Prolonged hiccups induced by renal infarction: a case report.

BACKGROUND: Hiccups are common symptoms that last for less than 48 hours. However, we encountered a case of renal infarction in a patient with prolonged hiccup. The relationship between hiccups and renal infarction is important in differentiating patients with prolonged hiccups. CASE PRESENTATION: An 87-year-old Japanese man with atrial fibrillation and receiving antithrombotic therapy presented to the emergency department with prolonged hiccups. The patient discontinued antithrombotic therapy for atrial fibrillation due to subcortical bleeding, after which he experienced right back pain. He was diagnosed with right renal infarction based on computed tomography images, and the antithrombotic therapy was continued. The patient's hiccups ceased, and he was discharged on hospital day 11. CONCLUSION: Hiccups can be induced by various clinical conditions. It is hypothesized that the inflammation of the right kidney infarction stimulated the diaphragm and induced prolonged hiccups in this patient; this theory is supported by the computed tomography images. This case report shows that internal organ diseases irritating the diaphragm can cause hiccups, and renal disease should be considered in patients with prolonged hiccups.

Levetiracetam poisoning with acute kidney injury treated with hemodialysis: A case report.

INTRODUCTION: Levetiracetam is a newer second-generation anticonvulsant for the treatment of generalized and partial seizure disorders. Common adverse effects are rhabdomyolysis and neuropsychiatric problems, such as somnolence, dizziness, and mood changes. The present report describes the first case, to our knowledge, of levetiracetam overdose resulting in acute kidney injury for which hemodialysis was required. PATIENT CONCERNS: A 51-year-old man presented with hypotension and disturbance of consciousness with subsequent development of oliguria and elevated creatinine. Based on his history of ingesting a large dose of levetiracetam and the course of the disease, he was considered to have been poisoned by levetiracetam. DIAGNOSIS: Acute kidney injury induced by levetiracetam poisoning. INTERVENTIONS/OUTCOMES: Dialysis was performed for the rapidly progressing renal failure. His renal function improved, and he was weaned from dialysis and discharged home on the 19th day. CONCLUSION: We should be aware of the possibility that severe renal function deterioration may occur in some patients with levetiracetam overdose. It is possible that clinicians underestimate the occurrence of this problem. In cases of acute renal failure in levetiracetam poisoning, induction of dialysis is beneficial.

Point-of-Care Ultrasound for an Esophageal Foreign Body.

BACKGROUND: Press-through packs (PTPs) are widely used for storing drugs. The number of cases involving improper swallowing and esophageal foreign bodies (EFBs) has increased with the increasing use of PTPs. Studies have reported the utility of point-of-care ultrasound (POCUS) for evaluating EFBs. The application of POCUS for esophageal PTPs has not been reported. CASE REPORT: An 83-year-old woman complaining of neck pain and odynophagia that occurred after improperly swallowing 2 PTPs was admitted to the emergency department. EFBs were suspected, and POCUS revealed a hyperechoic material, suggestive of a PTP, in the cervical esophagus. Endoscopy was immediately performed, and the PTPs were successfully removed without complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This study was significant because it documented the application of POCUS to detect esophageal PTPs. POCUS is a simple and noninvasive technique for identifying EFBs without radiation exposure. © 2022 Elsevier Inc.

Fat embolism syndrome in a patient with a right undisplaced femoral neck fracture.

Fat embolism syndrome (FES) is a rare condition characterised by the classic triad of respiratory distress, neurologic symptoms and petechial rash. Here, we encountered a case of FES in a patient with an asymptomatic right undisplaced femoral neck fracture (Garden Stage II). FES was diagnosed based on the Gurd and Willson's diagnostic criteria and brain magnetic resonance imaging features. To the best of our knowledge, this is the first case of FES in a patient with an undisplaced femoral neck fracture. This study highlights the importance of considering the possibility of FES even in patients with undisplaced femoral neck fractures.

Massive hemoptysis treated with embolization of an ectopic bronchial artery arising from the right thyrocervical trunk: a case report.

