Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本呼吸療法医学会  

症例は30歳代男性。身長170cm、体重203kg、体格指数(body mass index:BMI)70.2kg/m2の病的肥満体型でった。新型コロナウイルス(coronavirus disease 2019:COVID-19)肺炎の診断で前医に人院して人工呼吸管理を開始したが、酸素化を維持できないため当院へ転院搬送することになった。感染性と体格を考慮すると陸路搬送を選択せざるを得なかったが、早期接触と搬送支援を目的にドクターヘリで当院救急医を派遺した。当院転院後に、血管撮影と清潔環境でのカットダウンが可能なハイブリッド手術室において心臓血管外科・麻酔科と協力して静脈一静脈体外式膜型人工肺(veno-venous extracorporeal membrane oxygenation:V-V ECMO)を導入した。病的肥満かつCOVID-19という特殊な状況であったが、各部門のマンパワーを考慮した多職種連携によって早期理学療法を含む治療を行い得た。徐々に酸素化は改善し、入院13日目にV-V ECMOを離脱することができた。その後、気管切開と人工呼吸器離脱を経て入院48日目に紹介元へ転院した。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J02315&link_issn=&doc_id=20230615460012&doc_link_id=%2Fdz6respi%2F2023%2F004001%2F014%2F0079-0084%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz6respi%2F2023%2F004001%2F014%2F0079-0084%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床麻酔学会  

本邦において破傷風は減少傾向だが,年間100例以上の発生報告があり,死亡率は10～20%に上る重篤な疾患である.最も症状が強くなるIII期は苦痛緩和を目的とした深鎮静が必要となりリハビリテーションが進まないが,回復期といわれるIV期まで安静を続けると廃用が進行する.つまり,重症患者管理において重要なリハビリテーションを破傷風患者に行うのが困難なことが臨床上の問題である.今回われわれは人工呼吸管理を要した重症全身性破傷風のIII期から,プロポフォールをデクスメデトミジンに変更した鎮痛鎮静管理によって覚醒を維持した状態でリハビリテーションを行うことが可能となり,機能障害なく退院した症例を経験したため報告する.(著者抄録)

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Language：Japanese   Publisher：(一社)日本呼吸療法医学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J02315&link_issn=&doc_id=20230615460012&doc_link_id=10.50903%2Fjsrcm.40.1_79&url=https%3A%2F%2Fdoi.org%2F10.50903%2Fjsrcm.40.1_79&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本臨床麻酔学会  

本邦において破傷風は減少傾向だが,年間100例以上の発生報告があり,死亡率は10～20%に上る重篤な疾患である.最も症状が強くなるIII期は苦痛緩和を目的とした深鎮静が必要となりリハビリテーションが進まないが,回復期といわれるIV期まで安静を続けると廃用が進行する.つまり,重症患者管理において重要なリハビリテーションを破傷風患者に行うのが困難なことが臨床上の問題である.今回われわれは人工呼吸管理を要した重症全身性破傷風のIII期から,プロポフォールをデクスメデトミジンに変更した鎮痛鎮静管理によって覚醒を維持した状態でリハビリテーションを行うことが可能となり,機能障害なく退院した症例を経験したため報告する.(著者抄録)

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

緊張性気腹は閉塞性ショックを呈し心肺停止に至ることがある。腹腔穿刺による緊急脱気によって容易に改善が見込めるため,迅速な診断と処置が望まれる。原因の明確な医原性の緊張性気腹症例がしばしば報告されているが,消化管穿孔などの非医原性の機序でも緊張性気腹を来しうる。このような場合,予備情報がないため病態の把握に時間がかかる可能性がある。今回我々は,上部消化管穿孔から緊張性気腹を呈し,緊急腹腔穿刺で改善した症例を経験したので報告する。患者は60歳の女性。感冒症状の後に呼吸苦が出現,意識障害を呈したため当院に救急搬送された。当院受診時は心肺停止状態であったが,直ちに蘇生処置を行い4分程度で自己心拍が再開した。胸部X線写真で腹腔内遊離ガスと横隔膜の挙上ならびに右上肺野に空洞を伴う腫瘤影を認め,腹部CTでは腹部の膨隆と多量の腹腔内遊離ガスならびに胃穿孔を疑う所見がみられた。緊急手術を行う方針となったが,ショック状態が遷延した。緊張性気腹と判断し18G留置針で試験穿刺を行ったところ,速やかに循環動態は安定した。開腹手術を施行し,ICUに入室となった。手術後循環状態は安定し経過したが,肺アスペルギルス症によると思われる喀血が出現し,コントロールができず第24病日に死亡退院となった。(著者抄録)

