Toshitaka Ito

Isolated Unilateral Absence of the Left Pulmonary Artery: A Case Report

We report the case of a 37-year-old man with isolated unilateral absence of the pulmonary artery (UAPA), which was diagnosed upon the occurrence of hemoptysis. Plain chest radiography demonstrated decreased left pulmonary volume. Computed tomography of the chest revealed the complete absence of the left pulmonary artery. Angiography revealed marked dilation of the left bronchial artery, inferior phrenic artery, internal thoracic artery, and the arterial branches of the thyrocervical trunk. These arteries were considered as collateral circulation to the left lung. In cases with UAPA, collateral circulation should be evaluated by angiography to obtain useful information for treatment.

A vascular anomaly of the iliac artery in a patient with VATER association

In patients with VATER association, some have vascular anomaly that makes procedure difficult. Pretreatment CT angiography should be necessary for the patients with VATER associations feature.

Pulmonary edema caused by inhalation of vapors from water-soluble paint

To report the effects of inhaling vapor from water‐soluble paint after a recent encounter with 16 patients treated in our emergency department.

Accuracy of the smaller superior mesenteric vein sign for the detection of acute superior mesenteric artery occlusion

The smaller superior mesenteric vein (SMV) sign is a well‐known computed tomography (CT) parameter for acute superior mesenteric artery (SMA) occlusion. This CT sign is potentially beneficial for the early diagnosis of acute SMA occlusion; however, few reports have documented this sign. The present study aimed to determine the accuracy of the smaller SMV sign for the detection of acute SMA occlusion.

Fatal delayed rupture of the subclavian artery in a patient with first‐rib fracture caused by blunt trauma

This case highlights the probable association of significantly displaced posterior first‐rib fracture and jagged edges of the fracture line following blunt chest trauma with delayed ipsilateral subclavian artery rupture. Early angiography and first‐rib repair should promptly be considered under such circumstances.

Acute amiodarone poisoning occurring twice in the same subject

Bonati et al. 1 reported that a 20-year-old female, who was not on the drug, ingested 8 g of amiodarone with a QTc of 500 ms on days 2 and 3 after admission following the peak serum concentration of amiodarone on day 1. In contrast, a 67-year-old female receiving amiodarone ingested 2.6 g, and QTc was prolonged up to 680 ms; 2 a 57-year-old woman on a 5-year amiodarone therapy ingested 5 g, and developed prolonged QT interval, atrial flutter, atrioventricular block and severe hypotension, requiring administration of epinephrine. 3 We now report a 71-year-old male with bipolar disorder treated with sertraline and clotiazepam but not on amiodarone who was admitted following ingestion of 4 g of amiodarone. One year later, he again attempted suicide by ingesting 11.4 g of amiodarone with phenobarbital. Renal and hepatic function as normal. In the fi rst episode, 10 g of activated charcoal was administered 3 hours after ingestion. In the second, 50 g of activated charcoal was administered 8.5 hours after ingestion (0.5 hour after presentation) and 20 g at 2 and 6 hours subsequently. QTc was 446 ms on days 3 and 4 after admission in the fi rst episode, whereas it was 447 ms on day 2 in the second episode (Fig. 1A). In the fi rst episode, the concentration of amiodarone peaked on day 2 after admission while that of desethylamiodarone continued to increase until at least day 6 (Fig. 1B). In contrast, in the second episode, the concentration of amiodarone decreased rapidly while that of desethylamiodarone did not increase. The area under the curves (AUCs) for amiodarone concentration from admission till day Clinical Toxicology (2011), 49, 944–945 Copyright