Shoichi Ohta

Tokyo Medical University, Edo, Tōkyō, Japan

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Publications (26)52.18 Total impact

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    ABSTRACT: CaseA 20-year-old woman developed acute psychotic symptoms and altered level of consciousness. She presented with neck stiffness, tremulous arms, facial dyskinesia, and distension of the lower abdomen. Pelvic magnetic resonance imaging showed bilateral ovarian teratomas. Anti-N-methyl-D-aspartate receptor antibodies were detected in her cerebrospinal fluid.OutcomeResection of the tumors and immunotherapy were carried out. She gradually recovered and was discharged with few neurological deficits on the 105th day of hospitalization.Conclusion Our survey of 63 previous reports describing 92 cases revealed that 21.7% of the patients were sent to emergency departments and 59.8% of the patients were managed in intensive care units. Emergency physicians and intensivists should be aware of this disorder, as they may encounter undiagnosed disorders in patients with epileptic attacks, acute psychotic signs, dyskinesia, or hypoventilation in the course of the illness.
    Acute Medicine & Surgery. 09/2014;
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    ABSTRACT: CaseA 30-year-old woman had her left thigh run over by a train. We tried to compress the left femoral area to control the arterial bleeding, but bleeding continued from the stump and injured soft tissue. The application of a tourniquet bandage also failed because of the limited remaining thigh. She developed impending cardiac arrest. As the left femoral arterial pulsation was still palpable, we inserted an intra-aortic balloon occlusion catheter percutaneously. The hemorrhage from the stump region decreased rapidly. She was transferred to an operating room to carry out surgical hemostasis, and it was confirmed with deflation of the balloon in the common iliac artery.OutcomeThere was no complication of the skin or soft tissue at the surgical site caused by impaired circulation, and her consciousness fully recovered.Conclusion We report the successful control of bleeding by the emergently modified application of intra-aortic balloon occlusion in the left common iliac artery.
    Acute Medicine & Surgery. 08/2014;
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    ABSTRACT: It would be helpful if we could predict positive or negative blood culture results. This study considered the usefulness of measuring procalcitonin (PCT) level and standard clinical biomarkers such as white blood cell (WBC) count, C-reactive protein (CRP) level, and platelet (PLT) count to predict blood culture results. We retrospectively analyzed the data from 422 specimens collected at our emergency center within the preceding 36 consecutive months. Primary component analysis (PCA) was used for detecting the degree of the relational contribution of each of the 4 biomarkers to the blood culture results. Procalcitonin alone (cut-off value, 0.5 ng/mL) yielded a positive blood culture rate of 34.0%. Procalcitonin plus 3 biomarkers (WBC, CRP, and PLT) analyzed by PCA yielded 45.9% or 35.3% when a case was in the first or fourth quadrant, which was significantly higher than cases in the second or third quadrant. Primary component analysis also revealed that positive blood culture results were mainly affected by primary component 1, to which PCT and PLT (not WBC or CRP) predominantly contribute. Although it is difficult to predict blood culture results, even using 4 biomarkers analyzed by PCA, our new finding that blood culture results are affected not by WBC and CRP, but mainly by PCT and PLT, might help explain the mechanism of sepsis.
    The American journal of emergency medicine 12/2013; · 1.54 Impact Factor
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    ABSTRACT: INTRODUCTION: We speculated that initial middle latency auditory evoked potentials index (MLAEPi) can indicate cerebral function and predict the restoration of spontaneous circulation (ROSC), postresuscitation survival or of neurologic outcomes among patients with cardiac arrest. METHODS: This prospective study included 61 patients with cardiac arrest who received basic life support and did not achieve ROSC until arrival at the emergency center between September 2010 and September 2011. All patients were then administered advanced cardiac life support at the emergency department. Initial MLAEPi was immediately measured using an MLAEP monitor (aepEX plus; Audiomex, Glasgow, Scotland, UK) during the first cycle of advanced cardiac life support. Prediction of the ROSC, survival, and good outcome were investigated. RESULTS: Sixteen patients achieved ROSC (ROSC group), and 45 did not achieve ROSC at the scene (non-ROSC group). The initial MLAEPi was significantly higher in the ROSC than in the non-ROSC group (33 vs 28, P < .01). Four survivors in the ROSC group were classified as good outcomes (Cerebral Performance Category 1 and 2). Initial MLAEPi in survivors were significantly higher than that in nonsurvivors (43 vs 29, P < .01). The receiver operating characteristic curves for the initial MLAEPi with area under the curves was 0.75 (95% confidence interval [CI], 0.62-0.88; P < .01) for ROSC, 0.94 (95% CI, 0.88-1.00; P < 0.01) for survival, and 0.96 (95% CI, 0.89-1.03; P < .01) for a good outcome, respectively. CONCLUSIONS: Initial MLAEPi represented by simple numerical values upon presentation at emergency facilities could predict ROSC, survival, and neurologic outcomes among patients with cardiac arrest.