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
Sepsis is associated with life-threatening organ dysfunction caused by a dysregulated host response to infection. However, no specific therapy has been shown to improve mortality in patients with sepsis. We conducted a study to clarify the utilization status of various BPTs and the clinical characteristics of patients who received BPTs in northern Japan. In addition, the association of various BPTs with clinical outcomes was examined.


</sec><sec>
<title>Methods</title>
This is a sub-analysis of the Tohoku Sepsis Registry, a multicenter, prospective, observational cohort study. To determine whether BPT was independently associated with in-hospital mortality in patients with severe sepsis, the following analyses were performed. Differences between survivors and non-survivors were assessed using Wilcoxon rank sum tests for continuous variables and Chi-square tests for categorical variables. Univariate logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. In the multivariate logistic regression analysis, adjustments were made for the variables that were significant in the univariate logistic regression analysis. Clinical factors associated with mortality were analyzed.


</sec><sec>
<title>Results</title>
We enrolled 616 consecutive patients (≥ 18 years) with median Sequential Organ Failure Assessment scores of 8.0. During median of 22 days hospitalization, 139 patients died (mortality 22.6%). 20.7% of patients with severe sepsis received any type of BPT (mortality 38.6%). BPT consisted of 65.1% continuous renal replacement therapy (CRRT) with renal indication (mortality 48.8%), 26.0% CRRT with non-renal indication (mortality 21.2%), 22.2% intermittent renal replacement therapy (mortality 32.1%), and 33.1% polymyxin B-immobilized fiber column-direct hemoperfusion (mortality 42.9%). Meanwhile, no BPT group (mortality 18.5%) showed a significantly lower mortality than any BPT group. Besides, in multivariate analyses, all BPT modes were not independently associated with all-cause mortality.


</sec><sec>
<title>Conclusions</title>
This study suggested the clinical status of BPTs for severe sepsis patients in northern Japan. Among all types of BPT, continuous renal replacement therapy (CRRT) for renal indication was most frequently selected. Severe sepsis patients received BPT had a higher mortality and severity; however, the BPT implementation may not be associated with mortality.


<italic>Trial registration</italic> UMIN-CTR, UMIN000010297, Registered on 22 March 2013, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000012055">https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000012055</ext-link>).


</sec>

DOI： 10.1186/s41100-021-00366-4

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Other Link： https://link.springer.com/article/10.1186/s41100-021-00366-4/fulltext.html

Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

成人ムコ多糖症II型患者では、周術期の気道・呼吸管理が問題になる。本症例は意識下、気管支鏡ガイド下に経口挿管を試みたが、ムコ多糖の蓄積による気道のねじれと狭窄のため困難であった。経鼻アプローチに変更すると、咽頭軸との角度が緩やかになり比較的容易に挿管できた。成人症例では経鼻挿管が有用である可能性が示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01397&link_issn=&doc_id=20210601120006&doc_link_id=%2Fad3msuie%2F2021%2F007006%2F007%2F0602b0605%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2021%2F007006%2F007%2F0602b0605%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The distribution of body mass in populations of Western countries differs from that of populations of East Asian countries. In East Asian countries, fewer people have a high body mass index than those in Western countries. In Japan, the country with the highest number of older adults worldwide, many people have a low body mass index. Therefore, this study aimed to determine the association between a low body mass index and mortality in patients with sepsis in Japan. METHODS: We conducted this retrospective analysis of 548 patients with severe sepsis from a multicenter prospective observational study. Multivariate logistic regression analyses determined the association between body mass index and 28-day mortality adjusted for age, sex, pre-existing conditions, the occurrence of septic shock, Acute Physiology and Chronic Health Evaluation II scores, and Sequential Organ Failure Assessment scores. Furthermore, the association between a low body mass index and 28-day mortality was analyzed. RESULTS: The low body mass index group represented 18.8% of the study population (103/548); the normal body mass index group, 57.3% (314/548); and the high body mass index group, 23.9% (131/548), with the 28-day mortality rates being 21.4% (22/103), 11.2% (35/314), and 14.5% (19/131), respectively. In the low body mass index group, the crude and adjusted odds ratios (95% confidence intervals) for 28-day mortality relative to the non-low body mass index (normal and high body mass index groups combined) group were 2.0 (1.1-3.4) and 2.3 (1.2-4.2), respectively. CONCLUSION: A low body mass index was found to be associated with a higher 28-day mortality than the non-low body mass index in patients with sepsis in Japan. Given that older adults often have a low body mass index, these patients should be monitored closely to reduce the occurrence of negative outcomes.

DOI： 10.1371/journal.pone.0252955

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Most deaths of comatose survivors of out-of-hospital sudden cardiac arrest result from withdrawal of life-sustaining treatment (WLST) decisions based on poor neurological prognostication and the family's intention. Thus, accurate prognostication is crucial to avoid premature WLST decisions. However, targeted temperature management (TTM) with sedation or neuromuscular blockade against shivering significantly affects early prognostication. In this study, we investigated whether heart rate variability (HRV) analysis could prognosticate poor neurological outcome in comatose patients undergoing hypothermic TTM. METHODS: Between January 2015 and December 2017, adult patients with out-of-hospital sudden cardiac arrest, successfully resuscitated in the emergency department and admitted to the intensive care unit of the Niigata University in Japan, were prospectively included. All patients had an initial Glasgow Coma Scale motor score of 1 and received hypothermic TTM (at 34 °C). Twenty HRV-related variables (deceleration capacity; 4 time-, 3 geometric-, and 7 frequency-domain; and 5 complexity variables) were computed based on RR intervals between 0:00 and 8:00 am within 24 h after return of spontaneous circulation (ROSC). Based on Glasgow Outcome Scale (GOS) at 2 weeks after ROSC, patients were divided into good outcome (GOS 1-2) and poor outcome (GOS 3-5) groups. RESULTS: Seventy-six patients were recruited and allocated to the good (n = 22) or poor (n = 54) outcome groups. Of the 20 HRV-related variables, ln very-low frequency (ln VLF) power, detrended fluctuation analysis (DFA) (α1), and multiscale entropy (MSE) index significantly differed between the groups (p = 0.001), with a statistically significant odds ratio (OR) by univariate logistic regression analysis (p = 0.001). Multivariate logistic regression analysis of the 3 variables identified ln VLF power and DFA (α1) as significant predictors for poor outcome (OR = 0.436, p = 0.006 and OR = 0.709, p = 0.024, respectively). The area under the receiver operating characteristic curve for ln VLF power and DFA (α1) in predicting poor outcome was 0.84 and 0.82, respectively. In addition, the minimum value of ln VLF power or DFA (α1) for the good outcome group predicted poor outcome with sensitivity = 61% and specificity = 100%. CONCLUSIONS: The present data indicate that HRV analysis could be useful for prognostication for comatose patients during hypothermic TTM.

