Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study.

AIM: Aneurysmal subarachnoid haemorrhage (SAH) is a relatively common cause of out-of-hospital cardiac arrest (OHCA). Early identification of SAH-induced OHCA with the use of brain computed tomography (CT) scan obtained immediately after resuscitation may help emergency physicians make therapeutic decision as quickly as they can. METHODS: During the 4-year observation period, brain CT scan was obtained prospectively in 142 witnessed non-traumatic OHCA survivors who remained haemodynamically stable after resuscitation. Demographics and clinical characteristics of SAH-induced OHCA survivors were compared with those with "negative" CT finding. RESULTS: Brain CT scan was feasible with an average door-to-CT time of 40.0 min. SAH was found in 16.2% of the 142 OHCA survivors. Compared with 116 survivors who were negative for SAH, SAH-induced OHCA survivors were significantly more likely to be female, to have experienced a sudden headache, and trended to have achieved return of spontaneous circulation (ROSC) prior to arrival in the emergency department less frequently. Ventricular fibrillation (VF) was significantly less likely to be seen in SAH-induced than SAH-negative OHCA (OR, 0.06; 95% CI, 0.01-0.46). Similarly, Cardiac Trop-T assay was significantly less likely to be positive in SAH-induced OHCA (OR, 0.08; 95% CI, 0.01-0.61). CONCLUSION: Aneurysmal SAH causes OHCA more frequently than had been believed. Immediate brain CT scan may particularly be useful in excluding SAH-induced OHCA from thrombolytic trial enrollment, for whom the use of thrombolytics is contraindicated. The low VF incidence suggests that VF by itself may not be a common cause of SAH-induced OHCA.

Megacolon in an adult case of hypoganglionosis, a pseudo-Hirschsprung's disease: an autopsy study.

We report an autopsied 20-year-old man case of intestinal necrosis associated with megacolon from hypoganglionosis, a pseudo-Hirschsprung's disease. The patient had suffered from severe constipation since two years of age, and presented abdominal distention from age ten. Autopsy revealed marked dilatation and necrosis of the entire large intestine. Although ganglion cells in the intestinal plexus were found throughout the large intestine, their number was reduced to 12-20% of that in the normal control. In pseudo-Hirschsprung's disease, there are occasional cases where an acute abdomen first presents itself in adulthood after running its course as chronic constipation.

Risk stratification of adult pneumonia in a tertiary emergency center in Japan.

OBJECTIVE: To determine whether the guidelines for community-acquired pneumonia published by the Infectious Disease Society of America (IDSA) and the Japanese Respiratory Society (JRS) are applicable to stratifying the mortality risk of patients visiting a tertiary emergency center in Japan. METHODS: Patients were categorized into three risk groups (low, intermediate and high) based on the IDSA guidelines and three severity groups (mild, moderate and severe) using the JRS guidelines. The mortality rates among each set of groups were then compared using 30-day follow-up data. PATIENTS: Ninety-seven consecutive patients with pneumonia who visited the emergency room and were admitted to our hospital were retrospectively identified. RESULTS: Based on the IDSA guidelines, the patients were categorized into a high, intermediate, or low-risk group (38.1%, 51.5% and 10.3%, respectively). Cumulative mortality rates were 18.9% for the high-risk group and 4.0% for the moderate-risk group (p=0.02); no deaths occurred in the low-risk group. Based on the JRS guidelines, the patients were also classified into a severe, moderate, or the mild-severity group (69.1%, 25.8% and 5.2%, respectively). The mortality rate was 13.4% in the severe group, whereas no deaths occurred in the moderate or mild-severity groups. CONCLUSION: The IDSA and JRS guidelines allow short-term mortality risks to be recognized at a tertiary emergency center in Japan.

Afebrile scrub typhus (Tsutsugamushi disease) with acute respiratory distress syndrome.

A 74-year-old Japanese man with scrub typhus presented without the typical symptom of high fever and subsequently developed the complication of acute respiratory distress syndrome. It was suspected that exposure occurred at the river side of Kinugawa, Tochigi Prefecture, Japan. His body temperature was below 38.0 degrees C. After intensive supportive care and minocycline therapy, he dramatically recovered. With the increase in popularity of outdoor recreation, scrub typhus can be found in clinics all over Japan. Physicians should therefore be aware of the manifestations of the disease and the necessity of early treatment in suspected cases.