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ABSTRACT: AIM: The annual incidence of colonic diverticular bleeding is increasing, but treatments are not yet well established. Here we aimed to identify the risk factors for early re-bleeding and to determine the associated duration of hospitalisation. METHOD: Records of 90 emergent patients with colonic diverticular bleeding between 1999 and May 2012 were retrospectively reviewed. They were divided into an early re-bleeding within 1 month (n = 24) and a no re-bleeding group (n = 66) and investigated the risk factors for early re-bleeding. In the former, we calculated the time from the first haemostasis to early re-bleeding and the associated duration of hospitalisation. RESULTS: Univariate analysis showed that there were significantly more patients with signs of shock (P = 0.00055) and active bleeding on the first colonoscopy after admission (P = 0.020) in the early re-bleeding group. Multivariate conditional logistic regression analysis using stepwise variable selection showed signs of shock on admission (odds ratio, 5.23; 95% confidence interval, 1.84-14.90; P = 0.0019) remained statistically significant. All patients who re-bled without signs of shock (n = 7) and 16 of 17 with signs of shock re-bled within 126 h (5.25 days) of initial hospitalisation. CONCLUSION: Shock was an independent risk factor for early re-bleeding. The associated duration of hospitalisation was 6 days. This article is protected by copyright. All rights reserved.
Colorectal Disease 04/2013; · 2.93 Impact Factor
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ABSTRACT: The endotoxin activity assay (EAA) is a FDA-approved blood endotoxin assay that is reported as a useful tool for the diagnosis of gram-negative bacterial infection. However, discrepancies between the results of the EAA and those of the limulus amebocyte lysate (LAL) assay have been reported. Thus, we verified these methods. Blood was incubated with anti-endotoxin antibody, the resultant polymorphonuclear activation to produce oxidants was measured and the EAA level calculated. As a reference endotoxin assay, we used an endotoxin-specific LAL assay. Significant increases in plasma LAL assay levels were observed only in patients with sepsis caused by gram-negative bacterial infections, whereas higher EAA levels were observed in almost all the sepsis cases and the SIRS cases, especially those with acute pancreatitis. Graded amounts of LPS (1-10,000 pg/ml) were spiked into normal blood to obtain dose-response curves: a good dose-response curve, from 1 to 1,000 pg/ml, was obtained for the LAL assay. A good dose-response curve was barely obtained for the EAA; the lowest detection limit seemed to be 1,000 pg/ml. Addition of methylprednisolone decreased the EAA levels. Interleukin-8 (IL-8) induced elevation in EAA levels when IL-8 was added to volunteers' blood samples. Overall, the EAA kit could not measure clinically relevant doses of endotoxin. Because IL-8 induced an increase in EAA level, it is suggested that the EAA level reflects the primed state of polymorphonuclear leukocytes.
Journal of Infection and Chemotherapy 03/2013; · 1.80 Impact Factor
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ABSTRACT: 66-year-old man was hospitalized because of severe abdominal pain. He had been treated for chronic renal failure. Sodium polystyrene sulfonate (SPS) and the spherical carbon adsorbent AST-120 were routinely administered to him. However, after several treatments, his pain did not resolve and his serum creatine kinase concentration was markedly elevated, so he was transferred to our hospital. Before admission to the previous hospital, muscular weakness was noted in his extremities and those symptoms persisted. His serum potassium concentration was 1.6 mEq/L, and he was administered potassium. A lower gastrointestinal endoscopy revealed normal mucosa and SPS powder-like brownish-yellow stool containing AST-120 granules in the colorectum. After massive stool discharge, the patient's pain improved and his serum potassium concentration gradually increased. The patient was diagnosed with hypokalemic myopathy thought to be mainly caused by accumulation of SPS in the colorectum.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 03/2013; 26(1):49-53.
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ABSTRACT: The purpose of this study was to investigate the relationship between the blood levels of interleukin (IL)-18 measured in the early stage of acute respiratory failure and the prognosis for patient survival.
