Kenta Komoriya, Kanta Kitagawa, Yutaka Mihara, Kei Hagiwara, Yasuhito Hatanaka, Mayu Hikone, Kazuhiro Sugiyama
Background
Atomoxetine, a selective norepinephrine reuptake inhibitor for attention-deficit hyperactivity disorder, may lead to severe complications, notably cardiac issues, upon overdose. We present a unique case of venoarterial extracorporeal membrane oxygenation (VA-ECMO) rescue for atomoxetine-induced cardiogenic shock.
Case Presentation
We report a 30-year-old man who, after ingesting a significant overdose of atomoxetine, experienced seizures and severe cardiogenic shock, necessitating VA-ECMO for resuscitation. While prior reports have noted cardiovascular complications like QTc prolongation and Takotsubo cardiomyopathy following atomoxetine overdose, this case is notable for its life-threatening circulatory failure, which required ECMO intervention. Swift recognition coupled with VA-ECMO initiation, endoscopic medication removal, intravenous lipid emulsion, and activated charcoal may have played a pivotal role in stabilizing the patient and facilitating recovery.
Conclusion
Healthcare practitioners should recognize the severe cardiac complications of atomoxetine overdose. Careful monitoring with ECG and echocardiography, along with providing intensive care, is crucial in managing critical cases.
{"title":"Refractory cardiogenic shock due to atomoxetine overdose rescued by venoarterial extracorporeal membrane oxygenation: A case report","authors":"Kenta Komoriya, Kanta Kitagawa, Yutaka Mihara, Kei Hagiwara, Yasuhito Hatanaka, Mayu Hikone, Kazuhiro Sugiyama","doi":"10.1002/ams2.70001","DOIUrl":"https://doi.org/10.1002/ams2.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atomoxetine, a selective norepinephrine reuptake inhibitor for attention-deficit hyperactivity disorder, may lead to severe complications, notably cardiac issues, upon overdose. We present a unique case of venoarterial extracorporeal membrane oxygenation (VA-ECMO) rescue for atomoxetine-induced cardiogenic shock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report a 30-year-old man who, after ingesting a significant overdose of atomoxetine, experienced seizures and severe cardiogenic shock, necessitating VA-ECMO for resuscitation. While prior reports have noted cardiovascular complications like QTc prolongation and Takotsubo cardiomyopathy following atomoxetine overdose, this case is notable for its life-threatening circulatory failure, which required ECMO intervention. Swift recognition coupled with VA-ECMO initiation, endoscopic medication removal, intravenous lipid emulsion, and activated charcoal may have played a pivotal role in stabilizing the patient and facilitating recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Healthcare practitioners should recognize the severe cardiac complications of atomoxetine overdose. Careful monitoring with ECG and echocardiography, along with providing intensive care, is crucial in managing critical cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SARS-CoV-2 causes systemic immune dysfunction, leading to severe respiratory dysfunction and multiorgan dysfunction. Granulocyte and monocyte adsorptive apheresis (GMA) therapy is designed to regulate an excessive inflammatory response and has been proposed as a potential therapeutic strategy for coronavirus disease 2019 (COVID-19). We aimed to investigate a targeted subset of granulocytes and monocytes to be removed after GMA therapy in patients with severe COVID-19 infection.
Methods
We established an ex vivo experimental system to study the effects of GMA. Blood samples were collected into EDTA-treated tubes and a mixture of blood samples and cellulose acetate beads was used in GMA. After GMA, blood samples were removed, and the granulocyte and monocyte subtypes before and after GMA were determined by CyTOF mass cytometry. To analyze mass cytometry data with a self-organizing map, hierarchical clustering was used to determine the appropriate number of metaclusters from t-distributed stochastic neighbor embedding.
Results
We included seven patients with severe COVID-19 and four age- and sex-matched volunteers. Granulocyte subsets removed by GMA strongly expressed CD11b, CD16, and CD66b, and weakly expressed CD11c, consistent with mature and activated neutrophils. Monocyte subsets strongly expressed CD14, weakly expressed CD33 and CD45RO, and did not express CD16. These subsets were indicated to promote the release of inflammatory cytokines and activate T cells.
Conclusions
The identification of the granulocyte and monocyte subsets removed after GMA in patients with severe COVID-19 may help explain the potential mechanism underlying the effectiveness of GMA in COVID-19 and other inflammatory diseases.