DOI： 10.1186/s13054-019-2603-6

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W.B. Saunders  

Purpose: Disseminated intravascular coagulations (DIC), acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI) are major organ dysfunctions that occur in patients with sepsis. This study aimed to elucidate the impact of these organ dysfunctions on mortality in patients with severe sepsis. Material and methods: A prospective observational study was performed in 10 ICUs to obtain data from patients with severe sepsis. Multivariate analyses to examine in-hospital mortality were performed. Results: Data of 573 patients were analyzed. In-hospital mortality rate was 19.4% (111/573). The incidences of DIC, ARDS, and AKI were 58.4%, 18.7%, and 41.7%, while the associated mortality rates were 28.9%, 36.4%, and 31.8%, respectively. In multiple regression model, DIC (odds ratio 2.71, 95% confidence interval [CI] 1.45–5.27) and AKI stage 3 (odds ratio 1.98, 95% CI 1.07–3.63) were significantly associated with higher in-hospital all-cause mortality. DIC (hazard ratio 2.58, 95% CI 1.53–4.55) and AKI stage 3 (hazard ratio 1.73, 95% CI 1.07–2.80) were also significantly associated with longer survival durations. However, severe ARDS was not associated with these outcomes. Conclusions: DIC and AKI are frequent complications in patients with severe sepsis. In this study, DIC, and AKI stage 3 were independent risk factors of in-hospital mortality.

DOI： 10.1016/j.jcrc.2018.03.011

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Language：Japanese   Publisher：(株)日本メディカルセンター  

症例は66歳男性で、50歳頃より慢性腎臓病、高血圧症、メタボリック症候群を指摘され、二次性副甲状腺機能亢進症と尿毒症に対し炭酸カルシウム、球形吸着炭を開始した。慢性の便秘があり、腎機能低下で血液透析導入となったが、第4病日より腹部膨満感増強、腹痛が生じた。画像所見で横隔膜挙上、S状結腸から口側の腸管拡張を認め、血圧および動脈血酸素飽和度低下より大腸イレウス、ショックと判断した。腹部は膨隆し続け、膀胱内圧は21mmHgと上昇し、腹部コンパートメント症候群と診断した。下部消化管内視鏡でS状結腸内は球形吸着炭を混じた便塊で満たされ、腸管粘膜は虚血状態にあった。経肛門的に結腸閉鎖を解除できず、緊急開腹術を施行した。開腹直後より呼吸不全は改善し、血圧上昇、自尿流出を認めた。小腸部分切除の後、敗血症合併に対する持続的血液濾過透析と直接血液灌流法を行い、腎機能は改善して第62病日に退院した。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Opioid-induced spastic paraplegia after transient spinal cord ischemia during aortic surgery has been reported. Opioids modulate neurotransmission through mu (mu) opioid receptors (MORs) in the spinal ventral horn. However, their effects during ischemic insult are not understood.
The effects of the selective mu agonist [d-Ala(2),-N-Me-Phe(4), Gly(5)-ol]enkephalin (DAMGO) on ischemia-induced agonal currents were examined in the spinal lamina IX neurons of neonatal rats by using the whole-cell patch-clamp technique. Ischemia was simulated in vitro by oxygen/glucose deprivation.
DAMGO (1 mu M) produced outward currents in similar to 60 % of spinal lamina IX neurons at a holding potential of -70 mV. Superfusion with ischemia-simulating medium elicited an agonal current. The latency was 457 +/- A 18 s. Despite its neuromodulatory effects, DAMGO did not significantly change the latencies of the agonal currents with (440 +/- A 23 s) or without (454 +/- A 33 s) DAMGO-induced currents.
Activation of MORs does not influence ongoing ischemia-induced neuronal death. Our findings indicate that MOR agonist administration should be suitable as an anesthetic during aortic surgery.

DOI： 10.1007/s00540-014-1829-3

Web of Science

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.ccm.0000439818.36331.58

Web of Science

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Language：Japanese   Publisher：真興交易(株)医書出版部  