The study subjects were 38 patients with acute respiratory failure treated at our institution during the 4-year period from April 2004 to March 2008. The underlying clinical condition was defined as acute respiratory distress syndrome (ARDS; n = 12) or acute lung injury (ALI; n = 26). The serum levels of interleukin (IL)-18, IL-12, and tumor necrosis factor (TNF)-α were measured by enzyme-linked immunosorbent assays.
The ARDS group showed significantly higher serum levels of IL-18, IL-12, and TNF-α even at an early stage after disease onset compared with the ALI group. A negative correlation was noted between the PaO(2)/FIO(2) ratio (P/F ratio) and serum IL-18 level. Analysis of all 38 patients with ALI/ARDS revealed a 30-day mortality rate of 7.9 %, 60-day mortality rate of 15.8 %, and 90-day mortality rate of 18.4 %. The early-stage serum levels of IL-18, IL-12, and TNF-α were significantly higher in the non-survivors at 60 and 90 days, but not at 30 days, than in the corresponding survivors.
The present data demonstrate an inverse correlation between serum IL-18 level and the P/F ratio, suggesting the possible involvement of IL-18 in the pathogenesis of respiratory failure in patients with ALI/ARDS. Early-stage serum IL-18, IL-12, and TNF-α levels appear to reflect the >60-day prognosis in patients with ALI/ARDS.
Journal of Anesthesia 05/2012; 26(5):658-63. · 0.83 Impact Factor
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Yoshihiro Inoue,
Yasuhisa Fujino,
Makoto Onodera,
Satoshi Kikuchi,
Tatsuyori Shozushima,
Nobuyoshi Ogino,
Kiyoshi Mori,
Hirotaka Oikawa,
Yorihiko Koeda,
Hironobu Ueda,
Tomohiro Takahashi,
Katsutoshi Terui,
Toshihide Nakadate,
Hidehiko Aoki,
Shigeatsu Endo
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ABSTRACT: We encountered three cases of lung disorders caused by drowning in the recent large tsunami that struck following the Great East Japan Earthquake. All three were females, and two of them were old elderly. All segments of both lungs were involved in all the three patients, necessitating ICU admission and endotracheal intubation and mechanical ventilation. All three died within 3 weeks. In at least two cases, misswallowing of oil was suspected from the features noted at the time of the detection. Sputum culture for bacteria yielded isolation of Stenotrophomonas maltophilia, Legionella pneumophila, Burkholderia cepacia, and Pseudomonas aeruginosa. The cause of tsunami lung may be a combination of chemical induced pneumonia and bacterial pneumonia.
Journal of Anesthesia 11/2011; 26(2):246-9. · 0.83 Impact Factor
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Gaku Takahashi,
Naoya Matsumoto,
Tatsuyori Shozushima,
Chiaki Onodera,
Shigenori Kan,
Shinji Akitomi,
Koichi Hoshikawa,
Tomohiro Kikkawa,
Masahiro Kojika, Yoshihiro Inoue,
Kenji Suzuki,
Go Wakabayashi,
Shigeatsu Endo
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ABSTRACT: Tight glucose control (TGC) using a sliding scale based on intermittent blood glucose measurements occasionally can have a fatal outcome as a result of insulin-induced hypoglycemia. The present study was undertaken to examine whether the use of an artificial pancreas to achieve TGC would be possible in postoperative patients with sepsis. The retrospective study was carried out as an exploratory study, focusing on the possibility of precise evaluation of the significance of TGC as a beneficial intervention by serological monitoring of various mediators. TGC was accomplished using an artificial pancreas (STG-22; (Nikkiso, Tokyo, Japan). The patients were divided into two groups: the TGC group (6 patients with sepsis in whom the target blood glucose level set at <150 mg/dl was attempted using the artificial pancreas), and the glucose control (GC) group (6 patients with sepsis in whom glucose control was attempted using a sliding scale; target blood glucose level was set at 200 mg/dl or lower). The mean blood glucose level was 129.7 ± 9.7 mg/dl in the TGC group and 200.9 ± 14.7 mg/dl in the GC group (P < 0.01, ANOVA). No hypoglycemia associated with the artificial pancreas was seen in any of the patients. The serum levels of S100A12 and HMGB-1 tended to decrease, and those of sRAGE tended to increase, in the TGC group. Further data collection from a larger number of cases would be expected to allow a precise assessment of TGC as a potentially beneficial intervention in sepsis patients.
