著者

Takashi Ueno Tokuya Omi Eiji Uchida Hiroyuki Yokota Seiji Kawana

出版者

日本医科大学医学会

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.81, no.1, pp.4-11, 2014 (Released:2014-03-10)

参考文献数

23

被引用文献数

7 20

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Background: Treating chronic wounds is challenging. Despite standard wound care, some chronic wounds fail to heal. Therefore, hyperbaric oxygen therapy (HBOT) was developed as an adjunct to standard wound care. Objective: To evaluate the efficacy of HBOT for treating chronic wounds due to a variety of causes at our institution. Methods: We reviewed the medical records of patients with chronic wounds treated with HBOT in addition to standard wound care at the Department of Dermatology, Nippon Medical School Hospital, from 2009 through 2012. Twenty-nine patients were reviewed (14 men and 15 women; mean age, 64.1±14.4 years). The cause of chronic wounds was diabetes mellitus (DM) in 13 patients, venous stasis in 10, polyarteritis nodosa cutanea in 2, and livedoid vasculopathy, pyoderma gangrenosum, chronic renal failure, and systemic sclerosis in 1 patient each. The patients underwent HBOT for 60 minutes with 100% oxygen delivered via a mask in a hyperbaric chamber pressurized to 2.8 atmospheres of absolute pressure. The response of the chronic wounds to HBOT was evaluated according to the following criteria: "excellent": more than 90% wound healing; "good": a greater than 30% reduction in wound size, and wound healing was confirmed on follow-up visits within 6 weeks; "fair": wound healing was achieved with a combination of further invasive interventions; and "poor": the wound showed a less than 30% reducion or worsened during HBOT, or wound healing had not been completed by follow-up visits within 6 weeks. Results: The response to HBOT was "excellent" in 6 patients, "good" in 8, "fair" in 11, and "poor" in 4. All 4 patients with a "poor" response had DM and had undergone hemodialysis. Conclusions: HBOT is an effective treatment for patients with chronic wounds, due to a variety of causes, when used in combination with conventional standard therapy or further interventions. However, HBOT is less effective in patients with DM than in patients with venous stasis because hemodialysis, which is more common in patients with DM, has negative effects on wound healing.

著者

Takashi Araki Masato Miyauchi Makoto Suzaki Taro Wakakuri Sonoko Kirinoki Naoko Onodera Taro Saigusa Akihiro Takana Hideya Hyodo Toshihiko Ohara Makoto Kawai Masahiro Yasutake Hiroyuki Yokota

出版者

日本医科大学医学会

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.82, no.6, pp.295-299, 2015-12-15 (Released:2016-01-27)

参考文献数

10

被引用文献数

1

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Objective: Current data indicate that the rate of trauma in children during gymnastic formation is increasing, especially while creating a structure with a certain height, such as the human pyramid. The goal of the present study was to clarify the clinical characteristics of these injuries. Methods: In this single-institution review, all children treated for a gymnastic formation-related injury at Nippon Medical School Hospital from 2013 through 2015 were identified through the institution's registry. The injury mechanism was classified, and injury severity, interventions, and outcome were examined. Results: Eight children were treated for a gymnastic formation-related injury. They were 7 boys and 1 girl aged 10 to 15 years (mean age, 13.1±1.8 years). Neurotrauma ranging from concussion to spinal cord injury without radiographic abnormality occurred in 6 patients (75%). No intracranial hemorrhagic lesions were detected. The Glasgow Coma Scale score on arrival was 15 in all 8 patients, and neurological deficits were present in 1 patient. No patient required surgical intervention. All patients made a full recovery after discharge from the hospital. No patients died. The average follow-up period was 2.1±0.9 weeks. Conclusions: Neurotrauma is a frequent result of gymnastic formation accidents in children. Healthcare workers and teachers should recognize this type of injury, and public education that targets parents should be introduced.