{"title":"Phenotypic changes in immune cells induced by granulocyte and monocyte adsorptive apheresis in patients with severe COVID-19: An ex vivo study","authors":"Ryo Hisamune, Kazuma Yamakawa, Katsuhide Kayano, Noritaka Ushio, Takeshi Wada, Kohei Taniguchi, Akira Takasu","doi":"10.1002/ams2.70003","DOIUrl":"https://doi.org/10.1002/ams2.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>SARS-CoV-2 causes systemic immune dysfunction, leading to severe respiratory dysfunction and multiorgan dysfunction. Granulocyte and monocyte adsorptive apheresis (GMA) therapy is designed to regulate an excessive inflammatory response and has been proposed as a potential therapeutic strategy for coronavirus disease 2019 (COVID-19). We aimed to investigate a targeted subset of granulocytes and monocytes to be removed after GMA therapy in patients with severe COVID-19 infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We established an ex vivo experimental system to study the effects of GMA. Blood samples were collected into EDTA-treated tubes and a mixture of blood samples and cellulose acetate beads was used in GMA. After GMA, blood samples were removed, and the granulocyte and monocyte subtypes before and after GMA were determined by CyTOF mass cytometry. To analyze mass cytometry data with a self-organizing map, hierarchical clustering was used to determine the appropriate number of metaclusters from t-distributed stochastic neighbor embedding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included seven patients with severe COVID-19 and four age- and sex-matched volunteers. Granulocyte subsets removed by GMA strongly expressed CD11b, CD16, and CD66b, and weakly expressed CD11c, consistent with mature and activated neutrophils. Monocyte subsets strongly expressed CD14, weakly expressed CD33 and CD45RO, and did not express CD16. These subsets were indicated to promote the release of inflammatory cytokines and activate T cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The identification of the granulocyte and monocyte subsets removed after GMA in patients with severe COVID-19 may help explain the potential mechanism underlying the effectiveness of GMA in COVID-19 and other inflammatory diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Because of a scant report, it is little known that thyroid storms can occur after trauma, even in adolescence. Significantly, this increases the risk of delaying diagnosis resulting in life-threatening.
Case Presentation
A 13-year-old girl was admitted to the emergency department after a traffic accident. Despite receiving comprehensive trauma care, the patient developed hyperthermia and tachycardia that did not respond to temperature management therapy. On the 10th day of her admission, she was diagnosed with a thyroid storm. Treatment for thyroid storm was initiated; thereby, her condition was totally improved.
Conclusion
We experienced a case of an adolescent girl, who developed a thyroid storm during the treatment of trauma and could save her life. Clinicians should consider thyroid storm in post-traumatic hyperthermia and tachycardia patients, even in children.
{"title":"Trauma-related thyroid storm in adolescents: A case report","authors":"Atsushi Jinno, Naofumi Bunya, Junya Hagiwara, Kai Takao, Keigo Sawamoto, Akira Ishii, Takeshi Tsugawa, Eichi Narimatsu, Yoshihisa Tsuji","doi":"10.1002/ams2.70004","DOIUrl":"10.1002/ams2.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Because of a scant report, it is little known that thyroid storms can occur after trauma, even in adolescence. Significantly, this increases the risk of delaying diagnosis resulting in life-threatening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 13-year-old girl was admitted to the emergency department after a traffic accident. Despite receiving comprehensive trauma care, the patient developed hyperthermia and tachycardia that did not respond to temperature management therapy. On the 10th day of her admission, she was diagnosed with a thyroid storm. Treatment for thyroid storm was initiated; thereby, her condition was totally improved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We experienced a case of an adolescent girl, who developed a thyroid storm during the treatment of trauma and could save her life. Clinicians should consider thyroid storm in post-traumatic hyperthermia and tachycardia patients, even in children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osamu Nomura, Arisa Aoyagi, Jin Irie, Takeshi Goto, Kana Sugiyama, Hiroyuki Hanada, Yoshiya Ishizawa
Aim
The requirement during the COVID-19 pandemic to provide extracorporeal membrane oxygenation (ECMO) treatment regardless of experience caused high levels of anxiety among healthcare professionals. The aim of the present study was to evaluate the effectiveness of an in situ interprofessional simulation training conducted to improve readiness and preparedness for ECMO management of patients with COVID-19 at a non-high-volume ECMO centre.