橈骨動脈カニューレの開存性を維持することは重要であるが、ドレッシング材の添付文書(conventional method)に従い固定した場合でも、カニューレの閉塞や圧波形の描出不良をしばしば経験する。この問題を改善するため、新しい固定法(pillow method)を考案した。今回、対象症例102例をランダムにconventional methodとpillow methodに割り当てpillow methodの有効性を検討した。その結果、pillow methodによる固定は動脈カニューレの開存を良好に維持することができ、より細いカニューレでも安定した動脈圧モニタリングが行えることが示唆された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND: Opioids inhibit excitatory neurotransmission and produce antinociception through mu opioid receptors (MORs). Although MORs are expressed in the spinal ventral horn, their functions and effects are largely unknown. Therefore, we examined the neuromodulatory effects of mu opioids in spinal lamina IX neurons at the cellular level.
METHODS: The effects of the selective mu agonist [D-Ala(2),-N-Me-Phe(4), Gly(5)-ol]Jenkephalin (DAMGO) on synaptic transmission were examined in spinal lamina IX neurons of neonatal rats using the whole-cell patch-clamp technique.
RESULTS: DAMGO produced outward currents in 56% of the lamina IX neurons recorded, with a 50% effective concentration of 0.1 mu M. Analysis of the current-voltage relationship revealed a reversal potential of approximately -86 mV. These currents were not blocked by tetrodotoxin but were inhibited by Ba2+ or a selective mu antagonist. Moreover, the currents were suppressed by the addition of Cs+ and tetraethylammonium or guanosine 5'-[beta-thi]diphosphate trilithium salt to the pipette solution. In addition, DAMGO decreased the frequency of spontaneous excitatory and inhibitory postsynaptic currents, and these effects were unaltered by treatment with tetrodotoxin.
CONCLUSION: Our results suggest that DAMGO hyperpolarizes spinal lamina IX neurons by G protein-mediated activation of K+ channels after activation of MORs. Furthermore, activation of MORs on presynaptic terminals reduces both excitatory and inhibitory transmitter release. Although traditionally opioids are not thought to affect motor function, the present study documents neuromodulatory effects of mu opioids in spinal lamina IX neurons, suggesting that MORs can influence motor activity. (Anesth Analg 2012;115:703-12)

DOI： 10.1213/ANE.0b013e318259393d

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Language：Japanese   Publisher：克誠堂出版(株)  

症例1は14歳男性で、仙骨部の巨細胞腫に対し経カテーテル動脈塞栓術(TAE)を2回行ったが縮小せず、摘出手術となった。腫瘍は仙骨内を占拠し、一部脊柱管内に進展していた。麻酔導入後、出血量制御のため右大腿動脈よりシースを挿入し、大動脈遮断バルーンカテーテル(AOBC)の先端を第2〜3腰椎間に留置した。腫瘍操作直前にバルーンを膨らませ、血栓予防のためヘパリンを静注した。操作が脊柱管に及んだ際に硬膜外静脈叢からの出血が生じたが、閉鎖時間55分、総出血量1390mlで手術を終了した。残存腫瘍に対する再手術も同様に行った。症例2は43歳男性で、仙骨部の巨細胞腫に対しTAEを6回行ったが疼痛が増強し、摘出術を施行した。症例1と同様にAOBCの留置と操作を行ったが、腫瘍切除に伴って比較的大量に出血し、大動脈閉鎖時間50分、総出血量3705mlであった。手術5時間後に神経圧迫症状が出現し血腫除去・止血術を要したが、症状は軽快し退院に至った。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: The minimum alveolar concentration is determined in the spinal cord rather than in the brain. Xenon inhibits glutamatergic excitatory synaptic transmission in the dorsal horn neurons. However, its actions in the ventral horn neurons have not been investigated.
Methods: The effects of 50 or 75% xenon on excitatory and inhibitory synaptic transmission were examined in the spinal lamina IX neurons of neonatal rats by using a whole cell patch clamp technique.
Results: Fifty percent xenon inhibited the alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid-induced currents (amplitudes = 72 +/- 9% and integrated area = 73 +/- 13% of the control values), and alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid receptor-mediated electrically evoked excitatory postsynaptic currents (amplitudes = 69 +/- 13% of the control values). Seventy-five percent xenon similarly inhibited alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid-induced currents. However, xenon had no effect on the N-methyl-D-aspartate-induced currents or N-methyl-D-aspartate receptor-mediated electrically evoked excitatory postsynaptic currents. Xenon decreased the amplitude, but not the frequency, of miniature excitatory postsynaptic currents. There were no discernible effects on the currents induced by gamma-aminobutyric acid or glycine or on miniature inhibitory postsynaptic currents.
Conclusions: Xenon inhibits alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid receptor-mediated glutamatergic excitatory transmission in the spinal lamina IX neurons via a postsynaptic mechanism. In contrast, there are no substantial effects on N-methyl-D-aspartate receptor-mediated or inhibitory synaptic transmission. The suppressive effects on excitatory synaptic transmission in the ventral horn neurons partly account for the mechanism behind xenon's ability to produce immobility in response to noxious stimuli and to determine the minimum alveolar concentration.

