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In this study, a murine sepsis model was developed using the cecum ligation and puncture (CLP) technique. The expression of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β) in the brain increased 6 h after CLP but decreased 24 h later when elevated endogenous dopamine levels in the brain were sustained. Methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride reduced dopamine levels in the striatum and increased mortality in septic mice. Dopamine D1-like receptors were significantly expressed in the brain, but not in the lungs. Intraperitoneally administered SKF-81297 (SKF), a blood-brain barrier-permeable D1-like receptor agonist, prevented CLP-induced death of septic mice with ameliorated acute lung injury and cognitive dysfunction and suppressed TNF-α and IL-1β expression. The D1-like receptor antagonist SCH-23390 abolished the anti-inflammatory effects of SKF. These data suggest that D1-like receptor-mediated signals in the brain prevent CLP-induced inflammation in both the brain and the periphery.

DOI： 10.1016/j.isci.2024.109587

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BACKGROUND: Complete mesocolic excision (CME) and central vascular detachment are very important procedures in surgery for colorectal cancer. Preoperative and intraoperative assessments of the anatomy of major colorectal vessels are necessary to avoid massive bleeding, especially in endoscopic surgery. A case with a rare anomaly in which the middle colic artery (MCA) and ileocolic artery (ICA) had a common trunk is reported. CASE PRESENTATION: The patient was a 73-year-old woman diagnosed with ascending colon cancer on colonoscopy. Preoperative abdominal contrast-enhanced computed tomography confirmed that the MCA and ICA had a common trunk. She underwent laparoscopic ileocecal resection for the ascending colon cancer with D3 lymph node dissection. Intraoperative indocyanine green fluorescence imaging was conducted. After confirming vessel bifurcation, the ICA was dissected at the distal end of the MCA bifurcation. The patient has been followed as an outpatient, with no signs of recurrence as of 2 years postoperatively. CONCLUSION: A case of an ascending colon cancer with a unique vascular bifurcation pattern was presented. Preoperative and intraoperative evaluations of the major colorectal vessels are very important for preventing perioperative and postoperative complications.

DOI： 10.1186/s40792-024-01886-x

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To investigate dysphagia after extubation in patients with severe coronavirus disease 2019 (COVID-19). We retrospectively examined patients with severe COVID-19 treated in our hospital between August 2021 and March 2022. Feeding outcomes were categorized into two groups-(1) total oral intake, and (2) difficulty in oral intake. To assess the feeding outcome, we used modified water-swallowing test (MWST) for all patients. However, in cases where aspiration or recurrent laryngeal nerve palsy was suspected, we conducted the fiberoptic endoscopic evaluation of swallowing after MWST. Patient data were collected from medical records. Forty-six patients with severe COVID-19 were included. Among the 46 patients, 14 (30.4%) experienced difficulties with oral intake. Older age, longer length of hospitalization, duration of mechanical ventilation, tracheostomy, diabetes, and higher serum levels of C-reactive protein (CRP) and procalcitonin (PCT) at the time of intubation were associated with difficulty in oral intake. The rate of difficulty with oral intake in patients with severe COVID-19 was 30.4%, which is not as high as reported in previous studies. Older age, longer duration of mechanical ventilation, tracheostomy, diabetes, and higher levels of CRP and PCT were associated with the prevalence of oral intake difficulty, suggesting that early attention should be paid to high-risk patients who have preexisting deterioration of swallowing function due to aging and comorbidities, or who have prolonged intubation or tracheostomy to prevent aspiration pneumonia.

DOI： 10.1038/s41598-024-57508-x

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DOI： 10.23922/jarc.2022-077

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DOI： 10.3390/jcm12134386

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BACKGROUND: Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. METHODS: This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. RESULTS: The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). CONCLUSIONS: This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.

DOI： 10.1186/s12957-023-02919-9

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RATIONALE: Venovenous extracorporeal membrane oxygenation (ECMO) is recommended for the treatment of critically ill patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19). However, ECMO management can cause both bleeding and thrombotic complications. There are insufficient coagulofibrinolytic data for appropriate ECMO management in patients with COVID-19. PATIENT CONCERNS: A 48-year-old man with severe COVID-19-acute respiratory distress syndrome underwent long-term venovenous ECMO management for 48 days. Refractory oronasal bleeding developed on day 13, so the administration of unfractionated heparin was ceased for 29 days. DIAGNOSIS: The patient showed dynamic coagulofibrinolytic responses associated with ECMO management, as shown by fibrin/fibrinogen degradation products, soluble fibrin, thrombin-antithrombin complex, and plasmin-α2-plasmin inhibitor complex elevations, suggesting the development of ECMO-induced coagulopathy. INTERVENTIONS: We assessed coagulofibrinolytic markers to decide the appropriate timing for controlling excessive activation of coagulation by exchanging ECMO circuits. Moreover, viscoelastic hemostatic assays were used for adequate transfusion of blood products. OUTCOMES: Safe long-term ECMO management was completed, which was withdrawn on day 48. The patient was weaned off mechanical ventilation on day 57 and was transferred to another hospital for rehabilitation. LESSONS: Monitoring the coagulofibrinolytic status using markers and viscoelastic hemostatic assays may be effective for safe long-term ECMO management even without anticoagulant therapy.

DOI： 10.1097/MD.0000000000032817

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BACKGROUND: Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients. MATERIALS AND METHODS: Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation. RESULTS: Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04). CONCLUSIONS: These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.