Methods
Three emergency physicians, three clinical engineers and two nurses attended the 3-h simulation held at Hirosaki University Hospital in December 2021, during the COVID-19 pandemic. The training comprised a 30-min briefing, a 1-h ECMO circuit change session, a 1-h in-hospital transfer simulation for CT and a 30-min debriefing. Before and after the training, participants completed an online survey of their emotions, based on the Japanese version of the Medical Emotion Scale (J-MES). Related-samples Wilcoxon signed rank test was used to assess potential changes in emotional responses before and after the simulation, and p < 0.05 was considered to indicate significance.
Results
Participants' positive deactivating emotions increased from a median of 3.3 (range, 2.0–4.5) before the simulation to 4.0 (range, 2.5–5.0) after the simulation (p = 0.02), which indicates favourable performance according to the control value theory of educational psychology. There was no statistically significant change in other emotional categories.
Conclusion
Participants' positive deactivating emotions increased significantly following an in situ ECMO simulation training, which indicates the efficacy of the training for improving the quality of ECMO management in patients with COVID-19.
{"title":"Positive emotions for promoting quality improvement of extracorporeal membrane oxygenation therapy for COVID-19: In situ interprofessional simulation","authors":"Osamu Nomura, Arisa Aoyagi, Jin Irie, Takeshi Goto, Kana Sugiyama, Hiroyuki Hanada, Yoshiya Ishizawa","doi":"10.1002/ams2.70002","DOIUrl":"https://doi.org/10.1002/ams2.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The requirement during the COVID-19 pandemic to provide extracorporeal membrane oxygenation (ECMO) treatment regardless of experience caused high levels of anxiety among healthcare professionals. The aim of the present study was to evaluate the effectiveness of an in situ interprofessional simulation training conducted to improve readiness and preparedness for ECMO management of patients with COVID-19 at a non-high-volume ECMO centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three emergency physicians, three clinical engineers and two nurses attended the 3-h simulation held at Hirosaki University Hospital in December 2021, during the COVID-19 pandemic. The training comprised a 30-min briefing, a 1-h ECMO circuit change session, a 1-h in-hospital transfer simulation for CT and a 30-min debriefing. Before and after the training, participants completed an online survey of their emotions, based on the Japanese version of the Medical Emotion Scale (J-MES). Related-samples Wilcoxon signed rank test was used to assess potential changes in emotional responses before and after the simulation, and <i>p</i> < 0.05 was considered to indicate significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants' positive deactivating emotions increased from a median of 3.3 (range, 2.0–4.5) before the simulation to 4.0 (range, 2.5–5.0) after the simulation (<i>p</i> = 0.02), which indicates favourable performance according to the control value theory of educational psychology. There was no statistically significant change in other emotional categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Participants' positive deactivating emotions increased significantly following an in situ ECMO simulation training, which indicates the efficacy of the training for improving the quality of ECMO management in patients with COVID-19.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142045336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Traumatic cerebral aneurysms (TA) are a subset of traumatic cerebrovascular injury (TCVI). Misdiagnosis of TA can be fatal. To investigate factors that predict TA formation and the optimal timing for searching, we present four suspected cases of delayed TA rupture during hospitalization.
Case Presentation
Medical records of head injury cases to have delayed TA rupture during hospitalization between April 2021 and March 2022 were retrospectively reviewed. Of the four patients included, only one met the TCVI screening criteria. All the patients had acute subdural hematoma (ASDH) on arrival; two had delayed expansion of the traumatic subarachnoid hemorrhage (tSAH) on repeat imaging. All the patients received anticoagulants. Ruptured TA occurred between days 5 and 11. Three patients died during hospitalization.
Conclusion
It is advisable to suspect TA when imaging studies show ASDH on admission and intracranial hematoma expansion during hospitalization. We suggest TA screening around day 5.
