著者

山田 哲久 名取 良弘 今本 尚之

出版者

日本神経救急学会

雑誌

日本神経救急学会雑誌 (ISSN:16193067)

巻号頁・発行日

vol.26, no.2, pp.32-37, 2014-07-11 (Released:2015-05-02)

参考文献数

11

---

Sudden intense headache commonly develops in subarachnoid hemorrhage. Subarachnoid hemorrhage can be easily diagnosed using head computed tomography (CT) or head magnetic resonance imaging (MRI). We treated two patients with subarachnoid hemorrhage who could not be diagnosed on the basis of imaging findings. We diagnosed them with subarachnoid hemorrhage after performing lumbar puncture. Here, we report the case findings.Case 1: An 82-year-old manHe developed sudden intense headache while going to eat at home. Head CT did not reveal a clear subarachnoid hemorrhage. The iso-intensity mass was seen in basal cistern by head MRI. However, head magnetic resonance angiography (MRA) revealed an aneurysm in the anterior communicating artery. Cerebrospinal fluid extracted after lumbar puncture was clear. We considered the patient to have an unruptured cerebral aneurysm.Case 2: A 38-year-old womanShe developed sudden intense headache and vomited twice while relaxing at home. The iso-intensity mass was seen in basal cistern by head MRI. However, head MRA revealed an aneurysm in the right internal posterior communication artery. Cerebrospinal fluid extracted after lumbar puncture had a light red color. We considered the patient to have subarachnoid hemorrhage due to a ruptured cerebral aneurysm, and performed emergency clipping and craniotomy.Consideration and conclusionWe think that performing an imaging examination in all patients with headache is unnecessary. We performed an imaging examination only when we suspected subarachnoid hemorrhage after analyzing a patient’s medical history. If subarachnoid hemorrhage is suspected in a case with no abnormal imaging findings, lumbar puncture should be considered.

著者

山田 哲久 名取 良弘

出版者

特定非営利活動法人 日本脳神経外科救急学会 Neurosurgical Emergency

雑誌

NEUROSURGICAL EMERGENCY (ISSN:13426214)

巻号頁・発行日

vol.24, no.1, pp.1-5, 2019 (Released:2019-04-03)

参考文献数

7

---

当院は人口43万人の医療圏で唯一の救命救急センターである.救急搬送件数も年々増加し2013年には年間8,000件を超えており,受け入れ困難症例が多くなってきた.2015年と2016年の救急搬送受け入れ断り症例に関して検討を行った.2015年救急搬送件数7,846件,救急搬送受け入れ断り症例は191件(2.4%)であった.2016年救急搬送件数7,161件,救急搬送受け入れ断り症例は538件(7.0%)であった.断った理由が当院側にある(救急外来満床,入院病床満床など)割合は,2015年は40%で,2016年は32%であった.三次症例は可能な限り受け入れが必要である.軽症を断ることで,救急外来満床,入院病床満床を減らすことが可能となると考え,近隣二次病院へ軽症患者受入の依頼,救急隊に軽症患者を二次病院へ搬送依頼を行った.2017年には,断り症例はさらに増加し,救急外来満床,入院病床満床が増えた.受け入れ体制の整備だけでは限界があり,退院促進,救急病床退室促進など出口側の体制整備が必要である.

著者

山田 哲久 名取 良弘 熊城 伶己 三股 佳奈子 松元 宗一郎 香月 洋紀

出版者

日本脳死・脳蘇生学会

雑誌

脳死・脳蘇生 (ISSN:1348429X)

巻号頁・発行日

vol.32, no.2, pp.58-61, 2020-08-11 (Released:2020-08-11)

参考文献数

11

---

[Purpose] Our hospital is the only emergency and critical care center in the region serving a population of 420,000. The number of emergency transports is 7,000-7,500 annually, and the number of cardiopulmonary arrest cases is 250-300. Early intervention is necessary to return of spontaneous circulation in patients with cardiopulmonary arrest. Herein, we analyzed the transition of treatment interventions by emergency medical service paramedics annually and examined pre-hospital interventions for return of spontaneous circulation before arriving at the hospital.[Methods] We included 2,010 adults with out-of-hospital cardiopulmonary arrest between 2011 and 2018. We conducted an annual review on the following aspects: number of cases per year, rate of return of spontaneous circulation before arrival at hospital, rate of bystander witness, rate of bystander cardiopulmonary resuscitation, rate of cardioversion by paramedics, rate of securing venous access by paramedics, rate of adrenaline administration by paramedics, and rate of advanced airway management by paramedics.[Results] The number of cases remained approximately 250, and the rate of return of spontaneous circulation before arrival at the hospital increased. As for treatment by a paramedic, the cardioversion rate remained unchanged at 10-15%, and the venous access rate and adrenaline administration rate increased. There was no change in the rate of advanced airway management, and it remained at approximately 10%.[Conclusion] To return of spontaneous circulation before arriving at the hospital, it was considered for the paramedic to perform venous access and administer adrenaline.

著者

山田 哲久 名取 良弘

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.35, no.2, pp.32-36, 2023-06-22 (Released:2023-06-23)

参考文献数

14

---

Introduction: We report the case of a patient transported to emergency outpatient department by ambulance due to cardiopulmonary arrest following a head injury. He underwent systemic management, leading to organ donation.Case: A 56-year-old man.Current illness history/course: The patient sustained a head injury after falling from the bed of a truck and then suffered cardiopulmonary arrest. He was transported to the emergency department by ambulance. After his heart resumed beating, his intention to donate his organs was confirmed on the back of his health insurance card. Discussions with the organ donation hospital coordinator reveal that, donating organs after brain death was difficult due to the general condition; still the possibility of organ donation after cardiac arrest was considered. Systemic management was continued in the emergency department, and upon obtaining consent from his family, post-cardiac arrest organ donation was carried out.Conclusion: Establishing a system to confirm the intention to donate organs is important. Donor management can be done by performing normal life-saving measures, but certain donor-specific matters require attention.

