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ABSTRACT: Human core temperature is strictly controlled by mechanism of radiation, conduction, convection, and evaporation from skin surface. Serial hot and humid climate induces dehydration which interferes heat pump-out from the body. Heart dysfunction is the third factor to rise body temperature. Hyperthermia and hypo-perfusion caused by dehydration and heart failure deteriorate specific organ functions, i.e. central nervous system, liver and renal functions and coagulation system. Disseminated intravascular coagulopathy is one of the standard indicators of severity and mortality of heat stroke.
Nippon rinsho. Japanese journal of clinical medicine 06/2012; 70(6):940-6.
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ABSTRACT: We described Characteristic of the heat stroke in the sports activity in Japan. It was common in teenage men, and 15 years old had a peak with a man, the woman. Most patients did not need specific treatment. Many happened from the end of July on the outdoors around 3:00 p.m. in mid-August. There are many in order of baseball, football, tennis, and a basketball. Running and cycling had high severity of illness. Probably, grasp of an environmental condition, suitable sportswear, suitable hydration, and condition management are the best things as preventive measures.
Nippon rinsho. Japanese journal of clinical medicine 06/2012; 70(6):986-9.
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ABSTRACT: A 37-year-old female presented with acute chlorpromazine and phenobarbital poisoning. Contrast enhanced abdominal CT on admission revealed a high density area at the gastric fundus and residual drugs were suspected. Activated charcoal and cathartics were administered following the gastric lavage under the intubation. As the plasma concentration of phenobarbital was high, urinary alkalinization and crystalloid infusion were carried out to reduce it. However, at 3 days after admission, the plasma concentration level had increased and the consciousness disturbance and respiratory depression continued. Abdominal CT was performed again and bezoars formation was suspected. Endoscopy was carried out to remove the bezoars. After the removal, the plasma concentration level significantly decreased. Her consciousness disturbance and respiratory depression also improved and high density area at the gastric fundus disappeared. Acute endoscopy is seldom advocated in cases of drug overdose. However, aggressive endoscopic removal should be considered in the case of acute poisoning of drugs with form bezoars.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 06/2012; 25(2):113-6.
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Yasufumi Miyake
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ABSTRACT: New guidelines on cardiopulmonary resuscitation(CPR) and emergency cardiovascular care (ECC) were published in October 2010 from International Liaison Committee on Resuscitation (ILCOR). Changes of these guidelines will have dramatic effects on Japan. Starting with chest compressions first will increase by-stander CPR. Cases of recovery of spontaneous heartbeat could increase as a result. Intensive care and radical treatments for cardiovascular emergency and brain damage after cardiopulmonary arrest would be essential. Education, implementation and teams (EIT) will be the third subject.
Nippon rinsho. Japanese journal of clinical medicine 04/2011; 69(4):589-97.
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ABSTRACT: Acute subdural hematoma (ASDH) is a critical condition following the onset of traumatic brain injury, and it is essential to immediately reduce elevated intracranial pressure (ICP). Single burr hole surgery/twist drill craniostomy is commonly performed in patients with ASDH as an emergency surgical intervention, usually preceding decompressive craniotomy. A novel method using a cerebrospinal fluid (CSF) drainage catheter kit for rapid drainage of ASDH is described. Percutaneous twist drill craniostomy using a CAMINO(®) micro ventricular bolt pressure-temperature monitoring kit was performed in the emergency room in 12 patients with severe ASDH. The kit contained a closed-system CSF drainage and pressure-temperature monitoring catheter, which allowed aspiration of the hematoma and monitoring of the ICP. The tip of the catheter was inserted into the hematoma from the forehead. The mean initial ICP was 61 mmHg, with a range of 31 to 120 mmHg. The liquid hematoma was aspirated, and the ICP was temporarily controlled to the normal range. Pupil dilation recovered immediately after aspiration of the hematoma in 3 patients. No complications occurred either during or after the operation. This new method for craniostomy is easy, safe, and effective to monitor and rapidly control ICP in the emergency room. This technique also offers the possibility of evaluating the patient's prognosis and determining indications for further decompressive craniectomy by the continuation of ICP control under ICP monitoring and evaluation of the reversibility of pupillary findings in ASDH patients.