背景：外伤性脑动脉瘤（TA）是外伤性脑血管损伤（TCVI）的一个分支。外伤性脑动脉瘤的误诊可能是致命的。为了研究预测TA形成的因素和最佳搜索时机，我们介绍了四例住院期间TA延迟破裂的疑似病例：病例介绍：我们回顾性审查了2021年4月至2022年3月期间住院期间发生延迟TA破裂的颅脑损伤病例的病历。在纳入的四名患者中，只有一人符合 TCVI 筛查标准。所有患者在入院时都有急性硬膜下血肿（ASDH）；其中两名患者在复查造影时发现外伤性蛛网膜下腔出血（tSAH）延迟扩大。所有患者都接受了抗凝治疗。蛛网膜下腔出血破裂发生在第5天至第11天。三名患者在住院期间死亡：结论：当影像学检查显示入院时有 ASDH，住院期间颅内血肿扩大时，最好怀疑 TA。我们建议在第 5 天左右进行 TA 筛查。
{"title":"Clinical features and risk factors for delayed rupture of traumatic cerebral aneurysm: A case series","authors":"Masataka Sugii, Kazuhiro Okada, Shimpei Ikeda, Yoshiaki Hara, Shoji Yokobori","doi":"10.1002/ams2.70000","DOIUrl":"10.1002/ams2.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traumatic cerebral aneurysms (TA) are a subset of traumatic cerebrovascular injury (TCVI). Misdiagnosis of TA can be fatal. To investigate factors that predict TA formation and the optimal timing for searching, we present four suspected cases of delayed TA rupture during hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>Medical records of head injury cases to have delayed TA rupture during hospitalization between April 2021 and March 2022 were retrospectively reviewed. Of the four patients included, only one met the TCVI screening criteria. All the patients had acute subdural hematoma (ASDH) on arrival; two had delayed expansion of the traumatic subarachnoid hemorrhage (tSAH) on repeat imaging. All the patients received anticoagulants. Ruptured TA occurred between days 5 and 11. Three patients died during hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It is advisable to suspect TA when imaging studies show ASDH on admission and intracranial hematoma expansion during hospitalization. We suggest TA screening around day 5.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The overdose of caffeine, a cytochrome P450 1A2 probe, in young women has become a problem. The aim of this study was to evaluate possible drug interactions between intentionally overdosed caffeine (12 g) and oral contraceptive doses of ethinyl estradiol prescribed to a young woman in a suicide attempt.
Methods
The serum concentrations of caffeine in the patient and the time-dependent ethinyl estradiol inhibition of caffeine oxidation in vitro were evaluated.
Results
The serum concentration of caffeine 4 h after overdose was 136 μg/mL; from the data obtained between 4 and 28 h after overdose, the half-life was estimated to be 33 h, which is many times larger than the normal value. Prescribed ethinyl estradiol prolonged caffeine elimination in vivo and inhibited paraxanthine formation, as evidenced by the low serum concentrations. In human liver microsomes, ethinyl estradiol (50 nM) inhibited half of caffeine N3-demethylation. Pre-incubation of human liver microsomes with ethinyl estradiol resulted in a powerful time-dependent inhibitory effect on caffeine N3-demethylation in human liver microsomes.
Conclusion
These results suggest that a prescription history of contraceptives at clinical doses may have a strong effect on the pharmacokinetics of overdosed caffeine in young women, resulting in dangerous drug interactions.
{"title":"Interaction of a caffeine overdose with clinical doses of contraceptive ethinyl estradiol in a young woman","authors":"Koichiro Adachi, Maki Murata, Akiyoshi Inada, Takeyori Morimoto, Makiko Shimizu, Satoru Beppu, Hiroshi Yamazaki","doi":"10.1002/ams2.985","DOIUrl":"https://doi.org/10.1002/ams2.985","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The overdose of caffeine, a cytochrome P450 1A2 probe, in young women has become a problem. The aim of this study was to evaluate possible drug interactions between intentionally overdosed caffeine (12 g) and oral contraceptive doses of ethinyl estradiol prescribed to a young woman in a suicide attempt.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The serum concentrations of caffeine in the patient and the time-dependent ethinyl estradiol inhibition of caffeine oxidation in vitro were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The serum concentration of caffeine 4 h after overdose was 136 μg/mL; from the data obtained between 4 and 28 h after overdose, the half-life was estimated to be 33 h, which is many times larger than the normal value. Prescribed ethinyl estradiol prolonged caffeine elimination in vivo and inhibited paraxanthine formation, as evidenced by the low serum concentrations. In human liver microsomes, ethinyl estradiol (50 nM) inhibited half of caffeine <i>N</i><sub><i>3</i></sub>-demethylation. Pre-incubation of human liver microsomes with ethinyl estradiol resulted in a powerful time-dependent inhibitory effect on caffeine <i>N</i><sub><i>3</i></sub>-demethylation in human liver microsomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results suggest that a prescription history of contraceptives at clinical doses may have a strong effect on the pharmacokinetics of overdosed caffeine in young women, resulting in dangerous drug interactions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141967897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-occlusive mesenteric ischemia (NOMI) is associated with high mortality rates, but definitive treatments have not yet been established. Although experimental animal models are worthwhile, reproducible models that reflect the pathophysiology of NOMI have not been developed.
