日本救急医学会雑誌
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
11 巻, 5 号
選択された号の論文の9件中1~9を表示しています
  • 笹野 千英子, 佐野 宏明, 花木 芳洋, 神谷 春雄, 堀田 壽郎, 大野 三良, 城所 仁
    2000 年 11 巻 5 号 p. 207-213
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
    急性大動脈解離は致死的な合併症を起こしやすく予後不良な疾患である。その治療の向上には的確な早期診断が不可欠と考えられる。われわれは,名古屋第一赤十字病院における急性大動脈解離症例について検討した。対象と方法;1994年1月から1998年12月に急性大動脈解離と診断され名古屋第一赤十字病院に入院した105症例のうち,救急外来に直接来院受診,または急性大動脈解離と診断されずに紹介受診した51症例である。診断に要した時間を1時間未満のI群,1時間以上4時間未満のII群,4時間以上のIII群に分け解析した。結果;男性31症例,女性20症例,年齢は28~82歳(平均69歳),Stanford A型が23症例,B型が28症例であった。I群は16症例,II群は21症例,III群は14症例であった。入院時の身体所見,検査所見は3群間に有意差は認められなかった。胸背部痛が認められたのはI群が16症例,II群が17症例,III群が5症例で,3群間に有意差が認められた。III群の症例の多くは非特異的症状を訴えていたために診断に時間を要した。III群の症例の専門以外の医師により診断された13症例のうち,外来担当医師間の連絡や専門医師への連絡が不十分であった症例が6症例あった。III群の症例のうち死亡症例は2例で,診断が遅れたために死亡した症例は1例のみであった。考察;I群の症例は,全例が典型的な自覚症状を訴え,大動脈解離と臨床診断しCTにより確定された。II群の症例は,専門医師が早期に診療した症例は少なかった。他疾患の除外の後,造影CTにより確定された。III群の症例は症状が非特異的で,診断が困難であった。結語;急性大動脈解離の救命率向上には,救急外来担当医師が急性大動脈解離と臨床的に診断し,確定診断のために適切な検査を指示する必要がある。専門医師が受診早期から参加できるようなシステム構築も不可欠であると考えられる。
  • 溝端 康光, 横田 順一朗, 石田 建, 東平 日出夫
    2000 年 11 巻 5 号 p. 214-218
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
    We present a case of puffer fish poisoning that developed marked changes in hemodynamic status. A 42-year-old man recognized numbness in his fingers and lips 3 hours after tasting pieces of puffer fish liver, and was admitted to our emergency center with dyspnea. Since spontaneous breathing weakened after admission, mechanical ventilation was started. One hour after admission, his blood pressure gradually decreased to 60mmHg with a pulse rate of 60/min. Rapid infusion and dopamin administration successfully elevated and stabilized his hemodynamics. However, his blood pressure increased to 235mmHg accompanied with remarkable sweating 6 hours later. Although dopamin was discontinued, his blood pressure re-elevated and required nicardipine to decrease and stabilize it. Thirty-two hours after admission, spontaneous breathing resumed and he was extubated. Analyses of his hemodynamics using a Swan-Ganz catheter revealed that the cardiac index decreased to 1.9l/min/m2 with a normal systemic vascular resistance (SVRI 1, 780dynes/sec/cm-5/m2) when his blood pressure decreased. On the other hand, elevation of blood pressure was accompanied with increases of both cardiac index and vascular resistance. The extreme changes in hemodynamics in this case were thought to be caused by the time course of impairment and recovery of the peripheral sympathetic nerves induced by the tetrodotoxin in puffer fish.
  • 菅原 孝行, 関 博文, 和田 司, 須貝 和幸, 藤村 幹
    2000 年 11 巻 5 号 p. 219-224
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
    The authors report a case of dural arteriovenous fistula in the anterior fossa that presented with impending herniation due to right frontal intracerebral and subdural hematoma. The patient, a 67-year-old male, suffered from a sudden headache and lapsed into a coma. CT scan, 2 hours after onset, showed a right frontal intracerebral, thick subdural hematoma. He was comatose, and his right pupil was fully dilated with no light reflex. Under local anesthesia and drip infusion of mannitol, emergent one burr hole drainage for subdural hematoma was performed as soon as possible after admission. This emergent procedure dissolved the impending herniation. Thereafter, under general anesthesia, intraoperative digital subtraction angiography was performed using a portable digital subtraction angiography (DSA) system. A dural arteriorvenous fistula in the anterior fossa was disclosed by DSA. Removal of the subdural hematoma and varix of the dural arteriovenous fistula was completed in one session. About seven weeks later, he was able to return to home without neurological deficit. Emergent one burr hole craniotomy was useful for avoiding impending cerebral herniation due to acute subdural hematoma. Intra-operative DSA was also useful for diagnosing an unknown cause of hemorrhage before radical removal of the subdural hematoma.