BACKGROUND: Ectopic bronchial artery and non-bronchial systemic arteries may be the culprit vessels of hemoptysis. The main cause of clinical failure of bronchial artery embolization is incomplete embolization caused by the misidentification of the culprit arteries by conventional angiography. Multidetector computed tomography angiography is useful for visualizing the culprit arteries. CASE PRESENTATION: An 82-year-old man was admitted with hemoptysis. Preprocedural multidetector computed tomography angiography revealed an ectopic bronchial artery branching from the right thyrocervical trunk. Superselective embolization of the ectopic bronchial artery was performed using gelatin sponge particles and metallic coils. Hemoptysis was controlled by this procedure without any associated complications. CONCLUSIONS: Ectopic bronchial arteries originating from the thyrocervical trunk are rare. Preprocedural multidetector computed tomography angiography is useful for visualizing the culprit arteries of hemoptysis, especially if a patient has an ectopic bronchial artery or an ectopic non-bronchial systemic artery.

Cold agglutinin-induced hemolytic anemia during room temperature fluid resuscitation: a case report.

BACKGROUND: Cold agglutinin disease can cause the agglutination of red blood cells and hemolytic anemia due to cold temperature. Herein, we report a case of progressive hemolytic anemia due to cold agglutinin disease during fluid resuscitation and in the absence of exposure to cold. CASE PRESENTATION: A 71-year-old Japanese man was admitted to the emergency department with signs of hypotension and disturbed consciousness. He was diagnosed with diabetic ketoacidosis, and treatment with fluid resuscitation and insulin infusion was initiated. Laboratory test results obtained the following day indicated hemolytic anemia. On day 5 after admission, red blood cell agglutination was detected, and the patient was diagnosed with cold agglutinin disease. CONCLUSIONS: Cold agglutinin disease should be considered in the differential diagnosis of progressive hemolytic anemia during fluid resuscitation, even if the solution is at room temperature.

Disparities in Bystander Cardiopulmonary Resuscitation Performed by a Family Member and a Non-family Member.

BACKGROUND: Although bystander cardiopulmonary resuscitation (BCPR) plays an essential role in out-of-hospital cardiac arrest (OHCA) care, little is known about the bystander-patient relationship in the actual setting. This study aimed to assess the disparities in BCPR performed by a family member and that performed by a non-family member. METHODS: This population-based observational study involved all adult patients with witnessed OHCAs of medical origin in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. We used logistic regression analysis to assess the association between the witnessing person and the probability of providing BCPR. Next, among those who received BCPR, we sought to investigate the difference between BCPR performed by family and that performed by non-family members in terms of whether those who witnessed the arrests actually performed BCPR. RESULTS: During the study period, 818 were eligible for this analysis, with 609 (74.4%) patients witnessed by family and 209 (25.6%) patients witnessed by non-family members. Multivariable logistic regression analysis showed that OHCA patients witnessed by family were less likely to receive BCPR compared to those witnessed by non-family members (260/609 [42.7%] versus 119/209 [56.9%], P = 0.017). Among the witnessed patients for whom BCPR was performed, the proportion of BCPR actually performed by a family member was lower than that performed by a non-family member (242/260 [93.1%] versus 116/119 [97.5%], P = 0.011). CONCLUSIONS: In this community-based observational study, we found that a witnessing family member is less likely to perform BCPR than a witnessing non-family member.

Measurement Device for Ambient Carbonyl Sulfide by Means of Catalytic Reduction Followed by Wet Scrubbing/Fluorescence Detection.

A portable chemical analysis system for monitoring ambient carbonyl sulfide (COS) was investigated for the first time. COS is paid attention to from the perspectives of photosynthesis tracer, breath diagnosis marker, and new process-use in the manufacture of semiconductors. Recently, the threshold level value of COS was settled at 5 ppm in volume ratio (ppmv) for workplace safety management. In this work, COS was converted to H2S by a small column packed with alumina catalyzer at 65 °C. Then, the H2S produced was collected in a small channel scrubber to react with fluorescein mercuric acetate (FMA), and the resulting fluorescence quenching was monitored using an LED/photodiode-based miniature detector. The miniature channel scrubber was re-examined to determine its robustness and easy fabrication, and conditions of the catalyzer were optimized. When the FMA concentration used was 1 µM, the limit of detection and dynamic range, which were both proportional to the FMA concentration, were 0.07 and 25 ppbv, respectively. Ambient COS in the background level and even contaminated COS in the nitrogen gas cylinder could be detected. If necessary, H2S was removed selectively by reproducible adsorbent columns. COS concentrations of engine exhaust were measured by the proposed method and by cryo-trap-gas chromatography-flame photometric detection, and the results obtained (0.5-5.9 ppbv) by the two methods agreed well (R 2 = 0.945, n = 19). COS in ambient air and exhaust gases was successfully measured without any batchwise pretreatment.

Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan.