Methods
We combined risk factors for NOMI, comprising hemorrhagic shock, systemic vasopressor infusion, and local vasopressor infusion from the superior mesenteric artery (SMA) in swine under maintained anesthesia. Experiment 1 involved full-intensity (40%) phlebotomy and systemic vasopressor (norepinephrine and epinephrine). Experiment 2 involved full-intensity (40%) phlebotomy, systemic norepinephrine, and local vasopressor infusion into the SMA. Experiment 3 involved moderate (27%) phlebotomy, systemic norepinephrine infusion, and local epinephrine infusion. We evaluated serum lactate levels, intestinal serosa color, computed tomography (CT) angiography, and pathological findings.
Results
After inducing hemorrhage, systemic vasopressor alone and in combination with local vasopressin or norepinephrine infusion did not induce ischemic color changes in the intestine. The combination of systemic norepinephrine and local epinephrine (0.5 μg/kg/min) after moderate (27% blood loss) hemorrhage induced gross color change, pathological destruction, and elevation of serum lactate. Patent flow in the SMA was confirmed on CT angiography.
Conclusion
We established a swine NOMI model with systemic norepinephrine infusion and local epinephrine with moderate hemorrhagic shock.
目的：非闭塞性肠系膜缺血（NOMI）与高死亡率有关，但目前尚未确立明确的治疗方法。尽管实验动物模型很有价值，但反映 NOMI 病理生理学的可重复模型尚未开发出来：方法：我们结合了NOMI的风险因素，包括失血性休克、全身血管加压输注以及在维持麻醉的情况下从猪肠系膜上动脉（SMA）进行局部血管加压输注。实验 1 包括全强度（40%）抽血和全身血管加压（去甲肾上腺素和肾上腺素）。实验 2 包括全强度（40%）抽血、全身去甲肾上腺素和向 SMA 输注局部血管抑制剂。实验 3 涉及中度（27%）抽血、全身去甲肾上腺素输注和局部肾上腺素输注。我们对血清乳酸水平、肠道血清膜颜色、计算机断层扫描（CT）血管造影和病理结果进行了评估：结果：诱导出血后，单独使用全身血管加压素或联合使用局部血管加压素或去甲肾上腺素输注均不会诱导肠道缺血性颜色变化。中度（27% 失血量）出血后联合使用全身去甲肾上腺素和局部肾上腺素（0.5 μg/kg/min）可引起肠道颜色改变、病理破坏和血清乳酸升高。CT血管造影证实了SMA的通畅：我们建立了一个猪 NOMI 模型，在中度失血性休克时使用全身去甲肾上腺素输注和局部肾上腺素。
{"title":"Establishment of a swine experimental model of non-occlusive mesenteric ischemia: Combining induced hemorrhagic shock and vasopressor administration","authors":"Yasutaka Tanaka, Yosuke Matsumura, Makoto Aoki, Yosuke Hayashi, Yoshimitsu Izawa, Kazuhiro Endo, Takashi Mato","doi":"10.1002/ams2.982","DOIUrl":"10.1002/ams2.982","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Non-occlusive mesenteric ischemia (NOMI) is associated with high mortality rates, but definitive treatments have not yet been established. Although experimental animal models are worthwhile, reproducible models that reflect the pathophysiology of NOMI have not been developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We combined risk factors for NOMI, comprising hemorrhagic shock, systemic vasopressor infusion, and local vasopressor infusion from the superior mesenteric artery (SMA) in swine under maintained anesthesia. Experiment 1 involved full-intensity (40%) phlebotomy and systemic vasopressor (norepinephrine and epinephrine). Experiment 2 involved full-intensity (40%) phlebotomy, systemic norepinephrine, and local vasopressor infusion into the SMA. Experiment 3 involved moderate (27%) phlebotomy, systemic norepinephrine infusion, and local epinephrine infusion. We evaluated serum lactate levels, intestinal serosa color, computed tomography (CT) angiography, and pathological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After inducing hemorrhage, systemic vasopressor alone and in combination with local vasopressin or norepinephrine infusion did not induce ischemic color changes in the intestine. The combination of systemic norepinephrine and local epinephrine (0.5 μg/kg/min) after moderate (27% blood loss) hemorrhage induced gross color change, pathological destruction, and elevation of serum lactate. Patent flow in the SMA was confirmed on CT angiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We established a swine NOMI model with systemic norepinephrine infusion and local epinephrine with moderate hemorrhagic shock.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pelvic ring fractures (PRFs) due to high-energy trauma often result in severe bleeding and high mortality. Pelvic circumferential compression devices (PCCD) are widely used to stabilize PRF and decrease bleeding. However, evidence supporting their effectiveness is still inconclusive.
