日本救急医学会雑誌
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
9 巻 , 10 号
選択された号の論文の6件中1~6を表示しています
  • 森本 文雄, 吉岡 敏治, 織田 順, 田中 裕, 松岡 哲也, 平出 敦, 嶋津 岳士
    1998 年 9 巻 10 号 p. 539-544
    発行日: 1998/10/15
    公開日: 2009/03/27
    ジャーナル フリー
    目的:クラッシュ症候群におけるカルシウム動態を明らかにする。対象と方法:阪神・淡路大震災に係わる初期救急医療実態調査によって得られたクラッシュ症候群のうち,受傷3日以内に血清カルシウム値が測定された66例を対象に血液浄化施行の有無別に最低血清カルシウム値を検討した。また最低血清カルシウム値と最高血清CPK値との関係を41例で検討した。自験例(大阪大学医学部附属病院入院例)においては,血清カルシウム値と血清リン値の経日的変化を検討し,うち7例については血清カルシウム値と同時にintact PTHを測定した。結果:対象66例の最低血清カルシウム値は,7.24±1.37mg/dl(参考値8.4-10.0mg/dl)であった。血液浄化施行例では平均6.37±1.37mg/dl,血液浄化非施行例では平均7.86±1.06mg/dと統計学的に有意な差を認めた(p<0.01)。最高血清CPK値と最低血清カルシウム値は逆の相関を示した(y=8.58-2.04×10-5x, r=0.81)。自験例の低カルシウム血症は受傷後8日から50日間持続した。腎不全合併の5例では高リン血症を,腎機能良好な3例では低リン血症を示したが,低カルシウム血症の程度やその持続期間に差はなかった。intact PTH濃度は血清カルシウム値の低下とともに著しく高値となった。結語:クラッシュ症候群では,腎不全合併の有無にかかわらず,障害を受けた筋肉量に応じて低カルシウム血症を来すと考えられた。
  • 小林 正直, 冨士原 彰, 森田 大, 浜口 伊久夫, 秋元 寛
    1998 年 9 巻 10 号 p. 545-550
    発行日: 1998/10/15
    公開日: 2009/03/27
    ジャーナル フリー
    We report a case of Waterhouse-Friderichsen syndrome with excessive hypercytokinemia in a previously healthy 59-year-old man. The patient complained of a 20 hour history of fever and multiple pain. He was in shock on arrival and diffuse petechiae were observed on his trunk. The laboratory data evaluated metabolic acidosis (BE-16.9mmol/l), leukopenia (WBC 3, 900/μl) with a shift to the lef, obvious thrombocytopenia (1.8×104/μl), hypoglycemia (49mg/dl), and disseminated intravascular coagulation (DIC). Abdominal computerized tomography (CT) scan showed bilateral adrenal swelling and irregular shape of left gland. Immediately he developed adult respiratory distress syndrome (ARDS), then died 17.5 hours after arrival without recovery from shock. On microbiological investigation, group 12 (Danish classification) of penicillin sensitive Streptococcus pneumniae was detected in his blood. The serum data demonstrated excessive hypercytokinemia (interleukin [IL]-1β 1, 010pg/ml, IL-6 1.03×106pg/ml). An autopsy revealed massive hemorrhagic necrosis and fibrinous thrombosis in a half of bilateral adrenal cortex and DIC in multiple organs, while the spleen was intact. Neither focus of original infection nor what aggravated the infection was clear.
  • 傳田 定平, 黒川 智, 木下 秀則, 国分 誠一郎, 肥田 誠治, 福田 悟, 下地 恒毅
    1998 年 9 巻 10 号 p. 551-555
    発行日: 1998/10/15
    公開日: 2009/03/27
    ジャーナル フリー
    Swan-Ganz (S-G) catheters were introduced into pulmonary artery (PA) with the aid of multiplane transesophageal echocardiography (TEE) in 15 patients undergoing elective open heart surgeries. This method promptly allowed us to find the causes for the difficulties of the catheters in advancing through the tricuspid valve into the right ventricle and for the abnormalities in pressure waveform measured by the catheter. We could easily and safely place the S-G catheter in the PA by TEE guidance, indicating that TEE monitoring might be useful for placement of the S-G catheter in PA paticularly during operation and emergency situation.
  • 坂野 勉, 吉岡 伴樹, 木村 眞一, 田中 礼一郎, 松山 重成, 渋谷 正徳
    1998 年 9 巻 10 号 p. 556-560
    発行日: 1998/10/15
    公開日: 2009/03/27
    ジャーナル フリー
    Three cases of necrotizing fasciitis are presented. In all cases aggressive antibiotic therapy were performed soon after admission, and fever up, leucocytosis and elevation of CRP improved. However, a follow-up CT scan taken several days after admission revealed severe aggravation of lesions; surgical treatment was performed immediately. The amount of gas production was small compared with the area of necrosis in two cases. It was suggested during the follow-up, that X-ray's nor inflammatory findings such as body temperature, leucocyte and CRP do not necessarily reflect aggravation of the lesions, and that frequent CT scan is essential.
  • 柳川 洋一, 清住 哲郎, 岡本 健, 岡田 芳明
    1998 年 9 巻 10 号 p. 561-565
    発行日: 1998/10/15
    公開日: 2009/03/27
    ジャーナル フリー
    A 57-year-old man developed unconsciousness, miosis and tetraplegia with fasciculation due to acute organophosphate (OP) intoxication. His symptoms improved and he revived with a transient alpha coma, rigidity, mirror-movement-like reaction and tetraplegia dominating in the lower extremities, but these signs finally subsided. As acetylcholinesterase was thought to be rich in the medial frontal lobe, basal ganglia and brainstem, the disturbance of these areas due to OP may lead to the neurological focal signs mentioned above. Thus we need pay attention to these focal signs in the case of severe acute OP intoxication.
  • 小山 完二, 幸田 幸直, 阿久沢 尚士, 小山 恭子, 後藤 勝年
    1998 年 9 巻 10 号 p. 566-567
    発行日: 1998/10/15
    公開日: 2009/03/27
    ジャーナル フリー
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