Mitsuhiro Fujii

Predictive equations and the reliability of the impulse oscillatory system in Japanese adult subjects

Background:  The impulse oscillation system (IOS) measures respiratory impedance (Zrs) in terms of resistance (Rrs) and reactance (Xrs) at multiples of 5 Hz. These measurements can be used clinically to help diagnose and monitor respiratory disorders, independent of effort.

Introduction of a Physician-Staffed Helicopter Emergency Medical Service in Eastern Shizuoka Prefecture in Japan

OBJECTIVE To analyze the operating situation of a physician-staffed helicopter emergency medical service in eastern Shizuoka prefecture. METHODS A retrospective analysis was performed using the conveyance records reported by staff members of the physician-staffed helicopter. A comparison between 2007 (n = 619) and 2012 (n = 678) was performed. RESULTS There were no significant differences between the 2 groups with regard to the sex, ratio of cardiopulmonary arrest, and survival ratio. In contrast, the duration from the request of dispatch to arrival at the hospital in 2007 was significantly longer than that in 2012 (53.7 vs 48.2 minutes, P < 0.0001). The average age in 2007 was significantly younger than in 2012 (55.7 vs 59.4 years, P < 0.01). The ratio of trauma case in the 2012 was higher than that in 2007 (47 vs 37%, P < 0.001). The ratio of severe cases in 2007 was higher than in 2012 (45 vs 39%, P < 0.05). CONCLUSION Japan is an aging society. In eastern Shizuoka prefecture, the increase in the number of trauma and minor injury cases may have increased due to the emphasis on the importance of early medical intervention by the fire department.

Factors influencing weaning from mechanical ventilation in elderly patients with severe pneumonia.

Aims:  The purpose of this study was to determine the factors that adversely affect the weaning of elderly patients with community‐acquired pneumonia from mechanical ventilation.

Autoimmune pulmonary alveolar proteinosis with primary lung cancer in a patient of very advanced years

We present a case of 78-year-old women with no smoking habit or occupational exposure who was referred to Juntendo University Shizuoka Hospital in Izunokuni, Shizuoka, Japan, with an abnormality on her chest X-ray in February 2011. There were no symptoms, although thoracic computed tomography (CT) showed a reticular shadow and ground-glass opacity in the bilateral lung fields (Fig. 1a). The fluid obtained by bronchoalveolar lavage, carried out in April 2011 appeared slightly muddy, but different from the milky fluid seen in pulmonary alveolar proteinosis (PAP). Subsequently, hypoxemia and the chest X-ray

Chylothorax ascribed to chronic heart failure in a woman of very advanced years: Chylothorax and chronic heart failure

(Fig. 1c) compared with a sample from a patient with hypertrophic cardiomyopathy as a control (Fig. 1d). The patient was diagnosed with ARVC according to the 2010 task force criteria for ARVC. An implantable cardioverter defibrillator was implanted, and 5 mg of carvedilol was administered to her twice a day. Since then, she has experienced no ventricular tachycardia or heart failure for approximately 10 years. Several factors have been reported as risk factors of arrhythmic or sudden cardiac death, including a history of resuscitation from sudden cardiac death, syncope, very young age, marked right ventricular involvement, left ventricular involvement and dispersion of ventricular depolarization–repolarization. However, the relationship between reduced expression of plakoglobin and progression/prognosis of ARVC is unclear. The elderly patient in the present case with reduced expression of plakoglobin showed no apparent progression of ARVC and no events for 10 years. Although genetic testing was not carried out for the present patient, homozygous mutations in plakoglobin appear associated with a progressive and adverse prognosis, and other desmosomal variant carriers, such as desmoplakin, plakophilin-2 and desmoglein-2, are associated with poor clinical outcomes in younger patients. The pathogenesis of this elderly patient might thus differ from that of young ARVC patients, or proteins other than plakoglobin might be more related to prognosis in ARVC. Another possibility is that carvedilol might be effective against ARVC, with one case report showing carvedilol to be useful for controlling arrhythmia and improving left ventricular function. In conclusion, reduced expression of plakoglobin might not be useful for evaluating the prognosis of ARVC, especially in elderly patients.