Masato Homma

Incidence and prediction of psychiatric morbidity after a motor vehicle accident in Japan: the Tachikawa Cohort of Motor Vehicle Accident Study.

Objectives:To assess both the incidence of new-onset psychiatric illness after involvement in a motor vehicle accident in Japan for comparison with Western data and the predictors of psychiatric morbidity and posttraumatic stress disorder (PTSD) evaluated immediately after the accident. Design:Prospective cohort study of injured patients assessed immediately and 4–6 wks after involvement in a motor vehicle accident. Setting:Intensive care unit in a teaching hospital in Tokyo, Japan. Patients:Total of 100 consecutive patients with motor vehicle accident–related injuries (mean Injury Severity Score, 11.2; mean Glasgow Coma Scale, 14.5; age, 18–69 yrs) admitted to the intensive care unit. Patients with traumatic brain injury, suicidality, current psychiatric or neurologic illness, or cognitive impairment were excluded. Measurements:An extensive clinical interview and evaluation of vital signs, sociodemographic variables, previous traumatic events, family history of psychopathology, Impact of Event Scale–Revised, Hospital Anxiety and Depression Scale, Clinician-Administered PTSD Scale, and Mini-International Neuropsychiatric Interview. Results:A total of 31 patients showed some form of new-onset psychiatric illness at the 4- to 6-wk follow-up. The majority of illnesses consisted of depression (major depression, n = 16; minor depression, n = 7) and PTSD (full PTSD, n = 8; partial PTSD, n = 16). Other illnesses included alcohol dependence (n = 3), obsessive–compulsive disorder (n = 2), agoraphobia (n = 2), and social phobia (n = 1). Both psychiatric morbidity and PTSD were predicted by a sense of life threat (odds ratio, 4.2 and 6.2, respectively), elevated heart rate (odds ratio, 1.6 and 1.7), and higher Impact of Event Scale–Revised intrusion subscale score (odds ratio, 1.1 and 1.1). Conclusion:This study showed that psychopathology and PTSD after a motor vehicle accident in Japan is common and that the incidence is within the range of that in Western countries. A combination of a sense of life threat, heart rate, and Impact of Event Scale–Revised intrusion subscale allowed for significant prediction of psychiatric morbidity and PTSD.

Gluteal Soft Tissue Necrosis After Transcatheter Angiographic Embolization for Pelvic Fracture: a Report of Two Cases

In this paper, two cases of the gluteal soft tissue necrosis after pelvic fractures will be discussed. In the case of a 29-year-old man, a localized area of skin necrosis on the buttock appeared after transcatheter arterial embolization (TAE) of the right internal iliac artery (IIA). In the second case, a 52-year-old man, who was treated using TAE of the bilateral IIAs, developed an extensive area of necrosis in the gluteus maximus muscle with subsequent severe infection. In both cases, complete excision of the necrotic tissue and reconstructive flap surgery were imperative. Gluteal soft tissue necrosis is clinically important as one of the serious complications of TAE.

Successful Rapid Helicopter Transportation for a Ruptured Abdominal Aortic Aneurysm Patient

We examined a case of rapid helicopter transportation, which was crucial to the survival of a ruptured abdominal aortic aneurysm (AAA) patient with profound shock. A 70-year-old woman, who presented at home with acute severe back pain, was transferred by helicopter 50km to our hospital. On arrival, she had no detectable blood pressure and soon developed bradycardia with subsequent cardiac arrest, which required an emergency room thoracotomy A @ (ERT). After open cardiac massage and thoracic aortic cross-clamping, her heart beat was recovered. Additional laparotomy revealed about 500ml of blood from intraperitoneal bleeding and a large dilated and ruptured retroperitoneal hematoma. The AAA was reconstructed using a Y-graft. On the 78 hospital day, she was discharged from our hospital without any neurological defects. In this case, all factors such as the intimate cooperation between the ambulance EMTs and aviation team, early call and prompt dispatch of the helicopter, and effective therapy by the receiving hospital were necessary for the survival of this patient. We concluded that we should promptly prepare an emergency helicopter system for improving the outcome of patients in local areas, and that these systems will prove effective in case of natural or civil disaster.