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Gaku Uchiyama, Taichi Nakazawa, Yuusuke Miyatani, Junichiro Iio, Atsuh ...
2019 Volume 39 Issue 3 Pages
348-350
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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A 62 years old woman who had a sputum and cough on the day before visiting our emergency room. Her chief complaint was fever, shivering and difficulty in exercising. She was assessed septic shock because by fever, hypotension, disturbance of consciousness. A Howell-Jolly body was observed in the blood smear, and CT scan showed hypoplastic spleen. She was diagnosed as invasive pneumococcal infection caused by reduced splenic function. If Howell-Jolly body are observed in a blood smear, it suggests that spleen function is decreasing. It is supportive that searching Howell-Jolly body to prove spleen disfunction.
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Kentaro Fukano, Akiyoshi Hagiwara, Wataru Matsuda, Tatsuki Uemura, Aki ...
2019 Volume 39 Issue 3 Pages
351-354
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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Leptospirosis is zoonosis caused by pathogenic bacteria called Leptospires that belong to Spirochaetales. We reported a 74 year-old man who had a sense of malaise and his body color is yellow. He had a conjunctival suffusion and muscle pain which had characteristically the calves. His blood test indicated elevated serum bilirubin, kidney impairment, or thrombopenia. We diagnosed him with Leptospirosis and started antibiotics. After starting antibiotics his blood pressure lowered by Jarisch-Herxheimer reaction, but it was getting better within 24 hours. He was discharged without any sequelae.
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Midori Kayakiri, Ayako Yoshiyuki, Raira Nakamoto, Nao Urushibata, Kiyo ...
2019 Volume 39 Issue 3 Pages
355-358
Published: January 31, 2019
Released on J-STAGE: February 01, 2019
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Patients with multiple myeloma are vulnerable to infection, although cellulitis is rare as complication of multiple myeloma. In our case of a 56-year-old man, refractory cellulitis led us to investigate immunosuppressive factors, and we found that he was suffering from multiple myeloma. As our case, unusual skin lesions suggest comorbid immunosuppressive disease such as malignancy. We need close investigation of complications in patients with atypical skin lesions.
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Kenta Shigeta, Tomohiko Masuno, Junko Kobayashi, Kazuma Sasaki, Takahi ...
2019 Volume 39 Issue 3 Pages
359-362
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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Quick and prompt cannulation is required for Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO), especially ECPR cases. Because of increase number of elderly patients with arteriosclerosis, it is not uncommon to encounter complications associated with cannulation. We report two elderly cases that direct contact of the cannula tip to arterial wall at right angle due to strong arterial meandering caused complications as severe hemolysis and aortic dissection. In elderly patients, it is necessary to place cannula in the right position considering arteriosclerosis and meandering of artery.
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Ryo Fujii, Masaki Ano, Satoru Miyatake
2019 Volume 39 Issue 3 Pages
363-365
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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27-year-old man with a history of epilepsy and no risks of arrhythmias was transported to the emergency department with coma. He developed convulsive seizures in the emergency department and was still in coma. His serum carbamazepine level was 56.9µg/mL so he was hospitalized due to status epilepticus and suspicion of carbamazepine intoxication. On day 4 of hospitalization, he developed ventricular fibrillation (VF) and achieved return of spontaneous circulation after cardiopulmonary resuscitation. Ictal VF was suspected due to the presence of remarkable artifacts in the electrocardiogram monitor before the onset of VF so sudden unexpected death in epilepsy was considered.
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Haruna Nohara, Satoshi Arino, Takeaki Imamura, Takeo Matsuyoshi, Nobuo ...
2019 Volume 39 Issue 3 Pages
366-369
Published: February 08, 2019
Released on J-STAGE: February 07, 2019
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A 49-year-old woman was admitted to the emergency department due to shock, and showed hypotension and acute renal failure due to overdose of amlodipine (535 mg). The patient showed poor response to catecholamines and treatment with intravenous calcium gluconate, glucagon and lipid emulsion therapy. However, treatment with calcium chloride showed immediate increase in blood pressure. Reports suggest that calcium chloride is more effective than calcium gluconate for the treatment of calcium channel blocker poisoning. Therefore, intravenous administration of calcium chloride should be considered as an alternative treatment for patients who showed poor response to calcium gluconate.
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Akihiro Fujita, Kenichi Hondo, Shusuke Mori, Yasuhiro Otomo
2019 Volume 39 Issue 3 Pages
370-372
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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Upon accepting foreigners, medical facilities sometimes face problems such as availability of an interpreter, medical safety, religious differences, lawsuit risks, and uncollectible fees. Japan became the first country in Asia to initiate a third country resettlement program. Refugee support organizations like RHQ and ISSJ are working for refugee issues. We report a case of an uncertified and uninsured refugee troubled with a prolonged hospital stay for 70 days due to difficulty in obtaining the designated activities visa, utilizing free/Low-cost medical services, and having an interpreter. Every hospital should be prepared for cases that an uncertified refugee seeks medical assistance.
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Satoshi Fujie, Kenichi Yoshikawa, Yutaka Seki, Kunihiro Mashiko, Takao ...
