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Objective: There have been few reports in English medical journals analyzing patients with difficulty moving. Herein, we conducted a retrospective survey of emergency patients admitted to our hospital with the chief complaint of difficulty moving, to clarify the clinical characteristics of the frequency, causative disease, and outcome in these patients.Patients and Methods: Between August 2017 and October 2021, we surveyed the patient database maintained by our department, covering cases in which the main complaint at the time of patient transport by ambulance to our hospital was difficulty moving.Results: In 111 cases, the patient’s primary complaint was difficulty moving or adynamia. Patients included 59 males and 52 females, with a mean age of 76.3 years old. The most frequent diagnosis in these patients was rhabdomyolysis, followed by infection, body temperature abnormalities, electrolyte disorder, blood glucose abnormality, hypoxia, and renal failure. Trauma and various other diseases, such as stroke and malignancy, were also found to be causative diseases. After discharge from the hospital, the number of patients with a dependent status was greater than those with an independent status.Conclusion: Patients with difficulty moving were primarily elderly, and had a variety of causative diseases. Therefore, multiple approaches are required to manage these patients.
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Objective: This study aimed to retrospectively determine which laboratory data on arrival for patients with mamushi bites was useful to predict the severity of mamushi bites.Materials and Methods: The subjects were divided into the following two groups: the mild group included subjects with mamushi bites Grades I and II, while the severe group included subjects with mamushi bites Grades III, IV, and V. The subjects’ variables were compared between the two groups.Results: There were no significant differences between the two groups regarding the levels of hematocrit, total protein, alanine aminotransferase, aspartate aminotransferase, creatinine phosphokinase, blood urea nitrogen, creatinine, and international normalized ratio of prothrombin time on arrival. Moreover, white blood cell count and platelet count on arrival in the mild group were significantly lower than those in the severe group. Furthermore, activated partial thromboplastin time on arrival was significantly higher in the mild group than in the severe group. Multivariate analysis using white blood cell count and platelet count and level of activated partial thromboplastin time revealed the following significant prognostic indicators of severity of mamushi bites: white blood cell count (Log Worth, 2.1; p<0.01) and platelet count (Log Worth, 1.6; p<0.05).Conclusion: White blood cell count and platelet count on arrival of patients with mamushi bites are considered significant prognostic indicators in determining the severity of mamushi bites.
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Objective: We herein report our analysis of patients evacuated by a physician-staffed helicopter (doctor helicopter; DH) from a Japan Self Defense Force (JSDF) base.Methods: From March 2004 to November 2018, a medical chart review was retrospectively performed for all patients who were transported by a DH from the temporary heliport at the JSDF Fuji base. The subjects were divided into two groups: the Before-2013 group (n=6) and the After-2013 group (n=7).Results: The rate of military-patient involvement and the heart rate of the After-2013 group were greater than those of the-Before 2013 group, and the percutaneous oxygen saturation in the After-2013 group was lower than the Before-2013 group. Furthermore, the Glasgow Coma Scale in the After-2013 group was significantly lower than in the Before-2013 group. The survival rate was not significantly different between the two groups.Conclusion: Patients transported by DHs in the After-2013 group tended to be in more severe conditions than those transported in the Before-2013 group. This might be due to the fact that over time, the fire department, or JSDF, began to appreciate the useful role played by the DH in life-saving management.
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A 32-year-old man started building a wooden desk atop Mount Fuji at an altitude of 3,776 m. Over the course of the second day, he developed lassitude and cough and experienced a headache that night; however, he continued to work. He was transported to our hospital with an altered level of consciousness. On arrival, chest radiography revealed increased opacities in both lungs, and magnetic resonance imaging (MRI) revealed a high-intensity signal in the splenium on diffusion-weighted imaging. He received mechanical ventilation following tracheal intubation. His respiratory function improved, and he was extubated on the fourth hospital day. Physical examination showed no motor weakness, and although he responded to verbal commands, he was unable to speak and was unresponsive to visual stimulation. On the seventh hospital day, head MRI showed improvement in the lesion in the splenium, although other signal changes were observed in the body of the corpus callosum. His verbal responsiveness and voice volume improved on a daily basis. Two months after the incident, he continued to experience mild recent memory disturbance. The patient described in this case report showed delayed signal changes in the body of the corpus callosum, possibly secondary to the onset of microbleed-induced edema.