OBJECTIVE: This study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry. DESIGN: Population-based, retrospective cohort study. SETTING: An urban city with approximately 800 000 residents. PARTICIPANTS: Patients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement. RESULTS: During the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23). CONCLUSIONS: Among adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.

Post-traumatic thrombotic microangiopathy following pelvic fracture treated with transcatheter arterial embolization: a case report.

BACKGROUND: Thrombotic microangiopathy is caused by various conditions, but few cases secondary to trauma have been reported. We present the rare case of a patient with thrombotic microangiopathy-induced high-impact trauma with hemorrhagic shock. CASE PRESENTATION: An 86-year-old Japanese woman was transferred to our hospital after a traffic accident. A whole-body computed tomography scan revealed pelvic fractures with massive extravasation. She received a blood transfusion and emergency angiographic embolization. On post-traumatic day 1, she showed unexplained severe hemolysis, thrombocytopenia, and renal failure despite her stable condition. Disseminated intravascular coagulation was excluded because her activated partial thromboplastin time and prothrombin time-international normalized ratio were normal. Her fragmented red blood cell concentration was 28.8%. We suspected clinical thrombotic thrombocytopenic purpura and started plasma exchange. She recovered fully after the plasma exchange and was discharged on day 31. We eventually diagnosed thrombotic microangiopathy because her ADAMTS13 activity was not reduced. CONCLUSIONS: It is important to recognize the possibility that thrombotic microangiopathy may occur after severe trauma. In the critical care setting, unexplained thrombocytopenia and hemolytic anemia should be investigated to eliminate the possibility of thrombotic microangiopathy. Early plasma exchange may help to prevent unfortunate outcomes in patients with thrombotic microangiopathy following trauma.

Ultra-sensitive Trace-Water Optical Sensor with In situ- synthesized Metal-Organic Framework in Glass Paper.

Monitoring of trace water in industrial gases is strongly recommended because contaminants cause serious problems during use, especially in the semiconductor industry. An ultra-sensitive trace-water sensor was developed with an in situ-synthesized metal-organic framework as the sensing material. The sample gas is passed through the sensing membrane and efficiently and rapidly collected by the sensing material in the newly designed gas collection/detection cell. The sensing membrane, glass paper impregnated with copper 1,3,5-benzenetricarboxylate (Cu-BTC), is also newly developed. The amount and density of the sensing material in the sensing membrane must be well balanced to achieve rapid and sensitive responses. In the present study, Cu-BTC was synthesized in situ in glass paper. The developed system gave high sensing performances with a limit of detection (signal/noise ratio = 3) of 9 parts per billion by volume (ppbv) H2O and a 90% response time of 86 s for 200 ppbv H2O. The reproducibility of the responses within and between lots had relative standard deviations for 500 ppbv H2O of 0.8% (n = 10) and 1.5% (n = 3), respectively. The long-term (2 weeks) stability was 7.3% for 400 ppbv H2O and one-year continuous monitoring test showed the sensitivity change of <∼3% before and after the study. Furthermore, the system response was in good agreement with the response achieved in cavity ring-down spectroscopy. These performances are sufficient for monitoring trace water in industrial gases. The integrated system with light and gas transparent structure for gas collection/absorbance detection can also be used for other target gases, using specific metal-organic frameworks.

[Bowel obstruction-induced cholinergic crisis with progressive respiratory failure following distigmine bromide treatment].

A 54-year-old female experienced rapid respiratory failure while being transported in an ambulance to our emergency department for evaluation and management of constipation and abdominal pain. The patient was on treatment with distigmine bromide for postoperative urination disorder and magnesium oxide for constipation. Increased salivary secretions, diminished respiratory excursion, type 2 respiratory failure (PaCO2 : 65 mmHg), low serum cholinesterase, and hypermagnesemia were detected. Imaging studies revealed that the patient had bilateral aspiration pneumonia, fecal impaction in the rectum, and a distended colon causing ileus. The patient was mechanically ventilated and was weaned off the ventilator on day 3. Therapeutic drug monitoring after discharge revealed that the serum level of distigmine bromide on admission was markedly elevated (377.8 ng/mL vs. the normal therapeutic level of 5-10 ng/mL). Distigmine bromide induced a cholinergic crisis with a resultant increase in airway secretions and respiratory failure. In this particular case, orally administered distigmine bromide was excessively absorbed because of prolonged intestinal transit time secondary to fecal impaction and sluggish bowel movement; this caused a cholinergic crisis and hypermagnesemia contributing to respiratory failure. Clinicians should be aware that bowel obstruction in a patient treated with distigmine bromide can increase the risk of a cholinergic crisis.