DOI： 10.3389/fsurg.2023.1082699

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OBJECTIVES: Laryngeal complications have been reported after endotracheal intubation and prone positioning in patients with critical coronavirus disease 2019 (COVID-19), but their association is unclear. In this study, we investigated the rate of laryngeal complications in patients with COVID-19 compared to an alternative condition (control group). METHODS: We retrospectively analyzed the data of 40 patients who underwent endotracheal intubation for either COVID-19 or an alternative condition (control group). Data on age, sex, body mass index (BMI), cardiovascular disease (CVD) risk factors, use of prone therapy, duration of endotracheal intubation, and duration from extubation/tracheostomy to laryngeal evaluation were collected from medical records. RESULTS: There were no significant differences in BMI, frequency of CVD risk factors, duration of endotracheal intubation, or duration from extubation/tracheostomy to laryngeal evaluation between the two groups. In the COVID-19 group, all patients adopted the prone position. In comparison, only one patient in the control group adopted the prone position. Significant differences were observed between the two groups regarding the incidence of vocal fold immobility and laryngeal granuloma. CONCLUSION: Laryngeal complications were more common in the COVID-19 group than in the control group. Prone positioning may be a risk factor for these complications. LEVEL OF EVIDENCE: 4.

DOI： 10.1002/lio2.874

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PURPOSE: During the perioperative period, coagulofibrinolytic activation occurs, which occasionally results in thromboembolic complications. However, natural perioperative coagulofibrinolytic responses have not been well investigated. The present study examined perioperative coagulofibrinolytic changes and their association with the development of venous thromboembolism (VTE). METHODS: We retrospectively analyzed the changes in coagulofibrinolytic markers for 7 days in 70 patients undergoing elective colorectal surgery. To explore the natural coagulofibrinolytic response, we investigated patients not undergoing perioperative chemical thromboprophylaxis. RESULTS: Coagulation activation occurred from just after surgery to postoperative day (POD) 1, followed by a gradual decrease, but persisted to even POD 7. Fibrinolytic activity showed a tri-phasic response: activation, shutdown and reactivation. Consequently, fibrin/fibrinogen degradation product (FDP) and D-dimer levels continued to increase until POD 7. The development of deep vein thrombosis (DVT) was observed in 11 patients (15.7%). Postoperative sustained hyper-coagulation [soluble fibrin (SF) or thrombin-antithrombin complex (TAT) values on POD 7 > their normal limits] was significantly associated with the development of DVT (SF, p < 0.001; TAT, p = 0.001). CONCLUSION: We found initial coagulation activation and a tri-phasic response of fibrinolytic activity after colorectal surgery. Thus, physicians need to pay attention to these responses when attempting to prevent or treat VTE.

DOI： 10.1007/s00595-021-02393-4

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BACKGROUND: The increasing age of patients with severe motor and intellectual disabilities (SMID) has become a serious concern. Few studies have investigated tumor treatment in this population. METHODS: Tumor treatments for 12 SMID patients were examined. RESULTS: Blood tests and ultrasonography were useful for screening. With regard to treatment, surgery for SMID patients was performed in the same manner as for patients without SMID, and the results were generally satisfactory, without major complications. Typically, cancer was diagnosed at an advanced stage, and many metachronous double cancers were observed. CONCLUSIONS: Treatment yielded satisfactory results for patients with SMID and their families. Future studies should examine the clinical significance of screening and tumor operative method for patients with SMID.

DOI： 10.1272/jnms.JNMS.2022_89-217

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Indocyanine green (ICG) fluorescence angiography has recently been reported useful as a method for predicting intestinal blood flow and may reduce anastomotic leakage. However, the quantification method for ICG fluorescence angiography has not been established. We usually measure the tissue oxygen saturation (StO2 ) in the intestinal tract via near-infrared spectroscopy, as it is able to measure the oxygen concentration accurately and immediately shows objective data. In this study, we propose that the time to reach the anastomotic site after intravenous ICG injection is an effective parameter for quantifying ICG fluorescence angiography from the comparison to the data of StO2 in the intestinal tract.

DOI： 10.1111/ases.13002

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BACKGROUND: We conducted a prospective observational study for investigating the changes in the 13th member of a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) and its association with the coagulofibrinolytic response in adult trauma patients. METHODS: In 39 trauma patients hospitalized for longer than 7 days, time-course changes in biomarkers of coagulofibrinolysis and systemic inflammation along with ADAMTS13 activity were examined. The patients were stratified into three groups based on ADAMTS13 activities on admission (day 0): normal group (≥70%), mildly decreased group (≥50 and < 70%) and moderately decreased group (< 50%). RESULTS: Among 39 patients with a median Injury Severity Score (ISS) of 20, 11 patients developed disseminated intravascular coagulation (DIC) and 16 patients required transfusion. Six of 39 patients (15.4%) showed moderate decreased ADAMTS13 activity to < 50%, and 20 patients (51.3%) showed mild drops (≥50 and < 70%). These changes in ADAMTS13 activity on day 0 were significantly correlated with changes in IL-6 and other coagulofibrinolytic markers such as platelet counts, prothrombin time and fibrin/fibrinogen degradation product (FDP). Antithrombin activity (AT) and serum albumin (Alb) level showed significantly positive linear correlations with ADAMTS13 activity (AT: r = 0.513, p < 0.001; Alb: r = 0.647, p < 0.001). Simple logistic regression analyses showed that ADAMTS13 activity, if less than 50%, was significantly correlated with the development of DIC (OR 7.499, 95%CI 1.121-49.242, p = 0.038) and the need for transfusion of fresh frozen plasma (OR 9.000, 95%CI 1.327-61.025, p = 0.028). CONCLUSIONS: ADAMTS13 activity decreased even in the early phase of trauma, which was complicated by coagulopathy and systemic inflammation. Furthermore, the decrease in ADAMTS13 activity was correlated with DIC and plasma transfusion.

