Purpose: Three systems for classifying means of attempted suicide are used in research on suicide behaviors: the International Classification of Diseases, Ninth Revision (ICD-9), the ASUKAI classification (relatively dangerous, absolutely dangerous), and the invasiveness classification (non-violent, violent). This study was performed to clarify whether the differences in classification have an impact on the relations between means of attempted suicide and psychiatric disorders.
Subjects and Methods: The study population consisted of 169 cases, transported by ambulance, with five main psychiatric disorders (depression, bipolar disorder, schizophrenia, adjustment disorder, and personality disorder). The relations between means of attempted suicide according to the three classifications and psychiatric disorders were analyzed by correspondence analysis.
Results: Strong relations were found between E953 (hanging, strangulation, and suffocation) and depression, E950 (poisoning by solid or liquid substance) and adjustment disorder by ICD-9 classification. The code E957 (jumping from a high place) was weakly related to schizophrenia. Although the relatively dangerous group of the ASUKAI classification was not related to psychiatric disorders, the absolutely dangerous group was strongly related to schizophrenia. The non-violent and violent groups according to the invasiveness classification were strongly related to bipolar disorder and schizophrenia, respectively.
Conclusion: The relations between means of attempted suicide and psychiatric disorders varied markedly between classifications.

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Objectives: The US-style emergency medicine (ER-style) has been considered to provide a suitable educational environment in which to complete the emergency medicine training curriculum under the new compulsory post graduate training system. However, the present status of the training for post graduates in accredited training institutions for Fellowship of the Japanese Association for Acute Medicine (JAAM) remains unclarified. The objectives were to estimate the percentage of the institute providing the ER-style training and to clarify the characteristics of those.
Methods and Results: We reanalyzed the Questionnaire survey conducted by the ER Committee of the JAAM to the institutions who put forward candidates for JAAM Fellowship in 2007. Of the 408 institutes, 269 replied and those answers were analyzed. Of those, 70% provided ER-style training. Factor analysis for categorical data extracted two principal factors to characterize the ER-style training institutes. The first factor was regarded as preparation of resources for severe emergency patients, and the second factor was regarded as preparation of resources for emergency patient volume. The institutes providing the ER-style training were characterized as the hospitals that were able to accept many emergency patients but had limited resources for critical patients.
Conclusions: Of the accredited training institutions for Fellowship of the JAAM, 70% provided ER-style training for post graduates. Those institutions had resources for large volume of emergency patients, but their resources had limitations to provide critical care.

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We describe a case in which transcatheter arterial embolization (TAE) for a ruptured middle colic artery aneurysm (MCA-A) was successfully performed. A 51-year-old woman with a history of alcoholic liver dysfunction was transferred to our hospital with severe abdominal pain, diarrhea, and vomiting that had developed one week before admission. On arrival, the patient was pale, and showed significant peripheral coldness, tachycardia, and abdominal distension. The white blood cell count was 11,700/mm³ and the hematocrit value was 15.1%. Abdominal computed tomography (CT) with contrast enhancement revealed an aneurysm in the MCA and marked fluid collection. With a diagnosis of ruptured MCA-A, TAE was emergently performed. Arteriography of the superior mesenteric artery demonstrated an aneurysm of 8 mm in diameter in the MCA. TAE was successfully performed. Persistent fever occurred from the 18th hospital day, and a remaining intramesocolic hematoma detected on follow-up CT was thought to be its cause. Drainage was performed on the 23rd hospital day. The patient was subsequently discharged on the 39th hospital day. In conclusion, detailed CT examination is helpful for a diagnosis of MCA-A, and TAE is effective in the treatment of a ruptured MCA-A.

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We present a case of direct pituitary gland injury accompanied by progressive carotid injury in transorbital penetrating trauma. A 53-year- old woman sustained a penetrating injury to her left eye because of a twig and was transferred to our hospital. There was visual loss in the left eye and mild disturbance of consciousness. Initial computed tomography revealed that the foreign body was embedded in the left orbit and penetrated till the left anterior clinoid process. Carotid angiography (CAG) revealed luminal irregularity of the left internal carotid artery (ICA) in the cavernous portion. The foreign body was surgically removed, and transient diabetes insipidus developed during the operation. Magnetic resonance imaging revealed a low-signal-intensity lesion in the left side of the pituitary gland. Left CAG on day 7 revealed aneurysm formation at the site of the luminal irregularity, which was inferred to be an impending rupture. Left ICA, including the aneurysm, was successfully treated by coil embolization on day 24. The patient was discharged on day 35, with complete blindness of the left eye, but no other problems. Complications of penetrating head trauma are sometimes unexpected, and careful and repeated examinations are strongly recommended for proper evaluation and treatment.

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An 80-year-old man was treated at another hospital for sudden abdominal pain. Plain computed tomography (CT) suggested the presence of an upper abdominal retroperitoneal hematoma. During examination, abdominal distention and hypotension between 70 and 79 mmHg occurred, then the patient fell into shock. He was emergently referred to our hospital. Immediately, abdominal contrast-enhanced CT was performed, revealing a ruptured pancreaticoduodenal artery aneurysm, and selected interventional radiology (IVR) was performed. A 1-cm aneurysm was identified in the posteroinferior pancreaticoduodenal artery, and arterial embolization was performed by injecting N-butyl-2-cyanoacrylate (Histoacryl) and fatty acid ethyl esters of iodized poppy seed oil (Lipiodol) into the first jejunal artery, through which the catheter tip had been successfully advanced. On the sixth day after arterial embolization, bleeding occurred from multiple ulcers that had presumably formed due to bowel ischemia. The ulcers penetrated the hematoma, but subsided after conservative treatment. The number of patients who undergo emergency IVR for such hemorrhagic lesions has increased, which highlights the importance of thoroughly understanding their diagnosis, treatment, and complications. In addition, because advances in IVR technology now allow access to aneurysms of relatively peripheral arteries, a comprehensive knowledge of embolic materials is critical.

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The complication of a splenic abscess in infective endocarditis has been reported to occur in from 0.8 to 4.8% and this occurrence is rare. We herein report a case of multiple splenic abscesses complicating infective endocarditis. A 53-year-old female was admitted to our hospital due to a thalamic hemorrhage that was incurred in a traffic accident. On day 11, she felt significant left hypochondrial pain which appeared to be due to a splenic infarction. Subsequently, she suffered from hyper pyrexia for a few consecutive days. As a result of further examinations, she was diagnosed to have multiple splenic abscesses accompanied by infective endocarditis. Antibiotic treatment was initiated, but the low grade fever and inflammatory reaction were prolonged, and therefore we performed a splenectomy on day 48. Thereafter, the low grade fever was alleviated, and the inflammatory reaction subsided, thus resulting in a transfer to another hospital on day 99. We recommend that a splenectomy be performed at the early stage, if antibiotic therapy is not effective for the treatment of multiple splenic abscesses accompanied by infective endocarditis. In addition, if surgery is necessary for infective endocarditis, then it is important to perform a splenectomy for such patients.

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