Journal of Infection and Chemotherapy 06/2011; 17(6):812-20. · 1.80 Impact Factor
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ABSTRACT: A 79-year-old man with diabetes mellitus developed prolonged hypoglycemia. The patient had ingested two Chinese dietary supplements in addition to his prescribed nateglinide (Fastic). Using liquid chromatography tandem mass spectrometry, glimepiride from sulfonylurea, as well as rosiglitazone from a thiazolidine derivative, were detected in the Chinese dietary supplements, which were then quantitatively analyzed using liquid chromatography with UV detector. Mean values (n=3) of glimepiride contents of the Chinese dietary supplements were 0.75 and 0.86 mg/capsule. Predicted intake of glimepiride in the patient was estimated to be 4.8-8.2 mg/day according to the glimepiride contents and directions of the Chinese dietary supplements. The daily intake of glimepiride in this patient was greater than daily maintenance doses (1-4 mg) of glimepiride for diabetic patients. Therefore, overdose of glimepiride by ingestion of the Chinese dietary supplements appears to be associated with the development of prolonged hypoglycemia.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 03/2011; 24(1):51-6.
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ABSTRACT: A patient committed suicide with hydrogen sulfide (H(2)S) by combining two commercial products. The patient was given hydroxocobalamin as an antidote in addition to treatment with cardiopulmonary resuscitation, but died approximately 42 min after his arrival at the hospital. The patient's cause of death was attributed to acute hydrogen sulfide poisoning. Serum concentrations of sulfide before and after administration of hydroxocobalamin were 0.22 and 0.11 μg/mL, respectively; serum concentrations of thiosulfate before and after hydroxocobalamin administration were 0.34 and 0.04 μmol/mL, respectively. Hydroxocobalamin is believed to form a complex with H(2)S in detoxification pathways of H(2)S. Although H(2)S is rapidly metabolized and excreted, the decreased sulfide concentration may be also associated with this complex formation. The decreased sulfide concentration suggests that hydroxocobalamin therapy may be effective for acute H(2)S poisoning. The decreased thiosulfate concentration seems to be associated with formation of a thiosulfate/hydroxocobalamin complex, because hydroxocobalamin can form a complex with thiosulfate. The thiosulfate concentration decreased to a greater extent than did sulfide, suggesting that hydroxocobalamin has a higher affinity for thiosulfate than for H(2)S. Therefore, prompt administration of hydroxocobalamin after H(2)S exposure may be effective for H(2)S poisoning.
Journal of analytical toxicology 01/2011; 35(2):119-23. · 2.02 Impact Factor
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ABSTRACT: A 49-year-old man lost consciousness after being accidentally exposed to what was probably hydrogen sulfide gas while performing maintenance on a machine producing feather meal. He was immediately taken to the hospital. Upon admission, his consciousness level was 14 (E4V4M6) on the Glasgow Coma Scale (GCS), but it subsequently decreased, and the patient was intubated when his respirations became depressed as well. About 5 hours after the initial incident, he was transferred to our department. His consciousness level was GCS 9 (E2V2M5), his blood pressure was 95/78 mmHg, and his heart rate was 90 beats per min. There was no metabolic acidosis. Mechanical ventilation was begun and 10% sodium nitrite was intermittently administered intravenously, with the goal of lowering arterial blood methemoglobin saturation to 20%. Two days following admission, the patient regained full consciousness and sodium nitrite administration was stopped. The following day mechanical ventilation was also discontinued. This patient exhibited severe recurring neurologic symptoms without metabolic acidosis; thus, the manifestations of toxicity in this case might have been due to the direct neurologic toxicity of hydrogen sulfide, hypoxia, or delayed post-ischemic cerebral hypoperfusion syndrome. The patient made a full recovery without any sequelae; therefore we would like to hypothesize that repetitive intravenous administration of sodium nitrite is effective in cases of hydrogen sulfide exposure.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 12/2010; 23(4):297-302.