Methods
We conducted an observational study using the Japan Trauma Data Bank (JTDB) from 2019 to 2021. Patients with blunt lower body trauma aged 15 years or older were included. We used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to evaluate the association of PCCD and mortality.
Results
Of the 74,393 patients in the database, 235 PCCD group and 23,429 control group were analyzed. After PSM, 231 patients in both groups were enrolled. Crude analysis indicated significantly higher in-hospital mortality in the PCCD group (odds ratio (OR) = 3.8 [95% CI = 2.51–5.75]). However, PSM and IPTW analysis indicated that PCCD was associated with decreased in-hospital mortality (PSM: OR = 0.79 [0.43–1.42]; IPTW: OR = 0.73 [0.62–0.86]). In a subgroup analysis of the IPTW analysis, PCCD fitting resulted in increased in-hospital mortality in the group without PRF (OR = 2.08 [1.91–2.27]), a decrease in stable PRF (OR = 0.74 [0.6–0.91]), and a further decrease in unstable PRF (OR = 0.18 [0.12–0.27]). Additional factors, such as a fall from a height, a fall downstairs, and pre-hospital PCCD placement also influenced the treatment effect.
Conclusion
The present, large, registry-based study found that PCCD reduced mortality in patients with a lower body injury, especially those with an unstable PRF.
{"title":"Effectiveness of pelvic circumferential compression device for lower body trauma: Insights from a Japan Trauma Data Bank retrospective study","authors":"Shohei Ono, Satoshi Miyata, Hiroaki Suzuki, Keiki Shimizu","doi":"10.1002/ams2.983","DOIUrl":"10.1002/ams2.983","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Pelvic ring fractures (PRFs) due to high-energy trauma often result in severe bleeding and high mortality. Pelvic circumferential compression devices (PCCD) are widely used to stabilize PRF and decrease bleeding. However, evidence supporting their effectiveness is still inconclusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an observational study using the Japan Trauma Data Bank (JTDB) from 2019 to 2021. Patients with blunt lower body trauma aged 15 years or older were included. We used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to evaluate the association of PCCD and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 74,393 patients in the database, 235 PCCD group and 23,429 control group were analyzed. After PSM, 231 patients in both groups were enrolled. Crude analysis indicated significantly higher in-hospital mortality in the PCCD group (odds ratio (OR) = 3.8 [95% CI = 2.51–5.75]). However, PSM and IPTW analysis indicated that PCCD was associated with decreased in-hospital mortality (PSM: OR = 0.79 [0.43–1.42]; IPTW: OR = 0.73 [0.62–0.86]). In a subgroup analysis of the IPTW analysis, PCCD fitting resulted in increased in-hospital mortality in the group without PRF (OR = 2.08 [1.91–2.27]), a decrease in stable PRF (OR = 0.74 [0.6–0.91]), and a further decrease in unstable PRF (OR = 0.18 [0.12–0.27]). Additional factors, such as a fall from a height, a fall downstairs, and pre-hospital PCCD placement also influenced the treatment effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present, large, registry-based study found that PCCD reduced mortality in patients with a lower body injury, especially those with an unstable PRF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe metformin intoxication can lead to lactic acidosis and vasoplegic shock, for which the optimal management strategy remains uncertain, especially in cases of severe circulatory collapse.
