Kohei Tsukahara

Current experience and limitations of extracorporeal cardiopulmonary resuscitation for cardiac arrest in children: a single-center retrospective study

BackgroundThere are few reports detailing the importance of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac arrest in Japan. We investigated the status and issues surrounding extracorporeal cardiopulmonary resuscitation (ECPR) at our institution.MethodsPatients aged <15 years who underwent ECPR between April 1, 2003 and March 31, 2012 were eligible. The characteristics, cannulation site, durations of cardiopulmonary resuscitation (CPR), cannulation procedure, and ECMO, and neurologic outcomes were retrospectively reviewed. A favorable neurologic outcome was defined as Pediatric Cerebral Performance Categories 1 and 2.ResultsA total of 21 ECPR events were identified. The median CPR and cannulation durations were 60 and 25 min, respectively. Central and peripheral access sites were employed in 15 and six cases, respectively. Five of the 21 patients (24%) were successfully weaned from ECMO and three of the 21 (14%) survived. Two of the three survivors had a favorable neurologic outcome.ConclusionsThe mortality of patients undergoing ECPR at our institution was low. However, about 10% of all patients had a favorable neurologic outcome, which suggests that ECPR may be effective in pediatric cardiac arrest patients.

A successfully treated case of criminal thallium poisoning

Thallium was once commonly used as a household rodent or ant killer, but many countries have banned such use due to unintentional or criminal poisonings of humans. A common initial clinical manifestation of thallium poisoning is gastrointestinal symptoms followed by delayed onset of neurological symptoms and alopecia. These clinical characteristics can provide important diagnostic clues regarding thallium poisoning. Here, we report a 23-year-old woman who was poisoned by a business colleague when she unknowingly drank tea containing the toxic substance several times. The patient was treated with multi-dose activated charcoal with airway protection and Prussian blue.

Successfully-treated asymptomatic celiac artery aneurysm: A case report

Highlights • Although rare, celiac artery aneurysm may carry a definite risk for rupture and other complications.• Because of its rarity, no strong consensus concerning indications for intervention of asymptomatic celiac artery aneurysm exists in the literature.• Clinicians awareness regarding this rare entity and efforts to discover before rupturing are imperative.

Recurrent apnea in an infant with pertussis due to household transmission

Bordetella pertussis causes life‐threatening apnea in infants. Lymphocytosis is an important clue for diagnosis and for determining the severity of pertussis. Antibiotics do not shorten or ameliorate the disease and only decrease the risk of transmission. Antepartum maternal immunization is important for preventing pertussis in infants.

Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening

Venous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population.

Donor pretreatment with carbon monoxide prevents ischemia/reperfusion injury following heart transplantation in rats

Because inhaled carbon monoxide (CO) provides potent anti-inflammatory and antioxidant effects against ischemia reperfusion injury, we hypothesized that treatment of organ donors with inhaled CO would decrease graft injury after heart transplantation. Hearts were heterotopically transplanted into syngeneic Lewis rats after 8 hours of cold preservation in University of Wisconsin solution. Donor rats were exposed to CO at a concentration of 250 parts per million for 24 hours via a gas-exposure chamber. Severity of myocardial injury was determined by total serum creatine phosphokinase and troponin I levels at three hours after reperfusion. In addition, Affymetrix gene array analysis of mRNA transcripts was performed on the heart graft tissue prior to implantation. Recipients of grafts from CO-exposed donors had lower levels of serum troponin I and creatine phosphokinase; less upregulation of mRNA for interleukin-6, intercellular adhesion molecule-1, and tumor necrosis factor-α; and fewer infiltrating cells. Although donor pretreatment with CO altered the expression of 49 genes expressly represented on the array, we could not obtain meaningful data to explain the mechanisms by which CO potentiated the protective effects.Pretreatment with CO gas before organ procurement effectively protected cardiac grafts from ischemia reperfusion-induced injury in a rat heterotopic cardiac transplant model. A clinical report review indicated that CO-poisoned organ donors may be comparable to non-poisoned donors.

A case of cricothyroidotomy for facial trauma in a patient taking antiplatelet agents after a simple ground-level fall

Highlights • We describe a case of facial trauma in which cricothyroidotomy was required after simple ground-level fall.• Mandibular condyle fractures can cause emergency airway in an elderly patient who is taking antiplatelet agents even after simple ground-level fall.• Prophylactic intubation should be considered prior to transfer or deterioration in such a trauma patient.

Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism.

Highlights • Massive bleeding from the thyroid without direct neck trauma rarely causes airway compromise.• Physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck.• Airway management is the most important consideration in such patients with thyroid injury.

Targeted age, device deployment, and problems associated with pediatric defibrillation in pediatric prehospital emergency medical care settings in Japan

The use of automated external defibrillators was expanded to include infants according to the 2010 cardiopulmonary resuscitation guidelines in Japan. However, deployment has been slower for pediatric patients in Japan, because there are fewer appropriate pediatric patients for automated external defibrillators than adults. This study aimed to investigate the targeted age range for pediatric defibrillation and device deployment of defibrillators for pediatric patients in prehospital emergency medical care settings in Japan, and present the issues associated with automated external defibrillators.

Superior ophthalmic vein thrombosis associated with severe facial trauma: a case report.

IntroductionSuperior ophthalmic vein thrombosis is a rare entity, but is associated with significant morbidities. We describe a case in which superior ophthalmic vein thrombosis occurred shortly after severe facial trauma.Case presentationA 77-year-old Japanese man was transferred to our tertiary hospital after a motor vehicle accident. Le Fort III facial bone fractures and a minor cerebral contusion were detected. Follow-up computed tomography scans detected dilatation of his left superior ophthalmic vein on day 3 and thrombosis on day 12; however, no causative carotid cavernous fistula was observed. As he did not present with any symptoms other than slight conjunctival congestion, a conservative management strategy was adopted along with anticoagulant therapy against deep venous thrombosis. The superior ophthalmic vein thrombosis resolved spontaneously and the conjunctival congestion also improved.ConclusionsSuperior ophthalmic vein thrombosis should be taken into consideration and managed properly after severe facial injuries, and further investigation of its cause is necessary to prevent morbidities.