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1.
J UOEH ; 38(1): 61-4, 2016 Mar 01.
Article in Japanese | MEDLINE | ID: mdl-26972946

ABSTRACT

Although angiotensin-converting enzyme (ACE) inhibitors are widely used as the first choice drug for treating hypertension, we have only a superficial understanding of their relationship to angioedema. We report a case of life-threatening angioedema. The case was a 60-year-old man who had been taking an ACE inhibitor for hypertension for 11 years. He visited his home doctor for dyspnea, and tongue and neck swelling. He was transported to our hospital because of the possibility of airway obstruction. On admission, his tongue and neck swelling became more severe. We performed an intubation using an endoscope and started airway management. We also stopped his ACE inhibitor. The severe tongue and neck swelling improved gradually and he was extubated on day 3. On the fifth day he was discharged. We diagnosed angioedema caused by an ACE inhibitor. Although the risk of airway obstruction with ACE inhibitors is acknowledged, we have only a superficial understanding of how prolonged ACE inhibitor treatment induces angioedema. So we should consider angioedema in cases of taking ACE inhibitors, especially in cases of prolonged treatment.


Subject(s)
Airway Obstruction/chemically induced , Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Imidazolidines/adverse effects , Humans , Male , Middle Aged , Severity of Illness Index , Time Factors , Treatment Outcome , Withholding Treatment
2.
Intern Med ; 53(16): 1797-800, 2014.
Article in English | MEDLINE | ID: mdl-25130113

ABSTRACT

We herein present a rare case of acquired methemoglobinemia associated with alkaptonuria. Alkaptonuria is a congenital error of metabolism caused by the deficiency of homogentisic acid oxidase, which subsequently results in the accumulation of homogentisic acid (HGA) in body tissues. As renal dysfunction progresses, the level of HGA excretion in the urine decreases and the blood concentration of HGA increases. HGA oxidizes oxyhemoglobin to methemoglobin, which can induce multiple organ failure accompanied by tissue hypoxia, intravascular hemolysis and metabolic acidosis. The mortality of this disease is high when alkaptonuria is associated with the presence of methemoglobinemia; therefore, treatment should be carefully planned in such cases.


Subject(s)
Alkaptonuria/complications , Alkaptonuria/diagnosis , Methemoglobinemia/diagnosis , Methemoglobinemia/etiology , Aged , Alkaptonuria/metabolism , Fatal Outcome , Female , Homogentisic Acid/metabolism , Humans , Kidney Failure, Chronic/etiology , Methemoglobinemia/drug therapy , Rare Diseases
3.
J UOEH ; 36(1): 11-6, 2014 Mar 01.
Article in Japanese | MEDLINE | ID: mdl-24633180

ABSTRACT

A significant relationship between lactate clearance and mortality rates in cardiac arrest cases has been reported. However, the relationship between lactate clearance and neurologic outcomes in cardiac arrest cases is not clear. We examined lactate clearance in cardiac arrest cases induced by ventricular fibrillation. We investigated 13 patients with cardiac arrest induced by ventricular fibrillation from April, 2006 to March, 2012 in which therapeutic hypothermia was performed. Patients were classified into two groups: those with a favorable neurologic outcome (n=7) and those with a poor outcome (n=6). We compared lactate clearance levels between the two groups. There was no significant difference in lactate concentrations at admission and 8 or 24 hours lactate clearance between the two groups 8 or 24 hours after admission. This result suggests we may not predict the neurologic outcome of cardiac arrest cases induced by ventricular fibrillation using lactate clearance.


Subject(s)
Heart Arrest/etiology , Heart Arrest/therapy , Hypothermia, Induced , Lactates/blood , Ventricular Fibrillation/complications , Adult , Biomarkers/blood , Female , Forecasting , Heart Arrest/complications , Humans , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , Prognosis , Time Factors
4.
J Anesth ; 28(4): 587-92, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24389941

ABSTRACT

PURPOSE: Nifekalant is a pure potassium channel blocker that has been used to treat ventricular tachyarrhythmias since 1999 in Japan. Intravenous amiodarone was approved later than nifekalant in Japan, and it is still unclear which of the two agents is superior. The aim of this study was to compare the efficacy of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest caused by shock-resistant ventricular fibrillation. METHODS: From December 2005 to January 2011, ambulance services transported 283 out-of-hospital cardiopulmonary arrest patients to our hospital. Of these, 25 patients were treated with nifekalant or amiodarone in response to ventricular fibrillation that was resistant to two or more shocks. We undertook a retrospective analysis of these 25 patients. RESULTS: We enrolled 20 men and 5 women with a mean age (± standard deviation) of 61.1 ± 16.4 years. All 25 patients were treated with tracheal intubation and intravenous epinephrine. Fourteen patients received nifekalant and 11 patients received amiodarone. The rates of return of spontaneous circulation (ROSC) (nifekalant, 5/14, versus amiodarone, 4/11; P = 0.97) and survival to discharge (nifekalant, 4/14, versus amiodarone, 2/11; P = 0.89) were not significantly different between the two groups. The time from nifekalant or amiodarone administration to ROSC was 6.0 ± 6.6 and 20.3 ± 10.0 min, respectively, which was significantly different (P < 0.05). CONCLUSION: In this small sample size study, nifekalant, compared with amiodarone, is equally effective for ROSC and survival to discharge after shock-resistant ventricular fibrillation and can achieve ROSC more quickly. Further prospective studies are needed to confirm our results.


Subject(s)
Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Cardiopulmonary Resuscitation/methods , Out-of-Hospital Cardiac Arrest/drug therapy , Pyrimidinones/therapeutic use , Ventricular Fibrillation/complications , Aged , Dose-Response Relationship, Drug , Electric Countershock , Female , Humans , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/etiology , Prospective Studies , Retrospective Studies
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