    The American journal of emergency medicine 05/2013; · 1.54 Impact Factor
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    ABSTRACT: We investigated active screening for colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission and weekly follow-up surveillance after admission to a tertiary care center (TCC) between June 2007 and 31 December 2007. Eleven percent (30/267) of patients were found to be positive for MRSA by polymerase chain reaction (PCR) and/or culture on admission; 5% (12/267) became positive during the TCC stay. The major primary diagnoses in MRSA-positive patients were pneumonia and cerebrovascular diseases. Twenty-two (52%) of 42 patients were found to be MRSA positive by both PCR and culture, compared with 19 (45%) of 42 who were PCR positive and culture negative. These findings suggest that active surveillance with PCR is highly sensitive and useful for the detection of MRSA colonization. To our knowledge, this is the first report of active surveillance of MRSA by PCR and bacterial culture in critically ill inpatients in Japan.
    Journal of Infection and Chemotherapy 02/2012; · 1.55 Impact Factor
  • Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2011; 9(8):e78-9. · 5.64 Impact Factor
  • Hirokazu Taguchi, Takao Arai, Shoichi Ohta
    Gastroenterology 02/2010; 138(4):e3-4. · 12.82 Impact Factor
  • Nihon Kyukyu Igakukai Zasshi 01/2010; 21(4):172-176.
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    ABSTRACT: Rapid trauma evaluation and intervention without time delay are considered integral to time-efficient management of trauma patients, particularly for those with hemodynamic instability. This study examined the impact of immediate availability of mobile angiography with digital subtraction angiography technology in the emergency department (ED) for hemodynamically unstable multiple trauma patients with pelvic injury. This retrospective review examined a cohort of all blunt trauma patients with pelvic injury who underwent transcatheter arterial embolization (TAE) using mobile angiography by trauma surgeons in the ED. This system was set up on a 24-hour basis with full-time trauma surgeons available in-hospital. Data collected included clinical characteristics, injury severity, resuscitation intervals from admission through to completion of hemostasis, metabolic factors (pH and core body temperature), mortality, and TAE-related complications. Subjects comprised 29 patients (hemodynamically stable group, n = 17; hemodynamically unstable group, n = 12) with a median age of 36 years (interquartile range [IQR], 29-53 years). Mean shock index, injury severity score, and trauma and injury severity score were 1.1 +/- 0.5, 32 +/- 12, and 0.79 +/- 0.27, respectively. Median intervals from ED arrival to diagnosis and from diagnosis to starting TAE were 66 minutes (IQR, 42-80 minutes) and 30 minutes (IQR, 25-37 minutes), respectively. Median interval from diagnosis to completion of TAE was 107 minutes (IQR, 93-130 minutes). Physical and anatomic injury statuses were more severe in the hemodynamically unstable group than in the hemodynamically stable group. However, intervals from diagnosis to starting TAE and from diagnosis to completion of hemostasis did not differ significantly between groups. No exacerbations of metabolic factors during resuscitation were identified. Pelvic injury related mortality was 17% and no TAE-related complications were encountered. Immediate availability of mobile angiography in the ED seems safe and effective for hemodynamically unstable trauma patients with pelvic injury and results in a rapid improvement in resuscitation intervals without leaving the ED. An adequately randomized controlled trial of mobile angiography in this subset of patients, who would seem to derive the most benefit from mobile angiography, would be ideal.