Case Presentation
A 45-year-old diabetic woman on metformin therapy presented with impaired consciousness and seizures. She had experienced a cardiac arrest and undergone extracorporeal cardiopulmonary resuscitation. Blood gas analysis showed severe lactic acidosis. A 71-g metformin packet was found at the patient's home, suggesting an overdose. Despite extracorporeal support and blood purification, severe lactic acidosis and hypotension persisted. Methylene blue was administered 32 h from the onset, which improved her metabolic and circulatory status. We examined her blood sample throughout the case to check the transition of metformin blood concentration.
Conclusion
Methylene blue may be beneficial for severe metformin toxicity, regardless of the blood concentration of metformin and the time since intoxication. However, further research is needed to establish its optimal use and effectiveness.
{"title":"Successful use of methylene blue for catecholamine-refractory vasoplegic shock due to metformin intoxication: A case report and literature review","authors":"Yuji Takahashi, Hidehiko Nakano, Maiko Motoki, Yuji Wakimoto, Daisuke Ikechi, Yasuaki Koyama, Hideki Hashimoto","doi":"10.1002/ams2.981","DOIUrl":"10.1002/ams2.981","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Severe metformin intoxication can lead to lactic acidosis and vasoplegic shock, for which the optimal management strategy remains uncertain, especially in cases of severe circulatory collapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 45-year-old diabetic woman on metformin therapy presented with impaired consciousness and seizures. She had experienced a cardiac arrest and undergone extracorporeal cardiopulmonary resuscitation. Blood gas analysis showed severe lactic acidosis. A 71-g metformin packet was found at the patient's home, suggesting an overdose. Despite extracorporeal support and blood purification, severe lactic acidosis and hypotension persisted. Methylene blue was administered 32 h from the onset, which improved her metabolic and circulatory status. We examined her blood sample throughout the case to check the transition of metformin blood concentration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Methylene blue may be beneficial for severe metformin toxicity, regardless of the blood concentration of metformin and the time since intoxication. However, further research is needed to establish its optimal use and effectiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141618984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of venovenous extracorporeal membrane oxygenation (VV-ECMO), particularly during radiotherapy, for severe malignant central airway obstruction has rarely been reported.
Case Presentation
A 47-year-old female presented to our emergency department with severe respiratory distress. Given her medical history, she was initially diagnosed with asthma. Despite initial treatment, which included intubation, her condition deteriorated, necessitating VV-ECMO. Computed tomography performed following the initiation of VV-ECMO revealed extensive lung cancer involving both bronchial types. Radiotherapy while on VV-ECMO led to a significant reduction in tumor size, allowing for the weaning of ECMO support and successful extubation.
Conclusion
Malignant central airway obstruction is life-threatening. Our case demonstrates the efficacy of combining VV-ECMO with radiotherapy when conventional therapies fail. Further research is necessary to validate and explore this novel approach's implications.
{"title":"Extracorporeal membrane oxygenation-facilitated palliative radiotherapy for severe airway obstruction due to lung cancer: A case report","authors":"Hitoshi Mori, Masahiro Kashiura, Yuya Yoshimura, Yuki Yamahata, Tomohisa Tokura, Tatsuya Nodagashira, Akihide Konn, Takashi Moriya","doi":"10.1002/ams2.980","DOIUrl":"10.1002/ams2.980","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of venovenous extracorporeal membrane oxygenation (VV-ECMO), particularly during radiotherapy, for severe malignant central airway obstruction has rarely been reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 47-year-old female presented to our emergency department with severe respiratory distress. Given her medical history, she was initially diagnosed with asthma. Despite initial treatment, which included intubation, her condition deteriorated, necessitating VV-ECMO. Computed tomography performed following the initiation of VV-ECMO revealed extensive lung cancer involving both bronchial types. Radiotherapy while on VV-ECMO led to a significant reduction in tumor size, allowing for the weaning of ECMO support and successful extubation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Malignant central airway obstruction is life-threatening. Our case demonstrates the efficacy of combining VV-ECMO with radiotherapy when conventional therapies fail. Further research is necessary to validate and explore this novel approach's implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11246608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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