Nihon Kyukyu Igakukai Zasshi
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
Volume 10, Issue 2
Displaying 1-8 of 8 articles from this issue
  • Intersection with Acute Medicine
    Kouichi Hiraiwa
    1999 Volume 10 Issue 2 Pages 67-80
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Most trauma patients treated in emergency hospitals are involved in several insurances. From the view point of causation, the Japanese compensation law for damage due to injury considers that probability is sufficient for a civil decision. According to the above concept, the modern trend of civil suit for compensation of damage seems to be based on proportional judgment of legal causation. In suicide cases, the courts have judged that sequela after a traffic accident contributed to suicide to a certain degree. In addition, in some trials of worker's accident insurance, the courts have judged that the rupture of cerebral aneurysm may probably be due to excessive work. As for the issue of medical causation, trauma may cause sudden death due to complication such as pulmonary thromboembolism at a high frequency, or injury to the neck or head may cause complications of traumatic cerebrovascular diseases, such as cervical artery occlusion, cerebral aneurysm or arteriovenous fistula at a low frequency. Complications following variable latent periods may lead to misdiagnosis of spontaneous diseases, especially in cases of aged victims, and may result in neither a determination of cause and effect relationship nor of compensation for damages. The author discusses the cause and effect relationship in the legal and medical field from the view point of Compensation Science. Much attention should be paid to alleged causation by the doctors of acute medicine.
    Download PDF (2428K)
  • An Estimate from the Cases with Successful Resuscitation
    Hiroshi Morita, Isao Nishihara, Masahiro Ohno, Hitoshi Fukumoto, Akira ...
    1999 Volume 10 Issue 2 Pages 81-90
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Purpose: To clarify the clinical characteristics of patients with out-of-hospital cardiopulmonary arrest (OHCPA) due to acute myocardial infarction (AMI). Methods: From November 1985 to August 1996, 257 consecutive patients were successfully resuscitated from OHCPA of non-traumatic cause. Among them, forty seven patients (18.3%) were found to have AMI and subject to this study (CPA group). Six hundred and fifty one patients were admitted alive in the same period with the diagnosis of AMI within 24 hours after the onset of symptoms and served as control (nonCPA group). Results: The time of onset of AMI in the CPA group had a circadian variation with peak incidence between 10 to 12AM and 8 to 12PM. In 72% of the CPA group, sudden cardiac arrest occurred at home. While 71% of the CPA group was admitted by ambulance within one hour after the onset of AMI, in the rest of patients (29%) the emergency call was delayed more than one hour after the onset of AMI. The electrocardiogram on arrival showed ventricular fibrillation (Vf) in 40%, electromechanical dissociation in 21% and asystole in 38%. In comparison with the nonCPA group, the rate of acute anteroseptal MI was significantly greater in the CPA group (72% vs 38%, p=0.016), so were the rates of old MI (32% vs 12%, p=0.0002) and recent anginal episode (53% vs 29%, p=0.0003). In the CPA group 64% of cases had been under medical care for ischemic heart disease. The rate of smoking history in the CPA group was significantly lower than in the nonCPA group (40% vs 59%, p=0.01). Chest radiograph on arrival revealed pulmonary congestion in 17% of the CPA group and in 6.5% of the nonCPA group (p=0.015). In 13 cases studied by coronary angiogram, the infarct related coronary arteries were occluded totally at their proximal portion in all cases. Two cases were studied by autopsy. In reviewing the coronary arteries of 20 cases, including 5 other cases in whom coronary angiograms were studied at other institutions before the episode of CPA, 50% of the cases were found to have multivessel disease and 25% had left main trunk lesions in the coronary arteries. Four out of 6 patients who received bystander CPR discharged home (66%), while only 3 out of 41 patients (7%) who could not receive bystander CPR did so (p=0.006). Vf on hospital arrival was significantly related to a favorable survival rate (60% vs 26%, p=0.049). Conclusion: Sudden cardiac arrest was frequently observed in patients with anteroseptal AMI who had histories of MI, recent anginal episode, multivessel lesions or left main trunk lesions in their coronary vessels. The underlying cause of cardiac arrest seemed to be cardiac failure in 17% of the cases. Bystander CPR or Vf on arrival seemed to befavorable outcome factors.
