日本救急医学会雑誌
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
3 巻 , 2 号
選択された号の論文の10件中1~10を表示しています
  • 菊野 隆明, 相馬 一亥, 新藤 正輝, 土屋 敦, 北原 孝雄, 高崎 光紀, 大和田 隆
    1992 年 3 巻 2 号 p. 57-62
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    脂肪塞栓症候群(以下FESと略す)の三大徴候は呼吸不全・意識障害・皮下点状出血であるが,これらがすべて認められることは少なく,このために確定診断は困難なことが多い。今回,われわれはFES診断の補助検査として気管支肺胞洗浄液(以下BALFと略す)検査の有用性について検討した。対象は外傷後,一定時間経過後,意識障害を来し,頭部CT異常なく,呼吸不全を来した5例(三大徴候あり2例,他の3例は点状出血なし;FES群),および外傷による骨折に対して髄内釘挿入など観血的骨接合術を行った5例(コントロール群)である。気管支肺胞洗浄液について総細胞数,アルブミン濃度,細胞分画,脂肪滴貪食細胞比率について測定した。またFES群のうち2例で経時的BALFの検討を行った。FES群ではBALF中のアルブミン濃度は341.4μg/ml,多核白血球(以下PMNと略す)比率は19.3%,脂肪滴貪食細胞比率は32.0%であった。FES 2症例のBALFの経時的検討では細胞成分の塗抹標本で,急性期には多数の空胞化マクロファージが目だち,経過とともに空胞化を認めない小型の肺胞マクロファージの増加が認められた。また総細胞数の増加を認めた。この空胞化マクロファージはPMN比率が高い症例ほど顕著であった。BALFはFESの補助診断法として臨床的有用性が高いと考えられた。
  • 小瀧 正年, 升田 好樹, 七戸 康夫, 表 哲夫, 高橋 弘毅, 柳内 統, 並木 昭義
    1992 年 3 巻 2 号 p. 63-67
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    A 60-year-old woman suddenly became nearly asphyxiated. She was intubated orally, but it was too difficult to ventilate her manually. Bronchofibroscopy revealed airway obstruction by foreign matter, but it was too difficult to remove with forceps. Emergency tracheostomy was then performed, and after removal with forceps, the patient recovered dramatically. The matter was determined to consist of pseudomembranes histologically, and Staphylococcus aureus was detected in a bronchial biopsy specimen. Based on these findings a diagnosis of necrotizing tracheobronchitis (NTB) was made. NTB is not a very common disease, especially in adults. Sloughing of pseudomembranes may occur in NTB, however, and cause paroxysmal dyspnea or asphyxia. In such cases, not only should intubation be attempted but bronchofibroscopy and, if necessary, immediate tracheostomy.
  • 藤岡 政行, 奥地 一夫, 中嶋 民夫, 阪井 利幸, 田伏 久之, 宮本 誠司, 榊 寿右
    1992 年 3 巻 2 号 p. 68-72
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    We present the case of a 38-year-old female with subarachnoid hemorrhage due to a minor leak from an anterior communicating aneurysm. CT scans of the brain failed to detect the hemorrhage, and the patient was treated for menigitis for two weeks. At the onset of minor leaks, the patient developed headaches associated with nausea and loss of consciousness which lasted for a few minutes. A general physician gave the patient antibiotics and antiepileptic agents, after diagnosing meningitits, because the CT scans failed to reveal any evidence of hemorrhage. The patient's clinical symptoms gradually improved, but similar episodes occurred on the 11th and 20th day afterthe first, and she was referred to our clinic and admitted for precise clinical evaluation of her clinical symptoms. We also were unable to find any evidence of hemorrhage on CT scans. Since the patient's history strongly suggested subarachnoid hemorrhage, we performed a lumbar puncture and obtained bloody cerebrospinal fluid, confirming the diagnosis of subarachnoid hemorrhage. Cerebral angiography demonstrated an anterior communicating aneurysm, and on the same day, the neck of the aneurysm was successfully clipped. The patient's postoperative course was uneventful, and she was discharged on the 24th postoperative day without sequelae. Minor leaks from cerebral aneurysms reportedly occur relatively often within several weeks prior to amajor aneurysmal rupture. The detection of minor leaks is strongly correlated with an excellent prognosis, if minor leaks are found and treated before a major rupture. CT scanning is not always effective in detecting minor leaks. Lumbar puncture, however, is an important method of detecting them.