著者

Hisashi Matsumoto Kunihiro Mashiko Yuichiro Sakamoto Noriyoshi Kutsukata Yoshiaki Hara Hiroyuki Yokota

出版者

日本医科大学医学会

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.77, no.1, pp.13-20, 2010 (Released:2010-02-15)

参考文献数

21

被引用文献数

7 17

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Background: Several reports have validated the criteria for damage control surgery (DCS). However, although metabolic acidosis and body temperature can be measured quickly, tests for predicting the severity of coagulopathy require special laboratory equipment and take 15 to 30 minutes. Such delays could be life-threatening for patients requiring DCS. The aim of this study was to establish simplified and practical criteria to enable rapid decision-making regarding the need for DCS. Methods: Thirty-four consecutive patients with unstable hemodynamics after initial fluid resuscitation who had undergone DCS for severe abdominal or pelvic injuries were retrospectively analyzed. The patients' characteristics, clinical courses, laboratory data, and outcomes were reviewed using the data contained in their medical records. Results: The overall survival rate was 55.9% (survivors group: n=19; nonsurvivors group: n=15), which was similar to the calculated mean probability of survival (Ps=0.5671). At the start of surgery, the systolic blood pressure (SBP) was less than 90 mm Hg in all cases in which surgery failed, and the mean SBP in the nonsurvivors group (69.6 ± 14.8 mm Hg) was significantly lower than that in the survivors group (93.2 ± 22.9 mm Hg, p=0.006). Except in two cases, the value of the base excess in the nonsurvivors group was less than -7.5 mmol/L, and the mean base excess (-11.5 ± 5.3 mmol/L) in the nonsurvivors group was significantly less than that in the survivors group (-5.5 ± 4.9 mmol/L, p=0.008) at the start of surgery. The core temperature at the start of surgery was less than 35.5°C in all cases in the nonsurvivors group. On the basis of these results, three indicators (SBP less than 90 mm Hg, base excess less than -7.5 mmol/L, and core temperature less than 35.5°C at the start of surgery) were identified. The success rate of DCS in patients who possessed all three indicators (28.6% ) was significantly lower than that in patients who did not possess all three indicators (75.0%; p=0.014). Conclusion: Our results indicate that surgeons should decide to perform DCS when only one or two criteria defined in this study are met and should not wait for all three criteria. Although our proposed criteria are not strict and may broaden the indications for DCS, leading to an increase in the number of DCS procedures, saving the lives of patients who have sustained severe torso trauma must be the priority; 'over-triage' may be acceptable in situations where an appropriate decision-making protocol has been followed.

著者

Ryuta NAKAE Yasuo MURAI Yasuhiro TAKAYAMA Kaoru NAMATAME Yoshiyuki MATSUMOTO Takahiro KANAYA Yu FUJIKI Hidetaka ONDA Go SUZUKI Junya KANEKO Takashi ARAKI Yasutaka NAOE Hidetaka SATO Kyoko UNEMOTO Akio MORITA Hiroyuki YOKOTA Shoji YOKOBORI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0226, (Released:2022-10-13)

参考文献数

37

被引用文献数

5

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Coagulopathy, a common complication of traumatic brain injury (TBI), is characterized by a hypercoagulable state developing immediately after injury, with hyperfibrinolysis and bleeding tendency peaking 3 h after injury, followed by fibrinolysis shutdown. Reflecting this timeframe, the coagulation factor fibrinogen is first consumed and then degraded after TBI, its concentration rapidly decreasing by 3 h post-TBI. The fibrinolytic marker D-dimer reaches its maximum concentration at the same time. Hyperfibrinolysis in the acute phase of TBI is associated with poor prognosis via hematoma expansion. In the acute phase, the coagulation and fibrinolysis parameters must be monitored to determine the treatment strategy. The combination of D-dimer plasma level at admission and the level of consciousness upon arrival at the hospital can be used to predict the patients who will "talk and deteriorate." Fibrinogen and D-dimer levels should determine case selection and the amount of fresh frozen plasma required for transfusion. Surgery around 3 h after injury, when fibrinolysis and bleeding diathesis peak, should be avoided if possible. In recent years, attempts have been made to estimate the time of injury from the time course of coagulation and fibrinolysis parameter levels, which has been particularly useful in some cases of pediatric abusive head trauma patients.