Neurologia medico-chirurgica 01/2010; 50(11):1039-44. · 0.61 Impact Factor
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ABSTRACT: Lipid peroxidation is induced by reactive oxygen species and is involved in acute neuronal damage. Thus, controlling this
process may be a realistic therapeutic strategy for treating or preventing neuronal damage. However, the study of free radicals
in body fluids is currently severely hampered by technical difficulties in their detection. We have developed an ex vivo electron
spin resonance (ESR) method, that employs 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) as a spin trap, to measure the alkoxyl radical
(OR) in human blood. We found that this method can detect OR produced by treating human blood ex vivo. Analysis of jugular
venous and radial arterial blood from patients with acute neuronal damage revealed higher OR levels in the venous blood compared
to arterial samples. In brain death patients, however, the jugular vein OR spectrum was similar to the radial artery OR level.
The ratio between radial artery and jugular vein levels, expressed as the RI (radical intensity) ratio = aORI/jORI, was calculated.
A rterial-jugular bulb RI ratio below 1, together with accepted clinical criteria (unresponsive coma with brainstem areflexia),
may provide a non-invasive assessment of cerebral circulatory arrest that can help to predict brain death. This novel ex vivo ESR method may be very useful for measuring oxidative stress in patients with acute neuronal damage.
12/2006: pages 49-56; , ISBN: 978-4-431-28774-2
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ABSTRACT: Oxygen free radicals play important roles in brain injury, and one of the most important effects of brain hypothermia treatment is to suppress the generation of free radicals. In the present study, alkoxyl radical was determined utilizing ex vivo electron spin resonance (ESR) spectroscopy. Brain hypothermia was induced in traumatic brain injury (TBI) patients (n = 12) and global ischemic (GI) patients after cardiac arrest (n = 3) for 72h. Whole blood was sampled from the jugular vein and the radial artery at each stage of the treatment. In TBI patients, the radical intensity of the jugular vein (RIJV) was significantly higher than that of the control group and decreased gradually (P < 0.05: Student’s t-test). Conversely, the radical intensity of the radial artery (RIRA) gradually increased throughout the treatment. In GI patients, high RIJV and RIRA were observed in comparison with those of TBI patients. These data reflect the oxidative stresses of patients under brain hypothermia, and the ex vivo ESR method is useful for determination of the kinetics of oxygen free radical generation.
12/2004: pages 94-97; , ISBN: 978-4-431-67967-7
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ABSTRACT: A 65-yr-old man treated for depression was transferred to our hospital. He ingested over 150 ml of formalin for suicidal attempt. On admission, he was hypotensive, developing acute renal failure and liver dysfunction. During first 36 hours, he needed 21 l of lactate Ringer solutions to maintain enough urination. The abdominal computed tomography showed obvious edema of intestine and endoscopic findings of the upper digestive tract were corrosive erosions. We started proton pump inhibiter on the first day. After a week, they changed in many ulcers with smooth-surfaced elevation on the greater curvature of the stomach. On the 15th hospitalized day, he was discharged from our hospital without sequelae. Formalin consists of forty percent solution of formaldehyde and methanol. Ingestion of formaldehyde may cause burning in the digestive systems and harmful effect to major organ such as kidney or liver. Although previous reports said that formalin has direct toxicity to major organs, we could discharge him without sequelae by treatment with large amount of fluid resuscitation.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 11/2003; 16(4):447-51.
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ABSTRACT: Bilirubin, a powerful endogenous antioxidant, is one of the catabolites of heme oxygenases (HOs). In this study, the plasma bilirubin concentration was measured to establish bilirubin kinesis after traumatic brain injury (TBI). Furthermore, in in vitro studies, the free radical scavenging activity and antioxidant potency of bilirubin was also investigated at various concentrations, including physiological ones. Indirect plasma bilirubin was measured in 25 patients on days 1, 2, 3 and 4 after presentation with TBI. The ability of bilirubin to scavenge the hydroxyl (OH) and 1,1-diphenyl-2-picrylhyrazyl (DPPH) radicals, and its antioxidant potency, were also analyzed using electron spin resonance (ESR) and the bioantioxidant power (BAP) methods, respectively. Plasma bilirubin levels were significantly higher on days 2, 3 and 4 than on patient admission (day 1; p < 0.05). ESR and BAP results revealed that bilirubin has direct OH and DPPH radical scavenging activities and potent antioxidant effects in vitro at physiological concentrations. These data indicate that physiological concentrations of bilirubin have antioxidant properties and that it constitutes one of the biological defense mechanisms in neurotrauma patients.
In vivo (Athens, Greece) 19(5):855-60. · 1.17 Impact Factor