2019 Volume 39 Issue 3 Pages
373-375
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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A 70 yeaes old woman who use a steroid long time presented to our emergency department with 7-days history of vomiting and diarrhea. Although fruid resuscitation and antibiotics therapy, she died dramatically in Aeromonas hydrophila infection due to sepsis was diagnosised after culture of the blood and the stool taken on admission yielded Aeromonas hydrophila. Because of this suspectibility of immunecompromised pahients, in examing and treating patients with severe sepsis we need to remember that Aeromonas hydrophila is a potential cause.
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Misa Saito
2019 Volume 39 Issue 3 Pages
376-379
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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Health care workers have thought that it was difficult to care for elderly patients at home. On the other hand, the family have thought that it was possible to care them at home, because they had had some home care experiences before.However, they started to appeal for bewilderment and anxiety about home care, because the care necessity level and the amount had obviously increased than before being hospitalized. The gap between the notion of what health care workers can do and the one of family's is large. It is important that we fill the gap carefully.
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Takanori Ohno, Hiroshi Horiuchi, Kousuke Kasai, Kenichi Hirukawa, Masa ...
2019 Volume 39 Issue 3 Pages
380-383
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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A 61-year-old woman was treated as our emergency room chiefly with a consciousness disorder. It was due to methanol intoxication that passed from 24 hours to 36 hours after the passage of time. The estimated methanol blood concentration was 331.5 mg / dL. Considering the fact that metabolism from methanol to formic acid has already progressed since it had already metabolic acidosis with pH 6.713, intermittent blood purification was attempted to remove blood methanol and formic acid. After completion of hemodialysis, the pH was improved up to 7.623, but pupil dilatation occurred after 2 hours, and brain edema with remarkable psuedoSAH was found when head CT was reexamined. Compared with past cases that followed the same course, it was found that the elapsed time was long, and cases with high methanol concentration at the time of visit appeared to tend to cause cerebral edema after hemodialysis. Causes of cerebral edema may be due to re-expansion of nerve cells due to the accumulation of methanol or its metabolite in nerve cells.
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Yutaro Inoue, Akiyoshi Hagiwara, Takunori Satou, Saho Takaya, Makiko Y ...
2019 Volume 39 Issue 3 Pages
384-386
Published: January 31, 2019
Released on J-STAGE: January 31, 2019
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A 77-year-old man with fever and pain from the right neck to the shoulder was transferred to our hospital by ambulance. He was diagnosed with acute pyelonephritis and treated with a urine stent and antibiotics. However, his neck pain did not improve. MRI of the cervicothoracic spine, ultrasound of the neck, and CT scan of the neck were performed and showed vertebral osteomyelitis and a deep cervical abscess. The abscess was drained, and the antibiotic therapy was continued for 63 days. His subsequent clinical course was uneventful, and he was discharged on day 99.
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Shinsuke Karatsu, Yutaka Kondo, Tadashi Ishihara, Hiroshi Suginaka, Sh ...
2019 Volume 39 Issue 3 Pages
387-390
Published: January 31, 2019
Released on J-STAGE: February 01, 2019
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Over 24-million tourists visit Japan every year and 30% of them are uninsured. Here we report a case, 25-year-old male foreigner and came to our department for dyspnea. He was hospitalized and diagnosed with acute lymphocytic leukemia. Because he didn't want expensive treatment, we did minimum treatments to help his breathing. After discharge, the full amount for his medical bills was paid, successfully. To the tourists who are uninsured, we believe that it is important to work as a team to come up with an inclusive approach where we choose the required treatments while taking the medical expenses into account.
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Shoya Arai, Yuichiro Ishigami, Atsuhiro Ogawa, Seitaro Sugawara, Kenji ...
2019 Volume 39 Issue 3 Pages
391-393
Published: February 15, 2019
Released on J-STAGE: February 15, 2019
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Paravertebral abscess is a rare disease with few case reports. Because the symptoms are nonspecific, the diagnosis is difficult. We experienced a case with paravertebral abscess which presented with ataxic gait and tilted body truck. The paravertebral muscle is composed of three muscles (i.e. the iliocostal muscle, longissimus muscle, spinal muscle) and when one side of the paravertebral muscle contracts, the body truck turns and bends to the side. We thought that the inflammation from the abscess contracts the paravertebral muscle, resulting in the ataxic gait and tilted body truck.
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Moeko Misaki, Junya Tsurukiri, Katsuhiro Nagata, Hidefumi Sano, Hirosh ...
2019 Volume 39 Issue 3 Pages
394-397
Published: February 25, 2019
Released on J-STAGE: February 25, 2019
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Background : We encountered a case of mycoplasma pneumonia (MP) that relapsed and increased in severity after providing standard treatment. Case : A 75-year-old man was admitted to hospital for MP. He was administered standard antibiotic therapy and was discharged home. However, he was readmitted 4 days later in the recurrence of MP. Discussion : Retrospective evaluation revealed several factors that might have induced the relapse. Conclusion : It may be necessary to reconsider the standard treatment for severe MP.
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