DOI： 10.1186/s12959-021-00270-1

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INTRODUCTION: It is difficult to use a traction table during surgery for an ipsilateral displaced femoral trochanteric fracture following above-the-knee amputation. However, there are few reports regarding such cases. We describe the simple method we used for positioning the traction table and reducing fracture site during fixation surgery for a displaced femoral trochanteric fracture in this patient following above-the-knee amputation. CASE REPORT: An 80-year-old man was injured in a head-on collision with an oncoming vehicle. We diagnosed him with traumatic gastric perforation, multiple right lower leg fractures, and right lower leg severe crush wound. We performed right above-the-knee amputation and laparoscopic gastrorrhaphy for lifesaving purposes. Thereafter we performed internal fixation for the right femoral trochanteric fracture on the 5th day after the injury. In that operation, we first inserted a 2.4 mm Kirschner wire under fluoroscopic guidance 3 cm proximal to the femoral cut end and attached a horseshoe and traction rope to it. Then, we tightened the rope to the foot piece of the traction table and secured it. Although shortening of the bone fracture was reduced by traction, rotation control was impossible; therefore, the horseshoe was manually controlled through clean sheets during surgery to reduce rotational displacement. We performed internal fixation surgery using a trochanteric femoral nail in the usual manner. CONCLUSION: In the osteosynthesis surgery of displaced femoral trochanteric fractures following above-the-knee amputation, the method of inserting the Kirschner wire at the distal end of the patient's femur and pulling it through the rope enables surgeons to reduce fracture shortening. Reduction of rotational displacement was possible by controlling the horseshoe by hand. In this way, intramedullary nail fixation could be performed without trouble under fluoroscopic guidance.

DOI： 10.13107/jocr.2020.v10.i07.1926

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Sepsis is a leading cause of mortality in intensive care units due to multi-organ failure caused by dysregulated immune reactions. In this study, kinetic changes in the immune system were analyzed for 72 h in cecal ligation and puncture (CLP)-induced septic mice while preventing animal death by keeping body temperature. Increase of myeloid cells and decrease of B cells in circulation at 6 h after CLP were markedly observed. At the same time point, interleukin (IL)-10 expressing CD5+ regulatory B cells (Bregs) appeared. IL-10 and programmed death-ligand 1 (PD-L1) mRNA as well as IL-1β, IL-6 and interferon γ (IFNγ) mRNA was increased in the spleen at 6 h. A gradual decrease in Bcl-2 and abrupt increase of Bim expression in the spleen at the late phase were also found. These results showed that B lymphocytopenia with the appearance of Bregs is the earliest event, likely leading to immunoparalysis in sepsis.

DOI： 10.1016/j.bbrc.2019.12.041

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We analyzed the Nationwide Registry database on sepsis to examine the effects of an anticoagulation therapy, especially with rh-thrombomodulin (rh-TM) and/or antithrombin (AT) III agent, in septic disseminated intravascular coagulation (DIC) patients. In 3,193 patients enrolled after the exclusion, we investigated the association with in-hospital mortality using Cox proportional hazards models. DIC was diagnosed using the Japanese Association of Acute Medicine (JAAM) and the International Society of Thrombosis and Hemostasis (ISTH) criteria. To analyze the separate treatment effects of rh-TM and/or AT III, we excluded the data of 345 patients treated with all available anticoagulation treatments (rh-TM and/or AT III plus "other anticoagulants": protease inhibitors and heparin/heparinoids). The DIC criterion populations were as follows: JAAM DICs, n = 1,891 and ISTH DICs (overt DIC), n = 1,002. Septic DIC patients were divided into 3 groups: Group 1, no anticoagulation therapy for DIC; Group 2, received rh-TM and/or AT III; and Group 3, received only "other anticoagulants." In JAAM DIC patients, Group 2 did not show an independent association with a reduced risk of in-hospital mortality (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.73-1.01]) as compared with Group 1. However, in ISTH DIC patients, Group 2 showed an inverse association with the risk of in-hospital mortality (HR 0.74; 95% CI: 0.60-0.92) as compared with Group 1, but the same was not true for Group 3 (HR 0.73; 95% CI: 0.47-1.14). The present results support previous findings of the beneficial effects of anticoagulation therapies in septic DIC, also expands the importance of using rh-TM and/or AT agent for septic overt DIC.

DOI： 10.1097/SHK.0000000000001230

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BACKGROUND: Heat stroke induces coagulofibrinolytic activation, which leads to life-threatening disseminated intravascular coagulation (DIC). However, treatment strategies for DIC in heat stroke have not yet been established, and also, the time course changes in coagulofibrinolytic markers have not been thoroughly evaluated. We report a severe heat stroke case with DIC who was eventually saved by anti-DIC treatments in accordance with changes in coagulofibrinolytic markers. CASE PRESENTATION: A 45-year-old man was found unconscious outside, and his body temperature was elevated to 41.9 °C. For heat stroke, we performed an immediate tracheal intubation under the general anesthesia along with cooling by iced gastric lavage, cold fluid administration, and an intravascular cooling using Thermogard™. About 4 h after admission, his core temperature fell to 37 °C. We assessed coagulofibrinolytic biomarkers and treated in accordance with changes in these parameters. This case exhibited a biphasic change varying from an enhanced to a suppressed fibrinolytic type of DIC depending on the relative balance between fibrinolytic activation and the level of plasminogen activator inhibitor-1 (PAI-1). In the early phase with consumption coagulopathy and enhanced fibrinolysis, we transfused a large amount of fresh frozen plasma (FFP) and platelets with tranexamic acid, an antifibrinolytic agent, possibly providing relief for the bleeding tendency. Anticoagulant therapy using recombinant human thrombomodulin-α (rh-TM-α) and antithrombin III (ATIII) concentrate was especially effective for DIC with a suppressed fibrinolytic phenotype in the later phase, after which organ failure that included severe hepatic failure was remarkably improved. CONCLUSION: The present case may indicate the clinical significance of monitoring coagulifibrinolytic changes and the potential benefits of anticoagulants for heat stroke-induced DIC.

