{"title":"ECMO脱血カニューレが上行腰静脈経由で下大静脈に留置されたが静脈造影下の抜去に成功した1例(A case of successful removal of an ECMO drainage cannula placed into the inferior vena cava via the ascending lumbar vein under venography)","authors":"本田 博之, 栗田 秀一郎, 松井 亨, 大橋 さとみ, 平田 哲大, 堀井 陽祐, 西山 慶","doi":"10.1002/jja2.12859","DOIUrl":"https://doi.org/10.1002/jja2.12859","url":null,"abstract":" 体外式膜型人工肺（extracorporeal membrane oxygenation: ECMO）施行時に超音波検査で脱血カニューレ先端が下大静脈–右房接合部に存在することを確認したにもかかわらず上行腰静脈迷入が判明した症例を経験した。症例は70歳代の男性。呼吸不全に対してveno–venous ECMOを導入した。脱血カニューレを挿入する際に抵抗があったが，心窩部超音波検査でガイドワイヤが下大静脈内にあることを確認していたため手技を続行した。その後，ECMOの血液流量が減少したため画像検索を行ったところ，脱血カニューレが上行腰静脈を経由して下大静脈に到達していることが判明した。抜去に際して出血の懸念があった。緊急手術に対応できるように準備し，脱血カニューレ内腔にバルーン付きガイドカテーテルを挿入して閉塞させ，静脈造影しつつ抜去した。出血時は静脈塞栓術を行う予定であったが出血は生じなかった。本症例のような迷入経路がありうるため，心窩部超音波検査のみではカニューレの上行腰静脈迷入を除外できない。下腹部超音波検査やX線撮影で確認することも考えられるが，時間に余裕があれば血管造影室で透視下にECMOを導入すべきである。迷入したカニューレを抜去する際にはバルーン付きガイドカテーテルを用いた静脈造影が選択肢の一つとなりうる。","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"34 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"高血糖と循環不全により救急搬送された脊椎の気腫性骨髄炎の1例(Emphysematous osteomyelitis of the spine with concomitant hyperglycemia and circulatory failure: a case report)","authors":"野田 透, 平井 忠幸, 岡島 正樹","doi":"10.1002/jja2.12858","DOIUrl":"https://doi.org/10.1002/jja2.12858","url":null,"abstract":"70歳代の女性。先行する腰痛と意識障害，循環不全にて救急搬送された。著明な高血糖と脱水の所見があり，また，画像検査および血液検査，尿検査にて腰椎の気腫性骨髄炎と尿路感染，血小板減少の所見を認めた。尿路感染に起因する気腫性骨髄炎により糖尿病性ケトアシドーシスと高血糖高浸透圧状態，感染性の播種性血管内凝固を発症したものと診断し，集学的治療を行った。感染に対しては来院時より抗生剤投与が行われ，また，入院3日目に腰椎の椎弓切除ならびに椎間板の掻把が行われた。血液，尿，椎間板のいずれからもEscherichia coliが検出された。入院61日目の時点で，全身状態は安定したが椎体の感染に対して加療が継続されている。気腫性骨髄炎は稀な疾患であるが死亡率も高く，適切な全身管理ならびに抗生剤投与，必要時の迅速な外科的介入が必要である。","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"81 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139458239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"自己決定権について倫理的配慮を要した自殺企図によるアセトアミノフェン中毒の1例(A case of acetaminophen poisoning in a patient with suicidal ideations: ethical considerations regarding the right to self–determination)","authors":"大田原 正幸, 今長谷 尚史, 濱田 尚一郎, リチャード・ カシンスキー, 中野 智継, 中島 幹男","doi":"10.1002/jja2.12855","DOIUrl":"https://doi.org/10.1002/jja2.12855","url":null,"abstract":"アセトアミノフェンは比較的安全性の高い解熱鎮痛薬として，一般にも広く用いられているが，大量摂取により肝毒性を呈し，急性肝不全に至った場合は人工肝補助療法や肝移植が必要な場合もある。症例は65歳の女性，意識障害と痙攣を主訴に救急搬送された。病院到着後も症状が遷延し，血液検査で肝胆道系酵素の著明な上昇と腎機能障害を認めたが意識障害のため原因は不明であった。入院後アセトアミノフェン中毒が判明しN–アセチルシステインによる治療を行ったが急性肝不全が進行し，人工肝補助療法や肝移植が必要な状況と考えられた。侵襲的な医療処置はすべて拒否するという本人による事前指示があったため，臨床倫理委員会に判断を付託した結果，内科的加療は継続するが，患者の自己決定権に対する倫理的配慮を重んじて侵襲的治療は差し控えることとなり，第2病日に患者は死亡した。救急現場において，自殺を企図して過量服薬し重症化した際に，意識障害を呈する場合には精神障害の診断をつけることが難しく，医師の裁量権が重視され，侵襲的処置を望まないという患者の意思表示に配慮することは容易でない。十分な情報を得たうえで意思決定を下している事前指示がある場合，患者の自己決定権が尊重される場合もあり，倫理委員会などを通して，判断の妥当性を検討すべきだと考えられる。","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"35 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ポスター（学生・研修医セッション）","authors":"","doi":"10.1002/jja2.12879","DOIUrl":"https://doi.org/10.1002/jja2.12879","url":null,"abstract":"","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ご協力いただいた企業・団体一覧","authors":"","doi":"10.1002/jja2.12880","DOIUrl":"https://doi.org/10.1002/jja2.12880","url":null,"abstract":"","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Panel