Cardiopulmonary arrest caused by nafamostat mesylate during hemodialysis.

Dialysis-related adverse reactions can be serious and difficult to predict. In our case, nafamostat mesylate (NM) was thought to be the cause of cardiopulmonary arrest (CPA) due to NM-induced anaphylaxis but was not reflected in the allergy tests. Rare but life-threatening drawbacks occur immediately after hemodialysis initiation.

Isolated tricuspid valve infective endocarditis with multiple septic pulmonary emboli in a patient with atopic dermatitis.

Multiple lung nodules in atopic dermatitis patients may reflect infective endocarditis. Our case underlines the importance of potentially severe infections due to staphylococci associated with atopic dermatitis.

Characteristics of COVID-19 patients admitted into two hospitals in sapporo, Japan: Analyses and insights from two outbreak waves.

BACKGROUND: Coronavirus disease (COVID-19) emerged in January 2020 in Sapporo city, and the outbreak has shown two peaks. METHODS: A total of 260 COVID-19 patients were enrolled and categorized into three groups according to the pandemic pattern, jobs and situation, and disease severity. We compared clinical characteristics according to these categories. RESULTS: We found two pandemic peaks, and the proportion of patients and health providers who were infected in other hospitals had increased in the latter two periods (period 2: 49.6%, period 3: 32.7%). Particularly, the proportion of infected health providers was 27% in period 2, and they tended to be younger females with a mild condition. Severity of the disease (requirement of oxygen and/or mechanical ventilation) was associated with advanced age, and all the patients who died during admission were over 60 years old. CONCLUSIONS: We reported the temporal dynamics and characteristics of the COVID-19 pandemic in Sapporo city, Japan. This survey from the viewpoint of the hospital provides a new insight into and a better guide for the further management of the COVID-19 pandemic.

Enlargement of Intrathoracic Goiter with Unilateral Phrenic Nerve Paralysis Leading to Cardiopulmonary Arrest.

As an intrathoracic goiter expands, it causes airway stenosis and phrenic nerve paralysis, and slight respiratory stimuli can trigger sudden life-threatening hypoventilation. A 78-year-old obese woman with a large intrathoracic goiter was found unconscious with agonal breathing in her room early in the morning. Cardiopulmonary resuscitation restored spontaneous circulation. She underwent surgical removal of the goiter; however, she required long-term mechanical ventilation because of atelectasis due to phrenic nerve paralysis. In patients with large intrathoracic goiters, difficulty breathing on exertion and diaphragm elevation on chest X-ray may be significant findings predicting future respiratory failure.

Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation.

BACKGROUND: Ventricular septal perforation (VSP) can be caused by a penetrating cardiac injury. Diagnosis of VSP tends to be delayed because a shunt might not be detected by color flow Doppler at an early stage following injury. CASE PRESENTATION: A 60-year-old man with depression was admitted to the emergency center after a knife injury in the chest. A focused assessment with sonography for trauma revealed cardiac tamponade. Shortly after an open cardiac massage and a pericardiotomy, his spontaneous circulation returned. At a later stage, follow-up computed tomography, echocardiography, and left ventriculography showed traumatic ventricular septal perforation. Conservative therapy was chosen because the pulmonary blood flow/systemic blood flow ratio was 1.42. CONCLUSION: The initial contrast computed tomography shows a septal hematoma. Its presence could be perceived as a perforation site in the interventricular septum.

Effects of epinephrine administration in out-of-hospital cardiac arrest based on a propensity analysis.

BACKGROUND: Epinephrine administration has been advocated for cardiopulmonary resuscitation (CPR) for decades. Despite the fact that epinephrine administration during CPR is internationally accepted, the effects of the prehospital epinephrine administration still remain controversial. We investigated the effects of epinephrine administration on patients with out-of-hospital cardiac arrest based on a propensity analysis with regard to the 'CPR time'. METHODS: From April 1, 2007, to December 31, 2009, 633 out-of-hospital cardiac arrest patients with bystander witnesses were included in the present study. To rule out any survival bias, we used the propensity scores, which included CPR time. CPR time was defined as the time span from when the emergency medical technicians started CPR until either the return of spontaneous circulation or arrival at the hospital. After performing propensity score matching, the epinephrine and no-drug groups each included 141 patients. The primary study endpoint was a favorable neurological outcome at 30 days after cardiac arrest. RESULTS: After propensity score matching, the frequency of the return of spontaneous circulation before arrival at the hospital in the matched epinephrine group was higher than that in the matched no-drug group (27% vs. 13%, P = 0.002). However, the frequency of a favorable neurological state did not differ between the two groups. With regard to the frequency of a favorable neurological state in the patients, the adjusted odds ratio of the time span from cardiac arrest to the first epinephrine administration was 0.917 (95% confidence interval 0.850-0.988, P = 0.023) per minute. CONCLUSIONS: In patients with witnessed out-of-hospital cardiac arrest, prehospital epinephrine administration was associated with increase of the return of spontaneous circulation before arrival at the hospital. Moreover, the early administration of epinephrine might improve the overall neurological outcome.