DOI： 10.1186/s40560-019-0359-3

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PURPOSE: Screw fixation for unstable pelvic ring fractures is generally performed using the C-arm. However, some studies reported erroneous piercing with screws, nerve injuries, and vessel injuries. Recent studies have reported the efficacy of screw fixations using navigation systems. The purpose of this retrospective study was to investigate the accuracy of screw fixation using the O-arm® imaging system and StealthStation® navigation system for unstable pelvic ring fractures. METHODS: The participants were 10 patients with unstable pelvic ring fractures, who underwent screw fixations using the O-arm StealthStation navigation system (nine cases with iliosacral screw and one case with lateral compression screw). We investigated operation duration, bleeding during operation, the presence of complications during operation, and the presence of cortical bone perforation by the screws based on postoperative CT scan images. We also measured the difference in screw tip positions between intraoperative navigation screen shot images and postoperative CT scan images. RESULTS: The average operation duration was 71 min, average bleeding was 12 ml, and there were no nerve or vessel injuries during the operation. There was no cortical bone perforation by the screws. The average difference between intraoperative navigation images and postoperative CT images was 2.5 ± 0.9 mm, for all 18 screws used in this study. CONCLUSION: Our results suggest that the O-arm StealthStation navigation system provides accurate screw fixation for unstable pelvic ring fractures.

DOI： 10.1007/s00590-017-2075-9

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BACKGROUND: We conducted a prospective observational study for investigating coagulofibrinolytic changes and mechanisms of antithrombin (AT) alternations in trauma. METHODS: Trauma patients hospitalized for more than seven days were analyzed for coagulofibrinolytic biomarkers. The patients were stratified into two groups according to AT activity level on admission (day 0), comprising normal AT and low AT patients. RESULTS: Thirty-nine patients (median Injury Severity Score 20) exhibited initial coagulatory activation and triphasic fibrinolytic changes. AT activity did not show a negative linear correlation with levels of thrombin-antithrombin complex (TAT), a marker of coagulation activity and AT consumption, but was strongly correlated with levels of albumin (Alb), an index of vascular permeability, on day 0 (r = 0.702, p <  0.001). Furthermore, Alb was one of the independent predictors for AT on day 0. IL-6 on day 0 and thrombomodulin (TM) levels during the study period, reflecting systemic inflammation and endothelial cell injury, respectively, were significantly higher in the lower AT group (n = 10) than in the normal group (n = 29) (IL-6, p = 0.004; TM, p = 0.017). On days 2 and 4, TAT levels in the lower AT group were significantly higher than in the normal group. CONCLUSIONS: Trauma caused clear triphasic coagulofibrinolytic changes. Decreased AT in the later phase might lead to a prolonged hypercoagulation. AT reduction in the initial phase of trauma is strongly associated with extravascular leakage as suggested by the association of Alb depletion with IL-6 and TM elevation, but not with AT consumption.

DOI： 10.1186/s12959-018-0171-7

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Case: An increase in cerebrospinal fluid pressure (CSFP) is usually prominent in cryptococcal meningitis, which has a high mortality rate, so aggressive management to control CSFP is crucial. In this case, a 40-year-old-man survived cryptococcal meningitis treated with continuous spinal drainage under bispectral index (BIS) monitoring. He unexpectedly showed hypertension, went into a coma, and even loss his light reflexes due to CSFP elevation. His BIS values had abruptly dropped before developing these symptoms, but dramatically recovered after lumbar puncture drainage, suggesting that BIS monitoring could reflect cerebral function changes due to CSFP alternations. Outcome: Inducing continuous spinal drainage to control CSFP provided stable control of blood pressure and brain activity, which was continuously monitored by BIS, enabling us to provide prompt treatment. Conclusion: Cerebral depressions due to elevated CSFP may suddenly develop, so continuous spinal drainage is needed for preventing catastrophic events. Bispectral index could be useful for detecting early changes from CSFP elevation in meningitis cases with intracranial hypertension.

DOI： 10.1002/ams2.276

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BACKGROUND: Reports regarding arthroscopic fixation of the osteochondral fragments for elbow osteochondritis dissecans (OCD) are few. This study assessed the clinical outcomes of arthroscopic fixation of unstable osteochondral fragments by using absorbable pins over a postoperative period of at least 1 year. METHODS: The patients were 13 adolescent baseball players with a mean age of 14 years (range, 12-16 years) who underwent OCD of primary lesions at International Cartilage Repair Society grades III and IV. The patients were evaluated by using validated outcome measures at a mean follow-up period of 24 months (range, 12-50 months). RESULTS: The mean (standard deviation) score in the disability/symptom section of the Disabilities of the Arm, Shoulder, and Hand improved from 12.4 (6.0) before the surgery to 0.5 (1.2) after the surgery, and the sports section improved from 74.5 (25.4) to 1.4 (5.2). The mean (standard deviation) extension improved from -11° (10.8) to -2° (3.9; P < .001). The mean (SD) flexion improved from 129° (11.6) to 137° (5.6; P = .040). All patients were able to resume playing baseball, and 9 (69%) resumed playing at the same position as before their injuries. CONCLUSIONS: The clinical results of arthroscopic osteochondral fragment fixation in the teenaged baseball players with elbow OCD, albeit obtained over only a short period, were favorable. This arthroscopic treatment enables repair of lesions and is considered appropriate for unstable OCD during the adolescent growth spurt.

DOI： 10.1016/j.jse.2015.07.009

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CASE REPORT: A 43-year-old male was admitted to a regional hospital after being diagnosed with severe acute pancreatitis. The patient developed a pancreatic abscess with multiple organ failure. He was transferred to our hospital in critical condition. Computed tomography scans revealed enormous pancreatic abscesses expanding from the pancreatic body to the pelvic area. Pigtail catheters were inserted for percutaneous drainage. Even after the drainage, the abscesses did not improve. Percutaneous necrosectomy was performed using a resectoscope through a fistulous tract. After two necrosectomies, the CT scans showed remarkable decreases in the size of the cystic abscesses, and finally, no abscesses were detectable on the 117 th hospital day. CONCLUSION: We herein present the first description of a minimally invasive technique, using resectoscopy, for treating intractable pancreatic abscesses. Future studies are warranted to examine the efficacy and safety of this procedure for difficult cases, as presented in this report.