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ABSTRACT: The subjects of this study were 208 patients who underwent endoscopic hemostasis at the Department of Gastroenterology and Hepatology, Iwate University between January 2004 and December 2008. There were 153 men and 55 women with a mean age of 65.3 years. Among them, 181 patients underwent endoscopic hemostasis in the stomach or duodenum and were divided into the peptic ulcer and artificial ulcer groups. The following were retrospectively analyzed: success rates of endoscopic hemostasis, rates of rebleeding, and devices used during treatment. The overall success rate of endoscopic hemostasis was 97.2%. Hemostasis was achieved in 98.2% of the cases with peptic ulcer bleeding and in 88.9% of the cases with artificial ulcer bleeding. Monotherapy (one hemostatic device) was used in 141 cases (77.9%), combination therapy (multiple hemostatic devices) was used in 39 cases (21.5%), and primary hemostasis was used in one case (0.6%) because of blood flow reduction during the observation period. A heat probe was used in 145 cases (80.1%), making it the most frequently used device. Endoscopic hemostasis is very effective for nonvariceal upper gastrointestinal bleeding.
Digestive Endoscopy 07/2010; 22 Suppl 1:S31-4. · 1.19 Impact Factor
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Gaku Takahashi,
Nobuhiro Sato,
Yasunori Yaegashi,
Masahiro Kojika,
Naoya Matsumoto,
Tomohiro Kikkawa,
Tatsuyori Shozushima,
Shinji Akitomi,
Kiichi Aoki,
Naoko Ito,
Koichi Hoshikawa,
Yasushi Suzuki, Yoshihiro Inoue,
Go Wakabayashi,
Shigeatsu Endo
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ABSTRACT: The purpose of this study was to assess lipopolysaccharide (LPS)-stimulated cytokine production in the presence of linezolid (LZD) in comparison with the drug effect on the plasma endotoxin level. Peripheral venous whole-blood samples collected from five healthy subjects were stimulated with 10 microg/ml of LPS. LZD was then added to the LPS-stimulated blood samples at concentrations of 0, 2, 4, and 15 microg/ml , followed by incubation for 24 h at 37 degrees C in a 5% CO(2)-95% air atmosphere. Supernatants of the resultant cultures were assayed to determine the levels of tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-10, monocyte chemoattractant protein (MCP)-1, and endotoxin. Significant decreases in the levels of TNF-alpha and IFN-gamma were observed in the LZD 2, 4, and 15 microg/ml groups as compared with that in the 0 microg/ml group (Dunnett's procedure; P < 0.05). The level of IL-10 tended to increase irrespective of the LZD concentration; however, no significant intergroup differences were observed [analysis of variance (ANOVA); P = 0.68]. No significant decrease of the endotoxin level was observed in the LZD 2, 4, or 15 microg/ml groups as compared with that in the 0 microg/ml group, with no significant intergroup differences (ANOVA; P = 0.83). No change in the MCP-1 levels was observed irrespective of the LZD concentration (ANOVA; P = 0.82). To conclude: (1) it appears possible that LZD inhibits the production of INF-gamma and TNF-alpha to a limited extent; (2) LZD did not exert any inhibitory effect on endotoxin production by bacteria, while suppressing cytokine production. The results indicate that LZD may have a significant role in saving the lives of patients with sepsis.
Journal of Infection and Chemotherapy 04/2010; 16(2):94-9. · 1.80 Impact Factor
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ABSTRACT: The rupture of gastric varices is associated with high mortality rate. Balloon-occluded retrograde transvenous obliteration (B-RTO), a minimally invasive procedure that was introduced in the mid-1990s, has been widely accepted in Japan. Several reports have indicated that B-RTO yields satisfactory results; however, few reports have discussed the recurrence of gastric varices after this therapy. The purpose of this study is to retrospectively evaluate the technical aspects of B-RTO and the recurrence of gastric varices after treatment with this procedure.