    The Journal of trauma 01/2010; 68(1):90-5. · 2.35 Impact Factor
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    ABSTRACT: Vital-organ transplantation has become acceptable as the treatment of choice for end-stage organ failure. If the patient, facing the end of life, wishes to donate organs after cardiac arrest (CA), donation after cardiac death (DCD) is increasingly important for the realization of the patient's desires after CA. In Japan, kidney transplantation from uncontrolled DCD donors, who are identified in modified Maastricht categories II or V, is one of the critical factors in expanding the donor pool. However, according to the forensic code for post-mortems and the requirement of legal consent for transplantation, the time required to meet all procedural requirements has sometimes prohibited organ procurement from uncontrolled DCD donors. We have therefore attempted to use an automated cardiopulmonary resuscitation (CPR) device and maintain arterial pressure for uncontrolled DCD donors during all interim procedures after sudden CA. Comparing kidneys procured from standard DCD donors (n = 10) and uncontrolled DCD donors (n = 4), significant differences were seen in warm ischemic time (WIT), defined as the time from CA to initiation of cooling in situ. However, our early experience showed good tolerance and viability of uncontrolled DCD kidneys. Immediate availability of an automated CPR device might provide a bridge to kidney procurement from uncontrolled DCD donors.
    Clinical Transplantation 11/2009; 24(5):620-5. · 1.63 Impact Factor
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    ABSTRACT: : To assess the immunologic alteration and long-term prognosis after splenic injury from preservation treatment (PT) (embolization, splenorrhaphy, partial splencetomy) and to compare with splenectomy (SN). : The long-term prognosis of patients with blunt splenic injury treated at seven tertiary emergency centers in Japan was retrospectively studied. Patients were followed up by telephone interview and written questionnaire. Blood samples and abdominal computer tomography scans were taken from patients who consented, and immunologic indices and the remaining volume of the spleen were measured. : There was no episode of severe infection requiring hospitalization among the 66 SN patients (760 patient-year) and the 34 PT (213 patient-year) patients. Blood tests from 58 patients (24 SN vs. 34 PT) revealed significant differences in platelet count, Howell-Jolly body positive rate (SN 87% vs. PT 3%), white blood cells, total lymphocyte count, T-cell count, B-cell count, and serum IgG level. There was no significant difference in serum levels of IgM or specific IgG antibodies against 14 types of Streptococcus pneumoniae capsular polysaccharide, C3, C4, high-sensitivity C-reactive protein, and B -cell subset (surface marker immunoglobulins: IgA, IgG, and IgM). Most patients had anti-S. pneumoniae antibody levels less than that of the reference level for multiple serotypes (average 3 in SN and 4 in PT). A computer tomography scan was taken from 33 PT patients; the volume of spleen remaining averaged 130 mL (range, 48-287 mL). : PT did not show discernible advantage over SN in immunologic indices including IgM and 14 serotypes of anti-S. pneumoniae antibodies, suggesting prophylactic measures and close follow-up are necessary after PT and SN.
    The Journal of trauma 10/2009; 67(3):557-63; discussion 563-4. · 2.35 Impact Factor
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    ABSTRACT: Digital subtraction angiography is frequently required in the initial evaluation of trauma patients. We hypothesized that mobile digital subtraction angiography technology directly into the trauma resuscitation area would save time in restoring metabolic derangements for patients with on-going hemorrhage. This is a retrospective review of a cohort of trauma patients treated before and after the direct availability of mobile angiography in the trauma resuscitation room performed by the trauma surgeons. Data collected for comparison-included demographics, hemodynamic variables, metabolic factors (pH and temperature), units of blood administered, and outcomes. Mean age, Shock Index, and Injury Severity Score were similar. The interval from the decision to perform transcatheter arterial embolization (TAE) to starting TAE were significantly different (59 minutes +/- 45 minutes vs. 31 minutes +/- 11 minutes, p = 0.001). The other resuscitation intervals were similar. The mean Deltabody temperature from emergency department arrival through completion of TAE between the two groups were significantly different (-1.18 +/- 1.69 vs. -0.08 +/- 1.42, p = 0.026). The mean DeltapH from emergency department arrival through completion of TAE were also significantly different (-0.118 +/- 0.083 vs. 0.028 +/- 0.127, p = 0.001). There were clinically significant correlations between Deltabody temperature and resuscitation interval, and between DeltapH and resuscitation interval. The introduction of mobile angiography into the trauma resuscitation room and the immediate availability of trained trauma surgeons to perform diagnostic and therapeutic angiographic procedures shortened the time required to restore normal physiology.