著者

山田 哲久 名取 良弘

出版者

特定非営利活動法人 日本脳神経外科救急学会 Neurosurgical Emergency

雑誌

NEUROSURGICAL EMERGENCY (ISSN:13426214)

巻号頁・発行日

vol.28, no.1, pp.1-5, 2023 (Released:2023-09-21)

参考文献数

14

---

新型コロナウイルス感染症の流行や緊急事態宣言の発令で人々の生活は感染対策が中心となった.この状況下で脳神経外科疾患の症例数に変化が生じたか検討した.当院脳神経外科で2017年1月から2022年12月までに入院加療を行った症例を対象とした.対象症例を2017年~2019年まで(コロナ禍前)と2020年~2022年まで(コロナ禍)に分けて,総数および脳腫瘍,脳血管障害,神経外傷,慢性硬膜下血腫,その他に分けて前後で症例数を比較した.コロナ禍前の年平均値とコロナ禍の年平均値は総数および脳血管障害以外で減少していた.総数は2020年に減少し,2021年は変化なし,2022年にさらに減少していた.脳腫瘍,脳血管障害は2020年に減少し,2021年以降はコロナ禍前に戻っていた.神経外傷,その他は,2020年に減少し,2021年は変化なし,2022年にさらに減少していた.慢性硬膜下血腫は,2020年は変化なし,2021年に減少し,2022年は変化なしであった.病院側の要因と患者側の要因が考えられた.外出の自粛で交通量を減少させることで神経外傷が減少した可能性が考えられた.

著者

山田 哲久 Akihisa Yamada

出版者

同志社大学国文学会

雑誌

同志社国文学 = Doshisha Kokubungaku (ISSN:03898717)

巻号頁・発行日

no.70, pp.91-104, 2009-03-20

著者

山田 哲久 名取 良弘 中塚 昭男

出版者

一般社団法人 日本外傷学会

雑誌

日本外傷学会雑誌 (ISSN:13406264)

巻号頁・発行日

vol.26, no.1, pp.47-54, 2012-01-20 (Released:2020-09-07)

参考文献数

18

---

外傷性視神経症に対する治療法として, ステロイドを中心とした保存的療法と視神経管開放術を行う外科的療法がある. これまでもステロイド療法と視神経管開放術で, どちらが視力予後に優れているか検討されてきた. 今回当院で経験した外傷性視神経症10症例に関して検討し, 視力予後改善のための考察を行った. 視力予後改善のためには, 受診時の視力が保たれていること, 可能な限り早期に治療を開始することが重要である. したがって, ステロイド療法を早期に開始し, 症例に応じて視神経管開放術を併用することが視力予後改善につながると考えられる. そのためには, 病歴, 身体所見, 画像所見から外傷性視神経症を疑い, 瞳孔所見を確認し早期に診断することが重要である.

著者

山田 哲久 名取 良弘

出版者

一般社団法人 日本脳神経外傷学会

雑誌

神経外傷 (ISSN:24343900)

巻号頁・発行日

vol.35, no.1, pp.16-21, 2012-11-10 (Released:2021-04-20)

参考文献数

7

---

Chronic subdural hematoma is one of the most common diseases encountered in neurosurgical practices. The relationship between the case number of chronic subdural hematoma and seasons has not been reported until now. The relationship between recurrence rate of chronic sub­dural hematoma and seasons has not been reported, too. We examined the monthly case number of and recurrence case number of chronic subdural hematoma in our hospital.The examination included 769 adult patients who had undergone the first one burr-hole surgery between January 2000 and December 2010. We examined the monthly number of cases (recurrence cases and non-recurrence cases), recurrence rate, and recurrence risk factor.The number of cases was higher in August, April, July and September. November and March had few cases. Recurrence rate was highest in July and lowest in December. We found an association between age and monthly recurrence rate among a recurrence risk factor.We think that there is an association between the daily life activity of the elderly person and case number of chronic subdural hematoma. The daily life activity of elderly persons shows seasonality. Therefore, we think that the case number of chronic subdural hematoma shows seasonality. To decrease the recurrence rate, examination of the post­operative volume of infusion and an appropriate rest period are necessary.

著者

森本 静夫 小塚 隆弘 高宮 誠 木村 晃二 松山 正也 栗林 幸夫 重田 帝子 梅村 純 原田 潤太 山田 哲久 鎌田 力三郎 氷見 和久 小川 暢也 田中 豊 中野 重行 Morimoto Sizuo Kozuka Takahiro Takamiya Makoto Kimura Kohji Matsuyama Seiya Kuribayashi Sachio Shigeta Akiko Umemura Jun Harada Junta Yamada Tetsuhisa Kamata Rikisabro Himi Kazuhisa Ogawa Nobuya Tanaka Yutaka Nakano Sigeyuki モリモト シズオ コヅカ タカヒロ タカミヤ マコト キムラ コウジ マツヤマ セイヤ クリバヤシ サチオ シゲタ アキコ ウメムラ ジュン ハラダ ジュンタ ヤマダ テツヒサ カマタ リキサブロウ ヒミ カズヒサ オガワ ノブヤ タナカ ユタカ ナカノ シゲユキ

出版者

日本医学放射線学会

雑誌

日本医学放射線学会雑誌 (ISSN:00480428)

巻号頁・発行日

vol.50, no.9, pp.1087-1101, 1990-09-25