DOI： 10.1007/s00595-014-1063-5

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DOI： 10.1016/j.resuscitation.2015.04.033

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

2013年に日本国内において重症熱性血小板減少症候群(severe fever with thrombocytopenia syndrome:SFTS)の発生が確認されて以来、その発生報告は増えている。今回、急激な多臓器不全の進行から短期間で死亡に至った重症のSFTSの1例を経験したので、病理解剖結果を加え報告する。症例は85歳の女性で、山中での農作業の3日目に、嘔吐症状にて発症した。速やかに対症療法が開始されたが、全身状態は悪化した。併発した播種性血管内凝固症候群に対する抗凝固療法や、血球貪食症候群に対するステロイド投与を含め集中治療を行ったが、改善せず、受傷から12日目に死亡した。病理解剖では、リンパ節や肝臓などのリンパ球に高コピーのSFTSウイルスが認められ、重症度が高いことが示唆された。また、末梢血の異型リンパ球やリンパ節でみられた多数のリンパ球はB細胞リンパ球であり、重篤なSFTSの病勢との関連が示唆された。今後、さらなる症例集積による病態の解明が必要である。(著者抄録)

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：日本臨床外科学会  

症例は83歳,女性.歩行中に左側方より走行してきた250ccバイクと衝突した.搬入時,努力呼吸でフレイルチェストを伴う左第3〜11肋骨骨折,肺挫傷,血気胸などを認めた.人工呼吸管理による内固定を行うも,通常の圧設定では胸郭の動揺が遷延し,強い疼痛を伴った.人工呼吸器からの早期離脱と早期の疼痛改善を目的として,合併する腹部臓器損傷の安定を得た後の受傷5日目に肋骨観血的整復固定術を施行した.固定部位は最も動揺や疼痛の強く,換気に影響している骨折部を選定し,最小限とした.術後,胸郭の動揺や疼痛は軽快し,受傷9日目に人工呼吸器を離脱した.多発肋骨骨折に対する外固定の適応や時期,固定部位については多く議論されている.本症例は高齢であったが,有効で低侵襲な骨折固定部位の選定や早期に外固定により人工呼吸器離脱を図ることで,良好な経過を得たので報告する.(著者抄録)

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

A middle age man underwent immediate cardiopulmonary resuscitation (CPR) for ventricular fibrillation (VF) occurred in an ambulance. After arrival in a regional hospital, return of spontaneous circulation (ROSC) was achieved 82 minutes after the collapse. He was in coma even three hours after ROSC. So, he was transferred to our university hospital to receive therapeutic hypothermia (TH). An initial bispectral index (BIS) value suggested a favorable outcome. Thus we decided to aggressive therapies including TH of 34°C for 48 hours, followed by a very slow rewarming at the rate of 1°C per day. Eventually he was discharged from the hospital with good neurological state. This case shows us two points: 1) the importance of the chain of survival: CPR done immediately after the collapse, persistent CPR for refractory VF, followed by coronary interventions after ROSC, continuing care to the university hospital, 2) decision making for TH using BIS monitoring.

DOI： 10.1089/ther.2014.0021

PubMed

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

A 37-year-old man was admitted to our hospital with acute phenobarbital poisoning. On arrival, he was in deep coma with respiro-circulatory depressions. The serum concentration of the agent was elevated to 149.04 μg/mL which was consistent with a lethal concentration level. He underwent a gastric lavage, administration of activated charcoal, urinary alkalinazation and bowel irrigation. Respiro-circulatory status was recovered rapidly, while the serum concentration of phenobarbital did not decrease smoothly. Although the concentration of the agent decreased to 77.07 μg/mL that should be a comatose level, BIS values were gradually elevated, and then eventually the patient regained his consciousness. Because he was a chronic user of Vegetamin-A containing phenobarbital, the serum level might not have been correlated with symptoms. BIS values were highly reflective of the consciousness level, so it could be a useful indicator for predicting the consciousness levels of patients in deep coma with acute poisoning from hypnotic agents.

PubMed

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：日本臨床外科学会  

生来健康な39歳の男性が右中肺野の繰り返す肺炎に対する精査を目的に当科へ紹介があった.胸部MDCTでは上下葉区(S6)と底区域の間において,総肺底区気管支から分岐する区域枝レベルで途絶し拡張した気管支とその周囲の気腫状肺を認めた.本症例は右肺下葉気管支の分岐パターンは正常であったため,上枝下下葉枝(B*)が閉塞した先天性気管支拡張症と診断した.また,この症例はS*と底区域の間に,馬渡らがPosterior Pulmonary Lobe(PPL)と報告している深い異常分葉を伴っていた.この症例に対して胸腔鏡補助下にS6+S*区域切除術を施行した.今回われわれは,B*が閉鎖しさらに異常分葉を伴った非常に稀な先天性気管支閉鎖症を経験した.MDCTが診断とともに術式決定における詳細な解剖学的理解に有用であった.(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

69歳、男性。既往歴なし。仕事中に壁とトロッコに挟まれ受傷し、近医に搬送された。骨盤骨折が疑われ、当院に紹介された。来院時、意識清明であったが、ショック状態であった。急速輸液を行い、撮影した腹部造影CTで膀胱前腔に血腫、仙骨骨折、尿道損傷を認め、ただちに経カテーテル的動脈塞栓術を施行した。濃厚赤血球8単位、新鮮凍結血漿8単位の投与を行った。入院後に血液検査でDダイマーの上昇を認めたため、ヘパリンを開始した。入院10日目に施行した下肢静脈超音波検査で深部静脈血栓症を認めた。呼吸症状は認めなかったが、造影CTで肺動脈主幹部に巨大な血栓を認めたため、同日肺動脈血栓破砕術、下大静脈フィルター留置を施行した。骨盤骨折による出血性ショックの後に肺動脈主幹部の巨大血栓にもかかわらず、破砕術時以外には無症状で軽快退院した症例を報告する。(著者抄録)