B-RTO was performed in 47 patients with gastric varices, who were at a risk of variceal ruptures and who may or may not have had a history of variceal bleeding. We injected a sclerosing agent into the gastric varices for 30-60 minutes. To evaluate the therapeutic efficacy of the technique, we obtained contrast-enhanced computed tomography (CT) scans 5 days after B-RTO. As a general rule, if the gastric varices did not appear thrombosed, we repeated the procedure 7 days after the first procedure.
B-RTO was a technical success in 37 patients. It was performed once in 26 patients, twice in 6 patients, thrice in 2 patients, and 4 times in 3 patients. Contrast-enhanced CT scans obtained after B-RTO showed thrombosed gastrorenal shunts in 29 patients and patent gastrorenal shunts in 8 patients. The gastric varices recurred in 2 patients who had patent gastrorenal shunts. The overall cumulative relapse-free rate of gastric varices was 90% at 5 years after B-RTO.
B-RTO is an effective treatment modality for gastric varices. Moreover, obliteration of the gastrorenal shunt as well as the gastric varices appears to be important for the treatment of gastric varices.
BMC Medical Imaging 01/2010; 10:2. · 1.09 Impact Factor
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Annals of Hematology 12/2009; 89(8):825-6. · 2.62 Impact Factor
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ABSTRACT: In this study, we measured the urine concentrations of methamphetamine and amphetamine as metabolites of selegiline after ingestion of an overdose of selegiline. A patient who had developed Parkinson disease took selegiline in a suicide attempt. Analysis by gas chromatography-mass spectrometry (GC-MS) with trifluoroacetic acid-derivatization revealed the presence of methamphetamine and amphetamine in the patient's urine at concentrations of 0.62 microg/ml and 0.25 microg/ml, respectively. To determine the stereospecificity of the methamphetamine and amphetamine, a urine sample was analyzed by GC-MS after derivatization with N-(trifluoroacetyl)-l-prolyl chloride. The methamphetamine and amphetamine were levorotatory in form. The ratio of the methamphetamine to amphetamine concentration in the urine was 2.5. This value is consistent with other case reports of ingestion of selegiline, which suggests that the methamphetamine to amphetamine concentration ratio in urine is useful information for indicating use of selegiline.
Yakugaku zasshi journal of the Pharmaceutical Society of Japan 11/2008; 128(10):1507-12. · 0.39 Impact Factor
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ABSTRACT: Case 1 was a 59-year-old female who had been taking distigmine bromide 20 mg/day for 2 years. She had concurrently developed pneumonia and was admitted to the hospital. Her pupil diameter was 1.0 mm, serum ChE value was decreased at 25 IU/L. Case 2 was a 72-year-old male who had been taking distigmine bromide 15 mg/day for 8 months. He was transported to the hospital with a chief complaint of dyspnea. His pupil diameter was 2.0 mm, serum ChE value was decreased at 75 IU/L, and he had concurrent pyothorax. Case 3 was a 74-year-old male who had been taking distigmine bromide 10 mg/day for 4 years. He was transported to the hospital with a chief complaint of disturbance of consciousness. His pupil diameter was 2.0 mm, and serum ChE value was decreased at 55 IU/L. He had concurrent aspiration pneumonia. In Case 1, the distigmine bromide concentration was elevated at 13.2 ng/mL at admission. However, it decreased from the following day. The two other patients had low concentrations of distigmine bromide. In all patients, ChE levels recovered after discontinuing distigmine bromide, and respiratory conditions also improved. Distigmine bromide was no longer detected in blood before ChE levels recovered.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 02/2008; 21(1):75-81.
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ABSTRACT: A 67-year-old woman underwent distal gastrectomy (Billroth type II reconstruction) for gastric ulcer perforation in March, 2001. In October of the same year, she was admitted to our hospital with a diagnosis of acute afferent loop syndrome with severe acute pancreatitis. The patient was successfully treated by endoscopic decompression of the afferent loop, followed by continuous drainage. Combined use of decompression and percutaneous abscess drainage was effective for the management of the retroperitoneal abscess. The most common treatment strategy employed for acute afferent loop syndrome is surgical therapy, however, the experience in this patient suggests that endoscopic drainage, which is less invasive, may also be considered.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 09/2007; 104(8):1218-24.