DOI： 10.1097/ALN.0b013e31825037a1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/ALN.0b013e31823cfaad

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Language：Japanese   Publisher：克誠堂出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J01397&link_issn=&doc_id=20110513160006&doc_link_id=%2Fad3msuie%2F2011%2F006005%2F008%2F0582-0589%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2011%2F006005%2F008%2F0582-0589%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

To clarify the vulnerability of spinal motoneurons to excitotoxicity, we analyzed the agonal current induced by experimental ischemia in ventral lamina IX neurons of spinal cord slices from neonatal rats by using whole-cell patch-clamp. Ischemia was simulated in vitro by oxygen/glucose deprivation. Super-fusion with ischemia-simulating medium elicited an agonal inward current, which was initially slow and then became rapid. We compared 8-, 9-, 10-, 11-, and 12-day postnatal rats and found age-dependent shortening of the latency of the rapid inward current. Furthermore, the membrane capacitance (Cm) and resting membrane potential (RMP) of the lamina IX neurons demonstrated significant negative correlations with the latency of the rapid inward current. Logistic regression analysis showed that postnatal age, Cm, and RMP were independent contributing factors to ischemic vulnerability. These results suggest that not only cell volume and ionic balance but also early postnatal maturation of the intracellular environment is vital for developing vulnerability to excitotoxicity. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2011.03.003

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Language：Japanese   Publisher：克誠堂出版(株)  

47歳女。7年前両側特発性乳び胸と診断された。次第に呼吸状態悪化のため、7ヶ月前胸管結紮術を施行し、術後肺炎のため約1ヵ月人工呼吸管理を要した。3ヵ月前に難治性の膿胸に対し右胸腔開窓術を施行し、夜間の非侵襲的陽圧換気(NPPV)および労作時酸素吸入を要する状態となったが、膿胸は改善し右胸郭形成術を予定した。Hugh-Jones分類IV度で、胸部X線で左側に若干の胸水貯留と下肺野浸潤影を認めた。著しい肺機能低下のため胸部硬膜外麻酔とし、硬膜外カテーテルよりメピバカインとロピバカインの等量混合液を投与した。SpO2低下のため鼻マスクによるNPPV導入し呼吸困難は消失した。局所麻酔薬投与から15分後にT1-12の冷覚消失を確認して手術を開始した。鎮静にプロポフォールを投与し、血圧低下は輸液負荷とエフェドリン投与で対処した。手術は肋骨部分切除、肋間筋を含む周囲軟部組織の胸腔内充填を行った。閉胸時に軽度の疼痛を訴え、同じ局所麻酔薬混合液を追加投与し自発呼吸を維持して手術を遂行した。NPPV中止で酸素飽和度低下もなく、術後鎮痛にロピバカインを3日間持続硬膜外投与した。呼吸状態も良好に経過して退院した。

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Language：Japanese   Publisher：真興交易(株)医書出版部  

虚血性神経細胞障害の主要な機序としてグルタミン酸-Ca2+負荷による興奮性神経細胞死が挙げられる。ケタミンはグルタミン酸のNMDA受容体に対する作用を拮抗するため、興奮性神経細胞死の経路を遮断して、神経細胞を虚血から保護すると考えられてきた。さらに抗炎症作用やアポトーシス抑制、神経再生効果が保護作用に寄与するとも報告されており、実際、動物実験では虚血負荷による脳梗塞の範囲を縮小させる効果が認められている。しかし、臨床においては明らかな神経細胞保護作用が証明されていない。今後は最も有効な投与量や投与時期を詳細に検討する必要がある。(著者抄録)