  • 三輪 博久, 前川 貢一, 松浦 多賀雄, 村山 章裕, 佐伯 典之, 篠崎 伸明, 渡部 和巨
    1992 年 3 巻 2 号 p. 73-77
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    Four cases of spontaneous pneumomediastinum (SP) are reported. Severe cough induced SP in the first case, violent vomiting in the second case, jogging with underlying SLE and pulmonary fibrosis in the third case, and a back contusion with closed vocal cords in the fourth case. In second case, spontaneous rupture of the esophagus (Boerhaave's syndrome) was suspected and surgery was performed, but the findings were negative. Gastrografin swallow is essential to rule out Boerhaave's syndrome. Fiberoptic bronchoscopy can be recommended to rule out a traumatic respiratory tract injury. SP is usually a benign, self-limited disease of young men and parturient women and frequently occurs with no apparent precipitating cause. Supportive care is usually effective.
  • 足立 和己, 川上 勝弘, 千代 孝夫, 田中 孝也
    1992 年 3 巻 2 号 p. 78-82
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    A 20-year-old man presented with severe exophthalmos on the left as a result of a traffic accident. X-ray films revealed that foreign bodies, suspected of being parts of the windshield, had extended into the orbital apex. An intracranial lesion, however, could not be excluded. Craniotomy (fronto-zygomatic approach) was performed to remove the orbital foreign bodies, while preserving the optic nerve, and to identify intracranial foreign bodies in a wide surgical field. No dural lacerations or intracranial foreign bodies were observed during surgery. Total removal of the orbital foreign bodies was accomplished via the left fronto-zygomatic approach. Postoperatively, there was marked improvement in the severe exophthalmos, and visual acuity was restored. This type of surgical procedure is a good approach for removing deep orbital foreign bodies and checking for the presence of possible intracranial foreign bodies.
  • 千保 純一郎, 浜崎 正行, 堀越 淳, 大石 知実, 内 孝, 斉藤 徹, 上嶋 権兵衛
    1992 年 3 巻 2 号 p. 83-87
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    A 39-year-old woman was admitted with complaints of fever and severe dyspnea. Chest X-ray revealed bilateral widespread opacity with glass shadow. In addition arterial blood gas analysis revealed severe hypoxemia (PaO2 44.1mmHg, 100% mask). On the day of admission, she was intubated and ventilated mechanically with FiO2 1.0, PEEP 10cm H2O. Subsequently, treatment with intravenous minocycline (200mg/day) was started. The abnormal chest X-ray findings and hypoxemia improved by day 5. On the 12th day of her hospital stay, she was successfully weaned from the ventilator. Analysis of complement fixation antibodies against Chlamydia showed a significant rise, 1:128. The titer of IgM antibodies to Chlamydia psittaci by the microplate immunofluorescent antibody technique was 20 (normal:10>). This disease was considered to be acute pneumonia due to fulminant psittacosis causing acute respiratory failure. Psittacosis should always be borne in mind as a possible cause of fulminant pneumonia with acute respiratory failure, and such a situation can be handled successfully if emergency care including mechanical ventilation is available.
  • 広瀬 保夫, 三井田 努, 本多 拓, 西村 喜宏, 丸山 正則, 木村 秀樹, 吉田 和清
    1992 年 3 巻 2 号 p. 88-91
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
    A case of glufosinate poisoning is reported. A shizophrenic 39-year-old woman took 55 g of glufosinate to commit suicide. Seven hours later, she was found to be asymptomatic at a local hospial. Twenty-three hours later she developed generalized convulsive movements with consciousness disturbance and was transferred to our hospital. Since her consciousness and respiration were rapidly deteriorating, she required mechanical ventilation. Glufosinate poisoning was proven by urine qualitative analysis using thin-layer chromatography. She was treated with forced diuresis and direct hemoperfusion for 3 days. Four days later, urine qualitative analysis failed to reveal any glufosinate and she was smoothly weaned from mechanical ventilation. The patient was discharged without any sequelae after a 12-day hospitalization. It has been documented in animal experiments that the central nervous system is a major target of acute glufosinate toxicity. BASTATM herbicide contains 18.5% ammonium glufosinate and a surface active agent. A previously described case of BASTATM poisoning showed decreased systemic vascular resistance and hypovolemic shock caused by the surface-active agent. It seems important to give adequate attention to the toxicitiy of both glufosinate and the surface-active agent in cases of BASTATM poisoning.
  • 遠藤 重厚, 稲田 捷也, 山下 尚彦, 星 秀逸, 吉田 昌男, M. Ceska
    1992 年 3 巻 2 号 p. 92
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
  • 1992 年 3 巻 2 号 p. 93-97
    発行日: 1992/04/15
    公開日: 2009/03/27
    ジャーナル フリー
  • 1992 年 3 巻 2 号 p. 115
    発行日: 1992年
    公開日: 2009/03/27
    ジャーナル フリー
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