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(一社)日本腹部救急医学会  

症例は,63歳の男性。突然の左下肢痛,脱力を主訴に近医を受診し,ガス壊疽の診断の下,当院紹介となった。来院時,全身状態は安定しており,腹部症状はなく,左大腿の腫脹,発赤,疼痛を認めた。血液検査では著明な炎症反応の上昇と,CTで下行結腸周囲の炎症性変化および後腹膜から左膝上部にかけての膿瘍形成とガス像がみられた。下行結腸での後腹膜穿通からの左大腿ガス壊疽と診断し,まず後腹膜から左大腿部の洗浄ドレナージ術を行った。続いて行った大腸内視鏡検査にて下行結腸癌を認め,待機的に腹腔鏡下に原発巣の根治手術を行った。大腿ガス壊疽の原因病態として消化管疾患も考慮する必要がある。ガス壊疽部の確実なドレナージで早期に全身状態の安定化を得られれば,待機的に低侵襲で根治性の高い手術治療を選択することが可能である。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

切除不能進行癌による腸閉塞に対する緩和手術として、腹腔鏡下ストーマ造設術症例を検討した。対象:2009〜2012年までの4年間に施行した腹腔鏡下ストーマ造設術24例を検討した。結果:手術時間の中央値は59分で、手術合併症としてはSSIがなく、DICが1例、AMIが1例であった。術後の減圧チューブ抜去率100%・点滴抜去率88%、食事再開率100%、退転院率83%、後治療施行率46%と良好であった。手術関連死(30日以内死亡)を2例(8%)に認めた。予後については3ヵ月生存率58%、1年生存率29%、MSTは約4ヵ月であった。術後に化学放射線治療などの後治療を施行し得た症例では、生存期間が有意に長くなった。開腹手術との比較では、腹腔鏡の群において手術時間が有意に短く、SSIが少なかった。考察:腹腔鏡下ストーマ造設術は、切除不能・進行癌に対する緩和的ストーマ造設術によい適応であると考える。(著者抄録)

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PubMed

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(一社)日本救急医学会  

飲食物による咽喉頭および食道熱傷は臨床上、しばしば経験されるが、その報告例は少ない。今回、我々は90℃の高温飲料の摂取後に緊急気道確保を要する咽喉頭熱傷および遅発性瘢痕狭窄を来した食道熱傷の1例を経験したので報告する。症例は28歳の男性。飲酒の席で約90℃のコーヒーを約200ml飲用し、呼吸苦・嚥下痛にて当院受診となった。来院時、上気道粘膜の腫脹が強く、喉頭ファイバーにて喉頭蓋および声帯の腫脹も認め、気道緊急の状態にあり、気管切開による緊急気道確保を行った。咽喉頭熱傷については、経時的に粘膜腫脹は軽快してきたものの喉頭蓋の腫脹が遷延し、容易に誤嚥する状況が続いた。喉頭蓋の腫脹改善とともに第39病日に気管切開チューブを抜去でき、その後も瘢痕形成などは来さなかった。食道熱傷について、受傷早期は食道穿孔等を来さずに経過したが、第25病日に吐血のため、上部消化管内視鏡検査をしたところ、下部食道を中心として食道全長に渡る粘膜の易出血性びらん、潰瘍所見を認めた。第40病日に再度上部消化管内視鏡検査を施行したところ、内視鏡通過は可能であったが、散在性に瘢痕狭窄所見を認めた。粘膜所見は治癒経過にあり、流動食より食事を開始し、第48病日の食道透視検査にて全体的に伸展不良を認めたが、普通食まで摂取可能となったため、第53病日に退院となった。しかしながら、その後も緩徐に食道狭窄は進行し、食道拡張術も奏功せず、第264病日に食道切除術施行となった。温熱熱傷においても、上気道閉塞および遷延する喉頭蓋腫脹に伴う嚥下障害に対する気道管理や、食道瘢痕狭窄に対する経時的な評価、治療が必要である。(著者抄録)

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(株)癌と化学療法社  

MRSA感染を伴う難治性深部手術部位感染に対し、リネゾリド投与が奏効した1例を経験したので報告する。症例は66歳、男性。進行接合部癌に対し術前化学療法を施行後、左開胸開腹胃全摘術を施行した。術後3日目に開胸創部に深部手術部位感染を併発し、培養検査にてMRSAが検出された。創部のデブリドメント、洗浄処置を続けたが排膿は継続し、術後10ヵ月後には肋骨が露出するようになった。術後11ヵ月後より抗MRSA薬のリネゾリドの経口投与を開始したところ、1週間でMRSAは陰性化し、1ヵ月後には創の治癒が得られた。外来患者で難治性のMRSA深部手術部位感染に対し、リネゾリド投与は有用な治療法と考えられた。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publisher：(地独)堺市立病院機構堺市立総合医療センター  

【はじめに】手術部位感染(SSI)は入院期間の延長や更なる合併症のリスクにもつながるため、SSIの低減は重要課題である。近年、抗菌作用をもつトリクロサンをコートした吸収糸が発売され、当院では2010年8月より開腹手術の体腔内縫合糸および筋膜閉鎖縫合糸を通常の吸収糸(Vicryl)から抗菌縫合糸(Vicryl Plus)へと変更した。【目的】胃癌手術において抗菌縫合糸の使用がSSIの発生予防に有用か否かを検証する。【対象と方法】通常の吸収糸を使用した2009年8月から2010年7月までの胃癌手術症例(Vicryl群)107例と抗菌縫合糸を使用した2010年8月から2011年7月までの胃癌手術症例(Vicryl Plus群)85例とで患者背景やSSI発生率を比較検討した。なお、皮膚切開法、抗菌剤投与、筋膜閉鎖法に関しては両群で差はなかった。【結果】臨床病理学的因子の性別、ASAスコア、BMI、進行度は両群で差はなく、手術因子の出血量、リンパ節郭清にも差はなかった。年齢とSSI risk index、手術時間に関しては、むしろVicryl Plus群で高かった。SSI発生率は、Vicryl群が13例(12.1%)で、Vicryl Plus群が6例(7.05%)であり、両群で統計学的な有意差は検出されなかった。ただし、深部切開創および体腔SSIの発生率に関してはVicryl群で12例(11.2%)、Vicryl Plus群で3例(3.5%)と、Vicryl Plus群で有意に深部・体腔SSIの発生が少なかった(p=0.048)。【まとめ】胃癌手術において、抗菌縫合糸の使用はSSI低減に有用である可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)総合医学社  