    The Journal of trauma 09/2009; 67(2):245-51. · 2.35 Impact Factor
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    ABSTRACT: Normal gut flora plays an important role in the intestinal mucosal barrier function under various critical conditions. The flora may alter after severe insults, such as trauma and shock. Enteral nutrition should preserve the gut environment; however, full support is usually difficult for severely ill patients because of impaired gastrointestinal motility. Currently, we have commercial enteral supplementation product enriched with glutamine, dietary fiber, and oligosaccharide (GFO) in Japan. This study examines the hypothesis that the enteral supplementation ameliorates gut injury induced by a bacterial overgrowth model, even in small volumes and quantities. Balb/c mice received antibiotics (4 mg/mL of streptomycin) in their drinking water for 4 days to kill the normal gut flora after which they were orally inoculated with a streptomycin-resistant strain of Escherichia coli, known as E. coli C-25. The mice that were administered bacterial monoassociation received 0.5 mL of GFO twice daily (GFO group) or 10% of glucose solution (GLU group). Unsupplemented drinking water was used for control animals (control) whose gut flora was normal. The mice were killed and their mesenteric lymph nodes complex was harvested and processed to test gut bacterial translocation. The cecal population levels of bacteria and ileum histology were also examined. The incidence and magnitude of gut translocation to the lymph nodes complex in the GLU group were significantly higher than those in the control (p < 0.01). Treatment with GFO prevented the gut translocation although animals in the GFO group had same level of the cecal bacterial population. Histologic findings in the ileum were not different between the GLU and GFO. GFOs supplement prevented gut translocation for bacterial overgrowth even in small volumes and quantities. The intestinal histologic findings could not explain the protective mechanisms of GFO. Further studies may be needed to elucidate the benefit of the partial enteral nutrition.
    The Journal of trauma 02/2009; 66(1):110-4. · 2.35 Impact Factor
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    ABSTRACT: Donation after cardiac death (DCD) is increasing in importance as a potential source of vital organs for clinical transplantation. In Japan, the method of kidney procurement from DCD is one of the critical factors in successful deceased renal transplantation. The efforts to shorten the warm ischemic time (WIT), which is defined as the time from cardiac arrest to initiation of cooling in situ, or maintaining adequate renal blood flow during WIT by consistent chest compression are essential. We experienced one case of successful kidney transplantation using a non-invasive load-distributing-band chest compression device using AutoPulse (ZOLL Circulation, Sunnyvale, California), which is designed for use as an adjunct to cardiopulmonary resuscitation (CPR) to maintain adequate aortic pressure. This is the first report of our experiences of successful kidney transplantation from DCD using a load-distributing-band chest compression device for maintaining renal blood flow during long WIT. We can speculate that this mechanical CPR device can become a bridge to deceased organ transplantation.
    Resuscitation 02/2009; · 4.10 Impact Factor
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    ABSTRACT: The barrier function of the intestinal mucosa can be disturbed under a variety of pathologic insults. Reactive oxygen species play an important role in intestinal mucosal injury. This in vitro study examines the hypothesis that a free radical scavenger, edaravone (ED), ameliorates gut epithelial permeability increase caused by xanthine oxidase (XO)-mediated oxidative stress in a cell monolayer model. Human intestinal epithelial (HIE) cells were grown as monolayer in bicameral chambers. Twenty milliunits per milliliter of XO+0.25 mM of xanthine (XO+X group) or saline (control) were administered into the basal chambers. Another set of chambers was treated with XO+X and 0.6 mg/ml of ED (XO+X+ED group). The permeability was assessed by quantifying the transepithelial passage of fluorescence in isothiocyanate-labeled dextran. In another series of experiments, Escherichia coli C-25 was also applied in an apical chamber to evaluate the bacterial translocation through the monolayer. The concentration of the fluorescence in isothiocyanate-labeled dextran in the basal chamber of the control group was significantly higher than the control (705 +/- 50.2 vs 155 +/- 45.4 mg/dl, P < .01). Treatment with ED prevented this permeability increase induced by the oxidative stress (P < .01). The incidence of bacterial translocation through the HIE monolayer in XO+X group was also higher than that of the control group (75 vs 13%, P < .05). Increased HIE cell monolayer permeability mediated by xanthine and XO was significantly attenuated with ED. This synthesized radical scavenger may have potential clinical applications against gut mucosal barrier dysfunction.