Late Metabolic Acidosis Caused by Renal Tubular Acidosis in Acute Salicylate Poisoning.

A 16-year-old man was transferred to our emergency department seven hours after ingesting 486 aspirin tablets. His blood salicylate level was 83.7 mg/dL. He was treated with fluid resuscitation and sodium bicarbonate infusion, and his condition gradually improved, with a decline in the blood salicylate level. However, eight days after admission, he again reported nausea, a venous blood gas revealed metabolic acidosis with a normal anion gap. The blood salicylate level was undetectable, and a urinalysis showed glycosuria, proteinuria and elevated beta-2 microglobulin and n-acetyl glucosamine levels, with a normal urinary pH despite the acidosis. We diagnosed him with relapse of metabolic acidosis caused by renal tubular acidosis.

Delayed chest wall hematoma caused by progressive displacement of rib fractures after blunt trauma.

Rib fracture is a common injury resulting from blunt thoracic trauma. Although hemothorax and pneumothorax are known delayed complications of rib fracture, delayed chest wall hematoma has rarely been reported. We discuss the case of an 81-year-old woman who was not undergoing antiplatelet or anticoagulant therapy who presented to our emergency department after a traffic injury. This patient had a nondisplaced rib fracture that went undetected on the initial computed tomography scan; the development of progressive displacement led to hemorrhagic shock due to delayed chest wall hematoma. The chest wall hematoma was effectively diagnosed and treated via contrast-enhanced computed tomography and angiographic embolization. This case highlights the possibility of this potential delayed complication from a common injury such as a rib fracture.

A fiber optic sensor with a metal organic framework as a sensing material for trace levels of water in industrial gases.

Industrial gases such as nitrogen, oxygen, argon, and helium are easily contaminated with water during production, transfer and use, because there is a high volume fraction of water in the atmosphere (approximately 1.2% estimated with the average annual atmospheric temperature and relative humidity). Even trace water (<1 parts per million by volume (ppmv) of H2O, dew point < -76 °C) in the industrial gases can cause quality problems in the process such as production of semiconductors. Therefore, it is important to monitor and to control trace water levels in industrial gases at each supplying step, and especially during their use. In the present study, a fiber optic gas sensor was investigated for monitoring trace water levels in industrial gases. The sensor consists of a film containing a metal organic framework (MOF). MOFs are made of metals coordinated to organic ligands, and have mesoscale pores that adsorb gas molecules. When the MOF, copper benzene-1,3,5-tricarboxylate (Cu-BTC), was used as a sensing material, we investigated the color of Cu-BTC with water adsorption changed both in depth and tone. Cu-BTC crystals appeared deep blue in dry gases, and then changed to light blue in wet gases. An optical gas sensor with the Cu-BTC film was developed using a light emitting diode as the light source and a photodiode as the light intensity detector. The sensor showed a reversible response to trace water, did not require heating to remove the adsorbed water molecules. The sample gas flow rate did not affect the sensitivity. The obtained limit of detection was 40 parts per billion by volume (ppbv). The response time for sample gas containing 2.5 ppmvH2O was 23 s. The standard deviation obtained for daily analysis of 1.0 ppmvH2O standard gas over 20 days was 9%. Furthermore, the type of industrial gas did not affect the sensitivity. These properties mean the sensor will be applicable to trace water detection in various industrial gases.

Elimination of flammable gas effects in cerium oxide semiconductor-type resistive oxygen sensors for monitoring low oxygen concentrations.

We have investigated the catalytic layer in zirconium-doped cerium oxide, Ce0.9Zr0.1O2 (CeZr10) resistive oxygen sensors for reducing the effects of flammable gases, namely hydrogen and carbon monoxide. When the concentration of flammable gases is comparable to that of oxygen, the resistance of CeZr10 is affected by the presence of these gases. We have developed layered thick films, which consist of an oxygen sensor layer (CeZr10), an insulation layer (Al2O3), and a catalytic layer consisting of CeZr10 with 3 wt% added platinum, which was prepared via the screen printing method. The Pt-CeZr10 catalytic layer was found to prevent the detrimental effects of the flammable gases on the resistance of the sensor layer. This effect is due to the catalytic layer promoting the oxidation of hydrogen and carbon monoxide through the consumption of ambient O2 and/or the lattice oxygen atoms of the Pt-CeZr10 catalytic layer.