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ABSTRACT: A 54-year-old man took approximately 180 mL of rapid-hardening cement (75% sodium silicate) with suicidal intent and was transferred to our department after at least 2 hours had elapsed from the time he took the poison. Milk, sodium alginate, and a proton pump inhibitor were administered to the patient, and intravenous fluid infusion in a large dose with antibiotics was started. Upper gastrointestinal endoscopy revealed lesions in the oral cavity, pharynx, esophagus, and stomach. The most severe lesions observed were in the greater curvature of the stomach body. Hemodialysis was performed because of persistent oliguria and worsening of the renal function parameters. The patient underwent 8 sessions of hemodialysis over a period of 11 days, after which the dialysis was stopped. The serum level of silicon was 25.1 microg/mL on admission and 9.2 microg/mL at the time of withdrawal from hemodialysis. The gastrointestinal mucosal lesions resolved completely in response to the treatment. There were no residual lesions except for some scarring in the greater curvature of the stomach. Although the serum levels of silicon decreased transiently following each hemodialysis session, they increased again on the following day. Based on the observations in this case, it was proposed that a serum silicon level of less than 10 microg/mL is unlikely to cause renal dysfunction.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 08/2007; 20(3):263-8.
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ABSTRACT: We encountered 2 patients (No. 1 and 2) with pseudocyst hemorrhage of the pancreas. Patient No. 1, who presented with hemorrhagic shock due to rupture of a splenic aneurysm, was evaluated as a responder based on the response to the initial transfusion, and emergency TAE (transcatheter arterial embolization) was performed, which proved to be a successful life-saving measure. In Patient No. 2, also judged to be a responder, angiography was conducted and the course could be observed, because the hemorrhage was localized in the cyst. These results indicate that it is important to promptly select treatment policies based on the hemodynamic responses to the initial transfusion in cases with cystic hemorrhage of the pancreas.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 12/2006; 103(11):1280-7.
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ABSTRACT: Sivelestat sodium hydrate (sivelestat) is a selective inhibitor of polymorphonuclear leukocyte elastase (PMN-E). We administered sivelestat to patients with septic acute lung injury (ALI) to examine its usefulness. The primary endpoints in the study were the duration of artificial ventilation and pulmonary oxygenation ability, and the secondary endpoints were mortality and the concentrations of PMN-E, SP-D, TNF-alpha and IL-8 in blood. In the sivelestat group, the duration of artificial ventilation, pulmonary oxygenation ability, and the blood PMN-E, SP-D, TNF-alpha and IL-8 concentrations decreased significantly. Administration of sivelestat was found to reduce alveolar dysfunction and improve respiratory function, and it was suggested that early administration might be useful.
Research communications in molecular pathology and pharmacology 02/2006; 119(1-6):53-65.
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ABSTRACT: We studied 13 emergency cases of liver abscess. Five cases of septic shock or clouding of consciousness were identified on admission. Six patients had diabetes mellitus. Twelve patients met the diagnostic criteria for systemic inflammatory response syndrome, and nine met the criteria for disseminated intravascular coagulation. Plasma endotoxin levels improved rapidly after drainage. Causative organisms were isolated in all patients, and the most common organism was Klebsiella pneumoniae (seven cases). Percutaneous transhepatic abscess drainage (PTAD) was performed not only in single cases but also in multiple cases with main huge abscesses. Surgical treatment was performed in the following three cases: a ruptured abscess, an ineffective PTAD, and a case of peritonitis after PTAD. Irrigation of abscesses with strong acidic electrolyzed water revealed a significant decrease in treatment duration. In the majority of our cases, severe conditions were identified on admission. Strong acidic electrolyzed water was useful for management of PTAD.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 10/2005; 102(9):1153-60.