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Language：Japanese   Publisher：克誠堂出版(株)  

小児先天性心疾患手術患者96例において、頸部エコーガイド下に内頸静脈を穿刺し、セルジンガー法でガイドワイヤー留置までの穿刺回数と所要時間、内頸静脈横径の左右差、およびカテーテル留置不成功について検討した。91例でカテーテル留置に成功し、全体の成功率は95.8%であった。不成功の5例はいずれも年齢が1歳以下で、この月齢区分の成功率は76.9%であった。1回目の穿刺でのガイドワイヤー留置の成功率は55.2%、2回目での成功率は18.8%、3回目での成功率は7.6%、4回目での成功率は5.5%、5回目での成功率は2.1%で、10例は7回以上要した。左右の内頸静脈横径を比較すると、40例で右に比べ左が大きく、このうちの7例で左内頸静脈から穿刺を行った。また、不成功3例は左右の横径とも5mm未満であった。なお、動脈穿刺症例はなかった。

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No postoperative paraplegia occurred in a patient whose leg myogenic motor evoked potentials (mMEPs) disappeared during thoracoabdominal aortic aneurysm repair. A 69-year-old man underwent resection and repair of a type III (Crawford classification) thoracoabdominal aneurysm. An epidural catheter was placed into the epidural space for epidural cooling, and a Swan-Ganz catheter was placed into the subarachnoid space for cerebrospinal fluid (CSF) drainage. Continuous CSF pressure and temperature measurement was carried out the day before surgery. The mMEPs gradually disappeared 10 min after proximal double aortic clamping and complete aortic transection. Selective perfusion of intercostal arteries was started about 20 min after the loss of the mMEPs, but the mMEPs were not restored. Possibly, spinal cord hyperemia, induced by selective perfusion of the intercostal vessels, narrowed the subarachnoid space so that CSF could not be satisfactorily drained during surgery. The spinal cord hyperemia may have decreased spinal function and suppressed the leg mMEPs. The persistence of the loss of mMEPs was undeniably due to the influence of the anesthetic agent or a perfusion disorder in the lower-extremity muscles. Of note, moderate spinal cord hypothermia and postoperative CSF drainage probably resulted in improved lower-limb motor function. © JSA 2006.

DOI： 10.1007/s00540-006-0439-0

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Language：Japanese   Publisher：新潟市民病院  

31歳男性。患者は14歳時よりネフローゼ症候群でプレドニゾロン内服中であった。今回、四肢末梢に浮腫が出現し、まず通院中の病院へ入院となった。しかし、ステロイドパルス療法後、プレドニゾロン内服中に腹痛が出現し、造影CTで上腸間膜動脈閉塞症が疑われ、紹介転院となった。所見では腹部は軽度膨隆し、全体に著明な圧痛と筋性防御を認めた。緊急開腹手術を行ったところ、上腸間膜動脈より1cm大の塞栓子が摘出され、血流改善で良好な拍動を認めた。だが、回結腸動脈の拍動再開がなく、同動脈より塞栓子を摘出した。その結果、小腸・大腸の色調が回復し腸管切除を回避できた。術中の超音波検査では胸部下行大動脈内に浮遊する物体を認め、造影CTで左鎖骨下動脈分岐直後に2〜3cm大の腫瘤が認められた。ヘパリン持続静注とプロスタグランジンE1併用により、経過は良好となり、腎膠原病科に転科となった。

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Language：Japanese   Publisher：東北救急医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：新潟大学  

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Other Link： http://search.jamas.or.jp/link/ui/2007062325

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Other Link： http://search.jamas.or.jp/link/ui/2007062328

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Other Link： http://search.jamas.or.jp/link/ui/2007062311

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Other Link： http://search.jamas.or.jp/link/ui/2007062310

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Other Link： http://search.jamas.or.jp/link/ui/2006148624

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Other Link： http://search.jamas.or.jp/link/ui/2006148628

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Other Link： http://search.jamas.or.jp/link/ui/2006148615

Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)診断と治療社  

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Language：Japanese   Presentation type：Oral presentation (general)  

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