    Download PDF (1375K)
  • Toshiaki Iba, Kunihiko Nagakari, Kengo Onodera, Akio Kidokoro, Yoichi ...
    1999 Volume 10 Issue 2 Pages 91-97
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Antithrombin III (AT-III) supplement in severe sepsis has been thought to modulate not only coagulopathic function but also to regulate cytokine production or endothelial function. The purpose of this study is to reveal the effects of AT-III on cytokine production. [Material and methods] Wistar rats received either 250U/kg (250 group) or 500U/kg (500 group) of AT-III from a central venous catheter, while, the control group received saline alone. Thirty minutes later, 5.0mg/kg endotoxin was continuously infused for 3hrs. Blood samples were collected at 0, 3 and 6 hrs after endotoxin infusion and serum levels of rat tumor necrosis factor α (TNF), interleukin 4 and cytokine-induced neutrophil chemoattractant (CINC) were measured by ELISA. AT-III activity, fibrinogen, AST, ALT, platelet and WBC counts were examined at 6 hrs. [Results and discussion] AT-III activity was 120% in the 250 group and 170% in the 500 group. Depletion of platelet count and fibrinogen was prevented in the 500 group (p<0.05), which showed a so-called “supranormal level” of AT-III. Increases of AST and ALT were suppressed in both groups (p<0.05) Although TNF levels in the 500 group at 0 hrs was approximately half of that in the 250 group, the difference was not significant. No significant difference was seen in interleukin 4 nor CINC at any time point in the three groups. In conclusion, the organ protective effects of AT-III is not expressed by regulation of cytokine production, but might be expressed through coagulation control or endothelial regulation in the present endotoxemic rat.
    Download PDF (894K)
  • The Machanism of Breaking Stress on the Liver
    Hidehisa Iwamoto, Shuji Seki, Kaoru Seno, Kouhei Akagi, Tsuneyuki Itan ...
    1999 Volume 10 Issue 2 Pages 98-103
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Breaking stresses were measured to investigate blunt trauma to the hepatic tissues by a 3-point seat-belt during car crash. The minimum deceleration and velocity were determined from the breaking stresses on the liver and from the internal force on the contact area against the liver and thoracoabdominal wall (the body wall). The body cushioning effect was estimated from the breaking stresses and the impact transmitted to the body wall from the seat-belt. The breaking stresses were determined in the livers of 5 swine with and without its visceral peritoneum by means of a rheometer. The contact wall area covering the liver was measured by cross-sectional CT scans and was positioned from its left end at mid-line to a point of 45 degrees to the left. The contact area with the seat-belt and the body wall also was measured to calculate the impact force from the seat-belt on an occupant seated on the left front seat. The breaking stresses on the liver were 4.7±0.3kgf/cm2 with the peritoneum, and 3.5±0.2kgf/cm2 without the peritoneum. In conclusion, the minimum deceleration and velocity for the 45-degree area were 59±11g and 84-100km/h. Furthermore, the body cushioning effect was estimated at 25-32kgf/cm2.
    Download PDF (875K)
  • Takashi Mato, Hitoshi Kamio, Masami Omori, Toshio Wakabayashi, Masao O ...
    1999 Volume 10 Issue 2 Pages 104-105
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Download PDF (251K)
  • Masaru Sakurai, Hideharu Tanaka, Hiroharu Matsuda, Shuji Shimazaki
    1999 Volume 10 Issue 2 Pages 106-107
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Download PDF (251K)
  • 1999 Volume 10 Issue 2 Pages 108-109
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Download PDF (182K)
  • 1999 Volume 10 Issue 2 Pages 113-114
    Published: February 15, 1999
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Download PDF (248K)
feedback
Top