2017年時点の成人の心肺蘇生および心停止後の病態や管理についてupdateした。二次救命処置における高度な気道確保が、近い将来大幅な変更が加わる可能性がある。ECPR(extra-corporeal resuscitation)に関して、世界中でchallengingな試みがなされ、その適応基準も見直される可能性もある。一方、2015年ガイドラインで予後評価に否定されたBISモニターに、復権の兆しがある。心肺蘇生術の普及では、統計データから、統一かつ継続した教育が強調された。PCAR管理では、凝固系や免疫系の臓器障害との関連が明らかにされつつある。低体温療法に関して、持続時間を比較したRCTが報告され、持続時間では利点は検出できなかったが、5年前のRCTに比し方法や転帰の改善があり示唆に富んでおり、今後の展開が期待される。(著者抄録)

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：日本脳死・脳蘇生学会  

心停止後症候群(PCAS)における低体温療法に関する大規模無作為試験研究(TTM trials)を検証し、今後のPCASに対する低体温療法の展望を述べた。TTM trialsは研究限界の多いランダム化比較試験(RCT)であり、PCASに対する低体温療法を中止させるだけのevidence levelは有しておらず、むしろ、さらに厳密なRCTの必要性を示唆している。PCASに対するbundle careを適切に行うには、PCASの病態生理の理解と、特に低体温療法施行時の合併症対策が、神経学転帰改善のため重要と思われた。

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＜point＞体液移動の概念はStarlingの理論から変化してきている。アルブミンは膠質浸透圧の維持に有用である。現在のところ、蘇生輸液におけるアルブミン製剤の使用の有効性は示されていない。頭部外傷におけるアルブミン製剤の使用は死亡率を上げる可能性がある。病態に応じた輸液製剤の選択が必要である。(著者抄録)

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Language：Japanese   Publisher：(株)総合医学社  

<piont>Surviving Sepsis Campaign Guidelines 2012には、重症敗血症に合併するDIC(disseminated intravascular coagulation)治療の記載がありません。欧米ではその治療が行われておらず、死亡率は同程度の重症度で見ると、本邦に比し高値です。日本版敗血症診療ガイドラインでは、敗血症性DICに対する治療が盛り込まれています。本邦では、敗血症に凝固障害が合併すると多臓器不全率や死亡率が高まるとし、原病への治療とDIC治療が行われています。本邦での敗血症性DICの治療薬として、アンチトロンビン(antithrombin:AT)製剤とヒトリコンビナント・トロンボモジュリン(recombinant human thrombomodulin:rh-TM)製剤が主なものです。AT製剤の多施設前向きの試験のサブグループ解析で、AT製剤の投与が予後を改善することが報告されていますが、当ガイドラインでは、AT製剤は、敗血症性DICに対して、弱い推奨をしています。rh-TMは、人工呼吸器装着のDIC合併敗血症患者において、歴史的対照群に対し、入院後28日の死亡率を低減したと報告されており、AT製剤と同等の弱い推薦をしています。(著者抄録)

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Language：Japanese   Publisher：愛媛医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

2003年にILCOR(International Liaison Committee on Resuscitation)は、心停止後自己心拍が再開し、意識がない症例に対して、神経学的予後を改善するため、低体温療法を強く推奨している。しかし、同療法の導入法、目標体温、維持期間、復温法など共通したものはない。欧米では、米国心臓学会(AHA)のガイドラインに従って同療法が行われている。すなわち自己心拍再開後、意識障害があるが、低血圧のない症例において、可能な限り早期に低体温を導入し、32〜34℃の低体温を12〜24時間維持する。その後、1℃/時程度で復温する。日本以外のアジア諸国でも、このAHAの方法を踏襲している。このような低体温療法の方法は、低体温療法の本邦のそれとは適応症例を始め、目標体温、持続期間、復温方法も異なっている。本稿では、その方法論や神経学的予後について、欧米のそれと比較した。(著者抄録)

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

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

Surviving Sepsis Campaign Guidelines 2012には,敗血症に合併するDIC(Disseminated Intravascular Coagulation)治療に関しての記載はない。期しくも同年に公開された日本版敗血症診療ガイドラインでは,そのような敗血症治療が盛り込まれている。欧米,とくに米国では,敗血症に合併する凝固障害への対応は,原病への治療のみである。一方,本邦の多くの施設では,敗血症に凝固障害が合併すると多臓器不全率や死亡率が高まるとし,原病への治療とDIC治療を行う。本邦では,その治療薬としてAT(anti-thrombin)製剤とrh-TM(recombinant human thrombomodulin)製剤が主なものである。AT製剤の多施設前向きの試験で,ヘパリン併用例で出血が悪化し敗血症の生命予後は改善できなかった。しかし,その後のsubgroup解析では,AT製剤の投与が予後を改善することが報告されており,当ガイドラインでは,AT製剤は,敗血症性DICに対して,弱い推奨としている。rh-TMに関しては,DIC合併の敗血症で,DIC離脱率がヘパリンより良好であること,またその後も臨床で追試が行われ,比較的良好な結果が得られており,AT製剤と同等の弱い推薦とした。最近の報告で,重症敗血症の生命予後が日本では,他国に比し良好であった。その報告では各治療の関連は検討していないが,重症敗血症にDICが合併した際の対応として,本邦では原病の治療および抗凝固療法の施行が一般的であり,同病態における抗凝固療法の役割についてさらなる検討が必要である。(著者抄録)