  • 軽度低体温療法による治療経験
    飯田 幸治, 栗栖 薫, 有田 和徳, 右田 圭介, 大庭 信二, 岡林 清司, 大谷 美奈子
    2000 年 11 巻 5 号 p. 225-230
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
    The case of a 20-year-old woman presenting with delayed, potentially fatal intracranial hypertension as a result of a head injury is reported. On admission, the patient had a Glasgow Coma Scale (GCS) score of 10. A brain CT scan showed an epidural hematoma in the left temporal region and a mild contusion of the bilateral frontal lobes. Two days after her injury, the patient's consciousness level suddenly deteriorated (GCS 4). Transcranial Doppler (TCD) examination disclosed a marked reduction (18cm/sec) in the velocity of the blood flow through the middle cerebral artery and a significant increase (2.11) in the pulsatility index. A second brain CT scan showed diffuse brain swelling but no changes in the size of the hematoma. The intracranial pressure (ICP) was 58mmHg. Although the cause of the acute brain swelling was unknown, moderate hypothermia therapy was initiated. The ICP was difficult to control during the hypothermia treatment but was maintained at above 20mmHg for most of the time. Hypothermia treatment was continued for 18 days before ICP control was regained. The patient was discharged with mild memory disturbances 4 months after admission. A literature, review has suggested that the TCD and ICP values of this patient could have been fatal. Thus, moderate hypothermia treatment may improve the outcome of potentially fatal intracranial hypertension.
  • 気管支喘息2症例による検討
    鶴田 良介, 井上 健, 金田 浩太郎, 金子 唯, 佐藤 由美子, 定光 大海, 前川 剛志
    2000 年 11 巻 5 号 p. 231-236
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
    In asthma patients using a metered dose inhaler (MDI) of a beta-2 agonist immediately prior to death, the possible involvement of beta-2 agonist side-effects in cardiopulmonary arrest remain unclear. Two cases of nearfatal asthma were transfered to our hospital. In the first case, a 20-year-old female was being treated with a tulobuterol MDI and suffered an episode of sudden-onset asthma. In the second case, a 16-year-old male was being treated with a procaterol MDI and suffered an episode of slow-onset asthma. After resuscitation, the adequately oxyganated patients were treated with a procaterol MDI using a dose large enough to reduce airway pressure and PaCO2. In the first case, normal breathing was quickly resumed. In the second case, however, five days of procaterol MDI use and intravenous steroids were required before normal breathing was resumed. The decrease in arterial potassium ions (less than 3mEq/l) as a result of frequent procaterol inhalation produced no clinically significant arrhythmias in either case. In conclusion, the patients did not experience any adverse cardiac events while adequately oxygenated despite the frequent inhalation of procaterol.
  • 紙尾 均, 間藤 卓, 志賀 元, 堤 晴彦, 若林 寿雄, 大村 昌男
    2000 年 11 巻 5 号 p. 237-242
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
    We report the case of a 28 year-old man with multiple trauma who had persistently high serum levels of (1→3)-β-D-glucan (7, 400pg/ml) even after the state of systemic inflammatory response syndrome (SIRS) subsided. This finding suggests that the serum level of (1→3)-β-D-glucan dose not always reflect the state of illness nor serve as a guide for treatment. This case did not show any findings of intestinal fungal infection, but the state of SIRS subsided after enteral medication of amphotericin B. Several oral medications and enteral diets were found to contain a significant amount of (1→3)-β-D-glucan, so we hypothesized that fungi or (1→3)-β-D-glucan had translocated from the intestines to the blood.
  • pulse dye densitometryによる検討
    水島 靖明, 東平 日出夫, 寺戸 通久, 溝端 康光, 横田 順一朗
    2000 年 11 巻 5 号 p. 243-244
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
  • 宮本 哲也, 松浦 泰彦, 加藤 洋二, 安田 雄紀, 鎌田 浩和, 森 功
    2000 年 11 巻 5 号 p. 245-246
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
  • 2000 年 11 巻 5 号 p. 247-249
    発行日: 2000/05/15
    公開日: 2009/03/27
    ジャーナル フリー
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