Discussion（WINFOCUS）","authors":"","doi":"10.1002/jja2.12874","DOIUrl":"https://doi.org/10.1002/jja2.12874","url":null,"abstract":"","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"教育講習","authors":"","doi":"10.1002/jja2.12870","DOIUrl":"https://doi.org/10.1002/jja2.12870","url":null,"abstract":"","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear colleagues and friends, new and old members of the Lawson Wilkins Pediatric Endocrine Society and most welcome guests. The honor of serving as President of this Society carries with it the privilege and responsibility of formulating and delivering the annual Presidential address. What to talk about exercises one’s mind for several weeks if not months before the meeting. There are no guidelines and no published record of prior addresses. One can get an idea by perusing the titles in past programs. Or, one can try to emulate the topics of the President’s of like-minded if not identical societies such as the Society for Pediatric Research, the American Society for Clinical Investigation, their senior counterparts the American Pediatric Society and Association of American Physicians or our own particular senior counterpart, the Endocrine Society. Each publishes their annual Presidential address which makes for interesting historical and scientific reading. Whatever the group, the speaker generally focuses on one of four major themes.
{"title":"Presidential Lecture","authors":"Allan Drash, Tom Foley, Peter Lee, Claude Migeon","doi":"10.1002/jja2.12868","DOIUrl":"https://doi.org/10.1002/jja2.12868","url":null,"abstract":"Dear colleagues and friends, new and old members of the Lawson Wilkins Pediatric Endocrine Society and most welcome guests. The honor of serving as President of this Society carries with it the privilege and responsibility of formulating and delivering the annual Presidential address. What to talk about exercises one’s mind for several weeks if not months before the meeting. There are no guidelines and no published record of prior addresses. One can get an idea by perusing the titles in past programs. Or, one can try to emulate the topics of the President’s of like-minded if not identical societies such as the Society for Pediatric Research, the American Society for Clinical Investigation, their senior counterparts the American Pediatric Society and Association of American Physicians or our own particular senior counterpart, the Endocrine Society. Each publishes their annual Presidential address which makes for interesting historical and scientific reading. Whatever the group, the speaker generally focuses on one of four major themes.","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139213206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ハイライトセッション","authors":"","doi":"10.1002/jja2.12869","DOIUrl":"https://doi.org/10.1002/jja2.12869","url":null,"abstract":"","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139213744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"会長講演","authors":"","doi":"10.1002/jja2.12865","DOIUrl":"https://doi.org/10.1002/jja2.12865","url":null,"abstract":"","PeriodicalId":19346,"journal":{"name":"Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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