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Language：Japanese   Publisher：日本蘇生学会  

心停止後症候群に対する低体温時のモニターとして、呼吸・循環モニター、体温、脳波検査などがある。各モニターの解釈に際して、同症候群に対する低体温療法の特殊性(心抑制機序、交感神経賦活、中枢-皮膚温格差などで反映される末梢)を考慮し、評価する必要がある。とくに、心原性心停止からの自己心拍再開例の場合、急性冠症候群に対する早期冠動脈再灌流や、カテコラミン不応例でのIntra-aortic balloon pumpingなどの対応が必要である。今後、低体温療法中に行われる治療法の呼吸・循環に及ぼす効果のみならず、脳循環、脳代謝などによる中枢神経系に対する治療効果判定が可能なモニターの開発が必要である。(著者抄録)

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Language：Japanese   Publisher：日本循環制御医学会  

心肺蘇生術における病態としての、「心停止後症候群」について、循環制御領域における話題として、この言葉が提唱された背景や、心停止後自己心拍が再開した際の集学的治療の概要を述べた。これまでの自己心拍再開後の病態生理、治療、予後などの報告を整理・評価し、治療レベルの底上げと、今後の研究の方向性を議論するため、国際蘇生連絡協議会(ILCOR)は、心停止後症候群に関する声明文を発表した。その声明文の内容を概説し、この声明文が発表されてから以降の、本症候群に関係する最近の論文も紹介した。

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Language：Japanese   Publisher：日本蘇生学会  

自己心拍再開後のEarly-directed Goal Therapy(EGDT)が検証されている。これは、前負荷、後負荷、心収縮力などを至適な状態に改善し、神経学的予後改善を目指す。急性冠症候群症例では経皮的冠動脈形成術、IABP(Intra-Aortic Balloon Pumping)と、カテコラミンでは、NorepinephrineおよびDobutamineが重要であり、低体温療法中は、前負荷の減少に対する輸液負荷、IABPおよびカテコラミンも重要である。一方、著者らは、自身が報告した低体温中の直接的心抑制に対しdobutamineを投与し、末梢循環不全に対し血管拡張療法も併用する(CCM、2000;28:3854)。本稿では、心停止症症候群例に対するEGDTと、これまで著者らが行ってきた低体温療法中の循環管理について概説する。(著者抄録)

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Language：Japanese   Publisher：愛媛医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

【目的】心停止後症候群(PCAS)において、低体温療法中投与される鎮静・鎮痛剤などにより、神経学的予後判定が困難である。今回、BISモニターA-2000を用い、PCASのBIS値およびSuppression Ratio(SR)値を検討した。【対象および方法】PCASの意識障害を合併した連続性の20例。年齢34〜88歳、性別(M/F:13/7)。意識回復によって、不良群N=14と良好群N=6に分けた。低体温療法は、不良群で1例、良好群で6例に施行。両群比較はMann-Whitney U testにて行った。また、各測定項目の感受性および特異度を併せ検討した。【結果】来院時GCSは、両群間で差はなかった。筋弛緩剤が投与されていない場合、意識障害があるにも拘らず、BIS値は高値であった。筋弛緩剤投与例では、BIS値は良好群で有意に高値、SR値は、良好群では有意に低値であった。筋電図混入がない状況で、BIS値30以上の場合、予後良好と判定できる感度は95%、特異度は100%であり、とくに、来院24時間後のSR値50以上で、予後不良と判定できる感度、特異度はともに100%であった。【結論】今回の結果からとくに筋弛緩剤投与例においては、低体温療法中であっても、BIS値およびSR値の連続測定によって、心停止後症候群における神経学的予後判定ができる可能性がある。しかし、心拍再開後24時間以前の判定には、偽陽性の可能性があり注意が必要である。(著者抄録)

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Language：Japanese   Publisher：日本蘇生学会  

頭部外傷例に対する低体温療法の多施設研究では、有用性が見いだせなかったが、心室細動からの自己心拍再開例における二次的脳損傷に対し行われた多施設研究では、低体温療法が神経学的予後を改善した。本稿では低体温療法の歴史と現況について概説し、頭部外傷および自己心拍再開後脳症に対する大規模RCTの結果の差異を分析する。そこから得られた教訓を報告し、今後の低体温療法の方向性や方法論にて議論する。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01761&link_issn=&doc_id=20100406360002&doc_link_id=%2Fcg9sosei%2F2010%2F002901%2F002%2F0006-0012%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcg9sosei%2F2010%2F002901%2F002%2F0006-0012%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：医学図書出版(株)  

心停止後自己心拍が再開した場合、様々な生体反応が惹起され病態が形成される。そのような病態をこれまでは、蘇生後病と表現していたが、本来の蘇生の意味からすると、自己心拍再開後に、真の蘇生が行われなければならない。2008年ILCOR(国際蘇生連絡協議会)が他の蘇生関連団体とともに、自己心拍再開後の病態を総称して、心停止後症候群(PCAS)と定義した。さらに、これまでの自己心拍再開後の病態生理、治療、予後などの知見を整理・評価し、治療レベルの底上げや今後の研究の方向性に言及した声明文を発表した。その声明文によれば、現時点でのPCAS例に対する、最も推奨される治療戦略は、早期の低体温療法と緊急冠血流再開術の併用である。また、早期の循環安定化、血糖値調節、慎重な再酸素化なども重要である。さらに、PCAS状態を敗血症様状態として捉え、高流量血液濾過法などの抗サイトカイン療法の試みがあるが、症例の蓄積を待ちたい。いずれにしても、以上の治療法が、確実に行われれば、PCAS症例の神経学的予後改善に繋がる可能性があり、広く定着することが望まれる。(著者抄録)

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