the first case report of lumbar vertebral osteomyelitis following community acquired Serratia marcescens bacteremia due to enteritis.

Spontaneous rupture of the urinary bladder (SRUB): Recovery from cardiopulmonary arrest

Spontaneous rupture of the urinary bladder (SRUB) is rare and results in a lethal condition, i.e., pan peritonitis. However, early and accurate diagnosis of SRUB is very difficult. A 54-year-old woman was transported to our hospital with suspicion of pan peritonitis after spontaneous return of circulation with pulseless electrical activity. Laboratory investigation seemed to indicate acute renal failure. Namely, her serum urea and creatinine levels were grossly elevated. Exploratory laparotomy showed unexpected rupture of urinary bladder. Her recovery after surgery was relatively smooth. SRUB should be considered in the differential diagnosis of pan peritonitis, because urgent appropriate surgical intervention can rescue patients from this rare lethal disease.

Hypothermia does not hasten death during uncontrolled hemorrhagic shock presenting as the “triad of death” in rats

The aim of this study was to investigate the effect of hypothermia on survival and coagulopathy in hemorrhagic shock presenting as the “triad of death”.