    Journal of burn care & research: official publication of the American Burn Association 01/2009; 30(2):335-40. · 1.54 Impact Factor
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    Injury Extra 01/2009; 40(7):122-124.
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    Injury Extra 01/2009; 40(6):112-114.
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    The Journal of trauma 07/2008; 64(6):E86-8. · 2.35 Impact Factor
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    ABSTRACT: Hypoxia-induced hypothermia (HIH) is regarded as an adaptive response to hypoxia in a variety of creatures, but no details of the mechanism have yet been elucidated in the clinical setting. This study was designed to analyze alteration of core body temperature with hemorrhagic shock and to clarify HIH in the clinical setting. Patients were categorized in the hemorrhage shock (S, n = 15) or cardiopulmonary arrest (C, n = 88) group. The tympanic membrane temperature (TMT) was measured, and the length of the interval of call-to-arrival (CTA) at a hospital was set as the time-course parameter. There was a significant negative linear relationship between CTA interval and TMT (S group: TMT = -0.055 degrees C, CTA = +36.1 min, r = -0.833, P < 0.001; C group: TMT = -0.046 degrees C, CTA = +36.3 min, r = -0.548, P < 0.001). Analysis of variance revealed no significant difference in the slope of the regression lines of both groups. However, when the CTA interval was used as a covariate, there was a significant difference in the TMT (P = 0.014), which means that the regression line of the S group was significantly lower than that of the C group with time. Furthermore, in the S group, all patients were hypothermic (<35 degrees C) when their CTA interval was more than 20 min; on the other hand, in the C group, only 64 (75%) of 85 were hypothermic. Patients in S group were more likely to become hypothermic (P < 0.05). In humans with cellular hypoxia, HIH takes place, as seen in other animals. This result emphasizes the necessity for studies of analysis of the mechanisms of temperature control and determination of optimal body temperature during acute critical care.
    Shock 04/2007; 27(4):354-7. · 2.61 Impact Factor
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    ABSTRACT: We have developed a laser pointing system, the GestureLaser, which allows a remote operator to control a videocamera and a laser beam via a networked personal computer. The laser spot can be moved by the mouse cursor controlled by the remote instructor. The system was tested by giving remote instruction in thoracentesis to inexperienced operators using a training mannekin. Seven medical students received instructions using the laser pointer and another seven received instruction without the laser pointer. All operators completed the task correctly. The laser pointer group correctly identified the centesis space and performed the task on the first trial. When the laser pointer was not used, four operators (57%) made a mistake in selecting the centesis space at the first trial. The mean times for both stage 1--verbal versus GestureLaser 59 s (SD 13) versus 44 s (SD 5), p = 0.015 - and stage 2--verbal versus GestureLaser 98 s (SD 20) versus 64 s (SD 7), P = 0.002 - were significantly shorter when the GestureLaser was used. The study shows that the laser pointing system can be used to remotely instruct a novice operator in performing thoracentesis. It could improve collaboration between geographically separated sites.
    Journal of Telemedicine and Telecare 02/2006; 12(1):44-8. · 1.47 Impact Factor

Publication Stats

71 Citations
52.18 Total Impact Points

Institutions

  • 2006–2014
    • Tokyo Medical University
      • Department of Emergency and Critical Care Medicine
      Edo, Tōkyō, Japan
    • Saitama Medical University
      Saitama, Saitama, Japan
  • 2002
    • Kyorin University
      • Department of Traumatology and Critical Care Medicine
      Edo, Tōkyō, Japan