[Evaluation of autologous transfusion for radical prostatectomy].

Forty-six radical prostatectomy patients in whom an autologous transfusion had been performed in our hospital were studied retrospectively. Preoperative autologous donation (PAD), erythropoietin (EPO) administration and acute normovolemic hemodilution (ANH) were used for autologous transfusion. Red blood cell volume lost during hospitalization was calculated as 1329 +/- 493 ml. Red blood cell volume saved by PAD and ANH were calculated as 470 +/- 33 ml and 301 +/- 90 ml, respectively. Three patients made use of allogeneic blood transfusion. Radical prostatectomy can be performed using PAD, EPO and ANH without allogeneic transfusion.

[Perioperative complications of patients with cementless femoral head replacement].

BACKGROUND: Studies have shown that use of cement is a risk factor for fat embolism in elderly patients with femoral neck fracture. We investigated the usefulness of the cementless femoral head replacement technique. METHODS: A retrospective study of 58 patients who had undergone this technique between January 1995 and May 2001 was conducted. Perioperative complications, hospital length of stay, activities of daily living, and postoperative mortality were studied. RESULTS: Of 58 patients, 42 (72.4%) were fe- males, and the mean age was 75.4 years. Twenty patients (69.0%) were classified as ASA class 2, and 50 patients (86.2%) had preoperative medical complications. Cardiovascular complications were the most prevalent, and 6 patients (10.3%) had serious perioperative complications, and postoperative death was noted in 1 patient within one month (1.7%), and 4 patients (6.9%) within one year. Average length of hospital stay was 64.2 days and activities of daily living were the same level as before the fracture. CONCLUSIONS: Early rehabilitation was possible and hospital length of stay and activities of daily living were not inferior to the other treatments. We believe that cementless femoral head replacement technique was useful for elderly patients.

[Anesthetic management for a radical operation in an infant with cloacal exstrophy].

We report the anesthetic management for a radical operation in an infant with cloacal exstrophy. Diagnosis of cloacal exstrophy with meningocele was made at the 26th week of gestation. Cesarian section was performed under general anesthesia in order to keep the infant in a state of apnea to prevent aerophagia, the so-called "sleeping baby", at the 38th week of gestation. As soon as the infant was born, she was intubated orotracheally and a radical operation (abdominal closure, removal of meningocele, and vesico-intestinal-pelvioplasty) was performed. Some complications occurred during the operation including hypotension, oliguria, hypothermia, hypoproteinemia, hyponatremia and hyperpotassemia. The operation time was 10 hours and 30 minutes. Mechanical ventilation was continued for 4 days in the NICU and the infant was discharged 37 days after the operation. Early prenatal diagnosis and simulation of the operation enabled an effective surgical procedure allowing us to minimize these intraoperative complications.

[Myoglobinemia in a patient due to positioning during nephrectomy].

We report a case of myoglobinemia observed in the postoperative period due to forced positioning during nephrectomy. A 32-year-old male, weighing 93 kg, underwent the left nephrectomy due to renal cell carcinoma under general anesthesia with epidural block. The operation was performed uneventfully but he complained of severe pain in his right hip immediately after the recovery from anesthesia. Neither skin flush nor edema was observed and the other superficial tissue injury was not detected. On the day following the operation, severe myoglobinemia was observed and the serum myoglobin level increased to over 20,000 ng.ml-1. CT findings showed topical edema or necrosis of his right minor and medial gluteus muscle. Myoglobinemia continued only for 3 days after the operation without renal dysfunction. We may conclude that muscle injury during an operation followed by forced positioning for nephrectomy is caused not only by direct compression of the muscle, but also by obstruction of the profound intramuscular artery.

Effect of the lithotomy position on spinal anesthesia with hyperbaric tetracaine.

This study was performed to determine the effects of lithotomy position on the spread of analgesia and hemodynamics following spinal anesthesia with 0.5% hyperbaric tetracaine. Thirty patients who underwent hysterectomy due to myoma uteri were studied. All patients received spinal anesthesia in the left lateral decubitus position and were turned supine immediately after intrathecal administration of the drug. Fifteen patients were then placed in the horizontal lithotomy position within 10 s, and the remaining 15 were kept in the horizontal supine position for 30 min. There were no significant differences between the groups in mean arterial pressure, heart rate, cardiac output, and in the cephalad spread of analgesia. The lithotomy position had no effect on the spread of analgesia or anesthetic course of spinal anesthesia with hyperbaric tetracaine.